Frail Seniors Find Ways To Live Independently

DENVER — Pauline Jeffery had let things slide since her husband died. Her bedroom was a mess. Her bathroom was disorganized. She often tripped over rugs in her living and dining room.

“I was depressed and doing nothing but feeling sorry for myself,” said the 85-year-old Denver resident.

But Jeffery’s inertia faded when she joined a program for frail low-income seniors: Community Aging in Place — Advancing Better Living for Elders (CAPABLE). Over the course of several months last year, an occupational therapist visited Jeffery and discussed issues she wanted to address. A handyman installed a new carpet. A visiting nurse gave her the feeling of being looked after.

In short order, Jeffery organized her bedroom, cleaned up her bathroom and began to feel more upbeat. “There’s a lot of people like myself that just need a push and somebody to make them feel like they’re worth something,” she said. “What they did for me, it got me motivated.”

New research shows that CAPABLE provides considerable help to vulnerable seniors who have trouble with “activities of daily living” — taking a shower or a bath, getting dressed, transferring in and out of bed, using the toilet or moving around easily at home. Over the course of five months, participants in the program experienced 30 percent fewer difficulties with such activities, according to a randomized clinical trial — the gold standard of research — published this month in JAMA Internal Medicine.

“If someone found a drug that reduced disability in older adults by 30 percent, we’d be hearing about it on TV constantly,” said John Haaga, director of the Division of Behavioral and Social Research at the National Institute on Aging, which provided funding for the research.

Positive findings are especially notable given the population that was studied: 300 poor or near-poor older adults, nearly 90 percent women, over 80 percent black, with an average age of 75 and multiple chronic medical conditions such as heart disease, arthritis and chronic obstructive pulmonary disease. While about 1 in 3 older adults in the U.S. need help with one or more daily activities, rates of disability and related health care costs are higher in this challenged population.

Half of the older adults in the trial received the CAPABLE intervention, which includes six visits by an occupational therapist, four visits by a registered nurse, and home repair and modification services worth up to $1,300. The control group received 10 visits of equal length from a research assistant and were encouraged to use the internet, listen to music, play board games or reminisce about the past, among other activities.

Both groups experienced improvements at five months, but older adults who participated in CAPABLE realized substantially greater benefits. Eighty-two percent strongly agreed that the program made their life easier and their home safer. Nearly 80 percent said it enabled them to live at home and increased their confidence in managing daily challenges.

Sarah Szanton, who developed CAPABLE and directs the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, attributes positive results to several program elements. Instead of telling an older adult what’s wrong with them, a mainstay of medical practice, CAPABLE staff ask older adults what they’d like to be able to do but can’t do now.

Seniors often say they want to cook meals for themselves, make their beds, use the stairs, get out of the house more easily, walk around without pain or go to church.

The focus then turns to finding practical solutions. For someone who wants to cook but whose legs are weak, that could mean cutting vegetables while sitting down before standing up at the stove. A bed may need to be lifted on risers and a grab bar positioned between the mattress and box spring so a person can push herself up to a standing position more easily. Or, a nurse may need to go over medications and recommend potential changes to a person’s primary care doctor.

“Why does it work? Because we’re guided by what people want, and in order to get better, you have to want to get better: It has to be important to you,” said Amanda Goodenow, program manager for CAPABLE at the Colorado Visiting Nurse Association, the agency that assisted Jeffery. In Colorado, CAPABLE has been funded by a local foundation and Habitat for Humanity, which supports the program in six markets.

Hattie Ashby, 90, who has lived in the same two-story house in Aurora, a city adjacent to Denver, for 43 years, told Goodenow last summer that she wanted to get up and down the stairs more easily and walk around outside the house. Ashby has high blood pressure and COPD.

“They gave me a walker and made arrangements for me to put my oxygen tank on it so I could go to the mall,” she said, recalling some of what the CAPABLE staff did. “They fixed the wall in my bathroom and put something I could hold onto to get in and out of my bathtub. And going up and down my stairs, they put another rail on the wall where I would be able to hold onto.”

