Live Well Ohio: September 2015

NEWS + Notes from the Ohio Department of Health

Insect I.Q.
All mosquitoes are annoying, but a few species carry disease that can be harmful to humans. Here are some simple strategies for keeping your autumn free of bites. 

Every fall, mosquitoes are a familiar pest in backyards, parks and campgrounds. Most are merely a nuisance and are not major carriers of disease. In fact, only a few of the 59 species of mosquitoes in Ohio can transmit disease.

However, the diseases these mosquitoes can carry are very serious ones, such as encephalitis and malaria in humans and heartworm in dogs. Therefore, it is always advisable to take preventive measures to protect yourself and your family against mosquito bites.

West Nile virus is an arthropod-borne virus (arbovirus) most commonly spread by infected mosquitoes. It can lead to severe fever, encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord).

The primary carrier in Ohio is the northern house mosquito, Culex pipiens. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread the virus to humans and other animals when they bite.

Approximately 80 percent of people who are infected with West Nile Virus will not show any symptoms at all, but there is no way to know in advance if you will develop an illness.

Those who do eventually develop symptoms usually do so between three to 14 days after being bitten by the infected mosquito.

The most effective way to prevent mosquito-borne diseases is to avoid being bitten. Being aware of mosquito and mosquito-borne disease activity in your area allows you to take action to protect yourself and others.

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3 Ways to Avoid Mosquito Bites
These pointers will help you stay bite-free this fall.

1. Use insect repellent when you go outdoors: Repellents containing DEET, picaridin, IR3535 and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection. To optimize safety and effectiveness, repellents should be used according to the label instructions. 

2. When weather permits, wear long sleeves, long pants and socks when outside: Mosquitoes may bite through thin clothing, so spraying clothes with repellent containing permethrin or another EPA-registered repellent will give extra protection. Don’t apply repellents containing permethrin directly to skin and do not spray repellent on the skin under your clothing.

3. Be extra cautious during peak mosquito-biting hours: Take extra care to use repellent and protective clothing from dusk until dawn, when mosquitos are their most active, or consider avoiding outdoor activities during these times.

How To: Mosquito-proof your home:
• Install or repair screens on windows and doors. Use your air conditioning, if you have it.
• Empty standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires and birdbaths on a regular basis.
• Keep children’s wading pools empty and on their sides when not in use.
• Consider using a product containing Bacillus thuringiensis israelensis (or Bti), available at many garden and home improvement stores, to control mosquito larvae in containers that are too large to empty.

News + Notes is written by the Ohio Department of Health. The remainder of Live Well Ohio is written by the editorial staff of Ohio Magazine.

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Hike Smart
Hitting the trails is a wonderful way to get some exercise this time of year. Here’s how to prepare, pack and ensure a safe excursion. 

Fall is prime time for taking in some fresh air as temperatures start to cool and the leaves begin to sport vibrant hues. But hiking requires proper research and preparation. We checked in with a few Ohio sports medicine experts to get their advice for what to consider before lacing up your hiking boots.

PLANNING

An avid hiker himself, Dr. Christopher Kaeding, a professor of orthopedic surgery at The Ohio State University, head team physician of OSU’s athletic department and executive director of OSU’s sports medicine center, says its important to understand the trail you plan to tackle.  

Maps are usually available online at the website of the state or regional park system you’re planning to visit, and they provide an easy way to familiarize yourself with the layout of the trail and the distance you’ll be covering. Don’t overestimate how much ground you can cover or try to tackle hills that are beyond your skill level. Err on the side of caution, and pay attention to whether it seems like you’re overdoing it. Bryan Rogers, an athletic trainer and a tactical medic with the Kettering Health Network, offers a few tips for assessing your exertion.  

“The talk test is a simple and reliable way to measure intensity,” he says. “If you can talk and sing without puffing at all, you’re exercising at a low level.  If you can comfortably talk, but not sing, you’re doing moderate intensity activity. If you cannot say more than a few words without gasping for breath, you are exercising at a vigorous intensity.” Kaeding agrees, adding, “If you can carry on a conversation, that’s the nicest pace — [a safe] level of exertion.”

Remember, when traveling with a group, it’s important to assess everybody’s fitness level. As Kaeding cautions, “Your fitness companions may not speak up if they are inexperienced. Then you can get into a bad situation.”

      

Planning ahead, packing smart and preparing for any problems that may arise are the keys to a successful and safe autumn outing.

    

PACKING

Heading out on a hike longer than an hour means supplies are necessary. This includes food and water, but Kaeding says there are other issues to consider as well, starting with a good backpack.

