Health and Disability

https://ind.pn/2ID37x0

Common fungal infections are “becoming incurable” with global mortality exceeding that for malaria or breast cancer because of drug-resistant strains which “terrify” doctors and threaten the food chain, a new report has warned.

Writing in a special “resistance” edition of the journal Science, researchers from Imperial College London and Exeter University have shown how crops, animals and people are all threatened by nearly omnipresent fungi.

“Fungal infections on human health are currently spiralling, and the global mortality for fungal diseases now exceeds that for malaria or breast cancer,” the report notes.

While the problem of bacteria becoming resistant to commonly used antibiotics has been widely reported on, and likened to the “apocalypse” by medical leaders, the risks of disease-causing fungi have received far less recognition.

Fungicides share a problem with antibiotics in that the organisms they aim to kill are becoming resistant to treatments faster than they can be developed, and there are growing numbers of people vulnerable to infection.

“We’ve got increasing numbers of immunosuppressed patients, that’s what fungi love to parasitise,” Matthew Fisher, professor of fungal disease epidemiology at Imperial, told The Independent.

“Half a million people a year probably die from fungal meningitis in Africa, which wouldn’t affect them if they didn’t have Aids.

“Similarly in the UK we have transplant patients as well, as soon as you whack them on immunosuppressants they start coming down with fungal infections.”

“Transplant doctors are absolutely terrified of these fungal infections,” he added, and the same issues arise in cancer patients, or people whose immune systems are destroyed by disease or age – leaving them unable to fight off infection on their own.

Our immune systems have evolved alongside fungi for millennia to keep us protected against the ever-present pathogens.

Unlike bacteria on surfaces and water droplets, fungi are much better at getting airborne and there are at least five types of potentially disease-causing spores in every breath.

“Compost heaps are absolutely lethal if you don’t have fully functioning innate immunity,” said Mr Fisher.

“If you dig into a heap and get a puff of powder, that will be aspergillus fumigatus.

“If your lung macrophages [white blood cells], don’t mop those spores up, they’re absolutely happy growing at 37 degrees and they’ll just rot you down as quick as a flash – that’s a heavy-duty pathogen.”

http://bit.ly/2GIIhqb

BACKGROUND:

Blood cell aggregation and adherence to vascular endothelium and inflammation play a central role in vaso-occlusive crisis in sickle cell disease. The antiaggregatory, antiadhesive, antiinflammatory, and vasodilatory omega-3 (n-3) fatty acids (DHA and EPA) are significantly reduced in patients with the disease.

OBJECTIVE:

The aim was to investigate the therapeutic potential of omega-3 fatty acids for patients with homozygous sickle cell disease in a randomized, placebo-controlled, double-blind trial.

RESULTS:

Omega-3 treatment reduced the median rate of clinical vaso-occlusive events (0 compared with 1.0 per year, P < 0.0001), severe anemia (3.2% compared with 16.4%; P < 0.05), blood transfusion (4.5% compared with 16.4%; P < 0.05), white blood cell count (14.4 ± 3.3 compared with 15.6 ± 4.0 ×10(3)/μL; P < 0.05), and the OR of the inability to attend school at least once during the study period because of illness related to the disease to 0.4 (95% CI: 0.2, 0.9; P < 0.05).

CONCLUSION:

The findings of this trial, which need to be verified in a large multicenter study, suggest that omega-3 fatty acids can be an effective, safe, and affordable therapy for sickle cell anemia.

http://bit.ly/2khLsw9

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.

“Aimovig provides patients with a novel option for reducing the number of days with migraine,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We need new treatments for this painful and often debilitating condition.” 

The effectiveness of Aimovig for the preventive treatment of migraine was evaluated in three clinical trials. The first study included 955 participants with a history of episodic migraine and compared Aimovig to placebo. Over the course of six months, Aimovig-treated patients experienced, on average, one to two fewer monthly migraine days than those on placebo. The second study included 577 patients with a history of episodic migraine and compared Aimovig to placebo. Over the course of three months, Aimovig-treated patients experienced, on average, one fewer migraine day per month than those on placebo. The third study evaluated 667 patients with a history of chronic migraine and compared Aimovig to placebo. In that study, over the course of three months, patients treated with Aimovig experienced, on average, 2 ½ fewer monthly migraine days than those receiving placebo. 

The most common side effects that patients in the clinical trials reported were injection site reactions and constipation. 

These are the kinds of problems that develop when you try to design a system for a task that really requires human input...

http://bit.ly/2Li8QWW

To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors.

We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%).

In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Because of medicine's ready leap to victim blaming whenever medicine doesn't have an explanation for a person's complaint, I thought Morgellons was likely a physical disorder. I'm glad I lived long enough to see the truth of that belief....

http://bit.ly/2KG3djQ

Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. 

Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. 

Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. 

In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. 

Further studies of the genetics, pathogenesis, and treatment of MD are warranted.

http://bit.ly/2IPATyg

Home health care visits that are longer by just one minute may be tied to lower hospital readmission rates. That’s the key finding from a recent study from the National Bureau of Economic Research (NBER).

“We obviously see an effect,” Guy David, associate professor at the University of Pennsylvania’s Wharton School and author of the research, told Home Health Care News. “Shorter visits tend to increase the likelihood of readmissions.”

