Ask Sharon 3: Health care + mental health, & vaccinations for children – Video

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Ask Sharon 3: Health care + mental health, vaccinations for children
Rep. Sharon Wylie (D-Vancouver) responds to constituent emails on funding for health care, including mental health, and on her stand on vaccines for children.

By: Washington House Democrats

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Ask Sharon 3: Health care + mental health, & vaccinations for children - Video

Annual health care crisis grips B.C.

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Surrey Memorial Hospital's expanded emergency was reporting crowding soon after it opened.

image credit: Black Press files

VICTORIA The annual ritual of declaring a crisis in health care is upon us, with the B.C. Liberal government boasting that we have the best system in Canada, while the NDP and the B.C. Nurses Union try to portray it as the worst.

The BCNU is the last big public sector union still to settle in the latest round of contract talks. Feeding horror stories to the media is part of its strategy, and this time it was a patient at Abbotsford Hospital assigned a bed in a small shower room for a month due to chronic overcrowding. Hospital officials said his care wasnt compromised.

Weve seen it in Abbotsford, Surrey and elsewhere: a new hospital or expansion is built and is immediately overcrowded. We are reminded every winter that influenza season brings a wave of people into emergency, expecting treatment for a viral infection that in most cases can only run its course.

The problem peaks around Christmas, when more patients than usual use ER as their walk-in clinic.

Many people still dont understand what the flu is, beyond the notion thatitsounds serious enough to tell the boss you wont be in to work. And as fewer doctors choose the endless demands of family practice, the expectation that all problems must be dealt with quickly and for free seems to grow as inexorably as the health care budget.

An emergency physician of my acquaintance provided a typical scenario for night shift at the ER. Where once nights were quiet, now there are patients waiting for hours, around the clock.

Several are drunk, and one has urinated on the floor. Surveys show as many as half of ER visits are alcohol-related, from overdoses to fights, falls, car crashes and chronic conditions.

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Annual health care crisis grips B.C.

Obesity is a health care time bomb, warn Lancet authors

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Unprecedented obesity rates are a time bomb of future burdens on health care systems but global efforts to reverse the epidemic are failing, according to a major new series in the Lancet, one of the worlds top medical journals.

An estimated 2.1 billion people are now overweight and even modest targets set by the World Health Organization to maintain zero growth in obesity rates between 2010 and 2025 are at risk of being missed.

Turning this tide will require strong government policies, as well as engagement from the food industry, civic society and health practitioners, according to the Lancet series, published Wednesday.

But the world also needs to shift how it currently thinks about obesity, said Christina Roberto, who led one of the six studies in the series.

Obesity, she said, is a multi-faceted health problem caused by everything from genes and globalization to predatory food marketing aimed at children that demands an equally complex solution.

An individual is responsible for his or her food choices but its often true that the environment shapes what we eat, said Roberto, an assistant professor with the Harvard T.H. Chan School of Public Health.

The discourse has traditionally been focused on oh, its either the individual or its the food environment. What were trying to say is both are true.

The Lancet series explores a wide-ranging approach to tackling obesity, which can lead to chronic ailments like diabetes, cardiovascular diseases and cancer. As of 2010, a high body mass index (which calculates body fat based on height and weight) accounted for roughly 2.8 million deaths per year.

While everybody is vulnerable to eating too much unhealthy food, modern environments have been designed to exploit that biological vulnerability, Roberto said.

The risk is particularly high for children, who are heavily targeted by the food industry, according to Dr. Tim Lobstein with the World Obesity Federation, another study author.

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Obesity is a health care time bomb, warn Lancet authors

Obamacare 2015: 11 Million Enroll But Health Care Sign-ups Remain Uncertain

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More than 11 million people signed up for private health insurance under the Affordable Care Act during the 2015 open enrollment period that ended Feb. 15, the Obama administration announced Tuesday. But the numbers are just preliminary and, depending on several factors, could fall or rise further.

The number could grow because the government has extended the deadline until Sunday, Feb. 22, for those who had technical problems signing up over the weekend or had to deal with long wait times when signing up through the ACAs call center. (More people signed up on Sunday, Feb. 15, than any day during the 2014 and 2015 enrollment periods.) The administration also is considering adding a special enrollment period around the time when taxes are due in April and when people realize they will have to pay penalties for not having health insurance. Many of the states that run their own exchanges have also extended their deadlines.

But the number could fall. In 2014, 8 million people signed up during the first open enrollment period of Obamacare, which ended in April of that year. But by the time fall came around, 1.3 million people had dropped out of plans run by the exchange, although some may have found coverage elsewhere. Forbes thencalculated that plans offered on the exchange had a retention rate of 87 percent.

