08 Dec

Medical News Today: New Parkinson's drug heralded as breakthrough

A drug initially designed to treat diabetes may be a breakthrough treatment for Parkinson’s disease. After decades of disappointment, could MSDC-0160 be the drug researchers have been searching for?
[Old man smiling with doctor]
Breaking research promises a much-needed Parkinson’s breakthrough.

Parkinson’s disease is a progressive condition that strikes the central nervous system.

Causing a range of motor symptoms, it develops gradually, starting with a subtle tremor.

Parkinson’s affects an estimated 60,000 Americans and up to 10 million people worldwide.

Due to society’s steadily increasing in lifespan, this figure is likely to increase over the coming years.

Despite billions of dollars of research, there is still no cure for Parkinson’s. A drug designed in the 70s – levodopa – is still in use, but its benefits are limited, and the side effects are troubling.

Currently, the only available drugs tackle the symptoms of Parkinson’s; none make a dent on the processes that underpin the disease’s progression.

Against this somber backdrop, any news of a potential breakthrough drug is likely to turn heads.

Research, published today in the journal Science Translational Medicine, provides such a glimmer of light. A drug, initially designed to treat diabetes, appears to tackle the underlying causes of Parkinson’s. If this turns out to be the case, it will be the first of its kind and has the potential to change millions of lives.

MSDC-0160, diabetes, and Parkinson’s

Investigators from the Van Andel Research Institute’s Center for Neurodegenerative Science in Great Rapids, MI, believe their recent findings show that MSDC-0160 could be the breakthrough medical science has been waiting for.

“We hope this will be a watershed moment for millions of people living with Parkinson’s disease. All of our research in Parkinson’s models suggests this drug could potentially slow the disease’s progression in people as well.”

Dr. Patrik Brundin, senior author

MSDC-0160 was designed by Kalamazoo, a Metabolic Solutions Development Company. As an insulin sensitizer, it was created to treat type 2 diabetes. The company focuses on looking for drugs that might be repurposed to treat conditions other than the ones they were designed for.

This drug has already been proven safe in humans, and its manufacturing process is already established; because of this, the path through clinical trials and into widespread use is shorter and simpler to navigate. Recent trials in a mouse model of Parkinson’s have provided positive results, and trials in humans are now set to begin next year.

Tom Isaacs, co-founder of The Cure Parkinson’s Trust, says:

“Our scientific team has evaluated more than 120 potential treatments for Parkinson’s disease, and MSDC-0160 offers the genuine prospect of being a breakthrough that could make a significant and permanent impact on people’s lives in the near future. We are working tirelessly to move this drug into human trials as quickly as possible in our pursuit of a cure.”

Parkinson’s and metabolism

Although diabetes and Parkinson’s seem like unrelated diseases with an entirely different set of symptoms, researchers are finding that some of the underlying molecular mechanisms share similarities.

Parkinson’s is believed to be, in part, a disease of the metabolic system. Rather than attempting to repair or counteract damage that has already been done, this new drug intervenes in the metabolic processes beneath Parkinson’s.

MSDC-0160 is an mTOT (mitochondrial target of thiazolidinediones) modulator; it regulates the function of mitochondria – the powerhouses of the cell. It appears to restore brain cells’ ability to convert nutrients into usable energy.

Once the cell’s power is restored, it is able to handle the buildup of potentially harmful proteins. In turn, this reduces inflammation and brain cell death. This one-a-day tablet has the potential to be a lifesaver.

This finding, if clinical trials are successful, is a huge step forward. Not only is there a potential treatment that reaches the source of Parkinson’s, but an entirely new pathway has been discovered for future drug designers to hone in on.

Dr. Brundin is equally excited about MSDC-0160’s potential use in other diseases, including Lewy body dementia and Alzheimer’s.

Learn how the gut microbiome may contribute to Parkinson’s

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Source: medicalnewstoday

08 Dec

Medical News Today: Optimism may boost women's longevity

Is the glass half full or half empty? The answer to this question may not seem to be a matter of life or death, but for women, it could be. New research suggests women who have a positive outlook on life are less likely to die prematurely than those who are less optimistic.
[A happy woman reflecting]
Researchers suggest optimism may reduce women’s risk of death from numerous medical conditions.

Co-lead author Eric Kim, of the Department of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health in Boston, MA, and colleagues say their findings suggest people should look at boosting their optimism as a way to improve health.

The researchers recently published their findings in the American Journal of Epidemiology.

Optimism is defined as a mental attitude characterized by positive thinking, whereby a person is hopeful and confident that good things will happen.

A number of studies have suggested that people who are optimistic tend to have better mental and physical health than those who are pessimistic – that is, those who have a negative outlook on life, always expecting the worst.

