Whitney Howell

Healthcare. Politics. Family.

RA Survival Rates Outpacing that of General Population

Published on the July 13, 2016, Rheumatology Network website

By Whitney L.J. Howell

Advances in drug development and management strategies for rheumatoid arthritis over the past 15 years have improved survival rates for patients, researchers say.

The study appears in the June 23, 2016,Annuals of the Rheumatic Diseases.

To date, there have been no investigations into whether these improvements have positively impacted the lifespan of patients with rheumatoid arthritis. A few studies exist, researchers said, looking into how treatments impacted mortality up to 2004. However, there are none that look at later dates.

In a population-based cohort study, researchers reviewed how standard rheumatoid arthritis treatments impacted patients with this condition and compared the results to similar patients who did not have rheumatoid arthritis. They were also interested in whether other co-morbidities impacted survival.

Led by Yuqing Zhang, M.D., professor of medicine and epidemiology at Boston University School of Medicine, investigators determined rheumatoid arthritis patients treated after the advent of new drugs and management strategies had a longer survival rate than those treated earlier. The study, which looked at patients treated from 1999 to 2014, also revealed co-morbidities did not significantly impact life span.

Throughout the study, researchers surveyed electronic medical records from The Health Improvement Network in the United Kingdom for 10.2 million patients from 580 general practice clinics. They identified all patients, ages 18 to 89, with rheumatoid arthritis and up to five similar individuals who didn’t have the condition. They, then, divided patients into two cohorts: those treated between 1999 and 2006 (10, 126 rheumatoid arthritis patients and 50,546 non-rheumatoid arthritis patients) and those treated between 2007 and 2014 (10, 769 rheumatoid arthritis patients and 53, 749 non-rheumatoid patients).

According to study results, more patients from the early cohort died – and died younger – than patients from the later cohort. Based on the data, 936 rheumatoid arthritis patients from the early cohort, and 2,968 non-rheumatoid arthritis, died. The average ages were 77 and 78.4, respectively. In the later cohort, 605 rheumatoid arthritis patients, and 2,293 non-arthritis patients, died. The average ages were 77.9 and 78.4 respectively.

In terms of relative risk, rheumatoid arthritis patients in the early cohort had a 56 percent higher risk of all-cause mortality, and the later cohort had a 29 percent higher risk, researchers reported.

Investigators also found disease-modifying anti-rheumatic drug use was greater in the later cohort than the earlier one – 81 percent to 65 percent, respectively. And, of those using these medicines, 85 percent of late cohort and 68 percent of early cohort received methotrexate. Dosing and administration modes for these medications also improved between early to later cohorts.

“While patients with rheumatoid arthritis had higher mortality rates than individuals without rheumatoid arthritis in either the early or the late cohorts, the magnitude of difference in mortality was smaller in the late cohorts compared with that in earlier cohorts,” researchers said.

Investigators found age, sex, body mass index, alcohol consumption, and medication use didn’t impact results. However, rheumatoid arthritis patients were more likely to smoke and did have more co-morbidities.

Recent U.K. studies show a tripling (156 percent) of methotrexate use between 2001 and 2012. There was also an increase in the use of tumor necrosis factor inhibitor. Seen together, these measures are seen to reduce rheumatoid arthritis disease activity and to have led to improved longevity for patients.

Not only does this data indicate that early and effective interventions for rheumatoid arthritis help prevent permanent damage, but it also demonstrates that treat-to-target strategies have been utilized more frequently. When taken together, all the findings point to a reduction in rheumatoid arthritis disease activity and improved life longevity.

Further study is needed, however, because not enough data existed to determine actual cause of death in a large number of cases. Researchers also said future studies would be valuable to assess the extent to which improved survival among rheumatoid arthritis patients is directly attributable to the improvement of rheumatoid arthritis management and disease activity.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/ra-survival-rates-outpacing-general-population

July 19, 2016 Posted by | Healthcare | , | Leave a comment

Methotrexate Associated with “Profound” Improvements in RA

Published on the June 27, 2016, Rheumatology Network website

By Whitney L.J. Howell

Methotrexate therapy in patients with rheumatoid arthritis can cause significant changes in clinical disease activity, researchers say.

The study appears in the June 16 issue of RMD Open.

To date, researchers said, there have been no studies into the mechanism of action of methotrexate which look at serial prospective measures of serum cytokines and simultaneous measures of pharmacokinetics and clinical variables.

In this prospective, open-label, long-term mechanism of action study, investigators looked to describe changes in immune parameters that are observed during long-term methotrexate therapy in patients with active rheumatoid arthritis. They also wanted to explore correlations with simultaneously measured methotrexate pharmacokinetic parameters.

Led by Joel M. Kremer, M.D., from the Division of Rheumatology at Albany Medical College, researchers demonstrated that methotrexate treatment is associated with serum interleukin-6 (IL-6) and interleukin-8 (IL-8) decreases. This three-year study, conducted in the 1990s, also shows these drops correlate well with long-term, sequential measures of methotrexate pharmacokinetics and with clinical outcomes.

