Trump Passed a Cognitive Exam. Exactly What Does That Actually Mean?


During President Trump’s health check now, he was handed a cognitive make sure passed having a perfect score.

“I’ve found pointless whatsoever to consider obama has any issues whatsoever together with his thoughts,” stated the president’s physician, Dr. Ronny L. Jackson, a rear admiral within the Navy.

The exam, known as the Montreal Cognitive Assessment, or Moca, is really a 10-minute screening exam designed to highlight potential problems with thinking and memory. But it’s in no way definitive, nor even diagnostic, experts stated.

Screening tests such as these cannot eliminate declines in reasoning or memory, or problems with planning or judgment. The exam is simply too blunt a musical instrument, as well as for many high-functioning people, too easy.

“You wouldn’t create a diagnosis either in direction with different screening exam,” stated Dr. Ronald Petersen, director from the Alzheimer’s Research Center in the Mayo Clinic in Rochester, Minn. (He emphasized he was speaking generally, not particularly about President Trump’s situation.)

Here are a few solutions to questions regarding cognitive exams the things they measure, and just how specialists decide whether someone is really impaired.

What’s the Moca?

This screening test was created two decades ago just as one substitute for an additional test, the Small-Mental Condition Examination, this was broadly used because the 1970s to consider outright dementia. The Moca can be used in most 31 from the National Institute on Aging’s Alzheimer Disease Centers.

While there are lots of such screening tests, the Moca is gaining acceptance because it’s kind of harder compared to Small-Mental and may get issues that exist in the first stage of dementia, mild cognitive impairment — a kind of everyday forgetfulness.

About 1 in 5 quickly age 65 have M.C.I., and roughly another will build up Alzheimer’s within 5 years.

Exactly what does the exam ask?

Moca has 30 questions designed to briefly assess memory, attention and concentration, control and self-regulation, along with other mental skills.

To check memory, for instance, the examiner reads…

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Action Planning: Breaking Lower Health Goals into Manageable Steps


By Cindy Brach, MPP, Senior Healthcare Investigator, Agency for Healthcare Research and Quality

Have someone you never know he must slim down, but the quantity of weight is really daunting he doesn’t understand how to get began? Or perhaps a patient rich in cholesterol who’s getting trouble making changes in lifestyle that will reduce her chance of a cardiovascular event? If that’s the case, you might like to begin to make action plans together with your patients.

What Exactly Are Action Plans?

Sample plan of action template in the UCSF Center for Excellence in Primary Care

Action plans, produced jointly by clinicians and patients, show small , realistic steps the individual is intending to decide to try address any adverse health goal. Additionally to creating changes to diets and exercise routines, action plans can be used as a multitude of goals—including giving up smoking, reducing stress, and improving sleep habits. Studies have proven that the majority of patients who made an plan of action inside a primary care site reported making an connected behavior change.

Where to start Action Planning

You might like to begin by performing any adverse health assessment of the patients. Any adverse health assessment is really a systematic collection and analysis of health-related info on someone. It can benefit identify and support advantageous health behaviors and try to direct alterations in potentially dangerous health behaviors. Health Assessments in Primary Care, helpful information in the Agency for Healthcare Research and Quality (AHRQ), will help you initiate health assessments to your practice.

Next, it’s important to decide who’s going to interact patients for action planning. It may be the main care clinician, or it may be clinical support. Alternatively, you might wish to have clinicians introduce the experience planning process and also have clinical support conduct follow-up. To understand more about optimizing team functioning and handoffs, see TeamSTEPPS for Office-Based Care.

Let Patients Call the Shots

It’s crucial that patients choose both goal and also the steps they intend to take. It may be tempting to create suggestions, but action plans have to originate from patients. For instance, it may seem the very best priority change gets more exercise, however, if the patient is interested in modifying her diet, that’s the goal. People, however, could be excessively ambitious. A part of your work, therefore, is to aid in selecting realistic goals and steps. Try getting a menu of options (e.g., lists of exercises, foods to chop lower on) that may give patients suggestions for specific steps they are able to take. is loaded with lots of recommendations for making healthy changes.

