How digital tools are revolutionising patient care

New electronic devices are being used by people of all ages to track activity, measure sleep and record nutrition. Credit: Shutterstock

Imagine you've recently had a heart attack.
You're a lucky survivor. You've received high-quality care from nurses and doctors whilst in hospital and you're now preparing to go home with the support of your family.

29 july 2018--The doctors have made it clear that the situation is grim. It's a case of: change your lifestyle or die. You've got to stop smoking, increase your physical activity, eat a healthy balanced diet (whilst reducing your salt), and make sure you take all your medicine as prescribed.
But before you leave the hospital, the cardiology nurse wants to talk to you. There are a few apps you can download on your smartphone that will help you manage your recovery, including the transition from hospital to home and all the health-related behavioural changes necessary to reduce the risk of another heart attack.
Rapid advancements in digital technologies are revolutionising healthcare. The benefits are numerous, but the rate of development is difficult to keep up with. And that's creating challenges for both healthcare professionals and patients.

What are digital therapeutics?

Digital therapeutics can be defined as any intervention that is digitally delivered and has a therapeutic effect on a patient. They can be used to treat medical conditions in a similar way to drugs or surgery.
Current examples of digital therapeutics include apps for managing medications and cardiovascular health, apps to support mental health and well being, or augmented and virtual reality tools for patient education.
Paper-based letters, health records, prescription charts and education pamphlets are outdated. We can now send emails, enter information into electronic databases and access electronic medication charts.
And patient education is no longer a static, one-way communication. The digital revolution facilitates dynamic and personalised education, and a two-way interaction between patient and therapist.

How do digital therapeutics help?

Digital health care improves overall quality of care, even in cases where a patient lives hundreds of kilometres away from their doctor.
Take diabetes for example. This condition affects 1.7 million Australians. It's a major risk factor for developing cardiovascular disease and stroke. So it's important that people with diabetes manage their condition to reduce their risk.
A recent study evaluated a team-based online game, which was delivered by an app to provide diabetes self-management education. The participants who received the app in this trial had meaningful and sustained improvements in their diabetes, as measured by their HbA1c (blood glucose levels).
App based games of this kind hold promise to improve chronic disease outcomes at scale.
New electronic devices are also being used by people of all ages to track activity, measure sleep and record nutrition. This information provides instant and accurate feedback to individuals and their therapists, allowing for adjustments where necessary. The logged information can also be combined into large data sets to reveal patterns over time and inform future treatments.
Digital therapeutics are spawning a new language within the healthcare industry. "Connected health" reflects the increasingly digital ways clinicians and patients communicate. A few examples include text messaging, telehealth, and video consultations with health professionals.
There is increasing evidence that digitally delivered care (including apps and text message based interventions) can be good for your health and can help you manage chronic conditions, such as diabetes and cardiovascular disease.

But not all health apps are the same

Whilst the digital health revolution is exciting, results of research studies should be carefully interpreted by patients and providers.
Innovation has led to 325,000 mobile health apps available in 2017. This raises significant governance issues relating to patient safety (including data protection) when using digital therapeutics.
A recent review identified that most studies have a relatively short duration of intervention and only reflect short-term follow up with participants. The long-term effect of these new therapeutic interventions remains largely unknown.
The current speed of technological development means the usual safety mechanisms face new ethical and regulatory challenges. Who is doing the prescribing? Who is responsible for the efficacy, storage and accuracy of data? How are these technologies being integrated into existing care systems?

Digital health needs a collaborative approach

Digital health presents seismic disruption to patient care, particularly when new technologies are cheap and readily accessible to patients who might lack the insight required to recognise normality or cause for alarm. Technology can be enabling and empowering for self management, however there's a lot more needs to be done to link these new technologies into the current health system.
Take the new Apple Watch functionality of heart rate notifications for example. Research like the Apple Heart Study suggests this exciting innovation could lead to significantly improved detection rates of heart rhythm disorders, and enhanced stroke prevention efforts.
But when a patient receives a high heart rate notification, what should they do? Ignore it? Go to a GP? Head straight to the emergency department? And, what is the flow on impact on the health system?
Many of these questions remain unanswered suggesting there is an urgent need for research that examines how technology is implemented into existing healthcare systems.
If we are to produce useful digital therapeutics for real-world problems, then it is critical that the end-users are engaged in the process. Patients and healthcare professionals will need to work with software developers to design applications that meet the complex healthcare needs of patients
.
This article was originally published on The Conversation. Read the original article.

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The right lighting can calm Alzheimer's patients

Lighting that mimics natural night-day patterns might improve sleep and mood problems for Alzheimer's patients living in nursing homes, new research suggests.
The lighting intervention, designed to stimulate dementia patients' circadian rhythm—which regulates sleep and wake cycles—led to significant decreases in sleep disturbance, depression and agitation, the study authors said.

27 july 2018--"One of the main reasons Alzheimer's disease patients are institutionalized is lack of sleep and behavior issues," explained study author Mariana Figueiro. She directs the Lighting Research Center at Rensselaer Polytechnic Institute in Troy, N.Y.
"This is a very simple solution," Figueiro added. "It has worked with over half of patients, if not more. Even if it can help half of the people exposed to [the light], that's a pretty good outcome."
In addition to thinking and memory problems, dementia patients typically experience symptoms such as sleep disturbance, irritability, anxiety and wandering. An estimated 5.7 million Americans have Alzheimer's disease, the most common form of dementia, according to the Alzheimer's Association.
No medications have been approved by the U.S. Food and Drug Administration specifically to treat these symptoms in Alzheimer's patients, according to the researchers. All drugs currently available are used "off-label" for these purposes.
Figueiro and her team tested the lighting interventions on 43 nursing home residents in three states for four weeks, and 37 nursing home residents for six months. The tailored lighting included either a custom-designed LED light table or individual room lighting, depending on where patients spent most of their time during the day. Personal light meters monitored the patients' exposures.
The lighting was designed to stimulate the body's circadian rhythm, which prompts the release of the hormone melatonin in the brain that regulates normal sleep-wake cycles. Because nursing home residents are often exposed to varying levels of artificial light at all hours of the day and night, these sleep-wake patterns can be disrupted, study authors noted.
At the end of four weeks, sleep disturbance and depression scores in patients exposed to the tailored light intervention declined significantly. By the end of six months, sleep disturbance scores were lowered by about half. Depression scores among the light-exposed were less than half of baseline levels, on average, the researchers reported.
Dr. Joseph Masdeu, director of the Houston Methodist Nantz National Alzheimer Center in Texas, wasn't surprised by the findings.
"If you put these patients in an environment where light is present all day [and night], their system is more prone to be confused than in people who are healthy," said Masdeu, who wasn't involved with the research. "If you correct this problem, you may be contributing to their well-being."
It shouldn't be expensive for nursing homes and other facilities that serve dementia patients to install lighting like that used in the research, Figueiro said.
Several years ago, she said, "one of the barriers was technology. LEDs are much easier now … one of the barriers is cost, but it's going down, so I'm hoping in the next couple of years we'll see this more."
Figueiro also suggested that nursing home staffers bring patients outdoors more often to take advantage of natural light and to install skylights and other architectural features that bring more light inside.
"Hopefully we'll entice people to think of this issue differently," Figueiro said.
The study is scheduled for presentation Tuesday at the Alzheimer's Association annual meeting, in Chicago. Research presented at scientific conferences typically hasn't been peer-reviewed or published, and results are considered preliminary.

More information: The U.S. National Sleep Foundation has more on circadian rhythms.

Exercise cuts risk of chronic disease in older adults

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New research has shown that older adults who exercise above current recommended levels have a reduced risk of developing chronic disease compared with those who do not exercise.
Researchers at the Westmead Institute for Medical Research interviewed more than 1,500 Australian adults aged over 50 and followed them over a 10-year period.