Throughout the study, 17 patients received single, weekly 7.5 mg doses of methotrexate. The doses were adjusted for efficacy and toxicity throughout the study, and researchers gathered baseline measures for disease activity and took follow-up measurements every six months for three years. Each clinical evaluation assessed serum cytokine measurements in blood together with lymphocyte surface immunophenotypes and stimulated peripheral blood mononuclear cell cytokine production.

According to study results, cytokine concentrations revealed several significant correlations over time with disease activity measures. The two strongest were: interleukin-6 (r=0.45, p<0.0001 for swollen joints and r=0.32, p=0.002 for tender joints) and interleukin-8 (r=0.25, p=0.01 for swollen joints).

Results also found significant decreases for serum interleukin-1B, interleukin-6, and interleukin-8 from baseline measurements with interleukin-6 being the most substantial change (p<0.001). Data also revealed noteworthy increases from baseline for interleukin-2 release from peripheral blood mononuclear cells ex vivo (p<0.01). However, the change in swollen joint count correlated inversely with the changes for methotrexate (r=-0.63, p=0.007).

“These data strongly support the notion that MTX (methotrexate) mediates profound and functionally relevant effects on the immunological hierarchy in the RA lesion,” the researchers wrote.

Ultimately, investigators said, knowing methotrexate can significantly affect serum interleukin-6 will increase understanding around methotrexate’s mechanism of action. It also offers insight into further changes in transaminase levels and possible additive effects on interleukin-6 when used with biological response modifiers and Janus kinase inhibitors.

“The compelling relationship between the immune changes reported and simultaneous pharmacokinetic measures strongly suggest that the findings are related to methotrexate intervention and are not simply a surrogate for general disease improvement,” investigators said.

In addition, they said, the significant decrease in serum interleukin-6 observed with methotrexate may further explain increases in transaminase enzymes when the drug is combined with either interleukin-6 or Janus kinase inhibitors.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/methotrexate-associated-%E2%80%9Cprofound%E2%80%9D-improvements-ra?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=28062016

June 28, 2016 Posted by | Healthcare | , , , , , , | Leave a comment

High BMI Not a Factor in Axial Spondyloarthritis

Published on the June 22, 2016, Rheumatology Network website

By Whitney L.J. Howell

Researchers say it is not necessary to take body mass index into account when assessing disease activity in axial spondyloarthritis patients.

The study appears in the June 16 issue of RMD Open.

Physicians primarily rely on two measures to assess axial spondyloarthritis (axSpA) and ankylosing spondylitis disease status:  the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS). While BASDAI relies on patient-reported outcomes to measure ankylosing spondylitis in patients, ASDAS combines patient-reported outcomes with C reactive protein (CRP) to assess axial spondyloarthritis status.

Because adipose tissue is frequently associated with increased production of pro-inflammatory cytokines, such as C reactive protein, investigators hypothesized whether an elevated body mass index could be an accurate disease-activity indicator. Obesity, measured by body mass index (BMI), is associated with increased levels of C reactive protein (CRP). High levels occur in response to inflammation, including that associated with ankylosing spondylitis.

Led by Roxana Rubio Vargas of the Leiden University Medical Center in The Netherlands, researchers found body mass index only influences CRP blood serum levels in women. But, the impact is not clinically relevant.

Knowing whether body mass index and excess adipose tissue contributed to CRP levels and self-reported outcomes could influence how providers guide patients on how best to control their axial spondyloarthritis.

Using patients and data from the existing SPondyloArthritis Caught Early (SPACE) cohort, launched in January 2009, researchers evaluated 428 patients over age 16 who had chronic back pain for more than three months, but less than two years. Investigators divided patients into normal weight (body mass index ≤24.9) and overweight (≥25). Collected C reactive protein levels of ≥5 mg/L were considered elevated.

Of the 428 patients, 168 (39.3%) fulfilled the Assessment in SpondyloArthritis International Society axial spondyloarthritis classification. This group had statistically lower rates of overweight and obesity— 18.4% and 11.9%, respectively — than those without the condition — 31.5% and 14.2%, respectively. Among patients with axial spondyloarthritis and those without, overweight patients had statistically significant higher C reactive protein rates (p=0.02 and 0.01, respectively). Researchers also discovered body mass index increases C reactive protein blood serum levels by 0.35 mg/L for each body mass index point – but only for women.

Overall, the researchers found, the impact of body mass index on C reactive protein in women isn’t enough to warrant using it as a measure of disease activity. It also doesn’t significantly impact any patient-reported outcomes.

“In general, it is not necessary to take BMI into account when assessing disease activity by ASDAS in axSpA patients with high BMI, but there may be a slight increase in ASDAS in female patients with very high BMI,” researchers wrote.

Further research into the influence of body mass index on CRP is needed, though. Researchers recommend conducting MRI and spectroscopy studies on a larger sample size of overweight women with axial spondyloarthritis to achieve more accurate results.

