La demora en el calendario de la Ley de Dependencia anunciada para 2012 en la primera andanada de recortes afectará a unas 30.000 personas, según la tendencia de incorporaciones al sistema de dependientes moderados (grado I, nivel II) registrada en los últimos años. En total, apenas suponen el 2,3% de los beneficiarios y el coste de su atención es prácticamente insignificante respecto al total de las ayudas concedidas, un 0,6%. Las prestaciones para estas personas, las más baratas del sistema, alcanzarían unos 40 millones al año. El Gobierno concede 60 euros mensuales por cada uno de ellos y las comunidades, de forma global, suelen aportar algo más del doble de esa cifra (dependiendo de la prestación concedida).
La entrada al sistema de los dependientes leves (grado I, nivel I) también sufrirá un retraso de un año, hasta enero de 2014. En este caso habría unas 250.000 personas afectadas, pero el ahorro tampoco sería mucho porque las ayudas previstas para ellos tampoco son muy altas.
Tanto los empresarios del sector como el colectivo de afectados creen que el ahorro es insignificante y, sin embargo, la demora traerá consigo desempleo y ahogo económico, así como nuevas carencias para los dependientes. El coordinador de las plataformas para la defensa de la dependencia, Jaume E. García, considera que “el ahorro planteado con este recorte parece irrisorio”. En su opinión, “lo que en realidad se busca cuando se habla de cambiar el modelo de financiación es privatizar la ley, dejarla en manos de las empresas privadas, y eso le saldrá más caro al ciudadano”.
Una de las patronales del sector, la FED, también ha criticado los recortes: “El sector está al borde de la quiebra, ahogado por las deudas de la Administración, con miles de empleos en riesgo, y ahora, encima, plantean una demora. Tenemos centros de día y atención a domicilio, dos de las ayudas previstas para los dependientes moderados, y si los sacan del sistema durante un año será otra pérdida más”, ha criticado el presidente de la FED, Alberto Echevarría. “Lo propuesto es un ataque a las operadoras y a los usuarios, y además el ahorro es ridículo”, sostiene.
Para la Asociación Estatal de Directoras y Gerentes de Servicios Sociales, “el asunto es grave, tanto para los usuarios como para las empresas, que también participan en la marcha de esta ley y en la generación de empleo”. “A pesar de ello, si el recorte se quedara solo en esto, quizá durante este año se podría ir reduciendo la lista de espera. Hay más de 150.000 personas esperando cuya gravedad es mayor que la de los moderados”, explica el presidente de la asociación, José Manuel Ramírez.
Por otro lado, este anuncio de un año en blanco para los dependientes moderados en realidad supone dar cobertura legal a lo que ya se ha venido haciendo, puesto que en 2011 apenas han entrado nuevos beneficiarios al sistema. Solo cuatro comunidades autónomas (País Vasco, Castilla y León, La Rioja o Cantabria) han incorporado al sistema a estos beneficiarios en el ejercicio que acaba de cerrar. “Este recorte, por tanto, penaliza a aquellas regiones que lo estaban haciendo mejor y da la razón a las que se han saltado el calendario durante todo 2011”, critican en la Asociación de Gerentes.
Ni el total de afectados, ni el ahorro por esta vía parecen ser de consideración, por lo que se teme que los recortes vayan a ser más profundos en el futuro, dado que el Ejecutivo ya advirtió hace unos días de que los ajustes anunciados son solo “el inicio del inicio”. Los cambios podrían venir por la vía de la financiación. El PP ya advirtió durante la campaña electoral de que la financiación de la ley no era suficiente ni sostenible y que habría que modificarla. También lo recordaron el pasado viernes. Para el PP, un modelo adecuado es el que esbozaron en su día un grupo de expertos en un estudio encargado por el Parlamento. De corte liberal, este modelo planteaba una financiación basada en seguros privados, subidas del IVA o cotizaciones adicionales, entre otras cosas. Todo ello se planteó ya cuando se negociaba la ley y se descartó antes de ser aprobada, también con los votos del PP.
El programa electoral del PP plantea varias veces la “libre elección” de las ayudas que el ciudadano puede obtener, o, lo que es lo mismo, la Administración concede el dinero y el beneficiario elige el servicio que quiere. El modelo, ya recurrente en educación, es inequívoco: el famoso cheque-servicio. “Esto encierra la creación de un sistema dual, en el que los que más tienen pueden elegir el mejor servicio, cuyo pago complementarán con sus recursos, y los más pobres habrán de conformarse con las ayudas estatales, que acabarán siendo las que pueda proporcionar un sistema parecido a la beneficencia”, lamenta José Manuel Ramírez. “Con este modelo, que nadie se engañe, no es el ciudadano el que elige el geriátrico, sino el geriátrico el que elige a qué ciudadanos acoge, que son los que más dinero tienen, claro”.
