Aging With Grace: In-Home Assessments Lead To Better Care, Lower Health Costs

The March 2011 issue of the journal Heath Affairs highlights an evidence-based model of geriatric care management developed, implemented and tested by researchers and clinicians from Indiana University, the Regenstrief Institute and Wishard Health Services

Geriatric Resources for Assessment and Care of Elders (GRACE) optimizes the health and functional status of community dwelling lower income, older adults. GRACE is now in use by Wishard Health Services, the third-largest safety-net health organization in the United States; by HealthCare Partners Medical Group, a large managed care organization in Southern California and by a growing number of other organizations.

A previous clinical trial found that GRACE improves health and quality of life, decreases emergency department visits and lowers hospital admission rates in lower income older adults at high risk for hospital admission. The care delivery model focuses on the many issues faced by older adults — access to needed services, medications, mobility, depression, transportation, nutrition, as well as other health issues of aging.

“Healthcare reform is calling out for ways to improve health and lower costs. We have found a strategy to do that for a very vulnerable growing population in a way that shows cost savings over time and has the added benefit of providing services that these seniors desperately need but can’t get elsewhere,” said Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor of Geriatrics at the IU School of Medicine, an IU Center for Aging Research center scientist, a geriatrician at Wishard, and an affiliated scientist of the Regenstrief Institute, the principal investigator of the GRACE clinical trial. He is currently leading GRACE dissemination initiatives while working to influence health policy to improve integration of medical and social care for vulnerable elders.

The key to GRACE is two teams. The support team, consisting of a nurse practitioner and a social worker, meet with each patient in the home to conduct an initial comprehensive geriatric assessment from the medicine cabinet to the kitchen cabinet. Based on the support team’s findings, a larger interdisciplinary team (including a geriatrician, pharmacist, mental health social worker, and community-based services liaison) helps develop an individualized care plan.

Then the ball is back in the support team’s court. The nurse practitioner and the social worker meet with the patient’s primary care doctor to come up with a healthcare plan consistent with the patient’s goals, such as maintaining the ability to participate in social and religious activities. The support team then works with the patient to implement the plan which contains strategies for medical issues of concern as well as elements related to maintaining quality of life. With the assistance of an electronic medical record and web-based tracking system, the GRACE support team provides ongoing comprehensive care management.

Because it improves health and quality of life, GRACE is cost effective. By the second year GRACE even saves money for the sickest (those with three to four chronic diseases). Results of the GRACE trial were published in the Dec. 12, 2007, issue of the Journal of American Medical Association (JAMA). The cost analysis of the GRACE model was published in the August 2009 issue of the Journal of the American Geriatrics Society.

“The GRACE model improves health and reduces healthcare costs by lowering hospitalization rates in high risk seniors. The GRACE intervention can be financed by a health plan under managed care Medicare using the savings from fewer hospitalizations to offset GRACE program expenses. Most seniors, however, are not enrolled in managed care Medicare plans, and most services provided by the GRACE program are not currently reimbursed by traditional fee-for-service Medicare. Thus, payment reform is needed for broad dissemination of the GRACE model to benefit seniors under traditional Medicare. We are pleased that the newly created U.S. government Center for Medicare and Medicaid Innovation is looking at GRACE and other novel ways of delivering medical care and paying healthcare providers that can improve health and also save money for Medicare and Medicaid,” said Dr. Counsell.

Development of GRACE was funded by the National Institute on Aging, the Nina Mason Pulliam Charitable Trust and Wishard Health Services. Dissemination of GRACE to Healthcare Partners Medical Group was supported by a grant from The SCAN Foundation, based in Long Beach, California. The SCAN Foundation is dedicated to creating a society in which seniors receive medical treatment and human services that are integrated in the setting most appropriate to their needs.

The Indiana University School of Medicine, the Regenstrief Institute and Wishard Health Services are located on the Indiana University-Purdue University Indianapolis campus.

Source:

IU School of Medicine

UK Travellers Could Pay The Price For Paradise – More Brits Considering Long Haul Trips But Ignoring The Threat Of Malaria

Brits taking advantage of last-minute credit crunch deals to tropical destinations could be seriously risking their health, according to a survey of over 1,000 UK travellers.1

Published to coincide with Malaria Awareness Week, the survey has revealed that while over half of the 1,004 (52%) Survey of 1,004 people – Malaria Awareness Campaign Holiday Health Survey (2009), Tickbox, April 2009 questioned will consider travelling to a long haul destination rather than Europe this year, a shocking 63%1 will think first about buying new clothes, looking good and working out what they will do when they get there, rather than seeking travel health advice to avoid potentially deadly diseases such as malaria.

Only just over a quarter of those surveyed (27%)1 said they would consider seeking travel health advice before they fly off. This attitude was particularly rife among 16-24 year-olds, 78% Sample of 55 16-24 year olds from the Survey of 1,004 people – Malaria Awareness Campaign Holiday Health Survey (2009), Tickbox, April 2009 of whom placed having fun and looking good at the top of their priority list. Only 4%2 in this age group said they would seek travel health advice after booking their bargain break.

Furthermore, of those who had already visited a country with a malaria risk, more than a quarter (26%) Sample of 443 who had visited a country with a malaria risk, from the Survey of 1,004 people – Malaria Awareness Campaign Holiday Health Survey (2009), Tickbox, April 2009 did not take antimalarials on their last trip. Slightly less than half of those surveyed were not aware that Thailand (49%)1 and the Dominican Republic (41%)1 have malaria risks, despite Thailand being the most popular winter destination for travellers in 2008-9, with bookings up 18% from last year. Winter booking figures for 2008/09 for UK holidaymakers departing by end of February 2009, Ascent Market Intelligence

Between 1,500 and 2,000 travellers have returned to the UK with malaria every year for the last ten years, with over 70% of cases contracting the most dangerous strain, Plasmodium falciparumFigures taken from cases over a ten year period from Imported malaria cases and deaths, United Kingdom: 1989-2008, Health Protection Agency, April 2009. Available here. [Accessed 30 April 2009].