To read the story at its original location: http://www.rheumatologynetwork.com/spondyloarthritis/high-bmi-not-factor-axial-spondyloarthritis

June 23, 2016 Posted by | Healthcare | , , , | Leave a comment

Challenges in the Radiologist-Technologist Relationship

Published on the June 9, 2016, DiagnosticImaging.com website

By Whitney L.J. Howell

In radiology, there’s no more important – no closer relationship – than the one between the radiologist and the radiologic technologist (RT). You work together day-in and day-out, but there’s no guarantee that your partnership is as healthy as it should be.

According to industry experts, effective radiologist-RT work habits should share some of the same characteristics, enabling those pairs to provide quality patient care. But, radiology has changed drastically over the past 25 years, and stumbling blocks challenge how smoothly your daily interactions will be in today’s environment.

“I remember the days of film in the 1990s when technologists would come into the reading room and hang the film,” said Paul Nagy, PhD, associate professor of radiology and radiological sciences at Johns Hopkins School of Medicine. “It was great because of the cross-section of interaction that happened when the radiologists looked at the film and gathered information from the tech for diagnostic purposes. But, there are several strains on the relationship today.”

There are strategies in place that are working to fortify the partnership, though, because this interaction is necessary to produce an actionable radiology report.

“The radiologist is very dependent upon the technologist to get the most information from patients,” said Michael Delvecchio, technical director of radiology at Brigham and Women’s Hospital. “It helps them get better reads and provide a better diagnosis.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/challenges-radiologist-technologist-relationship

June 9, 2016 Posted by | Healthcare | , , , , , | Leave a comment

Omega-3 Fatty Acids May Have a Protective Effect in RA

Published on the June 6, 2016, Rheumatology Network website

By Whitney L.J. Howell

The Omega-3 fatty acids found in certain fish can provide a possible protective benefit to individuals with rheumatoid arthritis and other related autoimmunity conditions. In fact, the benefit is strongest among those who have a genetic susceptibility to rheumatoid arthritis.

An Annals of Rheumatic Diseases studypublished in May, “Omega-3 fatty acids are associated with a lower prevalence of autoantibodies in shared epitope-positive subjects are at risk for rheumatoid arthritis,” found that people with the human leucocyte antigen class II genetic susceptibility are most likely to experience the positive result.

It’s the association between the n-3 fatty acids and anti-CCP2, the antibody that can pinpoint early rheumatoid arthritis development, as well as rheumatoid factor positivity, that supports the fatty acid’s ability to be protective, the study revealed. And, this work supports and furthers existing research, investigators said.

“Previous studies suggest n-3 [fatty acids] could possibly protect against the development of rheumatoid arthritis where our results suggest that the mechanism behind this might be through the prevention of autoantibody development,” they wrote. “More importantly, our results suggest the effect of longer-chain n-3 [fatty acids] on rheumatoid arthritis-related autoimmunity could depend on shared epitope status.”

Researchers recruited 2,166 participants from the Studies of the Etiology of Rheumatoid Arthritis (SERA) multi-center study, including those who didn’t have rheumatoid arthritis but were at-risk. They included two groups: first-degree relatives of persons with rheumatoid arthritis and parents of children with the allele for type 1 diabetes.

Each participant completed a 68-count joint exam and a questionnaire about environmental risk factors to evaluate the association between n-3 fatty acid supplement use and the prevalence of rheumatoid factor and anti-CCP2, the antibody that can pinpoint early rheumatoid arthritis development.

SERA participants were screened for shared epitope, the strongest predictor of seropositive rheumatoid arthritis. They were considered shared epitope positive if they a subtype of human leucocyte antigen-antigen D related 4 or –antigen D related 1 was present in their blood.

Investigators also conducted a 136-participant nested case-control study to understand the association between rheumatoid factor and anti-CCP2 positivity and n-3 fatty acid percentage in red blood cells.

According to results, in the shared epitope-positive group, rheumatoid factor cases are more likely to have lower levels of total red blood cell n-3 fatty acid percentage compared to the control group (OR 0.26, 95% CI 0.09 to 0.77, p=0.02). There was no association observed among the shared epitope-negative group.

In addition, data revealed an inverse association between anti-CCP2 positivity and the increasing total of red blood cell n-3 fatty acid percentage. (0.59, 95% CI 0.36 to 0.96) and the longer-chain n-3 fatty acids, eicosapentaenoic and docosahexaenoic acid (OR 0.56, 95% CI 0.34 to 0.92). The increasing total red blood cell n-3 fatty acid percentage was also inversely associated with anti-CCP2 positivity in shared epitope-positive participants (OR 0.44, 95% CI 0.21 to 0.93, p=0.03).

Based on questionnaire data, n-3 fatty acid supplement use was connected to a lower prevalence of anti-CCP2 in the shared epitope-positive group.

However, additional research is needed to study the interaction between n-3 fatty acids and shared epitope, as well as the progression of clinically-apparent rheumatoid arthritis. Doing so, investigators said, could offer insight into the group most likely to benefit from prevention strategies and how they are timed.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/omega-3-fatty-acids-may-have-protective-effect-ra

June 7, 2016 Posted by | Healthcare | , , , , | Leave a comment

Common Genetic Pathways Implicated RA and SLE

Published on the May 31, 2016, Rheumatology Network website

By Whitney L.J. Howell

Rheumatoid arthritis and lupus are distinct conditions that present in unique ways, but they do share various genetic risk factors. A recent study revealed a new risk locus for both diseases.

