The researchers examined whether hospitals are adhering to guidelines from The American Academy of Pediatrics (AAP) that all children younger than 2 years old suspected of being victims of child abuse undergo skeletal surveys, a series of X-rays used to identify broken bones that are not readily apparent, called occult fractures.

The results, published in the journal Pediatrics, reveal a significant variation in hospitals’ evaluation of occult injuries, despite the AAP’s recommendations.

“In the young population, medical providers can miss important injuries. … Skeletal surveys can help identify them,” said Dr. Joanne Wood, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and senior author of the study.

Wood and her colleagues highlight the importance of skeletal surveys, explaining how the detection of occult fractures can point to the need for additional medical services, provide additional evidence of abuse and help protect the child.

The study looked at records for nearly 4,500 children treated at 366 hospitals around the country between 2009 and 2013.  That group included children under the age of 2 who had been diagnosed with physical abuse and children under the age of 1 with high risk injuries.

Past research has demonstrated that skeletal surveys are key to assessing young children suspected as victims of abuse. Prior to this study, however, there was little information on how hospitals in general have adhered to the AAP’s protocol.

Researchers in the current study found that across all the hospitals, 48 percent of the children younger than 2 with an abuse diagnosis underwent proper occult fracture examinations. But a by Wood and her colleagues reveal that approximately 83 percent of children suspected of being victims of child abuse underwent skeletal surveys when treated in pediatric hospitals.

This study reveals “a need for standardization of care” across hospitals, said Wood.

Dr. Robert Sege,  the director of family and child advocacy at Boston Medical Center and member of the AAP Committee on Child Abuse and Neglect, said in an interview the disparity in hospital practices is due to “a big educational gap for colleagues who primarily see adults.”

“Doctors who treat children should be trained to know about [occult evaluation] procedures when there is abuse suspicion,” he said.

In a commentary accompanying the study, Dr. Kristine Campbell, assistant professor of pediatrics at the University of Utah, suggested that follow-up research is necessary, as “no study reveals how often occult fractures provide the critical evidence to assure a child’s protection.”

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One of Kennedy’s greatest legislative achievements is spearheading the passage — with the help of his father, the late Sen. Edward Kennedy, D-Mass. — of the landmark Mental Health Parity and Addiction Equity Act of 2008.

Since choosing to leave Capitol Hill in 2010, he has pushed to bring mental health policy out of what he says is “the dark ages” — using the advantages, he says, of coming “from a famous family with a powerful, nationally recognized name. [It] gives me a convening power.”

These days, he is most visible in his role as founder of , an advocacy coalition for the mentally ill and mental health policy, and co-founder of the nonprofit research organization called .

“One Mind’s mission,” he says, “is to accelerate [mental health] cures and therapy by ensuring that we don’t duplicate science.” To this end, he adds, “we have already … created the largest platform to study traumatic brain injury and PTSD in the world,” bringing other countries into the effort.

Testifying last month before the House Energy and Commerce Subcommittee on Health, he said the pending Helping Families in Mental Health Crisis Act of 2015 would provide resources and programs for psychiatric care. “The time is now” for reform, he said, questioning why “with mental illness and addiction we wait for crisis” instead of intervening early.

KHN reporter Alana Pockros talked with Kennedy about problems he sees in the nation’s mental health system and the steps needed to fix them. The following interview has been edited and condensed.

Q. You’ve said that the health system is “stuck in the same mentality as five decades ago.” What does this mean?

A. Culturally, we still assign issues of mental health and addiction [to] moral character. We still assign blame to people with these diseases even though they have been known to be diseases for five decades. … Instead of saying “it’s your fault” to addicts, “you made this choice to start,” we now know to look at this as a biological disease.

So, we need to approach illnesses in a different way. Our science tells us one thing, but our culture has told us some completely different story. That’s why our public policy is medieval. In another 20 years from now, they are going to look back on this period like we look back on segregation [or] bigotry against gays and lesbians.

