Nearly a third of U.S. heart patients die at home, which is more than the number who die in the hospital, according to a new study.
Researchers examined data on more than 12 million heart disease patients who died between 2003 and 2017. They looked at whether the deaths occurred in a hospital, home, nursing or long-term care facility, inpatient hospice, or elsewhere (outpatient medical facility, emergency department, or dead-on-arrival at the hospital).
The number of heart disease deaths in the hospital fell from nearly 331,000 in 2003 to nearly 235,000 in 2017. Home deaths, meanwhile, rose from almost 193,000 to over 265,000, accounting for about 31% of heart disease deaths in 2017.
Conflict within families can be stressful and confusing, and it can lead to feelings of sadness. It also is incredibly common and in many cases, a necessary part of family dynamics. New research from the University of Missouri highlights how caregivers can better manage family conflict as they deal with the approaching death of a loved one.
Jacquelyn Benson, assistant professor of human development and family science, found that autonomy is a central tension in caregiving at the end of life. She suggests that several strategies, including communication, formal support and emotional self-care, can be used by caregivers to address family conflict.
“Conflict is stressful, we all know that,” Benson said. “However, it also is necessary and can lead to positive change. I hope these findings will inspire alternative ways to think about family conflict when it comes to end-of-life decision-making.”
A team of New Jersey stroke researchers has linked recovery of reading and language competence with cerebral blood flow in the left reading network. Their findings may contribute to new approaches to identifying and treating reading deficits after stroke. The open access article, “Cerebral perfusion of the left reading network predicts recovery of reading in subacute to chronic stroke” was epublished on August 26, 2019 in Human Brain Mapping. The authors are Olga Boukrina, PhD, and A.M. Barrett, MD, of Kessler Foundation, and William Graves, PhD, of Rutgers, the State University of New Jersey.
Despite the fundamental role of reading ability in everyday living, little research has been conducted on patterns of reading recovery after stroke, or the development of interventions to improve reading outcomes. In this study of left-brain stroke, a team of New Jersey scientists examined patterns of cerebral perfusion bilaterally, including left and right networks of brain areas important for healthy reading, the area surrounding the stroke lesion, and the corresponding contralateral area.
People with gum disease (periodontitis) have a greater likelihood of high blood pressure (hypertension), according to a study published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).
Senior author Professor Francesco D’Aiuto of UCL Eastman Dental Institute, UK, said: “We observed a linear association — the more severe periodontitis is, the higher the probability of hypertension. The findings suggest that patients with gum disease should be informed of their risk and given advice on lifestyle changes to prevent high blood pressure such as exercise and a healthy diet.”
High blood pressure affects 30-45% of adults and is the leading global cause of premature death, while periodontitis affects more than 50% of the world’s population. Hypertension is the main preventable cause of cardiovascular disease, and periodontitis has been linked with increased risk of heart attack and stroke.
Even though exercise is known to be healthy, many people find it difficult to maintain an exercise program for a longer time. This applies even more to people with a chronic illness such as Parkinson’s disease, where physical and mental limitations are additional obstacles. The Park-in-Shape study, funded by ZonMW (Netherlands Organization for Health Research & Development), tested an innovative solution for this challenge. The participants were divided into two groups. Both groups had a motivational app at their disposal, which offered the participants rewards for exercising. The control group only performed stretching exercises, while the active intervention group was instructed to exercise for 30-45 minutes on a stationary bicycle at home, at least three times a week.
The active group’s exercise bikes were also equipped with motivating games, making the program more entertaining and challenging for the participants. For example, the participants could race against their own previous performance — a “ghost rider” — or against a group of other cyclists. The system adjusted the difficulty of the game to the patient’s heartbeat, making the challenge just right. The challenges also became more difficult as the participants got fitter.
CHOOSING AN APPROPRIATE assisted living community is a challenging decision for residents and family members alike. To help, U.S. News is now publishing an extensive directory and data resource on nearly 9,000 assisted living communities, in collaboration with Caring.com.
