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DAILY UPDATE

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July 30, 2014   Download print version

CDC downplays Ebola's threat to the United States

Second Africa airline halts flights to Ebola stricken capitals

Medicare, Social Security disability fund headed in different directions

Joint Commission declares medical doctors not the only providers qualified to lead patient-centered medical homes

Slow walking speed and memory complaints can predict dementia

In asthma, it's not just what you smell, but what you think you smell

Study examines therapeutic bacteria’s ability to prevent obesity

Surgeon general issues skin cancer warning

 

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CDC downplays Ebola's threat to the United States

The deadly Ebola virus that continues to rage throughout West Africa poses little risk to Americans, U.S. health officials stressed Monday. Ebola only spreads through physical touch, and it can't be spread by people who aren't showing symptoms of infection, Stephan Monroe, deputy director of the National Center for Emerging & Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention, explained in a Monday afternoon news conference.

Those factors -- and the fact that most flights between West Africa and the United States require one or more stops in other countries -- make it unlikely that a sick person could make it all the way to America and spread the Ebola virus, CDC officials said.

Concern was raised over the weekend when it was reported that an Ebola-infected man from Liberia flew to Lagos, the capital of Nigeria, only to die soon after his arrival. Health officials are trying to track down any contacts the man might have had during his journey.

Still, Monroe believes that "the likelihood of this outbreak spreading outside of West Africa is very low," although countries in the region will probably continue to see cases.

The current outbreak is the deadliest ever for Ebola, causing more than 670 deaths and 1,200 infections in Guinea, Liberia and Sierra Leone, according to the World Health Organization.

However, the death rate from Ebola during the current outbreak is about 60 percent compared to 90 percent from prior outbreaks -- indicating that early treatment efforts have been effective, Monroe said.

A pair of recent cases have highlighted the ease with which people can hop an airplane after becoming infected with Ebola or having come in contact with an Ebola patient.

No one is certain how the Liberian man, Patrick Sawyer, was able to board a plane and travel to Nigeria. His plane had a layover in the West Africa nation of Togo, and health officials are now scrambling to trace anyone who may have been exposed to Sawyer at any of the three international airports through which he traveled. Sawyer, a 40-year-old employee of the Liberian finance ministry, recently had a sister die from Ebola. He was vomiting and had diarrhea aboard at least one of his flights, according to the Associated Press.

U.S. doctors are also keeping an eye on the wife and children of a Texas doctor who was working in Liberia to help Ebola patients. The family returned to America last week, days before the Dr. Kent Brantly -- who stayed behind -- came down with Ebola himself.

Public health workers are also discussing whether to step up monitoring at airports. "The idea of whether additional border-based controls can be more effective is actively under discussion by the international community," Monroe said.

But despite these cases, the odds are extremely low that an Ebola infection could reach the United States and spread into a full-fledged outbreak, said Thomas Geisbert, an expert on the deadly virus and a professor of microbiology and immunology at the Institute for Infectious Diseases at the University of Texas Medical Branch in Galveston.

Instead, Ebola is spread through body fluids like blood, vomit or saliva. A person has to come into contact with those fluids to risk infection. (HealthDay) Visit NIH for the release.

 

 

Second Africa airline halts flights to Ebola stricken capitals

Asky Airlines suspended flights to the capitals of Sierra Leone and Liberia, making it the second carrier in West Africa to halt routes to the cities after a man with the deadly disease traveled by plane to Nigeria.

Flights to Monrovia and Freetown have been temporarily suspended, the Lome, Togo-based airline said in a statement handed to reporters. Nigeria’s Arik Air canceled its route to those cities yesterday.

A Liberian man died in Lagos, Nigeria’s commercial capital, last week after contracting the virus in Freetown. He boarded an Asky flight headed to Lagos that made a stopover in Lome, according to Nigerian officials. Visit Bloomberg for the story.

 

 

Medicare, Social Security disability fund headed in different directions

Medicare's hospital-insurance program spent less on benefits in 2013 than it did the previous year, despite covering an additional 1 million people, according to a federal report released Monday, the latest sign that growth in health costs is tapering off.

The findings come in the annual report card from the trustees of Medicare and Social Security. They project Medicare will be able to continue paying full hospital benefits for its elderly or disabled clients without any changes in the law through 2030—four years later than last year's estimate. Lower-than-expected hospitalization and readmission rates helped curb the spending.

But the Social Security disability-insurance program faces a more pressing conundrum. The report projects it will be able to pay only 81% of benefits starting in late 2016 unless Congress intervenes.

Roughly 11 million Americans collected a total of $140 billion in Social Security disability benefits last year, up from 7.9 million people collecting $78.2 billion in 2004.

