China reports new African swine fever in Hunan province

BEIJING (Reuters) – China’s agricultural ministry reported on Sunday a new outbreak of African swine fever in Changde city of central Hunan province, where 99 pigs were killed and 106 were sick.

The affected farm has a herd of 7,684 pigs, the ministry said on its website.

China has since August reported more than 40 outbreaks of the highly contagious disease in about a dozen provinces and municipalities, culling an estimated 200,000 pigs.

Reporting by Chen Aizhu

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Eighth child dies at New Jersey center hit by viral outbreak

(Reuters) – An eighth child has died at a New Jersey rehabilitation center where 23 people have been infected in a deadly viral outbreak, state health officials said on Friday.

The outbreak of adenovirus at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey, was first reported by the New Jersey Department of Health on Tuesday with the deaths of six children with compromised immune systems. The seventh death was announced the next day.

The department said in a statement on Friday that the latest death involved a child who was “medically fragile with respiratory illness.” It said it did not have laboratory confirmation of adenovirus in the child.

The department said that the facility, which includes a pediatric center, had agreed not to admit new patients until the outbreak ended.

Adenovirus frequently causes mild to severe illness with cold-like symptoms, particularly in young children. The infection can cause other illnesses, including pneumonia, diarrhea and bronchitis, the department said.

“The strain of adenovirus seen in this outbreak is associated with communal living arrangements and known to cause severe illness, especially in those with compromised immune systems,” the department said on Friday.

The Wanaque Center, about 32 miles (50 km) northwest of New York, serves newborns to 22-year-olds who are “medically fragile.”

The department said the Centers for Disease Control and Prevention were helping with lab tests and expertise.

Reporting by Andrew Hay in New Mexico; Editing by Bill Berkrot

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Time, staffing top obstacles to sustaining school gardens

(Reuters Health) – Lack of time and staff support are the two biggest barriers to school garden success, according to a study published in the American Journal of Public Health.

“The physical space itself doesn’t seem to be the problem,” Dr. Kate G. Burt of the City University of New York in The Bronx, who led the study, told Reuters Health in a telephone interview.

Across the US, 44 percent of schools reported growing edible gardens during the 2013-2014 school year, up from 31 percent in 2011-2012, according to the US Department of Agriculture’s most recent data. Over the same period, the number of school gardens rose from 2,401 to 7,101.

School gardens have been shown to help students eat more fruits and veggies, be more active and do better in math and science, to name just a few of their benefits. But for a school garden to succeed, it must be well-integrated, meaning it “fosters meaningful educational experiences for students, and is valued as part of the school’s culture,” Dr. Burt and her team note in their September 25 report.

To better understand why some gardens flourish and others fail, the researchers surveyed 99 school gardeners from 15 states, asking them to rank five barriers to success.

Time and staffing were the top two, followed by funding, curriculum and space.

About 66 percent of the school gardeners cited “time for all classes to use the garden” as a challenge, and 62 percent named “time to train staff and faculty about gardening.” Staffing-related challenges included having too few volunteers, cited by 65 percent, and “teacher-faculty disinterest,” by 60 percent. Overall lack of funding was a challenge for 55 percent of the school gardeners, while 35 percent said they did not know how to obtain funds.

When asked how they would spend additional funding, 54 percent said infrastructure such as raised beds and tool storage; 28 percent said hiring and training more support staff to maintain the garden; 20 percent said program expansion and 19 percent would put it toward tools and materials.

Based on the responses, the authors propose three approaches to addressing time- and staff-related issues: strengthening garden committees, incorporating gardening into teachers’ professional development, and community outreach.

Tackling time and staffing challenges – for example by offering a stipend to participating teachers and incorporating school gardens into teachers’ professional development – would do more to help school gardens flourish, Burt suggests.

“So much money is going into school gardens that if we don’t identify the additional resources and support that are needed then we won’t achieve the success that everyone hoped as school gardens have surged,” she said.

SOURCE: American Journal of Public Health, online September 25, 2018.

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Abbott, AbbVie settle U.S. case over TriCor marketing for $25 million

FILE PHOTO: A screen displays the share price for pharmaceutical maker AbbVie on the floor of the New York Stock Exchange July 18, 2014. REUTERS/Brendan McDermid/File Photo

(Reuters) – Abbott Laboratories and AbbVie Inc will pay a total of $25 million to resolve allegations that Abbott paid kickbacks to doctors in exchange for their prescribing the cholesterol drug TriCor and promoted the medication for unapproved purposes.

The U.S. Justice Department announced the settlement on Friday, which resolves claims first raised in a whistleblower lawsuit filed in federal court in Philadelphia in 2009 by a former Abbott sales representative. AbbVie was spun out of Abbott in 2013.