The new Assisted Living directory offers comparison information on key factors including size, location and health services offered for the millions of Americans making this decision each year. Families can use the directory to match the right community to their loved one’s unique needs.
The directory provides comprehensive information about health services, activities and amenities offered at each residence. Reviews from residents and families add perspective for almost all licensed assisted living communities in the U.S. The tool is designed to let individuals easily conduct a customized search for a highly rated facility by location, resident rating, Alzheimer’s and memory care and size.
The ACL-funded Mental Health & Developmental Disabilities National Training Center is launching a Fall 2019 ECHO virtual learning network. The MHDD ECHO gives participants the opportunity to take an active role in dialogue with subject matter experts and with their fellow participants.
Fall 2019 sessions will be held every other Thursday from September 12 to December 19. Each session includes a brief lecture, deidentified case presentation, and open discussion. Experts include a psychologist, a clinician, an applied behavior analyst, a parent, and self-advocate guests with personal experience. CMEs and NASW CEUs are available at no cost to participants.
In late-breaking clinical trial results presented in a Hot Line Session today at the European Society of Cardiology Congress 2019, investigators from Brigham and Women’s Hospital and Greater Paris University Hospitals — AP-HP/Université de Paris presented the results from The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study (THEMIS), a clinical trial sponsored by AstraZeneca that evaluated whether adding ticagrelor to aspirin improves outcomes for patients with stable coronary artery disease and diabetes mellitus but without a history of heart attack or stroke. Taking ticagrelor in addition to aspirin reduced the risk of a composite of cardiovascular death, heart attack, or stroke. Patients on this dual-antiplatelet therapy also experienced greater risk of major bleeding. In THEMIS-PCI, a study that specifically looked at THEMIS patients with a history of previous percutaneous coronary intervention (PCI) that includes stenting, versus the overall THEMIS population, investigators found even more favorable results for patients taking ticagrelor plus aspirin. Results of THEMIS are published simultaneously in The New England Journal of Medicine and results from THEMIS-PCI are published simultaneously in The Lancet.
“With prolonged dual-antiplatelet therapy, we need to be thoughtful in considering which patients are most suited to taking the regimen — that is, those at high ischemic risk and low bleeding risk,” said THEMIS co-chair Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at the Brigham and professor of medicine at Harvard Medical School. “Our findings show that the greatest benefit occurred in those patients with diabetes and stable coronary artery disease with a history of prior stenting for whom ticagrelor, when added to aspirin, reduced important cardiovascular events, such as heart attacks, strokes and amputations.”
A new method for permanently marking cells infected with chikungunya virus could reveal how the virus continues to cause joint pain for months to years after the initial infection, according to a study published August 29 in the open-access journal PLOS Pathogens by Deborah Lenschow of Washington University School of Medicine in St. Louis, and colleagues. According to the authors, uncovering the mechanisms for long-term disease could aid in the development of treatments and preventative measures for this incapacitating, virally induced chronic arthritis.
Chikungunya virus is spread by mosquitoes and causes severe joint and muscle pain. Approximately 30 to 60 percent of people infected with the virus continue to experience joint pain for months to years after the initial infection. However, the cause of this persistent joint pain is unclear, as replicating virus cannot be detected during the chronic phase. To address this question, Lenschow and colleagues developed a reporter system to permanently mark cells infected by chikungunya virus.
Using this system, they show in mice that marked cells surviving chikungunya virus infection are a mixture of muscle and skin cells that are present for at least 112 days after initial virus inoculation. Treatment of mice with an antibody that blocks chikungunya virus infection reduces the number of marked cells in the muscle and skin. Moreover, surviving marked cells contain most of the persistent chikungunya virus RNA. Taken together, the findings provide further evidence for musculoskeletal cells as targets of chikungunya virus infection in the acute and chronic stages of disease. According to the authors, this reporter system represents a useful tool for identifying and isolating cells that harbor chronic viral RNA in order to study the mechanisms underlying chronic disease.