Treasury Secretary Jacob Lew on Monday for the first time endorsed a policy change that would allocate more payroll-tax revenue to disability benefits, diverting money from Social Security's main program, which gives monthly benefits to retirees. If Congress makes the change, the combined funds would exhaust their reserves by 2033. Without the change, Social Security retiree reserves would run out in 2034.

The slowdown in Medicare spending over the past few years—mirroring slower growth in health costs reported by private insurers—has stumped economists, lawmakers and hospital administrators. Many believe it stems from the recent economic downturn, but the lower spending growth has persisted throughout the recovery.

Sylvia Mathews Burwell, secretary of the Department of Health and Human Services, said Medicare's rapid improvement since the 2010 passage of the Affordable Care Act suggests a direct link to the health law. Her agency cited provisions of the law that give hospitals incentives to avoid readmitting patients, saying that led to 150,000 fewer readmissions in 2012 and 2013.

Medicare's hospital-insurance program paid out $261.9 billion on benefits and consumed $4.3 billion in administrative expenses in 2013. It collected $251.1 billion in revenue, meaning it had to draw down its trust fund by $15.1 billion to cover the difference. This gap isn't as wide as previously forecast, and the trustees believe this trend will continue for several years.

Per capita Medicare spending, on an average annualized rate, has risen just 0.8% a year in the past four years, reflecting the relative good health of many aging baby boomers who recently qualified for benefits, compared with many older, less healthy Americans who pass away. The trustees also noted that spending on skilled-nursing facilities and home-health care was lower than expected.

Eventually, they warned, the aging U.S. population, combined with healthcare costs that are expected to eventually grow much faster, will wipe out the trust fund in 2030, if Congress doesn't intervene. If the fund is depleted, the agency that runs Medicare would be forced to cut benefits. Visit the Wall Street Journal for the article.

 

 

Joint Commission declares medical doctors not the only providers qualified to lead patient-centered medical homes

The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, applauds the Joint Commission, for its restatement in favor of “non-physician” led patient-centered medical home (PCMH) healthcare teams. The F4CP points to doctors of chiropractic (D.C.s) as being trained to both serve and lead within the PCMH setting. 

“Collaboration between providers is a central element to achieving the high quality and cost-effective goals of the PCMH model,” says Gerard Clum, D.C., spokesperson, F4CP. “Possessing extensive training in diagnosis and treatment, doctors of chiropractic (D.C.) can contribute tremendous value to PCMHs. Particularly, for patients with conditions, such as low back pain, neck pain and headaches, evidence supports chiropractic as a suitable option that presents greater opportunity for superior outcomes.”

According to the F4CP report, “The Role of Chiropractic Care in the Patient-Centered Medical Home,” there are several roles a D.C. can assume within a PCMH to advance patient care:

·         As neuromuscular and musculoskeletal specialists with direct patient access

·         As neuromuscular and musculoskeletal specialists, on referral from primary care providers (PCP)

·         As PCPs who also deliver care to patients seeking help for non-musculoskeletal conditions

·         As providers of diagnostic and therapeutic prevention and health promotion services, including, but is not limited to, evidence-based diet and exercise counseling

National entities, including the National Committee for Quality Assurance, Accreditation Association for Ambulatory Health Care and URAC, agree that an organization can provide the attributes of a PCMH without physician leadership – with the exception of the American Medical Association House of Delegates. Visit Business Wire for the release.

 

 

Slow walking speed and memory complaints can predict dementia

A study involving nearly 27,000 older adults on five continents found that nearly 1 in 10 met criteria for pre-dementia based on a simple test that measures how fast people walk and whether they have cognitive complaints. People who tested positive for pre-dementia were twice as likely as others to develop dementia within 12 years. The study, led by scientists at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, was published in Neurology.

The new test diagnoses motoric cognitive risk syndrome (MCR). Testing for the newly described syndrome relies on measuring gait speed (our manner of walking) and asking a few simple questions about a patient's cognitive abilities, both of which take just seconds. The test is not reliant on the latest medical technology and can be done in a clinical setting, diagnosing people in the early stages of the dementia process. Early diagnosis is critical because it allows time to identify and possibly treat the underlying causes of the disease, which may delay or even prevent the onset of dementia in some cases.

"In many clinical and community settings, people don't have access to the sophisticated tests—biomarker assays, cognitive tests or neuroimaging studies—used to diagnose people at risk for developing dementia," said Joe Verghese, M.B.B.S., professor in the Saul R. Korey Department of Neurology and of medicine at Einstein, chief of geriatrics at Einstein and Montefiore, and senior author of the Neurology paper. "Our assessment method could enable many more people to learn if they're at risk for dementia, since it avoids the need for complex testing and doesn't require that the test be administered by a neurologist. The potential payoff could be tremendous—not only for individuals and their families, but also in terms of healthcare savings for society. All that's needed to assess MCR is a stopwatch and a few questions, so primary care physicians could easily incorporate it into examinations of their older patients."

