Alzheimer’s Vaccine Shows Promise in Mice

News Picture: Alzheimer's Vaccine Shows Promise in Mice

Latest Alzheimer’s News

MONDAY, Nov. 26, 2018 (HealthDay News) — An experimental Alzheimer’s disease vaccine shows promise in animal tests, and researchers say it could have the potential to reduce dementia cases by half.

In mice created to develop Alzheimer’s, the vaccine triggered an immune response that reduced accumulation of two toxic proteins associated with the fatal brain disease.

There was a 40 percent reduction in beta-amyloid proteins and up to a 50 percent reduction in tau proteins, with no harmful side effects, according to researchers at the University of Texas.

But there’s a catch: While such tests showed positive results in mice, research on animals doesn’t always produce the same effects in humans. More study is needed.

Still, the researchers remained optimistic. Reductions in these proteins could someday have significant benefits in people at risk for Alzheimer’s disease, said study senior author Doris Lambracht-Washington, of the UT Southwestern Medical Center Brain Institute in Dallas.

“If the onset of the disease could be delayed by even five years, that would be enormous for the patients and their families,” she said in a center news release. “The number of dementia cases could drop by half.”

Lead researcher Dr. Roger Rosenberg is founding director of the Alzheimer’s Disease Center at UT Southwestern.

“This study is the culmination of a decade of research that has repeatedly demonstrated that this vaccine can effectively and safely target in animal models what we think may cause Alzheimer’s disease,” said Rosenberg.

“I believe we’re getting close to testing this therapy in people,” he added.

Two previous studies from Rosenberg’s lab showed that the vaccine triggered similar immune responses in rabbits and monkeys.

UT Southwestern scientists are also working to create a test to detect abnormal tau levels in spinal fluid before the memory-loss symptoms of Alzheimer’s appear. They said such a test would identify people who could benefit from the vaccine.

In people with Alzheimer’s, the beta-amyloid and tau proteins spread in lethal plaques and tangles on the brain, the study authors explained.

“The longer you wait [to administer the vaccine], the less effect it will probably have,” Rosenberg said. “Once those plaques and tangles have formed, it may be too late.”

About 5.7 million Americans have Alzheimer’s disease. That number is expected to more than double by the year 2050, according to the U.S. Centers for Disease Control and Prevention. There is no effective treatment for the disease.

The study was published recently in the journal Alzheimer’s Research and Therapy.

— Robert Preidt

MedicalNews
Copyright © 2018 HealthDay. All rights reserved.

SOURCE: University of Texas Southwestern Medical Center, news release, Nov. 20, 2018


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One Twin’s Difficult Birth Puts A Project Designed To Reduce C-Sections To The Test

The tiny hand and forearm slipped out too early. Babies are not delivered shoulder first. Dr. Terri Marino, an obstetrician in the Boston area who specializes in high-risk deliveries, tucked it back inside the boy’s mother.

“He was trying to shake my hand and I was like, ‘I’m not having this — put your hand back in there,’” Marino would say later, after all 5 pounds, 1 ounce of the baby lay wailing under a heating lamp.

This is the story of how that baby, Bryce McDougall, tested the best efforts of more than a dozen medical staffers at South Shore Hospital in Weymouth, Mass., that day last summer.

Bryce’s birth also put to the test a new method of reducing cesarean sections developed at Dr. Atul Gawande’s Ariadne Labs, a “joint center for health systems innovation” at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health in Boston.

The story starts before Bryce’s birth, on the last day of August at about 9:30 in the morning.

Melisa McDougall has just checked into South Shore, after a routine ultrasound. She’s in her 36th week, pregnant with twin boys. The doctors have warned Melisa that her placenta won’t hold out much longer. She’s propped up in bed, blond hair pulled into a neat bun, makeup still fresh, ordering a sandwich, when her regular obstetrician arrives.

“How are you?” asks Dr. Ruth Levesque, sweeping into the room and clapping her hands. “You’re going to have some babies today! Are you excited?”

The first of the twins — Brady — is head-down, ready for a normal vaginal delivery. But brother Bryce is horizontal at the top of Melisa’s uterus.

That’s one reason Melisa is a candidate for a C-section. Babies do not come out sideways. And there’s another reason most doctors would not consider a vaginal delivery in Melisa’s case, Levesque says. Four years ago, she delivered the twins’ sister by cesarean.

“[Melisa] has a scar on her uterus,” Levesque explains, “so there’s a risk of uterine rupture — very rare, but there’s always a possibility.”

And that possibility may be greater for Melisa because she’s 37 and having twins. But the McDougalls hope to have vaginal deliveries for both boys.

“I just feel like it’s better for the kids — better for the babies,” Melisa says.

