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AUGUST ISSUE â&#x20AC;˘ 2011

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Also in this issue 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

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Medicare Part D Reduced Spending on Medical Care

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,

More U.S. Men Die From Cancer Than Women: Study PAGE 8

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

Foods to Eat for Healthy, Glowing Skin PAGE 10

graduation ............................13 Help Your Kids Stay

In dollars, Medicare spent nearly $306 per quarter less than expected on beneficiaries who previously had a limited drug coverage.

in Shape This Summer .........14 Medicaid Coverage 'Substantially' Improves 22nd annual Wellington Regional Medical Center Residency Program graduation PAGE 13

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

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Medicare Part D Reduced Spending on Medical Care The results also highlight a need for better coordination between all parts of Medicare, the investigators wrote.

edicare Part D coverage significantly reduced nondrug medical spending for beneficiaries who had limited drug coverage prior to the start of the federal prescription drug plan, Harvard Medical School researchers reported in JAMA. The 10.6% savings was mostly due to a decrease in spending on acute and postacute care under Medicare Part A "These reductions in nondrug medical spending suggest that Part D has not cost as much as what we initially thought," Dr. J. Michael McWilliams, the study’s lead author, said in an interview. The findings could also lend support to the Affordable Care Act’s

before age 65 or those with veterans’ health benefits, were excluded. For the control cohort, they selected a similar group of 5,988 beneficiaries who had generous (2,537) and limited (3,451) drug coverage in 2002. They studied the group up to 2005.

goal of closing the "doughnut hole," the gap in drug coverage under Part D, he added. "The cost of closing the doughnut hole could be less than what we might expect because of these partially offsetting reductions in spending on nondrug medical care." The results also highlight a need for better coordination between all parts of Medicare, the investigators wrote. "Even though Part D plans function completely separately from Part A and Part B of the Medicare program, and even though they have no financial incentive to lower copayments, particularly for beneficial medications, clearly providing this benefit to seniors through standalone Part D plans has been quite effective," Dr. McWilliams said.

Dr. J. Michael McWilliams.

The authors used data from the Health and Retirement Study and linked it to Medicare claims data from 2004 to 2007 on 6,001 beneficiaries, then categorized the beneficiaries as having had generous (2,538) and limited (3,463) drug coverage prior to implementation of Part D. Nontraditional Medicare beneficiaries, such as those who qualified for Medicare

They found that total nondrug medical spending before Part D implementation was not significantly higher for beneficiaries with limited drug coverage compared with those who had generous drug coverage (7.6% relative difference). However, after implementation of Part D, nondrug medical spending for beneficiaries who previously had limited drug coverage was 3.9% lower than those who previously had generous drug coverage, leading to a significant differential reduction of 10.6%. In dollars, Medicare spent nearly

$306 per quarter less than expected on beneficiaries who previously had a limited drug coverage. "The economic and clinical benefits suggested by these reductions may be enhanced by further expansions in prescription drug coverage for seniors, improvements in benefit designs for drug-sensitive conditions, and policies that integrate Medicare payment and delivery systems across drug and nondrug services," the authors wrote. Previous studies have shown that the implementation of Part D has been associated with reduced outof-pocket costs, increased medication use, and better medication adherence as well as decreased hospitalization for ambulatory care-sensitive conditions. The authors had no conflicts of interest to disclose. The study was supported by grants from several charitable foundations.

Sometimes Sleeping on the Job May Be a Good Thing People who power nap perform much better, sleep experts say.

rhythm, particularly those whose jobs demand constant vigilance. Instead, they believe that employers should set aside space, such as a break room or duty area, where workers can go to grab a quick nap.

op U.S. officials who have taken a hard line against air traffic controllers napping on the job are missing an opportunity to improve air safety, sleep experts say. Studies have shown that short "power naps" have a rejuvenating effect, improving reaction time and critical thinking for people impaired by drowsiness, said Dr. Alon Avidan, associate professor of neurology and associate director of the sleep disorders program at the University of California, Los Angeles.

"The data show if people take a short power nap, it actually makes them perform much better," Avidan said. "It doesn't disrupt their sleep. It doesn't make them wake groggy." The U.S. transportation secretary, Ray LaHood, has expressed opposition to napping by air traffic controllers. Under his guidance,

"All you need is about 15 or 20 minutes to have a significant impact on performance," Avidan said. the U.S. Federal Aviation Administration has added an extra hour to the amount of time controllers must be off between shifts, after incidents this spring when controllers were found sleeping while on overnight duty. But, the agency has kept its zero-tolerance policy for sleeping on the job. However, Avidan said that an extra hour does not address the core problem. Air traffic controllers, like others working late shifts, are fighting against a number of biological factors that encourage their bodies to sleep -- factors that only grow stronger as they remain awake. "The longer we are awake, the more drive we have for sleep," Avidan said. "It gets stronger and

stronger as the day goes by." Chief among these factors is the body's circadian rhythm, which helps set each person's cycle of waking and sleeping. The circadian rhythm tends to dip during late mid-day, at around 3 p.m. to 4 p.m. for someone working daytime hours. The dip makes the person drowsy, reducing their alertness and capabilities, Avidan said. "That's why we all go to Starbucks around 3 to 4 p.m.," he said. People eventually shrug off the effects of the circadian dip, but while it has them in its grip, he said, they'll be slightly impaired. Sleep experts believe it's better if people don't fight the circadian

The nap needs to be short. Anything longer than 30 minutes starts to encroach upon actual sleep and can have a detrimental effect on a person's alertness, said Dr. Helene A. Emsellem, director of the Center for Sleep & Wake Disorders in Chevy Chase, Md. "Long naps can be difficult to wake up from and are not as productive as short naps," Emsellem said. Avidan agreed, adding that people who take longer naps are more likely to wake up groggy. Nonetheless, power naps are not for everyone. Some people find it hard to wind down while they're at work, Emsellem said. And some people simply will not nap, even if they need it, because of societal perceptions of people who sleep

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on the job, she said. "Unfortunately, I think there's a stigma attached to taking a nap, so many people don't take advantage of the opportunity," she said. "We tend to think of sleepy people as lazy people." On the other hand, workers should not burn the candle at both ends and expect to successfully substitute on-the-job naps for actual sleep. "A nap is a Band-Aid, in a sense," Emsellem said. "You don't want to Band-Aid grossly misallocated sleep with a power nap. Employees need to understand their sleep requirements." But for those who could use a workday nap, research has found that employers are beginning to catch on, with a growing number offering workers a place to power nap, she said. "I don't think it's an unreasonable option to have available," Emsellem said. "As we move toward a 24/7 society, we have to be careful to give people the opportunity to get the sleep they need."