Despite increased awareness of the dangers of malaria among British travellers, an
average of 10 people returning to the UK with the disease die every year.5

Frances Tuke, representative of the Travel Association, ABTA, says: ‘The survey results are particularly worrying as this year we have seen an increase in people booking last minute holidays, mainly due to the strong Euro against a weak pound making long-haul travel to tropical destinations particularly attractive.’

Frances continues: ‘Malaria is increasingly a major health concern for British travellers who are travelling further afield. What’s worrying about the results of this survey is not only the ignorance that exists around the countries that carry a risk of malaria, but the fact that travellers’ priorities are fixed on trivial matters such as buying new clothes rather then seeking travel health advice.’

While the trend for long haul travel bookings is good news for the tourism industry, it could be bad news for travellers’ health: ‘We know from studies that people who book their trips at the last minute are much less likely to seek travel health advice before they go,’ says Dr George Kassianos, GP and member of the UK Malaria Guidelines Committee.

‘Deaths can occur within 24 hours of the first symptoms of the most dangerous strain of malaria, so all travellers need to recognise the importance of speaking to their GP, practice nurse or travel clinic before going abroad. Ideally, appointments should be made six to eight weeks before travel, but even later than this, your healthcare professional can still recommend a number of options.’

Malaria is one of the world’s biggest killers – but it is overall preventable if the right steps are taken, such as avoiding being bitten and taking antimalarial medication as instructed: ‘With people visiting more exotic destinations and malaria hotspots changing over time, up-to-date health advice should be considered just as essential as renewing your passport,’ adds Dr Kassianos.

For more information on malaria, please visit: malariahotspots. To find out if your next holiday destination is a malaria hotspot, text the destination to 07800 000 571.

Source
GlaxoSmithKline Travel Health

News From The Jan. Issue Of Chest

MUSCLES ARE AFFECTED BY CIGARETTE SMOKING

A new study has revealed the effects of smoking on skeletal muscles. Researchers from Venezuela studied the vastus lateralis muscle in 14 smokers and 20 nonsmoking control subjects. Elements such as muscle structure, enzyme activity, constitutive and inducible nitric oxide synthases, and the presence of macrophages were analyzed. Researchers found that some muscular structural and metabolic damage was present in the smokers, but they did not exhibit local inflammation. In addition, the findings suggest a possible effect of tobacco smoke impairing the normal process of nitric oxide generation. This study is published in the January issue of the journal CHEST.

FLU VACCINE MAY NOT BE NECESSARY FOR PATIENTS WITH ALPHA-1 DEFICIENCY

The influenza vaccine is recommended for all patients with COPD, including those with alpha-1 antitrypsin deficiency (AATD). However, a new study shows that while people with AATD receive adequate vaccination, it may not have a significant impact on disease exacerbations. Researchers from the University of Miami, the Miami-Dade Health Department, and National Jewish Medical and Research Center conducted monthly phone calls with 939 subjects with AATD during the 2003-2004 flu season, 81% of whom received a vaccine. No significant differences were noted in the number or severity of acute exacerbations between patients who received the vaccine and those who did not. Researchers also found that there were no significant differences in the scheduled visits, emergency room visits, or hospitalizations between the two groups. This study is published in the January issue of the journal CHEST.

ICU MEDICAL CARE AT THE END OF LIFE CONTINUES TO RISE

As a result of hospice expansion in the 1990s, it was believed that ICU use would decrease over time in older adults with advanced lung cancer. However, new research from the University of Texas Medical Branch – Sealy Center on Aging shows that the opposite is true. Using retrospective analysis, researchers determined that ICU use for patients in the last 6 months of life increased from 17.5% in 1993 to 24.7% in 2002, and that there was a 6.6% annual increase in ICU use from 1992 to 2002. However, researchers also noted that there was an increase in hospice care during that time. This study is published in the January issue of the journal CHEST.

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Source: Deana Dziadosz

American College of Chest Physicians

What Is Q Fever (Query Fever)? What Causes Q Fever?

Q fever, also known as Query fever is a bacterial infection caused by the coxiella burnetii bacterium. Animals, most typically sheep, goats, cattle and other livestock infect humans – i.e. humans get it from animals. The organism is uncommon.

People become infected by inhaling contaminated particles of air, or from contact with milk, urine, feces, vaginal mucus or semen of infected animals. The incubation period – time from initial infection to the appearance of symptoms – is from 9 to 40 days.

Experts say Q fever may be considered the most infectious disease in the world, as a human being can be infected by a single bacterium.

The infection is also known as Query fever because when it was initially identified nobody knew what caused it. Even though we now know what the cause is, the term query has continued.

There are two main types of Q fever:

Acute Q fever – the most common and less serious type. The infected individual experiences flu-like symptoms, including muscle pain and an elevated body temperature (fever). In rare cases mild pneumonia may develop, and/or mild hepatitis.

Chronic Q fever – much less common, but more serious. The inner lining of the heart may become inflamed (endocarditis) – this is potentially extremely serious. If left untreated it could lead to heart failure.
According to the National Health Service (NHS), UK, Q fever may occur in many parts of the world, especially in Australia and the south of France. Approximately 70 cases are reported annually in the UK. The figure is probably much higher because people with mild symptoms may not seek medical help. According to the Centers for Disease Control and Prevention (CDC), USA, on average, approximately 50-60 cases of Q fever are reported in the United States each year, and the average annual reported incidence is 0.28 cases per million persons.

