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Health Care Costs For Small Businesses Considered
"Health care costs are killing small businesses. Their insurance premiums are rising dramatically and unpredictably," NPR reports. "Jody Hall, who owns Seattle"s Cupcake Royale, now pays as much in health insurance for her employees as she does in rent for four choice Seattle storefronts. A majority of working Americans are employed by small businesses, but according to the Kaiser Family Foundation, only 6 in 10 small businesses provide health care. What"s more, the National Federation of Independent Business reports that small companies pay substantially more in premiums than large firms do. Hall, for example, has just three or four insurers to choose from, and she says they won"t negotiate on price."
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Work Status Changes More Common Among Women Receiving Chemotherapy For Breast Cancer, Study Says
Women with breast cancer who receive chemotherapy appear more likely than those treated with radiation therapy to experience a major change in work status, according to a study published in the journal Cancer, Reuters reports. For the study, Dana-Farber Cancer Institute researcher Michael Hassett and colleagues used a large health insurance claims database to identify 3,233 women who were first diagnosed with breast cancer between 1998 and 2002. All of the women were younger than age 64, insured, and working full time or part time as of diagnosis. About 54% of the women received chemotherapy, and 58% received radiation therapy.Hassett said that most of the women did "not experience a significant change in their employment after cancer diagnosis and treatment." However, of the 6.6% who experienced such a change, those who received chemotherapy had a 1.8-fold greater risk of leaving work, retiring or going on long-term disability leave in the subsequent year. Sixty-seven percent of women who experienced a change went from full-time employment to early retirement, while the rest went from full-time employment to long-term disability or retirement, or their status was unknown. Although the study looked at many factors, only chemotherapy and older age were associated with an increased likelihood of a change in employment. Hassett said that most of the participants in the study worked for large employers that offered health insurance. He added that further research is needed to evaluate the effect of cancer diagnosis and treatment on work status for women who are self-employed or work for smaller companies (Hendry, Reuters, 6/30).
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Sotomayor Nomination Raises Questions About How Female Judges View Cases Differently
Following President Obama"s nomination of Judge Sonia Sotomayor to replace retiring Supreme Court Justice David Souter, the differences between how male and female judges see and rule on cases has come into question, the New York Times reports. Although retired Supreme Court Justice Sandra Day O"Connor, the first woman to serve on the Supreme Court, often said that a female judge would come to the same decision as a male judge, Justice Ruth Bader Ginsburg has said that her perspective on certain cases is different because of her gender.The Times cites two examples, one involving the strip search of a 13-year-old girl -- to which Ginsburg said that her male colleagues could not understand how the girl felt. The second example involves the issue of certain abortion procedures. When deciding about the constitutionality of a federal ban on so-called "partial-birth" abortions, Ginsburg took issue with Justice Anthony Kennedy"s majority opinion that women who undergo the procedure likely would experience attacks of conscience. She responded that Kennedy"s views reflected "ancient notions of women"s place in the family and under the Constitution -- ideas that have long since been discredited."The issue has come up again with Sotomayor"s nomination, specifically regarding her 2001 statement that she "would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn"t lived that life." The perception that female judges inherently might view cases differently than male judges has raised some concerns even among some female judges who believe it might be true, according to the Times. Judge Judith Kaye, former chief judge of New York state, said that she avoided discussing the issue with others but then accepted the idea that female judges see things differently at times. "To defend the idea that women come out different on some cases, I just feel it," Kaye said, adding, "I feel it to the depths of my soul" because women"s experiences are "just different." Attorney Lawrence Robbins, however, said, "Any person in the real world should be highly reluctant to make these broad generalizations."The most recent study comparing male and female judges found that female judges were more likely to rule in favor of plaintiffs who claim sex discrimination at workplaces. The study also found no differences in cases involving disability law, environmental issues and capital punishment (Lewis, New York Times, 6/3).
Endocrinology

Calming Parents Might Help Kids Cope With Anesthesia

The start of anesthesia can be distressing for children. Although antianxiety drugs can help keep kids calm, side effects exist. Non-drug methods offer alternatives, but a new review of studies finds that no single method shows a clear advantage in keeping the child calm and cooperative. The most commonly used tactic having the parent present while the child receives anesthesia medications does not appear to have any benefit. Clinicians frequently ask parents to stay with their children during the start of anesthesia to make the experience go smoothly as possible. "We were a little surprised that the presence of parents was not shown to be helpful," said review co-author Dr. Allan Cyna. "We did find some evidence suggesting that anxious parents may be associated with a more anxious or less cooperative child during the administration of the anesthetic," said Cyna, a senior consultant anesthetist at the Women"s and Children"s Hospital, in Adelaide, South Australia. He said that although there might not be a clear benefit to having the parent present during anesthesia induction, there are no studies showing there are any serious risks. The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic. Anesthesia in children often begins with inhaled drugs because some consider a facemask and gas to be less upsetting than needles and injections. However, a child might become agitated and fight having the mask put on. The review article notes that preoperative anxiety might lead to agitation after surgery. Antianxiety drugs or sedatives can increase anxiety in some children, which is why the review evaluated non-drug methods. Cyna and his colleagues reviewed 17 studies of different ways to help reduce children"s stress as they started anesthesia. The methods ranged from having the parent present, which eight studies evaluated, to having the child play with video games or having a clown entertain the child. Several studies evaluated methods that focused on keeping the parent calm, including acupuncture for the parent or providing the parent with information about the surgery and anesthesia. One study found that the presence of a parent was significantly less effective in reducing children"s anxiety at induction than using an antianxiety drug on the child. Individual studies found that clowns, a quiet environment or game playing showed some benefits, such as improved cooperation in children. However, saying that there is no evidence of benefit for a given method does not mean it is never beneficial, said David Polaner, M.D., an associate professor of anesthesiology and pediatrics with Children"s Hospital, in Denver. "When dealing with behavioral issues, we use the findings of aggregate studies as a guide, but we may find it difficult or even misleading to take those generalized findings and apply them to a very specific situation," he said. "I think that it is overreaching to say that there is never a benefit to having parents present at induction of anesthesia." Polaner said that he generally finds the presence of a parent helpful, although in the truly anxious child, it cannot substitute for premedication, which he notes studies show to be the most effective intervention. A parent is present 80 percent to 90 percent of the time for children over the age of one year at Children"s Hospital, he added. "Nevertheless, parents must be cautioned that many will find the experience upsetting, and if they are not able to conceal or suppress their tears it may be upsetting to the child, and they may be better off not coming in." In many regions, having a parent present as anesthesia starts is so routine that parents expect it, Polaner said. "That"s OK, as long as it is very clear that the judgment of the anesthesiologist, based on the best interest of the child, is final." Curiously, the study that evaluated acupuncture for the parent before the induction of anesthesia in the child found that it seemed to help keep the child calmer and more cooperative. Using acupuncture on the parent "is fascinating and underutilized," Polaner said. Most pediatric anesthesiologists are aware of this work, but acupuncture is not being widely used, primarily because of lack of training, he said. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Health Behavior News Service


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