In recent years, scientists have shown that financial incentives can drive short-term behavioral changes that are associated with improved health; things like losing weight and quitting cigarettes, for example. The rewards in these studies include direct cash incentives, gift cards and so on.

Recently, the Centers for Medicare and Medicaid Services announced plans to leverage this strategy with a $100 million initiative that permits states to offer incentives to Medicaid enrollees for adopting healthy behaviors.

Called a “demonstration program,” the CMS initiative is designed to figure out which strategies produce long-term behavioral changes. It should also help CMS determine the extent to which special populations (like adults with disabilities or children with special needs) can participate in the program, the level of satisfaction with the program, and the administrative costs incurred by State agencies that administer the program.

The program is funded by the new health care law (known as the Affordable Care Act). It invites each state to submit one proposal . Grant Applications are due to CMS by May 2, 2011. There are no state cost-sharing requirements.

According to CMS, the proposals must be “comprehensive, evidence-based, widely available, and easily accessible.” When states prepare their proposals, CMS recommends that they rely on evidence-based research which can be found in documents like the Guide to Community Preventive Services, the Guide to Clinical Preventive Services, and the National Registry of Evidence-based Programs.

“Keeping people healthy is an important goal of the Affordable Care Act,” HHS Secretary Kathleen Sebelius said in a press release. “One way to reach that goal is to encourage all Americans to make better choices about diet, exercise and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer or diabetes.” (more…)

Younger, healthier patients would be more likely than older, sicker ones to get the best kidneys if a new proposal by UNOS, the US’ organ transplant network is accepted. The proposal would supersede an existing first-come, first-served policy. It is designed to match-up the life expectancies of patients with the expected functional life of donated organs.

According to the proposal by the United Network for Organ Sharing, recipients and donor organs will be graded. The top 20% of patients and kidneys—based on age and health—will be placed in separate pools such that patients with the longest life expectancies will receive the best kidneys. The other 80% will be assigned to a separate a pool from which UNOS will match recipients and donors such that the age difference between the two is no greater than 15 years. For example, a 60 year-old person could only receive a kidney from donors who are between the ages of 45 and 75.

“Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it,” Richard Formica, a member of the UNOS  panel that penned the new proposal said in an interview. “You’ll die with that kidney still functioning…a 30-year-old could have gotten that kidney and lived with it to see his kids graduate college.”

The new proposal would affect the 90,000 or so people that are currently on waiting lists for donor kidneys. In 2009, 10,442 kidney transplants were performed using organs from deceased individuals. An additional 6,387 procedures involved live donors who typically specify the recipient. Nearly 5,000 people die while waiting for a kidney transplant.

Many transplant surgeons and medical ethicists support the proposal. Arthur Caplan, a leading bioethicist at the University of Pennsylvania reflected this sentiment as follows: “If it’s a choice between saving grandpa or granddaughter, I think you save granddaughter first.” (more…)

Scientists have known for years that people with type 2 diabetes can benefit from exercise, although the precise roles played by aerobic exercise and resistance training have been somewhat of a mystery. Until now, that is.

In a paper published last month in JAMA, Timothy Church and colleagues from LSU showed that type 2 diabetes patients benefit more from an exercise regimen that combines the 2 forms of exercise than programs based on either one, alone.

To assess the relative effects of aerobic training and resistance training, Church’s group studied 262 sedentary male and female patients that had type 2 diabetes. In the 9-month study, dubbed HART-D, the average age of the patients was 56. They had diabetes for an average of 7 years. Their average HbA1c level was 7.7%, indicating moderately well controlled diabetes at study onset. Nearly half the patients were not Caucasian.

The scientists randomized enrollees into a non-exercise control group, a resistance training only group, an aerobic training only group, and a group that underwent combined aerobic and resistance training.

Participants in the 3 intervention groups spent about 140 minutes in supervised exercise per week, including time spent warming-up and cooling-down. Aerobic exercise involved walking fast enough on a treadmill to burn 12 kcal/kg per hour. Resistance training was divided into 3 sessions per week, and focused on the upper body, legs, abs and back. Participants in the combination training program engaged in resistance training only twice per week in order to keep total exercise time the same as the other groups.

