Immunology

Researchers from The Miriam Hospital have found that people with mobility impairments under age 65 have significantly higher rates of smoking than those without mobility impairments. Additionally, smokers with mobility impairments were less likely to attempt quitting than those without mobility impairments, and evidence-based, quit-smoking treatments may not be sufficient for this population. The study and its findings are published online in advance of print in the American Journal of Public Health.

Lead researcher Belinda Borrelli, Ph.D., of The Centers for Behavioral and Preventive Medicine at The Miriam Hospital, and her colleagues sought to report cigarette smoking prevalence and quit attempts among individuals with mobility impairments as they have greater health risks than the general population.

Borrelli conducted an analysis of 13,308 adults aged 21-85 years old with mobility impairments such as using special ambulatory equipment and having difficulty walking one-quarter mile without equipment. Results showed that among 21 to 44 year olds with mobility impairments, 39.2 percent were smokers, compared with only 21.5 percent of adults without mobility impairments. Among 45 to 64 year olds with mobility impairments, 31.2 percent were smokers versus 20.7 percent without mobility impairments.

The analysis also found that women ages 21 to 44 years old with mobility impairments had the highest smoking prevalence at 45.9 percent, exceeding same-aged women without mobility impairments. Men with mobility impairments had greater smoking prevalence than women with mobility impairments. Smokers with mobility impairments were also less likely to attempt quitting than smokers without mobility impairments.

"People with physical disabilities constitute 16.2 percent of the population and the majority of the population will experience physical disability at some point during their lifetime," Borrelli says. "However, the prevalence of smoking among people with disabilities was unknown prior to our paper. Our particular interest was in pinpointing smoking prevalence among those who use a device to help them get around. Literature indicates that those who use mobility aids have higher rates of depression, and in the general population, this is associated with greater smoking rates and lower likelihood of quitting smoking."

Borrelli focused on smokers with mobility impairment because in addition to being at risk for the same smoking-related health problems as the general population, this population is at risk for worsening their existing disability and underlying medical condition. Continued smoking exacerbates physical disabilities and causes or contributes to many secondary conditions including respiratory and circulatory difficulties, muscle weakness, delayed wound healing, worsening arthritis and osteoporosis. Smokers with a relapsing-remitting multiple sclerosis (MS) are three times more likely to develop a secondary-progressive disease course.

Borrelli concludes, "Our data points to the need for future research investigating why smoking prevalence is so high in this population, as well as the best methods of smoking cessation treatment for this population.

"It is not clear that evidenced-based treatments that are effective for the general population will be sufficient to help people with mobility impairments quit smoking," she adds. "We speculate that smokers with mobility impairments may need more intensive treatment given their greater risk factors for treatment failure such as high depression rates and stress levels, less physical activity and multiple medical comorbidities, coupled with high unemployment and low income. In the meantime, practicioners should recommend a combination of treatment modalities that include both psychosocial support that can be home based and pharmacological treatment."

According to three new studies, the health law has in its first year reduced the number of uninsured adults by between 8 million and 11 million, and the majority of enrollees report satisfaction with their plans.

Politico: The Verdict Is In: Obamacare Lowers Uninsured
A survey by the Commonwealth Fund found that 9.5 million fewer adults are uninsured now than at the beginning of the Obamacare enrollment season. The Urban Institute's Health Reform Monitoring Survey found a similar drop, with 8 million adults gaining coverage. And Gallup-Healthways survey reported that the uninsured rate has fallen to 13.4 percent of adults, the lowest level since it began tracking health coverage in 2008. That was all on Thursday. In recent months, other surveys in the Gallup series have consistently found the same downward trend, and a RAND survey in April estimated that the law extended health coverage to 9.3 million Americans (Nather, 7/11). 

Los Angeles Times: Health Law Covers At Least 8 Million
President Obama's health care law has reduced the number of uninsured adults by 8 million to 11 million in its first year, according to three new studies, and the vast majority report satisfaction with their new health plans. The studies -- done separately by the Commonwealth Fund, the Urban Institute and the Gallup organization -- use different methods to estimate the effect that the Affordable Care Act has had (Terhune and Lauter, 7/10).

Los Angeles Times: Rate Of Uninsured Californians Is Halved Under Obamacare, Survey Finds
The percentage of Californians without health insurance was cut in half in the last nine months during the federal health law's expansion of coverage, a new survey shows. Nationwide, an estimated 9.5 million adults under the age of 65 gained health insurance between late summer 2013 and last month, according to a survey the Commonwealth Fund released Thursday (Terhune, 7/10).

Reuters: Californians Lacking Health Insurance Halved Under Obamacare: Study
The number of Californians without health insurance has been cut in half since the implementation of Obamacare, according to a survey published Thursday. The study by the Commonwealth Fund, a healthcare research foundation, showed that about 11 percent of adults in the most populous U.S. state were uninsured as of last month, down from 22 percent in the summer of 2013. California was the first state to pass legislation to set up its own marketplace allowing consumers and small businesses to purchase highly regulated coverage under the Affordable Care Act, and the state has also expanded its Medicaid program, providing insurance to more low-income residents (7/10).

