Health and Disability

Bladder cancer and hypothyroidism were moved to the category of "limited or suggestive" evidence of an association from their previous positions in the default "inadequate or insufficient" category. A finding of limited or suggestive evidence of an association means that the epidemiologic evidence indicates there could be a link between exposure to a chemical and increased risk for a particular health effect. A finding of inadequate or insufficient evidence indicates that the available studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of such a link. For both bladder cancer and hypothyroidism, new results from a large study of Korean veterans who served in the Vietnam War were compellingly suggestive of an association. In combination with pre-existing supportive epidemiologic findings and substantial biologic plausibility, the new information provided evidence to merit a change in category of association for these two outcomes.

The method, known as desensitization, “has the potential to save many lives,” said Dr. Jeffery Berns, a kidney specialist at the University of Pennsylvania’s Perelman School of Medicine and the president of the National Kidney Foundation.

The procedure, Mr. Smith said, “changed my life.”

Health care consolidation may offer some promise, and potentially some peril, but we should determine how it impacts those communities with the poorest health and thereby addresses health inequality. After all, those who have the means can already access the greatest medical services, technology, and expertise in the world. Our global rankings in health outcomes do not match our health expenditures because of the disproportionate health burdens suffered by low socioeconomic communities. They are subjected to poor health services, if they receive any at all.

How, then, does consolidation address barriers these vulnerable citizens face, such as geography, cost, and a lack of profitability in addressing many of their health needs? If we are to accept the proposition that consolidation will lead to integrated health care, those who are already receiving the benefits of our current system will inevitably be rewarded. But is there evidence that these benefits will trickle down to those who suffer most?

Moreover, health disparities do not arise only, or even primarily, from health care disparities; heath disparities instead stem largely from social determinants of health that differentially affect minority and low-income communities. The water issues in Flint are an unfortunate reminder that health can no longer be narrowly addressed through improvements in health care services. What good is increased insurance coverage and improved medical technology for those consuming poisoned water from birth?

And this is not just in Flint. As one article rightly pointed out, “America is Flint!” While 4.9 percent of children in Flint have elevated levels of lead, in the most recent data for Iowa 32 percent of tested children had elevated lead levels. The Centers for Disease Control and Prevention (CDC) estimates that 535,000 children between the ages of 1 and 5 suffer from lead poisoning, which research has associated with impaired cognitive development associated with violent and criminal behavior.

“Quite frequently in the computer security business, we invent things that are super secure but hard to use, and people don’t understand them,” said Tim Pierson, doctoral student and Wanda’s creator. “We set out to make something that my parents and in-laws could use.”

The wand relies on Wi-Fi to operate, and the prototype currently consists of a ruler with two attached antennas. Plug it into a Wi-Fi router, and it acquires the network name and password. From there, it can be detached and pointed at a medical device to connect the latter to the network, as well.

For example, if a doctor sends a patient home with a Wi-Fi-enabled blood pressure cuff, the patient can simply point the wand at the cuff rather than manually enter a password to establish a Wi-Fi connection. And once the connection is made, blood pressure readings will be transmitted to the doctor’s office.

“One of the good things about this system is that the user doesn’t even have to know that information,” Pierson told the AP. “The wand can get it from your Wi-Fi router and impart it on the device. We talked to a lot of people who have Wi-Fi in their homes and have no idea what their password is.”

As corresponding author Professor David D'Cruz says "Systemic lupus erythematosus is a complex autoimmune disease that can be life or organ threatening. Conventional immunosuppressive agents are widely used in the management of SLE with recent regimens optimising the use of these agents while minimising potential toxicity. Biologic therapies have advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab, are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials although the failure of many large scale trials has been disappointing."

Professor David D'Cruz continues "The importance of managing co-morbidities such as cardiovascular risk factors, bone health, and minimising susceptibility to infection should not be neglected. This review article gives a comprehensive but readable overview of treatment approaches for this fascinating but challenging disease."

As Dr Michael R. Shurin, Editor-in-Chief, explains "SLE is an important clinical problem and it will be great to show approved and potential therapeutic approaches to the general public. This is well written review."

To improve the quality of care, Miller and the project team make several recommendations. Among them:

• policymakers and payers should establish payment methodologies that support team, not individual, providers;
• policymakers and payers should invest in a national technical assistance center focused on how to improve care by revising federal, state and local policy and regulatory barriers;
• providers should engage communities in service to advancing needs for behavioral health and assure consistency across care delivery;
• providers should share information on how to operationalize successful strategies, such as telehealth; and
• businesses and philanthropies could create resources and technical assistance strategies that improve access to data for patients and other providers.