La Asociación de Gerentes aboga por cambiar el modelo de financiación, pero no en el sentido que parece haber elegido el PP: “La financiación debe atender al coste del servicio que se presta, no a la gravedad del dependiente, porque no es lo mismo atender a un anciano que no puede valerse por sí mismo en casa que en una residencia. Los servicios profesionalizados son más caros, pero generan empleo”, afirma Ramírez. “Y para cambiar así la financiación no hay por qué tocar la ley, bastaría con modificar un decreto”.
**Publicado en "EL PAIS"
03 January 2012
Demographic and Clinical Factors Appear Associated With Survival in Patients With Parkinson's Disease
Demographics and clinical factors appear to be associated with survival in patients with Parkinson disease (PD), and the presence of dementia is associated with a significant increase in mortality, according to a report in the January issue of Archives of Neurology, one of the JAMA/Archives journals.
Although Parkinson disease is a common neurodegenerative disease among the elderly, there are conflicting data on the survival rates of patients with this disease, according to background information in the article.
Allison W. Willis, M.D., from Washington University School of Medicine, St. Louis, and colleagues conducted a nationwide retrospective cohort study of 138,000 Medicare beneficiaries with incident Parkinson disease who were identified in 2002 and followed up through 2008.
Sex and race "significantly predicted" survival, the researchers note. Patients who were women, Hispanic or Asian had a lower adjusted risk of death than white men. During the six-year study, 64 percent of patients with Parkinson disease died, with black patients having the highest crude death rate (66.4 percent), followed by white patients (64.6 percent), Hispanics (55.4 percent) and Asian patients (50.8 percent).
Dementia was diagnosed in 69.6 percent of the study population by the end of the study period and the highest frequency was found in black patients (78.2 percent) followed by Hispanics (73.1 percent). White and Asian patients with PD had lower, similar rates of dementia at 69 percent and 66.8 percent, respectively.
Patients with Parkinson disease and dementia had a greater likelihood of death than those without dementia. The researchers also note that patients with terminal Parkinson disease were hospitalized frequently for cardiovascular disease and infection but rarely for Parkinson disease. They also suggest Parkinson patients living in urban high industrial metal emission areas had a slightly higher adjusted risk of death, but researchers suggest more work is needed to understand if environmental exposures can influence the course of Parkinson disease or survival.
"We demonstrate that dementia occurs commonly in patients with incident PD 65 years and older; this had the strongest effect on age-adjusted survival among the variables that we studied," the authors conclude. "Our data highlight the need for prevention of or treatment for dementia in patients with PD because of its effect on survival," the authors conclude.
**Story Source:
The above story is reprinted from materials provided by JAMA and Archives Journals.
Although Parkinson disease is a common neurodegenerative disease among the elderly, there are conflicting data on the survival rates of patients with this disease, according to background information in the article.
Allison W. Willis, M.D., from Washington University School of Medicine, St. Louis, and colleagues conducted a nationwide retrospective cohort study of 138,000 Medicare beneficiaries with incident Parkinson disease who were identified in 2002 and followed up through 2008.
Sex and race "significantly predicted" survival, the researchers note. Patients who were women, Hispanic or Asian had a lower adjusted risk of death than white men. During the six-year study, 64 percent of patients with Parkinson disease died, with black patients having the highest crude death rate (66.4 percent), followed by white patients (64.6 percent), Hispanics (55.4 percent) and Asian patients (50.8 percent).
Dementia was diagnosed in 69.6 percent of the study population by the end of the study period and the highest frequency was found in black patients (78.2 percent) followed by Hispanics (73.1 percent). White and Asian patients with PD had lower, similar rates of dementia at 69 percent and 66.8 percent, respectively.
Patients with Parkinson disease and dementia had a greater likelihood of death than those without dementia. The researchers also note that patients with terminal Parkinson disease were hospitalized frequently for cardiovascular disease and infection but rarely for Parkinson disease. They also suggest Parkinson patients living in urban high industrial metal emission areas had a slightly higher adjusted risk of death, but researchers suggest more work is needed to understand if environmental exposures can influence the course of Parkinson disease or survival.
"We demonstrate that dementia occurs commonly in patients with incident PD 65 years and older; this had the strongest effect on age-adjusted survival among the variables that we studied," the authors conclude. "Our data highlight the need for prevention of or treatment for dementia in patients with PD because of its effect on survival," the authors conclude.
**Story Source:
The above story is reprinted from materials provided by JAMA and Archives Journals.
