Health and Disability

Common viruses pose a serious threat in nursing homes, often sabotaging standard infection control measures, a new case study suggests.

A new study by researchers at the University of East Anglia (UEA) and the University of Glasgow has found that a low-cost therapy can improve the lives of stroke patients with vision problems.

A stroke can affect the way the brain processes the information it receives from the eyes which can cause a number of visual processing problems. The study aimed to test the effectiveness of visuomotor feedback training (VFT) in treating the most common of these, visual neglect, which happens when the brain does not process the information about what is seen on one side of space.

Patients with visual neglect may not be aware of the left or right side depending on the side of their stroke. For example, if the stroke affects the right side of the brain then patients will have problems processing the left side. This means they might accidentally ignore people, or even their own body, and may bump into things because they do not realise they are there.

The researchers, led by Dr Stephanie Rossit of UEA's School of Psychology and Dr Monika Harvey of the University Glasgow's School of Psychology, developed and tested a version of VFT for rehabilitating visual neglect in the patient's home.

A simple treatment of grasping, lifting and balancing wooden rods of different sizes, the idea is that by repeatedly grasping the rod so that it is balanced when lifted, the patients receive different sources of feedback from their senses - seeing, touching and feeling the rod tilting - which helps reduce the visual neglect. This relatively unexplored technique is not currently in clinical use.

Last week, Senate Republicans held hearings for Rep. Tom Price and Betsy DeVos, who respectively have been nominated to lead the U.S. Department of Health and Human Services and the U.S. Department of Education. For those of us who care about access to high-quality health care and education, each nominee has made many concerning statements. However, if we are thinking about the impact of these two departments on America’s kids, the views of the two nominees have the potential to do unique harm, in particular to children with disabilities and their families.

First, let’s start with health care. Congressional Republicans are working hard to repeal the Affordable Care Act, although they are encountering resistance nationwide and substantial skepticism from many senators and governors from their own party. Rep. Price, the nominee for HHS Secretary, is fully on board with repealing the law. One of the provisions at risk of being repealed is the essential health benefits (EHB) requirement. The essential health benefits (EHB) package creates a required floor of benefits for all consumers—including children with disabilities—and set a new federal standard to ensure that all consumers have access to needed services to be healthy.

One important benefit for many children with autism, for example, is habilitative services. According to current regulation, habilitiative care is defined as “services and devices that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.” Repealing the ACA means denying children with disabilities access to these important services.

It may surprise you how many children have periods of time in their development when they need these services—and then may no longer rely on them. Think about whether a child meets specific milestones around speech, walking, talking or has difficulty with their environment—sometimes termed as “sensory issues” or “being on the spectrum.” These children need access to supports that will give them the tools that they need to succeed at school and in their communities. Access to these types of services at the right time can significantly improve both their health and education outcomes.

For kids, health and education are closely linked. A healthy child is better able to stay focused in school and participate fully in their education. Moreover, research shows that kids with coverage through Medicaid or CHIP, a program that covers over 43 percent children with special health care needs, are more likely to succeed in school and go on to higher education.

Sepsis accounts for considerably more hospital readmissions and associated costs than any of the four medical conditions tracked by the federal government to measure quality of care and guide pay-for-performance reimbursements, according to an analysis led by the University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System.

The findings, published in the Journal of the American Medical Association, highlight the need for coordinated efforts to develop new medical interventions aimed at improving sepsis outcomes and reducing readmissions.

Sepsis is the No. 1 killer of hospital patients and was defined last year by an international panel as a condition that arises when the body's response to an infection injures its own tissues and organs, sometimes progressing to septic shock. According to the National Institutes of Health, it may occur in more than 1 million U.S. patients every year, and - despite best practice - an estimated 28 to 50 percent of these people do not survive.