The 11.4 million figure that's touted by the government also doesnt necessarily reflect the number of new enrollees. Forbes reported that of those who signed up for coverage during the 2015 open enrollment period, about 5.4 million new enrollees had been previously uninsured -- less than half of the 11.4 million enrollees -- meaning that the rate of new enrollment in health care plans had slowed significantly. Estimates from last year put the number of uninsured people gaining coverage through the Affordable Care Act exchanges at 10 million, or almost twice as many as in 2015.

The other issue is that despite people signing up for health care, there's no guarantee they will actually gain that coverage, because they have to pay their premiums in order to actually be covered. About 80 percent of those who buy coverage through exchanges received government subsidies that covered about three-quarters of the price of monthly premiums.

The Congressional Budget Office has estimated that this year the Affordable Care Act reduced the number of uninsured Americans by 19 million. It also estimated that in 2015, 12 million people will get coverage through the exchange, a slightly higher estimate than the 11.4 million signed up so far, and nearly 3 million more than the White Houses initial projection of 9.1 million sign-ups for the 2015 open enrollment period.

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Obamacare 2015: 11 Million Enroll But Health Care Sign-ups Remain Uncertain

Health Care Sector Update for 02/18/2015: EGRX, CAPN, MDAS, TEVA

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Top Health Care Stocks

JNJ -0.71%

PZE -0.94%

MRK -0.16%

ABT -0.78%

AMGN +0.19%

Health care stocks were mostly lower, with the NYSE Health Care Sector Index dropping 0.6% and shares of health care companies in the S&P 500 declining 0.5% as a group.

In company news, Eagle Pharmaceuticals ( EGRX ) rose to a new all-time high Wednesday, extending its rally to a second day after last night reporting financial results for its transitional quarter ended Dec. 31 above Wall Street expectations.

Net loss attributable to common stockholders was $5.5 million, or $0.39 per share, expanding on a $4.4 million net loss during the year-ago period but still beating the Capital IQ consensus by $0.10 per share.

Revenue rose 1.8% year over year to $5.6 million, trumping analyst projections by $2.45 million. Royalty income rose 24.2% over the same quarter last year to $4.1 million, offsetting a 31.8% decline in product sales compared with last year.

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Health Care Sector Update for 02/18/2015: EGRX, CAPN, MDAS, TEVA

Targeted mobile ad drive raises issue of abuse against health care workers

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People turning to their phones to kill time in waiting rooms at health care facilities may soon see an unexpected image: a person in blue scrubs, with dark purple bruises on her arm.

It is one of the ads in a targeted mobile campaign launching Wednesday, designed to raise awareness about the pervasive problem of abuse against health care workers. It is using new advertising technology targeting people with mobile ads based on the GPS location of their phones to get the message out.

The campaign, launched by Ontarios Public Services Health & Safety Association (PSHSA), will show ads to people in more than 100,000 health care facilities in the province, including hospitals and rehabilitation centres. Ads will appear in mobile apps people use to play games, read the news, or map their routes home, for example, as long as those people have agreed to allow those apps to gather information about their whereabouts.

The issue of violence against health care workers is growing, said Henrietta Van hulle, executive director of the PSHSA, a non-profit funded by the Ministry of Labour. The association is charged with taking a preventative approach to workplace health and safety (as opposed to enforcement, which is the purview of the Occupational Safety and Health Administration, or OSHA.)

The campaign is the beginning of a multiyear process to push for better tools to protect these workers. That will include more awareness among families of patients, who need to inform doctors and nurses if the patient has certain triggers or warning signs of a violent outburst. It could also involve tools such as personal alarms workers can wear to call for help when a situation arises. More generally, it also means informing workers of their rights, and encouraging workplaces to do better risk assessments and even flag patients who may become violent. For people working in home care, who do not have security nearby, risk assessment is even more important.

Last year, 639 health care workers in Ontario were injured in a violent incident, badly enough that they were unable to work their next shift. That statistic does not account for incidents where workers are pushed, hit, or scratched, for example, and do not report them or take time away from work.

Theyre seeing [these incidents] as part of the job, Ms. Van hulle said.

In October, a nurse was stabbed in the head and neck at the Brockville Hospital Mental Health Centre in Ontario.

The issue is not limited to Ontario. In December, a nurse was punched and thrown against a wall at a hospital in Kamloops, B.C., and a doctor was beaten severely at a hospital in Penticton, B.C. Last month, a home care worker was stabbed in Parksville, B.C.

