Review of NHS drugs assessment ordered

Review of NHS drugs assessment ordered

  • 31 January 2016
  • From the section Scotland

DrugsImage copyright
Thinkstock

An independent review is to be carried out of the way drugs are assessed for use on the NHS in Scotland.

Former medical director for NHS Fife Dr Brian Montgomery will lead the study.

The review will look at how changes made to the Scottish Medicines Consortium (SMC) process in 2014 have affected patient access to medicines for rare and end-of-life conditions.

It will also examine how the system for getting patients access to newly-licensed drugs is working.

The SMC in an independent body that advises health boards about how effective medicines are and whether they represent value for money for the health service.

Announcing the review, Health Secretary Shona Robison said reforms had already been introduced by the SMC, designed to give more weight to the views of patients and clinicians when considering certain drugs.

‘Better quality lives’

She said: “Access to new medicines for rare or end-of-life conditions is an extremely complex issue.

“Over the last few years, this government hastaken a number of significant steps to improve the balance of these decisions and help patients get better access to treatments that can give them longer, better quality lives.

“Since we introduced our £90m New Medicines Fund and made changes to the SMC process in 2014, 26 medicines have been approved under the new system, and together with other reforms have benefited more than 1,000 patients in Scotland.

“However, with new treatments coming to market all the time, it is important to take stock of the progress to date to continually assure ourselves that our systems for assessing and accessing new drugs are keeping pace and meeting the expectations of patients.

“An important part of this is that the NHS pays a fair price for these new drugs.”

The review team is expected to report on its findings in the summer.

‘More time’

Dr Montgomery, a former GP, said he was looking forward to hearing a wide range of views on the topic.

Breast Cancer Now’s Scotland Director Mary Allison, said: “Women with incurable secondary breast cancer and those treating them need better access to innovative life-extending medicines.

“We believe that the systems in Scotland can work better to get a fairer deal for patients and the NHS.

“These drugs don’t only represent medical advances, they represent the hope of more time to see that last birthday, Christmas or holiday; they offer people a chance to share some more time with those they love.

“The solution is complicated and we welcome the fact that the systems in Scotland will be reviewed.”

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More than 2,100 pregnant Colombian women infected with Zika virus


More than 2,100 pregnant Colombian women are infected with the mosquito-borne Zika virus, the country’s national health institute said on Saturday, as the disease continues its spread across the Americas.

The virus has been linked to the devastating birth defect microcephaly, which prevents fetus’ brains from developing properly. There is no vaccine or treatment.

There are 20,297 confirmed cases of the disease in Colombia, the national health institute said in a epidemiology bulletin, among them 2,116 pregnant women.

There are so far no reported cases of microcephaly or deaths from the virus in Colombia.

The institute said 37.2 percent of pregnant women with Zika live in Norte de Santander province, along the eastern border with Venezuela.

Earlier figures from the health ministry showed 560 pregnant women had the disease, out of more than 13,500 infections.

Zika cases have been confirmed in 23 countries and territories in the Americas and scientists are racing to develop a vaccine for the virus.

Nearly half of Colombia’s Zika cases have been reported in the country’s Caribbean region, the bulletin said. More than 60 percent of those infected are women.

The health ministry has said Zika infection falls within the health requirements women must meet to get abortions in the country, which restricts the procedure unless patients are victims of rape, have significant medical problems or the fetus is fatally deformed.

Many women, especially those living far from large cities, struggle to find abortion providers even when they meet the legal requirements and illegal abortions are widespread.

The government has urged women to delay pregnancy for six to eight months to avoid potential infection. Officials expect up to 700,000 cases.

Brazil is the country hit hardest by the disease. It has reported around 3,700 cases of microcephaly strongly suspected to be related to Zika.

The World Health Organization has said as many as 4 million people in the Americas may become infected.

(Reporting by Julia Symmes Cobb; Editing by Meredith Mazzilli)


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Remicade co-developer funds new microscopy facility on Scripps Florida campus

The co-developer of Remicade®, one of the three top-selling drugs in the world, has donated more than $500,000 to fund what will be known as the Iris and Junming Le Foundation Super-Resolution Microscopy Facility on the Florida campus of The Scripps Research Institute (TSRI).

“We are grateful to Junming and Iris for their generous contribution,” said Chair of the TSRI Department of Neuroscience Ronald Davis, who will oversee the new facility. “The gift will have a dramatic and highly positive effect on the brain science pursued by our department. This is the perfect opening to what will be a genuinely state-of-the-art facility right here in Jupiter.”

The new donation will support the purchase of a powerful microscope that will give Scripps Florida neuroscientists an extraordinarily detailed view of the brain.

