Mereja

Author: Serkadis

  • Among Indian immigrants, religious practice and obesity may be linked, study shows

    Asian Indians are one of the fastest growing ethnic groups in the United States, and roughly half a million people of Indian ancestry live in California — more than any other state. Individuals from this group are strongly predisposed to obesity-related conditions such as diabetes and heart disease, due in large part to physical inactivity, diets low in fruit and vegetables, and insulin resistance.
     
    Among other racial and ethnic groups, research has shown that religious practices and religiosity have been associated with obesity and greater body weight, but no one had studied this potential link among Indians.
     
    Now, a UCLA-led research team that examined the relationship between religious practices and obesity among Indian immigrants has found that religiosity in Hindus and Sikhs — but not Muslims — appears to be an independent factor associated with being overweight or obese. The findings are published online in the peer-reviewed journal Preventive Medicine.
     
    “This is the first known study to examine the relationship between religiosity and obesity among Asian Indians in the United States and among traditional Asian Indian religious subgroups,” said the study’s primary investigator, Dr. Nazleen Bharmal, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
     
    “These different subgroups have different practices: Muslims may abstain from alcohol or avoid pork, and Hindus and Sikhs may eat only plant foods,” Bharmal said. “We were surprised to find an association between religiosity and obesity for Hindus and Sikhs but not Muslims.”
     
    The researchers used data from the 2004 California Asian Indian Tobacco Survey, a telephone survey of 3,200 adult Asian Indian residents of California. Among those surveyed, the mean age was 37 years and most were married, well educated and had health insurance. More than half were highly religious, and most practiced Hinduism, followed by Sikhism, other religions and Islam. 
     
    Those Indian immigrants who were highly religious were more likely to be older, female, less educated and less acculturated than the less religious immigrants. Even after adjusting for differences in demographics, health status, health care access and acculturation, the researchers found that those Indians who were highly religious were more likely (1.53 greater odds) to be overweight or obese than those who were less religious. This relationship — or increased odds — persisted for Hindus and Sikhs but not Muslims. 
     
    The researchers posit that people who are more religious may be more likely to be overweight or obese because religious organizations tend to place greater emphasis on avoiding vices other than gluttony, they may provide a welcoming environment for those seeking refuge from the social stigma of obesity, and religious gatherings often involve the consumption of food and drink. 
     
    There are several possible explanations, the researchers said, for why there appears to be a link between religiosity and weight status among Hindus and Sikhs but not among Muslims.
     
    First, there were fewer Muslims in the dataset, so there may have been too few to see an impact. Second, there are differences in religious practices: Hindus and Sikhs may adhere to a vegetarian diet but drink alcohol heavily or eat food high in saturated fat or refined sugar at frequent religious and social gatherings, while Muslims abstain from alcohol and practice 30 days of daytime fasting during Ramadan, which may decrease their risk for weight gain.
     
    The researchers noted that the study had some limitations. For instance, though different religious practices among Hindus, Sikhs and Muslims may impact diet and physical activity, there were no measures of diet and physical activity in the dataset used by the researchers.
     
    Also, while those who were highly religious generally had lower educational attainment than those who were less so, the majority of the individuals in the sample were “exceptionally well-educated,” with about 77 percent holding college degrees and 40 percent holding professional or doctoral degrees, according to Bharmal. As a result, that relatively narrow range may not have been enough to capture any associations between socioeconomic status, religiosity and obesity.
     
    Additional authors are Martin F. Shapiro, Marjorie Kagawa-Singer, Mitchell D. Wong, Carol M. Mangione and William J. McCarthy, all of UCLA; Robert M. Kaplan of the National Institutes of Health; and Hozefa Divan of HealthCore Inc.
     
    General Internal Medicine and Health Services Research is a division within the Department of Medicine at the David Geffen School of Medicine at UCLA. It provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work. The division’s 100-plus clinicians and researchers are engaged in a wide variety of projects that examine issues related to access to care, quality of care, health measurement, physician education, clinical ethics and doctor/patient communication. The division’s researchers have close working relationships with economists, statisticians, social scientists and other specialists throughout UCLA and frequently collaborate with their counterparts at the RAND Corp. and Charles Drew University.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • Women who suffered severe sexual trauma as kids benefit most from intervention

    A UCLA-led study of HIV-positive women who were sexually abused as children has found that the more severe their past trauma, the greater their improvement in an intervention program designed to ease their psychological suffering.
     
    The study, conducted by researchers at UCLA’s Collaborative Center for Culture, Trauma and Mental Health Disparities, suggests that such interventions should be tailored to individuals’ experience and that a “one size fits all” approach may not be enough to successfully reduce women’s depression, post-traumatic stress and anxiety symptoms.
     
    “This study shows that those who suffer early and severe trauma can improve their psychological symptoms,” said primary investigator Dorothy Chin, an associate research psychologist at the Semel Institute for Neuroscience and Human Behavior at UCLA. “Indeed, those who improve the most are those who suffered the most trauma.”
     
    The research findings are published in the peer-reviewed journal Psychological Trauma: Theory, Research, Practice and Policy.
     
    For the study, researchers used data on women who had participated in the Healing Our Women program, a clinical trial testing an HIV/trauma intervention for HIV-positive women who had suffered sexual abuse as children. Previous research demonstrated that this program was successful at reducing psychological distress among these women. The question for the current study was: Who benefited the most?
     
    The trial used a psycho-educational group intervention called the enhanced sexual health intervention (ESHI), which linked these women’s early sexual abuse–related trauma to their current sexual risk behavior and taught them ways of coping and emotional problem-solving.
     
    The 121 women who participated in the trial were recruited from community-based organizations, health clinics, physicians’ offices, hospitals and HIV support groups in the Los Angeles area. The researchers randomly assigned 51 of them to the ESHI group, an 11-week intervention that included writing exercises, group processing, strategies for identifying and coping with potentially risky or stressful situations, and problem-solving.
     
    The other 70 were assigned to a standard control-group intervention, also 11 weeks, which consisted of one face-to-face session in which the women were provided with information and pamphlets on HIV prevention and child sexual abuse, as well as weekly calls and referrals to support services. At the end of the 11 weeks, 27 women from the control group moved to the ESHI intervention, for a total of 78 women in the treatment group.
     
    The women’s psychological symptoms were assessed both before and after the intervention program. The researchers found among the women in the ESHI intervention, those whose sexual abuse was most severe as children showed the greatest overall improvement in reducing their symptoms of depression, post-traumatic stress and anxiety.
     
    Chin suggests that the most severely traumatized women improved the most because the insights they gained between their past and present experiences, as well as the problem-solving strategies they learned, “resonated more” with them than with the others.
     
    “This is somewhat surprising at first glance, as one might assume that the more trauma, the more difficult it is to improve one’s symptoms,” Chin said. “But this shows that these focused interventions have targeted the right groups of people and need to continue to target the most traumatized.”
     
    The authors noted that the small sample size was not ideal and that more research is needed. The next step, they said, is to replicate these findings with larger samples, as well as to target the most severely traumatized women.
     
    The National Institute of Mental Health funded this study (grants H059496-0451 and  MH073453-01A1).
     
    Other study co-authors are Hector Myers, Muyu Zhang, Tamra Loeb, Gail Wyatt and Jennifer Carmona of UCLA, and Jodie B. Ullman of California State University, San Bernardino.
     
    The Collaborative Center for Culture, Trauma, and Mental Health Disparities at UCLA is a multi-disciplinary group promoting interdisciplinary research examining the prevalence and impact of traumatic experiences on psychological functioning and concomitant cognitive/emotional, behavioral, and biological processes in multi-ethnic populations. The aim is to understand how traumatic experiences affect men and women who may not seek or receive effective care, as well as to elucidate the contexts in which traumatic experiences occur. This understanding would help healthcare professionals create new strategies to reduce mental health disparities among these groups.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • Obituary: David Solomon, 90, UCLA leader in geriatrics and medicine

    Dr. David H. Solomon, who led a major expansion of the UCLA Department of Medicine, created the campus’s geriatrics program to deal effectively with the unique health care needs of the elderly, and was the first board-certified endocrinologist in Los Angeles, died July 9 at his home in Thousand Oaks, Calif. He was 90.
     
    Solomon received many awards from various medical societies in recognition of his contributions and was the author of 220 scientific papers in peer-reviewed journals, four books, 49 book chapters and 32 editorials, letters and popular articles.
     
    “Dr. Solomon is a legendary figure at UCLA and nationally in internal medicine, endocrinology and geriatrics,” said Dr. David Reuben, chief of the geriatrics division at the David Geffen School of Medicine at UCLA. “His legacy will live on.”
     
