Health and Disability

http://bit.ly/2nfZmAl

Then, the question, "Can specialists prevent the disease in people deemed at increased risk?" arises.

The authors of a new study, from the University of Virginia in Charlottesville, suggest that one drug called memantine — which is currently used to manage Alzheimer's symptoms — may actually help prevent the disease. This, however, might only happen if a person takes the drug before symptoms set in.

"Based on what we've learned so far, it is my opinion that we will never be able to cure Alzheimer's disease by treating patients once they become symptomatic," says Prof. George Bloom, of the University of Virginia, who oversaw the study.

"The best hope for conquering this disease is to first recognize patients who are at risk, and begin treating them prophylactically with new drugs and perhaps lifestyle adjustments that would reduce the rate at which the silent phase of the disease progresses," he says, adding, "Ideally, we would prevent it from starting in the first place."

http://bit.ly/2O5jzV2

Clinical Question  In adults and children prescribed antibiotics, is co-administration of a probiotic associated with a lower risk of symptomatic Clostridium difficile infection without an increase in adverse events?

Bottom Line  Moderate-quality evidence suggests that probiotics are associated with a lower risk of C difficileinfection and very low–quality evidence suggests that probiotics are associated with fewer adverse events vs placebo or no treatment.

Antibiotics are commonly prescribed and are associated with Clostridium difficile infection (CDI) and its complications including toxic megacolon and death.¹ Recent data suggest that treating CDI costs $24 205 per patient.² This JAMA Clinical Evidence Synopsis summarizes a recent Cochrane review.³

Among 31 studies comparing antibiotics and probiotics vs placebo or no treatment for preventing CDI in patients receiving antibiotics, probiotics were associated with a lower risk of CDI, adverse events, and antibiotic-associated diarrhea. 

http://bit.ly/2O5jzV2 

http://bit.ly/2LJyYxF

Electrical signals generated outside the body by transcranial stimulation have helped repair severed sciatic nerves in rats, say researchers.

Much evidence suggests the body can repair certain types of peripheral nerve damage. But only in certain circumstances and often in limited ways. So new ways to reconnect severed nerves and to trigger repair and regrowth are of considerable interest.

Which is why the work of Ashour Sliow at Western Sydney University in Australia and a few colleagues is important. These guys have developed a new way to reconnect a severed nerve with a biodegradable scaffold and then stimulate it electrically using a magnetic field outside the body.

They say their technique is minimally invasive, unlike other nerve regeneration approaches and can repair severed nerves in rats.

In recent years, neurologists have discovered that brief electrical stimulation can significantly improve the way nerves repair and regrow.

But there are significant challenges in perfecting this kind of treatment. One is that severed nerves are often stitched back together again and the sutures are a significant source of scaring and inflammation.

Then there is the problem of applying electrical stimulation. This is often done using a conducting band around the reconnected part of the nerve that is connected to a wire that extends out of the body.

This often causes in problems. Any invasive connection is prone to infection and any small tug on the wire can dislodge the band. In practice, the conducting band often migrates, which significantly reduces its therapeutic effectiveness.

“Repairing and electrically stimulating peripheral nerves with a non-invasive device is very challenging and the current scientific and technological know-how has yet to produce an effective system to combine and perform these two tasks together,” says Sliow and co.

http://bit.ly/2LJyYxF 

http://bit.ly/2v0tbsZ

A recent study demonstrates that pain relief drugs produce more pronounced side effects when taken by people with dementia. A second study uncovers why this might be the case.

Roughly 50 percent of people with dementia who are living in nursing homes experience substantial pain. According to earlier studies, this pain often goes unnoticed by clinicians and is therefore poorly managed.

Although paracetamol is generally the first line of treatment for pain, opioids are used when paracetamol is not effective. In fact, around 40 percent of people with dementia living in nursing homes are prescribed opioids.

The team found that side effects such as personality changes, sedation, and confusion were significantly worse in individuals taking opioids, compared with those taking a placebo.

In fact, those who were prescribed the opioid buprenorphine experienced three times the level of harmful side effects. Also, the patients taking buprenorphine were much less active.

"Pain is a symptom that can cause huge distress and it's important that we can provide relief to people with dementia. Sadly, at the moment, we're harming people when we're trying to ease their pain."

Prof. Clive Ballard, University of Exeter Medical School, U.K.

