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Chinese adults who have children prefer to receive end-of-life care from family members at home, while those who lost their only child prefer to be cared for in hospice or palliative care institutions, finds a new study led by an international team of researchers and published in the November issue of The Journal of Palliative Medicine. Income, property ownership, and support from friends also influenced individuals' end-of-life care preferences.

"Childlessness greatly influences adults' end-of-life care preferences, as children play an important role in traditional Chinese family-based end-of-life care," said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of NYU Aging Incubator. She is the study's senior author.

Filial piety, or respect for one's parents, is a core value in traditional Chinese culture, and children play a critical role in caring for aging parents and providing end-of-life care. End-of-life care is the support and medical care provided during the days, weeks, or months leading up to one's death.

China's one-child policy has led to a unique situation in caring for aging parents. As of 2010, one million Chinese parents had lost their only child, a number projected to grow to 11.8 million in 2050. Chinese adults who lose their only child are particularly disadvantaged when it comes to family-based end-of-life care.

In Western society, the end-of-life care model relies less on family members, instead using hospice and palliative care institutions and professional health care providers to provide support, reduce pain, and improve comfort. Hospice and palliative care systems are underdeveloped in China and face many structural and cultural challenges, including traditional views toward death, limited public funding, and a shortage of end-of-life care professionals at all levels.

In this study, Wu and her colleagues used data from a survey of 1,400 older adults in Shanghai to explore their end-of-life care preferences. The majority (1,200) were adults aged 60 years and older; the researchers also surveyed 200 adults aged 45 years and older who lost their only child. Participants were coded as having children who live with them, having children who do not live with them, or having lost their only child.

The researchers asked participants to share how they would want to be cared for at the end of their lives: by family, by visiting health care professionals, or in a specialized hospice or palliative care institutions.

They also measured factors related to end-of-life care, including sociodemographic characteristics such as gender, age, marital status, education, income, and property ownership; whether they have a support network of relatives and friends; health status, including chronic diseases, recent hospitalizations, mental health, and limitations in performing daily tasks; and whether they have health insurance.

The researchers found that adults who lost their only child prefer end-of-life care provided by a specialized hospice or palliative care institution (58 percent), while adults with children prefer family care at home (47 percent for adults whose children do not live with them and 49 percent for those whose children live with them).

Additional analyses show that adults with higher incomes and property tend to opt for family care at home. Conversely, those with a supportive network of friends prefer end-of-life care provided by visiting health care professionals or in end-of-life care institutions over family care at home. Health status was not associated with end-of-life care preferences; nor were other demographic factors (age, gender, marital status, and education).

"Our findings demonstrate a need to develop hospice and palliative care in China, both at-home care and care in hospitals and other clinical settings. Health care professionals and policymakers should recognize the particular preferences of those who have lost their only child and should develop tailored care accordingly," said Wu, who is also the director of research for the Hartford Institute of Geriatric Nursing at NYU Meyers.

About 6 million Australians aged 18 years and over have high blood pressure. Of these, more than two thirds had uncontrolled or unmanaged high blood pressure (not taking medication), representing 4 million adult Australians.

High blood pressure, or hypertension, is suggested to be one of the leading risk factors for heart disease.

The process in which high blood pressure causes heart disease is not completely understood.

But now scientists at the Baker Heart and Diabetes Institute have found that high blood pressure caused by specific signalling from the brain promotes heart disease by altering stem cells with the bone marrow.

The results, published in Haematologica demonstrate how an overactive sympathetic nervous system that causes elevated blood pressure can instruct bone marrow stem cells to produce more white blood cells that clog up blood vessels.

The Baker Institute's Head of Haematopoiesis and Leukocyte Biology, Associate Professor Andrew Murphy says the findings represent a new era of heart disease research.

"Hypertension is a major, independent risk factor of atherosclerotic cardiovascular disease, but we need more information to determine how it is resulting in heart attacks and strokes," said Associate Professor Murphy.

Atherosclerotic cardiovascular disease is a build-up of cholesterol plaque in the walls of arteries, causing obstruction of blood flow.

"We now know that significance changes in the immune system contributes significantly to heart disease," he said. "We aimed to determine how the sympathetic nervous system through the brain directly promotes atherosclerosis in the setting of hypertension."

"We have discovered that this form of high blood pressure, often associated with stress, causes changes within the bone marrow leading to increased white blood cells circulating though our vessels. This is significant as the general view of hypertension is that it is mainly a disease of the blood vessels, which means other heart damaging events are missed."

The team is now exploring the specific molecules involved, which may shed light as to why some current therapies are ineffective. They also suggest that managing stress, anxiety and pain are likely to help in controlling this form of hypertension and the effects it has on the body's bone marrow stem cells.

What would happen if you suddenly stopped growing at age 12 or 13?

Solving genetic growth mysteries and scheduling regular appointments with pediatric endocrinologists is atypical for most parents and pediatricians.