People who are in contact with livestock (farm animals) have a significantly higher risk of developing Q fever; these may include farmers, stablehands, meat packers and abattoir workers (slaughterhouse workers).

In the majority of cases, individuals with acute Q fever make a full recovery within a few weeks without treatment. Experts say that antibiotics can help relieve symptoms within a few days. Chronic Q fever is usually fatal if left untreated. Outlook for patients with chronic Q fever depends on whether they have access to antibiotics. Outlook is moderately good if the patient has treatment (NHS: mortality 10%). People with chronic Q fever commonly have to take antibiotics for several years to prevent recurrence.

There is a Q fever vaccine which has been produced in Australia. In some countries, including the UK, it has not been licensed for use. British authorities are still deciding whether to approve the vaccine for high-risk individuals.

According to Medilexicon’s medical dictionary:

Q fever is a disease caused by the rickettsia Coxiella burnetii, which is propagated in sheep and cattle, in which it produces no symptoms; human infections result from contact not only with such animals but also with other infected humans, air and dust, wild reservoir hosts, and other sources.

What are the Signs and Symptoms of Q fever?
A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms develop between 7 and 40 days after the initial infection – this is known as the incubation period.
Acute Q Fever – possible signs and symptoms include:
Fever – a body temperature of at least 39.4C (104F)
Very bad headache
Muscle pain
Joint pain
Sweats
Photophobia – sensitivity to light
Weight loss
Skin rash (rare)
Mild pneumonia (rare) – symptoms here may include a dry cough, sharp chest pain that worsens when the patient breathes deeply, coughs or laughs.
Hepatitis, inflammation of the liver (rare) – symptoms may include yellowing of the skin and whites of the eyes (very rare)
Chronic Q Fever – signs and symptoms generally appear about six months after the acute Q fever. The most common symptom is Endocarditis.

Endocarditis – the heart consists of four chambers and four valves – these have lines around them with a thin layer of cells (a membrane). This membrane is called the endocardium. An infection of the endocardium causes endocarditis. Put simply, endocarditis is inflammation of the inner lining of the heart. Signs and symptoms of endocarditis include:
A high temperature (fever)
A new heart murmur
Aching muscles (sometimes quite painful)
Alterations in heart murmur
Bleeding under fingernails or toenails
Broken blood vessels in the eyes
Broken blood vessels in the skin
Chest pains
Coughing
Headache
Shortness of breath (panting)
Small lumps (nodules) on fingers and/or toes
Sweating (this may include night sweats)
Swelling of abdomen
Swelling of limbs
Tiredness (fatigue)
Unexpected weight loss
Weakness
Mild pneumonia may also develop.

Osteomyelitis – bone infection. Patients typically experience deep pain and muscle spasms in the inflammation area, as well as fever.

What are the Risk Factors for Q Fever?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Occupation – people who are exposed to livestock (farm animals) and animal products have a higher risk of developing Q fever, such as veterinarians, meat processing workers, livestock farmers, those involved in animal research, and abattoir (slaughterhouse) workers.
Geographical location – being near a farm or farming facility may increase the risk of developing Q fever. The bacteria may travel through the air and be inhaled.
Gender – males are much more likely to develop symptomatic acute Q fever.
Medical history – people who have had acute Q fever are at risk of developing the chronic form of the disease, especially individuals with heart valve disease, blood vessel abnormalities, some kidney diseases, as well as patients with a weakened immune system.

What are the Causes of Q Fever?
The bacterium, coxiella burnetii (or c. burnetii) usually spread to animals by infected ticks. C. burnetii samples have been found in nearly all types of animals, even fish. As far as humans are concerned, the animals that pose a risk are:
Sheep
Cows
Goats
Pets, such as dogs, guinea pigs and cats
In the majority of cases the infected animal has no signs or symptoms. This makes it hard to know whether an animal is infected. Infected animals are much more likely to have miscarriages.

The infected animal may release the bacteria through its:
Milk
Urine
Feces
Placenta – a birth by-product. The placenta is the organ that connects the fetus to its mother. Birth products contain the highest number of c. burnetii bacteria. According to the NHS, UK, an estimated 1 gram of infected bacteria can infect 100 million guinea pigs with Q fever.
Humans can become infected by either indirect or direct exposure to infected animals:
Direct exposure – most commonly, the human inhales small particles released by an infected animal, such as when the animal is giving birth or being slaughtered.
Indirect exposure – the c. burnetii bacterium is hardy and may survive outside its environment, such as in soil, for up to 10 months. Contaminated soil, dust or hay may be picked up by the wind, spreading the bacteria over a long distance. A 2003 Q fever outbreak in an Italian prison was believed to be caused by contaminated dust that had originated from a nearby field where sheep had been grazing.
Unpasteurized milk from an infected cow, sheep or goat may also be a source of human infection.
Experts say that the only way a human can infect another human is either by sexual intercourse, or by an infected pregnant mother to her fetus (unborn child).

What are the Causes of Chronic Q Fever?
In the majority of cases, chronic Q fever develops in patients with certain pre-existing health conditions, such as:
Heart disease – especially stenosis or other diseases that affect the heart valves
Kidney disease
Blood cancer – such as leukemia or lymphoma
Weakened immune systems – patients with weakened immune systems, such as those with HIV/AIDS, or patients receiving chemotherapy or long-term steroids.

How is Q Fever Diagnosed?
The doctor, often a GP (general practitioner, primary care physicians) will carry out a physical examination, and also ask the patient questions about his/her occupation.

