Health

New ‘Space Hopper’ Device Allows Astronauts to Spend Less Time Exercising in Space

Published by Anonymous (not verified) on Thu, 21/11/2019 - 11:04pm in

This is another story from yesterday’s I, this time about a new development in space research. At the moment astronauts have to spend over an hour a day exercising in order to combat the harmful effects of zero gravity. Without the pull of the Earth’s gravity, their muscles waste, including the heart. They also have to take care to try to prevent the loss of calcium from their bodies, which weakens their bones. But now inventor John Kennett has invented an exercise machine that allows them to do many of the exercises at once, thus cutting down drastically the amount of time they need trying to maintain a level of fitness. The article by Tom Bawden, ‘Astronauts jump at chance to use ‘space hopper’ to get fitter quicker’ runs

Keeping healthy in space is so vital that astronauts typically spend up to 90 minutes a day doing vigorous exercises.

But that could be about to change thanks to a new “jumping machine” that will gie them the same physical benefit in three or four minutes, according to its inventor.

Without effective exercise, astronauts’ fitness would quickly decline and their muscles and bones would lose strength.

At the moment, they spend much of their space-day running, cycling and doing strength training – on equipment that takes up a lot of valuable room and can take up to an hour to set up and dismantle.

According to the inventor John Kennett, his machine replaces the existing regime with a smaller, all-in-one device that boosts muscle and bone strength and provides cardiovascular exercise at the same time. it is 1.3 metres long and 20 centimetres thick when folded to be stowed.

The bed has a board that presses up against the bottom of the astronaut’s feet. This exerts a force that replicates the motion of jumping and is a highly effective form of exercise that can be varied to work different parts of the body.

“This piece of equipment has the potential to change the way astronauts travel through the solar system,” Mr Kennett said.

“The equipment they use at the moment is based on being in the gym – things like dead lifting or bench pressing. This is good but, when you jump, you do something incredible effective to the muscle and the tendons because you’re absorbing the landing force and then pushing away,” he added.

The device, known as the High Frequency Impulse for Microgravity, has been specially designed to eliminate vibrations and forces that would normally apply to exercise equipment but have the potential to damage spacecraft.

There’s also an additional snippet reporting that the UK space agency has given St Mary’s University in Twickenham a grant to conduct further research on Kennett’s invention after initial tests proved promising.

This is really interesting, and could be a great step forward. But I’ve heard rumours of breakthroughs in tackling the effects of Zero G on the human body before. About twenty or so years ago I went to see the British expert on space medicine, Dr. Kevin Fong, talk about the some of the problems space causes on astronauts’ physical and mental health. He believed that these problems were near to being solved through a device, a vibrating plate, that astronauts would stand on. I haven’t heard anything about this since, so I presume it didn’t work. But the inclusion of a fixed plate for the bottom of the astronaut’s feet in this decision also suggests that the previous invention made have played a role in the development of this device. And if this does prove effective in combating zero G, it will be a great help in allowing humans to cope better with the long interplanetary voyages necessary to open up and hopefully colonise the solar system.

Charging for GP services leads to sub-optimal prescribing that’s bad for health

Published by Anonymous (not verified) on Tue, 19/11/2019 - 8:40pm in

Tags 

Election, Health, NHS

I have little doubt that the Tories will eventually lead this country towards a charged-for NHS. Discussion of GP charging is already commonplace, not least amongst GPs, as a way to ration services. In that context it's easy to compare the UK with Jersey, a place that is the same as the UK in all but dubious constitutional status. As the Jersey Evening Post has reported today:

The use of antibiotics in Jersey is falling, with prescriptions down 10% in the past five years to 0.82 per person per year.However, the fall in the UK has been much greater – 60% – to an average of 0.52 prescriptions per person per year.

Dr Philip Terry, chairman of Jersey Doctors on Call, said the cost of GP fees was one contributing factor to higher prescription rates, as patients want to ‘get something for their £40’.

It is widely known that excessive antibiotic prescribing is bad for patients, for populations and long term drug resistance that undermines public health. And yet it is prevalent in Jersey where the only really likely factor to explain the difference in prescribing is charging (and I have noted the other arguments in the article and think they are extraordinarily unlikely to be relevant across the population as a whole, to which this data relates).

Giving people a prescription to justify their fee is bad medicine, but all too easy to succumb to. Charging leads to bad medicine. It's an easy, and in this case, very obviously correct conclusion.

But it keeps drug companies happy.