Recibir poca atención en los primeros meses genera efectos negativos en el bebé
Los cuidados y la atención que dispensa una madre al bebé durante sus primeros meses de vida pueden ejercer un importante influjo sobre su desarrollo. A este hecho, ya conocido por los expertos, acaba de añadirse una nueva circunstancia: los recién nacidos que han tenido una relación menos cercana con su madre tienen más probabilidades de ser obesos en su adolescencia.
Así lo acaba de mostrar un nuevo estudio estadístico que ha seguido a más de 900 niños desde sus tres primeros meses de vida -cuando el trato con sus madres fue objeto de repetidos exámenes- hasta los 15 años de edad. Llegados a la adolescencia, los niños que reflejaron una peor relación con sus madres presentaban tasas de obesidad significativamente mayores, aun descontando otros factores como los niveles de educación o ingresos.
Los autores del estudio, encabezados por Sarah Anderson, de la Universidad Estatal de Ohio (EEUU), midieron la calidad de las relaciones entre madre y bebé mediante dos parámetros: la sensibilidad materna y el apego de seguridad. El primero se estableció a partir de la interacción en situaciones de juego que fueron registradas en vídeo. El segundo evaluaba las reacciones de los niños en presencia o en ausencia de sus progenitoras, en condiciones controladas en laboratorio.
Se valoraban positivamente tanto la capacidad de la madre para reconocer el estado de ánimo y las necesidades del hijo como la tendencia de este a explorar sin miedo el entorno, a sabiendas de que estaría bien cuidado y vigilado por su madre. Ambos parámetros se midieron repetidamente a medida que los niños crecían: a los 15, 24 y 36 meses de edad.
Así lo acaba de mostrar un nuevo estudio estadístico que ha seguido a más de 900 niños desde sus tres primeros meses de vida -cuando el trato con sus madres fue objeto de repetidos exámenes- hasta los 15 años de edad. Llegados a la adolescencia, los niños que reflejaron una peor relación con sus madres presentaban tasas de obesidad significativamente mayores, aun descontando otros factores como los niveles de educación o ingresos.
Los autores del estudio, encabezados por Sarah Anderson, de la Universidad Estatal de Ohio (EEUU), midieron la calidad de las relaciones entre madre y bebé mediante dos parámetros: la sensibilidad materna y el apego de seguridad. El primero se estableció a partir de la interacción en situaciones de juego que fueron registradas en vídeo. El segundo evaluaba las reacciones de los niños en presencia o en ausencia de sus progenitoras, en condiciones controladas en laboratorio.
Se valoraban positivamente tanto la capacidad de la madre para reconocer el estado de ánimo y las necesidades del hijo como la tendencia de este a explorar sin miedo el entorno, a sabiendas de que estaría bien cuidado y vigilado por su madre. Ambos parámetros se midieron repetidamente a medida que los niños crecían: a los 15, 24 y 36 meses de edad.
-Niveles preocupantes
Cuando cumplieron los 15 años, se observó que más de un cuarto de los niños con bajas puntuaciones en estas interacciones con la madre presentaba niveles preocupantes de obesidad. En contraste, sólo el 13% de quienes mejor atendidos estaban según las pruebas presentaba este mismo problema.
Los científicos recuerdan que la calidad de las relaciones entre madre y bebé son un factor conocido en la regulación de las emociones, el desarrollo neuronal y la respuesta al estrés durante el crecimiento de los niños. Además, el manejo del estrés está relacionado con anomalías en sistemas fisiológicos de los que depende el balance energético, las cuales pueden derivar en obesidad.
"Se da una superposición en el cerebro entre las áreas que gobiernan el estrés y el balance energético", explica Anderson, según informa Reuters. "Esta respuesta al estrés podría relacionarse con la obesidad a través de la regulación del apetito", añade la investigadora. Los expertos en nutrición recuerdan, no obstante, que los principales factores de obesidad son los ya conocidos: una mala dieta, el sedentarismo o la falta de sueño. Por ello, Anderson reconoce que "culpar a los padres no va a resolver el problema".
Cuando cumplieron los 15 años, se observó que más de un cuarto de los niños con bajas puntuaciones en estas interacciones con la madre presentaba niveles preocupantes de obesidad. En contraste, sólo el 13% de quienes mejor atendidos estaban según las pruebas presentaba este mismo problema.
Los científicos recuerdan que la calidad de las relaciones entre madre y bebé son un factor conocido en la regulación de las emociones, el desarrollo neuronal y la respuesta al estrés durante el crecimiento de los niños. Además, el manejo del estrés está relacionado con anomalías en sistemas fisiológicos de los que depende el balance energético, las cuales pueden derivar en obesidad.
"Se da una superposición en el cerebro entre las áreas que gobiernan el estrés y el balance energético", explica Anderson, según informa Reuters. "Esta respuesta al estrés podría relacionarse con la obesidad a través de la regulación del apetito", añade la investigadora. Los expertos en nutrición recuerdan, no obstante, que los principales factores de obesidad son los ya conocidos: una mala dieta, el sedentarismo o la falta de sueño. Por ello, Anderson reconoce que "culpar a los padres no va a resolver el problema".
