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Millions of diabetes patients are missing out on Medicare’s nutrition help

LOUISIANA WEEKLY — The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

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Glucose meter with result sugar level, healthy food, dumbbells and centimeter, diabetes (Photo by: Ratmaner)

By Phil Galewitz

(Special from khn.org) — Louis Rocco has lived with diabetes for decades but, until he met with a registered dietitian in August, he didn’t know eating too much bread was dangerous for him.

“I’m Italian, and I always eat a lot of bread,” he said. After two hour-long visits with a dietitian — including a session at his local grocery store in Philadelphia — Rocco, 90, has noticed a difference in his health.

“It’s helped bring down my sugar readings,” he said of changes in his diet including eating less bread. “I wish I knew I could have had this help years ago.”

After getting a referral this summer from his doctor, Rocco learned that Medicare covers personal nutritional counseling for people with diabetes or kidney disease.

The estimated 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data is available. The data does not include the 20 million enrollees in private Medicare Advantage plans.

Health experts say the little-used benefit represents a lost opportunity for beneficiaries to improve their health — and for the program to save money by preventing costly complications from the diseases.

An estimated one in four people 65 and older have diabetes and one in three have chronic kidney disease. Kidney disease is often a complication of diabetes.

The prevalence of diabetes has risen markedly in the past 20 years and the condition is more common as people age.

Nationwide, there are 100,000 registered dietitians — more than enough to meet demand, said Krista Yoder Latortue, executive director of Family Food in Philadelphia, which employs about 50 dietitians including the one who visited Rocco. Medicare data showed about 3,500 dietitians billed the program for nutritional counseling in 2017.

The problem may be that not enough physicians know about the Medicare benefit. Doctors have to refer patients to a dietitian.

Congress approved the benefit, which began in 2002, after studies found medical nutrition counseling leads to improved health outcomes and fewer complications for older patients. Under the preventive health provisions of the Affordable Care Act, the counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011.

Medicare pays for three hours of dietary counseling during the first year the benefit is used and two hours in subsequent years. A doctor can appeal to Medicare for additional nutritional therapy if the physician believes it is medically necessary.

Larry Lipman, 70, of Falls Church, Va., said he was shocked to learn he had diabetes earlier this year because he’s relatively thin and is an avid cyclist.

When his doctor recommended meeting with a dietitian, he not only said yes but also brought along his wife, who does most of the cooking.

“It was great because I could ask specific questions and get into the nitty-gritty about how I eat, what I eat and when I eat,” said Lipman, a retired journalist.

“I’ve learned I needed to cut down on portion sizes of rice and other things to keep my carbohydrates down,” he said. “I’m thinking more about what I eat every time and staying away from Doritos and ice cream.”

Doctors shoulder some of the blame for patients not getting dietary counseling by failing to refer them to dietitians.

“It’s a lot easier to prescribe a medication than it is to discuss the importance of nutrition and get patients to meet with a registered dietitian,” said Dr. Holly Kramer, a Chicago nephrologist and president of the National Kidney Foundation.

“I don’t understand how we have this burgeoning obesity and diabetes epidemic and we are not using dietitians in our clinics for all these patients, yet we are paying for all these things that mediate from the disease process such as arthritis, dialysis and amputations,” she said.

Jennifer Weis, a registered dietitian in Philadelphia, said the limited hours Medicare covers is frustrating given how difficult it is to change behaviors in older adults.

“It’s better than nothing, but in my mind is not sufficient,” she said.

Doctors might not be aware of the Medicare option since “it’s a challenge to keep up with what is a covered benefit and what is not,” said Dr. Michael Munger, chairman of the American Academy of Family Physicians who practices in Overland Park, Kan. He said that many doctors who don’t practice with a large health system may not be familiar with dietitians in their community.

For convenience, Munger said, he refers his diabetes patients to a nurse practitioner in his office for nutritional counseling. But only registered dietitians are covered under the Medicare benefit, so his Medicare patients face a copayment for that service.

Nutritional counseling is not the only underused Medicare benefit that can prevent health complications.

Fewer than five percent of Medicare beneficiaries use their 10 to 12 hours of diabetes self-management training benefit, which can cover individual and group sessions providing tips for eating healthily, being active, monitoring blood sugar, taking drugs and reducing risks.

Part of the problem, said Yoder Latortue in Philadelphia, is there is a lot of misinformation about whom the public can trust on nutrition advice.

“Everyone eats and everyone has an opinion,” Yoder Latortue said.

Lauri Wright, a Jacksonville, Fla., registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, said the federal Centers for Medicare & Medicaid Services sends out notices to health providers once a year but more information is needed.

About 10,600 registered dietitians have enrolled to treat Medicare patients, a CMS spokeswoman said. She said the agency has been advising health providers about the benefit and promoting it to enrollees on its website and its annual handbook that it sends to beneficiaries.

Still, “I think because only two diseases are covered by Medicare and the rest aren’t, it falls off everybody’s radar,” Wright said.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

This article originally published in the September 16, 2019 print edition of The Louisiana Weekly newspaper.