The Neurology paper reported on the prevalence of MCR among 26,802 adults without dementia or disability aged 60 years and older enrolled in 22 studies in 17 countries. A significant number of adults—9.7 percent—met the criteria for MCR (i.e., abnormally slow gait and cognitive complaints). While the syndrome was equally common in men and women, highly educated people were less likely to test positive for MCR compared with less-educated individuals. A slow gait, said Dr. Verghese, is a walking speed slower than about one meter per second, which is about 2.2 miles per hour (m.p.h.). Less than 0.6 meters per second (or 1.3 m.p.h.) is "clearly abnormal."

Dr. Verghese emphasized that a slow gait alone is not sufficient for a diagnosis of MCR. "Walking slowly could be due to conditions such as arthritis or an inner ear problem that affects balance, which would not increase risk for dementia. To meet the criteria for MCR requires having a slow gait and cognitive problems. An example would be answering 'yes' to the question, 'Do you think you have more memory problems than other people?'"

For patients meeting MCR criteria, said Dr. Verghese, the next step is to look for the causes of their slow gait and cognitive complaints. The search may reveal underlying—and controllable—problems. Visit EurekAlert for the study.

 

 

In asthma, it's not just what you smell, but what you think you smell

New research from the Monell Center reveals that simply believing that an odor is potentially harmful can increase airway inflammation in asthmatics for at least 24 hours following exposure. The findings highlight the role that expectations can play in health-related outcomes.

"Asthmatics often are anxious about scents and fragrances. When we expect that an odor is harmful, our bodies react as if that odor is indeed harmful," said study lead author Cristina Jaén, PhD, a Monell physiologist. "Both patients and care providers need to understand how expectations about odors can influence symptoms of the disease."

Asthma is a chronic inflammatory disorder of the lungs. According to the National Institutes of Health, over 25 million Americans have the disease, which can interfere with quality of life. The airways of asthmatics are sensitive to 'triggers' that further inflame and constrict the airways, making it difficult to breathe. There are many different types of triggers, including pollen, dust, irritating chemicals, and allergens. Strong emotions and stress also can act to trigger asthma symptoms.

Because asthma has no cure, it is important for individuals with the disease to understand how to manage their symptoms to help prevent severe asthma attacks.

Many health organizations list scents and fragrances as asthma triggers, leading patients to become anxious when exposed to environmental odors. The current research was conducted to determine whether odor-triggered asthma symptoms can be elicited or worsened by associated negative expectations.

In the study, published online ahead of print in the Journal of Psychosomatic Research, 17 individuals characterized as moderate asthmatics were exposed to the odor phenylethyl alcohol (PEA) for 15 minutes. Often described as rose-smelling, PEA is regarded as a 'pure' odorant with no associated physiological irritant qualities.

Eight subjects were told that the odor had potential therapeutic properties, while nine were told that it potentially could cause mild respiratory problems.

During odor presentation, the subjects rated the odor's sensory properties, including intensity, irritancy, and annoyance. Measures of lung function and airway inflammation were collected before and immediately after exposure and again at two hours and 24 hours post-exposure.

Subjects' beliefs about the odor, specifically whether it was potentially harmful (asthma-triggering) or therapeutic, influenced both their psychological and physiological responses to odor exposure.

Individuals who were told that the odor was potentially harmful rated it as more irritating and annoying as compared to those who thought it might be therapeutic.

In addition, airway inflammation increased immediately following odor exposure in subjects who believed the odor might be harmful and remained elevated 24 hours later.

There was no increase of inflammation when the odor was characterized as therapeutic, even in individuals who described themselves as sensitive to perfumes and other odors.

The findings suggest that some fragrance effects on asthma symptoms may be related to the expectation of harm as opposed to chemical properties of the odor.

Looking forward, the researchers want to identify the biological mechanisms that connect expectations to airway inflammation. They also intend to explore whether a reverse phenomenon also exists. Pamela Dalton, PhD, a cognitive psychologist at Monell, asks, "Can we improve health outcomes by reducing concern or fear in a disease where emotional arousal is counter-productive?"

Visit Monell for the study.

 

 

Study examines therapeutic bacteria’s ability to prevent obesity

Bacteria that produce a therapeutic compound in the gut inhibit weight gain, insulin resistance and other adverse effects of a high-fat diet in mice, Vanderbilt University investigators have discovered.

