New Gene Linked To Osteoarthritis Found, Making It The Third

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Main Category: Arthritis / Rheumatology
Also Included In: Bones / Orthopedics;  Genetics
Article Date: 25 Aug 2011 – 9:00 PDT

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Today investigators have revealed a new gene making it only the third to be identified for this painful and debilitating disease connected with osteoarthritis. The disease affects over 40% of people aged 70 years and over.

The disease-associated variant, in the gene MCF2L, was found when Wellcome Trust Sanger Institute investigators used information from the 1000 Genomes Project to increase the power of their genome-wide association scan. The initial stage of the original arcOGEN investigation, funded by Arthritis Research UK, compared the genomes of 3,177 individuals with osteoarthritis with 4,894 people from the general population and looked at 600,000 variants.

Even though the full investigation had yet to be published, no new genes were identified at that level of detail. The new study was able to scan for 7.2 million variants and revealed the connected of MCF2L with osteoarthritis without needing any new sequencing to be carried out, by imputing the information from the 1000 Genomes Project.

Dr Eleftheria Zeggini, senior author from the Sanger Institute explained:

“By using the 1000 Genomes Project information to add value to our original genome-wide association scan for osteoarthritis, we have uncovered a disease-associated gene that had previously remained hidden.

We were able to analyze our results in greater detail and zoom in on variants that we hadn’t been able to identify before. We hope that this approach and our findings will help to improve our biological understanding of this very painful disease.”

As osteoarthritis is a complicated condition investigators have found it hard to identify its genes. Just two loci have been discovered to date in European populations – GDF5 and a signal from a region on chromosome 7.

The newly identified gene, MCF2L, is found on chromosome 13 and regulates a nerve growth factor (NGF). When those with osteoarthritis in the knee are treated with a humanized monoclonal antibody against NGF, they experience reduced pain and show improvement in their movement, it has been reported. Suggesting that MCF2L is involved in the development of osteoarthritis and gives a new focus for investigations in the future.

The team worked with international collaborators to research 19,041 individuals with arthritis and 25,504 without in order to make sure that the variant of MCF2L is linked with the development of osteoarthritis. For the newly identified variant to corroborate the association, numerous centers throughout Europe worked together by screening people in Iceland, Estonia, the Netherlands and the UK.

Aaron Day-Williams, first author of the study from the Sanger Institute says:

“The discovery of this MCF2L variant suggests a possible genetic link to the finding that regulating NGF is important in knee osteoarthritis, and is supported by the fact that the variant is more strongly linked with knee osteoarthritis than hip osteoarthritis in the investigation.

We hope the identification of this variant will lead to further insights into the biological processes at work and offer potential treatment targets.”

The investigation’s discoveries are based on the work of the arcOGEN Consortium, which has been funded by Arthritis Research UK and is an essential supporter of research in this area.

Alan Silman, Medical Director of Arthritis Research UK explains:

“Osteoarthritis is a complicated disease with many genetic causes. However, it has proved very difficult to discover the genes involved and help us to identify potential areas of treatment.

We are delighted that investigators at the Sanger Institute have been able to identify a new gene connected with this painful condition and offer new lines of research for possible treatments. We are also excited that employing the technique of using the 1000 Genomes Project data to investigate genetic associations in far greater depth could reveal even greater insights into this debilitating disease.”

Written by Grace Rattue

Copyright: Medical News Today

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Charity Spotlight: Children of Fiji

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Smoking Linked With Chronic Pain

Main Category: Pain / Anesthetics
Also Included In: Arthritis / Rheumatology;  Smoking / Quit Smoking
Article Date: 24 Aug 2011 – 0:00 PDT

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Smokers are much more likely to report problems with persistent musculoskeletal pain than non-smokers, according to a new study reported in the Journal of Pain, published by the American Pain Society.

Researchers from the University of Kentucky School of Public Health surveyed more than 6000 women participating in the Kentucky Women’s Health Registry, which regularly polls women on health-related issues to better understand the state’s disease burden. The study was intended to assess the association of smoking with the presence of different types of chronic musculoskeletal pain.

Only two states have a higher smoking prevalence than Kentucky, estimated at 25 percent. The state also ranks first in smoking-related deaths per capita among women.