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Florida Health News is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2010, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.

AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Heal that wound, Save Your Leg, Save Your Life sores, a break in the skin that just does not heal, a recurring blister or open area that bleeds, or an open draining sore. Chronic wounds, without appropriate treatment, are likely to become infected and unfortunately many lead to leg amputations. Following a below knee amputation mortality rates of the patient increase significantly over the next 5-15 years.

Arthur Hansen DPM, M.S.

o you are someone you know have a stubborn sore that just will not seem to heal? A scratch, blister, open wound, or an area that seems to bleed when you knick it and it doesn’t seem to heal? If so, you may have a chronic wound. With the constant development of new treatments, new drugs, earlier diagnoses , and preventive education we, as a population, are living longer, even with diseases and maladies that before would shorten our life spans. Most chronic wounds are associated with systemic disease processes that inhibit the wound healing. Therefore, since our population is living longer with these systemic disease processes, the chronic wound care population is increasing.

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

The wound care physician must first determine expected outcomes of any wound. The outcome is healing. However, many factors influence the outcome measurement of a chronic wound, therefore, a comprehensive assessment is the sentinel starting point. The patient's health history is the first critical indicator of one's ability to heal. Disease processes such as peripheral arterial disease, pulmonary disease, diabetes, immune deficiencies, poor nutrition, collagen vascular diseases, and malignancies are all known to impede wound healing and must be identified and addressed. Therefore, determining the cause of the wound is first and foremost followed by identifying any complicating factors associated with the patients health, care setting, financial situation, and/or the patient's expectations. Once all of the above considerations have been taken into account, then an aggressive plan of action can be developed specific to the patient. Some characteristics of common chronic wound factors that we identify when first developing a treatment plan are outlined below: Pressure Wound • Bony Prominence

Nonblanchable erythema of intact skin Partial thickness skin loss involving epidermis and/or dermis • Full thickness skin loss involving damage or necrosis of subcutaneous tissue down to but not through fascia • Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures • Chronic Illnesses • Poor Nutrition • Decrease mobility • Decrease activity Decrease sensory perception Extrinsic factors-- presence of moisture friction and shear trauma Venous 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 Peripheral arterial disease Ability to heal wound usually maintained <0.5 Severe arterial insufficiency Wound healing unlikely unless revascularization 1.3 Abnormally high range, typically because of calcification of the vessel wall 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 sensory and motor • Charcot deformity--abnormal shape of foot/mid foot collapse • Peripheral arterial disease • Atherosclerosis • Smoking Hypertension When developing a treatment plan we always consider the following: Pressure Wound • Reduce pressure--select appropriate pressure reduction support surface for both chair and bed. • Minimize skin exposure to moisture from incontinence, perspiration, or wound drainage. • Minimize environmental factors leading to drying of skin, such as exposure to cold.

Chronic Venous Insufficiency • Surgical obliteration or ligation of veins • Valvular repair • Compression therapy • Elevation Arterial Wound • Measures to improve tissue perfusion: surgical revascularization • Hyperbaric oxygen • Pharmacologic options Non-Wound Specific • Optimize nutrition/hydration • glucose control • Measures to support tissue oxygenation • Smoking cessation

At LA Podiatry we view healing wounds as a priority. Our physicians offer services at three local wound care centers and have working relationships with other specialists that aid in wound healing. As wound care specialists, we know that healing wounds and saving legs saves lives.

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A Safe Tan? No Way, Experts Say

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From wrinkles to skin cancer, risks increase with exposure to UV rays indoors or out.

oung women say they flock to tanning salons to gain a healthy glow that adds to their natural beauty, protects them from the sun's rays and fills them with self-confidence.

Except none of it is true or lasting. A deep tan may help project beauty and confidence for a while, but health experts stress that it will eventually give way to permanent skin damage caused by the ultraviolet rays emitted by a tanning bed -damage up to and including potentially deadly skin cancer. "We're seeing more young women with tmelanoma," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. "Based on recent research, we believe it is linked to use of tanning beds." Also, any notion that a "base tan" can protect a person from a nasty sunburn is just plain wrong, he said. And though most people spend more time in the sun during the summer months, exposure to ultraviolet light has become increasingly a year-round danger. "The bottom line is excessive UV exposure increases your risk of skin cancer, whether you are indoors or outdoors," said Dr. James Spencer, a dermatologist in St. Petersburg, Fla., who's on the board of directors of the American Academy of Dermatology. Tanning beds have become a particular hazard. The World Health Organization's International Agency for Research on Cancer has classified the devices as within its highest cancer risk category -- basically as potentially carcinogenic as cigarettes. Nonetheless, about a third of the 3,800 young women questioned in an American Academy of Dermatology survey released in May said they had visited a tanning salon within the previous year. About a fourth said they used indoor tanning beds at least once a week. The survey also found that 81 percent of the young women said they also tanned out-