Politico: More Signs That Health Coverage Is Growing Under Obamacare
Millions of Americans have gained health insurance since Obamacare went into effect, according to several new surveys that show the law is bringing down the nation's uninsurance rate after its "train wreck" of a start. Three new surveys released in rapid succession Thursday found substantial numbers of newly insured adults. None of those findings will put to rest the political debate about the cost, structure and wisdom of the Affordable Care Act but they do give advocates firm evidence that the law is meeting coverage goals (Wheaton, 7/10).

Another study finds increased health plan enrollment in areas that saw heavy advertising against the law --

The Hill: Anti-Obamacare Ads Might Have Increased Sign-ups
Millions of dollars in conservative ads against ObamaCare might have backfired and actually boosted enrollment in key states, according to a new study. A fellow with the Brookings Institution found a "positive association" between ad spending against ObamaCare and enrollment in health plans under the law. The trend appeared strongest in states with competitive Senate races this year, where conservative groups are spending widely on ads against the Affordable Care Act (Viebeck, 7/10).

---

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

UN Member States have reaffirmed their commitment to take bold measures to reduce the avoidable burden of noncommunicable diseases (NCDs). These ailments, including heart disease and stroke, cancer, diabetes and lung disease kill 38 million people every year, many of them before they reach the age of 70. Most of these largely preventable deaths occur in developing countries, where this epidemic threatens to undermine social and economic development.

Member States, gathered for the second time in 3 years at the United Nations in New York to discuss this topic, pledged to intensify efforts to combat the growing menace of NCDs. They acknowledged that progress has been too slow and uneven since 2011, when the UN General Assembly adopted the Political Declaration and pledged to better protect the lives of their people.

"Success [in combating NCDs] will depend on finding new ways to strengthen the ability of countries to adopt bolder measures,"

UN Secretary-General Ban Ki-moon

"Three years ago we agreed that it is time to act," UN Secretary-General Ban Ki-moon said in a message. "The global epidemic of noncommunicable diseases is a major and growing challenge to development."

He also noted that "success will depend on finding new ways to strengthen the ability of countries to adopt bolder measures," calling for strong leadership and action from governments, the private sector and others.

Under the leadership of the WHO, the international community agreed in 2011 on global mechanisms including a Global NCD Action Plan. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025, in part by addressing factors such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity that increase people's risk of developing these diseases.

UN support to developing countries

The United Nations, through an Interagency Task Force established by the Secretary-General, is providing support to developing countries. Civil society, academia and the private sector contribute to NCD prevention and control worldwide through a Global Coordination Mechanism, and achievements are measured by a set of joint indicators.

"The obesity epidemic has been getting worse, not better, for more than 3 decades," stressed WHO Director-General Dr Margaret Chan. "Industry practices, especially the marketing of unhealthy foods and beverages to children, play a contributory role."

She noted that the article in the political declaration calling for collaboration with the private sector "has not been fully implemented. Healthier food formulations are neither affordable nor accessible in large parts of the developing world. Unfortunately, the unhealthiest foods are usually the cheapest and most convenient."

New WHO NCD country profiles give detailed picture

The most recent WHO NCD country profiles give a detailed picture on the situation in 194 Member States and identify existing gaps and weaknesses. They also indicate that countries need to do more to reduce the toll of death and disease from NCDs. As one of the results of the New York meeting WHO will prepare a Framework for Country Action together with partners. WHO was also tasked to establish systems to register and publish contributions of the private sector, philanthropies and civil society to the achievement of the 9 voluntary targets of the Global NCD Action Plan.

The first UN General Assembly High-level on NCDs took place in 2011 and resulted in the adoption of a Political Declaration that put NCDs high on the development agenda. In 2018, the UN General Assembly will convene a third high-level meeting to take stock of progress.

Cataract surgery for people with Alzheimer's disease and other dementias not only improves vision but can slow decline in cognition and improve quality of life for both people with the disease and their caregivers, according to clinical trial results reported today at the Alzheimer's Association International Conference^® 2014 (AAIC^® 2014) in Copenhagen.

"This study supports the Alzheimer's Association view that people with dementia retain, and benefit from, full healthcare treatment," said Maria Carrillo, Ph.D., Alzheimer's Association vice president of Medical and Scientific Relations. "Too common attitudes such as, 'There's no need for extra care' or 'Why put them through all of that' are not justified and are bad medical practice."

"Appropriate thoughtfulness and restraint are necessary when considering surgery or other procedures for people with Alzheimer's or another dementia. However, we should not assume that medical procedures cannot be pursued or are too risky. As these new results show, improving sensory abilities, for example, can provide benefits in a variety of ways â€" for people with Alzheimer's and also for their caregivers from whom unnecessary burden can be lifted," Carrillo said.