    Solomon was born March 7, 1923, and raised in Brookline, Mass. He graduated from Brown University in 1944 and entered Harvard Medical School that year. By taking courses year-round, he was able to complete medical school in two years, graduating magna cum laude in 1946. After graduation, Solomon married his wife, Ronda Markson. He completed his internship and residency at the Peter Bent Brigham Hospital in Boston and fulfilled his two-year military commitment in the U.S. Public Health Service at the Gerontology Research Center in Baltimore, Md.
     
    Solomon was recruited to the new UCLA School of Medicine in 1952. He became the first board-certified endocrinologist in Los Angeles and led the development of the division of endocrinology in the new department of medicine at UCLA. In 1966, he was named chief of medicine at Harbor General Hospital, where he expanded UCLA’s training program. He returned to UCLA’s main campus in 1971 as executive chair of the department of medicine, holding that position until 1981.
     
    Solomon led a major development and expansion of the department of medicine during his 10-year tenure, and in the mid-1970s, he spearheaded the effort to form one of the first organized, centrally managed clinical practice groups at an academic medical center with the creation of the Department of Medicine Practice Group.
     
    “David Solomon’s contributions to UCLA, internal medicine, geriatrics and endocrinology will live on because of the number of lives that he touched and the approach to care that he taught,” said Dr. Alan M. Fogelman, executive chair of the UCLA Department of Medicine.
     
    In 1979, Solomon recognized the need for a new medical specialty to deal effectively with the growing number of elderly individuals and their unique medical, social and health needs. The specialty of geriatric medicine was in its infancy and not widely recognized or accepted as a legitimate field of medicine. He spent the year on sabbatical at the RAND Corp. and, along with Dr. John Beck, studied the problem of an insufficient number of trained geriatricians in the United States. The result was the book “Geriatrics in the United States: Manpower Projections and Training Considerations.” 
     
    Solomon stepped down as chairman of department of medicine in 1981 and began his second career — geriatrics and gerontology. He recruited Dr. Beck to UCLA to lead the Multicampus Programs in Geriatric Medicine and Gerontology, and together they integrated and coordinated all of the aging activities within UCLA-affiliated hospitals. Under the MPGMG, the individual fellowships in geriatric medicine at UCLA, the Veterans Administration hospitals in Los Angeles and the Los Angeles Jewish Home for the Aging were integrated, creating the largest U.S. fellowship training program in geriatrics. Solomon served as associate director of the MPGMG from 1981 to 1989.
     
    From 1991 to 1996, he devoted most of his energy and talents to establishing and developing the UCLA Center on Aging, now known as the UCLA Longevity Center, a campus-wide organization dedicated to helping older people live better and longer with improved quality of life through research, community education programs and patient care. He retired as the center’s director in 1996. The UCLA Longevity Center continues to be a major force in the community and nationally under its current leadership. 
     
    “We continue to expand and develop programs at the UCLA Longevity Center that are inspired by Dr. Solomon’s original vision and drive to meet the growing needs of an aging population,” said Dr. Gary Small, the center’s director and UCLA’s Parlow–Solomon Professor on Aging.
     
    Solomon also served as editor-in-chief of the Journal of American Geriatrics Society from 1988 to 1993, was a member of the board of directors of the American Geriatrics Society for eight years, and is a past president of the American Thyroid Association, the Association of Professors of Medicine and the Western Association of Physicians.
     
    He received awards in recognition of his research and educational contributions from the National Council on Aging, the Gerontological Society of America, the American Geriatrics Society, the American College of Physicians, the American Federation for Aging Research, the American Thyroid Association, the Endocrine Society, the Western Society for Clinical Investigation and the UCLA Medical Alumni Association. Solomon was also the initial recipient of the ICON Award from the UCLA Center on Aging. 
     
    In addition to his wife, Ronnie, Solomon is survived by daughters Patti (Mrs. Richard Sinaiko) and Nancy Solomon; grandsons Jeffrey and Gregory Sinaiko; daughter-in-law Marcie Sinaiko; and great-granddaughters Shayna, Samantha and Jamie Sinaiko.
     
    As committed as he was to his career in academic medicine, Solomon was equally committed to his family. His dedication to excellence, concern for all members of society and high standards and expectations for integrity were a continual influence at home, as was his unrestrained enthusiasm for UCLA basketball.
     
    In lieu of flowers, the family asks the public to consider making a donation to UCLA Division of Geriatrics and/or the Venice Family Clinic in Solomon’s memory. For donations to the UCLA Division of Geriatrics, checks can be made payable to the UCLA Foundation (mailing address: UCLA Health Sciences Development, 10945 Le Conte Ave., Suite 3132, Los Angeles, Calif. 90095-1784) or online at www.geronet.ucla.edu/gero-giving. Please indicate “Tribute to David Solomon, MD” in the check memo line; online, please check the “Tribute” box. 
     
    For donations to the Venice Family Clinic, checks can be made payable to Venice Family Clinic, (mailing address: Venice Family Clinic, ATTN: Development, 604 Rose Ave., Venice, Calif. 90291) or online at www.venicefamilyclinic.org.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • UCLA School of Nursing, Children’s Hospital Los Angeles partner to improve kids’ health

     
    An innovative new partnership between the UCLA School of Nursing and Children’s Hospital Los Angeles will bring together nurses working in clinical practice, education and research to improve the health and well-being of children while advancing nursing practice.
     
    “There are so many opportunities with this collaboration that will advance nursing practice by bridging clinical practice and research,” said Courtney H. Lyder, dean of the UCLA School of Nursing. “And by integrating nursing practice and science, we can improve patient care.”
     
    Under the memorandum signed on July 10, both institutions will encourage the development of a variety of collaborative initiatives, including:
    • The creation and implementation of an institutional nursing research department at the Children’s Hospital campus to support nurses in designing research, analyzing data and presenting findings.
       
    • Joint education efforts to teach the next generation of pediatric nurses, including enhancing the Pediatric Nurse Practitioner Program at the UCLA School of Nursing.
       
    • The exchange of scholarly information and materials to keep clinicians and researchers abreast of current findings and best practices.
       
    • Attendance at scholarly and technical meetings and at national and international conferences to showcase research results and find new ways to treat and prevent pediatric illnesses.
       
    • The organization of joint conferences, symposia and other scientific meetings on subjects of mutual interest.
    “Research is a core element of our nursing and patient care mission at Children’s Hospital Los Angeles,” said the hospital’s chief nursing officer and vice president for patient care services Mary Dee Hacker, who noted that the hospital earned Magnet redesignation this year — a status awarded by the American Nurses Credentialing Center (ANCC) to health care facilities that act as a “magnet” in attracting nurses by creating a work environment that rewards them for outstanding clinical practice and collaboration with the rest of the organization.
     
    “The honor served as acknowledgement that our nurses are becoming leaders in research and education,” Hacker said. “We look forward to our new relationship with UCLA and the structure it will provide to enhance our collaborative research projects.”
     
    The development of the institutional nursing research department, in particular, will provide the opportunity for frontline staff to get involved in clinical research, Lyder noted. 
     
    “We believe that countless patients will benefit from the answers to questions that nurses are uniquely qualified to ask,” he said. 
     
    Hacker, who was recently named a commissioner for the ANCC’s Commission on the Magnet Recognition Program, said there is much room for growth and opportunity in the field of pediatric nursing research.
     
    “The number of Ph.D.-prepared pediatric nurses is small,” she said. “Nursing practices based on our adult patient population need to be rigorously tested to see how they can be applied to our pediatric patients.”
     
    Children’s Hospital Los Angeles has been named the best children’s hospital on the West Coast and among the top five in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. Children’s Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children’s Hospital is also one of America’s premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California. Follow CHLA on Twitter, Facebook, YouTube and LinkedIn, and visit their blog at WeAreChildrens.org.  
     
    The UCLA School of Nursing is redefining nursing through the pursuit of uncompromised excellence in research, education, practice, policy and patient advocacy.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • UCLA Health System named a national leader in providing equitable care for LGBT patients

    The UCLA Health System has been named a “Leader in LGBT Healthcare Equality” in the Healthcare Equality Index, an annual survey conducted by the Human Rights Campaign Foundation, the educational arm of the country’s largest lesbian, gay, bisexual and transgender (LGBT) organization.
     
    The health system earned top marks for its commitment to equitable, inclusive care for LGBT patients and their families, who can face significant challenges in securing adequate health care. UCLA applied for the distinction to demonstrate its commitment to the goals of human rights, education, outreach and a better understanding of LGBT individuals in the community and within its health system.
     
    “The UCLA Health System is committed to providing quality care to all of our patients, and we believe that the Healthcare Equality Index is a unique resource for health care organizations to use as a guidepost in providing equitable, inclusive care to lesbian, gay, bisexual and transgender patients,” said Dr. David Feinberg, president of the UCLA Health System. “We decided to participate in the 2013 survey to gain more knowledge through the sharing of best health care practices and policies for LGBT patients and to demonstrate our commitment to equal care for all patients, in keeping with our mission of healing humankind one patient at a time.”
     
