Functional neurological disorder (FND) is associated with considerable distress and disability. The symptoms are not faked
Diagnose FND positively on the basis of typical clinical features. It is not a diagnosis of exclusion
FND can be diagnosed and treated in presence of comorbid, pathophysiologically defined disease
Psychological stressors are important risk factors but are neither necessary nor sufficient for the diagnosis
Functional disorders are conditions whose origin arises primarily from a disorder of nervous system functioning rather than clearly identifiable pathophysiological disease—such as irritable bowel syndrome, fibromyalgia, and functional neurological disorder (FND)—they are the second commonest reason for new neurology consultations.1 FND is common in emergency settings,2 stroke,3 and rehabilitation services.4 It causes considerable physical disability and distress, and often places an economic burden both on patients and health services.5 Many clinicians have had little formal clinical education on the assessment and management of these disorders, and patients are often not offered potentially effective treatments.
Comprehensive care in patients with diabetes and CKD
Management of CKD in diabetes can be challenging and complex, and a multidisciplinary team should be involved (doctors, nurses, dietitians, educators, etc). Patient participation is important for self-management and to participate in shared decision-making regarding the management plan. (Practice point).
We recommend that treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated (1B).
Lifestyle interventions in patients with diabetes and CKD
We suggest maintaining a protein intake of 0.8 g protein/kg)/d for those with diabetes and CKD not treated with dialysis (2C).
On the amount of proteins recommended in these guidelines, they suggest (‘recommend’ becomes a ‘suggest’ at this level of evidence) a very precise intake of 0.8g/kg/d in patients with diabetes and CKD. Lower dietary protein intake has been hypothesized but never proven to reduce glomerular hyperfiltration and slow progression of CKD, however in patients with diabetes, limiting protein intake below 0.8g/kg/d can be translated into a decreased caloric content, significant weight loss and quality of life. Malnutrition from protein and calorie deficit is possible.
Physical activity
We recommend that patients with diabetes and CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance (1D).
Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease, limiting further disease spread.
Disease spread occurs when some proportion of a population is susceptible to the disease. Herd immunity occurs when a significant portion of a population becomes immune to an infectious disease and the risk of spread from person to person decreases; those who are not immune are indirectly protected because ongoing disease spread is very small.
The proportion of a population who must be immune to achieve herd immunity varies by disease. For example, a disease that is very contagious, such as measles, requires more than 95% of the population to be immune to stop sustained disease transmission and achieve herd immunity.
How Is Herd Immunity Achieved?
Herd immunity may be achieved either through infection and recovery or by vaccination. Vaccination creates immunity without having to contract a disease. Herd immunity also protects those who are unable to be vaccinated, such as newborns and immunocompromised people, because the disease spread within the population is very limited. Communities with lower vaccine coverage may have outbreaks of vaccine-preventable diseases because the proportion of people who are vaccinated is below the necessary herd immunity threshold. In addition, the protection offered by vaccines may wane over time, requiring repeat vaccination.
Achieving herd immunity through infection relies on enough people being infected with the disease and recovering from it, during which they develop antibodies against future infection. In some situations, even if a large proportion of adults have developed immunity after prior infection, the disease may still circulate among children. In addition, antibodies from a prior infection may only provide protection for a limited duration.
People who do not have immunity to a disease may still contract an infectious disease and have severe consequences of that disease even when herd immunity is very high. Herd immunity reduces the risk of getting a disease but does not prevent it for nonimmune people.
Herd Immunity and COVID-19
There is no effective vaccine against coronavirus disease 2019 (COVID-19) yet, although several are currently in development. It is not yet known if having this disease confers immunity to future infection, and if so, for how long. A large proportion of people would likely need to be infected and recover to achieve herd immunity; however, this situation could overwhelm the health care system and lead to many deaths and complications. To prevent disease transmission, keep distance between yourself and others, wash your hands often with soap and water or sanitizer that contains at least 60% alcohol, and wear a face covering in public spaces where it is difficult to avoid close contact with others.
Colonic diverticulosis refers to herniation of the mucosa and submucosa through the muscular layer of the colonic wall and may be the result of colonic smooth muscle over-activity. Diverticular disease may be defined as any clinical state caused by symptoms pertaining to colonic diverticula and includes a wide-ranging spectrum from asymptomatic to severe and complicated disease.
Mohamed Thaha, Senior Lecturer & Lead Consultant in Colorectal Surgery, National Bowel Research Centre, Barts and The London School of Medicine and Dentistry, tells us more.
The Los Angeles Lakers took home the NBA championship this week. But the close of the season also marked a big victory for the league itself. The NBA played its finals in a unique environment that came to be known as the bubble.
