Life in a Nutshell

lyncrain

I’m on Round 73 with the Mandala. I added orange, pale yellow and red from earlier rounds to bring the colors outward. My inspiration for part 11 was the fiery sunset, the sky glowed intensely Saturday evening with the beginning of our heat wave here in Jersey. Thankfully, today is the last of this heat and air advisory. I don’t mind the heat so much but 95 is more than I enjoy.  I’m crocheting the Mandala directly under a ceiling fan or I’d be roasting. The picture doesn’t do the three colors justice but next to the blue is the orange, then its yellow followed by the cherry red and when I begin Round 74 it will be yellow again then the orange will end this part. The stitches are hdc, dc and dtr which are easy enough to do.

I did sneak in a mental health break and worked on…

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Parenting and Risky Sexual Behavior in Teens

It may sound obvious, but parents matter. Both parents matter.

However, when it comes to risky sexual behavior in teen daughters, the spotlight is on the father.

A new study from the University of Utah relates the “quality of fathering” with teen behavior.

• High quality fathering is associated with setting standards for behavior and consistent monitoring of how the teen spends her time and money. It affects with whom the teen associates and reduces the likelihood of risky behavior.
• Low quality fathering does just the opposite.

The study strongly suggests that having a low quality father out of the home may be better for daughters than keeping the family intact.

The study may in fact underestimate the negative effects of low quality fathering. In some cases, parents or other family members are the source of risky behavior.

According to an The Atlantic article from 2013,

One in three-to-four girls, and one in five-to-seven boys are sexually abused before they turn 18, an overwhelming incidence of which happens within the family. These statistics are well known among industry professionals, who are often quick to add, “and this is a notoriously underreported crime.” (2)

Another review of the research literature suggests a 40% rate of molestation among girls and 30% among boys in the US. (4) In all cases, the figures are subject to some disagreement about definitions.

For those of us who know victims  of family abuse, this incidence is quite plausible. In my own conversations, I’ve been flabbergasted by the people who reveal histories of abuse — people I would never have suspected. It comes out in conversations after a certain level of trust is in place. And it surfaces too many times with too many people.

Ultimately, the statistics we have are unreliable, because too many people won’t talk about this. The statistics are incomplete, as they tend to focus on father-daughter abuse and not on mother-son or sibling relations (or on abuse by authority figures other than priests).

Traditional studies have focused on “broken” families and the importance of having two parents in the home. The truth seems to be a bit more complex. There are many cases in which the “intact” family is broken and dysfunctional, and breakup represents improvement.

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Sources:

1. Danielle J. DelPriore, Gabriel L. Schlomer, Bruce J. Ellis. Impact of Fathers on Parental Monitoring of Daughters and Their Affiliation With Sexually Promiscuous Peers: A Genetically and Environmentally Controlled Sibling Study. Developmental Psychology, 2017; DOI: 10.1037/dev0000327
2. Mia Fontaine, “America Has an Incest Problem,” The Atlantic, 24 January 2013. https://www.theatlantic.com/national/archive/2013/01/america-has-an-incest-problem/272459/
3. Margaret Ballantine and Lynne Soine, “Sibling Sexual Abuse — Uncovering the Secret,” Social Work Today Vol. 12 No. 6 P. 18. http://www.socialworktoday.com/archive/111312p18.shtml
4. Rational Skepticism.org. “Just how common is incest?” 11 July 2010. http://www.rationalskepticism.org/social-sciences/just-how-common-is-incest-t9841.html

More Scandals in For-Profit Medicine

Universal Health Services is a holding company that provides behavioral health services. Its Oklahoma subsidiary, Shadow Mountain Behavioral Health System, is now being penalized by loss of Medicaid and Medicare contracts. The current accusations against the parent and subsidiary include:

• Accounting irregularities at the parent company
• At the subsidiary, inflating reimbursements by
  • Holding patients longer than necessary and
  • Holding patients against their will.

The accounting investigation has been expanded to include the FBI and Department of Defense. The coverage notes that Shadow Mountain has the opportunity to correct the defects to satisfy Medicare, but that the withdrawal of Medicaid contracts cannot be appealed or reversed.

As I noted in an earlier post, both my own prior research for commercial clients and some third party studies suggest that private non-profit medical facilities provide superior care. They tend to be leaders in investment in new technology and research, while public facilities have budgets that are constrained by politics, and for-profit facilities are constrained by the need to maximize profits.

