Posts Tagged ‘research’

Medical Profession Needs to Prepare for the Rapidly Growing Elderly Population

Thursday, June 17th, 2010

The Philippines needs to prepare for the burgeoning population of older persons. The population 60 years and above has grown at a very rapid rate, increasing from 3.2 million in 1990 to 4.6 million in 2000. By the year 2030, ten percent of our population will be composed of senior citizens. The National Institutes of Health (NIH) study “Status of Geriatric Education in Philippine Medical Schools” presented during the NIH Forum 17 June 2010, looked at how Geriatrics (the study of health and disease in old age) is taught in Philippine Medical Schools and the perception of graduating medical students on how well they can take care of old patients after receiving their MD diplomas.

The study revealed that most medical schools do have Geriatrics as part of a required course and 61% enjoy institutional support for developing said course. However, although 70% of the graduating medical students believe they are prepared to take care of the elderly in outpatient clinics and hospitals, only 61% of their teachers think they possess the necessary KAP (knowledge, attitude and practice) for such a job!

Some of the contributors to the lack in KAP of fresh graduates include the crowded medical course schedule and the lack of a curricular map of subjects that teach them how to take care of the elderly. Medical students learn the basics during the first three years of med school (classroom) but may not possess the skills in the final clinical years called internship (hospital exposure). The lack of clinical teachers and researchers were also identified as obstacles to the development of a good Geriatric program.

This study also contains recommendations as to how the situation can be rectified; how we can mold our future doctors into providing excellent and compassionate healthcare for the elderly. We can begin by increasing the number of doctors that are trained and dedicated to teaching, and by establishing a well mapped curriculum in Geriatrics. We also need to support researches that lead to improvement of the health and quality of life of the aging Filipino. The Association of Philippine Medical Colleges, DOH, DSWD, NIH and CHED can help lead this change.

About the NIH and Aging Study Group:

The National Institutes of Health (NIH) was created on January 26, 1996 by the UP Board of Regents as an institutional home of a network of various research and extension units specializing in health and socio-biomedical concerns. This thrust is consistent with the country’s vision of “Health for All”.

Currently, the NIH has various research institutes and active study groups that continue to develop and produce outputs that serve as vital guideposts in shaping national programs and policies. The Aging Study Group and the Committee on Aging and Degenerative Diseases (COMADD) has contributed greatly to current clinical and educational programs and policies on Aging. The vision of COMADD is “The Filipino elderly enjoying a healthy body, mind and spirit, being treated with dignity, and valued as a productive member of society, in a dynamic process unique to himself, and beginning a life of unlimited possibilities”.

Principal Investigator:
Shelley F. de la Vega, MD., MSc
Chair, Aging Study Group
Institute of Health Policy and Development Studies
UP Manila-NIH

Co-Investigators:
Jose Alvin Mojica, M.D., MHPEd
Chair, Department of Rehabilitation Medicine
Philippine General Hospital

Josephine Agapito, PhD
College of Arts and Sciences
UP Manila

Click here to view related post in Manila Bulletin Online

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Age ≥65 yr Highest Case Fatality Rate for AH1N1 Swine Flu Pandemic

Monday, June 7th, 2010

Source: Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza
Downloaded from www.nejm.org on May 6, 2010

Risk Factors for Complications of or Severe Illness with 2009 H1N1 Virus Infection.

Risk Factor Examples and Comments
1. Age <5 yr Increased risk especially for children <2 yr of age; highest hospitalization rates among children <1 yr
2. Pregnancy Risk of hospitalization increased by a factor of 4 to 7, as compared with agematched nonpregnant women, with highest risk in third trimester
3. Chronic cardiovascular condition Congestive heart failure or atherosclerotic disease; hypertension not shown to be an independent risk factor
4. Chronic lung disorder Asthma or COPD, cystic fibrosis
5. Metabolic disorder Diabetes
6. Neurologic condition Neuromuscular, neurocognitive, or seizure disorder
7. Immunosuppression Associated with HIV infection, organ transplantation, receipt of chemotherapy
or corticosteroids, or malnutrition
8. Morbid obesity – but not yet proved to be an independent risk factor for complications requiring hospitalization or ICU admission and possibly for death
9. Hemoglobinopathy Sickle cell anemia
10. Chronic renal disease Renal dialysis or transplantation
11. Chronic hepatic disease Cirrhosis
12. Long history of smoking Suggested but not yet proved to be an independent risk factor
13. Long-term aspirin therapy in children Risk of Reye’s syndrome; drugs containing salicylates should be avoided in children with influenza
14. Age ≥65 yr Highest case fatality rate but lowest rate of infection

* COPD denotes chronic obstructive pulmonary disease, HIV human immunodeficiency virus, and ICU intensive care unit.
† Morbid obesity is defined as a body-mass index (the weight in kilograms divided by the square of the height in meters)
of 40 or more.