“It is a remarkable service for a senior citizen to be encouraged, to be helped, to be supported that way,” Ashby said.

It also turns out to be a cost-effective investment. For every dollar spent on CAPABLE, nearly $10 in combined savings accrues to Medicare and Medicaid, largely because of hospitalizations and nursing home placements that are prevented, research by Szanton and others has shown. (Many CAPABLE participants are eligible for both government health insurance programs because of their low incomes.) The average program cost per person is $2,825, far below the average $7,441 monthly cost of a semiprivate room in a nursing home in 2018.

With a new grant of nearly $3 million from the Rita & Alex Hillman Foundation, Szanton is turning her attention to expanding CAPABLE across the country. Currently, the program is available at 26 locations in 12 states, and Medicaid programs in Massachusetts and Michigan have adopted a version of it for some members. A major challenge is securing funding, since public and private insurers don’t typically pay for these kinds of services. So far, foundation and grant funding has been a major source of support.

Szanton hopes to persuade Medicare Advantage plans, which cover about 19 million Medicare recipients and can now offer an array of nonmedical benefits to members, to adopt CAPABLE. Also, Johns Hopkins and Stanford Medicine have submitted a proposal to have traditional Medicare offer the program as a bundled package of services. Accountable care organizations, groups of hospitals and physicians that assume financial risk for the health of their patients, are also interested, given the potential benefits and cost savings.

Another priority will be looking at how to extend CAPABLE’s impact over time. Since benefits diminished over a 12-month period in the just-published clinical trial, additional program elements — phone calls, extra visits and follow-up assessments — will probably be needed, said Dr. Kenneth Covinsky, a professor of geriatrics at the University of California-San Francisco and co-author of an editorial on CAPABLE that accompanied the study.

He’s bullish on CAPABLE’s prospects. “As clinicians, when we see older patients with conditions we can’t reverse, we need to understand we haven’t run out of things we can do,” Covinsky said. “Referring patients to a program like CAPABLE is something that could make a big difference.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

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U.S. court blocks San Francisco health warning on soda ads

(Reuters) – A U.S. appeals court on Thursday blocked a San Francisco law requiring health warnings on advertisements for soda and other sugary drinks in a win to the American beverage industry which fought the requirements in court.

The 11 judges of the 9th U.S. Circuit Court of Appeals in a unanimous decision said the city’s ordinance violated commercial speech protected under the U.S. Constitution.

“The required warnings therefore offend plaintiffs’ First Amendment rights by chilling protected speech,” the judges wrote in granting a preliminary injunction that prevents the law from taking effect.

The judges said beverage makers were likely to suffer “irreparable harm” if the law is implemented because the warning would “drown out” the advertisements’ other visual elements.

The San Francisco ordinance is part of a national effort to curb consumption of soft drinks and other high-calorie beverages that medical experts have said are largely to blame for an epidemic of childhood obesity.

Over the past years, many U.S. localities have imposed taxes on sugary beverages, adding a surcharge of up to 1.75 cents per ounce (29 milliliters). At that rate, the cost of a typical 12-ounce can of soda would rise by 21 cents.

The beverage industry has opposed the measures, saying they hit poor and working-class families and small businesses the hardest.

The ordinance passed by San Francisco in June 2015 required advertisements on billboards and posters within city limits to include a warning that drinking high-sugar beverages contributes to obesity, diabetes and tooth decay.

A smaller, three-judge panel of the 9th blocked the law in 2017, saying it unfairly targeted one group of products. The entire 11-judge panel in January 2018 agreed to rehear the case.

The American Beverage Association, which in 2015 asked for the preliminary injunction, did not immediately respond to a request for comment on Thursday’s ruling.

San Francisco’s City Attorney Dennis Herrera, whose office defended the law in court, also did not immediately respond to a request for comment.

Reporting by Tina Bellon in New York; Editing by Sonya Hepinstall

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Suicide-risk screening might cut deaths among incarcerated youth

(Reuters Health) – Teens and young men in correctional facilities are at increased risk of dying by suicide, but they are otherwise fairly similar to unincarcerated youth who take their own lives, a U.S. study suggests.

