Testing several genes can provide precise knowledge about the choice of right medicinal products

Most of us have genetic variations that increase the risk of medicinal products not being effective. In order to provide a more effective treatment with fewer side effects, we need to analyze more of these genetic variations. This will provide us with more precise knowledge about how the individual patient reacts to medicinal products. A new research result from Aarhus University shows that.

Personalized medicine has been a hot topic in recent years, using information about the genes to adapt the treatment to the individual patient. Personalized medicine potentially provides better treatment and fewer side effects for the patient. At least in an ideal world.

How the body converts medicinal products – the scientific term is metabolizes – is also affected – among other factors – by our genes, among other factors. Research from Aarhus University now shows that more than eighty per cent of the participants in a study based on data from the National Psychiatry Project iPSYCH, have more than three genetic variants, which increase the potential risk of the medicinal products not having the effect they should.

"Pharmacogenetic variation can impact how we metabolize or react to drugs compared with the average patients. Rapid metabolism can increase the risk of a reduced effect of medicine, and slow metabolism can increase the risk of an 'overdose' that can be experienced as side effects," explains Christiane Gasse from Aarhus University, who is leading the study.

Not only applicable to medicine for mental disorders

The researchers have analyzed the frequency of genetic variants in clinically relevant drug metabolism or drug targets of 51,464 people with a diagnosed mental disorder and 26,220 without – a total of 77,684 people.

The study has primarily analyzed pharmacogenetic variants with documented recommendations of dose adjustment having great importance for the effect of the affected drugs. Many of these drugs are psychotropic medications – i.e. medicine for people with a mental disorder, but include also drugs for cardiovascular disorders. We found that more than 80% of the analyzed population had more than three pharmacogenetic variants that potentially affect the metabolism of these drugs."

Christiane Gasse from Aarhus University

Criteria for how the medication and dose work most effectively on the majority of the population defines the dosage of a medicine. However, the desired effect is not achieved in some cases, or or patients experience side effects. Individualized treatment with medicinal products may include a pharmacogenetic test, in which the patient's genes are analyzed. Based on the patient's genetic profile, it is possible to determine how effectively the actual medicine is metabolized in the individual patient.

"Most often there are several genes and genetic variants that influence the effect of the medicine. Within all medicinal products, we know of 42 variants where international pharmacogenetic consortia have described recommendations about pharmacogenetic guided dosing. They are therefore relevant for adjustments, and are therefore relevant for clinical practice," explains Christiane Gasse.

Now, genetic tests often analyze a single genetic variation, which is known to have an effect on the metabolism of the drug in question. However, the researchers believe that it would be possible to obtain far more accurate information about the patient's disposition to metabolize medicines, if more genetic variants were analyzed.

The solution is a wide-ranging panel test that can analyze several pharmacogenetic variations at the same time and in this way provide the opportunity to plan more optimal treatment.

"The study demonstrates the need to use a pharmacogenetic test that analyses a wide range of genes and genetic variants. This can provide information about the choice of the right medicinal product or the right dose for the individual patient", says Christiane Gasse.

She adds that a pharmacogenetic test can either be performed prior to the first treatment with a relevant drug, and can be used as guidance for the planned and future treatments, or it can be done during the course of treatment with aim to adjust the dose and if needed the medicine.

Source:

Aarhus University

Journal reference:

Lunenburg, C.A.T.C., et al. (2021) Pharmacogenetic genotype and phenotype frequencies in a large Danish population-based case-cohort sample. Translational Psychiatry. doi.org/10.1038/s41398-021-01417-4.

Posted in: Medical Science News | Medical Research News

Tags: Biomedicine, Drug Metabolism, Drugs, Frequency, Genes, Genetic, Hospital, Medicine, Mental Disorder, Metabolism, Overdose, Pharmacogenetics, Psychiatry, Research

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Researchers investigate how pollen facilitates the spread of COVID-19 virus

Most models explaining how viruses are transmitted focus on viral particles escaping one person to infect a nearby person. A study on the role of microscopic particles in how viruses are transmitted suggests pollen is nothing to sneeze at.

In Physics of Fluids, by AIP Publishing, Talib Dbouk and Dimitris Drikakis investigate how pollen facilitates the spread of an RNA virus like the COVID-19 virus. The study draws on cutting-edge computational approaches for analyzing fluid dynamics to mimic the pollen movement from a willow tree, a prototypical pollen emitter. Airborne pollen grains contribute to the spread of airborne viruses, especially in crowded environments.

To our knowledge, this is the first time we show through modeling and simulation how airborne pollen micrograins are transported in a light breeze, contributing to airborne virus transmission in crowds outdoors."

