Anchor lead:  How good are we at providing healthcare services to older people? Elizabeth Tracey reports

People 80 and older are the fastest growing segment of our population, yet a study by Alicia Arbaje, a geriatrics expert at Johns Hopkins, and colleagues, shows that when it comes to provide healthcare services to older adults, things aren’t looking good.

Arbaje: Nationwide we’re not doing that well relative to providing services for the care of older people, and not only weren’t we not doing that well but we hadn’t been doing that well for some time.   :10

Arbaje says there is a national mismatch between where older adults actually live and where services are provided, as well as an inpatient/outpatient mismatch.

Arbaje:  What we found was that although hospitals were offering some inpatient specialty care services they really weren’t offering a lot of the outpatient or post-acute care specialty services that are really needed by older people when they leave the hospital.     :14

Arbaje says services that are targeted toward helping people age in place will help avoid rehospitalizations, and both patients and caregivers should ask about such services at discharge from the hospital.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can controlling high blood pressure reduce diabetes risk? Elizabeth Tracey reports

Certain types of blood pressure medicines taken at night seem to reduce the risk of developing diabetes, a recent study found.  Gregory Prokopowicz, a high blood pressure expert at Johns Hopkins, describes the intervention.

Prokopowicz: What they did specifically in this study is they randomly had their patients take all of their medications in the morning or at least one of the medications in the evening. And the group that took at least one of their medications in the evening had a significantly lower incidence of new diabetes, which is a fascinating finding. This effect was not true for all blood pressure medications.  It turns out that certain classes produced this effect and other classes did not so I don’t think it would be correct to conclude from this that we should immediately take everything in the evening.   :29

Prokopowicz says this study is yet one more indicating that timing of medications is an important aspect of their therapeutic value, and one that is being actively investigated for many types of medicines.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do blood pressure medicines work better at night? Elizabeth Tracey reports

If you take blood pressure medicines, would you be better off taking them at bedtime rather than in the morning?  A new study concludes that some types taken at night may reduce the risk of diabetes.  Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, explains the rationale.

Prokopowicz: Previously we didn’t pay a whole lot of attention to when our patients took their medications as long as they took them everyday. But increasingly we’re gathering data that suggests that the timing of blood pressure medication is actually important.   This current study is done by a group in Spain that has done a number of studies looking at bedtime dosing of blood pressure medication.  The thinking is that by taking the medication at nighttime you have lower pressures during sleep and lower pressures when you first wake up in the morning, and those blood pressures in the morning are typically some of the highest in the whole 24 hour cycle.  :33

Prokopowicz says it’s too early to make a wholesale shift to pm dosing but it may be something to ask your doctor about.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is obesity really the problem with respect to a common type of brain tumor? Elizabeth Tracey reports

Obese people are at a 50% higher risk to develop meningiomas, a common type of brain tumor, than their thinner counterparts, a recent study concludes.  Jon Weingart, a neurosurgeon at Johns Hopkins, says obesity may be a stand-in for something else.

Weingart: These things are always multifactorial.  Sometimes a higher weight can reflect other health problems, which may play more of a role in the development of certain illnesses or tumors, than just the weight itself.  So it’s a reflection of overall health.  Certainly if you’re physically active and keep your weight down, all health problems seem to be less in that circumstance.  :22

Weingart says achieving a healthy weight is key.

Weingart: It’s just not a number that you’re shooting for.  One wouldn’t want to starve oneself to get to a lower weight, one would be much better off to do regular physical exercise, eat healthy, and then find whatever your natural weight would be.   :14

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is there a relationship between overweight and certain brain tumors? Elizabeth Tracey reports

Over a third of all brain tumors actually develop from the tissue covering of the brain and are called meningiomas.  Now a new study implicates overweight and obesity in the development of these tumors.  Jon Weingart, a neurosurgeon at Johns Hopkins, describes the findings.

Weingart: What they found was that in people who have higher weight, and the way that they divided that up was BMI, if they had a BMI of 25 to 29, that they had a 20% higher risk for meningioma, and those who were obese, which is defined as a BMI of greater than 30, had about a 50% higher risk of meningioma.  They also found that high physical activity levels conferred about a 25% lower risk for meningioma.   :26

Weingart says the study didn’t examine whether so-called ‘fit and fat’ people, those who are overweight but very physically active, also had an increased risk for meningiomas, and says the study doesn’t explain why obesity and these tumors may be related, but says a healthy weight and exercise are always good choices.  At Johns Hopkins, I’m Elizabeth Tracey.

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Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during July 2015.

Program Notes:

0:11 Treatment of advanced prostate cancer
1:12 Improved overall survival
2:11 Real flurry of new agents
2:27 Active surveillance
3:27 More threatened by other health maladies
4:11 Treatment of DCIS
5:11 99% had no additional problems
6:11 A moving target?
6:35 Ongoing debate on aspirin or NSAIDs and colorectal cancer
7:35 Reduced risk by 27%
8:20 Who is best to take it?
9:20 End

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This week’s topics include calcium supplements, chemotherapy during pregnancy, cardiometabolic impact of obesity in children, and a low nicotine cigarette.
Program notes:
0:31 Low nicotine cigarette
1:32 Attempted to prove that nicotine addicts
2:30 FDA should regulate nicotine level
3:26 No significant withdrawal
4:00 Childhood obesity and risk
5:00 Three stratifications based on weight
6:00 Need to intervene early
6:27 Pregnancy and cancer treatment
7:27 Looked at outcomes in 129 children
8:25 Calcium supplements?
9:26 Meta-analysis
10:35 End
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