Santa Fe Institute study: Private property, not productivity, precipitated Neolithic agricultural revolution

13 Oct

Benjamin Powell wrote in Private Property Rights, Economic Freedom, and Well Being:

The question of why some countries are rich, and others are poor, is a question
that has plagued economists at least since 1776, when Adam Smith wrote An Inquiry into the Nature and Causes of the Wealth of Nations. Some countries that have a wealth of human and natural resources remain in poverty (in Sub-Saharan Africa for example) while other countries with few natural resources (like Hong Kong) flourish.
An understanding of how private property and economic freedom allow people to
coordinate their activities while engaging in trades that make them both people better off, gives us an indication of the institutional environment that is necessary for prosperity. Observation of the countries around the world also indicates that those countries with an institutional environment of secure property rights and high degrees of economic freedom have achieved higher levels of the various measures of human well being.

Property Rights and Voluntary Interaction

The freedom to exchange allows individuals to make trades that both parties
believe will make them better off. Private property provides the incentives for
individuals to economize on resource use because the user bears the costs of their actions. When private property is combined with market exchange, the price system that results provides the information and incentives for the many anonymous individuals in society to coordinate their activities to channel available resources to the people with the most urgent demand for them.

Private property forces individuals to bear the costs of their actions.

Without private ownership, when a person uses resources, they impose a cost on everyone else in society. Economists call this the “tragedy of the commons.” Communal property leads to over use, and depletion of resources. Once property is privatized and individually held, the owner may use the property for his own benefit but he also directly incurs the cost of using it. Private property provides an incentive to conserve resources and maintain capital for future production….
WORKING PAPER
https://www.mercatus.org/system/files/Private-Property-Rights-Economic-Freedom-and-Well-Being.pdf

Science Daily reported in Private property, not productivity, precipitated Neolithic agricultural revolution:

Humankind first started farming in Mesopotamia about 11,500 years ago. Subsequently, the practices of cultivating crops and raising livestock emerged independently at perhaps a dozen other places around the world, in what archaeologists call the Neolithic Agricultural Revolution. It’s one of the most thoroughly-studied episodes in prehistory — but a new paper in the Journal of Political Economy shows that most explanations for it don’t agree with the evidence, and offers a new interpretation.
With farming came a vast expansion of the realm over which private property governed access to valued goods, replacing the forager social norms around sharing food upon acquisition. A common explanation is that farming increased labor productivity, which then encouraged the adoption of private property by providing incentives for the long-term investments required in a farming economy.
“But it’s not what the data are telling us,” says Santa Fe Institute economist Samuel Bowles, a co-author of the paper. “It is very unlikely that the number of calories acquired from a day’s work at the advent of farming made it a better option than hunting and gathering and it could well have been quite a bit worse.”
Prior studies, including those of human and animal bones, suggest that farming actually took an extreme nutritional toll on early adopters and their livestock. So why farm in the first place?
Some have suggested an inferior technology could have been imposed by political elites as a strategy for extracting taxes, tribute, or rents. But farming was independently adopted millennia before the emergence of governments or political elites capable of imposing a new way of life on heavily-armed foraging communities.
Bowles and co-author Jung-Kyoo Choi, an economist at Kyungpook National University in South Korea, use both evolutionary game theory and archaeological evidence to propose a new interpretation of the Neolithic. Based on their model, a system of mutually recognized private property rights was both a precondition for farming and also a means of limiting costly conflicts among members of a population. While rare among foragers, private property did exist among a few groups of sedentary hunter-gatherers. Among them, farming could have benefited the first adopters because it would have been easier to establish the private possession of cultivated crops and domesticated animals than for the diffuse wild resources on which hunter-gatherers relied….
https://www.sciencedaily.com/releases/2019/10/191011131858.htm

Citation:

Private property, not productivity, precipitated Neolithic agricultural revolution
Date: October 11, 2019
Source: Santa Fe Institute
Summary:
The Neolithic Agricultural Revolution is one of the most thoroughly-studied episodes in prehistory. But a new article shows that most explanations for it don’t agree with the evidence, and offers a new interpretation.