**Publicado en "EL MUNDO"
Schizophrenia Diagnosis Associated With Progressive Brain Changes Among Adolescents
Adolescents diagnosed with schizophrenia and other psychoses appear to show greater decreases in gray matter volume and increases in cerebrospinal fluid in the frontal lobe compared to healthy adolescents without a diagnosis of psychosis, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses," the authors write as background information in the study.
Celso Arango, M.D., Ph.D., of the Hospital General Universitario Gregorio Marañón, Madrid, Spain, and colleagues, examined the progression of brain changes in first-episode early-onset psychosis and the relationship to diagnosis and prognosis at two-year follow-up among patients at six child and adolescent psychiatric units in Spain. The authors performed magnetic resonance imaging (MRI) of the brain for 61 patients (25 diagnosed with schizophrenia, 16 with bipolar disorder and 20 with other psychoses) and 70 healthy control participants. MRI scans were conducted at study baseline and after two years of follow-up.
Compared with control patients, those diagnosed with schizophrenia showed greater gray matter volume loss in the frontal lobe during the two-year follow-up. Patients with schizophrenia also showed cerebrospinal fluid increase in the left frontal lobe. Additionally, changes for total brain gray matter and left parietal gray matter were significantly different in patients with schizophrenia compared with patients in the control group.
Among patients with schizophrenia, progressive brain volume changes in certain areas were related to markers of poorer prognosis, such as more weeks of hospitalization during follow-up and less improvement in negative symptoms. Greater left frontal gray matter volume loss was related to more weeks of hospitalization whereas severity of negative symptoms correlated with cerebrospinal fluid increase in patients with schizophrenia.
The authors did not find any significant changes in patients with bipolar disorder compared to control patients, and longitudinal brain changes in the control group were consistent with the expected pattern described for healthy adolescents.
"In conclusion, we found progression of gray matter volume loss after a two-year follow-up in patients who ended up with a diagnosis of schizophrenia but not bipolar disease compared with healthy controls," the authors write. "Some of these pathophysiologic processes seem to be markers of poorer prognosis. To develop therapeutic strategies to counteract these pathologic progressive brain changes, future studies should focus on their neurobiological underpinnings."
*Story Source:
The above story is reprinted from materials provided by JAMA and Archives Journals. e cited above
"Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses," the authors write as background information in the study.
Celso Arango, M.D., Ph.D., of the Hospital General Universitario Gregorio Marañón, Madrid, Spain, and colleagues, examined the progression of brain changes in first-episode early-onset psychosis and the relationship to diagnosis and prognosis at two-year follow-up among patients at six child and adolescent psychiatric units in Spain. The authors performed magnetic resonance imaging (MRI) of the brain for 61 patients (25 diagnosed with schizophrenia, 16 with bipolar disorder and 20 with other psychoses) and 70 healthy control participants. MRI scans were conducted at study baseline and after two years of follow-up.
Compared with control patients, those diagnosed with schizophrenia showed greater gray matter volume loss in the frontal lobe during the two-year follow-up. Patients with schizophrenia also showed cerebrospinal fluid increase in the left frontal lobe. Additionally, changes for total brain gray matter and left parietal gray matter were significantly different in patients with schizophrenia compared with patients in the control group.
Among patients with schizophrenia, progressive brain volume changes in certain areas were related to markers of poorer prognosis, such as more weeks of hospitalization during follow-up and less improvement in negative symptoms. Greater left frontal gray matter volume loss was related to more weeks of hospitalization whereas severity of negative symptoms correlated with cerebrospinal fluid increase in patients with schizophrenia.
The authors did not find any significant changes in patients with bipolar disorder compared to control patients, and longitudinal brain changes in the control group were consistent with the expected pattern described for healthy adolescents.
"In conclusion, we found progression of gray matter volume loss after a two-year follow-up in patients who ended up with a diagnosis of schizophrenia but not bipolar disease compared with healthy controls," the authors write. "Some of these pathophysiologic processes seem to be markers of poorer prognosis. To develop therapeutic strategies to counteract these pathologic progressive brain changes, future studies should focus on their neurobiological underpinnings."