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Preventing Alzheimer’s Part 2: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 2: Cognitive Engagement and Physical Activity

1. Cognitive Engagement.

Cognitive Training – modest benefits on cognitive functioning and a small but statistically significant effect on reducing the extent of age-related decline in cognitive function at a 5-year follow-up. Very small but statistically significant benefit on instrumental activities of daily living—for example, managing finances, managing medications, keeping house, and, in a subgroup analysis, benefit on driving performance in the elderly.

However, these results from a single trial must be replicated to confirm the benefits of cognitive engagement on preventing
cognitive decline over a longer time period and in study subjects with varying levels of baseline cognitive abilities before a firm recommendation can be made.

2. Physical Activity. Increased physical activity, including walking, may help maintain or improve cognitive function in normal adults.

Tai chi PGH Geriatric Clinic

Although encouraging, these data should be viewed as preliminary. Work is ongoing to further investigate the benefits of
physical activity.

Factors associated with decreased risk of Alzheimer’s disease and cognitive decline were cognitive engagement (as indicated by literacy and social enrichment), physical activities in later life, and a diet low in saturated fat and high in vegetable intake. Light to moderate alcohol intake
is reported to be associated with reduced risk of Alzheimer’s disease, but results are inconsistent for cognitive decline

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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How to Make Wise Health Choices

Saturday, March 13th, 2010

Ask yourself these questions before following a health advise from a friend:

1. Is this person giving advise a friend or a salesperson?

2. Will I suffer from harm if I do not follow his/her health advise?

3. What kind of product or procedure is this person recommending?

4. What are the benefits?

a. what are the effects on my body/mind and are these the effects I desire?
b. how soon can the benefits be felt?
c. how long will the effects last?
d. how many in 10 who follow the advise will feel the benefit? how many in 100?
e. how many in 10 people tested represent my age group?


Watch out for testimonials or personal anecdotes! One person in ten may have benefited but you need to ask: “How many took the product? What happened to the nine others who took the product?”

5. Are there side effects or harmful outcomes?

how many in 10 persons will feel worse? how many in 100?

7. Will the cost/money/time I spend be worth the benefit?

8. Do I have enough information to make a wise health choice?

a. ask about scientific randomized trials or systematic reviews on the product or procedure in which all relevant studies are identified and those of adequate quality selected. Results from selected studies are usually pooled (using meta-analysis) to give the
best single estimate of effect.
b. ask for help from a trusted physician but avoid doctor shopping.
c. search trusted internet sites and peer reviewed medical journals.

Do your homework! Click any of these links for medical information on western and complementary medicine Medline Plus , the Cochrane Review of Complementary Medicine and Pubmed and the US Food and Drug Administration

Watch out for quacks and snake-oil salesmen!
You may be dealing with a quack if:
1. The information only includes stories of patients who benefit from the product.
2. You cannot obtain information on the number of people who do not improve after taking the product/procedure.
3. The advertiser is quiet about those who experience harmful side effects.

Reference: Irwig et al. Smart Health Choices. Allen and Unwin 1999.

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Comatose Patient Answers YES or NO thru MRI

Sunday, February 14th, 2010

Authors: Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., et al published by the New England Journal of Medicine February 2010.

In this study, 5 out of the 54 comatose patients were able to modulate their brain activity using functional MRI testing.

One patient was able to answer YES or NO using the technique described.

While in the functional MRI scanner, all patients were asked to perform two imagery tasks. In the motor imagery task, they were instructed to imagine standing still on a tennis court and to swing an arm to “hit the ball” back and forth to an imagined instructor. In the spatial imagery task, participants were instructed to imagine navigating the streets of a familiar city or to imagine walking from room to room in their home and to visualize all that they would “see” if they were there.

This technology may be developed further to help comatose patients communicate their need for pain medication, manipulate their environment, express their feelings and choices, and improve their quality of life.

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Googling Good for Elderly

Thursday, October 16th, 2008

AFP – Thursday, October 16

WASHINGTON (AFP) – - Googling is good for you. No, really.

A team of US researchers has found that searching the Internet stimulates brain activity in the elderly and middle-aged and may help keep their minds sharp.

The study was carried out by scientists at the University of California at Los Angeles (UCLA) and published in the latest edition of the American Journal of Geriatric Psychiatry.

The UCLA scientists found that searching the web triggers key centers in the brain that control decision-making and complex reasoning and may help stimulate and possibly improve brain function.

“The study results are encouraging, that emerging computerized technologies may have physiological effects and potential benefits for middle-aged and older adults,” said Dr. Gary Small, the principal investigator of the study.

“Internet searching engages complicated brain activity, which may help exercise and improve brain function,” said Small, a professor at UCLA’s Semel Institute for Neuroscience and Human Behavior.

