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Back to School Health Tips
(Fall 2003)

Backpacks, shoes, lunchboxes, clothes are probably all on your back to school checklist. But, have you done the following for your child's health? If not, be sure to get these items on your to-do list:

Obtain Your Child's Health Report from Your Child's Pediatrician: File the form with the school. If your child's after school care and/or sports require health forms, be sure to have your pediatrician complete the form; photocopy the health form for other sporting or camp needs. Your doctor should document height, weight, blood pressure measurements, vision screening, and developmental and behavioral assessments.

Map Out the Route to School: If your child is walking, walk the route together before school starts, reviewing safety issues, such as remaining on the sidewalks and main roads. Arrange for an older child to walk with your younger child. If your child is taking a bus, review safety rules such as waiting for the bus to stop before leaving the curb or exiting the bus. Make sure your child knows to look both ways for oncoming traffic before crossing the street.

Meet With The School Nurse if Necessary: If your child has a chronic medical condition, such as asthma or diabetes, it is important to discuss your child's medical history and medications with the school nurse or designated school health provider. Provide the nurse with emergency contact and physician information. Ask your doctor for a written action plan including medications to use for symptoms and before exercise. Keep rescue medications like inhalers or Epi-pens at the nurse's office.

Schedule A Dental Check Up: Schedule your child's dental check up and be sure to purchase new toothbrushes twice a year. Look inside your child's mouth. If he or she has any signs of periodontal disease, such as red or swollen gums, bleeding, or persistent bad breath, contact your dentist.

Designate a Homework Area and Homework Time: The homework area can be a table or desk. It should be free of clutter and away from distractions, such as the television. Be sure the chair is the right height for your child and optimal lighting to avoid back pain and eyestrain. Set aside time each day for homework and check homework to make sure it is completed. If other activities are interfering with homework, consider cutting back, or arranging for homework time at after-school care.

Tackle Weight Issues Effectively: Fifteen percent of children and adolescents age 6 to 19 are severely overweight or obese according to the National Center for Health Statistics. Overweight children are at a higher risk of becoming obese adults. Obesity increases a person's risk for many serious health conditions, such as heart disease, high blood pressure, and colon, breast and stomach cancer. If you think your child is overweight, talk to your pediatrician to find out if your child is in the healthy weight range for his/her height and build. Ask the doctor for informational materials about healthy eating, physical activity, and weight control. If your child is overweight, it is important to engage the entire family in building healthy eating and exercise habits. Always be supportive and assure your child that he or she is loved. If your child is not successful in losing weight, ask the pediatrician for referrals to other professionals, such as registered dietitians and psychologists, who can help.

Food Shop Wisely: Stock up on healthy snacks and lunch items. Be a role model by eating the foods you want your child to eat. Make sure your child has a well-balanced breakfast. Limit soft drinks, chips, cookies and candy.

Get Moving: Discourage or limit inactive pastimes, such as watching television. Instead, find fun activities to enjoy together. Discourage snacking while the TV is on. Children need at least 60 minutes of physical activity a day, but the time doesn't have to be all at once. Set a good example yourself through exercising with them or independently. Before the season starts, talk with your child to find out what sport interests him or her. Participating in sports is both physically and socially beneficial.

New Contraceptives Increase Options
(spring 2003)

The U.S. Food and Drug Administration has approved four new contraceptives over the last two years, giving women more birth control options. Of the nearly 39 million U.S. women who use contraception, more than 10.5 million currently choose birth control pills. However, their failure rate varies considerably, depending on patient compliance. With perfect use, the failure rate of oral contraceptives is only 0.1%. Most women fail to take the pill every day. The consequence -- 3% to 8% of women taking the pill become pregnant. A 1998 study found that over time 47% of women miss one or two pills per cycle and 22% of women miss two or more pills per cycle.

The new birth control options offer more convenience than a daily pill regimen. However, that convenience must be weighed against their effectiveness rates, drawbacks, and adverse effects. Before you decide to use one of these birth control methods, talk with your doctor about all prescription and nonprescription medications (including herbal medications) you may use and review your medical history. None of the new options help prevent Sexually Transmitted Diseases (STDs). All of these options are covered by your GIC health plan or pharmacy program (Indemnity, PLUS, and PPO members). Call your Plan for co-payment details.