The scientists found that the absolute change in HbA1c in the combination group compared to the control group was -0.34%. This compared favorably with an absolute change of -0.16% and -0.24% for the resistance only and the aerobic only groups.

Church’s group estimated that if such reductions were maintained for years, people with type 2 diabetes would reduce the risk of cardiovascular disease risk by 5% to 7% and the risk of microvascular complications by 12%.

Of great significance, Church’s group also noted that the frequency with which oral hypoglycemic drugs had to be increased was 18% in the combination group. This was significantly lower than the 22% for the aerobic training only group, 32% for the resistance training only group, and 39% in the controls. Without these aggressive interventions, the absolute improvements in HbA1c levels in the combined exercise group would almost certainly have been much greater, according to the scientists.

All exercise groups reduced waist circumference by about the same amount [-.75 to -1.1 inches] when compared to the control group.

In an accompanying editorial, Canadian researchers, Ronald  Sigal and Glen Kenny concluded that, “based on the results of the HART-D trial, patients with type 2 diabetes who wish to maximize the effects of exercise on their glycemic control should perform both aerobic and resistance exercise. The HART-D trial clarifies that, given a specific amount of time to invest in exercise, it is more beneficial to devote some time to each form of exercise rather than devoting all the time to just one form of exercise.”

One note of caution: Although this is clearly good news, the study may not be easily generalizable to the population at large because the study design required that all exercise sessions be supervised.  It turns out that without that pesky trainer and the forced adherence to an exercise regimen, many folks, whether they have diabetes or not, can’t manage to stick with an exercise plan.

Scientists at UC Berkeley have found that an afternoon nap improves cognition later in the day, and posit that the beneficial effects of a nap have to do with letting a particular area of the brain clear out short-term memory “storage space” so it can absorb new information.

To reach these conclusions, Matthew Walker and colleagues randomized 39 healthy adult volunteers into a nap group and a no-nap group.

The groups performed equally well on a midday test which involved absorbing a lot of facts. After that, the nappers retired for a 1.5 hour respite, while unfortunate souls in the no-nap group toiled away. Then,  at 6 pm, both groups underwent further cognitive testing.

The scientists found that the nappers outperformed the non-nappers. In fact, the nappers performed better than they did on the first test, which occurred before their nap.

The results supported earlier research which showed that that the hippocampus temporarily stores fact-based memories before relaying them to the brain’s prefrontal cortex, and that the hippocampus has a relatively limited storage capacity.

They also supported earlier research showing that students who work through the night reduce their capacity to absorb new facts by 40% by the following morning.

According to Walker, “Sleep not only rights the wrong of prolonged wakefulness but, at a neurocognitive level, it moves you beyond where you were before you took a nap.”

Walker’s group also demonstrated using EEGs that the memory-refreshing process occurs during stage 2 non-REM sleep (non Rapid Eye Movement sleep). This is why, Walker suggests, humans spend nearly half their nap time in this stage of sleep.

Walker presented these preliminary findings at last month’s annual meeting of the American Association of the Advancement of Science (AAAS) in San Diego.

The obesity epidemic has become a major public health concern. The phenomenon is typically attributed to changes in diet and lifestyle, and socioeconomic factors like poverty and poor education.

Genetic factors have been known play a role as well, but a recent study by UK-based scientists suggests they play much more prominent role, at least in a subset of people who become morbidly obese at a young age.

In the study, Sadaf Farooqi of the University of Cambridge and colleagues showed that many such kids are missing a large chunk of DNA, known as SH2B1, from chromosome 16.

The missing genetic code had been known to play a role in regulating weight and blood sugar levels. Kids with the chromosomal abnormality tended to overeat on a massive scale, and gain weight easily. 

To reach these conclusions, the scientists scanned the genomes of 300 morbidly obese kids in search of copy number variants (CNVs), which are lengthy strands of DNA that are either duplicated or missing.
The scientists compared their findings with information from healthy controls.

