September | 2019

Archive | September, 2019

National Jewish Health study: African American children respond differently to asthma medications

The Mayo Clinic provides a concise definition of Asthma:

Overview
Asthma attack
Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.
For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.
Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

The National Center for Health Statistics has stats on health related issues.

According to the National Center for Health Statistics:

Asthma
Data are for the U.S.
Morbidity
• Number of adults aged 18 and over who currently have asthma: 19.0 million
• Percent of adults aged 18 and over who currently have asthma: 7.7%
Source: Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2017, tables A-2b, A-2c pdf icon[PDF – 137 KB]
• Number of children under age 18 years who currently have asthma: 6.2 million
• Percent of children under age 18 years who currently have asthma: 8.4%
Source: Summary Health Statistics Tables for U.S. Children: National Health Interview Survey, 2017, tables C-1b, C-1c pdf icon[PDF – 99.8 KB]
Physician office visits
• Percent of visits to office-based physicians with asthma indicated on the medical record: 7.1%
Source: National Ambulatory Medical Care Survey: 2016 National Summary Tables, tables 18 pdf icon[PDF – 793 KB]
Emergency department visits
• Percent of visits to emergency departments with asthma indicated on the medical record: 10.1%
Source: National Hospital Ambulatory Medical Care Survey: 2016 Emergency Department Summary Tables, table 13 pdf icon[PDF – 738 KB]
Mortality
• Number of deaths: 3,564
• Deaths per 100,000 population: 1.1
Source: Deaths: Final Data for 2017, Supplemental Tables, tables I-12, I-13 pdf icon[PDF – 2 MB]
https://www.cdc.gov/nchs/fastats/asthma.htm

According to a study by National Jewish Health, African-American children respond differently to different medications for asthma.

Resources:

Need Help Managing Your Asthma? https://www.asthma.com/?bing=e_&rotation=71700000038361464&banner=58700004208867532&kw=34938313622&cc=6A9489DC2E35&pid=43700012675028871&gclid=CLygyM2c9OQCFYOngQodxLwFHQ&gclsrc=ds
Asthma: Causes, Symptoms, Diagnosis, Treatment https://www.webmd.com/asthma/what-is-asthma

Asthma | National Heart, Lung, and Blood Institute (NHLBI) https://www.nhlbi.nih.gov/health-topics/asthma

Science Daily reported in African American children respond differently to asthma medications:

African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers at National Jewish Health and their colleagues around the nation in the National Heart, Lung & Blood Institute’s AsthmaNet report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.
“Asthma is a tremendously variable disease,” said Michael Wechsler, MD, professor of medicine at National Jewish Health and first author on the study published in the New England Journal of Medicine. “We need to more closely study subgroups of asthma patients, especially those disproportionately burdened by disease, such as African Americans.”
The researchers evaluated 280 children, ages 5-11, and 294 adolescents/adults of African American ancestry whose asthma was inadequately controlled with low doses of inhaled corticosteroids. Treatment guidelines call for adding a long-acting beta agonist as the preferred step-up therapy. Researchers several medication strategies — adding long-acting beta agonists, increasing inhaled steroids alone and both increasing inhaled steroids and adding long-acting beta agonists.
The researchers measured response by evaluating several factors including exacerbations, asthma control days and lung function.
More adult African Americans responded better to adding long-acting beta agonists (49 percent) versus increasing inhaled steroids alone (28 percent). Caucasians have shown a similar response in previous trials.
However, even numbers of African American children responded better to increasing the dose of inhaled corticosteroids along (46 percent) and adding long-acting beta agonists (46 percent).
“These results indicate that asthma treatment guidelines do not necessarily apply to African American children and that physicians should consider alternatives,” said Dr. Wechsler. “We need to do a better job of understanding how different subgroups respond to asthma treatment….” https://www.sciencedaily.com/releases/2019/09/190927135119.htm

Citation:

African American children respond differently to asthma medications
BARD trial suggests shortcomings in treatment guidelines and demonstrates need for trials of specific subgroups

Date: September 27, 2019
Source: National Jewish Health
Summary:
African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.

Journal Reference:
Michael E. Wechsler, Stanley J. Szefler, Victor E. Ortega, Jacqueline A. Pongracic, Vernon Chinchilli, John J. Lima, Jerry A. Krishnan, Susan J. Kunselman, David Mauger, Eugene R. Bleecker, Leonard B. Bacharier, Avraham Beigelman, Mindy Benson, Kathryn V. Blake, Michael D. Cabana, Juan-Carlos Cardet, Mario Castro, James F. Chmiel, Ronina Covar, Loren Denlinger, Emily DiMango, Anne M. Fitzpatrick, Deborah Gentile, Nicole Grossman, Fernando Holguin, Daniel J. Jackson, Harsha Kumar, Monica Kraft, Craig F. LaForce, Jason Lang, Stephen C. Lazarus, Robert F. Lemanske, Dayna Long, Njira Lugogo, Fernando Martinez, Deborah A. Meyers, Wendy C. Moore, James Moy, Edward Naureckas, J. Tod Olin, Stephen P. Peters, Wanda Phipatanakul, Loretta Que, Hengameh Raissy, Rachel G. Robison, Kristie Ross, William Sheehan, Lewis J. Smith, Julian Solway, Christine A. Sorkness, Lisa Sullivan-Vedder, Sally Wenzel, Steven White, Elliot Israel. Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma. New England Journal of Medicine, 2019; 381 (13): 1227 DOI: 10.1056/NEJMoa1905560

Here is the press report from National Jewish Health:

NEWS RELEASE 27-SEP-2019
African American children respond differently to asthma medications
BARD trial suggests shortcomings in treatment guidelines and demonstrates need for trials of specific subgroups
NATIONAL JEWISH HEALTH
African Americans suffer asthma more often and more severely than Caucasian patients. However, clinical trials that have shaped treatment guidelines have included few African Americans. A new report demonstrates a shortcoming of that history. Researchers at National Jewish Health and their colleagues around the nation in the National Heart, Lung & Blood Institute’s AsthmaNet report that African American children respond differently than African American adults and Caucasian adults and children to step-up therapies for inadequately controlled asthma.
“Asthma is a tremendously variable disease,” said Michael Wechsler, MD, professor of medicine at National Jewish Health and first author on the study published in the New England Journal of Medicine. “We need to more closely study subgroups of asthma patients, especially those disproportionately burdened by disease, such as African Americans.”
The researchers evaluated 280 children, ages 5-11, and 294 adolescents/adults of African American ancestry whose asthma was inadequately controlled with low doses of inhaled corticosteroids. Treatment guidelines call for adding a long-acting beta agonist as the preferred step-up therapy. Researchers several medication strategies – adding long-acting beta agonists, increasing inhaled steroids alone and both increasing inhaled steroids and adding long-acting beta agonists.
The researchers measured response by evaluating several factors including exacerbations, asthma control days and lung function.
More adult African Americans responded better to adding long-acting beta agonists (49 percent) versus increasing inhaled steroids alone (28 percent). Caucasians have shown a similar response in previous trials.
However, even numbers of African American children responded better to increasing the dose of inhaled corticosteroids along (46 percent) and adding long-acting beta agonists (46 percent).
“These results indicate that asthma treatment guidelines do not necessarily apply to African American children and that physicians should consider alternatives,” said Dr. Wechsler. “We need to do a better job of understanding how different subgroups respond to asthma treatment.”
The researchers also looked at several biological and genetic factors to determine if any could predict treatment response. However, they did not find that any biomarkers or percentage of African American ancestry was associated treatment response.
###
National Jewish Health is the leading respiratory hospital in the nation. Founded 120 years ago as a nonprofit hospital, National Jewish Health today is the only facility in the world dedicated exclusively to groundbreaking medical research and treatment of patients with respiratory, cardiac, immune and related disorders. Patients and families come to National Jewish Health from around the world to receive cutting-edge, comprehensive, coordinated care. To learn more, visit http://www.njhealth.org.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

It is important to seek competent medical advice for the diagnosis or treatment of asthma.

