Health and Disability

A new method of stimulating the renewal of living stem cells in tooth pulp using an Alzheimer's drug has been discovered by a team of researchers at King's College London.

The novel, biological approach could see teeth use their natural ability to repair large cavities rather than using cements or fillings, which are prone to infections and often need replacing a number of times. Indeed when fillings fail or infection occurs, dentists have to remove and fill an area that is larger than what is affected, and after multiple treatments the tooth may eventually need to be extracted.

As this new method encourages natural tooth repair, it could eliminate all of these issues, providing a more natural solution for patients.

Significantly, one of the small molecules used by the team to stimulate the renewal of the stem cells included Tideglusib, which has previously been used in clinical trials to treat neurological disorders including Alzheimer's disease. This presents a real opportunity to fast-track the treatment into practice.

Using biodegradable collagen sponges to deliver the treatment, the team applied low doses of small molecule glycogen synthase kinase (GSK-3) to the tooth. They found that the sponge degraded over time and that new dentine replaced it, leading to complete, natural repair. Collagen sponges are commercially-available and clinically-approved, again adding to the potential of the treatment's swift pick-up and use in dental clinics.

Lead author of the study, Professor Paul Sharpe from King's College London said: "The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentine.

Read more at: http://medicalxpress.com/news/2017-01-natural-tooth-method-alzheimer-drug.html#jCp

This kind of self-interested organizational immorality is all too common.....

A former nursing home employee has said a co-worker who assaulted her 13-year-old wasn't reported to the state in a timely fashion and continued to work at a nearby facility, according to local reports.

The 13-year-old was volunteering at the Cherry Creek Nursing Center in Aurora, CO, reported Fox 31 Denver, where she was assaulted by certified nursing assistant Alex J. Martinez, 34. He was arrested on four counts of child sex assault in July 2015, according to state documents. He pled guilty to lesser charges in September 2016, and in October was sentenced to two years in jail.

The mother of the victim, however, told the station she repeatedly asked the nursing home, her former employer, if it was going to report Martinez but said she was told that it didn't need to because the teenager was “just a volunteer.”

Martinez kept working as a nursing assistant at another facility for months after his arrest, the station reported. That nursing home said it had no knowledge of his arrest and would have terminated him if it they knew he was arrested for a sex crime at a different facility.

State laws vary on how abuse in nursing homes should be reported, including whether the abuse involved a patient or a volunteer. Lee said that Colorado's reporting system for the Board of Nursing "is focused on violations of the Nurses Practice Act and the Nurse Aides Practice Act. These statutes require reporting actions of nurses and nurse aides that have endangered their patients." However, when state officials received an email in late October about Martinez's conduct, it terminated his CNA certification within a week. 

Even a partial repeal of the Affordable Care Act will have a great impact on hospitals.

A new report by the Urban Institute finds that a partial repeal of the health reform law would increase the amount of uncompensated care that hospitals and healthcare systems provide to the uninsured at a free or reduced rate by $1.1 trillion over a 10-year period.

“Healthcare providers stand to lose considerable revenue if Congress moves forward with partial repeal of the ACA through the budget reconciliation process,” the study noted. “If the reconciliation bill is modeled on the one President Obama vetoed in January 2016, then we estimate that about 30 million more people could be uninsured by 2019. As a result, healthcare spending by insurers (public and private) and households would decrease by billions of dollars every year.”

The study, funded by the Robert Wood Johnson Foundation, used the 2016 budget reconciliation package repealing the ACA as the baseline for their analysis. Since that bill delayed its repeal of most budget-related components of the ACA for two years, researchers said they simulated the cost and coverage implications of a similar 2017 bill in 2019.

The report found that a repeal would cause healthcare spending by Medicaid, private insurance and households to drop by $145.8 billion in 2019, but an additional 30 million uninsured people would seek $88 billion in uncompensated care.

Federal funding for uncompensated care would increase by no more than $3.2 billion in 2019 unless lawmakers took legislative action. And the financial burdens on state and local governments, healthcare providers and the uninsured would likely rise dramatically.

In 2014, Community Catalyst shared Olivia Richard’s story in a video. Olivia is enrolled in the One Care program, the Massachusetts demonstration project which coordinates care for people with disabilities eligible for both Medicare and Medicaid (“dual eligibles”). Olivia uses a wheelchair and relies on personal care attendants (PCAs) to help her with activities of daily living. Before enrolling in the One Care program, she had not been receiving an adequate amount of PCA hours, nor other services she needed to achieve the quality of life and degree of independence she envisioned for herself. After enrolling in One Care, Olivia was able to live independently, with services that met her needs, preferences and goals, thanks to a coordinated plan developed together with her Independent Living-Long Term Services and Supports Coordinator. This was possible because of the Affordable Care Act (ACA), which enabled the creation of the dual eligible demonstration projects now ongoing in Massachusetts and 12 other states (formally termed the Financial Alignment Initiative.)