Ortho Evra (Birth Control Patch) - Approved November 2001
What it is
The birth control patch is a one and 3/4 inch square, thin patch that continuously delivers two synthetic hormones (progestin and estrogen) through your skin, preventing a woman's ovaries from releasing eggs (ovulation).
Administration
You place a patch each week for a three-week period on your abdomen, buttocks, arm, or upper abdomen. On the fourth week you will be patch free and your menstrual period occurs. You restart the sequence the following week.
Effectiveness
Highly effective: 0.1% failure rate
Risks
Similar to oral contraceptives - risk of blood clots, heart attack and stroke; cardiovascular side effects if combined with smoking.

Mirena - Approved November 2000
What it is
A small, flexible device placed in the uterus that slowly releases a hormone (levonorgestrel).
Administration
Implanted and removed by a properly trained health care professional for a period of up five years.
Effectiveness
Highly effective: 0.8%-2.0% failure rate
Risks
At time of insertion, small risk of expulsion or uterine infection or perforation. Some risk of bleeding and cramping, headache, nausea, breast pain, acne, rash, hair loss or weight gain.

Nuva Ring - Approved October 2001
What it is
A soft, flexible, transparent plastic vaginal ring containing hormones similar to birth control pills that prevents ovulation.
Administration
You insert the ring into the vagina. After four weeks, you remove it and your menstrual period occurs. On the fifth week, you insert another ring.
Effectiveness
Highly effective: 0.1% failure rate.
Risks
Similar to oral contraceptives - vaginal discharge, nausea, moderate weight gain, headaches, breast tenderness, vaginitis, slight risk of blood clots in the legs or lungs.

Lunelle - Approved October 2000
What it is
A monthly injection containing estrogen and progesterone that inhibits ovulation.
Administration
A health care professional administers your monthly injection during your menstrual period. It is injected in the buttocks, thigh or upper arm.
Effectiveness
Highly effective: 0.03% failure rate.
Risks
Irregular bleeding, moderate weight gain, headaches, and mood swings. Risk of blood clots and stroke. Not recommended for smokers, those with high blood pressure, breast or uterine cancer, liver disease, or a history of heart attack or stroke.

Seat Belts Are Not Enough for Children Ages Four to Eight (summer 2001)

The hassle factor of car seats is well known to parents. However, the costs of not using them are immense. A 1997 National Highway Traffic Safety Administration (NHTSA) report found that 56,700 children were seriously injured in a car crash that year despite wearing a seat belt. Many parents mistakenly believe that once a child is five, a seat belt is sufficient to protect their child. The NHTSA report found that 91% of parents use car seats for children age four and under, but the number who used booster seats drops to 5% after age five. "Children under eight sink too low in the seat to use only a seat belt," explained Art Kinsman, Director of Government Affairs for AAA Southern New England. "Although a seat belt is preferable to no restraint at all, a booster seat acts as a critical belt positioning device. A booster seat ensures that the lap and shoulder belts, designed for adults, fit correctly on a child. A booster seat prevents serious abdominal and neck injuries that can result in a crash when a child is only restrained with a seat belt."

Your Health
And Chlamydia (summer 2000)

Did you know that chlamydia is the most common bacterial sexually transmitted disease in America? More than four million new cases of chlamydia occur in the U.S. each year. It primarily strikes adolescents and young adults; 1 in 10 adolescent girls are infected. However, approximately 75% of women and 50% of men who have chlamydia may not know they have the disease as they have few or no symptoms. Chlamydia can be transmitted through any type of sexual contact with an infected partner.

Without treatment, 20 to 40 percent of women with chlamydia develop pelvic inflammatory disease, an upper reproductive tract infection. PID can cause chronic pelvic pain and can permanently damage fallopian tubes. Up to thirty percent of infertility is attributable to complications of PID. If not treated in men, chlamydia can lead to urethritis, an infection that causes pain and difficulty urinating. Men are also at risk for infertility.