Looking at a nationally-representative sample of all suicides by boys and men aged 10-24 years over a decade, one of the few differences researchers noted was that jailed youth were most likely to die within the first seven days of incarceration.

That suggests screening these youth for suicide risk factors at intake and monitoring them for signs of suicidal intent might reduce deaths, the authors conclude in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Suicide prevention efforts for incarcerated youth should focus on timely and ongoing suicide risk assessment and safety planning,” said lead study author Donna Ruch of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Columbus, Ohio.

From 2000 to 2014, suicide rates were two to three times higher for youth in custody than those in the general population, with more youth in confinement dying by suicide than any other reported cause of death, Ruch’s team notes.

In general, suicide is the second leading cause of death among youth ages 10-24, according to the Centers for Disease Control and Prevention.

“The National Action Alliance for Suicide Prevention has also identified youth in custody as high-risk individuals for suicide and established a strategic goal to reduce suicidal behavior in this population,” Ruch told Reuters Health by email.

The researchers analyzed the characteristics and circumstances around 10,000 suicides among young men ages 10-24 between 2003 and 2012, including 213 incarcerated youth who were in a short-term juvenile detention center, long-term juvenile correctional facility, adult jail or adult prison. The study team used the National Violent Death Reporting System, which captures and links violent death data from multiple reports by coroners, medical examiners and law enforcement.

Overall, the majority of suicides in and out of incarceration were white males, aged 20-24. But suicides among black youth were significantly more likely to take place in custody.

In addition, those who were incarcerated were more likely to die by hanging, strangulation or suffocation and less likely to die by firearms than those not incarcerated. The youth in custody were also more likely than unincarcerated peers to disclose their reason for suicide, leave a note, or show depressive symptoms leading up to the suicide.

About 37 percent of all youth who died by suicide had a documented mental health problem, the study also found. In general, risk factors for suicide, such as a history of suicide attempts, a history of mental health conditions and drug or alcohol use, were not significantly different between those who were in custody and not in custody.

This could mean unique aspects of the incarceration environment may be associated with a higher risk of suicide, the study authors note.

Based on a few case studies, they also found that one third of these suicides in custody occur within 24 hours of incarceration, and 76 percent within seven days of incarceration.

“This may be due to many factors, including the shock of the incarceration, aggravating the already fragile state of the youth,” said Madhav Bhatta of Kent State University in Ohio, who wasn’t involved in the study.

“Correctional facilities need better ways to screen youths in their custody for potential suicide risk, especially at intake and early incarceration,” Bhatta said in an email.

Ruch’s team is planning a follow-up study to identify the best screening tools to detect suicide risk in the criminal justice system and the most effective way to administer these assessments.

Correctional facilities may also consider computer adaptive testing for suicide assessments, which changes the questions based on the respondent’s prior answers and can adapt over time if given multiple times, said Karen Abram of Northwestern University Feinberg School of Medicine in Chicago, who also wasn’t involved in the study.

“Youth suicide is a preventable public health problem,” she said in an email. “Suicide prevention training for staff is critical, especially training to recognize warning signs for suicide.”

SOURCE: bit.ly/2TpXvr9 Journal of the American Academy of Child & Adolescent Psychiatry, online January 23, 2019.

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Study: Low-calorie diet prevented asthma symptoms in mice

Experimenting with mice, Johns Hopkins Medicine researchers report that a low-calorie diet prevented asthma symptoms regardless of the diet’s fat and sugar content. The researchers also say they found that obesity resulting from a high-calorie diet led to asthma symptoms in the animals by causing lung inflammation, and a drug that blocks inflammation eased those symptoms.

In a report on the experiments, published in Scientific Reports on Jan. 22, the researchers say their results add to evidence supporting the links between obesity, inflammation and asthma, and the value of anti-inflammatory drugs in treating characteristic symptoms of asthma tied to obesity in people. Scientists and clinicians have known for decades that obese people are far more likely than people with normal weight to develop certain kinds of asthma or to have asthma symptoms increase. According to the U.S. Centers for Disease Control and Prevention, 38.8 percent of adults with asthma are obese, much higher than the obesity rate in adults without asthma, which stands at 26.8 percent. But, the biological mechanisms underlying obesity-related asthma symptoms and risk have remained somewhat unclear.