According to a decade-old Statistics Canada study, 33.8 per cent of more than 73,000 nurses surveyed in hospitals and long-term care facilities reported being physically assaulted by a patient in the past 12 months. Nearly half of more than 100,000 surveyed reported emotional abuse on the job. More recent national statistics are hard to come by, but industry associations and unions say the problem is growing.

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Targeted mobile ad drive raises issue of abuse against health care workers

Dana-Farber Experts Share Five Things You Should Know About Precision Medicine

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Newswise BOSTON President Barack Obama is requesting an increase of $215 million in the 2016 federal budget to launch the Precision Medicine Initiative. This boost in funding for research will give genetic causes of cancer a national focus specifically around precision or personalized treatments for cancer in the future.

Here are some facts about precision medicine:

1) What is precision or personalized medicine?

Physicians have long recognized that the same disease can behave differently from one patient to another, and that there is no one-size-fits-all treatment. Precision medicine makes diagnosis and treatment of cancer and other diseases more accurate, using the specific genetic makeup of patients (and, in cancer, of their tumors) to select the safest and most effective treatments for them.

In cancer, precision medicine involves testing DNA from patients tumors to identify the mutations or other changes that drive their cancer. Then a treatment for a particular patients cancer that best matches, or targets, the culprit mutations in the tumor DNA is used. While such therapies are not widespread yet, many cancer specialists believe precision treatments will be central to the future of cancer care.

2) Do all patients receive precision or targeted treatment?

Not all patients need targeted therapy to treat their type of cancer. The use of targeted therapies is meant for patients whose tumors have specific gene mutations that can be blocked by available drug compounds. Patients who have mutations in certain types of genes, who have mutations that are beyond the reach of available drugs, or whose tumor cells lack identifiable mutations generally would not be candidates for personalized medicine treatments.

According to the National Cancer Institute, a patient is a candidate for a targeted therapy only if he or she meets specific criteria, which vary depending on the disease. These criteria are set by the Federal Drug Administration (FDA) when it approves a specific targeted therapy.

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Dana-Farber Experts Share Five Things You Should Know About Precision Medicine

New Insights into 3D Genome Organization and Genetic Variability

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Newswise While genomics is the study of all of the genes in a cell or organism, epigenomics is the study of all the genomic add-ons and changes that influence gene expression but arent encoded in the DNA sequence. A variety of new epigenomic information is now available in a collection of studies published Feb. 19 in Nature by the National Institutes of Health (NIH) Roadmap Epigenomics Program. This information provides a valuable baseline for future studies of the epigenomes role in human development and disease.

Two of these studies, led by researchers at University of California, San Diego School of Medicine and Ludwig Cancer Research, address the differences between chromosome pairs (one inherited from mom, the other from dad) and how chromosome folding influences gene expression.

Both of these studies provide important considerations for clinicians and researchers who are developing personalized medicines based on a patients genomic information, said Bing Ren, PhD, professor of cellular and molecular medicine at UC San Diego, Ludwig Cancer Research member and senior author of both studies.

The first paper by Rens group takes a look at differences in our chromosome pairs. Each of us inherits one set from our mother and the other from our father. Chromosome pairs are often thought to be identical, one just a backup for the other. But this study found widespread differences in how genes are regulated (turned on and off) between the two chromosomes in a pair. It turns out that we all have biases in our chromosomes. In other words, different traits have a stronger contribution from one parent than the other. The study also suggests that these biases are rooted in inherited sequence variations and that they are not randomly distributed. These findings help explain why, for example, all kids in a family may have their fathers hair but their mothers eyes.

The second paper by Rens group tackles how the genome is organized and how it changes as stem cells differentiate (specialize). DNA strands in every cell are tightly wound and folded into chromosomes. Yet chromosomal structures, and how they influence gene expression, are not well understood. In this study, Ren and team mapped chromosomal structures in stem cells and several different differentiated cell types derived from stem cells. First, they induced differentiation in the stem cells. Then they used molecular tools to examine how the structure of the cells chromosomes changed and how that change is associated with gene activity. The team found that chromosomes are partitioned into relatively stable structural units known as topologically associating domains (TADs), and that TAD boundaries remain constant in different cell types. Whats more, the researchers found that the changes in chromosomal architecture mostly take place within the TADs in a way that correlates with changes in the epigenome.

The epigenome chemical modifications to chromosomes and 3D chromosomal structure is not just a linear object, Ren said. The epigenome is a 3D object, folded in a hierarchical way, and that should affect how we think about many aspects of human development, health and disease.