Get the Help You Need
The National Center for Quality Assurance (NCQA) recommends that all sexually active 15 to 25 year old women be screened regularly for chlamydia in order to reduce the incidence of PID. See your doctor if you have symptoms such as abnormal discharge or pain during urination. See your doctor. Be frank with your doctor about your sexual history, and follow his or her advice.

Timely Treatment Makes a Difference
The sooner you receive treatment for chlamydia, the faster you reduce your chances for complications. Your doctor will prescribe antibiotics. As with all antibiotics, you need to take all the prescribed medications until they are used up, even after symptoms disappear.

Learning How to Live After a Heart Attack
Members Give Proof That GIC CAD Program Works
(winter 2004)

Ken Foster was beginning to doze off at ten p.m. when intense pain shot through his shoulder, awakening him immediately. The pain spread down his arm and back, his chest tightened and a feeling of apprehension overcame him. He woke his wife and they called 911 for an ambulance. Mr. Foster had just had a heart attack. He would have three more incidents over a three-week period and would undergo a quadruple bipass.

Teresa Paretti's chest tightened in the evening and she thought she was experiencing indigestion. However, the feeling of indigestion continued in the early morning, much later than a normal episode. At 5 in the morning she woke her husband to take her to the hospital. Unbeknown to her at the time, she had suffered a heart attack.

Although heart disease is the number one killer of men AND women, women are less likely than men to think they are having a heart attack. Similar to men, women often experience chest pain or discomfort when they are having a heart attack. However, they are more likely to experience shortness of breath, unexplained and unusual fatigue, back or jaw pain, and
nausea or vomiting.

The emergency rooms saved Mr. Foster and Ms. Parretti's life. The GIC's Coronary Artery Disease (CAD) Program enabled them to live more fully. Mr. Foster joined the GIC CAD program, called "Heart and Soul," at the Deaconess Hospital. Ms. Paretti entered the CAD Program at St. Vincent's Hospital after her doctor recommended it. These programs teach participants how to relax, what to eat, how to quit smoking, how to exercise safely -- in other words, how to live a more healthy life.

"My dad came from the 'clean plate' club school of thought, and I had developed bad eating habits, which had clogged my arteries," said Mr. Foster. "Additionally I was under tremendous stress at work." The Commonwealth Indemnity Plan sent him information on the GIC's CAD Program and Mr. Foster decided to give it a try. "The CAD Program gave me the impetus to change my way of life. I can't believe the things I can now do," said Mr. Foster. Additionally, he established long time friendships with the 20 other participants - all of whom are still living and enjoying life.

"I really had not exercised or watched what I ate," said Ms. Paretti. "The CAD Program taught me how to read labels, what to order at a restaurant, and how to shop at the supermarket." The nurses also provided encouragement for walking and helped participants to warm up properly.

For Mr. Foster, typical CAD meetings would run two hours at night once a week. The class would start with exercise and participants were taught how to use a heart rate monitor. Next, the class would learn relaxation techniques. Participants learned how to implement these techniques throughout the day. Typically there would be a brief lecture, covering topics such as recognizing symptoms of a heart attack, and realizing that symptoms might not be the same each time, learning about heart medications and treatments, diet, quitting smoking, and exercise. Each week a participant would bring in a healthy meal for the group. At the end of the program, the recipes were collated and disseminated for all to use. Finally, the group had the opportunity to ask questions and socialize.

At the 2003 GIC health fairs, 69.5% of the GIC enrollees screened by the Boston Heart Party™ had high risk for cardiovascular disease. The factors screened included smoking, cholesterol level, blood pressure, blood sugar and family history of heart disease. Always talk with your doctor about how to control your risk for cardiovascular disease.

"You can't worry about the things you can't change," said Mr. Foster. "I had not appreciated just what a killer stress can be, and getting help for relieving stress was key for my mental AND physical health." Five years after joining the GIC CAD Program, Mr. Foster is living a full life, practicing the relaxation techniques he learned, making healthy food choices, and exercising regularly. He even plays first base for the Eastern Massachusetts softball league's Boys of Summer team for men age 65 or over. Similarly, Ms. Paretti has changed her exercise habits. She now walks four to five times a week with her sisters-in-law. For her combined birthday and retirement, her children gave her a treadmill, which she plans to use frequently.