doors, either frequently or occasionally. Exposure to UV light at a relatively young age appears to come at a cost. The World Health Organization released a study that found a 75 percent increased risk for melanoma in people whose first exposure to a tanning bed occurred before age 30, Lichtenfeld said. Researchers also have found an increase in melanoma occurrence on specific parts of the body, particularly the chest and trunk. "They believe it's due to the widespread use of tanning beds," Lichtenfeld noted. College-age women are most at risk for UV exposure through indoor tanning. The American Academy of Dermatology survey found that women 18 to 22 years old were almost twice as likely as 14- to 17year-olds to have used a tanning bed. These women are responding to a message that permeates modern society, Spencer and Lichtenfeld said. "It's a societal norm that a tan is attractive and desirable," Spencer said. "People like how it looks. They're worried about the prom this weekend." Add to that the perception of invincibility that young people share -- the idea that nothing can harm them, so there's no reason why they shouldn't use a tanning bed to turn their bodies bronze. "They don't connect tanning at age 17, 18, 19 with what's going to happen to them at age 40," Lichtenfeld said. The true irony, experts agree, is that tanning may indeed help them look and feel beautiful when they're young, but it will cause their 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 they will have wrinkles earlier." Proponents of healthy skin have tried educating young women about the risks associated with tanning bed use, but many now believe that legislation may be needed to protect them. Lichtenfeld said he believes that lawmakers should undertake legislation to restrict access to tanning beds for anyone younger than 18. Laws also should be considered, he said, to tighten regulation of the devices, including how much UV light they emit and the length of exposure during a tanning session.

AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

More U.S. Men Die From Cancer Than Women: Study ing," said Rebecca Siegel, an epidemiologist at the American Cancer Society, commenting on the study.

But disparity mirrors differences in incidence, not ability to fight disease, researchers say. en in the United States are much more likely than women to die of cancer, a new report from the U.S. National Cancer Institute found.

metabolism and susceptibility," he said. Increased rates of smoking among men, and differences in infections, hormones and contact with toxic metals may all come into play, he said.

gender differences in cancer incidence -- more men than women develop cancer in the first place - rather than differences in cancer survival appeared to drive the findings, the researchers said.

In terms of survival, however, the gender gap was minimal, the researchers found.

"If we can identify modifiable causes of sex difference in cancer incidence and mortality then preventative actions could reduce the cancer burden in both men and women," said lead researcher Michael B. Cook, a National Cancer Institute epidemiologist. Cook said that for many cancers, male and female incidence rates, and by extension death rates, have changed disproportionately over time. This is likely because of differences in "carcinogenic exposures,

"We know that men have a higher risk of developing and dying from cancer for a variety of reasons, and some reasons which we don't fully understand," she added. "The fact they didn't find large differences in survival is comforting," she said. The death rates reflect different smoking and drinking patterns, Siegel pointed out. Also, cancers related to work exposures are more common among men, she noted.

The study is published in the August issue of Cancer Epidemiology, Biomarkers & Prevention. To look for gender differences in cancer deaths and survival rates, Cook's team used information from the NCI's Surveillance, Epidemiology and End Results database, which includes information on survival and deaths for 36 different cancers. Lip cancer, for example, killed 5.51 men for every 1 woman. Larynx cancer claimed the lives of 5.37 men for every 1 woman; throat cancer, 4.47 men for each woman; and urinary bladder cancer, 3.36 men per 1 woman.

Examining cancers with the highest death rates overall, the researchers again found higher mortality among men than women. For example, lung and bronchus cancer killed 2.31 men for every 1 woman. Liver cancer killed 2.23 men for every woman; colon and rectum cancer took 1.42 males' lives for every woman; pancreatic cancer, 1.37 men for each woman; and leukemia, 1.75 men for every woman.

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The research team found that gender was not a major factor in fiveyear survival when age, year of diagnosis and tumor stage were taken into account. "But, for certain cancers we did observe slight sex differences in survival," Cook said, adding it is difficult to assign any root cause to that observation. "This is not really a novel find-

Because smoking among women peaked in the 1970s and 1980s, Siegel said she expects to see the gender difference in cancer deaths start to narrow. Men may get diagnosed later than women because they tend to see their doctors less often, and this could affect mortality rates, Siegel also suggested. Future studies should explore the factors responsible for the disparity, the study authors said.

6 AUgUST ISSUE

• 2011

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The anatomy of a healthy office These 13 must-haves will make you healthier—and your space work harder.

A back-friendly seat Look for a chair with lower-back support and adjustable height and arm rests so you can sit up straight with your knees level. And lean back now and then: New research says it’s good for you.

A well-placed monitor Your neck and eyes will thank you if the top of your screen is at eye level and about 18 to 28 inches away from you. To avoid fatigueinducing glare, don’t park your computer in front of a window.

der, into your office, says Leatrice Eiseman, executive director of the Pantone Color Institute and author of Color Messages and Meanings.

Typing tricks Prevent carpal tunnel syndrome with a cushioned wrist support (wrists should be in a straight, not bent, position).

Soothing sounds

Calming color

Minimize irritating background racket (which can actually make you eat more!) by getting a fan, a sound machine, an iPod, or earplugs to help block it out.

To lower your stress level, work cooler hues, such as aqua or laven-

Green power

The right plant can add oxygen and humidity to dry office air. Or, go with flowers to enhance creativity.

Green power

Sunny-side up

Natural sunlight can increase the brain’s levels of the calming chemical serotonin and also help suppress the sleep-inducing hormone melatonin.

Typing tricks

Channel the chi

Prevent carpal tunnel syndrome with a cushioned wrist support (wrists should be in a straight, not bent, position).

A minifountain on your shelf or desk taps into the Chinese practice of feng shui balance; moving water is a symbol of wealth and empowerment.

Soothing sounds Minimize irritating background racket (which can actually make you eat more!) by getting a fan, a sound machine, an iPod, or earplugs to help block it out.

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The right plant can add oxygen and humidity to dry office air. Or, go with flowers to enhance creativity.

Soothing smells get the calming effects of aromatherapy at work with a bowl of potpourri, a bouquet of sweetsmelling flowers like lilies, a jas-

mine plant, or a scent diffuser for your office.

The right light Overhead lighting can cause glare and make you look like you pulled an all-nighter. Turn off the overheads and use task lighting.