At AAIC 2014, Alan J. Lerner, M.D. of Case Western Reserve University and University Hospitals Case Medical Center and colleagues reported interim results from an ongoing clinical trial to determine the effects of cataract removal on several measures of visual ability, cognitive measures, and quality of life in people with dementia. Study participants are recruited from dementia and ophthalmology clinics at University Hospitals Case Medical Center and MetroHealth Medical Center in Cleveland, Ohio, and are divided into two groups: (1) immediate surgery following recruitment and (2) delayed or refused surgery. Vision and cognitive status, mood, and capability to complete daily activities are evaluated at baseline and six months after recruitment, or six months after surgery.

Preliminary analysis of results from 20 surgical and eight non-surgical participants showed that the surgical group had significantly improved visual acuity and quality of life, reduced decline in memory and executive functioning, and improvements in behavioral measures compared with the non-surgical group. Levels of perceived burden for caregivers of people in the surgical group also showed improvement.

"These preliminary results indicate that improved vision can have a variety of benefits for people with dementia and their loved ones, both visual and non-visual," said Lerner. "Our findings need to be verified in a larger study, but they suggest the need to aggressively address dementia co-morbidities such as vision-impairing cataracts, while balancing safety and medical risks."

"If the results hold up, it will significantly affect how we treat cataracts in individuals with dementia. Other interventions to offset sensory loss â€" including vision and hearing â€" may help improve quality of life for people with dementia and their caregivers," Lerner added.

According to the Alzheimer's Association, a person with dementia has the right to any medical treatment available. People with the disease may require longer courses of some treatments such as rehabilitative therapies compared to people with intact cognition. Therapies that may be of benefit should not be discontinued because a person with Alzheimer's has failed to make progress as the same rate as someone without the disease.

Making medical decisions about treatment remains the right of the person with Alzheimer's until he or she no longer has the cognitive capacity to understand the decision. At that time, medical decisions are made by the person's surrogate. The Alzheimer's Association recommends that preferences about medical treatment and decisions should be addressed early in the disease process through the execution of advance directives. Absent an advance directive, the surrogate decision maker should be guided by the values and any expressed wishes of the person with Alzheimer's disease.

With the support of the Alzheimer's Association and the Alzheimer's community, the United States created its first National Plan to Address Alzheimer's Disease in 2012. The plan includes the critical goal, which was adopted by the G8 at the Dementia Summit in 2013, of preventing and effectively treating Alzheimer's by 2025. It is only through strong implementation and adequate funding of the plan, including an additional $200 million in fiscal year 2015 for Alzheimer's research, that we'll meet that goal.

NeoGenomics, Inc. (NASDAQ: NEO), a leading provider of cancer-focused genetic and molecular testing services, announced today it has launched 23 new and innovative NeoTYPEâ„¢ Cancer Profiles based on next-generation sequencing (NGS). These new advanced cancer-profiling tools offer oncologists and pathologists a more targeted and comprehensive ability to tailor cancer testing to an individual patient's needs than has ever been available before.

Next-generation sequencing is an advanced molecular testing approach that is used to more precisely detect a variety of mutations using smaller amounts of tissue. As a result, NeoGenomics will accept fine needle aspirate and other minute samples for testing.

In March, NeoGenomics announced that it was the first to offer plasma-based Next-generation tests for hematologic neoplasms. This testing can allow patients to avoid a bone marrow biopsy, and allow clinicians to monitor tumor load and detect emerging subclones. NeoTYPEâ„¢ plasma-based testing using NGS is now available for AML Prognostic, CLL Prognostic, JMML, Lymphoma, MDS/CMML, MPN, and a comprehensive, 54-gene Myeloid Disorders Profile.

Similarly, the NeoTYPEâ„¢ solid tumor tests are designed to provide precise and complete coverage of "actionable" molecular abnormalities found specifically in the tested tumor. NeoTYPEâ„¢ solid tumor cancer testing is available for Brain, Breast, Cervix, Colorectal, Endometrial, Esophageal, Gastrointestinal Stromal (GIST), Lung, Melanoma, Ovarian, Soft Tissue, Thyroid, and Other Solid Tumors.

Douglas VanOort, the company's Chairman and CEO, said "Tumor profiling is the key to precision medicine, and we are eager to put next-generation sequencing tools into the hands of our physician clients. We have worked hard to develop an innovative and unique approach, using multiple technologies, plasma testing, expert result interpretation and reporting, and other tools to make cancer testing efficient for our health care system and informative for physicians and patients. Our company considers it a privilege to provide the most advanced tools available for the very personalized treatment of a patient's cancer."

Dr. Maher Albitar, the Company's Chief Medical Officer and Director of Research and Development, commented, "These new profiles are designed to provide information that clinicians can utilize in the management of their patients. They provide information on clinical behavior, prognosis, and potential response to currently approved drugs and investigational therapies undergoing clinical trials. While each profile covers, on average, less than 20 different actionable molecular abnormalities, physicians can customize each profile and add additional genes from a list of validated genes. We believe that these small targeted profiles of driver genes are the most clinically justifiable approach to cancer testing given the targeted drugs that are currently available."