Journal Reference:
Samuel Bowles, Jung-Kyoo Choi. The Neolithic Agricultural Revolution and the Origins of Private Property. Journal of Political Economy, 2019; 127 (5): 2186 DOI: 10.1086/701789

Here is the press release from the Santa Fe Institute:

OCTOBER 10, 2019
Humankind first started farming in Mesopotamia about 11,500 years ago. Subsequently, the practices of cultivating crops and raising livestock emerged independently at perhaps a dozen other places around the world, in what archaeologists call the Neolithic Agricultural Revolution. It’s one of the most thoroughly-studied episodes in prehistory — but a new paper in the Journal of Political Economy shows that most explanations for it don’t agree with the evidence, and offers a new interpretation.
With farming came a vast expansion of the realm over which private property governed access to valued goods, replacing the forager social norms around sharing food upon acquisition. A common explanation is that farming increased labor productivity, which then encouraged the adoption of private property by providing incentives for the long-term investments required in a farming economy.
“But it’s not what the data are telling us”, says Santa Fe Institute economist Samuel Bowles, a co-author of the paper. “It is very unlikely that the number of calories acquired from a day’s work at the advent of farming made it a better option than hunting and gathering and it could well have been quite a bit worse.”
Prior studies, including those of human and animal bones, suggest that farming actually took an extreme nutritional toll on early adopters and their livestock. So why farm in the first place?
Some have suggested an inferior technology could have been imposed by political elites as a strategy for extracting taxes, tribute, or rents. But farming was independently adopted millennia before the emergence of governments or political elites capable of imposing a new way of life on heavily-armed foraging communities.
Bowles and co-author Jung-Kyoo Choi, an economist at Kyungpook National University in South Korea, use both evolutionary game theory and archaeological evidence to propose a new interpretation of the Neolithic. Based on their model, a system of mutually recognized private property rights was both a precondition for farming and also a means of limiting costly conflicts among members of a population. While rare among foragers, private property did exist among a few groups of sedentary hunter-gatherers. Among them, farming could have benefited the first adopters because it would have been easier to establish the private possession of cultivated crops and domesticated animals than for the diffuse wild resources on which hunter-gatherers relied.
“It is a lot easier to define and defend property rights in a domesticated cow than in a wild kudu,” says Choi. “Farming initially succeeded because it facilitated a broader application of private property rights, not because it lightened the toil of making a living.”
Read the paper, “The Neolithic Agricultural Revolution and the Origins of Private Property,” in the Journal of Political Economy (October 2019) https://www.journals.uchicago.edu/doi/10.1086/701789

Tom DeWeese wrote in Private Property Ownership Is the Only Way to Eradicate Poverty:

Poverty. It’s the excuse for nearly every government spending program. Help the poor. Tax the Rich. Get the One Percent. How dare they get so wealthy while everyone else suffers!

And what is the preferred way to eliminate poverty? Redistribution of wealth. It is the force behind the Occupy Wall Street movement, Agenda 21 and its Social Justice schemes, nearly every poverty program of the Federal government, and even most charitable poverty programs….
The Real Way to End Poverty

It is becoming increasingly clear that poverty will never be eradicated unless those working on the problem will allow themselves to look for a drastically new way to attack it. Simply put, rather than constantly applying band-aids to the effects of poverty, they must look for the cause and fix it.

One must first look at the world and see where wealth is created and why it is so. The greatest example of wealth creation is obviously the United States. It is the beacon of wealth and freedom for the entire world. Most people in the world envy America’s wealth and seek ways to share it, yet very few look at how the nation got its wealth, or attempt to copy its system for success.

Why did the United States become so wealthy? Was it the possession of vast natural resources? Africa has more. Was it the existence of greater industry? Japan has more. Was it the existence of a superior education system? The United States now ranks below the top ten nations in education.

The reason the United States has led the world in wealth, standard of living, and abundance is that the average resident of the United States has had the ability and the opportunity to invest and produce capital.

Why could ordinary citizens of the United States produce their own capital to create personal wealth, while most of the rest of the world failed at such an attempt? The answer is actually very simple. The United States created a very easy, immediate, complete system for recording and securing ownership of private property.

Peruvian economist Hernando de Soto explains the root of American wealth in his book, The Mystery of Capital. De Soto asks, “Why does Capitalism thrive only in the West, as if enclosed in a bell jar?”