A neck-saving phone get a headset to avoid neck and shoulder pain from cradling the phone between your shoulder and ear.

A feel-good moment A special photo of an important person, place, or pet can help make even a bad day tolerable.

Temperature control Hot office? Cold outside? Or vice versa? Keep a wrap handy so you can stay comfortable.

AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Top 10 Skin Myths Debunked Are you approaching your regimen all wrong? Dermatologists expose common blunders that could be sabotaging your complexion.

MYTH 3: Scrubs make skin glow. TRUTH: Overexfoliating leads to extra oil production, so the glow you see the first week will eventually turn into a greasy mess. "Skin is actually a good exfoliator on its own, so I rarely recommend manual scrubs," says Hirsch. MYTH 4: Dryness causes fine lines.

MYTH 1: A complete skincare routine must have three steps. TRUTH: Cleanse, tone, then moisturize has been drilled into our heads, but feel free to skip the second step, says Cambridge, Massachusetts, dermatologist Dr. Ranella Hirsch: "People think that toning an oily complexion will make it better, but oil is protective and the body produces it in response to injury. When you strip your skin, it reacts by making a ton of grease." MYTH 2: You need to cleanse your face at least twice a day. TRUTH: Using a face wash in the morning is just an excuse to go through more product, according to Hirsch, who advises avoiding antibacterial soaps at all costs because they're too harsh for your face. "In the morning, the best thing is water and your fingers, not a cleanser," she says.

TRUTH: People confuse dryness and flaking with wrinkles, says Hirsch, who suggests smoothing things out visually with a little lotion: "Just moisturizing will make wrinkles look better. The lines are still there, but you won't see them anymore." MYTH 5: You should buy your best friend's favorite eye cream. TRUTH: "Everyone has different eye issues, so one size does not fit all," reveals New York City dermatologist Dr. Anne Chapas. If you have puffiness, choose a gel (heavy creams can boost swelling) with caffeine and store the tube in the fridge to maximize benefits. If you have dark circles, look for a product with a lightening ingredient like vitamin C and a collagenbuilder like retinol. MYTH 6: Leaving a mask on overnight gives you more for

your money. TRUTH: Masks deliver a potent dose of active ingredients or moisture quickly into the skin, but you can overdo it, causing irritation or breakouts. "You should use things as directed. Rarely do you outsmart the people who have done the clinical testing for a product," says Hirsch. MYTH 7: Wearing foundation with an SPF means you're being sun safe. TRUTH: You should still apply a sunscreen underneath, says Chapas. "Unless you're slathering on a mask of makeup, you're not getting enough protection. You need to wear an SPF of at least 30 on your face every day, and nobody puts on enough foundation to get that SPF value out of it." MYTH 8: Nano-size titanium dioxide sunscreen causes cancer. that are applied topically are safe." TRUTH: "The majority of studies show that titanium dioxide nanoparticles are not absorbed through the normal skin," explains Dr. Chapas. "There are animal studies that show a link between nano-size titanium dioxide and organ damage, but the mice tested were ingesting or inhaling multiple times the amount that you would put on your skin. As far as we know, nano-size sunscreens

MYTH 9: More wrinkle cream you apply, the better your results. TRUTH: Morning and evening applications are a waste of money, says Hirsch. Most active ingredients work really well once a day, and antiaging retinols should be used only at night (because they're broken down by sunlight). Plus, slathering on too many retinols

will cause irritation and make your skin look worse, leading to redness, peeling, and inflammation. MYTH 10: The best way to get rid of blackheads is extractions. TRUTH: Pulling and pressing on pores can cause scarring, warns Chapas. "After extractions, skin just fills right back up with oil. Using retinols and gentle acid peels at home is enough to unclog pores."

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Advances in Cancer Treatment: IMRT and IGRT

Kishore K. Dass, MD.

Anthony E. Addesa, M.D.

Board-Certified Radiation Oncologist Has been trained at Cleveland Clinic, Ohio

Board-Certified Radiation Oncologist. Completed his fellowship at Harvard Joint Center for Radiation Oncology

adiation therapy has been in use as a cancer treatment for more than 100 years, with its earliest roots traced from the discovery of x-rays in 1895 by Wilhelm Röntgen.

dose distribution within the patient. Megavoltage linear accelerators, useful for their penetrating energies and lack of physical radiation source, have replaced the older machines, such as cobalt units.

The field of radiation therapy began to grow in the early 1900s largely due to the groundbreaking work of Nobel Prize-winning scientist Marie Curie, who discovered the radioactive elements polonium and radium. This began a new era in medical treatment and research. Radium was used in various forms until the mid-1900s when cobalt and cesium units came into use. Medical linear accelerators have been used too as sources of radiation since the late 1940s.

The advent of new imaging technologies, including magnetic resonance imaging (MRI) in the 1970s and positron emission tomography (PET) in the 1980s, has moved radiation therapy from 3-D conformal to intensitymodulated radiation therapy (IMRT) and image-guided radiation therapy (IgRT) Tomotherapy. These advances allowed radiation oncologists to better see and target tumors, which have resulted in better treatment outcomes, more organ preservation and fewer side effects Intensity-modulated radiation therapy (IMRT) is an advanced type of high-precision radiation that is the next generation of 3DCRT. IMRT also improves the ability to conform the treatment volume to concave tumor shapes; for example, when the

