sábado, 1 de diciembre de 2018

Viewpoint: Let’s hope the Chinese gene editing fiasco doesn’t lead to a cruel and unnecessary ban on germline gene therapy | Genetic Literacy Project

Viewpoint: Let’s hope the Chinese gene editing fiasco doesn’t lead to a cruel and unnecessary ban on germline gene therapy

Henry Miller | Genetic Literacy Project | November 30, 2018

Chronic kidney disease rates are increasing faster than other noninfectious diseases

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Reviewed by Alina Shrourou, BScNov 30 2018

Advances in treating cancer, heart disease and other major health conditions in recent decades have extended life spans for millions of people.

However, chronic kidney disease is an outlier, with cases accelerating at a faster pace than all other noninfectious diseases, according to a study from Washington University School of Medicine in St. Louis and the Veterans Affairs (VA) St. Louis Health Care System.

The researchers found that the burden of chronic kidney disease, as well as the probability of death related to chronic kidney disease, have increased substantially over the past 15 years in all 50 U.S. states. Such increases also were seen in younger adults ages 20 to 54, a group in which kidney disease had been uncommon.

The findings are published Nov. 30 in JAMA Network Open.

"Unfortunately, chronic kidney disease is known as a 'silent epidemic' because many people don't realize they have it until the disease is at an advanced stage," said Ziyad Al-Aly, MD, the study's senior author and an assistant professor of medicine. "It is particularly concerning that chronic kidney disease is becoming more common in younger people. This is a remarkable move in the wrong direction."

The researchers noted that the abundance of high-sugar, high-salt foods in many American diets and obesity-related health problems such as high blood pressure and type 2 diabetes are likely driving the increase in kidney disease. This is because poor diets and metabolic problems contribute to the buildup of toxins that can interfere with the kidneys' job, which is to remove harmful waste from the body.

The researchers also showed that the increasing rates of chronic kidney disease varied considerably by state. For example, while all states experienced rising rates of chronic kidney disease, significantly higher increases occurred in states with the highest obesity rates among adults -- such as West Virginia, Mississippi, Louisiana, Georgia and Alabama.

"The findings suggest the need to address the health risks such as diabetes that can lead to kidney disease," Al-Aly said. "This means healthier diets and exercise, as well as increased monitoring by health-care workers of patients with obesity or metabolic disorders who are at a greater risk of developing kidney disease."

To compare rates of kidney disease with other diseases, the researchers tapped into a public database of the Global Burden of Disease (GBD) initiative. It provides a detailed epidemiologic assessment of about 350 diseases and injuries by age and sex, as well as more than 80 risk factors, in all U.S. states and countries worldwide. For this study, the analysis focused on U.S. data by age from 2002 to 2016.

The researchers measured and compared the percent change in healthy life-years lost due to kidney disease with the diseases and injuries in the GBD database. They found that chronic kidney disease rates are increasing faster than the rates of all noninfectious diseases, including cardiovascular disease, cancer, cirrhosis and other chronic lung diseases, mental disorders and neurological disorders.

The measure of how many years of healthy life are lost is often referred to as "disability-adjusted life years." During the 15-year period covered by the study, health loss due to kidney disease increased by 18 percent, while the burden of cardiovascular disease and cancer have decreased by 22 percent and 13 percent, respectively.

"The decline is largely reflective of medical advances in cardiovascular disease and cancer treatment," Al-Aly said. "Similarly, the increase in chronic kidney disease reflects a relative stagnation in new treatments. There have been no major advances to slow or reverse kidney disease during the past two decades."

Overall, deaths due to chronic kidney disease increased 58 percent from 52,127 in 2002 to 82,539 in 2016.

While deaths attributable to chronic kidney disease are rare among younger people, the numbers are rising. Among adults ages 20 to 54, the probability of death due to chronic kidney disease increased almost 26.8 percent, from 0.1 percent (or 100 deaths per 100,00 people) in 2002 to 0.125 percent (125 deaths per 100,000 people) in 2016.

"This also is worrisome from an economic perspective because it is the younger adults, in particular, who often contribute most to economic prosperity on local, state and federal levels," Al-Aly said.

Those 55 years and older experienced a 25.6 percent increase in deaths due to chronic kidney disease, from 1.95 percent (1,950 deaths per 100,000 people in 2002 to 2.45 percent (2,450 deaths per 100,000 people) in 2016.