Co-authors on the paper Integrative Analysis of Haplotype-Resolved Epigenomes Across Human Tissues include Danny Leung, Inkyung Jung, Nisha Rajagopal, Anthony Schmitt, Siddarth Selvaraj, Ah Young Lee, Chia-An Yen, Yunjiang Qiu, Samantha Kuan, Lee Edsall, Ludwig Cancer Research; Shin Lin, Yiing Lin, Stanford University and Washington University School of Medicine; Wei Xie, formerly at Ludwig Cancer Research and now at Tsinghua University; Feng Yue, formerly at Ludwig Cancer Research and now at Pennsylvania State University; Manoj Hariharan, Joseph R. Ecker, Howard Hughes Medical Institute and Salk Institute for Biological Studies; Pradipta Ray, University of Texas; Hongbo Yang, Neil C. Chi, UC San Diego; and Michael Q. Zhang, University of Texas, Dallas and Tsinghua University.

Co-authors on the paper Chromatin Architecture Reorganization during Stem Cell Differentiation include Jesse R. Dixon, Siddarth Selvaraj, Ludwig Cancer Research and UC San Diego; Inkyung Jung, Yin Shen, Ah Young Lee, Zhen Ye, Audrey Kim, Nisha Rajagopal, Yarui Diao, Ludwig Cancer Research; Jessica E. Antosiewicz-Bourget, Morgridge Institute for Research; Wei Xie, Tsinghua University; Jing Liang, Huimin Zhao, University of Illinois at Urbana-Champaign; Victor V. Lobanenkov, National Institute of Allergy and Infectious Diseases; Joseph R. Ecker, Howard Hughes Medical Institute and Salk Institute for Biological Studies; James Thomson, Morgridge Institute for Research, University of Wisconsin and University of California, Santa Barbara.

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New Insights into 3D Genome Organization and Genetic Variability

Decoy protein stops all tested HIV strains

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How HIV infects a CD4+ T-helper cell. (1) The gp120 viral protein attaches to CD4. (2) The gp120 variable loop attaches to a coreceptor, either CCR5 or CXCR4. (3) HIV enters the cell.

In a new approach to stopping HIV, a Scripps Research-led team has created a genetically engineered protein that inactivates virtually all strains of the virus. While it will take years before this approach can be tested in humans, the concept provides a fresh insight on how to protect people against infection from the AIDS-causing virus.

The protein mimics two receptors on the surface of the immune cells that HIV infects. When the virus encounters the protein, it springs into action as if infecting a cell. The changes the virus undergoes render it incapable of future attempts at infection, said Michael Farzan, a Scripps Research scientist who led the study.

The protein neutralized 100 percent of neutralization-resistant strains of HIV-1, HIV-2 and SHIV-AD8, an artificially made cross between HIV and simian immunodeficiency virus, an HIV relative found in monkeys. The protein was tested in cell cultures, mice with humanized immune systems and macaque monkeys given SHIV. This degree of protection far exceeds that of the strongest anti-HIV antibodies in the body's immune system.

For people, the protein could one day offer lasting protection against HIV infection by means of gene therapy, Farzan said. A designated gene would be carried into muscle cells by an innocuous virus. Then the gene, called eCD4-Ig, would be deposited into the muscle cells, where it would churn out the artificial protein into the bloodstream. If the protein encounters any HIV, it would bind to it, rendering the virus harmless.

In essence, the new study's authors said the approach acts as a vaccine against HIV.

Michael Farzan is a professor at the Florida campus of The Scripps Research Institute. / The Scripps Research Institute

The study was published Wednesday in the journal Nature. Farzan, in Scripps' campus in Jupiter, Florida, was the senior author. Matthew R. Gardner, also of Scripps Florida, was co-first author along with Lisa M. Kattenhorn of Harvard Medical School's New England Primate Research Center in Southborough, Mass. From Scripps' La Jolla headquarters, Dennis R. Burton, a noted expert on broadly neutralizing antibodies, also participated. More than 30 scientists in all took part in the study.

The study takes a novel approach to hitting HIV's weak spots; the receptors it must attach to infect the cells. These are called CD4 and CCR5, (along with CXCR4, a receptor close to CCR5 that can serve in its place). HIV must attach to both locations to enter into the cell, Farzan said. Once it attaches, the virus changes shape to drive itself into the cell.

Shane Crotty, a vaccine researcher at the La Jolla Institute for Allergy and Immunology, praised the study as creative and exciting science. However, Crotty said the study is preliminary and the concept needs to be more rigorously tested. Just four macaque monkeys were tested, and while the results were impressive, more monkeys need to be tested.

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Decoy protein stops all tested HIV strains