    Facilities awarded this title meet key criteria for equitable care, including non-discrimination policies for LGBT patients, non-discrimination policies for employees, a guarantee of equal visitation for same-sex partners and parents, and training for staff in LGBT patient–centered care. The UCLA Health System was one of a select group of 464 health care facilities nationwide to be named “equality leaders” by meeting all four core criteria.
     
    “LGBT patients deeply appreciate the welcoming environment provided by a ‘Leader in LGBT Healthcare Equality,’” said Shane Snowdon, the Human Rights Campaign’s health and aging director. “It makes a big difference to know that your local health care facility is fully committed to giving you the same care it gives your neighbors and co-workers.”
     
    The Health Equality Index survey asked each institution to respond to such questions as whether its employee non-discrimination policy and its patient non-discrimination policy or bill of rights include such terms as “sexual orientation” and “gender identity”; whether its visitation policy explicitly grants equal visitation to LGBT patients and their visitors; and whether its staff receives training in LGBT patient–centered care.
     
    LGBT patients are able to access and search the report to learn which institutions have participated in the Health Equality Index and which have been designated as “equality leaders.” To get more information about the Healthcare Equality Index 2013, or to download a free copy of the report, visit www.hrc.org/hei.
     
    Read more and watch a video about how UCLA is working to improve the health care experience for members of the LGBT community. 
     
    The UCLA Health System has for more than half a century provided the best in health care and the latest in medical technology to the people of Los Angeles and the world. Comprised of Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA and the UCLA Medical Group, with its wide-reaching system of primary care and specialty care offices throughout the region, the UCLA Health System is among the most comprehensive and advanced health care systems in the world. For information about clinical programs or help in choosing a personal physician, call 800-UCLA-MD1 or visit www.uclahealth.org.   
     
    For more news, visit UCLA Newsroom and follow us on Twitter.

  • UCLA Health System named one of health care’s ‘most wired’ institutions in 2013 survey

    For the first time, the UCLA Health System and its hospitals have been designated among the nation’s “most wired” institutions in recognition of their implementation and use of information technology in their health-care delivery systems.
     
    The annual Health Care’s Most Wired Survey, sponsored by Hospitals and Health Networks magazine, measures a hospital’s level of adoption of information technology (IT) relative to other hospitals and health systems. The survey data is distributed, collected and analyzed by Health Forum, an American Hospital Association company, which develops industry-standard benchmarks for IT adoption.
     
    The UCLA Health System’s award was based on a comprehensive assessment that examined UCLA’s overall IT infrastructure and its use of IT and electronic processes (versus paper) for business and administrative purposes, clinical quality and safety, and clinical integration.
     
    “This award is the result of hard work by many dedicated staff and clinicians and expresses our core belief that quality information leads to improved patient care,” said Virginia McFerran, chief information officer for the UCLA Health System. “Integrating clinical thinking and dialog into information-systems planning is the cornerstone of our IT strategy to provide the best patient experience possible.”
     
    This year marks the 15th anniversary of the Most Wired Survey. In that time, hospitals and health care systems have made great strides in establishing the basic building blocks of robust clinical information systems aimed at improving patient care. This process includes adopting technologies to improve patient documentation, advance clinical-decision support and evidence-based protocols, reduce the likelihood of medication errors, and rapidly restore access to data in the case of a disaster or outage.
     
    “This year’s Most Wired organizations exemplify progress through innovation,” said Rich Umbdenstock, president and CEO of the American Hospital Association, which co-sponsors the survey. “The hospital field can learn from these outstanding organizations ways that IT can help to improve efficiency.”
     
    The Most Wired Survey, conducted this year between January 15 and March 15, asked hospitals and health systems nationwide to answer questions regarding their IT initiatives. Respondents completed 659 surveys, representing 1,713 hospitals, or roughly 30 percent of all hospitals in the U.S.
     
    Among the key findings of this year’s survey:  
    • 69 percent of the Most Wired hospitals and 60 percent of all hospitals surveyed reported that medication orders were entered electronically by physicians — a significant increase from 2004, when the figures were 27 percent for Most Wired hospitals and 12 percent for all hospitals. 
       
    • 71 percent of Most Wired hospitals had an electronic disease registry to identify and manage gaps in care across a population, compared with 51 percent of total survey respondents.
       
    • 66 percent of Most Wired hospitals share patient discharge data with affiliated hospitals, compared with 49 percent of total respondents. In addition, 37 percent of Most Wired hospitals share this data with non-affiliated hospitals, versus 24 percent of total respondents.
    “The concept of health information exchange is absolutely correct. We need to do it and do it in a robust, refined way,” said Russell P. Branzell, president and CEO of the College of Healthcare Information Management Executives. “The answer here is standards, standards, standards. We need to standardize the entire process, which we’ve done in almost every other business sector.”
     
    The 2013 Most Wired Survey also covered some new areas, such as big data analytics and patient-generated data. An emerging practice, big data analytics looks at large amounts of data to uncover patterns and correlations. The survey found that 32 percent of Most Wired hospitals conduct controlled experiments or scenario-planning to make better management decisions and that 41 percent of Most Wired hospitals provide a patient portal or Web-based solution for patient-generated data.  
     
    The cover story in the July issue of Hospitals and Health Networks (H&HN) magazine details the results of the survey and is available at www.hhnmag.com.
     
    The American Hospital Association is a not-for-profit association of health-care provider organizations and individuals committed to the health improvement of their communities. The AHA is the national advocate for its members, which includes nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA Web site at www.aha.org.
     
    The 2013 Most Wired Survey is conducted in cooperation with McKesson Corp., AT&T, the College of Healthcare Information Management Executives and the American Hospital Association.
     
    The UCLA Health System has for more than half a century provided the best in health care and the latest in medical technology to the people of Los Angeles and the world. Comprising Ronald Reagan UCLA Medical Center; UCLA Medical Center, Santa Monica; the Resnick Neuropsychiatric Hospital at UCLA; Mattel Children’s Hospital UCLA; and the UCLA Medical Group, UCLA Health, with its wide-reaching system of primary care and specialty care offices throughout the region, is among the most comprehensive and advanced health care systems in the world. For information about clinical programs or help in choosing a personal physician, call 800-UCLA-MD1 or visit www.uclahealth.org.   
     
    For more news, visit UCLA Newsroom and follow us on Twitter.

  • Note to teens: Just breathe

    In May, the Los Angeles school board voted to ban suspensions of students for “willful defiance” and directed school officials to use alternative disciplinary practices. The decision was controversial, and the question remains: How do you discipline rowdy students and keep them in the classroom while still being fair to other kids who want to learn?
     
    A team led by Dara Ghahremani, an assistant researcher in the department of psychiatry at UCLA’s Semel Institute for Neuroscience and Human Behavior conducted a study on the Youth Empowerment Seminar, or YES!, a workshop for adolescents that teaches them to manage stress, regulate their emotions, resolve conflicts and control impulsive behavior. Impulsive behavior, in particular — including acting out in class, engaging in drug or alcohol abuse, and risky sexual behaviors — is something that gets adolescents in trouble.
     
    The YES! program, run by the nonprofit International Association for Human Values, includes yoga-based breathing practices, among other techniques, and the research findings show that a little bit of breathing can go a long way. The scientists report that students who went through the four-week YES! for Schools program felt less impulsive, while students in a control group that didn’t participate in the program showed no change.
     
    The study appears in the July issue of the Journal of Adolescent Health.
     
    “The program helps teens to gain greater control over their actions by giving them tools to respond to challenging situations in constructive and mindful ways, rather than impulsively,” said Ghahremani, who conducted the study at the UCLA Center for Addictive Behaviors and UCLA’s Laboratory for Molecular Neuroimaging. “The program uses a variety of techniques, ranging from a powerful yoga-based breathing program called Sudarshan Kriya to decision-making and leadership skills that are taught via interactive group games. We found it to be a simple yet powerful approach that could potentially reduce impulsive behavior.”
     
    Ghahremani noted that teens are often just as stressed as adults.
     
    “There are home and family issues, academic pressures and, of course, social pressures,” he said. “With the immediacy and wide reach of communication technology, like Facebook, peer pressure and bullying has risen to a whole new level. Without the tools to handle such pressures, teens can often resort to impulsive acts that include violence towards others or themselves.”
     
    Impulsive behavior, or a lack of self-control, in adolescence is a key predictor of risky behavior, Ghahremani said.
     
