Intestine Crucial To Function Of Immune Cells, Research Shows

Main Category: Immune System / Vaccines
Also Included In: GastroIntestinal / Gastroenterology;  Arthritis / Rheumatology;  Multiple Sclerosis
Article Date: 15 Dec 2011 – 0:00 PST

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Researchers at the University of Toronto have found an explanation for how the intestinal tract influences a key component of the immune system to prevent infection, offering a potential clue to the cause of autoimmune disorders like rheumatoid arthritis and multiple sclerosis.

“The findings shed light on the complex balance between beneficial and harmful bacteria in the gut,” said Prof. Jennifer Gommerman, an Associate Professor in the Department of Immunology at U of T, whose findings were published online by the scientific journal, Nature. “There has been a long-standing mystery of how certain cells can differentiate between and attack harmful bacteria in the intestine without damaging beneficial bacteria and other necessary cells. Our research is working to solve it.”

The researchers found that some B cells – a type of white blood cell that produces antibodies – acquire functions that allow them to neutralize pathogens only while spending time in the gut. Moreover, this subset of B cells is critical to health.

“When we got rid of that B-cell function, the host was unable to clear a gut pathogen and there were other negative outcomes, so it appears to be very important for the cells to adopt this function in the gut,” said Prof. Gommerman, whose lab conducted the research in mice.

Textbook immunology – based mostly on research done in the spleen, lymph nodes or other sterile sites distant from gut microbes – has suggested that B cells develop a specific immune function and rigidly maintain that identity. Over the last few years, however, some labs have shown the microbe-rich environment of the gut can induce flexibility in immune cell identity.

Prof. Gommerman and her colleagues, including trainees from her lab Drs. Jörg Fritz, Olga Rojas and Doug McCarthy, found that as B cells differentiate into plasma cells in the gut, they adopt characteristics of innate immune cells – despite their traditional association with the adaptive immune system. Specifically, they begin to look and act like inflammatory cells called monocytes, while maintaining their ability to produce a key antibody called Immunoglobulin A.

“What intrigued us was that this theme – B cells behaving like monocytes – had been seen before in fish and in vitro. But now we have a living example in a mammalian system, where this kind of bipotentiality is realized,” said Prof. Gommerman.

This B-cell plasticity provides a potential explanation how cells dedicated to controlling pathogens can respond to a large burden of harmful bacteria without damaging beneficial bacteria and other cells essential for proper function of the intestine.

It also may explain how scientists had failed to appreciate the multi-functionality of some B cells. “There are classical markers immunologists use to identify B cells – receptors that are displayed on their surface – and most of them are absent from plasma cells,” said Prof. Gommerman. “So in some cases, what people thought was a monocyte could have been a plasma cell because it had changed its surface identity, although monocytes play an important role in innate immunity as well.”

This transformational ability, the researchers also found, is dependent on bacteria called commensal microflora that digests food and provides nutrients. That relationship highlights the importance of the gut in fighting infection, and begs the question of whether plasma cells trained in the gut to secrete specific anti-microbial molecules can play a role in other infectious disease scenarios, such as food-borne listeria infection.

It also opens a line of investigation into whether a systemic relationship exists between those anti-microbial molecules and healthy cells in sites remote from the intestine. Understanding the nature of that relationship could improve understanding of inflammatory mechanisms in autoimmune disorders such as lupus, rheumatoid arthritis and multiple sclerosis, in which immune cells attack and eventually destroy healthy tissue.

But the next step, said Prof. Gommerman, is to look at human samples for the same type of multi-potentiality they saw in rodent plasma cells that acquired their anti-microbial properties in the gut.

“We’re really at the early stages of understanding what we call the microbiome in the gut,” said Prof. Gommerman. “There is a role for plasma cells in many autoimmune diseases, and B cells can do a lot more than just make antibodies. We need to understand the full spectrum of their effects within the immune response.”

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Not All NJ Youngsters Are Equal When It Comes To Use Of Dental Services

Main Category: Dentistry
Also Included In: Pediatrics / Children’s Health;  Health Insurance / Medical Insurance;  Medicare / Medicaid / SCHIP
Article Date: 14 Dec 2011 – 1:00 PST

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When it comes to receiving dental care, New Jersey has its share of underserved children, according to a Rutgers study.

In 2009, more than one-fifth of the state’s children between 3 and 18 received no dental care within the previous year. While an improvement over 2001, when almost one-third of the state’s children received no care, the study found that foreign-born children and those without health insurance were still likely to forgo visits to the dentist.

The Facts Findings report, New Jersey Children without Dental Services in 2001 and 2009, was prepared by Rutgers’ Center for State Health Policy (CSHP). The study used data from the center’s 2001 and 2009 New Jersey Family Health surveys (NJFHS) to describe the characteristics of children ages 3 to 18 who received no dental services within a year. The report concludes that generally, New Jersey’s children experienced improved access to dental care between surveys but that gaps remain largely based on race/ethnicity, health insurance status and family income.