Dimitris Drikakis, Researcher

The researchers noticed a correlation between COVID-19 infection rates and the pollen concentration on the National Allergy Map. Each pollen grain can carry hundreds of virus particles at a time. Trees alone can put 1,500 grains per cubic meter into the air on heavy days.

The researchers set to work by creating all the pollen-producing parts of their computational willow tree. They simulated outdoor gatherings of roughly 10 or 100 people, some of them shedding COVID-19 particles, and subjected the people to 10,000 pollen grains.

"One of the significant challenges is the re-creation of an utterly realistic environment of a mature willow tree," said Dbouk. "This included thousands of tree leaves and pollen grain particles, hundreds of stems and a realistic gathering of a crowd of about 100 individuals at about 20 meters from the tree."

Tuning the model to the temperature, windspeed, and humidity of a typical spring day in the U.S., the pollen passed through the crowd in less than one minute, which could significantly affect the virus load carried along and increase the risk of infection.

The authors said the 6-foot distance often cited for COVID-19 recommendations might not be adequate for those at risk for the disease in crowded areas with high pollen. New recommendations based on local pollen levels could be used to manage the infection risk better.

While calling attention to other forms of COVID-19 transmission, the authors hope their study stokes further interest in the fluid dynamics of plants.

Next, they look to better understand the mechanisms underlying the interaction between airborne pollen grains and the human respiratory system under different environmental conditions.

Source:

American Institute of Physics

Journal reference:

Dbouk, T & Drikakis, D., (2021) On pollen and airborne virus transmission. Physics of Fluids. doi.org/10.1063/5.0055845.

Posted in: Medical Science News | Medical Research News | Disease/Infection News

Tags: Allergy, Foot, Pollen, Respiratory, RNA, Virus

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Dual-Antibody Drugs Effective Against COVID-19 Variants in Animal Study

(Reuters) – COVID-19 therapies made from a cocktail of two types of antibodies were effective against a wide range of variants of the coronavirus in a mice and hamster study, researchers at the Washington University School of Medicine in St. Louis reported in the journal Nature on Monday.

Antibodies are used to treat cases of COVID-19, often early in the process. Former U.S. President Donald Trump was treated with an antibody cocktail by Regeneron Pharmaceuticals in October after he tested positive for COVID-19.

The latest study included three of the four variants that have been designated “variants of concern” by the World Health Organization, including Alpha, first identified in the UK, Beta, first found in South Africa, and Gamma found in Brazil, as well as a variant from India, B.1.617.1, in the same lineage as the Delta variant of concern.

The U.S. Food and Drug Administration in April revoked the emergency use authorization of Eli Lilly’s single antibody therapy, bamlanivimab, saying there was increased circulation of variants resistant to the therapy when used alone.

Other studies https://www.reuters.com/article/us-health-coronavirus-science-idUSKBN29W2P5 have previously shown that some antibody combination therapies remained potent against those emerging variants of the coronavirus that were resistant to single antibody therapies.

The latest study found that combinations of two antibodies often retained potency against variants even when one of the two antibodies lost some or all ability to neutralize the variant in lab studies.

The study, which was conducted in mice and hamsters, tested all single and combination antibody therapies authorized for emergency use by the FDA against emerging international and U.S. variants of the virus.

The researchers evaluated the FDA-authorized combination therapies made by Regeneron, Eli Lilly and a single antibody therapy, sotrovimab, by Vir Biotechnology Inc and GlaxoSmithKline Plc.

They also assessed the antibodies currently in clinical trials by AbbVie Inc, Vir and AstraZeneca.

“Resistance arose with some of the monotherapies, but never with combination therapy,” study co-author Jacco Boon noted in a statement.

SOURCE: https://go.nature.com/35K4XVU Nature, online June 21, 2021.

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How The Full Moon On June 24 Will Affect You If Youre An Aquarius

The full moon on June 24 is set to be a big one. According to Allure, the celestial event will be one of “the most powerful astrological days of the year.” June’s full moon has been given the name Strawberry Moon due to the fact that it occurs around the time that strawberries begin to ripen and are gathered in the Northern hemisphere. Since full moons are the perfect time to regroup and think about the goals that we want to achieve, manifestation is key during this time of the month.

The moon will also be the final supermoon of the year, which means that it will appear to look larger than usual in the sky. It may also cast more light. However, despite being named the Strawberry Moon, it won’t have a pink tint. The outlet also encourages those willing to meditate, using the energy to draw things such as money and success into your life. For Aquarius, the event may force you to deal with some insecurities and worries, which may be weighing heavily on your mind, per Vogue.