26 july 2018--People who engaged in the highest levels of total physical activity were twice as lively to avoid stroke, heart disease, angina, cancer and diabetes, and be in optimal physical and mental shape 10 years later, experts found.
Lead Researcher Associate Professor Bamini Gopinath from the University of Sydney said the data showed that adults who did more than 5000 metabolic equivalent minutes (MET minutes) each week saw the greatest reduction in the risk of chronic disease.
"Essentially we found that older adults who did the most exercise were twice as likely to be disease-free and fully functional," she said.
"Our study showed that high levels of physical activity increase the likelihood of surviving an extra 10 years free from chronic diseases, mental impairment and disability."
Currently, the World Health Organization recommends at least 600 MET minutes of physical activity each week. That is equivalent to 150 minutes of brisk walking or 75 minutes of running.
"With aging demographics in most countries, a major challenge is how to increase the quality and years of healthy life," Associate Professor Gopinath said.
"Our findings suggest that physical activity levels need to be several times higher than what the World Health Organization currently recommends to significantly reduce the risk of chronic disease.
"Some older adults may not be able to engage in vigorous activity or high levels of physical activity.
"But we encourage older adults who are inactive to do some physical activity, and those who currently only engage in moderate exercise to incorporate more vigorous activity where possible," she concluded.
The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992.
It is one of the world's largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases.

More information: Bamini Gopinath et al, Physical Activity as a Determinant of Successful Aging over Ten Years, Scientific Reports (2018). DOI: 10.1038/s41598-018-28526-3


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First dementia prevalence data in lesbian, gay and bisexual older adults

The first dementia prevalence data from a large population of lesbian, gay and bisexual older adults was reported today at the 2018 Alzheimer's Association International Conference in Chicago.

25 july 2018--Researchers from University of California, San Francisco and Kaiser Permanente Division of Research, Oakland, CA, examined the prevalence of dementia among 3,718 sexual minority adults age 60+ who participated in the Kaiser Permanente Research Program on Genes, Environment, and Health (RPGEH). Dementia diagnoses were collected from medical records.
Over 9 years of follow-up, the overall crude prevalence of dementia was 7.4 percent for sexual minority older adults in this study population. For comparison, Alzheimer's Association 2018 Alzheimer's Disease Facts and Figures reports U.S. prevalence of Alzheimer's disease dementia and other dementias for age 65+ at approximately 10 percent. According to the researchers, significant rates of depression, hypertension, stroke and cardiovascular disease in the study population may be contributing factors to the level of dementia.
"Current estimates suggest that more than 200,000 sexual minorities in the U.S. are living with dementia, but—before our study—almost nothing was known about the prevalence of dementia among people in this group who do not have HIV/AIDS-related dementia," said Jason Flatt, Ph.D., MPH, Assistant Professor at the Institute for Health & Aging, School of Nursing, University of California, San Francisco. "Though our new findings provide important initial insights, future studies aimed at better understanding risk and risk factors for Alzheimer's and other dementias in older sexual minorities are greatly needed."
"With the growing prevalence of Alzheimer's disease dementia and the swelling population of LGBT older adults, we place a high priority on examining the intersections of Alzheimer's disease, sexual orientation, and gender identity and expression," said Sam Fazio, Ph.D., Alzheimer's Association Director of Quality Care and Psychosocial Research. "A more thorough and thoughtful understanding of this intersection will enable us to better meet the needs of LGBT elders living with dementia and their caregivers."
"Encouraging people to access healthcare services and make healthy lifestyle changes can have a positive impact on both LGBT and non-LGBT communities. Effective outreach to LGBT communities that is sensitive to racial, ethnic, and cultural differences could result in earlier diagnosis, which has been linked to better outcomes," Fazio added.
"Our findings highlight the need for culturally competent healthcare and practice for older sexual minorities at risk for, or currently living with, Alzheimer's disease or another dementia. There are also important implications for meeting the long-term care services and caregiving needs of this community. Given the concerns of social isolation and limited access to friend and family caregivers, there is a strong need to create a supportive healthcare environment and caregiving resources for sexual minority adults living with dementia," Flatt said.

The LGBT Community and Dementia

According to "Issue Brief: LGBT and Dementia," a co-publication of the Alzheimer's Association and SAGE (Services and Advocacy for GLBT Elders), there are 2.7 million LGBT people over age 50, and that number will likely double over the next 15 years. While the LGBT community faces similar health concerns as the general public, the LGBT population who receive a dementia diagnosis face uniquely challenging circumstances.

• Even with recent advances in LGBT rights, LGBT older adults are often marginalized and face discrimination.
• They are twice as likely to age without a spouse or partner, twice as likely to live alone and three to four times less likely to have children—greatly limiting their opportunities for support.
• There's also a lack of transparency as forty percent of LGBT older people in their 60s and 70s say their healthcare providers don't know their sexual orientation (Out and Visible).

The Institute of Medicine identified the following pressing health issues for LGBT people: lower rates of accessing care (up to 30%); increased rates of depression; higher rates of obesity in the lesbian population; higher rates of alcohol and tobacco use; higher risk factors of cardiovascular disease for lesbians; and higher incidents of HIV/AIDS for gay and bisexual men (Brennan-Ing, Seidel, Larson, and Karpiak, 2014). Risk factors for heart disease—including diabetes, tobacco use, high blood pressure and high cholesterol—are also risk factors for Alzheimer's and stroke-related dementia.
Due to the healthcare-related challenges they and others have faced, an LGBT person may not reach out for services and support because they fear poor treatment due to their LGBT identity, because they fear the stigma of being diagnosed with dementia, or both. Several studies document that LGBT elders access essential services, including visiting nurses, food stamps, senior centers, and meal plans, much less frequently than the general aging population.
Among the 16 recommendations for organizations and service providers in their Issue Brief, the Alzheimer's Association and SAGE suggest:

• Expand your definition of family.
• Educate yourself and your staff on LGBT cultural competency.
• Find or create support groups specifically for LGBT people.
• Partner with local LGBT community groups and political organizations.
• Help LGBT people and their families with legal and financial planning.

Dementia Survival Time is Short, Regardless of Age at Onset

Previous studies of survival times in persons with dementia have varied considerably, reporting between three and 12 years in elderly populations with either general dementia or Alzheimer's disease dementia. To better understand survival time in individuals of a relatively young age and with different types of dementia, Hanneke Rhodius-Meester, MD, Ph.D., of VU University Medical Center in Amsterdam, and colleagues investigated survival time of 4,495 early-onset dementia patients in a memory clinic (aged 66 ±10 years; 45 percent female) enrolled in the Amsterdam Dementia Cohort between 2000-2014, with any type of dementia (n=2,625), mild cognitive impairment (n=739) or subjective cognitive decline (n=1,131).
The study found that the median survival time across all groups was six years and varied based on dementia type: 6.4 years in frontotemporal lobe degeneration; 6.2 years in Alzheimer's disease; 5.7 years in vascular dementia; 5.1 years in dementia with Lewy bodies; and 3.6 years for rarer causes of dementia. Survival time hardly differed when comparing younger patients (age 65 or younger) to those older than 65. However, over time and compared to the general Dutch population, survival time in older patients showed a marginal increase, while survival time in younger patients remained unchanged.
"These findings suggest that, despite all efforts, and despite being younger and perhaps physically healthier' than older people, survival time in people with young-onset dementia has not improved since 2000," said Rhodius-Meester. "While these results still need to be replicated and confirmed, they do highlight the urgency of the need for better treatments and effective prevention strategies."