Some blood tests may be ordered, and other tests too if the doctor suspects chronic Q fever.
Platelet count – this is a blood test that calculates the number of platelets in a volume of blood. Platelets are the smallest cell-like structures in the blood. This test result may suggest Q fever, but it is not definitive.
Serologic testing – test of blood serum for the diagnosis of infectious diseases. In this case, to determine whether there are any antibodies to the c. burnetii antigen. An antigen is anything that causes an immune response when it enters the body, such as bacteria, foreign blood cells, and the cells of transplanted organs.
Echocardiogram – this may be done if the doctor suspects chronic Q fever. Sound waves produce images of the parts of the heart, including muscle, valves and chambers. This allows the doctor to look at the structure and workings of the patient’s heart in more detail. Clumps of bacteria and cells (vegetations) can be identified with an echocardiogram, as well as infected or damaged heart tissue.

What are the Treatment Options for Q Fever?
Acute Q fever treatment – mild or nonsymptomatic (no symptoms) cases usually resolve within a couple of weeks without any treatment. Even so, doctors will generally recommend treatment, even if there are no clear symptoms, to prevent any subsequent complications.

Antibiotic – doxycycline is the standard treatment for Q fever. In most cases the patient will take it for two or three weeks – course duration depends on the severity of the infection. As the antibiotic is most effective within one week of symptoms onset, it is important to take it as soon as possible.

The doctor may ask the patient to return in six months for serologic testing to determine whether the Q fever has returned. If specific antibodies are detected, another course of antibiotics will be required.

Chromic Q fever treatment – in this case antibiotics are taken for much longer, often for at least 18 months, and in advanced cases perhaps for four years.

Q fever endocarditis – the patient may require surgery to remove or graft affected heart valves, or to repair an aneurysm. An aneurysm occurs when part of a blood vessel (artery) or cardiac chamber swells, – either the blood vessel is damaged or there is a weakness in the wall of the blood vessel. As blood pressure builds up it balloons out at its weakest point. The swelling can be quite small or very large – when large it tends to extend along the blood vessel. As the aneurysm grows there is a greater risk of rupture – this can lead to severe hemorrhage, and other complications, including sudden death.

The patient will need to keep coming back for checkups for several years, in case the infection returns.

Pregnancy – most of the antibiotics used for Q fever treatment are not recommended during pregnancy, treating a pregnant woman is not easy. The patient may chose to wait until after giving birth before receiving treatment – however, this decision carries its own risks; Q fever can cause complications for the baby. It is important that the medical staff explain all the treatment options and their risks clearly to the patient.
What are the Possible Complications of Q Fever?
Q fever has the potential to affect many organs, including the heart, lungs, brain and liver. The following complications are possible:
Endocarditis
Pneumonia
Acute respiratory distress – the body does not get enough oxygen. This is a medical emergency.
Pregnancy complications – miscarriages, low birth weight, premature birth, stillbirth, and intrauterine growth retardation.
If the patient does not have any underlying disease/condition, has a healthy immune system, and receives treatment, the risk of complications is minimal. Even people at risk of complications have those risks significantly reduced if they receive prompt treatment.
Preventing Q Fever
Occupational hazards – it is important that preventative measures are in place to minimize the risk for people who work with animals and animal products. For example, all animal birth products should be disposed of properly, and access to infected animals should be strictly restricted.

Pasteurizing milk destroys the bacterium that causes Q fever.

Be careful not to touch anything that has been in contact with animal urine, feces or blood.

If you have an underlying disease/condition, such as chronic kidney disease, heart valve problems, abnormalities with blood vessels, or a weakened immune system, try to avoid jobs, such working with livestock, in an abattoir (slaughterhouse), a meat packing factory, or a veterinary center.

Pregnancy – avoid contact with farm animals, especially when they are giving birth, e.g. lambs and sheep during the lambing season. Avoid contact with clothing and footwear worn by people who were in contact with animals, such as ewes and lambs.

Q&A About Bird Flu Vaccine For Poultry

As the UK Government takes precautionary measures and places an order for over 2 million doses of Nobilis Influenza, the vaccine licensed in the UK to protect birds against the H5N1 avian flu strain, Intervet UK sets out the argument for vaccines. General manager of Intervet UK, Jim Hungerford, answers some of the topical questions.

Why do you have a vaccine for the H5N2 strain of avian flu when it is the H5N1 strain that is causing the problem?

Intervet produces a H5N2 vaccine, which is closely related to the present H5N1 strain so that it induces protection, but also allows differentiation of vaccinated versus infected birds.

How quickly will the birds be protected after vaccination?

Birds have to build up immunity following vaccination. We have indications that the protection starts 1-2 weeks post vaccination. After 3 weeks, there is significant protection that peaks at approximately 5 weeks after vaccination. The duration of protection is increased to one year by re-vaccinating 6-10 weeks after the first vaccination.

The first injection will provide protection against clinical disease from at least 2 weeks onwards and reduce excretion of virus dramatically. As a result, it will reduce the spread of disease and, for the few birds that do get infected the amount of virus produced will be drastically reduced.

Are there any vaccination methods other than injection?

The vaccines currently used are inactivated vaccines, which means that the virus is inactivated (not live) and in order to get a good immune response the vaccine has to be injected. Intervet is investigating the possibilities for mass application, which could be for example spray or water application. However, this does require developing a new type of vaccine, e.g. by applying biotech methods. Research projects are in an early stage and it will take time before such a product can be registered and then brought to the market.

How can vaccinated animals be differentiated from infected animals?