Aquarius should focus on personal growth during the full moon on June 24

For those born under the sign of Aquarius (January 21 – February 18), the full moon on June 24 could bring some deeply rooted fears to light. Vogue notes that Aquarius should think about their hopes and dreams while focusing on their intuition and instincts. This time could bring up some feelings of instability or rejection, or even leave you questioning your place in the world. Uncertainty surrounding your career could also come into play. However, a close family member or friend may help calm your fears by giving you some advice that allows you to move on and begin healing.

The outlet adds that if you’re an Aquarius, you may want to use this time to clear the clutter from your mind and put the past behind you as you work on getting closure on any issues you’ve been dealing with. This will allow you a fresh start and put you in a better headspace going forward. For Aquarius, this summer may be about healing and personal growth, and the full moon could be the perfect time to start the process.

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How The Full Moon On June 24 Will Affect You If Youre A Scorpio

We can all agree, 2021 has been an eventful year when it comes to the zodiac the celestial events that they center around. 

In addition to the recent summer solstice and Mercury retrograde, there were two eclipses in the spring that may have coincided with some big changes in your life, per Elite Daily. However, the full moon on June 24 will likely be no different. The moon, which has been named the Strawberry Moon, is the final supermoon of the year and is sure to bring some interesting events into the lives of many, including Scorpios (via Bustle).

The outlet notes that full moons are the time of the month when a specific force in your life is being highlighted. This can be an amazing thing that could lead to new opportunities, love, and friendship. However, it may cause an emotional overload that leaves you feeling less than thrilled with your personal state of affairs. For Scorpios, June’s full moon is set to be an eventful one so buckle in for what may be a bit of a bumpy ride.

Scorpios may experience heightened emotions

Vogue notes that those born under the sign of Scorpio – born between October 24 and November 22 – will be full of emotion as the full moon on June 24 approaches. 

The celestial event is set to trigger you to examine the areas of your life that might need some extra attention and work hard to get them in order. For some, this could mean that you’ll need to use your voice to get your point across as you communicate with those with whom you may have unresolved issues with. Make sure you let it all out and put into place, but make sure that you have all the facts straight before going into the situation.

Meanwhile, Scorpios should also be extra cautious when it comes to travel. The summer season is upon us and if you’re planning a trip, you may want to prepare for any problems or scheduling conflicts to come when it comes to transportation. While your emotions will likely run high for a short period of time, it will pass and then you can focus on restructuring your life to better fit your current situation. 

Even if you feel like you’re hitting a wall, the full moon may offer up some life lessons that could prove to be beneficial in the long run.

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Children’s birthdays may have fueled COVID-19 spread, study claims

Biden touts COVID vaccine progress amid delta variant warning

Fox News correspondent Gillian Turner has the latest from the White House on ‘Special Report’

Before the national vaccine rollout, health officials spent months urging Americans to limit social gatherings and keep celebrations to within members of their household. Now, a study assessing the association between informal social gatherings and SARS-CoV-2 transmission suggests that birthday parties, especially those involving children taking place in counties with the prevalence of virus, resulted in increased rates of diagnosed COVID-19. 

The study, published in JAMA, analyzed the potential increased risk of COVID-19 around small social gatherings by studying changes in COVID-19 rates after birthday parties. The study, which specifically looked at the changes in household COVID-19 infection rates after the presence of a birthday in the household, included data from January through November 2020. 

The researchers also separated children’s birthdays and adult birthdays into two different categories. Overall, data from over 6.5 million individuals from 2.9 million households were analyzed. The researchers found that a presence of a birthday within a household was associated with greater rates of COVID-19 diagnosis, with the risk highest in counties with a high prevalence of the disease. 

“The estimated increase in COVID-19 infections in households with birthdays was larger in magnitude in households that had a recent child’s (vs adult’s) birthday, suggesting an increased likelihood of gathering around children’s birthdays, a large number of participants, relaxed masking and social distancing behavior, or a combination of these,” the researchers wrote. “Households may also be more likely to have a social gathering for a child’s birthday than for an adult’s birthday.” 

The researchers noted that the increase in infections was not greater for milestone birthdays, nor was there a decrease in infections in households located in counties with an active shelter-in-place order. 

The authors noted that the study was observational in nature and that it relied on administrative health care data for COVID-19 diagnoses rather than lab-confirmed data. The study was also “unlikely to capture asymptomatic cases” that did not require medical attention, as the diagnoses included in the data appeared in medical claims data. 

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How The Full Moon On June 24 Will Affect You If You’re A Libra

For those who follow astrology, full moons are generally considered to be the pinnacle of the month, the point at which all the energies that have been building since the new moon reach their peak and come to full fruition (via Mind Body Green). For those who set intentions during the darkness of the new moon, the full moon is when we “harvest” the fruit of what we “planted” with those new moon intentions. 