Prevalence of Dementia Increases with Age, Even in "Oldest Old"

Evaluating data from 17 centenarian studies conducted across 11 countries through the International Centenarian Consortium for Dementia (ICC-Dementia), Yvonne Leung, Ph.D., a postdoctoral fellow from the Centre for Healthy Brain Ageing (CHeBA), University of New South Wales in Sydney, and colleagues examined dementia prevalence, risk factors and cognitive and functional impairment in 4,121 centenarians and near-centenarians (aged 95-110).
When statistical predictive models were applied to examine impairment as a function of age, sex and education, researchers found that:

• Prevalence increased with age (from 95-99 to 105 years) in all societies for dementia (from 35.75 to 75.61 percent), cognitive impairment (from 45.24 to 78.72 percent) and functional impairment (from 67.46 to 91.55 percent).
• The risk of dementia, cognitive and functional impairment varied significantly between countries, suggesting cultural and lifestyle factors play a role in remaining physically and cognitively healthy as we age.
• Participants with higher levels of education expressed lower prevalence of dementia and cognitive impairment than those with fewer years of education.
• Women in this age group had a higher risk of dementia and cognitive impairment compared to men.

"This is the first study to define the global prevalence of dementia in this advanced age group using a set of common diagnostic criteria," said Dr. Leung. "These data, and this type of research, may help identify protective factors to reduce the risk of dementia, and provide insights into longevity and brain health."


Provided by Alzheimer's Association

First practice guidelines for clinical evaluation of Alzheimer's disease

PET scan of a human brain with Alzheimer's disease. Credit: public domain

Despite more than two decades of advances in diagnostic criteria and technology, symptoms of Alzheimer's disease and Related Dementias (ADRD) too often go unrecognized or are misattributed, causing delays in appropriate diagnoses and care that are both harmful and costly. Contributing to the variability and inefficiency is the lack of multidisciplinary ADRD evaluation guidelines to inform U.S clinicians in primary and specialty care settings.

23 july 2018--Responding to the urgent need for more timely and accurate Alzheimer's disease diagnosis and improvement in patient care, a workgroup convened by the Alzheimer's Association has developed 20 recommendations for physicians and nurse practitioners. There currently are no U.S. national consensus best clinical practice guidelines that provide integrated multispecialty recommendations for the clinical evaluation of cognitive impairment suspected to be due to ADRD for use by primary and specialty care medical and nursing practitioners.
The recommendations range from enhancing efforts to recognize and more effectively evaluate symptoms to compassionately communicating with and supporting affected individuals and their caregivers. The recommendations were reported at the Alzheimer's Association International Conference (AAIC) 2018 by Alireza Atri, MD, Ph.D., Co-chair of the AADx-CPG workgroup, and Director of the Banner Sun Health Research Institute, Sun City, AZ, and Lecturer in Neurology at the Center for Brain/Mind Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Details of the AADx-CPG workgroup document are being honed with input from leaders in the field, with the goal of publication in late 2018.
At their core, the recommendations include guidance that:

• All middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation.
• Concerns should not be dismissed as "normal aging" without a proper assessment.
• Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (e.g., family member or confidant).

"Too often cognitive and behavioral symptoms due to Alzheimer's disease and other dementias are unrecognized, or they are attributed to something else," said James Hendrix, Ph.D., Alzheimer's Association Director of Global Science Initiatives and staff representative to the workgroup. "This causes harmful and costly delays in getting the correct diagnosis and providing appropriate care for persons with the disease. These new guidelines will provide an important new tool for medical professionals to more accurately diagnose Alzheimer's and other dementias. As a result, people will get the right care and appropriate treatments; families will get the right support and be able to plan for the future."
In 2017, the Alzheimer's Association convened a Diagnostic Evaluation Clinical Practice Guideline workgroup (AADx-CPG workgroup) of experts from multiple disciplines in dementia care and research, representing medical, neuropsychology, and nursing specialties. The AADx-CPG workgroup used a rigorous process for evidence-based consensus guideline development.
"Our goal is to provide evidence-based and practical recommendations for the clinical evaluation process of cognitive behavioral syndromes, Alzheimer's disease and related dementias that are relevant to a broad spectrum of U.S. health care providers," Atri said. "Until now, we have not had highly specific and multispecialty U.S. national guidelines that can inform the diagnostic process across all care settings, and that provide standards meant to improve patient autonomy, care, and outcomes."
"Whether in primary or specialty care, the recommendations guide best practices for partnering with the patient and their loved ones to set goals, and to appropriately educate and evaluate memory, thinking and personality changes," Atri added.
The Clinical Practice Guidelines (CPG) recognize the broader category of "Cognitive Behavioral Syndromes"—indicating that neurodegenerative conditions such as ADRD lead to both behavioral and cognitive symptoms of dementia. As a result, these conditions can produce changes in mood, anxiety, sleep, and personality—plus interpersonal, work and social relationships—that are often noticeable before more familiar memory and thinking symptoms of ADRD appear.
"In all cases, there is something we can do to help and support those who entrust us with the privilege of advising and caring for them," said Atri. "The guidelines can empower patients, families, and clinicians to expect that symptoms will be evaluated in a patient-centered, structured, and collaborative manner. In addition, they help to ensure that, regardless of the specific diagnosis, the results are communicated in a timely and compassionate way to help patients and families live the best lives possible."
The 20 consensus recommendations describe a multi-tiered approach to the selection of assessments and tests that are tailored to the individual patient. The recommendations emphasize obtaining a history from not only the patient but also from someone who knows the patient well to:

• First, establish the presence and characteristics of any substantial changes, to categorize the cognitive behavioral syndrome.
• Second, investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses.
• Third, appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care and support.

"Evaluation of cognitive or behavioral decline is often especially challenging in primary care settings," said Bradford Dickerson, MD, MMSc, Co-chair of the workgroup, and Director of the Frontotemporal Disorders Unit at Massachusetts General Hospital, and Associate Professor of Neurology at Harvard Medical School, Boston. "Also, with recent advances in available diagnostic technology, there is a need for guidance on use of such tests in specialty and subspecialty care settings."
According to the workgroup, a timely and accurate diagnosis of ADRD increases patient autonomy at earlier stages when they are most able to participate in treatment, life and care decisions; allows for early intervention to maximize care and support opportunities, and available treatment outcomes; and may also reduce health care costs. The Alzheimer's Association encourages early diagnosis to provide the opportunity for people with Alzheimer's to participate in decisions about their care, current and future treatment plans, legal and financial planning, and may also increase their chances of participating in Alzheimer's research studies.
"Next steps include reaching out to physician groups and medical societies to encourage primary care doctors, dementia experts, and nurse practitioners to adopt these new best clinical practice guidelines," Hendrix said.


Provided by Alzheimer's Association

What you need to know about CBD oil

Industrial hemp plant products: tea, oil, rope, protein powder and hemp fabric. Credit: Shutterstock

There's plenty of anecdotal evidence that Cannabidiol (CBD) oil – a concentrated oily extract made from cannabis – can help treat a variety of ailments. It's said to help with everything from epileptic seizures to opioid addiction, PTSD to arthritis.

22 july 2018--But despite CBD oil's high profile status, there's still a lot of confusion about what it actually is, and what it's made from. Certain types of CBD oil are already legally available in the UK – such as those made from hemp – whereas other types are very much illegal in the UK – though are available to buy in other countries
CBD oil extracted from hemp is often marketed as a food supplement to promote well-being – similar to other herbals like Echinacea – and boost the immune system. Although Hemp CBD oil is legal, it is not a medicine and should not be confused with the recent confiscation of 12-year-old Billy Caldwell's CBD oil at Heathrow airport.
Billy had flown with his mother to Canada to buy the CBD oil – which helps to keep his daily epileptic seizures at bay. But his oil was confiscated because it was made from cannabis flowers and leaves, and so was classed as illegal in the UK, pushing childhood epilepsy and CBD oil into the spotlight.

