Monday, October 31, 2016
Do cranberries prevent burny pees?
There has been popular support for cranberries helping with urinary tract infections for a very long time. But the research findings have been uneven. There has therefore been a wish for studies which would settle the question for once and for all. The abstract of the latest study is below.
It is undoubtedly a well-conducted study and a contemporaneous review has used it as something of a final nail in the coffin of clinical use of cranberry juice.
I wish to prise that nail out of the coffin, in part because I have personally found cranberry juice to be very efficacious. It doesn't happen often but, if I get a twinge of UTI, I rapidly belt a couple of mouthfuls of supermarket cranberry juice into me and the problem disappears.
So why is my experience different from what we read in the report below? Several reasons. For a start, I am not a sick and elderly woman living in a Connecticut nursing home. More importantly, however, I take the juice as a cure, not as a preventive. Its effects could wear off if you take it all the time. Cranberries may not be able to prevent UTI but they could cure it.
I am also concerned that most of the studies administer the stuff in capsule form rather than as a drink. As a much-published academic researcher myself, I know exactly why they do that. It enables standardization and replicability. But what if the scientific precautions damage the effect? What if capsules are not a good way of delivering the power of the cranberry? To put it in academic terms, what if the finding is an artifact of the experimental method? What if capsules have processed all the goodness out of the cranberries? Health researchers are loud and frequent in condemning processed food generally, so how come cranberry capsules get a pass?
So it is my conclusion that most of the studies, including the one below, have been incautious despite themselves and have not examined the question adequately. Drink up your cranberry juice!
Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial
Manisha Juthani-Mehta et al.
Importance: Bacteriuria plus pyuria is highly prevalent among older women living in nursing homes. Cranberry capsules are an understudied, nonantimicrobial prevention strategy used in this population.
Objective: To test the effect of 2 oral cranberry capsules once a day on presence of bacteriuria plus pyuria among women residing in nursing homes.
Design, Setting, and Participants: Double-blind, randomized, placebo-controlled efficacy trial with stratification by nursing home and involving 185 English-speaking women aged 65 years or older, with or without bacteriuria plus pyuria at baseline, residing in 21 nursing homes located within 50 miles (80 km) of New Haven, Connecticut (August 24, 2012-October 26, 2015).
Interventions: Two oral cranberry capsules, each capsule containing 36 mg of the active ingredient proanthocyanidin (ie, 72 mg total, equivalent to 20 ounces of cranberry juice) vs placebo administered once a day in 92 treatment and 93 control group participants.
Main Outcomes and Measures: Presence of bacteriuria (ie, at least 105 colony-forming units [CFUs] per milliliter of 1 or 2 microorganisms in urine culture) plus pyuria (ie, any number of white blood cells on urinalysis) assessed every 2 months over the 1-year study surveillance; any positive finding was considered to meet the primary outcome. Secondary outcomes were symptomatic urinary tract infection (UTI), all-cause death, all-cause hospitalization, all multidrug antibiotic–resistant organisms, antibiotics administered for suspected UTI, and total antimicrobial administration.
Results Of the 185 randomized study participants (mean age, 86.4 years [SD, 8.2], 90.3% white, 31.4% with bacteriuria plus pyuria at baseline), 147 completed the study. Overall adherence was 80.1%. Unadjusted results showed the presence of bacteriuria plus pyuria in 25.5% (95% CI, 18.6%-33.9%) of the treatment group and in 29.5% (95% CI, 22.2%-37.9%) of the control group. The adjusted generalized estimating equations model that accounted for missing data and covariates showed no significant difference in the presence of bacteriuria plus pyuria between the treatment group vs the control group (29.1% vs 29.0%; OR, 1.01; 95% CI, 0.61-1.66; P = .98). There were no significant differences in number of symptomatic UTIs (10 episodes in the treatment group vs 12 in the control group), rates of death (17 vs 16 deaths; 20.4 vs 19.1 deaths/100 person-years; rate ratio [RR], 1.07; 95% CI, 0.54-2.12), hospitalization (33 vs 50 admissions; 39.7 vs 59.6 hospitalizations/100 person-years; RR, 0.67; 95% CI, 0.32-1.40), bacteriuria associated with multidrug-resistant gram-negative bacilli (9 vs 24 episodes; 10.8 vs 28.6 episodes/100 person-years; RR, 0.38; 95% CI, 0.10-1.46), antibiotics administered for suspected UTIs (692 vs 909 antibiotic days; 8.3 vs 10.8 antibiotic days/person-year; RR, 0.77; 95% CI, 0.44-1.33), or total antimicrobial utilization (1415 vs 1883 antimicrobial days; 17.0 vs 22.4 antimicrobial days/person-year; RR, 0.76; 95% CI, 0.46-1.25).
Conclusions and Relevance: Among older women residing in nursing homes, administration of cranberry capsules vs placebo resulted in no significant difference in presence of bacteriuria plus pyuria over 1 year.
JAMA. Published online October 27, 2016. doi:10.1001/jama.2016.16141
Health law tax penalty? I’ll take it, millions say
The architects of the Affordable Care Act thought they had a blunt instrument to force people — even young and healthy ones — to buy insurance through the law’s online marketplaces: a tax penalty for those who remain uninsured.
It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges.
The full weight of the penalty will not be felt until April, when those who have avoided buying insurance will face penalties of around $700 a person or more. But even then that might not be enough: For the young and healthy who are badly needed to make the exchanges work, it is sometimes cheaper to pay the Internal Revenue Service than an insurance company charging large premiums, with huge deductibles.
