Health and Disability

Visual representation of differences....

https://goo.gl/hzfTqS

This graphic shows how the House and Senate versions of the ACA replacement measure up against each other and the law they seek to overturn.

Rheumatoid arthritis patients who achieve remission while on potent disease modifying agents, including biologics, often – like many other individuals with chronic disorders – wonder about and experiment with tapering or stopping their drugs.

In his review of outcomes in psoriatic arthritis at the annual meeting of the European Congress of Rheumatology (EULAR) in Madrid, Filip von den Bosch, MD, professor of internal medicine at the University of Ghent, Belgium, cited a 2015 article [Araujo EG et al, Ann Rheum Dis 2015] in which the authors found that 77% of patients who discontinued treatment with biologic agents experienced renewed symptoms.

Seniors who want to age in place are often faced with numerous challenges just getting around their own homes, which is why one senior care program from Johns Hopkins is focusing on improving the home environment—and saving Medicare big bucks in return.

The program, dubbed Capable (Community Aging in Place, Advancing Better Living for Elders), combines three key elements of senior care services: nursing care, occupational therapy and home improvement. For every $3,000 cost per person, the program saves Medicare more than $10,000, according to recent results published in Health Affairs.

In general, there is no lack of effective support programs out there, but scaling them up and replicating them is always problematic. This is the same problem with pilots as innovation strategies......

https://goo.gl/QQU6d4

Improving our system of care for older adults with complex, chronic illnesses requires wrestling with a vexing dilemma. Models of care that are readily scalable have limited effectiveness, and effective models are difficult to scale. As an example of the former, the patient-centered medical home (PCMH) has become widespread, but its impact on population health and health care costs varies and has been modest overall. As a stand-alone solution, the PCMH appears insufficient to deliver the diverse set of interventions required by chronically ill, older adults with complex needs—a growing segment of the US population that drives health care costs. Two complementary approaches provide opportunities to address this challenge: 1) strengthen the design and implementation of scalable models to make them more effective, and 2) innovate methods to improve the replication and spread of models already proven to be effective. Recent research and interest among funders and model builders working in the emerging field of complex care suggests that option two, innovating new methods of replicating effective models of care, deserves more attention.

A small study hints that a substance in the crunchy veggy may help some with diabetes get better control of their blood sugar.

Researchers found that a concentrated extract of the substance, called sulforaphane, helped obese type 2 diabetes patients rein in their stubbornly high blood sugar levels.

The caveat, however, is that the study was short-term and small -- involving 97 people with diabetes followed for 12 weeks. And the extract was taken in addition to the diabetes drug metformin, not instead of it.

Plus, the extract the researchers used was not like the sulforaphane supplements available at your local health food store.

"The way that you produce and process the extract is important to keep the sulforaphane intact," said senior researcher Dr. Anders Rosengren, of the University of Gothenburg, in Sweden.

He said his team used a highly concentrated supplement that was tested for purity and side effects.

"At this point," Rosengren said, "we cannot recommend that anyone take the currently available extracts on the market to treat type 2 diabetes."

 It’s hard to get anyone to take the time to read (let alone  understand) scientific research, but it’s so important that we educate ourselves when the opportunity arises. People have short attention spans these days, probably from all the neurotoxins and wireless radiation we’re all being exposed to on a daily basis, so it’s great when we find information that is short and to the point.

Here is a great short video series from  the UCSF Program on Reproductive Health and the Environment.

High-need patients are a varied group of people who tend to interact with the health system frequently. To better understand these patients’ experiences, Healthwise—a nonprofit that aims to help people make better health decisions—has identified three key populations within the high-need group: individuals with at least three major chronic conditions, individuals under 65 living with a disability, and frail elders, defined as people over age 65 with functional limitations.

As part of this work, Healthwise researchers interviewed multiple people in each of these different segments of the high-need group. Understanding their problems with the health system as well as their daily challenges provides insights into what aspects of care are working for people, and what needs repair. The patient voices provide a much-needed patient perspective at a time when federal health funding cuts are being considered. Below, we offer video of these three interviews.

Also acne......

https://goo.gl/Zu2hK7

Right now, there are billions of viruses, fungi, and bacteria living on your skin. They make up what is known as your skin microbiome. Don’t worry, though. No need to rush over to a sink and scrub them away. Most of these microorganisms are normal – and not harmful – regular residents of your body. 

In fact, many of these tiny organisms are extremely beneficial. They get along well with your body and play an important role in warding off infection and keeping you healthy. Together, these bugs make up what is called your skin microbiome.  

But sometimes things can get off balance. Researchers are starting to think that when your skin microbes are altered, they may contribute to health problems such as acne and other skin conditions.    

“The microbiome can interact with the immune system in a negative way,” explains Julia Oh, Ph.D., an Assistant Professor at the Jackson Laboratory for Genomic Medicine in Farmington, Conn. “This can cause different immune pathways to function improperly and result in disease.” 

While scientists have known about the microbiome in general for a long time, they have a lot more to learn when it comes to the specifics, such as how microbes might impact skin cancer development. 

Oh and her team think the skin microbiome may play a role in the development of a common skin cancer known as squamous cell carcinoma.

The number of cases of squamous cell carcinoma has been increasing for years, and about 1 million cases are diagnosed each year. Treatment of squamous cell carcinoma and other skin cancers is also a burden on the healthcare system – in the US, billions of dollars are spent to treat skin cancer each year, and costs continue to rise.

States are making tepid progress helping millions of elderly and disabled people on Medicaid avoid costly nursing home care by arranging home or community services for them instead, according to an AARP report released Wednesday.

“Although most states have experienced modest improvements over time, the pace of change is not keeping up with demographic demands,” said the report, which compared states’ efforts to improve long-term care services over the past several years. AARP’s first two reports on the subject were in 2011 and 2014.

The organization ranked states’ performance on long-term care benchmarks such as supply of home health aides, nursing home costs, long nursing home stays, the employment rate of people with disabilities and support for working caregivers.

AARP officials said the House’s bill to repeal the Affordable Care Act would worsen the situation by capping annual federal revenue for states’ Medicaid programs. That bill is now before the Senate.

“The proposed cuts to Medicaid — the largest public payer of long-term assistance — would result in millions of older adults and people with disabilities losing lifesaving supports,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute.

The report found strikingly wide variances in the share of state Medicaid spending for long-term care directed to home- and community-based services for elderly and disabled adults in 2014, the latest year for data covering all states. Minnesota, the top-ranked state, spent about 69 percent, but Alabama, ranked last, spent less than 14 percent.