Research conducted by the University of Illinois last year, for example, found that optimists were twice as likely to have better heart health than their more pessimistic counterparts.

For the new study, Kim and colleagues set out to investigate whether having a positive outlook on life might influence the risk of death from various medical conditions.

Optimism reduced all-cause mortality by almost 30 percent

To reach their findings, the researchers analyzed 2004-2012 data from around 70,000 women who were part of the Nurses’ Health Study – an ongoing project that assesses women’s health through surveys conducted every 2 years.

Kim and colleagues looked at the self-reported optimism of each participant, as well as other factors that might contribute to mortality risk, such as high blood pressure, diet, and exercise.

Compared with women in the lowest quartile of optimism, those in the highest quartile of optimism were found to be nearly 30 percent less likely to die from all causes.

Looking at individual illnesses, the researchers found that women who were the most optimistic were 16 percent less likely to die from cancer, 38 percent less likely to die from heart disease, and 39 percent less likely to die from stroke, compared with women who were the least optimistic.

Additionally, women in the top quartile of optimism were at 38 percent lower risk of death from respiratory disease and were 52 percent less likely to die from infection, compared with those in the bottom quartile.

The researchers note that previous studies have linked optimism to reduced risk of cardiovascular death, but theirs is the first to associate the mental attitude with reduced mortality from other major illnesses.

‘We should make efforts to boost optimism’

When accounting for healthy behaviors among participants, the team found that these could only partly explain the association between optimism and reduced mortality. With this in mind, Kim suggests it is possible that optimism may have a direct influence on our biological systems.

Based on their results, the authors say it might be worth focusing on ways to boost optimism as a means to good health.

“While most medical and public health efforts today focus on reducing risk factors for diseases, evidence has been mounting that enhancing psychological resilience may also make a difference.

Our new findings suggest that we should make efforts to boost optimism, which has been shown to be associated with healthier behaviors and healthier ways of coping with life challenges.”

Eric Kim

Read about how pessimists may be at greater risk of death from heart disease.

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Source: medicalnewstoday

08 Dec

Medical News Today: Silent Reflux: Causes, Symptoms, and Treatment

Silent reflux is a somewhat confusing term used to describe laryngeal pharyngeal reflux. It is a condition in which stomach acid causes throat discomfort.

The term can be confusing because the condition is not exactly silent. It is marked by hoarseness, frequent throat clearing, and coughing.

The condition is caused by a reflux action, meaning a backward or return flow. In silent reflux, stomach acid flows back into the esophagus and irritates the throat.

It is called “silent” because individuals who have it do not show the typical symptoms associated with acid reflux, such as heartburn.

Silent reflux can develop in infants and adults. It is treatable.

Differences between silent reflux and other reflux conditions

[woman holding throat]
Silent reflux can cause discomfort in the throat.

Laryngeal-pharyngeal reflux (LPR) is related to gastroesophageal reflux (GER). GER is a condition in which the contents of the stomach, instead of moving on through the digestive system, go back into the food pipe.

The contents of the stomach include stomach acids. When these acids make contact with the food pipe, they cause irritation, discomfort, and burning sensations. These sensations – often felt behind the breastbone, in the middle of the trunk – are called heartburn.

Most individuals with GER experience heartburn, but many people with LPR do not.

Causes of silent reflux

In infants, the muscular valves at the end of the food pipe are not fully developed. These valves keep the contents of the stomach from flowing back into, and through, the food pipe. This explains why it is common for infants to spit up, especially after they have been fed and their stomachs are full.

Adults often have a cold or the flu before they develop LPR. These conditions may make the vocal cords more sensitive to stomach acid.

Certain physical characteristics may make some individuals more likely to develop LPR, including those who have:

  • Problems with the lower food pipe valve
  • A low-emptying stomach
  • A hiatal hernia
  • Problems with food pipe contractions

Individuals who use their voices a lot, such as teachers and singers, may also be more at risk from the condition.

Symptoms and complications

Most people will experience heartburn or GER at some point in their lives. When these symptoms occur more frequently and persist, such as twice a week for 3 weeks or more, the condition is more serious. In this instance, it is known as gastroesophageal reflux disease, or GERD.

The National Institute of Diabetes and Digestive and Kidney Diseases report that roughly 1 in every 5 Americans have been affected by GERD.

Silent reflux develops when the stomach acid travels all the way back through the food pipe and reaches the back of the throat.

The most common symptoms of LPR in adults include:

  • Feeling like something is stuck in the throat
  • Hoarseness
  • Frequent throat clearing
  • Coughing
  • A bitter taste at back of throat
  • Difficulty swallowing
  • Swelling and irritation of vocal cords
  • Sensation of post-nasal drip
  • Difficulty in breathing

Damage to the vocal cords can result if LPR is not treated in adults.