With godfrey Hounsfield’s invention of computed tomography (CT) in 1971, three-dimensional planning became a possibility and created a shift from 2-D to 3-D radiation delivery; CT-based planning allows physicians to more accurately determine the

tumor is wrapped around a vulnerable structure such as the spinal cord or a major organ or blood vessel. Computer-controlled x-ray accelerators distribute precise radiation doses to malignant tumors or specific areas within the tumor. The pattern of radiation delivery is determined using highly tailored com-

puting applications to perform optimization and treatment simulation (Treatment Planning). The radiation dose is consistent with the 3-D shape of the tumor by controlling, or modulating, the radiation beam’s intensity. The radiation dose intensity is elevated near the gross tumor volume while radiation among the neighboring normal tissue is decreased or avoided completely. The customized radiation dose is intended to maximize tumor dose while simultaneously protecting the surrounding normal tissue. This results in better tumor targeting, lessened side effects, and improved treatment outcomes than even 3DCRT. 3DCRT is still used extensively for many body sites but the use of IMRT is growing in more complicated body sites such as brain, head and neck, prostate, breast and lung. Unfortunately, IMRT is limited by its need for additional time from experienced medical personnel. This is because physicians must manually outline the tumors one CT image at a time through the entire disease site which can take much longer than 3DCRT preparation. Then, medical physicists and dosimetrists must be engaged to create a viable treatment plan. Also, the IMRT technology has only been used commercially since the late 1990s even at the most advanced cancer centers, so radiation oncologists who did not

learn it as part of their residency program must find additional sources of education before implementing IMRT. Proof of improved survival benefit from either of these two techniques over conventional radiation therapy (2DXRT) is growing for many tumor sites; and, its ability to reduce toxicity is generally accepted. Both techniques enable dose escalation, potentially increasing usefulness. There has been some concern, particularly with 3DCRT, about increased exposure of normal tissue to radiation and the consequent potential for secondary malignancy. Overconfidence in the accuracy of imaging may increase the chance of missing lesions that are invisible on the planning scans (and therefore not included in the treatment plan) or that move between or during a treatment (for example, due to respiration or inadequate patient immobilization). Newer techniques have developed to better control this uncertainty—for example, real-time imaging combined with real-time adjustment of the therapeutic beams. This new technology is called imageguided radiation therapy (IgRT) or four-dimensional radiation therapy. Both IMRT and IgRT are some of the latest tools we have to fight cancer. These new techniques are proving to improve cure rates for many types of cancers while reducing side effects for patients.

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10 AUgUST ISSUE

• 2011

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Foods to Eat for Healthy, Glowing Skin These nutrient-rich foods will give your skin a replenishing boost.

t may be a cliché, but the simple truth is that you are what you eat. Just as radiant, glowing skin is an indicator of good health and a nutrient-rich diet, a lackluster complexion reflects poor diet choices and overall health. Your skin is an indication of what’s going on inside the body, and great skin starts from the inside. If you eat high quantities of processed foods, sugar, caffeine, and fried foods, chances are, your skin is not going to be looking its most radiant. But, loading up on fruits and veggies, whole grains, and vitamin-rich foods makes for a healthy body and, in turn, healthier, more radiant skin. Check out these skin-boosting super foods that contribute to overall good health, and contain properties which help your skin become its most healthy and radiant:

Almonds One of nature’s greatest gifts to the skin, almonds are packed with antioxidant vitamin E—which protects your skin from UV rays and helps build collagen—fiber, and omega-6 and omega-9 fatty acids, which help maintain the skin’s elasticity and suppleness. Snack on raw almonds, add almond milk to your morning gra-

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

Avocados If you tend to steer clear of avocados because of their fat content, think again. The healthy monounsaturated fats found in avocados make them one of the best foods for your complexion. These healthy fats keep skin from drying out and help to maintain its youthful appearance. Avocadoes are also high in B vitamins (particularly vitamin B3) which contain antiinflammatory properties.

Green Tea

Strawberries

Salmon

High in fiber and low in sugar, strawberries are the perfect summer snack and a potent skinbooster. With their high concentration of Vitamin C—an antioxidant essential to healthy skin, which combats aging and the effects of sun exposure—they’re a delicious way to get glowy. Vitamin C has an important role in collagen production, the key to keeping your skin elastic, fresh and young-looking. Strawberries contain even more Vitamin C per serving than oranges or grapefruit, and with fewer overall calories. They’re also high in alpha-hydroxyl acid, which helps eliminate dead skin cells and helps the body build collagen.

With its high concentration of omega-3 fatty acids, oily fishes such as salmon and tuna aid in decreasing the occurrence of clogged pores. Plus, salmon is loaded with selenium, a trace mineral that helps smooth the skin and acts as a powerful antioxidant when joined with its fellow skin-booster, vitamin E.

Packed with antioxidants and free radical-fighting agents, you can drink your way to great skin with green tea. It’s high in vitamins C, D, and K, as well as the essential minerals riboflavin, zinc, calcium, magnesium, and iron. Try swapping your morning coffee, which dehydrates the skin, for green tea — your complexion will thank you.

Hemp Seeds It’s a little-known nutritional secret that hemp seeds are one of the best things you can eat for skin and overall good health. These little seeds are loaded with protein, iron, vitamin E, and omega-3 and omega-6 fatty acids, which help keep the skin looking supple.

Hemp seeds are also great for vegans and vegetarians, as they boast one of the highest protein contents of any plant-based food, with 2520% protein. Like almonds, you can enjoy them raw, toss them into salads or enjoy hemp milk with whole-grain cereal for a healthy breakfast.

Whole Grains An essential part of a healthy diet, whole grains are as much a friend to the skin as any other part of the body. Their high fiber content helps your body stay hydrated and flushes out toxins, while their high concentration of B vitamins aids metabolism. Be sure to incorporate whole grains into every meal for improved digestive health and skin that reflects it.

Sweet potatoes High in antioxidant beta-carotene, vitamin E, vitamin C and fiber, sweet potatoes are delicious, fun to cook with, and great for your complexion. Vitamins C and E are a powerful combo—Vitamin E helps maximize the effectiveness of vitamin C because it aids the body in the regeneration of vitamin C.

Low-fat Yogurt and Cottage Cheese Low in fat and high in vitamin A (a major player in skin health) and selenium, cottage cheese is a nutritious and low-calorie food that also has significant skin-boosting properties. In yogurt, the live enzymes and healthy bacteria contributes to good intestinal health and a healthy digestive tract, both of which are important to healthy skin.