Intervet’s vaccine is based on a different strain (H5N2) than the current field strain (H5N1). Because the vaccine is based on a H5 strain it fully protects against all H5 viruses. If you vaccinate with H5N2 you get extra antibodies in the vaccinated animals (against the N2) that you don’t get if birds get infected with H5N1. You can monitor these antibodies with a number of standard methods.

Does the vaccination mask field infection?

No. Vaccinated chickens may rarely still become infected. A minority of these few chickens may still excrete a very limited amount of virus. However, the amount of virus is too small to infect other vaccinated birds. The excretion is so limited that it does not lead to the transmission of the virus.

In Hong Kong, Intervet’s vaccine has been used extensively on infected farms. On these farms virus transmission was blocked completely from 18 days after vaccination. Vaccinated birds no longer transmitted the virus and did not turn into carriers.

Further information is available on our dedicated website avian-influenza

How is avian flu transmitted from bird to bird and from birds to humans?

Infected birds excrete high amounts of virus in their droppings, which facilitates further spread. Bird to bird infection mainly occurs by inhaling the virus whilst breathing. From poultry house to poultry house the virus is transmitted mainly by contact with contaminated equipment and/or movement of birds and people. People can be become sick when they are exposed to a large amount of virus caused by intensive contact with infected birds.

Is it safe to eat birds vaccinated with inactivated AI vaccine?

Yes, it is perfectly safe. To keep birds healthy, all of our commercial British poultry are vaccinated routinely against various diseases, so of course poultry products from those vaccinated birds are safe for consumption. This is the same for birds vaccinated with Nobilis Influenza. The withdrawal period for the vaccine is zero days. (The withdrawal period is the time which passes between the last dose of a medicine given to the animal and the time when it can be used for human consumption).

Therefore, it is both safe and effective for poultry to be vaccinated and safe for people to eat birds that have been vaccinated. There is also no risk associated with eating eggs from vaccinated hens. It is important to emphasise that avian flu cannot be passed on by eating poultry or eggs.

Statement from an independent third party

The Netherlands Nutrition Centre (Voedingscentrum) states that eating prepared chicken meat and eggs is safe even when avian flu is prevalent. This also applies when it comes from chickens which have been vaccinated against avian influenza. The virus can only infect people who have intensive contact with sick or dead birds.

Moreover, the Government will make every effort to ensure the virus is not present in chickens and eggs that are sold. This will not only protect the consumer but will also prevent the spread of the disease. In the hypothetical event that infected chicken meat or eggs would be sold the virus will not survive cooking.

Do you make vaccines for avian flu regularly?

Yes, we produce vaccines on a regular basis to protect birds against Avian Influenza caused by different strains occurring more frequently such as H9, H5, H7.

How much vaccine do you have available? How quickly can you supply? Is it enough for the countries affected now?

We produce the vaccine in question on a regular basis. We have sufficient stock to support our regular sales. In case of a sudden substantial increase in demand we still can increase our production. However, delivery can vary from a few weeks to some months. This depends on the stage of the production process, orders that have been placed and our current stock situation. We can only supply if we receive official orders. We cannot guarantee immediate supply if demand is growing.

Britain’s first shipment of Nobilis Influenza vaccine will arrive by mid March.

How long does it take to make new batches of vaccines?

It normally takes months to start from the suitable antigen in stock before you have produced a batch and you then have to run all required quality control tests. Even if you speed up production as much as possible, it will still take several weeks to get a batch produced ready for tests.

Testing of the vaccine has to be done according to European Regulations on antigen and final product. In case of an emergency, testing of the final product can (partially) be waived with approval of the UK authority, and if so the product may become available earlier.

Where is your avian flu vaccine made?

Intervet routinely produces AI vaccines in Spain and Mexico.

How are the birds actually vaccinated?

Birds are vaccinated by injection under the skin or into the muscle.

How much does it cost to vaccinate?

The vaccine costs around three pence per dose, which equates to six pence per bird, as they need two doses. There are also associated labour costs for administering the vaccine.

What is your recommendation regarding vaccination?

Intervet is recommending that the UK’s free range hens (approximately 9 million) and other outdoor birds are vaccinated to help in the fight to keep avian flu out of the UK’s poultry flock.

Wouldn’t it be cheaper just to move the free-range hens indoors?

While this is a good theoretical solution, we believe that it would be impossible to achieve in reality without serious welfare implications. Some free range farmers will not have the facilities to do this and hens that are not used to being kept in close proximity have a tendency to fight. A pro-active vaccination policy will also help avoid the need for millions of birds to be destroyed should an outbreak occur.

What protocol has the Dutch Government adopted with regards to vaccination?

The Dutch Government is already vaccinating zoo birds and endangered species. It has also developed a programme for its free range poultry flocks, incorporating elements of planned vaccination, response assessment and sentinel birds. Intervet believes this type of integrated programme is critical to the successful use of the vaccine.

The aim of the Dutch vaccination programme is to reduce the risk to AI by protecting free range and hobby poultry. Vaccination is at the producer’s cost, with the Government paying for the diagnostics.

What about the French Government’s prevention plan?

The French Government has implemented a vaccination programme to protect target species like geese and ducks which are kept for rearing. The programme applies to breeding farms located in 373 communities throughout in the regions of Landes, Loire and Vendйe.

At present, the vaccination protocol relates only to the geese and duck farms where confinement is not feasible.

intervet

Air Pollution Linked To Bronchitis In Preschoolers

In one of the first studies to examine air pollution in relation to infant and early childhood health, a UC Davis researcher has discovered a strong link between exposure to components of air pollution and acute bronchitis diagnoses in preschool-aged children. Those components – polycyclic aromatic hydrocarbons, or PAHs – contribute to air pollution from a variety of sources, including coal burning, vehicle exhaust, wood-burning stoves, tobacco smoke and grilling food.