*Story Source:
The above story is reprinted from materials provided by JAMA and Archives Journals. e cited above
Un equipo español apunta que la pérdida de manganeso causa la osteoporosis
Las cuernas de los ciervos son prácticamente irrompibles. Pero en 2005 algo le sucedió a estos animales en España porque sus cornamentas comenzaron a fracturarse de forma alarmante. Para resolver el misterio, un equipo del Instituto de Investigación en Recursos Cinegéticos de la Universidad de Castilla-La Mancha analizó en detalle los cuernos rotos y observó que la causa de la debilidad era una reducción del manganeso, un mineral que obtienen por la alimentación. Este hallazgo les lleva a plantear la hipótesis de que quizás esto ocurra también en los humanos y el origen de la osteoporosis sea un descenso de este mineral y no la pérdida de calcio, como se cree hasta ahora.
"El descenso de manganeso impide que se fije bien el calcio y, por tanto, los huesos se debilitan. Si el cuerpo humano con la edad pierde manganeso (que absorbe sobre todo del intestino delgado y el hígado) tendrá que obtenerlo del esqueleto, pues el mineral es necesario para varios órganos, entre ellos el cerebro. Lo que sucede es que al mismo tiempo que saca el manganeso extrae también calcio, que ya no vuelve a fijar bien y se elimina por la orina", explica a ELMUNDO.es Tomás Landete-Castillejos, coordinador del trabajo que se publica en la revista 'Frontiers of Bioscience'. De esta forma puede ir desarrollándose poco a poco la osteoporosis.
La teoría tiene que ser confirmada ahora con estudios y ensayos médicos, pero sus autores consideran, según han declarado a la Agencia SINC, que "puede dar un giro en una nueva dirección totalmente distinta a las consideradas hasta ahora en osteoporosis, al establecer que la pérdida de calcio puede ser la consecuencia pero no el origen". Si se valida la hipótesis, la terapia para combatir el trastorno también tendrá que cambiar, porque hasta ahora todos los tratamientos se orientan a potenciar los niveles de calcio.
El año en el que las cuernas de los ciervos se empezaron a romper hizo mucho frío. Esto provocó que las plantas redujeran sus concentraciones de manganeso, como respuesta al estrés y, por tanto, los animales obtuvieron menos cantidad de este mineral y sus cuernos pagaron las consecuencias de esta carencia.
"Un estudio en ratas de 1986 ya confirmó que una pérdida de manganeso daba huesos con menos calcio, pero no ha habido muchos más estudios en la misma línea", reconoce Landete-Castillejos.
-Vínculo con el Alzheimer y el Parkinson
La teoría de estos investigadores va aún más allá y sugieren que al desarrollarse la osteoporosis e ir agotándose el manganeso, esencial para el cerebro, podrían aparecer otros trastornos, como el Parkinson o el Alzheimer.
"Hemos tratado de buscar esta relación y vimos en el Hospital de Hellín (Albacete) que de un grupo de pacientes operados por osteoporosis, el 40% desarrolló algún tipo de problema cerebral, como el Alzheimer, mientras que los operados de osteoartritis (que es el desgaste del cartílago, no del hueso) ninguno desarrolló estos trastornos", señala el autor del estudio.
"De momento tenemos una hipótesis que es como un queso gruyère. Tiene una base sólida -la relación entre el manganeso y la debilidad de los huesos- y muchos agujeros que tendrán que ir rellenando los investigadores médicos. Ésa ya no es nuestra labor", argumenta el experto de la Universidad de Castilla-La Mancha.
No obstante, cree que la base es suficientemente sólida para profundizar en el tema e investigar a fondo, por las implicaciones médicas que puede tener.
**Publicado en "EL MUNDO"
"El descenso de manganeso impide que se fije bien el calcio y, por tanto, los huesos se debilitan. Si el cuerpo humano con la edad pierde manganeso (que absorbe sobre todo del intestino delgado y el hígado) tendrá que obtenerlo del esqueleto, pues el mineral es necesario para varios órganos, entre ellos el cerebro. Lo que sucede es que al mismo tiempo que saca el manganeso extrae también calcio, que ya no vuelve a fijar bien y se elimina por la orina", explica a ELMUNDO.es Tomás Landete-Castillejos, coordinador del trabajo que se publica en la revista 'Frontiers of Bioscience'. De esta forma puede ir desarrollándose poco a poco la osteoporosis.
La teoría tiene que ser confirmada ahora con estudios y ensayos médicos, pero sus autores consideran, según han declarado a la Agencia SINC, que "puede dar un giro en una nueva dirección totalmente distinta a las consideradas hasta ahora en osteoporosis, al establecer que la pérdida de calcio puede ser la consecuencia pero no el origen". Si se valida la hipótesis, la terapia para combatir el trastorno también tendrá que cambiar, porque hasta ahora todos los tratamientos se orientan a potenciar los niveles de calcio.
El año en el que las cuernas de los ciervos se empezaron a romper hizo mucho frío. Esto provocó que las plantas redujeran sus concentraciones de manganeso, como respuesta al estrés y, por tanto, los animales obtuvieron menos cantidad de este mineral y sus cuernos pagaron las consecuencias de esta carencia.