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“Our foundation gives money to the best institutions and hospitals to support basic medical research and patient care through those projects we think will be successful,” said Junming Le, chairman and director of The Iris and Junming Le Foundation and adjunct associate professor of microbiology at New York University School of Medicine. “This is certainly one of them. When I learned that this microscope could advance the understanding of the brain and its function, I realized this would be an important investment for us. That kind of information could lead to breakthroughs in diseases like Alzheimer’s.”

The new microscope will be one of the most advanced available. Known as a structured illumination microscope, the technology uses a super-imposed pattern (grate), taking multiple images at various angles. These images are then merged–effectively doubling the resolution of a traditional light microscope.

“With this super-resolution microscopy,” Davis said, “we will be able to see synapses between neurons and to actually count them–to determine, for example, if the number of neurons in a brain affected by Alzheimer’s or Parkinson’s disease is different than a normal brain. This is a nearly unimaginable leap forward.”

Source:

Scripps Research Institute

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Proton cancer therapy 'proves effective'

Proton beam cancer therapy ‘effective with fewer side effects’

By Dominic Howell
BBC News
  • 30 January 2016
  • From the section Health

Ashya KingImage copyright
AP

Image caption

Ashya King left the UK to have proton beam therapy in the Czech Republic

A cancer treatment at the centre of an NHS controversy in 2014 causes fewer side effects in children than conventional radiotherapy, according to new research.

The study, published in The Lancet Oncology, suggests proton beam therapy is as effective as other treatments.

Researchers looked at 59 patients aged between three and 21 from 2003 to 2009.

In 2014 the parents of Ashya King took him out of hospital in Hampshire to get the treatment abroad.

Their actions led to a police operation to find them.

Ashya, who was five at the time of his treatment, is now cancer free, his family said last year.

‘Acceptable toxicity’

All the patients who took part in the study, led by Dr Torunn Yock from the Massachusetts General Hospital in the US, had the most common kind of malignant brain tumour in children, known as medulloblastoma.

After five years, their survival rate was similar to that of patients treated with conventional X-ray radiotherapy, but there were fewer side effects to the heart and lungs, the study found.

Dr Yock told BBC Radio 5 live: “The major finding is that proton therapy is as effective as photon therapy [conventional X-ray radiotherapy] in curing these patients and what is also very exciting is that it is maintaining these high rates of cure but doing so with less late toxicity, which has dramatic quality of life improvements.”

The paper said: “Proton radiotherapy resulted in acceptable toxicity and had similar survival outcomes to those noted with conventional radiotherapy, suggesting that the use of the treatment may be an alternative to photon-based treatments.”

What is proton beam therapy?

Media captionAnimated graphic comparing traditional radiation treatment with proton beam therapy.

It uses charged particles instead of X-rays to deliver radiotherapy for cancer patients.

The treatment allows high-energy protons to be targeted directly at a tumour, reducing the dose to surrounding tissues and organs.

In general, it gives fewer side effects compared with high-energy X-ray treatments.

It can be used to treat spinal cord tumours, sarcomas near the spine or brain, prostate cancer, lung cancer, liver cancer and some children’s cancers.

Sources: NHS England, Cancer Research UK

Independent expert Prof Gillies McKenna, who is the head of the department of oncology at the University of Oxford, said the research suggested that the “side effects are indeed dramatically reduced” with proton beam therapy.

“There were no side effects seen in the heart and lungs and gastrointestinal tract, which are almost always seen with X-rays, and no secondary cancers were seen at a time when we would have expected to see them in X-ray treated patients,” he added.

But Dr Kieran Breen, from Brain Tumour Research, said there was still more research needed into the treatment.

“In the longer term, we need to try and understand what effects it will have on people and there are many other forms of tumour both in the brain and in other parts of the body,” he said.

Proton beam therapy is currently only available in the UK to treat eye cancers, but patients with other forms of cancer can apply for NHS funding for the therapy abroad.

The first proton beam facility in the UK is due to be made available in Newport by the end of 2016, as a “result of direct investment by the Welsh government,” according to a Welsh Assembly spokesman.

The Department of Health has said that from April 2018 the treatment will be offered to up to 1,500 cancer patients at hospitals in London and Manchester, following investment worth £250m.

Image copyright
Science Photo Library

Two years ago a dispute about the use of the treatment prompted Brett and Naghemeh King, of Southsea, Hampshire, to remove their son Ashya from a hospital in Southampton against his doctors’ advice.

The parents wanted their five-year-old to undergo proton beam therapy in Prague, which had not been recommended by his care team in Southampton.

