Health and Disability

Meet David, a 47 year old Veteran of the Navy. He is divorced with three kids, one in his custody. Over the last few years he has been in and out of homelessness, making minimum wage just outside of Philadelphia. He hasn’t seen a doctor in 8 years. If you ask him if he has applied for healthcare he will tell you “yea, dozens of times.” The answer is “dozens of times” because the current application process is confusing, frustrating, and often inefficient. Over the past few months, our team has been working to make applying for healthcare at the VA easier.

A new study published Friday in the Journal of Palliative Medicine reveals that our veterans aren’t always getting the end-of-life care they deserve.

The researchers analyzed the medical records of nearly 12,000 veterans over the age of 65 who died of cancer in 2012. From there, they looked at the type and quality of medical care the patients received in the last 180 days of their lives, either through the United States Department of Veterans Affairs (VA) or Medicaid. Both systems allowed the patients to receive hospice care, which is strictly defined as medical care and support intended for terminally ill patients and their families, but only VA patients could also receive palliative care — treatment intended solely to ease patients’ quality of life, regardless of whether their illnesses are necessarily terminal.  

They found that 71 percent of veterans across both systems received some degree of hospice care, and that 52 percent of VA patients had received palliative care. More specifically, Medicaid patients were more likely to receive hospice care for at least three days, and VA patients had the shortest median length of stay in hospice compared to Medicaid patients and VA patients who received their care from non-VA medical centers. There were also widespread differences in when palliative care was provided to patients with different types of cancer.

Pediatricians are being encouraged to take a more active role in helping families prepare for and adapt to the changes that come with puberty for girls with disabilities.

In a clinical report that will be published in the July issue of the journal Pediatrics, the American Academy of Pediatrics says that doctors should be ready to address the unique needs of adolescents with physical and intellectual disabilities surrounding puberty and menstruation.

The team found that increased beta-amyloid production led to increased expression of pro-inflammatory proteins in nerve cells, causing inflammation and nerve cell death.

"Inflammation within the brain is a major component of the damage associated with Alzheimer's disease, but it has always been assumed that this response was coming from immune-like cells in the brain, not the nerve cells themselves," notes first author Antonio Currais, also of the Salk Institute for Biological Studies.

They found that the marijuana compound reduced beta-amyloid levels and eradicated the inflammatory response to the protein, which prevented nerve cell death.

While clinical trials are needed to confirm the role THC might play in protecting nerve cells against beta-amyloid, the researchers believe their findings shed more light on the role beta-amyloid plays in Alzheimer's disease, which could pave the way for new treatments.

"Although other studies have offered evidence that cannabinoids might be neuroprotective against the symptoms of Alzheimer's, we believe our study is the first to demonstrate that cannabinoids affect both inflammation and amyloid beta accumulation in nerve cells."

Oral health is more than pearly white teeth — research has shown that oral health is linked to the health of the entire body. For those who can’t find a dentist to treat them, tooth loss, gum disease and pain negatively impact daily life and can erode their overall health. Consider:

• More than one-third of all Michigan seniors have lost six or more natural teeth due to tooth decay or gum disease. Low-income seniors are more than three times as likely to have lost six or more teeth from tooth decay and/or gum disease.
• Almost 3 out of 4 new mothers in 2008 did not receive dental care during their most recent pregnancy. Research shows gum disease is associated with preterm birth.
• 66 percent of third-graders in the Upper Peninsula had a history of dental decay in their primary and/or permanent teeth, compared with 56 percent statewide.

This situation exists despite efforts in Michigan to create and expand meaningful supports, particularly expansion of the Healthy Kids Dental program, which will cover all children on Medicaid in all counties beginning next year. According to the 2016 University of Michigan’s Child Health Evaluation and Research Unit, approximately 40 percent of children covered under Healthy Kids Dental did not receive dental services in 2014.

Years of studies, reports and task forces show us there is no one solution to this problem. But one strategy that hasn’t been tried in Michigan yet is adding mid-level dental providers to our state’s workforce to expand access to care.

Senate Bill 1013, introduced earlier this month by Sen. Mike Shirkey, would authorize a type of midlevel dental professional called a dental therapist. These providers would be able, with appropriate training and licensing, to deliver routine but critically necessary care such as filling cavities.

Similar to a physician assistant on a medical team, dental therapists would not work independently, but under the supervision of a dentist. Only dentists who want to hire dental therapists to expand their practices would do so.

Right now many people in Michigan have difficulty finding a dentist who will see them. They may face those challenges because there are not enough dentists where they live, or because no dentist nearby accepts Medicaid, or because they have barriers to traditional dental settings like a physical disability.