However, for children with growth disorders--a classification that typically describes children below the third or above the 97th percentile of growth charts for their age--receiving a diagnosis is half the battle to reaching average height. Understanding and creating treatment for a growth disorder, which could stem from an underlying medical illness, a genetic mutation or a problem with endocrine function, such as the production or action of growth hormone, is often the next step.

For Andrew Dauber, M.D., MMSc., the chief of endocrinology at Children's National Health System, a third step is to use these clues to create larger datasets and blueprints to identify risk factors for rare growth disorders. By understanding genetic markers of growth disorders, endocrinologists can identify solutions and create plans for multidisciplinary care to help children reach developmental milestones and receive coordinated care throughout their lifespan.

A case study that Dauber and his research team continue to explore is how to correct for mutations in the PAPPA2 gene, which regulates human growth by releasing a key growth factor called insulin-like growth factor 1 (IGF-1). Dauber and his colleagues recently described a mutation in PAPPA2, observed in two families with multiple children affected with significant short stature. He found that this mutation decreased the bioavailability of IGF-1, stunting the growth and development of the children who carry this mutation.

While the PAPPA2 mutation is rare, endocrinologists, like Dauber, who understand its function and dysregulation can create solutions to support IGF-1 bioavailability, thereby supporting healthy growth and development in children.

Understanding barriers to IGF-1 function can also help researchers gain insight into the relationship between PAPPA2, levels of circulating insulin in the body, which could cause insulin resistance, and other growth hormones. For now, Dauber and his research team are exploring how to use PAPPA2 to increase IGF-1 in circulation among people with height disorders in the hopes of improving their growth.

"The population of children who have PAPPA2 mutations is small and we're finding out that two children could respond to the same treatment in different ways," says Dauber. "One medication could work modestly in one child and support short growth spurts, such as growing by 5 or 6 cm a year. It could also create undesirable side effects, such as headaches and migraines in another, and render it ineffective. However, the clues we walk away with enable us to test new solutions, and confirm or dissolve our hunches, about what may be preventing the bioactive release of essential growth hormones."

To generate controls for healthy patterns of growth and development, Dauber and his research team are analyzing the relationship between PAPPA2, STC2 and IGFBP-3 concentrations among 838 relatively healthy pediatric participants, ages 3-18, with traditional growth patterns.

They are studying PAPPA2, STC2 and intact IGFBP-3 concentrations throughout childhood and the researchers are already surprised to find PAPPA2, a positive modulator of growth and IGF- bioavailability, decreased with age, while STC2, a negative modulator and traditional growth inhibitor, increased with age.

"As pediatric endocrinology researchers and clinicians, we're looking at the pathology of traditional growth patterns and growth disorders with an open mind," says Dr. Dauber. "These data sets are invaluable as they confirm or challenge our theories, which enable us to create and test new forms of personalized treatments. We'll continue to share this knowledge, which informs other researchers and accelerates the field of pediatric endocrinology."

LOS ANGELES -- Oct. 31, 2018 -- A team led by a Cedars-Sinai physician-scientist has discovered a biomarker--a protein found in the blood--for the most common type of heart failure, a new study published today in JAMA Cardiology shows.

Heart failure with preserved ejection fraction (HFpEF) affects more than 6.5 million Americans each year. And now, thanks to the discovery of the first-ever biomarker for HFpEF, a simple blood test can reveal whether a patient's heart is not making enough of an important protein. If the protein levels are decreased, the biomarker signal increases and physicians will be able to diagnose heart failure sooner, prescribe corrective medicines and prevent further disease progression.

"By the time heart failure symptoms develop, the critical window for corrective therapy has typically closed," said Robin Shaw, MD, PhD, the Wasserman Endowed Chair in Cardiology and professor of Medicine at the Smidt Heart Institute at Cedars-Sinai and principal investigator on the study. "Our discovery allows us to not only diagnose the disease sooner, but also to treat patients before that critical period of early intervention for lifesaving care has closed."

Heart failure with preserved ejection fraction is a condition where the heart can contract, but has problems relaxing--limiting the heart's ability to fill with blood between each beat--and therefore lowers the amount of blood moving forward with each contraction. Prior to the discovery of the biomarker, clinicians had to wait for patients to have symptoms to make a diagnosis of HFpEF and had to use an echocardiogram that measured how well the heart relaxed. There was no method to gauge the health of the heart muscle before symptoms developed or determine the severity of disease once symptoms were present.

The biomarker--named cBIN1 Score, or CS for short--allows doctors to measure muscle deterioration and measure a protein that regulates the heart's ability to both contract and relax. As the protein decreases, CS increases, serving as an indication of onset heart failure. The CS biomarker can be measured using a simple blood draw.

The CS biomarker is designed to be used in an outpatient clinic setting. For patients with known HFpEF, doctors can draw a CS level and use it to both guide current care, including medication adjustments, and predict the chances of a patient being admitted to the hospital in the next 12 months.

"More broadly, this discovery will allow the most at-risk patients--including older patients and patients with high blood pressure, diabetes or dyslipidemia--to be checked during an annual exam from their primary care physician," said Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute. "This pivotal research has the potential to impact millions of people and serve as a critical tool for preventive heart care."