Previously, the genetic overlap between the two hadn’t been thoroughly examined. But, a study published in the May Annals of Rheumatic Diseases identified additional risk loci that are shared between rheumatoid arthritis and lupus.

Using genome-wide association studies, the study, “A combined large-scaled meta-analysis identifies COG6 as a novel shared risk locus for rheumatoid arthritis and systemic lupus erythematosus,” revealed the genetic variant rs9603612 is located near the COG6 (component of oligomeric Golgi complex 6) gene.

COG6 is located on chromosome 13q14.11, and it’s crucial to proper protein sorting and glycosylation. However, its role in immune-mediated disorders remains unknown.

This study is the first comprehensive, large-scale analysis that looks into the genetic overlap between both disorders. Small sample sizes has been a limiting factor to-date.

“Our results highlight the existence of a relevant genetic correlation between both diseases, as well as the influence of common molecular mechanisms in their pathophysiology,” the authors wrote. “Since common genetic pathways are implicated in rheumatoid arthritis and lupus, a reclassification of patients from a genetic point of view will lead to more specific and effective therapeutic procedures.”

Overall, researchers included 17,552 patients with rheumatoid arthritis, 4,194 patients with lupus, and 46,907 control patients. Data came from Sweden, the United Kingdom, Germany, Italy, Spain, The Netherlands, and the United States.

Through silico expression quantitative trait locus analysis, researchers learned the associated polymorphism acts like a regulator variant that influences COG6 expression. In particular, rs9603612 impacts the transcription factor binding and is linked to gene target expression, most likely regulating COG6 expression in monocytes.

According to investigators, the protein-protein interaction and gene ontology enrichment analyses pointed to an overlap with specific biological processes. Results pointed specifically to the type I interferon signaling pathway. Additionally, the genetic correlation and polygenic risk score analyses showed cross-phenotype associations between rheumatoid arthritis and lupus.

Bivariate analysis revealed a significant genetic correlation between rheumatoid arthritis and lupus. Polygenic risk score analysis showed significant differences between the case groups and controls and that lupus cases had a significant enrichment of rheumatoid arthritis-risk alleles.

The findings, they said, point to rs9603612 being a good candidate for being the casual variant involved in the genetic predisposition of autoimmune disorders.

To read the story at its original location: http://www.rheumatologynetwork.com/lupus/common-genetic-pathways-implicated-ra-and-sle

June 2, 2016 Posted by | Healthcare, Science | , , , , | Leave a comment

Unsung Hero of First U.S. Penile Transplant: Radiology

Published on the May 27, 2016, DiagnosticImaging.com website

By Whitney L.J. Howell

This month, medical news has been filled with fanfare about the first successful penis transplantation in the United States. According to all reports, the surgery was a success, but little attention has been paid to why the procedure went so well.

Working collaboratively, it took a multidisciplinary team of a dozen surgeons and approximately 30 additional members to attach a penis from a deceased donor to a 64-year-old man who had his penis removed due to penile cancer. But, crucial to this win , buried under the spectacle– and driving the capability to correctly attach the organ and provide full functionality – was radiology. Having clear glimpses into the body was critical for the surgical team.

“Radiology was integral because they created a road map for us with the diagnostic arterial angiography, CT angiography, and MRI,” said co-lead surgeon Dicken Ko, MD, director of the Massachusetts General Hospital (MGH) Urology Regional Program and associate professor of surgery at Harvard Medical School. “We could actually define how much tissue was left behind and what the possibilities were for reconstruction.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/interventional-radiology/unsung-hero-first-us-penile-transplant-radiology

May 30, 2016 Posted by | Healthcare | , , , , , | Leave a comment

Right From the Start

Published in the Spring 2016 University of North Carolina Greensboro Research Magazine

By Whitney L.J. Howell

The best foot forward. It’s what we all want for our children in those first few years. But, the question is — how do we get there?

Nationally and locally, debates rage. It’s difficult to find consensus on the best way to educate our children or even prepare them to be educated. One thing we can be sure of? It’s no simple task. It will require a lot of work and collaboration to get it right.

UNCG is leading the way. Here, researchers have investigated — sometimes for years — what it takes to make sure children are healthy and ready to learn. And, now, investigators are combining their knowledge, resources, and networks to meet these challenges directly.

Faculty and staff, from the UNCG Department of Human Development and Family Studies to the UNCG Center for Youth, Family, and Community Partnerships, conduct basic research, translate research into evidence-based practice, and help create local, state, and national educational policy. As they reach out to families, help towns and cities identify and intervene with struggling children, and teach professionals vital skills for the classroom, these investigators have one goal in mind — giving every child the right start.

“We take what we glean from research and teaching and put it together to make a difference. That knowledge shouldn’t remain in the academy,” says Dr. Chris Payne, director of the Center for Youth, Family, and Community Partnerships. “It’s our mission to work for the greater good of our community.”