The Mayo Clinic explained the diagnosis of asthma:

Diagnosis

Physical exam

To rule out other possible conditions — such as a respiratory infection or chronic obstructive pulmonary disease (COPD) — your doctor will do a physical exam and ask you questions about your signs and symptoms and about any other health problems.
Tests to measure lung function
You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:
• Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
• Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.
Lung function tests often are done before and after taking a medication called a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it’s likely you have asthma.
Additional tests
Other tests to diagnose asthma include:
• Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
• Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels.
• Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
• Allergy testing. This can be performed by a skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.
• Sputum eosinophils. This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).
• Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.
How asthma is classified
To classify your asthma severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests.
Determining your asthma severity helps your doctor choose the best treatment. Asthma severity often changes over time, requiring treatment adjustments.
Asthma is classified into four general categories:
Asthma classification Signs and symptoms
Mild intermittent Mild symptoms up to two days a week and up to two nights a month
Mild persistent Symptoms more than twice a week, but no more than once in a single day
Moderate persistent Symptoms once a day and more than one night a week
Severe persistent Symptoms throughout the day on most days and frequently at night
More Information
https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-20369660

Resources:

Asthma: Treatment & Care – WebMD http://www.webmd.com/asthma/guide/asthma-treatment-care

Asthma – Management and Treatment | CDC https://www.cdc.gov/asthma/management.html

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Tags: African American children respond differently to asthma medications, asthma, asthma medication, Mayo Clinic, National Center for Health Statisitics, National Jewish Health, Science Daily

Comments Leave a Comment
Categories Dr Wilda

ETH Zurich study: Antimicrobial resistance is drastically rising

22 Sep

The National Pesticide Information wrote in Antimicrobials: Topic Fact Sheet:

What are antimicrobials?
Antimicrobial products kill or slow the spread of microorganisms. Microorganisms include bacteria, viruses, protozoans, and fungi such as mold and mildew.1 You may find antimicrobial products in your home, workplace, or school.
The U.S. Environmental Protection Agency (EPA) regulates antimicrobial products as pesticides, and the U.S. Food and Drug Administration (FDA) regulates antimicrobial products as drugs/antiseptics. As pesticides, antimicrobial products are used on objects such as countertops, toys, grocery carts, and hospital equipment. As antiseptics, antimicrobial products are used to treat or prevent diseases on people, pets, and other living things.
If a product shows “EPA” anywhere on the label, you know it’s a pesticide and NOT meant for use on the body. This fact sheet will focus on antimicrobials used as pesticides.
If a product label claims to kill, control, repel, mitigate or reduce a pest, it is a pesticide regulated by the U.S. EPA.2 When manufacturers make this kind of claim on the label, they must also include:
• application instructions that are effective at killing or controlling the pest, and
• first aid instructions, in case of accidental exposure.
What types of antimicrobial pesticides are there?
There are two general categories for antimicrobial pesticides: those that address microbes in public health settings, and those that do not. “Public health products” are designed to handle infectious microbes. See Table 1.
Table 1. Sites of application for antimicrobial pesticides1
Non-public health settings Public health settings
Microbes that may cause objects to spoil or rot Microbes that may cause people to get sick
• cooling towers
• fuel
• wood textiles
• paint
• paper products • bathrooms
• kitchens
• homes
• hospitals
• restaurants
There are three types of public health antimicrobials: sterilizers, disinfectants, and sanitizers. See Table 2.
Sanitizers are the weakest public-health antimicrobials. They reduce bacteria on surfaces.1 Some sanitizers may be used on food-contact surfaces such as countertops, cutting boards, or children’s high chairs. The label will indicate how a sanitizer can be used. Some sanitizers can be used only for non-food contact surfaces like toilet bowls and carpets, or air.5,6
Sterilizers are the strongest type of public health antimicrobial product. In addition to bacteria, algae, and fungi, they also control hard-to-kill spores.5 Many sterilizers are restricted-use pesticides. These require applicator training and certification. Sterilizers are used in medical and research settings when the presence of microbes must be prevented as much as possible. In addition to chemical sterilizers, high-pressure steam and ovens are also used to sterilize items.5
What do I need to know?
• Always follow the label directions. The “Directions for Use” are specific, and the product may not work if you don’t follow them.
• Never mix different antimicrobial products.
• Most antimicrobial products take time to work. Read the label to find out how long the product must remain in contact with the surface in order to sanitize, disinfect or sterilize it.10
• Dirt, food, slime, and other particles may reduce the effectiveness of antimicrobial products.10
• Take steps to reduce your exposure to antimicrobial pesticides. Some products can be harmful when touched or inhaled.
References:
1. What are Antimicrobial Pesticides?; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2010.
2. Pesticide Registration and Classification Procedures, Protection of the Environment; Code of Federal Regulations, Part 152, Title 40, 2010.
3. Anthrax Spore Decontamination Using Bleach (Sodium hypochlorite); U.S. Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs. U.S. Government Printing Office: Washington, DC, 2010.
4. Label Review Manual – Chapter 2: What is a Pesticide?; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2006.
5. Antimicrobial Pesticide Products; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2010.
6. Pesticide Labeling Questions & Answers; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, accessed Dec 2010. updated Dec 2010.
7. Antimicrobial Products Registered for Use Against the H1N1 Flu and Other Influenza A Viruses on Hard Surfaces; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2010.
8. Selected EPA-registered Disinfectants; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2010.
9. Gilbert, P.; McBain, A. J. Potential Impacts of Increased Use of Biocides in Consumer Products on Prevalence of Antibiotic Resistance. Clinical Microbiology Reviews, 16, 2, 189-208.
10. Rutala, W. A.; Weber, D. J. Guideline for Disinfection and Sterilization in Health Care Facilities, 2008. U.S. Center for Disease Control, Healthcare Infection Control Practices Advisory Committee (HICPAC). https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines.pdf (accessed Dec 2010), updated Dec 2010.
11. Sanitizer Test for Inanimate Surfaces; U.S Environmental Protection Agency, Office of Prevention, Pesticides, and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, DC, 2010. http://npic.orst.edu/factsheets/antimicrobials.html

There is growing alarm about antimicrobial resistance.

The Centers for Disease Control and Prevention describe antimicrobial resistance in

About Antimicrobial Resistance:
Antibiotic resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow.
Infections caused by antibiotic-resistant germs are difficult, and sometimes impossible, to treat. In most cases, antibiotic-resistant infections require extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives.
Antibiotic resistance does not mean the body is becoming resistant to antibiotics; it is that bacteria have become resistant to the antibiotics designed to kill them.
Antibiotic Resistance Threatens Everyone

Antibiotic resistance has the potential to affect people at any stage of life, as well as the healthcare, veterinary, and agriculture industries, making it one of the world’s most urgent public health problems.
Each year in the U.S., at least 2 million people are infected with antibiotic-resistant bacteria, and at least 23,000 people die as a result.
No one can completely avoid the risk of resistant infections, but some people are at greater risk than others (for example, people with chronic illnesses). If antibiotics lose their effectiveness, then we lose the ability to treat infections and control public health threats.
Many medical advances are dependent on the ability to fight infections using antibiotics, including joint replacements, organ transplants, cancer therapy, and treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis…. https://www.cdc.gov/drugresistance/about.html

ETH Zurich studied antimicrobial resistance.

