Association Insurance Pushes On Despite Court Ruling

When the Trump administration in June issued rules making it easier for small employers to band together to buy health insurance, “we started looking immediately,” recalled Scott Lyon, a top executive at the Small Business Association of Michigan.
Although he offered traditional small-group health insurance to his association’s employees and members, Lyon liked adding a new option for both: potentially less expensive coverage through an association health plan, which doesn’t have to meet all the rules of the Affordable Care Act.
Now, a few months in, “we’ve got 400 companies and a couple of thousand workers signed up,” said Lyon last week.
Nationally, an estimated 30,000 people are in such association health plans, a type of health insurance seeing a nascent resurgence following an initial drop-off after the ACA took effect in 2014.
Most of the new enrollees joined through groups like Lyon’s or local chambers of commerce, farm bureaus or agriculture-based cooperatives. Such groups see the plans not only as a way to offer insurance, but also as an enticement to boost membership.
In the first legal test, however, U.S. District Judge John Bates at the end of March sided with 11 states and the District of Columbia challenging the law. He invalidated a large chunk of those June rules, saying the administration issued them as an “end-run around the Affordable Care Act.”
So what now?
Unless the government seeks — which it has yet to do — and is granted a stay of the judge’s order, “plans formed under the vacated sections of the rule are illegal,” said Timothy Jost, an emeritus health law professor from Washington and Lee University.
Still, that won’t mean anything for existing plans if the states or federal regulators choose not to enforce the ruling, Jost said.
And that could cause more confusion in the marketplace.
While the states that brought the challenge are expected to enforce the ruling, some other states support broader access to association health plans, said Christopher Condeluci, an attorney who represents several such plans, including the one formed by Lyon’s group.
“These plans are not an end run around the ACA,” said Condeluci.
Association health plans already established under the administration’s rules cover “virtually” all the federal law’s essential health benefits, he said, with the exception of dental and vision care for children.
Local chamber of commerce plans are mainly continuing business as usual while watching to see if the government will appeal, said Katie Mahoney, vice president of health policy at the U.S. Chamber of Commerce.
A few, including a plan offered through the Las Vegas chamber, may limit new enrollment for sole proprietors, she said, as the judge sharply questioned whether they qualified as “employers” under federal laws.
Sole proprietors are generally individuals who own and operate their own businesses without any employees.
Bates wrote that, in the regulation, the Department of Labor “stretches the definition of employer” beyond what federal law allows. The rule was designed to increase access to plans that “avoid the most stringent requirements” of the ACA.
The opinion by Bates, who was appointed by President George W. Bush, is widely expected to be appealed, although the government has not yet done so.
The decision affects one pillar of a broader effort by the Trump administration to expand access to less expensive health insurance. Association plans have long been a favorite of Republicans, existing before the ACA. Supporters say they are one way to pool groups of businesses together to get better premium rates.
Still, some plans faced problems in the past, including bankruptcy or complaints that they misled consumers by not fully informing them about what is covered.
After the ACA took effect, enrollment fell, partly because many small businesses were buying new ACA plans and many existing association plans had to comply with ACA rules for small-group coverage anyway. People who ran their own businesses and had no employees qualified only for coverage through the ACA’s individual market.
But the Trump administration in June broadened the definition of those eligible to buy insurance through employer-based associations to include sole proprietors and also made it easier to form associations to offer coverage.
In addition, the changes allowed more association plans to be classified as large-employer coverage, which exempts them from some of the ACA’s requirements. For example, association plans don’t have to include all 10 of the ACA’s “essential” health benefits, such as mental health care and prescription drug coverage.
Also, unlike ACA plans, association insurers can set premium rates based on an employer’s industry, as well as taking into account the age range and gender makeup of their workforce.
In other words, association plans can charge less for companies with workforces that are generally younger and male in occupations that involve mainly desk work than for firms with mostly older workers or companies doing riskier work, such as cutting down trees or roofing.
Still, such plans must abide by other ACA provisions, including accepting people with preexisting medical conditions.
Critics, including the states that sued, say the new rules and other administration-backed changes will weaken the market for ACA plans by drawing out younger and healthier people. The states also argued that the new rules would be costly for them to administer, alleging they would have to devote more resources to preventing consumer fraud.
In Michigan, Lyon said the association his group formed, called Transcend, offers coverage to small employers and sole proprietors that is just as generous as large-group plans. It is a fully insured plan through the state’s Blue Cross Blue Shield carrier that covers a broad array of benefits, except children’s dental and vision.
“One thing we don’t want to do is sell a bag of air to our members,” said Lyon.
While some new members have reported large savings by enrolling, Lyon said association plans are not necessarily less expensive than small-group coverage. It all depends on the demographic and occupational makeup of the small business, he said.
“Our best estimate was association health plans would be the right solution for 30 to 35% of the small-group world,” said Lyon. “It all has to come together. Age matters. Gender matters. It’s so specific to each company.”
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Traditional and e-cigarette users may be more receptive to smoking cessation interventions

A study by MassGeneral Hospital for Children (MGHfC) researchers finds that parents who use both traditional cigarettes and e-cigarettes may be more receptive to smoking cessation interventions than parents who only smoke traditional cigarettes.

“Our findings suggest that smoking parents who start using e-cigarettes may have done so out of a desire to quit smoking,” says Emara Nabi-Burza, MS, of the MGHfC Division of General Academic Pediatrics and the Massachusetts General Hospital (MGH) Tobacco Research and Treatment Center (TRTC), lead author of the report published online in Academic Pediatrics. “However, many of them end up becoming dual users of cigarettes and e-cigarettes, maintaining their addiction to nicotine and also exposing their children to e-cigarette aerosols, which contain hazardous substances.”

The study also found that parents using both cigarettes and e-cigarettes were as likely as cigarette-only smokers to allow smoking in their homes but were much more likely to allow smoking in their cars and vaping in both homes and car, suggesting they may believe that e-cigarette aerosols contain few health hazards, a belief not supported by the most recent evidence.

The current study is an outgrowth of the CEASE (Clinical Effort Against Secondhand Smoke Exposure) program, which trains pediatric office staff members to ask the parents of patients whether anyone uses tobacco products in their homes or cars and to provide assistance to help those who smoke to quit. The CEASE study was conducted at 10 pediatric practices – two each in the states of Ohio, Virginia, Tennessee, North Carolina and Indiana – and the current study was conducted at the five control practices where the CEASE training had not been initiated.

Among a group of more than 700 parents who reported currently using cigarettes, 11 percent reported also using e-cigarettes, making them dual users of both products. Of 115 parents who reported using e-cigarettes, 70 percent were still smoking traditional cigarettes. Compared with parents who reported smoking traditional cigarettes only, dual users were more likely:

  • to have a child less than 1 year old at home,
  • to plan to quit smoking in the next 6 months,
  • to have attempted to quit smoking in the past 3 months,
  • to have used nicotine replacement or called a smoking quitline in the past two years.

