tag:ltcreform.posthaven.com,2013:/posts Health and Disability 2018-02-20T11:12:17Z Norm DeLisle tag:ltcreform.posthaven.com,2013:Post/1250243 2018-02-20T11:12:17Z 2018-02-20T11:12:17Z Strong Eczema Response to JAK Inhibitor https://goo.gl/iWvPHH

Patients with moderate or severe atopic dermatitis (AD) had as much as 74% improvement in disease status with the oral Janus kinase (JAK) inhibitor upadacitinib, a randomized trial showed.

After 16 weeks, patients randomized to one of three doses of upadacitinib had a mean improvement of 39.4% to 74.4% in the Eczema Area and Severity Index (EASI), as compared with 23% in the placebo group. Half of the patients had 90% improvement in the index (EASI 90) after 16 weeks. The same proportion met the criteria for almost/completely clear by investigator global assessment criteria (IGA 0/1).

Upadacitinib is a once-daily, oral JAK1-selective inhibitor under evaluation for several inflammatory diseases, Guttman-Yassky noted. The FDA recently granted breakthrough therapy status for the drug.

Adverse events, serious adverse events, and severe adverse events occurred in a similar proportion of placebo- and upadacitinib-treated patients. Rates of discontinuation because of adverse events were 5.0% with placebo and 2.4-9.5% with upadacitinib. The most common adverse events in all groups (including placebo) were upper respiratory tract infection, worsening of AD, and acne.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1249880 2018-02-19T10:30:54Z 2018-02-19T10:30:54Z Those scented products you love? NOAA study finds they can cause air pollution https://goo.gl/Fph7PC

Emissions from volatile chemical products like perfumes, paints and other scented consumer items now rival vehicles as a pollution source in greater Los Angeles, according to a surprising new NOAA-led study.

Even though 15 times more petroleum is consumed as fuel than is used as ingredients in industrial and consumer products, the amount of chemical vapors emitted to the atmosphere in scented products is roughly the same, said lead author Brian McDonald, a CIRESoffsite link scientist working at NOAA.

A paper presenting these study findings was published today in Science.offsite link

The chemical  vapors, known as volatile organic compounds or VOCs, react with sunlight to form ozone pollution, and, as this study finds, also react with other chemicals in the atmosphere to form fine particulates in the air.

“As the transportation sector gets cleaner, these other sources of VOCs become more and more important,” McDonald said. “A lot of stuff we use in our everyday lives can impact air pollution.”

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1249447 2018-02-18T11:33:12Z 2018-02-18T11:33:12Z New and Proposed Changes to Medicare Part D https://goo.gl/emBD9e

Late last week, Congress passed and the President signed a sweeping spending bill that will fund the government through March 23 and raise the spending caps imposed by the Budget Control Act of 2011 for two years, paving the way for a longer-term spending agreement. The legislation – the Bipartisan Budget Act of 2018 (BBA of 2018) – also contains a number of health care provisions important to people with Medicare and their families, including changes to Medicare Part D prescription drug coverage that will close the donut hole in 2019.

Just days later, on February 12, the White House released President Trump’s fiscal year (FY) 2019 budget request to Congress, which also includes several proposals related to Medicare, including changes to Part D drug coverage and Part B drug reimbursement.

The BBA of 2018 also addressed critical “extenders” – creating permanent fixes for the therapy cap and extending for two years funding for critical Medicare outreach and assistance activities. But the bill also included increases in premiums for some higher-income beneficiaries, further means testing the program. Both the legislation and the budget request allow for more flexibility for private Medicare Advantage plans and target Medicare Part D for a number of changes.

new brief from the Kaiser Family Foundations focuses on the Part D related changes and their potential impact – including, in the President’s request, the imposition of an out-of-pocket cap on Part D, changes to how the donut hole is calculated that will increase the amount of time people spend in it, and allowing the administration to shift medications from Part B to Part D.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1248464 2018-02-16T11:23:45Z 2018-02-16T11:23:45Z Aging area near Traverse City joins “village movement” to stay at home https://goo.gl/qk11dC

Decades ago, before “aging in place” became a movement, a small group of residents in rural Leelanau County began a conversation.