Experimenting with mice, Johns Hopkins Medicine researchers report that a low-calorie diet prevented asthma symptoms regardless of the diet’s fat and sugar content. The researchers also say they found that obesity resulting from a high-calorie diet led to asthma symptoms in the animals by causing lung inflammation, and a drug that blocks inflammation eased those symptoms.

In a report on the experiments, published in Scientific Reports on Jan. 22, the researchers say their results add to evidence supporting the links between obesity, inflammation and asthma, and the value of anti-inflammatory drugs in treating characteristic symptoms of asthma tied to obesity in people. Scientists and clinicians have known for decades that obese people are far more likely than people with normal weight to develop certain kinds of asthma or to have asthma symptoms increase. According to the U.S. Centers for Disease Control and Prevention, 38.8 percent of adults with asthma are obese, much higher than the obesity rate in adults without asthma, which stands at 26.8 percent. But, the biological mechanisms underlying obesity-related asthma symptoms and risk have remained somewhat unclear.

“Previous studies suggested that the high fat or high sugar content in diets that led to obesity promoted inflammation and caused asthma,” says Vsevolod Polotsky, M.D., Ph.D., professor of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine, and senior author of the study. “However, our study shows that obesity leads to inflammation-associated asthma symptoms regardless of the makeup of the diet, and that restricting calories by any means may prevent or treat asthma by reducing inflammation.”

Asthma is a common chronic lung disease in which inflammation causes narrowing of airways, leading to wheezing, coughing, shortness of breath and chest tightness.

Polotsky said his team pursued their animal study in a bid to clarify the links among obesity, asthma, diet and inflammation, and develop new treatment options, particularly because traditional therapies such as steroid inhalers don’t work as well for asthmatics who are obese.

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In this study, researchers fed normal male mice one of four diets: (1) a low-calorie chow diet, which is a standard laboratory diet of crunchy food pellets without calorie restrictions; (2) a calorie-dense diet containing more calories and fat per gram; (3) a calorie-dense diet containing more fat per gram and supplemented with additional sugar; and (4) a calorie-dense, high transfat diet supplemented with sugar. Furthermore, separate groups of mice were fed the calorie-dense diets, but their daily food intake was restricted to match the number of calories that mice eat on a low-calorie diet.

After eight weeks, mice on any high-calorie diet, whose eating wasn’t restricted, gained at least 7 grams more than mice on the low-calorie diet or mice on food-restricted, calorie-dense diets.

The researchers went on to evaluate the animals’ lung function to see if the mice developed asthma symptoms by measuring the narrowing of lung airways when the mice inhaled different doses of methacholine, a drug that causes airways to constrict. When given a 30 milligrams per milliliter dose of methacholine, mice on all kinds of high-calorie diets whose eating wasn’t restricted had their airways constricted at least 6.3 times more than baseline, while mice on low-calorie diets or food-restricted mice on high-calorie diets had their airways constricted at most 4.7 times more than baseline. The results of these tests–similar to those used to screen for or diagnose asthma in people–indicated that mice on high-calorie diets developed asthma symptoms, as well as obesity.

In previous studies, Polotsky and his team showed that mice fed high-fat diets for two weeks had increased levels of IL-1 β (interleukin-1 beta), a protein whose presence indicates inflammation in the body.

In the new experiments, researchers sought to further pin down the links between obesity, inflammatory response and asthma by first feeding mice high-fat diets for eight weeks. Then they injected one group of mice with a drug called anakinra every day during the last two weeks to block the activity of IL-β protein–and thus inflammation–by preventing it from reaching its targeting sites. Because of its anti-inflammatory properties, anakinra is used to treat rheumatoid arthritis.

At the end of eight weeks, when given a 30 milligram per milliliter dose of methacholine to test their airway responsiveness, obese mice on the drug anakinra had their airways constricted 2.9 times more than baseline, lower than the 5.1 times increase observed in obese mice not given the drug.