“Make sure you get a pack that fits you comfortably, and if it is more than 15 pounds, make sure you have a waist strap or a strap that takes the weight off your shoulders and puts it on your hips,” he says. “If you get a larger backpack, make sure you understand how all the straps and adjustments work to make use of them as much as possible.”

When it comes to what goes inside the pack, Rogers offers a checklist of essentials: Band-Aids, gauze pads, Neosporin cream, a knife, tweezers, sunscreen, roller gauze, scissors, a thermometer, safety pins, plastic bags, Ace bandages and some type of material for splinting.

Kaeding suggests adding a whistle, a GPS device and a lightweight LED flashlight headlamp, while Dr. James Gasparine, doctor of sports medicine at Orthopaedic Associates of Zanesville, also suggests a small mirror, watch, duct tape, gloves and extra batteries.  

POSSIBILITIES

Most hikes go off without a hitch, but accidents do happen. The most common types of injuries are sunburn,  blisters, dehydration, scrapes and burns, and joint injuries such as sprained ankles, wrists, fingers and even knees.

“Make sure you use your sunscreen, make sure you have the proper clothing to help prevent blisters, and drink plenty of fluids to help prevent dehydration,” advises Rogers.

Always hike with a buddy just in case you do suffer an injury that would keep you from getting yourself back to your car. Even when hiking with a companion, realize that a situation may arise when a call for outside help is necessary. If your destination has cellular phone service, make sure you have at least one charged mobile phone with you. If it doesn’t, let others know where you will be.

“It would be helpful if you would write an itinerary for your family and friends,” says Gasparine. “Let them know your expected time of return and the plans for if you are not back at the appointed time.”

If you do encounter an emergency on the trail in which you need to leave a friend to go for help, you may need extra food, water and clothing to leave with him or her. No one wants to think about such situations, but some forethought can help in a stressful situation.

“Have a rescue plan,” says Kaeding. “If there is any illness or injury to me or anyone in my party, what is my plan?  — Kara Kissell
  
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Study Guide
Here’s how to help your children have a happy, healthy and productive school year.

Although pens, pencils and binders are easy to check off the back-to-school list at your local store, there are a number of wellness to-do’s that need to be considered, too. We talked with a few of our state’s health experts about wholesome lunches, proper vaccinations and getting the kids in the right state of mind for learning.

Daily Exercise

Building a routine that’ll ready children for academic success and promote long-term health means including exercise.

“There are few better ways to prepare students for school than with daily physical activity,” says Ashley Davis, manager of the Ohio Department of Health’s Creating Healthy Communities program. “Overall, Americans have become more sedentary and the consequences are seen in both adults and children. In Ohio, almost 30 percent of adolescents are overweight or obese.”

Forty years ago, almost half of the students in the nation walked to school, according to the National Center for Safe Routes to School. Today, that number is less than 15 percent. The time spent getting to and from school is an opportunity for physical activity that parents should help their children capitalize on if possible.

“Walking and biking to school improves the health of students and decreases their risk for chronic disease in their lifetime, along with an endless list of co-benefits,” says Davis.

She points to MRI studies that show dramatic increases in brain activity after 20 minutes of walking. Following activity, kids complete learning tasks more quickly and accurately and are more likely to read above their grade level.

In addition to the health benefits, getting children on a bike or providing them a safe walking route to school helps create a sense of independence. Parents should plan the route with their kids, walking it a few times before the school year starts and familiarize the entire family with it.

Although adults need to accompany small children, older students can pair up with friends to make for a social walk to school. And be sure to go over rules for crossing the road and understanding traffic signals. Walk Bike to School, a program through the National Center for Safe Routes to School, offers resources on further safety tips and how to create route-safety events in your town at its website, walkbiketoschool.org.

      

Biking to school helps kids work exercise into their day.

    

Vaccination Checklist

Getting the proper vaccinations for new-to-school students is a significant factor in creating safe and healthy communities, and a state of Ohio statute calls for children to be properly immunized within 14 schools days after they begin attending.  

Kindergartners are required to receive vaccinations for DTaP (Diphtheria, Tetanus, Pertussis), Polio, MMR (Measles, Mumps, Rubella), Hepatitis B and Varicella (Chicken Pox). They are completed in a series — none are simply one immunization — so it is important to plan ahead. Although most students will receive the core of their vaccinations before entering kindergarten, there is one booster vaccination — a dose of the Tdap vaccine — required before entering seventh grade.

Although some districts offer a vaccination clinic at the school, most families need to have the vaccinations completed through a family doctor or local health department.

“If a family has trouble paying for immunizations they can go to their local health department and get the immunizations themselves for free or low cost,” says Ann Connelly, supervisor of the school nursing and asthma programs with the Ohio Department
of Health.

The federally funded Vaccines for Children program provides the low-cost vaccines, and if the local health department does not offer shots on-site, parents are directed to a location in the community where their children can be immunized.