Neither company, both of which are based in Chicago, admitted to wrongdoing as part of the settlement. AbbVie did not respond to a request for comment. Abbott declined to comment.

The lawsuit alleged that from 2006 to 2008, Abbott, through its sales representatives, provided physicians kickbacks in the form of gift baskets, gift cards and other items in order to encourage them to write prescriptions for TriCor.

The lawsuit claimed that Abbott also retained health-care providers for consulting services and speaking engagements in order to induce or reward doctors for writing prescriptions for the drug.

Abbott also improperly marketed and promoted TriCor for purposes other than those approved by the U.S. Food and Drug Administration, including as a treatment to prevent or reduce cardiac health risks in diabetic patients, the lawsuit said.

The lawsuit was filed by Amy Bergman, a former Abbott sales representative, under the False Claims Act, which allows whistleblowers to sue companies on the government’s behalf to recover taxpayer money paid out based on fraudulent claims.

The government may intervene in such cases, but chose not to in Bergman’s, leaving her to litigate it on her own prior to the settlement’s being announced. As a reward, Bergman will receive $6.5 million as her share of the settlement.

The case is U.S. ex rel. Amy Bergman, et al. v. Abbott Laboratories, U.S. District Court, Eastern District of Pennsylvania, No. 09-04264.

Reporting by Nate Raymond in Boston; Editing by Chris Reese and Leslie Adler

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Hospital accreditation not linked to patient outcomes in U.S.

(Reuters Health) – Hospital accreditation isn’t necessarily tied to better outcomes for U.S. patients, researchers say.

Based on records for more than 4.2 million patients over age 65 covered by Medicare, the study team found no difference between accredited and unaccredited hospitals in patient death rates, and only a slightly lower rate of patient readmissions at accredited hospitals, according to the report in The BMJ.

“When you walk into a hospital, one thing you want to count on as a patient is that the hospital will do a good job and achieve the best outcomes possible,” said senior study author Dr. Ashish Jha of the Harvard T. H. Chan School of Public Health in Boston.

“The national strategy” has been to assure patients through accreditation, he said in a phone interview. “But for years, there has been concern that the (accreditation) process has lost sight of the bigger picture and now focuses on the minute details.”

To be reimbursed for care provided to Medicare patients, hospitals either need to be accredited by an independent organization approved by the Centers for Medicare and Medicaid Services, or they must have passed a review by a state survey agency.

To see if accredited hospitals offer better quality care, Jha and colleagues analyzed data from 4,400 U.S. hospitals, including 3,337 accredited facilities and 1,063 that passed state-based review in 2014-2017. They linked this data with Medicare files and with results of government-sponsored patient satisfaction surveys for all the hospitals.

Overall, they found that patients treated at accredited hospitals had slightly lower 30-day mortality than those at hospitals reviewed by a state agency (10.2 percent versus 10.6 percent), although the difference was too small to rule out the possibility it was due to chance.

The research team also found identical mortality rates (2.4 percent) and nearly identical readmission rates (15.9 percent versus 15.6 percent) for six types of major surgery at accredited and state-reviewed hospitals.

For the medical conditions, readmissions were lower at accredited hospitals, at 22.4 percent versus 23.2 percent, a statistically meaningful difference.

Patient experience scores were slightly higher at state-survey hospitals than at accredited hospitals.

In addition, the research team found no differences in mortality, readmission rates or patient experience scores between the hospitals accredited by The Joint Commission, considered the “gold standard” for accreditation, or other independent organizations, the study team notes.

“Mortality is the big measure that tends to matter most to patients,” Jha said. “In this case, accreditation doesn’t seem to do much in terms of improving outcomes.”

“This adds momentum to a national conversation that started a few months ago,” he said. “Policymakers are starting to ask hard questions about whether the strategy of accreditation is paying off for consumers.”

Future studies should look at what type of accreditation and by which organization seem most helpful for better patient outcomes. For instance, hospitals designated as stroke centers or rehabilitation centers may have better outcomes for particular medical conditions, said Laura Wagner of the University of California, San Francisco, who wasn’t involved in the study.

“Accreditation is seen as a Good Housekeeping Seal of Approval for some patients, especially those in the nursing home setting,” she said in a phone interview.

“The bottom line is that accreditation does matter, and it provides a framework for both patients and healthcare providers around quality,” Wagner said. “It can improve quality in some cases, and we need to improve that framework to provide care.”

SOURCE: The BMJ, online October 18, 2018.