According to the UK’s National Institute for Care and Excellence (NICE), at least 40 percent of infants show some signs of reflux.

While it is common for infants to spit up, problems with breathing and feeding could be signs of something more serious, which should be investigated by a doctor.

[girl coughing]
Cough can be a sign of silent reflux in children.

The symptoms of silent reflux in infants and children include:

  • Coughing
  • Vomiting
  • Failure to grow and gain weight
  • Asthma
  • Sore throat
  • Hoarseness
  • Noisy breathing
  • Ear infections
  • Difficulty feeding
  • Turning blue
  • Aspiration

Researchers are currently exploring possible links between LPR in children and recurrent ear infections and sinusitis.

Some worrisome symptoms, such as projectile vomiting or bile, or bloodstained vomit, may not be signs of silent reflux. They could be indications of other health problems and should be reviewed by a doctor.

Diagnosis and treatment

Due to the possibility of life-threatening events in children with LPR, prompt medical treatment is extremely important. If an infant has breathing and feeding problems along with any other symptoms of silent reflux, they should see a doctor as soon as possible.

Caregivers should watch for signs of GER in children with asthma, because it seems to be more common in children with this condition. Asthma may interfere with the ability to observe typical symptoms of GER.

Parents can help with diagnosis by providing the doctor with a thorough medical history of the child’s behavior and what prompted their concern. The doctor can draw from this information to make, will do a physical examination, and may conduct tests with a camera.

Adults should see a doctor if throat problems continue over time, especially if they experience a sensation of something stuck in their throat. A doctor might refer the patient to a specialist for ear, nose, and throat problems.

A diagnosis of LPR is usually made through a physical examination. Additional tests may be needed, such as a barium X-ray. The doctor may also do an exam of the stomach and food pipe, which involves passing a scope through the mouth.

Many adults manage to control their silent reflux symptoms by adjusting their eating habits and making changes in their lifestyles.

More challenging cases require more intense treatment.

Dietary recommendations include:

  • Avoiding spicy and acidic foods, such as pineapples and hot peppers, which will irritate the lining of the throat
  • Cutting down on carbonated beverages to bring less acid to the throat
  • Keeping away from foods that weaken the lower food pipe valve, including chocolate, alcohol, and caffeine

Ways to prevent acid reflux from irritating the throat include:

  • Eating smaller amounts, more frequently
  • Avoiding bending, singing, or exercising for at least 2 hours after eating
  • Waiting at least 3 hours to lie down after eating

Adults with LPR may also be treated with a variety of medications. Some of these, such as antacids, are available over the counter.

What should a parent do for children with the condition?

Most infants outgrow their silent reflux by their first birthday, but some will require treatment.

The following practices are recommended for childhood LPR:

  • Feeding the infant smaller, more regular meals
  • Keeping the infant in an upright position for at least 30 minutes when feeding
  • Closely monitoring the infant for signs of breathing or feeding trouble

If breathing or feeding problems develop, medical help should be sought.

How do approaches differ for children and adults?

Diagnosing and treating LPR in infants and children requires special care and a stepped approach.

[woman feeding child]
Feeding a child small amounts and keeping them upright after eating can reduce symptoms.

Such an approach may include the following steps:

  • Reviewing the young patient’s eating habits and practices
  • Adapting feeding practices to prevent GER
  • Evaluating the use of age-appropriate medications
  • Considering tube feeding for infants
  • Exploring surgical options as a last resort

Certain studies, such as contrast studies of the gut, are not recommended for infants, children, and young people.

An endoscopy of the gut may be called for if certain concerning symptoms are present, such as a failure to thrive without visible vomiting, trouble swallowing, a dislike of feeding, or unexplained distress.

Healthcare workers are advised not to treat infants and children for LPR unless at least two of the common symptoms of silent reflux are present.

According to NICE, 90 percent of infants recover from their GER-related symptoms before their first birthday, and further treatment is not necessary.

For adults with silent reflux, lifestyle changes can keep the throat from becoming dry and irritated. These actions include:

  • Drinking plenty of fluids
  • Avoiding tobacco, alcohol, caffeine, and antihistamines
  • Avoiding fried and fatty foods, as well as tomatoes, citrus fruits, chocolate, and peppermint
  • Losing weight

Shouting, whispering, extensive speaking, and clearing the throat can put stress on the throat, so these should be avoided where possible.

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Source: medicalnewstoday

08 Dec

New Clues to Huge Jump in U.S. Mosquito Population

News Picture: New Clues to Huge Jump in U.S. Mosquito Population

Latest Infectious Disease News

TUESDAY, Dec. 6, 2016 (HealthDay News) — New research hints at why the number of mosquitoes has jumped 10-fold in the past 50 years in certain U.S. states: Increased urbanization and shrinking levels of the pesticide DDT in the environment could be major factors.