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New Covered California Sign-Ups Plummet

The number of new enrollees in Covered California plans plunged by nearly a quarter this year, largely because of the elimination of the tax penalty for people without insurance, officials announced Wednesday.

The decrease was steeper than expected — and larger than the drop in new enrollment in the federal marketplace, healthcare.gov. It occurred even as Covered California, the state health insurance exchange, spent millions on advertising to entice people to sign up for coverage during the open-enrollment period that ended Jan. 15.

Overall, more than 1.5 million Californians selected a health plan for 2019 coverage, a figure similar to last year’s, the agency said. But new enrollment fell by 23.7 percent, with 295,980 sign-ups compared with 388,344 last year. Meanwhile, plan renewals remained strong, and posted a 7.5 percent increase.

“Recent actions at the federal level appear to be causing large drops in enrollment that will lead to more uninsured and higher premiums for all Californians,” said Covered California Executive Director Peter Lee.

“The federal removal of the individual mandate penalty appears to have had a substantial impact on the number of new consumers signing up for coverage,” he said.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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Boot Camp After 60: 10 Steps To Turn Around Unhealthy Habits

It takes moxie to flip an unhealthy lifestyle to a healthy one — particularly for folks over 60.

Most baby boomers approach retirement age unwilling to follow basic healthy lifestyle goals established by the American Heart Association, said Dr. Dana King, professor and chairman of the department of family medicine at West Virginia University, referencing his university’s 2017 study comparing the healthy lifestyle rates of retired late-middle-aged adults with rates among those still working.

Kaiser Health News interviewed three other prominent experts on aging and health about how seniors can find the will to adopt healthier habits.

“People do financial planning for retirement, but what about retirement health planning?” King said.

Motivated seniors can begin by following KHN’s 10-step program:

1. Buy great sneakers. Purchase a pair of top-quality sneakers specifically designed for walking, said Carolyn Rosenblatt, founder of AgingParents.com, who started participating in triathlons at age 63 and continues to do them at age 70. Start by walking around the block. Expand that to 30-minute walks at least three times weekly — or set a goal to increase your walking distance 10 percent each week. And leave your sneakers by the front door.

2. Practice your balance. The best way to avoid falls is to retain a good sense of balance, said Rosenblatt. Practice standing on one leg with your eyes closed for at least 30 seconds.

3. Improve your breakfast. Stop eating the sweet roll with coffee. Consider substituting a home-blended smoothie with a banana, seasonal fruits, almond milk and protein powder or a protein patty without sugar. And cut out excess sugar in all your meals, said Rosenblatt. Replace soda with seltzer water.

4. De-stress wisely. Find ways to manage your stress that don’t involve food, alcohol or smoking. There are lots of meditation programs you can download on your phone and listen to for even 10 minutes, said Rosenblatt.

5. Practice resistance training. To keep your muscle mass from disappearing, do resistance training by lifting dumbbells or barbells or using weight machines, said Kay Van Norman, owner of Brilliant Aging, a consulting firm for healthier aging. “Your muscles are amazing, but if you don’t use them, you lose them,” she said.

6. Hit the floor. Aging adults need to regularly practice getting down on the floor and standing back up again. “If you don’t get down on the floor and back up, you won’t be able to do it after a while,” said Van Norman.

7. Challenge your speed. While it might not seem as if folks over 60 need to worry about exercise that involves speed and intensity, they do, said Van Norman. “Most people don’t even think about speed in order to stay healthy. But tennis players are doing that all the time. You need to do something to challenge your speed, not just your power.” That’s why sports like tennis can be terrific as you age, she said.

8. Believe in yourself. Faced with self-doubt and depression after several tragic, challenging events, Sharon Sultan Cutler, 71, turned to therapy to help her feel better about herself. “The first person you have to believe in is yourself,” said Sultan Cutler, an author. “People like to be around other people who believe in themselves.”

