Health and Disability

Researchers at Yale School of Medicine have found that a compound produced by the body when dieting or fasting can block a part of the immune system involved in several inflammatory disorders such as type 2 diabetes, atherosclerosis, and Alzheimer's disease.

In their study, published in the Feb. 16 online issue ofNature Medicine, the researchers described how the compound β-hydroxybutyrate (BHB) directly inhibits NLRP3, which is part of a complex set of proteins called the inflammasome. The inflammasome drives the inflammatory response in several disorders including autoimmune diseases, type 2 diabetes, Alzheimer's disease, atherosclerosis, and autoinflammatory disorders.

It is widely agreed that person centred services for people with long term conditions should be coordinated; support self management; engage people in decisions; provide effective prevention, early diagnosis, and intervention; and offer emotional, psychological, and practical support.6 More needs to be done to realise the untapped potential of patient led care through increasing tailored information, education, and training; access to new technologies; and peer and community support.12 13 Accumulating evidence and experience shows that people who are “activated”—that is, have the knowledge, skills, and confidence to manage their health effectively—are more likely to adopt healthy behaviours and have better health outcomes and care experiences.11 This may lead to better use of resources.11

Thus, health services need to provide a comprehensive and coordinated range of interventions for populations but organised to provide a tailored response for each person. This requires fundamentally new ways of thinking about service delivery and relationships, recognising that whole system approaches are needed with support for self management as the central component, as set out in the chronic care model.14 Recent comprehensive programmes of care, such as TEAMcare in the United States15 and the Flinders programme in Australia,16 show that system wide organisational change can be achieved and improve clinical and personal outcomes.

The new study reveals that they often do when they advance in age, and that it happens regardless of being in a long-term relationship when faced with a bleak diagnosis. "The quality of our social ties plays a role when it comes to coping with the effects of serious disease in later life. And just having a partner around may not be enough," Barlow says.

Looking at the numbers provided some insights into how self-protective strategies can reduce the stress associated with a serious health issue. In particular, positively reappraising a difficult health situation and not blaming oneself for the illness prevented feelings of loneliness, most likely because it helps maintain motivation for social involvement and prevents depressive symptoms. "Putting a halt to socializing only contributes to a downward spiral," Barlow says. "Dealing with a chronic illness shouldn't prevent you from still trying to get out there if you can."

The study, which examined 5,050 patient-physician encounters, found that -- despite doctors' perceptions -- patients aren't demanding medicine they don't need.

Analyzing the records of more than 5,000 cancer patient visits in Philadelphia, a team of researchers at the University of Pennsylvania found that patients requested additional treatment in 9 percent of conversations with doctors. Of those, only 1 percent of the requests were for "clinically inappropriate" treatment — the other 99 percent were for medicine that would be appropriate for the given prognosis.

"Most of the demands or requests are clinically appropriate and many seem reasonable," the researchers wrote. "Other patient demands are even desirable. For instance, requests for additional palliative interventions, such as pain medications or insomnia treatments, accounted for 1 in 6 of the demands or requests (15.5%) and provide insight into patients’ symptoms, which is obviously valuable."

This is a great week for SPM, for our colleagues at the Stanford Medicine X conference, and for everyone else who’s been working for years to shift medicine’s thinking about the role of the patient: Yesterday the BMJ (formerly British Medical Journal) released a big, 21 article “Spotlight” supplement on “patient centred care.” The print edition is due out tomorrow, Feb. 12. The list of articles in the Spotlight is below.  Important: they’re all open-access – no subscription required.

The world is an exceedingly strange place when products that are designed to kill unwanted and uncared for “pests” have fragrance chemicals added to change the way they smell, and those fragrance chemicals are better regulated than the ones in products we living (wanted and cared for?) humans are sold, for intimate use, on a daily basis.

My Drug Genome is your resource to learn about how genetics can affect the way medications work and how genetic results can be incorporated into personalized patient care.  Part of personalized medicine means ensuring that patients receive medications that are right for them.

What is PREDICT?  Vanderbilt University has launched PREDICT (Pharmacogenomic Resource for Enhanced Decisions in Care & Treatment), which empowers patients and doctors with the genetic information needed to predict and help prevent bad drug side effects. Because each person responds differently to medicines, this knowledge helps doctors to prescribe drugs that work better and have fewer side effects.