Water Okay, so it’s not technically a food, but water is hands-down the number one skin-booster. It’s a simple equation: hydrated skin is healthy skin, and healthy skin is beautiful skin. Dry, dehydrated skin looks older, has more lines, and is more prone to breakouts. For your beautiful skin, make sure to stay hydrated and eat a balanced diet that incorporates these skinboosting super foods. Your health will shine through your radiant skin, and have everyone wondering how your face has such a gorgeous, healthy glow.

Study: Potassium Boosts Heart Health, Salt Harms It Combo of high sodium, low potassium called 'double whammy' for cardiovascular risk.

oo much salt and too little potassium in your diet may boost your risk for cardiovascular disease and death, a new study shows. Earlier studies had found an association between high blood pressure and high levels of salt consumption and low levels of potassium intake. The combination of high salt -- sometimes called sodium -- and low potassium appears to convey a stronger risk for cardiovascular disease and death than each mineral alone, the study authors said. "The combination of high sodium and low potassium is re-

ally a double whammy for cardiovascular risk and for mortality," said lead researcher Dr. Frank B. Hu, a professor of medicine at Harvard Medical School. Although sodium and potassium act independently, high potassium levels can counteract some of the effect of high sodium, Hu said. "But the adverse effects of high sodium cannot be completely offset by a high potassium diet," he said. To find out the role of salt and potassium and the risk of cardiovascular disease and death, the researchers looked at the levels of these minerals and the ratio between them. Over an average of 14.8 years of follow-up, 2,270 people died. Of these, 825 died from cardiovascular disease -which includes stroke -- and 443 died of heart disease. After taking into account variables such as gender, race and ethnicity, weight, high blood pressure, education and physical activity, Hu's

group found that high salt intake was associated with a 20 percent increased risk of death, while high potassium intake was associated with a 20 percent decreased risk of dying. What's more, high salt consumption coupled with low potassium intake was a significant risk factor for cardiovascular disease and heart disease, the researchers added. "We should continue to reduce the amount of sodium in our diet, especially in processed foods," Hu said. "We should also promote high consumption of potassium, especially from fruits and vegeta-

bles," he added. "Those things should go hand-in-hand."

are naturally low in sodium," she explained.

While the study uncovered an association between heart disease and the two minerals, it did not prove a cause-and-effect.

"The DASH (Dietary Approaches to Stop Hypertension) diet does just that and has been around for quite some time now," she stated. "It encourages people to eat more foods high in potassium (fruits, vegetables, low-fat dairy) while eating less sodium-laden foods."

Commenting on the study, Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas, said, "The findings are not surprising to me." The benefits of potassium to counterbalance the effects of salt for controlling high blood pressure have been known for years, but get little attention, Sandon said. "There have been hints in the past research literature that the ratio of the two may be more important than the nutrients individually," she said. Diets with plenty of fruits and vegetables are associated with better heart health, Sandon said. "Fruits and vegetables are your best natural sources of potassium and they

Sandon noted that this is consistent with the 2010 Dietary guidelines for Americans, which encourage increased fruit and vegetable intake while lowering intake of foods high in sodium. Those guidelines recommend that Americans limit their daily salt intake to less than 2,300 milligrams (about a teaspoon) for most people, and to less than 1,500 milligrams for people 51 or older, all blacks, and people who have high blood pressure, diabetes or chronic kidney disease, regardless of their age.

AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Testimonials from our patients

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12 AUgUST ISSUE

• 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Life Tweaks That Will Make You Happier and Healthier Brush Your Teeth with Your Other Hand

Eat an Apple... Researchers from Pennsylvania State University found that people who ate an apple before lunch consumed nearly 190 fewer calories at the meal than those who'd taken in the same number of calories (125) in the form of applesauce, fiber-fortified apple juice, and plain apple juice. "All calories are not created equal," says Mark Hyman, MD, author of Ultrametabolism: The Simple Plan for Automatic Weight Loss. "A whole apple feels like more. It has more fiber and nutrients, and makes you feel full longer." The Penn State volunteers ate their apple about 15 minutes before lunch—and the authors suspect the effects might have been even more dramatic had they eaten the peel (which was removed), thanks to the extra fiber.

Using your nondominant hand to do simple chores can improve your mood and your memory; that's because the action stimulates the production of brain-derived neurotrophic factor (BDNF), a protein that encourages the growth of neurons linked to long-term memory and mood. "When you're depressed or under stress, your brain's production of BDNF plummets," says Moses Chao, PhD, professor of neuroscience and psychiatry at New York University School of Medicine. (One of the lesser-known effects of antidepressants, he says, is to raise the levels of BDNF.) Anything unexpected—smelling rosemary first thing in the morning, for example—can activate BDNF.

Drink Filtered Coffee

Power Up Your Walk

Have a Few Walnuts

A growing body of evidence is linking unfiltered coffee to higher levels of both LDL and total cholesterol. The reason, scientists suspect, has to do with terpenes—compounds found in the oil from coffee beans. Unfiltered coffees such as those made in an espresso machine or with a French press or a percolator have more terpenes, which interfere with cholesterol metabolism. "Filters catch surface oils," says Nancy Snyderman, MD, chief medical editor at NBC News and author of Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life. "I learned the hard way that gold filters do very little. Paper filters are far more effective."

If you've been anywhere near a gym lately, you've probably heard the word "core". Targeting the abs and back, core work develops supple muscles and decreases the risk of injuries. It also improves athletic performance and eases lower back pain, according to a review from the University of Colorado School of Medicine. You can easily slip in a little core conditioning while you're walking, says Michelle Demus, program director at New York's Pure Yoga studio. Take a deep inhalation, then, with a strong exhalation, pull in your navel toward your spine; hold for a count of five, and release. Do this 10 times while you're walking, take a short rest, and do two more sets. Another way to add core conditioning to your walk is to throw in a few lunges: Keeping the spine long and abdominals engaged, step about 3 feet forward with the right foot—the knee must stay directly above the ankle—and draw the left foot up, so you're balancing on the right leg for a moment. Repeat with the other foot.