In their write-up, which appears in Nature, the scientists wrote, “we identified several rare copy number variants that were recurrent in patients but absent or at much lower prevalence in controls.”

“Part of chromosome 16 can be deleted in some families. People with this deletion have severe obesity from a young age,” Farooqi told Medical News Today: “One particular gene on chromosome 16 called SH2B1 plays a key role.”

The finding may have broad social implications, since it is common to blame parents or guardians for morbid obesity in kids. The scientists noted for example, that some kids in the study had been handed over to Social Services because their parents were assumed to have been deliberately overfeeding them.

Young adults may be putting themselves at increased risk of unplanned pregnancies and sexually transmitted diseases (STDs) during the upcoming holiday period, according to new independent research conducted by YouGov and published on the Web site of UK-based Marie Stopes International.

Nearly half (48%) of respondents aged 18-34 stated that they drink more alcohol during the holidays than at other times of the year, and 27% admitted having unprotected sex because they were too drunk to remember to use contraception.

In response, Marie Stopes has launched a ‘Wrap it Up’ campaign that urges men and women to carry condoms and practice safe sex during the holidays.

Marie Stopes’ UK centers are also offering an emergency contraceptive pill  (which can be taken up to 3 days after unprotected sex to terminate unwanted pregnancies) at the reduced price of £10 until January 31st 2010 or while stocks last.

The research also showed that of the 18-34 year olds questioned:

- 19% had sex with someone they just met due to the influence of alcohol at a holiday party,
- 45% had sex under the influence of alcohol with someone that they wouldn’t have, had they been sober,
- 41% had sex that they regretted the morning after.

“The combination of alcohol and the festive party spirit may reduce inhibitions, and lead men and women to make decisions about their sexual behavior that they may not have made if sober,” said Lindsay Davey, Sexual Health Nurse at Marie Stopes. “In January and February last year Marie Stopes’  UK centers saw greater numbers of women seeking abortion services than at any other time of the year.”

Fourteen years ago, Harvard researchers revealed that insurance companies were big-time investors in tobacco companies. The seemingly hypocritical position prompted outrage and calls for them to divest.

But when the same scientists recently re-examined the matter, they found the industry had failed to kick the habit.

By reviewing SEC filings and news reports from 2008, J. Wesley Boyd and colleagues determined that US, UK and Canadian-based insurance companies owned at least $4.4 billion worth of stock in companies whose subsidiaries produce cigarettes, cigars, chewing tobacco and related products.

“Despite calls upon the insurance industry to get out of the tobacco business by physicians and others, insurers continue to put their profits above people’s health,” Boyd told Medical News Today. “It’s clear their top priority is making money, not safeguarding people’s well-being.”

The World Health Organization estimates that tobacco products contribute to 5.4 million deaths per year worldwide.

New Jersey-based Prudential Financial Inc., which markets life and disability insurance, has holdings in tobacco firms like Reynolds American and Philip Morris, that total $264 million.
 
These numbers are dwarfed by Toronto-based Sun Life which sells health, disability, life and long-term care insurance. It owns just north of $1 billion in tobacco company stock.

Meanwhile, London-based Prudential Plc, which offers disability, health and long-term care insurance, holds $1.38 billion in British American Tobacco and other such companies.

“Insurance firms have figured out ways to profit from both… investing in tobacco (and) selling life or health insurance. (They) exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit - and smokers lose - twice over,” wrote the authors.

Boyd’s group first reported on the matter in a 1995 Lancet article.

Over 185 million Americans live under skies so polluted it endangers life, according to a report released last week by the American Lung Association.

The report grades 900 US counties on an A to F scale for ozone (smog), annual particle pollution, and 24-hour particle pollution.

Cities ranking in the top 3 on ozone pollution were the Los Angeles-Long Beach-Riverside metropolitan area, Bakersfield and Visalia-Porterville.

The three cities also top the charts for year-round particle pollution, and follow just behind Pittsburgh-New Castle at the top of the list on 24-hour particle pollution.