Melisa McDougall hears comforting words from her nurse at South Shore Hospital in Weymouth, Mass. Part of the focus of the Team Birth Project is on facilitating communication among parents, nurses and doctors.(Jesse Costa/WBUR)

How The ‘Team Birth Project’ Came To Be

Avoiding C-sections is also better for many moms. With cesareans, there’s a longer recovery period, a greater risk of infection and an association with injury and death. And most C-sections are not medically necessary, said Dr. Neel Shah, who directs the Delivery Decisions Initiative at Ariadne Labs.

“We’re fairly confident that, when you look nationally, the plurality — if not the majority — of C-sections are probably avoidable,” said Shah.

Those avoidable C-sections are the focus of the Team Birth Project, designed by Shah with input from roughly 50 doctors, nurses, midwives, doulas, public health specialists and consumer advocates who focus on childbirth. South Shore Hospital is one of the pilot sites for the project.

In describing the collaboration, Shah begins with an acknowledgement: Childbirth is complicated. You’ve got two patients — the mother and the baby — and an ad hoc, often shifting team that at a minimum includes the mom, a nurse and a doctor.

“So you’ve got three people who have to come together and become a very high-performing team in a really short period of time, for one of the most important moments in a person’s life,” Shah said.

And this team has to perform at its best during an unpredictable event: labor.

Shah says doctors and nurses generally agree about three things: when a mom is in active labor; when a mom can definitely try for a vaginal delivery; and when she must have a C-section.

“And then there’s this huge gray zone,” Shah said. “And actually, everything about the Team Birth Project is about solving for the gray.”

To avoid unnecessary C-sections when what to do isn’t clear, this hospital, in conjunction with Ariadne, has changed the way labor and delivery is handled from start to finish.

First, women aren’t admitted until they are in active labor. Secondly, the mom’s preferences — such as whether she’d like an epidural or not, whether she wants to have “skin-to-skin contact” with the baby immediately after birth — help guide the members of the labor team. The team members map the delivery plan — including mom’s preferences and the medical team’s guidance — on a whiteboard, like the one in Melisa’s room.

For the births of Bryce and Brady McDougall, the white erasable planning board gets a lot of use.

Under “Team,” Levesque and registered nurse Patty Newbitt write their names. Melisa and Shaun McDougall are also listed as equal partners. The names of other family members or nurses may be added and erased as labor progresses. Shah’s idea is that this team will “huddle” regularly throughout the labor to discuss the evolving birth plan.

The birth plan itself is divided into three separate elements on the board: Maternal (the mom), Fetal (the baby) and Progress (in terms of how the labor is progressing). A mom with high blood pressure, for instance, may need special attention — and that would be noted on the board — but she could still have a normal labor and vaginal delivery.

The whiteboard in Melisa McDougall’s hospital room details the birth plan, including her preferences and the medical team’s guidance.(Jesse Costa/WBUR)

Good Communication Throughout Labor And Delivery Is Key

Dr. Kimberly Dever, who chairs the OB-GYN department at South Shore, highlights a section of the whiteboard called “Next Assessment.”

That category is included on the board, Dever said, “because one of the things I often heard from patients is that they didn’t know what was going to happen next. Now they know.”

Asking the mom — and the couple — about their preferences for the delivery is crucial, too, Levesque said.

“It forces us to stop and to think about everything with the patient,” she explained. “It makes us verbalize our thought process, which I think is good.”

Shaun McDougall walks across the room to get a closer look at the whiteboard.

“Honestly, it seems like common sense,” he says. “I would always think the nurses would have something like this, but to have it out where mom and dad can see it — I think it’s pretty cool.”

With Melisa McDougall’s plan in place, everyone settles in, to wait. About four hours later, Melisa isn’t yet feeling contractions. Levesque breaks the water sac around Brady.

“Looks nice and clear,” Levesque reports. “Hey bud, come on and hang out with us,” she says to the baby.

“So, you’re going to keep leaking fluid until you leak babies,” the doctor explains to Melisa. “Whenever you start getting uncomfortable, we’ll get you an epidural at that point.”

Levesque moves to the board and adds updates: Melisa is 4 centimeters dilated; her waters broke at 13:26; the next assessment will be after she gets an epidural.

The medical team insisted ahead of time that Melisa agree to be numbed from the waist down if she wants to deliver Bryce — the second twin — vaginally. Melisa agreed. The obstetricians may need to rotate the baby in her uterus, find a foot and pull Bryce out, causing pain most women would not tolerate.

One of those doctors — Marino — peeks into the room and waves.

“Just came to say hi,” says Marino, who has more experience than most obstetricians in delivering babies positioned like Bryce. Along with Levesque, Marino has been seeing Melisa regularly through office visits.

Shaun McDougall asks the physicians if they’ll pose for a picture with his wife.

“Can we make funny faces?” asks Levesque.

“I want you to,” says Shaun. “You guys are like her favorite people on the planet.”

As the hours tick by, there’s a shift change, and registered nurse Barbara Fatemi joins the McDougall team. She checks Melisa’s pain level regularly to determine when she’s ready for the epidural.

