Culture

Water infrastructure in the western United States was funded in the early and mid-20th Century by federal financing through the Bureau of Reclamation, but such financing has declined in recent decades and there has been increased interest in alternative approaches to infrastructure funding. A new Journal of the American Water Resources Association article notes that two of these approaches--public-private partnerships and loan guarantees--are hampered by existing federal budgetary policies, however.

In the article, Dr. Martin Doyle, of Duke University, notes that significant policy changes are needed to allow private capital to play an important role in funding and financing water systems characterized by aging infrastructure.

"Everyone likes the idea of bringing more private capital to aging infrastructure; but no one is able, or willing, to get into the really weedy details of policy changes necessary to make such investments possible," he said.

Patients who receive care in a for-profit hospital are more likely to be readmitted than those who receive care in nonprofit or public hospitals, according to a new study published by University of Illinois at Chicago researchers.

The study, which is published in PLOS ONE, analyzed readmission data obtained from the national Hospital Readmission Reduction Program (HRRP) from 2012 to 2015 for six major and common diseases: heart attack, heart failure, coronary artery bypass surgery, pneumonia, chronic obstructive pulmonary disease, and total hip or knee replacement surgery. Using provider identifiers verified with a Center for Medicaid and Medicare Services' report, the researchers compared readmission rates and categorized the hospitals by type: public, for-profit or nonprofit.

They found that across all six major diseases there was a statistically significant difference in readmission rates based on type. Hospitals with fewer readmissions than expected, based on a government ratio accounting for disease severity, were primarily public and nonprofit. In contrast, hospitals with more readmissions than expected were predominated by for-profit hospitals.

In each category, for-profit hospitals had the highest mean and median readmission ratios.

"It is remarkable to see such clear data in a study like this," said Andrew Boyd, the corresponding author and associate professor of biomedical and health information sciences at the UIC College of Applied Health Sciences. "There is not a single category in which for-profit hospitals shined when it came to readmissions. This was unexpected. It was also surprising to see that the trend existed independent of geography."

The researchers say that while the study shows there is a correlation between hospital type and readmission rates, the data does not provide any clues as to why for-profit hospitals fare worse than nonprofit or public hospitals. Possible reasons mentioned in the paper include a relative lack of resources at for-profit hospitals due to higher taxes and a focus on maximizing profit that may steer funds away from investment in staff or medical technology.

"This study shows an important national trend to which policymakers, health care providers, researchers and patients should pay attention, especially in light of a changing health care landscape marked by discussions on reimbursement rates and network consolidations, which are occurring across all types of hospitals," Boyd said.

More important, Boyd says, is what this means for patients.

"Readmission to the hospital means additional days and weeks away from work, hobbies, friends and family. At the very least, I hope this study helps bring awareness to the fact that data on readmission rates at all types of hospitals is available to the public," he said.

"As we transform health care, we need to pay attention to the data to make sure we make it better - for example, by reducing readmission rates - not worse," Boyd said. "Because we used publicly available data, the door is wide open for future studies to explore these trends in more detail."

Yogurt may be an "unrecognised" source of dietary sugar, particularly for young children, who eat a lot of it, highlight the researchers.

The evidence suggests that yogurt and other fermented dairy products aid digestive and overall health. A good source of 'friendly' bacteria, they also contain protein, calcium, iodine and vitamin B.

UK and US dietary guidelines recommend low fat and low sugar dairy products, and the researchers wanted to assess how far yogurt products, particularly those marketed to children, meet these guidelines. Children up to the age of 3 in the UK eat more yogurt than any other age group.

They therefore assessed the nutrient content of almost 900 yogurts and yogurt products, which were available from five major UK online supermarket chains in October/November 2016. Between them, these chains account for 75 per cent of the market share.

All the products were grouped into eight categories: children's, which included fromage frais; dairy alternatives, such as soy; desserts; drinks; flavoured; fruit; natural/Greek; and organic.

Low fat and low sugar were classified according to European Union regulations, currently used for the front of pack food traffic light labelling system used in the UK: 3 g of fat/100g or less or 1.5 g or less for drinks; and a maximum of 5 g of total sugars/100 g.

The sugar content varied enormously both within and across the categories, the analysis showed. But, with the exception of natural/Greek yogurts, the average sugar content of products in all the categories was well above the low sugar threshold.

Fewer than one in 10 (9%) qualified as low sugar, almost none of which were in the children's category. This is "concerning," given the rise in childhood obesity and the prevalence of tooth decay among young children, say the researchers.

Unsurprisingly, desserts contained the most total sugar, at an average 16.4 g/100 g, an amount that represents more than 45 per cent of energy intake. These were followed by products in the children's, flavoured, fruit, and organic categories.