“At first glance, recent increases in mosquito populations appear to be linked to rising temperatures from climate change, but careful analyses of data over the past century show that it’s actually recovery from the effects of DDT,” said study co-author Marm Kilpatrick. He is an associate professor of ecology and evolutionary biology at the University of California, Santa Cruz.

Still, Kilpatrick said, climate change may be a factor going forward.

“On the cold edge of a species’ distribution, temperature matters a lot. In Washington, D.C., for example, where Aedes aegypti is not common now, it might become more common if the winters get milder,” Kilpatrick said in a university news release.

Apart from the mere annoyance of mosquito bites, the insects can carry numerous diseases and viruses. The A. aegypti mosquito is considered the main culprit in spreading the Zika virus, which is believed to have caused thousands of devastating birth defects in babies, mainly in Brazil. The most common birth defect seen since the outbreak began in April 2015 is microcephaly, where the infant’s head is too small and its brain is underdeveloped.

Kilpatrick’s team based its findings on an analysis of mosquito-monitoring programs.

Why might urbanization — which the study linked to mosquito levels in New Jersey and California — be a factor?

The study authors suggested that it could boost the number of mosquitoes that feed on humans because there are more people around to bite.

As for DDT, which was commonly used through the early 1970s until it was banned, levels of the pesticide appeared to stick around.

“Everyone knew DDT was an extremely effective insecticide, but I was surprised by how long-lasting its effects were. In some areas, it took 30 to 40 years for mosquito populations to recover,” Kilpatrick said.

The study was published in the Dec. 6 issue of the journal Nature Communications.

— Randy Dotinga

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCE: University of California, Santa Cruz, news release, Dec. 6, 2016

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Source: MediciNet

08 Dec

Many Americans Skip the Dentist Due to Cost

News Picture: Many Americans Skip the Dentist Due to CostBy Karen Pallarito
HealthDay Reporter

Latest Oral Health News

TUESDAY, Dec. 6, 2016 (HealthDay News) — Americans are more likely to skip needed dental care because of cost than any other type of health care, researchers report.

Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost.

That’s nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed.

Cost was the main impediment to dental care even for adults with private insurance.

“It seems like medical insurance is doing a better job at protecting consumers from financial hardship than dental insurance,” said study author Marko Vujicic.

Typically, private dental insurance includes annual maximum benefit limits and significant “coinsurance” — the patient’s share of costs on covered services, Vujicic explained.

He is chief economist and vice president of the American Dental Association’s (ADA) Health Policy Institute in Chicago.

“Anything beyond checkups, like getting a cavity filled or a root canal and a crown, you’re looking right away at 20 to 50 percent coinsurance,” Vujicic said.

Typical fees for fillings range from $86 to $606, according to a 2013 ADA Health Policy Institute survey. Root canals go for $511 to $1,274. For a crown, the range is $309 to $1,450.

Evelyn Ireland, executive director of the National Association of Dental Plans, agreed with the report that avoiding dental care can affect overall health.

Fortunately, the percentage of the population citing cost as a reason for not getting dental services has declined steadily since 2010, Ireland said. And in 2014, it was the lowest since 2003, she added.

Colin Bradley is vice president of business development at Winston Benefits Inc., a company that helps employers administer dental benefits.

He said employers who offer private dental plans must emphasize the value of those benefits, including preventive services often provided at no out-of-pocket cost.

The new study is published in the December issue of the journal Health Affairs. The issue is devoted to oral health in America.

Collectively, one theme emerges: “that the divide between dental care and medical care is vast, has significant consequences for patients, and is entirely of our own making,” wrote Alan Weil, the journal’s editor-in-chief.

Vujicic and his co-authors, from the University of Michigan School of Business and Families USA, noted an intrinsic divide in coverage levels between children and adults.

Kids’ dental care is covered under the Affordable Care Act and is a mandatory benefit in state Medicaid programs. Adults have no such guarantee. Dental care isn’t covered by Medicare, and it’s an optional benefit in Medicaid, the researchers reported.

In 22 states, Medicaid only covers adults’ emergency dental services, the research team noted.

For the analysis, Vujicic and his colleagues used data from the 2014 National Health Interview Study and the ADA Health Policy Institute’s 2015 Oral Health and Well-Being Survey.

They examined barriers to dental care and other health services by age group — children, adults and seniors — and type of insurance.

Across all ages, people in households with lower incomes experienced more problems.

Nearly one in four adults aged 19 to 64 with incomes below 100 percent of the federal poverty level didn’t get needed care because of cost. By comparison, only 5 percent of adults in the highest income category faced that barrier to care.