The NJFHS, funded by the Robert Wood Johnson Foundation, provides population-based estimates of health care coverage, access, use and other topics important for New Jersey policy formulation and evaluation.

Many groups recommend regular trips to the dentist for children. An American Dental Association report calls for regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth and no later than the child’s first birthday. An American Academy of Pediatric Dentistry advisory calls for a dental check-up at least twice a year for most children.

“Tooth decay remains one of the most preventable common chronic diseases among children,” said José Nova, research project coordinator and lead author of the study. He cited a U.S. Surgeon General report that tooth decay affects more than 25 percent of American children ages 2 to 5 and 50 percent of those ages 12 to 15.

CSHP found that the percentage of study-age children without dental care in the previous year decreased between surveys by 11 percentage points to 22 percent in 2009. A high percentage of Hispanic children did not have a dental visit in each year (51 percent and 38 percent, respectively). By about a 2 to 1 margin, non-Hispanic black children were also less likely than white children to have had a visit to the dentist in each survey year. This group, however, also experienced the most improvement: nonvisitors fell 18 points to 28 percent in 2009.

Health insurance status is a major determinant of dental care utilization, the research found. The rate of uninsurance for New Jersey children fell by almost 50 percent to 7 percent in 2009, but the percentage of uninsured children who went without dental care increased from 68 percent to 76 percent. The large majority of publicly insured children are covered by Medicaid/NJ Family Care. Still, about one-third did not see a dentist in 2009. Children with employer-sponsored or privately purchased insurance were much more likely to receive dental care.

Youngsters in families with incomes less than double the federal poverty level (FPL) were less apt to receive dental care. About half of children whose family’s income was below the FPL did not see a dentist in both 2001 and 2009. Also, foreign-born children were much more likely to lack dental care than U.S.-born children with or without an American-born parent.

The report also called well-care doctor visits an important indicator of the likelihood of a child receiving dental care, perhaps due to concerted efforts to increase dental referrals in managed care plans and the expansion of dental care in federally qualified health centers. “The odds were three times as great for children who did not have a well-child doctor visit in the past year to not receive dental care as those who visited a doctor,” Nova said. He added that care for underserved youngsters could be improved with expanded health coverage under the Patient Protection and Affordable Care Act.

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Bilateral Oophorectomy Associated With Higher Prevalence Of Low Bone Mineral Density And Arthritis In Younger Women

Main Category: Arthritis / Rheumatology
Also Included In: Bones / Orthopedics
Article Date: 09 Dec 2011 – 2:00 PST

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Women who underwent surgery to remove their ovaries before the age of 45 years were more likely to have arthritis and low bone mineral density compared with women with intact ovaries, researchers found.

Anne Marie McCarthy, Sc.M., a doctoral candidate in epidemiology at Johns Hopkins Bloomberg School of Public Health, presented the results at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium, held Dec. 6-10, 2011.

“Our study suggests that some women with oophorectomy, particularly at a young age, can experience clinically relevant decreases in bone mineral density (BMD). Clinicians need to be aware of this so they can intervene early if required,” McCarthy said.

She and senior investigator Kala Visvanathan, M.D., MHS, associate professor at Johns Hopkins Sidney Kimmel Cancer Center and Bloomberg School of Public Health, examined associations of oophorectomy with arthritis and BMD in the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative survey conducted from 1988 to 1994.

The BMD analysis included 3,660 women, and the arthritis analysis included 4,039 women. Women aged 40 years and older who had no cancer history and reported a bilateral oophorectomy or intact ovaries were included for analysis.

Researchers used dual-energy X-ray to measure BMD in the femoral neck.

Women who had both ovaries removed before 45 years of age and who never used HRT had a lower BMD on average than women with intact ovaries (0.691 g/cm2 vs. 0.729 g/cm2, respectively). They were also twice as likely to have very low bone mineral density compared to women with intact ovaries.

Participants were also asked if they had been diagnosed with arthritis. Researchers found that 45.4 percent of women who had oophorectomy reported arthritis compared with 32.1 percent of women with intact ovaries. They found a higher prevalence of arthritis 47.7 percent among women who had undergone oophorectomy before 45 years of age.

“[The study] highlights the need for more research in this area to identify those women at risk and to determine appropriate screening and preventive strategies for these young women,” McCarthy said.

She added that NHANES III is a cross-sectional study, so “therefore, we cannot make statements on whether oophorectomy actually causes osteoporosis or arthritis at this time.”

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First-Of-Its-Kind Study Finds Public Health Insurance Coverage For Infants Is More Comprehensive And Costs Less Than Private Plans

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pediatrics / Children’s Health;  Health Insurance / Medical Insurance
Article Date: 09 Dec 2011 – 0:00 PST

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In the fierce national debate over a new federal law that requires all Americans to have health insurance, it’s widely assumed that private health insurance can do a better job than the public insurance funded by the U.S. government.