Housing must be a priority in mental health reform

Published by Anonymous (not verified) on Mon, 18/11/2019 - 8:19am in

Tags 

Health

She told us 'I am applying for places and competing with people who are in good jobs and with women who have kids. Why would they give me a place?'

The Fixer: An Insurance Giant Embraces ‘Housing First’

Published by Anonymous (not verified) on Thu, 14/11/2019 - 2:17am in

Welcome back to The Fixer, our weekly briefing of solutions reported elsewhere. This week: one of the biggest companies in America gets on board with “housing first.” Plus, Indigenous communities in the Amazon adopt sustainable farming techniques, and small towns in Minnesota take a hyper-local approach to fighting climate change.

Housing the homeless and making a profit

Recently, we reported on governments embracing “housing first,” a strategy for getting a roof over people’s heads before tackling other issues they struggle with. Now, Bloomberg Businessweek reports that UnitedHealth, America’s largest health insurer, is embracing housing first as a way to increase its profit margins.

This is a big deal. UnitedHealth, a private company, covers six million Medicaid patients, a small percentage of whom are homeless and require frequent, costly hospital visits. For instance, in Camden, New Jersey, just one percent of its Medicaid members incur 30 percent of the group’s health care costs. These high-cost patients are why the company’s Medicaid division has been missing its profit targets. So UnitedHealth decided to get some of those people into stable housing, where they can better care for their health—and save the company money.

Through the program, UnitedHealth is paying for housing in Phoenix, Milwaukee and Las Vegas for homeless Medicaid members whose medical bills exceed $50,000 per year. Since these people were given housing, some of them have seen their medical bills drop by 80 percent. It’s not just the patients who are healthier—so is UnitedHealth’s bottom line: the company’s Medicaid division is back on track to meet its profit targets next year. This is why the insurer has decided to expand the program to 30 markets in 2020. 

The sheer size of UnitedHealth makes the potential for expansion enormous. The company covers 43 million patients and has the sixth-highest revenues of any corporation in the country. Even better, its experiment is proving that housing first can be used to generate private sector profits. In other words, doing the right thing can be good business.

Read more at Bloomberg Businessweek.

Growth that saves the canopy

While logging by big corporations grabs most of the headlines, the Peruvian Amazon’s biggest deforestation threat comes from subsistence farming. The slash-and-burn techniques used by smallholder farmers to let the sunlight reach their crops are the primary reason Peru lost nearly 350,000 acres of rainforest last year.

To fix this, an organization called Cool Earth helps Indigenous farmers develop practices that require less clear-cutting. For instance: “People in remote areas have an obsession with growing yuca,” says Aurora Lume, a member of Cool Earth’s field team. But yuca crops need to be drenched in sun. So Cool Earth brings in technicians to teach farmers to grow coffee instead, which thrives under the shady forest canopy. 

Farmers participating in a Cool Earth project in the Peruvian Amazon. Credit: Cool Earth

Cool Earth doesn’t strong arm farmers into changing their harvests. Instead, it shows them satellite imagery of how much forest their agricultural methods have destroyed. “The people were taken aback by what they saw,” another Cool Earth officer told the Guardian. These satellite maps are then used to plan new, more sustainable crop plantings. “You can’t be too heavy handed, but people have to understand that if they continue to clear at the present rate, in 15-20 years, they will have no forest. Mapping is helping villages to plan how they use land.”

So far, it’s working. In the areas where Cool Earth has engaged with farmers, deforestation has fallen by half. The Peruvian government has gotten on board as well, launching the National Forest Conservation Program, which pays communities that implement sustainable farming systems. “It’s a tried-and-tested strategy in South America,” says Tony Juniper, a Cool Earth ambassador. “It has worked in Brazil, Colombia and Peru. If you look at maps of the forest in those countries, you will see that the areas under Indigenous control are best protected.”

Read more at the Guardian. 

Climate action without debate

There’s a stereotype that rural Americans don’t care about the environment, but the farming community of Morris, Minnesota has found a way to disprove it. In 2014, the town held a three-day “rural climate dialogue” attended by 300 residents. Rather than debate or lecture about the science of climate change, the event “mixed facts and testimonies [from residents] with their personal beliefs, experiences, and emotions,” according to Grist. The dialogues have since become a regular event, in which residents share their own perspectives, while identifying opportunities to reduce carbon emissions and create a more sustainable community.