The Importance of Early Social & Emotional Development

For children to maximize their educational experiences, it’s critical they come into the classroom ready to learn. That makes the first five years invaluable to healthy growth, Payne says. During that time, approximately 90 percent of brain structures develop, establishing the foundation for how a child learns and processes information.

The healthiest growth occurs, explains Payne, when children have secure relationships with their caregivers and feel free to express emotions, including fear, anger, and happiness.

Emotion Regulation

Although school carries an inherent focus on grades, academic ability isn’t the only factor determining whether a child is actually classroom-ready. Another key indicator is whether he or she can appropriately regulate emotions, says Dr. Susan Calkins. “The more structured preschool and school environments present a unique set of challenges to children — challenges that require emotional readiness.”

If you visit the Human Development and Family Studies (HDFS) professor’s lab while her team collects data, you’ll observe children singing, counting, or playing games. Others might be crying and flailing fists. They’re expressing a wide range of emotional abilities, dependent on their age and experiences.

While some children control their impulses by employing various learned strategies, others lack these skills and have trouble delaying gratification or managing frustrating tasks. Their negative emotional responses indicate immature emotional readiness.

“Being able to manage emotions is critical for academic achievement, school readiness, and mental health,” Calkins explains. Without emotion regulation skills, children can’t establish positive student-teacher and peer-to-peer relationships. If they can’t express themselves or manage their feelings in ageappropriate ways, they also risk social rejection. “If children don’t master emotional regulation, they face challenges for years to come.”

To help children reach appropriate levels of emotional maturity, adults must recognize their natural responses and know how to handle them, Calkins says. To find the tools parents and caregivers need, she and her team have recruited children from more than 450 families to participate in the RIGHT Track study.

Although we can begin to understand emotion regulation by observing the behavior of and collecting information from children and their caregivers, collecting data at the physiological level also provides a key piece of the puzzle in understanding not only how emotional regulation develops but also the degree to which it impacts various areas of the child development.

In one component of the study, Calkins team attaches heart rate electrodes to each child to measure their physiological arousal and then presents them with a frustrating task. Two-year-olds are asked to open a cookie jar that was glued shut or wait to open a present, while 5-yearolds are tasked with unlocking a box using a set of keys that does not actually include the correct key.

The team watches both the child’s actions as well as the caregiver’s responses. Did the children quit or did they stick with the task? Did the parent offer guidance or withdraw from the situation? Children and parents returned to the lab for more advanced tests as they aged.

“So far, we’ve seen that children who get extremely frustrated with these tasks also experience behavior problems,” Calkins says. “These kids who lack skills to control their emotions and cope are also more likely to experience depression and academic and health issues and to engage in substance abuse and risky sexual behavior later in life.”

There are many ways children can rein in overwhelming feelings. Distractions, such as singing songs, diverting concentration, or engaging in self-soothing behaviors, can effectively control emotions.

Knowing how to implement these behaviors helps a child navigate social and academic environments, says Calkins. They also help children stay focused on tasks and enhance their autonomy. When children have these skills, they can approach difficult situations without adult intervention.

Calkins’ findings are important not just for parents but for educators too. Early development of a positive teacher-student relationship can help children sidestep many of the aforementioned problems. “This is critical knowledge, especially in today’s kindergarten climate where we’re getting young children ready for a series of tasks and tests.”

Parent-Child Relationships

Healthy emotion regulation is imperative for children to achieve school readiness, but of course they can’t do it alone. Parents must be involved, points out HDFS professor Esther Leerkes. And, at every step, parents must provide age-appropriate guidance or children won’t internalize the correct skills.

“The quality of parenting matters. We know that how parents respond when a child is upset can help children learn to regulate their emotions — which in turn affects their early cognitive development and school readiness,” she says. “We also know if children struggle emotionally, they are more likely to struggle academically.”

Inside Leerkes’ lab, parents and young children are completing a treasure hunt. They must find the best route for a bear to cross a body of water and reach a prize on an island. While the child’s goal is getting to the treasure, the research team’s objective is to determine how differing parenting styles affect a child’s emotional and cognitive abilities and early readiness for school.

The kids and adults are participants in the School Transition and Academic Readiness (STAR) project. With over $6 million in funding over the last decade from the National Institute of Child Health and Human Development, Leerkes and her collaborators are following over 500 children from age 4 to the first grade.

It matters, she says, whether parents engage children in stimulating ways. The adults can choose to withdraw from the game, take it over, or engage the child and guide him or her through the process, helping them understand and make decisions.

The most successful children, she says, have emotionally supportive parents. They were involved in play and offered age-appropriate guidance, praise, and encouragement. Children faltered when parents took charge, became frustrated, or didn’t participate at all. Children were also more likely to lose interest, appear bored, or withdraw when parents pushed too hard or became negative.

Leerkes’ team also assesses the children’s physiological and neural activity as they problem solve.