In 2016, poverty is defined as a household income of $11,800 for a individual and $24,300 for a family of four, according to the U.S. government.

Cost was nearly three times more likely to be the reason for people not seeing the dentist in the past year than fear of the dentist. Cost also surpassed inconvenient appointments or trouble finding a dentist who takes their insurance as reasons for skipping dental care.

In 2015, an estimated 40 percent of spending on dental care was out of pocket, compared to 11 percent of total health spending, according to a recent U.S. Centers for Medicare and Medicaid Services analysis.

The data in the new study were self-reported and merely describe the financial barriers that people encounter, the authors noted. In other words, the findings don’t prove that financial barriers cause people to skip needed care.

Still, the results suggest “important shortcomings” exist in the design of private and public dental insurance, the study authors said.

“To me, it’s really time to redo this insurance model,” Vujicic said.

Instead of paying per procedure, dental benefits should be designed to incentivize dentists to care for patients’ overall dental health, the researchers argued.

Trouble is, there’s been no consensus in dental care on what those outcomes should be, Vujicic said. But he’s encouraged because there are now groups working on developing those measures.

“It’s late, but it’s starting,” he said.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Marko Vujicic, J.D., chief economist and vice president, Health Policy Institute, American Dental Association, Chicago; Evelyn Ireland, executive director, National Association of Dental Plans, Dallas; Colin Bradley, vice president, business development Winston Benefits Inc., Manasquan, N.J; National Health Expenditures 2015 Highlights, Centers for Medicare and Medicaid Services, Baltimore; December 2016, Health Affairs

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Source: MediciNet

08 Dec

Patient Safety May Drop During Doc Rotations

News Picture: Patient Safety May Drop During Doc RotationsBy Alan Mozes
HealthDay Reporter

Latest Prevention & Wellness News

TUESDAY, Dec. 6, 2016 (HealthDay News) — Hospitalized patients who are handed off by their original medical team to a new set of caregivers may ultimately face a higher risk of early death, new research warns.

The finding does not apply to daily shift changes or new patients who see one doctor or nurse at admitting, and then another shortly thereafter.

Rather, it centers on a standard hospital dynamic known as “rotations,” in which teams of caregivers hold the fort for a defined amount of time, sometimes weeks, before turning their pool of patients over to a new team.

Such a transition “occurs each month when a training physician [resident] switches clinical rotations by transferring the care of hospitalized patients, often up to 10 to 20 at a time, to an oncoming physician who has never met the patients,” explained study author Dr. Joshua Denson. He is a fellow in the division of pulmonary sciences and critical care medicine at the University of Colorado in Aurora.

“Our results show that patients exposed to this type of transition in care were at a greater risk of death in the hospital as compared to those not undergoing this type of transition,” he said.

Denson was chief resident in the department of medicine at New York University School of Medicine when he conducted the study.

The research looked at the experiences of nearly 231,000 patients being cared for at one of 10 U.S. Veterans Health Administration hospitals between 2008 and 2014.

Most (nearly 96 percent) were men, average age 66, and the median hospital stay was just three days.

Just over 2 percent of the patients died in hospital, while nearly 10 percent and 15 percent died within a month or three months after discharge, respectively, the investigators found.

Overall, the risk of dying both while in hospital or soon after discharge (at 30 and 90 days out) was, in fact, “significantly greater” among those patients who underwent an end-of-rotation transfer while hospitalized, compared with those who didn’t.

One major caveat was found: When patient transfers were handled solely by resident physicians — who have a higher level of training than interns — death risk did not go up by as much. Elevated risk only went up “significantly” among transfers handled either by interns alone, or by an intern/resident team.

Apart from training status, the apparent rise in mortality risk held up across age, gender, race, ethnicity or length of hospital stay.

“We are unable to determine exactly why the risk goes up,” said Denson. “But one likely explanation may be that important patient care information is not being relayed appropriately to the oncoming physician, which could be leading to mistakes.”

This could be the case even up to the point of release, he noted, which might explain the continued rise in death risk seen among discharged patients.

As for what families might be able to do to minimize their loved one’s exposure to such risk, Denson advocated taking an “active role” during treatment.

“Ask questions,” he suggested.

“Learn about the treatments being given, and most importantly, communicate any concerns to the medical team. We, as physicians, encourage family to be present for rounds and alert us when something seems off. A patient’s family knows them best, and they really can make a difference, particularly during the inevitable periods of transition,” Denson said.

That thought was seconded by Dr. Vineet Arora, an associate professor at the University of Chicago and co-author of an accompanying editorial.

“Yes, patients and loved ones can help,” she said, noting that many patients do not even know that a new physician is caring for them.

