High intensity training helps ease arthritis pains

Arthritis: it’s a disease that sneaks up on you. Fingers and toes slowly but surely become stiff and painful. A nice morning stretch is no longer all it takes to get your body moving. Arthritis is a chronic illness that sinks its claws into your body, and causes inflammation in your joints. It can destroy your joints, which causes weakness and loss of movement. New research suggests that high intensity training can help with the pain that the illness provides.
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New dying care guidelines proposed

Dying care: ‘Improved’ guidelines proposed

By Smitha Mundasad
Health reporter
  • 29 July 2015
  • From the section Health
Palliative care

England’s health watchdog has put forward new draft guidance to improve the care of adults in their last few days of life.

It comes after concerns that misuse of the previous system – the Liverpool Care Pathway – led to some patients being deprived of water and food.

The guidelines encourage staff to involve patients and relatives in decisions and to communicate well.

The Department of Health and charities welcomed the move.

‘Tick-box care’

The Liverpool Care Pathway was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.

It involved a checklist to ensure patients were free from invasive procedures and medications that were no longer necessary.

But it faced increasing opposition, with some describing it as a a “tick-box exercise”.

And an independent review found some patients had been left thirsty and decisions sometimes taken by inexperienced staff.

While the National Institute for Health and Care Excellence acknowledges many failings were down to how the pathway was implemented – rather than a direct consequence of the document itself – the new draft proposals are designed to address these problems.

The wide-ranging guidance intended for patients, relatives, hospitals, hospices and others involved in end-of-life care is open for public review until September 2015.

It focuses on providing personalised care, good communication and shared decisions between staff, relatives and patients when appropriate.

Staff are advised to undertake daily reviews of medication and check if people are thirsty or need more nutrition.

NICE also says people important to the dying person should be encouraged to help with giving drinks if they wish.

According to the guidelines patients must be monitored for any improvements and if there is any uncertainty staff should seek help from more experienced colleagues.

Dignity

Tony Bonser was involved in reviewing the Liverpool Care Pathway and campaigns for better end-of -life care. His son died at the age of 35 from a rare cancer.

He told the BBC: “The problems arose because of a lack of communication. We as his parents didn’t know what was going on.

“No one was telling us that he was terminally ill and the word dying was never used.

“Towards the end of his life we were totally unaware that death was approaching and so when it did happen it was a shock.”

Prof Rob George, president of the Association of Palliative Medicine, says the concerns with the Liverpool Care Pathway were a wake up call to change the system.

He told the BBC: “The problem in a sense with an industrialised approach to managing dying people is that everyone gets preoccupied with ticking the boxes and not looking at the person in front of them.

“Let’s not forget we are dealing with people who are dying and who are distressed and actually bedside assessment, communication – the milk of human kindness – is what matters.

“It is often difficult in a modern health service with the pressures on staff – almost a compassion fatigue that sometimes people have engaging with those individual needs.”

The charity, the National Council for Palliative Care, says it supports the strong focus on personalised care in the draft guidelines.

‘Everybody’s business’

Claire Henry, chief executive, said: “It is not a tick-box exercise that someone just has to follow. It focuses on individual needs.

“People need to have meaningful choice and be involved in decisions about their end-of-life care, allowing them to maintain comfort and dignity until they die.”

However, she added that health and care staff needed to be provided with ongoing training “as end-of-life care is everybody’s business and there is only one chance to get it right”.

Prof Bee Wee, at NHS England, said: “We want to ensure that people who are dying receive the best possible care, including effective communication between them, their loved ones and the professionals looking after them.

“This draft guidance is therefore welcome, and I would encourage members of the public and professionals alike to contribute to the consultation.”

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No target for most ambulance calls

Time targets scrapped for most ambulance calls

  • 29 July 2015
  • From the section Wales politics
Welsh ambulances

The number of code red calls subject to an eight minute target will be cut from 40% to 10% of total

Targets for ambulance response times in Wales are to be dropped for all but the most life-threatening calls.

In a one-year trial from October, performance for less urgent incidents will be assessed by clinical outcomes – the results of the treatment delivered.

The target of responding to 65% of very urgent calls within eight minutes will remain in place but be monitored.