Our upcoming full moon in Capricorn occurs on June 24th, and in general we will all be focusing to some degree or another on our careers and professional lives (via Vogue). A goal we set some time ago might be coming into bloom at this time, or we might be considering a change or shift in our professional lives and find that this is finally the time to take that step. 

This full moon, also called the Strawberry Moon, will also be a Super Moon, and its energies will feel especially lush and fulfilling (via Bustle). Of course, how this lunar phase will affect us individually can be better broken down by zodiac sign. So if you are a Libra, read on to discover how you can expect this upcoming full moon to affect you, and how to make the most of its energies. 

How the June 24th full moon will affect Libras

Libra, as you feel the energies of this Strawberry Super Moon rising, you may feel the need to pull back a little bit on your professional responsibilities (via Bustle). If things at work have been starting to feel overwhelming, this is the right time to take a small break. Take the weekend to rest and recharge. You are the balance-loving sign of harmony; if your own life is out of balance, you cannot shine your loving light into the world. Consider doing a full moon ritual or some other self-care rituals, whether a bath or a pedicure or a night in with a book and a glass of wine.

You could also be feeling a situation at home reaching its crescendo right now (via Vogue). If you’ve been contemplating a change in your living situation, or if you have been feeling it might be time to let go of a relationship or another type of domestic situation that is no longer serving you, this is a great time to clear out the old to make room for the new. The energy right now is very supportive for Libras who seek to breathe new, fresh energy into their lives.   

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70-practice Central Ohio Primary Care tells a digital imaging success story

Photo: Central Ohio Primary Care

Central Ohio Primary Care is an independent, physician-owned, primary care group with more than 70 practices and more than 400 physicians serving more than 400,000 patients. It also has three imaging centers around Columbus, and 10% of its physician practices provide in-office imaging capabilities.

THE PROBLEM

COPC needed more advanced radiology communication capabilities to run its practices more efficiently – and a system that would grow with the organization.

“Another significant challenge for COPC was moving hard film from office to office or physician to physician,” said Steve Saeger, manager of radiology services at Central Ohio Primary Care. 

“Even with CD-ROM transfer, immediate access remained a top concern. Lastly, paper scheduling was a tough operational issue with not being able to provide timely scheduling electronically – or access results for efficient sharing across providers.”

PROPOSAL

COPC needed a technology solution to replace the use of imaging CD-ROMs to provide advanced digital capabilities for much more efficient and effective imaging operations. Immediate needs required the implementation of a more advanced picture archiving and communication system (PACS). COPC needed to better manage communications with secure storage and imaging sharing across its practices for its 25,000 annual exams.

“Another critical need for operational efficiencies was the ability to migrate data and move away from paper scheduling,” Saeger remarked. “COPC required an enterprise software solution with PACS technology to improve provider and patient experiences to meet our patient care excellence standards.

“To support the organization’s continued growth, COPC also required a very stable system, so as to not experience downtime – even with upgrade installations,” he continued. “While upgrades can provide enhanced capabilities and practical tools for support that improve patient and provider experiences, installation issues or downtime significantly affect clinical operations.”

“Contacts across various health systems and practices are valuable in the initial digital transformation planning process; it’s important to learn from those that have experienced similar situations.”

Steve Saeger, Central Ohio Primary Care

In addition to system stability, COPC wanted a vendor to drive and advance digital imaging innovation. In COPC’s experience, it is critical that a vendor provide a dedicated support team so when support is needed, technology vendor team members are familiar with COPC’s practice and interface, helping more quickly with operations and IT staff – even making recommendations to catch issues on the front-end before they become problems, Saeger said.

“Communication is a key component of any vendor relationship, so COPC required strong communications as a primary consideration for technology vendor partners,” he said. “The ability to track details such as support tickets with resolution notes would also help more efficiently resolve issues if they occur again.”

MEETING THE CHALLENGE

A colleague of Saeger’s recommended Novarad, and that began an almost 20-year relationship.

“Through our partnership with Novarad, COPC eliminated its inefficient paper processes and cumbersome CD-ROM review of images,” Saeger explained. “One of the substantial benefits of Novarad is that it was founded and is still led by a radiologist. This clinical provider perspective keeps products and services aligned with the seamless communication capabilities required of modern imaging solutions to support accurate diagnosis and ongoing clinical progress monitoring.

“In addition to enhanced operational efficiencies, Novarad’s support was vital in the integration of COPC’s chosen electronic health records and Nuance PowerScribe 360, a real-time radiology reporting platform to enable high-quality radiology reports from physician dictation,” he added.