If you're dragging, consider an unusual suspect: your liver. Thanks to the fatty, carbheavy American diet, millions of adults are "increasing their odds of liver inflammation and putting themselves on the path toward cirrhosis—and they might never have touched a drink," says Jan garavaglia, MD, host of the Discovery Health Channel's Dr. g: Medical Examiner and author of How Not to Die: Surprising Lessons on Living Longer, Safer, and Healthier from America's Favorite Medical Examiner. Fatigue and malaise are early symptoms of nonalcoholic fatty liver disease; to help prevent or reverse it, try eating an ounce of walnuts daily; they contain liver-healthy omega-3s. In general, try to replace junk food with fruit, vegetables, fish, and whole grains.

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AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

22nd annual Wellington Regional Medical Center Residency Program graduation

Regional ellington Medical Center held its 22nd annual Wellington Regional Medical Center Residency Program graduation on June 15, 2011. Wellington Regional Medical Center Residency programs are affiliated with the Lake Erie College of Osteopathic Medicine. The ceremonies were led by Jeffrey Bishop, DO Director of Medical Education and Chief Medical Officer of Wellington Regional Medical Center. We are proud to announce eight physicians graduated from our residency program this year. The physicians are as follows: Adam Weiner, DO- Dermatology, Adam is taking over a Dermatology practice in Melbourne, FL Thomas J. Singer, DO- Dermatology, T.J. will be practicing Moh’s Surgery with a Dermatology group in Fort Myers, FL Kim Sussman, DO – Internal Medicine, Kim is opening her own practice in Boynton Beach, FL James Landero, DO – Internal Medicine, James is continuing on in our Dermatology Residency Program Hadi Siddiqui, DO – Internal Medicine, Hadi will continue on in a gastroenterology Fellowship in Illinois.

Front: Jeffrey Bishop, D.O., Ishan Gunawardene, M.D., Melissa Mora, D.O., Alissa Tomaiolo, D.O., Marianna Zelenak, 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.

physicians in Internal Medicine, Traditional Rotating Internship and Dermatology. Our residency programs have produced approximately 150 graduates, with many staying in the community to practice. The Internal Medicine program is led by Joanna Widdows, D.O and the Dermatology program is led by Brad glick, DO, MPH and Richard Rubenstein, MD.

Robert Fernandez, DO from LECOM presents Adam McDaniel, DO with the LECOM Resident award

The evening graduation ensued with Chief resident Alissa Tomaiolo, DO receiving the Most Valuable Resident award and Ben Tishman, DO receiving the Most Valuable first year resident award. Four of our Clinical Professors received awards as follows:

William Stechschulte, DO received the Andrew Egol, DO Osteopathic award. Gordon Johnson, DO received the Resident’s Choice Award. Ishan Gunawardene, MD received the Golden Apple Award.

Joanna Widdows, DO received the Distinguished Teaching award. Chief Resident Alissa Tomaiolo, DO presents Internal Medicine Program Director Joanna Widdows, DO with Distinguished Teaching award

Renee Young, DO – Traditional Rotating Internship, Renee was accepted into an Anesthesia Residency Program in Pittsburgh, Pennsylvania

Program Director Brad Glick, DO MPH presents Dermatology resident Thomas Singer, DO with Diploma.

Our affiliate college also presented two awards for the evening. Adam McDaniel, DO a second year resident received the Resident Award and David Weissberger, MD received the Physician Teacher award.

Program Director Brad Glick, DO MPH presents Dermatology resident Adam Wiener, DO with Diploma

Ben Tishman, DO – Traditional Rotating Internship, Ben was accepted into an Emergency Medicine Residency Program in Cuyahoga Falls, Ohio Vik Belous, DO – Traditional Rotating Internship, Vik was accepted into an Anesthesia Residency Program in California. The Wellington Regional Residency Program, which began on July 13, 1989, trains Osteopathic

Robert Fernandez, DO presents David Weissberger, MD with LECOM’s Faculty award

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

Chief Resident Alissa Tomaiolo, DO presents Ishan Gunawardene, MD with the The Golden Apple award.

Physical Activity Levels Linked to Employment Status tary jobs were less physically active Monday through Friday compared to unemployed women. These differences in activity levels between employed and unemployed people did not extend to weekends, the researchers noted.

Men's and women's exercise levels affected differently by being unemployed, study finds.

eople's employment status has an impact on how physically active they are during the workweek, but men and women are affected differently, new research shows. The study from the U.S. National Institute on Aging measured the levels of physical ac-

tivity in people participating in the U.S. National Health and Nutrition Examination Survey, which gathers data on about 5,000 people each year. Physical activity data was collected with the help of an accelerometer, a device worn around the waist that detects body

movements and their intensity. The investigators found that fulltime employed men in either active or sedentary jobs were more active than healthy unemployed men during the work week. In comparison, women with seden-

The study authors also pointed out that, not surprisingly, working people with sedentary jobs were less active than those in more active professions. gender, however, still played a role in this finding: 22 percent of the men and 30 percent of the women who held desk jobs were less active than those in more active positions. As a result, the study authors con-

cluded that people who are unemployed, particularly men, and those with sedentary jobs, particularly women, should take steps to become more physically active to reduce their risk of obesity, heart disease and high blood pressure. Moreover, exercise might boost morale among men who are job hunting. Dane R. Van Domelen, postbaccalaureate fellow at the U.S. National Institute on Aging Laboratory of Epidemiology, Demography and Biometry, and colleagues published their findings in the online edition of the American Journal of Preventive Medicine.

14 AUgUST ISSUE

â&#x20AC;˘ 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Help Your Kids Stay in Shape This Summer

Experts share tips on planning for exercise, fun and healthy eating.

dren need to stay hydrated with water, not calorie-laden sugary drinks, Wallace added. Summer is also a good time for parents to reinforce healthy eating habits among children.