This article originally appeared in The Louisiana Weekly.

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Tunisia: Raja Amari’s ‘She Had a Dream’ Doc Premieres on AfroPoP

NNPA NEWSWIRE — Amari is one of these artists and Ghofrane is an activist. Exploring how racism has shaped her life in all aspects including her early school days, her romantic life and everyday activities, Amari’s film showcases how Ghofrane uses her experiences as impetus to work to bring change to her country for all people. A compassionate and hopeful exploration of the life and aspirations of Ghofrane, She Had A Dream sheds light on women’s roles in Tunisia’s changing society and one woman’s battle to create change for her community.
The post Tunisia: Raja Amari’s ‘She Had a Dream’ Doc Premieres on AfroPoP first appeared on BlackPressUSA.

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By Nsenga K. Burton, Ph.D, NNPA Newswire Entertainment and Culture Editor

The documentary She Had A Dream by Tunisian filmmaker Raja Amari premieres on AfroPoP: The Ultimate Cultural Exchange series tonight at 8 p.m. EST on WORLD CHANNEL. Season 14 of the acclaimed documentary series captures Black artists and activists shaping and reclaiming culture, advocating for change and mobilizing for brighter futures. She Had A Dream offers an intimate portrayal of one young Black Tunisian woman’s quest for political office and her fight against racism and oppression in a society that often seeks to overlook both.

The documentary follows Ghofrane, a 20-something Black woman from Tunisia as she walks the path of self-discovery of young adulthood while running for political office in a homeland where many still view her as an outsider.

Watch the trailer below:

A dedicated, charismatic activist and a modern, free-speaking woman, Ghofrane in many ways is the embodiment of contemporary Tunisian political hopes still alive years after the Arab Spring. She Had A Dream follows Ghofrane as she works to conquer her own self-doubts while attempting to persuade close friends and complete strangers to vote for her. As audiences follow her campaign, they also follow the dichotomies of her life as a woman striving for a role in politics in the Arab world and as a Black person in a country where racism is prevalent, yet often denied.

“The 14th season of AfroPoP shines a light on the collective power, strength and resilience of Black people and movements around the world,” said Leslie Fields-Cruz, AfroPoP executive producer. “Viewers will see artists use their platforms to push for progress and human rights and see ‘ordinary’ people do the remarkable in the interest of justice.”

Amari is one of these artists and Ghofrane is an activist. Exploring how racism has shaped her life in all aspects including her early school days, her romantic life and everyday activities, Amari’s film showcases how Ghofrane uses her experiences as impetus to work to bring change to her country for all people. A compassionate and hopeful exploration of the life and aspirations of Ghofrane, She Had A Dream sheds light on women’s roles in Tunisia’s changing society and one woman’s battle to create change for her community.

She Had A Dream airs on AfroPoP: The Ultimate Cultural Exchange Monday, April 11 at 8 p.m. ET on WORLD Channel and begins streaming on worldchannel.org at the same time.

AfroPoP: The Ultimate Cultural Exchange is presented by Black Public Media and WORLD Channel. For more information, visit worldchannel.org or blackpublicmedia.org.

This article was written by Nsenga K. Burton, founder & editor-in-chief of the award-winning news site The Burton Wire. Follow Nsenga on Twitter @Ntellectual.

Follow The Burton Wire on Twitter or Instagram @TheBurtonWire.

The post Tunisia: Raja Amari’s ‘She Had a Dream’ Doc Premieres on AfroPoP first appeared on BlackPressUSA.

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Nairobi: Water Crisis Exploits Women & Girls

NNPA NEWSWIRE — “Sextortion” refers to sex being used as currency instead of money for services or products — in this case water. According to the Water Integrity Network (WIN), the testimonies collected from women over the past five years in Kibera and Mukuru Kwa Njenga, which are some of the largest informal settlements in Nairobi, point towards an invisible, unspoken, and sinister consequence of corruption in the water sector i.e. sextortion. Sex for water is not a new phenomena.
The post Nairobi: Water Crisis Exploits Women & Girls first appeared on BlackPressUSA.

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BBC Africa is reporting Nairobi, the capital city of Kenya, is facing a water shortage because of changing weather patterns and aging water facilities. The article reports, “Residents in informal communities like Kibra pay private vendors for water, meaning they now control the supply and access to water in the community.” The privatization of water access has led to an increase in the exploitation of women and girls in exchange for water.

“Sextortion” refers to sex being used as currency instead of money for services or products — in this case water. According to the Water Integrity Network (WIN), the testimonies collected from women over the past five years in Kibera and Mukuru Kwa Njenga, which are some of the largest informal settlements in Nairobi, point towards an invisible, unspoken, and sinister consequence of corruption in the water sector i.e. sextortion. Sex for water is not a new phenomena. Check out the 2018 ANEW documentary short below:

The water crisis and the sexual exploitation of girls and women as a result of the water crisis shows no signs of slowing down.

To read more about this crisis, visit BBC Africa‘s series of articles and videos on Kenya’s water crisis and the Water Integrity Network’s (WIN) study on sextortion.