That led to a plan: a grassroots network of volunteers and basic services for the elderly so they could remain in their homes as long as possible.

More than 20 years later, Pauline McClure, 91, is still in her home in Northport, a pretty beachfront town popular with retirees north of Traverse City. That’s in no small part due to ShareCare of Leelanau Inc., the nonprofit that grew from those discussions.

“It’s almost a lifesaver,” McClure said.

McClure was a ShareCare charter member in 1994. She’s served on its board, as board vice president and has given her time driving members to dental or medical appointments, visiting the lonely or taking meals to those in need.

Now she’s on the receiving end.

A couple years ago, she fell and bruised her left leg, which led to infection and surgery. After her release from the hospital, ShareCare’s nurse came to her home to change her dressing. Members brought meals. McClure now depends on a volunteer driver from the organization to take her to doctor appointments in Traverse City 30 miles away.

“When we were younger, we said, ‘We’ll never need that.’ Well, now I’m the one having to ask for help once in a while,” McClure said.

There’s another name for what ShareCare does ‒ what’s become known nationally as the “village movement” that now counts 230 like-minded programs across the United States, with another 130 in development. Officially the Village to Village Network, it traces its origins to a Boston nonprofit called Beacon Hill Village that opened in 2002 – eight years after network member ShareCare was founded on similar principles.

Other Michigan nonprofits are exploring establishing something similar, though none has taken it as far as ShareCare.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1247964 2018-02-15T12:15:58Z 2018-02-15T12:15:58Z Ice Age Mammoth Footprints Show How Juveniles Took Care Of The Elderly In Ancient Times https://goo.gl/cjaKBT

As explained in a report from the Daily Mail, a team of researchers from the University of Oregon examined a total of 117 mammoth prints dating back to approximately 43,000 years ago, with these fossilized footprints first spotted in 2014, and excavated some time later. In 2017, the Oregon Bureau of Land Management gave study lead author and University of Oregon professor Greg Retallack and his colleagues permission to return to the area. This was when the researchers’ interest was piqued by a collection of about 20 Ice Age mammoth footprints that hinted at some interesting behavior from the prehistoric elephants.

After analyzing the footprints, the researchers concluded that they might have belonged to Columbian mammoths that were, during those times, quite plentiful in certain parts of the present-day United States. A look at the 20 recently spotted footprints suggested that some of the prints came from a wounded, possibly elderly mammoth, with the other prints coming from younger mammoths.

“These prints were especially close together, and those on the right were more deeply impressed than those on the left, as if an adult mammoth had been limping,” explained Retallack.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1247963 2018-02-15T12:14:29Z 2018-02-15T12:14:29Z Brain Chemical Blamed For Old Age Mental Decline Could Hold Key to Its Reversal https://goo.gl/Z1yEmw

In both C. elegans and humans, the chemical kynurenic acid (KYNA) accumulates with age. As it builds up, KYNA interferes with the activity of glutamate, a brain chemical essential for learning and memory. In humans, it has previously been linked to neurodegenerative disorders, including Alzheimer’s and Parkinson’s disease.
In the study published Jan. 31, 2018, in Genes and Development, researchers looked at the effect of KYNA on the worms’ ability to learn an association between a neutral smell and food.

The researchers found that by keeping KYNA levels low throughout the worm’s life, they could prevent the onset of age-related decline – the worms kept learning. In older worms already impaired, lowering KYNA levels could counteract the impairments – raising hope that interventions later in life may be effective in reversing neurological decline.

The reason that KYNA increases with age is still a mystery, but the new study offers an intriguing hint, by linking KYNA buildup in aging worms to elevated levels of insulin, a hormone that controls blood sugar in both worms and humans. In contrast, earlier experiments by Ashrafi’s team had found that fasting, which has been linked to longevity, reduced levels of KYNA in worms and improved learning and memory.