Their actions sparked an international police manhunt, and the couple were later arrested and held in a prison in Madrid.

They were eventually released and Ashya’s therapy took place, with the NHS later agreeing to pay for it.

A spokesman for University Hospital Southampton NHS Foundation Trust, said that medulloblastoma was not currently on the list of tumours approved for this treatment on the NHS.

“However, we welcome any update to the existing clinical evidence on cancer treatments and will follow any expansion of the current national criteria,” a spokesman added.


Key events for Ashya’s treatment

  • Ashya had surgery for a medulloblastoma brain tumour at Southampton General Hospital in July 2014
  • His parents, Brett and Naghemeh, removed him from the hospital on 28 August and sparked a manhunt when they travelled to Spain
  • They were arrested but later released and Ashya was flown to Prague, Czech Republic, for proton beam treatment
  • He had six weeks of proton beam therapy, which cost between £60,000 and £65,000, according to the treatment centre, and which was paid for by the NHS
  • Ashya returned to hospital in Spain
  • In March 2015, Brett King announced his son was free of cancer

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Did Brazil, global health agencies fumble Zika response?


Last January, long lines formed outside health clinics in Recife, a city in Brazil’s northeast hit hard in recent years by outbreaks of dengue, a painful tropical disease.

Doctors were on guard because federal health officials and the World Health Organization (WHO) had warned 2015 would be a bad year for dengue and possibly another viral disease, chikungunya, both spread by the same type of mosquito.

But the symptoms of the hundreds of people seeking treatment did not fit dengue. Instead of high fevers and intense muscular aches that dengue is known to cause, patients were running only slight temperatures and complaining of joint pain. Many had rashes sooner than with dengue and chikungunya.

“We knew this was something else,” says Carlos Brito, a doctor from Recife who told state and federal health authorities in January-February last year that they were wrong to classify all the cases as dengue. “But the authorities were slow to believe,” he said.

Kleber Luz, a physician in Natal, a city 300 km up the Atlantic coast, says he gave similar feedback but got the same response. The two – who were part of a group of doctors discussing the odd symptoms in text messages – grew frustrated with the authorities’ narrow focus. They asked the federal health ministry to broaden its search beyond viruses known in the area.

It took until early May for the health ministry to recognize that the Zika virus had arrived in Brazil and to alert the WHO’s regional arm, the Washington-based Pan American Health Organization. And it wasn’t until November that a Rio de Janeiro laboratory made a link between the virus and microcephaly, which can lead to abnormally small brains in developing babies.

    The WHO has been lambasted in the past couple of years by scientists, aid organizations, and public health experts for the slow way in which it initially reacted to the Ebola epidemic as it spread across West Africa in 2014. And so far, the hesitant response to the Zika outbreak, which has created the worst global health scare since Ebola, says much about the difficulties that the WHO and other health authorities face in combating unexpected public health threats.

EXPLODING ACROSS THE REGION

On Dec. 1, the WHO cited the lab evidence linking Zika to microcephaly in an advisory to its member countries. It will consider on Monday whether to declare an international emergency.

    The WHO said in Geneva on Thursday that Zika in the last few months has spread “explosively” to more than 20 other countries in the Americas and could infect as many as 4 million people.

Whether the health authorities in Brazil and the leadership at the WHO have taken too long to get to this point is a subject of debate within the international health community.

The Brazilian government says its response when it was first alerted by the doctors about the unusual symptoms they were seeing was driven by the evidence.

“It was too early,” said Claudio Maierovitch, director of the health ministry’s Department of Communicable Disease Surveillance. “There are so many other viral possibilities and Zika had never been seen in this hemisphere.”

    And he said that when Zika was identified, the authorities’ response was based on knowledge of the disease. Previous outbreaks  of Zika, a virus first identified in 1947 in Uganda, had occurred in small and scattered rural populations in Africa and Southeast Asia and the symptoms were relatively benign.  

“We based our response on the scientific knowledge available, that Zika caused a mild illness without major complications,” said Maierovitch. “But as soon as we saw that there was an association with microcephaly, we reacted in record time.”

Critics say that the WHO has been slow to act after the link between Zika and microcephaly was made, and should have declared an emergency as soon as that was determined. “My chief criticism is of WHO in Geneva. After being widely condemned for acting late on Ebola, it is now sitting back with Zika,” said Lawrence O. Gostin, a professor of public health law at Georgetown University, who has worked with the WHO and written extensively about pandemics and policy. 

WHO officials say the agency’s response to Zika is driven by science, and they point out that much remains unclear, including the precise nature of any link between Zika and microcephaly.