“Of course it’s hard to speculate from mouse to human,” said senior investigator Sean Davies, Ph.D., assistant professor of Pharmacology. “But essentially, we’ve prevented most of the negative consequences of obesity in mice, even though they’re eating a high-fat diet.”

Regulatory issues must be addressed before moving to human studies, Davies said, but the findings published in the Journal of Clinical Investigation suggest that it may be possible to manipulate the bacterial residents of the gut – the gut microbiota — to treat obesity and other chronic diseases.

Davies has a long-standing interest in using probiotic bacteria — “friendly” bacteria like those in yogurt — to deliver drugs to the gut in a sustained manner, in order to eliminate the daily drug regimens associated with chronic diseases.

In 2007, he received a National Institutes of Health Director’s New Innovator Award to develop and test the idea.

“The types of bacteria you have in your gut influence your risk for chronic diseases,” Davies said. “We wondered if we could manipulate the gut microbiota in a way that would promote health.”

To start, the team needed a safe bacterial strain that colonizes the human gut. They selected E. coli Nissle 1917, which has been used as a probiotic treatment for diarrhea since its discovery nearly 100 years ago. They genetically modified the E. coli Nissle strain to produce a lipid compound called NAPE, which is normally synthesized in the small intestine in response to feeding. NAPE is rapidly converted to NAE, a compound that reduces both food intake and weight gain. Some evidence suggests that NAPE production may be reduced in individuals eating a high-fat diet.

The investigators added the NAPE-producing bacteria to the drinking water of mice eating a high-fat diet for eight weeks. Mice that received the modified bacteria had dramatically lower food intake, body fat, insulin resistance and fatty liver compared to mice receiving control bacteria.

They found that these protective effects persisted for at least four weeks after the NAPE-producing bacteria were removed from the drinking water. And even 12 weeks after the modified bacteria were removed, the treated mice still had much lower body weight and body fat compared to the control mice. Active bacteria no longer persisted after about six weeks.

The investigators are currently working on strategies to address regulatory issues related to containing the bacteria, for example by knocking out genes required for the bacteria to live outside the treated host. Visit Vanderbilt for the study.

 

 

Surgeon general issues skin cancer warning

Skin cancer is on the rise, according to the American Cancer Society, with more cases diagnosed annually than breast, prostate, lung and colon cancer cases combined.

On Tuesday, the United States surgeon general issued a call to action to prevent the disease, calling it a major public health problem that requires immediate action. Nearly 5 million people are treated for skin cancer each year.

"Until today, the surgeon general has never said, 'UV radiation is bad for you; protect your skin,' " acting Surgeon General Dr. Boris Lushniak said.

The U.S. Department of Health and Human Services has set five goals for communities to decrease the risk of skin cancer, such as providing shade at parks, schools and other public spaces, and reducing indoor tanning.

A dermatologist himself, Lushniak said it's important for parents to teach their children about sun safety, just as they would dental care and eating healthily.

"We have to change the social norms about tanning," he said. "Tanned skin is damaged skin, and we need to shatter the myth that tanned skin is a sign of health."

Melanoma, the deadliest form of skin cancer because of how fast it spreads to other parts of the body, accounts for only 2% of skin cancer cases but is responsible for the majority of skin cancer deaths, according to the American Cancer Society.

Each year, more than 63,000 cases of melanoma are diagnosed in the United States, and 9,000 people die from it. From 1973 to 2011, melanoma rates increased more than 200%, according to the Department of Health and Human Services. The National Cancer Institute reported that melanoma is the most common form of cancer in adults ages 25 to 29 and second most common for young adults aged 15 to 29.

To reduce the risk of skin cancer, the Centers for Disease Control and Prevention recommends wearing a hat, sunglasses and protective clothing and using sunscreen with an SPF of at least 15.

On Monday, the House of Representatives passed the Sunscreen Innovation Act.

The bill includes a review process for all manufacturers submitting a new sunscreen to the Food and Drug Administration, with a deadline for the FDA to provide final decisions: one year for pending applications and 1½ years for new ones.

The last over-the-counter sunscreen ingredient approved by the FDA was in the 1990s, according to the Public Access to SunScreens Coalition. Eight new sunscreen applications have since been filed with the FDA. All are still waiting for review, the coalition says; some have been waiting for over a decade.

The current policy requires the FDA to undergo an extensive rule-making process before reviewing any new product application and adding it to the approved list, according to coalition policy director Michael Werner. This can take years, making the process inefficient.

Many of the new sunscreens awaiting approval in the United States have been available in Europe, Central Asia and South America for years. Generally speaking, the ingredients waiting for approval are simply newer types of UVA filters than are currently being used, Werner said, but they differ slightly by manufacturer. Visit CNN for the announcement.