Melisa says she isn’t feeling much, but adds that she has a high tolerance for pain. Shaun tells Fatemi he sees the strain on his wife’s face. Fatemi acts on Shaun’s assessment, and calls an anesthesiologist to prepare the epidural, something Shaun later says reinforces his feeling that they’re a team.

Levesque soon arrives for the promised “next assessment.” Melisa is now 10 centimeters dilated and ready to deliver — but she must hold on until nurses can get her into an operating room.

The OR will be the right place if the second baby, Bryce, doesn’t shift his position, and the doctor needs to do a last-minute cesarean.

“I’ll see you in a few minutes. No pushing without me, OK?” Levesque says over her shoulder as she heads to the OR to prep.

“I’ll try,” Melisa says, weakly. In a minute, nurses are rolling her down the hall, following Levesque.

Almost five years ago, two women who were wheeled into this hospital’s operating rooms during childbirth died after undergoing C-sections. Though state investigators found no evidence of substandard care, Dever, the head of obstetrics, said the hospital scrutinized everything.

“When you have something like that happen, that expedites your efforts,” she said. “Exponentially.”

Now, Dever said, she sees an opportunity, through the Team Birth Project, to model changes that could help women far and wide.

“I would love women everywhere to be able to come in and have a safe birth and healthy baby,” she said. “That’s why I’m doing it.”

‘They Did Not Flinch’

Dever is about to see her pilot study of the Team Birth Project pushed to new limits by little Bryce McDougall. First, though, Melisa must deliver Bryce’s twin brother, Brady. Even his birth, the one that was expected to be easier, is more difficult than anticipated.

Bent nearly in half, her face beet red, Melisa strains for five pushes. She throws up, then gets back to laboring. And suddenly, there he is.

“Oh my goodness Brady, oh Brady,” wails Shaun. He follows a nurse holding his son over to a warmer.

Marino takes Shaun’s place next to Levesque, who has reached inside Melisa to get the next twin. Levesque’s mission is to grab Bryce’s feet and guide him out. But everything feels like fingers, not toes.

That’s a hand,” she murmurs. “That’s a hand, too.”

Marino rolls an ultrasound across Melisa’s belly, hoping the scan will show a foot. But Bryce’s feet are out of sight and out of reach.

Marino has had more experience than most obstetricians with transverse babies and this procedure, known as a breech extraction; she asks to try. She reaches into Melisa’s uterus while Levesque moves to Melisa’s right side and uses her forearm to shift Bryce and push him down. Dever has come into the room, and takes over the ultrasound. At least six doctors and nurses encircle Melisa, whose face is taut. Shaun frowns.

“Babe, you OK?” he asks.

Melisa nods. Bryce’s heart rate is steady. But there’s still no sign of a foot. One little hand slips out and Marino nudges it back in.

“Open the table,” says Marino, her voice strained.

It’s open and ready, her colleagues say, referring to the array of sterile surgical instruments that Marino may soon need, to begin a C-section.

For 36 seconds, this room with more than a dozen adults grows oddly quiet. Everyone is watching Marino twist her arm this way and that, determined to find Bryce’s feet. Levesque leans hard into Melisa’s belly. Shaun bites his lip. Then Marino yanks at something — and her gloved hand emerges, clenching baby Bryce by his two teeny legs.

“Oh babe, here he comes, here he comes — Woo!” squeals Shaun.

Shaun is overcome with emotion again. Melisa manages an exhausted giggle. Baby Bryce keeps everyone waiting a few more seconds and then howls.

Levesque tends to Melisa, and Marino comes around to congratulate the new mom.

“He was fighting you, huh?” Melisa says, and laughs.

“I think I found at least five hands,” says Levesque.

Outside the OR, Levesque and Marino look relieved and elated. Both agree that most doctors would have delivered Bryce by C-section. But at South Shore, the McDougalls found a hospital that has challenged itself to perform fewer C-sections, and a doctor with experience in these unusual deliveries — one who knew and respected the parents’ preference.

“They specifically wanted to have a vaginal delivery of both babies,” Marino says — and that was on her mind during the difficult moments.

Bryce was fine, says Marino, so the deciding factor for her was that Shaun and Melisa did not panic.

“They did not flinch — they were like, ‘Keep going,’” Marino recalls. “Sometimes the patient will say ‘stop,’ and then you have to stop.”

The babies’ father says he came close to requesting that, in the very last minute before Bryce was born.

“That part with the arm — it was pretty aggressive,” Shaun says.

But in that moment, he adds, the feeling that he and Melisa were part of the team made a difference.

“It made us more comfortable,” Shaun says, and that comfort translated to trust. “We trusted the decisions they were making.”

Melisa says she’s grateful for the vaginal delivery.

“I did not want to have a natural birth and a C-section,” she says. “That would be a brutal recovery.”