    “In any unfolding crisis you’re dealing with a lot of uncertainty,” Bruce Aylward, the WHO’s assistant director-general, told reporters on Thursday.

Since October, 4,180 cases of microcephaly have been reported in Brazil but only 270 have so far been confirmed, with just six so far linked by the government to Zika. Of the rest, 3,448 are still being investigated through a long process involving clinical research, laboratory testing and monitoring of the infants’ development, and 462 were dismissed as not being microcephaly.

Following the spread of the disease is difficult. Many of those who get Zika can recover quickly from only mild symptoms, and across the Americas, hospitals do not have the clinical testing materials to quickly and definitively determine whether a patient is infected.

     “I THINK IT’S ZIKA”

     Luz, the Natal doctor, may have been the first person to make a link between the symptoms his patients had shown and Zika.

    After poring over scientific literature about a 2013 outbreak in French Polynesia, Luz in early March sent a text to a WhatsApp group for doctors, declaring: “I think it’s Zika.” He compared the symptoms he had seen with those reported in that outbreak.

Soon, several doctors in the same region began collecting blood samples from patients and sent them to various laboratories for analysis. On April 30, a laboratory at the Federal University of Bahia, also in Brazil’s northeast, said it had identified the presence of Zika in samples from one patient.

    The health ministry alerted state governments.

    On May 2, it notified PAHO. The notification put a Zika outbreak on record at the WHO.

    On May 7, PAHO issued an “epidemiological alert” saying “public health authorities of Brazil are investigating a possible transmission of the Zika virus.”

    But concern remained limited mostly to the contagiousness of Zika, rather than whether it could be a serious threat. In its alert, PAHO wrote: “Complications (neurological, autoimmune) are rare.”

    ‘REAL ANGUISH’

    In late May, Brito received a call from a Recife neurologist who noticed a surge of new patients with symptoms of Guillain-Barré, a little-understood autoimmune syndrome that can weaken the muscles and cause paralysis.

Brito interviewed the patients, many of whom said they had previously suffered a light fever, joint pain and rashes. He collected blood samples and by June a laboratory had used genetic testing to find traces of the Zika virus.

“It was real anguish,” Brito said of the patient’s suffering and the wait for official confirmation of Zika’s presence.

But despite the results, there was no proof to show that it was Zika causing the syndrome. Neither the Brazilian health ministry nor PAHO heightened warnings.

    By September, the chat groups among doctors were abuzz over a spike in the number of babies born with microcephaly.

    Many mothers of affected babies recalled having Zika-type symptoms.

    In October, Adriana Melo, an obstetrician in the nearby state of Paraiba, noticed troubling signs in sonograms of a 34-year-old expectant mother.

    There were calcium deposits in the developing baby’s brain, a possible sign of viral infection. The cerebellum, the part of the brain crucial for motor control, was shrinking.

    Melo phoned the Oswaldo Cruz Foundation, a public health institute in Rio de Janeiro, and got a lab there to test the patient’s amniotic fluid.

    By then, the number of babies born with microcephaly was surging. The health ministry, now more alarmed, declared a national emergency on Nov. 11 and in public comments mentioned that there were possible ties between the condition and Zika.

    The WHO was not yet ready to draw the same parallels.

    On November 17, the Rio lab said it had found the virus in the amniotic fluid. On Nov. 28, after lab tests from another baby, Brazil’s government confirmed the link between the virus and microcephaly.

    Starting Nov. 30, WHO deployed a small team of researchers from PAHO’s Washington headquarters to Brazil.

    On December 1, PAHO issued a new advisory,  warning countries in the region of the link between the virus and microcephaly. Two months later, the WHO is considering whether to declare an international emergency.

    “You have to gather the data,” says Marcos Espinal, director of the department of communicable diseases at PAHO, dismissing criticism that the regional body or headquarters could have moved any sooner.

(Additional reporting by Anthony Boadle, Brad Brooks, Stephanie Nebehay, Tom Miles and Julie Steenhuysen; Editing by Kieran Murray, Lisa Girion and Martin Howell)

Sueli Maria (obscured) holds her seven-day-old daughter Milena, who has microcephaly, at a hospital in Recife, Brazil, January 28, 2016.  REUTERS/Ueslei Marcelino
Sueli Maria (obscured) holds her seven-day-old daughter Milena, who has microcephaly, at a hospital in Recife, Brazil, January 28, 2016.

Reuters/Ueslei Marcelino

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Race for Zika vaccine gathers momentum as virus spreads


Companies and scientists are racing to create a Zika vaccine as concern grows over the mosquito-borne virus that has been linked to severe birth defects and is spreading quickly through the Americas.