For example, the team puts each child through a Stroop test. These tests tax participants by requiring them to inhibit their initial responses — a child might be required to say the word “night” when they see a picture of the sun. The researchers observe which regions of the brain are active, and they record how many picture presentations the children get right.

They’re looking to see, Leerkes says, what types of brain activity correlate to high performance levels. One day, their findings could help predict a child’s level of academic performance and perhaps even help identify children who need early interventions.

In another study with infants and toddlers, the team monitors both parents and children as children are presented with frightening or frustrating situations. Leerkes’ team has found that a younger child’s emotional control is strongly linked to the caregiver’s behavior and emotions. If parents exhibit frustration, irritation, or anxiety — identified by elevated heart rates accompanied by poor regulation — children aren’t as able to control their emotions and behavior. To minimize a child’s exposure to negativity, Leerkes suggests that parents pay attention to their own emotions while interacting with their children. Imagine your child’s perspective, she advises, and calm yourself by pausing to take deep breaths and relax when you can feel your own strong emotions rising.

When parent-child interaction is positive, everyone benefits, Leerkes says. Children develop better emotional control, and they use that skill to maintain their attention and manage their frustration, both critical for adaptive peer relationships and active engagement in school. And parents proudly watch their children succeed in school transitions.

Child Care Program Quality and Teacher Support

In laying the foundation for school readiness and a lifetime of success, we know that quality of parent-child interactions and the home environment is critical. But quality in other child care environments, including preschools and child care centers, is just as crucial.

It’s important for parents to know what an early childhood program offers, how effective their teachers are, and where the curricula are strong. In 1999, HDFS faculty Dr. Deb Cassidy, Dr. Linda Hestenes, Dr. Sharon Mims, and Dr. Steve Hestenes began collaborating with the N.C. Division of Child Development and Early Education to help parents make these important choices.

Their long-running N.C. Rated License Assessment project, which has received over $50 million in funding, rates child care programs throughout the state — currently over 7,000 programs. Of these, 45 percent of child care centers and approximately 11 percent of home-based programs have earned the top, five-star rating.

The N.C. Rated License Assessment project is just one of many ways UNCG is helping improve the overall quality of child care and education statewide. Another example? In conjunction with the N.C. Department of Public Instruction, HDFS Associate Professor Catherine Scott-Little is providing technical support for a new North Carolina K-3 assessment system. The system collects data on students from kindergarten through third grade, to help individualize their teaching and learning. Teachers, support staff, and families provide information for the assessment from observations, conversations, work samples, and more.

Teachers are better prepared and can better personalize teaching strategies when they understand how children learn. The K-3 Assessment system will arm teachers with a more complete picture of each of their students, improving their instruction and helping to meet their individual needs. With the information from the assessment Scott-Little is helping to design, teachers can more effectively target and teach to areas where high-need children need the most help.

A well-educated, prepared teaching staff is the biggest factor in achieving a five-star rating in the current N.C. Rated License guidelines. But finding the best qualified teachers to choose from can be difficult in the current environment of student loan debts and low teacher wages statewide. UNCG is taking steps to help grow our pool of highly educated teachers and to make sure they are supported and paid a living wage to keep them in the field.

HDFS Professor Deborah Cassidy has led the charge in preparing North Carolina teachers for more than two decades. Her latest focus is the EQuIPD (Education Quality Improvement & Professional Development) program. Funded by a Smart Start grant from the Guilford County Partnership for Children, EQuIPD is bringing professional development directly to existing early childhood professionals in Guilford County.

“Traditionally, early childhood professionals struggle to find the time and resources to get the continuing education and professional development they need,” says Cassidy. “Through this program, our staff brings interconnected services, such as peer coaching and training, directly to teachers and directors in early childhood settings. Together, we are implementing strategies we know have a direct impact on increasing the quality of early care and education.”

Another example of efforts in this area, says Cassidy, is UNCG’s mentoring program, which pairs teachers working in higher-quality programs with those working in lower-quality programs over a four month period. Mentors — who receive a stipend — meet regularly with mentees to discuss problems, strategies, and tactics. These conversations help identify opportunities for reaching children, as well as actions that might hamper a child’s academic progress. The connections are designed to give teachers a safe, reliable sounding board to analyze problems.

“The relationships that develop are more important than the content discussed. Being an early-education teacher can be isolating,” Cassidy says. “Having someone to discuss issues with can be invaluable.”

It’s also important, Cassidy says, for teachers to feel comfortable instructing students on complicated subject matters. To foster that confidence, UNCG supports community-training events that raise awareness of early-education topics through keynote speakers and workshops. For example, a recent session offered guidance for teaching science and math in age-appropriate ways. The hope, she said, is these sessions will enhance teachers’ abilities to create strong curricula that reach children of all readiness levels.

But having high-quality teachers who know how to reach students and who have targeted curricula that teach to every student’s needs means nothing if those teachers don’t make it into or stay in the classroom. There’s only one way to ensure high quality teachers are available, Cassidy says. Current and future educators must receive salaries that accurately reflect the time and effort that goes into the job.