Sticking to sensible, local solutions keeps the dialogues from becoming polarizing. “You don’t have to sit in a meeting room and argue about whether there’s climate change that’s happening,” said Morris city manager Blaine Hill. “We don’t focus on the words ‘climate’ or ‘environment’ because it’s not necessary, and sometimes it gets in the way of what we’re actually trying to do.”

View this post on Instagram

#tbt to the Rural Climate State Convening. Rural communicates play a key part in designing climate solutions and building resilience. . . . . #democracy #climatechange #community #civicengagement #civiceducation

A post shared by Jefferson Center (@jeffersonctr) on Sep 7, 2017 at 11:26am PDT

The approach has worked. This year, Morris replaced its 450-watt street lights with LED bulbs, installed electric vehicle charging stations and erected solar arrays around town. And a survey conducted with the University of Minnesota concluded that participants left the dialogues with a deeper understanding of climate change.

The “Morris Model” has since been replicated in other towns in Minnesota—in one case, a statewide Morris-style dialogue was held among multiple far-flung farming communities. In each case, empathy and openness are emphasized over debate or pedagogy. “We are a small, rural town and we’re able to do things here that are going to be renewable and sustainable for the future,” Hill said. “If we can do it, then anyone can do it.”

Read more at Grist.

The post The Fixer: An Insurance Giant Embraces ‘Housing First’ appeared first on Reasons to be Cheerful.

Culinary Medicine

Published by Anonymous (not verified) on Mon, 11/11/2019 - 4:08am in

The art and science of eating.

Three Stunning Psychological Truths

Published by Anonymous (not verified) on Thu, 31/10/2019 - 2:44am in

Stating obvious truths about addiction is a revolutionary activity.

The Truth About Dog Ownership and Your Health

Published by Anonymous (not verified) on Thu, 17/10/2019 - 1:03am in

Tags 

empathy, Health

Recent exaggerated claims that owning a dog could increase life expectancy provide a cautionary tale in how scientific research is interpreted.

Vulnerability in a greying Australia: the aged in a changing climate

Published by Anonymous (not verified) on Thu, 10/10/2019 - 9:51am in

Tags 

Health

Australia’s geographical location and size add a further dimension ensuring that the country experiences a widely variable climate.

Free the Paramedics!

Published by Anonymous (not verified) on Sat, 05/10/2019 - 12:14am in

Twice a week, Amy Yang drives her white Chevy Malibu to Mollie Wagar’s apartment in a senior living community in Fort Worth, Texas. Wagar, 78, lives alone and is a bit of a night owl, so Yang always calls her a few minutes before her scheduled 9 a.m. arrival to warn her she’s on the way. 

Once situated in Wagar’s living room, an array of devices appear from Yang’s black cargo pants and medical bag—a stethoscope, a blood pressure cuff, a blood sugar meter. While the paramedic gets to work, she chats with Wagar about her recent road trip to Mississippi and new developments in her health since they last saw each other four days earlier.

These casual visits and friendly chats are a gratifying change for Yang, who, until about a year ago, spent 11 years speeding patients to emergency rooms in an ambulance. Now, she is able to develop a slow-paced relationship with patients like Wagar, witnessing and monitoring their health improvements first-hand. Wagar’s situation isn’t an emergency, but in another city it might be treated as one, not because she requires urgent care, but because most cities don’t have a system like Fort Worth’s. 

In most cities, a call placed to 911 triggers an automatic series of responses involving an ambulance, a crew of paramedics and a rush to the ER, sirens blaring. But this response is often excessive—one in three 911 calls don’t require an ER visit. Yet few cities have a system in place to deal with cases like Wagar’s—non-emergencies that nonetheless necessitate a medical professional to be dispatched to the person’s home.

Mollie Wagar and Amy Yang discuss Wagar’s health issues in the living room of her home. Credit: Allison McNearney

For a long time, Wagar, who has diabetes and stomach problems, often called 911 for help. These calls would inevitably land her in the hospital, where she’d receive a full, costly workup, often after her health problems had escalated. It was during one of these stays that she first met Yang, who connected her with the MedStar Mobile Integrated Health Program, one of the U.S.’s first community paramedicine programs. 

Launched in 2009, MedStar’s idea was simple: empower paramedics to provide care beyond simply transporting people to emergency rooms. Giving paramedics more time and flexibility to customize their responses to non-emergency situations, the theory went, would provide more effective care for patients, save money for cities and depressurize overburdened ERs. 