“Immunization has been one of the most effective public health treatments ever,” says Connelly. “People today just don’t even know what these illnesses have looked like or how many children used to die from them because they haven’t seen them.”

She adds that vaccinating children is not only beneficial to them but also boosts the health of the community as a whole.

“Herd immunity means that if most of the people in the herd have been vaccinated, then it is less likely for a particular disease to occur,” explains Connelly. For cases in which a child cannot be vaccinated — those who are battling cancer, for example — the herd immunity can protect them. “If you get the children immunized, it helps reduce the incidence and the prevalence of disease in the community.”

Healthy Lunches

School cafeterias across the state are enhancing their food offerings thanks to the Smarter Lunchrooms Movement, which makes fruits and vegetables more appealing simply by strategic placement and serving these foods in attractive bowls and with attractive serving ware. But parents can also up their children’s intake of healthy foods with what they pack in school lunches.

The USDA’s MyPlate — an updated version of the food pyramid — shows parents and kids what a healthy plate should look like, making it easy to build a well-balanced meal.

“The MyPlate concept emphasizes more fruits and vegetables and a variety of vegetables, making sure that those take up quite a substantial amount of the plate. Then we have transitioned to leaner meats and whole grains,” says Brigette Hires, assistant director in the Office for Child Nutrition at the Ohio Department of Education.

The new approach focuses on portions, allowing kids to visually gauge what a proper-size lunch or dinner plate should look like and what the proportion of vegetables and fruits should be to meats and grains.

“[It’s also] the importance of all of these food groups coexisting instead of a stacked concept like the old [food pyramid,]” adds Hires.
Parents should take time in the morning to walk through packing their kids’ lunch with them. That way they can start to see what this balance looks like for when they pack their own lunch or choose foods to purchase in the school cafeteria.

“Perhaps some peaches and some baby carrots. Then a nice sandwich that will [offer] the whole grain and a little bit of meat or [a meat] alternative,” says Hires. “Then, send along milk or buy milk at school. That is a nice, well-rounded meal.”  — KK

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Eating Advice
September is Childhood Obesity Awareness Month and parents can help their kids both maintain a healthy weight and boost their immunity against viruses by making the right choices when it comes to packing lunches. Emia Oppenheim, a registered dietitian and early childhood obesity prevention coordinator for the Ohio Department of Health, shares her advice.

Limit Processed Foods: “Processed foods start with fresh foods and remove many good nutrients — like Vitamin C — and mix in many less healthy ingredients, such as dyes, preservatives and salt,” says Oppenheim. “Ingredients that are added, such as sugar, fats or salt, can weaken immune systems.” Parents who do buy packaged foods for kids should choose ones with a short list of recognizable ingredients. In addition, grain-based foods should list “whole grain” as the first ingredient.

Fill Up on Fruits and Vegetables: “Fruits and vegetables are the richest source of nutrients that help [boost] immunity and therefore are the most important food to tuck into lunches,” says Oppenheim, who suggests apple slices with cinnamon. “Cinnamon is a super food and prevents [the] apple browning.”

Snack on Super Foods: “Super foods are those rich in antioxidants, phytochemicals, vitamins, minerals and other micronutrients,” says Oppenheim, adding that many herbs, spices, vegetables, fruits and unroasted nuts fall into this category. “High in micronutrients, these foods also offer the right balance of fatty acids that your child’s body needs to reinforce immunity but also to stay feeling full.” Nuts in particular are full of protein and healthy fats, but because they are a common allergen, parents should check with their child’s school to learn about its current nut policy.

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Insurance Plan
For those nearing retirement, figuring out how to cover the health care expenses Medicare does not is an important decision. Here’s the first step to deciphering the options available.  

It was a centerpiece of President Lyndon B. Johnson’s Great Society and arguably one of the most successful government programs ever created, leading to an increase in longevity and quality of life for elderly Americans. The one thing Medicare is not, however, is comprehensive health care coverage.  

“Medicare was not designed to be the be-all, end-all for health care coverage,” says Kim Booher-Smith, owner of Booher Insurance Agency in Brookville. “It was designed to assist.”

Medicare consists of Part A, which covers hospital stays, nursing-facility care, home health care and hospice; and Part B, which covers doctor visits, lab tests, outpatient services and preventive care. For most, there is no premium associated with Part A, but part B premiums start at $104.90 and go up based on your income. Conversely, there is assistance with paying that premium for people with lower incomes. “Most people should budget a minimum of $104.90 monthly [for Medicare],” advises Booher-Smith.

A prescription drug plan (known as Part D) was added in 2003. But with Medicare routinely covering just 80 percent of prescription costs, out-of-pocket expenses can add up quickly.