While around 18 percent of cigarette-only users and 26 percent of dual users reported having been asking about their smoking status at the current office visit, discussions about FDA-approved medications to help them quit were reported by only 2 percent of the cigarette-only users and none of the dual users. The authors note that this result implies that, although some pediatric offices not in the CEASE program have systems prompting clinicians to screen for parental tobacco use, few routinely deliver the evidence-based tobacco control treatments that can help parents quit.

While e-cigarettes are marketed as helping smokers reduce or eliminate the use of traditional cigarettes, they are not approved for smoking cessation by the FDA. Both the U.S. Preventive Services Task Force and a committee of the National Academies of Sciences, Engineering and Medicine have concluded that current evidence does not support the use of e-cigarettes as smoking cessation aids.

Studies have shown that significant percentages of U.S. adults either don’t know whether e-cigarette aerosols are harmful to children or believe they cause some or little harm, and the National Academies report also noted that there is “conclusive evidence” that e-cigarette use increases airborne concentrations of nicotine and particulate matter in indoor environments, compared with background levels.

Jonathan Winickoff, MD, MPH, of the MGHfC Division of General Academic Pediatrics and director of Pediatric Research in the MGH TRTC, senior author of the Academic Pediatrics paper, says, “While e-cigarettes emit numerous toxins in addition to nicotine and still pose health risks, nicotine replacement therapy in the form of gum, lozenges or patches has proven effectiveness in supporting smoking cessation and eliminating nicotine exposure to infants and children. Pediatric offices are an ideal location for offering evidence-based treatments to patients’ parents and educating them that e-cigarettes are not a safer option.” Winickoff is a professor of Pediatrics at Harvard Medical School.


Delving into tumor’s cellular lineage may offer clues for customized therapies

To explain a person’s actions in the present, it sometimes helps to understand their past, including where they come from and how they were raised. This is also true of tumors. Delving into a tumor’s cellular lineage, a Ludwig Cancer Research study shows, can reveal weaknesses to target for customized therapies.

The findings, detailed in the April 24 issue of the journal Nature, also illustrate how knowledge of the biochemistry and microenvironment of the tissue from which a tumor arises can help predict the genetic alterations its cancer cells are likely to undergo.

“We’re trying to understand what might make a cancer vulnerable to precision oncology,” said Paul Mischel, a member at the San Diego Branch of the Ludwig Institute for Cancer Research, who led the study. “These findings suggest that understanding the interactions between genes and environments can lead to potentially more effective, selective and specific ways to treat cancer.”

In their study, Mischel and his colleagues, including Ludwig San Diego’s Bing Ren, postdoctoral fellow Sudhir Chowdhry and Vineet Bafna, computer science professor at the University of California, San Diego (UCSD), analyzed more than 7,000 tumors from 200 cancer studies and 2,600 normal samples of 19 different tissue types. They identified two simple patterns, or “rules,” that had to do with the production of nicotinamide adenine dinucleotide (NAD), a biomolecule essential to metabolism and a broad range of other vital cellular processes.

First, tumors arising in tissues whose cells normally express high levels of an enzyme known as NAPRT become dependent on one of three available pathways to generate NAD. Secondly, cancers of tissues where NAPRT expression is not normally elevated end up relying on a different pathway to make the crucial biomolecule.

“NAD is a critical ingredient of cells,” said Mischel, who is also a professor of pathology at UCSD. “It’s vital to the DNA damage response and is also involved in epigenetic regulation,” the chemical tagging of the genome that regulates gene expression.

NAD is so important that healthy cells have three different ways of generating it, so that if one method fails, a backup is always available. “Using genetic approaches, we showed in a very rigorous way that healthy cells really do have the capacity to use any of those pathways,” said Mischel. “Cancer cells are different.”

Mischel and his colleagues noticed that cancer cells arising from tissues where NAPRT levels are high to begin with tend to have multiple copies of the NAPRT gene (and/or one other critical gene in the PH pathway called NADSYN1) and so produce even more NAPRT. These cancer cells rely exclusively on the so-called Preiss-Handler (PH) pathway to produce NAD. Inhibiting or depleting NAPRT in these cells leads to tumor death.

“It appears that the type of tissue from which tumors arise may be quite important for determining which NAD biosynthesis pathway is chosen,” Mischel said.

In contrast, cancer cells arising from tissues where NAPRT levels are not normally elevated produce NAD using another method called the salvage pathway, and they do this by remodeling their epigenome. Most important: In both cases, the cancer cells lose the ability to use other means of producing NAD.

“They have to make a pathway choice, and they can’t switch,” Mischel said. “They effectively become addicted to either the PH or the salvage pathway.”

To demonstrate how these tumor addictions might be exploited, the researchers implanted engineered human ovarian cancer cells addicted to the PH pathway into the left side of mice and human lung cancer cells hooked on the salvage pathway into their right sides. The ovarian tumors shrank when genes important for the PH pathway were silenced using genetic engineering approaches, but not when key proteins in the salvage pathway were depleted. The lung tumors showed the opposite effect: they shrank only when salvage pathway proteins were depleted.

The team also demonstrated how the same effect could be achieved with drugs. Currently, there are no drug inhibitors for the PH pathway in mammalian cells, but the scientists found that a compound known to block NADSYN in bacteria was also effective against the human tumors.

Mischel and Ren’s groups, and their colleagues, will continue to work together to better understand the processes and specific molecular events that drive the cancer cell’s addiction to a particular NAD biosynthesis pathway.


Two studies uncover brain mechanisms underlying decision making process

New research conducted in the Cognitive Neuroscience group of SISSA shows that a perceptual decision – recognizing an object and taking the appropriate action – is triggered as soon as the brain’s processing networks accumulate the exact right quantity of sensory information. Our sensory receptors continuously collect information from the outside world, allowing us to understand what surrounds us and to behave accordingly. Recognizing the identity of an object often seems almost instantaneous. However, sometimes information enters the sensory system more gradually, in fits and starts, and an immediate percept is not possible. How, then, are signals accumulated over time? When does the nervous system decide that “enough is enough: it’s time to act”? Two new publications in Current Biology by Yanfang Zuo and Mathew E. Diamond (director of SISSA’s Tactile Perception and Learning Lab) show that the brain compares the incoming sensory evidence in favor of competing percepts and expresses a decision as soon as the total acquired evidence for one choice reaches a fixed boundary. The studies uncover fundamental brain mechanisms underlying decision making in an uncertain world.