Science Daily reported in Antimicrobial resistance is drastically rising:

The world is experiencing unprecedented economic growth in low- and middle-income countries. An increasing number of people in India, China, Latin America and Africa have become wealthier, and this is reflected in their consumption of meat and dairy products. In Africa, meat consumption has risen by more than half; in Asia and Latin America it is up by two-thirds.
To meet this growing demand, animal husbandry has been intensified, with among other things, an increased reliance on the use of antimicrobials. Farmers use antimicrobials to treat and prevent infections for animals raised in crowded conditions but these drugs are also used to increase weight gain, and thus improve profitability.
This excessive and indiscriminate use of antimicrobials has serious consequences: the proportion of bacteria resistant to antimicrobials is rapidly increasing around the world. Drugs are losing their efficacy, with important consequences for the health of animals but also potentially for humans.
Mapping resistance hotspots
Low- and middle income countries have limited surveillance capacities to track antimicrobial use and resistance on farms. Antimicrobial use is typically less regulated and documented there than in wealthy industrialized countries with established surveillance systems.
The team of researchers led by Thomas Van Boeckel, SNF Assistant Professor of Health Geography and Policy at ETH Zurich, has recently published a map of antimicrobial resistance in animals in low- and middle-income countries in the journal Science.
The team assembled a large literature database and found out where, and in which animals species resistance occurred for the common foodborne bacteria Salmonella, E. coli, Campylobacter and Staphylococcus.
According to this study, the regions associated with high rates of antimicrobial resistance in animals are northeast China, northeast India, southern Brazil, Iran and Turkey. In these countries, the bacteria listed above are now resistant to a large number of drug that are used not only in animals but also in human medicine. An important finding of the study is that so far, few resistance hotspots have emerged in Africa with the exception of Nigeria and the surroundings of Johannesburg.
The highest resistance rates were associated with the antimicrobials most frequently used in animals: tetracyclines, sulphonamides, penicillins and quinolones. In certain regions, these compounds have almost completely lost their efficacy to treat infections.
Alarming trend in multi-drug resistance
The researchers introduced a new index to track the evolution of resistance to multiple drugs: the proportion of drugs tested in each region with resistance rates higher than 50%. Globally, this index has almost tripled for chicken and pigs over the last 20 years. Currently, one third of drugs fail 50% of the time in chicken and one quarter of drug fail in 50% of the time in pigs.
“This alarming trend shows that the drugs used in animal farming are rapidly losing their efficacy,” Van Boeckel says. This will affect the sustainability of the animal industry and potentially the health of consumers.
It is of particular concern that antimicrobial resistance is rising in developing and emerging countries because this is where meat consumption is growing the fastest, while access to veterinary antimicrobials remains largely unregulated. “Antimicrobial resistance is a global problem. There is little point in making considerable efforts to reduce it on one side of the world if it is increasing dramatically on the other side,” the ETH researcher says…. https://www.sciencedaily.com/releases/2019/09/190919142211.htm

Citation:

Antimicrobial resistance is drastically rising
Date: September 19, 2019
Source: ETH Zurich
Summary:
Researchers have shown that antimicrobial-resistant infections are rapidly increasing in animals in low and middle income countries. They produced the first global of resistance rates, and identified regions where interventions are urgently needed.
Journal Reference:
Thomas P. Van Boeckel, João Pires, Reshma Silvester, Cheng Zhao, Julia Song, Nicola G. Criscuolo, Marius Gilbert, Sebastian Bonhoeffer, Ramanan Laxminarayan. Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science, 2019; 365 (6459): eaaw1944 DOI: 10.1126/science.aaw1944

Here is the press release from ETH Zurich:

Antimicrobial resistance is drastically rising
19.09.2019 | News
By: Peter Rüegg
An international team of researchers led by ETH has shown that antimicrobial-resistant infections are rapidly increasing in animals in low and middle income countries. They produced the first global of resistance rates, and identified regions where interventions are urgently needed.

The world is experiencing unprecedented economic growth in low- and middle-income countries. An increasing number of people in India, China, Latin America and Africa have become wealthier, and this is reflected in their consumption of meat and dairy products. In Africa, meat consumption has risen by more than half; in Asia and Latin America it is up by two-thirds.
To meet this growing demand, animal husbandry has been intensified, with among other things, an increased reliance on the use of antimicrobials. Farmers use antimicrobials to treat and prevent infections for animals raised in crowded conditions but these drugs are also used to increase weight gain, and thus improve profitability.
This excessive and indiscriminate use of antimicrobials has serious consequences: the proportion of bacteria resistant to antimicrobials is rapidly increasing around the world. Drugs are losing their efficacy, with important consequences for the health of animals but also potentially for humans.
Mapping resistance hotspots
Low- and middle income countries have limited surveillance capacities to track antimicrobial use and resistance on farms. Antimicrobial use is typically less regulated and documented there than in wealthy industrialized countries with established surveillance systems.
The team of researchers led by Thomas Van Boeckel, SNF Assistant Professor of Health Geography and Policy at ETH Zurich, has recently published a map of antimicrobial resistance in animals in low- and middle-income countries in the journal Science.
The team assembled a large literature database and found out where, and in which animals species resistance occurred for the common foodborne bacteria Salmonella, E. coli, Campylobacter and Staphylococcus.

According to this study, the regions associated with high rates of antimicrobial resistance in animals are northeast China, northeast India, southern Brazil, Iran and Turkey. In these countries, the bacteria listed above are now resistant to a large number of drug that are used not only in animals but also in human medicine. An important finding of the study is that so far, few resistance hotspots have emerged in Africa with the exception of Nigeria and the surroundings of Johannesburg.
The highest resistance rates were associated with the antimicrobials most frequently used in animals: tetracyclines, sulphonamides, penicillins and quinolones. In certain regions, these compounds have almost completely lost their efficacy to treat infections.
Alarming trend in multi-drug resistance
The researchers introduced a new index to track the evolution of resistance to multiple drugs: the proportion of drugs tested in each region with resistance rates higher than 50%. Globally, this index has almost tripled for chicken and pigs over the last 20 years. Currently, one third of drugs fail 50% of the time in chicken and one quarter of drug fail in 50% of the time in pigs.
“This alarming trend shows that the drugs used in animal farming are rapidly losing their efficacy,” Van Boeckel says. This will affect the sustainability of the animal industry and potentially the health of consumers.
It is of particular concern that antimicrobial resistance is rising in developing and emerging countries because this is where meat consumption is growing the fastest, while access to veterinary antimicrobials remains largely unregulated. “Antimicrobial resistance is a global problem. There is little point in making considerable efforts to reduce it on one side of the world if it is increasing dramatically on the other side,” the ETH researcher says.
Input from thousands of studies
For their current study, the team of researchers from ETH, Princeton University and the Free University of Brussels gathered thousands of publications as well as unpublished veterinary reports from around the world. The researchers used this database to produce the maps of antimicrobial resistance.
However, the maps do not cover the entire research area; there are large gaps in particular in South America, which researchers attribute to a lack of publicly available data. “There are hardly any official figures or data from large parts of South America,” says co-author and ETH postdoctoral fellow Joao Pires. He said this surprised him, as much more data is available from some African countries , despite resources for conducting surveys being more limited than in South America.
Open-access web platform
The team has created an open-access web platform resistancebank.org to share their findings and gather additional data on resistance in animals. For example, veterinarians and state-authorities can upload data on resistance in their region to the platform and share it with other people who are interested.
Van Boeckel hopes that scientists from countries with more limited resources for whom publishing cost in academic journal can be a barrier will be able to share their findings and get recognition for their work on the platform. “In this way, we can ensure that the data is not just stuffed away in a drawer” he says, “because there are many relevant findings lying dormant, especially in Africa or India, that would complete the global picture of resistance that we try to draw in this first assessment. The platform could also help donors to identify the regions most affected by resistance in order to be able to finance specific interventions.
As meat production continues to rise, the web platform could help target interventions against AMR and assist a transition to more sustainable farming practices in low- and middle-income countries. “The rich countries of the Global North, where antimicrobials have been used since the 1950s, should help make the transition a success,” says Van Boeckel.
The research was funded by the Swiss National Science Foundation and the Branco Weiss Fellowship.
Reference
Van Boeckel TP, Pires J, Silvester R, Zhao C , Song J, Criscuolo NG, Gilbert M, Bonhoeffer S, Laxminarayan R. Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science 365, 2019, doi: 10.1126/science.aaw1944
Research|
International|
Agricultural sciences|
Sustainability|
World food system https://ethz.ch/en/news-and-events/eth-news/news/2019/09/antimicrobial-resistances-on-the-rise.html

The Centers for Disease Control and Prevention have a page devoted to prevention of antimicrobial resistance.