Ashrafi thinks that KYNA is the linchpin through which fasting makes the brain better at learning, while aging makes it worse. “These are two sides of the same coin,” he said.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1247443 2018-02-14T12:38:38Z 2018-02-14T12:38:38Z Disability Competent Care: Videos to support truly accessible health care https://goo.gl/HGTmGh

Disability Competent Care Resources

External Resources

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1246389 2018-02-12T10:38:56Z 2018-02-12T10:38:56Z People Often Overdo it with NSAIDS https://goo.gl/TwD8ZC

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.

Educating consumers about OTC NSAIDs and their dosing directions could reduce excessive dosing and potential toxicity.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1246388 2018-02-12T10:37:36Z 2018-02-12T10:37:36Z Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses https://goo.gl/fLmDVB

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.

Public Health Implications. Expanding public health insurance may be an avenue for improving cancer detection, which is associated with improved patient outcomes, including reduced mortality.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1245889 2018-02-11T11:08:30Z 2018-02-11T11:08:30Z Vitamin B-3 could be used to treat Alzheimer's https://goo.gl/ct2iH8

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.

The team added NR to the drinking water of mice that had been genetically engineered to develop the hallmarks of the neurodegenerative disorder. These included toxic buildups of the proteins tau and amyloid beta, dysfunctional synapses, and neuronal death — all of which resulted in cognitive deficits.

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.

Additionally — probably as a result of NR's ability to aid the self-renewal of stem cells, or cells that have the ability to transform into any other type of cell that the body needs — the mice in the intervention group produced more neurons from neuronal stem cells.

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.

All the brain changes were backed up by results from cognition and behavioral tests. All of the NR-treated mice performed better at maze tasks and object recognition tests, and they demonstrated stronger muscles and better gait.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1243090 2018-02-05T10:53:29Z 2018-02-05T10:53:30Z CMS to Allow Non-Skilled Home Care Benefit in Medicare Advantage

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.”

The new policy enables supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” the announcement reads.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1241263 2018-02-01T11:52:25Z 2018-02-01T11:52:25Z Cancer ‘vaccine’ eliminates tumors in mice https://goo.gl/xNAqsD

Activating T cells in tumors eliminated even distant metastases in mice, Stanford researchers found. Lymphoma patients are being recruited to test the technique in a clinical trial.

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 approach works for many different types of cancers, including those that arise spontaneously, the study found.

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.”

One agent is currently already approved for use in humans; the other has been tested for human use in several unrelated clinical trials. A clinical trial was launched in January to test the effect of the treatment in patients with lymphoma.

“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.

Levy’s method works to reactivate the cancer-specific T cells by injecting microgram amounts of two agents directly into the tumor site. (A microgram is one-millionth of a gram). One, a short stretch of DNA called a CpG oligonucleotide, works with other nearby immune cells to amplify the expression of an activating receptor called OX40 on the surface of the T cells. The other, an antibody that binds to OX40, activates the T cells to lead the charge against the cancer cells. Because the two agents are injected directly into the tumor, only T cells that have infiltrated it are activated. In effect, these T cells are “prescreened” by the body to recognize only cancer-specific proteins.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1240181 2018-01-30T11:04:24Z 2018-01-30T11:04:24Z Lifestyle Changes Prevent Cognitive Decline Even in Genetically Susceptible People https://goo.gl/k672Ni

Enhanced lifestyle counselling prevents cognitive decline even in people who are carriers of the APOE4 gene, a common risk factor of Alzheimer’s disease, according to a new study published in JAMA Neurology.

The two-year FINGER trial involved 60-77 year-old people living in Finland and with risk factors for memory disorders. The study participants were divided into two groups: one of the groups was given regular lifestyle counselling and the other enhanced lifestyle counselling. Enhanced counselling involved nutrition counselling, physical and cognitive exercises, and support in managing the risk of cardiovascular diseases.

Earlier findings from the FINGER trial have shown that the regular lifestyle counselling group had a significantly increased risk of cognitive and functional impairment compared to the intervention group, i.e. the group receiving enhanced counselling.