“If patients and caregivers are active participants in their plan of care, then they can serve as an important safety check to make sure the new team is following that plan, or ask questions if they see any differences,” Arora explained.

The findings were published Dec. 6 in the Journal of the American Medical Association.

In a second study in the same journal, lead author Charlie Wray, from the San Francisco Veterans Affairs Medical Center, reported on the results of a patient hand-off “best practices” survey involving more than 230 internal medicine program directors across the United States.

The poll examined routine adherence to national recommendations regarding ideal rotation policies, such as providing a dedicated time and place for patient hand-offs and/or ensuring hand-off supervision by senior physicians.

The responses varied widely, with adherence ranging from just 6 percent in some cases to 67 percent in others, depending on the particular recommendation in question.

Investigators suggested that the problem may stem from a lack of clarity on the part of hospital directors as to which practices actually work best in their specific hospital, as well as inadequate training and/or expertise among directors, faculty and supervisors.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Joshua Denson, M.D., fellow, division of pulmonary sciences and critical care medicine, University of Colorado, Aurora; Vineet Arora, M.D., MAPP, associate professor, University of Chicago; Dec. 6, 2016, Journal of the American Medical Association

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Source: MediciNet

08 Dec

New Clues to Huge Jump in U.S. Mosquito Population

News Picture: New Clues to Huge Jump in U.S. Mosquito Population

Latest Infectious Disease News

TUESDAY, Dec. 6, 2016 (HealthDay News) — New research hints at why the number of mosquitoes has jumped 10-fold in the past 50 years in certain U.S. states: Increased urbanization and shrinking levels of the pesticide DDT in the environment could be major factors.

“At first glance, recent increases in mosquito populations appear to be linked to rising temperatures from climate change, but careful analyses of data over the past century show that it’s actually recovery from the effects of DDT,” said study co-author Marm Kilpatrick. He is an associate professor of ecology and evolutionary biology at the University of California, Santa Cruz.

Still, Kilpatrick said, climate change may be a factor going forward.

“On the cold edge of a species’ distribution, temperature matters a lot. In Washington, D.C., for example, where Aedes aegypti is not common now, it might become more common if the winters get milder,” Kilpatrick said in a university news release.

Apart from the mere annoyance of mosquito bites, the insects can carry numerous diseases and viruses. The A. aegypti mosquito is considered the main culprit in spreading the Zika virus, which is believed to have caused thousands of devastating birth defects in babies, mainly in Brazil. The most common birth defect seen since the outbreak began in April 2015 is microcephaly, where the infant’s head is too small and its brain is underdeveloped.

Kilpatrick’s team based its findings on an analysis of mosquito-monitoring programs.

Why might urbanization — which the study linked to mosquito levels in New Jersey and California — be a factor?

The study authors suggested that it could boost the number of mosquitoes that feed on humans because there are more people around to bite.

As for DDT, which was commonly used through the early 1970s until it was banned, levels of the pesticide appeared to stick around.

“Everyone knew DDT was an extremely effective insecticide, but I was surprised by how long-lasting its effects were. In some areas, it took 30 to 40 years for mosquito populations to recover,” Kilpatrick said.

The study was published in the Dec. 6 issue of the journal Nature Communications.

— Randy Dotinga

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCE: University of California, Santa Cruz, news release, Dec. 6, 2016

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Source: MediciNet

08 Dec

Many Americans Skip the Dentist Due to Cost

News Picture: Many Americans Skip the Dentist Due to CostBy Karen Pallarito
HealthDay Reporter

Latest Oral Health News

TUESDAY, Dec. 6, 2016 (HealthDay News) — Americans are more likely to skip needed dental care because of cost than any other type of health care, researchers report.

Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost.

That’s nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed.

Cost was the main impediment to dental care even for adults with private insurance.

“It seems like medical insurance is doing a better job at protecting consumers from financial hardship than dental insurance,” said study author Marko Vujicic.

Typically, private dental insurance includes annual maximum benefit limits and significant “coinsurance” — the patient’s share of costs on covered services, Vujicic explained.

He is chief economist and vice president of the American Dental Association’s (ADA) Health Policy Institute in Chicago.

“Anything beyond checkups, like getting a cavity filled or a root canal and a crown, you’re looking right away at 20 to 50 percent coinsurance,” Vujicic said.

Typical fees for fillings range from $86 to $606, according to a 2013 ADA Health Policy Institute survey. Root canals go for $511 to $1,274. For a crown, the range is $309 to $1,450.

Evelyn Ireland, executive director of the National Association of Dental Plans, agreed with the report that avoiding dental care can affect overall health.

Fortunately, the percentage of the population citing cost as a reason for not getting dental services has declined steadily since 2010, Ireland said. And in 2014, it was the lowest since 2003, she added.