"Many people think infections and sepsis are short-term illnesses and that once patients are discharged from the hospital, they are better," said senior author Sachin Yende, M.D., M.S., associate professor in the Pitt School of Medicine's departments of Critical Care Medicine and Clinical and Translational Sciences and vice president of Critical Care at the VA Pittsburgh. "But all research to date shows that sepsis has serious, lingering consequences, and patients continue to have problems well after they are discharged."

What causes the stigma and fear? It’s the stereotype of dementia: someone who cannot understand, remembers nothing, and is unaware of what is happening around them. This stereotype tugs at the heartstrings and loosens the purse strings, so is used in seeking funds for research, support and services. It’s a Catch 22, because Alzheimer’s associations promote our image as non-persons, and make the stigma worse.

— Christine Bryden, Austrailian Advocate Living with Dementia

On January 25 PBS will air Alzheimer’s: Every Minute Counts, a documentary framed as “an urgent wake-up call about the national public health threat posed by Alzheimer’s disease.” The film starts with phoned in quotes about the tragedy of Alzheimer’s from the perspective of care partners overlaid with dramatic images and music and then goes to experts with catastrophizing predictions such as, “It is going to sink the health care economy and in turn sink the national economy” and “It will take us down, this disease will take us down.”

The film details only one side of the story when it comes to Alzheimer’s. The result highlights just how hard care partnering can be without giving voice to people living with dementia or how society causes much of this suffering. The film uses scare tactics in the name of safety without respecting the dignity of taking risks  which those of us without a diagnosis take for granted every day. The film speaks about mounting medical costs with no mention of innovation or social capital. It warns us of the hardships of people living with dementia in isolation without highlighting communities who are banding together and helping each other live well regardless of cognitive ability. The film pathologizes “wandering” without asking how people are getting creative to protect the freedom to go where one chooses. The film interviews only one person living with dementia and the interview takes place immediately following her being given the diagnosis. The single ray of hope and possibility for living well comes at the end of the film when a family care partner is supported by hospice and remarks, “I have always been against any kind of help because I thought I would have to put her in a home or something, and I was totally wrong.” The film concludes with a plug for medical research funding as the only possible thing one can do about this so-called crisis.

A new study finds that the prevalence of dementia has fallen sharply in recent years, most likely as a result of Americans' rising educational levels and better heart health, which are both closely related to brain health.

Billboards are some of the more unlikely enhancers of the urban sensory experience: wafting out the buttery smell of baked potatoes, creating bubbles of fresh, pollution-free air, pointing out the identities of commercial airliners soaring overhead.

Now Stockholm has a billboard that takes aim at a habit that arguably degrades the public experience, with an interactive model who reacts with visible disgust to smoking. The advertisement, located on the city’s busy Odengatan plaza, uses smoke detectors to suss out the presence of lit cigarettes. A man on its computer screen then starts wincing and coughing, before the ad segues into a selection of smoking-cessation products.

CNN reports passersby have reacted to the billboard in a “mostly really positive” way, according to the pharmacy chain that commissioned the billboard from creative agency Akestam Holst. Up next: A billboard that detects the sound of muddy spit hitting the sidewalk to publicly shame dip users?

On January 17, 2017, the Congressional Budget Office—Congress’ nonpartisan scorekeeper—released a report on how the enactment of reconciliation legislation to repeal the Affordable Care Act (ACA) similar to that adopted by Congress in 2015 (and vetoed by President Obama) would affect health insurance coverage and premiums.

The report assumes that reconciliation legislation would repeal the individual mandate penalties and then, after a delay of two years, the premium tax credits and Medicaid expansions. The CBO further assumes that the legislation would leave intact the ACA’s insurance reforms, which presumably cannot be amended through reconciliation under the Senate’s reconciliation rules. These include the ACA’s essential health benefit and actuarial value requirements; its limitations on health status underwriting and pre-existing condition exclusions; and its rating requirements that allow premiums to vary only based on age, geographic locations, and tobacco use.