"Un estudio en ratas de 1986 ya confirmó que una pérdida de manganeso daba huesos con menos calcio, pero no ha habido muchos más estudios en la misma línea", reconoce Landete-Castillejos.
-Vínculo con el Alzheimer y el Parkinson
La teoría de estos investigadores va aún más allá y sugieren que al desarrollarse la osteoporosis e ir agotándose el manganeso, esencial para el cerebro, podrían aparecer otros trastornos, como el Parkinson o el Alzheimer.
"Hemos tratado de buscar esta relación y vimos en el Hospital de Hellín (Albacete) que de un grupo de pacientes operados por osteoporosis, el 40% desarrolló algún tipo de problema cerebral, como el Alzheimer, mientras que los operados de osteoartritis (que es el desgaste del cartílago, no del hueso) ninguno desarrolló estos trastornos", señala el autor del estudio.
"De momento tenemos una hipótesis que es como un queso gruyère. Tiene una base sólida -la relación entre el manganeso y la debilidad de los huesos- y muchos agujeros que tendrán que ir rellenando los investigadores médicos. Ésa ya no es nuestra labor", argumenta el experto de la Universidad de Castilla-La Mancha.
No obstante, cree que la base es suficientemente sólida para profundizar en el tema e investigar a fondo, por las implicaciones médicas que puede tener.
**Publicado en "EL MUNDO"
Nowhere to Go, Patients Linger in Hospitals, at a High Cost
Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.
Yu Kang Fu was moved to a care center in Brooklyn last spring after spending over four years at New York Downtown Hospital.
As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost.
“Many of those individuals no longer need that care, but because they have no resources and many have no family here, we, unfortunately, are caring for them in a much more expensive setting than necessary based on their clinical need,” said LaRay Brown, a senior vice president for the city’s Health and Hospitals Corporation. Under state law, public hospitals are not allowed to discharge patients to shelters or to the street.
Medicaid often pays for emergency care for illegal immigrants, but not for continuing care, and many hospitals in places with large concentrations of illegal immigrants, like Texas, California and Florida, face the quandary of where to send patients well enough to leave. Officials in New York City say they have many such patients who are draining money from the health system as the cost of keeping people in acute-care hospitals continues to escalate.
But even if Medicaid pays for some care, taxpayer dollars are ultimately being consumed by patients who could be cared for in nursing homes or other health facilities, and even at home if supportive services were available. Care for a patient languishing in a hospital can cost more than $100,000 a year, while care in a nursing home can cost $20,000 or less.
Patients fit to be discharged from hospitals but having no place to go typically remain more than five years, Ms. Brown said. She estimated that there were about 300 patients in such a predicament throughout the city, most in public hospitals or higher-priced skilled public nursing homes, though a smattering were in private hospitals.
One patient, a former hospital technician from Queens, has lived at the city’s Coler-Goldwater Specialty Hospital and Nursing Facility on Roosevelt Island for 13 years because the hospital has no place to send him, Ms. Brown said. The patient, who is in his mid-60s, has been there since an arterial disease cost him part of one leg below the knee and left him in a wheelchair. The city’s public health system declined to provide the names of any long-term patients or make them available for interviews, citing confidentiality laws.
Five years ago, Yu Kang Fu, 58, who lived in Flushing, Queens, and was a cook at a Chinese restaurant in New Jersey, was dropped off by his boss at New York Downtown Hospital, a private institution in Manhattan, complaining of a severe headache. Mr. Yu was admitted to the intensive-care unit with a stroke.
Within days, he was well enough for hospital personnel to begin planning for his release, but as an illegal immigrant (he had overstayed a work visa a decade ago), he was ineligible for health benefits. And no nursing home or rehabilitation center would take him. Neither would his son in China nor the Chinese government, although the hospital volunteered to fly him there at its expense.
Mr. Yu’s protracted hospital stay was first chronicled in an article in The New York Times in 2008 about the treatment of uninsured immigrants.
Mr. Yu remained in the hospital for over four years until he was transferred last spring to the Atlantis Rehabilitation and Residential Health Care Facility, a private center in Fort Greene, Brooklyn, after the federal government certified him as a “permanent resident under color of law,” essentially acknowledging that he could not be returned to China and qualifying him for medical benefits.
“This gentleman cost us millions of dollars,” said Jeffrey Menkes, the president of New York Downtown. “We try to provide physical, occupational therapy, but this is an acute-care hospital. This patient shouldn’t be here.”
Mr. Yu said that the hospital had treated him well, but that he had made enormous progress in regaining his ability to walk through his rehabilitation regimen at Atlantis. He hopes to return to China when he is well enough to be discharged.
“Here, I am very happy,” he said. “This is very nice — No. 1.”