Antibiotic resistance is one of the biggest public health challenges of our time. Each year in the U.S., at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die. Fighting this threat is a public health priority that requires a collaborative global approach across sectors. CDC is working to combat this threat. Find out how you can help.

About Antimicrobial Resistance
Food & Food Animals
Combat Resistance Globally
Biggest Threats & Data
Laboratory Testing & Resources
Latest News & Resources
Protect Yourself & Your Family
What CDC is Doing
AR Isolate Bank
Healthcare Providers
U.S. Action

https://www.cdc.gov/drugresistance/index.html

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Tags: Antimicrobial, Antimicrobial resistance is drastically rising, Antimicrobial Resistence, CDC, ETH Zurich, Global trends in antimicrobial resistance in animals in low and middle-income countries, Science Daily, The Center for Disease Control and Prevention, The National Pesticide Information, What are antimicrobials?

Comments Leave a Comment
Categories Dr Wilda

University of Pittsburgh study: High social support associated with less violence among male teens in urban neighborhoods

15 Sep

Denise Williams had a hit with a catchy little tune, “let’s hear it for the boy.” The question for many parents and schools is how are boys doing? Boy Crisis is an organization which examines challenges faced by boys. According to Boy Crisis:

WHAT IS THE BOY CRISIS?

IT’S A CRISIS OF EDUCATION. Worldwide, boys are 50 percent less likely than girls to meet basic proficiency in reading, math, and science.
IT’S A CRISIS OF MENTAL HEALTH.
ADHD is on the rise. And as boys become young men, their suicide rates go from equal to girls to six times that of young women.
IT’S A CRISIS OF FATHERING.
Boys are growing up with less-involved fathers and are more likely to drop out of school, drink, do drugs, become delinquent, and end up in prison.
IT’S A CRISIS OF PURPOSE.
Boys’ old sense of purpose—being a warrior, a leader, or a sole breadwinner—is fading. Many bright boys are experiencing a “purpose void,” feeling alienated, withdrawn, and addicted to immediate gratification.
SO, WHAT IS THE BOY CRISIS?
A comprehensive blueprint for what parents, teachers, and policymakers can do to help our sons become happier, healthier men and fathers and leaders worthy of our respect…. http://boycrisis.org/

Boys face different issues than those faced by girls.

Gary Wilson wrote thoughtful article about some of the learning challenges faced by boys. Boys Barriers to Learning He lists several barriers to learning in his article.

1. Early years
a. Language development problems
b. Listening skills development
2. Writing skills and learning outcomes
A significant barrier to many boys’ learning, that begins at quite an early age and often never leaves them, is the perception that most writing that they are expected to do is largely irrelevant and unimportant….
3. Gender bias
Gender bias in everything from resources to teacher expectations has the potential to present further barriers to boys’ learning. None more so than the gender bias evident in the ways in which we talk to boys and talk to girls. We need to be ever mindful of the frequency, the nature and the quality of our interactions with boys and our interactions with girls in the classroom….A potential mismatch of teaching and learning styles to boys’ preferred ways of working continues to be a barrier for many boys….
4.Reflection and evaluation
The process of reflection is a weakness in many boys, presenting them with perhaps one of the biggest barriers of all. The inability of many boys to, for example, write evaluations, effectively stems from this weakness….
5. Self-esteem issues
Low self-esteem is clearly a very significant barrier to many boys’ achievement in school. If we were to think of the perfect time to de-motivate boys, when would that be? Some might say in the early years of education when many get their first unwelcome and never forgotten taste of failure might believe in the system… and themselves, for a while, but not for long….
6. Peer pressure
Peer pressure, or the anti-swot culture, is clearly a major barrier to many boys’ achievement. Those lucky enough to avoid it tend to be good academically, but also good at sport. This gives them a licence to work hard as they can also be ‘one of the lads’. …To me one of the most significant elements of peer pressure for boys is the impact it has on the more affective domains of the curriculum, namely expressive, creative and performing arts. It takes a lot of courage for a boy to turn up for the first day at high school carrying a violin case….
7. Talk to them!
There are many barriers to boys’ learning (I’m currently saying 31, but I’m still working on it!) and an ever-increasing multitude of strategies that we can use to address them. I firmly believe that a close examination of a school’s own circumstances is the only way to progress through this maze and that the main starting point has to be with the boys themselves. They do know all the issues around their poor levels of achievement. Talk to them first. I also believe that one of the most important strategies is to let them know you’re ‘on their case’, talking to them provides this added bonus….

If your boy has achievement problems, Wilson emphasizes that there is no one answer to address the problems. There are issues that will be specific to each child. See, https://www.garywilsonraisingboysachievement.com/publications

Science Daily reported in High social support associated with less violence among male teens in urban neighborhoods:

Among teen boys in urban neighborhoods with low resources, the presence of adult social support is linked to significantly fewer occurrences of sexual violence, youth violence and bullying, and to more positive behaviors, including school engagement and future aspirations, according to a new study from researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.
The study, published today in JAMA Network Open, suggests that prevention efforts that focus on adult support can mitigate patterns of co-occurring violent behavior.
“Teen boys in urban neighborhoods are disproportionately exposed to violence and consequently are at higher risk of violence perpetration and victimization,” said the study’s senior author Alison Culyba, M.D., Ph.D., M.P.H., a physician at UPMC Children’s Hospital and assistant professor of pediatrics at Pitt’s School of Medicine. “Historically, research often has focused on a single type of violence, but our study shows that there are complex co-occurring behavior patterns and shared protective factors that we need to pay attention to.”
The researchers analyzed survey data from a recently completed sexual violence prevention trial that enrolled 866 adolescent boys aged 13- to 19-years-old from lower-resource neighborhoods in the Pittsburgh region. More than three fourths of the participants self-identified as black and six percent self-identified as Hispanic.
The survey included data on 40 “risk” and 18 “protective” behaviors that were classified into one of seven categories — youth violence, bullying, sexual and/or dating violence, violence exposure and adversities, substance use, school engagement, and career and future aspirations. The participants also rated their personal level of dependable adult social support.
When it came to the data analysis, Culyba and her colleagues took a less conventional approach. “We borrowed methods that have proven effective for large scale genetic analyses,” she said.
The analysis revealed interesting patterns. Teen boys with high social support engaged in approximately eight of the 40 risk behaviors — significantly fewer than those with low social support who engaged in around 10 risky behaviors. Those who had high social support and reported more career and future aspirations were less likely to report all types of violent behavior. In contrast, among those with low social support, school engagement was an important protective factor. Feeling happy at a school that promoted diversity was strongly correlated with fewer instances of both physical and sexual partner violence and dating abuse.
The researchers also found patterns in how different violent behaviors co-occurred. The strongest correlations were between different types of sexual violence perpetration behaviors. For example, teens who endorsed posting sexual pictures of partners were 14 times more likely to also report having coerced someone who they were going out with to have sex. On the other hand, while gang involvement was infrequently associated with violence perpetration, it was more frequently reported among those who had been exposed to sexual violence, bullying or substance use.
“Our analysis revealed how interconnected these behaviors are,” said Culyba. “By creating programs that help parents and mentors support teen boys, we may be able to reduce multiple types of violence at once.”
The authors caution that the study is limited in that the findings don’t demonstrate causative links, and further analysis of the associations is required. “It’s a starting point for beginning to understand detailed patterns of violence at a much deeper level — and for offering new opportunities for prevention,” said Culyba…. https://www.sciencedaily.com/releases/2019/09/190913111348.htm

Citation:

High social support associated with less violence among male teens in urban neighborhoods
Date: September 13, 2019
Source: University of Pittsburgh
Summary:
Researchers find that the presence of adult social support is linked to less violence among at-risk teen boys.

