Dr. Howard Smith Reports

Obsessive, compulsive symptoms (OCS) in adolescents and young adults may be a sign of serious mental illness including major depression and suicidal intent.  A study at the University of Pennsylvania looked at 7,000 subjects 11 through 21 years of age and found that 20% of those with OCS had thoughts about harming themselves or others and pictured violent images.  Psychiatrists know that such children are likely to develop major mental disorders.

Teens who evidence repetitive and ritualistic behaviors including checking and rechecking things, cleaning over and over, and ordering and reordering items need to be carefully monitored for the development of mental illness.  If you see this in your teen, speak with their pediatricians about a referral to a child psychiatrist.

Vidcast: https://youtu.be/0T2vkePHt8

#Obsessivecompulsivesyndrome #depression #suicide #repetitivebehavior #cleaning #ordering #checking

Ran Barzilay, Ariana Patrick, Monica E. Calkins, Tyler M. Moore, Daniel H. Wolf, Tami D. Benton, James F. Leckman, Ruben C. Gur, Raquel E. Gur. Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? Journal of the American Academy of Child & Adolescent Psychiatry, 2018; DOI: 10.1016/j.jaac.2018.06.038

Obsessive, compulsive symptoms (OCS) in adolescents and young adults may be a sign of serious mental illness including major depression and suicidal intent.  A study at the University of Pennsylvania looked at 7,000 subjects 11 through 21 years of age and found that 20% of those with OCS had thoughts about harming themselves or others and pictured violent images.  Psychiatrists know that such children are likely to develop major mental disorders.

Teens who evidence repetitive and ritualistic behaviors including checking and rechecking things, cleaning over and over, and ordering and reordering items need to be carefully monitored for the development of mental illness.  If you see this in your teen, speak with their pediatricians about a referral to a child psychiatrist.

Vidcast: https://youtu.be/0T2vkePHt8

#Obsessivecompulsivesyndrome #depression #suicide #repetitivebehavior #cleaning #ordering #checking

Ran Barzilay, Ariana Patrick, Monica E. Calkins, Tyler M. Moore, Daniel H. Wolf, Tami D. Benton, James F. Leckman, Ruben C. Gur, Raquel E. Gur. Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? Journal of the American Academy of Child & Adolescent Psychiatry, 2018; DOI: 10.1016/j.jaac.2018.06.038

Campaigns by Medicare to reduce patient readmissions to a hospital within a month following discharge, the so-called Hospital Readmissions Reduction Program, is associated with more patient deaths from heart failure and pneumonia rather than improvement in care quality.  This is the conclusion of a study of some 8 million hospitalizations over a decade beginning in 2005 was completed and recently published by Harvard cardiologists at the Brigham and Women’s Hospital and the Mass. General Hospital.

They compared post-hospital mortality statistics before and after announcement and implementation of new financial penalties for hospitals to discourage readmission within a month after discharge.  Their findings suggested that this penny pinching resulted in some 8,000 deaths from heart failure and some 12,000 deaths from pneumonia that could have possibly been avoided.

In addition, many sick persons who did return to the hospital were not formally readmitted as inpatients as their condition demanded, but they were instead brought back into the hospital on observation status.  This limbo status permits the hospital to treat them as inpatients but not categorize them as such for insurance purposes skirting the Medicare rules.  

Observation status is a terrible rip-off for patients, since your insurance classifies you as an outpatient, pays the hospital less, and holds you responsible for a greater percentage of the charges that can be considerable for what are essentially complicated and expensive inpatient services such as CT scans and MRIs.

Do not permit the hospital doctors and discharge planners to throw you or family members out prematurely.  If you do have to go back into the hospital, scream until you they admit you as an inpatient and not on observation status.  If you make enough noise, they will reluctantly do the right thing!

Vidcast: https://youtu.be/UWv6rxh2tWc

#HospitalReadmissionsReduction #heartattack #heartfailure #pneumonia #prematuredischarge #observationstatus

Wadhera RK, Joynt Maddox KE, Wasfy JH, Haneuse S, Shen C, Yeh RW. Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia. JAMA. 2018;320(24):2542–2552. doi:10.1001/jama.2018.19232

Campaigns by Medicare to reduce patient readmissions to a hospital within a month following discharge, the so-called Hospital Readmissions Reduction Program, is associated with more patient deaths from heart failure and pneumonia rather than improvement in care quality.  This is the conclusion of a study of some 8 million hospitalizations over a decade beginning in 2005 was completed and recently published by Harvard cardiologists at the Brigham and Women’s Hospital and the Mass. General Hospital.