Cannabis law explained

So far, so confusing, but part of the problem is that terms like cannabis and hemp are often used interchangeably – which masks the nuances and complexities of the cannabis plant.
Cannabis sativa L, the scientific name of the cannabis plant, is cultivated to produce two distinctive products – industrial hemp, and cannabis. The main difference between hemp and cannabis is based on two criteria. First, the levels of cannabinoids – a family of chemical compounds, the cannabis plant naturally produces – and second, the end use.
According to current UK drug laws, cannabis is classified as an illegal drug because of the psychoactive properties of THC, the component in it that creates the "high". And under UK law, cannabis is deemed to have a high potential for abuse – with no accepted medical properties.

Hemp vs cannabis

But this is where it gets even more confusing because cannabis can be bred to create different strains. Cannabis consumed for recreational purposes is selectively bred to optimise high THC content strains – to maximise the "high" feeling. But cannabis also contains CBD, which is a non-psychoactive component.
Hemp, on the other hand, is harnessed as seed, oil and fibre to produce a wide range of products. It is cultivated to produce a low concentration of the psychoactive cannabinoid THC – as well as higher levels of the non-psychoactive cannabinoid CBD.
Cannabis is classified as hemp if it has a maximum level of 0.2% THC. Billy's CBD oil, confiscated at Heathrow, was made from cannabis with a higher level than 0.2% of THC – so it was classed as cannabis, which is why it was confiscated.

Medical marijuana

A recent survey conducted by Sky News found that 82% of their poll subjects agreed that medical cannabis should be legalised. Professor Dame Sally Davies, the chief medical officer for England, who was appointed to investigate the current scientific and medical evidence, about the therapeutic properties of cannabis-based products, also believes this. She recently said that"doctors should be able to prescribe" cannabis.
Davies has recommended the removal of cannabis from schedule one classification – which covers a group of drugs considered to have no medical purpose, that cannot be legally possessed or prescribed.
In Billy Caldwell's case, the home secretary, Sajid Javid, made the decision to grant Billy access to imported CBD oil. This fresh approach to reconsider the classification of cannabis has been seminal, and mirrors wider sentiment in other countries. In the US, for example, medical cannabis programmes have been initiated in 30 states. Hence, medical tourism to Canada – where cannabis is legal for medicinal purposes – and the US to gain access to CBD oil.
In the UK, however, Sajid Javid will not reclassify cannabis until the Advisory Council on the Misuse of Drugs provides recommendations about the public health implications – which will include the abuse potential of cannabis-based CBD. Though it seems very likely that the home secretary will continue to move towards a patient focused resolution.
For patients like Billy then, what this means is that cannabis-based CBD oil could soon be prescribed in the UK under controlled conditions, by registered practitioners, and for medical benefit.

This article was originally published on The Conversation. Read the original article.

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Would a longer lifespan make us happier? A philosopher's take

Credit: cdrin/Shutterstock

One of the biggest questions in ageing research is whether there is a ceiling on how long human beings can live. A recent study, published in Science, suggests there isn't. The study measured the survival probabilities of 3,896 people in Italy aged 105 and older. It found that, while we are much more likely to die at 75 than at 55, once we reach about 105, the odds of death remain about the same each year of life.

18 july 2018--This effect is often referred to as a "mortality plateau". If it were impossible to live past a certain age, we would expect mortality rates to continue rising as people age, rather than plateau. The fact that the odds of dying don't appear to increase past 105 suggests that we have not yet approached our maximum lifespan as a species. But is potentially living for over a century something we ought to look forward to? Here, philosophy can offer some important insights.
Of course, we still don't know for sure that there is no ceiling. Some researchers argue that there is a natural "expiration date" for human beings, at about 125 years. Chiyo Miyako is currently the oldest known person in the world, at 117 years old. Jeanne Calment, who died in 1997, had the longest recorded lifespan, at 122 years.
In the UK, the number of people over the age of 100 has more than doubled since 2002, and could reach 36,000 by 2030. If there is a mortality plateau, by the year 2300 the oldest person alive could be about 150 years old.

Pleasure versus pain

Would a maximum lifespan of 150 make our lives better or just longer? One way of thinking about this is in terms of pleasure and pain: the more pleasure (and the less pain) we have over the course of our lives, the better our lives are. Other things being equal, a life which lasts 100 years is better than one that lasts 80 years, as long as the extra 20 years contain more pleasure than they do pain.
How likely an outcome is this? As people age, they are much more likely to develop degenerative conditions that could lead to a lower quality of life. But these conditions can be mitigated by a healthy lifestyle and adequate support services. While elderly life may be restricted in some ways, there is no reason that it cannot be, on balance, pleasurable.
On the other hand, an extended lifespan might influence our earlier quality of life. In 2017, there were about 3.5 people of working age (16-64) for every person over age 65, but this ratio is expected to fall to 2.1 to one by 2040. This means that there will be relatively more people claiming pension benefits, and fewer people in the workforce paying taxes to support them. This could lead to the working population being required to pay additional taxes and remain in the workforce for longer, or a reduction in other services to cover pension costs.

An unwanted postscript

We might also think that our lives go better when we get the things we want. Having a longer life might give us more time to accomplish our goals and projects. But we might also think that a desirable life is one with a certain narrative structure.
The late philosopher Ronald Dworkin distinguished between "experiential interests" and "critical interests" to shed light on how people may view their life goals. Experiential interests are for things like pleasure – anything we enjoy. Critical interests are those what we value becoming a reality – essential to what we think constitutes a good life. This could be a parent's interest in the happiness of their child, for example.
We can imagine a person having a critical interest in avoiding the perceived indignity of dementia, which may accompany extreme old age. Even if the person doesn't seem bothered by their cognitive decline in the moment, this may not have been how they wanted their life to go. We might think it would be better for this person, taking the whole of their life into account, if they had died prior to this period of decline.
In other words, there could be many circumstances in which we might live for too long. Sometimes it might be better for us to die earlier than we otherwise might have, if doing so is more consistent with the "life story" we wanted for ourselves – for example, being active and independent throughout our lives.

Declining desires?

A similar concern has been raised by the late philosopher Bernard Williams. Williams argued that the things which give meaning to our lives are "categorical desires", which are essential to our identity. They include things like writing a novel, raising children or pulling off a charity project. These sit alongside more "meaningless" desires, such as the need for food or sex, which he argued can't make us happy in the long run.
Williams believed that, if we live long enough, we will fulfil all our categorical desires – losing an important driver of our happiness. We are then faced with a remaining life of oppressive boredom, or replacing our fundamental desires and radically changing who we are.
However, as I see it, life can remain rich and complex even for the very elderly, and taking on new projects need not undermine who we are. This is especially true if our friends and loved ones are living longer as well. While our desires and interests may change, connection to others can help to promote continuity among the various stages of our lives.
What each of these views shows is that living longer does not in itself make us better off. As our population continues to age, we will need to make important and potentially difficult choices about how we want to care for the elderly. Crucially, strategies to promote healthy ageing may not only ease the burdens on society, but help to ensure that our longer lives are better lives – even in a philosophical sense.

This article was originally published on The Conversation. Read the original article.

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Study finds potential link between alcohol and death rates

Credit: CC0 Public Domain

Drinking heavily results in uncontrolled iron absorption into the body, putting strain on vital organs and increasing the risk of death, according to a new study published in the journal Clinical Nutrition.
The study looked at health outcomes in 877 women in sub-Saharan Africa over a median follow-up time of nine years. The results of the study showed levels of ferritin, a blood marker of the extent of body iron loading, were higher in drinkers than non-drinkers.

