Health and Disability

A recent study by water activists and researchers at Henry Ford Global Health Initiative has shown an association between shutoffs and some water-associated illnesses.

Working with the group We the People of Detroit, researchers compared block-level water disconnection data in Detroit from January 2015 to February 2016 with Henry Ford Hospital admissions and diagnoses for gastrointestinal and soft tissue infections during that time.  

The records showed that patients who lived on a block with shutoffs were 1.55 times more likely to have a water-associated illness, even when other socioeconomic situations are taken into consideration

The significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes, according to a meta-analysis published in the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

The systematic literature review and meta-analysis, conducted by Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN, and others at the Columbia University School of Nursing, found the prevalence of MDR-GNB colonization among sampled nursing home residents ranged from 11.2 percent to 59.1 percent, with a pooled average of 27 percent. Researchers also found that nine of the 12 studies involved identified specific factors that are associated with increased MDR-GNB colonization risk, including advanced age, gender, comorbid chronic diseases, history of recurrent hospitalization, increased interaction with healthcare workers, frequent antimicrobial exposure, delayed initiation of effective antibiotic therapy, presence of medical devices, decreased functional status, advanced dementia, nonambulatory status, fecal incontinence, severe sepsis present on admission, and residency in a long-term care facility.

The study is thought to be the first systematic review and meta-analysis of its kind, and should raise concerns among infection control professionals and nursing home facilities.

Older people newly prescribed sleeping pills like benzodiazepines and 'Z-drugs' have over double the odds of a hip fracture in the first two weeks compared with non-users, according to a new study by researchers at Cardiff University and King's College London.

Dr Ben Carter, Cardiff University's School of Medicine and the Institute of Psychiatry, Psychology and Neuroscience, King's College London, explains: "While 'Z-drugs are fast becoming the doctor's hypnotic prescription of choice, there is no evidence that they are a safer alternative to benzodiazepines in relation to hip fracture risk.

"Our study shows that both appear to significantly increase the risk of hip fracture when newly prescribed by doctors."

The study of people aged over 65 found that new users of these hypnotic medicines experienced nearly two and a half times the fracture rate, when compared with older people not taking hypnotics. An estimated 53% increase in fracture risk was identified in medium-term users (15 to 30 days), as well as a 20% increased risk of hip fracture in long-term users (greater than 30 days).

Dr Carter added: "Careful consideration of the immediate increased risk of hip fracture should inform the clinical decision-making process. Clinically effective measures like strength training to improve frailty, removal of hazards at home, visual correction and a medication review are also needed to mitigate the risk of hip fractures, particularly in the first few days of use."

Patients who were treated within six months of developing the first signs of the autoimmune disease did better in the long run and were less likely to suffer early death, British researchers found.

The findings stem from an analysis of more than 600 patients who were initially diagnosed with rheumatoid arthritis (RA) between 1990 and 1994. They were tracked for over 20 years.

Over the study time frame, investigators assessed key symptoms of RA, such as swollen and/or tender joints, and indications of disability. All deaths were also noted.

The research team found that patients who started treatment for RA within the first half-year after the first symptoms surfaced tended to have no greater levels of disability over a 20-year period than patients who required no treatment.

THIS SUMMER, A NEWS SITE CALLED TARBELL will make its debut and join a growing number of health-journalism startups. Named for the famous early 20th century muckraker Ida Tarbell, whose landmark expose of Standard Oil led to the breakup of the company, Tarbell.org will strive to produce similarly consequential investigative journalism, and pledges to “uncover how lobbyists and special interests affect you.”

Wendell Potter, Tarbell’s founder, oversaw public relations for Humana and served as head of corporate communications for Cigna from 1997 until 2008, when he left after what he called a “crisis of conscience.” Potter said he realized that much of what he had been doing during his insurance career was misleading the public.

The strategy of big insurers, Potter says, was to move everybody into high-deductible plans. “I was expected to promote them, to persuade reporters and the public that they were great for everybody,” he says. “And that was not true.”