But a first-of-its-kind analysis of newly available government data found just the opposite when it comes to infants covered by insurance.

Among the insured, infants in low-income families are better off under the nation’s government-funded public health insurance than infants covered by private insurance, says economist and study author Manan Roy, Southern Methodist University, Dallas. The finding emerged from an analysis that was weighted for the fact that less healthy infants are drawn into public health insurance from birth by its low cost.

The finding is surprising, says Roy, because the popular belief is that private health insurance always provides better coverage. Roy’s analysis, however, found public health insurance is a better option – and not only for low-income infants.

“Public health insurance gets a lot of bad press,” says Roy. “But for infants who are covered by health insurance, the government-funded insurance appears to be more efficient than private health insurance – and can actually provide better care at a lower cost.”

Why?

“Private health insurance plans vary widely,” Roy says. “Many don’t include basic services. So infants on more affordable plans may not be covered for immunizations, prescription drugs, for vision or dental care, or even basic preventive care.”

The U.S. doesn’t have a system of universal health insurance. But the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010, requires all Americans to have health insurance. The act also expands government-paid free or low-cost Medicaid insurance to 133 percent of the federal poverty level.

“Given the study’s surprising outcome, it’s likely that the impact of national reforms to bring more children under public health insurance will substantially improve the health of infants who are in the worst health to begin with,” Roy says. “It’s likely to also help infants who aren’t low-income.”

Roy presented her study, “How Well Does the U.S. Government Provide Health Insurance?” at the 2011 Western Economic Association International Conference, San Diego. Roy is a Ph.D. student and an adjunct professor in SMU’s Department of Economics.


Study weighted to account for less healthy infants covered under public health insurance

A large body of previous research has established that insured infants are healthier than uninsured infants. Roy’s study appears to be the first of its kind to look only at insured infants to determine which kind of insurance has the most impact on infant health – private or public.

Roy found:

  • Infants covered by public insurance are mostly from disadvantaged backgrounds. Those under Medicaid and its sister program – CHIP – come mostly from lower-income families. Their parents – usually black and Hispanic – are more likely to be unmarried, younger and less educated. Economists refer to this statistical phenomenon – when a group consists primarily of people with specific characteristics – as strong positive or negative selection. In the case of public health insurance, strong negative selection is at work because it draws people who are poor and disadvantaged.
  • Infants on public health insurance are slightly less healthy than infants on private insurance. On average they had a lower five-minute Apgar score and shorter gestation age compared to privately insured infants. They were less likely to have a normal birth weight and normal Apgar score range, and were less likely to be born near term.
  • Infants covered by private health insurance are mostly from white or Asian families and are generally more advantaged. They are from higher-income families, with older parents who are usually married and more educated. Their mothers weigh less than those of infants on public insurance. This demonstrates strong positive selection of wealthier families into private health insurance.
  • Roy then compared the effect of public insurance on infant health in relation to private health insurance. To do that, she used an established statistical methodology that allows economists to factor negative or positive selection into the type of insurance. In comparing public vs. private insurance – allowing for strong negative selection into public health care – a different picture emerged.

“The results showed that it’s possible to attribute the entire detrimental effect of public health insurance to the negative selection that draws less healthy infants into public health insurance,” Roy says.

In fact, in a most striking revelation, allowing for a modest to significant amount of negative selection of infants into public health insurance, Roy’s findings suggest that among the insured population of infants, private health insurance is detrimental to child health.

“The real surprise with these findings is that despite a less healthy population – due to the negative factors created by poverty – public health insurance is actually improving the health of these infants,” Roy says.


Public health insurance provides more comprehensive benefits

The findings are less surprising upon deeper analysis.

  • A previous study by the nonpartisan Center on Budget and Policy Priorities sheds light on Roy’s research. That group found that public health insurance provides more comprehensive benefits than private insurance. For example, all children on Medicaid and CHIP receive preventive and primary medical care, inpatient and outpatient care, pediatric vaccines, laboratory and X-ray services, prescription drugs, immunizations, and dental, vision and mental health care coverage.
  • The Medical Expenditure Panel Survey collected by the U.S. Department of Health and Human Services found that on a per person basis, government-provided health insurance for children under 4 years old is cheaper on average compared to private health insurance plans.

“Enrollees in private health insurance can choose from a wide variety of plans,” Roy says. “Those who cut their costs by purchasing less coverage are reducing their access to quality care, including basic services like preventive care, prescription drugs, and vision and dental care.”

Roy says she can only speculate why infants from advantaged and disadvantaged families differ in their health outcomes. It’s possible, however, that infants from families that are better off have access to better nutrition, a healthier lifestyle and possibly safer, cleaner neighborhoods than those from poorer backgrounds.