Symptoms of heart failure typically appear as fatigue, fluid weight gain, leg swelling and shortness of breath. Heart failure with preserved ejection fraction is typically diagnosed in elderly people or those living with high blood pressure, diabetes, elevated cholesterol, hypertension, obesity, obstructive sleep apnea, anemia, iron deficiency or diabetes. Its prevalence is projected to rise drastically over the coming decades. Previous studies have shown that women represent the majority of patients diagnosed with the disease.

As next steps, Cedars-Sinai researchers plan on identifying specialty populations in which the CS biomarker could be useful, including sex-based differences, those who have undergone a heart transplant or valve replacement, as well as individuals with no known heart disease or risk factors.

A newly published scientific paper indicates that occupational safety and daily day performance in 7 out of 10 workers, from several European industries, is negatively affected by a combination of heat stress and failure to maintain water balance. The study combines field observations and motor-cognitive testing in the lab, and was conducted by the Pan-European Heat-Shield project coordinated by researchers from Department of Nutrition, Exercise and Sports at University of Copenhagen.

The importance of preventing dehydration has received much attention in health and work-safety advisories, as well as highlighted in the media during hot periods. It is therefore astonishing that 7 out of 10 workers are not adequately hydrated already at the onset of work.

"The very high prevalence of dehydration was a surprise to us, and the potential influence on workers cognitive function and motor performance in key industries is quite problematic, because it markedly increase the risk of making mistakes and therefore threaten both safety and productivity," says professor Lars Nybo from the Department of Nutrition, Exercise and Sports at University of Copenhagen, and project coordinator for Heat-Shield.

A threat to productivity and safety

During the previous two years, the Heat-Shield project has assessed hydration status at the onset and end of work shift across five different European industries. The study included 139 workers from four different countries; Denmark, Cyprus, Greece and Spain, and respectively working as manufacturing workers (in the aluminum industry) or as agricultural workers, police officers, tourism workers and construction workers.

The study combines field data with advanced testing of cognitive and motor function, and demonstrate how the combination of dehydration and occupational heat stress is a significant threat to productivity and safety. The impaired cognitive and motor task performance will be problematic in many occupations, as they rely on the workers cognitive function e.g. their ability to keep focus on task and react appropriately to occupational challenges.

For agricultural workers dehydration is a problem that aggravates during work shifts, but across all industries it is mainly failure to rehydrate from day to day that causes a state of mild to moderate dehydration. In itself a health problem, however when combined with heat stress it markedly influenced the ability to perform complex tasks. This may indeed influence productivity, but especially it can be a threat to safety at work places with high environmental temperatures.

Risk of larger problems in the near future

Andreas Flouris, Associate Professor at the University of Thessaly, Greece, and head of the field studies conducted in Southern Europe emphasizes that the problem can be even bigger in the near future: "This is already a problem under the current conditions. However, facing a future with more frequent heat waves it is of utmost importance for workers to adopt better hydration habits and for companies to develop effective hydration strategies."

Considering that many occupational tasks as handling of industrial machinery, driving, harvesting etc. rely on alertness and the ability to integrate multiple input and react appropriately, it is of great importance to emphasize the importance of informing on the consequences of dehydration and the needs for adopting appropriate prevention.

These findings let us suggest that prevention plans with implementation of suitable and more effective hydration and rehydration strategies are warranted at work places to minimize the negative effects of dehydration on workers performance, when they are exposed to occupational heat stress.

Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis, according to a new study by researchers at Université de Montréal and its affiliated Maisonneuve Rosemont Hospital Research Centre (CRHMR), in collaboration with researchers at Boston University. Their findings were published Oct. 11 in the journal Arthritis & Rheumatology.

Osteoarthritis (OA) is a common cause of pain and altered joint function, affecting 302 million adults worldwide. It can lead to chronic disability, frequently in the knee joint. Past research suggests that a number of factors outside of structural pathology may contribute to pain in patients with OA.

"Understanding the factors that contribute to the development of persistent pain is critical to improving our ability to prevent its onset and the transition to more persistent pain," said lead author Lisa Carlesso, an assistant professor at UdeM's School of Rehabilitation and a scientist at CRHMR, part of the CIUSSS de l'Est-de-l'Île-de-Montréal.

She and her team analyzed data from a multicentre OA study that followed 852 adults (ages 50-79) with or at risk of knee OA but who were free of persistent knee pain at the beginning of the study. Sociodemographic data, pain sensitization measurements, as well as risk factors traditionally associated with knee pain such as psychological factors, widespread pain and poor sleep were collected on the participants, who then were followed for development of persistent knee pain over two years.

The researchers used the risk factors and pain sensitization data to identify four distinct subgroups called pain susceptibility phenotypes (PSPs). They found these PSPs were primarily characterized by varying degrees of pain sensitization. The PSP with the highest degree of sensitization had the highest risk of developing persistent knee pain. Female gender, non-Caucasian race and age 65+ were significant sociodemographic predictors of being a member of the PSP with the highest degree of sensitization.

