Health and Disability

http://goo.gl/9b7Oeg

The biggest declines were in the rates of heart attacks and deaths from high blood sugar, which dropped by more than 60 percent from 1990 to 2010, the period studied. While researchers had had patchy indications that outcomes were improving for diabetic patients in recent years, the study, published in The New England Journal of Medicine, documents startling gains.

“This is the first really credible, reliable data that demonstrates that all of the efforts at reducing risk have paid off,” said Dr. David M. Nathan, director of the Diabetes Center at Massachusetts General Hospital, who was not involved in the study. “Given that diabetes is the chronic epidemic of this millennium, this is a very important finding.”

This is part of an ongoing set of issues related to saving money at the expense of PWD mobility....

http://goo.gl/gjVUJF

DREDF opposes any attempts to expand the competitive bidding program to include either additional regions or additional product categories. We oppose any proposal to expand the program for the following reasons: 1) competitive bid pricing can drive smaller, community-based durable medical equipment (DME) providers on whom people with disabilities rely, out of business, and 2) force DME providers to have smaller product inventories in stock, which has an impact on consumer choice, product quality and the speed with which urgent, emergency repairs can be made.

http://goo.gl/3MZTyy

In recognition of Residents' Rights Month and National Coming Out Day, the National Long-Term Care Ombudsman Resource Center released a new consumer fact sheet titled produced by NORC in collaboration with the National Resource Center on LGBT Aging and Lambda Legal about LGBT residents rights in nursing home.

This fact sheet highlights federal residents' rights and nursing home requirements that may be of particular importance to LGBT residents, options for complaint resolution, information for reporting abuse and resources regarding long-term care and LGBT advocacy.

http://goo.gl/lfD7U0

Steven Laureys, neuroscientist at the Université de Liège and lead author of the study, told Maclean's that the consequences of this study "are huge." His group found that 13 out of the 42 patients they screened showed signs of brain activity. In this state, he said, patients may have emotions and they might feel pain, so the neglect they often face is unacceptable. Moreover, patients who show small signs of consciousness sometimes have better health outcomes than patients who are truly "vegetative," so it's important to identify them early on. When given the right care, some may reach higher levels of consciousness over time. There have even been a few instances where patients have emerged from their comas.

Laureys hopes that this latest study will force the medical community to take notice. Currently, he said, "nobody questions whether or not there could be something more going on." But if Laureys' results are any indication, there might be more "going on" in more patients than doctors ever anticipated.

This legislation will be popping up in Michigan as well. Important to understand the implications....

http://goo.gl/NcXZ3G

I call the Disability Perspective a Quest for Balance because advance care planning has developed under the false premise that the primary or only problem is overtreatment of dying people. A balanced approach would also address the problem of undertreatment of people who may or may not be terminally ill. I want to emphasize that while the disability community may be most sensitive to this problem, it affects everyone who may find themselves on the patient end of the health care system.

The following suggested POLST statute is intended to allow individuals to use the form to effectuate their end of life treatment preferences while including protections against abuse and the possibility of death under unintended circumstances.  It contains protections not found in most POLST laws.  The protections for patients are the following:

• Limiting use of the POLST to individuals who have qualifying medical conditions
• Setting standards for the POLST “conversation” to ensure that people using the form have stable treatment preferences and are not steered to reject treatment.
• Requiring a patient or surrogate signature on the POLST for it to be effective.
• Requiring that the patient or surrogate promptly receive a copy of the POLST, so he or she can discuss it with family members and reconsider, if appropriate.
• Requiring mandatory reviews to update the form periodically.
• Requiring ongoing quality control reviews in facilities that use the POLST and mandating a review of compliance with the POLST law as part of licensing inspections. 

http://goo.gl/4Lk0tK

The researchers studied the number and kind of microRNAs expressed by adult mice exposed to traumatic conditions in early life and compared them with non-traumatized mice. They discovered that traumatic stress alters the amount of several microRNAs in the blood, brain and sperm - while some microRNAs were produced in excess, others were lower than in the corresponding tissues or cells of control animals. These alterations resulted in mis-regulation of cellular processes normally controlled by these microRNAs.

After traumatic experiences, the mice behaved markedly differently: they partly lost their natural aversion to open spaces and bright light and had depressive-like behaviors. These behavioral symptoms were also transferred to the next generation via sperm, even though the offspring were not exposed to any traumatic stress themselves.

http://goo.gl/CZEEbl

For those patients getting more than four hours of undisturbed sleep before waking to urinate, there were highly significant improvements in symptom bother, HRQL, activity levels, health status and how refreshed they felt the next day compared to those getting four or less hours of undisturbed sleep (p<0.0001) ^[ii].

Sufferers of nocturia consider disturbed sleep to be the most burdensome symptom, and around a third of people with nocturia are unable to get back to sleep after urinating, leading to insomnia^[iii]. Given the prevalence of nocturia is high with estimates suggesting 77% of men and women aged 60-80 years suffering, it is important that this condition is recognised and treated accordingly^[iv

http://goo.gl/RvZr5i

AARP surveys consistently find that nearly 90 percent of people age 45 and older want to remain in their homes and communities for as long as possible.

If you're one of them, the AARP Home Fit Guide can help you do just that with comprehensive advice, tips, and checklists for getting your home in top form for comfort, safety and long-term livability.

http://goo.gl/BYjSoE

There can be benefits for independent hospitals that merge with or are acquired by large health systems, such as greater access to capital for improvements to aging facilities, savings through joint purchasing and administration, and a financial “cushion” to help survive through hard times. But, there are also perils for hospitals and their patients. The shifting of local control to out-of-town system managers can mean a hospital is less responsive to community needs. Acquisition by a for-profit system can mean much greater attention to the bottom line, and sometimes, inappropriate practices such as demanding deposits from uninsured patients. Concerns remain that costs at for-profit hospitals could exceed those at non-profit hospitals.

http://goo.gl/hPoiVq

Churn—cycling in and out of insurance coverage or between types of coverage—is a persistent and challenging characteristic of our health insurance landscape. Churn can disrupt an individual's care by interrupting the patient-provider relationship, complicating access to medications, or causing a consumer to delay care. Moving in and out of coverage also leaves consumers at risk of incurring significant financial burdens. The effects of churn on children, many of whom are covered through Medicaid and CHIP, can be especially problematic, as children require frequent contact with the health care system for preventative services, developmental needs, and routine and acute care.

In many cases, uncertainty about the causes of churn adds complexity to our efforts to resolve this issue. Many different policy and administrative levers, can contribute to churn, and these causes require carefully tailored policy solutions.

This toolkit is designed to aid advocates in obtaining the data they need to understand the scope and causes of churn in their state's Medicaid/CHIP program(s), as well as resources to select policy approaches to resolving the causes they identify. Additionally, we have provided resources on the costs of churn and success stories of states that have adjusted their practices to reduce churning. We have also provided a guide for advocates who work directly with consumers and want to help individual families avoid losing coverage.