"One key is to keep healthy foods in the house, such as fruits, vegetables and whole grain granola bars, but don't deprive the kids either," Beth Kitchin, an assistant professor of nutrition sciences at UAB, said in the news release.

bit of planning can help parents ensure their children eat right and get enough exercise during the summer, experts say.

To start, parents can seek a minimum commitment from their children of one hour of physical activity a day, suggested Dr. Stephenie Wallace, an assistant professor of pediatrics at the University of Alabama at Birmingham.

"Set an expectation of doing something in the house -- chores, set some goals and rewards for your young person," she said in a university news release. "get them to play basketball with their friends or spend some time in the neighborhood, and really encourage them to do so." Parents should remember that active chil-

"get the kids involved in choosing foods. Take them grocery shopping. Show them healthy choices and have them choose," she recommended. The authors said they hope that parent involvement will help prevent more children from becoming overweight or obese. Poor diet and lack of physical activity have led to a tripling of obesity among American children over the last 30 years, according to the U.S. Centers for Disease Control and Prevention.e not required to see Me-dicaid patients.

Higher Folic Acid Levels in Teens Tied to Academic Success Folate levels should be monitored to ensure kids are getting enough, researchers say.

eens who have high levels of folic acid appear to do better in school than those with lower levels, Swedish researchers report. "Folate intake had a positive association with academic achievement" in the students studied, the authors wrote in the report published in the online edition and the August print issue of Pediatrics. Not only should health providers monitor folic acid levels in teens, but the findings should influence school meals, school teaching and information given to parents, according to the researchers. Teens often have high levels of the blood protein homocysteine, an amino acid linked to heart disease, and low levels of folic acid. In previous studies, folic acid levels have been linked to mental ability; however, until now this had not been linked with improved school performance, the study authors said. "We know that folate plays a really critical role in brain development and brain func-

tion," said Dr. Daniel Armstrong, associate chair of pediatrics at the University of Miami Miller School of Medicine. "We know that, in young children, folate deficiencies are associated with poorer neurocognitive function and neurocognitive development," he noted. In fact, folate deficiencies may be involved in the development of autism, he added. To find out whether folate might do some good, a team led by Dr. Torbjorn K. Nilsson, from the department of laboratory medicine at Orebro University Hospital in Sweden, collected data on folic acid levels in 386 teens aged 15 years. The researchers also looked at any possible effects of socioeconomic status and genetics. The investigators found that teens who had the highest levels of folic acid also got the best grades. None of the other factors they examined accounted for their finding, Nilsson's team noted. "These results provide new information that points to the importance of keeping a closer watch on folate status in childhood and adolescence. They may also have direct implications for school meal provisions, school teaching programs and information to parents," the authors concluded.

AUgUST ISSUE • 2011

FLORIDAHEALTHNEWS-ONLINE.COM

Medicaid Coverage 'Substantially' Improves Access to Care: Study Coverage resulted in better outcomes, more use of health services among low-income adults, researchers say. xpanding Medicaid coverage among low-income adults increases health care use, improves health and well-being and reduces the financial strain for people with the publicly funded health coverage, according to new research.

The first year of the ongoing study showed that Medicaid coverage increases the likelihood of outpatient care by 35 percent, the use of prescription drugs by 15 percent, and of hospital admission by 30 percent. This leads to about a 25 percent increase in annual health care spending.

"This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured," co-principal investigator Katherine Baicker, professor of health economics at Harvard School of Public Health, said in a Harvard news release.

Medicaid coverage also increases the use of recommended preventive care such as mammograms by 60 percent and cholesterol monitoring by 20 percent. It also increases access to care. For example, people with Medicaid were 70 percent more likely than those without insurance to have a regular doctor's office or clinic for primary care, and were 55 percent more likely to have a particular doctor that they usually see.

The researchers also found that the adults with Medicaid coverage were 25 percent more likely to report they were in good to excellent health, and 10 percent less likely to report being depressed.

Compared to uninsured people, those with Medicaid coverage were 40 percent less likely to have to borrow money or skip paying other bills to pay for health care, and 25 percent less likely to have

The findings are published as a working paper (number 17190) on the website of the National Bureau of Economic Research. Support for the study was provided by the U.S. National Institute on Ag-

She and her colleagues looked at 10,000 low-income, uninsured adults in Oregon who were randomly selected in a 2008 state lottery to accept additional people into its Medicaid program. The health outcomes of these people were compared to the 80,000 applicants who weren't selected in the lottery.

an unpaid medical bill sent to a collection agency.

ing, the Centers for Medicare & Medicaid Services, the California Healthcare Foundation, and other foundations and government agencies. "Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does. People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care," co-principal investiga-

tor Amy Finkelstein, a professor of economics at MIT, said in the news release. The researchers will follow the lottery participants for another year and directly measure health outcomes such as obesity, blood pressure, cholesterol and blood sugar control. Under the Obama administration's Affordable Care Act, Medicaid coverage will be expanded to cover additional low-income adults in all states in 2014.

Golf-Cart Head Injuries on the Upswing, Study Finds Researchers surprised to find alcohol involved in many cases.

olf carts are a popular mode of transportation on and off the links, but they also are a growing cause of serious

head trauma, a new study finds. Researchers identified 68 people treated for golf cart-related injuries from 2000 to 2009 at the level 1 trauma center at georgia Health Sciences University in Augusta, not far from the setting of the Masters golf Tournament. More than two-thirds had suffered significant head injuries, defined as loss of

Classified

consciousness, hemorrhage or skull fracture. About 60 percent of the injuries occurred in children age 9 years on average. Alcohol was detected in about 59 percent of injured people over age 16, the investigators reported. The study, published in the issue of Otolaryngology -- Head and Neck Surgery, noted that golf carts

and similar slow-speed buggies are used at some retirement communities, college campuses and sporting events, and more frequently by children. But riders and passengers rarely wear helmets or other protective gear and, unlike motor vehicles, golf carts typically lack doors and safety features such as seat belts, mirrors and lights.

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