Zika is now present in 23 countries and territories in the Americas. Brazil, the hardest-hit country, has reported around 3,700 cases of the devastating birth defect called microcephaly that are strongly suspected to be related to Zika.

The Geneva-based World Health Organization (WHO), stung by criticism that it reacted too slowly to West Africa’s Ebola epidemic, convenes an emergency meeting on Monday to help determine its response to the spread of the virus.

The U.S. Centers for Disease Control and Prevention has activated an emergency operations center staffed around the clock to address Zika, agency officials told Reuters.

On Thursday, the WHO said as many as 4 million people in the Americas may become infected by Zika, adding urgency to the research efforts. Vaccine developers made clear a vaccine for widespread public use is at least months, if not years, away.

The closest prospect may be from a consortium including drugmaker Inovio Pharmaceuticals Inc (INO.O) that could have a vaccine ready for emergency use before year-end, according to one of its lead developers. Inovio’s share price gained more than 15 percent in Friday trading.

Canadian scientist Gary Kobinger told Reuters on Thursday the first stage of testing on humans could begin as early as August. If successful, the vaccine might be used during a public health emergency by October or November, said Kobinger, who helped develop a trial vaccine for the Ebola virus.

Privately owned vaccine developer Hawaii Biotech Inc said it began a formal program to test a Zika vaccine last fall as the virus started to gain traction in Brazil, although it has no timetable yet for clinical trials.

“Right now, we are in the pre-clinical stage, as I suspect everyone is,” Chief Executive Officer Dr. Elliot Parks told Reuters.

Another private vaccine developer, Boston-based Replikins Ltd, said it was preparing to start animal studies on a Zika vaccine in the next 10 days. Data from the trials on mice and rabbits would likely be out in the next couple of months, Replikins Chairman Samuel Bogoch told Reuters.

“No one has the $500 million on hand to take it (a vaccine) all the way to human trials. Somewhere along the course we hope to have big pockets join us,” Bogoch said.

‘FIGHT THE MOSQUITO’

Zika had been viewed as a relatively mild illness until Brazilian health officials identified it as a matter of concern for pregnant women. While a direct causal relationship has not been established, scientists strongly suspect a link between Zika and thousands of children born in Brazil with abnormally small heads, brain defects and impaired vision.

There is no treatment for Zika infection.

Efforts to combat Zika are focused on protecting people from being bitten and on eradicating mosquitoes, a tough task in many parts of Latin America, where people live in poverty and there are plentiful breeding grounds for the insect.

“We do not have a vaccine for Zika yet. The only thing we can do is fight the mosquito,” Brazilian President Dilma Rousseff said on Friday, reiterating her call for a national eradication effort.

Rousseff said tests for the development of a vaccine would begin next week at the Butantan Institute, one of Brazil’s leading biomedical research centers in Sao Paulo.

U.S. President Barack Obama spoke on Friday with Rousseff about the spread of the virus, the White House said.

“The leaders agreed on the importance of collaborative efforts to deepen our knowledge, advance research and accelerate work to develop better vaccines and other technologies to control the virus,” the White House said in a statement.

Zika has hit Brazil just as it prepares to host the Olympic Games in Rio de Janeiro on Aug. 5-21, an event that draws hundreds of thousands of athletes, team officials and spectators. The International Olympic Committee (IOC) assured teams on Friday the Olympics would be safe from Zika, but urged visitors to carefully protect themselves.

U.S. lawmakers have begun to press the Obama administration for details of its response to Zika. At least 31 people in the country have been infected, all of them after travel to affected countries.

The U.S. Senate Health, Education, Labor and Pensions Committee is planning a hearing on Zika “very soon,” said Republican Senator Lamar Alexander of Tennessee, who called the threat posed by the virus to the United States a “big concern.”

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease, said he did not expect the United States to be hit hard like other some countries in South America and the Caribbean.

“We prepare for the possibility of a major outbreak but we believe it is unlikely to happen,” Fauci said.

(Reporting by Rod Nickel in Winnipeg, Manitoba; and Natalie Grover in Bengaluru; Additional reporting by Amrutha Penumudi in Bengaluru; Julie Steenhuysen in Chicago, Toni Clarke in Washington, Karolos Grohmann in Berlin, Anthony Boadle in Brasilia, Jeffrey Dastin in New York; Writing by Frances Kerry; Editing by Will Dunham and Lisa Shumaker)


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Too Few Older Adults Tell Doctors About Memory Loss: Study

Too Few Older Adults Tell Doctors About Memory Loss: Study

News Picture: Too Few Older Adults Tell Doctors About Memory Loss: Study

Latest Alzheimers News

THURSDAY, Jan. 28, 2016 (HealthDay News) — Do you worry that forgetting names, or where you put your keys, might be a sign of impending dementia? If you’re like most older Americans, you don’t bring this up with your doctor, a new study shows.