Prof. Ballard's team has also carried out studies on the mechanism behind the increased risk of side effects for people with dementia.

Initially, they were looking at the treatment of arthritis in a mouse model. But along the way, they noticed that mice with Alzheimer's were much more sensitive to the effects of morphine; they needed less for adequate pain relief and experienced worse adverse effects.

They discovered that this was because mice with Alzheimer's release higher levels of the body's natural opioids, such as endorphins.

While we tend to focus on anti-inflammatory treatments, like biologics or ibuprofen, exploring the mechanisms of inflammation is the bigger picture of treatment possibilities in every part of medicine and personal recovery.......

http://bit.ly/2LGDCeT

Before You Start: Terms to Understand

Inflammation: The immune system’s local, short-term response to cellular damage by increasing blood flow 
and other repair-focused compounds.

Low-grade chronic inflammation: A “slow drip” response to widespread cell damage caused by aging, with 
the byproduct of impairing the function of cells and organs.

Inflammasome: A multiprotein intra-cellular complex that regulates inflammatory responses.

Metabolism: The sum of every chemical reaction that happens in the body. It breaks down (catabolism) 
food for energy and also rebuilds (anabolism) those basic molecules into cells.

Macrophage: Immune cells that reside in every organ in the body and are critical to maintaining organ 
function.

Our discoveries have to do with the specific pathways between inflammation and disease. The question has always been, if inflammation causes all of these age-related diseases, well, there are lots of anti-inflammatory drugs on the shelf of your local pharmacy. We ought to be able to take those and not get old, and not get diseases, which isn’t the case. 

The problem is inflammation is a very broad term. Within the phenomena, we’re finding very specific pathways, and within those we’ve found that there is not only an association but a causal link between specific inflammatory pathways and diseases of aging. 

For instance, this complex called the NLRP3 inflammasome. It’s found in every macrophage in all human organs. If we lower the activity of this inflammation-producing mechanism, at least in mice, we find they are protected from many aging disorders like bone loss and diabetes. In the elderly, we’ve found that lowering the activity of this pathway improves metabolism. 

These are the kind of new findings that are linking the very disparate fields of metabolism and the immune system and even the nervous system, since we recently discovered very special macrophages that hug the nerves in the periphery of the brain. Activity in those macrophages can actually impair the functioning of the nervous system.

http://bit.ly/2uWe4km

Some people use magnesium to treat and prevent migraine symptoms, including a severe headache, visual disturbances, sensitivity to light and sound, and nausea and vomiting.

Some research has indicated that taking a magnesium supplement could be an effective way to prevent headaches. Other studies have also suggested that the magnesium levels in a person's brain may be low during a migraine.

The American Migraine Foundation suggest taking a 400–500 milligram (mg) supplement of magnesium oxide daily to prevent migraines.

Some researchers think that magnesium's effectiveness as a preventive against migraines increases when a person takes higher doses — over 600 (mg) — for at least 3 to 4 months.

However, taking high doses of magnesium as a supplement may cause adverse effects in some people. (usually diarrhea because the magnesium isn't absorbed)

Taking magnesium may be more effective for people whose migraines include aura, or visual disturbances.

http://bit.ly/2JPgBS1

At its annual meeting here, the Alzheimer's Association previewed its first-ever clinical practice guidelines for primary care physicians evaluating Alzheimer's disease, dementia, and neurodegenerative cognitive behavioral syndromes, to be released in full later this year.

Twenty recommendations for primary and specialty care settings are in the new guidelines that were introduced at the Alzheimer's Association International Conferenceon Sunday. Key points were outlined in a press release; the formal clinical practice guidelines will appear later in a peer-reviewed journal and will include rationales behind the recommendations to provide context for physicians and nurse practitioners, a spokesperson for the association said.

The most important guideline may be the first one: patients who have cognitive, behavioral, or functional changes should be evaluated, said James Hendrix, PhD, the association's director of global sciences initiatives.

Alzheimer's disease and dementias often are undiagnosed, Hendrix told MedPage Today. "When patients come in with complaints of symptoms, they should be followed up for further evaluation. All too often, they're not, for whatever reason -- physicians feel they don't have the right tools, or they think a little bit of memory problems as we get older is normal. Physicians need to take these concerns seriously."

And patients who are more challenging to diagnose -- those with atypical or rapidly progressive cognitive-behavioral symptoms -- should be referred to a specialist.

