Health and Disability

Researchers from the University of Valencia (UV) have taken part in a study analysing the influence of gut bacteria on immune recovery in HIV-infected patients undergoing antiretroviral treatment (ART). They have discovered a correlation between immune recovery and the behaviour of a certain subset of gut bacteria in reponse to treatment. Interestingly, this behaviour appears to be both a consequence and a cause of recovery.

The implications of this finding are that new complementary therapies could be developed that target these bacteria to boost the efficiency of ART and prevent the complications associated with immune deficiency and chronic inflammation.

"HIV patients suffer from persistent immune deficiencies and chronic intestinal inflammation caused, in part, by the very toxins released by the cells to fight off the HIV infection. In this study we have found that, in some patients, certain gut bacteria become activated during ART and begin to amass anti-inflammatory molecules", explains CSIC researcher Manuel Ferrer of the Catalysis Institute. The immune recovery of these "ART responders" is much better than that of their peers, the make-up and behaviour of whose gut bacteria does not lead to the same anti-inflammatory effect.

It's not particularly hard to win a new game called EpiPen Tycoon: As Mylan CEO Heather Bresch, you just jack up drug prices to keep investors happy and boost your salary. If public outrage rises too high, you just wait it out—or press a button to "Call Your Dad (Senator)" or "Offer Generic Version."

It's a tidy simplification of the real story. Mylan raised prices on EpiPen packs 400% since 2007, from $57 to $600; Bresch's compensation rose as the drug price did, from $2,453,456 in 2007 to $18,931,068 in 2015. When customers became angry enough, and a petition quickly gathered more than 100,000 signatures, Mylan eventually announced that it would roll out a $300 generic version.

In any given year, around 100 million adults in the United States experience chronic pain - pain that persists for at least 12 weeks - of whom around 40 million have severe chronic pain.

While there are medications available to help ease chronic pain - such as nonsteroidal anti-inflammatory drugs (NSAIDs) - they are not always effective.

"For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects," notes Nahin. "As a result, many people may turn to nondrug approaches to help manage their pain."

By analyzing the MEDLINE database, Nahin and team identified 150 randomized, controlled U.S. clinical trials conducted over the past 50 years that looked at the effects of nondrug approaches on chronic pain.

Specifically, the researchers assessed the safety and efficacy of complementary health approaches for the treatment of five of the most common pain conditions: back pain, osteoarthritis, neck pain, fibromyalgia, and severe headaches andmigraine.

The researchers found there was strong evidence to suggest that yoga and acupuncture are safe and effective for back pain, while acupuncture and tai chi might benefit people with pain caused by osteoarthritis of the knee.

Results also suggested that massage therapy is safe and effective - particularly if administered in 1-hour sessions two to three times weekly - for short-term alleviation of neck pain.

Furthermore, there was evidence to suggest relaxation techniques - such asstress management and relaxation training - are safe and effective for the treatment of severe headaches and migraine.

There was some evidence to suggest that people with back pain might benefit from spinal manipulation, massage therapy, and osteopathic manipulation, while tai chi and relaxation approaches might benefit patients with fibromyalgia. However, these associations were not as strong.

Comorbidities (other health conditions) are highly prevalent in patients with COPD. Low physical activity (PA), a critical feature of COPD, is believed to be an important risk factor for comorbidities. In this new study, the authors assessed the association of PA with incidence of 7 categories of comorbidities in COPD.

The study included 409 patients from primary care practice in the Netherlands and Switzerland. The researchers assessed PA using the Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire at baseline and followed patients for up to 5 years. During follow-up, patients reported their comorbidities (cardiovascular, neurological, hormonal, musculoskeletal, cancer, and infectious diseases) and completed the Hospital Anxiety and Depression Scale questionnaire for mental health assessment.

The authors conclude: “In COPD patients, those with high PA are less likely to develop depression or anxiety over time. PA promotion programs may be considered to lower the burden of mental disorders in COPD patients.”

They add: “These findings have particular significance since mental disorders are common in patients with COPD. The prevalence of depression and anxiety is approximately 40% in COPD patients while the corresponding figure is less than 10% in the general population.”

It is a scary thought to consider. What if we were ill, suffering from Alzheimer’s or dementia, and didn’t know it? How would our loved ones cope?

In fact, it is very difficult for caregivers and family members to make progress with a person’s illness when a loved one is showing signs of anosognosia. Yet, the condition is alarmingly common: After stroke, some studies show up to 77% of patients suffer anosognosia at least temporarily, reports one review of the literature.

It occurs frequently in those with mental illness, according to the Treatment Advocacy Center, and can also affect people who have suffered traumatic brain injury, as well as people with Alzheimer’s and other types of dementia.

Studies suggest that deterioration in the frontal lobes may be involved, which “play an important role in problem-solving, planning and understanding the context and meaning of experiences and social interactions,” according to the New York Times’  New Old Age blog.

To put it another way, our right brain is wired to detect anomalies and new information and incorporate these into our sense of reality, says the neuroscientist Dr. V.S. Ramachandran, also in the New York Times. When something happens to damage that part of the brain – a stroke or dementia, for instance – then “the left brain seeks to maintain continuity of belief, using denial, rationalization, confabulation and other tricks to keep one’s mental model of the world intact.”

