Health and Disability

The majority of patients who undergo routine, uncomplicated operations prefer online postoperative consultations to in-person visits, according to results from a new study published online as an "article in press" on the Journal of the American College of Surgeons website. The study will appear in the print publication of the Journal later this year.

In this prospective pilot study from Vanderbilt University Medical Center, Nashville, Tenn., researchers tracked 50 patients who completed both online and in-person visits after their operations. The patients underwent elective laparoscopic cholecystectomy, laparoscopic ventral hernia repair, umbilical hernia repair, or inguinal hernia repair. Seventy-six percent of this group said that online visits were acceptable as the only form of follow-up care. Further, the surgeons conducting the study said that for 68 percent of patients, online and in-person visits were equally effective; indicating that offering an option for online care may have largely impacted patient preferences.

Dementia, Rights and the Social Model of Disability, a new report published by the Mental Health Foundation, is calling for a radical shift in current thinking around dementia - specifically that dementia should be viewed as a disability. At present dementia is often seen through the lens of a conventional medical model - as an illness that needs a cure or treatment. In light of recent figures from Alzheimer's Research UK which show that one-third of British people born in 2015 will develop dementia, it is important that we support efforts to treat or reduce the impact of the disease. However, it is also crucial that people with dementia have their rights respected and upheld. This requires more attention being paid to the impairments caused by dementia and how they impact on the person's everyday life, including the way society treats them.

The report argues that viewing dementia as a disability rather than an illness would unlock the potential for policy to be developed and services designed, delivered, and monitored by people living with dementia. Who as a result will have a strengthened ability to advocate for appropriate levels of investment in social care so they can live as active citizens in the community.

The latest environmental influence, observed by Mauricio Farez, a neuroscientist at the Raúl Carrea Institute for Neurological Research, and colleagues could involve peak melatonin levels in the body, which occur during the darker months. The researchers assessed a group of 139 multiple sclerosis patients in Buenos Aires and found a 32 percent reduction in the number of relapses in the fall and winter, when people living in the Southern Hemisphere produce more of the hormone, compared with summer and spring. The results are published on the September 10 Cell.

Past research has shown that melatonin can have a protective effect against MS and that shift work, which disturbs melatonin production, can increase the risk of developing the disease. According to the authors, this research is one of the first to bring together epidemiological evidence with results from both human cells and animal models.

Earlier this month, over five years after the Affordable Care Act was adopted, the Obama Administration finally proposed the highly anticipated rule that implements the ACA’s main nondiscrimination provision: Section 1557. The rule prevents discrimination on the basis of race, color, national origin, sex, age, and disability, and broadly applies to all health programs and activities that receive assistance through HHS.

For those who have experienced discrimination in its many forms, the regulation includes a number of provisions to protect consumers. Each health entity must provide appropriate aids and services to those with limited English proficiency and disabilities. The rule extends protections for transgender persons unlike ever before, including it as a form of sex discrimination. Furthermore, all services must be made available for gender transition (like a hysterectomy) that are available to a person seeking non-transition related care. All transgender persons must be treated consistent with their own gender identity.

The proposed rule also establishes a private right of action, giving individuals the ability to file a lawsuit under Section 1557 (courts had already begun to authorize private Section 1557 lawsuits, but this makes it official). This is an important step forward, because unlike the Section 1302 regulation, insurers will be highly motivated to comply with the 1557 regulation or face costly litigation. Insurers will think twice about changing their benefit design to discourage enrollment by individuals of a certain race, color, national origin, sex, age, and disability. Instead of taking years to pass a new regulation, a private cause of action allows the justice system to “keep pace” with quickly evolving insurer practices.

However, these positive developments are tempered by some noticeable omissions. Namely, the rule is conspicuously silent about discrimination on the basis of health status. As Timothy Jost stated in his recent post, “Surprisingly, the proposed rule does not directly address one of the most salient current discrimination questions: whether insurers can impose high cost sharing or otherwise limit access to expensive drugs needed by certain disabled populations.”

Eighty-seven of 91 former NFL players who donated their brains to science after death tested positive for a brain disease that is believed to be linked with repeated head trauma and concussions, researchers said.

The former players were found to have had chronic traumatic encephalopathy, known as CTE, according to the U.S. Department of Veterans Affairs and Boston University.

It's not clear why some players develop the disease and others don't.

The study results don't necessarily mean that 96% of all NFL players are at risk for CTE, said Dr. Robert Cantu. The brains came from players who, while they were alive, had concerns about CTE. His group began its work in 2008.

The FCSA is the brainchild of Mildred Velez who has been living with fibromyalgia since 2007. The organization is committed to introducing new approaches to care, dedicated care centers, professional training and education as well as a host of non-clinical direct services for people living fibromyalgia. Mrs. Velez, in partnership with a team of doctors, social workers and non-profit professionals has been working to design an organization that fills the gap in care that exists in the fibromyalgia care community.

"There are a handful organizations dedicated to fibromyalgia in the United States" said Mrs. Velez, President and Board Chair of the FCSA, she continued "some are focusing on research, others are focusing on education, some on support groups and some on a combination of all three which is great. I never set out to start my own organization; I was always interested in helping what was already in place. But over the past few months I took a real close look at what was in place and it occurred to me that there are some very critical things being done for other diseases that is are not being done for fibromyalgia."

"The important implications of this are that the optimal treatment may be different for each group, there may be different causes, and, for future clinical trials, it may be helpful to study specific groups separately."

The subtypes are:

• Inflammatory, in which markers such as C-reactive protein and serum albumin to globulin ratios are increased.
• Non-inflammatory, in which these markers are not increased but other metabolic abnormalities are present.
• Cortical, which affects relatively young individuals and appears more widely distributed across the brain than the other subtypes of Alzheimer's. It typically does not seem to cause memory loss at first, but people with this subtype of the disease tend to lose language skills. It is often misdiagnosed, typically affects people who do not have an Alzheimer's-related gene and is associated with a significant zinc deficiency.

Even patients with health insurance who have multiple myeloma may be vulnerable to "financial toxicity" - including those who make over $100,000 a year - because of the higher use of novel therapeutics and extended duration of myeloma treatment, researchers from Penn's Abramson Cancer Center report in this week's Lancet Haematology. Nearly half of the 100 patients surveyed tapped into their savings to pay for their care, and 17 percent reported delays in treatment due to costs, the team found. Ten stopped treatment altogether.

A relatively new term, "financial toxicity" is described as the burden of out-of-pocket costs experienced by patients that can affect their wellbeing and become an adverse event of treatment. Past studies suggest patients frequently employ coping mechanisms to help defray out-of-pocket costs, some which comprise treatment adherence. It may also negatively impact quality of life--and some reports suggest it may even contribute to increased mortality.