“In my experience, the penalty has not been large enough to motivate people to sign up for insurance,” said Christine Speidel, a tax lawyer at Vermont Legal Aid.
Some people do sign up, especially those with low incomes who receive the most generous subsidies, Speidel said. But others, she said, find that they cannot afford insurance, even with subsidies, so “they grudgingly take the penalty.”
The IRS says that 8.1 million returns included penalty payments for people who went without insurance in 2014, the first year in which most people were required to have coverage. A preliminary report on the latest tax-filing season, tabulating data through April of this year, said that 5.6 million returns included penalties averaging $442 per return for people uninsured in 2015.
With the health law’s fourth open-enrollment season beginning Tuesday, consumers are anxiously weighing their options.
William H. Weber, 51, a business consultant in Atlanta, said he paid $1,400 a month this year for a Humana health plan that covered him and his wife and two children. Premiums will increase 60 percent next year, Weber said, and he does not see alternative policies that would be less expensive. So he said he was seriously considering dropping insurance and paying the penalty.
“We may roll the dice next year, go without insurance and hope we have no major medical emergencies,” Weber said. “The penalty would be less than two months of premiums.” (He said that he did not qualify for a subsidy because his income was too high, but that his son, a barista in New York City, had a great plan with a subsidy.)
Iris I. Burnell, the manager of a Jackson Hewitt Tax Service office on Capitol Hill, said she met this week with a client in his late 50s who has several part-time jobs and wants to buy insurance on the exchanges. But, she said, “he’s finding that the costs are prohibitive on a monthly basis, so he has resigned himself to the fact that he will have to suffer the penalty.”
When Congress was writing the Affordable Care Act in 2009 and 2010, lawmakers tried to balance carrots and sticks: subsidies to induce people to buy insurance and tax penalties “to ensure compliance,” in the words of the Senate Finance Committee.
But the requirement for people to carry insurance is one of the most unpopular provisions of the law, and the Obama administration has been cautious in enforcing it. The IRS portrays the decision to go without insurance as a permissible option, not as a violation of federal law.
The law “requires you and each member of your family to have qualifying health care coverage (called minimum essential coverage), qualify for a coverage exemption, or make an individual shared responsibility payment when you file your federal income tax return,” the tax agency says on its website.
Some consumers who buy insurance on the exchanges still feel vulnerable. Deductibles are so high, they say, that the insurance seems useless. So some feel that whether they send hundreds of dollars to the IRS or thousands to an insurance company, they are essentially paying something for nothing.
Obama administration officials say that perception is wrong. Even people with high deductibles have protection against catastrophic costs, they say, and many insurance plans cover common health care services before consumers meet their deductibles. In addition, even when consumers pay most or all of a hospital bill, they often get the benefit of discounts negotiated by their insurers.
The health law authorized certain exemptions from the coverage requirement, and the Obama administration has expanded that list through rules and policy directives. More than 12 million taxpayers claimed one or more coverage exemptions last year because, for instance, they were homeless, had received a shut-off notice from a utility company, or were experiencing other hardships.
“The penalty for violating the individual mandate has not been very effective,” said Joseph J. Thorndike, director of the tax history project at Tax Analysts, a nonprofit publisher of tax information. “If it were effective, we would have higher enrollment, and the population buying policies in the insurance exchange would be healthier and younger.”
Americans have decades of experience with tax deductions and other tax breaks aimed at encouraging various types of behavior, as well as “sin taxes” intended to discourage other kinds of behavior, Thorndike said. But, he said: “It is highly unusual for the federal government to use tax penalties to encourage affirmative behavior. That’s a hard sell.”
Jury acquits Bundy family
The Bundy brothers have been acquitted of federal conspiracy charges after leading a 41-day standoff at a rural Oregon wildlife refuge that grabbed national attention.
Ammon and Ryan Bundy, as well as five additional defendants, were found not guilty of conspiracy to impede federal officers and possession of firearms in a federal facility.
David Fry, Jeff Banta, Shawna Cox, Kenneth Medenback and Neil Wampler were also exonerated.
The decision, unveiled in federal court in Portland on Thursday, is a blow to the US government, which had aggressively prosecuted the right-wing activists who led an armed takeover of the Malheur National Wildlife Refuge in January and February.
The courtroom erupted into chaos on Thursday as Ammon Bundy's attorney Marcus Mumford demanded that his client be immediately released from prison.
US Marshals tackled Mumford to the ground, used a stun gun on him several times and arrested him.
Both Bundy brothers will remain behind bars due to charges they face in Nevada stemming from an armed standoff at their father Cliven's ranch in 2014, US District Judge Anna Brown told the courtroom.
The group took over the bird sanctuary in remote southeastern Oregon on January 2. following a protest to the prison sentences handed down to Dwight and Steven Hammond, two local ranchers convicted of setting fires.
The Bundy brothers and their supporters demanded the government free the father and son and relinquish control of public lands to local officials.
Ammon Bundy gave frequent news conferences and the group used social media in a mostly unsuccessful effort to get others to join them.
He used the protest to shine national attention on the Bundy's family long fight against federal land ownership and restrictions on ranching meant to help protect the environment.
The government, which controls much of the land in the West, says it tries to balance industry, recreation and wildlife concerns to benefit all.
Armed occupiers were allowed to come and go for the first several weeks of the protest as authorities tried to avoid bloodshed seen in past standoffs.
But it all came to a head on January 26, when the Bundy brothers and other key figures in the protest were arrested in a traffic stop outside the refuge, where police fatally shot occupation spokesman Robert 'LaVoy' Finicum.
There is a new lot of postings by Chris Brand just up -- mainly about immigrants
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Posted by JR at 1:15 AM