However, that doesn’t mean home health care providers should immediately start mandating longer visits.

Length of visit

The study looked at data from an unnamed private, for-profit, multi-state home health care company with 96 offices in 16 states. The data spanned three years and eight months: January 2012 to August 2015.

“An extra minute relative to the average length of a patient’s home health visits reduces their readmission likelihood by approximately 8%,” the study found.

The results were opposite than what researchers expected to find, according to David, who anticipated that longer visits would indicate higher patient acuity and a greater likelihood of heading back to the hospital.

“One [thought] is that longer visits [are] associated with more readmissions—with sicker patients who require more attention and are [therefore] likely to be readmitted,” he said. “It’s interesting that we are seeing the opposite. The causal relationship runs in the other direction.”

The relationship between length of visit and readmission rates is a little more nuanced, though.

http://bit.ly/2IIAAFD

According to the agency's fact sheet, CMS is focused on accomplishing five goals through the new strategy: advance telehealth services, apply a "rural lens" to agency policies, improve access to care, empower rural patients to make healthcare decisions, and leverage partnerships to achieve these objectives.

Below are specific actions CMS plans to take to advance its five goals:

• Reduce barriers to implementing telehealth and telemedicine services. This addresses reimbursement, cross-state licensure issues as well as administrative and financial burdens surrounding set-up.

• Institute a redesigned checklist with a rural lens to relevant policies, procedures and initiatives.

• Promote evidence-based practices to improve access to rural service providers.

• Provide technical assistance to ensure providers participate in CMS programs.

• Address patient barriers like lack of transportation.

• Work to develop and distribute materials to citizens through rural communications networks.

• Bolster health technology and infrastructure to improve patient access to health information.

• Partner with federal agencies like the Office of the National Coordinator for Health Information Technology to promote interoperability and increased use of EHRs among patients and providers.

• Increase focus on maternal health, behavioral health, and substance abuse through partnership with Center for Disease Control.

• Assist state Medicaid agencies to advance rural health strategies to citizens in need.

http://bit.ly/2jVfqWG

In the 1990s, the prevalence of autism spectrum disorder (ASD) among children rose sharply. These children are now entering adulthood, yet physicians and scientists know very little about the health outcomes they might face. Most studies of health have focused on children and adolescents.

However, new research published this week by scientists at the University of Wisconsin­­–Madison found that older adults with ASD may be at greater risk than people without the disorder of developing several health problems, including cardiovascular, urinary, respiratory and digestive issues.

“This is one of the few studies to look at health problems in a primarily middle-aged and older population of individuals with ASD,” says lead author, Lauren Bishop-Fitzpatrick. “Knowing what health issues adults with autism are more likely to encounter is critical to provide them with effective care and develop prevention strategies.”

The researchers found that individuals with ASD had increased risks of developing several health complications, including various cardiovascular issues, hypothyroidism, and other neurological issues. They were at decreased risk of alcohol abuse, hypertension, and of developing metastatic cancers.

http://bit.ly/2jVfqWG

In the 1990s, the prevalence of autism spectrum disorder (ASD) among children rose sharply. These children are now entering adulthood, yet physicians and scientists know very little about the health outcomes they might face. Most studies of health have focused on children and adolescents.

However, new research published this week by scientists at the University of Wisconsin­­–Madison found that older adults with ASD may be at greater risk than people without the disorder of developing several health problems, including cardiovascular, urinary, respiratory and digestive issues.

“This is one of the few studies to look at health problems in a primarily middle-aged and older population of individuals with ASD,” says lead author, Lauren Bishop-Fitzpatrick. “Knowing what health issues adults with autism are more likely to encounter is critical to provide them with effective care and develop prevention strategies.”

http://bit.ly/2IckQv1

If we were to sum up allergies with an emoji, it’d be a shrug. We know so little about them, and yet tens of millions of Americans experience allergies of some kind or another throughout their lives. They come. They go. They evolve slowly or shift rapidly. Perhaps the only constant is that they’re becoming more common.

But there is some positive news for allergy sufferers everywhere.

“The only good thing about getting older is that​,​ in many cases, allergies are less prevalent,” says Clifford Bassett, medical director of Allergy & Asthma Care of NY and an allergy specialist at New York University. Changes inside and outside our bodies as we age affect the way we react to potential irritants from ragweed to crab to dogs. Why? Well, that’s a little more complicated, and there’s more than one possible reason that your allergy status just switched.

You outgrew it

Around 60 to 80 percent of kids with milk and egg allergies outgrow them by age 16. Only 20 percent of kids with peanut allergies do so, and only 14 percent of those allergic to tree nuts. Just 4 or 5 percent outgrow a shellfish allergy.

Why? Unfortunately, the answer is that we mostly have no idea. We know some general associations — the earlier a child has an adverse reaction to food, the more like they are to outgrow it — but scientists don’t yet understand why some kids age out of their reactions and others don’t. We do know that early exposure to small amounts of food allergens, especially peanuts, helps prevent allergies in the first place. But we have no idea how to actively reverse them once they happen. If you get allergies as a kid, you just have to wait and see if your tolerances change in the future.

One of the few things researchers have observed is that there does seem to be a time limit to ridding yourself of childhood allergies — if you haven’t outgrown an allergy by your teens, you’re likely to have it for life.