They compared post-hospital mortality statistics before and after announcement and implementation of new financial penalties for hospitals to discourage readmission within a month after discharge.  Their findings suggested that this penny pinching resulted in some 8,000 deaths from heart failure and some 12,000 deaths from pneumonia that could have possibly been avoided.

In addition, many sick persons who did return to the hospital were not formally readmitted as inpatients as their condition demanded, but they were instead brought back into the hospital on observation status.  This limbo status permits the hospital to treat them as inpatients but not categorize them as such for insurance purposes skirting the Medicare rules.  

Observation status is a terrible rip-off for patients, since your insurance classifies you as an outpatient, pays the hospital less, and holds you responsible for a greater percentage of the charges that can be considerable for what are essentially complicated and expensive inpatient services such as CT scans and MRIs.

Do not permit the hospital doctors and discharge planners to throw you or family members out prematurely.  If you do have to go back into the hospital, scream until you they admit you as an inpatient and not on observation status.  If you make enough noise, they will reluctantly do the right thing!

Vidcast: https://youtu.be/UWv6rxh2tWc

#HospitalReadmissionsReduction #heartattack #heartfailure #pneumonia #prematuredischarge #observationstatus

Wadhera RK, Joynt Maddox KE, Wasfy JH, Haneuse S, Shen C, Yeh RW. Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia. JAMA. 2018;320(24):2542–2552. doi:10.1001/jama.2018.19232

Celiac disease may be initiated by an agent used to improve food texture and to literally glue together meat fragments into a more substantial, steak-like product.  The agent is microbial transglutaminase, and a review of data about the causation of celiac diease just published in Frontiers in Pediatrics suggests that the increasing amounts of this substance that are finding their way into our food supply may be at fault.

Over 3 million American have celiac disease.  It is an inherited autoimmune disorder, and you are 6 times more likely to have it if a close member member is affected.    It is characterized by an attack of a person’s own immune system on their gut lining, and it’s triggered by the presence of the gluten protein found in wheat, barley, and rye.  Other factors such as stress, infection, or antibiotic use seem to initiate or exacerbate the process.

Although our own systems make transglutaminase, they do so in very small quantities compared with what we can ingest in processed foods.  The extra transglutaminase appears to break down any available gluten into small protein fragments that often bind to the transglutaminase itself and then serve to ignite the auto-immmune attack on the intestinal linings.

The FDA has not yet ruled on the safety of transglutaminase as a food additive.  The smart money is on avoiding it if possible even if you don’t now have celiac disease.  

By federal law, packaging must indicate its presence. Transglutaminase is more likely to be in meat products labeled as “formed” such as “formed turkey thigh roast, “ and it is also found in many baked goods.  When dining out, you can ask the restaurant staff about its use in their cuisine.

Vidcast: https://youtu.be/6B9c3AIvNMc

Celiacdisease #transglutaminase #foodadditives #healthnews #radio news

Matthias Torsten, Lerner Aaron. Microbial Transglutaminase Is Immunogenic and Potentially Pathogenic in Pediatric Celiac Disease. Frontiers in Pediatrics, 2018; 6 DOI: 10.3389/fped.2018.00389

https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/food-labeling/safety-of-transglutaminase-tg-enzyme/safety-of-tg-enzyme#3

Celiac disease may be initiated by an agent used to improve food texture and to literally glue together meat fragments into a more substantial, steak-like product.  The agent is microbial transglutaminase, and a review of data about the causation of celiac diease just published in Frontiers in Pediatrics suggests that the increasing amounts of this substance that are finding their way into our food supply may be at fault.

Over 3 million American have celiac disease.  It is an inherited autoimmune disorder, and you are 6 times more likely to have it if a close member member is affected.    It is characterized by an attack of a person’s own immune system on their gut lining, and it’s triggered by the presence of the gluten protein found in wheat, barley, and rye.  Other factors such as stress, infection, or antibiotic use seem to initiate or exacerbate the process.