The researchers believe identifying these PSPs is an important step in understanding the complex pathology of knee osteoarthritis. "Our findings suggest that therapy aimed at prevention or improvement of pain sensitization may be a novel approach to preventing persistent knee pain," said co-author Tuhina Neogi, a professor of medicine and epidemiology at Boston University's School of Medicine and School of Public Health. "Preventing pain is crucial to improving quality of life and function in patients who suffer from OA."

NEW YORK, Oct. 30, 2018 - A new report funded by the Muscular Dystrophy Association (MDA) and released by the IQVIA Institute for Human Data Science indicates that genetic testing and breakthrough therapies will transform the diagnosis and care of neuromuscular disease within the next decade. The report, "Understanding Neuromuscular Disease Care," highlights current gaps in care and opportunities to optimize care and accelerate the emergence of new therapies. Insights gained from a survey of health care professionals focused on the care of patients with neuromuscular disease are also included.

Neuromuscular diseases encompass a broad group of disorders that collectively impact an estimated 250,000 patients and their caregivers in the United States alone. Although these diseases are rare and treatment options are currently limited, the financial impact is high. IQVIA's report reveals total annual costs across all neuromuscular patients exceed $46 billion. The diagnostic odyssey can often take upwards of a year, although improvements in the speed, price and comprehensiveness of available genetic testing are accelerating the process. The report sheds light on the role data will play in revolutionizing the importance of early genetic screening, intervention and treatment, including through the newborn screening public health program, which has enormous implications on time to diagnosis and intervention.

"MDA is in the best possible position to transform the lives of people with neuromuscular disease," says MDA President and Chief Executive Officer Lynn O'Connor Vos. "As the umbrella organization for more than 40 neuromuscular diseases, and with multidisciplinary clinics providing best in class care at more than 150 of the nation's top medical institutions, we are galvanizing both industry and the research arena to develop better care and more cures."

Through its comprehensive data hub, MOVR (NeuroMuscular ObserVational Research), MDA is playing a pivotal role in the advancement of research and care in neuromuscular disease. MOVR rolled out in 2018 and will become fully implemented at 50 MDA Care Centers in 2019 to improve the ability for researchers and health care providers to identify precision medicine treatments, enhancing options for care.

"The MOVR Data Hub will be extraordinarily powerful, enabling us to capture genome data, clinical data, professionally reported data and patient/family-reported data all in in one place," says Dr. R. Rodney Howell, chairman of MDA's Board of Directors. "The data from MOVR will provide benefits both in the present, identifying patients for treatments based on their genomic data, as well as in the future, as new treatment options become available. The study of the genomic data will identify important new genetic modifiers."

Other insights from the study:

Treatment for neuromuscular disease is generally provided through a multidisciplinary care model, allowing patients to visit a range of specialists synchronously in a dedicated center.

Care paradigms and provider treatment decisions may be inconsistent, reflecting the challenges of small patient populations, varied symptoms and a lack of official guidelines, particularly for many of the less prevalent diseases.

Adopting technologies for remote appointments and real-time monitoring can improve care management by minimizing patient travel and increasing communication with health care providers.

There is a need to develop innovative approaches to pricing and reimbursement to tackle access to care for patients.

Psychological symptoms are an ongoing challenge, affecting 75 percent of patients and recognized by 90 percent of neuromuscular disease health care professionals as a high unmet need.

"The rapid progress being made in improving patient care and outcomes through the combination of scientific breakthroughs and the development of secure, scalable cloud-based data hubs is remarkable," says Murray Aitken, executive director of the IQVIA Institute for Human Data Science. "Expectations are high for advancing patient care and bringing disease-modifying therapies across a number of neuromuscular diseases to patients and their families. We are pleased to collaborate with MDA in undertaking research that highlights both the gaps in care and the opportunities to address them in the near-term."

PHILADELPHIA - As many as 16.5 million adults in America suffer from a skin disease known as atopic dermatitis, an inflammatory disease that results in red, itchy skin. The estimate comes from a new study from the Perelman School of Medicine at the University of Pennsylvania, which also projected 6.6 million of these adults have disease that would be classified as moderate to severe, leading to a decrease in quality of life. Researchers published the findings in the Journal of Investigative Dermatology today.

Atopic dermatitis (AD) is commonly associated with children but can occur at any age. The dry, itchy, red patches can occur anywhere on the skin and tend to flare periodically and unpredictably. There is no cure for the condition, but treatment to control it can involve a gentle skin care regimen including over-the-counter products as well as topical or systemic corticosteroids. In more resistant or severe cases, treatment can include the use of immunosuppressive therapies such as methotrexate, cyclosporine, azathioprine or mycophenolate mofetil. In 2017, the U.S. Food and Drug Administration approved a biologic called dupilumab, which is given by injection and targets the inflammation from the inside-out. It is currently the only FDA-approved medication for treatment of atopic dermatitis and the only biologic available.