Paper scheduling also was eliminated with the implementation of the Nova RIS scheduling system for improved operational efficiencies. 

Not only did moving away from paper scheduling intuitively improve scheduling speed, Saeger noted, it also allowed COPC to operate with Modality Worklists in the technologies, in turn increasing the efficiencies of the technologists scanning and reducing the errors associated with the manual input of patient demographics into modality equipment.

“As a result of these incremental changes, COPC has effectively enhanced its clinical services and quality of care and created efficiencies across the organization,” he added.

RESULTS

COPC has seen patient volumes increase annually at a rate of 6-7% in part due to broader imaging system capabilities, effective cost containment and building interfaces with EHR vendors, Saeger reported.

“The interface process was simple, with reasonable costs,” he said. “COPC team members could make changes mid-stream that improved the results without additional costs. One of the most significant benefits to COPC is that the Novarad team always makes COPC feel like they are their top priority, in addition to the fact that Novarad is always looking out for COPC and its team, enabling us to reach the best outcomes and efficiency gains possible for our technology needs.”

COPC clinical specialists now can access imaging studies electronically, seamlessly and effectively connecting with other healthcare providers, he added. This is especially important in emergencies, such as when a patient is in the ER. Immediate access to imaging studies prevents duplication of imaging – which is safer for patients and more cost-effective for both patients and systems.

“COPC also is focused on population health initiatives, including cost versus expenses for patients, to deliver the best care options and improve the health of the populations they serve,” said Saeger. 

“COPC often uses Novarads’s comparison studies that are immediately accessible through secure web viewing capabilities so radiologists can review and provide diagnostic support to specialists – and save money and time by avoiding the duplication of imaging orders.”

ADVICE FOR OTHERS

“Make sure you are confident in your vendor selection,” Saeger advised. “Most likely, once you have a vendor in place, you are with them for the long haul, and it can be difficult to make a switch.

“Find a vendor that guides the process and offers the ability for database building for healthcare complexities, including procedures, CPT codes and schedules,” he continued. “A knowledgeable vendor should be able to take a database of information and build a program that works. For those that like to be more involved, the more hands-on experience you have in the build, the more you understand the system when you need to adjust or adapt to new circumstances.”

Every minute counts in patient care, so find a vendor that allows one “behind the curtain” so one can fix things quickly when patients need answers, he added.

“Don’t hesitate to dig into the details, be as involved as possible and understand every nuance of the system,” he said. “Find a vendor team that welcomes input and embraces the opportunity to work together as partners – always improving and enhancing services. As true partners, you should have a solid foundation of innovative digital technology – and a stable digital environment – so providers can take the very best care of patients without interruption due to technology concerns.”

And as technology continues to evolve, one should expect additional digital innovations and cost efficiencies to increase patient and provider satisfaction, he added.

“COPC’s goal is to work smarter with patient care through digital transformation and is proud of its current success in operational improvements for both patients and their business model,” Saeger said. “To help other providers prepare for such a transition, COPC invites organizations that are considering similar digital technology to visit our office so they can see the technology in action, ask questions about successful installations and integrations, and learn what to expect.

“I often share this advice: Pick a partner that will invest in your organization’s knowledge base for the best possible outcomes,” Saeger concluded. “Contacts across various health systems and practices are valuable in the initial digital transformation planning process; it’s important to learn from those that have experienced similar situations.”

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.

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Research findings on the links between air pollution and neurodegeneration

There is growing awareness that air pollutants are playing a critical role in the development of neurodegenerative diseases. A new book, Alzheimer’s Disease and Air Pollution: The Development and Progression of a Fatal Disease from Childhood and the Opportunities for Early Intervention, edited by Lilian Calderón-Garcidueñas, MA, MD, PhD, compiles the latest research establishing links between air pollution and neurodegeneration. It is part of the Advances in Alzheimer’s Disease series, published by IOS Press.

Dr. Calderón-Garcidueñas, University of Montana and Universidad del Valle de Mexico, recalls looking at a slide of brain cells from an 11-year-old child who died in an automobile accident in Mexico City and seeing positive neurites and tangles usually associated with Alzheimer’s disease. “It gave me a sudden intense fear,” she says. “It has since become clear that for residents of Mexico City exposed to concentrations of air pollution above US Environmental Protection Agency (EPA) standards, Alzheimer’s disease starts in early childhood and progresses for the first four decades. The concept of a long asymptomatic period decades prior to clinical cognitive impairment does not apply for millions of people massively exposed day in and day out to polluted environments.”