Fargo, North Dakota came up cleanest in all categories.

“60% of Americans are breathing air dirty enough to send people to the emergency room, to shape how kids’ lungs develop, and to kill,” said ALA Chairman Stephen Nolan.

The ALA report indicates that 175 million Americans live in areas where there is a dangerous abundance of days in which unhealthy ozone levels are present. Ozone irritates the lungs like a bad sunburn. It triggers asthma and shortens life expectancy.

Particle pollution is the “most dangerous and deadly of the outdoor air pollutants,” according to the ALA, because it “can increase the risk of early death, heart attacks, strokes and emergency room visits for asthma and cardiovascular disease.”

One in 6 Americans lives in an area having unhealthy level of year-round fine particle pollution, and 30% reside in counties with unhealthy 24-hour levels, in which atmospheric fine particle concentrations spike to unhealthy levels for hours or even days.

“Air pollution can impair the lung function of even the healthiest people,” said Norman Edelman, the ALAs Chief Medical Officer, but “people with lung and heart disease (are) especially vulnerable,” he added.

Scientists at SUNY Downstate have demonstrated that injecting a compound known as ZIP into the brains of mice causes them to instantly forget distasteful memories, raising hope the stuff could someday be used to treat humans with PTSD or drug addiction.

Todd Sacktor and colleagues made the discovery after deducing that a substance known as PKMzeta was involved in murine memory.

Sacktor’s group found for example, that when neurons in the hippocampus and neocortex of mice were activated by a certain memory, they released PKMzeta to recruit nearby neurons. This apparently helped the brain construct visual, auditory and olfactory components of that particular experience.
 
These PKMzeta molecules subsequently remained at their new locations, effectively hard-wiring the memory for easy recall at a later time.

Sacktor’s group then leveraged work by André Fenton, a colleague at SUNY Downstate, who had devised a technique for generating powerful spatial location memories in mice such as the position in a chamber where they could expect to receive an electric shock.

Once Fenton’s mice learned the avoidance behavior, they didn’t forget, at least until Sacktor nailed ‘em with a short, sharp, shot of ZIP. Almost instantly thereafter, the mice behaved as if they had completely forgotten the lesson.

“If this molecule is as important as it appears to be, you can see the implications,” Sacktor told the New York Times. “For trauma. For addiction, which is a learned behavior. Ultimately for improving memory and learning.”

But Thomas Carew, a neuroscientist at UC Irvine was circumspect. “There is not going to be one, single memory molecule, the system is not that simple,” he said. “There are going to be many molecules involved, in different kinds of memories, all along the process of learning, storage and retrieval.”

Christakis and Fowler are at it again!

Two months ago they caused a stir by publishing research in BMJ which seemed to show that happiness is contagious, a conclusion that some chalked up to an inexcusably naïve failure to recognize the effects of epiphenomena in social networks.

Now these crowd pleasers have put a piece in PNAS which concludes that a person’s popularity is genetically determined. 

Or as Christakis, a medical sociologist at Harvard told Medical News Today, “We were able to show that our particular location in vast social networks has a genetic basis.”

“In fact, the beautiful and complicated pattern of human connection depends on our genes to a significant measure,” he waxed.

Does this guy think he’s Ram Dass or what?

To reach this data-mining epiphany, Christakis and Fowler characterized the social networks of 1,110 identical and non-identical teen-aged twins from the National Longitudinal Study of Adolescent Health.

They measured popularity by the number of times an individual was named as a friend and the likelihood those friends knew each other.

Does this work for everybody?

Whatever, the scientists observed a higher concordance among the networks of identical twins than their non-identical counterparts.

They also concluded that whether a person was central to, or at the periphery of her social network was genetically determined, which inspired them to raise Charles Darwin from the dead, all in the same article.

Maybe it’s good to be on the periphery of a social group, they mused, like when there’s Ebola virus floating around. Then again, those hub-of-the-network types have access to more information like which Starbucks still has Christmas Blend in stock.
 
Please people.