Dr. Bray Links

Wednesday, December 13, 2017

The Caregiver Crisis: Rising Demand, Short Supply Puts Elderly at Risk

    The median cost for a one-bedroom apartment in a senior assisted living community is $43,539. It ranges from roughly $30,000 (Missouri) to $80,000 (District of Columbia), according to Consumer Reports.

    The average cost of a private room in a full-service nursing home is over $87, 000 per year.

    At the other end of the age curve, childrens' daycare costs an average of about $20,000. In the last 25 years, childcare costs have doubled.

https://holisticprimarycare.net/topics/topics-h-n/healthy-aging/1919-the-caregiver-crisis-rising-demand-short-supply-puts-elderly-at-risk.html

Monday, December 4, 2017

Pediatric non alcoholic fatty liver disease

Recently, interesting dietary supplements such as probiotics and long-chain omega-3 polyunsaturated fatty acids have been adopted in adults with NAFLD [91, 92]. Interestingly, these dietary supplements, although considered pharmacological interventions, are often based on natural compounds present in specific foods (yogurt, fish oil, etc.). Among the pathogenetic factors leading to NAFLD, the persistent crosstalk among the gut, the immune system, and the liver, plays a pivotal role [93]. In fact, it is now accepted that specific nutrients increase the intestinal permeability to bacterial endotoxins, activating an immune-mediated inflammatory response of liver resident cells, leading to a profibrogenic phenotype [94]. One recent study on animal models [95], has demonstrated a pivotal role of restoring gut microflora in protecting the liver from fat and preventing cardiovascular disease.

https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-40

Friday, December 1, 2017

Taking Care of the Physician - NYTimes.com

"It has been shown in some studies that if the physician is exercising, if the physician is taking care of themself, eating well, sleeping better, they have patients who have better clinical outcomes," said Dr. Hilary McClafferty

https://mobile.nytimes.com/2017/11/13/well/family/taking-care-of-the-physician.html

Thursday, November 30, 2017

Benzodiazepines Tied to a 41% Increased Mortality Risk in AD

Patients with Alzheimer's disease (AD) who use benzodiazepines and related drugs (BZRDs) have a 41% higher risk for death than patients who do not use these drugs, new research shows.

Mortality rates in patients with AD who use BZDRs was 13.4 per 100 person-years, vs 8.5 per 100 person-years in nonusers during the 6-month study period (adjusted hazard ratio [HR], 1.4). The association was significant from initiation of use.

"I was surprised by how big the increased risk was," lead author Laura K. Saarelainen, a PhD candidate at the Kuopio Research Center for Geriatric Care, University of Eastern Finland, told Medscape Medical News.

"We would like clinicians to know that these drugs have major adverse events from the very beginning of use," she added.

The study was published online November 15 in the International Journal of Geriatric Psychiatry.

https://www.medscape.com/viewarticle/889244

Tuesday, November 28, 2017

WellCare Ex-Exec Sentenced in $35M Florida Medicaid Fraud

Bereday was general counsel at WellCare's Medicaid HMOs StayWell and Healthease in 2006. According to a plea agreement, Bereday admitted that he and four other executives submitted inflated expenditures in the company's annual reports to the Florida Medicaid Program that reduced the HMOs' payback obligations for behavioral healthcare services.  

http://www.healthleadersmedia.com/leadership/wellcare-ex-exec-sentenced-35m-medicaid-fraud?nopaging=1

Medicare Pay-for-Performance Didn't Deliver

Medicare's Value-Based Payment Modifier program inadvertently shifted money away from physicians who treated sicker, poorer patients to pay for bonuses that rewarded practices treating richer, healthier populations, according to a study this week in Annals of Internal Medicine.

In addition, components from that failed pay-for-performance prototype that do not account for patient demographics remain its successor program, and could scuttle its chances for success, researchers said.

"As long as these programs do not account adequately for patient differences, which is very difficult to do, they will further deprive practices serving low-income populations of important resources," said Eric Roberts, assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health and lead author of the study.

The research suggests that the Value Modifier may have hit a trifecta of failure. It did not reduce the cost of care, nor improve the quality of the care, nor improve the health of the patients. In fact, it may have made things worse.  


http://www.healthleadersmedia.com/quality/medicare-pay-performance-didnt-deliver?nopaging=1

CDC urges consumers who drank raw milk product to seek treatment | Fox News

As a result, the CDC warned that anyone who has consumed the company's raw milk product may have been infected with Brucella abortus RB51, a rare germ that requires antibiotics.

The bacteria is used to vaccinate young female cattle against B. abortus, but can cause fever, muscle pain, lasting fatigue, joint pain, and swelling of the testicles in humans, according to Live Science. If left untreated it could lead to arthritis, heart problems, enlargement of the liver or spleen, meningitis or miscarriage.


http://www.foxnews.com/health/2017/11/28/cdc-urges-consumers-who-drank-raw-milk-product-to-seek-treatment.html

Monday, November 27, 2017

Flavocoxid for OA Tied to Life-Threatening Health Problems

The US Food and Drug Administration (FDA) is investigating serious adverse events involving flavocoxid (Limbrel, Primus Pharmaceuticals), a prescription product in capsule form that is marketed as a medical food for the management of metabolic processes associated with osteoarthritis.

