Health and Disability

UCLA researchers have found that a game-changing immunotherapy drug produces positive responses that are long-lasting and with less side effects than traditional treatments in people with advanced melanoma, the deadliest and most aggressive form skin cancer.

The study, published online in the journal JAMA Oncology, is a long-term follow-up of the phase 1 clinical trial that led to the approval of the drug pembrolizumab by the U.S. Food & Drug Administration. The trial is the largest ever conducted in people with advanced melanoma, said Dr. Antoni Ribas, a professor of hematology and oncology, and director of the UCLA Jonsson Comprehensive Cancer Center Tumor Immunology Program.

"The early data from this research showed the unprecedented activity of pembrolizumab in people with advanced melanoma, and we can now report the full results of the study," Ribas said.

Pembrolizumab (marketed as Keytruda®) is a targeted therapy known as a checkpoint inhibitor. The drug is an antibody that blocks a protein called PD-1 that is expressed by immune cells. PD-1 puts the immune system's brakes on, keeping T cells from recognizing and attacking cancer cells. It releases the brakes from the body's immune system which allows it to attack the cancer cells.

Results of a multi-institutional national study of nearly 700 people who survived life-threatening illness with a stay in an intensive care unit (ICU) suggest that a substantial majority of them are at high risk for persistent depression, anxiety andpost-traumatic stress disorder -- especially if they are female, young and unemployed.

The study, led by Johns Hopkins University researchers, found that two-thirds of study participants who survived a condition called acute respiratory distress syndrome (ARDS) and spent time in the ICU self-reported symptoms of at least one of these psychiatric disorders, and one-third of those patients with at least one psychiatric symptom said they experienced all three at the same time.

Contrary to the common risk factors associated with post-ARDS physical impairments and mortality, such as severity of illness and length of ICU stay, this study demonstrated that none of these risk factors had positive association with psychiatric symptoms.

"We need to pay more attention to the psychiatric vulnerability of ICU patients in recovery who are women, younger and unemployed prior to hospitalization, not just look at traditional measures of risk, such as greater illness severity and longer length of stay," says Dale Needham, M.D., professor of medicine at the Johns Hopkins University School of Medicine.

new research shows that American cities with lead water pipes had higher murder rates in the first half of the 20th century.

The paper, which will be published in the journal Explorations in Economic History, builds on a growing body of research linking lead exposure to various criminal behaviors, amounting to a plausible explanation for rising and falling crime rates in the United States over the past several decades. Most of that research to date has focused on lead exposure from air pollution caused by leaded gasoline, not water. 

A secondary analysis of data gathered in scores of interviews with female inmates suggests girls who have an incarcerated adult in the family may be at greater risk for lifelong neurological problems.

The new findings in a study by Kathleen Brewer-Smyth of the University of Delaware's College of Health Sciences show that female inmates with at least one adult incarcerated family member during childhood were more than twice as likely to have neurological abnormalities as adults than female inmates who had no incarcerated family members. The article was published by Health Care for Women International.

The implications are significant internationally, Brewer-Smyth said, in light of a World Health Organization 2015 report¹ that predicts neurological decline will be an increasing public health problem worldwide.

Because of the nature of the study - a cross-sectional review of data gathered in other research - no cause and effect can be determined, said Brewer-Smyth, associate professor in the School of Nursing.

However, knowledge of the many challenges and potential deficits facing children with an adult family member behind bars can help researchers, child advocates, and policy makers find better strategies and support systems for those children in the future.

"We're good at identifying problems," Brewer-Smyth said, "but we haven't figured out the best ways to fix them."

President Obama has signed the Older Americans Reauthorization Act (OAA) into law, reestablishing funding levels for many services that enable millions of older adults to remain in their homes through retirement.

The legislation provides funding for critical services including Meals on Wheels, transportation, caregiver support, legal services, elder abuse protection and more, for the next three years. Congressional members in the House and Senate approved the legislation earlier this year.

“The OAA underpins a promise to preserve the right to live independently, with dignity, making everyday decisions according to our individual preferences and goals across our lifespan,” Kathy Greene, assisted secretary of aging with the Department of Health and Human Services (HHS), said in a statement.

Many industry groups voiced their support of the reauthorization.

“Our nation faces a severe and growing shortage of eldercare providers with the skills and training to meet the unique health care needs of older adults,” Amy York, director of the Eldercare Workforce Alliance (EWA), said in a statement. “EWA is committed to supporting the reauthorization of the OAAA as it invests in building and maintaining an eldercare workforce—the includes family caregivers—that supports well-coordinate, high-quality care for older adults.”