Now the researchers analysed whether the presence of the APOE4 gene affected the intervention results. The analysis included 1,109 persons of whom 362 were carriers of the APOE4 gene. The findings show that enhanced lifestyle counselling prevented cognitive decline despite the presence of the risk gene. Analyses carried out within the groups also indicate that the intervention results might even be better in carriers of the APOE4 gene.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1240178 2018-01-30T11:00:05Z 2018-01-30T11:00:05Z A New Zealand City the Size of Berkeley, CA, Has Been Studying Aging for 45 Years. Here’s What They Discovered https://goo.gl/Ee7Eue

The Dunedin Study, which began as a study of childhood development, has become one of humanity’s richest treasure troves of data on what makes us who we are.

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.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1239548 2018-01-29T10:38:37Z 2018-01-29T10:38:38Z Familywize: Get the lowest price on your prescriptions with the FamilyWize card.
I've always been very skeptical of prescription discount cards, but this one is free and doesn't ake their cost of doing business out of your pocket. Worth a look for some situations that many people run into with prescriptions....

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Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1238736 2018-01-27T12:00:37Z 2018-01-27T12:00:37Z Gut Microbes Involved in PCOS? https://goo.gl/MmAuZ4

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 coprophilusBlautia 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."

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1237673 2018-01-25T11:45:20Z 2018-01-25T11:45:20Z Trump Signs Family Caregivers Act https://goo.gl/hMnGrK

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.

The law calls for the secretary of health and human services to establish a national plan to “recognize and support family caregivers” within 18 months. The plan is supposed to include recommendations for federal, state and local governments as well as health care and long-term services and supports providers. The strategy is to be updated every other year.

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.

The bipartisan legislation received broad support from disability advocacy groups including the The Arc, the Autism Society, the Autistic Self Advocacy Network, Easterseals and United Cerebral Palsy, among others.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1237096 2018-01-24T12:16:22Z 2018-01-24T12:16:23Z SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs https://goo.gl/F4s6bp

New and emerging research links the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the nation’s most important anti-hunger program, with improved health outcomes and lower health care costs. This research adds to previous work showing SNAP’s powerful capacity to help families buy adequate food, reduce poverty, and help stabilize the economy during recessions.

SNAP is the primary source of nutrition assistance for many low-income people. In a typical month of 2017, SNAP helped about 42 million low-income Americans afford a nutritious diet. It provides important nutritional support for low-wage working families, low-income seniors, and people with disabilities living on fixed incomes: close to 70 percent of SNAP participants are in families with children, and more than one-quarter are in households with seniors or people with disabilities. While SNAP provides only a modest benefit — just $1.40 on average per person per meal in 2017 — it forms a critical foundation for the health and well-being of low-income Americans, lifting millions out of poverty and improving food security.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1236561 2018-01-23T11:23:57Z 2018-01-23T11:23:57Z Flu Season Just Keeps Getting Worse https://goo.gl/soT5Hb

Flu deaths surpassed the epidemic threshold at the end of December, with pediatric flu-related deaths also up, according to data from the CDC.

The CDC's weekly FluView surveillance report found that pneumonia- and influenza-related mortality comprised 8.2% of all deaths in the last week of December. This was above the epidemic threshold of 7.1%.

Outpatient influenza-like illnesses were up, and continued to spread across the country. Data from this week indicates that 6.3% of reported patient visits were due to influenza-like illness (up from 5.8% a week ago). Thirty-two states now reported experiencing high influenza-like illness activity versus 26 states a week prior, and influenza remains widespread in 49 states -- Hawaii being the lone exception.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1235903 2018-01-22T10:46:52Z 2018-01-22T10:46:52Z Biologics Prove Best for Psoriasis Patients https://goo.gl/qYqijm

Although all major treatment classes reviewed in a Cochrane meta-analysis were more effective than placebo for moderate to severe psoriasis, biologic agents appeared to be the most efficacious.

The researchers found that all of the anti-IL17 drugs and guselkumab (Tremfya) were more effective than the anti-TNF alpha drugs infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel) for reaching PASI 90 status.

Ustekinumab (Stelara, an IL-12/23 inhibitor) was better than etanercept but there was no clear difference between infliximab, adalimumab, and etanercept. Tofacitinib (Xeljanz, a small molecule) was superior to methotrexate (a conventional systemic agent), but there was no difference between the other small molecules and conventional drugs.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1234949 2018-01-20T11:43:38Z 2018-01-20T11:43:38Z FDA to Expedite Release of Recall Information https://goo.gl/KvZxVh

Among other actions, FDA assures that the public is warned when products present the most significant public hazards, including those recalls associated with an outbreak.