New York Downtown serves a largely immigrant population, and many patients have no insurance or proof that they are in the United States legally, which is necessary for discharge purposes and eventual reimbursements, said Chui Man Lai, assistant vice president of patient services at the hospital.
**Source: "The New York Times"
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Yu Kang Fu was moved to a care center in Brooklyn last spring after spending over four years at New York Downtown Hospital.
As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost.
“Many of those individuals no longer need that care, but because they have no resources and many have no family here, we, unfortunately, are caring for them in a much more expensive setting than necessary based on their clinical need,” said LaRay Brown, a senior vice president for the city’s Health and Hospitals Corporation. Under state law, public hospitals are not allowed to discharge patients to shelters or to the street.
Medicaid often pays for emergency care for illegal immigrants, but not for continuing care, and many hospitals in places with large concentrations of illegal immigrants, like Texas, California and Florida, face the quandary of where to send patients well enough to leave. Officials in New York City say they have many such patients who are draining money from the health system as the cost of keeping people in acute-care hospitals continues to escalate.
But even if Medicaid pays for some care, taxpayer dollars are ultimately being consumed by patients who could be cared for in nursing homes or other health facilities, and even at home if supportive services were available. Care for a patient languishing in a hospital can cost more than $100,000 a year, while care in a nursing home can cost $20,000 or less.
Patients fit to be discharged from hospitals but having no place to go typically remain more than five years, Ms. Brown said. She estimated that there were about 300 patients in such a predicament throughout the city, most in public hospitals or higher-priced skilled public nursing homes, though a smattering were in private hospitals.
One patient, a former hospital technician from Queens, has lived at the city’s Coler-Goldwater Specialty Hospital and Nursing Facility on Roosevelt Island for 13 years because the hospital has no place to send him, Ms. Brown said. The patient, who is in his mid-60s, has been there since an arterial disease cost him part of one leg below the knee and left him in a wheelchair. The city’s public health system declined to provide the names of any long-term patients or make them available for interviews, citing confidentiality laws.
Five years ago, Yu Kang Fu, 58, who lived in Flushing, Queens, and was a cook at a Chinese restaurant in New Jersey, was dropped off by his boss at New York Downtown Hospital, a private institution in Manhattan, complaining of a severe headache. Mr. Yu was admitted to the intensive-care unit with a stroke.
Within days, he was well enough for hospital personnel to begin planning for his release, but as an illegal immigrant (he had overstayed a work visa a decade ago), he was ineligible for health benefits. And no nursing home or rehabilitation center would take him. Neither would his son in China nor the Chinese government, although the hospital volunteered to fly him there at its expense.
Mr. Yu’s protracted hospital stay was first chronicled in an article in The New York Times in 2008 about the treatment of uninsured immigrants.
Mr. Yu remained in the hospital for over four years until he was transferred last spring to the Atlantis Rehabilitation and Residential Health Care Facility, a private center in Fort Greene, Brooklyn, after the federal government certified him as a “permanent resident under color of law,” essentially acknowledging that he could not be returned to China and qualifying him for medical benefits.
“This gentleman cost us millions of dollars,” said Jeffrey Menkes, the president of New York Downtown. “We try to provide physical, occupational therapy, but this is an acute-care hospital. This patient shouldn’t be here.”
Mr. Yu said that the hospital had treated him well, but that he had made enormous progress in regaining his ability to walk through his rehabilitation regimen at Atlantis. He hopes to return to China when he is well enough to be discharged.
“Here, I am very happy,” he said. “This is very nice — No. 1.”
New York Downtown serves a largely immigrant population, and many patients have no insurance or proof that they are in the United States legally, which is necessary for discharge purposes and eventual reimbursements, said Chui Man Lai, assistant vice president of patient services at the hospital.
**Source: "The New York Times"
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Outside temperatures, sun exposure and gender may trigger glaucoma
When it comes to whether or not you will develop exfoliation syndrome (ES) -- an eye condition that is a leading cause of secondary open-angle glaucoma and increased risk of cataract as well as cataract surgery complications -- age, gender and where you live does matter. "Although many studies from around the world have reported on the burden of the disease, some aspects of the basic descriptive epidemiologic features, which may help shed light on the cause, are inconsistent," said Louis Pasquale, M.D., study co-author and director of Massachusetts Eye and Ear's Glaucoma Center of Excellence. "In this study we found that women are more vulnerable to this disease then men, that ES is not a disease of Norwegian descent, and that where you live does matter when it comes to developing the disease."
Researchers from the Mass. Eye and Ear, Harvard Medical School, Boston, Mass., Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, Boston, Mass., Department of Ophthalmology and Visual Sciences, and University of Michigan, Ann Arbor, Mich., set out to find out how demographic and geographic risk factors are associated with ES. Their study, the "Demographic and Geographic Features of Exfoliation Glaucoma in two United States-Based Prospective Cohorts" is published in the January 2012 issue of Ophthalmology.