Researchers who looked at federal government data on more than 10,000 people found that in 2011, only 1 in 4 adults aged 45 or older discussed memory problems with a health care professional during a routine checkup.

In fact, the likelihood that a person would admit to a memory problem in a doctor’s office visit actually declined with advancing age, says a team led by Mary Adams, of On Target Health Data in West Suffield, Conn.

The findings were published Jan. 28 in the journal Preventing Chronic Disease.

“Routine checkups are a missed opportunity for assessing and discussing memory problems for the majority of older adults,” Adams said in a journal news release.

Experts agreed that the stigma around memory loss and dementia may hold people back from discussing these issues with their physicians.

“Because dementia is unfortunately an all too common illness, older adults are quite familiar with its heralding signs and symptoms, which they have painfully observed in a long time neighbor or a family member,” said Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Health in New Hyde Park, N.Y.

“This reality leads to denial and avoidance, both on the part of the patient and the physician,” she said. “‘As long as we don’t mention it, maybe it’s just normal aging.'”

But mentioning memory troubles is important, because it doesn’t necessarily have to herald dementia, Wolf-Klein said. “Memory loss may well not be due to dementia, but another highly treatable condition, such as depression,” she noted.

And if it is linked to dementia, recognizing that fact early is crucial, she said.

“Patients can promptly meet with family members and elder law advisers, who can best help them in making individualized decisions for their care, rather than rely on last-minute decisions completed by family members at a time when patients now lack capacity,” Wolf-Klein said.

Dr. Bruce Polsky is chair of the department of medicine at Winthrop-University Hospital in Mineola, N.Y. He acknowledged that talking about “memory loss and the possibility of the early development of dementia is a difficult discussion for both the physician and patient, mostly because of the long-term implications.”

But early diagnosis of dementia can be important, he said.

“Even mild memory loss associated with early Alzheimer’s disease may be improved with some of the medicines now available, although these medications do not stop the progression of the disease,” he said. “Lifestyle modifications, such as smoking cessation, may also be of value in some cases.”

“Although it is difficult for individuals to assess whether their own subtle memory loss is ‘normal’ or not, open discussion with their physician and, in some cases, testing may result in answers that could potentially lead to treatment and improved functioning,” according to Polsky.

— E. J. Mundell

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Gisele Wolf-Klein, M.D., director, geriatric education, Northwell Health, New Hyde Park, N.Y.; Bruce Polsky, M.D., chairman, department of medicine, Winthrop-University Hospital, Mineola, N.Y.; Jan. 28, 2016, Preventing Chronic Disease

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In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

January 29

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

Affordable coverage options are available in the Health Insurance Marketplace for eligible immigrant families. In fact, most people shopping for coverage on the Marketplace can find a plan with monthly premiums of $75 or less. But, act soon:  January 31, 2016 is the final deadline for you to sign up at HealthCare.gov or CuidadodeSalud.gov for 2016 coverage.  Don’t miss out on getting coverage for 2016 and risk owing a fee of $695 or more.

If you work with immigrant communities, we need your help to make sure people who are eligible for coverage understand that they should not be worried about applying for coverage if they have a family with mixed immigration status.

Here are 10 things immigrant families need to know about Marketplace coverage:

