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Severe Brain Injury: patients at the edge of consciousness

By Barbara Glickstein

September 22, 2016

PhotoCredit: Book Cover Rights Come to Mind Joseph Fins, MD
PhotoCredit: Book Cover
Rights Come to Mind
Joseph Fins, MD

A disturbing insight has motivated much of Dr. Joseph Fins work in understanding the minimally conscious state (MCS).  “Indeed, it keeps me up at night, worrying about a class of people, in the shadows of their own cognition, whom society  has forgotten, abandoned in nursing homes.”

The general public has been reading about severe brain injury cases from Quinlan to Schiavo for many years. HealthCetera host, Barbara Glickstein, talks with Dr. Joseph Fins, physician, researcher and bioethicist about the minimally conscious state (MCS), a diagnostic category that came into the medical literature in 2002. 

What are the neurobiological differences between the vegetative state and the minimally conscious state.

What is consciousness?

What do we know about the best treatment approaches to restore lost functioning in human brains?

What are the health care policy challenges related to the care of patients with severe brain injury, especially in light of health care reform and the Affordable Care Act?

This conversation could have gone on for hours for the host. She left it and wandered to a park bench to contemplate how much more there is to know about life.

Joseph J. Fins, MD, MACP is The E. William Davis, Jr. MD Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He is the founding Chair of the Ethics Committee of New York-Presbyterian Weill Cornell Medicine where he is an Attending Physician and the Director of Medical Ethics.
He is a 2016-2017 Fellow Ambassador of The New York Academy of Medicine.

His most recent book is Rights Come to Mind: Brain Injury, Ethics & The Struggle for Consciousness, published by Cambridge University Press

Tune in Thursday, September 21 at 1 PM to wbai 99.5 FM and streamed live www.wbai.org. You can listen to the podcast now on iTunes

Barbara Glickstein
Barbara is a founder of the Center for Health, Media & Policy, as well as a nurse, media guru & activist in New York City. She is the chairman of the board of Project Kesher and a consultant to many health care organizations and creative projects. Barbara tweets and 'grams @blickstein.

Scary Baby Symptoms That Are Actually Normal

By Kristi Westphaln

September 22, 2016

Mason Richard Sieng PhotoCredit: Auntie Kristi Westphaln
Mason Richard Sieng
PhotoCredit: Auntie Kristi Westphaln

A three week old baby boy with persistent nasal congestion since birth, but otherwise seems fine. A four-day old female who appears to have swollen breasts and she had a small smear of bloody discharge in her diaper. A two-month old baby girl who hasn’t had a bowel movement in six days. A seven-month old male who seems to be turning orange. A one month old female who spit up a small amount of blood after breastfeeding. Normal or not?

Decoding baby sounds and behaviors can be both challenging and scary. Parents want to ensure the health of their baby, but can often get lost in translation. The nonspecific cries, coos, gurgles, and poos don’t clearly communicate how a baby is feeling; this can be especially anxiety provoking when parents are trying to decipher if a particular baby symptom is normal or if it warrants a visit to a pediatric healthcare provider or emergency room.

Babies are not simply “little adults.” The differences in their body systems help to explain many common baby behaviors that are concerning to parents.

In order to further explore the science behind scary baby symptoms and help parents to better understand their babies, Senior Fellow Kristi Westphaln interviews emergency department pediatrician and baby science blogger, Dr. Wendy Hunter. Dr. Hunter debunks common baby myths, brings baby science alive, and decodes scary baby symptoms that are actually normal.

Auntie/Senior Fellow Kristi Westphaln is pleased to announce the birth of her first nephew, Mason Richard Sieng.

Congratulations to Karri, Tom, and all of the amazing parents who continue to work on speaking “baby.”

There are three ways to access the show: 1. Tune in at 1:00pm on Thursday to WBAI radio, 99.5 FM & streamed at www.wbai.org 2. Download the show for free from iTunes 3. listen to the podcast now below.

Kristi Westphaln
Kristi Westphaln, RN MSN PNP-PC is a San Diego based Nurse Practitioner with a passion for pediatric clinical practice, child advocacy, and nursing education. She has over a decade of experience in pediatric emergency care, with a focus on trauma and abuse. She is pursuing a PhD, and as a senior fellow, produces frequent HealthCetera Radio segments.

Healthy Aging: a life-long journey

By Liz Seegert

September 20, 2016

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cc Tiago Costa 

September is Healthy Aging Month, a time for renewed focus on staying healthy, maintaining independence, and keeping a positive outlook on life in our 60s, 70s, 80s and beyond.

 

Perhaps because I write often about aging, it seems a bit silly to designate just one month to this topic. Healthy aging is a year-long, life-long process that should begin well before people begin their retirement.

 

By now, most of us have heard the statistics: the first Baby Boomers are turning 70. About 1 in 7 Americans, (14.5 % or 46.2 million people) were age 65 years or older in the U.S. in 2014 (the latest year for which data is available), By 2060, that number will more than double to about 98 million older persons. People are living longer, with more chronic diseases, putting more cost pressure on our health system, and we don’t have enough qualified geriatric providers to care for them. These are great reasons to focus on healthy, active aging (by the way Active Aging Week is Sept. 25-October 1).

 

Much of healthy aging incorporates common sense approaches that are as logical at age 35 as at age 75. The points I made when I wrote this Consumer Reports article in 2014 are just as valid today: exercise, eat right, get enough sleep, manage any chronic conditions and avoid social isolation. This applies to brain health as well. You need to do the same things for your brain as you do to keep your body in shape. And don’t wait until you’re 50 or 60 to begin.

 

But, health behaviors and clinical care are only half the story of healthy aging, Scientifically, evidence continues to accumulate about the “life course” approach to healthy aging. In a nutshell, this approach links health in later years to physical, cognitive and emotional development in early life, and to lifetime environmental factors and lifestyles. It’s easy to understand, but much harder to do something about it.

 

That’s because social and economic factors — things like education, employment and community safety — make up a whopping 40% of health determinants over the life span. The remaining 10% include factors like housing and air quality, according to Laura Mosqueda, MD, chair, department of family medicine and professor of family medicine and geriatrics at the Keck School of Medicine at USC. To promote health across the life course, she says that we need to do a better job of linking and harmonizing these sectors. That requires both policy changes at the highest levels and more community-based efforts to boost social, educational and economic opportunities.

 

As Steven P. Wallace, PhD, chair of and professor in the department of community health sciences at the UCLA Fielding school of public health, points out, the groups at highest risk of poor outcomes are often the last to benefit from public policies aimed at improving health.

 

Think about health challenges like obesity and heart disease and diabetes; then think about how many fast food restaurants and are located in poor neighborhoods, often these are also communities of color. Think about crime rates, and high school graduation rates, and poverty. Those at the bottom of the socio-economic ladder today are also most likely to be the sickest, most costly patients in their later years.

 

Medicine has gotten very good at extending life span, but there’s a world of difference between growing old and healthy aging. Mounting evidence points to the critical need to lay the groundwork for aging well by eliminating disparities and improving social determinants of health long before anyone is ready to sign up for Medicare.

Liz Seegert
Liz Seegert is a health care journalist and directs the media fellows program at the Center. She serves as topic editor on aging for the Association of Healthcare Journalists, writes for a variety of print and online publications and coproduces HealthCetera Radio on WBAI-FM. She tweets @lseegert.