While the out of pocket maximum for Part D caps at $4,700, there is no out-of-pocket limit for Medicare. “I would never advise anyone to go on straight Medicare,” says Booher-Smith. “I’d want them to pick up a supplemental or Advantage plan.”

Medicare supplemental insurance is frequently referred to as MedSup or Medigap. It is additional health insurance available through many private insurance companies that works in conjunction with Medicare Parts A, B and D to help cover copays and deductibles.

A Medicare Advantage plan (referred to as Part C) is a health plan offered by private companies that contract with Medicare to help cover doctor visits, hospitalization and, in many cases, prescription drug coverage. You must be enrolled in Medicare Parts A and B to be eligible for Medicare supplemental insurance or a Medicare Advantage plan.

The offerings are distinctly different, and the right one for you depends on your particular health care needs, as well as what you anticipate them to be in the future.

Medigap: An Overview

Shannan Jursa, a State Farm agent in Garrettsville, says Medicare supplemental insurance plans are standardized, with a total of 10 different plans available, which cover expenses ranging from coinsurance payments for plans A and B up to medical bills incurred while traveling abroad. Jursa says supplemental insurance is typically accepted anywhere Medicare is accepted, and there are usually no copayment costs for services covered by Medicare.

“Each plan is the same in benefit coverage regardless of the provider,” Jursa says. “However, the premium and customer service can vary between insurance companies.”

Jursa says supplemental policy benefits typically don’t change from year to year and are guaranteed renewable as long as you pay the premium. However, they don’t offer prescription drug coverage. “You would have to consider signing up for a stand-alone Medicare Part D prescription drug plan,” she explains.

Booher-Smith says in signing up for a Part D plan, consumers should look into the plan’s list of covered drugs. In some instances, the plans cover primarily generics, while in others more brand names are covered. Part D plans range from a $15.60 monthly premium for a plan offering mostly generic drugs ($320 annual deductible) to $114 monthly for a plan that covers brand names and has no annual deductible. There is also assistance available based on need.

The cost of a supplemental insurance plan in Ohio varies depending on location, although from company to company, the difference in premiums is generally less than $5. State Farm bases its premiums on three territories statewide; in Jursa’s territory, costs can range from $91 monthly for just the basic coinsurance to $139.57 monthly for a plan that covers all cost overruns.

“Some people might need a supplemental plan, but can’t pay for it,” Booher-Smith says. “That’s when we start looking at Advantage plans.”

Is an Advantage Plan Right for You?

Medicare Advantage plans, unlike Medicare supplemental insurance, can change annually, but customers usually remain in the plan, Jursa says. She also notes that many Advantage plans already include prescription drug coverage, and some even offer extra dental, vision and hearing coverage.

However, she explains that Advantage plans, like many private insurance plans, have an HMO (Health Maintenance Organization) network, which means you can only see providers within the network of the plan. Others have PPO (Preferred Provider Organization) plans, which means you can see someone out of network, but at an additional cost.

Advantage plans also include Private Fee-For-Service plans, where those enrolled can see any Medicare-approved provider, as long as they agree to treat you and accept payment. There are also Special Needs Plans available for people who are on Medicaid, live in care facilities such as nursing homes, or have chronic conditions like diabetes, dementia or congestive heart failure.

Ultimately, Booher-Smith says, a person’s health as he or she nears Medicare eligibility will probably be the driving factor in whether to opt for Medicare supplemental insurance or a Medicare Advantage plan. Advantage plans are, on the whole, less expensive in terms of premiums.

But those who have a condition that needs to be maintained may prefer supplemental insurance instead, because Advantage plans typically have higher copays. Consequently, the more you use them, the more you end up paying in the long run.

“If you’re in and out of the hospital, or in long-term care, Advantage might not be in your best interest,” Booher-Smith says. “At that point, supplemental [insurance] would pay for itself. It all comes down to how much we anticipate they’re going to use it.”

In Ohio, Advantage plans can be had starting around $30 a month (including a prescription drug plan), but deductibles are typically $320 and out-of-pocket caps can run up to $8,000. And, unlike supplemental insurance, what each plan offers can vary greatly from one provider to the next.

Right now, Medicare eligibility starts at the age of 65, or under for those with certain disabilities or end-stage kidney disease requiring transplant or dialysis. Booher-Smith says if you’re not close to eligibility age, it’s all right to wait to start research on augmenting your Medicare coverage

“It changes ... and some of those changes have been big, and some of them have been small,” she says. “If you’re closing in on retirement age, I’d say start looking, understand what your options are, what the terminology is.

“Do your homework a little bit,” she adds. “Try to understand the cost and terms before you start shopping particular companies.”  — Vince Guerrieri