Journal Reference:
Alison J. Culyba, Elizabeth Miller, Steven M. Albert, Kaleab Z. Abebe. Co-occurrence of Violence-Related Risk and Protective Behaviors and Adult Support Among Male Youth in Urban Neighborhoods. JAMA Network Open, 2019; 2 (9): e1911375 DOI: 10.1001/jamanetworkopen.2019.11375

Here is the press release from the University of Pittsburgh:

NEWS RELEASE 13-SEP-2019
High social support associated with less violence among male teens in urban neighborhoods
UNIVERSITY OF PITTSBURGH
SHARE
PRINT E-MAIL
PITTSBURGH, Sept. 13, 2019 – Among teen boys in urban neighborhoods with low resources, the presence of adult social support is linked to significantly fewer occurrences of sexual violence, youth violence and bullying, and to more positive behaviors, including school engagement and future aspirations, according to a new study from researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine.
The study, published today in JAMA Network Open, suggests that prevention efforts that focus on adult support can mitigate patterns of co-occurring violent behavior.
“Teen boys in urban neighborhoods are disproportionately exposed to violence and consequently are at higher risk of violence perpetration and victimization,” said the study’s senior author Alison Culyba, M.D., Ph.D., M.P.H., a physician at UPMC Children’s Hospital and assistant professor of pediatrics at Pitt’s School of Medicine. “Historically, research often has focused on a single type of violence, but our study shows that there are complex co-occurring behavior patterns and shared protective factors that we need to pay attention to.”
The researchers analyzed survey data from a recently completed sexual violence prevention trial that enrolled 866 adolescent boys aged 13- to 19-years-old from lower-resource neighborhoods in the Pittsburgh region. More than three fourths of the participants self-identified as black and six percent self-identified as Hispanic.
The survey included data on 40 “risk” and 18 “protective” behaviors that were classified into one of seven categories — youth violence, bullying, sexual and/or dating violence, violence exposure and adversities, substance use, school engagement, and career and future aspirations. The participants also rated their personal level of dependable adult social support.
When it came to the data analysis, Culyba and her colleagues took a less conventional approach. “We borrowed methods that have proven effective for large scale genetic analyses,” she said.
The analysis revealed interesting patterns. Teen boys with high social support engaged in approximately eight of the 40 risk behaviors — significantly fewer than those with low social support who engaged in around 10 risky behaviors. Those who had high social support and reported more career and future aspirations were less likely to report all types of violent behavior. In contrast, among those with low social support, school engagement was an important protective factor. Feeling happy at a school that promoted diversity was strongly correlated with fewer instances of both physical and sexual partner violence and dating abuse.
The researchers also found patterns in how different violent behaviors co-occurred. The strongest correlations were between different types of sexual violence perpetration behaviors. For example, teens who endorsed posting sexual pictures of partners were 14 times more likely to also report having coerced someone who they were going out with to have sex. On the other hand, while gang involvement was infrequently associated with violence perpetration, it was more frequently reported among those who had been exposed to sexual violence, bullying or substance use.
“Our analysis revealed how interconnected these behaviors are,” said Culyba. “By creating programs that help parents and mentors support teen boys, we may be able to reduce multiple types of violence at once.”
The authors caution that the study is limited in that the findings don’t demonstrate causative links, and further analysis of the associations is required. “It’s a starting point for beginning to understand detailed patterns of violence at a much deeper level — and for offering new opportunities for prevention,” said Culyba.
Culyba notes that the findings align with the recommendations of the Centers for Disease Control and Prevention’s Connecting the Dots Initiative, which encourages prevention programs that identify and address these common underlying factors through community involvement to keep kids safe.
###
Additional authors on the study included Elizabeth Miller, M.D., Ph.D., of Pitt and UPMC Children’s Hospital, and Steven Albert, Ph.D., and Kaleab Abebe, Ph.D., both of Pitt.
The study was funded by National Institutes of Health Grant T21 TR001856, Centers for Disease Control and Prevention grant U01CE002528, and the Children’s Hospital of Pittsburgh Foundation.
To read this release online or share it, visit http://www.upmc.com/media/news/091319-culyba-jama [when embargo lifts].
About UPMC Children’s Hospital of Pittsburgh
Regionally, nationally, and globally, UPMC Children’s Hospital of Pittsburgh is a leader in the treatment of childhood conditions and diseases, a pioneer in the development of new and improved therapies, and a top educator of the next generation of pediatricians and pediatric subspecialists. With generous community support, UPMC Children’s Hospital has fulfilled this mission since its founding in 1890. UPMC Children’s is recognized consistently for its clinical, research, educational, and advocacy-related accomplishments, including ranking in the top 10 on the 2019-2020 U.S. News & World Report Honor Roll of America’s Best Children’s Hospitals. UPMC Children’s also ranks 15th among children’s hospitals and schools of medicine in funding for pediatric research provided by the National Institutes of Health (FY2018).
About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.
http://www.upmc.com/media
Contact: Arvind Suresh
Office: 412-647-9966
Mobile: 412-509-8207
E-mail: SureshA2@upmc.edu
Contact: Andrea Kunicky
Office: 412-692-6254
Mobile: 412-439-5264
E-mail: KunickyA@upmc.edu
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Some in society are pushing the concept of gender-neutral. Alina Tugend wrote Engendering Sons: Is It Doable—or Even Desirable—to Raise Gender-Neutral Children?

Overcoming gender disparities may require us to take a more nuanced approach to problem solving. For example, if we want more girls and women, who are now woefully underrepresented, to take more science, technology, engineering, and math classes, and we agree that it’s not innate ability holding them back, the answer might be to show scientists, engineers, and mathematicians to be attractive and caring rather than nerdy. Or change the physical environment of classrooms and laboratories to make them more appealing to girls.
Then again, does this counter or reinforce gender stereotypes? Good people disagree.
One thing that’s easy to forget, as Janet Hyde points out, is that variations within genders are greater than variations between them. I see the truth of that in my own home. Both my boys are into sports, but one is far more talkative and intellectually curious, while the other ranks higher on intuition and emotional intelligence. If they were a boy and a girl, it would be easy to attribute these differences to gender. As it is, I guess I’ll have to blame—or credit—the vast and ever-shifting mishmash of biology, parenting, peer influence, and culture. http://alumni.berkeley.edu/california-magazine/winter-2014-gender-assumptions/engendering-sons-it-doable-or-even-desirable
One study points to the idea that gender concept starts early.