    “Substance abuse and various mental health problems that begin in adolescence are often very difficult to shake in adulthood — there is a need for interventions that bring impulsive behavior under control in this group,” he said. “Our research is the first scientific study of the YES! program to show that it can significantly reduce impulsive behavior.”
     
    For the study, students between the ages of 14 and 18 from three Los Angeles–area high schools were invited to participate, between spring 2010 and fall 2011. In total, 788 students participated — 524 in the YES! program and 264 in the control group. The program was taught during the students’ physical education courses for four consecutive weeks. Students were asked to fill out questionnaires to rate statements about their impulsive behavior — for example, “I act without thinking” and “I feel self-control most of the time” — directly before and directly after the program. The students who did not go through the program also completed the questionnaires.
     
    The YES! program is composed of three modules focused on healthy body, healthy mind and healthy lifestyle. The healthy body module consists of physical activity that includes yoga stretches, mindful eating processes and interactive discussions about food and nutrition. The healthy mind module includes stress-management and relaxation techniques, including yoga-based breathing practices, yoga postures and meditation to relax the nervous system, bring awareness to the moment and enhance concentration. Group processes promote personal responsibility, respect, honesty and service to others. In the healthy lifestyle module, students learn strategies for handling challenging emotional and social situations, especially peer pressure. Mindful decision-making and leadership skills are taught via interactive games. Students also create a group community-service project, applying their newly learned skills toward that goal.
     
    “There is a need for simple, engaging interventions that bring impulsive behavior under control in adolescents,” said Ghahremani. “This is important to the public because impulsive behavior in adolescents is associated with many mental health problems and, when left unchecked, can result in violent acts, such as those resulting in tragedies recently observed on school campuses.
     
    “The advantage of this program over approaches that center around psychiatric medications is that it develops a sense of responsibility and empowerment in teens, allowing them to clarify and pursue their goals while fostering a sense of connection to their community. Although some medications can help control impulsive behavior, they often come with unpleasant side effects and the risk of medication abuse. Moreover, approaches that rely on them don’t necessarily focus on empowering kids to take control of their lives. “
     
    Non-pharmacologically–based programs like YES! for Schools that increase self-control are important to explore since they offer concrete tools that students can actively apply to their everyday lives with noticeable results, Ghahremani said.
     
    To follow up on results from this study, the National Institute on Drug Abuse has awarded Ghahremani and his colleagues a grant to examine the effects of the YES! program by using functional magnetic resonance imaging (fMRI) to study the brain circuitry that is important for self-control and emotion regulation. The project also aims to examine how the YES! program can reduce cravings among teen smokers.
     
    Other authors of the study included Eugene Y. Oh, Andrew C. Dean, Kristina Mouzakis, Kristen D. Wilson and senior author Edythe D. London, all of UCLA. Funding for the study was provided by an endowment from the Thomas P. and Katherine K. Pike Chair in Addiction Studies and a gift from the Marjorie M. Greene Trust.
     
    The UCLA Department of Psychiatry is part of the Semel Institute for Neuroscience and Human Behavior at UCLA, a world-leading interdisciplinary research and education institute devoted to the understanding of complex human behavior — including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior and the causes and consequences of neuropsychiatric disorders. In addition to conducting fundamental research, institute faculty members seek to develop effective strategies for the prevention and treatment of neurological, psychiatric and behavioral disorders, including improving access to mental health services and the shaping of national health policy.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • PNNL wins R&D 100 Award for instrument that leads to rapid medical and environmental tests

    An instrument that quickly and more effectively analyzes complex biological and environmental samples was today named one of the past year’s 100 most significant scientific and technological products or advances.

    The innovation was recognized by R&D Magazine in their annual R&D 100 Awards competition and was developed by researchers at the Department of Energy’s Pacific Northwest National Laboratory.

    PNNL has now won 90 R&D 100 Awards — sometimes referred to as the “Oscars of Innovation” — since the contest began in 1963.

    “My sincere congratulations to the winners of this year’s R&D 100 Awards,” said Energy Secretary Ernest Moniz. “The scientists and engineers who developed these award-winning technologies at the cutting edge facilities across our national labs are keeping Americans at the forefront of the innovation community and assuring our nation’s economic competitiveness and national security.”

    Identification of small molecules that indicate disease, known as biomarkers, promises to significantly improve human heath through early diagnosis and customized treatment. However, improved research instruments for separation and identification of specific molecules in complex samples are needed to achieve this objective.

    PNNL researchers have recently developed a new instrument that can process such complex samples rapidly and accurately, detecting rare yet important molecules for early diagnosis that cannot be adequately characterized using existing instruments.

    The PNNL-developed instrument effectively merges two complementary analysis techniques — one known as multiplexed ion mobility spectrometry (IMS) and the other as ultrafast quadrupole time-of-flight mass spectrometry — into the Combined Orthogonal Mobility & Mass Evaluation Technology, or CoMet.

    The combination of the two distinct approaches enables CoMet to exhaustively characterize samples, some of which have many different components that vary greatly in abundance. This wide range of quantities commonly trips up less advanced separation methods. The exceptional speed of IMS permits CoMet to analyze large numbers of samples rapidly and inexpensively. This can be crucial in biomedical research, clinical practices, natural product management — where sample analysis is conducted by oil and mining industries — and in environmental studies.

    CoMet has been used in collaborations with Oregon Health Sciences University and the University of Washington to investigate several diseases and with the University of Wisconsin-Madison for environmental studies. The technology was created at EMSL, DOE’s Environmental Molecular Sciences Laboratory located at PNNL, and integrated into several instruments that are available for use by the scientific community through EMSL’s competitive peer review process. Developed using mass spectrometers from Agilent Technologies of Santa Clara, Calif., CoMet has been licensed by Agilent and commercially introduced at the National ASMS Meeting in June 2013.

    The winning PNNL team was led by Battelle Fellow Richard Smith, and included co-developers Gordon Anderson, Erin Baker, Kevin Crowell, William Danielson III, Yehia Ibrahim, Brian LaMarche, Matthew Monroe, Ronald Moore, Randolph Norheim, Daniel Orton, Alexandre Shvartsburg, Gordon Slysz, and Keqi Tang.

    PNNL staff involved in developing and commercializing the innovation will be honored at the annual R&D 100 Awards ceremony in Orlando, Fla., Nov. 7.

  • UCLA brain-pacemaker patient to play guitar in public for first time since live-tweeted surgery

    WHAT: 
    Brad Carter, a Los Angeles man who captured international attention when he strummed his guitar during a live-tweeted UCLA surgery to implant a pacemaker in his brain, will appear at a UCLA press conference to discuss with his surgeon how undergoing the procedure has changed his life. He will also play guitar in public for the first time since the May 23 surgery. 
     
    Carter chose to undergo the surgery to halt what is known as benign essential tremor, a neurological disorder that made his hands shake when he moved them. He was the 500th Ronald Reagan UCLA Medical Center patient to undergo the deep-brain stimulation procedure, which uses imaging technology to target the exact site in the brain producing abnormal electrical signals. When surgeons implant the pacemaker, they stimulate the region to restore a more normal pattern of brain activity, effectively stopping the tremors.
     
    WHO: 
    The following individuals will be available for interviews:
     
    Brad Carter
    The 39-year-old actor, musician and artist underwent deep-brain stimulation during an awake craniotomy, in which surgeons temporarily lifted a piece of his skull to implant a pacemaker inside his brain.
     
    Dr. Nader Pouratian
    An assistant professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of its neurosurgical movement disorders program, Pouratian is a leading expert on surgical therapies for Parkinson’s disease and essential tremor.
     
    WHEN: 
    Wednesday, July 10 (Press check-in at 10:30 a.m.; press conference begins at 11 a.m.)
     
    WHERE:       
    Auditorium of UCLA’s Neuroscience Research Building (map)
    635 Charles E. Young Dr. South, Los Angeles 90095
     
    PARKING:
    Parking for oversized media vans is very limited. Please R.S.V.P. to media contact by 3 p.m. on Tuesday, July 9, to be assigned a space for oversized trucks and to arrange a complimentary parking pass for passenger vehicles. 
     
    MEDIA CONTACT:
    Elaine Schmidt | [email protected] | 310-794-2272

  • Growth, not just size, boosts brain aneurysms’ risk of bursting

    Brain aneurysms of all sizes — even small ones the size of a pea — are up to 12 times more likely to rupture if they are growing, according to a new UCLA study.
     
    Published July 2 in the online edition of the journal Radiology, the discovery counters current guidelines suggesting that small aneurysms pose a low risk for rupture, and it emphasizes the need for regular monitoring and earlier treatment.
     
    “Until now, we believed that large aneurysms presented the highest risk for rupture and that smaller aneurysms may not require monitoring,” said lead author Dr. J. Pablo Villablanca, chief of diagnostic neuroradiology at the David Geffen School of Medicine at UCLA. “Our findings show this is not the case and shed light on additional risk factors for rupture in aneurysms of all sizes.”
     