9. Tackle a project. Pick a project that has meaning to you. Sultan Cutler opted to co-author (with two other writers) her first book, “Bandstand Diaries: The Philadelphia Years, 1956-1963,” an inside look at her once favorite TV show, Dick Clark’s “American Bandstand.” Never mind that she’d never written a book before. Now she’s on her third book, “Your New You After 65: Valuable Advice to Inspire Your Awesome Aging.” “It’s like having a daydream that you can actually make happen,” she said.

10. Embrace self-improvement. Some call this lifelong learning. Living a healthier lifestyle requires constant learning and self-improvement, said Sultan Cutler. Seek out local learning resources like community colleges, where classes are often steeply discounted for seniors, she said. “Self-improvement isn’t just physical. It’s mental, too.”

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U.S. lawmakers request info from insulin makers on rising prices

WASHINGTON (Reuters) – Two powerful U.S. lawmakers sent letters to the three leading insulin manufacturers on Wednesday requesting information on why its cost has skyrocketed in recent years and how much the companies profit from the life-sustaining diabetes treatment.

FILE PHOTO: Insulin supplies are pictured in the Manhattan borough of New York City, New York, U.S., January 18, 2019. REUTERS/Carlo Allegri

Democratic Representatives Frank Pallone and Diana DeGette, the chairman and a top-ranking member of the House Energy and Commerce Committee, respectively, wrote to the heads of Eli Lilly and Co, Novo Nordisk and Sanofi, the long-time leading manufacturers of insulin. The drugmakers have all raised the price of insulin at similar rates over the last several years.

“Despite the fact that it has been available for decades, prices for insulin have skyrocketed in recent years, putting it out of reach for many patients,” the lawmakers wrote.

“As one of the few manufacturers of insulin in the United States, your company is well-suited to shed light on these issues and offer potential solutions,” the letter to the three companies said.

The committee has not set a date for a hearing, a spokesman for DeGette said. It has the power to subpoena the drugmakers if they do not answer the committee’s request.

The annual cost of insulin for treating a type 1 diabetes patient in the United States nearly doubled from 2012 to 2016 to $5,705 from $2,864, according to a recent study.

The lawmakers’ letters come amid intensifying scrutiny from Congress over the high cost of prescription drugs for U.S. consumers. Both the House Oversight Committee and Senate Finance Committee held hearings on prescription drug prices on Tuesday, with a focus on insulin.

Sanofi confirmed receipt of the letter and said it would work with the committee on its request. Neither Novo nor Lilly immediately responded to requests for comment.

High prescription drug costs have consistently polled as a top voter concern and have been a top priority of the administration of U.S. President Donald Trump, a Republican.

U.S. prescription drug prices are far higher than in other developed nations that either directly or indirectly control medicine costs.

Democratic Representative Elijah Cummings earlier this month wrote to 12 pharmaceutical companies asking for detailed information on their pricing practices, including the makers of insulin.

About 1.2 million Americans have type 1 diabetes, requiring daily insulin. Type 2 diabetes, which affects nearly 30 million Americans, according to the American Diabetes Association, is treated with a variety of other medicines. But those patients may also eventually become dependent on insulin.

Reporting By Yasmeen Abutaleb; Editing by Bill Berkrot

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Physical punishment of kids tied to antisocial behavior in adulthood

(Reuters Health) – Children who are spanked, slapped, shoved or otherwise physically punished may be more prone to antisocial behavior as adults, a U.S. study suggests.

Four in five children in the U.S. have been spanked at least once by the time they reach kindergarten, researchers note in JAMA Network Open. While spanking and other forms of harsh physical punishment have long been linked to mental health problems in kids, less is known about how these childhood experiences influence adult behavior.

For the current study, researchers examined survey data from 36,309 adults who were 47 years old, on average. Participants were asked about childhood punishments like pushing, grabbing, shoving, slapping and hitting as well as any maltreatment like sexual violence and emotional or physical abuse or neglect.

Overall, 18 percent of participants had experienced some type of harsh physical punishment growing up, and 48 percent endured some form of maltreatment.