Now, as part of a larger effort to increase transparency, empower consumers, and enhance public health, the FDA is working to alert the public sooner whenever a product has been recalled.

However, recall classifications can sometimes take weeks – or even months when FDA needs to conduct a complex evaluation. Such analysis can involve determining whether any diseases or injuries have already occurred, the likelihood that a hazard might occur, or whether vulnerable segments of the population, such as children, are more at risk.

FDA has decided that the public would benefit by having recall information about FDA-regulated products as soon as possible, even though further evaluation remains to be done. Moving forward, FDA will include “not-yet-classified” recalls of human drugs, foods, and veterinary products in the weekly Enforcement Report, even while classification work is still ongoing.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1233744 2018-01-18T10:48:57Z 2018-01-18T10:48:57Z Fed Up With Drug Companies, Hospitals Decide to Start Their Own https://goo.gl/5i7QhE

A group of large hospital systems plans to create a nonprofit generic drug company to battle shortages and high prices.

For years, hospital executives have expressed frustration when essential drugs like heart medicines have become scarce, or when prices have skyrocketed because investors manipulated the market.

Now, some of the country’s largest hospital systems are taking an aggressive step to combat the problem: They plan to go into the drug business themselves, in a move that appears to be the first on this scale.

“This is a shot across the bow of the bad guys,” said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, the nonprofit Salt Lake City hospital group that is spearheading the effort. “We are not going to lay down. We are going to go ahead and try and fix it.”

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1233232 2018-01-17T11:46:22Z 2018-01-17T11:46:22Z Understand the Quality of Care at Michigan Hospitals

This site uses publically available data...


How can VerifyMICare help me make smart healthcare decisions?

Being informed can help improve your healthcare experiences, and it allows you to focus on what’s most important – your health. When making these decisions, you should use many tools to help you decide – and VerifyMICare is one of those tools. 

VerifyMICare can help you to understand how a hospital is doing on things like infection prevention. But it should not be the only factor in making healthcare decisions. You should always talk to your doctor(s) and your family about the option that is best for you.

What information is available through VerifyMICare?

VerifyMICare provides information about quality and safety measures for Michigan hospitals and allows you to compare them side by side. Future updates to the site will add information about hospital pricing and other topics that are important. 

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1233231 2018-01-17T11:44:46Z 2018-01-17T11:44:46Z How to Die of the Flu https://goo.gl/3uPXhY

The flu stalking us in Australia right now should scare you.

Every year the flu virus does an annual migration across the world, hitting the Southern Hemisphere during its winter, the Northern Hemisphere right about now, and hanging out in the tropics in between — especially in parts of Asia. That means we look to Australia to know what is coming to us... and Australia is seeing one of its worst flu years on record, with over 2½ times more infections than in the same period last year. Influenza A (H3N2) is the predominant circulating influenza A virus this year, and 81% of the confirmed flu deaths have been due to this strain.

U.S. Flu Vaccine Effectiveness Network data for the 2016–2017 influenza season showed this year’s flu vaccine is 48 percent effective in preventing laboratory-confirmed influenza A and B viral infection associated with medically attended acute respiratory illness.

The exact effectiveness estimates are 43 percent against the predominant influenza A (H3N2) viruses and 73 percent against influenza B viruses.

When older people die from flu, it is usually due to complications like pneumonia. But young healthy people get to die of the flu in special ways. Influenza A just loves young, healthy people, taking them down within days of exposure. In fact, it is more deadly to healthy young adults than to the elderly and infants.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1232701 2018-01-16T11:33:30Z 2018-01-16T11:33:30Z Flu Season Is Shaping Up To Be A Nasty One, CDC Says https://goo.gl/Fkt73C

The United States appears to be in the midst of an unusually severe flu season, officials at the federal Centers for Disease Control and Prevention said Friday.

The flu season started early, which is never a good sign, and the flu is already widespread throughout the country, the CDC's latest report shows. Half of states are reporting especially intense flu activity.