Instead, 30 minutes after Bryce’s birth, Melisa is nursing Brady and talking with family members on FaceTime.

Next Assessment For The Team Birth Project

South Shore began using the Team Birth approach in April. Three other hospitals are also pilot sites: Saint Francis in Tulsa, Okla.; EvergreenHealth in Kirkland, Wash.; and Overlake in Redmond, Wash. The test period runs for two years. In the first four months at South Shore, the hospital’s primary, low-risk C-section rate dropped from 31 percent to 27 percent — about four fewer C-sections each month.

Experts who contributed to the development of the Team Birth Project are eager to see whether other hospitals can lower their rates of C-section and keep them down.

“Once you get past the early adopters, how do you demonstrate the benefits for others that aren’t willing to change?” asked Gene Declercq, a professor of community health sciences at Boston University School of Public Health.

Declercq noted that a few insurers are beginning to force that question, refusing to include in their networks hospitals that have high C-section rates, or high rates of other unnecessary, if not harmful, care.

The federal government has set a target rate for hospitals: No more than 23.9 percent of first-time, low-risk mothers should be delivered by C-section. The U.S. average in 2016 was 25.7 percent.

The target was put in place because research has shown that if a woman’s first delivery is a C-section, her subsequent deliveries are highly likely to be C-sections, too — raising her (and her baby’s) risk for complications and even death.

Declercq said the project’s focus on communication in the labor and delivery room makes sense because many physicians decide when to perform a cesarean based on clinical habit or the culture of their hospital.

“If you can impact that decision-making process, you can perhaps change the culture that might lead to unnecessary cesareans,” said Declercq.

This story is part of a reporting partnership with WBUR, NPR and Kaiser Health News.


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Harsh parenting can be buffered by warm relationships with teachers, peers

(Reuters Health) – – Children whose parents often threaten and criticize them are more likely to become defiant and aggressive, research shows. But these effects can be buffered by warm relationships with teachers and school friends, a new study suggests.

Kindergartners who experienced harsh parenting but also had developed close buddies were less likely at the end of the school year to exhibit behaviors such as defiance towards adults, rule breaking and angry outbursts than those who did not have warm relationships, according to the study published in Development and Psychopathology.

“This highlights the potential utility of interventions that are more school based for oppositional defiant disorder behaviors,” said study leader Danielle Roubinov of the department of psychiatry at the University of California, San Francisco. “Parent management training programs are some of the most widely used interventions for these kids, but a large proportion of families don’t respond to these kinds of interventions.”

Roubinov and her colleagues studied the impact of school-based relationships on 383 kindergartners from 29 classrooms in six public schools in the San Francisco Bay Area. Seventy-one percent had been exposed to high levels of harsh parenting, while the other 29 percent had been exposed to lower levels of harsh parenting.

Overall, 10 percent of the children met the criteria for oppositional defiant disorder (ODD).

Young children with ODD often don’t outgrow it. ODD has been associated with an elevated risk of antisocial behavior, anxiety, depression, substance abuse, criminal offenses and incarceration in adolescence and adulthood.

To take a closer look at the possible buffering effects of warm relationships at school, the researchers collected information from the children themselves, parents, teachers and other students.

“First we asked parents to report on their parenting practices,” Roubinov said. “We asked about their discipline strategies, including how harsh, negative or critical their parenting was.”

Children were asked how warm, caring and positive they felt their relationships were with their teachers. Teachers were asked about their relationships with the children and about how well the children fit in with others in the classroom.

To get a sense of how well a child got along with peers, the researchers interviewed the entire class. “We went into the classroom and showed the children a big display board with pictures of all the classmates and told them to nominate which classmates they liked to play with,” Roubinov said. “From that we could derive how well accepted a student was among their peers.”

In the fall, at the beginning of the study, all three groups were asked about the children’s ODD behaviors. The groups were asked to rate the behaviors again in the spring.

When the researchers analyzed ODD symptoms from a composite of parent, teacher and children’s reports, they found harshly parented kids who were liked and accepted by their classmates had a 64 percent lower ODD symptom score than children who were not liked. Those who were exposed to harsh parenting but had a warm relationship with their teacher had a 29 percent lower ODD symptom score than counterparts without a positive teacher relationship.

The new study shows that “for kids who have parenting that is less than optimal, there are opportunities in both their friendships and relationships with teachers at school to get the support, engagement and reinforcement of their worth that may help blunt the negative impact of harsh parenting,” said Patrick Tolan, the Charles S. Robb Professor in the Curry School of Education and Human Development at the University of Virginia. “But I don’t think the message from this study is that having good friendships overcomes harsh parenting.”

The best solution, Tolan said, is to give parents the training they need so they will be less harsh with their children. “The first step is learning to monitor yourself and to calm yourself down,” Tolan said.

SOURCE: bit.ly/2AChWJB Development and Psychopathology, online November 21, 2018.