Action Planning Takes Practice

Although it’s an easy process after you have it beneath your belt, action planning has numerous moving parts. You have to:

  • See whether your patient is able to create a change.
  • Guide the option of goal and steps if you don’t take over.
  • Assess your patient’s confidence in finishing the experience steps which help your patient revise the program if his confidence is not enought.
  • Identify and address barriers that may keep the patient from finishing the plan of action.
  • Follow-up following the visit and customize the plan when needed.

There are several sources to help you use action intending to support behavior change. Take a look at Make Action Plans, something in the AHRQ Health Literacy Universal Safeguards Toolkit – for information on applying the procedure. Try watching videos of action planning, similar to this Action Plans video in the College of California San Francisco’s Center for Excellence in Primary Care. Then try action planning with one or two patients. It might take you a while before you decide to master the skill of letting the individual move forward and health literacy techniques for example confirming understanding while using educate-back method. But when you’re proficient, you can co-create an plan of action within minutes.

By transforming behavior change discussions together with your patients, action planning presents an chance to attain concrete progress on health promotion goals.


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Obscure Vomiting Illness Associated with Lengthy-Term Pot Use

For 17 years, Chalfonte LeNee Queen endured periodic instances of violent retching and abdominal discomfort that will knock her off her ft for several days, sometimes departing her writhing on the ground in discomfort.

“I’ve screamed out for dying,” stated Queen, 48, who resides in North Park. “I’ve cried out in my mother who’s been dead for 25 years, psychologically not realizing she can’t arrived at me.”

Queen lost a modeling job after being mistaken to have an alcoholic. She tallied up thousands of dollars in hospital bills, and her nausea interrupted her sex existence. Toward the finish of her illness, Queen, who stands 5-feet-9, considered in in a frail 109 pounds.

Through the nearly 2 decades of discomfort, vomiting and mental fog, she visited a healthcare facility around three occasions annually, but doctors never reached the foot of that which was ailing her. By 2016, she thought she was dying, that they “must have some kind of cancer or something like that they’re not able to identify,” Queen stated.

But she didn’t have cancer. She’d an obscure syndrome called cannabinoid hyperemesis syndrome, an ailment only lately acknowledged through the medical community. It impacts a little population—namely, a subset of marijuana users who smoke multiple occasions each day for several weeks, years or perhaps decades.

There isn’t any hard data around the prevalence from the illness. However in California and Colorado, that have loosened marijuana laws and regulations recently, emergency physicians say they’re seeing it more frequently. One study in Colorado suggests there might be a hyperlink.

Dr. Aimee Moulin, an urgent situation room physician at UC-Davis Clinic in Sacramento, stated she’s seen a boost in the amount of cases since California voters legalized recreational marijuana last November. She expects to determine another increase after commercial sales are allowed beginning this month.

Doctors say it’s hard to treat the problem. There’s no cure apart from to stop using marijuana, and lots of people are skeptical that cannabis is which makes them sick, so that they carry on using it as well as their vomiting episodes continue.

Doctors can perform little to alleviate the signs and symptoms, since traditional anti-nausea medications frequently do not work and you will find no pills to avoid the start of a chapter. Patients may require intravenous hydration and hospital stays before the signs and symptoms subside.

“That’s really frustrating being an emergency physician,” stated Moulin. “I really enjoy making people feel good.”

Diagnosing the syndrome may also be frustrating—and costly. There’s no bloodstream test to link the stomach condition with marijuana use, so physicians frequently order pricey CT scans and diagnostic tests to eliminate other medical conditions.

Cannabinoid hyperemesis syndrome was first documented in Australia in 2004. Physicians have in the past misdiagnosed it as being the greater generic cyclic vomiting syndrome, without any identifiable cause or, as with Queen’s situation, acute intermittent porphyria (AIP).