"We are currently in the midst of a very active flu season with much of the nation experiencing widespread and intense activity," CDC Director Brenda Fitzgerald told reporters during a briefing.

Based on the latest available data, the United States could be experiencing one of the most severe flu seasons in years, possibly similar to the severe 2014-2015 flu season, officials say.

"Flu is everywhere in the U.S. right now. There's lots of flu in lots of places," says Dan Jernigan, director of CDC's influenza division.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1232344 2018-01-15T11:30:02Z 2018-01-15T11:30:02Z Microsoft Wants To Diagnose Disease By Building Massive Database Of The Human Immune System https://goo.gl/cfJxo6

Imagine making a spreadsheet of every meal you've ever eaten, every hand you've ever shook, every bit of dust that's ever gotten in your eye - and multiply it by about a million times. Then you begin to get a sense of the size of the data problem that is your body's immune system. Through a new AI project, Microsoft hopes to solve this data problem and make diagnosing nearly any disease as simple as a single blood test.

You see, stored within your immune system is a record of virtually every threat to your health that you've ever encountered. When an invader shows up -- be it the flu, cancer, or something weird you picked up while showering without flip-flops at the gym -- your body identifies it and launches a targeted attack. This works the the help of special cells called T-cells, which each carry a corresponding surface protein called a T-cell receptor with a genetic code designed to target a specific disease, signalled by what's called an antigen.

So if the immune system's T-cells each contain genetic markers of every pathogen the body has encountered, then decrypting those markers could theoretically give you a log of every threat you have ever faced. That's what Microsoft is hoping. In a new research effort with the Seattle biotech firm Adaptive, the company is working to decode the human immune system so that it can diagnose disease.

"Your immune system should know what you have before your doctor does," said Adaptive CEO Chad Robins at the annual JP Morgan Healthcare Conference in San Francisco on Wednesday.

The idea is, in essence, to make a map of the human body's immune responses -- of its T-cell receptors sequences and the codes of the antigens they have fought against. And using that map, eventually, the idea is to be able to diagnose practically any disease from a sample of blood.

Remember the massive spreadsheet we imagined earlier? That spreadsheet is the reason this problem calls for artificial intelligence.

"We're searching for patterns in a giant space," Peter Lee, vice president of AI Research for Microsoft, told Gizmodo. "In machine-learning, a problem this big is exotic."

Your body is constantly coming into contact with foreign invaders and having immune reactions to them. Because many T-cell receptors bind to different antigens, the presence of one T-cell receptor could indicate a host of different diseases. That's a lot of complicated data to crunch. The information is all there, but right now, we just can't read it.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1227433 2018-01-06T11:13:42Z 2018-01-06T11:13:43Z Alphabet spinoff Cityblock raises $20 million to help low-income Americans get health care https://goo.gl/wWKzTK

Here's a story that bucks the idea that the tech industry is selfish and myopic: A technology start-up raised more than $20 million this week to help low-income Americans, including the elderly and the homeless, access basic health services.

Cityblock Health, which spun out of Alphabet's urban innovation unit, Sidewalk Labs, will use its funds to open up or partner with community health centers in Brooklyn, New York, and other urban hubs across the country. That's coupled with the development of a technology product, which it calls Commons.

It aims to treat low-income patients who qualify for Medicaid, which accounts for about 1 in 5 Americans, including many with complex and costly needs.

Its team includes a mix of technologists from companies such as Google, as well as nonprofit and community health experts. The company named to its board some big names in health and technology, including former CMS administrator Andy Slavitt, Rock Health co-founder Halle Tecco and Cloudera co-founder Jeff Hammerbacher.

Alphabet subsidiary Sidewalk Labs is moving ahead with its own plansto redevelop Toronto's waterfront, an effort that will include sensors and other technologies.

Cityblock was initially based at Sidewalk's offices, but will now operate as an independent company.