"We tend to think of this disease as a children's disease, but our data show that's not the case," said the study's lead author Zelma C. Chiesa Fuxench, MD, MSCE, an assistant professor of Dermatology at Penn. "Our findings show this disease affects seven percent of the population, far more than other inflammatory conditions like psoriasis, which only affects about three percent. Yet psoriasis has eight biologic treatments available for patients, whereas atopic dermatitis only has one that's approved."

The study's senior author was Peck Ong, MD, an associate professor of Clinical Pediatrics at the Keck School of Medicine of the University of Southern California and an attending physician at Children's Hospital Los Angeles.

Researchers surveyed 1,278 adults sampled from the GfK Knowledge Panel, a probability-based online panel that is thought to be representative of the adult population of the United States. Among those respondents, 7.3 percent met the criteria for diagnosis of AD. Sixty percent of those with AD classified as mild, 29 percent as moderate, and 11 percent as severe. Since the panel is representative of the country's population, researchers used U.S. census population data to project that 16.5 million American adults are living with AD, with 6.6 million of those cases being moderate-to-severe. Patients with AD and those with more severe disease also had higher scores in other patient-reported outcome measures, including the Dermatology Life Quality Index, indicating a worse impact on quality of life and an increased likelihood of anxiety or depression as measures by the Hospital Anxiety and Depression Scale.

"These findings show a disconnect between the prevalence of this disease - and its impact on patient quality of life - compared to the resources being dedicated to developing systemic therapies," Chiesa Fuxench said. "With only one approved biologic available, it's clear the need is not being met."

Chiesa Fuxench says the numbers also hint at larger questions about this population, including whether they developed the condition as they got older or whether they had it as children and stopped seeking treatment at some point during their lives due to unhappiness with or poor response to currently available therapies. Many patients, she notes, are told they will grow out of the disease, but these data suggest that may not be the case, and that the disease may change over time. She also notes the medical and social impact of AD can also lead to a financial impact for many patients.

"When these patients experience flare ups, they're more likely to call out of work, avoid going out, or remove themselves from other situations they might typically enjoy," she said. One study from 2017 estimates the annual cost of AD in the United States is $5.3 billion each year, which only further drives home the point.

"Topical and oral corticosteroids don't work for everyone, and even when they do, patients should not be on them long-term," Chiesa Fuxench said. "We need to prioritize our understanding of this complex disease as well as the development of innovative therapies for these patients."

Alzheimer's disease (AD) is a brain disease that causes changes that kill brain cells. AD is a type of dementia, which causes memory loss and problems with thinking and making decisions. People with AD and other forms of dementia have difficulties performing the daily activities others might consider routine.

Dementia takes a toll on those who live with it--and it also places a burden on caregivers. Along with problems connected to memory, language, and decision-making, dementia can cause neuropsychiatric symptoms, such as depression, anxiety, changes in mood, increased irritability, and changes in personality and behavior. People who have AD/dementia also have twice the risk for falls compared to people without dementia. About 60 percent of older adults with dementia fall each year.

Researchers suggest that having neuropsychiatric symptoms might predict whether an older person with AD/dementia is more likely to have a fall. We also know that exercise can reduce the number of falls in older adults with dementia. However, we don't know very much about how neuropsychiatric symptoms may increase the risk of falls, and we know even less about how exercise may reduce the risk of falls for people with dementia and neuropsychiatric symptoms. A research team decided to explore whether exercise could reduce the risk of falling among community-dwelling people with AD who also had neuropsychiatric symptoms.

To learn more, the researchers reviewed a study that investigated the effects of an exercise program for older adults with AD (the FINALEX trial). The study included a range of people living with different stages of AD/dementia and with neuropsychiatric symptoms. Their findings were published in the Journal of the American Geriatrics Society.

The original FINALEX study examined and compared older adults who had home- or group-based exercise training with people who didn't exercise but who received regular care. The researchers learned that the people who exercised had a lower risk for falls than those who didn't exercise. There was also a higher risk for falls among those who had lower scores on psychological tests and who didn't exercise.

This study revealed that people with AD/dementia and neuropsychiatric symptoms such as depression and anxiety have a higher risk for falls. Exercise can reduce the risk of falling for older adults with these symptoms. Further studies are needed to confirm these results.

CHICAGO - Oct. 29, 2018 - A team of ophthalmologists went looking for scientific evidence in support of commercially available "cell therapy" for eye diseases. Not only did they find virtually none; they instead discovered a growing number of patients are being irreparably harmed by unapproved cell therapies. Their findings were presented today at AAO 2018, the 122nd Annual Meeting of the American Academy of Ophthalmology.

The researchers' review of published studies found only a few case series, involving a total of 18 patients. All patients were reported to have had positive treatment outcomes or no improvement. However, the researchers were able to identify at least seven patients who experienced devastating harm from an unapproved cell therapy.