Statistics released on Wednesday showed the service missed its target for responding to emergency calls in June.

An ambulance arrived on the scene within eight minutes for 61.4% of “red” emergency calls.

That is an improvement on the previous month and better than the same time last year.

The service has also announced that fewer calls will be classed as “red”, which need an eight-minute response.

The Welsh Conservatives described the latest statistics as “another month of failed Labour-managed ambulance response times”.

Welsh Conservative Shadow Minister for Health, Darren Millar, said: “Wales has amongst the worst response times in Britain and the most urgent target has now been missed for 20 consecutive months.

“It is Labour’s mismanagement of our NHS that’s led to this shameful failure in performance and only a change at the top will put that right.”

Plaid Cymru described the trial as a “dangerous experiment” and said the service was “moving the goalposts instead of dealing with the issue”.

Leader of the Welsh Liberal Democrats Kirsty Williams said targets should be about “patient outcome, not political convenience”.

She added: “Of course, it is politically convenient for the Welsh Labour government to scrap targets that they’ve been incapable of meeting, especially with an election just around the corner.”

The Welsh NHS Confederation described the changes as “innovative” and “patient-focused”.

New traffic light system

The new model will introduce three categories of calls – red, amber and green.

Red

  • Eight-minute response time
  • About 10% of calls fall into this category
  • Immediately life-threatening calls where someone is in imminent danger of death, such as a cardiac arrest

Amber

  • No time-based target
  • About 65% of calls fall into this category
  • Patients who may need treatment at the scene and fast transport to a healthcare facility

Green

  • No time-based target
  • About 25% of calls fall into this category
  • Non-serious calls which can often be managed by other health services

Shadow health minister Darren Millar described the latest response time statistics as “shameful”

Deputy Health Minister Vaughan Gething said he was “confident” the changes will improve patient experience.

He said: “The demands placed on our emergency ambulance service are more complex than ever before and are growing year-on-year.

“It is clear if we are to meet these demands and ensure the best outcomes for patients, we need to transform the way in which we deliver emergency ambulance services.”

Tracy Myhill, chief executive of the Welsh Ambulance Services NHS Trust, added: “Having a fast ambulance arrive at a patient’s door does not necessarily translate to a better outcome.

“However, having the right type of vehicle arrive at a patient’s door and timely transport to a treatment centre does.”

Officials have urged people only to call an ambulance if they really need one in order to reduce pressure on the service.

Those with less serious conditions have been encouraged to use alternative transport such as taxis to take them to hospital in a pilot scheme.

In England, ambulance services have a more ambitious target of responding to 75% of Category A calls within eight minutes.

The target was met for England as a whole in 2013-14 for the most serious of those calls – Red 1 – but was just missed for less serious Red 2 calls.

A row broke out in December when a leaked document suggested changing the target for some Red 2 calls in England from eight to 19 minutes.

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Humana says medical costs cut into second-quarter profit


Health insurer Humana Inc (HUM.N), which earlier this month agreed to be bought by Aetna Inc (AET.N) for $37 billion, on Wednesday reported a rise in a key medical cost metric that missed analyst expectations.

Humana’s consolidated benefit ratio, or the ratio of its spending on medical claims versus premium revenue it takes in, was 85.2 percent compared with 83.1 percent a year ago.

Leerink Partners analyst Ana Gupte said in a research note that the ratio was 50 basis points worse than Wall Street consensus.

Investors closely watch this ratio as a sign of whether insurers, who have benefited from years of low medical use and claims, will be caught out by sudden shifts in demand.

Humana first said in early July that costs related to the rate of hospital admissions among Medicare customers were higher than it had anticipated. It cut its 2015 outlook by 8 percent and shares fell at that time.

On Wednesday, Humana said medical costs have not worsened since it issued that outlook earlier this month. It reiterated that it believes it has priced its 2016 premium rates to cover these costs, indicating that this key metric should improve.

Humana had missed analyst expectations several quarters in a row because of cost issues, contributing to investor skepticism about the Aetna deal.

The deal is also expected to face antitrust scrutiny as regulators weigh the impact of the combination on competition. Authorities are also expected to closely look at Anthem Inc’s (ANTM.N) $54 billion purchase of Cigna Corp (CI.N) and require some asset sales.

