Health and Disability

Physicians have been mystified by chronic fatigue syndrome, a condition where normal exertion leads to debilitating fatigue that isn't alleviated by rest. There are no known triggers, and diagnosis requires lengthy tests administered by an expert. Now, for the first time, researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

In a study published June 23 in the journal Microbiome, the team describes how they correctly diagnosed myalgic encephalomyeletis/chronic fatigue syndrome (ME/CFS) in 83 percent of patients through stool samples and blood work, offering a noninvasive diagnosis and a step toward understanding the cause of the disease.

"Our work demonstrates that the gut bacterial microbiome in chronic fatigue syndrome patients isn't normal, perhaps leading to gastrointestinal and inflammatory symptoms in victims of the disease," said Maureen Hanson, the Liberty Hyde Bailey Professor in the Department of Molecular Biology and Genetics at Cornell and the paper's senior author. "Furthermore, our detection of a biological abnormality provides further evidence against the ridiculous concept that the disease is psychological in origin."

"In the future, we could see this technique as a complement to other noninvasive diagnoses, but if we have a better idea of what is going on with these gut microbes and patients, maybe clinicians could consider changing diets, using prebiotics such as dietary fibers or probiotics to help treat the disease," said Ludovic Giloteaux, a postdoctoral researcher and first author of the study.

The U.S. Supreme Court has declined to hear Home Care Association of America v. Weil, ending a long-running legal saga and putting to rest any question of whether home care workers will be afforded minimum wage and overtime protections.

At issue is the Fair Labor Standards Act’s so-called companionship exemption. Home care workers were for decades considered “companion” workers and so were exempt from overtime and minimum wage rules that applied to most other domestic workers. This changed when the Department of Labor published a new rule in October 2013.

Home care industry associations pushed back against the new rule in court, winning at the Federal District Court level before the U.S. Court of Appeals for the District of Columbia Circuit affirmed the DOL’s move; the new rule took effect in October 2015, though full enforcement was delayed.

 Federal health investigators released a report on Friday that reached the same conclusion a Flint-area doctor did nearly a year ago — that blood-lead levels among children jumped dramatically after the city switched water supplies — though they now say those numbers are dropping.

The Centers for Disease Control and Prevention’s results indicated that during the 18 months the city was using the Flint River as its water source, the likelihood that a child’s blood-lead level would be more than 5 micrograms per deciliter of blood was nearly 50% higher than before the switch in April 2014.

The findings largely tracked those reported last September by Dr. Mona Hanna-Attisha, a pediatrician at Hurley Children’s Hospital in Flint, who looked at blood test results and found the number of children with elevated lead levels had jumped from 2.1% to 4% and was even higher in certain areas of the city.

Hannna-Attisha’s report was considered a watershed moment in drawing attention to the then-growing public health crisis in Flint, where lead started leaching out of old lead water pipes into residents’ taps when the city switched water sources without being required by the state to also use corrosion control. Hanna-Attisha was traveling and unavailable for comment Friday.

Ototoxic medications, literally "toxic to the ear," can include common prescription and nonprescription drugs, ranging from the seemingly benign, like aspirin and ibuprofen, to powerful chemotherapy drugs and certain antibiotics. People with hereditary hearing loss may be even more susceptible to their effects.

A high-fiber diet rich in vitamin A may alter gut bacteria in a way that could prevent or reverse food allergies. This is the finding of a new study published in the journal Cell Reports.

Co-senior author Laurence Macia, of Monash University in Australia, and colleagues came to their conclusion after studying mice that were artificially bred to be allergic to peanuts.

The researchers fed some of the mice a high-fiber diet rich in vitamin A - found in many fruits and vegetables - while others were fed a diet with average fiber, sugar, and calorie content (the controls).

the researchers found that the high-fiber diet altered the gut bacteria of mice, which protected them against allergic reactions to peanuts.

Next, the researchers took some altered gut bacteria from mice fed the high-fiber diet and transferred it to the guts of mice with a peanut allergy that were "germ-free" - that is, they had no gut microbes.

Even though these germ-free mice were not fed a high-fiber diet, the team found that the addition of the altered gut bacteria protected them against allergic reactions to peanuts.

The researchers explain that gut bacteria break down dietary fiber into short-chain fatty acids.