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Roche buys U.S. biotech Jecure in race for liver disease drugs

FILE PHOTO: The logo of Swiss drugmaker Roche is seen at its headquarters in Basel, Switzerland February 1, 2018. REUTERS/Arnd Wiegmann

ZURICH (Reuters) – Swiss drugmaker Roche is buying U.S.-based Jecure Therapeutics, joining Pfizer, Gilead Sciences and Novartis in pursuit of new drugs to treat fatty liver disease.

Roche did not say how much it was paying for Jecure, which gives it a preclinical portfolio of so-called NLRP3 inhibitors being developed for fighting inflammatory diseases like non-alcoholic steatohepatitis (NASH) and liver fibrosis as well as gout, inflammatory bowel disease and cardiovascular diseases.

Novartis and Pfizer last month teamed up to develop treatments for NASH, which many drug companies believe will become a hugely lucrative market, as it is tied to the obesity and diabetes epidemics. Unchecked, NASH can lead to advanced cirrhosis and liver failure.

“We’re excited to combine Jecure’s portfolio with our discovery and development capabilities, as well as our expertise in NLRP3 biology, to potentially help people with inflammatory diseases,” James Sabry, Roche’s head of partnering, said in a statement on Tuesday.

NASH, so far with no approved treatments, is poised to become the leading cause of liver transplants by 2020. [reut.rs/2HojtnT]

Jecure Therapeutics is focused on novel therapeutics for the treatment of NASH and liver fibrosis and was founded by Dr. Ariel Feldstein, who heads gastroenterology at the University of California San Diego School of Medicine.

Reporting by John Miller; Editing by Alexander Smith

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Key Strategies When Caring for a Loved One With Dementia

News Picture: Key Strategies When Caring for a Loved One With Dementia

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SUNDAY, Nov. 25, 2018 (HealthDay News) — People caring for a loved one with Alzheimer’s or other types of dementia should focus on four main safety issues, an expert says.

Nearly 6 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. About 16.1 million Americans provide unpaid care for people with Alzheimer’s or other dementias.

“When approaching dementia families, I follow the safe and sane rule,” said Dr. Andrew Duxbury, a geriatrician in the Division of Gerontology, Geriatrics and Palliative Care at University of Alabama at Birmingham.

“Everything we do needs to make the patient safe and the family sane. In terms of safety, it boils down into the big four: meals, wheels, bills and pills,” he explained in a university news release.

In terms of meals, caregivers need to consider whether the person is capable of preparing food, eating healthy and appropriate amounts of food, and has the awareness that they need to eat, Duxbury said. “If any link in that chain breaks, the person may not eat,” he said.

When it comes to kitchen safety, the “biggest issue is leaving things on the stove and forgetting to turn the oven off; but if cooking is part of someone’s routine, let them cook on their own while monitoring what they are doing from another room,” he said.

“Think about it this way: Would you let your 12-year-old make dinner? You may, but you would definitely be in the next room listening for anything that could go wrong,” Duxbury said.

Other suggestions include planning meals that require minimal preparation or can be made in the microwave; removing scissors and knives from the countertop and drawers; putting labels on kitchen cabinets; and disguising the garbage disposal switch to prevent someone from turning it on accidentally.

It’s not safe for patients with late-stage dementia to prepare food on the stove or in the oven, Duxbury said.

When it comes to getting out of the house, the loss of independence caused by having to give up driving can be difficult for dementia patients.

“A lot of times, an older man may just want to have the car keys, feel them in his pocket and see the car in the driveway,” Duxbury said. “You can let him have the keys, just not the key to the actual car. Give him the keys to a different car or remove the car key from his set of keys. This way, he has the keys, hears them jingle in his pocket and sees his car, but can’t go anywhere.”

If a person can no longer drive, caregivers need to ensure there is another source of transportation, especially for medical appointments. Arrange to have medications, groceries or meals delivered.

Evaluate and monitor the person’s finances to make sure he or she has enough money to pay bills and is not being taken advantage of or scammed, Duxbury advised.

Many seniors take multiple medications. Those with dementia often forget to take their pills or take pills together that can cause harmful side effects. Caregivers need to ensure their loved one is correctly managing their medications and going to medical appointments. It’s also important to keep an eye on the person’s other health issues.

To help your loved one, set up a pillbox with a week’s worth of pills, sorted by day. Some pillboxes have timers and locks you can set to prevent him or her from taking the wrong day’s dose.

Duxbury said most people with dementia think they’re fine.

“Families need to remember that a person with dementia does not live in the same reality that we live in,” he said. “They live in a reality of their brain’s dementia. These individuals may have completely different perceptions of the world around them and what it means. … We have to accept their reality for what it is.”

— Robert Preidt

MedicalNews
Copyright © 2018 HealthDay. All rights reserved.