Although our own systems make transglutaminase, they do so in very small quantities compared with what we can ingest in processed foods.  The extra transglutaminase appears to break down any available gluten into small protein fragments that often bind to the transglutaminase itself and then serve to ignite the auto-immmune attack on the intestinal linings.

The FDA has not yet ruled on the safety of transglutaminase as a food additive.  The smart money is on avoiding it if possible even if you don’t now have celiac disease.  

By federal law, packaging must indicate its presence. Transglutaminase is more likely to be in meat products labeled as “formed” such as “formed turkey thigh roast, “ and it is also found in many baked goods.  When dining out, you can ask the restaurant staff about its use in their cuisine.

Vidcast: https://youtu.be/6B9c3AIvNMc

Celiacdisease #transglutaminase #foodadditives #healthnews #radio news

Matthias Torsten, Lerner Aaron. Microbial Transglutaminase Is Immunogenic and Potentially Pathogenic in Pediatric Celiac Disease. Frontiers in Pediatrics, 2018; 6 DOI: 10.3389/fped.2018.00389

https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/food-labeling/safety-of-transglutaminase-tg-enzyme/safety-of-tg-enzyme#3

Women’s who suffer from chronic peri- and post-menopausal hot flashes and night sweats, so called vasomotor symptoms or VMS, lasting close to 10 years or longer have a 13% higher risk of developing breast cancer.  This the conclusion of a Women’s Health Initiative analysis of more than 25,000 women 50 years of age and older who never had any menopausal hormone therapy and who were followed for a median of 18 years.

The good news is that, despite the higher incidence of breast cancer, those with persisting VMS did not have a less favorable outcome when treated for their cancers.  They were just as likely to become breast cancer survivors as women free of enduring hot flashes and night sweats.

If you or yours are suffering from these persisting menopausal VMS symptoms, increase your surveillence for breast cancer.  Don’t miss an opportunity for breast self-examination and be certain to follow a consistent mammography schedule.

Vidcast: https://youtu.be/LwGqm2BPGBg

hotflashes #nightsweats #menopause #vms #vasomotorsymptoms #breastcancer

Rowan T. Chlebowski, Joanne E. Mortimer, Carolyn J. Crandall, Kathy Pan, JoAnn E. Manson, Rebecca Nelson, Karen C. Johnson, Mara Z. Vitolin, Dorothy Lane, Jean Wactawski-Wende, Karen Kwan, Marcia L. Stefanick. Persistent vasomotor symptoms and breast cancer in the Womenʼs Health Initiative. Menopause, 2018; 1 DOI: 10.1097/GME.0000000000001283

Women’s who suffer from chronic peri- and post-menopausal hot flashes and night sweats, so called vasomotor symptoms or VMS, lasting close to 10 years or longer have a 13% higher risk of developing breast cancer.  This the conclusion of a Women’s Health Initiative analysis of more than 25,000 women 50 years of age and older who never had any menopausal hormone therapy and who were followed for a median of 18 years.

The good news is that, despite the higher incidence of breast cancer, those with persisting VMS did not have a less favorable outcome when treated for their cancers.  They were just as likely to become breast cancer survivors as women free of enduring hot flashes and night sweats.

If you or yours are suffering from these persisting menopausal VMS symptoms, increase your surveillence for breast cancer.  Don’t miss an opportunity for breast self-examination and be certain to follow a consistent mammography schedule.

Vidcast: https://youtu.be/LwGqm2BPGBg

hotflashes #nightsweats #menopause #vms #vasomotorsymptoms #breastcancer

Rowan T. Chlebowski, Joanne E. Mortimer, Carolyn J. Crandall, Kathy Pan, JoAnn E. Manson, Rebecca Nelson, Karen C. Johnson, Mara Z. Vitolin, Dorothy Lane, Jean Wactawski-Wende, Karen Kwan, Marcia L. Stefanick. Persistent vasomotor symptoms and breast cancer in the Womenʼs Health Initiative. Menopause, 2018; 1 DOI: 10.1097/GME.0000000000001283

Ever hear of prescription digital medicine?  Who ever heard of doctors and other therapists prescribing the playing of therapeutic video games? Well that is now a reality for children with autism spectrum disorder and attention deficit hyperactivity disorder and it may soon be used for other patients as well.