    An aneurysm occurs at a weak spot in an artery that supplies blood to the brain. The artery wall bulges outward, creating a balloon filled with blood. If an aneurysm ruptures, blood leaks into or around the brain, which can cause stroke, paralysis, brain damage or death.
     
    An estimated 6 million people in the U.S., one in 50, live with a brain aneurysm, most with no symptoms. But brain aneurysms rupture in some 30,000 Americans each year. The prognosis is grim: About 40 percent die before reaching the hospital, and another third die within the first 30 days post-rupture. The majority of those who survive are left with permanent brain damage and physical disability.
     
    Villablanca and his colleagues imaged the brain blood vessels of 165 patients with 258 asymptomatic aneurysms using a noninvasive method called computed tomography angiography, or CTA. Patients underwent CTA scans every six or 12 months.
     
    In 38 of the patients, the researchers saw growth in 46 aneurysms — nearly 18 percent of all the aneurysms. Three of the growing aneurysms ruptured; all were smaller than 7 millimeters when the patient enrolled in the study.
     
    “Our study shows that the size of the aneurysm is not as important as we once thought,” Dr. Villablanca said. “Any aneurysm is capable of growth and requires follow-up imaging.”
     
    Compared with the aneurysms that did not increase in size, growing aneurysms were associated with a 12-fold higher risk of rupture. The researchers calculated the risk of rupture for growing aneurysms at 2.4 percent per patient-year, versus 0.2 percent for aneurysms without growth.
     
    “Our data emphasize the importance of long-term follow-up imaging to watch for possible growth in all unruptured aneurysms, including small lesions,” Villablanca said.
     
    In a secondary finding, the researchers reported that tobacco smoking and an aneurysm’s initial larger size were independent factors predicting aneurysm growth. These combined risk factors were linked to nearly 80 percent of all aneurysm growth in the study.
     
    “Our findings correlated a higher risk of rupture to the combined factors of smoking, aneurysm growth and larger aneurysm size,” Villablanca said. “Patients who smoke and have growing aneurysms may require earlier treatment, such as brain surgery or endovascular coiling.”
     
    The research was supported by a grant from the National Institute of Biomedical Imaging and Bioengineering. 
     
    Villablanca’s co-authors included Dr. Gary Duckwiler, Dr. Reza Jahan, Dr. Satoshi Tateshima, Dr. Neil Martin, Dr. John Frazee, Dr. Nestor Gonzalez, James Sayre and Dr. Fernando Vinuela, all from UCLA.
     
    Ronald Reagan UCLA Medical Center offers three-dimensional imaging of brain aneurysms to predict which patients may be at higher risk of rupture and require immediate treatment.  
     
    UCLA Radiology is committed to providing outstanding patient care by combining xcellence in clinical imaging, research and educational programs with state-of-the-art technology. The department’s internationally recognized faculty and researchers collaborate with a vast number of departments within the hospital and university, allowing UCLA to rapidly implement new and often revolutionary imaging and therapeutic innovations to benefit patients.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • UCLA researchers find new clue to cause of human narcolepsy

    In 2000, researchers at the UCLA Center for Sleep Research published findings showing that people suffering from narcolepsy, a disorder characterized by uncontrollable periods of deep sleep, had 90 percent fewer neurons containing the neuropeptide hypocretin in their brains than healthy people. The study was the first to show a possible biological cause of the disorder.
     
    Subsequent work by this group and others demonstrated that hypocretin is an arousing chemical that keeps us awake and elevates both mood and alertness; the death of hypocretin cells, the researchers said, helps explain the sleepiness of narcolepsy. But it has remained unclear what kills these cells. 
     
    Now the same UCLA team reports that an excess of another brain cell type — this one containing histamine — may be the cause of the loss of hypocretin cells in human narcoleptics. 
     
    UCLA professor of psychiatry Jerome Siegel and colleagues report in the current online edition of the journal Annals of Neurology that people with the disorder have nearly 65 percent more brain cells containing the chemical histamine. Their research suggests that this excess of histamine cells causes the loss of hypocretin cells in human narcoleptics.
     
    Narcolepsy is a chronic disorder of the central nervous system characterized by the brain’s inability to control sleep–wake cycles. It causes sudden bouts of sleep and is often accompanied by cataplexy, an abrupt loss of voluntary muscle tone that can cause person to collapse. According to the National Institutes of Health, narcolepsy is thought to affect roughly one in every 3,000 Americans. Currently, there is no cure.
     
    Histamine is a body chemical that works as part of the immune system to kill invading cells. When the immune system goes awry, histamine can act on a person’s eyes, nose, throat, lungs, skin or gastrointestinal tract, causing the symptoms of allergy that many people are familiar with. But histamine is also present in a type of brain cell. 
     
    For the study, researchers examined five narcoleptic brains and seven control brains from human cadavers. Prior to death, all the narcoleptics had been diagnosed by a sleep disorder center as having narcolepsy with cataplexy. These brains were also compared with the brains of three narcoleptic mouse models and to the brains of narcoleptic dogs. 
     
    The researchers found that the humans with narcolepsy had an average of 64 percent more histamine neurons. Interestingly, the team did not see an increased number of these cells in any of the animal models of narcolepsy.
     
    “Humans and animals with narcolepsy share the same symptoms, but we did not see the histamine cell changes we saw in humans in the animal models we examined,” said Siegel, who directs the Center for Sleep Research at the UCLA Semel Institute for Neuroscience and Human Behavior and is the senior author of the research. “We know that narcolepsy in the animal models is caused by engineered genetic changes that block hypocretin function. However, in humans, we did not know why the hypocretin cells die.
     
    “Our current findings indicate that the increase of histamine cells that we see in human narcolepsy may cause the loss of hypocretin cells,” he said.
     
    The study results may also further our understanding of brain plasticity, Siegel noted. While scientists have known of the existence neurogenesis — the process by which the brain is populated with new neurons — it was thought to function mainly to replace existing cells that had died.
     
    “This paper shows for the first time that neuronal numbers can increase greatly and not just serve as replacement cells,” he said. “In the current example, this appears to be pathological with the destruction of hypocretin, but in other circumstances, it may underlie recovery and learning and open new routes to treatment of a number of neurological disorders.”
     
    Siegel is also the chief of neurobiology research at the Sepulveda Veterans Affairs Medical Center in Mission Hills, Calif. Other authors on the study included co–first authors Joshi John and Thomas C. Thannickal, Ronald McGregor, Lalini Ramanathan and Carly Stone of UCLA; Marcia Cornford of Harbor–UCLA Medical Center; Hiroshi Ohtsu of Japan’s Tohoku University; Seiji Nishino and Noriaki Sakai of Stanford University; and Akhiro Yamanaka of Japan’s Nagoya University.
     
    Funding for the study was provided by the Medical Research Service of the U.S. Department of Veterans Affairs and by National Institutes of Health grants NS14610 and MH064109.
     
    The UCLA Department of Psychiatry and Biobehavioral Sciences is the home within the David Geffen School of Medicine at UCLA for faculty who are experts in the origins and treatment of disorders of complex human behavior. The department is part of the Semel Institute for Neuroscience and Human Behavior at UCLA, a world-leading interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • UCLA discovery sheds light on why Alzheimer’s meds rarely help

    UCLA RESEARCH ALERT
     
    BACKGROUND:
    The nonprofit Alzheimer’s Association projects that the number of people living with Alzheimer’s disease will soar from 5 million to 13.8 million by 2050 unless scientists develop new ways to stop the disease. Current medications do not treat Alzheimer’s or stop it from progressing; they only temporarily lessen symptoms, such as memory loss and confusion.

    Current Alzheimer’s drugs aim to reduce the amyloid plaques — sticky deposits that build up in the brain — that are a visual trademark of the disease. These plaques are made of long fibers of a protein called amyloid beta, or Aβ. Recent studies, however, suggest that the real culprit behind Alzheimer’s may be small Aβ clumps called oligomers that appear in the brain years before plaques develop.   
     
    FINDINGS:
    In unraveling oligomers’ molecular structure, UCLA scientists discovered that Aβ has a vastly different organization in oligomers than in amyloid plaques. Their finding could shed light on why Alzheimer’s drugs designed to seek out amyloid plaques have no effect on oligomers.
     
    IMPACT:
    The UCLA study suggests that recent experimental Alzheimer’s drugs failed in clinical trials because they zero in on plaques and do not work on oligomers. Future studies on oligomers will help speed the development of new drugs specifically aiming at Aβ oligomers, the researchers say.
     