Reaching a boundary in visual perception

To date, how the brain commits to a decision under conditions of gradual, uncertain sensory inflow has been studied almost exclusively by having a subject (a human or monkey) view a computer monitor displaying many dots moving in different directions. The subject is tasked with judging the overall direction of the majority of the dots (this is akin to watching the main hall of Grand Central Station from a balcony at rush hour to assess whether more people are entering or exiting). If 100% of the dots on the monitor are moving to the left, the percept forms immediately and the decision is fast and easy. But if 55% of dots are moving to the left and 45% are moving to the right, motion signals must be collected over time. Decades of neuroscience research have shown that the incoming signals in favor of the two possible choices (left versus right) are in competition: the viewer can report a motion percept as soon as the total amount of visual motion information in favor of one of the two alternatives, integrated over time, reaches some fixed quantity. The model formulated to explain these results, “bounded integration,” is simple, efficient, and computationally optimal; there even exist robust neuronal correlates. But does the model generalize beyond visual motion perception?

Stepping from visual to tactile decision making

“Sensory-perceptual decision making is a pervasive element of behavior, carried out countless times each day. We wanted to see whether the “bounded integration” model for explaining visual motion perception can explain perceptual judgments in a different sensory modality, in a different species, and in a different form of sensing” explains Mathew Diamond, the senior author of both articles.

While primates are experts in vision, rats are experts in touch, especially when it comes to using the whiskers of their snout to identify the texture of an object. The perception of surface texture is critical to rats’ behavior, for example in the selection of nesting site and materials. Rats move their whiskers in a forwards/backwards cycle at 10 Hz, sweeping them across the surface on each cycle. Thus, rather than receiving sensory evidence (as in vision), the rat creates sensory evidence by actively controlling its own whisker motion. In the new published work, the investigators presented one of three possible textures before the rat on each trial. According to which texture it sensed through its whiskers, the rat selected a reward location, with the correct location set according to actual texture identity. Meanwhile, the investigators took video records at 1,000 images per second to examine whisker shape, motion and angle. They also measured neuronal activity in two regions of the cerebral cortex that are dedicated to processing tactile information.

When is enough enough?

On some trials, the rat touched once and quickly made its choice; on other trials, the rat touched as many as six times. If decision making were based on bounded integration, then the rat would end its exploration as soon as it had generated enough evidence to support a reliable choice, and its average accuracy would be independent of the count of touches. An alternative hypothesis proposes that a pattern generator in the rat’s motor system pre-sets the upcoming trial’s touch count even before the rat makes contact. The results turned out to be consistent with the bounded integration framework – accuracy was unrelated to the number of touches.

The main conclusions of the two studies are illustrated in this cartoon, where the rat must identify the texture as grooved or smooth. The first Current Biology study identified the nature of the tactile evidence: whisker kinematics (bending and motion) differ according to the contacted texture. Once kinematic features are converted to neuronal firing, the brain begins to process texture information, as shown on the left. While the information acquired in a single touch indicates one texture more strongly than the other, the signal is graded: whisker kinematics are consistent with the grooved texture to some degree, but also with the smooth texture to some degree. Thus, there are different quantities of evidence in favor of both textures, shown as the upward steps in the plot. The main finding is that the rat makes its choice when the total quantity of evidence for one texture, summated across touches, reaches a boundary. Here, the total evidence in favor of the grooved texture reaches the boundary on the 4th touch, while the total evidence in favor of the smooth texture remains below. As shown on the right, once the evidence for the grooved texture reaches the boundary, the rat forms a percept – a mental image of the object – and makes the correct choice. Had the evidence for the smooth texture reached the boundary first, the rat would have made an incorrect choice based on an erroneous percept. That is exactly what happened on 20% of trials.

Where is the information accumulated? The second Current Biology study shows that the somatosensory cortex encodes the whisker kinematics of individual touches, but does not accumulate information over the sequence of touches. Instead, somatosensory cortex distributes packets of evidence to a downstream brain region that integrates information across time (depicted here as the neuronal cluster in the rat’s head). On every trial, the rat stops whisking and makes its decision as soon as the summated quantity of touch-by-touch evidence reaches a boundary.

Tactile cognition

“The framework of decision making through bounded integration, previously attributed to primates, thus extends to rodents,” comments Diamond. A final observation concerns individual differences. “We tend to think that individual humans are different, but all rats must be alike. We were able to compute each rat’s decision boundary. Those with a higher boundary lost more time collecting evidence on each trial, but had better overall performance because they needed more certainty before committing to a decision; they traded speed for accuracy.” That is, rats are aware of how much they know, and decide when they have enough knowledge, a fundamental element of cognition. Current work is exploring other forms of tactile cognition.


Cardiometabolic Risk Better ID’d in Children Reclassified to Higher BP

MONDAY, April 22, 2019 — Children reclassified to higher blood pressure categories based on 2017 pediatric hypertension definitions are at increased risk for developing adverse cardiometabolic outcomes, according to a study published online April 22 in Hypertension.

Tingting Du, from Huazhong University of Science and Technology in Wuhan, China, and colleagues compared the consequences of the 2017 and 2004 pediatric hypertension definitions and examined their performance in predicting adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH). Data were included for 3,940 children with 36-year follow-up since childhood.

The researchers identified hypertension as defined in the 2004 and 2017 guidelines in 7 and 11 percent of children, respectively. Similar associations were seen with adulthood hypertension, metabolic syndrome, and LVH. There was an increase in the proportion of children identified as having hypertension who developed adult LVH, from 12 to 19 percent when defined by the 2004 and 2017 guidelines, respectively. The 8 percent of children who were reclassified by the 2017 guidelines to higher blood pressure categories were more likely to develop hypertension, metabolic syndrome, and LVH in later life, while similar cardiometabolic outcomes were seen for the 1 percent who were reclassified to lower blood pressure categories and their propensity score-matched normotensive counterparts.

“We demonstrated that the 2017 guidelines increased hypertension prevalence as a result of reclassification to higher BP categories,” the authors write.

Abstract/Full Text (subscription or payment may be required)

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Posted: April 2019

How the obesity epidemic is taking a toll on our bones and joints

How the obesity epidemic is taking a toll on our bones and joints
Deb Baranec struggled with obesity and osteoarthritis for 30 years. Now she works out six days a week and has lost 190 pounds. Credit: Don Molyneaux, for the McCaig Institute for Bone and Joint Health

Deb Baranec wasn’t always obese. As a teenager, she carried a few extra pounds but managed it by being active. Her weight crept up, however, and by the time she suffered her first knee injury while skiing at the age of 27, she weighed close to 200 pounds.

Doctors advised Baranec to lose weight to relieve the stress on her knees. She went on the first of many diets, started working out, and lost 50 pounds. But eventually her knees hurt too much to continue exercising and her weight increased.

“I’d visit different doctors looking for a solution to my knee pain. I’d see a new orthopaedic surgeon, and be advised to come back when I lost weight. I would try a new diet or exercise program, lose weight, gain it back, and then, gain a bit more—to the point I was 354 lb.,” she says.

Unfortunately, stories like Baranec’s are becoming more common.