Fast forward to November 9, 2016: Individuals like Olivia now face the serious possibility that this much-improved coordination of their Medicare and Medicaid benefits may be significantly undermined by repeal of the ACA, impacting the delivery of critical services. Dual eligibles are a particularly vulnerable population – doubly in the line of fire – not only from the immediate attack on the ACA, but also from proposals circulating among the Republican-controlled Congress that threaten to seriously undermine each program in other ways in the future.

Beyond the unfolding rush to repeal the ACA, proposals in favor among Republican congressional leaders and the nominee for HHS Secretary, Rep. Tom Price, would permanently rework the structure and financing of Medicaid and could end the existing guarantee of coverage for all those who qualify for the program. In addition, House Speaker Paul Ryan has for years floated proposals to change Medicare from a defined benefit program to one in which adults over 65 get “premium support” to purchase private insurance, a plan slanted toward benefitting those older adults who are more affluent and in better health, leaving low-income elders in poorer health without the safety net that they have counted upon.

This is only one of several Republican replacement proposals. It is similar to proposals made by the Study Committee in 2013 and 2015, which have been analyzed elsewhere. I will, therefore, only describe it in brief.

The proposal would:

Repeal The ACA Entirely, Effective January 1, 2018

This would not just repeal the ACA’s Title I insurance reforms and affordability provisions and the Title II Medicaid expansions and improvements, but would also repeal provisions closing the Medicare doughnut hole and expanding Medicare coverage and titles dealing with health care quality, prevention of chronic disease, fraud and abuse, scholarships and grants to expand the medical workforce, and approval of generic biologics. It would further repeal the ACA’s taxes, including taxes on people making more than $200,000 a year amounting to $346 billion over 10 years.

Replace The ACA’s Means-Tested Premium Tax Credits And The Current Tax Exclusion For Employer-Sponsored Coverage

The proposal would instead institute an above-the-line standard income and payroll tax deduction for people who have “qualified health plans” of $7,500 for individuals or $20,500 for families. The tax credits would apparently not be adjusted for income, age, geography, or health status and would only be adjusted annually for growth in the consumer price index, not for increases in the cost of health care or coverage. “Qualified health plans” would only need to cover inpatient and outpatient hospital care, emergency care, and physicians’ services and “meaningfully limit individual economic exposure to extraordinary medical expenses.”

As part of equalizing the playing field for those purchasing insurance on their own and through employers, AHCRA would allow employees to exclude from taxation only the value of employer-sponsored coverage up to the above amounts, replacing the current tax exclusions for employer-sponsored coverage.

Expand Access To And Tax-Subsidized Contributions And Expenditures For Health Savings Accounts

The proposal would allow individuals to use tax-subsidized HSAs to pay for health insurance premiums and up to $1,000 a year in exercise equipment and fitness club membership fees.

The proposal would also:

• Increase the incentives that employers could offer employees for participation or penalties they could impose for non-participation in a wellness program to 50 percent of the value of benefits of employer coverage;
• Authorize (but not appropriate) $25 billion over 10 years for state high-risk pools for people who will be unable to obtain affordable insurance once health status underwriting is reinstated, and cap premiums in the high-risk pools at 200 percent of standard premiums;
• Allow people with preexisting conditions to move from employer to individual market coverage (or vice versa) as long as they maintain continuous coverage, without having to exhaust COBRA coverage. No limit is imposed on the premiums that insurers could charge individuals with preexisting conditions;
• Allow the sale of insurance across state lines subject to certain consumer and fraud and abuse protections;
• Permit small businesses to purchase coverage through association health plans;
• Provide additional health care options for category-1 veterans and Medal of Honor recipients;
• Amend the McCarran-Ferguson Act to provide that federal antitrust laws apply to health insurance;
• Increase transparency for Medicare claims and payment data and provide funding to the states to provide information on insurance plans;
• Block the federal government from denying coverage for health services based on lack of effectiveness;
• Make it harder for patients claiming to be injured by medical negligence to sue their doctors; and,
• Provide that health plans do not have to cover abortion services and that federal programs do not cover abortions except in cases of rape, incest, or when the life of the mother is jeopardized.

Most of these proposals have been discussed here already. I add only a comment as to one feature of the AHCRA not found in most other proposals — the use of deduction rather than a tax credit or exclusion to help individuals purchase health care.

Tax Deductions Versus Tax Credits

The ACA offers lower- and moderate-income Americans means-tested tax credits which are also effectively adjusted for variation in costs based on age or geography, since the credits are keyed to the actual cost of the second-lowest cost-silver plan that will cover a particular individual or family. The ACA also offers reductions in cost-sharing such as deductibles and coinsurance to lower-income individuals and families.

The current employer-sponsored coverage tax exclusion is not means tested; indeed, it is worth more in dollar value to higher-income enrollees because it reduces their taxes to a greater extent. But the exclusion is tied to the actual cost of coverage, and thus its value varies based the age and geographic location of covered employees. Moreover, non-discrimination requirements tend to ensure relatively generous coverage for lower-income employees, although it is not always affordable.