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Booming Economy Helps Flatten Medicaid Enrollment And Limit Costs, States Report

Medicaid enrollment fell by 0.6 percent in 2018 — its first drop since 2007 — due to the strong economy and increased efforts in some states to verify eligibility, a new report finds.

But costs continue to go up. Total Medicaid spending rose 4.2 percent in 2018, same as a year ago, as a result of rising costs for drugs, long-term care and mental health services, according to the study released Thursday by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

States expect total Medicaid spending growth to accelerate modestly to 5.3 percent in 2019 as enrollment increases by about 1 percent, according to the annual survey of state Medicaid directors.

About 73 million people were enrolled in Medicaid in August, according to a federal report released Wednesday.

Medicaid, the state-federal health insurance program for low-income Americans, has seen its rolls soar in the past decade — initially as a result of massive job losses during the Great Recession and in recent years when dozens of states expanded eligibility using federal financing provided by the Affordable Care Act. Thirty-three states expanded their programs to cover people with incomes under 138 percent of the federal poverty level, or an income of about $16,750 for an individual in 2018.

Medicaid spending and enrollment typically rise during economic downturns as more people lose jobs and health benefits. When the economy is humming, Medicaid enrollment flattens as more people get back to work and can get coverage at work or can afford to buy it on their own. The national unemployment rate was 3.7 percent in September, the lowest since 1969.

The falling unemployment rate is the main reason for the drop in Medicaid enrollment, but some states have reduced their rolls by requiring adults and families to verify their eligibility. Arkansas, for example, has cut thousands of people after instituting new steps to confirm eligibility.

The brightening economic outlook for states has led many to increase benefits to enrollees and payment rates for health providers.

“A total of 19 states expanded or enhanced covered benefits in fiscal 2018 and 24 states plan to add or enhance benefits for the current fiscal year, which for most states started in July,” the Kaiser report said. “The most common benefit enhancements reported were for mental health and substance abuse services. A handful of states reported expansions related to dental services, telehealth, physical or occupational therapies and home visiting services for pregnant women.”

A dozen states increased pay to dentists and 18 states added to primary care doctors’ reimbursements for fiscal year 2019.

Medicaid covers about 20 percent of U.S. residents and accounts for nearly one-sixth of health care expenditures. Nearly half of enrollees are children.

Overall, the federal government pays about 62 percent of Medicaid costs with state’s picking up the rest. Poorer states get a higher federal match rate.

Seventeen Republican-controlled states have not expanded Medicaid. For individuals accepted into the program as part of the ACA expansion, the federal government paid the full cost of coverage from 2014 through 2016. It will pay no less than 90 percent thereafter.

In 2018, the states’ share of spending rose 4.9 percent. This was the first full year that states were responsible for part of the cost of the expansion. States expect their spending will grow about 3.5 percent in 2019.

Robin Rudowitz, one of the authors of the study and associate director of the Kaiser Program on Medicaid and the Uninsured, said the survey found many states were using Medicaid to address the opioid crisis by expanding benefits for substance disorders and also by implementing tougher restrictions on prescriptions.

“Almost every governor wants to do something, and Medicaid is generally a large part of it,” she said.

While the Trump administration’s approval of work requirements for some adults on Medicaid has generated controversy over the past year, the report shows that states are making many other changes to the program, such as increasing benefits and changing how it pays providers to get better value.

Correction: This story was updated on Oct. 25 at 3 p.m. ET to correct Robin Rudowitz’s title. She is the associate director for the Kaiser Program on Medicaid and the Uninsured. The Kaiser Commission on Medicaid and the Uninsured no longer exists.


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Trump seeks to base Medicare drug prices on lower overseas rates

WASHINGTON (Reuters) – U.S. President Donald Trump said on Thursday his administration is seeking to lower prescription drug prices by determining the price the government’s Medicare program pays for some drugs based on the lower prices paid in other countries.

FILE PHOTO: U.S. President Donald Trump speaks at a campaign rally in Mosinee, Wisconsin, U.S., October 24, 2018. REUTERS/Kevin Lamarque

Trump, speaking at the Department of Health and Human Service’s Humphrey Building near Capitol Hill, said the move takes aim at what he characterized as “global freeloading” on prescription drugs.

(This story corrects typographical error in headline to make it “Medicare”.)

Reporting by Yasmeen Abutaleb; writing by Michael Erman; editing by Jonathan Oatis

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Heart patients should consider cardiac rehab

(Reuters Health) – Patients who have had a heart attack, stent placement or bypass surgery should strongly consider enrolling in a cardiac rehabilitation program, say the authors of a new patient resource published in JAMA Cardiology.