Spanking on its own, and abuse on its own, were both associated with a higher risk of antisocial behavior in adulthood, the analysis found. And kids who experienced both harsh physical punishment and some form of abuse or neglect were even more likely to develop antisocial behaviors as adults than children who only encountered only one type of mistreatment.

Combined, these childhood experiences might explain about 46 percent of antisocial behavior among men and about 47 percent of antisocial behavior among women, the study concludes.

“Decades of data have indicated that spanking and harsh physical punishment increases the likelihood of many poor health, developmental and social outcomes for children and, importantly, no studies have ever shown that spanking is beneficial to the child,” said study leader Tracie Afifi of the University of Manitoba in Canada.

“We need to stop thinking of parenting in terms of punishments and move towards positive parenting approaches to guide children,” Afifi said by email. “This doesn’t mean that there are no consequences for problematic, unsafe or dangerous child behavior, but rather that we guide and teach children in safe and nurturing environments using non-physical discipline.”

The study focused on a broad range of antisocial behaviors including breaking the law, lying, impulsivity, aggression, recklessness, an inability to hold down a job or pay bills, and a lack of remorse for having mistreated, hurt or stolen from another person.

While spanking may not always lead to lasting mental health problems or antisocial behavior in adulthood, there’s no compelling reason for parents to use harsh physical punishment when there are less harmful and more effective ways to discipline kids, said Andrew Riley, a psychologist at Doernbecher Children’s Hospital and Oregon Health & Science University in Portland who wasn’t involved in the study.

Children who experience physical punishment may have a harder time controlling violent impulses and may learn that violence is the only way to solve conflicts, Riley said by email.

“Children learn by example, and parents are their most important models,” Riley added. “Learning it’s okay to hurt the ones you love – or that they will hurt you – is not a lesson we want taught to our children.”

Another problem is that parents don’t always realize how hard they are striking children when they choose spanking or other forms of physical punishment, said Dr. Frank Elgar, a psychiatry researcher at McGill University in Montreal, who wasn’t involved in the study.

“Parents have poor control over the amount of force used and tend to use more force than was intended,” Elgar said by email. “The slap usually comes out of frustration and anger, not the desire to teach, and because it’s ineffective in correcting a child’s behavior, the violence tends to escalate and become used indiscriminately.”

SOURCE: bit.ly/2Rmhu8q JAMA Network Open, online January 25, 2019.

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Can Strict Blood Pressure Control Lower Dementia Risk?

News Picture: Can Strict Blood Pressure Control Lower Dementia Risk?By Dennis Thompson
HealthDay Reporter

Latest Alzheimer’s News

TUESDAY, Jan. 29, 2019 (HealthDay News) — Tight control of your blood pressure won’t necessarily spare you from full-blown dementia, a new trial concludes.

But it might lower the risk of slight declines in thinking and memory, a condition known as mild cognitive impairment (MCI), the researchers added.

The clinical trial is the “first study in history to show that any intervention can reduce your risk of developing mild cognitive impairment, an early form of dementia,” said lead researcher Dr. Jeff Williamson. He is a professor of gerontology and geriatric medicine at Wake Forest School of Medicine, in Winston-Salem, N.C.

“What is good for your heart in terms of blood pressure-lowering is also good for your brain,” Williamson added. He noted that the trial ended early, which likely affected the dementia result. “We just didn’t have enough dementia cases develop over time” in the group with less-restricted blood pressure, he explained.

High blood pressure affects more than three-fourths of people over the age of 65, and it has been identified as a potential risk factor for MCI and dementia in observational studies, the study authors said in background notes.

The new clinical trial focused on nearly 9,400 people, average age 68, who had been randomly assigned to treatment that would keep their systolic blood pressure at or below a goal of either 120 or 140 mm Hg.

Participants were all at high risk for heart disease, and the clinical trial initially was aimed at seeing whether a more stringent blood pressure goal would save lives.

The planned five-year trial ended early, after a little over three years, because the group kept at 120 systolic blood pressure fared so much better than the other group, the researchers said.

The lower blood pressure goal “prevented death, stroke, heart attack and heart failure so much more quickly and so much more powerfully,” that people in the 140 systolic group were allowed to go on the same therapy as the lower blood pressure group, Williamson said.