Science Daily reported in Infants prefer toys typed to their gender:

Children as young as 9 months-old prefer to play with toys specific to their own gender, according to a new study from academics at City University London and UCL.
The paper, which is published in the journal of Infant and Child Development, shows that in a familiar nursery environment significant sex differences were evident at an earlier age than gendered identity is usually demonstrated.
The research therefore suggests the possibility that boys and girls follow different developmental trajectories with respect to selection of gender-typed toys and that there is both a biological and a developmental-environmental components to the sex differences seen in object preferences.
To investigate the gender preferences seen with toys, the researchers observed the toy preferences of boys and girls engaged in independent play in UK nurseries, without the presence of a parent. The toys used in the study were a doll, a pink teddy bear and a cooking pot for girls, while for boys a car, a blue teddy, a digger and a ball were used.
The 101 boys and girls fell into three age groups: 9 to 17 months, when infants can first demonstrate toy preferences in independent play (N=40); 18 to 23 months, when critical advances in gender knowledge occur (N=29); and 24 to 32 months, when knowledge becomes further established (N=32).
Stereotypical toy preferences were found for boys and girls in each of the age groups, demonstrating that sex differences in toy preference appear early in development. Both boys and girls showed a trend for an increasing preference with age for toys stereotyped for boys….
“Our results show that there are significant sex differences across all three age groups, with the finding that children in the youngest group, who were aged between 9-17months when infants are able to crawl or walk and therefore make independent selections, being particularly interesting; the ball was a favourite choice for the youngest boys and the youngest girls favoured the cooking pot.”
https://www.sciencedaily.com/releases/2016/07/16

See Dr. Wilda https://drwilda.com/tag/gender/ , https://drwilda.com/tag/gender-differences/

The only thing that is certain is the PC class will hate this post.

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART © http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

Tags: Boy Crisis, Boys and Learning, Co-occurrence of Violence-Related Risk and Protective Behaviors and Adult Support Among Male Youth in Urban Neighborhoods, Engendering Sons: Is It Doable—or Even Desirable—to Raise Gender-Neutral Children?, Gender, Gender Differences, High social support associated with less violence among male teens in urban neighborhoods, Infants prefer toys typed to their gender, social support, University of Pittsburgh

Comments Leave a Comment
Categories Dr Wilda

Rice University study: When physicians integrate with hospitals, costs go up

7 Sep

The American Medical Association wrote in 5 ways to improve access to health care:

Stabilize individual insurance marketplaces and retain ACA market reforms. The AMA advocates these actions to foster a stronger health insurance marketplace and ensure that low- and moderate-income patients are able to secure affordable and adequate coverage:
• Support expanding eligibility for premium tax credits up to 500% of the federal poverty level. Support providing young adults with enhanced premium tax credits while maintaining the current premium tax credit structure that is inversely related to income.
• Encourage state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections.
• Support the establishment of a permanent federal reinsurance program.
• Oppose the sale of health insurance plans in the individual and small-group markets that do not guarantee pre-existing condition protections along with coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses (with the exception of short-term, limited duration insurance offered for no more than three months).
Address physician shortages. Grow the clinical workforce by expanding the number of available graduate medical education residency slots, expand medical school loan-forgiveness programs, and remove barriers to physician immigration for foreign-trained physicians to practice in the U.S.
Telehealth and remote patient monitoring will become an essential, cost-effective and reliable means to expand capacity in a health system marked by significant and persistent specialty shortages and geographic disparities. Physicians should get assurances that digital health solutions are cost-effective and provide a path to payment.
Increase efficiency of the existing workforce by instituting common-sense medical liability reforms and reducing government and insurance industry regulatory burdens—such as prior authorization—that detract from patient care and increase costs. Also, there should be advancement of new physician-led payment models to achieve better outcomes at lower cost.

https://www.ama-assn.org/delivering-care/patient-support-advocacy/5-ways-improve-access-health-care

One model of health care is associated with higher costs.

Science Daily reported in When physicians integrate with hospitals, costs go up:

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study…. https://www.sciencedaily.com/releases/2019/09/190905161406.htm

Citation:

When physicians integrate with hospitals, costs go up

Date: September 5, 2019
Source: Rice University
Summary:
When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new article.

Journal Reference:
Vivian Ho, Leanne Metcalfe, Lan Vu, Marah Short, Robert Morrow. Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study. Journal of General Internal Medicine, 2019; DOI: 10.1007/s11606-019-05312-z

Here is the press release from Rice University:

When physicians integrate with hospitals, costs go up, Rice study says

JEFF FALK

– SEPTEMBER 4, 2019POSTED IN: CURRENT NEWS

When physicians integrate with hospitals, the cost of health care rises even though there’s no evidence patients get better treatment, according to a new paper by experts at Rice University and Blue Cross and Blue Shield of Texas (BCBSTX).
As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care, the researchers said in the paper, which appears in the Journal of General Internal Medicine.
“When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination,” said Vivian Ho, lead author and the James A. Baker III Institute Chair in Health Economics and director of the Center for Health and Biosciences at Rice’s Baker Institute for Public Policy. “For example, less duplicate testing might occur, which would lower costs. That hypothesis didn’t play out in the data.”
The tightest form of integration occurs when hospitals directly employ physicians, but physicians also become integrated with hospitals when they jointly contract for services with an insurer.
In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care.
The researchers analyzed all preferred provider organization (PPO) insurance claims processed for care through BCBSTX from 2014 through 2016 in Texas’ four largest metropolitan areas — Dallas, Houston, San Antonio and Austin. The population in these areas totaled 18.9 million in 2017, greater than the population of 46 U.S. states. The sample included all claims for health care services for patients aged 19 to 64 except for prescription drugs.
Several studies have found that vertical integration of physicians with hospitals is associated with higher annual spending, but none of these studies concurrently measured the relation between vertical integration and quality, the researchers said.
In their study, they examined claims to determine whether patients had visited a primary care physician (PCP) and, if so, which PCP they saw most frequently. The researchers attributed roughly 500,000 to 600,000 patients to a PCP for each year and used BCBSTX contracting data to determine whether each of these physicians worked in a physician-owned practice or one that was hospital-owned. The researchers then compared the annual spending for patients treated by doctors in physician- versus hospital-owned practices.
They found patients with PPO insurance coverage incur spending that is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices. The difference appears attributable to greater service use rather than higher prices. For four out of five common diagnostic tests (for example, X-rays and MRIs), claims per patient were equal to or higher in hospital- versus physician-owned practices. There was no consistent difference in quality of care (for example, 30-day hospital readmission rates, diabetic care or screening mammography) for hospital-owned versus physician-owned practices.
“Healthcare costs continue to rise faster than the growth rate of the overall economy,” said Ho, who is also a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “Tighter integration of physicians with hospitals appears to be contributing to that cost growth, with no evidence of better quality.”
Higher spending ultimately translates into higher insurance premiums for customers, said Leanne Metcalfe, executive director of research and strategy at BCBSTX and a co-author of the study.
“Centers for Medicare and Medicaid Services regulators should be wary of the burden that increasing reporting requirements place on physicians in small, independent practices,” Metcalfe said. “In the long run, these requirements may have the unintended consequence of raising health care costs.”
The paper, “Annual Spending per Patient and Quality in Hospital-Owned versus Physician-Owned Organizations: An Observational Study,” was also co-authored by Lan Vu, lead actuarial systems analyst at BCBSTX; Marah Short, associate director of the Center for Health and Biosciences at the Baker Institute; and Dr. Robert Morrow, Southeast Texas market president at BCBSTX.
TAGS: Baker Institute, Economics, Research, RNH, RNhome, Social Sciences
About Jeff Falk
Jeff Falk is associate director of national media relations in Rice University’s Office of Public Affairs.

The Healthcare Transformation Institute listed different models of healthcare.