Capital, he argues, “is the force that raises the productivity of labor and creates the wealth of nations, It is the lifeblood of the capitalist system, the foundation of progress, and the one thing that the poor countries of the world cannot seem to produce for themselves….”
https://www.thenewamerican.com/reviews/opinion/item/13821-private-property-ownership-is-the-only-way-to-eradicate-poverty

See, Reasons for Low Capital Formation in Under-Developed Countries http://www.economicsdiscussion.net/articles/reasons-for-low-capital-formation-in-under-developed-countries/1537

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University of California Davis study: A breath test for opioids

6 Oct

The National Institute on Drug Abuse provides information on opioids:

Brief Description
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.
• Summary
• All opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths.
• An opioid overdose can be reversed with the drug naloxone when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately, effective medications exist to treat opioid use disorders including methadone, buprenorphine, and naltrexone.
• A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. However, naltrexone requires full detoxification, so initiating treatment among active users was more difficult. These medications help many people recover from opioid addiction.
• NIDA’s Role in the NIH HEAL Initiative℠ https://www.drugabuse.gov/drugs-abuse/opioids/nidas-role-in-nih-heal-initiative
• Prescription Opioids https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
• Heroin https://www.drugabuse.gov/drugs-abuse/heroin
• Fentanyl https://www.drugabuse.gov/drugs-abuse/fentanyl
• Opioid Research Findings Funded by NIDA
https://www.drugabuse.gov/drugs-abuse/opioids

Opioids are powerful drugs and can be abused.

Resources:
What Is an Opioid? – Teens – Drug Information
https://teens.drugabuse.gov/blog/post/what-opioid

What are opioids and why are they dangerous? – Mayo Clinic
https://www.mayoclinic.org/…/expert-answers/what-are-opioids/faq-20381270

The American Society of Anesthesiologists has a concise description of opioid abuse at their site:

Opioid Abuse
Opioids are highly addictive, and opioid abuse has become a national crisis in the United States. Statistics highlight the severity of the epidemic, with the National Institute on Drug Abuse reporting that more than 2 million Americans abuse opioids and that more than 90 Americans die by opioid overdose every day, on average.
Why do people become addicted to opioids?
Opioids can make your brain and body believe the drug is necessary for survival. As you learn to tolerate the dose you’ve been prescribed, you may find that you need even more medication to relieve the pain or achieve well-being, which can lead to dependency. Addiction takes hold of our brains in several ways — and is far more complex and less forgiving than many people realize.
How can you avoid addiction to opioids?
If you or a loved one is considering taking opioids to manage pain, it is vital to talk to a physician anesthesiologist or other pain medicine specialist about using them safely and exploring alternative options if needed. Learn how to work with your physician anesthesiologist or another physician to use opioids more wisely and safely and explore what pain management alternatives might work for you.
What are the signs of an addiction?
People addicted to drugs may change their behavior. Possible signs include:
• Mixing with different groups of people or changing friends
• Spending time alone and avoiding time with family and friends
• Losing interest in activities
• Not bathing, changing clothes or brushing their teeth
• Being very tired and sad
• Eating more or less than usual
• Being overly energetic, talking fast and saying things that don’t make sense
• Being nervous or cranky
• Quickly changing moods
• Sleeping at odd hours
• Missing important appointments
• Getting into trouble with the law
• Attending work or school on an erratic schedule
• Experiencing financial hardship
https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/opioid-abuse/

The University of California Davis has developed a breath test for opioids.

Science Daily reported in A breath test for opioids:

A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians at the University of California, Davis. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.
“There are a few ways we think this could impact society,” said Professor Cristina Davis, chair of the Department of Mechanical and Aerospace Engineering at UC Davis, who led the research along with Professor Michael Schivo from the UC Davis Medical Center. The work is described in a paper published in the Journal of Breath Research Oct. 3.
Doctors and nurses treating chronic pain may need to monitor patients to make sure they are taking their drugs correctly, that their prescribed drugs are being metabolized properly and that they are not taking additional medications. Blood tests are the gold standard: a reliable, noninvasive test would be a useful alternative.
Collecting droplets from breath
For the test developed by postdoctoral researcher Eva Borras, Davis and colleagues, subjects breathe normally into a specialized collection device. Droplets in breath condense and are stored in a freezer until testing. Davis’ lab uses mass spectrometry to identify compounds in the samples.
The researchers tested the technique in a small group of patients receiving infusions of pain medications including morphine and hydromorphone, or oral doses of oxycodone, at the UC Davis Medical Center. They were therefore able to compare opioid metabolites in breath with both blood samples and the doses given to patients.
“We can see both the original drug and metabolites in exhaled breath,” Davis said.
Fully validating the breath test will require more data from larger groups of patients, she said. Davis’ laboratory is working toward real-time, bedside testing…. https://www.sciencedaily.com/releases/2019/10/191004105645.htm

Citation:

A breath test for opioids
Date: October 4, 2019
Source: University of California – Davis
Summary:
A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.