Q. This legislation encompasses a range of mental health issues. What do you think is the top priority?

´¡.ÌýI would say if we want to make a difference on a population basis, the number one issue is prevention. We know upon the first incident of psychosis how to interrupt the cycle of that illness with aggressive treatment, just as if we were to use aggressive treatment for cancer. If we did that, we would dramatically reduce incidence of disability in this country.

Today we are reacting to an epidemic of untreated mental illness. So the way to deal with that is to build a chronic care or intensive care system so that people are treated and cared for, and not abandoned. That goes back to the first point: we know these are chronic illnesses, yet we don’t employ a chronic care approach to their treatment. Treat it like asthma, treat it like diabetes; treat it in a chronic care management way.

Q. In terms of policy change and advocacy, are you targeting the federal level or state governments? How?

´¡.ÌýOn the federal level, we are looking at . [This bill is designed to speed the drug discovery and approval process. It includes provisions to improve communication and collaboration among researchers.]

It is littered with loopholes on data sharing. [The bill has] so many exceptions to [its] mandate that [scientists] share data, that it really undermines the whole purpose of making [research on mental illness] an urgent task. Even though the biggest [research] funders are taxpayers, through the National Institutes of Health, academia totally sequester and “secret away” all their data and don’t share with anyone else. [Universities] husband that data and try to sell it for profits, even though taxpayers pay for the data. That data belongs to the public, it doesn’t belong to universities. So we won’t learn whether there is an algorithm, because someone is holding back valuable information that could help to provide “the missing piece to the puzzle.” That’s what we are dealing with.

Q. How does your new role help you push for change? How has it affected your message?

´¡.ÌýI have been blessed by having led The Mental Health Parity and Addiction Equity Act fight. What that allowed me to have, even though I’m no longer in Congress, is a platform to organize and spur collaboration among the very disparate and fragmented stakeholders in neuroscience and for the clinical delivery of neuroscience. I’ve worked in both of those worlds and enjoyed a position of trust. … I still have some credibility in this space, and I’ve used it.

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A research letter published Monday by reported updated results from an earlier study highlighting the burden of chronic conditions associated with body mass index. The new findings use the most recent data available on obesity – from 2007 to 2012 – from the , or NHANES.

NHANES includes data for individuals 25 years or older and excludes pregnant women. “Overweight” and “obese” were classified by patients’ body mass indexes (BMIs).

Before the release of this study, the most recent examination of nation’s obesity and chronic disease burden was based on information from nearly 20 years ago, when researchers concluded that the prevalence of obesity-related health problems “emphasizes the need for concerted efforts to prevent and treat obesity” rather than just the other health conditions.

In the new analysis, the researchers found that nearly 40 percent of men and 30 percent of women were overweight, while nearly 35 percent of men and 37 percent of women were considered obese. Comparing this data with statistics from the earlier study, the researchers concluded that overweight and obesity rates in the U.S. have increased over the past two decades. The greatest increase in the proportion of individuals with BMI’s greater than 40, the highest obesity class, was among black women.

Rising trends demand attention from decision-makers in the health policy and health care fields, said Dr. Lin Yang, a lead researcher of the study.

“Overweight and obesity is something one can deal with as an individual, but we also need strategies for prevention at the collective level,” she said.

Those strategies include enhancing primary care efforts to prevent and treat obesity, changing behavior in schools and the workplace, and changing physical environments to make healthy food and exercise options more accessible.

Part of the problem now, according to Yang, is that “clinicians are not talking enough with their patients,” and when doctors see patients, “they probably aren’t doing counseling on the ways patients can change their lifestyles.” Yang proposed having obesity education literature in waiting rooms as a potential way to encourage this conversation or at least raise patients’ awareness.

Some experts maintain that they are already seeing signs of progress.

“While obesity has increased, in many states we’ve seen a leveling off among some subpopulations, such as kids,” said Dr. Jeffrey Levi, executive director of Trust for America’s Health. “I think that’s telling us that we are beginning to know what to do to tap into this problem.” Levi was not associated with this study.

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According to a  in the journal JAMA Internal Medicine, almost half of the 346,000 deaths from 12 different types of cancers in individuals 35 years of age or older in 2011 were attributable to smoking cigarettes.