This news brief was curated by Nsenga K. Burton, founder & editor-in-chief of the award-winning news site The Burton Wire. Follow Nsenga on Twitter @Ntellectual.

Follow The Burton Wire on Twitter or Instagram @TheBurtonWire.

The post Nairobi: Water Crisis Exploits Women & Girls first appeared on BlackPressUSA.

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#WordinBlack: Schools and Black Students’ Mental Health: The Kids Aren’t Alright

THE AFRO — Prior to the pandemic, in 2019, suicide was the second leading cause of death for Black youths ages 15 to 24, according to the Office of Minority Health. The same report found Black high school-aged girls were 60 percent more likely to attempt suicide than their white peers. And, by June 2020, the CDC saw the rate of Black respondents who reported having “seriously considered suicide” was significantly higher.
The post #WordinBlack: Schools and Black Students’ Mental Health: The Kids Aren’t Alright first appeared on BlackPressUSA.

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By Maya Pottiger, Word in Black

It’s no surprise that we’re living through difficult times. After two years, we’re still in a global pandemic, which has predominantly impacted people of color. In addition, Book bans, attacks on critical race theory, and partisan political fights target everything from Black youths’ sexuality, to history, to health.

And we’re seeing the effects.

Prior to the pandemic, in 2019, suicide was the second leading cause of death for Black youths ages 15 to 24, according to the Office of Minority Health. The same report found Black high school-aged girls were 60 percent more likely to attempt suicide than their white peers. And, by June 2020, the CDC saw the rate of Black respondents who reported having “seriously considered suicide” was significantly higher.

For a variety of reasons — ongoing stigma, lack of insurance, most accessible — Black students often rely on the mental health services offered at school.Outside of a mental health-specific practice, Black students were nearly 600 times as likely to get mental health help in an academic setting compared to other options, according to 2020 data from the Substance Abuse and Mental Health Services Administration.

In fact, mental health services in schools have been steadily gaining popularity among students since 2009, before dropping slightly in 2020 when the school year was interrupted, according to the SAMHSA report. As a result, the rate of students receiving mental health care through school decreased by 14 percent in 2020 compared to 2019.

So how are schools changing the way they address and prioritize mental health — and the specific needs of Black students — since 2020?

The Renewed Focus on Mental Health

For school-aged people, the majority of their time is spent in a school building — about eight hours per day, 10 months out of the year. To help address mental health during academic hours, schools are trying to focus on social-emotional learning: self-awareness, self-control, and interpersonal skills. This includes teaching kids how to be in touch with their emotions and protect against adverse mental health outcomes.

But it’s been difficult.

Though there’s been more conversation, the implementation is challenging, says Dr. Kizzy Albritton, an associate professor of school psychology at the University of Texas at Austin. There was already a shortage of school-based mental health professionals before the pandemic, which has now been exacerbated, as have mental health issues. In addition, though schools clearly recognize the importance of mental health, they aren’t always provided adequate resources.

“Unless there are more resources funneled into the school system, we’re going to see a continued catch-up issue across the board,” Albritton says. “And, unfortunately, our Black students are going to continue to suffer the most.”

In a survey of high school principals and students, Education Week Research Center found discrepancies in how principals and students viewed a school’s mental health services. While 86 percent of the principals said their schools provided services, only about 66 percent of students agreed. The survey did point out it’s possible the school offers these services and students aren’t aware. The survey also found Black and Latinx students were less likely than their peers to say their schools offered services.

Dr. Celeste Malone, the president-elect of the National Association for School Psychologists and a Howard University associate professor, says she hasn’t previously seen this degree of attention to mental health in schools.

“I see that a lot in my role for a school psychology graduate program: the outreach and people contacting me with openings where they didn’t exist previously,” Malone says. “With this increased push in funding to hire more, that’s definitely a very, very positive movement.”

Mental Health Is Not One Size Fits All

Just like with many aspects of health, Black youths need different mental health support from their peers of other races. They need a counselor who understands their lived experiences, like microaggressions and other forms of discrimination or racism, without the student having to explain.

For example, in order to best address the specific mental health needs of Black students, districts need to provide information breaking down mental health stigmas; focus on hiring Black counselors, social workers, and mental health professionals; and fund anti-racist and trauma-informed mental health practices, according to the Center for American Progress.

While she hears a lot of talk, Albritton says she isn’t seeing widespread evidence of these solutions in practice.

“There needs to be a willingness, first of all, to understand that our Black students, their needs look a lot different,” Albritton says. School officials need to understand where Black students are coming from — that their families and households experience systemic and structural racism, which are known to trigger anxiety and depression. The effects of the racial wealth gap also play a role, from the neighborhood kids are living in, to the schools they can attend to the impacts on their health. Students might be bringing worries about these challenges to school, which could be reflected in their behavior. This is why, Albritton says, it’s crucial to also work with students’ families.

The post #WordinBlack: Schools and Black Students’ Mental Health: The Kids Aren’t Alright appeared first on AFRO American Newspapers .

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