Several previous studies have linked smoking and chronic pain, especially low back pain. The consensus of past research is that smokers of both sexes are more likely than nonsmokers to report pain syndromes.

The Kentucky researchers categorized survey respondents according to age and smoking status, with smokers further classified by their amount of daily cigarette intake. Respondents also were asked about pain symptoms and if they had been diagnosed with musculoskeletal pain disorders, such as fibromyalgia and low-back pain. Pain variables selected for analysis were the presence or absence of low-back pain, neck pain, sciatica, nerve pain, fibromyalgia, joint pain and pain all over the body.

The study findings showed that smokers are significantly more likely to report chronic pain than nonsmokers. Daily smokers were two times more likely to report pain than non smokers. Those who smoke a pack or more a day also were most likely to report a high burden of chronic pain.

The authors noted that smoking-induced coughing increases abdominal pressure and back pain and nicotine may decrease pain thresholds by sensitizing pain receptors. The study also showed a dose-dependent relationship between smoking frequency and having chronic pain syndrome. This may indicate that smoking cessation treatments could be helpful for chronic pain management therapy.

Source: American Pain Society




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Only 1 In 5 Medicaid-Covered Kids In Ohio Finish Antidepressant Treatment

Main Category: Depression
Also Included In: Medicare / Medicaid / SCHIP;  Compliance;  Medicare / Medicaid / SCHIP
Article Date: 23 Aug 2011 – 0:00 PDT

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About half of Medicaid-covered children and adolescents in Ohio who are in treatment for depression complete their first three months of prescribed antidepressants, and only one-fifth complete the recommended minimum six-month course of drugs to treat depression, new research suggests.

Among those at the highest risk for not completing treatment are adolescents as opposed to younger children – and minority youths, particularly African Americans, according to the analysis of Medicaid prescription data over a three-year period.

Optimal follow-up visits and adequacy of antidepressant dosing was associated with better adherence during both the acute and continuation phases of treatment.

Though the study was conducted in Ohio, the findings are likely to have broad relevance to Medicaid-eligible children and adolescents across the United States who share similar problems affecting their access to quality mental health care, researchers say.

“There have been a lot of great advances in terms of medication and therapy interventions for depression. The best treatment is a combination of cognitive behavioral therapy and antidepressants,” said Cynthia Fontanella, an assistant professor of social work and psychiatry at Ohio State University and lead author of the study.

“But there is a huge gap between the science and what is happening in the real world. And the gap is even greater for kids who live in poverty.”

The findings underscore the need for clinicians treating this population to deliver care according to guidelines established by the American Academy of Child and Adolescent Psychiatry, and to develop interventions that improve adherence in the most vulnerable groups, the study authors conclude.

Untreated or poorly treated depression can lead to recurrence, which can increase suicidal behavior and drive up health care costs by increasing the likelihood of hospitalization.

The study is published in the current issue of The Annals of Pharmacotherapy.

Studies suggest that depression affects as many as 20 percent of youths by age 18, and that antidepressant use in people under age 20 has increased three- to five-fold in the past decade. Those experiencing depression are at risk for a number of problems, ranging from school failure and teen pregnancy to substance abuse and suicide.

Compared to youths covered by private insurance, children on Medicaid use more mental health services and are more likely to be prescribed psychotropic medications. They are considered at higher risk for psychiatric disturbances because of the multiple stresses associated with living in poverty.

“This population is very vulnerable,” Fontanella said. “Not only do they have to deal with poverty and other psychosocial issues, but also issues commonly associated with poverty, such as transportation limitations, single-parent households and unemployment. All this makes them even more vulnerable to receiving not just a poor quality of care, but poor access to mental health care.”

The researchers examined data from Medicaid eligibility and claims files for children and adolescents between the ages of 5 and 17 years who were diagnosed with a new episode of depression between Jan. 1, 2005, and Dec. 30, 2007. They examined cases in which the children were prescribed at least one antidepressant most of which came from the SSRI (selective serotonin reuptake inhibitor) class of antidepressants within 30 days of the diagnosis and were continuously enrolled in Medicaid for six months after the prescription date.

