Health and Disability

New data showed that nearly 15% of adult ibuprofen users exceeded the maximum recommended dose of ibuprofen or other NSAIDs in a 1-week period.

An online study analyzed nonsteroidal anti-inflammatory drugs (NSAID) use with a 1-week diary study in included 1,326 ibuprofen users. The vast majority (90%) of ibuprofen use was with over-the-counter (OTC) agents.

Of the participants, 37% took non-ibuprofen NSAID; the rest took ibuprofen. Those that exceeded the recommended daily NSAID limits included 11% on ibuprofen and 4% on other NSAIDs. This occurred an average of 9.1% of NSAID usage days.

Those with excessive daily use were more likely to be male, with ongoing pain, poor physical function, daily smoking, and the attitude of "choosing my own dose" and not starting with the lowest dose. They also had poor knowledge of the recommended one-time and 24-hour dose limits.

Among the 611 counties in this study, Medicaid expansion was associated with an increase in overall cancer diagnoses of 13.8 per 100 000 population (95% confidence interval [CI] = 0.7, 26.9), or 3.4%. Medicaid expansion was also associated with an increase in early-stage diagnoses of 15.4 per 100 000 population (95% CI = 5.4, 25.3), or 6.4%. There was no detectable impact on late-stage diagnoses.

Conclusions. In their first year, the 2014 Medicaid expansions were associated with an increase in cancer diagnosis, particularly at the early stage, in the working-age population.

Vitamin B-3 has previously been proposed as an alternative for treating Alzheimer's disease.

In an older study, large doses of nicotinamide — also referred to as B-3 — reversed Alzheimer's-related memory loss in mice.

A new study, however, focused on the effect of nicotinamide riboside (NR), which is a form of vitamin B-3, on Alzheimer's-related brain damage in mice.

More specifically, the researchers — who were jointly led by Dr. Vilhelm A. Bohr, the chief of the National Institute on Aging's (NIA) Laboratory of Molecular Gerontology, and Dr. Yujun Hou, a postdoctoral investigator in the laboratory — focused on how NR affects the brain's ability to repair its DNA, a function that is compromised in Alzheimer's disease.

As the scientists explain, a deficiency in the brain's ability to repair its DNA leads to dysfunction in the cells' mitochondria — the energy-creating organelles inside the cells — which, in turn, leads to neuronal dysfunction and lower neuron production.

But NR is "critical for mitochondrial health and biogenesis, stem cell self-renewal, and neuronal stress resistance." Thus, Dr. Bohr and his colleagues wanted to explore the effects of NR supplementation in a mouse model of the neurological disease.

Compared with the controls, the NR-treated mice had less of the protein tau in the brain, less DNA damage, and more neuroplasticity — that is, the brain's ability to "rewire" itself when it learns new things, stores new memories, or becomes damaged.

Also, fewer neurons died or were damaged in these mice. Intriguingly, however, their levels of the beta-amyloid protein stayed the same as those of the control mice.

Finally, the researchers say that in the hippocampi — a brain area involved in memory that often shrinks or is damaged in Alzheimer's — of the mice that received the treatment, NR appeared to get rid of the existing DNA damage or stop it from spreading.

Non-skilled in-home care supports will be included as a supplemental benefit in Medicare Advantage plans in 2019, according to the Centers for Medicare & Medicaid Service (CMS), which announced the policy change Thursday afternoon.

The move marks the first time that CMS has allowed an item or service to be eligible as a supplemental benefit that covers daily maintenance. Along with non-skilled in-home care supports, CMS will also include portable wheelchair ramps and other assistive devices and modifications when patients need them, according to an announcement Thursday.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” CMS Administrator Seema Verma said in a statement. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”

Injecting minute amounts of two immune-stimulating agents directly into solid tumors in mice can eliminate all traces of cancer in the animals, including distant, untreated metastases, according to a study by researchers at the Stanford University School of Medicine.

The researchers believe the local application of very small amounts of the agents could serve as a rapid and relatively inexpensive cancer therapy that is unlikely to cause the adverse side effects often seen with bodywide immune stimulation.

“When we use these two agents together, we see the elimination of tumors all over the body,” said Ronald Levy, MD, professor of oncology. “This approach bypasses the need to identify tumor-specific immune targets and doesn’t require wholesale activation of the immune system or customization of a patient’s immune cells.”

“All of these immunotherapy advances are changing medical practice,” Levy said. “Our approach uses a one-time application of very small amounts of two agents to stimulate the immune cells only within the tumor itself. In the mice, we saw amazing, bodywide effects, including the elimination of tumors all over the animal.”

Cancers often exist in a strange kind of limbo with regard to the immune system. Immune cells like T cells recognize the abnormal proteins often present on cancer cells and infiltrate to attack the tumor. However, as the tumor grows, it often devises ways to suppress the activity of the T cells.

Highlights:

→ The Dunedin Multidisciplinary Health and Development Study, which began more than four decades ago, has
generated data used in the publication of some 1,200 scientific papers.

→ It's an example of a longitudinal study, in which data related to a group of individuals are 
observed and recorded over a long period of time.

→ Findings from the study have taught us about the connection between self-control and success in life, the prevalence of mental illness, and identified many biological markers of aging.

It Works Like This:

Look Up Your Medication's Cost 

Polycystic ovary syndrome (PCOS) was linked with changes in the gut microbiome, a finding that might lead to novel treatments, scientists said.

Women with PCOS had a reduced overall number of bacterial species and lower phylogenic diversity in their gut microbes compared with a healthy control group (P<0.05), said Varykina Thackray, PhD, of the University of California San Diego, and colleagues.

he biodiversity of gut microbes in women with PCOS correlated with hyperandrogenism, the group found. More specifically, it strongly and negatively correlated with total testosterone levels (P=0.006) and hirsutism (P=0.02), Thackray and colleagues reported online in the Journal of Clinical Endocrinology & Metabolism.

Women with polycystic ovarian morphology (PCOM), but not PCOS, had changes in gut microbiome diversity that were intermediate between the control and PCOS groups, Thackray and colleagues said.

In women with PCOS, the relative abundance of Porphyromonas spp., Bacteroides coprophilus, Blautia spp., and Faecalibacterium prausnitzii was consistently higher, while Anaerococcus spp., Odoribacter spp., Roseburia spp., and Ruminococcus bromii were lower, the study found. The four types of bacteria found in lower abundance are all known to synthesize short-chain fatty acids, which are involved in processes such as downregulation of bacterial virulence, maintenance of colonic homeostasis, and anti-inflammatory effects, the study authors said.

The current study confirms the results of two other recent studies, one conducted in Austria and the other in China, that also tied changes in the gut microbiome to PCOS, Thackray and colleagues said.

"Our findings suggest that androgens may be an important factor in shaping the gut microbiome, and that changes in the gut microbiome may influence the development and pathology of PCOS," the study authors wrote. "If hyperandrogenism drives the microbial composition of the gut, it would be interesting to determine if treatment of PCOS with androgen antagonists or oral contraceptives results in recovery of the gut microbiome and improvement of the PCOS metabolic phenotype."

A new law will require the federal government to develop a national strategy to address the needs of family caregivers, including those supporting people with developmental disabilities.

President Donald Trump signed legislation this week known as the Recognize, Assist, Include, Support and Engage, or RAISE Family Caregivers Act.

Additionally, the legislation also creates a family caregiving advisory council comprised of federal officials and stakeholders in the community to guide the strategy’s development and advise the secretary and other members of government on how to support the more than 40 million family caregivers across the country.