Journal Reference:
Eva Borras, Andy Cheng, Ted Wun, Kristen L Reese, Matthias Frank, Michael Schivo, Cristina E Davis. Detecting opioid metabolites in exhaled breath condensate (EBC). Journal of Breath Research, 2019; 13 (4): 046014 DOI: 10.1088/1752-7163/ab35fd

Here is the press release from University of California Davis:

A Breath Test for Opioids
By Andy Fell on October 3, 2019 in Human & Animal Health
UC Davis researchers have developed a method for detecting opioid drugs and drug metabolites in breath. The test could be useful for management of patients with chronic pain, as well as for detecting illegal opioid use. (Credit: Charles Wollertz/Getty Images)
A test to detect opioid drugs in exhaled breath has been developed by engineers and physicians at the University of California, Davis. A breath test could be useful in caring for chronic pain patients as well as for checking for illegal drug use.
“There are a few ways we think this could impact society,” said Professor Cristina Davis, chair of the Department of Mechanical and Aerospace Engineering at UC Davis, who led the research along with Professor Michael Schivo from the UC Davis Medical Center. The work is described in a paper published in the Journal of Breath Research Oct. 3.
Doctors and nurses treating chronic pain may need to monitor patients to make sure they are taking their drugs correctly, that their prescribed drugs are being metabolized properly and that they are not taking additional medications. Blood tests are the gold standard: a reliable, noninvasive test would be a useful alternative.
Collecting droplets from breath
For the test developed by postdoctoral researcher Eva Borras, Davis and colleagues, subjects breathe normally into a specialized collection device. Droplets in breath condense and are stored in a freezer until testing. Davis’ lab uses mass spectrometry to identify compounds in the samples.
The researchers tested the technique in a small group of patients receiving infusions of pain medications including morphine and hydromorphone, or oral doses of oxycodone, at the UC Davis Medical Center. They were therefore able to compare opioid metabolites in breath with both blood samples and the doses given to patients.
“We can see both the original drug and metabolites in exhaled breath,” Davis said.
Fully validating the breath test will require more data from larger groups of patients, she said. Davis’ laboratory is working toward real-time, bedside testing.
Other authors on the paper include graduate student Andy Cheng, UC Davis forensic science program; Ted Wun, Department of Internal Medicine; Kristen Reese and Matthias Frank, Lawrence Livermore National Laboratory; and Michael Schivo, UC Davis School of Medicine and VA Northern California Health System.
Davis’ laboratory is working on a variety of applications for detecting small amounts of chemicals, especially in air and exhaled breath. Other projects include diagnosing influenza in people and citrus greening disease in fruit trees.
The work was supported by grants from the UC Davis Medical Center’s Collaborative for Diagnostic Innovation, the U.S. Department of Energy and the NIH.
Media contact(s)
Cristina Davis, Mechanical and Aerospace Engineering, 530-754-9004, cedavis@ucdavis.edu
Andy Fell, News and Media Relations, 530-752-4533, ahfell@ucdavis.edu
Media Resources
Read the paper (Journal of Breath Research) https://iopscience.iop.org/article/10.1088/1752-7163/ab35fd

The National Institute on Drug Abuse defines the opioid crisis:

Revised January 2019
Every day, more than 130 people in the United States die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.2
How did this happen?
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.3,4 Opioid overdose rates began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.1 That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (not mutually exclusive).5
What do we know about the opioid crisis?
• Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.6
• Between 8 and 12 percent develop an opioid use disorder.6
• An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.7–9
• About 80 percent of people who use heroin first misused prescription opioids.7
• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.10
• The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.10
• Opioid overdoses in large cities increase by 54 percent in 16 states.10

This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.
https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

 

“The mentality, thought system and relationships that got you into addiction will keep you there unless you disentangle yourself from them.”