Obesity: A growing problem

According to the World Health Organization, worldwide obesity has nearly tripled since 1975. In 2016, 39 per cent of adults were considered overweight, and 13 per cent were obese (having a body mass index— or BMI—greater than or equal to 30). That’s bad news for our bones and joints.

Being overweight is one of the biggest risk factors for developing osteoarthritis (OA). Carrying too much weight causes joint instability and muscle weakness, and increases the load on bones and joints. OA prevalence across Canada has increased in correlation with an aging population and rising rates of obesity. The result is an increased demand for arthritis-related health services, including a marked rise in hip and knee replacements.

A team of McCaig Institute for Bone and Joint Health researchers, comprised of a nutrition expert, a pioneer in biomechanics and an inflammation scientist, are tackling the problem.

Can your diet cause inflammation?

Over a decade ago, UCalgary scientist and registered dietitian Dr. Raylene Reimer, Ph.D., RD, Faculty of Kinesiology, found that a high-fat, high-sugar diet in rats changed the microbes that reside in the gastrointestinal tract, collectively termed gut microbiota.

While using Reimer’s high-fat, high-sugar diet to study the effect of obesity on the joints of rats, biomechanist and muscle researcher Dr. Walter Herzog, Ph.D., Faculty of Kinesiology, and graduate student Kelsey Collins made a startling discovery: The gut microbiota changes in rats that were fed a high-fat, high-sugar diet resulted in joint and muscle inflammation, a condition called metabolic OA. Some of these changes occurred as soon as three days into the experiment—even before the rats gained weight.

“This shows that arthritis isn’t just caused by wear and tear on a joint. We discovered that a high-fat, high-sugar diet alone can change the muscles and joints of animals,” says Herzog. This led the team to wonder whether altering the gut microbiota in obese rats could halt metabolic OA.

Can prebiotics help prevent the progression of osteoarthritis?

In 2017, Reimer and her team published a study that showed a prebiotic fibre supplement reduced body fat and altered intestinal microbiota in overweight or obese children.

Armed with this knowledge, Reimer, Herzog and inflammation expert Dr. David Hart, Ph.D., Cumming School of Medicine, wanted to see if using a prebiotic supplement could change gut microbiota, reduce inflammation and improve joint function. Graduate student Jacqueline Rios tested the hypothesis in rats, adding an exercise component as well. She found that feeding obese rats a prebiotic fibre supplement and/or having the rats perform light to moderate aerobic exercise (walking), completely prevented the damage the high fat/sugar diet caused in the joints of untreated rats. This work was recently published in Scientific Reports.

Postdoctoral Fellow Dr. Rafael Fortuna, Ph.D., is currently embarking on a similar study in humans. He wants to determine if prebiotic supplementation can reduce chronic inflammation through changes in the intestinal gut microbiota and improve knee function in patients with obesity and knee osteoarthritis. They are currently seeking volunteers for this study.

“All we ask participants to do is add fibre to a glass of water,” says Fortuna. “The goal is to find an inexpensive, easy intervention to prevent the progression of osteoarthritis in adults with obesity. If we can prevent patients from needing a knee replacement that would be great.”

Reimer is quick to point out that although the work with prebiotic fibre is promising, it is just one piece of the obesity/OA puzzle: “Obesity is a very complex disease that often requires multiple different strategies—diet and behaviour changes, motivation and exercise—they all play a huge part in helping individuals achieve a healthier body weight.”

Exercise and OA

There is no doubt that combining diet with physical activity is key to weight loss. But for someone with obesity and osteoarthritis, exercise can be extremely painful.

“Exercising with OA is easier said than done,” says Hart. “There is limited evidence on the safest and most appropriate types of physical exercises for adults with osteoarthritis and obesity. If we can develop interventions such as using prebiotic fibre to control the gut microbiota, decrease metabolic syndrome, and improve function, more patients with obesity and OA may be able to utilize exercise programs more effectively to enhance weight loss and continue to improve function.”

The University of Calgary and University of Alberta are collaborating on a study to understand the impact of different types of exercise programs on mobility, quality of life, medication use, blood markers, and willingness to pay for programming in knee osteoarthritis patients. The study, led by Hart and Dr. Jackie Whittaker, Ph.D., from the University of Alberta, compares two new exercise programs specifically designed for people with osteoarthritis: GLA:D Canada and JointEffort. Both programs feature group exercise sessions, but differ in terms of educational programming and followup. Researchers are currently seeking volunteers for this study.

“The goal of the team is to bring together the findings of the prebiotic fibre work and the exercise study to offer a complete diet and physical activity program for patients struggling with obesity and OA,” says Hart. “We want to keep people moving. Ultimately it’s not just about joint health. It’s about maintaining mobility and quality of life.”

Mobility for Life

Baranec eventually received a knee replacement in 2010. When she woke up from surgery, she had an epiphany. “I told myself, ‘You’ve been given a second chance. Don’t screw it up,'” says Baranec. “I signed-up for Weight Watchers with my daughter and started exercising six days a week.” By the time she received her second knee replacement in 2015, Baranec had dropped 130 pounds.

“It made a huge difference in my recovery and mobility. Every pound I took off helped my knees.” To date, Baranec has lost 190 pounds. “Getting my knees back, keeping the weight off, has given me my life back.”

Participate in research

Two UCalgary studies mentioned in this article are currently looking for research participants:

Can a dietary fibre supplement alleviate knee pain and improve knee function?

Researchers are recruiting individuals 30 to 70 years old with diagnosed knee osteoarthritis, with a BMI greater than 30/km/m (calculate here) to participate in this study.

Understanding the impact of different types of exercise programs on mobility, quality of life, medication use, and blood markers in knee osteoarthritis patients.

Researchers are looking for individuals 50 years of age and older with diagnosed knee osteoarthritis to participate in this study.

When it comes to weight loss in overweight and obese adults with knee osteoarthritis, more is better

More information:
Jaqueline Lourdes Rios et al. Protective effect of prebiotic and exercise intervention on knee health in a rat model of diet-induced obesity, Scientific Reports (2019). DOI: 10.1038/s41598-019-40601-x

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University of Calgary

How the obesity epidemic is taking a toll on our bones and joints (2019, March 25)
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E-cigarettes contaminated with dangerous microbial toxins

Harvard University researchers have discovered that many popular electronic cigarette (e-cigarette) products are contaminated with microbial toxins that are known to cause a range of health problems. The research was published today in the journal Environmental Health Perspectives.

E-cigarettes may contain harmful levels of microbial toxins, according to a new study.eldar nurkovic | Shutterstock

The authors warn that the findings indicate that “some popular [e-cigarette] brands and flavors may be contaminated with microbial toxins.”

The toxins identified were endotoxin − a potent toxic molecule found on the membranes of Gram-negative bacteria − and glucan, a polysaccharide that helps to form the cell walls of most species of fungi.