The authors cited the as a preface to their study, which provided estimates on the annual number of smoking-related deaths from cancer overall and from lung cancer specifically between 2005 and 2009.

Although other studies have looked at lung cancer deaths related to smoking, the researchers wrote that this was the first study to delineate the number of deaths from 11 other cancers that were associated with cigarettes.

The study was led by Rebecca L. Siegel of the Intramural Research Department at the American Cancer Society.

Siegel and her team demonstrated that smoking behavior as well as the correlation between smoking and cancer have changed over time. Between 2000 and 2012, the number of people who smoked decreased from 23 to 18 percent and the number of deaths for most types of cancer tied to smoking has also fallen.

Despite these positive statistics, the risk for cancer in individuals who smoke may increase over time.

“The bottom line is that despite 50 years of declining smoking prevalence, almost 170,000 cancer deaths each year are still caused by smoking,” Siegel said.

So the researchers sought to define the magnitude of risk for each of the different types of cancer.

Not surprisingly, of the 12 cancers studied in relation to cigarette smoking, lung, bronchus, and trachea cancers were found to be the most closely associated with this habit. However, half of the deaths from oral cavity, esophagus, and urinary bladder cancers were attributed to smoking as well.

The researchers concluded that to reduce the rates of cancer mortality caused by smoking behavior, there needs to be more extensive control of tobacco.

The best way to accomplish this goal, in Siegel’s opinion, is to “focus targeted tobacco control on groups that are most likely to smoke,” such as low-income people, gay and lesbian populations, and residents of Southern states known for tobacco production.

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“The critical decisions will sit with the Congress and states and governors to determine if those subsidies are available,” Burwell told the House Ways and Means Committee.Ìý The secretary earlier this year that the administration has no authority to undo “massive damage” that would come if the court invalidates the subsidies in the online marketplaces, or exchanges, which the federal government operates in about three dozen states.

By the end of this month, the court is expected to issue a ruling in the case, .Ìý could lose those payments and many more residents could see their premiums increase because of the havoc the loss of subsidies would cause in the market.

The challengers argue that one clause in the law says those federal payments would be available to consumers only in states that run their own exchanges. But the administration has argued the legislative intent was to make subsidies available to customers in every state, regardless of how its exchange was established.

During Wednesday’s hearing, Republicans pressed Burwell to indicate what type of legislation President Barack Obama might sign to restore subsidies if the court rules for the challengers. Many Republican lawmakers have acknowledged that they would like to find a way to offer a temporary option to help consumers, but they have failed to coalesce around a specific proposal.

Burwell said while the administration would be open to considering alternatives that make health care more affordable and accessible, the president would not sign from Sen. Ron Johnson, R-Wis. That bill would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law’s requirements that most individuals get coverage, that larger businesses offer insurance to their workers or pay a penalty and that plans provide specific types of benefits.

“Something that repeals the Affordable Care Act is not something the president will sign,” Burwell said.

A recent from the American Academy of Actuaries said some changes favored by Johnson and other Republicans, such as eliminating the individual mandate, “could threaten the viability” of the health insurance market for individual plans.

Echoing , Burwell said the administration will  to help mitigate the consequences for consumers if the Supreme Court ruled against federal subsidies.

The session was billed as a hearing on the HHS budget fiscal 2016 request, but it quickly veered to Republican attacks on the sweeping 2010 health law while Democrats rushed to defend it.

“Whatever the Supreme Court decides this month, I think the lesson is clear: Obamacare is busted. It just doesn’t work. And no quick fix can change this fact,” said Ways and Means Chairman Paul Ryan, R-Wis. “Its very linchpin—its central principle—is government control. That means higher prices, fewer choices, and lower quality.”

Rep. Sander Levin of Michigan, the panel’s ranking Democrat, replied in kind. “What’s busted,” he said, “is not the ACA but  [Republican] attacks on it. Endless attacks. Never coming up with a single comprehensive alternative all these years. So you sit as armchair critics while millions of people have insurance who never had it before. You’re livid because it’s getting better.”

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