Oche Otorkpa,
The Night Before I killed Addiction

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University of Nottingham study: You don’t have to go cold turkey on red meat to see health benefits

2 Oct

Joanne Marie wrote in the SF Gate article, Ways You Benefit by Eating Meat:

Meat refers to cuts of beef, pork, veal, lamb and poultry — and all but poultry are red meats. These foods provide you with protein, an important nutrient, along with some essential vitamins and minerals. Meat can be high in fat, a nutrient that you should consume in moderation. Choose low-fat meats and prepare them in the healthiest way to get the most benefit from these foods.
Protein
Protein is a nutrient that is critical to keep your body functioning normally. When you consume protein-containing food, your gastrointestinal tract digests it, breaking it down into its building blocks, amino acids. These molecules are absorbed into your blood and travel to all of your cells, which use them to construct many different new proteins. Examples include enzymes that fuel biochemical reactions, structural proteins in your muscles and proteins that control what molecules can enter your cells. Meat is a complete protein source that provides all the essential amino acids, according to the Centers for Disease Control and Prevention, which also says you should consume about 50 grams of protein daily. In general, a 3-ounce piece of red meat — the serving size recommended by the Mayo Clinic — contains about 21 grams of protein, and poultry has about 15 grams.
Iron
Meat is an excellent source of iron, a mineral required to support human life. When your bone marrow makes new red blood cells, it incorporates iron into hemoglobin, the compound that carries oxygen to all your cells. Your body also adds iron to myoglobin, a compound that allows your muscle cells to use oxygen; other iron-containing compounds support DNA production, immune function and the manufacture of some neurotransmitters. The recommended dietary allowance for iron is 8 milligrams per day for men and 18 milligrams for women under 50; after menopause, the RDA for women is the same as for men. A 3-ounce serving of beef, pork or lamb provides between 1 and 3 milligrams of iron; a similar serving of chicken or turkey contains about 1 milligram of iron.
Other Nutrients
Red meat and poultry contain a number of vitamins. These include vitamin A, which is important for healthy bones, teeth, skin and eyes, and vitamin D, which is critical for calcium metabolism and strong bones. Meat also provides B-complex vitamins, including thiamine, riboflavin, niacin, folic acid and vitamins B-5, B-6 and B-12. Your body uses these vitamins to help produce energy from your food to support your nervous system and keep your heart healthy. In addition to iron, red meat and poultry also provide several other minerals, including magnesium, potassium, selenium and zinc, all of which are needed to help keep your organs functioning well…. https://healthyeating.sfgate.com/ways-benefit-eating-meat-4357.html

A University of Nottingham study finds that meat can be included in a balanced diet.

Science Daily reported the University of Nottingham study: You don’t have to go cold turkey on red meat to see health:

A new study has found that halving the amount red and processed (RPM) meat in the diet can have a significant impact on health, reducing the amount of LDL ‘bad’ cholesterol in the blood which cuts the risk of developing heart disease.
Red and processed meat (RPM) include fresh pork, beef, lamb and veal and meats that have been smoked, cured or preserved (other than freezing) in some way. These meats are typically high in saturated fatty acids which cause an increase in LDL cholesterol. This is the “bad” cholesterol that collects in the walls of blood vessels, where it can cause blockages and raise the chance of a heart attack.
Increasing awareness of the risks associated with eating red and processed meat has led to a growing number of people adopting vegetarian and vegan diets, which cut out meat completely. Researchers at the University of Nottingham wanted to find out if reducing the amount of red meat eaten, rather than cutting it out completely, would have a positive effect on the health of the subjects taking part.
Reducing cholesterol
The results, published today in the journal Food & Function showed that the most significant change was a drop in the amount of LDL cholesterol in the blood, and those with the highest levels in the beginning had the biggest drop. Overall there was an average drop in LDL cholesterol of approximately 10% with men (who tended to have the highest starting values) seeing the biggest change.
For this intervention trial, 46 people agreed to reduce their red meat intake over a period of 12 weeks by substituting it for white meat, fish or a meat substitutes, or by reducing the portion size of their red meat. They kept a food diary during the study and were given blood tests at the beginning and intervals throughout.
Professor Andrew Salter, from the University of Nottingham’s School of Biosciences led the study and says: “With a high saturated fatty acid, content red and processed meat has been linked to heart disease, and other chronic diseases, particularly colon cancer. Studies have shown that in people who eat the most meat, there is a 40% increased risk of them dying due to heart disease. The results of the present study showed that, even in relatively young and healthy individuals, making relatively small changes to RPM intake induced significant changes in LDL cholesterol which, if maintained over a period of time could potentially reduce the risk of developing heart disease.”
As well as reducing levels of LDL cholesterol, reseachers were surprised to also see a drop in white and red cells in the blood.
Dr Liz Simpson from the University of Nottingham’s School of Life Sciences is co-author on the study, she explains: “Meat is a rich source of the micronutrients (vitamins and minerals) required for the manufacture of blood cells, and although it is possible to obtain these nutrients in plant-based diets, our results suggest that those reducing their meat intake need to ensure that their new diet contains a wide variety of fruit, vegetables, pulses and whole grains to provide these nutrients…. https://www.sciencedaily.com/releases/2019/09/190930101521.htm