“Five years back, this wasn’t something which [doctors] had on their own radar,” stated Dr. Kennon Heard, an urgent situation physician in the College of Colorado in Aurora, who co-authored the Colorado study showing a potential tie between your liberalization of marijuana along with a rush of the vomiting illness. “We’re a minimum of making diagnosing more now.”

One guaranteed manifestation of the condition happens when patients find relief in hot showers and baths. Queen stated she’d vomit frequently unless of course she is at a warm shower—so she’d remain in there for hrs. Toxicologists repeat the heat may draw attention away from the mind from discomfort receptors within the abdomen but, such as the syndrome itself, that phenomenon is not well understood.

The precise reason for the problem continues to be a mysterious. Toxicologists repeat the chemical substances in marijuana may mess up the standard purpose of the body’s cannabinoid receptors, that really help regulate the central nervous system.

Many people might be genetically predisposed towards the syndrome, or marijuana’s potency or chemical makeup might have altered with time, stated Dr. Craig Smollin, medical director from the Bay Area division from the California Poison Control System, who also works being an emergency physician at Zuckerberg Bay Area General Hospital.

The vomiting connect to cannabis is counterproductive to a lot of, due to its broadly known status being an anti-nausea fix for cancer patients.

“A large amount of occasions, people just don’t believe you,” stated Dr. John Coburn, an urgent situation physician at Kaiser Permanente in south Sacramento. Despite being told that quitting might help, some patients will go to the hospital multiple occasions before they quit smoking marijuana, Coburn stated. “I can’t really let you know why. I am talking about, so why do people ride motorcycles without helmets on?” (Kaiser Health News isn’t associated with Kaiser Permanente.)

Cameron Nicole Beard, 19, of East Moline, Ill., stated she battled to think her doctors concerning the outcomes of pot and severe vomiting.

“Who really wants to find out you cannot smoke marijuana, whenever you think marijuana might help?” stated Beard, while dealing with a marijuana-related vomiting episode in a College of Iowa hospital in Iowa City, Iowa, in October. She stated she’d lost 20 pounds in ten days.

Although there’s still no magic remedy for a patient’s marijuana-related hyperemesis, Moulin along with other doctors say they’re improving at treating the signs and symptoms, using old antipsychotic medications and cream for muscle aches.

Dr. Heard stated the instances in Colorado appear to possess leveled off. But without hard data, and since the general figures are small, it’s difficult to say without a doubt. Heard stated he doesn’t believe installments of the pot syndrome elevated after recreational use was legalized this year, because chronic users most likely already had medicinal marijuana cards.

Chalfonte LeNee Queen continues to be battling to totally quit marijuana, but her signs and symptoms are lower to some dull stomachache. She smokes a few occasions each day, in contrast to her near-constant use previously. She stated it’s the only real factor that actually works on her anxiety and depression.

Queen has returned to some healthy weight and hasn’t visited a healthcare facility each year. She stated she wouldn’t wish to discourage anybody from smoking weed she just wants individuals to know heavy use may bring them some serious misery.

“Now, basically become ill, as sad as I’ll be so that as upset and disappointed with myself when i could be, a minimum of it’s a freaking choice,” she stated.

This story was created by Kaiser Health News, which publishes California Healthline, something of the California Healthcare Foundation.

This story was initially printed by Kaiser Health News on The month of january 2, 2017. Browse the original story here.

Kaiser Health News, a nonprofit health newsroom whose tales come in news outlets nationwide, is definitely an editorially independent area of the Kaiser Family Foundation.

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Matter: Fiber Will work for You. Now Scientists May Have Heard Why.


Eating too much fiber-wealthy foods, for example vegetables and fruit, reduces the chance of developing diabetes, cardiovascular disease and joint disease. Indeed, evidence for fiber’s benefits extends beyond any particular condition: Individuals who eat much more of it really have lower likelihood of dying.

That is why experts will always be saying just how soluble fiber is perfect for us. But as the benefits are obvious, it isn’t so obvious why fiber is really great. “It’s a simple question to inquire about along with a hard someone to really answer,” stated Fredrik Bäckhed, a biologist in the College of Gothenburg in Norway.