The managed care sector is consolidating as insurers seek to cut costs and negotiate with doctors and hospitals over pricing.

Humana shares were off 0.5 percent at $183.59 in Wednesday morning trade. Aetna was off 2 cents at $112.29.

Excluding tax benefits from the sale of Concerta Inc, Humana earned $1.67 per share, compared with the average analyst estimate of $1.63 per share, according to Thomson Reuters I/B/E/S. On that basis, it had reported earnings of $2.19 per share in the year-ago quarter.

In early July, the company told analysts to expect earnings of $1.60 to $1.65 per share on an adjusted basis.

Net income rose to $431 million, or $2.85 per share, in the second quarter, from $344 million, or $2.19 per share, a year earlier.

The company reported revenue of $13.73 billion, which missed the average analyst estimate of $13.81 billion.

(Reporting by Caroline Humer in New York and Vidya L Nathan in Bengaluru; Editing by Anil D’Silva and Meredith Mazzilli)


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Express Scripts says costly new cholesterol drugs could wreak havoc


Express Scripts Holding Co, the largest pharmacy benefit manager in the United States, on Wednesday said the cost of potent new cholesterol drugs called PCSK9 inhibitors could “wreak financial havoc” among its clients.

U.S. regulators on Friday approved the first of the new medicines, Praluent from Regeneron Pharmaceuticals Inc and Sanofi SA. Given every other week by injection, Regeneron said it will have a wholesale price of $1,120 for a 28-day supply. That equates to about $14,560 per year.

By contrast, standard cholesterol fighters called statins, including generic forms of Pfizer Inc’s Lipitor and Merck & Co’s Zocor, can cost less than $50 a month.

A rival PCSK9 inhibitor from Amgen Inc, called Repatha, is expected to gain U.S. approval next month and was approved on July 21 in Europe. The new drugs work by blocking the protein PCSK9, whose natural function is to prevent “bad” LDL cholesterol from being removed from the bloodstream.

Express Scripts administers drug benefits for employers and health plans and also runs large mail order pharmacies.

In a conference call with investors on Wednesday to review quarterly earnings, company officials took aim at the expected costs of the medicines.

“While these drugs are being viewed as breakthroughs, they also have the potential to wreak financial havoc on clients who do not proactively manage” their drug costs, said Tim Wentworth, president of the PBM.

(Reporting by Ransdell Pierson; Editing by Marguerita Choy)


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High Blood Sugar May Boost Alzheimer's Risk

High Blood Sugar May Boost Alzheimer’s Risk

News Picture: High Blood Sugar May Boost Alzheimer's RiskBy Steven Reinberg
HealthDay Reporter

Latest Alzheimers News

MONDAY, July 27, 2015 (HealthDay News) — High blood sugar associated with prediabetes may increase the risk for Alzheimer’s disease, a new study suggests.

Researchers found that insulin resistance — higher-than-normal levels of blood sugar that often precede type 2 diabetes — was related to poorer performance on memory tests taken by late-middle-age adults.

“The findings are interesting because people with diabetes are at increased risk for developing Alzheimer’s disease, but we are only now learning why they may be at increased risk,” said lead researcher Barbara Bendlin, an assistant professor of medicine at the University of Wisconsin-Madison.

The study results suggest that insulin resistance could increase the risk for Alzheimer’s disease by altering the way the brain uses sugar (glucose), which is its primary fuel, she said.

However, “by altering insulin resistance in midlife, it may be possible to reduce future risk of Alzheimer’s disease,” Bendlin said. Medications and a healthy lifestyle are possible ways to do that, she said.

According to the American Diabetes Association, 29.1 million Americans have diabetes, and more than half of adults older than 64 have prediabetes. Poor diet, obesity and sedentary lifestyles are associated with insulin resistance, Bendlin noted.

“Healthier lifestyles may contribute to healthier brain aging by reducing insulin resistance,” Bendlin said.

One expert cautioned that having prediabetes, or insulin resistance, doesn’t mean you’re doomed to develop Alzheimer’s, the most common form of dementia.

