By Chelsea Conaboy, Globe Staff

The governor today announced the appointment of a new Medicaid director. Dr. Julian Harris will take the post July 18.

Harris now sees patients at the Southern Jamaica Plain Community Health Center and at Cambridge Health Alliance, both places that see large numbers of Medicaid patients. He previously worked for the World Bank Institute AIDS program and was a health consultant at McKinsey & Company.

Harris said in a press release that he is honored to lead the state program, which serves 1 million enrollees, including children, families, seniors, and people with disabilities, at a "pivotal moment" in its history.

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By Chelsea Conaboy, Globe Staff

Ellen Semonoff of Cambridge Health Alliance has been named to a White House advisory group focused on prevention and public health. Semonoff is vice chairwoman of the Cambridge Health Alliance board of trustees and assistant city manager for human services in Cambridge.

The panel, which includes up to 25 people from outside federal agencies, was established last June under the Affordable Care Act. It is charged with identifying the nation's top public health issues and ways to address them.

Semonoff has worked for the city nearly 20 years, focused on issues including child care, fuel assistance, nutrition, recreation, substance abuse and workforce development. She joined the Cambridge Health Alliance board in 1996.

Last week we told you about the shortage of physicians in Massachusetts as reported by the annual Massachusetts Medical Society workforce survey. There's another interesting finding that a Cambridge doctor brought to our attention.

When asked what form of national health insurance they favored, more Bay State doctors chose a single-payer system than any other model, including one styled after the near-universal mandate enacted in Massachusetts in 2006. Here's how the votes tallied:

Single-payer national health care system offering universal health care: 34 percent

Public and private plans with a public, Medicare-like buy-in option: 32 percent

The existing mix of public and private plans, but with optional plans with limited benefits, high deductibles, and low premiums: 17 percent

The Massachusetts model: 14 percent

Other: 3 percent

"Massachusetts physicians realize that the state's health reform has failed to make health care affordable and accessible, and won't work for the nation," Dr. Rachel Nardin, chair of neurology at Cambridge Hospital and president of the Massachusetts chapter of Physicians for a National Health Program, said in a statement. "These findings show the high support for single-payer Medicare for all by physicians on the front lines of reform."

Some people can sleep through anything. Phones ringing, doors slamming, cars rumbling can’t break through their slumber, while others wake at the slightest sound. Perhaps, suggests a new study in Current Biology, that's because some people’s brain wave patterns block noise from disrupting sleep.

Researchers from Massachusetts General Hospital tested 12 healthy volunteers in the hospital’s sleep lab for three nights. They looked at their brain rhythms with electroencephalograms, focusing on a particular pattern called spindles, which represent bursts of activity interspersed among slower periods.

Spindles are involved in how outside sensations -- including things we hear -- are transmitted from one part of the brain to another. During sleep, the researchers thought, spindles might block sounds, protecting people from shattered sleep.

For the first night, the study subjects slept hooked up to EEG electrodes in rooms equipped with sound machines to block out noise.

For the second and third nights, the subjects heard noise that had been recorded in a medical unit at Somerville Hospital, yielding the sounds of traffic, IV alarms, flushing toilets, conversations, snoring, an ice machine, and a helicopter, among other sonic challenges familiar to anyone who has spent a night in a hospital. Research staffers would turn on the sounds, gradually increasing the volume. Some subjects were aroused earlier than others but others didn’t wake up at all, no matter how loud the sound
got.

People whose EEGs showed more spindles while they were sleeping on the quiet night also had more spindles on the noisy nights than the other study subjects. The more spindles they produced, the less likely they were to wake up on the noisy nights.

“It is possible to predict which subjects are more disturbed by sounds in sleep by looking at brain activity and brain rhythms,” Dr. Thanh Dang-Vu said in an interview. “Here we show one important player is spindles: the more spindles, the more resistance to sounds.”

Scientists don't know why some people have more spindles than others, Dang-Vu said. Spindle production seems to be both individual and consistent, occurring amid quiet and noise. Further research might reveal ways to increase spindle rates through behavior, drugs, or devices. Some drugs that increase spindle rates have undesirable side effects, he said.

In the early days of the AIDS epidemic, before the syndrome had a scientific name, the illness was sometimes called “the 4H disease,” named for four groups thought to be at highest risk: homosexuals, hemophiliacs, heroin users, and Haitians.

Haitians who immigrated to the United States have been stigmatized, and even blamed for bringing the virus to North America, since that time, partly based on higher estimates of infections among Haitian-born people compared to other groups. A new study led by a Haitian-American researcher challenges those rates with data showing that the prevalence of AIDS among Haitian immigrants is similar to the levels reported among African-Americans.

Dr. Linda Marc of the Center for Multicultural Mental Health Research at Cambridge Health Alliance led a team that analyzed national AIDS data from 1985 through 2007. According to the US Centers for Disease Control and Prevention, Haitian-born immigrants made up 1.2 percent of AIDS cases in the country, but they accounted for only 0.18 percent of the US population. That amounts to a seven-fold over-representation of AIDS among Haitian immigrants compared to the US population as a whole.

But when higher population figures from Haitian consulates in US cities were used, that over-representation of AIDS cases fell to four-fold, which is about the same level as among African-Americans.

Haitian immigrants are likely to be undercounted by American census takers, Marc and her co-authors write, particularly if they are not in the country legally. Sources at Haitian consulates estimate that 1.2 million Haitian-born people live in the United States, double the US census figure.