These programs focus on nutrition, stress management, exercise, psychological support, tobacco cessation and heart disease education. They not only help the heart recover, they can ease anxiety, reduce heart risk factors and improve quality of life, the authors write.

“There are short-term and long-term benefits to participating, including less chest pain, less depression, and a decreased risk of death from heart disease,” said Dr. Tamara Horwich of the University of California, Los Angeles, who co-authored the one-page primer for patients.

Horwich, who is medical director of UCLA’s cardiac rehab program, emphasizes the importance of lifestyle changes to prevent and reverse heart disease. She encourages patients to enroll in heart recovery programs for the group support and medically-supervised guidance.

“I tell my patients that if we work together, this heart issue doesn’t have to happen to them again,” she told Reuters Health by phone. “By taking the right medications and having a healthy lifestyle, repeat heart attacks won’t be a problem.”

Available for free, the new patient page ( offers practical advice about joining cardiac rehabilitation programs.

“Unfortunately, patients who want to participate may face barriers such as insurance, transportation or time in their schedules,” Horwich said. “We need to work on addressing this.”

Horwich and co-author Dr. Gregg Fonarow, who is co-chief of UCLA’s cardiology division and co-director of its preventive cardiology program, first explain the goals of cardiac rehabilitation to halt or reverse the progression of heart disease. Aerobic exercise training is typically the cornerstone of these programs, but other key components focus on nutrition counseling and education about heart-related topics such as blood pressure, diabetes and cholesterol.

Usually based at a hospital or doctor’s office, cardiac rehab programs can include two or three one-hour sessions per week for 12 to 18 weeks, totaling about 36 hours. Intensive programs can continue for up to 72 hours.

“When you have a heart attack or undergo bypass or stenting, it’s a life-changing and often scary experience,” said Dr. Nieca Goldberg, medical director of the women’s heart program at New York University Langone Health in New York City.

“Often times, these patients didn’t exercise, were stressed and don’t know how to get started or get organized in taking care of various aspects of their cardiac health,” said Goldberg, who wasn’t involved in the patient resource.

The American Heart Association and American College of Cardiology highly recommend enrolling in these programs. Patients who take their medications and complete a cardiac rehabilitation program could reduce their risk of hospital readmission and cardiovascular death by 25 to 50 percent, according to the AHA. Plus, exercise capacity is likely to increase, and cholesterol, blood pressure and blood sugar levels should drop.

“These programs have been recommended for a long time because they really do improve patients’ quality of life,” Goldberg said in a phone interview. “At my practice, we always bring up cardiac rehab with patients.”

New studies are looking at ways to create remote or home-based cardiac programs by using smartwatches or monitors for heart rate, blood pressure and heart rhythm analysis. Then patients may be able to participate in group videos online from the comfort of their homes.

“We’re developing the program now and have the technology in place, so it’s a matter of getting the details of the program set,” Horwich said. “Plus, there are barriers to payment and insurance reimbursement for online programs, so we’re working on that as well.”

Following a cardiac rehab program, it’s important for patients and doctors to create a plan for what will happen after graduation, Goldberg said. By creating a plan and checking in, patients are more likely to stick with the lifestyle changes they’ve learned and continue to exercise, eat well and manage their stress.

“It’s a life-long process,” she said. “It’s not just about keeping patients out of the hospital but about healthy lifestyle choices that last.”

SOURCE: JAMA Cardiology, online October 10, 2018.

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Former Supreme Court Justice Sandra Day O’Connor Has Dementia

News Picture: Former Supreme Court Justice Sandra Day O'Connor Has Dementia

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TUESDAY, Oct. 23, 2018 (HealthDay News) — Retired U.S. Supreme Court Justice Sandra Day O’Connor — the first woman on the high court — has dementia, “probably Alzheimer’s disease,” she announced Tuesday.

Doctors diagnosed her with the beginning stages of dementia “some time ago,” O’Connor, 88, said in a letter addressed to “friends and fellow Americans.”

O’Connor wrote: “As this condition has progressed, I am no longer able to participate in public life. Since many people have asked about my current status and activities, I want to be open about these changes, and while I am still able, share some personal thoughts.”

She plans to continue living in Phoenix, surrounded by family and friends, USA Today reported.

O’Connor was nominated to the court by President Ronald Reagan. She served a quarter of a century, from 1981 to 2006.

Age is the greatest risk factor for Alzheimer’s, the most common form of dementia. The incurable, progressive disease challenges adults from all walks of life, destroying memory and the ability to perform everyday tasks.

The former justice knows well what lies ahead. She retired from the Supreme Court at age 75 to care for her husband, John, who had Alzheimer’s disease at the time. He died in 2009. O’Connor continued to raise awareness about the condition.