"While a range of adverse events have been reported, two serious and potentially life-threatening medical conditions are among them: drug-induced liver injury and hypersensitivity pneumonitis," the FDA said in a safety communication November 21.

The FDA said it has received 194 reports of adverse event involving flavocoxid. In 30 of those cases, there was sufficient information to determine that flavocoxid was likely associated with these adverse events, the FDA said.

Flavocoxid is available in capsule form in two doses: 250 mg and 500 mg. The labeling states that the products contain two types of flavonoids: baicalin (from Scutellaria baicalensis) and catechin (from Acacia catechu). The products also contain zinc. The product labels say flavocoxid is intended for the managaement of the metabolic processes associated with osteoarthritis.

https://www.medscape.com/viewarticle/889188

Saturday, November 25, 2017

Urinary Excretion of the Herbicide Glyphosate in Older Adults, 1993-2016 | Toxicology | JAMA

The herbicide Roundup is sprayed onto genetically modified crops and applied as a desiccant to most small non–genetically modified grains. Use of this herbicide has increased since 1994 when genetically modified crops were introduced in the United States. Glyphosate, the primary ingredient in the herbicide, is found in these crops at harvest.1 Environmental exposure through dietary intake of these crops has potential adverse health effects and can be assessed by measuring urinary excretion.2- 4 We measured excretion levels of glyphosate and its metabolite aminomethylphosphonic acid (AMPA) in participants from the Rancho Bernardo Study (RBS) of Healthy Aging.


https://jamanetwork.com/journals/jama/article-abstract/2658306

VA study shows parasite from Vietnam may be killing vets | Fox News

Liver flukes, parasites that infect a human when raw or undercooked fish is eaten, are being investigated as the cause of a rare bile duct cancer among veterans who served in the Vietnam War. It could take years for symptoms to show up, but when they do, the host is left with tremendous pain and given just a few months to live.

The Department of Veterans Affairs this spring commissioned a small pilot study to look into the link between liver flukes and the cancer. More than 20 percent of the 50 blood samples submitted to the study came back positive or bordering positive for liver fluke antibodies, said Sung-Tae Hong, the tropical medicine specialist who carried out the tests at Seoul National University in South Korea.

http://www.foxnews.com/health/2017/11/22/va-study-shows-parasite-from-vietnam-may-be-killing-vets.html

Why Is This Bacterium Hiding in Human Tumors? - NYTimes.com


A mysterious bacterium found in up to half of all colon tumors also travels with the cancer as it spreads, researchers reported on Thursday.

Whether the bacterium, called Fusobacterium nucleatum, actually plays a role in causing or spurring the growth of cancer is not known. But the new study, published in the journal Science, also shows that an antibiotic that squelches this organism slows the growth of cancer cells in mice.

Scientists are increasingly suspicious that there may be a link: another type of bacteria has been discovered in pancreatic cancer cells. In both types of cancer, most tumors host bacteria; however, only a small proportion of the cells in any single tumor are infected.

"The whole idea of bacteria in tumors is fascinating and unexpected," said Dr. Bert Vogelstein, a colon cancer researcher at Johns Hopkins.

https://mobile.nytimes.com/2017/11/23/health/bacteria-colon-cancer.html

Coronary Calcium Helps Stratify 10-Year Cardiac Risk in Diabetes

Coronary artery calcium (CAC) scores may be better at predicting the risk of a cardiovascular disease (CVD) event in patients with type 2 diabetes than traditional scores such as Framingham, even in those who've had diabetes for 10 years, researchers report[1].

This conclusion is based on a new analysis of participants in the Multi-Ethnic Study of Atherosclerosis (MESA) published online in JAMA Cardiology by Dr Shaista Malik (University of California, Irvine) and colleagues.

https://www.medscape.com/viewarticle/889148

Tuesday, November 21, 2017

The Death of Expertise

The Internet has provided people with an unprecedented abundance of information, but all too often it gives them the illusion of knowledge, encouraging them to believe they know as much as experts. They hear what they want to hear, and live in a bubble community of people with similar beliefs.

https://sciencebasedmedicine.org/the-death-of-expertise/

Thursday, November 16, 2017

Amish Mutation Protects Against Diabetes and May Extend Life - NYTimes.com

Amish people living in a rural part of Indiana have a rare genetic mutation that protects them from Type 2 diabetes and appears to significantly extend their life spans, according to a new study.

The findings, published on Wednesday in the journal Science Advances, shed light on the processes underlying cellular aging and could lead to new therapies for chronic diseases, some experts say. The researchers are planning at least one follow-up trial that will recreate the effects of the mutation so they can study its impact on obese people with insulin resistance, a precursor to diabetes.

The mutation described in the new paper affects a mysterious protein called plasminogen activator inhibitor-1, or PAI-1, that is known primarily for its role in promoting blood clotting. The mutation was first identified in 1991 in a secluded Amish farming community in Berne, Ind. An estimated 5 percent of the community carries the mutation, which causes them to produce unusually low levels of PAI-1.