According to Healthcare Transformation Institute, among models of healthcare are:

Healthcare Delivery Models
Please check back often for updates
ACO
• The ACO Model — A Three-Year Financial Loss?
• Accountable Care Organizations: The Case for Flexible Partnerships Between Health Plans and Providers
• The Collaborative Payer Model
• Continuous Innovation in Health Care: Implications of the Geisinger Experience
• Driving Population Health Through Accountable Care Organizations
• Growing an ACO-Easier Said Than Done
• Grand Junction, Colorado: A Health Community that Works
• Grand Junction, Colorado: How a Community Drew on its Values to Shape a Superior Health System
• Higher Health Care Quality and Bigger Savings Found at Large Multispecialty Medical Groups
• The Hot Spotters: Lower Costs and Better Care for Neediest Patients
• Improving The Coordination of Care for Medicaid Beneficiaries in Pennsylvania
• A National Strategy to Put Accountable Care into Practice
• Predictive Modeling and Team Care for High-Need Patients at HealthCare Partners
• How the Stars Aligned to Make Grand Junction a Success
Care Transitions
• Connected For Health – A Community-Based Care Transition Project
• Improving Care Transitions and Reducing Hospital Readmissions: Establishing the Evidence for Community-Based Implementation Strategies Through the Care Transitions Theme
• Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention
Disease Management
• ICC Asthma Program Evaluation 2007-2009
• German Diabetes Management Programs Improve Quality of Care and Curb Costs
• A Home-Based Diabetes Education Program and Its Approach to Disease Management
• How Direct Primary Care Reduces Primary Care Costs
• At Martin’s Point in Maine, Primary Care Teams for Chronic Disease Patients
• Primary Care Redesign: Delivering a Value Based Population Program for Chronic Disease
• Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine’s “Retooling for an Aging America” Report
• Taking Public Health Approaches to Care in Massachusetts
Medical Home
• American Medical Home Runs
• Changing the Conversation in California About Care Near the End of Life
• Community-Centered Health Homes: Bridging the Gap Between Health Services and Community Prevention
• The ‘GRACE’ Model: In-Home Assessments Lead to Better Care for Dual Eligibles
• The Group Health Medical Home at Year Two: Cost Savings, Higher Patient Satisfaction, and Less Burnout for Providers
• A Health Plan Spurs Transformation of Primary Care Practices Into Better-Paid Medical Homes
• Medical “Extensivists” Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use
• A New Care Paradigm Slashes Hospital Use and Nursing Home Stays for the Elderly and the Physically and Mentally Disabled
• Restructuring Care in a Federally Qualified Health Center to Better Meet Patients’ Needs
• Transforming Physician Practices to Patient-Centered Medical Homes: Lessons from The National Demonstration Project
• Vermont’s Blueprint for Medical Homes, Community Health Teams, and Better Health at Lower Cost
Medication Management
• Medication Adherence Leads to Lower Health Care use and Costs Despite Increased Drug Spending
• Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform
• Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending
Elements of Healthcare Transformation
• Alignment of incentives
• Connectivity among caregivers and patients
• Leadership assessment and development
• Business plans and models
• Metrics and evaluation
• Medication management
• In-home care
ASU Healthcare Delivery and Policy Program
Read about our affiliated program at Arizona State University.
http://healthcaretransformationinstitute.org/page/healthcare-delivery-models

Faith Abubey of WFMY News reported on a healthcare delivery system outside the traditional insurance model.

Abubey reported in New Model: Triad Doctor Offers Unlimited Visits For $50 Monthly Fee:

But a growing number of family doctors say they have found a way to make routine doctor visits cheap and give you better care.
In some cases, you pay as low as $25 a month and still see a doctor whenever you want with no extra costs.
The idea is called Direct Primary Care (DPC).
Think of it like a gym membership.
You pay a monthly fee and you get to go as often as you want.
It’s the same idea.
In this case you get unlimited visits to your family doctor.
Access to that doctor by phone or a secure messaging system — 24/7.
You get same day or next-day appointments.
Discounts on things like labs and your prescription medicine.
All for a monthly fee of anywhere between $25 and $85 a month.
That’s it.
No extra costs. No co-pays. No insurance involved.
If you’re thinking this sounds too good to be true, even the Triad doctor who’s offering it agrees.
“It does sound too good to be true. And I think that that’s the hardest thing about selling people on this model. Because they just don’t understand how it could be that easy,” Dr. James Breen said.
Dr. Breen and his wife, Dr. Dayarmys Piloto de la Paz, who is also a doctor, opened their direct primary care practice just over a month ago in Greensboro.
It is called Vitral Family Medicine.
It is the only clinic of its kind we know of in the Triad.
But according to the Journal of Medical Economics, there are more than 300 doctors’ offices across the country using the same model.
“A lot of people describe direct primary care as do it yourself health care reform,” Dr. Breen said.
He explains that in this model, your doctor visits are longer, patients get better care and there is no red tape from insurance companies about what he can and can’t do…. https://www.wfmynews2.com/article/news/local/2-wants-to-know/new-model-triad-doctor-offers-unlimited-visits-for-50-monthly-fee/266503909

Access to healthcare for the greatest number is an important concept, but as with many things, the devil is in the details. What is the definition, cost and the population defined are questions that are political difficult to build a consensus.

Blogs by Dr. Wilda:

Tags: 5 Ways to improve access to health care, AMA, american medical association, Direct Primary Care, DPC, health care costs, Healthcare Transformation Institute, models of health care, New Model Triad Doctor Offers Unlimited Visits For $50 Monthly Fee, Rice University, WFMY News, When physcians integrate with hospitals costs go up

Comments Leave a Comment
Categories Dr Wilda

Washington State University study: Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles

1 Sep

James Thorne wrote in the Geek Wire article, Apple-picking robots gear up for U.S. debut in Washington state:

Next fall, as you browse the produce section at your local grocery store, pay close attention to the apples. You might be witnessing American history.
For the first time, some of the apples sold in the U.S. will be picked by a robot rather than human hands. That’s thanks to agricultural automation startup Abundant Robotics, the maker of apple harvesting machines that will partake in Washington state’s next harvest.
“This will be the first season that we’re actually ready to harvest commercially,” said Abundant CEO Dan Steere. “It’s incredibly exciting.”
Abundant’s picker has more in common with a really smart Hoover vacuum than a human hand. The robot moves down rows of orchards and uses artificial intelligence with a dash of LIDAR to search for ripe apples. Once spotted, a robotic arm with a vacuum gently sucks the apples from the tree into a bin.
The achievement is owed to advances not only in machine learning and robotics but also in agriculture. The architecture of apple trees has evolved over the decades, and it’s now common to grow them on trellises like you would tomatoes or cucumbers. Modern apple trees are also smaller, derived from dwarf varietals that yield more per acre and produce fruit more quickly after being planted.
These horticultural leaps have allowed farmers to double their apple yields. They’ve also made the job of picking easier for humans and, now, for robots.
Karen Lewis, a tree fruit specialist at Washington State University who has worked with Abundant and other robotics startups, said that apple trees have reached a “sweet spot” for robotic harvesting. Orchards are now sufficiently uniform and predictable for machines to reliably pick fruit, and canopies are narrow enough for sunlight, the human eye and vision systems to penetrate.
Tech companies that are successful in agriculture, she said, are the ones that listen to what farmers need. “We’re not going to let technology be the driver here. Horticulture needs to be the driver.” https://www.geekwire.com/2019/apple-picking-robots-gear-u-s-debut-washington-state/

There are at least two issues regarding mechanical harvesting. The first is whether mechanical harvesting damages crops or results is lesser quality of the final product quality. The second is whether employment in agriculture will decline.