He along with other scientists are running experiments which are yielding some important new clues about fiber’s role in human health. Their research signifies that fiber doesn’t deliver a lot of its benefits straight to our physiques.

Rather, the fiber we eat feeds vast amounts of bacteria within our guts. Keeping them happy means our intestines and natural defenses stay in good condition.

To be able to digest food, we have to bathe it in enzymes that break lower its molecules. Individuals molecular fragments then go through the gut wall and therefore are absorbed within our intestines.

But our physiques create a limited selection of enzymes, to ensure that we can’t break lower most of the tough compounds in plants. The word “dietary fiber” describes individuals indigestible molecules.

But they’re indigestible simply to us. The gut is coated having a layer of mucus, atop which sits carpeting of countless types of bacteria, area of the human microbiome. A few of these microbes carry the enzymes required to break lower several types of soluble fiber.

Ale these bacteria to outlive on fiber we can’t digest ourselves has brought most professionals to question when the microbes are in some way active in the together with your fruits-and-vegetables diet. Two detailed studies printed lately within the journal Cell Host and Microbe provide compelling evidence that the…

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One Man’s Stand Against Junk Food as Diabetes Climbs Across India

India is “sitting on a volcano” of diabetes. A father’s effort to ban junk food sales in and near schools aims to change what children eat.

Rahul Verma distributing the Indian dish khichdi, a mixture of rice, lentils and vegetables, to patients outside a hospital in New Dehli. Mr. Verma has taken a stand against junk food in India, where people are more likely to develop diabetes from weight gain than people in other regions.CreditAtul Loke for The New York Times. Dec. 26, 2017
NEW DELHI — Rahul Verma’s son was born gravely ill with digestive problems, but over years of visits to the boy’s endocrinologist, Mr. Verma saw the doctor grow increasingly alarmed about a different problem, one threatening healthy children. Junk food, the doctor warned, was especially dangerous to Indians, who are far more prone to diabetes than people from other parts of the world.
One day in the doctor’s waiting room, Mr. Verma noticed a girl who had gotten fat by compulsively eating potato chips. He decided he had to do something.
“On one side you have children like my son, who are born with problems,” said Mr. Verma, “and on the other side you have children who are healthy and everything is fine and you are damaging them giving them unhealthy food.”
Mr. Verma, who had no legal training, sat late into the nights with his wife, Tullika, drafting a petition in their tiny apartment, which was bedecked with fairy lights and pictures of the god Ganesh, who is believed to overcome all obstacles. He filed the public interest lawsuit in the Delhi High Court in 2010, seeking a ban on the sale of junk food and soft drinks in and around schools across India. Mr. Verma with his son, Uday, who needed many surgeries to survive congenital birth defects. Uday’s struggles inspired Mr. Verma to help children born healthy combat the risks associated with a diet of junk…

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Personal Health: When Cancer Strikes Two times


Cancer can, and often does, strike two times. It famously became of Justice Ruth Bader Ginsburg from the Top Court, who had been effectively treated for cancer of the colon in 1999 as well as pancreatic cancer this year. Otherwise for that regular checkups she went through after cancer of the colon, it is extremely likely that her pancreatic cancer, that is rarely found early, will not have been detected while still curable.

Based on age, as much as 25 percent of cancer survivors is probably, eventually, to build up another new cancer that’s neither a recurrence nor spread from the original. Yet many survivors fail to benefit from well-established methods to have a future cancer away or do something to identify a brand new cancer when it’s still early on for cure.

The problem is hardly trivial. The populace in danger is big and growing. Because of better cancer screening and treatment and continuous aging of people, the amount of cancer survivors within the U . s . States has elevated fourfold within the last 3 decades, reaching 15.5 million by 2016, and it is likely to climb to 26.a million by 2040.

Although it may appear counterproductive, patients effectively treated for early breast or cancer of the lung will probably live more than individuals who didn’t have cancer, providing them with more years to create a second cancer.