One of the key provisions of SB 1013 is to ensure dental therapists help create access for underserved populations. The bill requires them to practice in safety net settings like a public clinic or that at least 50 percent of their patients are on Medicaid, uninsured or face other significant barriers to getting dental care.

In a study published online today in the journal Scientific Reports, Mangalam and his team say that MS patients do, in fact, have a distinct microbiome from their healthy peers.

“Although preliminary, our data suggest that patients with MS have reduced levels of good bacteria responsible for overall benefits obtained from consuming healthy foods, such as soybean and flaxseeds,” says Mangalam, who is senior author on the study.

Full Study Article

After years of big promises, telemedicine is finally living up to its potential.

Driven by faster internet connections, ubiquitous smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs—and it’s upending the delivery of health care.

Doctors are linking up with patients by phone, email and webcam. They’re also consulting with each other electronically—sometimes to make split-second decisions on heart attacks and strokes. Patients, meanwhile, are using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions at home.

Telemedicine also allows for better care in places where medical expertise is hard to come by.

Five to 10 times a day, Doctors Without Borders relays questions about tough cases from its physicians in Niger, South Sudan and elsewhere to its network of 280 experts around the world, and back again via the internet.

In the woods outside St. Louis, shifts of doctors and nurses work around the clock in Mercy health system’s new Virtual Care Center—a “hospital without beds” that provides remote support for intensive-care units, emergency rooms and other programs in 38 smaller hospitals from North Carolina to Oklahoma. Many of them don’t have a physician on-site 24/7.

Many features of the developing gut microbiome were found to be consistent across all study participants, with the presence and abundance of particular species rising and falling at similar age points. The researchers also found several clear differences from previous research regarding the impact of breast-feeding.

Earlier studies comparing breast-fed with formula-fed children reported increased abundance ofBifidobacterium species in those who were breast-fed for longer periods of time. All of the children in the current study were breast-fed for some period of time, and while there was some correlation between the length of breast-feeding and levels of Bifidobacteria, some of the children in this group had low levels of those bacteria even while being breast-fed.

Previous studies also have reported finding a particular microbiome signature, with low abundance of the Bacteroides genus in cesarean-section-delivered children during the first six months of life. In the current study, the researchers found the same pattern in the four cesarean-delivered children but were surprised to find it also occurred in seven of the vaginally born children.

No identified factors, including maternal antibiotic treatment, differentiated between vaginally born children with or without the low-Bacteroides signature. Because this pattern has been associated with reduced overall diversity of the microbiome, Xavier noted, it warrants further investigation.

Person-centered care programs within healthcare organizations are more cost effective, but notably decrease how long a patient spends in a skilled nursing facility, according to a new report.

“Person-Centered Care: The Business Case,” released  by the SCAN Foundation June 20, draws on real-world results of person-centered care programs in calculating how - and who - saves money.

Person-centered care programs reduced skilled nursing stays by 20%, as well as decreased hospital admissions, readmissions and emergency department visit rates.

The Allina Health LifeCourse Program, which targets individuals estimated to have two to three years to live but who don't believe they are ready for palliative care, was one such person-centered program that resulted in skilled nursing savings for the healthcare system. Priority Health Tandem365, which targets advanced and chronically ill patients who find traditional ambulatory care impractical, also cut down on skilled nursing costs.

Michigan Department of Health and Human Services data show 56 people died in Genesee County from pneumonia or influenza in 2013. This same year, eight other people in Genesee County are confirmed as contracting Legionnaires’ disease, though it was not widely publicized.

2014

April 25: Flint begins using the Flint River as its primary source of drinking water.

June 6: The first recorded Legionnaires’ disease case in the Genesee County outbreak is discovered. It’s unclear whether that first case involved a patient at McLaren Regional Medical Center, but a hospital spokesperson later told the Detroit News that McLaren first noticed an uptick in Legionnaire’s cases in the spring of 2014, a year before Bertie Marble entered the hospital.

August 2014: McLaren said this is when it found “a low level of legionella” bacteria in its water system. The hospital said it “put immediate measures in place that were successful in controlling the situation.”

End 2014: Michigan Department of Health and Human Services data shows a 60 percent increase in deaths in Genesee County attributed to pneumonia and influenza in 2014, though the numbers, and the outbreak itself, were not publicized. There were 92 deaths in 2014, compared with 56 in 2013. (The state won’t reveal how many of those deaths were pneumonia versus the flu, saying the data remains under review).