Researchers used data from 78,955 women in the Nurses' Health Study (NHS) and 41,191 men in the Health Professionals Follow-up Study (HPFS) residing throughout the continental United States who were prospectively followed for 20 years or more and who provided lifetime residence information to examine the descriptive epidemiologic features of ES or exfoliation glaucoma suspect (EGS).
This study confirmed established associations with age and family history and exfoliation glaucoma or exfoliation glaucoma suspect (EG/EGS), as well as provided new data on associations with gender, eye color and ancestry. "Importantly, those with a lifetime residential history of living in the middle tier and south tier of the United States was associated with 47% and 75% reduced risks, respectively, compared with living in the northern tier, and across the life span, residence at age 15 was the most strongly associated with risk, followed by current residence," the authors wrote.
The study showed an increased risk in females, but it was unclear as if gender-specific differences in the eye, such as axial length differences or environmental factors related to lifestyle, account for why women are more at risk for this disease.
Other findings include:
A positive family history of glaucoma was associated with a more than doubling of risk.
Neither Scandinavian decent nor Southern European ancestry was associated with risk when compared with the larger reference group of mainly other white persons in the study, which indicates that there may be strong environmental factors that may increase risk among populations in Scandinavian countries. Overall the study lacked adequate power to determine whether incidence rates differed by minority groups.
Iris (eye) color did not seem to be a risk factor.
"This large prospective cohort study demonstrates that there is a positive association between latitude and ES risk that is robust and not related to demographic features or other systemic covariates," Dr. Pasquale explained. "Another manuscript we published recently suggests that lower ambient temperature interacts with increased solar exposure to increase the risk of ES. This new work demonstrates a relation between increasing latitude and a condition with a strong predisposition to glaucoma. More work is needed to determine how environmental factors conspire to contribute to ES."
According to the National Eye Institute, ES is the major known cause of open-angle glaucoma, and is one of the leading causes of blindness. With the rapid aging of the U.S. population, the number of individuals affected by the disease will increase to more than three million by 2020.
**Source: Massachusetts Eye and Ear Infirmary
Researchers from the Mass. Eye and Ear, Harvard Medical School, Boston, Mass., Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, Boston, Mass., Department of Ophthalmology and Visual Sciences, and University of Michigan, Ann Arbor, Mich., set out to find out how demographic and geographic risk factors are associated with ES. Their study, the "Demographic and Geographic Features of Exfoliation Glaucoma in two United States-Based Prospective Cohorts" is published in the January 2012 issue of Ophthalmology.
Researchers used data from 78,955 women in the Nurses' Health Study (NHS) and 41,191 men in the Health Professionals Follow-up Study (HPFS) residing throughout the continental United States who were prospectively followed for 20 years or more and who provided lifetime residence information to examine the descriptive epidemiologic features of ES or exfoliation glaucoma suspect (EGS).
This study confirmed established associations with age and family history and exfoliation glaucoma or exfoliation glaucoma suspect (EG/EGS), as well as provided new data on associations with gender, eye color and ancestry. "Importantly, those with a lifetime residential history of living in the middle tier and south tier of the United States was associated with 47% and 75% reduced risks, respectively, compared with living in the northern tier, and across the life span, residence at age 15 was the most strongly associated with risk, followed by current residence," the authors wrote.
The study showed an increased risk in females, but it was unclear as if gender-specific differences in the eye, such as axial length differences or environmental factors related to lifestyle, account for why women are more at risk for this disease.
Other findings include:
A positive family history of glaucoma was associated with a more than doubling of risk.
Neither Scandinavian decent nor Southern European ancestry was associated with risk when compared with the larger reference group of mainly other white persons in the study, which indicates that there may be strong environmental factors that may increase risk among populations in Scandinavian countries. Overall the study lacked adequate power to determine whether incidence rates differed by minority groups.
Iris (eye) color did not seem to be a risk factor.
"This large prospective cohort study demonstrates that there is a positive association between latitude and ES risk that is robust and not related to demographic features or other systemic covariates," Dr. Pasquale explained. "Another manuscript we published recently suggests that lower ambient temperature interacts with increased solar exposure to increase the risk of ES. This new work demonstrates a relation between increasing latitude and a condition with a strong predisposition to glaucoma. More work is needed to determine how environmental factors conspire to contribute to ES."
According to the National Eye Institute, ES is the major known cause of open-angle glaucoma, and is one of the leading causes of blindness. With the rapid aging of the U.S. population, the number of individuals affected by the disease will increase to more than three million by 2020.
**Source: Massachusetts Eye and Ear Infirmary
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