“While the final chapter of my life with dementia may be trying, nothing has diminished my gratitude and deep appreciation for the countless blessings in my life,” O’Connor said in the letter.

She said she feels fortunate be an American and to have been presented with remarkable opportunities. “As a young cowgirl from the Arizona desert, I never could have imagined that one day I would become the first woman justice on the U.S. Supreme Court,” she wrote.

In a statement, the Alzheimer’s Association said it commended O’Connor “for bravely sharing her diagnosis.

“Since her husband’s diagnosis with Alzheimer’s disease, Justice O’Connor has been an advocate for caregivers and people living with the disease,” the group noted.

“She was a pivotal member of the Alzheimer’s Study Group, a committee convened by Congress and which presented its findings back to Congress in 2009. Justice O’Connor helped to position Alzheimer’s as a national priority that demands action from our nation’s policymakers,” the association said.

In a statement released Tuesday, U.S. Chief Justice John Roberts said O’Connor was “a towering figure in the history of the United States and indeed the world.

“She broke down barriers for women in the legal profession to the betterment of that profession and the country as a whole,” said Roberts.

No illness or condition can take away the inspiration she provides for those who will follow the many paths she has blazed, the chief justice added.

O’Connor was a key swing vote on the court. And she was a leader in the 1992 Planned Parenthood v. Casey ruling that maintained abortion rights but permitted some state restrictions.

It’s estimated that 1 in 10 Americans age 65 and older has Alzheimer’s dementia. Almost two-thirds of them are women, according to the Alzheimer’s Association.

— Robert Preidt

Copyright © 2018 HealthDay. All rights reserved.

SOURCES: USA Today, Oct. 23, 2018; news release, Alzheimer’s Association, Oct. 23, 2018

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Researchers track where tetracycline antibiotics go in human cells

We know that antibiotics treat bacterial infections. We also know why they work. Tetracycline antibiotics, for example, stop bacteria from making protein. Like a boot on a wheel, the drugs bind to the bacterial cell’s ribosome–where protein is made–and prevent it from working. Without protein, the bacteria weaken and die.

Recently, researchers discovered a possible new job for these tetracycline antibiotics: treatment for pathological inflammation and cancer in humans.

This treatment has proven effective in clinical trials. Two patients, a young man and an elderly woman, who suffered from rare, stubborn diseases experienced complete remission after treatment with doxycycline, a type of tetracycline. Other tetracycline varieties have shown potential in early clinical trials with patients who have a number of diseases, including refractory metastatic cancers, rheumatoid arthritis and osteoarthritis, fragile X syndrome, AIDS-related Kaposi’s sarcoma, and abdominal aortic aneurysm.

And yet, despite these promising results, exactly how the treatment works remained elusive.

Now, in a new paper published in Cell Chemical Biology, Andrew Myers and his team provide an answer. “Despite these promising clinical results and a wealth of published scientific research,” the paper states, “no relevant target(s) or mechanism(s) have been clearly identified to account for these non-canonical effects of tetracyclines.” This knowledge gap impedes further drug development and treatment.

So, Myers and his team set out to track and map exactly what happens when two tetracycline analogs, doxycycline and Col-3, enter a cell. This is far from easy. Like tracking a mouse in a blizzard, “the detective work to find targets of drug molecules is painstakingly difficult,” says Jon Mortison, the paper’s first author.

The team used a powerful technique (“affinity isolation in tandem with mass spectrometry (MS)-based quantitative SILAC–stable isotope labeling by amino acids in cell culture– proteomics”) to isolate each drug’s target. In so doing, they observed that both analogs target our cell’s ribosome, just as they do in a bacterial cell.

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“To our knowledge,” the paper notes, “this represents the first direct evidence that tetracyclines have observable effects on human cytosolic ribosomes.”

To uncover this evidence, the team used a novel strategy to hunt down the tetracycline targets. They believe their method could be adopted by other researchers for similar purposes, to build a broader map for how drugs interact with our bodies. “RNA targets in drug discovery is becoming an area of increasing interest,” Mortison said. “Some large companies and biotechs are already jumping into the space of identifying RNA targets for their pipelines.”

Going forward, the team hopes to clarify whether the exact point where doxycycline and Col-3 bind to our ribosomes could boost their ability to slow the spread of inflammation and cancer. Such precise information would provide crucial insights for drug development.

Further exploration is required to compile this intel. But Myers and his team have provided a crucial foundation for these studies to proceed. Soon, tetracyclines could be a valuable treatment option for numerous diseases, including cancer. In the meantime, the team’s new technique could, like a well-designed field guide, hasten drug discovery for myriad diseases.


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