Science Daily reported in Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles:

A study out of Washington State University sought to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption.
Travis Alexander, Thomas Collins, and Carol Miles also evaluated whether different extraction methods would yield differing output in either quantity or quality of ‘Brown Snout’ apple juice and cider. Their comprehensive findings are illustrated in their article, “Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-Harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington” as found in the open-access journal HortTechnology, published by the American Society for Horticultural Science.
Phenolics are secondary metabolites that have attracted increasing interest in science and industry in recent years due to their beneficial health effects, primarily for their antioxidant properties. They have been proven to act as reducing agents to free radicals. Phenolics contribute significantly to the sensory profile of fermented cider, especially in those made from cider apple fruit. “Phenolics can impact the pressing of fruit, the clarification of juice, the maturation of cider, and final cider quality, including the attributes of aroma, color, taste, and mouthfeel. And so, we wanted to determine if there was a change in phenolics due to harvest method” stated Collins….’
To carry out their research, Miles said they planted a block of ‘Brown Snout’ apple trees on a low trellis system so that trees were a suitable size to fit the over-the-row small fruit harvester. Each of the eight main plots consisted of an average of nine trees. When the fruit was fully ripe, harvesting was divided equally between hand harvesting by four relatively unskilled agricultural workers and machine harvest by an over-the-row small fruit harvester. When application of the two harvest methods was complete, equal qualities of ‘Brown Snout’ apples were randomly selected from each yield supply for further evaluation.
The selected fruit were pressed separately and fermented and allowed to mature for 5 months before final assessments were conducted. At that time, the researchers determined that harvest method and duration of storage were nonsignificant for all parameters measured on juice and cider samples.
Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.
https://www.sciencedaily.com/releases/2019/08/190830162305.htm

Citation:

Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles
Machine-harvested apples offer cost-effective option for growers and cider makers
Date: August 30, 2019
Source: American Society for Horticultural Science
Summary:
Study conducted to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption. Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.

Journal Reference:
Travis R. Alexander, Thomas S. Collins, Carol A. Miles. Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington. HortTechnology, 2019; 29 (4): 423 DOI: 10.21273/HORTTECH04342-19

Here is the press release from American Society for Horticultural Science:

NEWS RELEASE 30-AUG-2019
Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles
Machine-harvested apples offer cost-effective option for growers and cider makers
AMERICAN SOCIETY FOR HORTICULTURAL SCIENCE
SHARE
PRINT E-MAIL
MOUNT VERNON, WASHINGTON–Hand-harvested versus Machine-harvested Juice and Cider Apples: A Comparison of Phenolic Profiles
A study out of Washington State University sought to determine if there is a measurable impact of harvest method on the phenolic profile of ‘Brown Snout’ juice and cider to better inform equipment adoption.
Travis Alexander, Thomas Collins, and Carol Miles also evaluated whether different extraction methods would yield differing output in either quantity or quality of ‘Brown Snout’ apple juice and cider. Their comprehensive findings are illustrated in their article, “Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-Harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington” as found in the open-access journal HortTechnology, published by the American Society for Horticultural Science.
Phenolics are secondary metabolites that have attracted increasing interest in science and industry in recent years due to their beneficial health effects, primarily for their antioxidant properties. They have been proven to act as reducing agents to free radicals. Phenolics contribute significantly to the sensory profile of fermented cider, especially in those made from cider apple fruit. “Phenolics can impact the pressing of fruit, the clarification of juice, the maturation of cider, and final cider quality, including the attributes of aroma, color, taste, and mouthfeel. And so, we wanted to determine if there was a change in phenolics due to harvest method” stated Collins.
“The ‘Brown Snout’ specialty cider apple is desired by cider makers for its relatively high levels of phenolics, and over-the-row machine harvesting of ‘Brown Snout’ has been demonstrated to provide similar yield to hand harvest at a significantly lower cost” says Alexander.
To carry out their research, Miles said they planted a block of ‘Brown Snout’ apple trees on a low trellis system so that trees were a suitable size to fit the over-the-row small fruit harvester. Each of the eight main plots consisted of an average of nine trees. When the fruit was fully ripe, harvesting was divided equally between hand harvesting by four relatively unskilled agricultural workers and machine harvest by an over-the-row small fruit harvester. When application of the two harvest methods was complete, equal qualities of ‘Brown Snout’ apples were randomly selected from each yield supply for further evaluation.
The selected fruit were pressed separately and fermented and allowed to mature for 5 months before final assessments were conducted. At that time, the researchers determined that harvest method and duration of storage were nonsignificant for all parameters measured on juice and cider samples.
Over-the-row machine harvesting resulted in a final product of similar quality at reduced labor costs, and thus shows potential for increasing the commercial sustainability of cider apple operations.
###
The complete article is available on the ASHS HortTechnology electronic journal web site: https://journals.ashs.org/horttech/view/journals/horttech/29/4/article-p423.xml. DOI: https://doi.org/10.21273/HORTTECH04342-19 . Or you may contact Travis Alexander of Washington State University at travis.alexander@wsu.edu or call him at (360) 848-6120.
Founded in 1903, the American Society for Horticultural Science (ASHS) is the largest organization dedicated to advancing all facets of horticulture research, education, and application. More information at ashs.org.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.
David Meyer wrote in the Fortune article, Robots May Steal As Many As 800 Million Jobs in the Next 13 Years:
A new study by the McKinsey Global Institute estimates that between 400 million and 800 million of today’s jobs will be automated by 2030.
The research adds fresh perspective to what is becoming an increasingly concerning picture of the future employment landscape. “We’re all going to have to change and learn how to do new things over time,” institute partner Michael Chui told Bloomberg.
In the U.S., it seems it’s the middle class that has the most to fear, with office administrators and construction equipment operators among those who may lose their jobs to technology or see their wages depressed to keep them competitive with robots and automated systems…. https://fortune.com/2017/11/29/robots-automation-replace-jobs-mckinsey-report-800-million/

Think not of yourself as the architect of your career but as the sculptor. Expect to have to do a lot of hard hammering and chiseling and scraping and polishing.-
B.C. Forbes

Resources:

In Praise of Short-Term Thinking
For hundreds of years, economic observers have feared that machines were making human workers obsolete. In a sense, they’ve been right. https://www.theatlantic.com/business/archive/2015/09/jobs-automation-technological-unemployment-history/403576/

Will robots and AI take your job? The economic and political consequences of automation https://www.brookings.edu/blog/techtank/2018/04/18/will-robots-and-ai-take-your-job-the-economic-and-political-consequences-of-automation/

Will machines eventually take on every job? http://www.bbc.com/future/story/20150805-will-machines-eventually-take-on-every-job

Every study we could find on what automation will do to jobs, in one chart: There are about as many opinions as there are experts. https://www.technologyreview.com/s/610005/every-study-we-could-find-on-what-automation-will-do-to-jobs-in-one-chart/

Blogs by Dr. Wilda:

Tags: Apple-picking robots gear up for U.S. debut in Washington state, Automation, Comparison of the Phenolic Profiles of Juice and Cider Derived from Machine- and Hand-harvested ‘Brown Snout’ Specialty Cider Apples in Northwest Washington, Geek Wire, Hand Harvesting, Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles, Machine Harvesting, Robots, Science Daily, Washington State University, Work

Comments Leave a Comment
Categories Dr Wilda

Search

drwilda

National Jewish Health study: African American children respond differently to asthma medications

ETH Zurich study: Antimicrobial resistance is drastically rising

Rice University study: When physicians integrate with hospitals, costs go up

Washington State University study: Hand- versus machine-harvested juice and cider apples: A comparison of phenolic profiles

Recent Posts

Archives

Categories

Follow Blog via Email

Twitter Updates

Meta

Subscribe to Blog via Email

Translate