Led by UC Davis environmental epidemiologist Irva Hertz-Picciotto, the Czech Early Childhood Health Study involved 1,133 children from birth to 4.5 years of age born in two districts of the Czech Republic between 1994 and 1998. One of those districts, Teplice (pronounced Tuh-PLEET-zuh), is known for its high levels of air pollution. The other, Prachatice (pronounced prah-kuh-TEET-zuh), has much lower levels of air pollution.

Hertz-Picciotto and colleagues compared information on medical diagnoses of lower respiratory illnesses such as bronchitis, croup, pneumonia and asthma with detailed data on air quality. The findings revealed a significant increase in diagnoses of acute bronchitis when children aged 2 to 4.5 were exposed to medium-to-high levels of PAHs for 30 consecutive days.

“This is the first large-scale, comprehensive study looking at early childhood respiratory infections and the constituents of today’s air pollution,” said Hertz-Picciotto, a UC Davis professor of epidemiology and lead author of the study. “We found that polycyclic aromatic hydrocarbons have a significant effect on the lung health of children in the study, in particular in increases in acute bronchitis diagnoses for toddlers and preschoolers. We saw the biggest impact on children old enough to play outside, while infants were affected but not quite as much.”

Scientists classify the components of air pollution as either particles or a variety of chemical compounds. Whereas a number of studies have examined particles, sulfur dioxide and ozone, very little research in human populations have addressed PAHs, which result from the incomplete combustion of carbon-containing fuels such as wood, coal, diesel or tobacco. Current environmental regulations in both the United States and Europe focus on controlling particulate emissions.

“Our work strongly suggests that regulators consider efforts to curb PAHs as well. Reducing particles may also reduce chemical emissions but the impact will depend on what control measures are taken. When it comes to children’s lung health, we need to take steps to reduce all risk factors,” Hertz-Picciotto said. “Additional precautions particularly pertinent here in California to protect children from the harmful effects of PAHs include not smoking around children and using alternatives to wood for heating homes in the winter.”

Hertz-Picciotto and colleagues collected standardized medical records and information from parent questionnaires about work history, demographics, lifestyle, and reproductive and medical histories. Follow-up information was collected once for each child at the age of 3 for those born between 1994 and 1996 and at age 4.5 for those born in 1997 or 1998.

At the same time, the team collected detailed air quality sampling data on levels of particulate and PAH air pollution in the regions. PAHs are particularly difficult and expensive to measure. Hertz-Picciotto and her researchers had unique access to daily measures of air quality — both particulate matter and PAHs — for winter months, while measures were taken at three-day intervals in the fall and spring and six-day intervals in the summer when these air pollutants are at their lowest. As a result, the volume and detail of medical and environmental data used in the analysis is uniquely robust and allowed researchers to control for a whole host of potentially confounding factors.

“It is an impressive amount of very complete data, giving us a rare opportunity to look at the impact of air pollution on the health of young children and the actual components comprising that pollution,” Hertz-Picciotto explained. “We were able to correct for everything from duration of breast feeding to smoking in the home to average daily temperature.”

The PAH levels identified in the Czech Republic are comparable to those found in Western Europe and the United States. Some rural areas of California, for example, see sharp increases of PAHs in the winter due to the burning of wood stoves for heat. Likewise, increases in bronchitis in the Czech children were seen in the winter months when air quality was the poorest.

In addition to comparable air pollution profiles to those in the United States, the Czech Republic was an ideal study site for evaluating physician-diagnosed illnesses because of its open public-health infrastructure. All citizens of the Czech Republic are entitled to free, readily available medical care. Families remain with one pediatrician for all of their children from birth to adulthood. For researchers, this meant access to thousands of standardized medical records and participation rates of more than 95 percent by those asked to fill out follow-up questionnaires.

“There are virtually no barriers to receiving health care in the Czech Republic and virtually all families develop strong, lasting relationships with their pediatricians and nurses,” Hertz-Picciotto said. “This definitely helped keep participation levels high.”

Bronchitis occurs when the inner walls that line the main air passageways of the lungs become infected, inflamed and narrowed. It usually follows a cold or the flu. The result is a persistent, productive cough, shortness of breath and chest tightness and pain. Some cases of bronchitis can be treated by antibiotics but most are due to viruses, for which there are no treatments. Acute bronchitis is among the top 10 conditions for which patients seek medical care. It is a major contributor to missed school for children and workdays for parents who stay home with them. Estimated costs for evaluating and treating this illess are between $200 and $300 million each year.

“Air quality negatively impacts children’s health and has a definite economic impact on health systems and families,” Hertz-Picciotto said.

Scientists have yet to discover the biological mechanism by which air pollution in general and PAHs in particular contribute to lower respiratory illnesses. Hertz-Picciotto theorizes that the chemicals in air pollution may have an impact on the immune system.

“It’s possible that increased inflammation of the airways due to the PAH exposure compromises the immune system and makes it easier for viruses to take hold,” she explained. “We need more basic science to answer this question.”

In the meantime, Hertz-Picciotto and her colleagues will continue to investigate the impact of other air pollution components and their potential connections to childhood illnesses using the Czech data sets. They will also be looking at whether prenatal exposure to air pollution leads to increased susceptibility to illness, such as asthma and hay fever, later in life.