Pediatricians at the Children’s Hospital of Philadelphia’s Center for Autism Research collaborated with the prescription digital medicine company Akili Interactive to study the effectiveness of  the company’s AKL-T02 instrument via an action video game experience designed to improve the childrens’ attention, task completion, and memory.

The so-called Project: EVO studied a group of 19 children age 9-13 years diagnosed with both autism and attention deficit and exposed them to both the digital medicine and control therapy.  This group was selected since children with both autism and ADHD tend to respond poorly to conventional drug therapy used for ADHD alone.

Not suprisingly, the kids embraced the video game experience completing more than 95% of the treatment sessions.  This preliminary study revealed that the treated children with both autism and ADHD will focus on the high tech therapy and it improved their attention and focus while reducing their distractibility. 

Larger studies will follow, but Akili Interactive is already developing other prescriptive digital medicines, ATL-T03 and ATL-T04 for adult patients with depression to improve their memory, attention, executive function, and emotional processing.  Why are the products “by prescription?”  I’d guess: in order to qualify for health insurance coverage!

Vidcast: https://youtu.be/YmdupCzHKzE

autism #autismspectrumdisorder #ADHD #attentiondeficit #digitalmedicine

Benjamin E. Yerys, Jennifer R. Bertollo, Lauren Kenworthy, Geraldine Dawson, Elysa J. Marco, Robert T. Schultz, Linmarie Sikich. Brief Report: Pilot Study of a Novel Interactive Digital Treatment to Improve Cognitive Control in Children with Autism Spectrum Disorder and Co-occurring ADHD Symptoms. Journal of Autism and Developmental Disorders, 2018; DOI: 10.1007/s10803-018-3856-7

https://static1.squarespace.com/static/5a0457fa18b27dc7e8aef79b/t/5af5b7ba562fa7b05895c1c6/1526052798017/Yerys_Bertollo_EVO_IMFAR_2018_FINAL_2.pdf

https://www.akiliinteractive.com/programs-products/

Ever hear of prescription digital medicine?  Who ever heard of doctors and other therapists prescribing the playing of therapeutic video games? Well that is now a reality for children with autism spectrum disorder and attention deficit hyperactivity disorder and it may soon be used for other patients as well.

Pediatricians at the Children’s Hospital of Philadelphia’s Center for Autism Research collaborated with the prescription digital medicine company Akili Interactive to study the effectiveness of  the company’s AKL-T02 instrument via an action video game experience designed to improve the childrens’ attention, task completion, and memory.

The so-called Project: EVO studied a group of 19 children age 9-13 years diagnosed with both autism and attention deficit and exposed them to both the digital medicine and control therapy.  This group was selected since children with both autism and ADHD tend to respond poorly to conventional drug therapy used for ADHD alone.

Not suprisingly, the kids embraced the video game experience completing more than 95% of the treatment sessions.  This preliminary study revealed that the treated children with both autism and ADHD will focus on the high tech therapy and it improved their attention and focus while reducing their distractibility. 

Larger studies will follow, but Akili Interactive is already developing other prescriptive digital medicines, ATL-T03 and ATL-T04 for adult patients with depression to improve their memory, attention, executive function, and emotional processing.  Why are the products “by prescription?”  I’d guess: in order to qualify for health insurance coverage!

Vidcast: https://youtu.be/YmdupCzHKzE

autism #autismspectrumdisorder #ADHD #attentiondeficit #digitalmedicine

Benjamin E. Yerys, Jennifer R. Bertollo, Lauren Kenworthy, Geraldine Dawson, Elysa J. Marco, Robert T. Schultz, Linmarie Sikich. Brief Report: Pilot Study of a Novel Interactive Digital Treatment to Improve Cognitive Control in Children with Autism Spectrum Disorder and Co-occurring ADHD Symptoms. Journal of Autism and Developmental Disorders, 2018; DOI: 10.1007/s10803-018-3856-7

https://static1.squarespace.com/static/5a0457fa18b27dc7e8aef79b/t/5af5b7ba562fa7b05895c1c6/1526052798017/Yerys_Bertollo_EVO_IMFAR_2018_FINAL_2.pdf

https://www.akiliinteractive.com/programs-products/