Inside a recent report in JAMA Oncology by researchers in the College of Texas Southwestern Clinic in Dallas, roughly a quarter of Americans 65 and older and 11 percent of more youthful adults who have been formerly treated for cancer were subsequently found to possess a number of new cancers inside a different site. With respect to the kind of original cancer and also the person’s age, the chance of creating a second unrelated cancer ranged from three.five percent to 36.9 %. The research covered 765,843 new cancer diagnoses made between 2009…

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In Asia’s Fattest Country, Nutritionists Take Money From Food Giants

When the food industry funds nutritionists, critics say it subverts science to preserve its market.

Children buying snacks and soft drinks at a stand just outside their school in Kota Bharu, Malaysia. Malaysia has become the fattest country in Asia.CreditRahman Roslan for The New York Times Dec. 23, 2017
KUALA LUMPUR, Malaysia — Over the past three decades this increasingly prosperous nation has become the fattest country in Asia, with nearly half the adult population now overweight or obese. Several years ago, Dr. Tee E Siong, Malaysia’s leading nutrition expert, decided to act, organizing a far-reaching study of local diets and lifestyle habits.
The research, conducted by scientists from the Nutrition Society of Malaysia, which Dr. Tee heads, has produced several articles for peer-reviewed academic journals. But scientists weren’t the only ones vetting the material. One of the reviewers was Nestlé, the world’s largest food company, which financed the research.
Among the published articles was one that concluded that children who drank malted breakfast beverages — a category dominated in Malaysia by Milo, a sugary powder drink made by Nestlé — were more likely to be physically active and spend less time in front of a computer or television.
The research exemplified a practice that began in the West and has moved, along with rising obesity rates, to developing countries: deep financial partnerships between the world’s largest food companies and nutrition scientists, policymakers and academic societies. Dr. Tee E Siong, in front of a restaurant menu at a mall outside Kuala Lumpur, heads the Nutrition Society of Malaysia, which is financed in large part by some of the world’s largest food companies.CreditRahman Roslan for The New York Times
As they seek to expand their markets, big food companies are spending significant funds in developing countries, from India to Cameroon, in support of local nutrition scientists. The industry funds research projects, pays scholars consulting fees, and sponsors most major nutrition conferences at a time when…

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Phys Erectile dysfunction: Why Sitting Might Be Harmful to Your Heart


Sitting silently for longer amounts of time might be hurting your heart, based on an unexpected new study. It finds the more and more people sit, the higher the likelihood that they’ll show indications of injuries for their heart muscles.

Everyone has heard right now that sitting for hrs on finish is unhealthy, even when we from time to time exercise. Individuals who sit in excess of about nine or 10 hrs every day — an organization which includes a lot of us who operate in offices — are vulnerable to developing diabetes, cardiovascular disease along with other problems, and many of these risks remain relatively high, even when we exercise.

Excessive sitting has been connected with heart failure, an ailment where the heart becomes progressively less strong and not able to function enough bloodstream to help keep all of those other body oxygenated and well. But exactly how sitting, which appears to demand so very little in the heart, might be associated with heart failure, an ailment where the heart cannot respond adequately to effort, continues to be unclear.

So lately several cardiologists from around the globe started to question about troponins.

Troponins are proteins created by cardiac-muscle tissues when they’re hurt or dying. Cardiac arrest releases an abrupt tsunami of troponins in to the blood stream.

But slightly elevated troponin levels, less than individuals involved with cardiac arrest, are worrisome when they persist, most cardiologists believe. Chronically high troponin levels indicate that something goes wrong within the heart muscle which damage is happening and accruing there. When the damage isn’t stopped or slowed, it might eventually lead to heart failure.

No research, however, had ever examined whether sitting was connected rich in troponin levels.

So for that new study, printed in Circulation, they switched to existing data in the Dallas Heart Study, a sizable, ongoing study of cardiac health among several ethnically diverse women and men, supervised through the College of Texas Southwestern…

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In Opioid Battle, Cherokee Want Their Day in Tribal Court

Decimated by addiction, its heritage at risk, the Cherokee Nation is trying to sue pharmacies and distributors. But it may be blocked from doing so.