“Poor families and their infants may be subsisting on cheap food, for example, which tends to be fatty and less nutritious,” Roy says, “and that translates to worse health.”


Study relied on new U.S. government data on thousands of infants

Roy’s statistical analysis drew on data from more than 7,500 infants born in 2001. The data were the most recent available from the Early Childhood Longitudinal Study-Birth Cohort, released by the National Center for Education Statistics, U.S. Department of Education.

The Early Childhood Longitudinal Study follows children born in the United States from birth through the start of kindergarten. Children are from diverse socioeconomic and racial/ethnic backgrounds. Data were gathered from parents, teachers and providers of child care and early education.

Data collected cover children’s health, care, education and cognitive, social, emotional and physical development over time. Included are standard infant health measures like length, infant weight, five-minute Apgar score, and the number of weeks the child was in the womb, which is considered an indicator of birth weight.

Poor families living at or below 185 percent of the federal poverty level represented 49 percent of Roy’s data set.

Demand for public health insurance has increased during the past decade, says Roy, while demand for private insurance has declined. Specifically, between 1999 and 2009 there was an increase in the overall proportion of children under 3 years of age who were insured. Of those, the proportion covered by private insurance declined. The proportion covered by public health insurance increased.

Other researchers have firmly established that infants who are covered by health insurance have timely access to quality care, Roy says. Expanding access could reduce, for example, the number of infants born with low birth weight, which is associated with chronic medical diseases like diabetes, hypertension and heart disease in adulthood. Low birth weight also has been linked to lower average scores on tests of intellectual and social development.

The United States has the highest infant mortality rate among developed nations due to low birth weight and is the only industrialized nation without universal health insurance. The U.S. Supreme Court has agreed to hear a legal challenge to the Obama administration’s new law requiring everyone have health insurance.

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Many Women Not Receiving Recommended Breast Cancer Adjuvant Treatment

Main Category: Breast Cancer
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 08 Dec 2011 – 1:00 PST

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A first-of-its kind study led by Xiao-Cheng Wu, MD, MPH, Associate Professor of Public Health at LSU Health Sciences Center New Orleans, reports that a significant number of women are not receiving guideline-recommended treatment for breast cancer and what factors contribute. The research is published online in the Journal of Clinical Oncology.

The research team, which also included Vivien Chen, PhD, Professor and Director of the Louisiana Tumor Registry at LSU Health Sciences Center New Orleans School of Public Health, explored how race/ethnicity, insurance status, poverty, education, and hospital type were associated with the delivery of guideline-recommended adjuvant systemic therapy for breast cancers. Adjuvant systemic therapies like chemotherapy, a regimen of a group of specific chemotherapy drugs, and hormone therapy often follow an initial treatment like surgery to treat cells that may be too small to be seen and to reduce the chances of recurrence. Decisions about whether or not adjuvant systemic therapies are indicated, and which type, are determined by lymph node status, histology, tumor size, grade, and hormonal receptor status. The National Comprehensive Cancer Network (NCCN) guidelines were developed to improve cancer care and survival.

For this very large study of 6,734 women using Pattern of Care data from population-based cancer registries, the researchers grouped women by whether or not they received chemotherapy, chemotherapy regimen, or hormone therapy, according to the NCCN guidelines. The researchers found that 35% of the women studied received non-guideline chemotherapy (either no chemotherapy although recommended or use of chemotherapy when not recommended), 12% received non-guideline regimens (not treated with the chemotherapy drugs recommended), and 20% received non-guideline hormone therapy.

Significant predictors of non-guideline chemotherapy included Medicaid insurance, high poverty, and treatment at hospitals not accredited as Commission on Cancer (CoC) hospitals by the American College of Surgeons. Predictors of non-guideline regimens of specific chemotherapy drugs included lack of insurance and low education. Predictors of non-guideline hormone therapy included high poverty and treatment at non-CoC hospitals.

Previous studies focused primarily on racial differences and did not examine an association with poverty. This study found that women residing in high-poverty areas were less likely to receive guideline therapy. However, a number of other socioeconomic status factors may also contribute.

While women with Medicaid were less likely to receive guideline chemotherapy compared to women privately insured, uninsured women were not less likely to receive chemotherapy and hormone therapy according to the guidelines. They were, however, less likely to receive the recommended chemotherapy regimens than privately insured women. One of the reasons may be that uninsured women are often younger than privately insured women. Because younger women are more likely to receive chemotherapy than older women, the association may be diluted.

Not surprisingly, women were less likely to receive treatment according to the guidelines in hospitals not accredited by the American College of Surgeons. This is probably due to the multi-specialty approach, comprehensive care, and commitment to ongoing monitoring and improvement of cancer care by CoC hospitals. Women treated at CoC hospitals may also have greater access to oncology consultations.