The number of clinics that administer stem cell therapies that have not been authorized by the FDA has proliferated in recent years. Nearly 600 clinics have opened in the United States alone. These so-called therapy clinics tout their ability to help patients suffering from a broad range of conditions including the blinding eye disease, age-related macular degeneration, Parkinson's disease, autism and multiple sclerosis.

In May, the FDA began cracking down on clinics marketing unapproved therapies after three women with macular degeneration lost their vision after undergoing an unproven stem-cell treatment at a Florida clinic.

Ophthalmologist Ajay E. Kuriyan, M.D., treated one of those women following treatment at the stem cell clinic. He tried to save her vision, but the damage was too great.

Determined to learn the extent of the problem, Dr. Kuriyan and Andrew Chen, M.D., and colleagues at the University of Rochester's Flaum Eye Institute and the University of Miami's Bascom Palmer Eye Institute, reviewed evidence supporting cell therapy published in scientific journals and from the clinic's websites and marketing materials.

Though the clinics stopped advertising the treatment that blinded the women, many continue to offer therapies for a variety of blinding eye disease, including serpiginous choroidopathy, Leber Hereditary Optic Neuropathy, and nonarteritic anterior ischemic optic neuropathy.

What the researchers found is that the clinics omit poor outcomes in their reports. The data clinics report suggests that, at worst, no harm was done, and at best, patients experience improvement. But Dr. Kuriyan and his colleagues have found at least seven patients who suffered disastrous outcomes.

"When you look at these company's websites and their publications, you'll see a big under-reporting of profound complications," Dr. Kuriyan said. "This is in stark contrast to what we have seen in our clinics and in our personal experience. There's a fairly significant number of patients who experienced poor, or in some cases devastating results. The cases published to date just scratch the surface of the number of bad outcomes."

Dr. Kuriyan and his colleagues are currently collecting data for a larger study, detailing all the patients who suffered complications from unapproved cell therapy.

What Patients can do to Protect Their Health

he cell therapy clinics are not only endangering patient health, Dr. Kuriyan warns, they are also threatening to undermine both legitimate scientific progress and the public's trust in stem cell research.

To help patients identify legitimate research, Dr. Kuriyan advises against joining studies that require payment. Most large clinical trials don't require payment. Some smaller clinical trials may have a minimum cost, such as a copay or out-of-pocket deductible payment, and anything beyond that should be viewed more cautiously.

Centers or clinics that only offer cell therapy is another red-flag, Dr. Kuriyan said. A reputable clinic will offer a variety of treatments for conditions. Most importantly, he recommends patients ask questions and discuss potential treatments with their ophthalmologist.

Highlights

Nephrologists often lack confidence in managing women's health issues that may be related to kidney disease.

Results from the study will be presented at ASN Kidney Week 2018 October 23-October 28 at the San Diego Convention Center.

San Diego, CA (October 26, 2018) -- Many kidney specialists many need more training and support when it comes to managing women's health issues, according to a study that will be presented at ASN Kidney Week 2018 October 23-October 28 at the San Diego Convention Center.

A broad range of women's health issues are intimately related to kidney disease, yet little is known about clinicians' confidence in these issues. To investigate, Monica Reynolds, MD (University of North Carolina, Chapel Hill), Elizabeth Hendren, MD (University of Toronto) and their colleagues sent a 25-question survey to nephrologists in the United States and Canada.

Of the 154 respondents, 58% were from the United States, 53% were women, and the median age was 41- 45 years. Most nephrologists counseled on contraception (65%) or pre-conception planning (76%) to an average of less than one woman per month, though counseling was more frequent in the United States. Nephrologists often lacked confidence managing many women's health issues including menstrual disorders, contraception, osteoporosis and menopause. While female providers were more confident in counseling about contraception (42% vs. 23%), there were no other significant differences in confidence level based on gender or country of practice. Physicians also reported inconsistent documentation of obstetric history even though factors during pregnancy are clinically important for assessing a woman's risk of cardiovascular disease.

"It is our hope that by highlighting these gaps we can target future interventions to improve patient-centered care for women with chronic kidney disease," said Dr. Reynolds. "Further research is warranted to develop tools to increase knowledge in training, identify best mechanisms to enhance physician confidence, and facilitate formation of interdisciplinary clinics."

San Diego, CA (October 26, 2018) -- Adults with chronic kidney disease (CKD) have not been immune to the national opioid epidemic, suggests research that will be presented at ASN Kidney Week 2018 October 23-October 28 at the San Diego Convention Center.

Patients with CKD may be more likely to receive opioid prescriptions due to a high prevalence of pain and frequent contact with healthcare systems. To uncover trends in prescription opioid use in the CKD population over time, Daniel Murphy, MD (University of Minnesota) and his colleagues analyzed 1999-2014 information on patients with CKD participating in the National Health and Nutrition Examination Survey.

In the years 1999 to 2014, adults with CKD in the United States had a higher likelihood of having an active prescription for and to be using an opioid medication compared with those without kidney disease (7.5% vs 5.4%). After statistical adjustment for demographic factors, a higher prevalence of prescription opioid use was also seen among those with CKD in the years 2011-2014 compared with 1999-2002. No effect by race/ethnicity was seen, although higher prescription opioid use was seen with females and with older age.

The researchers also found that multiple comorbid conditions were associated with higher prevalence of prescription opioid use in patients with CKD, including those known to cause pain (such as cancer and arthritis), as well those that should not directly cause pain (such as diabetes, hypertension, and obesity).

"Our research suggests the need for further work investigating the indications for opioid prescribing and the outcomes associated with use of prescription opioids in those with CKD," said Dr. Murphy.

Another study found that several environmental factors are associated with long-term prescription opioid use among elderly patients with CKD. For the study, Yun Han, MD (University of Michigan) and her colleagues analyzed a linked dataset from Medicare 5% sample claims data from 2006-2009), the American Community Survey Data from 2005-2009, and the Health Resources and Services Administration Primary Care Service Area data from 2007.

Average county-level long-term opioid use was higher in counties in the West and South compared with those in the Northeast and Midwest. Counties with aging adults and higher deprivation index tended to have greater long-term opioid use, as did counties in Medically Underserved Areas.

"Our results highlight the importance of allocating resources for this epidemic at the county level. The environmental factors identified in our study may be helpful for healthcare providers to target CKD patients at high risk of opioid abuse/dependence, and for designing local regulation and treatment for appropriate opioid use in CKD patients," said Dr. Han.

PROVIDENCE, R.I. [Brown University] -- In the first three years of Medicaid expansion due to the Affordable Care Act (ACA), the number of patients with end-stage kidney disease who died within a year of starting dialysis decreased in states that expanded Medicaid compared to non-expansion states, new research found.

The study, led by Brown University researchers, was published on Oct. 25 in the Journal of the American Medical Association.

"To my knowledge, this is the first study to find an association between Medicaid expansion under the ACA and lower death rates in adults," said Dr. Amal Trivedi, senior author and an associate professor at Brown's School of Public Health. "Prior research on the effects of Medicaid expansion have generally found that expansion is associated with substantial gains in coverage, access to care, use of preventive health services and in some studies, better self-rated health."

In the study, Trivedi and colleagues tracked more than 230,000 non-elderly patients with end-stage renal disease between 2011 and 2017. In January 2014, 25 states and the District of Columbia extended Medicaid to non-elderly residents with incomes at or below 138 percent of the poverty level, while 25 states did not (though eight more have expanded Medicaid since then).

In Medicaid expansion states, the number of patients who died within the first year of beginning dialysis -- defined in the study as from the 91st day to the end of the 15th month of dialysis treatment -- decreased from 6.9 percent prior to expansion to 6.1 percent after expansion, a total reduction of 0.8 percentage points. In non-expansion states, the mortality rate was 7 percent from January 2011 to January 2014 (prior to ACA) and 6.8 percent from January 2014 to March 2017, a reduction of 0.2 percentage points.

Not only did the researchers compare death rates before and after expansion, they also compared rates between states that expanded Medicaid and states that did not. This method gave the researchers two layers of comparison -- before 2014 versus after and expansion states versus non-expansion states -- for determining whether the differences were associated with Medicaid expansion, Trivedi said.

The adjusted absolute reduction in mortality in expansion states versus non-expansion states was 0.6 percentage points. Since end-stage renal disease affects more than 100,000 Americans each year, 0.6 percentage points equals hundreds of deaths annually, Trivedi said.

Trivedi says that more research is needed to determine exactly what caused the decrease in deaths, but the study suggests expanded insurance coverage, which provided better access to care, was the key factor in reducing mortality among this group. Medicaid expansion reduced the rate of end-stage renal disease patients without insurance by 4.2 percentage points, primarily through Medicaid coverage.

"Multiple factors not explored in our paper may have contributed to the reduction of mortality among patients with end-stage renal disease," said Shailender Swaminathan, lead author and an adjunct assistant professor at Brown's School of Public Health. "Medicaid may have resulted in better adherence to treatment sessions, normally three times a week, because it eliminated co-payments of about $150 per week. On the other hand, because out-of-pocket medical payments were reduced, Medicaid may have also improved patients' finances, thereby improving health. More research may be essential to unravel this."

Medicaid expansion also improved pre-dialysis care for kidney disease, as indicated by the surgical placement of a fistula or graft before beginning dialysis, Trivedi said. Fistulas and grafts -- two methods for accessing the bloodstream for dialysis -- are less likely to become infected than temporary venous catheters, and in expansion states there was an increase of 2.3 percentage points in the number of patients beginning dialysis with a fistula or graft.

The study also found that black patients and patients between the ages of 19 and 44 had larger decreases in mortality rates, by 1.4 percentage points and 1.1 percentage points respectively. Trivedi said this is likely because these groups traditionally had lower rates of insurance. As blacks and Hispanics are more likely to develop end-stage kidney disease -- 3.5 times and 1.5 times respectively -- Trivedi said, "Medicaid expansion in the states that have yet to expand may be a significant strategy to address racial and ethnic health disparities among patients with end-stage renal disease."