Results of the study are published in the October 2007 issue of Environmental Health Perspectives and can be downloaded at ehponline. Funding for the research was provided by the Czech Ministry of Environment, U.S. Environmental Protection Agency, U.S. Agency for International Development, Commission of the European Community, Health Effects Institute and National Institute of Environmental Health Sciences. Hertz-Picciotto’s research team included an international group of scientists from the Czech Republic, Germany, UC Davis and the University of North Carolina, Chapel Hill.

UC Davis Health System is the leading tertiary care provider for a 33-county region of Northern California. Research strengths at UC Davis Health System include clinical and translational science, stem cell science, infectious diseases, vascular biology, neuroscience, cancer, functional genomics and mouse biology, comparative medicine, combinatorial chemistry and nutrition, among many others.

ucdmc.ucdavis.edu

Four High School Football Players Died Of Heat Stroke In 2010

Practices for football, cross country and other high school sports are starting up this month, and many athletes will do two-a-day workouts in the August heat.

Last year, four high school football players died of heat stroke, according to the Annual Survey of Football Injury Research.

High school fall sports include boys football, soccer and cross country and girls tennis, volleyball and cross country. While some teams schedule practices in early morning or early evening, other teams with limited field space must practice in the mid-day sun.

“Players and coaches should take common-sense precautions to prevent heat exhaustion and heat stroke,” said Loyola University Health System athletic trainer Jennifer Janczak. “Players also should expect to be sore after the first days of tryouts. But soreness is not necessarily injury.”
Janczak is a sports medicine outreach coordinator in Ambulatory Orthopaedic Surgery and Rehabilitation. She is an athletic trainer for Trinity High School in River Forest, Ill. and Lewis University in Romeoville, Ill. She offers these safety tips:

Preventing heat exhaustion and heat stroke

– Drink water before practice and during water breaks, even if you’re not thirsty. Bring a water bottle.

– It may seem gross, but check your urine. If it’s dark, you’re not getting enough water.

– Don’t drink beverages with caffeine, including tea, coffee and soda.

– If you experience dizziness, nausea, trouble concentrating, headache or heavy sweating, you may be suffering heat exhaustion. Alert your coach or athletic trainer. Rest in an air-conditioned room, or if that’s not possible, get in the shade.

– Untreated heat exhaustion can develop into life-threatening heat stroke that requires immediate medical attention. Symptoms include confusion, loss of consciousness, frequent vomiting and shortness of breath and skin that feels hot but not sweaty.

Injury vs. soreness

Soreness is normal when starting a new season, new drill or new lifting routine. The aching, weakness and decreased motion you feel the next day or two result from challenging muscles. Warming up and stretching can help. Continuing with the program also can ease the discomfort.
Potential signs of injury include pain in a joint or muscle that follows a twist or hit and a sharp pain and/or swelling in a specific area. Tell your athletic trainer. If you try to handle it yourself, you could wind up losing more time.

And make sure your equipment fits. “Equipment that is too big or too small is an injury waiting to happen,” Janczak said.

Source: Loyola University Health System

Abbott’s SIMCOR® (Niacin Extended-Release / Simvastatin) Receives FDA Approval For New Dosage Strengths

Abbott has received U.S. Food and Drug Administration (FDA) approval for two new dosage strengths of SIMCOR®, a cholesterol medication. The new SIMCOR dosage strengths combine 40 mg of simvastatin – the most commonly prescribed dose of simvastatin – with either 500 mg or 1,000 mg of niacin extended-release. SIMCOR is the first treatment to combine Abbott’s proprietary niacin extended-release and simvastatin, the most commonly used statin.

SIMCOR is a prescription medication used along with diet in people who cannot control their cholesterol levels by diet and exercise alone. SIMCOR is approved to raise HDL “good” cholesterol and lower levels of elevated total cholesterol, LDL “bad” cholesterol and triglycerides. SIMCOR is a combination medicine used when treatment with simvastatin alone or niacin extended-release alone is not considered adequate. No additional benefit of SIMCOR on heart disease over and above that shown for simvastatin alone and niacin alone has been demonstrated.

“Approval of the new SIMCOR dosage strengths means that physicians and patients now have more options to treat complex lipid disease,” said Eugene Sun, M.D., vice president, Global Pharmaceutical Development, Abbott.

SIMCOR was approved by the FDA in February 2008 in the following strengths: 500/20 mg, 750/20 mg and 1,000/20 mg. The original FDA approval was supported by results from the SEACOAST trial, which demonstrated efficacy and safety of SIMCOR up to doses of 2,000 mg niacin extended-release / 40 mg simvastatin daily in patients with mixed dyslipidemia and type II hyperlipidemia. The SIMCOR 40 mg strengths will be available in early August 2010.

Treatment guidelines endorsed by the National Cholesterol Education Program, the American College of Cardiology and the American Heart Association have called for more aggressive management of lipids, including a lower LDL goal for some patients, as well as more aggressive management of HDL and triglycerides.

Important Safety Information About SIMCOR

SIMCORshould not be used by people with liver problems, stomach ulcers, or serious bleeding problems; in women who are pregnant, may become pregnant, or nursing. Unexplained muscle pain, tenderness, or weakness may be a sign of a serious but rare muscle disorder, from which rare cases of death have occurred. This risk of these muscle side effects is increased when SIMCOR is taken with certain types of medicines. SIMCOR is associated with increases in liver enzymes as measured by blood tests. Blood tests should be performed before and during treatment with SIMCOR to check for liver problems. SIMCOR should be used with caution by patients who consume large amounts of alcohol. SIMCOR may cause an increase in blood sugar levels which should be monitored closely in patients with diabetes.

Flushing (warmth, redness, itching, and/or tingling of the skin) is a common side effect that may subside after several weeks of consistent use. Other common side effects include headache, itching, nausea, back pain, and diarrhea.