Racial minorities and lower-income people typically fare far worse when it comes to health outcomes. And figuring out why has long been one of health care’s black boxes. Forthcoming research may help shed light on what’s driving those inequities — and how the system can fix them.

What is needed? Better bedside manner, so patients actually trust their doctors. Communication that is easily understood by everyday people. And transparency about what medical care costs, plus a willingness to discuss how price points fit into consumers’ health decisions.

The paper suggests that “implicit bias” — doctors and nurses subtly or subconsciously treating some patients differently than others — or patients’ perception of it could have consequences for people’s health. Patients who felt that they had experienced bias based on factors like race, income or insurance were less likely to follow advice about medication, for instance, and ended up sicker in the long run.

“We for a long time have neglected the human element,” said Chris Duke, director of Altarum’s Center for Consumer Choice in Health Care, and the white paper’s author. “The number one predictor of patient satisfaction is if your nurse listened to you. We neglect this at our great peril.”

Our hypothesis was that critical illness would lead to a loss of diversity of the microbiome and that this loss of diversity would correlate with adverse outcomes, or perhaps even predict them. That was really the goal of the project: to use the microbiome diagnostically to identify patients who are at risk for bad outcomes, then ultimately guide us in replacing the healthy bacterial population to drive recovery.

Our initial results have really supported that hypothesis. Patients lose significant, significant amounts of their normal flora, the families of bacterial species that make up a healthy gut or oropharynx. They’re largely replaced by pathogens or proteobacteria; like staph, proteus, and other bacteria we associate with GI-associated bacterial translocation. Under normal circumstances, the human gut is made up of many different species. The most abundant bacterial family might make up 25 or 35 percent, and there are many others present. Our patients often start out with that normal appearance, but within just a few days we saw that in some patients 95 percent of bacteria in the gut were one taxa, and often this was a pathogen that dominated. One bacterial taxa overwhelms the rest, or grows because the others have been wiped out by antibiotics or other interventions. The lack of diversity that can occur is severe.

Life story work involves helping people to record aspects of their past and present lives along with future hopes and wishes, often in a book or folder or, increasingly, in music, film and multi-media formats.

The study found that many health and social care services in England now use life story work, but the ways in which they do this vary considerably.

Researchers compiled evidence on life story work in dementia care through a systematic literature review, in addition to listening first-hand to views of people with dementia, family carers and professionals through a series of focus groups.

Conducting a national survey of family carers and dementia service providers, along with an in-depth analysis of life story work in six care homes and four hospital wards, researchers tested the feasibility of doing a full scale evaluation of life story work in these settings.

The study concluded that life story work has the potential to help people with dementia, but a full scale evaluation is needed.

Considering switching from a brand name to a generic drug, or vice versa? Here’s what you need to know.

Many medications can be changed from brand name to generic, or vice versa, with no problems. But sometimes even tiny changes in a medication formula can make a big difference in how a medication affects your body. Here are nine types of medications you need to talk to your doctor about before switching.

Medications for underactive thyroid

Because the thyroid is such a sensitive gland, even a small change in the dose of your thyroid medication may have a major effect on the amount of thyroid hormone in your blood. “Generic products do not have to contain the same inactive ingredients as the comparable brand-name products,” explains Susan W. Miller, professor and chair of the Department of Pharmacy Practice at Mercer University College of Pharmacy in Atlanta. “For any patient, levothyroxine — whether brand names Synthroid, Levoxyl or Levothroid, or generic — should ideally not be switched,” Miller says. If a switch is necessary, “the patient’s thyroid levels should be closely monitored to detect changes in the blood levels of the hormone,” she cautions.

Asthma inhalers

There are several different forms of albuterol inhalers (Ventolin, Proventil HFA, ProAir HFA, ProAir RespiClick) and levalbuterol (Xopenex HFA). Miller says it’s hard to get the exact same response when using different albuterol inhalers because they are “rescue therapy” for asthma attacks. To play it safe, don’t change the brand of your albuterol inhaler without your doctor’s supervision and monitoring. Also, you might want to double-check your prescription before you leave the pharmacy in order to make sure your new inhaler matches the one you had picked up the last time.

Digoxin for heart failure

In 1984, Congress passed a law that made it faster and easier to get generic medications approved. However, since both brand name Lanoxin and its generic version digoxin were already on the market before this law was passed, makers of the generic version didn’t have to prove whether digoxin worked similarly enough to Lanoxin for the two to be swapped. Since the differences between digoxin and Lanoxin haven’t been studied, Miller says it’s best not to switch.

Several more drug families listed. Worth a look......

High school athletes who kept playing in the minutes after a concussiontook nearly twice as long to recover as those who left the game immediately after the head trauma, a new study shows.

The finding, published in the journal Pediatrics, is believed to be the first to focus on one of the most difficult social challenges of treating concussions: a pervasive sports culture that encourages young athletes to keep playing through pain. Medical guidelines call for benching the athlete immediately after the head injury to prevent long-term complications and the potentially devastating consequences of a second hit.

“Kids are often reluctant to acknowledge a concussion,” said Dawon Dicks, a youth football coach with CoachUp in Andover, Mass. “The kid may want a scholarship and want to go to college, or it could be that ‘Dad or Coach wants me to play.’ That’s when they’re going to start to be a little dishonest in what they’re truly feeling.”