“Guideline-recommended adjuvant systemic therapies for breast cancer are not disseminated proportionally in the community,” notes Dr. Wu, who is also Assistant Director of the LSU Health Sciences Center New Orleans’ Louisiana Tumor Registry. “Socioeconomically disadvantaged and medically under-served women are less likely to receive guideline therapies. Underlying causes for the disparities need to be identified so we can target interventions to help improve care and cancer prognosis for women across the board.”

According to the American Cancer Society, breast cancer is the most frequently diagnosed cancer in women, excluding cancers of the skin. An estimated 232,620 new cases of breast cancer are expected to be diagnosed this year, with 39,970 deaths.

The study was funded by the Centers for Disease Control and Prevention’s National Program of Cancer Registries. Besides LSU Health Sciences Center New Orleans School of Public Health, the team included researchers from Emory University, Duke University Medical Center, the Centers for Disease Control and Prevention, the University of Kentucky, the University of Wisconsin, and the California Cancer Registry.

“This is an example of how registry data, in conjunction with special studies, can help to ensure quality care for every cancer patient in Louisiana and beyond,” concludes Dr. Vivien W. Chen, Professor of Public Health and Director of LSU Health Sciences Center New Orleans’ Louisiana Tumor Registry.

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Rare Gene Variants Critical For Personalized Drug Treatment Discovered By Pharmacogenomics Study

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: Pharma Industry / Biotech Industry;  Pediatrics / Children’s Health;  Arthritis / Rheumatology
Article Date: 06 Dec 2011 – 2:00 PST

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The use of genetic tests to predict a patient’s response to drugs is increasingly important in the development of personalized medicine. But genetic tests often only look for the most common gene variants. In a pharmacogenomics study published online in Genome Research, researchers have characterized rare genetic variants in a specific gene that can have a significant influence in disposition of a drug used to treat cancer and autoimmune disease, a finding that will help improve the effectiveness of personalized care.

The drug methotrexate is used to treat cancers such as acute lymphoblastic leukemia, and autoimmune diseases including rheumatoid arthritis. Common genetic variants in the SLCO1B1 gene, which encodes a transporter in the liver important for clearance of medication from the body, are present in 10-15% of the population and affect the efficiency of methotrexate clearance from the body.

Low clearance of methotrexate results in high levels in the blood and increased side effects. Rare variants could also significantly affect drug clearance, but the influence of rare versus common SLCO1B1 variants in methotrexate clearance had not yet been explored.

In this report, an international team of researchers sequenced the exons of SLCO1B1, the gene regions that code for protein, in a cohort of pediatric patients receiving methotrexate, finding rare genetic variants that have an effect on the efficiency of clearance of the drug from the body. “We showed that rare inherited genomic variants, present in as few as 1 in 699 people, account for a significant percentage of variability in blood levels of methotrexate,” said Dr. Mary Relling of St. Jude Children’s Research Hospital, senior author of the study. “This means that the high blood levels present in 2% of people are due to very rare genetic variants.”

The research group then utilized computational algorithms to predict the potential negative impact of genomic variants identified in this study on function of the SLCO1B1 protein in the transport of methotrexate. They then tested these predictions in laboratory cell lines, confirming that these genetic variants conferred lower transport of the drug.

“Our discovery of important but rare coding variants in SLCO1B1 not only has implications for methotrexate, but also possibly for other drugs,” explained Dr. Laura Ramsey of St. Jude Children’s Research Hospital, primary author of the study. Ramsey noted that SLCO1B1 variants are tested to inform choice of the appropriate dosage of statins, commonly used to treat or prevent high cholesterol.

Ramsey added that clinical genetic tests are currently limited, generally only testing for the most common SLCO1B1 variants. “Our findings that there are additional rare functional coding variants in this gene suggest that genotyping tests would need to expand to include rare variants in order to avoid false negative test results.”

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Scientists from St. Jude Children’s Research Hospital (Memphis, TN), Aarhus University (Aarhus, Denmark), MD Anderson Cancer Center (Houston, TX), the University of Tennessee Health Science Center (Memphis, TN), the Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD), and the University of California, San Francisco (San Francisco, CA) contributed to this study.
This work was supported by the National Institute of General Medical Sciences’ Pharmacogenomics Research Network, the National Cancer Institute, the National Institute of Child Health and Human Development, and the American Lebanese Syrian Associated Charities (ALSAC).

About the article: The manuscript will be published online ahead of print on December 6, 2011. Its full citation is as follows: Ramsey LB, Bruun GH, Yang W, Trevino LR, Vattathil S, Scheet P, Cheng C, Rosner GL, Giacomini KM, Fan Y, Sparreboom A, Mikkelsen TS, Corydon TJ, Pui C, Evans WE, Relling MV. Rare versus common variants in pharmacogenetics: SLCO1B1 variation and methotrexate disposition. Genome Res doi: 10.1101/gr.129668.111.