SOURCE: University of Alabama at Birmingham, news release, Oct. 29, 2018


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Nonprofit Bets Asian-American Students Can Learn To Avoid Unhealthy Gambling

The students listened attentively as Ryan Wong explained how casinos keep customers chasing that elusive jackpot.

Labyrinthine layouts force guests to walk past card tables and slot machines in search of well-concealed restrooms and exits, said Wong, an intern at the nonprofit NICOS Chinese Health Coalition, a San Francisco partnership of health and social service organizations. Casinos ply customers with free alcohol to loosen inhibitions, and clocks are nowhere to be found.

“You lose track of time,” Wong, 23, told the members of an Asian-American studies class at City College of San Francisco. “The more you gamble, the more it favors the casino.”

NICOS staff members and interns visit Asian-American studies classes around the San Francisco Bay Area to talk to students about gambling because studies suggest Asian-American college students have a higher rate of problem gambling than their peers. NICOS hopes to reduce their risk.

It’s not that they gamble more than others but that they are significantly more likely than their white, black or Latino counterparts to report unhealthy gambling behavior, according to a 2016 study in the Journal of Gambling Studies. It found that 8 percent of Asian-American students at a large public research university in Texas met the criteria for pathological gambling, compared with about 5 percent of whites and 4 percent of blacks and Latinos.

Problem gambling includes lying about losses, feeling guilty about gambling, and missing school or work because of it.

When problem gambling worsens into an addiction, also known as pathological or compulsive gambling, people fail repeatedly to curb their habit. And if they manage to stop, they have withdrawal symptoms, including restlessness and irritability. They gamble increasing sums to maintain the rush of excitement.

Why Asian-American students have a higher rate of gambling-related problems is not entirely clear, said Nolan Zane, a professor of psychology and Asian-American studies at the University of California-Davis.

He thinks cultural, social and psychological factors all play a role. In many Asian cultures, he noted, a “belief in good luck or fortune pervades customs and rituals.”

At family and social events, for example, many Asian-American adults bet money in games that involve skill and chance, such as mahjong. Often, they teach children to play, too. Exposing youngsters to gambling at an early age tends to normalize it.

“If you look across cultures, anytime there’s a behavior that’s more acceptable, then people are more likely to develop problems with that behavior,” Zane said.

Zane’s research suggests that impulsivity is not a factor in problem gambling among Asian-American students, as it is for white students. Rather, they gamble to cope with negative feelings, such as anxiety, shame, loneliness or a sense of being disconnected from the college culture or mainstream society.

Asian-American studies departments at Bay Area colleges first approached NICOS more than a decade ago about educating students, said Michael Liao, the organization’s program director. “Instructors were noticing that gambling affected their students, either directly or through someone they knew, like a family member.”

Liao has firsthand experience: His stepfather attempted suicide after racking up insurmountable gambling debts and losing the family’s life savings.

Some immigrants who work at low-paying jobs are under financial strain and perceive gambling as a magic ticket, especially if their English is poor, Liao said. “‘Oooo, that next lottery ticket, that next trip to Vegas — that could be my way out, my way to send my kids to that school that they want to go to.’”

San Francisco State University graduate student Calvin Zhao and Michael Liao, NICOS Chinese Health Coalition’s program director, present study findings at the 2018 Nevada State Conference on Problem Gambling. (Courtesy of NICOS Chinese Health Coalition)

Even well-educated young Asian-Americans can get caught up in the allure of big money. College graduate Calvin Zhao’s ordeal began at age 21. He was an assistant and translator for an investor in a cosmetics company. The man was known as a high roller, or “whale” in casino parlance — a customer who wagered thousands of dollars in a single day. Zhao tagged along with his boss to the casinos.

“I would spend days, even all-nighters, in casinos,” Zhao recalled.

When he started betting his own money and lost several thousand dollars, he realized his gambling had become a harmful habit. “You lose money, you get sad,” he said. As his gambling habit grew, Zhao said, he became more isolated.

He ultimately broke the bad cycle by quitting his job and setting limits on his gambling. His scrape with problem gambling led Zhao, now a 23-year-old graduate student at San Francisco State University, to study unhealthy gambling among his Asian-American peers on campus for his master’s thesis.

If students visit casinos, NICOS offers these tips: Limit spending by leaving credit and debit cards at home, and set an alarm on phones or watches to signal when it’s time to quit.

When students ask Zhao for advice about their own gambling worries, he tells them that gambling itself isn’t a bad thing. Just “don’t do it excessively,” he said. “Even if you lose, you should be OK with what you lost.”


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Loved ones with health-care decision-making power often over-confident

(Reuters Health) – People entrusted with decision-making for incapacitated loved ones tend to believe they know what their loved ones would choose – but the vast majority of surrogate decision-makers in a recent study were wrong about loved ones’ wishes.