17 july 2018--Iron loading is when the regulation of iron in the body is compromised by alcohol consumption, leading to more of it being absorbed. It is known to cause health issues such as heart attacks, liver disease and diabetes.
The study found that higher levels of ferritin and its statistical interaction with alcohol in these subjects predicted all-cause and cardiovascular mortality. This means that the prognostic significance of iron loading depends on alcohol consumption.
Dr. Rudolph Schutte, Course Leader of the BSc (Hons) Medical Science at Anglia Ruskin University, and lead author of the study, said: "Iron loading puts strain on especially the cardiovascular system through oxidisation, which can cause damage to cells, proteins and DNA.
"The link between iron and mortality has been disputed for around 30 years, but this study is the first to investigate the significance of the interaction between iron loading and alcohol intake.

"These findings may have health implications globally for people who consume large quantities of alcohol."

More information: Rudolph Schutte et al, Iron loading, alcohol and mortality: A prospective
study, Clinical Nutrition (2018). DOI: 10.1016/j.clnu.2018.05.008


Provided by Anglia Ruskin University

Health coaching might sound 'new age,' but it could help you reach old age

OMG. Credit: Fred Ho

There are two ways of tackling chronic lifestyle diseases such as cancer, heart disease and diabetes: discover new drugs and treatments or persuade people to make positive lifestyle changes to avoid developing them in the first place.

15 july 2018--Health coaching is one of the most powerful ways of changing people's mindsets for the long term. Practitioners are rapidly taking their place alongside executive coaches, life coaches and personal trainers as another means of making us better people through one-to-one improvement sessions.
It has only been around a couple of decades, but the techniques date all the way back to the 5th century BC – specifically Socrates' famous method of questioning his students to uncover truths. Coaches ask clients questions to help them gain a clearer insight into who they are and their potential. It's a process of self-discovery that helps people to take actions that change their behaviour.
Specialists often group together the likes of cancer, heart conditions and obesity as the non-communicable diseases, meaning you can't catch them from someone else. Together they kill some 40m people each year, about 70% of all deaths around the world – and poor lifestyles frequently increase the risks. This looks like getting worse – adult obesity levels are forecast to reach 40% by 2030 in the UK, for example, while diabetes prevalence is expected to rise by almost a third in the next couple of decades.
This is making healthcare expenditure unsustainable. UK spend was £192 billion in 2016, for example, and is rising at around 4% a year. Long-term illnesses account for about 70% of spending. For this reason, the direction of travel in the UK and elsewhere is to focus on the common risk factors behind these diseases and work towards reducing them by promoting behaviour change. This is where health coaching comes in.
The modern coaching phenomenon dates back to Timothy Gallwey, an American tennis player who wrote a series of very successful books about sports coaching in the 1970s and early 1980s called The Inner Game. They were all about using techniques that focused on gameplay to prevent the brain from interfering with your performance.
Gallwey then began applying similar techniques to leadership, kicking off a whole new industry in executive coaching. Health coaching grew out of this and began to spark interest from the early 1990s, but has only really taken off in the past five years. It is now common in the US and Australia, though still somewhat novel in the UK – but this looks set to change.
The NHS ran a health coaching pilot for training practice nurses in Suffolk at the beginning of the decade, which was then rolled out to nearly 800 doctors, nurses and other health professionalsacross the east of England in 2013. More recently, NHS England has launched a wider programme for disseminating coaching techniques to health professionals. The intention is to offer nine-month coaching programmes to the five million people in England with blood sugar levels that put them at high risk of diabetes.

What the research says

Health coaching is not the same as counselling, therapy or handing out advice. Typically a first session would be about helping the client to arrive at an overall health or lifestyle goal – cutting their weekly alcohol intake in half, say. The health coach would use the questioning technique to uncover what that goal means to the person in terms of their personal values, and draw up a specific action plan for reaching it.
Coach and client would look at what makes change a good thing and what is getting in the way – avoiding "why" questions, which are seen as judgemental. The emphasis is about turning barriers into opportunities, focusing on the future rather than the reasons why the person got into that cycle of behaviour.
Over a few follow-up sessions, clients come back and discuss their progress, what they have found challenging, how to proceed and so on. If they are succeeding, the coach may get them to start working on another goal – running twice a week, for example.
There are certainly research findings to support this new approach to healthcare. Health coaching has been shown to be one of the most effective methods for managing lifestyle diseases. It helps people make physical changes such as losing weight and lowering their cholesterol and blood pressure.
Health coaching has been found to help diabetic sufferers to take more responsibility for their condition and change their behaviour. One review article from 2016 found it to be an effective way of improving blood sugar levels, for example.
A more recent study in which I was involved in Turkey and Denmark found that around 150 diabetic patients receiving health coaching for a year reduced their three-month blood glucose levels by 6%, while a similar-sized group who received health education saw little improvement. The International Diabetes Federation considers a 1% reduction in three-month blood glucose to be a significant improvement in diabetes management.
I have also looked at health coaching beyond diabetes, including in my own original specialism, dentistry. My co-authored work has found that it can enhance people's oral health, help them to take more exercise, eat better and improve their quality of life – again we studied Turkey and Denmark, suggesting that health coaching may be benefical regardless of differences in healthcare systems.
In short, health coaching appears to have a bright future. One thing that doesn't exist yet in the UK is professionally accredited health coaches – a step beyond the NHS training in England which requires at least 100 hours of training.
To that end, I'm trying to get a masters programme in health coaching off the ground at the University of Dundee, in association with the World Health Organization Collaborating Center. If we are going to create a new workforce of health coaches, we will need evidence-based academic training that meets international standards across the country.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

DBS treatment may slow the progression of Parkinson's tremor in early-stage patients

Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: Wikipedia

Deep brain stimulation (DBS) may slow the progression of tremor for early-stage Parkinson's disease patients, according to a Vanderbilt University Medical Center study released in the June 29 online issue of Neurology, the medical journal of the American Academy of Neurology.

11 july 2018--The study is the first evidence of a treatment that slows the progression of one of the cardinal features of Parkinson's, but a larger-scale clinical trial across multiple investigational centers is needed to confirm the finding.
"The finding concerning tremor progression is truly exceptional," said senior author David Charles, MD, professor and vice-chairman of Neurology. "It suggests that DBS applied in early-stage Parkinson's disease may slow the progression of tremor, which is remarkable because there are no treatments for Parkinson's that have been proven to slow the progression of any element of the disease."
Patients in the Vanderbilt study were randomized to receive DBS plus drug therapy or drug therapy alone; the drug therapy alone group was seven times more likely to develop new rest tremor after two years in comparison to the DBS plus drug therapy group.
The trial, which began in 2006, was controversial because it recruited patients with early-stage Parkinson's disease for DBS brain surgery. At that time, DBS was approved for only advanced-stage Parkinson's disease when symptoms were no longer adequately controlled by medication.
"Since this was the first early DBS trial, it was unknown whether there were individual motor symptoms very early in Parkinson's disease that may be more potently improved by DBS," said lead author Mallory Hacker, Ph.D., research assistant professor of Neurology.
The post hoc analysis showed that 86 percent of the drug therapy patients developed rest tremor in previously unaffected limbs over the course of the two-year period, while that occurred in only 46 percent of patients who had received DBS therapy in addition to drug therapy. Four of the DBS patients had rest tremor improvement and rest tremor completely disappeared from all affected limbs for one DBS patient.
The FDA has approved Vanderbilt to lead a large-scale, Phase III multicenter study that will enroll 280 people with very early-stage Parkinson's disease, beginning in 2019, and 17 other U.S. medical centers have joined the DBS in Early Stage Parkinson's Disease Study Group to participate.
"The field of DBS therapy for Parkinson's disease is moving toward earlier stages of treatment, therefore, we must conduct the pivotal trial to ensure patient safety and provide the Parkinson's community with the best possible medical evidence to guide treatment," Charles said.