Chronic kidney disease also accounted for a 52 percent increase among all age groups of healthy life-years lost, from 1.2 million in 2002 to 2 million in 2016.

"Public health priorities, policy initiatives, funding allocation and advocacy efforts need to catch up to this reality that the burden of chronic kidney disease is rising, and the speed of change now outpaces other noncommunicable diseases," Al-Aly said. "A concerted effort should be made to put the brakes on this."

Source:

https://medicine.wustl.edu/news/rising-rates-of-chronic-kidney-disease-deaths-outpace-other-diseases/

Study explores whether patients from poorest neighborhoods experience longer total ambulance times

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Reviewed by Alina Shrourou, BScNov 30 2018

Bottom Line: Patients from the poorest neighborhoods who had cardiac arrest had longer total ambulance times than those from the wealthiest neighborhoods.

Why The Research Is Interesting: Emergency medical services (EMS) provide critical care before patients reach the hospital and differences in ambulance times may contribute to disparities in patient outcomes.

What and When: National data from 46 states on 63,600 patients who had cardiac arrest and didn't die on scene and were transported to a hospital

What (Study Measures and Outcomes): Four time measures were examined (response time, on-scene time, transport time and total EMS time) and compared with EMS response time benchmarks for responding to cardiac arrest calls.

How (Study Design): This was an observational study. Researchers weren't intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Renee Y. Hsia, M.D., M.Sc., University of California, San Francisco, and coauthors

Study Limitations: The registry analyzed for this study wasn't of individual patients so multiple reports associated with the same patient exist; other explanations beyond the variables assessed in this study may have contributed to time disparities; and the findings may not be generalized to other types of time-sensitive EMS calls.

Source:

https://media.jamanetwork.com/news-item/do-lower-income-neighborhoods-experience-longer-ambulance-times/

Study reveals significant increase in hospitalization rates among homeless adults

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Reviewed by Alina Shrourou, BScNov 30 2018

Hospitalization rates among homeless adults have increased sharply in recent years, with a very different set of causes from those in non-homeless individuals, reports a study in the January issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Despite greater policy and public health focus over the last few decades, mental illness and substance use disorder still remain the primary drivers of acute hospitalizations among homeless adults," according to the new research, led by by Rishi Wadhera, MD, MPhil, of the Smith Center for Outcomes Research at Beth Israel Deaconess Medical and Brigham and Women's Hospital, Boston. The authors discuss the implications for policies to improve healthcare and outcomes for homeless Americans.

Data from Three States Show 'Urgent Need' to Improve Care for Homeless Adults

The researchers assessed trends in hospital admissions for homeless adults from 2007 to 2013 in three states: Massachusetts, Florida, and California. The analysis included data on more than 185,000 hospitalizations for homeless individuals and 32 million admissions for non-homeless individuals. The two groups were standardized for demographic characteristics: average age was 46 years, 76 percent were male, and 62 percent were white.

All three states showed a significant increase in hospitalizations for homeless adults: from 294 to 420 per 1,000 homeless residents in Massachusetts, from 161 to 240 per 1,000 in Florida, and from 133 to 164 per 1,000 in California. Most homeless patients were uninsured (42 percent) or insured by Medicaid (32 percent).

Fifty-two percent of homeless patients were hospitalized for mental illness or substance use disorder, compared to 18 percent for non-homeless individuals. Other reasons for hospitalization were less likely in homeless individuals, including cardiovascular disease, gastrointestinal illness, and injury or poisoning.

Homeless individuals spent more days in the hospital - possibly because discharge decisions were affected by their lack of stable housing. They also had lower average costs of care, which may reflect differences in the intensity of care. In-hospital mortality was lower among homeless adults: 0.9 versus 1.2 percent.

"In the United States, an estimated 553,000 people are homeless on any given night," according to the authors. Recent years have seen intensified efforts to address the health of the homeless population, including Medicaid expansion and increased funding for healthcare centers and clinical services under the Affordable Care Act (ACA). Few studies have looked at how these policy initiatives have affected patterns of hospitalization among homeless people.

"We found that hospitalizations among homeless persons are rising," said Dr. Wadhera. "We think this is related to aging of the homeless population, and potentially, the rise of the opioid epidemic. Strikingly, more than half of hospitalizations for homeless adults were for mental health and substance use disorders, which we suspect reflects limited access to and coordination of behavioral health services." Expanded mental health and substance use disorder services under the ACA, as well as newer integrated healthcare delivery approaches, might help to improve provision of behavioral health services to homeless patients, the authors suggest.