  1. To buy private health insurance through the Marketplace, you must be a U.S. citizen, a U.S. national, or be lawfully present in the United States. In addition, immigrants with certain other statuses are also eligible.  See a list of immigration statuses that qualify for Marketplace coverage.
  2. If you recently gained U.S. citizenship or had a change in your immigration status that makes you newly eligible to enroll in coverage through the Marketplace, you may qualify for a Special Enrollment Period. See if you can enroll in a Marketplace health plan outside Open Enrollment.
  3. Financial help is available. If you’re a lawfully present immigrant and meet other eligibility criteria, you can buy private health insurance through the Marketplace, and may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income. More than 8out of 10 people who have enrolled in a health insurance plan through the Marketplace have qualified for financial help. In fact, most people can find monthly premiums for $75 or less, after financial assistance. In general, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the premium tax credit or financial assistance to pay for your premium.  You can find the levels here based on the household size. If you make less than 100 percent of the federal poverty line, which is $11,770 for an individual or $24,250 for a family of 4 (higher in Alaska and Hawaii) and you aren’t eligible for Medicaid because of your immigration status, you may still qualify for lower costs on Marketplace coverage.
  4. If you’re a “qualified non-citizen” and meet your state’s income and other eligibility rules, you may be eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage. See a list of “qualified non-citizen” statuses and other important details.
  5. If you’re a “qualified non-citizen,” you may have a 5-year waiting period to get full Medicaid or CHIP coverage. This means you must wait 5 years after receiving “qualified” immigration status and meet all other eligibility rules in the state before being eligible for full Medicaid or CHIP. See a list of exceptions to the 5-year waiting period and other important details.
  6. Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for financial assistance for private insurance for their dependent family members who are eligible for coverage through the Marketplace, or for Medicaid and CHIP coverage. Family members who aren’t applying for health coverage for themselves won’t be asked if they have eligible immigration status.
  7. Federal and State Marketplaces, as well as state Medicaid and CHIP agencies, can’t require you to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage for themselves.
  8. States can’t deny you benefits because a family or household member who isn’t applying has not provided his or her citizenship or immigration status.
  9. Information that you provide to the Marketplace won’t be used for immigration enforcement purposes.
  10. If you’re not eligible for Marketplace coverage or you can’t afford a health plan, you can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents in the health center’s service area. Find more information here.

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In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

January 29

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

Affordable coverage options are available in the Health Insurance Marketplace for eligible immigrant families. In fact, most people shopping for coverage on the Marketplace can find a plan with monthly premiums of $75 or less. But, act soon:  January 31, 2016 is the final deadline for you to sign up at HealthCare.gov or CuidadodeSalud.gov for 2016 coverage.  Don’t miss out on getting coverage for 2016 and risk owing a fee of $695 or more.

If you work with immigrant communities, we need your help to make sure people who are eligible for coverage understand that they should not be worried about applying for coverage if they have a family with mixed immigration status.

Here are 10 things immigrant families need to know about Marketplace coverage:

  1. To buy private health insurance through the Marketplace, you must be a U.S. citizen, a U.S. national, or be lawfully present in the United States. In addition, immigrants with certain other statuses are also eligible.  See a list of immigration statuses that qualify for Marketplace coverage.
  2. If you recently gained U.S. citizenship or had a change in your immigration status that makes you newly eligible to enroll in coverage through the Marketplace, you may qualify for a Special Enrollment Period. See if you can enroll in a Marketplace health plan outside Open Enrollment.
  3. Financial help is available. If you’re a lawfully present immigrant and meet other eligibility criteria, you can buy private health insurance through the Marketplace, and may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income. More than 8out of 10 people who have enrolled in a health insurance plan through the Marketplace have qualified for financial help. In fact, most people can find monthly premiums for $75 or less, after financial assistance. In general, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the premium tax credit or financial assistance to pay for your premium.  You can find the levels here based on the household size. If you make less than 100 percent of the federal poverty line, which is $11,770 for an individual or $24,250 for a family of 4 (higher in Alaska and Hawaii) and you aren’t eligible for Medicaid because of your immigration status, you may still qualify for lower costs on Marketplace coverage.
  4. If you’re a “qualified non-citizen” and meet your state’s income and other eligibility rules, you may be eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage. See a list of “qualified non-citizen” statuses and other important details.
  5. If you’re a “qualified non-citizen,” you may have a 5-year waiting period to get full Medicaid or CHIP coverage. This means you must wait 5 years after receiving “qualified” immigration status and meet all other eligibility rules in the state before being eligible for full Medicaid or CHIP. See a list of exceptions to the 5-year waiting period and other important details.
  6. Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for financial assistance for private insurance for their dependent family members who are eligible for coverage through the Marketplace, or for Medicaid and CHIP coverage. Family members who aren’t applying for health coverage for themselves won’t be asked if they have eligible immigration status.
  7. Federal and State Marketplaces, as well as state Medicaid and CHIP agencies, can’t require you to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage for themselves.
  8. States can’t deny you benefits because a family or household member who isn’t applying has not provided his or her citizenship or immigration status.
  9. Information that you provide to the Marketplace won’t be used for immigration enforcement purposes.
  10. If you’re not eligible for Marketplace coverage or you can’t afford a health plan, you can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents in the health center’s service area. Find more information here.

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TSRI scientists reveal workings of key 'relief-valve' in cells

A team led by scientists at The Scripps Research Institute (TSRI) has solved a long-standing mystery in cell biology by showing essentially how a key “relief-valve” in cells does its job.