Tobacco smoke from traditional tobacco cigarettes also contains endotoxins and glucans that that contaminate the products at some point during the manufacturing process. Exposure to such toxins is associated with respiratory health problems such as asthma, reduced lung function, and lung inflammation. Furthermore, studies conducted over many decades have demonstrated chronic lung impairment in populations exposed to airborne biological contaminants.

Yet, according to the authors of the current study, no studies have ever explored whether these common microbial agents could also be present in e-cigarette products.

Acute and chronic respiratory effects

Now, Professor of Environmental Genetics, David Christiani, and colleagues have tested 75 popular products from ten leading e-cigarette brands, including 37 single-use cartridges (also called “cigalikes”) and 38 e-liquids (which are used to refill cartridges). All products were purchased online, with the exception of products from one brand, which was bought at a convenience store on the university’s campus.

The products were divided into four different flavors, which included tobacco, menthol, fruit, and other. All products were then tested for the presence of endotoxin and glucan.

As reported today in the journal Environmental Health Perspectives, the researchers found that 17 (23%) of the products contained detectable levels of endotoxin and that 61 (81%) contained traces of glucan.

Further analysis showed that, on average, the cartridges contained 3.2 times more glucan than the refillable e-liquid samples.

On average glucan levels were ten times higher in the tobacco and menthol-flavored products, compared with in the fruit-flavored samples, while endotoxin concentrations were found to be significantly higher in the fruit-flavored products.

Airborne Gram-negative bacterial endotoxin and fungal-derived glucans have been shown to cause acute and chronic respiratory effects in occupational and environmental settings. Finding these toxins in e-cigarette products adds to the growing concerns about the potential for adverse respiratory effects in users.”

Contamination can occur at any stage in the manufacturing process

The authors suggest that the raw materials used to produce ‘fruity’ flavors are a potential source of microbial contamination.

They also note that contamination could be introduced at any stage during the manufacture of the e-cigarette ingredients or in the production of the finished e-cigarette products themselves. One potential source, for example, is the cotton wicks used in the cartridges, since both endotoxins and glucans are known to contaminate cotton fibers.

The use of e-cigarettes has gradually been in creasing over recent years, particularly among high-school age and middle-school age pupils. Estimates suggest that last year, more than three million high school students used the products, a significant increase on the 220,000 students estimated to have used the products in 2011.

Mi-Sun Lee says the new findings should be considered when developing regulatory policies for e-cigarettes:

In addition to inhaling harmful chemicals, e-cig users could also be exposed to biological contaminants like endotoxin and glucan.”

Mi-Sun Lee, Lead Author

Further research is needed

Lee and colleagues note that there are limitations to the study. For example, the team did not test the concertation of toxins that are aerosolized and passed on to the user.

Furthermore, the team only screened for toxins in first-generation devices and not more recently developed products such as tanks, pods or pens. Pods, especially, are known to deliver a higher concentration of nicotine per puff, compared with first-generation devices, yet scientists do not know how this may impact on the degree of exposure to toxins.

Many scientists believe that exposure to environmental toxins is significantly less among people who vape than among those who smoke traditional cigarettes, but that this does not necessarily mean that e-cigarettes products are not damaging to health at all.

Should the government ban e-cigarettes?

Currently, there is no scientific evidence that can conclusively support the hypothesis that the levels of endotoxin and glucan found in e-cigarette products is enough to raise public health concerns.

However, given that exposure to high enough levels of airborne endotoxin does appear to harm the lungs and that the toxins are thought to contribute to the damage that cigarette smoking has on respiratory health, the authors think that further study is needed.

Future research will look at how often the toxins are present in e-cigarette flavors and whether exposure to them through vaping poses and significant health risk, since there may be strategies that could be used to minimize the risk of contamination.

Researchers document specific characteristics of storefront tobacco advertisements

In response to U.S. restrictions on where tobacco companies are allowed to advertise their products, the industry now dedicates nearly all of its $9 billion advertising budget to activities occurring in retail settings. A new study by researchers at Columbia University Mailman School of Public Health fills an important gap by documenting specific characteristics of storefront tobacco advertisements in the context of today’s diverse tobacco product landscape. Findings are published online in the journal Preventive Medicine.

“The mechanisms through which tobacco advertising in retail settings influence product use are not well understood, particularly for non-cigarette products,” said Daniel Giovenco, PhD, assistant professor of Sociomedical Sciences. “The aim of our study was to describe how ad features, such as flavor promotion, size, and placement, vary across product categories, and how this may contribute to consumer behavior.”

The researchers analyzed nearly 1,000 photos of storefront tobacco ads taken from a representative sample of 796 licensed tobacco retailers in New York City between July and October 2017. Cigarettes were the most commonly advertised product (40 percent of ads), followed by electronic nicotine delivery systems (ENDS, 28 percent), cigars (27 percent), and smokeless tobacco (5 percent). Nearly a quarter of all ads were for Newport cigarettes, a brand commonly used by African American smokers. The promotion of menthol or flavored product styles was documented in 60 percent of cigarette and smokeless tobacco ads, versus 26 and 30 percent of cigar and ENDS ads, respectively.

Although cigarette ads generally took up a larger amount of window space compared to other product types, cigar and ENDS ads were more commonly placed directly on the door of entry, potentially making them more noticeable to consumers. Tobacco ads were frequently displayed directly next to other tobacco ads and other “vice” products. For example, a quarter of cigar and cigarette ads were adjacent to ads for sugary drinks and lottery tickets.

Importantly, advertising features did not always align with local or federal tobacco control policies. For example, 10 percent of cigarette ads did not contain a warning label, despite a federal mandate. Similarly, a third of cigar ads promoted a flavored product, even though flavored cigars are now prohibited from being sold in New York City. Advertising policy violations may be attributed to retailers who leave “older” ads displayed for long periods of time, irrespective of the evolving policy landscape.

“By documenting and monitoring specific point-of-sale advertising strategies, compliance with tobacco control policies, and assessing their impact on tobacco use behaviors, we are building the necessary evidence base needed to inform sound policymaking,” said Giovenco. “It is important that local, state, and federal governments forcefully move forward in regulating one of the ‘last frontiers’ and most effective forms of tobacco marketing. “


Oncotype DX-guided treatment could reduce cost for breast cancer care, study suggests

A new study suggests that Oncotype DX-guided treatment could reduce the cost for the first year of breast cancer care in the U.S. by about $50 million (about 2 percent of the overall costs in the first year). The study by Georgetown Lombardi Comprehensive Cancer Center and National Cancer Institute researchers was published April 24, in JNCI.

The landmark TAILORx (Trial Assigning IndividuaLized Options for Treatment) trial results suggested that use of the Oncotype DX® gene test can offer women valuable information about treatment options, potentially sparing 70 percent of women from needing chemotherapy if they are newly diagnosed with the most common subtype of breast cancer. The information only applied to women with early-stage breast cancer that is hormone positive (ER/PR+), HER2neu negative, and has not spread to the lymph nodes.