Community paramedicine programs emerged in rural Canada in the late 1990s to serve populations where medical needs were high, but doctors few and far between. The concept was described in a U.S. publication in 1996 as a way to “decrease emergency department utilization, save health care dollars and improve patient outcomes.” Fort Worth became an early adopter after discovering that it had a small population of residents who disproportionately used 911 when they needed non-emergency care. Today, community paramedicine programs are being developed in countries around the world, from the United Kingdom to Australia to the Maldives. 

The concept sounds straightforward. After all, who better to address the root causes of ER visits than the paramedics who interact face-to-face with patients in their own homes? But there are complexities. Implementing the community paramedicine model requires a radical shift in how an entire sector of the medical system views its job. “Our goal is to not be the patients’ medical home or their primary provider,” says Desiree Partain, MedStar’s Mobile Integrated Healthcare Manager. “Our goal is to determine what their gaps are and then to link them to resources in the community.”

Wagar’s case is a prime example. After she was flagged as a high-utilizer of 911 this summer, Yang visited her at the hospital to explain the mobile health care program. Wagar agreed to give it a try. Now, for 30 days, per Wagar’s insurance authorization, Yang is visiting Wagar at home twice a week to check her vitals and help manage her prescribed treatment. 

Since Yang’s visits began, Wagar hasn’t been back to the hospital. “I’ll be quite frank,” says Wagar. “MedStar seems to be better than the home health care people when they come in. They take a little more time, a little more personal interest. [Amy] really cares, and I feel like she’s a friend and not just someone who’s doing her job.”

That job goes beyond rote medical treatment. Yang helps patients navigate America’s convoluted health care system, coordinating care between a patient’s doctors and explaining diagnoses and prescription regimes. She often calls doctors’ offices on her patients’ behalf to clarify instructions or address new health issues. Yang will even sometimes attend doctors’ appointments alongside her patients. 

Other work Yang undertakes has seemingly little to do with her medical training. Many of her patients’ problems stem from social and environmental issues that a 15-minute doctor’s appointment might not uncover. Is a patient skipping his follow-up appointments? Yang can observe that he lacks transportation and organize a ride for him. Is a diabetic not eating correctly to manage her illness? As a visitor to her home, Yang can observe that she is living in a food desert, and direct her to a nearby food pantry with quality groceries, or help her apply to Meals on Wheels. Or maybe it becomes clear to Yang that a patient is unable to carry out basic tasks. She can set them up with home health care services, or, if the problem is psychological, connect them to mental health resources.

“I think what the health care industry needs to understand is the role we play is truly being other organizations’ eyes and ears,” says Partain. “We’re going into these patients’ homes where the hospitals and some other agencies don’t have that advantage.”

Saving money, and needing more

According to Partain, out of over 20,000 EMS providers in the U.S., only around 300 have community paramedicine programs. Each is shaped to serve the needs of its specific community. In Fort Worth, for instance, with a metro-area population of 7.5 million, congestive heart failure and high-utilizers of ERs were the most pressing issues. In rural Eagle County, Colorado, on the other hand, the problem was simpler: basic access to care. As Chris Montera, CEO of the Eagle County Paramedic Services (ECPS) quips, Eagle County is a “tale of two stories.”

Spread across a vast expanse of some of the world’s most breathtaking natural terrain, Eagle County’s economy is fractured, with a high-wealth population clustered around the Vail and Beaver Creek ski resorts, and on the valley floor in the shadow of the mountains, communities of lower-income resort workers and service providers, many of whom lack access to health care. 

A community paramedic working with the Eagle County Paramedic Services meets with a patient in her home. Credit: ECPS

In 2009, ECPS started one of the first rural community paramedic programs in the U.S. At the time, the county’s uninsured rate was extremely high, and Montera determined that the new program could increase access to primary and preventative care. As the program has expanded, they have added additional services like a long-term, in-home detox program (their six-month sobriety rate is higher than typical, around 50 percent, says Montera) and a joint initiative with a team of mental health clinicians to respond to suicide calls. According to Montera, Eagle County suffers from a suicide rate that is three times the national average, but in the year that their program has been in place, they have “reduced ambulance transfer off-scene by 78 percent.” 