Scientists have long suspected that PAI-1 has other functions outside of clotting that relate to aging. Dr. Douglas Vaughan, a cardiologist at Northwestern medical school, noticed, for example, that mice that had been genetically engineered to produce high levels of the protein age fairly quickly, going bald and dying of heart attacks at young ages. People who have higher levels of the protein in their bloodstreams also tend to have higher rates of diabetes and other metabolic problems and to die earlier of cardiovascular disease.

https://mobile.nytimes.com/2017/11/15/well/live/amish-mutation-protects-against-diabetes-and-may-extend-life.html

Monday, November 13, 2017

Mortality Lower When Inpatients See Their Own PCP in Hospital

A primary care physician (PCP)'s prior knowledge of a patient has a significant effect on outcomes when that patient is hospitalized, data from a new study suggest.

In a retrospective analysis of more than 560,000 Medicare patients, hospital care by a PCP who had previously seen the individual as an outpatient was associated with a greater chance of being discharged home and a lower 30-day mortality compared with care delivered by a hospitalist or other generalist who had never met the patient before, Jennifer P. Stevens, MD, MS, and colleagues report today in JAMA Internal Medicine.

These findings may be especially important for patients with multiple illnesses and those who require a complex level of care, Seth Landefeld, MD, coauthor of an accompanying editorial, said in an interview with the journal.

https://www.medscape.com/viewarticle/888520

Saturday, November 11, 2017

Mitochondrial Networks Explain Why Caloric Restriction Extends Worms’ Lives | The Scientist Magazine(R)

 "Low-energy conditions such as dietary restriction and intermittent fasting have previously been shown to promote healthy aging," lead author Heather Weir, who conducted the research while at Harvard T. H. Chan School of Public Health and is now a research associate at Astex Pharmaceuticals, tells the Harvard Gazette. "Understanding why this is the case is a crucial step toward being able to harness the benefits therapeutically."

Mitochondria exist in networks that alternate between "fused" and "fragmented" states, which affect how the organelles process energy. This dynamic fission and fusion of mitochondria has been linked to aging, and the new study provides two key players—AMPK and peroxisomes—in orchestrating those fluctuating connections and their effect on organismal health and senescence. 

"Although previous work has shown how intermittent fasting can slow aging, we are only beginning to understand the underlying biology," senior author William Mair, associate professor of genetics and complex diseases at Harvard Chan School, tells the Harvard Gazette. "Our work shows how crucial the plasticity of mitochondria networks is for the benefits of fasting. If we lock mitochondria in one state, we completely block the effects of fasting or dietary restriction on longevity."

http://mobile.the-scientist.com/article/50886/mitochondrial-networks-explain-why-caloric-restriction-extends-worms-lives

Friday, November 10, 2017

New Study Shows Antioxidant-Rich Foods Diminish Diabetes Risk

Consuming a diet rich in antioxidant foods may help decrease the risk of type 2 diabetes, according to a new study published November 9 in Diabetologia.

The trial is the first prospective investigation into the link between total antioxidant consumption and risk of type 2 diabetes, say the researchers.

"This work complements our current knowledge of the effect of isolated foods and nutrients and provides a more comprehensive view of the relationship between food and type 2 diabetes," senior author Guy Fagherazzi, PhD, of the University Paris-Sud, Villejuif Cedex, France, said in a press release.

Prior research has suggested that oxidative stress may contribute to the development of type 2 diabetes. While some studies have found that the antioxidant vitamin E may help decrease the risk of type 2 diabetes, others have not confirmed this effect for the antioxidants vitamin C, flavonoids, and lycopene.

https://www.medscape.com/viewarticle/888350

Wednesday, November 8, 2017

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy — NEJM

Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

http://www.nejm.org/doi/full/10.1056/NEJMsa065779

How Has the Physician-Patient Relationship Changed?

We know from [our experiences from] the early 1970s to now that talking about your dissatisfaction by itself doesn't lead to meaningful change. We need physicians and providers, people who work in the practice, as well as patients, to be willing to make change at a grassroots level. We need to stop looking for a silver bullet from either the government or health insurers to fix healthcare. We need to take that burden on ourselves.

If people say, "I will shift to doctors who spend time with me; I will shift my health insurance to places that treat me like a person and not like a number," then we will see a shift. The thing that is helping people is that more of the healthcare dollar—how much we pay for healthcare—is being shifted to people, and so they can vote with their dollars.

https://www.medscape.com/viewarticle/887853

Tuesday, October 31, 2017

What to Do When Patients Don't Heed Your Advice

The overwhelming majority of my patients act with good sense. Nevertheless, the confusion of preexisting patient conclusions and the use of self-validating search engine searches as a substitute for either research or offered wisdom and experience are seemingly on the rise. It is human nature to seek confirmation bias. However, we've been a nation that has sought education and knowledge, and celebrated wisdom. Increasingly, I've seen the consequences of a societal derision of the educated as being uncool and of the wise as unworthy of notice.


https://www.medscape.com/viewarticle/881711_2