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Excessive drooling by patients with advanced Parkinson’s disease is an indicator of greater motor and nonmotor dysfunction, new research shows.
“Sialorrhea is not just a cosmetic problem,” study investigator Francesca Morgante, MD, associate professor of neurology, St. George’s University, London, United Kingdom, told Medscape Medical News.
“We need to understand the relationship between sialorrhea and these speech and swallowing disturbances and whether treatment for sialorrhea improves that,” Morgante added.
The findings were presented at the virtual Congress of the European Academy of Neurology (EAN) 2021.
Sialorrhea is an underrecognized nonmotor symptom that can affect up to 70% of patients with PD, co-investigator Ioana Cociasu, PhD, postdoctoral research fellow, Neurosciences Research Center, St. George’s University, told meeting attendees. The impact on quality of life increases with disease severity, she said.
The current study included 101 consecutive patients attending an advanced PD disorders clinic. Researchers collected demographic data that included information on gender, age, age at PD onset, and disease duration.
They also gathered data on motor symptoms by assessing total levodopa equivalent daily dose (LEDD) and LEDD dopamine agonists. They also assessed results on the Unified Parkinson’s Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr scale for on- and off-medication states.
Nonmotor functioning was assessed using the Non-Motor Symptoms Scale (NMSS) and Scales for Outcomes in Parkinson’s disease–autonomic dysfunction (SCOPA-AUT) questionnaire. Among patients with PD, autonomic dysfunction can precede motor impairment and can involve orthostatic and postprandial hypotension, among other symptoms, the investigators note.
Health status and quality of life were assessed using the Parkinson’s disease questionnaire–39 items (PDQ-39). The Radboud Oral Motor Inventory for PD (ROMP) was used to measure orofacial symptoms. ROMP is a self-administered questionnaire that evaluates speech, swallowing disturbances, and drooling of saliva. The Montreal Cognitive Assessment test was also used.
Investigators compared participants with sialorrhea to those without sialorrhea, described as droolers and nondroolers. Droolers were defined as those scoring >1 on the UPDRS-II item 6. This signified slight but definite presence of saliva in the mouth and/or the possibility of nighttime drooling.
Among the participants, 65 (64.4%) were classified as droolers, and 36 (35.6%) as nondroolers.
Patients with both PD and sialorrhea were significantly more impaired in terms of motor functioning than those without sialorrhea. In these patients, the UPDRS-III was more severe in both the off- (P = .03) and on-states (P = .002), and they had less improvement with the levodopa challenge test (P = .007).
Droolers were also more severely affected by nonmotor problems. They had more severe speech dysfunction (P < .0001) and swallowing dysfunction (P < .05), and they had higher scores on the NMSS (P = .0008) and SCOPA-AUT (P = .003) and poorer quality-of-life scores on the PDQ-39 (P = .049).
To evaluate respiratory tract infections, the researchers used electronic health records. About 15.4% of the study population had had a documented respiratory infection since they were diagnosed with PD.
Upper and lower respiratory tract infections were more frequent among droolers than nondroolers (P = .05).
“Infections might arise from swallowing disturbances leading to aspiration and drooling,” Morgante noted.
The drooling did not appear to affect cognition or sleep in these patients.
Following the study presentation, session co-chair Philippe G. Damier, MD, PhD, professor of neurology, University Hospital, Nantes, France, asked about the best treatment for sialorrhea for these patients.
In general, those with milder disease might try chewing gum to improve swallowing; patients with more severe cases may benefit from botulinum toxin injections, said Cociasu. The treatment choice, she added, “very much depends on the severity of the sialorrhea.”
Botulinum toxin therapy involves injections into the salivary gland to reduce saliva production. It is typically administered about every 4 months.
The second session co-chair, Elena Moro, MD, PhD, director of the Movement Disorders Unit at Grenoble Alpes University, Grenoble, France, pointed out that chewing gum may be a swallowing hazard for patients with PD and severe dementia.
Asked by Moro whether patients with higher scores on balance and posture were more likely to have sialorrhea, Cociasu said she and her colleagues are currently looking into this.
Morgante told Medscape Medical News that the current study did not examine the effect of treatment on speech disorders associated with sialorrhea.