Older adults might want to avoid a using class of drugs commonly used in over-the-counter products such as nighttime cold medicines due to their links to cognitive impairment, a research team led by scientists at the Indiana University School of Medicine has recommended.

Using brain imaging techniques, the researchers found lower metabolism and reduced brain sizes among study participants taking the drugs known to have an anticholinergic effect, meaning they block acetylcholine, a nervous system neurotransmitter.

Previous research found a link between between the anticholinergic drugs and cognitive impairment and increased risk ofdementia. The new paper published in the journal JAMA Neurology, is believed to be the first to study the potential underlying biology of those clinical links using neuroimaging measurements of brain metabolism and atrophy.

"These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia," said Shannon Risacher, Ph.D., assistant professor of radiologyand imaging sciences, first author of the paper, "Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults."

"Given all the research evidence, physicians might want to consider alternatives to anticholinergic medications if available when working with their older patients," Dr. Risacher said.

Drugs with anticholinergic effects are sold over the counter and by prescription as sleep aids and for many chronic diseases including hypertension, cardiovascular disease, and chronic obstructive pulmonary disease.

A list of anticholinergic drugs and their potential impact is here.

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April is minority health month, and we’ve been featuring blogs about health equity. This week the biggest story was about a new study documenting the widening life expectancy gap between the rich and the poor. But there are some other important stories as well:

While the contaminated drinking water crisis in Flint continues, the problem of lead contamination is actually widespread, causing at least some members of Congress to propose more expansive testing standards, especially in schools and daycare centers. The EPA is also working to strengthen the rules that would protect drinking water, but say that a final rule is at least a year (and a new administration) away.

And, ICYMI, a new study University of Massachusetts’ study appearing in the American Journal of Public Health shows that older African Americans are more likely to have medical debt than are older whites. The study underscores how the issues of racial, economic and health care justice are intertwined

Disabled individuals receiving long-term support are losing services as they transition from fee-for-service to managed Medicaid, according to research by the National Council on Disability, a federal agency that advises the White House and Congress on issues affecting Americans with disabilities.

Historically, managed-care arrangements have excluded people with disabilities who use long-term services and supports because of their complex needs. Now, however, some states are moving this population to managed care.

For decades, Medicaid programs paid long-term-care providers on a fee-for-service basis even as they moved more nondisabled beneficiaries into managed care. But as of 2014, 26 states were using managed long-term care, up from eight in 2004, according to the CMS. The number of beneficiaries in managed long-term care has grown from 105,000 in 2004 to 389,000 in 2012.

For the past two years, the NCD has hosted 10 community forums around the country with over 650 people sharing experiences with managed Medicaid. The audiences were made up of beneficiaries, advocates, providers, state government agency workers, and managed care organizations. The report is built on feedback heard at the events. 

Overwhelmingly, disabled beneficiaries said they lost access to care. Participants reported that MCOs frequently deny long-term care services and supports that were previously provided by the Medicaid FFS system. 

Although there are various interventions designed to improve voice and breathing deficits, they do not tend to address overall quality of life, and, as symptoms progress, drop out rates of these therapies are often high. This means that even the most beneficial therapies do not always have the opportunity to take full effect.

Researchers at Iowa State University, led by Elizabeth Stegemöller, set out to investigate whether group singing could help relieve some of the voice symptoms of Parkinson's disease and, at the same time, increase quality of life and whole health measures.

Singing is a culturally universal pastime that improves bonding and produces a sense of belonging that traditional therapies often cannot match. Additionally, singing can be considered an elongated type of speech with particular emphasis on rhythm, tempo, tonal changes and respiratory control.

Parkinson's therapy involving singing has been trialed in previous studies, but findings have been mixed. This study is the first to test whether improvements in symptoms can be affected by "dosage," in other words, can two singing sessions a week be more effective than one?

Therapy sessions involved vocal exercises, followed by renditions of popular songs, including "You Are My Sunshine" and "Show Me The Way To Go Home."

The researchers found that, after 2 months of singing, there were significant improvements in pitch duration, vocal loudness and swallow control.

Both groups (one session per week and twice per week) demonstrated a significant improvement in maximum inspiratory and expiratory pressure, as well as phonation time. Other voice measures improved, but not to a statistically significant degree.

Importantly, questionnaires that assessed the impact of voice changes on their quality of life (and their overall quality of life) showed significant improvements. Interestingly, there were no differences between the two groups; both benefited equally.