    AUTHORS:
    Zhefeng Guo, an assistant professor of neurology at the David Geffen School of Medicine at UCLA and a member of UCLA’s Brain Research Institute and Molecular Biology Institute, is available for interviews.
     
    JOURNAL:
    The study was published as the “paper of the week” in the June 28 issue of the peer-reviewed Journal of Biological Chemistry.
     
    GRAPHICS:
    Images of Aβ oligomers and Aβ fibers are available upon request.
     
    FUNDING:

    The research was supported by the Alzheimer’s Association and the American Health Assistance Foundation.

  • Doctor-patient communication about dietary supplements could use a vitamin boost

    Vitamins, minerals, herbs and other dietary supplements are widely available in supermarkets and drug stores across the nation without a prescription, so it’s no surprise that nearly half of all Americans take them.
     
    But they do carry risks, including potentially adverse interactions with prescription drugs, and some people may even use them in place of conventional medications. So it’s important that primary care physicians communicate the pros and cons of supplements with their patients. In fact, both the Food and Drug Administration and the National Institutes of Health suggest that patients consult with their doctors before starting to take them.
     
    A new UCLA-led study currently available in the journal Patient Education and Counseling examined the content of doctor–patient conversations about dietary supplements and found that, overall, physicians are not particularly good at conveying important information concerning them.
     
    “This is the first study to look at the actual content of conversations about dietary supplements in a primary care setting,” said Dr. Derjung Tarn, an assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the study’s primary investigator. “The bottom line was that discussions about meaningful topics such as risks, effectiveness and costs that might inform patient decisions about taking dietary supplements were sparse.”
     
    The researchers analyzed transcripts of audio recordings from office visits by 1,477 patients to 102 primary care providers. The data were collected in three separate studies conducted between 1998 and 2010. Of those visits, 357 included patient–physician discussions of 738 dietary supplements. The team found that five major topics were discussed with regard to the supplements: the reason for taking the supplements, how to take them, their potential risks, their effectiveness, and their cost or affordability.
     
    For scoring, the researchers used the Supplement Communication Index (SCI), which is calculated by giving one point for discussion of each of the five major topics.
     
    Among the findings:
    • Less than 25 percent of the five major topics — fewer than two on average — were discussed during the office visits.
       
    • All five topics were covered during discussions of only six of the 738 supplements.
       
    • None of the five major topics were discussed for 281 of the supplements patients told their physicians they were taking.
       
    • SCI scores were significantly higher for discussions of non-vitamin, non-mineral supplements such as herbs, compared with those about vitamins and minerals. The former have a greater potential for adverse medication–supplement interactions than the latter.
    The researchers pointed out that since the original studies did not focus specifically on dietary supplements, they could not ascertain how many of the 1,477 patients from the three studies were actually taking them. The researchers also did not have information about the patients’ medications or medical conditions, so they could not assess if patients were at risk for interactions.
     
    But given these supplements’ popularity, easy availability and potential risks, more should be done to improve physician communication about them, the researchers said.
     
    “Future studies should examine the relationship between physician–patient discussions on patient decision-making about dietary supplements, and investigate whether discussions are effective for preventing adverse events and supplement–drug interactions,” the researchers write. “A better understanding about these relationships could inform future interventions to enhance physician–patient communication about dietary supplements.”
     
    Grants from the Robert Wood Johnson Foundation (034384), a UCLA Mentored Clinical Scientist Development Award (5K12AG001004), the UCLA Older Americans Independence Center (NIH/NIA Grant P30-AG028748); the National Center for Complementary and Alternative Medicines and the Office of Dietary Supplements (R01AT005883) funded this study.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
     
    Study co-authors included Ian D. Coulter, Arun S. Karlamangla and Neil S. Wenger, all of UCLA; Richard L. Kravitz and Debora A. Paterniti of UC Davis; Jeffrey S. Good of Syracuse University; and James M. Galliher of the AAFP National Research Network. Coulter is also associated with the RAND Corp.
     
    The UCLA Department of Family Medicine provides comprehensive primary care to entire families, from newborns to seniors. It  provides low-risk obstetrical services and prenatal and inpatient care at UCLA Medical Center, Santa Monica, and outpatient care at the UCLA Family Health Center in Santa Monica and the Mid-Valley Family Health Center, located in a Los Angeles County Health Center in Van Nuys, Calif. The department is also a leader in family medicine education, for both medical students and residents, and houses a significant research unit focusing on health care disparities among immigrant families and minority communities and other underserved populations in Los Angeles and California.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • Salmonella infection is a battle between good and bad bacteria in the gut

    The blockbuster battles between good and evil are not just on the big screen this summer. A new study that examined food poisoning infection as-it-happens in mice revealed harmful bacteria, such as a common type of Salmonella, take over beneficial bacteria within the gut amid previously unseen changes to the gut environment. The results provide new insights into the course of infection and could lead to better prevention or new treatments.

    “We’re trying to tease apart a largely unknown area of biology,” said systems biologist Josh Adkins and team lead at the Department of Energy’s Pacific Northwest National Laboratory. “Infection changes the populations of bacteria in the gut with resulting inflammation. We want to understand the interplay between these events.”

    Out this week in PLOS ONE, the study shows that Salmonella Typhimurium might use the sugar fucose either as a sign that it has found a good place to reproduce or use fucose to sustain itself during infection, or both. This was the first time researchers saw fucose as an important player during Salmonella infection.

    “We were taken completely by surprise with the fucose results,” said Adkins. They also saw other sugars that normally are eaten by resident bacteria going untouched. “By knowing what the bacteria eat, we can try to promote the good bacteria and throw off the battle.”

    The Mice

    Food poisoning caused by Salmonella bacteria hits more than 40,000 people every year. One of the common types that infect people, Salmonella Typhimurium, doesn’t usually get mice sick, so Adkins and colleagues used mice uniquely sensitive to Salmonella infection. After infecting mice with the disease-causing bacteria orally, the researchers could follow the course of the illness by analyzing what came out of the other end of the mice.

    “In most studies, researchers clear out the resident bacteria with antibiotics before introducing infectious bacteria,” said microbiologist Brooke Deatherage Kaiser. “In this study, we could watch Salmonella knock out the commensal organisms and then watch them come back. Following the interactions through time is not something we’ve been able to do before.”

    The story they put together shows how Salmonella usurps microbes that normally populate the gut. Known as commensal bacteria, resident bugs perform important functions such as breaking down carbohydrates and sugars that people and mice can’t. Using advanced instruments and techniques, the researchers identified which populations of bacteria dominated as infection progressed and mice recovered, as well as changes in the gastrointestinal tract, such as the presence of inflammation and available nutrients. Some of the experiments were performed in EMSL, the DOE’s Environmental Molecular Sciences Laboratory on PNNL’s campus.

    The Sugars

    While many events the team witnessed were expected, such as infection causing inflammation in the gut, some were not. One unexpected change was in the kinds of sugars available for bacteria to eat. A handful of sugars that good bacteria normally chow down on lay around the gut untouched.

    This stockpile of unusual sugars likely occurred because the good bacteria had, by that point, been overtaken by Salmonella and another bacterial variety, Enterococci. Enteroccoci are normally found in the gut but can take advantage of opportunities to overgrow their welcome.

    Unexpectedly, several lines of evidence suggested that Salmonella might use the sugar fucose as a food source. This study showed that the bacteria produced proteins that specifically help it digest fucose, which was the first time these researchers observed fucose proteins during Salmonella infection.

    Although additional research will be needed to flesh out the role of fucose in the infectious cycle of Salmonella Typhimurium, this observation may help to control or prevent gastrointestinal infection in the future by a better understanding of nutrient sources and signals in the gut.

    Overall, the study allowed the PNNL researchers to follow the rise and fall of the infecting bacteria, the fall and rise during recovery of the commensal bacteria, and changes to the gut as the mice fended off the infection. Future research will focus on what happens in other areas of the intestine to get a handle on the difference between the type of illness this study represented, acute gastrointestinal disease, and more systemic infection.

    This work was supported by the National Institute of Allergy and Infectious Disease.

    Reference: Brooke L. Deatherage Kaiser, Jie Li, James A. Sanford, Young-Mo Kim, Scott R. Kronewitter, Marcus B. Jones, Christine T. Peterson, Scott N. Peterson, Bryan C. Frank, Samuel O. Purvine, Joseph N. Brown, Thomas O. Metz, Richard D. Smith, Fred Heffron, and Joshua N. Adkins. A Multi-Omic View of Host-Pathogen-Commensal Interplay in Salmonella-Mediated Intestinal Infection, PLOS ONE June 26, 2013. doi: 10.1371/journal.pone.0067155

  • Nurse practitioners can help boost quality of care for older patients with chronic conditions

    U.S. residents today are living longer than previous generations, thanks to improved public health and medical treatment. But they’re also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care.
     
    Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions.
     
    Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments. One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings?
     
    The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study’s findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions.
     
    “It is becoming increasingly clear that care of chronic geriatric conditions is better when it’s done in teams,” said the study’s lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA. “There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners.”
     
    Reuben noted that while doctors are generally good at treating acute medical conditions and those requiring highly complex decision-making, some chronic conditions tend to be “swept by the wayside” because physicians either don’t have the time or are simply not as skilled in dealing with them.
     
    In addition, doctors often can’t make the time to deal with both patient symptoms and the management of chronic illnesses that may not have acute symptoms. “There just isn’t enough time in the office to do both,” Reuben said.
     
    For the current study, researchers screened 1,084 patients at two primary care facilities in Southern California for four chronic geriatric conditions: falls, urinary incontinence, dementia/Alzheimer’s disease, and depression. Of those patients, 658 had at least one condition; 485 of the 658 patients were then randomly selected for medical review.
     
    Of those 485 patients, 237 (49 percent) were seen by a nurse practitioner, for co-management with a primary care physician of at least one condition. The rest were seen only by a primary care physician.
     
    The researchers examined whether a set of measures known as “quality indicators” were performed for each condition. For example, if a patient had a history of falls, did the care provider assess whether the patient might be taking medications that increase the risk of falls and assist the patient in reducing or stopping the use of that drug?
     
    The study authors found that the percentage of quality indicators that were satisfied for patients whose cases were co-managed by a nurse practitioner and a physician was higher than for those seen only by a physician.
     
    For falls, 80 percent of quality indicators were satisfied for co-managed cases, compared with 34 percent for physicians alone; for urinary incontinence, 66 percent of indicators were satisfied, compared with 19 percent; for dementia, 59 percent were satisfied, compared with 38 percent; and for depression, 63 percent were satisfied, compared with 60 percent.
     
    Much of the difference was due to the fact that the nurses were likely to take far more detailed patient histories and to perform other assessments. For instance, the pass rates — that is, whether the measure was performed — for taking a patient’s history of falls was 91 percent for co-managed cases, versus 47 percent; vision testing was 87 percent, versus 36 percent; and discussion of treatment options for urinary incontinence was 79 percent, versus 28 percent.
     
    The findings were limited by several facts, the researchers said. Some cases that primary care physicians considered “mild” were not referred for co-management, the study was conducted in only two facilities within a single geographic area, and it was a one-time intervention with minor revisions as the study went along rather than a longer, continuous learning process.
     
    Grants from the UniHealth Foundation; a Career Development Award from the Health Services Research and Development Service of the Veterans Affairs Health Administration (U.S. Department of Veterans Affairs) through the VA Greater Los Angeles Health Services Research and Development Center of Excellence (Project # VA CD2 08-012-1); and the National Institute on Aging (5P30AG028748) funded this study.
     
    Other researchers on this study included David A. Ganz, Heather E. McCreath, Karina D. Ramirez and Neil S. Wenger of UCLA, and Carol P. Roth of the RAND Corp. Ganz and Wenger are also associated with RAND, and Ganz is associated with Veterans Affairs Greater Los Angeles Healthcare System.
     
    The UCLA Division of Geriatrics within the department of medicine at the David Geffen School of Medicine at UCLA offers comprehensive outpatient and inpatient services at several convenient locations and works closely with other UCLA programs that strive to improve and maintain the quality of life of seniors. UCLA geriatricians are specialists in managing the overall health of people age 65 and older and treating medical disorders that frequently affect the elderly, including memory loss and dementia, falls and immobility, urinary incontinence, arthritis, arthritis, high blood pressure, heart disease, osteoporosis and diabetes. As a result of their specialized training, UCLA geriatricians can knowledgably consider and address a broad spectrum of health-related factors — including medical, psychological and social — when treating patients.

    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • Memory improves for older adults using computerized brain-fitness program

    UCLA RESEARCH ALERT
     
    FINDINGS:  
    UCLA researchers have found that older adults who regularly used a brain-fitness program on a computer demonstrated significantly improved memory and language skills. 
     
    The UCLA team studied 69 dementia-free participants, with an average age of 82, who were recruited from retirement communities in Southern California. The participants played a computerized brain-fitness program called Dakim BrainFitness, which trains individuals through more than 400 exercises in the areas of short- and long-term memory, language, visual-spatial processing, reasoning and problem-solving, and calculation skills.
     
    The researchers found that of the 69 participants, the 52 individuals who over a six-month period completed at least 40 sessions (of 20–25 minutes each) on the program showed improvement in both immediate and delayed memory skills, as well as language skills.
     
    The findings suggest that older adults who participate in computerized brain training can improve their cognitive skills.
     
    IMPACT:    
    The study’s findings add to a body of research exploring whether brain fitness tools may help improve language and memory and ultimately help protect individuals from the cognitive decline associated with aging and Alzheimer’s disease.
     
    Age-related memory decline affects approximately 40 percent of older adults.  And while previous studies have shown that engaging in stimulating mental activities can help older adults improve their memory, little research had been done to determine whether the numerous computerized brain-fitness games and memory training programs on the market are effective in improving memory. This is one of the first studies to assess the cognitive effects of a computerized memory-training program.  
     
    AUTHORS:  
    Authors of the study were Karen Miller, Ph.D., an associate clinical professor at the Semel Institute for Neuroscience and Human Behavior at UCLA, and Prabha Siddarth, Ph.D., a research statistician in psychiatry and biobehavioral sciences at the Semel Institute. Both are available for interviews.
     
    FUNDING:   
    The study was funded in part by Dakim, manufacturer of Dakim BrainFitness, the computerized program used in the study. Miller and Siddarth have served as consultants on the development of the software included in the program.
     
    JOURNAL:  
    The study is published in the July issue of the American Journal of Geriatric Psychiatry. A copy of the full study is also available.

  • Three UCLA physicians help save plane passenger in distress

  • Innovative intervention program improves life for rural women in India living with HIV/AIDS

    A multidisciplinary team of researchers from UCLA and India has found that a new type of intervention program, in which lay women in the rural Indian province of Andra Pradesh were trained as social health activists to assist women who have HIV/AIDS, significantly improved patients’ adherence to antiretroviral therapy and boosted their immune-cell counts and nutrition levels.
     
    The lay women were trained by the research team to serve as accredited social health activists, or ASHA, and their work was overseen by rural nurses and physicians. These ASHA then provided counseling and support to the women with HIV/AIDS, as well as assistance aimed at removing the barriers they face in accessing health care and treatment.
     
    “For rural women living with AIDS in India, stigma, financial constraints and transportation challenges continue to exist, making lifesaving antiretroviral therapy difficult to obtain,” said lead researcher Adey Nyamathi, distinguished professor and associate dean of international research and scholarly activities at the UCLA School of Nursing.
     
    In India, 2.47 million people are affected with HIV/AIDS, and more than half are women. The epidemic is shifting from urban to rural areas, and the rice-producing Andhra Pradesh district in southeastern India is at the epicenter; this area has the highest total number of HIV/AIDS cases of all states in the country, with nearly 20 percent of the population infected.
     
    For the intervention study, women with HIV/AIDS in Andra Pradesh were randomly selected to participate either in the intervention, called AHSA-LIFE (AL), or in a control group.
     
    Over a six-month period, the ASHA visited the women in the AL group to monitor the barriers they faced in accessing health care and adhering to their antiretroviral therapy and provided assistance to help mitigate these barriers. The ASHA also provided counseling to help women develop coping strategies to deal with discrimination. The intervention group also received monthly supplies of high-protein foods, such as black gram and pigeon pea.
     
    In addition, the women in the AL group participated in six education sessions covering a variety of topics, including learning about HIV and AIDS, adhering to antiretroviral therapy, overcoming barriers and dealing with the illness. The courses also focused on improving coping, reducing the stigma of the disease, caring for family members and children, the basics of good nutrition and benefits of participating in a life-skills class. 
     
    Women in the control group also attended the education sessions, but they did not receive visits and supportive services from the ASHA. They received only standard protein supplementation, not the high-protein supplements of the intervention group.
     
    Among the women in the AL group, the researchers found significant increases in therapy adherence and CD4+ T-cell levels, as well as significant reductions in internalized stigma, avoidance coping and depressive symptoms, compared with the control group. The women in the AL group also showed significant increases in body mass index, muscle mass and fat mass, compared with the other women.
     
    The pilot study holds promise for rural women and other populations afflicted by HIV/AIDS, Nyamathi said.
     
    “The findings of our study lay the groundwork for a national model related to the benefits of training and working with ASHA in rural India in an effort to improve antiretroviral therapy adherence and reduce stigma and depression, as well as improve nutritional status,” she said.
     