Provided by Vanderbilt University Medical Center

Wearable, at-home patch could spot your A-fib early

Zio®XT patch. Photo: iRhythm Technologies

The common but dangerous heart rhythm disorder known as atrial fibrillation—or a-fib—can go undetected for years. Now, research suggests a high-tech, wearable patch might spot the condition early.

11 july 2018--Use of the Zio XT wireless patch, made by iRhythm, produced "an almost threefold improvement in the rate of diagnosis of a-fib in those actively monitored compared to usual care," said study lead author Dr. Steven Steinhubl. He directs digital medicine at the Scripps Translational Science Institute, in La Jolla, Calif.
The patch monitors electrocardiogram (ECG) readings via the skin, looking for telltale signs of arrhythmia—an irregular heartbeat.
Spotting the irregular heartbeat is key, Steinhubl said, since a-fib greatly raises stroke risk.
"Timely diagnosis of a-fib more effectively can enable the initiation of effective therapies and help reduce strokes and death," Steinhubl said in a Scripps news release.
One heart specialist not tied to the study said that the late detection of a-fib—which plagues nearly 6 million Americans—is a real issue.
"Many patients who come in with a diagnosis of atrial fibrillation have had it for quite some time prior to seeing a doctor," said Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York City. "By catching it early—that is, before symptoms of palpitations, passing out and stroke—one can lower the incidence of stroke related to undiagnosed atrial fibrillation."
The new study was funded by Janssen Pharmaceuticals as well as the U.S. National Institutes of Health. The study involved more than 5,200 people from across the United States, many of whom received and returned the small wearable patch by mail. Participants were all deemed to have risk factors that boosted their odds for a-fib.
About one-third of the participants wore the patch— which adheres to the skin—and were monitored continuously for up to two weeks.
The other two-thirds served as a comparison group. These patients received usual care, typically routine visits to their primary care physician. If they were diagnosed with a-fib that information turned up in their medical claims records.
The result: After one year, a-fib was diagnosed in 109 people in the patch-monitored group (6.3 percent) versus 81 people in the unmonitored group (2.4 percent), Steinbhul's group reported. That's a near tripling of the diagnosis rate, the study authors noted.
"This study demonstrates the utility of a digital approach not only to diagnosing asymptomatic a-fib, but to the clinical research field as a whole," Steinhubl said.
Dr. Marcin Kowalski directs cardiac electrophysiology at Staten Island University Hospital, in New York City. He believes the advent of devices like the Zio XT patch could be a boon to medical care, but it might also bring new problems.
Aside from spotting a-fib, these devices are "capable of diagnosing other arrhythmias," which otherwise might go undetected, Kowalski said.
The potential downside, he said, is more work for an already overloaded health care system.
"One must be mindful of the increase in data volume and the resources necessary to process," Kowalski explained. "This technology could increase the number of transmissions, which may burden a health care provider's limited resources."
The study was published July 10 in the Journal of the American Medical Association.

More information: The U.S. National Heart, Lung, and Blood Institute has more on atrial fibrillation.

Senolytic drugs reverse damage caused by senescent cells in mice

Injecting senescent cells into young mice results in a loss of health and function but treating the mice with a combination of two existing drugs cleared the senescent cells from tissues and restored physical function. The drugs also extended both life span and health span in naturally aging mice, according to a new study in Nature Medicine, published on July 9, 2018. The research was supported primarily by the National Institute on Aging (NIA), part of the National Institutes of Health (NIH).

10 july 2018--A research team led by James L. Kirkland, M.D., Ph.D., of the Mayo Clinic in Rochester, Minnesota, found that injecting even a small number of senescent cells into young, healthy mice causes damage that can result in physical dysfunction. The researchers also found that treatment with a combination of dasatinib and quercetin could prevent cell damage, delay physical dysfunction, and, when used in naturally aging mice, extend their life span.
"This study provides compelling evidence that targeting a fundamental aging process—in this case, cell senescence in mice—can delay age-related conditions, resulting in better health and longer life," said NIA Director Richard J. Hodes, M.D. "This study also shows the value of investigating biological mechanisms which may lead to better understanding of the aging process."
Many normal cells continuously grow, die, and replicate. Cell senescence is a process in which cells lose function, including the ability to divide and replicate, but are resistant to cell death. Such cells have been shown to affect neighboring ones because they secrete several pro-inflammatory and tissue remodeling molecules. Senescent cells increase in many tissues with aging; they also occur in organs associated with many chronic diseases and after radiation or chemotherapy.
Senolytics are a class of drugs that selectively eliminate senescent cells. In this study, Kirkland's team used a combination of dasatinib and quercetin (D+Q) to test whether this senolytic combination could slow physical dysfunction caused by senescent cells. Dasatinib is used to treat some forms of leukemia; quercetin is a plant flavanol found in some fruits and vegetables.
To determine whether senescent cells caused physical dysfunction, the researchers first injected young (four-month-old) mice with either senescent (SEN) cells or non-senescent control (CON) cells. As early as two weeks after transplantation, the SEN mice showed impaired physical function as determined by maximum walking speed, muscle strength, physical endurance, daily activity, food intake, and body weight. In addition, the researchers saw increased numbers of senescent cells, beyond what was injected, suggesting a propagation of the senescence effect into neighboring cells.
To then analyze whether a senolytic compound could stop or delay physical dysfunction, researchers treated both SEN and CON mice for three days with the D+Q compound mix. They found that D+Q selectively killed senescent cells and slowed the deterioration in walking speed, endurance, and grip strength in the SEN mice.
In addition to young mice injected with senescent cells, the researchers also tested older (20-month-old), non-transplanted mice with D+Q intermittently for 4 months. D+Q alleviated normal age-related physical dysfunction, resulting in higher walking speed, treadmill endurance, grip strength, and daily activity.
Finally, the researchers found that treating very old (24- to 27-month-old) mice with D+Q biweekly led to a 36 percent higher average post-treatment life span and lower mortality hazard than control mice. This indicates that senolytics can reduce risk of death in old mice.
"This is exciting research," said Felipe Sierra, Ph.D., director of NIA's Division of Aging Biology. "This study clearly demonstrates that senolytics can relieve physical dysfunction in mice. Additional research will be necessary to determine if compounds, like the one used in this study, are safe and effective in clinical trials with people."
The researchers noted that current and future preclinical studies may show that senolytics could be used to enhance life span not only in older people, but also in cancer survivors treated with senescence-inducing radiation or chemotherapy and people with a range of senescence-associated chronic diseases.

More information: Senolytics improve physical function and increase lifespan in old age, Nature Medicine (2018). DOI: 10.1038/s41591-018-0092-9 , https://www.nature.com/articles/s41591-018-0092-9


Provided by National Institutes of Health

New research finds 'mind over matter' key to a healthy lifestyle

Credit: CC0 Public Domain

People who want to increase their participation in regular exercise and adopt a healthier lifestyle may be best to mentally visualise it, new research by Curtin University has found.