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Spatiotemporal Signals Guide Stem Cell Changes Enabling Engineering Of Cartilage Replacements

Main Category: Bones / Orthopedics
Also Included In: Arthritis / Rheumatology;  Sports Medicine / Fitness;  Stem Cell Research
Article Date: 05 Dec 2011 – 1:00 PST

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A lab discovery is a step toward implantable replacement cartilage, holding promise for knees, shoulders, ears and noses damaged by osteoarthritis, sports injuries and accidents.

Self-assembling sheets of mesenchymal stem cells permeated with tiny beads filled with growth factor formed thicker, stiffer cartilage than previous tissue engineering methods, researchers at Case Western Reserve University have found. A description of the research is published in the Journal of Controlled Release.

“We think that the capacity to drive cartilage formation using the patient’s own stem cells and the potential to use this approach without lengthy culture time prior to implantation makes this technology attractive,” said Eben Alsberg, associate professor in the departments of Biomedical Engineering and Orthopaedic Surgery, and senior author of the paper.

Alsberg teamed with biomedical engineering graduate students Loran D. Solorio and Phuong N. Dang, undergraduate student Chirag D. Dhami, and Eran L. Vieregge, a student at Case Western Reserve School of Medicine.

The team put transforming growth factor beta-1 in biodegradable gelatin microspheres distributed throughout the sheet of stem cells rather than soak the sheet in growth factor.

The process showed a host of advantages, Alsberg said.

The microspheres provide structure, similar to scaffolds, creating space between cells that is maintained after the beads degrade. The spacing results in better water retention – a key to resiliency.

The gelatin beads degrade at a controllable rate due to exposure to chemicals released by the cells. As the beads degrade, growth factor is released to cells at the interior and exterior of the sheet, providing more uniform cell differentiation into neocartilage.

The rate of microsphere degradation and, therefore, cell differentiation, can be tailored by the degree to which the microsphere are cross-linked. Within the microspheres, the polymer is connected by a varying number of threads. The more of these connections, or cross-links, the longer it takes for enzymes the cell secretes to enter and break down the material.

The researchers made five kinds of sheets. Those filled with: sparsely cross-linked microspheres containing growth factor, highly cross-linked microspheres containing growth factor, sparsely cross-linked microspheres with no growth factor, highly cross-linked microspheres with no growth factor, and a control with no microspheres. The last three were grown in baths containing growth factor.

After three weeks in a petri dish, all sheets containing microspheres were thicker and more resilient than the control sheet. The sheet with sparsely crosslinked microspheres grew into the thickest and most resilient neocartilage.

The results indicate that the sparsely cross-linked microspheres, which degraded more rapidly by cell-secreted enzymes, provided a continuous supply of growth factor throughout the sheets that enhanced the uniformity, extent, and rate of stem cell differentiation into cartilage cells, or chondrocytes.

The tissue appeared grossly similar to articular cartilage, the tough cartilage found in the knee: rounded cells surrounded by large amounts of a matrix containing glycosaminoglycans. Called GAG for short, the carbohydrate locks water ions in the tissue, which makes the tissue pressure-resistant.

Testing also showed that this sheet had the highest amount of type II collagen – the main protein component of articular cartilage.

Although the sheet was significantly stiffer than control sheets, the mechanics still fell short of native cartilage. Alsberg’s team is now working on a variety of ways to optimize the process and make replacement cartilage tough enough for the wear and tear of daily life.

One major advantage of this system is that it may avoid the troubles and expense of growing the cartilage fully in the lab over a long period of time, and instead permit implantation of a cartilage sheet into a patient more rapidly.

Because the sheets containing microspheres are strong enough to be handled early during culturing, the researchers believe sheets just a week or two old could be used clinically. The mechanical environment within the body could further enhance cartilage formation and increase strength and resiliency of the tissue, completing maturation.

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High Level Of Waste In Health Spending, Says Medicare And Medicaid Boss

Editor’s Choice
Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance;  Public Health
Article Date: 04 Dec 2011 – 10:00 PST

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4.69 (16 votes)

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4.29 (14 votes)

Article Opinions: 1 posts

Dr. Donald M. Berwick, head of Medicare and Medicaid until last Thursday, stated that up to 30% of spending on health is wasted with absolutely no benefit to beneficiaries (patients). He added that his agency’s cumbersome and archaic regulations are partly to blame. He claims too many resources and too much time is dedicated to things that do not help patients one bit; something doctors are fully aware of too.

In an interview last Thursday, Dr. Berwick said:

“Much is done that does not help patients at all,
and many physicians know it.”

During the interview, Berwick talked about the previous 17 months, while he was at the helm as Administrator of the Centers for Medicare and Medicaid Services, his failures, successes and frustrations, and dealing with criticisms from Republican lawmakers.