Colin Bradley is vice president of business development at Winston Benefits Inc., a company that helps employers administer dental benefits.

He said employers who offer private dental plans must emphasize the value of those benefits, including preventive services often provided at no out-of-pocket cost.

The new study is published in the December issue of the journal Health Affairs. The issue is devoted to oral health in America.

Collectively, one theme emerges: “that the divide between dental care and medical care is vast, has significant consequences for patients, and is entirely of our own making,” wrote Alan Weil, the journal’s editor-in-chief.

Vujicic and his co-authors, from the University of Michigan School of Business and Families USA, noted an intrinsic divide in coverage levels between children and adults.

Kids’ dental care is covered under the Affordable Care Act and is a mandatory benefit in state Medicaid programs. Adults have no such guarantee. Dental care isn’t covered by Medicare, and it’s an optional benefit in Medicaid, the researchers reported.

In 22 states, Medicaid only covers adults’ emergency dental services, the research team noted.

For the analysis, Vujicic and his colleagues used data from the 2014 National Health Interview Study and the ADA Health Policy Institute’s 2015 Oral Health and Well-Being Survey.

They examined barriers to dental care and other health services by age group — children, adults and seniors — and type of insurance.

Across all ages, people in households with lower incomes experienced more problems.

Nearly one in four adults aged 19 to 64 with incomes below 100 percent of the federal poverty level didn’t get needed care because of cost. By comparison, only 5 percent of adults in the highest income category faced that barrier to care.

In 2016, poverty is defined as a household income of $11,800 for a individual and $24,300 for a family of four, according to the U.S. government.

Cost was nearly three times more likely to be the reason for people not seeing the dentist in the past year than fear of the dentist. Cost also surpassed inconvenient appointments or trouble finding a dentist who takes their insurance as reasons for skipping dental care.

In 2015, an estimated 40 percent of spending on dental care was out of pocket, compared to 11 percent of total health spending, according to a recent U.S. Centers for Medicare and Medicaid Services analysis.

The data in the new study were self-reported and merely describe the financial barriers that people encounter, the authors noted. In other words, the findings don’t prove that financial barriers cause people to skip needed care.

Still, the results suggest “important shortcomings” exist in the design of private and public dental insurance, the study authors said.

“To me, it’s really time to redo this insurance model,” Vujicic said.

Instead of paying per procedure, dental benefits should be designed to incentivize dentists to care for patients’ overall dental health, the researchers argued.

Trouble is, there’s been no consensus in dental care on what those outcomes should be, Vujicic said. But he’s encouraged because there are now groups working on developing those measures.

“It’s late, but it’s starting,” he said.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Marko Vujicic, J.D., chief economist and vice president, Health Policy Institute, American Dental Association, Chicago; Evelyn Ireland, executive director, National Association of Dental Plans, Dallas; Colin Bradley, vice president, business development Winston Benefits Inc., Manasquan, N.J; National Health Expenditures 2015 Highlights, Centers for Medicare and Medicaid Services, Baltimore; December 2016, Health Affairs

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08 Dec

Patient Safety May Drop During Doc Rotations

News Picture: Patient Safety May Drop During Doc RotationsBy Alan Mozes
HealthDay Reporter

Latest Prevention & Wellness News

TUESDAY, Dec. 6, 2016 (HealthDay News) — Hospitalized patients who are handed off by their original medical team to a new set of caregivers may ultimately face a higher risk of early death, new research warns.

The finding does not apply to daily shift changes or new patients who see one doctor or nurse at admitting, and then another shortly thereafter.

Rather, it centers on a standard hospital dynamic known as “rotations,” in which teams of caregivers hold the fort for a defined amount of time, sometimes weeks, before turning their pool of patients over to a new team.

Such a transition “occurs each month when a training physician [resident] switches clinical rotations by transferring the care of hospitalized patients, often up to 10 to 20 at a time, to an oncoming physician who has never met the patients,” explained study author Dr. Joshua Denson. He is a fellow in the division of pulmonary sciences and critical care medicine at the University of Colorado in Aurora.

“Our results show that patients exposed to this type of transition in care were at a greater risk of death in the hospital as compared to those not undergoing this type of transition,” he said.

Denson was chief resident in the department of medicine at New York University School of Medicine when he conducted the study.

The research looked at the experiences of nearly 231,000 patients being cared for at one of 10 U.S. Veterans Health Administration hospitals between 2008 and 2014.

Most (nearly 96 percent) were men, average age 66, and the median hospital stay was just three days.

Just over 2 percent of the patients died in hospital, while nearly 10 percent and 15 percent died within a month or three months after discharge, respectively, the investigators found.