“We are running another study now to understand the effect of treatment of sialorrhea on these features,” she said.
Morgante and Cociasu have reported no relevant financial relationships.
Congress of the European Academy of Neurology (EAN) 2021: Session: Movement Disorders 1. Presented June 20, 2021.
This post originally appeared on Medscape Medical News Headlines
A Flash Flood Watch is in effect for all of Southeast Texas until 7 a.m. Thursday, but it might get extended into Friday when additional downpours are expected.
Drivers should use caution on the roads as roadways will have the potential for flooding over the next couple of days.
Stay weather aware by downloading the ABC13 app to have the latest breaking news and weather alerts sent straight to your phone.
When will the heaviest rain fall?
The greatest concern for flooding from heavy rain will happen overnight through all of Wednesday and into Thursday morning. Street and creek flooding will be likely then. And we’ll really need to watch the bayous during that time since the heavy rain could fall for several hours. River flooding is also likely due to the widespread rains coming to the eastern half of Texas over the next several days.When will rain chances come to an end?
Moisture will still be sticking around keeping rain chances in the forecast into the weekend. We should finally get a break on Sunday.
Montgomery/Walker/San Jacinto/Polk/Grimes Counties
Fort Bend/Wharton/Colorado Counties
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Author: Vanessa Chalmers
This post originally appeared on Health News – The Sun
THERE is no evidence that women are at greater risk from blood clots after the AstraZeneca coronavirus vaccine, MPs have been told.
But as extremely rare cases of blood clots are “increasing” in line with the speedy jab rollout, the trend continues to show that younger people are more at risk.
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The evidence is “firming up” that the jab is the underlying cause of these unusual and sometimes fatal blood clots, which occur in the brain and stomach.
However, there is still no clear link to prove it.
Regulators in the UK, the MHRA, have reported more cases and deaths in women compared to men.
But experts have said this appears to be due to the way the vaccines were rolled out, as opposed to a genuine higher risk in women.
It comes as:
Professor Sir Munir Pirmohamed, chairman of the Commission on Human Medicines, told the Science and Technology Committee: “There are two things to consider – the first is the way the vaccine was deployed, particularly in healthcare workers and social care workers.
“The majority of the workforce there is female and so they had higher exposure rates.
“But when you then start relating to the exposure rate in different populations, what you find is that the case incidence rate between male and female is actually very similar.
“So, from our data that we’ve got in the UK, it doesn’t look as if the females are at a higher risk of this adverse event compared to males.”
Professor John Aston, Harding Professor of Statistics in Public Life, University of Cambridge, said he “absolutely agreed”.
He said in the lower age groups, the rollout was mostly geared towards people working in health and social care.
“Because there was a higher relative number of females to males, it is not unexpected we would see that proportion coming out in terms of cases [of blood clots].”
EU regulators have also said that although most cases of blood clots have been in women, no specific risk factors have been confirmed.
Asked about the medical history of cases, Sir Munir said that a past blood clot is not seen as a predisposer so far.
And he said the “only risk factor that we are finding is age in that there is a slightly higher risk in the younger age group compared to the older age group”.
Some 95 per cent of people over the age of 50 have had their first dose of the jab.
There have been a smaller proportion of younger people – NHS health care workers and people with underlying conditions – who have been jabbed.
Therefore, with more blood clot cases in younger people, this suggests there is an increased risk for them.
The MHRA has decided the NHS should offer people under 30 an alternative vaccine to the AstraZeneca vaccine.
MPs discussed that there had been 168 cases of extremely rare blood clot events in around 21 million first doses of the AstraZeneca jab, the majority of which (93) were in women.
There have been 32 deaths.
Sir Munir said: “It is important to again stress this is extremely rare, only 168 cases given millions and millions of doses of the vaccine has been given.
“The number of cases has been increasing since they were first reported, and what we feel is the evidence is firming up of a possible link.
“But we do not have true causality determined yet.”
He said there seems to be an immune reaction occurring after people are given a vaccine, but the reasons why are not clear.