Berwick’s appointment, which was to expire at the end of 2011, was done in a way that drew criticisms from both sides of the House. President Barak Obama nominated him in April 2010, then there was an investigation regarding his qualifications, subsequently a temporary recess appointment was given to bypass Congress.

In Thursday’s interview, Berwick said:

“I did not even know if I was fit for it. I came with an agenda. I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

Government is much more complex than he had realized

Berwick went on to explain that the new health legislation is a “..complex and complicated” one. It is a law that takes time to explain properly. “To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.” He admitted that government is much more complex than he had realized.

Berwick had been President of the Institute for Healthcare Improvement, an organization that trains health professionals; a much faster-moving environment compared to public office. Being a federal official would sometimes infuriate him, because of the much slower pace.

Even so, because of the new law’s ultimate destination, it should be supported, Berwick stressed. He gave the manned moon missions as an example – people did not fully understand the intricacies of rocket science, but supported the ultimate aim of the mission.

Dr. Berwick said:

“We are a nation headed for justice, for fairness and justice in access to care. We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

If up to 30% of Medicare and Medicaid’s spending is being needlessly squandered, reigning in that waste could save between $150 billion and $250 billion annually.

Dr. Berwick said:

“I wish they (government) could go faster. I don’t think you want government to be impulsive. You want it to be regulated, with just a tad of conservatism.”

Berwick listed five reasons for the enormous waste in health spending:

  • Patients are overtreated
  • There is not enough coordination of care
  • US health care is burdened with an excessively complex administrative system
  • The enormous burden of rules
  • Fraud

Donald M. Berwick (born 1946)

Donald Berwick CMS Administrator
Dr. Donald M. Berwick, Administrator of the Centers for Medicare and Medicaid Services, July 7, 2010 – December 2, 2011

Dr. Berwick was nominated to be Administrator of the Centers for Medicare and Medicaid on April 19th, 2010. Some newspapers at the time commented that he might be able to reduce health care costs. He was criticized by Republicans regarding some comments he had made about health care, saying it involves a redistribution of wealth, rationing care with “our eyes open”.

In the United Kingdom there is universal healthcare, everyone is covered, and healthcare spending represents less than 7% of the country’s GDP. The USA, on the other hand, spends over 17% of GDP on healthcare and has over 50 million people with no coverage at all, and tens of millions more with inadequate coverage. Berwick advocated adopting some of the NHS (National Health Service) approaches of the UK and its NICE (National Institute for Health and Clinical Excellence). NICE decides which therapies and drugs are covered by the NHS.

Conservatives dubbed him “Obama’s rationing man.” They said NICE decides what treatments people can and cannot have in the UK. This is untrue – NICE decides which treatments and therapies people will get free (if NICE does not approve it, private health care can still offer it, if it is approved by another national regulatory agency, the MHRA, the UK equivalent of the FDA).

Honors and Awards

Dr. Berwick has received the following honors and awards:

  • 1999 – Ernest A. Codman Award
  • 2001 – Alfred I. DuPont Award for excellence in children’s healthcare
  • 2002 – American Hospital Association, “Award of Honor”
  • 2004 – Fellow of the Royal College of Physicians in London
  • 2005 – Honorary Knight Commander of the Most Excellent Order of the British Empire
  • 2007 – Purpose Prize
  • 2007 – The 13th Annual Heinz Award for Public Policy

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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figures

posted by Rider on 4 Dec 2011 at 10:43 am

Now my doctor wants 65$ a month/780$ yr more for “optimal care” program, with a limited number of members, that’s in addition to what I already pay for insurance thru my employer.
– I won’t be getting optimal care and will be shopping for another doctor–all the new program did was filter out more people–brilliant program-make it so only the ones who can afford it attend.

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Everyday Health Network

Younger Americans’ Health Disparity Gets Worse

Editor’s Choice
Academic Journal
Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance;  Medicare / Medicaid / SCHIP
Article Date: 02 Dec 2011 – 12:00 PST

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There is a growing disparity between healthy and sick Americans born after 1980, caused by various factors, including a widening income gap, obesity which tends to hit certain income and ethnic groups more, access to health care services, and some other factors, researchers from Ohio State University wrote in American Sociological Review.

The authors added that the difference in the health of people gets wider as they approach and reach middle age, before closing during old age.

This being the case, the researchers predict that over the next couple of decades, as younger generations get older and replace existing ones, differences will widen.

Lead Hui Zheng, said:

“As young people today reach middle age and preceding cohorts with a smaller health gap die off, we expect health disparities in the whole population to grow even larger.”

The trend has been for disparities to widen – a future widening gap will obviously depend on whether this trend continues.

Zheng added:

“If that trend continues, as I expect it will, health disparities in the whole population will increase in the coming decades.”

The researchers explain that the health disparity has not always been widening. In fact, during the first half of the 20th century the health gap closed decade after decade. From the late 1960s the gap started widening, and then progressively faster after 1980.