"There is really is an urgent need to reduce financial and nonfinancial barriers to the use of ambulatory care, for behavioral health services in particular, to improve long-term management of physical and mental illness for homeless individuals," said senior author Karen Joynt Maddox, MD, MPH, of Washington University in St. Louis. "We need better longitudinal data and further studies to understand how Medicaid expansion and other policy initiatives affect the health of this highly vulnerable population."

Source:

http://home.lww.com/news.entry.html/2018/11/30/study_shows_risingr-kVOB.html

September 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the September 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

The full report is available on Medicaid.gov at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html

National Family Caregivers Month 2018: Celebrating a Year of Accomplishment

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News & Events

National Family Caregivers Month 2018: Celebrating a Year of Accomplishment

By Lance Robertson, Administrator and Assistant Secretary for Aging

We hear repeatedly that without family caregivers, our long-term services system would be stretched to the breaking point. Family caregivers make it possible for so many of our nation’s citizens to remain independent, living in the settings of their choice.

Supporting families and family caregivers in their efforts to assist their friends and loved ones is at the very core of the mission of the Administration for Community Living. That gives us a tremendous opportunity to advance how we think about supporting families that include older adults who need assistance in their later years, people with disabilities at every stage of their lives, or both. We also have the opportunity to make a real difference in the lives of real people, through programs that provide support to families and caregivers.

Every November, we stop to recognize and thank family caregivers for all they do on behalf of their loved ones. This year, I think we have even more reason to be thankful, to celebrate family caregivers, and to be optimistic for the future of family caregiver support.

Earlier this year, we saw two key pieces of legislation signed into law, both of which will help to strengthen our ability to support family caregivers. The Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act was signed in January, and ultimately will help establish a national strategy to better support families. The Supporting Grandparents Raising Grandchildren Act became law in July, and will for the first time, focus national attention on better understanding the complex needs of grandparents and other older relatives who are caring for children and help to make information about promising practices and programs more accessible for these special families.

I am excited that ACL will be leading the Department of Health and Human Services’ work to implement these two important initiatives. Both fit perfectly with ACL’s commitment to supporting families and family caregivers. They offer valuable opportunities for federal agencies to come together in support of family caregivers, including grandparents and older relatives and build on ongoing and new initiatives to support families and family caregivers. We are currently accepting nominations to serve on the advisory councils these laws established, and we are looking forward to the work we will do together beginning in the new year.

There are other initiatives to celebrate, as well. In September, ACL awarded a new cooperative agreement to the Alzheimer’s Association to begin working on strategies and supports to bolster the financial literacy and preparedness of family caregivers. Earlier this month, ACL launched the redesigned Eldercare Locator web site, which feature a new Caregiver Corner complete with updated resources and information for family caregivers.

We also now know more about the programs we administer and the people we serve through National Family Caregiver Support Program funded through the Older Americans Act. ACL just completed a multi-year project to examine how the program is designed and administered at the state, local and provider levels and how it impacts family caregivers. We previewed the results at a webinar on November 28th, and we’ll be sharing the complete report soon. We anticipate learning more about service use and impacts, caregiver needs and preferences, and recommendations for the aging services network as it looks to build upon proven success in administering the program.

Similarly, we are evaluating the work done through the “Supporting Families Communities of Practice” initiative, which ACL funded for five years. This program was designed to build capacity across and within states to create policies, practices, and systems to better assist and support families that include people with intellectual and developmental disabilities, across the lifespan. We’ve seen good results from this work, with many states and communities adopting promising practices, such as the use of the LifeCourse Framework developed by the University of Missouri – Kansas City Institute for Human Development, which is one of the University Centers for Excellence in Developmental Disabilities funded by ACL.

We look forward to sharing the results of the evaluation, which will help us better understand the results from the project and which will inform our future work in supporting families.

I am confident in our capacity to be there to support families and family caregivers in meaningful and lasting ways. As 2018 National Family Caregivers Month comes to a close and as we continue to celebrate this season of thanks, I am grateful for the opportunities we have every day to make a difference in the lives of these amazing individuals, and appreciate our partners in the aging and disability networks who make that work possible.