Where you go for care effects the quality of care you get.

Unfortunately, as should be well known by now, medical misdeeds aren’t limited to for profit hospitals. Five NJ doctors have been charged this week related to an illegal kickback scheme. They were receiving payments for steering patients to one specific medical imaging center. (2)

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Sources:

1. Ayla Ellison, “UHS hospital in Oklahoma faces Medicare termination on heels of Buzzfeed News investigation,” Becker’s Hospital CFO Report, 12 June 2017. http://www.beckershospitalreview.com/finance/uhs-hospital-in-oklahoma-faces-medicare-termination-on-heels-of-buzzfeed-news-investigation.html
2. Tom Davis, “NJ Doctors Busted In Statewide Bribery Kickback Scheme,” The Patch, 13 June 2017. https://patch.com/new-jersey/princeton/s/g5g99/n-j-doctors-busted-in-statewide-bribery-kickback-scheme?utm_source=alert-breakingnews&utm_medium=email&utm_term=weather&utm_campaign=alert

Insight from Theodore Roosevelt

“People don’t care how much you know until they know how much you care.”

 

 

Source: Quote by Theodore Roosevelt

Brain Tumor Options

Brain tumors are pernicious. How do you know when a headache is just due to stress or a sign of something more serious? Right now, 1 in every 161 cancer diagnoses involves a brain tumor, but these tumors can be a natural follow-on to other cancers. Glioblastoma is the most deadly form of brain tumor, killing 83% of the youngest patients it infects within five years.

Medicine is changing rapidly, and that brings both benefits and problems. Obviously, new treatment methods can improve outcomes for patients. However, it is a challenge to keep up with developments and know what’s best. It’s a challenge for doctors, and worse for patients.

The traditional approach has involved surgery, chemotherapy and radiation therapy to remove and kill cancer cells.  These approaches have met with varied success. The five year survival rates for various brain tumors are shown in the chart below:

Five-year survival rates, selected brain tumors (2)

Five-year survival rates	Age of patient
Tumor type	20-44	45-54	55-64
Low-grade (diffuse) astrocytoma	65%	43%	21%
Anaplastic astrocytoma	49%	29%	10%
Glioblastoma	17%	6%	4%
Oligodendroglioma	85%	79%	64%
Anaplastic oligodendroglioma	67%	55%	38%

New research is finding that radiation treatment can affect brain function, possibly producing the cognitive impairment seen in many patients after treatment. (3,4)

There are a number of options, but your local doctor may or may not know what they are, or have access to them.

The NIH National Cancer Institute highlights three categories of research under way:

• Therapeutic vaccines
• CAR T-cell therapy (taking patient cells, re-engineering them, and reinjecting them in the patient)
• Checkpoint inhibitors that allow the patient’s immune system to attack tumor cells (5)

These approaches fall under the broad label of immunotherapy.

Where are clinical trials happening?

• Duke is a leader in brain tumor research and has a number of clinical trials underway testing treatments for brain tumors involving immunotherapy and the manipulation of T and B cells. (6)
• Other centers with clinical trials include:
  • The University of Florida
  • The University of Texas Southwestern Medical Center, also featuring clinical trials with imunotherapy
  • The Dana Farber Cancer Center, Boston, Massachusetts
  • Cedars-Sinai Medical Center, Los Angeles, California
  • University of California, Irvine, California
  • Mayo Clinic, Rochester, Minnesota
  • University of Alabama
  • MD Anderson Cancer Center, Univ. of Texas, Houston
  • Provident Cancer Center, Portland, Oregon
  • City of Hope Medical Center, Duarte, California
  • NIH Clinical Center, Bethesda, Maryland

The bulk of innovative work is happening on the east and west coast, leaving people in the North Central, Midwest, Plains and much of the South and Southwest without ready access to advanced medical treatment. Even with access, doctors in these areas will have little experience dealing with side effects, and that could be fatal for a patient.

This explains in part why, as discussed in prior blog posts, where you live in the US effects your life expectancy.

How prepared are you to relocate for three or six months for treatment?