The authors say their study is one of the most comprehensive yet to illustrate clearly and compellingly how wide health disparities have become in the USA. They say it is because of “a methodological innovation”.

They combined two statistical models which let them see how health disparities are, in the long-term, affected by three factors – people’s age, when they were born, and when their health was assessed.

Zheng said:

“We have never before been able to look at all three of these factors together and see how each interacts with the others to affect changes in health disparities.”

The researchers gathered data from the National Health Interview Survey over a 24-year span (1984-2007). Approximately thirty-thousand people were added to the database each year.

In the survey, respondents were asked to rate their health on a scale from one to five – with five being “excellent”.

They factored in elements which may influence their results, such as race, gender, marital status, income, education and work status.

The authors found that those born between 1955 and 1964 – the late baby boomers – appeared to enjoy better health than any other age group. They also found that overall self-rated health has deteriorated considerably since the end of the 1990s.

The largest gap in people’s state of health exists in Americans who were born from 1980 onwards.

This study was not designed to find out why health disparities got worse, the authors explained. Zheng says additional research is required in this area.

Some factors are probably linked to the widening health gap, such as income inequality, which has got progressively worse in America during the last thirty years. Income inequality impacts on access to health care and other resources which affect health. For example, eating junk or fast foods is generally cheaper than fresh fruit and vegetables and wholesome products.

Other factors include obesity rates across all age groups, as well as an increase in the immigrant population (documented and undocumented).

Access to medical and health information has changed considerably over the last three decades, because of the emergence of the Internet. There is a growing digital divide in the country, i.e. one part of the population is moving ahead in leaps and bounds as their access to medical and health information explodes, while another part is not.

If current young adults have a widening health gap, in the years to come this gap will grow as they reach middle age and replace current middle agers whose health gap is smaller.

Zheng said that most young people enjoy better health compared to older age groups – this fact keeps disparities to a minimum. People develop diseases, conditions and other health problems as they get older, resulting in more disparity. After middle age, disparities become narrower – this is partly because a higher percentage of sick people die, while the healthier ones remain.

Another reason for narrower disparities in old age is the similarity of health conditions and illnesses in this age group – older people have similar risk factors and frailties. Also, Medicare covers Americans over the age of 65, making access to health care for this age group more equal across the spectrum of society.

Zheng and team also report that during early adulthood males tend to enjoy better health than females of the same age. The disparity gradually narrows until the age of 61 years, when chronic conditions afflict the male population more.

Their study focused on health, Zhen said. However, the data they gathered and analyzed could also be used for studies on gaps in education, wealth and income.

Zheng said:

“This model provides a powerful framework to identify and study the evolution of inequalities across age, period and cohorts.”

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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Everyday Health Network

Freedom Alert – the gift that could save a life!

December is all about gift giving and showing loved one how much you can.  This year, if you have a friend or family member that is currently using a “Pay by the Month” emergency monitoring service, also known as PERS personal emergency response service, you know, you’ve see advertised on TV.  Think about getting them the best system ever and at the same time remove that monthly debt that is causing many seniors to suffer needlessly.

I’m talking about the Freedom Alert system.  This is the latest technology in PERS and there is NO MONTLY FEE!

Unlike the old systems that are offered on the TV commercials the Freedom Alert actually allow you contact, who you want in times of trouble.  And best of all you can actually talk to and listen to them directly from a very small pendant.

But as they say on those annoying TV commercials “But wait there’s more”!

You can actually communicate with your call anywhere in your home and your YARD!

Try that with those monthly service guys.

The Freedom Alert let you enter up to 4 contact people as well as your local 911 service.  It come with everything needed including all batteries, there are no hidden extra fees or costs.  Your Freedom Alert can be used on any standard home phone line.  Many of our customers will pack up their unit and take it with them when they visit friends and family for an extended time.  Just simply plug it in when you get there it’s that simply.

For year the monthly monitoring companies have been straining seniors who are on a fixed income.  For about the same amount of 4 to 6 months rental cost they can OWN this system and never pay out another dime.  We recently spoke with one of our customers and learned that he had been paying the monthly rent for over 5 years.  Together we figured that he has spend over $5,000.00 when he could have paid only $279.95 (includes free shipping) and had that other $4,000.00 + to use for other important expenses in his life.

It’s time to end the financial drain on our seniors, it’s time for taking control over whom you contact for help when needed.  It’s time you considered the latest product available and end that monthly auto billing deduction.

It time you looked at Freedom Alert  – Contact up to 4 people + 911

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NO Activation Cost!

HealthConnection, Inc. is a factory authorized dealer for Freedom Alert.  Located in Ohio they ship anywhere in the United States.  You can call HealthConnection for additional information at 1-800-838-8367 or visit the website www.AnActiveLife.com

This holiday season give a gift that could save a life.  This is possible the best give you’ll ever give to that special loved one or dear friend.