Health and Disability

During the last months of the Obama administration, the federal government rolled out a new rule aimed at shielding the elderly from unscrupulous, abusive, or merely bad nursing home practices. The Trump administration is now poised to yank that protection away.

Last fall, the Centers for Medicaid and Medicare Service finalized a rule that banned nursing homes and assisted living facilities from forcing patients and their families into private arbitration to resolve any disputes—a practice that keeps any such conflicts out of the court system, thereby weakening patients' legal leverage. The rule was set for implementation last November, although court challenges by the nursing home and healthcare industry have kept it on hold.

On Monday night, the CMS released a proposed rule that would almost completely rescind the ban on mandatory arbitration clauses in nursing home contracts. "These proposed revisions would help strengthen transparency in the arbitration process, reduce unnecessary provider burden, and support residents’ rights to make informed decisions about important aspects of their health care," the agency said.

A series of hyper-local pollution maps have revealed how air quality can vary drastically across even the smallest of distances.

In their analysis, the researchers identified hotspots where pollution on a single block was consistently higher than elsewhere in a neighbourhood. These pollution hotspots, unsurprisingly, included the port, busy intersections, restaurants, warehouses, industrial plants and vehicle dealerships.

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People who exercise very hard may be prone to acute or chronic gut issues, researchers reported.

A systematic review suggested that exercise intensity was a key regulator of gastric emptying rate, with higher intensity exercise (≥70% peak power output) causing the greatest disturbance to gastric motility, according to Ricardo J.S. Costa, MD, of Monash University in Victoria, Australia, and colleagues.

However, steady state moderate exercise (60-70% peak power output or 66% VO2max equivalent) did not appear to influence gastric emptying and intestinal transit compared with rest in well-trained individuals, they wrote online in Alimentary Pharmacology and Therapeutics.

Additionally, they found that the impact of high-intensity exercise on gastric motility appeared to be ephemeral, as the intensity of prior exercise had a negligible effect on post-exercise gastric emptying rate of a glucose solution.

"Understanding the effect of prolonged strenuous exercise on gastrointestinal motility is important since the consumption of foods/fluids during exercise aids in the maintenance of blood glucoseconcentration and euhydration, aimed at attenuating fatigue and enhancing exercise performance," Costa stated. 

Statins, already used to treat high cholesterol in patients, may also dramatically reduce the risk of death in patients with breast cancer. A new study, presented at the American Society of Clinical Oncology in Chicago this week, has found that the commonly used drug may cut the death rate by up to 38 percent.

The work has been carried out by scientists in China, and is a meta-analysis of seven other studies, coming to the conclusion that using lipophilic statins seemed to offer a protection to people suffering from breast cancer. It comes after many other studies have observed this link before, and has prompted fresh calls for clinical trials to investigate whether or not they could be used to improve the rates of breast cancer survival.

The analysis found that taking the statins after being diagnosed with breast cancer cut the risk of death from cancer and all other causes of death by an impressive 38 percent. Interestingly, however, this was only true for those who were taking them for under four years. After this cut-off period, the protective ability of the drug fell, and cut the death rate by a much lower 16 percent.

 The type of hospital neonatal intensive care unit may have an effect on the infant microbiome, with differences observed between infants in older and newer hospital NICUs, according to a pilot study presented here.

Overall, the authors detected several pathogens from infants in both NICUs, including respiratory syncytial virus, Clostridium difficile, Methicillin-resistant Staphylococcus aureus, and parasites (such as Acanthamoeba polyphaga). However, none resulted in clinical disease, the authors said.

They found significantly higher levels of STL polyomavirus and MW polyomavirus (Kruskal-Wallis, P=0.017). Also, papillomavirus trended toward significance in the environment of the shared space NICU.

Researchers here may have found an unlikely ally in their fight against antibiotic-resistant pathogens -- commercial yogurt.

Relman added that the positive properties of Lactobacillus are well-known. Prior research several years ago identified a different Lactobacillus species that normally lives in the vagina. It produced an antibiotic called lactocillin that kills off E. coli bacteria, but doesn't touch the other normal, healthy vaginal bacteria.

Other research on different species of Lactobacillus shows that it may affect a woman's risk of contracting HIV, as well as play a role in helping to prevent preterm birth.

"This yogurt organism is to presumably serve that Lactobacillus in its natural environment and to protect it from competitors," Relman said. "They're all doing interesting things, and a lot of them are in food. We just have to figure out how to select the right ones for the right properties and ensure that we're not killing them by mistake."

The isolate was identified as Lactobacillus parafarranginis KU495926 and it inhibited 14 multi-drug resistant and extended spectrum beta-lactamase bacteria, which are known for breaking down antibiotics. The 14 isolates were comprised of:

• Escherichia coli (5)
• Pseudomonas aeruginosa (2)
• Acinetobacter baumannii/haemolyticus (3)
• Enterobacter aerogenes (1)
• Proteus mirabilis (2)
• Klebsiella pneumoniae (1)

An analysis of billing records for more than 12,000 emergency medicine doctors across the United States shows that charges varied widely, but that on average, adult patients are charged 340 percent more than what Medicare pays for services ranging from suturing a wound to interpreting a head CT scan.

A report of the study's findings, published in JAMA Internal Medicine, also notes that the largest hospitals markups are more likely made to minorities and uninsured patients.

"There are massive disparities in service costs across emergency rooms and that price gouging is the worst for the most vulnerable populations," says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the study's senior investigator. "This study adds to the growing pile of evidence that to address the huge disparities in health care, health care pricing needs to be fairer and more transparent," adds Makary, whose widely published research focuses on health care costs and disparities.

For the study, Makary and his team obtained Medicare billing records for 12,337 emergency medicine physicians practicing in nearly 300 hospitals all 50 states in 2013 to determine how much emergency departments billed for services compared to the Medicare allowable amount.

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

Seniors with Alzheimer’s disease are dying in their homes more than they were nearly two decades ago.

That’s according to a new report from the Centers for Disease Control and Prevention (CDC) on deaths from Alzheimer’s disease. Alzheimer’s, a fatal form of dementia, is the sixth leading cause of death in the United States, making up 3.6% of all deaths in 2014.

President Trump's proposed budget includes billions of dollars in reductions to social service programs over the next decade, including one that has received a lot of attention: Social Security Disability Insurance.

The long-standing program, designed primarily to protect workers who become injured or disabled, currently serves nearly 9 million American workers, generally between the ages of 18 and 64, as well as almost 2 million of their dependents. Known in the jargon of Washington as SSDI, the program would bear a large share of the overall cuts, with roughly $70 billion slashed from its budget over the next 10 years.