More information about SIMCOR, including full prescribing information, is available on the Web site www.rxabbott/pdf/simcor_pi.pdf.

SourceAbbott

Fostering Chemical Senses Research And Understanding Smell And Taste In Health And Disease

The Association for Chemoreception Sciences (AChemS), a US-based scientific organization, is holding its 32nd annual meeting. About 700 scientists are gathering to present new information on the role of smell and taste in disease, nutrition and social interactions in humans as well as animals. Smell and taste play essential roles in our daily lives. These chemical senses serve as important warning systems, alerting us to the presence of potentially harmful situations or substances, including gas leaks, smoke, and spoiled food. Flavors and fragrances are also important in determining what foods we eat and the commercial products we use. The pleasures derived from eating are mainly based on the chemical senses. Thousands of Americans experience loss of smell or taste each year resulting from head trauma, sinus disease, normal aging and neurological disorders, such as brain injury, stroke and Alzheimer’s disease. By providing a better understanding of the function of chemosensory systems, scientific and biomedical research is leading to improvements in the diagnoses and treatment of smell and taste disorders.

Members of AChemS are arriving in St. Pete to present the latest findings generated from research on taste, smell and related issues (see program at achems/files/public/PROGRAMFINAL.pdf). Research topics range from molecular biology to the clinical diagnosis and treatment of smell and taste disorders.

Additionally, there will be 6 special-subject symposia, lectures and workshops (see achems/files/public/DescriptionsforWeb.pdf). Throughout the five-day meeting there will be nearly 374 presentations by scientists from around the world (see all scientific abstracts at flip-programs/ACHEMS/2010_Abstracts/.

Selected new discoveries to be presented at the meeting include:

Monell researchers confirm identity of elusive salty taste receptor

Chemosensory loss: functional consequences of the world trade center disaster

Taste buds help diabetics avoid salt

Taste aversion to quinine in mosquitoes

For once: men outsmell women

Taste enhancers are received by taste cells

Age dramatically delays recovery of sense of taste

Early neurocognitive changes in those at risk for Alzheimer’s disease

The bitter taste of feeling queasy

New salt taste enhancers discovered for healthier foods

Discovery of new odor-based tools may block mosquitoes from finding humans

The brain can smell what it hears

Reduced olfaction in Parkinson’s disease – what does it tell us?

When: April 21-25, 2010

Where: Tradewinds Island Grand St. Pete Beach Florida

Source:
Charles J. Wysocki
Association for Chemoreception Sciences

Stem Cell Therapy Shows Promise In Regenerating Damaged Muscle In Heart Attack Patients

Heart attack patients who received an new intravenous adult stem cell therapy, Provacel(TM), experienced a lower number of adverse events, such as cardiac arrhythmias, and had significant improvements in heart, lung and global function compared to those who received a placebo, according to six-month Phase I study data presented at the American College of Cardiology’s Innovation in Intervention: i2Summit in New Orleans on March 25.

Rush was one of 10 premier cardiac centers across the country that participated in the 53-patient, double-blind, placebo-controlled trial. Among other findings, patients receiving Provacel were 75 percent less likely to experience an arrhythmic adverse event compared to those receiving placebo (9 % vs. 37%, p=0.025) and significantly more patients who received Provacel experienced improvement in their overall condition at six months as compared to those receiving placebo (42% vs. 11%, p=0.027).

Provacel is a preparation of adult stem cells pre-formulated for intravenous delivery by the drug’s manufacture, Osiris Therapeutics. Patients were administered an infusion of either Provacel or placebo within 10 days of having a heart attack and are being followed for 2 years. To prevent bias, neither the patient nor the physician knows who received the stem cell treatment and who received placebo.

Rush principal investigator cardiologist Dr. Gary Schaer, head of the Rush Cardiac Catheterization Laboratory, says one reason the study results are so promising is that these stem cells can be used without tissue typing and do not trigger an immune response, and are available for every patient.

The mesenchymal stem cells (MSC) are found in the adult bone marrow and have the potential to develop into mature heart cells and new blood vessels. The MSC cells are derived from normal, healthy adult volunteer bone marrow donors and are not derived from a fetus, embryo or animal. Because they are in an early stage of development, it is believed that they do not trigger an immune response when placed in someone else’s body.

Similar to Blood Type O, these MSCs are being used without tissue type matching to a specific patient.

A unique benefit of the stem cell product is that it is given to patients through a standard IV line. Other therapies require delivery to the site of the disease through catheterization or open surgical procedures, but this one was very simple and easy for the patient.

Schaer says the cells were grown in culture to very high numbers, allowing a single donor’s cells to treat thousands of patients. “The cells have the ability to expand, or multiply, under controlled conditions, and the expanded cells have the ability to develop into different types of cells in the appropriate environment. One donation can produce billions of MSCs. The cells can be stored for years in a frozen state, ready to be used when they are needed.”

Adult stem cells are designed by nature to perform tissue repair in a mature adult. It is believed that these cells can be used in patients unrelated to the donor, without rejection, eliminating the need for donor matching and recipient immune suppression. Once transplanted, the cells promote healing of damaged or diseased tissues.

“Because of the participation by top tier sites such as Rush University Medical Center, we were able to conduct a study that was exceptionally well planned and executed” said C. Randal Mills Ph.D., President and CEO of Osiris Therapeutics. “We were confident in the safety profile given our previous experience using the intravenous form of these stem cells to treat other diseases in later stage clinical trials. However, we did not expect to see the across-the-board clinical improvement observed in patients at this early stage of testing.”

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Rush was the only academic medical center in Illinois participating in the trial.

Contact: Mary Ann Schultz
Rush University Medical Center