Antidepressant adherence measures were derived from the Health Plan Employer Data and Information Set (HEDIS) quality indicators on antidepressant management. Using what is called a medication possession ratio, the researchers predicted that when prescriptions for the youths were filled at a pharmacy for at least 80 percent of the days for which they were prescribed medications, the children were adhering to the treatment.

The cases of 1,650 pediatric depression patients were included in the analysis. Of those, 817, or 49.5 percent, adhered to the treatment during the acute phase the first three months. About half stopped taking the medicine within one month of starting treatment. And 41.6 percent of the patients who maintained treatment for the first three months also adhered to treatment during the continuation phase of three additional months.

Overall, only 340, or 20.6 percent, of the youths completed a full six months of antidepressant treatment as recommended by the standards set by HEDIS.

“Nonadherence is common,” Fontanella said. “With only half of the kids adherent during the first three months and only a fifth adherent for the full six months of treatment, most of these kids are not even meeting the minimum standards of care.”

Additional analyses showed that children aged 5 to 12 were more adherent than were adolescents, and non-Hispanic whites were more adherent than minority youths.

Higher rates of adherence during the first three months were associated with better follow-up care and proper dosing of the antidepressants: More than 58 percent of kids who had at least three contacts with a mental health practitioner kept taking their drugs, compared to about one-third of children who had fewer contacts. Similarly, 53.7 percent of children taking what was considered an adequate dose of their antidepressant adhered to treatment, compared to 37.1 percent of youths who received an inadequate dose.

Follow-up and dosing had even greater effects during the later treatment period.

“From a social work and physician perspective, follow-up is critical to monitor not just adherence but also adverse side effects, the potential for increased suicidal behavior and the other negative consequences associated with depression, like poor school performance, relationship issues and a variety of high-risk behaviors,” Fontanella said.

This work was supported by the National Institutes of Health and Ohio State’s Center for Clinical and Translational Science and its College of Social Work.

Source: Ohio State University




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Healthcare Industry Software Solution

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Road Block As A New Strategy For The Treatment Of Alzheimer’s

Main Category: Arthritis / Rheumatology
Article Date: 23 Aug 2011 – 0:00 PDT

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Blocking a transport pathway through the brain cells offers new prospects to prevent the development of Alzheimer’s. Wim Annaert and colleagues of VIB and K.U. Leuven discovered that two main agents involved in the inception of Alzheimer’s disease, the amyloid beta precursor protein (APP) and the beta secretase enzyme (BACE1), follow a different path through the brain cells to meet up. It is during the eventual meeting between protein and enzyme that the basis is laid for the development of the disease. The results of the study were published in the Proceedings of the National Academy of Sciences.

Wim Annaert suggests that “closing off or rerouting the path which beta secretase follows to get to APP may perhaps be used to inhibit the rise of the disease. However, a great deal of additional research will be necessary to confirm whether this discovery can effectively lead to a drug.”

Inhibiting the formation of amyloid plaques

The presence of amyloid plaques is typical of the brains of Alzheimer patients. These plaques are abnormal accumulations of a sticky short protein (beta amyloid) between the nerve cells. The beta amyloid peptide develops when the APP precursor protein is cut into pieces the wrong way, in a reaction which also involves the beta secretase enzyme. Overproduction of these peptides may give rise to the formation of plaques. The plaques disrupt the normal functioning of the brain. Preventing the formation of these plaques is a possible strategy for inhibiting the disease.

Alzheimer’s disease

Alzheimer’s is a memory disorder that affects up to 70% of patients with dementia. There are about 100 000 people with Alzheimer’s in Belgium. The disease slowly – step by step – destroys brain cells in the deep part of the brain that serve for memory and knowledge. Since Alois Alzheimer first reported on the disease 100 years ago, scientists have been searching for ways of treating the disease.

Sources: VIB, AlphaGalileo Foundation.




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Complexity Of Choices In Medicare Advantage Program May Overwhelm Some American Seniors

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Seniors / Aging
Article Date: 22 Aug 2011 – 7:00 PDT

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The wide choice of managed care plans that the Medicare Advantage Program offers could be counter-productive, says a new study published in Health Affairs and authored by Harvard Medical School researchers. Seniors, especially those with poor cognitive abilities, frequently make inadequate choices, or end up making no decision when presented with an excessively wide choice of complex insurance options.