To highlight this dire need, HDFS hosts Worthy Wage Day, an event that invites community leaders and politicians to work a child-care job for two hours, earning a teacher’s hourly pay — $10.97. They’re presented an honorary check during a press conference and are given the opportunity to discuss their experience.

Not only does Worthy Wage Day give community leaders a first-hand view of what teaching and caring for young children actually requires, but it also highlights the dire income insecurity experienced by many of North Carolina’s early-education teachers. Up to 45 percent receive income support. In fact, many can’t afford to enroll their own children where they work. Until this inequality is sufficiently addressed, Cassidy says, the state will continue to struggle to maintain a well-educated, dedicated, quality teacher workforce.

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2016/04/onlineUNCGResearchSpring016.pdf


May 25, 2016 Posted by | Education, Politics | , , , , , , , , , , , , , , , , , | Leave a comment

Beth Mayer-Davis

Published in the Spring 2016 Carolina Public Health Magazine

By Whitney L.J. Howell

Eat better and move more — that’s the quintessential prescription for what chronically ails most people. It’s simple and effective, and it works for many.

However, for some, despite their wish to be healthier, the prescription isn’t enough. There may be too little money to buy nutritious foods. Parents working two jobs may believe they have too little time to exercise or may need more education about how to implement changes. Because genes also play a key role in the development of chronic diseases such as diabetes, diet and physical activity might not be enough to prevent illness. Attention to lifestyle is critical, however, in preventing many complications of this very serious disease.

These circumstances highlight the need for targeted interventions to promote healthy lifestyles in communities that face more than their share of chronic conditions.

Gillings School of Global Public Health researchers are involved in a number of efforts to prevent or better manage diabetes, from discovery to application. (See sph.unc.edu/global/diabetes.)

Elizabeth Mayer-Davis, PhD, the Cary C. Boshamer Distinguished Professor and chair of nutrition at the UNC Gillings School, is one of those who are known and respected globally. For 25 years, Mayer-Davis has led the charge against diabetes, combating it through nutrition.

“I’m engaged to improve population health,” said Mayer-Davis. Social determinants are central to whether a person can succeed in preventing diabetes, can seek diabetes care if they’re diagnosed, and can care for themselves as they live with diabetes.”

Mayer-Davis has brought together academic, community and professional partners on several projects to fight diabetes.

Understanding the culture helps us face the challenge

Until the 1950s, there was no record of Type 2 diabetes in American Indian populations, but the disease began to surge in the 1960s and ’70s. Poverty, poor access to nutritious food, few opportunities and little support for physical exercise, and insufficient health education have added to the challenges.

“Reversing this trend among youth is critical, and the most effective strategy is weight management through healthful dietary choices and increased physical activity,” Mayer-Davis says.

However, effective interventions for weight management in American Indian youth have not been identified yet. In fact, even a “one-tribe-fits-all” approach won’t work, so Mayer-Davis’ team conducted a community-based participatory research study both with North Carolina’s Eastern Band Cherokee tribe and people from the Navajo tribe in Shiprock, Ariz.

In a two-year, National Institutes of Health-funded study, the team enrolled 61 children and their parents in a multi-component intervention that included a 12-session after-school program. The program offered exercise for children and behavioral-change classes for parents and youth, supplemented by individual child and parent counseling to aid in motivation, goal setting and problem solving.

Mayer-Davis says a wide range of topics are discussed in the sessions, including how to select healthful foods (given local food availability and cost), how to cook and how to make physical activity fun. “We tap into local culture in many ways, for example by incorporating native dance and native foods into classes,” Mayer-Davis says. “Native languages are used in all group sessions, and we celebrate local festivals, as appropriate. We provide opportunities for parents and their children to reflect on diet, physical activity and health and to develop specific goals and strategies to attain their goals.”

Understanding that families may face significant economic, medical or other difficulties, the program also provides resources and referrals when issues arise that are critical to the family’s overall well-being.

Initial results are promising. Children in the intervention have shown improvement in body mass index over time.

Type 1 diabetes

Traditionally, it was assumed that youth with Type 1 diabetes were invariably thin or of normal weight. Now, the prevalence of overweight and obesity in this group mimics the general population. Individuals with Type 1 diabetes face the same challenges related to weight management as anyone else, but also face unique challenges related to living with the disease.

Some youths choose not to take insulin to avoid gaining weight, thereby leaving their blood sugar uncontrolled. At the opposite end of the spectrum, low blood sugar requires treatment, typically with simple carbohydrates, and often is associated with hunger and overeating. Fear of low blood sugar can lead to avoidance of physical activity.

Mayer-Davis and colleagues have designed a behavioral intervention to help adolescents with Type 1 diabetes better control their blood sugar and maintain a healthy lifestyle. This intervention, called FL3X, is being tested in a multi-center randomized controlled trial funded by the NIH.

Chronic kidney disease

Chronic kidney disease (CKD) is a common and serious complication of diabetes.

“Nutrition is complicated for this group,” Mayer- Davis says. “CKD requires complex nutrition management designed to address kidney health, management of blood sugar and management of risk factors for cardiovascular disease.”