Citation:

You don’t have to go cold turkey on red meat to see health benefits
Date: September 30, 2019
Source: University of Nottingham
Summary:
A new study has found that halving the amount red and processed (RPM) meat in the diet can have a significant impact on health, reducing the amount of LDL ‘bad’ cholesterol in the blood which cuts the risk of developing heart disease.

Here is the press release from University of Nottingham:

NEWS RELEASE 30-SEP-2019

You don’t have to go cold turkey on red meat to see health benefits

UNIVERSITY OF NOTTINGHAM

A new study has found that halving the amount red and processed (RPM) meat in the diet can have a significant impact on health, reducing the amount of LDL ‘bad’ cholesterol in the blood which cuts the risk of developing heart disease.
Red and processed meat (RPM) include fresh pork, beef, lamb and veal and meats that have been smoked, cured or preserved (other than freezing) in some way. These meats are typically high in saturated fatty acids which cause an increase in LDL cholesterol. This is the “bad” cholesterol that collects in the walls of blood vessels, where it can cause blockages and raise the chance of a heart attack.
Increasing awareness of the risks associated with eating red and processed meat has led to a growing number of people adopting vegetarian and vegan diets, which cut out meat completely. Researchers at the University of Nottingham wanted to find out if reducing the amount of red meat eaten, rather than cutting it out completely, would have a positive effect on the health of the subjects taking part.
Reducing cholesterol
The results, published today in the journal Food & Function showed that the most significant change was a drop in the amount of LDL cholestorol in the blood, and those with the highest levels in the beginning had the biggest drop. Overall there was an average drop in LDL cholesterol of approximately 10% with men (who tended to have the highest starting values) seeing the biggest change.
For this intervention trial, 46 people agreed to reduce their red meat intake over a period of 12 weeks by substituting it for white meat, fish or a meat substitutes, or by reducing the portion size of their red meat. They kept a food diary during the study and were given blood tests at the beginning and intervals throughout.
Professor Andrew Salter, from the University of Nottingham’s School of Biosciences led the study and says: “With a high saturated fatty acid, content red and processed meat has been linked to heart disease, and other chronic diseases, particularly colon cancer. Studies have shown that in people who eat the most meat, there is a 40% increased risk of them dying due to heart disease. The results of the present study showed that, even in relatively young and healthy individuals, making relatively small changes to RPM intake induced significant changes in LDL cholesterol which, if maintained over a period of time could potentially reduce the risk of developing heart disease.”
As well as reducing levels of LDL cholestoral, reseachers were surprised to also see a drop in white and red cells in the blood.
Dr Liz Simpson from the University of Nottingham’s School of Life Sciences is co-author on the study, she explains: “Meat is a rich source of the micronutrients (vitamins and minerals) required for the manufacture of blood cells, and although it is possible to obtain these nutrients in plant-based diets, our results suggest that those reducing their meat intake need to ensure that their new diet contains a wide variety of fruit, vegetables, pulses and whole grains to provide these nutrients.
Professor Salter is also part of the Future Food Beacon at the University of Nottingham which is undertaking research to find more sustainable ways to feed a growing population in a changing climate. He explains: “As well as improving people’s health, reducing the amount of red meat we eat is also important from a food security and sustainability perspective, as livestock production utilizes a large proportion of our natural resources and is a major contributor to greenhouse gas production. Part of our research is centred on finding more sustainable, alternative sources of food that provide us with the protein and other nutrients supplied by meat, but without the negative health and environmental effects ”
###
This study was funded by BBSRC and MRC through the Innovate UK project.
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.

Cathy Fenster, M.Sc, RD wrote in 9 Reasons Why Eating Meat Is Good For Health:

I eat meat daily. I’m not Jewish. I’m not Arabic. What’s the kind of person that doesn’t eat meat? That’s right – I’m not a vegetarian.
Chuck Berry

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

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

28 Sep

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

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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

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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
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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
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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/

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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.

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