The CBO projects that the repeal legislation would not have an immediate dramatic effect in 2017 because premium increases would already be established and enrollment set for 2017. In 2018, however, 18 million people would become uninsured, including 10 million fewer enrollees in the nongroup (or individual) insurance market, 5 million fewer with Medicaid coverage, and 3 million fewer with employment coverage. These increases would be due to a combination of people dropping coverage because it was no longer mandated and to insurers abandoning the nongroup market and increasing premiums because of adverse selection concerns. As of 2018, insurers would increase premiums by 20 to 25 percent and about 10 percent of the population in areas where no insurers were available in the nongroup market.

In the year following the repeal of the Medicaid expansions and premium tax credits, the number of people without health insurance would grow to 27 million, further increasing to 32 million by 2026. If Congress repealed the insurance reforms as well, the number of uninsured people would only grow to 21 million in the year following repeal and to 23 million by 2026 (although coverage would be less comprehensive and individuals with pre-existing conditions may be unable to find coverage). The increase in the uninsured of 32 million would be the net result of 23 million fewer nongroup market enrollees, 19 million fewer covered by Medicaid, and 11 million more enrolled in employer coverage. In total, 59 million would be uninsured; 21 percent of the population.

CBO projects that the repeal of the individual mandate, premium tax credits, and Medicaid expansions would destabilize the nongroup market and that the destabilizing effects would worsen over time. In the first year after the repeal of the marketplace subsidies took place, nongroup market premiums would increase by 50 percent relative to current law projections and about half of the population would live in states with no insurer participation in the nongroup market. By 2026, nongroup market premiums would double and three-quarters of the population would live in states with no insurers in the nongroup market. Fewer than 2 million people would have nongroup market coverage.

The use of benzodiazepines and benzodiazepine-like drugs was associated with a 20 per cent increased risk of stroke among persons with Alzheimer's disease, shows a recent study from the University of Eastern Finland. Benzodiazepines were associated with a similar risk of stroke as benzodiazepine-like drugs.

The use of benzodiazepines and benzodiazepine-like drugs was associated with an increased risk of any stroke and ischemic stroke, whereas the association with hemorrhagic stroke was not significant. However, due to the small number of hemorrhagic stroke events in the study population, the possibility of such an association cannot be excluded. The findings are important, as benzodiazepines and benzodiazepine-like drugs were not previously known to predispose to strokes or other cerebrovascular events. Cardiovascular risk factors were taken into account in the analysis and they did not explain the association.

The findings encourage a careful consideration of the use of benzodiazepines and benzodiazepine-like drugs among persons with Alzheimer's disease, as stroke is one of the leading causes of death in this population group. Earlier, the researchers have also shown that these drugs are associated with an increased risk of hip fracture.

The team, led by Juyoung Park, Ph.D., and Dr. Ruth McCaffrey, conducted the first randomized trial to investigate the effects of chair yoga on adults with osteoarthritis in their lower extremities.

The study was published in the Journal of the American Geriatrics Society.

In the trial, 131 community-dwelling elderly adults with osteoarthritis of the hip, knee, ankle, or foot were randomly selected to follow either a Health Education program (HEP), or a Sit'N'Fit Chair Yoga program.

The participants undertook two 45-minute weekly sessions of either the HEP or chair yoga for 8 weeks.

Chair yoga is practiced either by sitting in a chair or standing while holding the chair for support.

The researchers primarily measured joint pain and how much the pain affects their day-to-day lives, or "pain interference." They also took secondary measurements of balance, fatigue, gait speed, and functional ability.

The team measured these parameters at baseline, 4 weeks, and 8 weeks into the interventions, as well as 1 month and 3 months after the interventions had ended.

The study showed an association between chair yoga and a reduction in pain, pain interference, and fatigue, as well as an improvement in gait speed.

Compared with participants in the HEP, those who participated in chair yoga reported a greater reduction in pain interference both during the sessions and 3 months after the chair yoga program ended.

However, the reductions in pain and fatigue did not last beyond the intervention, and chair yoga had no effect on balance.

Park explains the significance of the study:

"The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities."