Demanding Relatives May Raise Heart Risks in Middle Age
Worrisome partners, children linked to increased reports of angina symptoms, study finds
Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.
However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.
The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care…..
You are what your father ate
UMMS research suggests paternal diet affects lipid metabolizing genes in offspring
WORCESTER, Mass. — Scientists at the University of Massachusetts Medical School and the University of Texas at Austin have uncovered evidence that environmental influences experienced by a father can be passed down to the next generation, “reprogramming” how genes function in offspring. A new study published this week in Cell shows that environmental cues—in this case, diet—influence genes in mammals from one generation to the next, evidence that until now has been sparse. These insights, coupled with previous human epidemiological studies, suggest that paternal environmental effects may play a more important role in complex diseases such as diabetes and heart disease than previously believed.
“Knowing what your parents were doing before you were conceived is turning out to be important in determining what disease risk factors you may be carrying,” said Oliver J. Rando, MD, PhD, associate professor of biochemistry & molecular pharmacology at UMMS and principal investigator for the study, which details how paternal diet can increase production of cholesterol synthesis genes in first-generation offspring….
…These observations are consistent with epidemiological data from two well-known human studies suggesting that parental diet has an effect on the health of offspring. One of these studies, called the Överkalix Cohort Study, conducted among residents of an isolated community in the far northeast of Sweden, found that poor diet during the paternal grandfather’s adolescence increased the risk of diabetes, obesity and cardiovascular disease in second-generation offspring. However, because these studies are retrospective and involve dynamic populations, they are unable to completely account for all social and economic variables. “Our study begins to rule out the possibility that social and economic factors, or differences in the DNA sequence, may be contributing to what we’re seeing,” said Rando. “It strongly implicates epigenetic inheritance as a contributing factor to changes in gene function.”
The results also have implications for our understanding of evolutionary processes, says Hans A. Hofmann, PhD, associate professor of integrative biology at the University of Texas at Austin and a co-author of the study. “It has increasingly become clear in recent years that mothers can endow their offspring with information about the environment, for instance via early experience and maternal factors, and thus make them possibly better adapted to environmental change. Our results show that offspring can inherit such acquired characters even from a parent they have never directly interacted with, which provides a novel mechanism through which natural selection could act in the course of evolution.” Such a process was first proposed by the early evolutionist Jean-Baptiste Lamarck, but then dismissed by 20th century biologists when genetic evidence seemed to provide a sufficient explanation.
Taken together, these studies suggest that a better understanding of the environment experienced by our parents, such as diet, may be a useful clinical tool for assessing disease risk for illnesses, such as diabetes or heart disease. “We often look at a patient’s behavior and their genes to assess risk,” said Rando. “If the patient smokes, they are going to be at an increased risk for cancer. If the family has a long history of heart disease, they might carry a gene that makes them more susceptible to heart disease. But we’re more than just our genes and our behavior. Knowing what environmental factors your parents experienced is also important.”
The next step for Rando and colleagues is to explore how and why this genetic reprogramming is being transmitted from generation to generation. “We don’t know why these genes are being reprogrammed or how, precisely, that information is being passed down to the next generation,” said Rando. “It’s consistent with the idea that when parents go hungry, it’s best for offspring to hoard calories, however, it’s not clear if these changes are advantageous in the context of a low-protein diet.”
National survey reveals 45.1 million adults in the U.S. experienced mental illness in the past year
Study shows that nearly 1 in 5 people suffering from mental illness also have a substance use disorder
[Editor Flahiff’s note: A recent WSJ Health news story reported that almost 12,000 of the Screen Actors Guild participants will lose access to treatment for mental-health and substance-abuse issues beginning in January.“Others that have made the same move include the Plumbers Welfare Fund, representing about 3,500 members in the Chicago area, and Woodman’s Food Market, a chain in Wisconsin with 13 stores and about 2,200 employees.” …”According to the Kaiser Family Foundation’s 2010 Employer Health Benefits survey, about one-third of firms with more than 50 workers said they made changes in the benefits they offer in response to the law, and 5% of those said they dropped mental-health coverage.”]
According to new results from a national survey, 19.9 percent of American adults in the United States (45.1 million) have experienced mental illness over the past year. The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 11 million adults (4.8 percent) in the U.S. suffered serious mental illness in the past year — a diagnosable mental disorder has substantially interfered with, or limited one or more major life activities.SAMHSA’s 2009 National Survey on Drug Use and Health (NSDUH) reveals that 8.4 million adults in the U.S. had serious thoughts of suicide in the past year, 2.2 million made suicide plans, and one million attempted suicide.The survey also reveals that in many cases those experiencing mental illness, especially those with serious mental illness, also have a substance use disorder (abuse or dependence on alcohol or an illicit drug). Nearly 20 percent (8.9 million) of adults in the U.S. with mental illness in the past year also had a substance use disorder. Among those with serious mental illness in the past year, 25.7 percent had a substance use disorder in the past year — approximately four times the level experienced by people not suffering from serious mental illness (6.5 percent).“Too many Americans are not getting the help they need and opportunities to prevent and intervene early are being missed,” said SAMHSA Administrator Pamela S. Hyde, J.D. “The consequences for individuals, families and communities can be devastating. If left untreated mental illnesses can result in disability, substance abuse, suicides, lost productivity, and family discord. Through health care reform and the Mental Health Parity and Addiction Equity Act we can help far more people get needed treatment for behavioral health problems.”Administrator Hyde announced the survey’s findings during an address before the 6th World Conference on Promotion of Mental Health and Prevention and Mental and Behavioral Disorders in Washington, D.C. sponsored by the Education Development Center, Inc., The Clifford Beers Foundation, The Carter Center and the World Federation for Mental Health.The survey provides other insights into the nature and scope of mental illness, including information on those segments of the population who may be at greater risk of experiencing mental illness. For example, the survey shows that mental illness is more likely among adults who were unemployed than among adults who were employed full time (27.7 percent versus 17.1 percent).There is a marked difference in the percentages with mental illness between men and women as well, with 23.8 percent of women experiencing some form of mental illness, as opposed to 15.6 percent of men. In terms of age, young adults (ages 18 to 25) had the highest level of mental illness (30 percent), while those aged 50 and older had the lowest (13.7 percent).Less than four in ten (37.9 percent) of adults in the U.S. with mental illness in the past year received mental health services. Service use was higher for adults with serious mental illness (60.2 percent); however, 4.4 million adults with serious mental illness in the past year did not receive mental health services.Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings is based on the 2009 NSDUH — the latest in a series of scientifically conducted annual surveys of approximately 67,500 people throughout the country. Because of its statistical power, it is a primary source of information on the levels of a wide range of behavioral health matters including mental health and substance abuse issues.A copy of the report is accessible at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf
Caring for the elderly: Dealing with resistance
Caring for the elderly can be challenging — particularly if a loved one is resistant to care. Understand what’s causing your loved one’s resistance and how you can encourage cooperation.
Excerpts From the Mayo Clinic Tip Sheet
What’s the best way to approach a loved one about the need for care?
If you suspect that your loved one will be resistant to care — whether from family, other close contacts or a service — you may be hesitant to bring up the topic. To start communicating with your loved one about his or her need for care:
- Choose a time when you and your loved one are relaxed. This will make it easier for you and your loved one to listen to each other and speak your minds.
- Ask questions about your loved one’s preferences. This will help you provide the type of assistance your loved one wants. What type of care does your loved one want or need? Does your loved one have a preference about which family member or what type of service provides care? While you may not be able to meet all of your loved one’s wishes, it’s important to take them into consideration.
- Enlist the help of family members. Family and friends may be able to help you persuade your loved one to accept help.
- Don’t assume that your loved one is unable to discuss care preferences. While your loved one may be ill, he or she may still have care preferences and be able to make some decisions regarding care. If your loved one has trouble understanding you, be sure to simplify your explanations and the decisions you expect him or her to make.
- Don’t give up. If your loved one doesn’t want to discuss the topic the first time you bring it up, try again later.
What are the most effective strategies for managing resistance to care?
Getting an aging loved one to accept help can be difficult. To encourage cooperation, you might:
- Suggest a trial run. Don’t ask your loved one to make a final decision about the kind of care he or she receives right away. A trial run will give a hesitant loved one a chance to test the waters and experience the benefits of assistance.
- Enlist the help of a professional. Your loved one may be more willing to listen to the advice of a doctor, lawyer or care manager about the importance of receiving care.
- Explain your needs. Consider asking your loved one to accept care to make your life a little easier. Remind your loved one that sometimes you’ll both need to compromise on certain issues.
- Pick your battles. Focus on the big picture. Avoid fighting with your loved one about minor issues related to his or her care.
- Explain how care may prolong independence. Accepting some assistance may help your loved one remain in his or her home for as long as possible.
- Help your loved one cope with the loss of independence. Explain to your loved one that loss of independence isn’t a personal failing. Help your loved one to stay active, maintain relationships with caring friends and family and develop new physically appropriate interests.
Keep in mind that these strategies may not be appropriate when dealing with a loved one who has dementia.
Two related resources
- Caregivers (MedlinePlus) has links to overviews, coping materials, organizations, related issues, and much more
- National Association of Area Agencies on Aging provides information on how to locate a local area agency for personalized responses to questions, caregiver support and resource information , and additional resources and programs
Better Methods Needed to Measure Hospital Quality: Experts
Using patient death rates to assess care found to be unreliable in Massachusetts study
NCI announces plans to reinvigorate clinical trials
Consolidation of cooperative group program is designed to bring enhanced efficiencies to oncological sciences
The National Cancer Institute (NCI) has announced major changes to be made in the long-established Clinical Trials Cooperative Group Program that conducts many of the nationwide trials of new cancer therapies. In a major transformation, NCI intends to consolidate the nine groups that currently conduct trials in adult cancer patients into four state-of-the-art entities that will design and perform improved trials of cancer therapies. These changes are designed to provide greater benefits for cancer patients and more information for researchers. These moves come in response to an NCI-requested April 2010 report from the Institute of Medicine (IOM)**, which called for a series of changes to the cooperative groups program, including restructuring….
….The April IOM report noted that the current trials system is inefficient, cumbersome, underfunded, and overly complex. The report recommended consolidating existing adult cooperative groups into a smaller number of groups that could function in a more closely integrated manner….
…For the past several decades, clinical cancer trials have used one or a combination of drugs or other treatment modalities, such as surgery or radiation, in comparison to the prevailing standard of care to see if the new treatment was superior. Recently, some trials have begun to depend on the genetic profiling of tumors. For example, one ongoing NCI-sponsored breast cancer study, called TAILORx, is examining whether genes that are frequently associated with risk of recurrence for women with early-stage breast cancer can be used to assign patients to more appropriate and effective treatments.
These types of studies necessitate the screening of large numbers of patients in order to find subsets of patients with tumors that demonstrate changes in specific genetic pathways. These trials therefore require acquisition and distribution of many tumor specimens, DNA sequencing, and the matching of genetic information with treatment options. The increased complexity of these trials provides a rationale for modernization and simplification of the current cooperative group structure…..
..On Jan. 1, 2011, NCI will impose new deadlines, formulated by its Operational Efficiency Working Group, which will reduce by half the time to initiate new clinical studies and will terminate studies not begun within two years of concept approval….
**The IOM Web site has over 50 results with the search phrase clinical trials, including the most viewed Biomedical/Health Research report (as of Dec 27, 2010) - Transforming Clinical Research in the US: Workshop Summary
General Information about Clinical Trials (select Web sites)
- Clinical Trials (MedlinePlus) has overviews, related issues (as informed consent and ethics), directories, and more
- Understanding Clinical Trials (ClinicalTrials.gov) answers many basic questions relating to participation, safety, ethics, and types of clinical trials
- ClinicalTrials.gov is a registry and finding aid for clinical trials. It currently has 100,613 trials with locations in 174 countries. One can search by topic (as a particular drug or disease) or use the advanced search to use limiters as location, conditions, age groups, and sponsors. Results give contact information for individual clinical trials.The page How can I find the results of a clinical trial? provides places where they might be found, including the ClinicalTrials.gov Web site.