Trivedi would like to monitor the long-term effects of Medicaid expansion on end-stage kidney disease mortality and incidence rates. It is possible that increases in insurance rates due to Medicaid expansion could lead to better recognition, treatment and management of diabetes and hypertension, the two key underlying causes of kidney disease, ultimately reducing the number of people who develop end-stage renal disease, he said.

"Our study suggests that there are significant mortality reductions in patients with end-stage renal disease, who have substantial medical needs, in the states that expanded Medicaid," Trivedi said. "We're studying a central question in health policy: To what extent does expanded health coverage save lives?"

He added that the results may apply beyond patients with kidney disease to others with serious chronic conditions, but more research is needed.

Thanks to an innovative mosquito control approach developed at Rutgers University-New Brunswick, residents in several Maryland neighborhoods reduced populations of invasive Asian tiger mosquitoes by an impressive 76 percent, on average.

The Rutgers-led project, called Citizen Action through Science (Citizen AcTS), mobilizes neighbors guided by scientists to address local problems, according to a study in the journal Scientific Reports this week.

This approach was tested in University Park, Maryland, which had about 1,000 residential yards infested with the invasive Aedes albopictus, primarily a major nuisance pest in temperate climates but a vector of chikungunya, yellow fever and dengue fever and even Zika in more southern latitudes. Facilitated by Rutgers scientists, more than 500 University Town homeowners purchased lethal oviposition traps in early 2017, set them up and maintained them over the summer. The insecticide used was canola oil, a common household item.

"The Citizen AcTS model rejects the top-down approach that has consistently led to mosquito control failures," said study senior author Dina M. Fonseca, a professor in the Department of Entomology and director of the Center for Vector Biology. "Instead, this model works through respectful exchanges among scientists and residents that lead to trust, buy-in by residents and transferring program ownership to the community."

It has long been recognized that successful Aedes mosquito control programs in urban areas require community support. Worldwide, government and other organizations are increasingly using citizen-volunteers for large-scale mosquito surveillance and other labor-intensive activities. But using residents to control mosquitoes has rarely been successful due to high attrition and lack of personal motivation. However, immature mosquitoes that typically develop in small containers in residential yards are an especially good target for citizen efforts because it's difficult for state and county professionals to access and treat yards.

Initial participation in a mosquito control program largely depends on personal interest and awareness of social responsibility. Long-term participation often relies on cultivating strong relationships between volunteers and scientists, and between volunteers and their communities, the study says.

Under the Citizen AcTS model, residents purchase, deploy and maintain low-cost (about $15) traps that target and kill egg-laying females. Volunteers, along with community leaders, are mentored by and work closely with scientific advisors.

The researchers hope their pioneering approach to urban mosquito control will inspire other communities to try it. Last summer, they worked with Sligo Park Hills in Maryland, Mt. Pleasant within the District of Columbia and Highland Park in New Jersey. Other communities in North Carolina, Virginia, D.C., Maryland and New Jersey have since expressed interest in trying this approach.

Long-suffering community members trying to get their neighbors interested in bee-friendly yards, solar panels or runoff prevention have expressed how easy it is to get everyone "on board" when the objective is to kill mosquitoes. "It's a great conversation starter!"; "I have met all my immediate neighbors"; and "we are thinking of using the 'mosquito network' to strengthen our community" are examples of positive feedback.

Highlights

In a study of kidney transplant recipients, those with ideal BMI (18-25) had the best organ survival. There was no difference when comparing BMI 30-35 with >35.

There were no significant differences in patient survival across different BMI groups.

Results from the study will be presented at ASN Kidney Week 2018 October 23-October 28 at the San Diego Convention Center.

San Diego, CA (October 25, 2018) -- A new study sheds light on the potential impacts of obesity on health outcomes in kidney transplant recipients. The study will be presented at ASN Kidney Week 2018 October 23-October 28 at the San Diego Convention Center.

The prevalence of obesity is increasing in prospective kidney transplant recipients. To examine the potential effect on long-term health outcomes, Bhavna Chopra, MD (Allegheny General Hospital) and her colleagues analyzed information from the United Network for Organ Sharing database from 2006 to 2016 concerning recipients at different levels of body mass index (BMI). To minimize the impact of donor variables on transplant outcomes, the team used a paired kidney model in which kidneys from the same deceased donor were transplanted into recipients in different BMI categories.

Concerning delayed organ function, patients with ideal BMI (18-25) had the lowest risk, and the risk rose with increasing BMI categories; yet there was no difference in patient survival across different BMI groups.

"Our data support a more favorable consideration of obese patients for kidney transplantation and suggest that the use of a BMI cut off between 30 and 40 for wait listing, while common, is arbitrary and unfounded," said Dr. Chopra. "The resulting increase in access to transplantation for many obese patients will have a significant impact on quality of life and longevity for these patients compared to staying on long-term dialysis."