"We have to recognize there are people who may be diagnosed with a treatable disease or disorder," he said. "By not doing something, by not following up, by assuming that everybody who walks in the door is going to have a disease that's difficult to treat, we do patients a disservice."

"A significant portion of people with cognitive impairment or dementia who are taking medication for Alzheimer's may not actually have the disease," Hendrix pointed out. In IDEAS, a study assessing the effect of amyloid positron-emission tomography (PET) imaging on patient outcomes, interim results showed that about 45% of patients with mild cognitive impairment and 30% of patients with dementia did not have brain amyloid and therefore did not have Alzheimer's disease, he noted.

The guidelines also call for clear communication about diagnoses and test results. In an Alzheimer's Association survey a few years ago, only 45% of people with Alzheimer's disease or their caregivers said their doctor told them their diagnosis, Hendrix noted.

"People need to plan for their future. They need to prepare themselves and their families for what's to come. If you had a late-stage form of deadly cancer and only had a few months to live, you'd be told. We need to give people with Alzheimer's and dementia the same respect."

http://bit.ly/2Lf3FdF

Two large-scale studies showed modest benefits for daily use of aspirin, NSAIDs.

Daily or almost daily aspirin use modestly reduced ovarian cancer risk among women who took aspirin for less than 10 years, while women already diagnosed with the disease who had recently starting using aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly lower risk of ovarian cancer-specific death than never-users, two separate studies indicated.

Both teams said that if the findings are confirmed, the results may support the assessment of aspirin and NSAIDs either as a chemopreventative measure in women not yet diagnosed with ovarian cancer or to improve the prognosis of those who already have the disease.

Nice idea.....

http://strib.mn/2LxZSYA

Thousands of Minnesota seniors and people with disabilities who require help with daily living activities at home now have a place to go to find caregivers who can meet their needs.

After years of preparation, the Minnesota Department of Human Services (DHS) has launched the state's first online job portal that connects people who need assistance with tasks, such as bathing, dressing and preparing meals, with caregivers who are looking for work. State officials will roll out the new online job portal — Direct Support Connect — to the state's 140,000-person direct care workforce this summer and fall, with the hope of getting enough people to register for the website that it will become a reliable place for people to get help in their homes.

The new service, which will be announced Friday, is designed to reduce the daily frustrations many individuals with disabilities face in finding and keeping quality caregivers. All too often, people who are unable to get reliable aid have resorted to making desperate pleas for help on Facebook and other social media networks, only to receive scattershot responses that don't match their needs. The challenges of recruiting reliable care can be so daunting that people with significant physical disabilities can spend several hours a day just posting ads online, combing websites for help and interviewing possible candidates.

"This could really do miraculous things for the state's [home care] program," said Shawntel Harry, of east St. Paul, who has been a personal care attendant for 15 years. "If we can get the people who need care immediately connected to those who can provide it, then we could bring stability to people's lives."

The demand for a statewide service that would connect people to direct support workers has intensified over the past several years, amid a critical and deepening shortage of caregivers. The shortage has grown so acute that scores of people who could be living independently in their own homes or apartments are instead moving into sterile and restrictive nursing homes and assisted-living facilities, the Star Tribune reported in May. Others have been forced to go without care for hours or even days at a time, putting their health in jeopardy, say caregivers and their clients.

As of December, there were nearly 8,000 unfilled home health care jobs across the state — the most in at least 16 years, according to the state workforce agency.

"We are at a moment in time when we need to do everything we possibly can to bolster and support the direct care workforce," said DHS Assistant Commissioner Claire Wilson.

http://bit.ly/2JyiAdz

It’s hard to convey to people how I’m feeling and what the practical consequences are. Writing this is painful. I feel stalked by shame when I have to explain why I can’t go out in the evening because I’ll be overcome by fatigue, or why I can’t sit in the sun because I’m photosensitive and the sun makes my joints ache.

This afternoon, I’m contemplating the bruises on my legs, the latest manifestation of my malfunctioning immune system. In December 2017, I was diagnosed with antiphospholipid syndrome, a blood-clotting disorder that rapidly escalated the urgency of my previous lupus diagnosis. The bruises aren’t because of the disease, which just causes clots and strokes and whatnot. The bruises are about the anti-clotting medication.

They appear from nowhere. The other day, I was quietly writing and a huge welt came up on my thumb. I did nothing to provoke it, but there it appeared, red-brown and glowing.