Through the Practice and Continuing Education (PACE) division in the nutrition department, which she established in 2015, Mayer-Davis collaborates with the Department of Medicine in the UNC School of Medicine. Renal dietitian and clinical assistant professor Shaun Riebl, PhD, RD, LDN, uses state-of-the-art behavioral strategies and motivational interviewing to help patients address their unique nutritional needs. The clinic also provides links to needed resources, including those addressing food insecurities.

“Dr. Mayer-Davis’ work at UNC Health Care is novel and provides smart and innovative ways to solve a population health challenge,” says Gillings School Dean Barbara K. Rimer. “By motivating patients with diabetes and helping them manage their individual nutrition needs, she empowers them to avoid rehospitalization.”

American Diabetes Association

Research-based knowledge is critical, but it is not effective unless translated successfully into clinical practice. Mayer-Davis’ close relationship with the American Diabetes Association, as board member and past president for health care and education, makes that transition easier.

She helped draft clinical guidelines and practice recommendations and led a clinical trial on weight management strategies in rural areas. The trial demonstrated the importance of providing insurance reimbursement for a sufficient number of intervention hours if desired outcomes were to be achieved.

“Our study, ‘Pounds Off With Empowerment,’ highlighted the reality that you may have an effective intervention, but if you can’t pay for it, it will sit on the shelf,” she says.

Overall, her diabetes research has focused upon providing the best possible evidence-based care to solve problems related to diabetes and its complications.

“These experiences inspire my work in population health,” Mayer-Davis says. “We must determine how to integrate clinical care with community and public health services if we are to address the social determinants of health that may have a detrimental impact upon care.”

This is particularly critical for vulnerable populations, including youth and individuals living in under-resourced environments.

“Until the worlds of clinical care and community services meet,” Mayer-Davis says, “we’ll fall short of what we can do to support, care for, and optimize health and well-being for people living with diabetes and other chronic conditions.”

To read the article at its original location: http://sph.unc.edu/cphm/beth-mayer-davis/

May 25, 2016 Posted by | Healthcare | , , , , , , , , | Leave a comment

TNFis Pose No Cancer Risk for Spondyloarthritis Patients

Published on the May 19, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with spondyloarthritis can confidently undergo treatment with tumor necrosis factor ⍺ inhibitors (TNFi) without fear of increasing their overall risk of cancer, a new study finds. Existing safety data is scarce, and cancer risks aren’t clearly understood.

According to a May 4 Annals of the Rheumatic Diseases  (ARD)  study from the Karolinska Institute in Sweden, patients who use TNFi to treat spondyloarthritis (SpA) have an equivalent overall cancer risk as those who have never received TNFi. There is also no increased risk for six site-specific cancers: prostate, lung, colorectal, breast, malignant lymphoma and melanoma.

Traditionally, TNFi is a standard part of treatment for chronic inflammatory disease, including rheumatological arthritis, SpA , ankylosing spondylitis (AS). psoriatic arthritis (PsA) and undifferentiatied spondyloarthritis (SpA UNS). The study aimed to evaluate the role TNFi plays in increasing cancer risk and how it could vary across inflammatory diseases by age, sex, lifestyle and previous treatments.

“Apart from the immediate clinical importance considering the increasing use of TNFi in SpA, the study of cancer risk in these patients may provide new insights different from RA cohorts,” researchers wrote. “Patients with SpA are younger, often male, have different lifestyles, frequently use biological DMARDs as monotherapy and have no intrinsic associations with, for example, malignant lymphoma.”

Researchers gathered data from the Swedish Anti-Rheumatic Therapy in Sweden (ARTIS) and Danish Biologic (DANBIO) registers. They included information on 8,703 SpA patients (ARTIS=5,448; DANBIO=3,255) who used TNFi treatments for the first time between 2001 and 2011. They also gathered data on 28,164 SpA patients who never used TNFi for the Swedish National Patient and Population Registers. In addition, 131,687 patients from the general population were included for comparison.

Based on their results, out of 1, 188 cancers among those SpA patients never used TNFi, the relative risk (RR) of cancer overall was 1.1 (95% CI 1.0 to 1.2). The 147 cancers among SpA TNFi users showed an RR of 0.8 versus TNFi-naïve patients (95% CI 0.7 to 1.0). The results were similar to AS and PsA when analyzed separately. Site-specific RRS were: prostate, 0.5 (95% CI 0.3 to 0.8), lung, 0.6 (95% CI 0.3 to 1.3), colorectal, 1.0 (95% CI 0.5 to 2.0), breast, 1.3 (95% CI 0.9 to 2.0), lymphoma, 0.8 (95% CI 0.4 to 1.8), and melanoma, 1.4 (95% CI 0.7 to 2.6).

Although the study represents the largest assessment of cancer risk after TNFi therapy in patients with SpA to date, there were some limitations to the study, such as the time span which may not have been long enough to detect effects of TNFi therapy that may occur years after exposure.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/tnfis-pose-no-cancer-risk-spondyloarthritis-patients

May 19, 2016 Posted by | Healthcare | , , , | Leave a comment


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