This study shows that insulin resistance may make mental functioning worse and may be linked to reduced use of insulin in areas of the brain associated with Alzheimer’s disease, but this does not mean that insulin resistance leads to Alzheimer’s, said Dr. Luca Giliberto, an investigator at the Litwin-Zucker Research Center for the Study of Alzheimer’s Disease at the Feinstein Institute for Medical Research in Manhasset, N.Y.

“We do not know what causes Alzheimer’s disease,” said Giliberto, who was not involved in the study. “We don’t know if lowering blood sugar will prevent Alzheimer’s.”

For the study, Bendlin’s team gave memory tests to 150 adults with no mental impairments, at average age of 61. The researchers also measured insulin resistance and had the participants undergo a PET brain scan.

More than two-thirds of the participants had a parent who suffered from Alzheimer’s, about 40 percent had a gene mutation associated with increased Alzheimer’s risk and roughly 5 percent had type 2 diabetes, according to the study.

The researchers found insulin resistance was associated with poorer processing of sugar throughout the brain. Worse performance in immediate memory was linked to lower sugar metabolism in the left medial temporal lobe, the authors said.

The report was published July 27 online in JAMA Neurology.

Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City, said it appears there may be a difference “between the dementia related to full-blown diabetes, which seems to be primarily dementia caused by hardening of the arteries in the brain, and the mental impact of insulin resistance, which some investigators believe is associated with Alzheimer’s.”

In the brain, insulin helps transmit messages between cells, he noted.

“We have long thought of Alzheimer’s as a disease of defective brain signaling,” said Gandy, who had no role in the study. “Conceivably, there is also a disease of defective insulin signaling, which this paper would support.”

If that’s true, Gandy added, “then efforts at sensitizing the brain to insulin, using drugs such as pioglitazone [Actos, a diabetes drug], would make sense and might well lead to slowing of degeneration.”

Giliberto recommended healthy living as the best way to keep blood sugar under control and perhaps protect mental health.

“Increasing our health by reducing fats, reducing sugar, improving insulin resistance may reduce the risk of other factors, such as diabetes, on the susceptibility to Alzheimer’s disease and mental decline,” Giliberto said.

MedicalNews
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Barbara Bendlin, Ph.D., assistant professor, medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; Luca Giliberto, M.D., Ph.D., investigator, physician, Litwin-Zucker Research Center for the Study of Alzheimer’s Disease, Feinstein Institute for Medical Research, Manhasset, N.Y.; July 27, 2015, JAMA Neurology, online

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Heart Disease, Alzheimer's Linked by Common Risk Factors

Heart Disease, Alzheimer’s Linked by Common Risk Factors

News Picture: Heart Disease, Alzheimer's Linked by Common Risk Factors

Latest Alzheimers News

TUESDAY, July 28, 2015 (HealthDay News) — Some risk factors for heart disease may also be linked with Alzheimer’s and other types of dementia, a new study reports.

“We already know that vascular risk factors damage the brain and can result in cognitive [mental] impairment,” study lead author Dr. Kevin King said in a news release from the journal Radiology.

“Our findings give us a more concrete idea about the relationship between specific vascular risk factors and brain health,” said King, an assistant professor of radiology at the Keck School of Medicine at the University of Southern California, Los Angeles.

The study was published in the July 28 issue of the journal.

Prior research has linked heart risk factors and mental decline, but this study focused on specific risk factors and three brain structures — the hippocampus, precuneus and posterior cingulate cortex — that play a role in memory.

The analysis of data from more than 1,600 adults in the Dallas Heart Study showed that alcohol use and diabetes were associated with smaller total brain volume. Smoking and obesity, meanwhile, were associated with reduced volume in the posterior cingulate cortex, which is involved with memory retrieval, and emotional and social behavior.

Alcohol use and smoking were linked with reduced volume in the hippocampus, and obesity and high fasting blood sugar levels were associated with reduced precuneus size, according to the study.

The findings also suggest that reduced hippocampal and precuneus size may be early indicators for mental decline in people 50 and older, while reduced posterior cingulate size is a better predictor of mental decline in people younger than 50.

“We currently do not have effective treatments for Alzheimer’s disease, so the focus is on prevention,” King said.

“In the future, we may be able to provide patients with useful and actionable information about the impact different risk factors may be having on their brain health during routine clinical imaging,” he explained. “And since no special imaging equipment is needed, there is a great potential to provide this service at many centers.”