Most GIC enrollees who have experienced a cardiac event are eligible for Coronary Artery Disease Programs at participating hospitals. Contact your GIC Plan for details.

Coronary Artery Disease Strikes Many Families
How Can You Reduce Your Risks? (November 1999)

According to the Centers for Disease Control approximately 960,000 Americans die of coronary artery disease (CAD) each year, accounting for more than 40% of all deaths. Despite popular beliefs, CAD is a major killer of women, accounting for more than half of the 960,000 deaths. In addition, about 58 million Americans (almost 22% of the nation's population) live with some form of the disease.

Uncontrollable risk factors:

• Male gender or menopausal women who are not on hormone replacement therapy
  
• Family history of early CAD in first degree relatives

Controllable risk factors:

• Smoking
  
• High Cholesterol
  
• Sedentary lifestyle
  
• High Blood Pressure
  
• Diabetes
  
• Being Overweight
  
• Stress

According to the CDC:

• Smoking cessation has been demonstrated to lead to a 7% to 47% reduction in cardiac events
  
• Lowering your cholesterol by a range of 6% to 25% has been demonstrated to lead to a 7% to 42% reduction in cardiac events
  
• Participating in a physician approved exercise program after a cardiac event has been demonstrated to lead to a 20% to 25% reduction in cardiac deaths over follow-up durations of 3 months to 3 years
  
• Adequate control of hypertension has been demonstrated to lead to a 14% reduction in coronary events
  
• Initial trial results on intensive diabetic control appear to support a reduction in cardiac events
  
• Significant weight loss has shown to produce beneficial changes to coronary arteries.
  
• Studies on the benefit of stress management suggest a reduction of recurrent cardiac events by 43% to 50%. However, this benefit disappears within 6 months upon cessation of this stress management.

All GIC enrollees who have been diagnosed with Coronary Artery Diesease are eligible to participate in the GIC's CAD Program. This program is a behavioral and lifestyle education program focusing on the risk factors above that can be changed. Through the program, your needs for surgical intervention will be reduced. Contact your plan or physician to participate in GIC's CAD Program.

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GIC's Coronary Artery Disease Program Network Expands (summer 2001)

Two of GIC's health plan providers added Newton-Wellesley Hospital to their network of GIC Coronary Artery Disease Program (CAD) providers. UniCare (the administrator of the Indemnity and PLUS plans) and Tufts Health Plan (administrator of the Commonwealth PPO and Tufts HMO) added Newton-Wellesley hospital to the program. UniCare and Tufts also offer GIC's CAD Program at Beth Israel-Deaconess Hospital in Boston and Bay State Hospital in Springfield. UniCare also offers the CAD Program at St. Vincent's Hospital in Worcester.

GIC's other HMOs offer the CAD Program at the following hospitals: Health New England: Bay State. Fallon Community Health Plan: Bay State and St. Vincent's. Harvard Pilgrim Health Care: Beth Israel-Deaconess Boston and Bay State. CIGNA Healthcare: University of Massachusetts/Memorial Health Care in Worcester. Neighborhood Health Plan: Beth Israel-Deaconess Boston.

According to the Centers for Disease Control, approximately 960,000 Americans die of coronary artery disease (CAD) each year, accounting for more than 40% of all deaths. The CDC has found measurable decreases in cardiac events when patients modify their lifestyles. The GIC's CAD Program assists patients to decrease their risk for a cardiac event, focusing on risk factors that can be changed:
· Smoking
· Sedentary lifestyle
· Stress
· High cholesterol
· High blood pressure
· Being overweight

The GIC pays 90% of the CAD Program costs for the Indemnity and PPO Plans. Co-pays vary by each GIC HMO. If you have a history of heart disease, and believe that you could benefit from this program, call your health plan or doctor for more information.