Marc’s paper, which appears in the journal AIDS, also reports that Haitian immigrants tend to be diagnosed with HIV at a later stage than other people. That means public health messages need to be targeted and tailored to this group, Marc said in an interview.

“We didn’t know that Haitians are getting in much later for their diagnoses,” she said. “They’re not being tested for HIV as part of routine care and they don’t recognize the signs and symptoms of the illness. It has major implications for us.”

By Elizabeth Cooney, Globe Correspondent

Unrelenting heat and humidity are combining to send people to hospital emergency rooms with heat-related illnesses, and the worst may be yet to come, according to an informal survey of several Massachusetts hospitals.

“Today is going to be the day that it spikes. It’s really oppressive out there,” said Dr. Marc Restuccia of UMass Memorial Medical Center in Worcester.

Most of the people seeking urgent care are suffering from heat exhaustion. They have muscle cramps or feel light-headed; some are nauseous and vomiting. Others have racing pulses or feel faint. In these cases, dehydration has taken a serious toll that infusing intravenous fluids can reverse. But untreated heat exhaustion can progress to heat stroke, a life-threatening condition in which dangerously high body temperatures can have toxic effects on organs such as the kidneys or the brain.

One patient at Massachusetts General Hospital is suffering from heat stroke, Dr. Alasdair Conn, chief of emergency medicine at MGH, said today.

Only two patients with heat illnesses came to the ER yesterday, he said, but “the fact that we had four today by midday seems to indicate that it will continue to rise.”

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Migraine sufferers who are uninsured are twice as likely to receive substandard care for their headaches as people with private insurance, Cambridge researchers report in a new study.

Dr. Rachel Nardin and colleagues from Cambridge Health Alliance analyzed more than 6,000 patient records from an 11-year national survey that tracked patient visits for migraine to doctor's offices, hospital outpatient departments, and emergency rooms. Medical staff noted what kind of insurance patients had as well as the treatment they got for moderate to severe headaches.

Pain from  migraine headaches, which affect 12 percent of Americans, can be incapacitating. The standard treatment during a headache is a medication from the triptan class of drugs or dihydroergotamine, also known as DHE. Other drugs are prescribed to help stave off future headaches.

The study found that uninsured patients were twice as likely as insured patients  to receive substandard care. Patients insured by Medicaid were one and a half times as likely to get substandard care. The authors suggest that where uninsured or Medicaid patients got their medical care could explain the difference. Uninsured patients were more likely to seek care in hospital emergency departments, where patients were almost 5 times more likely to get substandard treatment for migraines. Based on estimates of the number of uninsured people across the country, that translates into about 5.5 million Americans who risk substandard care for their migraines, the authors say.

"We know what to do to help people," Nardin, senior author of the paper appearing in Neurology tomorrow, said in an interview. But "we have a health care system that is consigning a lot of people to getting care in the wrong setting for their condition."

The fault does not lie with hospital emergency departments, which might have chosen a narcotic for the intense pain a migraine headache can cause, she said. "Emergency departments do a great job at what they do, which is to treat the acute problem, but a bad job of sending people home with a prescription for the next migraine. It's not what they do."

Comprehensive coverage and the better access to regular medical care could ease the pain of migraine patients without private insurance, the authors conclude.

Comparing the effectiveness of different medical treatments, including their safety and their cost, is a cornerstone of health policy espoused by the Obama administration and funded by $1.1 billion in last year's economic stimulus package. Two Cambridge Health Alliance doctors explored the state of current research to see how helpful drug studies might be to doctors trying to prescribe the best medications for their patients.

Writing in tomorrow's Journal of the American Medical Association, Dr. Michael Hochman and Dr. Danny McCormick report that only about a third of 328 studies published in six top medical journals from June 2008 through September 2009 met the definition of comparative effectiveness. That means they directly compared drugs against other treatments to see which worked best.

The other two-thirds of the 328 studies compared a drug to unapproved, so unavailable, drugs or to inactive substances called placebos.  "Those are not particularly helpful for physicians and patients who are sitting down and figuring out what's the best treatment available for a given condition," McCormick said in an interview.


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The state appealed to the federal government today to help Massachusetts hospitals that care for disproportionately high numbers of patients who receive state-sponsored health insurance. Governor Deval Patrick is asking the federal government for $216 million for the public Cambridge Health Alliance, and another $115 million for six private hospitals with high Medicaid patient populations, including Boston Medical Center and Caritas Carney in Boston.

Patrick wants the Centers for Medicare and Medicaid Services to adjust an agreement known as a Medicaid waiver that provides a major portion of the funding for the state's landmark health care law. The increased support for hospitals would amount to $480 million this fiscal year and next.
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In the battle against dangerous infections contracted through tubes delivering treatment to seriously ill patients, seven Massachusetts hospitals had perfect records while others were much better or much worse than the national average, according to an article published today in Consumer Reports.

Charlton Memorial Hospital in Fall River, Faulkner Hospital in Boston, Holyoke Medical Center, Newton-Wellesley Hospital, North Shore Medical Center in Salem, Signature Health Brockton Hospital, and Sturdy Memorial Hospital in Attleboro all had no central-line infections in 2008. Ten hospitals had infection rates worse than the national average. There were variations across the state and within hospital systems.

Central-line infections occur when germs travel through catheters threaded into a patient's vein in the neck, chest, or arm so that blood, fluids, or medications can be quickly infused. About 90,000 patients a year die from infections they contract while they are in hospitals or other health care facilities, national estimates say, and a third are blamed on central-line infections. Reducing bloodstream infections has been a focus of state and national movements to improve the safety of patients in the hospital.

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