After Potter left Cigna, he wrote the book Deadly Spin, in which he detailed deceptive insurance practices and revealed how the industry operated. Potter also wrote a column and provided analysis for the Center for Public Integrity, and examined “the marriage of great wealth and intense political influence” in last year’s Nation on the Take, a book that Nicholas Kristof called “eye-opening.”

In summary, using an online questionnaire in schools, we found a high prevalence of poor asthma control, poor asthma knowledge and a high morbidity in London children with doctor-diagnosed asthma. Since suboptimal control by ACT is a risk factor for future severe exacerbations [6]Ko FW, Hui DS, LEUNG TF, CHU HY, Wong GW, Tung AH, et al. Evaluation of the asthma control test: a reliable determinant of disease stability and a predictor of future exacerbations. Respirology 2012;17(2):370–378.[CrossRef], [PubMed], [Web of Science ®] , and should prompt more intense clinical monitoring [7]Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, et al. Monitoring asthma in children. Eur Respir J 2015;45(4):906–925.[CrossRef], [PubMed], [Web of Science ®] , our results suggest a need for interventions aimed at addressing poor asthma control in UK schoolchildren.

Phase 1 studies are designed to evaluate the safety of a treatment and identify side effects, using a small number of participants. While it was not the goal of this study to measure how effective the treatment was, symptoms improved for three of the six participants.

“While these results are very preliminary and much more research is needed, we are excited there were no serious side effects,” said study author Michael Pender, MD, PhD, of The University of Queensland in Brisbane, Australia.

The study investigates the relationship between MS and the Epstein-Barr virus (EBV), a herpes virus that is extremely common but causes no symptoms in most people. However, when a person contracts the virus as a teenager or adult, it often leads to mononucleosis. Previous research has shown a link between the virus and MS.

The study involved six people with progressive MS with moderate to severe disability. People with progressive MS have a severe condition with slow, steady worsening of symptoms.

In MS, the body’s immune system attacks the nerves in the central nervous system. As part of the normal immune response, immune cells called T cells and B cells work together to protect the body against infectious agents. In some people with MS, the immune response may be altered and T cells may be unable to control EBV-infected B cells, which accumulate in the brain and produce antibodies that attack and destroy myelin, the protective layer that insulates nerves in the brain and spinal cord. This in turns leads to neurologic dysfunction and symptoms. Elimination of the EBV-infected B cells may reduce the destruction of myelin in MS.

For the study, researchers removed the participants’ own T cells and stimulated them to boost their ability to recognize and destroy cells infected with Epstein-Barr virus. They then injected participants with infusions of escalating doses of T cells every two weeks for six weeks. They followed the patients through 26 weeks to look for evidence of side effects and possible improvement of symptoms.

Three of the participants showed improvement, starting two to eight weeks after the first infusion.

According to the study, in five of the nine clinical areas there was a significant negative association between the presence of state medical marijuana laws and prescriptions filled for each category by Medicaid beneficiaries. Furthermore, the authors estimate that if all states had had a medical marijuana law in 2014, the total savings for fee-for-service Medicaid could have been $1.01 billion. These results are similar to those in a study the authors conducted about the effects of medical marijuana laws on the number of prescriptions within the Medicare population, published by Health Affairs in July 2016.

For their evaluation, the authors used State Drug Utillization Data, collected by the Centers for Medicare and Medicaid Services (CMS). The data cover all drugs reimbursed by each state’s Medicaid program. “Our findings suggest that patients and physicians in the community are reacting to the availability of medical marijuana as if it were medicine,” the authors concluded.

“Our work adds to the literature that shows the potential clinical benefits of marijuana.  Since our findings also raise important questions about individual behavior and plausible safety concerns for patients who might forgo regular physician monitoring if switching from a prescription drug to marijuana, an important next step for medical marijuana law researchers will be to secure data on individual patients over time to assess these and related questions.”