The projected cost savings in the new study are based on two factors: about a 50 percent increased cost in gene testing assuming that it will be done for all newly diagnosed women, which would be offset by an approximately 8 percent expected drop in the overall cost of chemotherapy due to fewer women being recommended this form of treatment. Chemotherapy is considerably more expensive than gene testing, hence the 8 percent reduction in its cost is greater, dollar-wise, than the 50 percent increase in cost for gene testing.

“Individual women’s decisions should not be about dollars and cents, but what is right for them based on consideration of the best evidence and personal preferences,” says Jeanne S. Mandelblatt, MD, MPH, professor of oncology and medicine at Georgetown Lombardi.

Mandelblatt and her colleagues examined the monetary impact in the U.S. of providing care based on evidence from TAILORx. The researchers looked at statistics on gene testing and chemotherapy use in National Cancer Institute and Medicare databases, before and after the TAILORx trial results were announced in 2018. The periods during which costs accrue are usually grouped into three timeframes: initial costs (diagnosis and treatment), terminal costs (last year of life) and everything in between (continuing care costs). This study only estimated initial costs.

The estimated individual Oncotype DX test costs in this analysis were about $3,400 and based on Medicare reimbursement rates. Many insurers, including Medicare, cover the cost for most women diagnosed with early-stage breast cancer. Another gene test that is used less often in the U.S., called MammaPrint®, has similar costs.

The investigators estimated that, prior to 2018, the mean initial costs of healthcare nationwide for newly diagnosed women with breast cancer, which were fairly stable for a number of years, included two components: chemotherapy costs of $2.701 billion and Oncotype DX testing costs estimated to be $115 million, for a total healthcare cost of $2.816 billion in the first year after diagnosis. The researchers estimated that only 34.8 to 57.2 percent of women were receiving the Oncotype DX testing in this period as the clinical application of such tests was still uncertain.

In 2018, the TAILORx findings showed no benefit from chemotherapy for women whose tumors had lower risks for recurrence based on Oncotype DX scores. For their modeling, the researchers projected that all women with scores of 0-25 (low to intermediate risk) would forgo chemotherapy starting in 2018, so those treatment costs would go down by 8 percent, saving $338 million in initial chemotherapy costs. The researchers also assumed 100 percent of women would get Oncotype DX testing, raising those costs by $116 million (from $115 to $231 million). The total initial costs for this period were therefore projected to be $2.766 billion.

Comparing the two initial 12-month costs of care for the pre-2018 and 2018 and after periods, the researchers projected that the combined treatment and testing costs would decrease from $2.816 to $2.766 billion, for a net savings of about $50 million (1.8 percent decrease).

“This study only answers the question about whether, in the first 12 months after diagnosis, costs of gene testing are likely to be offset by savings in avoided costs of chemotherapy – and the answer is yes. We did not estimate how the trial results could diffuse into medical practice, since those data will not be available for several years,” Mandelblatt says. “The gene tests are not perfect predictors of who will ultimately have a recurrence of breast cancer, so it will be important to model the long-term outcomes and costs from diagnosis to death.”


New review highlights how lifestyle affects our genes

In the past decade, knowledge of how lifestyle affects our genes, a research field called epigenetics, has grown exponentially. Researchers at Lund University have summarized the state of scientific knowledge within epigenetics linked to obesity and type 2 diabetes in a review article published in the scientific journal Cell Metabolism.

Epigenetic mechanisms control the activity of different genes. Disruptions in the epigenetic machinery may lead to diseases such as obesity and type 2 diabetes. This review summarises the role of epigenetic changes in different human tissues of relevance for metabolism, for example, in adipose tissue, skeletal muscle, pancreatic islets (which, among other things, contain the insulin-producing cells), liver and blood, linked to obesity and type 2 diabetes.

“Epigenetics is still a relatively new research field; however, we now know that epigenetic mechanisms play an important role in disease development. Similarly, the epigenetic patterns are affected by disease. Variations in genetic material (DNA), age, exercise and diet also have an impact on epigenetic variation”, says Charlotte Ling, professor and pioneer in the field of epigenetics and diabetes who authored the review together with researcher Tina Rönn.

The researchers detail the latest findings in epigenetics in the following categories:

  • The significance of diet
  • Physical activity
  • Aging
  • The significance of genes
  • Is the epigenome heritable?
  • How can epigenetics contribute to novel treatments?


Posted in: Genomics

Tags: Adipose, Blood, Cell, Cell Metabolism, Compound, CpG, Diabetes, Diet, DNA, DNA Methylation, Epigenetics, Exercise, Genes, Genetic, Genome, Inherit, Insulin, Liver, Metabolism, Muscle, Obesity, Physical Activity, Research, Type 2 Diabetes

Study provides evidence that blood tests can detect Alzheimer’s risk

A new study confirms that a simple blood test can reveal whether there is accelerating nerve cell damage in the brain. The researchers analyzed neurofilament light protein (NFL) in blood samples from patients with Alzheimer’s disease. Recently published in JAMA Neurology, the study suggests that the NFL concentration in the blood could be able to indicate if a drug actually affects the loss of nerve cells.

The blood samples were collected over several years, and on multiple occasions, from 1182 patients with different degrees of cognitive impairment, and 401 healthy subjects in a control group.

Very sensitive methods have been developed in recent years to measure the presence of certain substances in blood that can indicate damage in the brain and neurological diseases such as Parkinson’s, multiple sclerosis (MS) and Alzheimer’s. Neurofilament light protein (NFL) is one such substance.

“Standard methods for indicating nerve cell damage involve measuring the patient’s level of certain substances using a lumbar puncture, or examining a brain MRI. These methods are complicated, take time and are costly. Measuring NFL in the blood can be cheaper and is also easier for the patient”, explains Niklas Mattsson, researcher at Lund University and physician at Skåne University Hospital, who led the study.

When nerve cells in the brain are damaged or die, NFL protein leaks into the cerebrospinal fluid and onwards into the blood. It was previously known that the levels of NFL are elevated among people with neurodegenerative diseases, but there has been a lack of long-term studies.

“We discovered that the NFL concentration increases over time in Alzheimer’s disease and that these elevated levels also are in line with the accumulated brain damage, which we can measure using lumbar punctures or magnetic resonance imaging”, says Niklas Mattsson.

The new study focuses on the common form of the disease, sporadic Alzheimer’s disease. It is one of the most widespread chronic diseases in the world and the most common cause of dementia. The researchers have analyzed a large number of blood samples collected over several years from a total of 1583 patients.

“A recently published small-scale German-American study presented similar results on familial Alzheimer’s disease, a very rare form of the disease that is strongly related to heredity. Taken together, these studies indicate that NFL in the blood can be used to measure damage to brain cells in various forms of Alzheimer’s disease”, says Niklas Mattsson.