09 july 2018--The research, published in the leading journal Health Psychology, found that 'mental imagery interventions', or visualising an activity or task, may be effective in helping people change their behaviours, including moderating alcohol consumption and participating in regular physical activity.
Lead Australian author John Curtin Distinguished Professor Martin Hagger, from the School of Psychology at Curtin University, said the research aimed to explore the link between visualisation and increasing healthy behaviour.
"There are strong links between chronic illnesses like heart disease and diabetes and behaviour, and imagery-based interventions offer an inexpensive, effective way of promoting healthy behaviours such as physical activity and healthy eating," Professor Hagger said.
"We found that people who simply visualised the steps necessary to do the healthy behaviour on a regular basis were more likely to be motivated, and actually do, the healthy behaviour."
Mental imagery was also more effective in promoting healthy behaviours when the visualisation lasted longer, when people were reminded to do their imagery by text message, and when the person was given detailed instructions on how to conduct the imagery exercise.
Professor Hagger explained that the research could have important implications for health professionals and the broader community around the world.
"Previous studies have shown that imagery interventions have been used in various contexts including enhancing athletes' performance, flight simulation training for aircraft pilots and for symptom relief in hospital settings. Our research shows that imagery is also effective for promoting participation in healthy behaviours," Professor Hagger said.
"Our findings may not only be of interest to health professionals around the world, but could be of interest and potentially implemented within other industries."

More information: Dominic Conroy et al. Imagery interventions in health behavior: A meta-analysis., Health Psychology (2018). DOI: 10.1037/hea0000625


Provided by Curtin University

How support groups can boost your health and make chronic conditions easier to live with

Peer support groups don’t cost much, and thousands of Australians find them useful. Credit: www.shutterstock.com

People want to look after their own health, and with new technology, there are more tools than ever to help people manage it. But the greatest gains could come from a little help from your friends.
For people living with chronic health conditions such as arthritis, diabetes and cancer, the health system can seem impersonal and impractical.

08 july 2018--A large inhibiting factor to patients feeling involved in their own health care is the outdated medical model that sees the patient as a passive recipient of treatment and advice. The clinical nature of medical care doesn't take enough account of how people live their lives or how they'd like to. The focus is on managing disease, not promoting well-being.
Support from peers – people already living with health conditions – could help fill in the gaps. Instead of just helping combat the disease, peer support groups can help improve quality of life.
Promoting peer-based support from and for people living with chronic health conditions has the potential to improve outcomes, increase access and improve efficiency in health care.

What do peer support groups do?

The internet provides endless access to health information to people seeking more involvement in the management of their own conditions. But finding reliable and relevant sources can be difficult without guidance and support.
Peer-support groups offer advocacy, assistance and education; led and managed by people living with health conditions, for people like them. Traditionally peer support groups are location-based groups that meet regularly, but an increasing number of online groups are expanding access to support.
For example, the Young Women's Arthritis Support Group provides links to research, encouragement and "life-hacks" both online and with regular meetings.
Their Facebook page regularly includes comments seeking information and ideas for living with a range of musculoskeletal conditions, with topics such as work, relationships, pregnancy, exercise and technical questions about research. They talk among themselves and also link to experts who can provide clinical, legal and practical advice.
Peer support groups can offer real, practical advice the medical system is unlikely to bring up. For example, making a cup of tea in the morning to hang on to so the hands can warm up and lose some of the overnight stiffness with arthritis, or how to have a conversation with your boss about a condition they may never have heard of, such as fibromyalgia.

Better disease management

We know wealth affects health – chronic disease prevalence is greater in lower socio-economic populations. We also know health care is heavily influenced by culture, setting and population.
Social interactions have a vital relationship to health outcomes, but medical culture often neglects the importance of social relationships in disease management health and well-being.
The medical model is particularly poor at achieving behaviour change such as diet and exercise. But there's evidence to suggest people who attend "illness-affiliated" peer-support groups better manage their chronic conditions and have better health outcomes than those who solely rely on medical interventions.
For example, a 2013 study showed improved blood glucose management during peer support group attendance among diabetics.
A recent review also found people who attend illness-affiliated peer-support groups better manage their chronic conditions, with research showing:

• better health outcomes than those who solely rely on medical interventions
• improved access and exposure to additional health services, as well as greater confidence in people approaching or going through treatment
• peer-support groups are a cost-effective strategy.

Improving peer support

While all Australian state and territory governments contribute financially in some capacity to peer-support services, there is little consistency between jurisdictions' approaches.
Some state health departments explicitly recognise peer-support services as an essential component of public health strategies and have written policy plans of how to incorporate and build a peer workforce to help organise and lead groups, while others lack a coherent peer support infrastructure. The result is an ad hoc approach with patchy referrals, little quality control and no systemic evaluation.
As chronic disease becomes more prevalent, government and communities should consider a better structure to build upon peer support services to maximise health outcomes. Peer-support has the capacity to provide nuanced assistance and education to those living with chronic health conditions in a compassionate and non-judgemental way.
Government can assist a peer support group for people with arthritis for as little as $5,000 a year, to allow for things such as venue hire, catering and administration expenses. As the average cost of one knee replacement is between A$18-$30,000, it's likely even small changes in how people manage their diseases will provide a return on investment.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

WHO calls for renewed effort to combat chronic disease

The World Health Organization (WHO) Independent High-Level Commission has proposed six recommendations to address the growing epidemic of non-communicable diseases (NCDs), according to a report published online June 1 in The Lancet.

07 july 2018--According to the Commission, nations are not on track to meet the Sustainable Development Goal for NCDs: to reduce premature deaths from NCDs (cardiovascular diseases, cancers, respiratory diseases, and diabetes) by one-third by 2030, reduce premature mortality from NCDs, and promote mental health. Because of this, the Commission urges governments and heads of state to take bold actions to meet the goal.
The report includes six recommendations: (1) increased political leadership and responsibility from heads of state and governments; (2) prioritization and scaling up of a specific set of priorities within the overall NCD and mental health agenda; (3) identification of synergies within existing chronic care platforms; (4) increased government regulation and collaboration with the private sector and civil society; (5) increased financing of programs addressing NCDs; and (6) improved accountability to ensure commitments made by governments and the private sector are delivered.
"The challenge is not only to gain political support, but also to guarantee implementation, whether through legislation, norms and standards setting, or investment," the authors write. "There is no excuse for inaction, as we have evidence-based solutions."

More information: Abstract/Full Text (subscription or payment may be required)

Robots may soon join ranks of Alzheimer's caregivers

MARIO and nursing home resident. Photo: NUI Galway

Robots work on assembly lines and assist doctors in the operating room. They manage inventory in warehouses and vacuum floors in homes.And one day soon, they could help care for Alzheimer's patients.

04 july 2018--Several teams of scientists from around the world are investigating ways in which robots might help manage the daily living tasks of people with Alzheimer's disease.
Some robots help patients in and out of bed, remind them to take medication, measure their mood and provide regular updates to human caregivers.
A South Korean-made robot called Silbot3 has shown promise in this area, said researcher Elizabeth Broadbent. She's an associate professor of health psychology with the University of Auckland in New Zealand.
"It is designed to enable people to stay at home for longer before needing to go into a care home," Broadbent said.
"While a human could help with these things, the burden on caregivers of people with dementia is very high. Some people do not have a caregiver at home and caregivers often need a break during the day to get other things done. Robots can help provide extra care," she explained.
Other research teams have focused on using robots to combat the loneliness and isolation that can affect some Alzheimer's patients.
Broadbent and her colleagues have found that a Japanese baby seal robot called Paro can help calm people with dementia and keep them company.
"It can be good for people who cannot look after a real animal," Broadbent suggested.
Another team has taken this approach a step further, using a robot named MARIO.
MARIO has been built and programmed to "provide companionship and support the person with dementia to connect and/or remain connected to their family and friends, and stay engaged in activities and events that interest them," said researcher Dympna Casey. She's a professor with the National University of Ireland-Galway's School of Nursing and Midwifery.
The robot offers a number of individualized applications that promote social connectivity, Casey said.
These include more general offerings like game apps, news apps and apps that play music, as well as programs more specifically geared to helping the patient feel less lonely:

• The "My Memories" app presents photographs from the patient's past, with the robot prompting a conversation about the content of the photo.
• "My Family and Friends" gathers social media information to keep patients informed about loved ones and friends.
• "My Calendar/Events" reminds users of special events happening in their families or communities.