Researchers who interviewed patients and their surrogates separately found that just 21 percent of patients and surrogates were on the same page when it came to rating whether specific situations – for example, feeling daily pain, as with a broken bone or appendicitis – would be acceptable.

“Patients and their loved ones actually tend to overestimate how well they’ve talked to each other and how well the loved ones understand what the patient would want under circumstances of advanced illness and making decisions about those illnesses,” said the study’s lead author, Dr. Terri Fried, a professor of medicine at the Yale School of Medicine and an attending physician at the VA Connecticut Health Care System. “The thing that’s particularly disturbing in this study is we asked how confident they were and their confidence level was high.”

The problem is that many assume they’ve made their wishes clear when they haven’t, Fried said. “It’s not a conversation that comes naturally,” she added. “And people often mistake passing comments, when they see something on TV, as what their loved one would want. So some ER show might be on and the patient might say ‘O gee, I don’t want that to ever happen to me,’ and the surrogate thinks that means they’ve had a conversation.”

There are consequences for the surrogate who doesn’t really know what their loved one wants.

“It’s been found in other studies, that after having to make such decisions, surrogates often felt very burdened and afterwards felt like they didn’t know enough about the patient’s wishes to make an informed decision,” Fried said.

Instead of focusing on specific treatments, like mechanical ventilation, for example, the researchers focused on outcomes that a patient might or might not want to live with.

Those outcomes were: being bedbound and requiring assistance with bathing, dressing, grooming and toileting; being unable to recognize family members; daily pain feeling like a broken bone or appendicitis.

“It’s important to noted that the whole telephone survey probably took about 20 to 25 minutes and interviewers were asking questions about planning for the future and health care decisions,” Fried explained. “So, if people had questions, the interviewer could clarify anything the responder didn’t understand.”

As reported in JAMA Internal Medicine, the 349 patients in the study were randomly selected from a list of community-dwelling military veterans aged 55 and older who were receiving primary care through the VA Connecticut Healthcare System. At the outset, the patients were asked to provide the name of the person they would choose to make medical decisions if they were incapacitated. More half of the surrogates, 52 percent, were patients’ spouses.

Patients’ and surrogates’ responses were in agreement on single outcomes between 54 and 59 percent of the time. But surrogates got it right for all three outcomes just 21 percent of the time. Nevertheless, 75 percent of surrogates rated themselves as extremely confident that they knew what the patient’s wishes would be. And among those who were extremely confident, just 23 percent were correct in their prediction for all three outcomes.

Because people’s attitudes can change over time, Fried recommends people have not just one conversation about their wishes, but also to return regularly to the topic.

Dr. Albert Wu wasn’t surprised by the findings. “Americans are not comfortable thinking about death, especially their own,” said Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “And I think we are very uncomfortable having these conversations.”

While it may be difficult to talk about the topic, “it will be much more difficult to have the conversation at a time of crisis,” said Wu, who was not involved in the new study. “We don’t have enough of these discussions and we don’t have them soon enough to learn what a loved one wants. If we were to do so, a lot more people would have the kind of death everyone really wants to have: to die in bed without too much pain surrounded by your loved ones.”

SOURCE: bit.ly/2TLZczV JAMA Internal Medicine, online November 26, 2018.

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South Africa’s Aspen launches three-in-one HIV drug

JOHANNESBURG (Reuters) – South African drugmaker Aspen Pharmacare on Monday launched a triple-combination tablet for the treatment of HIV in the country where the virus is most prevalent.

The company’s new Emdolten drug is a once-a-day tablet in the form of dolutegravir, an antiretroviral medication that counters the drug resistance that often develops with older HIV treatments, Aspen said.

The drug also contains lamivudine and tenofovir disoproxil fumarate alongside dolutegravir.

In May the South African Health Products Regulatory Authority and the European Medicines Agency issued a warning advising doctors not to prescribe dolutegravir to women seeking to become pregnant.

This followed preliminary data from a study in Botswana, which found four cases of neural tube defects in babies born to mothers who became pregnant while taking the drug.

The drug is found in the branded medicines Tivicay and Triumeq, which are sold by GlaxoSmithKline’s majority-owned ViiV Healthcare unit.

Aspen, which pioneered the development and manufacture of generic antiretrovirals (ARV) in South Africa, said that using dolutegravir was safe for men, women who are not of child bearing age and child-bearing women using contraceptives, adding that these groups represent more than 70 percent of HIV patients.

“The fact that it (Emdolten) has been registered means that SAHPRA is comfortable that it is safe to take to the public,” Aspen strategic trade executive Stavros Nicolaou told Reuters, referring to South African Health Products Regulatory Authority.

The company launched Aspen Stavudine – its first generic ARV drug in August 2003 – at a time when the country was grappling with a high rate of HIV infection.

South Africa has 19 percent of the global number of people living with HIV, 15 percent of new infections and 11 percent of AIDS-related deaths, the United Nations AIDS agency says on its website.