Alzheimer’s is a complex, difficult-to-diagnose disease that develops gradually. The disease involves the deterioration of cognitive and physical functions along with the atrophy and death of brain cells. At present, there is no treatment that can reduce the loss of nerve cells in the brain. Drugs are available to mitigate cognitive disorders, but not to slow the course of the disease.

Measurements of the NFL concentration in the blood could indicate if a medicine is actually affecting the loss of nerve cells, when an optimal dosage of the drug has been reached or if another drug should be tried.

“Within drug development it can be valuable to detect the effects of the trialled drug at an early stage and to be able to test on people who do not yet have full-blown Alzheimer’s”, says Niklas Mattsson and continues;

“In previous drug trials there has been considerable uncertainty about the effects of the drugs. There are several reasons for this. For example, some of the patients involved probably did not have Alzheimer’s disease. In other cases, is was unclear if the drug had been introduced too late in the course of the disease. Measuring the NFL concentration in the blood could make things easier for future drug development, both through following the effects of the drug and by including test subjects who display markers of nerve cell deterioration. This approach will enable more reliable conclusions to be drawn from the results”.

Niklas Mattsson emphasizes the importance of continuing to examine how sensitive the measurement of NFL in the blood is as a marker for Alzheimer’s disease and what can be expected from longitudinal changes. The effects of promising drugs also need to be confirmed in new drug studies.

However, he believes that the method is not far from becoming a standard clinical procedure.

“Preparatory work is ongoing at Sahlgrenska University Hospital in Gothenburg to make this method available as a clinical procedure in the near future. Physicians can then use the method to measure damage to nerve cells in Alzheimer’s disease and other brain disorders through a simple blood test”, Niklas Mattsson concludes.


Computer program mimics natural speech using brain signals from epilepsy patients

Scientists used brain signals recorded from epilepsy patients to program a computer to mimic natural speech–an advancement that could one day have a profound effect on the ability of certain patients to communicate. The study was supported by the National Institutes of Health’s Brain Research through Advancing Innovative Technologies (BRAIN) Initiative.

“Speech is an amazing form of communication that has evolved over thousands of years to be very efficient,” said Edward F. Chang, M.D., professor of neurological surgery at the University of California, San Francisco (UCSF) and senior author of this study published in Nature. “Many of us take for granted how easy it is to speak, which is why losing that ability can be so devastating. It is our hope that this approach will be helpful to people whose muscles enabling audible speech are paralyzed.”

In this study, speech scientists and neurologists from UCSF recreated many vocal sounds with varying accuracy using brain signals recorded from epilepsy patients with normal speaking abilities. The patients were asked to speak full sentences, and the data obtained from brain scans was then used to drive computer-generated speech. Furthermore, simply miming the act of speaking provided sufficient information to the computer for it to recreate several of the same sounds.

The loss of the ability to speak can have devastating effects on patients whose facial, tongue, and larynx muscles have been paralyzed due to stroke or other neurological conditions. Technology has helped these patients to communicate through devices that translate head or eye movements into speech. Because these systems involve the selection of individual letters or whole words to build sentences, the speed at which they can operate is very limited. Instead of recreating sounds based on individual letters or words, the goal of this project was to synthesize the specific sounds used in natural speech.

“Current technology limits users to, at best, 10 words per minute, while natural human speech occurs at roughly 150 words/minute,” said Gopala K. Anumanchipalli, Ph.D., speech scientist, UCSF and first author of the study. “This discrepancy is what motivated us to test whether we could record speech directly from the human brain.”

The researchers took a two-step approach to solving this problem. First, by recording signals from patients’ brains while they were asked to speak or mime sentences, they built maps of how the brain directs the vocal tract, including the lips, tongue, jaw, and vocal cords, to make different sounds. Second, the researchers applied those maps to a computer program that produces synthetic speech.

Volunteers were then asked to listen to the synthesized sentences and to transcribe what they heard. More than half the time, the listeners were able to correctly determine the sentences being spoken by the computer.

By breaking down the problem of speech synthesis into two parts, the researchers appear to have made it easier to apply their findings to multiple individuals. The second step specifically, which translates vocal tract maps into synthetic sounds, appears to be generalizable across patients.

“It is much more challenging to gather data from paralyzed patients, so being able to train part of our system using data from non-paralyzed individuals would be a significant advantage,” said Dr. Chang.

The researchers plan to design a clinical trial involving paralyzed, speech-impaired patients to determine how to best gather brain signal data which can then be applied to the previously trained computer algorithm.

“This study combines state-of-the-art technologies and knowledge about how the brain produces speech to tackle an important challenge facing many patients,” said Jim Gnadt, Ph.D., program director at the NIH’s National Institute of Neurological Disorders and Stroke. “This is precisely the type of problem that the NIH BRAIN Initiative is set up to address: to use investigative human neuroscience to impact care and treatment in the clinic.”


Physicians turning to antibiotic alternatives for long-term acne treatment

Physicians are scaling back on prescribing antibiotics for long-term acne treatment in favor of a combinations of therapies, according to Rutgers researchers.

The findings, published as Part I and Part II in the journal Dermatologic Clinics, surveyed studies on acute and long-term acne treatments over the past decade to identify trends.

“People are more conscious about the global health concern posed by the overuse of antibiotics and that acne is an inflammatory, not infectious, condition,” said Hilary Baldwin, clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical School. “Overuse of antibiotics also can promote the growth of resistant bacteria, which can make treating acne more challenging.”

Prolonged use of antibiotics can affect the microbiome (the trillions of bacteria, viruses and fungi that inhabit our bodies) in areas other than the skin, resulting in disease. The report noted that people who use topical and oral antibiotics were three times as likely to show an increase of bacteria in the back of their throat and tonsils compared with non-users. Long-term use of antibiotics in acne treatment also is associated with an increase in upper respiratory infections and skin bacteria and was shown to affect a user’s blood-sugar level.

However, doctors are increasingly exploring combinations of therapies instead of antibiotics for long-term treatment. Baldwin said there is renewed interest in the antibacterial medication benzoyl peroxide that often is used in combination with topical retinoids, which are medicines derived from vitamin A. One benefit is that benzoyl peroxide, which kills the acne-causing bacteria, helps the skin shed more effectively, reduces clogged pores and does not promote resistant acne-inducing bacteria strains.

Although acne is common in teens, it can continue into adulthood, affecting mainly women. The report notes that about 50 percent of women in their 20s, one-third in their 30s and one-quarter in their 40s suffer from the condition. The oral medication spironolactone is particularly effective in women. Although this medication, which is typically prescribed for high blood pressure, heart failure and swelling, is not FDA-approved for acne treatment, it is commonly used for disorders related to androgens, a group of sex steroid hormones.

Since hormone imbalance can trigger acne, doctors are looking to hormonal therapies, which target androgens in the development of acne and have been shown to be effective, safe and require little continual monitoring.