It comes after blood clots linked with the vaccine from Johnson & Johnson, which uses the same technology as the AZ jab, has led to health chiefs in the US deciding to use a warning label on a fact sheet given to recipients.
After an 11-day pause of the use of the jab in the states, The Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) said
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However the agencies insisted the risks of experiencing the potentially deadly syndrome was “very low”.
Some 15 cases of blood clots have been idenfitied since regulators approved the jab in February.
All were women and most were under the age of 50 – with three dying and seven remaining in hospital.
The Republican governor had called for more oversight and an immediate investigation into reports the state had received of sexual abuse inside the facility holding more than 1,300 children.
But some who have demanded improved conditions in such facilities for years said they couldn’t help but question the governor’s timing and motivations. Abbott largely remained silent despite reports of widespread abuse in migrant shelters during former President Donald Trump’s administration. And while he has pledged to reform a handful of state agencies with long histories of abuse, problems continue to dog the agencies he oversees.
Now that he’s speaking out in the early days of a Democratic presidency, some said they couldn’t help but view his comments through a political lens.
“Gov. Greg Abbott has zero credibility on this or any other issue related to protecting human life,” said U.S. Rep. Veronica Escobar, D-El Paso, at a press conference on Thursday. “We saw Gov. Abbott’s failure to protect his own citizens during the freeze. We saw Gov. Abbott play politics with COVID.”
At the press conference Wednesday evening, Abbott said complaints about sexual assault at the Freeman Expo Center in San Antonio were reported early Wednesday to the Texas Department of Family and Protective Services and to the Texas Health and Human Services Commission. The governor said he did not know the identities of those who alleged assault, nor could he provide many details about the accusations. He said he was concerned more than one child may have been assaulted. He also said that the Texas Department of Public Safety will investigate the allegations.
But he was clear about who he felt deserved the blame: the Biden administration.
“In short, this facility is a health and safety nightmare,” Abbott told reporters Wednesday. “The Biden administration is now presiding over the abuse of children.”
“Unaccompanied children that arrive at our border have already endured dangerous conditions at home and a treacherous journey to get here,” Cornyn said in a statement. “The fact that any child would experience abuse in the care of the U.S. government is despicable.”
Abbott and many other Texas Republicans have repeatedly criticized the Biden administration as it struggles to address an increase in migrants being apprehended near the U.S.-Mexico border. Almost all single adults are being immediately expelled under a pandemic health order issued by Trump that Biden has kept in place, although the current administration is allowing in unaccompanied minors and some families to await their immigration court hearings in the U.S. But Democrats are also loudly questioning where the compassion was less than two years ago under Trump’s watch, when apprehensions hit near-record figures despite his crackdown on the border.
And while the allegations of abuse Abbott highlighted were disturbing, they were by no means rare. Thousands of accusations of harassment and sexual abuse have been leveled against government-run migrant shelters in recent years. From 2014 to 2018 — a time that included the Obama and Trump administrations — the Office of Refugee Resettlement, a division of HHS, received more than 4,500 complaints, including instances of inappropriate touching, staff members watching minors bathe and showing children pornography.
After Wednesday’s news conference, Abbott toured the facility. Renae Eze, an Abbott spokesperson, accused the Biden administration of “[rolling] out the red carpet for what turned out to be a dog and pony show.” She said in a statement that staff at the facility provided no information about the allegations of abuse and “abruptly cut off a doctor” who began to provide information about children with COVID-19.
“Because the Biden Administration has failed these children, the state of Texas is taking action,” Eze continued. “Texas Rangers and DPS have begun their investigation into the very serious complaints about the treatment of these unaccompanied minors and will not stop until they’ve uncovered the real truth and these children are safe.”
Rebeca Clay-Flores, a Democratic Bexar County commissioner, said she accompanied Abbott on the tour of the facility. She pushed back on Abbott’s characterization of the shelter and said that the children are happy and the facility is well-staffed. Abbott on Wednesday claimed that children were not being fed, but Clay-Flores said that the federal government has contracted with three catering companies to provide three meals and two snacks a day. She called the announcement of the abuse allegations “really great political timing.”
“Regardless of your political party or your nation of origin, children should not be politicized,” Clay-Flores told The Texas Tribune. “You want to talk about a dog and pony show? Politicizing children is a dog and pony show.”