Players were frequently tested and social distancing was heavily enforced. And, the experiment worked. The NBA did not report a single positive coronavirus case from players or staff. Reporters Emma Court and Brandon Kochkodin describe how the league did it, and whether other organizations can replicate its success.
First up, host Meagan Cantwell speaks with Abigail Echo-Hawk, director of the Urban Indian Health Institute and chief research officer for the Seattle Indian Health Board. Echo-Hawk shares what inspired her journey in public health and explains the repercussions of excluding native people from health data.
This story was originally reported by Lizzie Wade, who profiled Echo-Hawk as part of Science’s “voices of the pandemic” series. Next, host Sarah Crespi interviews Danielle Murashige, a Ph.D. student at the University of Pennsylvania, about her Science paper that attempts to quantify how much fuel a healthy heart needs.
There may be few issues that unite Americans ahead of the 2020 election as do their concerns about the cost of prescription drugs.
A clear majority — 75% — of respondents to a July survey said the cost of prescription medicines would be among the factors likely to influence their votes this year, according to a report from Gallup and the nonprofit West Health. Gallup reported on results from 1,007 interviews conducted with adults between July 1 and July 24.
1. What are the 2020 presidential candidates saying they will do to lower drug prices?
Both President Donald Trump, a Republican, and former Vice President Joe Biden, a Democrat, have highlighted insulin costs in their discussions of the need to lower drug prices.
In a January interview with the New York Times editorial board, Biden noted the widespread discontent among Americans about sticker shock often experienced at pharmacies. He spoke of a need for the federal government to act to make medicines more affordable.
“This is a place where I find, whether you’re Republican or Democrat, you think you’re getting screwed on drug prices. And you are, in terms of everything from insulin to inhalers and a whole range of other things,” Biden said. “So, again, can I guarantee that it gets done? No, but I can tell you what, if anybody can get it done, I can, and I think there’s a consensus for it.”
2. Why doesn’t Medicare, the biggest U.S. purchaser of drugs, directly negotiate on drug prices?
Congress has taken different approaches in designing the terms under which the two largest federal health programs, Medicaid and Medicare, buy drugs.
Medicaid is a program run by states with federal contributions and oversight. It covers people with low incomes and disabilities. Almost 67 million people were enrolled in Medicaid as of May 2020, including about 29 million children. In 1990 Congress decided that drugmakers who want to have their products covered by Medicaid must give rebates to the government. The initial rebate is equal to 23.1% of the average manufacturer price (AMP) for most drugs, or the AMP minus the best price provided to most other private-sector payers, whichever is greater. An additional rebate kicks in when prices rise faster than general inflation.
3. What’s the deal with rebates and discounts?
There’s widespread frustration among lawmakers and policy analysts about the lack of clarity about the role of middlemen in the supply chain for medicines. Known as pharmacy benefit managers (PBMs), these businesses describe the aim of their business as making drugs more affordable for consumers. Insurers like Cigna and UnitedHealth operate some of the nation’s largest PBMs, as does pharmacy giant CVS Health, which also owns insurer Aetna.
“They will tell you their mission is to lower drug costs,” said Rep. Earl L. “Buddy” Carter, a Georgia Republican, a pharmacist and a critic of PBMs, in a speech on the House floor last year. “My question to you would be: How is that working out?”
4. What is the “distinctly American” phenomenon of specialty drugs?
Kesselheim also has written on what he terms “Specialty Drugs — A Distinctly American Phenomenon.” That’s the title of a 2020 paper in the New England Journal of Medicine Kesselheim authored with Huseyin Naci, an associate professor of health policy at the London School of Economics.
In this Perspective article, Kesselheim and Naci look at how the “specialty” designation morphed from its origin in the 1970s. It then referred to a need for extra steps for preparation and delivery of new injectable and infusion products.
5. How much does it cost to bring a new drug to market anyway?
The median cost for a medicine developed in recent years was $985 million, according to a study published in JAMA in March 2020, “Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018.”
“Rising drug prices have attracted public debate in the United States and abroad on fairness of drug pricing and revenues,” write the study’s authors: Olivier J. Wouters of the London School of Economics; Martin McKee of the London School of Hygiene and Tropical Medicine; and Jeroen Luyten of Leuven Institute for Healthcare Policy, KU Leuven, Belgium. “Central to this debate is the scale of research and development investment by companies that is required to bring new medicines to market.”
The US Surgeon General’s office has released a report emphasizing the importance of making hypertension control a national public health priority. Vice Admiral Jerome Adams, MD, MPH, the 20th US Surgeon General, discusses the report’s background and recommendations.
Boomers Daily 