Second-graders studying the Cherokee language in Tahlequah, Okla.CreditRuth Fremson/The New York Times Dec. 17, 2017
TAHLEQUAH, Okla. — Cherokee children were disappearing.
At weekly staff meetings, Todd Hembree, the attorney general of the Cherokee Nation, kept hearing about babies in opioid withdrawal and youngsters with addicted parents, all being removed from families. The crush on the foster care system was so great that the unthinkable had become inevitable: 70 percent of the Cherokee foster children in Oklahoma had to be placed in the homes of non-Indians.
“We have addicted mothers and fathers who don’t give a damn about what their children will carry on,” said Mr. Hembree, a descendant of a revered 19th-century chief. “They can’t care for themselves, much less anything else. We are losing a generation of our continuity.”
Across the country, tens of thousands of people are dying from abuse of prescription opioids. Here in the capital of the Cherokee Nation, the epidemic is exacting an additional, deeply painful price. The tribe’s carefully tended heritage, traditions and memories, handed down through generations, are at risk, with so many families now being ruptured by drugs.
That fear is driving an unusual legal battle. Like authorities in dozens of cities, counties and states, including Ohio, New Jersey and Oklahoma itself, Mr. Hembree has sued big opioid distributors. Attorneys general from 41 states recently joined forces to investigate similar options. But instead of going to state court, Mr. Hembree filed his case in the Cherokee Nation’s tribal court. Todd Hembree, the attorney general for the Cherokee Nation, in his office in Tahlequah, Okla.CreditRuth Fremson/The New York Times
The Cherokee suit argues that the pharmacy chains Walmart, Walgreens and CVS Health, as well as the giant drug distributors McKesson, Cardinal Health and AmerisourceBergen, flouted federal drug-monitoring laws and allowed prescription opioids…

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A Nasty, Nafta-Related Surprise: Mexico’s Soaring Obesity

Few predicted when Mexico joined the free-trade deal that it would transform the country in a way that would saddle millions with diet-related illnesses.

An Oxxo convenience store in San Cristóbal de las Casas, Mexico. The chain, which had 400 stores in the country in 1990, now has nearly 16,000.CreditAdriana Zehbrauskas for The New York Times Dec. 11, 2017

SAN CRISTÓBAL DE LAS CASAS, Mexico — William Ruiz Sánchez spends his days grilling burgers and slathering fried hot dogs with pepperoni and cheese at his family’s restaurant. Refrigerators and fire-engine red tables provided by Coca-Cola feature the company’s logo in exchange for exclusive sale of its drinks.
Though members of the Ruiz family sometimes eat here, they more often grab dinner at Domino’s or McDonald’s. For midday snacks, they buy Doritos or Cheetos at Oxxo, a convenience store chain so ubiquitous here that nutritionists and health care advocates mockingly refer to the city as San Cristóbal de las Oxxos.
The family’s experience in food service began in the 1960s, when Mr. Ruiz’s grandmother sold tamales and home-cooked food made with produce from a nearby farm; those same ingredients sustained her boys with vegetable stews, beans, tortillas and eggs. Meat was a luxury.
Since then, the Ruizes have become both consumers and participants in an extraordinary transformation of the country’s food system, one that has saddled them and millions of other Mexicans with diet-related illnesses.
It is a seismic shift that some nutritionists say has an underappreciated cause: free trade. A family meal of Chinese takeout at the Ruiz’s restaurant in San Cristóbal de las Casas. William Ruiz is at left, his older brother, Gabriel, at center, and their father, Gabriel, is at right.CreditAdriana Zehbrauskas for The New York Times From left, Gabriel Ruiz, William Ruiz and Gabriel’s daughter, Emily.CreditAdriana Zehbrauskas for The New York Times
Mexico began lifting tariffs and allowing more foreign investment in the 1980s, a transition to free trade given an exclamation…

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