The study’s authors noted that their findings are the latest to suggest that complex activity that keeps the mind engaged, such as crossword puzzles, may help keep the brain healthy.

The UCLA researchers said they tested 24 neurologically normal research volunteers between the ages of 55 and 76, half with experience searching the Internet and half with no experience.

The study participants performed Web searches and book-reading tasks while undergoing functional magnetic resonance imaging (fMRI) scans, which record brain-circuitry changes.

They all showed significant brain activity during book reading and web searching, but the Internet-savvy group registered a twofold increase in brain activation during web use when compared with those with little Internet experience.

They said the web-savvy group also registered greater activity in the frontal, temporal and cingulate areas of the brain, which control decision-making and complex reasoning.

“Our most striking finding was that Internet searching appears to engage a greater extent of neural circuitry that is not activated during reading — but only in those with prior Internet experience,” said Small.

“A simple, everyday task like searching the web appears to enhance brain circuitry in older adults, demonstrating that our brains are sensitive and can continue to learn as we grow older,” he added.

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Improving Healthcare of Older Filipinos

Sunday, July 20th, 2008

The Baseline Survey for the National Objectives of Health (BSNOH) research done by the UP Manila NIH and DOH revealed that of the 2,690 older persons surveyed, only 0.3 percent ever had a Geriatric Health Screen. The number of elderly who had screening for geriatric syndromes such as urinary incontinence, memory and affective illnesses was less than 5 percent. The BSNOH Survey also revealed that fewer that 10 percent had their height and weight determined, and only 15 percent had a hearing evaluation. Sixty one percent indicated that lack of money was the major reason for delaying medical consultation, and ninety two percent were without any form of pension.

Philhealth (PHIC) is trying to address this gap by creating responsive benefits that will address the rising prevalence of chronic diseases. These include a hypertension package, out-patient drug benefits, home peritoneal dialysis. PHIC plans to invest in long-term care bundle payments for post hospital care, integration of acute care and some coverage into one delivery system. In the open forum that followed, issues raised included the difficulty in Philhealth reimbursement of all members of the multi-disciplinary healthcare team, and the lack of coverage for nursing home and home care.
Policy Workshop 2007

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Committee on Aging University of the Philippines-National Institutes of Health

Sunday, July 20th, 2008

Brief History of the Committee on Aging and Degenerative Diseases

The University of the Philippines Manila is the country’s leading institution for health research and development. The creation of the National Institutes of Health was approved by the Board of Regents at its 1094th meeting on 26 January 1996, and with it, the Gerontology and Disabilities Programs Cluster, through the Committee on Aging and Degenerative Diseases. The committee is composed of various physicians, academicians, and allied medical professionals within the UP-PGH system.

The COMADD is currently comprised of volunteer consultants from various Clinical and Basic Sciences Departments of the UP-PGH system:
1. Philippine General Hospital – Clinical Departments are involved through their representatives, including: Internal Medicine, Family Medicine, Surgery, Orthopedics, Rehabilitation, Neurology, Psychiatry and Nutrition.
2. UP College of Nursing – membership representation
3. UP Manila College of Arts and Sciences – membership representation thru the Department of Behavioral Sciences (Anthropology)
4. College of Allied Medical Professionals
5. College of Pharmacy
6. College of Dentistry

Mission-Vision: Institute for Aging and Degenerative Diseases
Vision
The Filipino elderly enjoying a healthy body, mind and spirit, being treated with dignity, and valued as a productive member of society, in a dynamic process unique to himself, and beginning a life of unlimited possibilities.
Mission
The institute shall create with the aging Filipino, unlimited possibilities for their value added life through scientific research, training and education, and specialized services.

Clinical Programs
The Committee on Aging and Degenerative Diseases through it multidisciplinary membership is involved in the development and management of various clinical programs within the UP-PGH system, including:
Outpatient geriatric evaluation and wellness clinic
Inpatient geriatric medical consultation
Memory clinic
Stroke unit
Rehabilitation unit (physical, occupational and speech therapy)
Menopause clinic
Specialized services such as Spine/Osteoporosis care; Rheumatology clinic

Policy Development
The Committee and its members have been directly involved as technical advisers in the development of
The Philippine Plan of Action for Older Persons, DSWD
The Health Program for Older Persons, DOH
Baseline Surveys for the National Objectives of Health, DOH, NIH
Periodic Health Examination Guideline, PHILCLEN, DOH
Alzheimer’s Disease Association of the Philippines Recommendations on Diagnosis, Prevention and Management
Education

The Committee has undertaken 9 successful Post-graduate courses in Geriatric Medicine for physicians, nurses, and allied medical professions since 1997

Research

The Committee and its members are involved in funding and development of essential national health researches including those that resulted in the Policy and Recommendation documents above.

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