Assistant professor of health care policy and medicine, J. Michael McWilliams, from Harvard Medical School, said:

“We are providing the most complex insurance choices to the very population that is least equipped to make these high-stakes decisions. Most other Americans choose from just a few health plans, but elderly Medicare beneficiaries often have to sift through dozens of options.”

Several payment increases to the Medicare Advantage program were initiated under the 2003 Medicare Modernization Act. These increases significantly raised the number of private plans that could participate in the program. They were encouraged to compete for beneficiaries by offering more benefits and cheaper premiums, such as coverage for prescription medications.

McWilliams and colleagues set out to determine what the effects of these expanded benefits and choices of enrollment in Medicare Advantage compared to traditional Medicare might be. The researchers gathered data on 21,815 enrollment decisions from 2004 to 2007 that 6,672 participants had made. They compared enrollment decisions made by participants with varying cognition levels, as well as types of plans offered in their areas.

They found that as long as the number of plan options being offered was fewer than 15, a rise in the number of plans resulted in an increase in Medicare Advantage enrollment. However, when there were over 30 options the number of enrollments actually dropped – this was the case in 25% of US counties.

Of notable concern was that beneficiaries with poor cognitive function appeared to be considerably less likely to understand the advantages these plans offered, compared to their peers with high cognitive function – they would opt to stay in the traditional Medicare program.

McWilliams and team believe that beneficiaries simply became overwhelmed and chose traditional Medicare by default, resulting in lower enrollment.

When faced with a complex series of Medicare alternatives, Medicare beneficiaries with poor cognitive abilities find it very hard to identify the best options. As the prevalence of dementia and cognitive impairment is rising among the country’s aging Medicare population, this is of particular concern, they added.

Their findings are especially relevant now, as health insurance exchanges are set up under the recent reform legislation under the Affordable Care Act.

McWilliams said:

“Efforts to limit choice and guide seniors to the most valuable options could especially benefit those with cognitive impairments, who without more help appear to be leaving money on the table. Better enrollment decisions could in turn strengthen competition by rewarding high-value plans with more enrollees.”

Written by Christian Nordqvist

Copyright: Medical News Today

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Myths And Realities About Medicare’s Competitive Bidding Program For Home Medical Equipment And Services

Main Category: Medicare / Medicaid / SCHIP
Article Date: 20 Aug 2011 – 0:00 PDT

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As Medicare expands a controversial “competitive” bidding program for home medical equipment and services, economists, consumer groups, and members of Congress have gone on record to oppose that program citing reduced patient access to care, flaws in the program design, and impact on local jobs.

“There’s a reason why more than 30 patient advocacy groups, 244 economists and auction experts, and 145 members of Congress oppose this program: it undermines quality of care and it increases costs,” said Tyler J. Wilson, president of the American Association for Homecare. “Because of this bidding program, beneficiaries will spend more time in expensive institutions, rather than in the far more cost-effective setting for care their own homes.”

New restrictions and unsustainable prices based on this controversial bidding system took effect on January 1, 2011, in nine of the largest metropolitan areas including Charlotte, Cincinnati, Cleveland, Dallas-Ft. Worth, Kansas City, Miami, Orlando, Pittsburgh, and Riverside, Calif. Another 91 areas throughout the U.S. will be subjected to the bidding program starting later in 2011. The bidding system affects providers and users of home medical equipment and services such as oxygen therapy, respiratory devices, hospital beds, wheelchairs, and other medically required equipment and supplies needed by seniors and people with disabilities in the Medicare system.

Proponents of the bidding system have conveyed misleading information that exaggerates the benefits and ignores the severe shortcomings of the program.

MYTH #1: Medicare overpays for home medical equipment and services, and the bidding system improves the method for setting reimbursement rates for that equipment and service.

REALITY: Proponents of the bidding system use out-of-date reimbursement rates and false comparisons of retail costs versus Medicare costs to argue their case. For many years, CMS has set reimbursement rates for home medical equipment through a fee schedule. Over the past decade, those reimbursement rates have dropped nearly 50 percent because of cuts mandated by Congress or imposed by CMS.