More than 40 chapters organized into six sections present new research findings and overviews, ranging from epidemiological studies establishing a strong link between dementia and particulate matter and ozone; to papers describing the properties of pollution; and works describing the intricate pathways that take normal neurons to ghost tangles surrounded by a devastated brain. Discussions of how neuroinflammation, traffic, air pollution, and tobacco smoke damage the brain and why years of education matter when the brain impact of pollutants are included.

The book begins with a comprehensive overview of the sources of nanoparticles and their formation in urban traffic-influenced environments. Generally defined as particles smaller than 100 nm in size, nanoparticles have been found in very high concentrations in the ambient air in heavily trafficked urban areas. Particulate matter pollution is associated with a variety of diseases, including Alzheimer’s disease and other neurological disorders. Particulate matter is emitted by gasoline vehicles, diesel vehicles, and vehicles using ethanol or gaseous fuels. It is formed both from wheel brakes and from gaseous emissions. Thus, there is no single solution such as focusing on a type of vehicle or engine. There are technological solutions, however, that clearly decrease the nanoparticle emissions of motor vehicles, and these technologies should be favored when developing emission regulations and air quality standards.

Cognitive performance and the fact that levels of air pollutants, accumulated lifetime exposure, and the specific characteristics of the pollution all play a role in neural effects are discussed in this book. The book includes a state-of-the-art review of environmental epidemiological studies on the association between traffic-related air pollution exposure and neurodegenerative diseases in the elderly. While the exact mechanisms are largely unknown, there is a growing body of evidence that higher exposure to traffic-related air pollution is associated with a range of neurodegenerative diseases. Unlike many personal risk factors for neurodegeneration, such as smoking or high blood pressure, traffic pollution is ubiquitous and cannot easily be avoided. The authors note the enormous potential for health benefits and healthcare cost-savings if the risk from traffic pollution could be reduced. The book also presents research on ozone, a likely “hidden player” in neurodegeneration.

In another study, exposure to mixed gasoline and diesel engine emissions (MVE) increased the expression of factors in the central nervous system associated with Alzheimer’s disease. Young and aged mice were exposed to either MVE or filtered air for six hours a day, seven days a week, for 50 days. Age-related increases in oxidative stress and the expression of Aβ and other markers for Alzheimer’s disease were observed. In older MVE-exposed mice, significant increases in the markers were seen compared to young and aged FA-exposed mice. The findings highlight the need to identify pollutants that contribute to Alzheimer’s disease for regulatory action and mechanistic pathways for preventive and therapeutic targets.

The book includes a section on the early detection of Alzheimer’s disease in children and young adults exposed to air pollution. A study [4] illustrates the significant risks this type of environment holds for the development of Alzheimer’s disease even early in life. Five hundred and seventeen young residents of Metropolitan Mexico City and other urban areas in Mexico with particulate matter concentrations greater than EPA standards were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Normal subjects score 26 or higher, making them unlikely to meet clinical standards for mild cognitive impairment (MCI). A score below 25 indicates MCI is likely. Fifty-five percent of these seemingly healthy young participants scored in the MoCA score range for MCI and dementia. Identifying and lowering key neurotoxicants and monitoring cognitive performance is encouraged to facilitate early diagnosis and prevention of Alzheimer’s disease in high-risk young populations.

The final section of the book explores air pollution and mental disorders, neurotoxicity, and the possible link between SARS-CoV-2 and the worsening of neurodegeneration. The underlying mechanisms and scale of air pollution effects remain largely unknown due to chemical and physical complexity. Individual responses to air pollution are shaped by the interface of pollutant mixture with the biological features of the exposed individual, such as age, sex, and genetic background, but also other environmental factors including exposure to cigarette smoke.

“Air Pollution and Alzheimer’s Disease brings to light our only hope,” explains Dr. Calderón-Garcidueñas. “Prevention is at hand and if we can protect millions of people exposed to air pollutants and ameliorate their brain effects, we will be on the right path to have a clean planet free of Alzheimer’s disease.”

Dr. Calderón-Garcidueñas is a pioneer in establishing a major environmental contributor to Alzheimer’s and other chronic diseases. Addressing this modifiable factor, this volume provides new direction on improving public health.”

George Perry, PhD, Editor-in-Chief, Journal of Alzheimer’s Disease and Professor, University of Texas at San Antonio

Source:

IOS Press

Posted in: Medical Research News | Medical Condition News

Tags: Air Pollution, Alzheimer's Disease, Blood, Blood Pressure, Brain, Central Nervous System, Children, Chronic, Cigarette, Dementia, Education, Ethanol, Genetic, Healthcare, High Blood Pressure, Nanoparticle, Nanoparticles, Nervous System, Neurodegeneration, Neurodegenerative Diseases, Neurons, Oxidative Stress, Ozone, Pollution, Public Health, Research, SARS, SARS-CoV-2, Smoking, Stress, Tobacco

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Hospitals, Insurers Invest Big Dollars to Tackle Patients’ Social Needs

PHILADELPHIA — When doctors at a primary care clinic here noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help.