The value of the proposed deduction in the AHCRA would be inversely related to income, as all deductions are. A millionaire in the 39.6 percent tax bracket would receive almost $3,000 in income tax reductions for purchasing individual coverage and over $8,000 for purchasing family coverage. An individual in the 15 percent bracket would receive a maximum of $1,125 in tax reduction for an individual or $3,075 for a family. An individual without earned income would get no help at all. All individuals who had income subject to payroll tax would additionally receive a reduction in their payroll taxes (The payroll tax reductions would presumably reduce the funding of the Medicare and Social Security trust funds.)

Most individuals with low incomes would not be able to afford coverage with this level of assistance. Moreover, low-income individuals would not have the capital to pay premiums for health insurance until they realized the deduction at tax filing time. Finally, they would get no help with cost sharing unless they had enough money to save through an HSA.

One analysis of a similar proposal by President-elect Trump found that it would increase the number of the uninsured by 15.6 million, mainly through loss of coverage by lower-income individuals, although it would increase the number of higher-income insureds by 2.7 million. Of course, lower-income individuals with health problems would be doubly disadvantaged by the AHCRA as they would have to pay higher premiums for high-risk pool coverage as well. In sum, the AHCRA would flip the redistributional effects of the ACA, moving resources away from the sick and poor to the healthy and wealthy.

Potential Effects On Employer Coverage

 Researchers have uncovered a higher risk of death in black vs. white children with kidney failure over the last two decades that seems to be mediated by differences in access to kidney transplantation. The findings, which appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN), point to the need to develop strategies that will ensure equal access to transplantation for children.

Children with kidney failure are given high priority in the allocation of deceased donor kidneys because kidney disease interferes with normal growth. It's unclear if some children face racial disparities in this allocation, however.

To investigate whether there are racial disparities in the survival of children with kidney failure, Elaine Ku, MD (University of California San Francisco) and her colleagues analyzed information on 12,123 non-Hispanic black, Hispanic, and non-Hispanic white children who started renal replacement therapy (either dialysis or transplantation) between 1995 and 2011 and were followed up through 2012.

During a median follow-up of 7.1 years, 1600 children died. Black children had a 36% higher risk of death than white children, which was mostly attributed to differences in access to transplantation. Hispanic children had lower risk of death than non-Hispanic white children even though they had lower access to transplantation. Also, when investigators accounted for black children's reduced access to transplantation, there was no longer an appreciable difference in survival in black and white children.

Prisons across the U.S. routinely flout the Americans With Disabilities Act, subjecting thousands of inmates with physical and mental health problems to painful and sometimes humiliating conditions, according to watchdog groups, inmates, corrections officials, and a former Justice Department official in charge of enforcing the law.

The alleged violations include a case in Washington state where an inmate with neuropathy, a nerve condition that can cause numbness in the hands and feet, ended up living on the floor of his cell in solitary confinement. The prisoner, 50-year-old Curtis Graham, claims he was forced to urinate in cups because he was unable to stand after prison staff changed his medication and confiscated his orthopedic shoes and cane.

Most fragrances are now are made from oil and gas based chemicals.

They are in our personal care, laundry, and cleaning products. They are in garbage bags, candles, and shoes. They are in toys, fire-place logs, and diapers. They are in toilet paper, stationary, and stickers. They are in clothing, pillows, and jewellery. They are in foods, plastics, and medicines. They are in kitty litter, trash bags,  and vacuum cleaner bags. They are even in pesticides, where they are regulated by the EPA, but they are not regulated by anyone when they are added to all the other products we use and are exposed to!

There’s no escaping fragrance even when housebound, because so many  deliveries of even the basics like food, arrive fragrance contaminated!

We were not designed for 24/7 exposures to toxic chemicals

Investigators at Johns Hopkins report they have new evidence that a bacterium known to cause chronic inflammatory gum infections also triggers the inflammatory “autoimmune” response characteristic of chronic, joint-destroying rheumatoid arthritis (RA). The new findings have important implications for prevention and treatment of RA, say the researchers.

In a report on the work, published in the Dec. 14 edition of the journal Science Translational Medicine, the investigators say the common denominator they identified in periodontal disease (gum disease) and in many people with RA is Aggregatibacter actinomycetemcomitans. An infection with A. actinomycetemcomitans appears to induce the production of citrullinated proteins, which are suspected of activating the immune system and driving the cascade of events leading to RA.

“This is like putting together the last few pieces of a complicated jigsaw puzzle that has been worked on for many years,” says Felipe Andrade, M.D., Ph.D., the senior study investigator and associate professor of Medicine at the Johns Hopkins University School of Medicine.

“This research may be the closest we’ve come to uncovering the root cause of RA,” adds first author Maximilian F. Konig, M.D., a former Johns Hopkins University School of Medicine fellow now at Massachusetts General Hospital.