The costs of delivering, setting up, maintaining, and servicing medically required equipment in the home are obviously greater than the cost of merely acquiring the equipment. But Medicare does not recognize the costs of these services. So comparing the cost of the equipment to the larger cost of furnishing the full array of required equipment, supplies, and services is false and misleading.

Moreover, 167 experts, including two Nobel laureates and numerous economics professors from leading universities, have warned Congress that this bidding system will fail. The experts, who do not otherwise oppose competitive bidding to set Medicare prices, point out that the system has four fatal flaws:

— The bidders are not bound by their bids, which undermines the credibility of the process.

— Pricing rules encourage “low-ball bids” that will not allow for a sustainable process or a healthy pool of equipment suppliers.

— The bid design provides “strong incentives to distort bids away from costs.”

— There is a lack of transparency in the bid program that is “unacceptable in a government auction and is in sharp contrast to well-run government auctions.”

These concerns have been shared with the federal Centers for Medicare and Medicaid Services (CMS), which designed the bidding system. But the agency has dismissed the concerns.

A September 30, 2010, New York Times’ “Freakonomics” article by two of the 167 economists addresses the bidding issue. Yale University economist Ian Ayres and University of Maryland economist Peter Cramton, conclude: “The mystery is why the government has failed over a period of more than ten years to engage auction experts in the design and testing of the Medicare auction. … We suspect the problem is that CMS initially did not realize that auction expertise was required, and once they spent millions of dollars developing the failed approach, they stuck with it rather than admit that mistakes were made.”

MYTH #2: The bidding program will make healthcare more cost-effective.

REALITY: The home is already a highly cost-effective setting for post-acute and long-term care. For many years, home medical equipment providers competed in Medicare on the basis of quality and service to facilitate the hospital discharge process and enable patients to receive cost-effective, high-quality care at home. As more people receive quality equipment and services at home, patients and taxpayers will spend less for hospital stays, emergency room visits, and nursing homes. Home medical equipment is an important part of the solution to the nation’s healthcare funding crisis. Home medical equipment represents approximately 1.5 percent of total Medicare spending. So while this bidding program would make even more severe cuts to reimbursement rates for home medical equipment, that will ultimately result in much higher spending in Medicare and Medicaid for hospital and nursing home stays and for physician and emergency treatments.

MYTH #3: The bidding program will eliminate fraud.

REALITY: CMS continues to describe the bidding program as an anti-fraud tool. In reality, it is a price-setting mechanism that has nothing to do with fraud prevention. In fact, the exact opposite is true, according to the 167 market experts who warned Congress that the CMS bidding program “will lead to a ‘race to the bottom’ fostering fraud and corruption.”

The real solution to keeping criminals out of Medicare is better screening, real-time claims audits, and better enforcement mechanisms for Medicare. Two years ago, the American Association for Homecare proposed to Congress an aggressive, 13-point legislative action plan to combat fraud, and many of those provisions have been included in legislation passed in Congress. Moreover, two important anti-fraud requirements for home medical equipment providers accreditation and surety bonds took effect nearly two years ago, in September 2009.

MYTH #4: Only the home medical equipment sector opposes the bidding system.

REALITY: In addition to the 167 economists and bidding experts who have expressed grave concerns about the bidding program, 30 consumer and patient advocacy organizations have called for a halt to the bidding system. Those groups include the ALS Association, the Brain Injury Association of America, the Christopher and Dana Reeve Foundation, the International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema and COPD Association, the National Council on Independent Living, the National Spinal Cord Injury Association, and United Spinal Association, among others.

These consumer groups support H.R. 1041, a bill in the U.S. House of Representatives that would eliminate the bidding program. The bipartisan bill has 145 cosponsors so far, including roughly equal proportions of Republicans and Democrats.

MYTH #5: The bidding system is good for Medicare beneficiaries.

REALITY: In January 2011, round one of the bid program was implemented in nine metropolitan areas. Since then, more than 500 patients, clinicians, and homecare providers have reported:

— Difficulty finding a local equipment or service provider;

— Delays in obtaining medically required equipment and services;

— Longer than necessary hospital stays due to trouble discharging patients to home-based care;

— Far fewer choices for patients when selecting equipment or providers Reduced quality; and

— Confusing or incorrect information provided by Medicare.

Source: American Association for Homecare




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