But the one-time complimentary ride didn’t reduce these patients’ 36% no-show rate at the University of Pennsylvania Health System clinics.

“I was super surprised it did not have any effect,” said Dr. Krisda Chaiyachati, the Penn researcher who led the 2018 study of 786 Medicaid patients.

Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.

It was not the first time that efforts by a health care provider to address patients’ social needs — such as food, housing and transportation — failed to work.

In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients’ social needs improves health and lowers medical costs.

But so far it’s unclear which of these strategies, focused on so-called social determinants of health, are most effective or feasible, according to several recent academic reports by experts at Columbia, Duke and the University of California-San Francisco that evaluated existing research.

And even when such interventions show promising results, they usually serve only a small number of patients. Another challenge is that several studies did not go on long enough to detect an impact, or they did not evaluate health outcomes or health costs.

“We are probably at a peak of inflated expectations, and it is incumbent on us to find the innovations that really work,” said Dr. Laura Gottlieb, director of the UCSF Social Interventions Research and Evaluation Network. “Yes, there’s a lot of hype, and not all of these interventions will have staying power.”

With health care providers and insurers eager to find ways to lower costs, the limited success of social-need interventions has done little to slow the surge of pilot programs — fueled by billions of private and government dollars.

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Paying for Health, Not Just Health Care

Across the country, both public and private health insurance programs are launching large initiatives aimed at improving health by helping patients with unmet social needs. One of the biggest efforts kicks off next year in North Carolina, which is spending $650 million over five years to test the effect of giving Medicaid enrollees assistance with housing, food and transportation.

California is redesigning its Medicaid program, which covers nearly 14 million residents, to dramatically increase social services to enrollees.

These moves mark a major turning point for Medicaid, which, since its inception in 1965, largely has prohibited government spending on most nonmedical services. To get around this, states have in recent years sought waivers from the federal government and pushed private Medicaid health plans to address enrollees’ social needs.

The move to address social needs is gaining steam nationally because, after nearly a dozen years focused on expanding insurance under the Affordable Care Act, many experts and policymakers agree that simply increasing access to health care is not nearly enough to improve patients’ health.

That’s because people don’t just need access to doctors, hospitals and drugs to be healthy, they also need healthy homes, healthy food, adequate transportation and education, a steady income, safe neighborhoods and a home life free from domestic violence — things hospitals and doctors can’t provide, but that in the long run are as meaningful as an antibiotic or an annual physical.

Researchers have known for decades that social problems such as unstable housing and lack of access to healthy foods can significantly affect a patient’s health, but efforts by the health industry to take on these challenges didn’t really take off until 2010 with the passage of the ACA. The law spurred changes in how insurers pay health providers — moving them away from receiving a set fee for each service to payments based on value and patient outcomes.

As a result, hospitals now have a financial incentive to help patients with nonclinical problems — such as housing and food insecurity — that can affect health.

Temple University Health System in Philadelphia launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city by providing them free housing, and caseworkers to help them access other health and social services. It helps them furnish their apartments, connects them to healthy delivered meals and assists with applications for income assistance such as Social Security.

To qualify, participants had to have used the ER at least four times in the previous year and had at least $10,000 in medical claims that year.

Temple has seen promising results when comparing patients’ experiences before the study to the first five months they were all housed. In that time, the participants’ average number of monthly ER visits fell 75% and inpatient hospital admissions dropped 79%.

At the same time, their use of outpatient services jumped by 50% — an indication that patients are seeking more appropriate and lower-cost settings for care.

Living Life as ‘Normal People Do’

One participant is Rita Stewart, 53, who now lives in a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood, home to many college students and young families.

“Everyone knows everyone,” Stewart said excitedly from her second-floor walk-up. It’s “a very calm area, clean environment. And I really like it.”

Before joining the Temple program in July and getting housing assistance, Stewart was living in a substance abuse recovery home. She had spent a few years bouncing among friends’ homes and other recovery centers. Once she slept in the city bus terminal.

In 2019, Stewart had visited the Temple ER four times for various health concerns, including anxiety, a heart condition and flu.

Stewart meets with her caseworkers at least once a week for help scheduling doctor appointments, arranging group counseling sessions and managing household needs.

“It’s a blessing,” she said from her apartment with its small kitchen and comfy couch.