— Robert Preidt

MedicalNews
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: Radiology, news release, July 28, 2015

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Depressive symptoms, mood may predict momentary pain among patients with rheumatoid arthritis

Depressive symptoms and mood in the moment may predict momentary pain among rheumatoid arthritis patients, according to Penn State researchers.

“The results of this study link momentary positive and negative mood with momentary pain in daily life,” said Jennifer E. Graham-Engeland, associate professor of biobehavioral health. “That is, we found evidence consistent with a common, but largely untested, contention that mood in the moment is associated with fluctuation in pain and pain-related restrictions.” The link was examined among individuals with rheumatoid arthritis, but may extend to other populations.

Greater positive mood as assessed in the moment — in daily life — was associated with less pain and fewer arthritis-related restrictions in the moment, whereas negative mood was associated with more restrictions. Individuals who reported greater depressive symptoms in general also reported more common pain and restrictions in daily life. This effect of depressive symptoms was not due to differences in day-to-day mood.

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The researchers report their results in the Annals of Behavioral Medicine, currently available online.

Study participants were provided mobile devices that prompted them to rate their own mood and pain five times a day across seven days. Ratings of pain, swelling, stiffness, and arthritis-related restrictions to routines and activities were similarly obtained five times a day across the same period.

“Although it is relatively common to hear people in everyday life acknowledging that their mood can exacerbate their physical pain, most evidence for this view is derived from cross-sectional comparisons, longitudinal associations over fairly lengthy periods of time, such as months or years, or laboratory studies where mood and/or pain are manipulated, as opposed to naturally occurring in everyday life,” Graham-Engeland said.

According to the researchers, several recent studies have used end-of-day assessments of mood and pain. In their study, this approach was extended to use multiple assessments per day to examine associations between mood and pain within individuals.

Study results also suggest that positive mood may be particularly important.

“Several of our analyses suggest that momentary positive mood is more robustly associated with momentary pain than negative mood,” Graham-Engeland said.

The researchers speculate that multi-component interventions aimed at both mood and depression and which incorporate non-traditional interventions as additions to pharmaceutical therapies may be needed to optimally improve pain and pain-related quality of life in many people with rheumatoid arthritis.

Although the researchers note that important questions remain about causality as well as directionality of effects, the present research suggests that interventions to target depression as well as interventions to target momentary mood warrant investigation for individuals with rheumatoid arthritis and, perhaps, chronic pain in general.

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Penn State

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TSRI scientists awarded grant to explore therapeutic potential of protein receptors in Parkinson's disease, other disorders

Scientists from the Florida campus of The Scripps Research Institute (TSRI) have been awarded nearly $1.5 million from the National Institute of General Medical Sciences of the National Institutes of Health to explore the therapeutic potential of a class of proteins that play essential roles in the regulation and maintenance of human health.

These proteins are expressed throughout the body, including the central nervous system during brain development, and are associated with conditions including Parkinson’s disease, inflammation, arthritis, cancer, metabolic disorders (dyslipidemia, obesity, diabetes) and cardiovascular disease.

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“These protein receptors have not been well studied, particularly in terms of small-molecule compounds that could affect their function,” said TSRI Associate Professor Douglas Kojetin, who is the principal investigator of the new four-year study. “We’ve found several natural small-molecule binding partners for a particular orphan receptor called Nurr1. It’s called an orphan receptor because natural small-molecule binding partners for this receptor are currently unknown, and this new grant will help uncover important details of the process. This study will potentially open up an entire new class of compounds that could affect millions of people with crippling diseases such as Parkinson’s.”

Kojetin’s laboratory focuses on the mode of action of small-molecule ligands (molecules that bind to other molecules and alter their function). In particular, the team studies how these ligands change the structure and dynamics of the proteins they target and how this contributes to biological function, disease and drug discovery.

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The Scripps Research Institute

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Link between mood, pain in rheumatoid arthritis patients

Depressive symptoms and mood in the moment may predict momentary pain among rheumatoid arthritis patients, according to researchers. Individuals in the study who reported greater depressive symptoms in general also reported more common pain and restrictions in daily life. This effect of depressive symptoms was not due to differences in day-to-day mood.
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