The relief valve, known as VRAC (volume-regulated anion channel), normally keeps cells from taking in too much water and swelling excessively. But VRAC’s importance to cellular health is just beginning to be understood—already it has been tentatively linked to stroke-induced brain damage, diabetes, immune deficiency and even cancer treatment resistance.

In a study published in Cell on January 28, 2016, the scientists showed that VRAC is a complex structure with five different protein subunits—the precise mix of which determines its relief-valve properties. The team also determined that VRAC’s relief-valve function is activated not by the physical swelling of a cell per se, but by a closely linked event: the low concentration of dissolved ions that results from a sudden flow of water into a cell.

“Knowing how VRAC is assembled and how it works is important not only because it is a fundamental regulatory mechanism in cells, but also because it seems to have relevance for a variety of diseases and conditions,” said principal investigator Ardem Patapoutian, a professor at TSRI and a Howard Hughes Medical Institute (HHMI) Investigator.

Sorting Through the Molecular Soup

Scientists discovered VRAC’s existence decades ago, but only recently began to identify its components. In early 2014, Patapoutian’s laboratory and a separate group in Germany discovered independently that one VRAC subunit is a protein called LRRC8A (SWELL1), which is necessary for VRAC to function properly. It was apparent at the time, however, that VRAC has other subunits.

In the new study, Patapoutian and his team sought a more complete understanding of how VRAC is put together and how it senses volume changes.

Knowing that LRRC8A is always present in VRAC, co-first author Zhaozhu Qiu, a postdoctoral fellow in the Patapoutian lab and at the Genomics Institute of the Novartis Research Foundation (GNF), created test cells that produce LRRC8A with a special protein tag attached. The tagged LRRC8A were used as a handle to pull the full VRAC complex out of the molecular soup contained in cells.

Co-first author Ruhma Syeda, also a postdoctoral fellow in the Patapoutian lab, led the effort to put purified VRAC complexes into model cell membranes (lipid bilayers) to measure the conductance of charged ions. The results were startling. Although an ion channel typically has a sharply defined single channel conductance, measurements of VRAC suggested a broad range of conductances.

Prior research had suggested that the VRAC structure can include other members of the LRRC8 family besides LRRC8A, namely LRRC8B, LRRC8C, LRRC8D and/or LRRC8E. Qiu and Stuart Cahalan, another postdoctoral fellow, therefore created a set of cell lines in which genes for one or more of the LRRC8 proteins were deleted. With this and other methods, the team established that VRAC is in fact a diverse family of ion channels, each of which has approximately six protein subunits. At least one subunit of any VRAC structure is LRRC8A, but the other subunits appear to be a variable mix of LRRC8B-E proteins. That variability of composition leads to different charge-flow properties when channel complexes were measured in the minimalistic bilayer system. Swetha Murthy, a postdoctoral fellow, and Adrienne Dubin, an assistant professor of neuroscience (and co-corresponding author), determined that charge-flow properties of single VRAC channels on intact swollen cells were also dictated by the subunit combination.

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“We speculate that different cell types need different forms of VRAC to cope with their different environments—that’s an idea we’re keen to test,” said Qiu.

“This finding also suggests that subtle variations in VRAC’s composition can have profound effects on how it works in cells and potentially contributes to disease,” said Patapoutian.

How to Sense a Swelling Cell

Perhaps the biggest unanswered question about VRAC has been: how does it sense the swelling of a cell?

“People have scratched their heads over this for decades, because it’s hard to imagine how a cell could directly measure an increase in its volume,” Patapoutian said.

One possibility has been that VRAC senses a volume increase indirectly, by detecting the stretching of the cell membrane, as some sensory ion channels do. However, examining VRAC complexes in the simplified environment of lipid bilayers, the team found that they were not activated by membrane stretching. They were, however, readily activated when the usual concentration of dissolved ions was reduced.

That made sense. “Local decrease in the ionic strength is an inevitable result when the water rushes in and the cell swells,” Syeda said.

Further studies of VRAC will be aimed at determining its precise physical structure, how variations in that structure alter its ion-conducting properties, how VRAC varies in different cell types, and how VRAC variants or mutants contribute to disease. VRAC is thought to worsen stroke-related brain damage and heart-attack damage, for example, by allowing abnormal, harmful flows of signaling molecules in the low-oxygen condition following arterial blockage. VRAC may also be linked to immune system development: a 2003 study found that a mutation of LRRC8A, now known to be VRAC’s chief subunit, prevents antibody-producing B cells from developing normally. A more recent study implicated VRAC in the clinical response to the cancer drugs cisplatin and carboplatin—the drug molecules use VRACs as portals into tumor cells.

Source:

The Scripps Research Institute (TSRI)

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