In their study, the team found that increased levels of these fatty acids work with the body's immune system, preventing dendritic cells - which regulate food allergies - from triggering an allergic response. Vitamin A is also important for dendritic cell regulation.

Their findings were supported when the team gave the allergic mice water enriched with short-chain fatty acids for 3 weeks, before exposing them to peanuts. Their allergic response was reduced.

Overall, the researchers say their findings indicate that a diet low in fiber could be driving food allergies, and that adopting a high-fiber diet - enriched with vitamin A - could be way to lower food allergy risk.

Some consumers who use health insurance copays to buy prescription drugs are paying far more than they should be and would be better off paying with cash, especially for generics.

Alzheimer’s is especially damaging for African-Americans, who are 2.52 times more likely than whites to develop cognitive impairments later in life.

Although scientists have not been able to pinpoint an exact cause for the racial disparity, recent studies have indicated a number of medical and socioeconomic risk factors.

Last July, neurologists at the Rush Alzheimer’s Disease Center in Chicago studied the brains of patients who died from the disease and discovered that Black patients’ were more likely than whites to show signs of irregularities more commonly associated with Parkinson’s, heart disease and stroke, in addition to the oft-reported plaques and tangles found in most brains.

A more recent Michigan State University study suggested the racial disparity could be attributed to childhood disadvantages faced by many older African-Americans, such as growing up impoverished in the segregated South, and lower educational attainment in adulthood.

That’s why organizations like the African American Network Against Alzheimer’s are critical in spreading the word. The AANAA was launched in 2013 by USAgainstAlzheimer’s, an independent non-profit agency committed to increasing government, industry and scientific resources toward research for a cure.

The Department of Veterans Affairs' Office of Inspector General said more than 200 appointments were incorrectly recorded for the year that ended in June 2015. Two former scheduling supervisors and a current director of two VA clinics instructed staff to incorrectly record cancellations as being canceled by the patient, the report shows.

Veterans in many instances then encountered average wait times of nearly three months when the appointments were rescheduled.

"These issues have continued despite the Veterans Health Administration ... having identified similar issues during a May and June 2014 system-wide review of access," according to the report. "These conditions persisted because of a lack of effective training and oversight."

Federal inspectors also determined that wait times for other veterans were understated by more than two months.

As a result, wait times "did not reflect the actual wait experienced by the veterans and the wait time remained unreliable and understated."

Opiates for chronic low back pain carry big risks with uncertain benefits

This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.

Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.

Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain.

We can watch Saving Private Ryan and cheer the heroics of our armed forces as they rescue the remaining son of a family who suffered horrendous battlefield casualties during World War II.

But there is less sustained effort to do something about the hundreds of thousands of people who entrust their lives to medical facilities and suffer or die—not from their illness, accident, or surgery—but because someone did not observe sanitary precautions, or was careless in stocking the crash cart, marking a surgical site, delivering the right medications, or using a safety checklist. Somehow, we accept excuses about this tremendous casualty toll.

The nation is unforgiving when the National Aeronautics and Space Administration (NASA) loses one of its astronauts—a reflection of our national commitment to preserving life.

But we can’t accept or process the extent of death by medical error, so we challenge the validity of the data. If 150,000 Americans die each year, or 440,000, does it matter?

Hospital and nursing home boards, management, and frontline supervisors should commit to dramatic reductions, within a year, in one or two of the nine leading causes of death: adverse drug events, catheter-associated urinary tract infections, central-line blood stream infections, patient falls in health care facilities, obstetric adverse events, pressure ulcers, surgical site infections, preventable blood clots, or ventilator-associated pneumonia.

The Centers for Medicare and Medicaid Services (CMS) is making this easy, with value-based payment initiatives that penalize providers for high rates of medical errors. So, act with alacrity! Enter a new era of transparency, by tracking progress month by month, unit by unit, and sharing best practices. Make reporting errors safe for employees, solve problems by getting to the root cause (forget workarounds), and reward high-performing staff members and unit directors. Use patient safety checklists and tools and technology to speed improvements.

Do this every year until there are dramatic reductions in all nine of the leading causes of death. Management at the highest level must continuously walk around and observe. It sends a clear message: this institution is deadly serious.