    Findings from the study are currently available on online in two journals: the Western Journal of Nursing Research, and AIDS Education and Prevention. The study was funded by the National Institute of Mental Health, part of the National Institutes of Health.

    Other researchers on the ASHA-LIFE project were Catherine Carpenter Ph.D., a faculty member with the UCLA School of Nursing and the UCLA Nutrition Center; Sanjeev Sinha M.D., AIDS director from the All India Institute of Medical Sciences in Delhi; and Kalyan Ganguly, Ph.D., a behavioral scientist from Indian Council for Medical Research in Delhi; and Maria Ekstrand Ph.D., a clinical psychologist from the Center for AIDS Prevention Studies at UC San Francisco.
     
    The UCLA School of Nursing is redefining nursing through the pursuit of uncompromised excellence in research, education, practice, policy and patient advocacy.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.

  • High cost of raising a child challenges state’s most vulnerable caregivers: grandparents

    Raising a child is not cheap. Now try raising one on a fixed income and long past the age one associates with parenthood: 65 years and older.
     
    More than 300,000 grandparents in California have primary responsibility for their grandchildren, and of this group, almost 65,000 are over the age of 65. More than 20,000 care for their grandkids without any extended family assistance at home.
    A new study from the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development shows that these families —older adults raising grandchildren alone — may be among the most vulnerable residents in California, due to the state’s high cost of living and low levels of public assistance.
    “California’s high cost of living turns the loving act of caring for a grandchild into a desperate financial risk,” said the UCLA center’s D. Imelda Padilla-Frausto, lead author of the study. “And older grandparents, many on fixed incomes and with limited mobility, are often the least able to advocate for, and access, public assistance.”
    The brief’s new calculations — based on the true cost of living in every California county — show that nearly half of custodial grandparents who are 65 and over in California do not have enough income to cover the most basic needs of the grandchildren placed in their care. Yet public programs that might provide benefits that could help grandparents cope, such as the state foster-care program, are often difficult to access or off-limits altogether for family caregivers.
    “There is a hypocrisy built into how assistance is allocated to children and their caregivers in California,” said Susan E. Smith, director of the California Elder Economic Security Initiative at the Insight Center. “We preach the importance of keeping families together yet deny grandparents essential assistance because they are ‘family.’ This is an injustice that policymakers could easily address by making more benefits available, and accessible, to grandparents.”
    Many older adults in California are ineligible for public programs like Medi-Cal, housing subsidies and food benefits because they have incomes that are above, often just slightly, the federal poverty level (FPL), which is the official federal definition of poverty. Yet this definition — $18,530 for a family of three and $14,710 for a family of two in 2011 — is considered by many experts to be inadequate, largely because it does not take into account variations in the cost of living from state to state and county to county.
    Grandparents whose incomes leave them above the FPL but below the income needed to cover their basic needs may struggle in a high-cost county such as Los Angeles or San Francisco. The costs involved in caring for a grandchild (or two) far exceed the FPL in every California county. For example, in 2011, an older couple with one grandchild who lived in a two-bedroom rental needed an income as high as $49,942 if they lived in Santa Cruz County and as low as $32,965 if they lived in Kern, the “lowest-cost” county. (See county breakdown below.)
    Among the study’s recommendations, the authors suggest raising the eligibility criteria for certain public programs to 200 percent of the FPL; extending state foster-care benefits to kinship caregivers; and limiting the frequency of cumbersome and bureaucratic benefit renewals (since most older adults live on fixed incomes and thus do not experience income fluctuations that require regular documenting).
    The data on the costs of raising a grandchild are part of a larger release of 2011 Elder Index data on the true cost of living for older Californians. See all Elder Index 2011 data here.
    Updated every two years by the UCLA Center for Health Policy Research, in partnership with the Insight Center for Community Economic Development, the Elder Index quantifies the cost of basic necessities like food, clothing and shelter for each county of California and is part of a national movement to improve the way poverty is measured in the U.S. The methodology for the basic amounts was developed by the Gerontology Center at the University of Massachusetts–Boston and Wider Opportunities for Women in Washington, D.C.

    Learn more about how the Elder Index is calculated.

    See county-by-county information on the Elder Index and on the Elder Index for Grandparents Raising Grandchildren.
     

    The Insight Center for Community Economic Development     is a 44-year-old national research, legal and consulting organization dedicated to building economic health in vulnerable communities.
     
    The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health-related information on Californians.
     
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  • Timely treatment after stroke is crucial, UCLA researchers report

    For years, the mantra of neurologists treating stroke victims has been “time equals brain.” That’s because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost.
     
    But specific information has been limited on just how the timing of giving the intravenous drug — known as a tissue plasminogen activator, or tPA — influences outcomes for victims of ischemic (clot-caused), stroke, the most common type of stroke.
     
    Now, a team led by UCLA researchers has conducted a major study on the importance of the speed of treatment when using tPA, analyzing outcomes for more than 50,000 stroke patients and determining just how critical the time between the onset of stroke and the administering of treatment is.
     
    “We found that treatment time has a profound influence on outcome,” said the study’s first author, Dr. Jeffrey Saver, a professor of neurology and director of the UCLA Stroke Center. “The sooner treatment is started, the better. Beginning treatment earlier resulted in an improved ability to walk, the ability to remain living independently, less bleeding in the brain and reduced mortality.”
     
    The team’s findings are reported in the June 19 issue of the JAMA, The Journal of the American Medical Association.
     
    Previous research had demonstrated that administering tPA intravenously up to 4.5 hours after a stroke occurs benefits patients with moderate to severe acute ischemic stroke. Data pooled from a number of small, randomized clinical trials showed that the benefit of tPA was greatest when given very early after stroke, and that the benefit declined throughout the first 4.5 hours.
     
    But the available data from these clinical trials was small — just 1,850 tPA-treated patients from eight trials — limiting precision in delineating the influence of time-to-treatment, as well as researchers’ ability to determine whether the benefits could be generalized to a wider population. To address this need, the current study used a large national registry to determine more precisely the association of time-to-treatment and the resulting outcomes.
     
    The team, which included UCLA’s Dr. Gregg C. Fonarow, a professor of cardiovascular medicine and the director of the Ahmanson–UCLA Cardiomyopathy Center, analyzed data from the national stroke care quality-improvement database maintained by the American Heart Association/American Stroke Association’s Get With the Guidelines–Stroke program (GWTG–Stroke). They looked at the relationship between the time of treatment and in-hospital outcomes for 58,353 acute ischemic stroke patients treated with tPA within 4.5 hours of stroke onset.
     
    The data was obtained from 1,395 hospitals between April 2003 and March 2012. The median age of patients, who were evenly divided between males and females, was 72. The average time from stroke onset to the beginning of treatment was 144 minutes, or roughly 2.5 hours. The extensive GWTG–Stroke database included information on each patient’s medical history, stroke onset time, arrival time at a hospital, the time tPA treatment began, and other treatments and procedures.
     
    Distilling this information, the researchers were able to confirm precisely how critical the time gap is between when a stroke occurs and when treatment begins.
     
    “We know from brain-imaging studies that in humans, the volume of irreversibly injured tissue in the brain from an ischemic stroke expands rapidly over time, consuming 2 million additional neurons every minute until blood flow to the brain is restored,” Saver said.
     
    In examining the data from the GWTG–Stroke database, the researchers found that for every 15-minute faster interval of treatment, going home was 3 percent more likely, walking at the time of discharge was 4 percent more likely, having symptoms of hemorrhaging in the brain was 4 percent less likely to occur, and death was 4 percent less likely.
     
    The findings underscore the important public health message that “time lost is brain lost in acute stroke,” Saver said. “These results support the importance of the American Heart Association’s “Target: Stroke” campaign, and the ongoing worldwide efforts to get stroke patients to a hospital and begin clot-busting treatment as soon as possible.”
     
    Please see the full JAMA paper for other authors and institutions that participated in the study, as well as for all author disclosures.
     
    The GWTG–Stroke program is provided by the American Heart Association/American Stroke Association and is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. The program has been funded in the past through support from Boehringer–Ingelheim, Merck, the Bristol–Myers Squibb/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable.
     
    The UCLA Stroke Center is certified as a comprehensive stroke center by the Joint Commission and the American Heart Association/American Stroke Association and is recognized as one of the world’s leading centers for the management of cerebral vascular disease. It treats simple and complex vascular disorders by incorporating recent developments in emergency medicine, stroke neurology, microneurosurgery, interventional neuroradiology, stereotactic radiology, neurointensive care, neuroanesthesiology and rehabilitation neurology. Part of the UCLA Department of Neurology, the program is unique in its ability to integrate clinical and research activities across multiple disciplines and departments.
     
    For more news, visit the UCLA Newsroom and follow us on Twitter.