“I have peace of mind that I am able to walk into my own place, leave when I want to, sleep when I want to,” Stewart said. “I love my privacy. I just look around and just wow. I am grateful.”

Stewart has sometimes worked as a nursing assistant and has gotten her health care through Medicaid for years. She still deals with depression, she said, but having her own home has improved her mood. And the program has helped keep her out of the hospital.

“This is a chance for me to take care of myself better,” she said.

Her housing assistance help is set to end next year when the Temple program ends, but administrators said they hope to find all the participants permanent housing and jobs.

“Hopefully that will work out and I can just live my life like normal people do and take care of my priorities and take care of my bills and things that a normal person would do,” Stewart said.

“Housing is the second-most impactful social determinant of health after food security,” said Steven Carson, a senior vice president at Temple University Health System. “Our goal is to help them bring meaningful and lasting health improvement to their lives.”

Success Doesn’t Come Cheap

Temple is helping pay for the program; other funding comes from two Medicaid health plans, a state grant and a Pittsburgh-based foundation. A nonprofit human services organization helps operate the program.

Program organizers hope the positive results will attract additional financing so they can expand to help many more homeless patients.

The effort is expensive. The “Housing Smart” program cost $700,000 to help 25 people for one year, or $28,000 per person. To put this in perspective, a single ER visit can cost a couple of thousands of dollars. And “frequent flyer” patients can tally up many times that in ER visits and follow-up care.

If Temple wants to help dozens more patients with housing, it will need tens of millions of dollars more per year.

Still, Temple officials said they expect the effort will save money over the long run by reducing expensive hospital visits — but they don’t yet have the data to prove that.

The Temple program was partly inspired by a similar housing effort started at two Duke University clinics in Durham, North Carolina. That program, launched in 2016, has served 45 patients with unstable housing and has reduced their ER use. But it’s been unable to grow because housing funding remains limited. And without data showing the intervention saves on health care costs, the organizers have been unable to attract more financing.

Often there is a need to demonstrate an overall reduction in health care spending to attract Medicaid funding.

“We know homelessness is bad for your health, but we are in the early stages of knowing how to address it,” said Dr. Seth Berkowitz, a researcher at the University of North Carolina-Chapel Hill.

Results Remain to Be Seen

“We need to pay for health not just health care,” said Elena Marks, CEO of the Houston-based Episcopal Health Foundation, which provides grants to community clinics and organizations to help address the social needs of vulnerable populations.

The nationwide push to spend more on social services is driven first by the recognition that social and economic forces have a greater impact on health than do clinical services like doctor visits, Marks said. A second factor is that the U.S. spends far less on social services per capita compared with other large, industrialized nations.

“This is a new and emerging field,” Marks said when reviewing the evaluations of the many social determinants of health studies. “The evidence is weak for some, mixed for some, and strong for a few areas.”

But despite incomplete evidence, Marks said, the status quo isn’t working either: Americans generally have poorer health than their counterparts in other industrialized countries with more robust social services.

“At some point we keep paying you more and more, Mr. Hospital, and people keep getting less and less. So, let’s go look for some other solutions” Marks said.

The covid-19 pandemic has shined further light on the inequities in access to health services and sparked interest in Medicaid programs to address social issues. Over half of states are implementing or expanding Medicaid programs that address social needs, according to a KFF study in October 2020. (The KHN newsroom is an editorially independent program of KFF.)

The Medicaid interventions are not intense in many states: Often they involve simply screening patients for social needs problems or referring them to another agency for help. Only two states — Arizona and Oregon — require their Medicaid health plans to directly invest money into pilot programs to address the social problems that screening reveals, according to a survey by consulting firm Manatt.

The Centers for Medicare & Medicaid Services, which is funding a growing number of efforts to help Medicaid patients with social needs, said it “remains committed” to helping states meet enrollees’ social challenges including education, employment and housing.

On Jan. 7, CMS officials under the Trump administration sent guidance to states to accelerate these interventions. In May, under President Joe Biden, a CMS spokesperson told KHN: “Evidence indicates that some social interventions targeted at Medicaid and CHIP beneficiaries can result in improved health outcomes and significant savings to the health care sector.”

The agency cited a 2017 survey of 17 state Medicaid directors in which most reported they recognized the importance of social determinants of health. The directors also noted barriers to address them, such as cost and sustainability.

In Philadelphia, Temple officials now face the challenge of finding new financing to keep their housing program going.

“We are trying to find the magic sauce to keep this program running,” said Patrick Vulgamore, project manager for Temple’s Center for Population Health.

Sojourner Ahebee, health equity fellow at WHYY’s health and science show, “The Pulse,” contributed to this report.

This story is part of a partnership that includes WHYY, NPR and KHN.

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