An HHS spokesperson in a statement declined to comment on specific allegations, but said the Office of Refugee Resettlement “has a zero-tolerance policy for all forms of sexual abuse, sexual harassment, and inappropriate sexual behavior at all [unaccompanied child] care provider facilities and acts quickly to address any alleged violations of policy, including initiating employee disciplinary action, termination, or reporting to appropriate investigative entities, such as law enforcement agencies and relevant licensing bodies.”
Escobar told reporters at a news conference Thursday that “any allegation around children always should be taken seriously and should be thoroughly investigated.” But advocacy groups shared her skepticism about what Abbott was trying to accomplish.
Jonathan Ryan, CEO of RAICES, a nonprofit that provides legal services to immigrants, said in a statement that “the only reason why Abbott is now acting like he cares about the children in these facilities is for political reasons.” Still, he doubled down on calls for increased oversight of child detention facilities.
“What the governor wants is for the Biden administration to stop allowing children to seek home and safety in this country,” Ryan said. “That is not the solution to the challenge we have in front of us. We must ensure the children are released as soon as possible and be reunited with their families in the U.S.”
Edna Yang, co-executive director of the nonprofit immigrant legal services provider American Gateways, told the Tribune that all allegations of abuse should be investigated. She declined to speculate on the motivations behind Abbott’s announcement, but said that if the governor and other state leaders are truly concerned about the wellbeing of immigrants, “there are definitely things that our state leaders can do to protect immigrants now who are suffering in our state.”
“There are lots of things like that that can be done to actually protect immigrants here and ensure that their rights aren’t being violated,” Yang said.
Meanwhile, advocates for children have long called for more actions to prevent the abuse of children in the care of the state. Texas Appleseed and Disability Rights Texas, two justice and legal organizations, in October filed a complaint with the U.S. Department of Justice against the Texas Juvenile Justice Department that alleged “grievous violations of children’s constitutional rights.”
The problems at the agency predate Abbott’s tenure as governor. The agency has undergone a series of major reforms that successfully shrank the number of kids in the state’s lockups and led to the closure of seven facilities. But the complaint alleged widespread sexual assault at the remaining facilities.
“How many years is it going to take until we’re going to realize that we need to throw everything out and start over?” Brett Merfish, director of youth justice at Texas Appleseed, said.
In addition, the embattled Texas Department of Family and Protective Services has struggled to implement a long list of court ordered reforms that stem from a decadelong lawsuit over abuse and neglect in the state’s foster care system. In 2017, Abbott signed a bill to overhaul the foster care system. Still, problems have persisted.
In February, the federal judge overseeing the case again chided state officials for failing to take sufficient corrective action. That same month, Abbott promised to do “exactly” what the judge ordered to fix the situation.
Earlier this year, the state had a backlog of more than 400 investigations into reports of abuse open for longer than 30 days. Only 38 had valid extensions.
“We should all be working together on this, and in that spirit, I’m going to tell you that this is not compliance,” U.S. District Judge Janis Jack said in a February hearing.
Disclosure: Texas Appleseed has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
Based on their initial levels of optimism, the follow-up study found that the most happiest people demonstrated, on average, a 15 percent longer lifespan.
Those who felt most optimistic had up to a 70 percent greater chance of reaching 85 years old compared to the least optimistic group.
The results were maintained after taking into account the following factors:
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Those with a happier outlook on life have also been linked to healthier habits, such as exercising more and are less likely to smoke.
A professor of epidemiology, Fran Grodstein, added: “Research on the reason why optimism matters so much remains to be done, but the link between optimism and health is becoming more evident.”
Dr Lee concluded: “Our study contributes to scientific knowledge on health assets that may protect against mortality risk and promote resilient ageing.
“Doing things that you enjoy is good for your emotional wellbeing,” said the national health body – as long as it’s not a detriment to your health.
This could be meeting with a friend, having a soak in the bath, or watching sports.
This can be achieved by positive self talk and taking care of yourself.
Other keys to happiness include: having a healthy lifestyle; sharing your feelings; and building resilience.