Tests of MARIO in hospitals and residential care facilities have provided positive results, Casey said.
"People with dementia were overall very accepting of the robot, as were carers and relatives. They had positive perceptions toward MARIO, and of having social robots in dementia care," Casey said. "People with dementia enjoyed their interactions with MARIO and they often referred to MARIO as he or she, and some referred to MARIO as 'a friend.'"
James Hendrix, director of global science initiatives for the Alzheimer's Association, said that robots could prove very useful in helping patients with dementia.
Robots could provide badly needed assistance for weary caregivers, he said.
"Caregivers of people with dementia carry a really heavy burden," Hendrix said. "If there's a way we can lighten that burden for folks a little bit, make it a little easier for them, that's going to help the person with dementia as well. Their care partner is just going to be that much more rested, that much more healthy, and that much more happy."
These robots also could help doctors better care for patients, by collecting data that tracks their mental decline and other health problems, Hendrix said.
On the other hand, Hendrix believes there should always be a role for human caregivers.
"I don't want to see that we totally impersonalize the care and support of people with dementia, that we warehouse them somewhere and they're managed by robots," Hendrix said. "The robotics provide tools of support for the human caregiver, and we still have that human touch."

More information: The MARIO Horizon 2020 project has more about the MARIO robot.

Who wants to live to 100?

A lonely life. Credit: Robert Kneschke/Shutterstock.com

While the ageing of society has become one of the givens in today's world, less is made of the lived experience of the very elderly in society. And although there is some suggestion that the much trumpeted steady expansion of the human lifespan has begun to slow down, the numbers of very old people continue to grow. Despite this, debates about the resourcing of universal health and social care tend not to examine the costs associated with extreme ageing. Yet the problem of chronic conditions and multiple morbidity is greatest among octagenerians and nonagenarians.


02 july 2018--Very old age, if commented upon, is presented as if it were a kind of extreme sports competition. Centenarians are celebrated simply for reaching 100. Nonagenarians hit the news when they run a mile, climb a mountain or pilot a plane. Otherwise, silence reigns. Yet the focus of most social care is on people aged 80 and over – a group for whom care is needed because health cures have failed them. The morbidities and infirmities that beset the extremely aged are not so much ignored as abandoned to the efforts of medical services and social care.
At UCL, we are trying to throw some light on this darker side of ageing. There are of course a number of ways that such "hyper-ageing" can be approached and understood. One view celebrates the fact that the more and more people can expect to live for 100 years or more. Another sees it as an apocalyptic disaster, as agedness "swamps" the resources of society needed to maintain itself. Yet another view juggles between the successes of more years of healthy active life and the failings of more years of living with disability and infirmity.

Changing patterns of disease

Across the world, the burden of disease has been receding. But this is more the case for illnesses affecting younger people and those that are likely to lead to death, rather than disablement. By contrast, conditions that are degenerative and disabling more often than causing death remain largely unchanged.
Rates of osteo-arthritis, for example, which disables but does not kill you, have been rising over the last 25 years (from 213·4 cases per 100,000 in 1990 to 232·1 cases per 100,000 in 2016). Rates for Alzheimer's disease, which disables more than it causes death, have also grown but in a less pronounced manner, (rising from 460·9 cases per 100,000 in 1990 to 470·6 cases per 100,000 in 2016).
Although some chronic conditions affecting older people, such as chronic obstructive pulmonary disease, which kills and disables you, have been falling (from 1666·8 cases per 100,000 in 1990 to 945·3 cases per 100,000 in 2016), the really large falls in disease prevalence have been in conditions affecting the young, such as cases of diarrhoea and related common infectious diseases, which have dropped remarkably, from 8951·2 in 1990 to 3275·6 in 2016.
In Denmark, one of the few national surveys of nonagenerians was conducted around the turn of this century. The researchers found that the majority contacted had some disability and that women were more often affected than men. The same researchers also observed that "about 10% of the octogenarians and more than 55% of the centenarians live in nursing homes, while dependency rises from approximately 30% to 70%, and the prevalence of dementia rises from approximately 7% to 50%".
In the UK, one study of 85-year-olds found a median number of five diseases per person, with more than half suffering from hearing impairment, just over half from osteoarthritis, and just under half suffering from high blood pressure. Just under a quarter had some form of cancer. Less than 5% told the researchers that their health was poor: most said it was good.

The silent issue

This last point emphasises how extreme ageing presents issues that easily go unremarked upon. Its problems are largely confined within the individual household or in long-term care institutions. Wider society scarcely acknowledges these problems and most of those on the receiving end, whether carers or people being cared for, are simply too overwhelmed to do much about them.
Although not closed off to the public, the nursing home remains more present in the imagination than in most people's everyday experience. The social networks of the frail elderly, whether living at home or in a nursing home, tend to be so much smaller than those of the rest of the population. Most people over 80 live alone. They often have only a few people to talk with. Meantime, stories of abuse, or TV footage of the inside of the nursing home paint a grim picture to all who watch, read or hear them.
These isolation and neglect of these spaces help preserve the distance between an "us" who are, if we are ageing, ageing well clear of such scenarios, and a "them", who are not. To be old and frail is not an identity to be acclaimed and the old and frail are generally unable or unwilling to represent themselves as such.
For many of these people, life can be difficult. Estimates suggest that chronic pain "in people aged 85 years or older is common", affecting the majority of people from this age group. Aged lives of quiet desperation are sadly not rare, nor are most lived in the heroic terms of the marathon-running nonagenarian that hits the news.
In drawing attention to this, we are not attempting to promote further victimhood. What we hope to achieve is to cast a little light upon the darker side of our ageing and of our ageing societies. Old age should not be sought out just for the sake of it.

This article was originally published on The Conversation. Read the original article

Provided by The Conversation

First guidelines for applying placebo effect in clinical practice

Credit: Leiden University

It is becoming increasingly clear that the placebo effect has a great influence on medical treatment. An international, interdisciplinary team of researchers led by Professor of Health Psychology Andrea Evers from Leiden University has now written a first set of guidelines on how to apply the placebo effect in clinical practice. Publication in Psychotherapy and Psychosomatics.

01 july 2018--The effect of many health-care treatments is explained in part by factors other than the medication or treatment itself, Andrea Evers explains. For instance, the doctor's confidence that the treatment will work , people's expectations of the treatment and any previous experiences they might have of a treatment. The placebo effect describes how a person's positive expectation of a treatment can have a positive effect on it. In contrast, the nocebo effect is a negative effect: for instance, if a patient experiences side-effects due to negative expectations of the medication.
'Placebo and nocebo effects influence the outcome of the treatment. We know this from scientific research,' says Evers. 'But the regular health-care system takes very little account of these findings when this knowledge would enable us to optimise treatments and at the same time reduce any adverse effects (such as side-effects).'
The publication in Psychotherapy and Psychosomatics is a first step in this direction. It was the result of the first official conference of the Society for Interdisciplinary Placebo Studies (SIPS), which was held in Leiden last year. During an interdisciplinary workshop led by Evers, a group of leading international researchers reached the consensus that knowledge about placebo and nocebo effects could lead to better treatment results with fewer side-effects. According to the researchers, it is crucial that patients receive more information about these effects, and that doctors receive training on the best doctor-patient communication to maximise placebo effects and minimise nocebo effects.
The group believes that future research should look at how to implement these recommendations in clinical practice. Evers: 'Now we have reached an international consensus on this, we can research how doctors and patients can benefit in everyday practice.'


Provided by Leiden University