Cityblock isn't yet treating patients. But Iyah Romm, the company's CEO and co-founder, explained on Wednesday that the company is hoping to provide a range of resources, including social services, access to affordable housing and more.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1227432 2018-01-06T11:12:07Z 2018-01-06T11:12:07Z Cancer: Virus fuels immune system to attack brain tumors https://goo.gl/1bzgYn

Researchers at the University of Leeds and the Institute of Cancer Research in London, both in the United Kingdom, found that the naturally occurring virus was able to cross the blood-brain barrier in all who took part in the study.

These findings are significant because it was previously thought that the only way to use the virus to treat brain cancer was to inject it directly into brain tissue. But this approach is limited; it cannot be repeated very often and does not suit all patients.

Reporting in the journal Science Translational Medicine, the researchers explain how the virus — a member of the reovirus family — not only infected cancer cells without affecting healthy cells, but it also helped the immune system to find and attack the cancer cells.

They believe that their study shows how reoviruses might enhance a type of immunotherapy called checkpoint therapy for cancers that start in the brain or spread to the brain from another part of the body.

"This is the first time it has been shown," explains co-lead study author Dr. Adel Samson, who is a medical oncologist at the University of Leeds, "that a therapeutic virus is able to pass through the brain-blood barrier, and that opens up the possibility [that] this type of immunotherapy could be used to treat more people with aggressive brain cancers."

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1226941 2018-01-05T10:54:34Z 2018-01-05T10:54:34Z Fiber Is Good for You. Now Scientists May Know Why. https://goo.gl/nL1aAS

He and other scientists are running experiments that are yielding some important new clues about fiber’s role in human health. Their research indicates that fiber doesn’t deliver many of its benefits directly to our bodies.

Instead, the fiber we eat feeds billions of bacteria in our guts. Keeping them happy means our intestines and immune systems remain in good working order.

In order to digest food, we need to bathe it in enzymes that break down its molecules. Those molecular fragments then pass through the gut wall and are absorbed in our intestines.

But our bodies make a limited range of enzymes, so that we cannot break down many of the tough compounds in plants. The term “dietary fiber” refers to those indigestible molecules.

But they are indigestible only to us. The gut is coated with a layer of mucus, atop which sits a carpet of hundreds of species of bacteria, part of the human microbiome. Some of these microbes carry the enzymes needed to break down various kinds of dietary fiber.

The ability of these bacteria to survive on fiber we can’t digest ourselves has led many experts to wonder if the microbes are somehow involved in the benefits of the fruits-and-vegetables diet. Two detailed studies published recently in the journal Cell Host and Microbe provide compelling evidence that the answer is yes.

Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1226363 2018-01-04T11:23:11Z 2018-01-04T11:23:12Z Afraid of Falling? For Older Adults, the Dutch Have a Cure https://goo.gl/NZsyxY

The shouts of schoolchildren playing outside echoed through the gymnasium where an obstacle course was being set up.

There was the “Belgian sidewalk,” a wooden contraption designed to simulate loose tiles; a “sloping slope,” ramps angled at an ankle-unfriendly 45 degrees; and others like “the slalom” and “the pirouette.”

They were not for the children, though, but for a class where the students ranged in age from 65 to 94. The obstacle course was clinically devised to teach them how to navigate treacherous ground without having to worry about falling, and how to fall if they did.

“It’s not a bad thing to be afraid of falling, but it puts you at higher risk of falling,” said Diedeke van Wijk, a physiotherapist who runs WIJKfysio and teaches the course three times a year in Leusden, a bedroom community just outside Amersfoort, in the center of the country.

The Dutch, like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity.

This one, called Vallen Verleden Tijd course, roughly translates as “Falling is in the past.” Hundreds of similar courses are taught by registered by physio- and occupational therapists across the Netherlands.

Yet falling courses — especially clinically tested ones — are a fairly recent phenomenon, according to Richard de Ruiter, of the Sint Maartenskliniek in Nijmegen, the foundation hospital that developed this particular course.

Virtually unheard-of just a decade ago, the courses are now common enough that the government rates them. Certain forms of Dutch health insurance even cover part of the costs.

While the students are older, not all of them seemed particularly frail. Herman van Lovink, 88, arrived on his bike. So did Annie Houtveen, 75. But some arrived with walkers and canes, and others were carefully guided by relatives.

Norm DeLisle