By providing more customized care and addressing the underlying elements of patients’ health problems, Fort Worth and Eagle County are saving money as well as lives. In 2008, the year before MedStar launched its Mobile Integrated Healthcare Program, 21 patients were taken to local emergency rooms by ambulance 2,000 times, racking up $962,429 in transportation charges alone. By contrast, an analysis of 670 patients enrolled in the program from 2013 to 2018 determined that a total of 5,116 ambulance trips were avoided during that time, with a total savings of $2,143,604. Between the ambulance, ER and hospital admissions that were prevented, $24,922 per enrolled patient was saved in Fort Worth. 

As for Eagle County, Montera says that in the first four years of the ECPS program, “We were consistently seeing right around $5,200 of health care savings per individual.”

But demonstrating the value of community paramedicine programs is only half of the equation. The expansion of the model requires a paradigm shift in how EMS programs make money. Historically, EMS services in the U.S. have been paid for their transportation services. A person calls 911, an ambulance arrives, paramedics provide critical care and the patient is delivered to a hospital, accruing hefty bills along the way. The idea behind community paramedicine is to provide lower-impact care that reduces costs. That requires a whole host of stakeholders—from hospitals and specialty clinics to insurance companies and tax payers—to buy into the system.

“The way ambulance services in the U.S. and most places, for that matter, have been reimbursed is to transfer patients to hospital,” says Dr. Peter O’Meara, an internationally recognized Australian expert on community paramedicine. “That’s how it’s been done historically. And that’s not a great model, because obviously the benefit is not taking people to hospital. So you have to find someone who’s willing to pay to not take people.” 

Most community paramedicine programs rely on fee-for-service payments, but many aren’t covered by insurance, and often the patients can’t pay for them, either. Credit: National Association of Emergency Medical Technicians

Fort Worth is moving towards a capitated financial model, where hospitals, home health providers and other referring institutions pay a set fee per patient enrolled in the program. Some patients like Wagar are authorized for 30- or 90-day programs covered by their insurance. MedStar also supplements their Mobile Integrated Health Program with revenue from specialty care transfers. But if the 911 team flags a high-utilizer patient who isn’t covered by one of the above entities, MedStar often picks up the tab. 

Ten years after its program began, Eagle County is just beginning to sign on health insurance companies. The program has stayed afloat so far mainly through grants and state funding. But many other programs are on shakier financial footing. A 2018 survey by the National Association of Emergency Medical Technicians found that, of the 129 programs included in the study, only 36 percent agreed or strongly agreed that their programs were financially sustainable. A quarter of the respondents said their programs were not. 

Smarter care requires higher skills

Just as important as program funding is the issue of paramedic education. The U.S. lags behind other countries in the standards paramedics must meet to perform their jobs. With increased education comes the ability to provide greater medical care, but efforts to upskill paramedics have faced some surprising opposition. For instance, some nursing unions view more highly skilled paramedics as a threat to their own jobs. Other stakeholders feel it is simply an unnecessary requirement.

“The U.S really needs to deal with their education level for entry-level paramedics before they can really attain the practitioner-level-type community paramedic,” says O’Meara. The issue is being addressed on a state-by-state basis. Montera has been advocating for changes in Colorado, which recently passed a law to recognize paramedic degree programs, and where the state college system will soon begin offering programs in paramedicine. Oregon now requires an associate degree for the position, and North Carolina has submitted a proposal to follow suit by 2023. “The true paradigm shift we need to make in the United States is really around education and how we view paramedics,” says Montera.

That image of paramedics as ambulance-driving crisis managers, so ingrained in our minds, may be the biggest hurdle. As with any new model of medicine, it takes trial and error to get things right. Both MedStar and ECPS are committed to transparency, hoping an open-source standard will help other programs learn from their successes and failures. 

“Health care has been changing and evolving from quantity to quality, and we see ourselves as a provider of health care services,” Partain says, adding that EMS programs trying innovative approaches need to be willing “to plan it a little bit, but [then] we’re going to throw ourselves out there. We’re going to bleed, we’re going to bruise, we’re going to make mistakes, but we learn best from our mistakes. And that’s just what we’ve done.”

The post Free the Paramedics! appeared first on Reasons to be Cheerful.

Pesticides in the Dock: Ecological Apocalypse but Business as Usual

Published by Anonymous (not verified) on Fri, 27/09/2019 - 3:16am in

It is worrying to think that, globally, sales of synthetic chemicals are to double over the next 12 years with alarming implications for health and the environment if governments continue to fail to rein in the plastics, pesticides and cosmetics industries. The second Global Chemicals Outlook (2019) says the world will not meet international commitments to reduce chemical hazards and halt pollution by 2020.

Pages