There is no vaccine to prevent HIV/AIDS. Current treatments only helping patients to manage the disease, but the fast-mutating virus has proved a challenge to the medical community because it often develops resistance to existing medicines.

Reporting by Nqobile Dludla; Editing by James Macharia and David Goodman

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Congo approves clinical trials for Ebola treatments

KINSHASA (Reuters) – Congolese authorities have authorized clinical trials for four experimental Ebola treatments, which will allow researchers to collect valuable data about their effectiveness, the health ministry said on Saturday.

FILE PHOTO: A doctor cares for a patient inside an isolate cube at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo

Health workers have already administered therapeutic treatments to more than 150 Ebola patients since August in an effort to contain the worst of Democratic Republic of Congo’s 10 outbreaks of the hemorrhagic fever since 1976.

But until now doctors have decided which treatment to use on a case-by-case basis. In the clinical trial, the choice of treatment will now be randomized.

Treatment will still be free of charge, the ministry added in a statement.

“Precious information about the effectiveness of the treatments obtained during the clinical trial will allow for the development of these treatments on a wider scale to save more lives,” the ministry said.

The four treatments are mAb114, which was developed by the U.S. government; ZMapp, an intravenous treatment made by Mapp Biopharmaceutical; Remdesivir, made by Gilead Sciences; and Regeneron’s REGN-EB3.

As of last weekend, 151 patients had received one of the four drugs. Of those, 76 had recovered, 44 had died and 31 were still hospitalized — a mortality rate of 37 percent.

By contrast, among those who had not received treatment, the mortality rate was close to 80 percent.

The ministry said that the data from the current outbreak would probably not be sufficient to make definitive conclusions about the effectiveness of the treatments and that the trials could continue during future outbreaks.

Despite the use of the treatments as well as an experimental vaccine manufactured by Merck, authorities have struggled to contain the outbreak due to widespread militia violence in eastern Congo and community resistance to health workers.

At least 228 people are believed to have died, and the World Health Organization said last week that it expects the outbreak to last at least another six months.

Reporting By Giulia Paravicini; Editing by Aaron Ross

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Dining out with food allergies may be safer with at least 15 precautions

(Reuters Health) – A survey of people with food allergies who dine out successfully has found they employ quite a few strategies.

Those who never had an allergic reaction in a restaurant tended to employ an average of 15 strategies to avoid allergens, while those who have had a reaction tended to use only six different strategies before suffering a problem, researchers found.

“Physicians can encourage families to use several different strategies when dining out in an effort to prevent food allergy reactions,” the study’s co-author, Dr. Leigh Ann Kerns, a pediatric allergist and immunologist at Cleveland Clinic Children’s Hospital in Ohio, told Reuters Health by email.

“Family members spend a lot of time reading labels and reducing chances of cross contamination in the home, but it is more difficult to prevent unintentional exposures in restaurants due to poor understanding of food allergy, miscommunication, and possible cross contamination of ingredients,” Dr. Kerns said.

Her team surveyed 39 people with food allergies, 19 of whom had suffered an allergic reaction while dining in restaurants. Based on the responses, the researchers compiled a list of 25 strategies that diners use and reported them November 16 at the American College of Allergy, Asthma, and Immunology’s annual conference in Seattle, Washington. (The strategies can be found here: bit.ly/2zxyCCj.)

The top five are these: Speak to waiter on arrival (80 percent), order food with simple ingredients (77 percent), double-check food before eating (77 percent), avoid restaurants with higher likelihood of cross-contamination (74%), and review ingredients on a restaurant website (72 percent).

The least-used strategies reported were these: place food allergy order separately (23%), use a personal allergy card or chef card (26 percent), no longer eat at restaurants (39 percent), choose a chain restaurant (41 percent), go to restaurants during off-peak hours (44 percent).

Patients with food allergies need to be vigilant when going to restaurants, primary investigator Dr. Justine Ade, of University Hospitals’ Rainbow Babies and Children’s Hospital in Cleveland, Ohio told Reuters Health.

“Using more strategies before going out to eat and while dining may help prevent food allergy reactions. (And) always bring an epinephrine device when going out to eat,” Dr. Ade said.

The survey suggests that engaging in a wide variety of preventive efforts may reduce a patient’s risk, said Dr. Clifford Basset, Medical Director of Allergy and Asthma Care of New York in New York City and a spokesperson for the ACAAI, who was not involved in the study.

“Optimal preventive strategies are an integral part of a successful food allergen risk reduction program. Several of the identified preventive strategies feature proactive, clear communication between the patient/family and the restaurant staff,” Dr. Basset said.

Adapting an old maxim to the topic, the takeaway from the study may be that there are two kinds of diners with food allergies: those who take lots of precautions and those who have not yet had their first reaction.

SOURCE: bit.ly/2zxyCCj American College of Allergy, Asthma, and Immunology, November 16, 2018.

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