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Sources:

1. American Brain Tumor Association. http://www.abta.org
2. American Cancer Society, “Survival Rates for Selected Adult Brain and Spinal Cord Tumors.” https://www.cancer.org/cancer/brain-spinal-cord-tumors-adults/detection-diagnosis-staging/survival-rates.html
3. University of California – San Diego. “Radiation therapy vital to treating brain tumors, but it exacts a toll: Researchers say treatment alters neural networks and may cause long-term cognitive impairment.” ScienceDaily. ScienceDaily, 9 June 2017. <www.sciencedaily.com/releases/2017/06/170609133810.htm>.
4. Carrie R McDonald et al. Altered network topology in patients with primary brain tumors after fractionated radiotherapy. Brain Connectivity, June 2017 DOI: 10.1059/brain.2017.0494
5. Duke Neurosurgery, “Research Initiatives.” https://neurosurgery.duke.edu/research/basic-research/duke-brain-tumor-immunotherapy-program/research-initiatives.
6. UT Southwestern Medical Center. “New approach to destroying deadly brain tumors.” ScienceDaily. ScienceDaily, 13 June 2017. <www.sciencedaily.com/releases/2017/06/170613102056.htm>.
7. Musella Foundation, “Clinical Trials and Noteworthy Treatments for Brain Tumors,” last updated 5 February 2017. https://www.virtualtrials.com/Immunotherapy_treatments.cfm

Shrouded

Words with profound emotion.

lyncrain

She gently caressed the withered rose in the vase sitting on the drop leaf table with the crocheted doily Grandma made. She sighed as the last petal slid to the table now shrouded in dust. On the other side of the room stands a silent Grandfather clock, the brass arms twined in cobwebs. She doesn’t miss the clanging of the clock; it used to wake her up when she slept over as a child. She left Grandpa’s old shirt with the tattered collar and worn sleeves draped on the kitchen chair just like it was every night after he came home from work. On the floor, two small dishes sit yellowed with age where Rhubarb used to feast at night now surrounded with mouse turds.  She misses Rhubarb, he kept the mice at bay in this beautiful old house, but she’s the only one left now, and she can’t bring…

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Impact of Weight on Friendships Between Children

In a previous post, we discussed the link between being overweight as a child and being bullied. A new Dutch study adds to this, by documenting how excess weight affects friendships between children.

Overweight children face a form of social isolation.

• Overweight children tend to think they have friends, when those people may not like them.
• Overweight children tend to be excluded from friendships more often than are children of normal weight.
• Overweight children see themselves as having more enemies than do children of normal weight.

The previous research suggested that these emotional effects may linger into  high school and young adulthood and be linked to depression and to self-harmful behaviors such as alcohol and drug abuse.

The growing literature on weight and the interactions between children strongly suggests the need to channel children at an early age into some form of physical activity, preferably team-based. If over-weight and isolation are harmful, team sports led by an appropriately trained coach would appear to be an antidote.

The good news is that managing weight in children who are heavy may be easier than expected. Another study suggests that use of a powdered prebiotic fiber could reduce weight gain in children by improving healthy gut bacteria and digestion. The fiber used in the study is oligofructose-enriched inulin.

“Powdered fiber, mixed in a water bottle, taken once a day is all we asked the children to change, and we got, what we consider, some pretty exciting results — it has been fantastic,” added Raylene A. Reimer, PhD, RD, professor and researcher in the Faculty of Kinesiology at University of Calgary, who led the study. (3)

Using an experimental design with a test and control group, the prebiotic fiber (taken mixed with water) appeared to cut weight gain among growing children by almost 2/3 (6.6 lb  gain among those using the prebiotic v. 17.6 in the control group).

Note: a prebiotic facilitates growth of good bacteria in the gut. A probiotic introduces new bacteria. They’re quite different and should not be confused.

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Sources:

1. Kayla de la Haye, Jan Kornelis Dijkstra, Miranda J. Lubbers, Loes van Rijsewijk, Ronald Stolk. The dual role of friendship and antipathy relations in the marginalization of overweight children in their peer networks: The TRAILS Study. PLOS ONE, 2017; 12 (6): e0178130 DOI: 10.1371/journal.pone.0178130
2. Crain, “Childhood Weight, Adult Depression and . . . Bullying? Time to Connect the Dots?” May 2017.
3. Alissa C. Nicolucci, Megan P. Hume, Inés Martínez, Shyamchand Mayengbam, Jens Walter, Raylene A. Reimer. Prebiotic Reduces Body Fat and Alters Intestinal Microbiota in Children With Overweight or Obesity. Gastroenterology, 2017; DOI: 10.1053/j.gastro.2017.05.055