The researchers said laser and light therapies and regulating diet also show promise as non-antibiotic alternatives, but more research is needed. “Our patients often ask about the role diet plays in acne development, but that remains unclear,” said Baldwin. “However, there is some evidence that casein and whey in dairy may promote clogged pores and that low levels of omega-3 polyunsaturated fatty acids in foods such as fish contribute to inflammation that can lead to acne.”

In severe acne, early intervention with the retinoid isotretinoin is effective without antibiotics. “This oral medication is unique among acne therapies in that it has the potential to not just treat acne but to eradicate it. It is 80 percent effective if a complete course is taken,” said co-author Justin Marson, a medical student at Rutgers Robert Wood Johnson Medical School. “Studies also have disproven internet theories that the medication increases the risk of depression, ulcerative colitis and Crohn’s disease.”

However, the researchers note, antibiotics remain highly effective for moderate to severe cases of inflammatory acne and are approved by the FDA as a supplement to other treatments such as benzoyl peroxide or a topical retinoid.

“Numerous studies have shown that these combinations are fast, effective and help reduce the development of resistant strains of bacteria that causes acne, but the Centers for Disease Control and Prevention recommend that antibiotics be used for a maximum of six months,” Baldwin said.


Preschool Is Prime Time to Teach Healthy Lifestyle Habits

MONDAY, April 22, 2019 — Teaching preschoolers about healthy habits can reduce their risk of obesity and heart disease later in life, new research suggests.

The New York City study included 562 youngsters in 15 preschools in Harlem, which has a largely black and Hispanic population. The two groups are known to have an increased risk of heart disease.

At the study’s start, the 3- to 5-year-olds answered a questionnaire to assess their knowledge, attitudes and behaviors about diet, physical activity, emotions and how the body and heart work.

For example, they were asked to pick healthier foods from among vegetables, fruits and cheeseburgers/fries. They were also asked how often they run, jump and play.

Kids in six preschools (the control group) continued their regular classroom curriculum, which included a health education component. Kids in the other nine schools (the intervention group) were part of a special program created by cardiologists, psychologists and educators.

Over four months, the intervention group was taught about healthy eating, physical activity, how the body works and managing emotions.

In addition, parents or caregivers were asked to do 12 hours of weekend activities over four months, including shopping for fresh fruit at the grocery store and increasing physical activity.

After four months, children were given the questionnaire again. Those in the intervention group had more than doubled their improvement in knowledge and attitudes about healthy habits compared to those in the control group, 12% versus 5.5%.

Children in the intervention group with the lowest scores at the start of the study showed the biggest gains. Those who took part in at least 75% of the intervention program improved more than those who did less than half of it.

The intervention was more effective for 4-year-olds than 3-year-olds, suggesting that 4 is a good age to start the intervention because kids are more mature and better able to retain information, according to the study.

“The interventions that we applied in the school system are low-cost and easy to implement, and we hope in time they can be integrated into schools across the country to promote healthy behaviors among children to ultimately reduce their risk factors for developing heart disease throughout their lives,” said study leader Dr. Valentin Fuster. He’s director of Mount Sinai Heart in New York City.

“Results from this new study prove early intervention is effective in preschool-age children, but we believe this can also promote healthy behaviors among their caregivers and teachers and have a far-reaching impact,” Fuster added in a Mount Sinai news release.

Researchers plan to expand the program across the city’s five boroughs.

The study was published online April 22 in the Journal of the American College of Cardiology.

More information

The American Academy of Pediatrics offers advice on healthy living for children.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

Study finds insidious and persistent discrimination among physician mothers

A US study in the Christmas issue of The BMJ today finds “insidious, persistent, and sometimes blatant” manifestations of discrimination experienced by physicians based specifically on their status as mothers.

While some of the experiences are consistent with those reported by women across professions, there are unique aspects of medical training and the medical profession that exacerbate maternal discrimination, say the researchers.

They call for structural changes that address pregnancy, parental leave, and childcare to mitigate the impacts of maternal discrimination in medicine.

The majority of medical student entrants are women, and recent studies suggest that women physicians may have better patient outcomes than their male counterparts. Yet there is compelling evidence of gender inequity in medicine.

Women physicians (around 80% of whom are or will become mothers) also report experiencing “maternal discrimination” based specifically on their role as a mother. Yet very little is known about this type of discrimination or its impact.

So a team of US researchers led by Eleni Linos at the University of California San Francisco, set out to identify ways in which women doctors experience this maternal discrimination.

They surveyed an online community of women who identified as medical mothers.

Mean age was 39 years (range 24-62), median number of children was 2, 74% were White, 12% were Asian, 8% were Hispanic or Latina, and 5% were Black. Most worked more than 40 hours per week.

They included questions about demographics, physical and reproductive health, perceived discrimination, potential workplace changes, and burnout.

Responses were reviewed and combined into themes which were used to create a conceptual model to illustrate the extent and nature of maternal discrimination in the medical workplace.

Emerging themes included varying expectations of performance (both higher and lower), fewer opportunities for career development, financial differences, lack of support before and after birth, and difficulties achieving life-work balance.

For example, participants described being denied earned salary increases or bonuses due to maternity leave (despite reaching or exceeding productivity goals), being passed over for leadership roles in favor of colleagues perceived as less qualified, or having their contracts grossly modified or terminated in response to announcing a pregnancy or when returning from maternity leave.

Participants also described ways in which the culture and structure of the medical workplace perpetuated maternal discrimination. These included policies and procedures that limit maternity leave, the lack of coverage and flexibility in physician schedules, the lack of physical space and time to breastfeed or pump milk, and the long (and often overnight) work hours generally required of physicians.

Reported effects of maternal discrimination included extreme stress due to work and family demands and financial instability, forcing some women to give up full-time work or leave the profession altogether.

The researchers point to some limitations that could have influenced their results, and say the findings “should be viewed as preliminary.”

But they conclude: “As we strive to build more equitable workplaces, our findings suggest that challenging norms around motherhood in the medical workplace, as well as structural changes that address pregnancy, parental leave, and childcare, are needed in order to mitigate the impacts of maternal discrimination in medicine.”

In a linked editorial, Kate Lovett, Dean at the Royal College of Psychiatrists in London, says further work to understand this complex area of human behaviour is needed.

However, she points out that, as long as parenthood is seen as a women’s issue rather than an issue for us all, “maternal discrimination will remain unresolved.”

As both men and women “lean in” on the domestic and work front, “we need to understand how we can support each other in equal relationships both inside and outside of work,” she concludes.

Physician moms are often subject to workplace discrimination

More information:
Physician mothers’ experience of workplace discrimination: a qualitative analysis,

Provided by
British Medical Journal

Study finds insidious and persistent discrimination among physician mothers (2018, December 12)
retrieved 25 April 2019

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