Overall, the risk of dying both while in hospital or soon after discharge (at 30 and 90 days out) was, in fact, “significantly greater” among those patients who underwent an end-of-rotation transfer while hospitalized, compared with those who didn’t.

One major caveat was found: When patient transfers were handled solely by resident physicians — who have a higher level of training than interns — death risk did not go up by as much. Elevated risk only went up “significantly” among transfers handled either by interns alone, or by an intern/resident team.

Apart from training status, the apparent rise in mortality risk held up across age, gender, race, ethnicity or length of hospital stay.

“We are unable to determine exactly why the risk goes up,” said Denson. “But one likely explanation may be that important patient care information is not being relayed appropriately to the oncoming physician, which could be leading to mistakes.”

This could be the case even up to the point of release, he noted, which might explain the continued rise in death risk seen among discharged patients.

As for what families might be able to do to minimize their loved one’s exposure to such risk, Denson advocated taking an “active role” during treatment.

“Ask questions,” he suggested.

“Learn about the treatments being given, and most importantly, communicate any concerns to the medical team. We, as physicians, encourage family to be present for rounds and alert us when something seems off. A patient’s family knows them best, and they really can make a difference, particularly during the inevitable periods of transition,” Denson said.

That thought was seconded by Dr. Vineet Arora, an associate professor at the University of Chicago and co-author of an accompanying editorial.

“Yes, patients and loved ones can help,” she said, noting that many patients do not even know that a new physician is caring for them.

“If patients and caregivers are active participants in their plan of care, then they can serve as an important safety check to make sure the new team is following that plan, or ask questions if they see any differences,” Arora explained.

The findings were published Dec. 6 in the Journal of the American Medical Association.

In a second study in the same journal, lead author Charlie Wray, from the San Francisco Veterans Affairs Medical Center, reported on the results of a patient hand-off “best practices” survey involving more than 230 internal medicine program directors across the United States.

The poll examined routine adherence to national recommendations regarding ideal rotation policies, such as providing a dedicated time and place for patient hand-offs and/or ensuring hand-off supervision by senior physicians.

The responses varied widely, with adherence ranging from just 6 percent in some cases to 67 percent in others, depending on the particular recommendation in question.

Investigators suggested that the problem may stem from a lack of clarity on the part of hospital directors as to which practices actually work best in their specific hospital, as well as inadequate training and/or expertise among directors, faculty and supervisors.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Joshua Denson, M.D., fellow, division of pulmonary sciences and critical care medicine, University of Colorado, Aurora; Vineet Arora, M.D., MAPP, associate professor, University of Chicago; Dec. 6, 2016, Journal of the American Medical Association

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08 Dec

New Clues to Huge Jump in U.S. Mosquito Population

News Picture: New Clues to Huge Jump in U.S. Mosquito Population

Latest Infectious Disease News

TUESDAY, Dec. 6, 2016 (HealthDay News) — New research hints at why the number of mosquitoes has jumped 10-fold in the past 50 years in certain U.S. states: Increased urbanization and shrinking levels of the pesticide DDT in the environment could be major factors.

“At first glance, recent increases in mosquito populations appear to be linked to rising temperatures from climate change, but careful analyses of data over the past century show that it’s actually recovery from the effects of DDT,” said study co-author Marm Kilpatrick. He is an associate professor of ecology and evolutionary biology at the University of California, Santa Cruz.

Still, Kilpatrick said, climate change may be a factor going forward.

“On the cold edge of a species’ distribution, temperature matters a lot. In Washington, D.C., for example, where Aedes aegypti is not common now, it might become more common if the winters get milder,” Kilpatrick said in a university news release.

Apart from the mere annoyance of mosquito bites, the insects can carry numerous diseases and viruses. The A. aegypti mosquito is considered the main culprit in spreading the Zika virus, which is believed to have caused thousands of devastating birth defects in babies, mainly in Brazil. The most common birth defect seen since the outbreak began in April 2015 is microcephaly, where the infant’s head is too small and its brain is underdeveloped.

Kilpatrick’s team based its findings on an analysis of mosquito-monitoring programs.

Why might urbanization — which the study linked to mosquito levels in New Jersey and California — be a factor?

The study authors suggested that it could boost the number of mosquitoes that feed on humans because there are more people around to bite.

As for DDT, which was commonly used through the early 1970s until it was banned, levels of the pesticide appeared to stick around.

“Everyone knew DDT was an extremely effective insecticide, but I was surprised by how long-lasting its effects were. In some areas, it took 30 to 40 years for mosquito populations to recover,” Kilpatrick said.

The study was published in the Dec. 6 issue of the journal Nature Communications.

— Randy Dotinga

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCE: University of California, Santa Cruz, news release, Dec. 6, 2016

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