But an offshoot of the trial continued to track the participants, to see whether tight blood pressure control had any effect on risk of developing dementia or mild cognitive impairment.

After five years of follow-up, the investigators found that tighter blood pressure control reduced the risk of MCI by 19 percent, and the risk of MCI or probable dementia combined by 15 percent.

The 120 systolic group also had a 17 percent reduced risk of dementia, but that result was not statistically significant, according to the report.

The Alzheimer’s Association has agreed to provide funding to keep tracking the patients for another couple of years, Williamson said.

“We feel additional follow-up of this cohort will provide the last piece of the puzzle we need,” he said.

There are a couple of ways blood pressure could influence brain health, Williamson suggested. High blood pressure could damage the tiny blood vessels in the brain, harming brain tissue. It also could affect the amount of toxic substances that enter and lodge in the brain.

Dr. Kristine Yaffe is chief of neuropsychiatry and director of the Memory Disorders Clinic at the San Francisco Veteran’s Affairs Medical Center. She said that even though the trial didn’t meet its primary endpoint of significantly reducing dementia, it’s still “exciting because it reminds us how important cardiovascular disease and vascular health is to the brain and to cognition.”

Yaffe, who wrote an editorial accompanying the results, added, “I think you can’t throw the baby out with the bathwater. You have to look at the whole picture here. They found an effect on MCI, which is the first time anybody’s shown a way to reduce MCI. Now we need to study this more. I think there’s a lot more we can try and understand.”

The clinical trial was published online Jan. 28 in the Journal of the American Medical Association.

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Innovate UK awards major grant to develop Rheumatoid Arthritis Flare Profiler

A partnership between the healthtech company Living With, the Royal United Hospitals Bath NHS Foundation Trust (RUH), and the University of Bath has been awarded a major grant to develop a Rheumatoid Arthritis Flare Profiler.

The award, from Innovate UK, will allow rheumatoid arthritis patients to use new methods capturing key disease activity data from smartphones, which will support clinicians to be able to classify and optimize care pathways.

Living With is developing the Flare Profiler in partnership with the RUH Trust’s Royal National Hospital for Rheumatic Diseases (RNHRD), which is the internationally leading centre of excellence for rheumatic conditions, and University of Bath’s Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), a leader in developing and evaluating new digital technologies such as the use of video, sound and motion for clinical application.

“We’re thrilled to have won an Innovate UK grant,’ says Living With’s CEO Chris Robson. “This will transform the way patients with rheumatoid arthritis can be monitored intelligently between appointments and hopefully help the NHS reduce the cost of treating patients with RA. It also adds a transformational new capability to our existing Living With Rheumatoid Arthritis product.”

Jane Carter, Research & Development Manager at the RNHRD, said: “The Trust has an established international reputation for research and expertise in rheumatology. We are always looking at ways to further improve the care and treatments we can offer patients. Using the latest technology and artificial intelligence is an exciting development. We are very excited to be part of this innovative project.”

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CAMERA was created to help further and transfer the knowledge developed within computer science, often targeting technology developed for the entertainment industries, to other sectors such as healthcare.

CAMERA Director, Professor Darren Cosker, says “This is a great project. Being able to take some of the computer vision techniques we developed for hand tracking for animation and transferring it into a condition monitoring platform that can operate in a person’s home is a very positive use of technology and exactly the kind of work we should all be doing.”

The Flare Profiler will test a unique range of patient data sources including video and thermal imaging technology. The project will then analyze patient data using cutting edge artificial intelligence (AI) and machine-learning technology to group patient disease activity patterns and identify the most effective treatment pathways for them.

The aim of the Flare Profiler is to demonstrate how better monitoring can provide earlier detection of issues, allow earlier clinical intervention and over time reduce need for costly acute treatments. It also aims to reduce the stress and need for patients to travel to hospital during treatment for specialist tests.

Source:

https://www.bath.ac.uk/announcements/smartphone-technology-will-use-ai-to-help-arthritis-patients-manage-their-flare-ups/

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