In these categories, total average sugars ranged from 10.8 g/100 g in children's products to 13.1 g/100 g in organic products. This compares with an average of 5g /100 g for natural/Greek yogurts.

By and large, average fat content was either below or just above the low fat threshold. Desserts had the highest fat content and the broadest range, averaging 5.2 g/100 g.

This is an observational study, and as such, can't establish cause, added to which it covered only products sold in five supermarket chains.

But write the researchers: "While yogurt may be less of a concern than soft drinks and fruit juices, the chief sources of free sugars in both children and adults' diets, what is worrisome is that yogurt, as a perceived 'healthy food,' may be an unrecognised source of free/added sugars in the diet."

This is particularly true of the organic yogurts analysed, they say. "While the organic label refers to production, the well documented 'health-halo effect' means that consumers most often underestimate the caloric content and perceive the nutritional contents of organic products, including yogurts, more favourably."

They conclude: "Not all yogurts are as healthy as perhaps consumers perceive them, and reformulation for the reduction of free sugars is warranted."

East Hanover, NJ. September 18, 2018. A recent article by Kessler Foundation researchers underscores the importance of processing speed in overall cognitive function in individuals with multiple sclerosis (MS) and their performance of everyday life activities. The article, "A pilot study examining speed of processing training (SPT) to improve processing speed in persons with multiple sclerosis", was published August 27, 2018 in Frontiers in Neurology.

The authors are Nancy D. Chiaravalloti, PhD, Yael Goverover, PhD (visiting professor from NYU), Silvana L Costa, PhD, and John DeLuca, PhD, of Kessler Foundation. The article link is: https://doi.org/10.3389/fneur.2018.00685

The researchers tested Speed of Processing Training (SPT), in individuals with MS. SPT is a computerized treatment shown to result in persistent improvements in processing speed and everyday function in older adults. There were 21 participants in this randomized controlled trial, 12 in the treatment group and 9 in the control group. The treatment group underwent 10 computerized training sessions over 5 weeks; controls had no treatment. The treatment group showed significant gains on neuropsychological tests of processing speed, new learning and memory, and activities of daily life.

"These results indicate that processing speed is fundamental to higher order cognitive function in individuals with MS," said Dr. Chiaravalloti, the Foundation's director of Neuropsychology, Neuroscience, and Traumatic Brain Injury Research. "Looking at the impact of cognitive interventions on neuropsychological measures isn't enough, however. The outcomes of our research studies need to include the effects of cognitive rehabilitation protocols on how people perform in their daily lives."

"Developing a cognitive rehabilitation protocol for treating deficits in processing speed is a priority," summarized Dr. Chiaravalloti. "Reaching that goal means improving the lives of individuals and easing the burdens of caregivers. This study is an important first step toward that goal."

LAWRENCE -- People who feel anxious surrounding mass shootings tend to abandon their political ideology on typically divided issues, according to a study by two University of Kansas professors.

Yet policymakers -- especially those seeking gun law reforms trying to stem the number of mass shootings -- in recent years have largely failed to capitalize on attitudes surrounding this type of anxiety.

"The immediate aftermath of a well-publicized mass shooting therefore represents a policy-window of sorts," said Mark Joslyn, KU professor of political science. "The anxious public appears open and supportive to policy change. We are not certain how long this moderated ideological state may last, but clearly the public opinion context changes substantially after mass shootings - and it is the emotion of anxiety that inhibits people's dependence on ideological thinking."

Joslyn and Don Haider-Markel, professor and chair of the KU Department of Political Science, examined the effects of individual anxiety in wake of the 2016 Orlando nightclub shooting in which a gunman killed 49 people and wounded 58 others.

The journal Research and Politics recently published their findings. Joslyn and Haider-Markel have published several studies on trends in gun politics during recent years. This study is the first research to examine the public's emotional responses to mass shootings.

During the shooting, the gunman Omar Mateen called 911 and made a pledge of allegiance to leader of the Islamic State of Iraq and Levant. Police later killed him, and the shooting was the deadliest in U.S. history until the 2017 Las Vegas shooting.

For the study the researchers conducted a national survey of U.S. adults that began less than a week after the Orlando tragedy. Respondents were asked questions designed to measure their anxiety about the shooting. About 25 percent of people responded a significant level of anxiousness while 40 percent reported being very anxious.

Joslyn said a key finding was the anxiety about a mass shooting produced a marked decline in ideological division among people. Support increased for new restrictive gun laws among these anxious people as well as an increase in confidence and support for government, especially among conservatives.

"An anxious public weighs information it may have otherwise ignored. Strong ideological difference recede and often we found liberals and anxious conservatives appeared to agree on such contentious issues as guns, causes of mass shootings, and support for government," Joslyn said. "The emotional response of anxiety changes how people typically think about politics. Anxious citizens do not employ ideological patterns of thought but rather moderate and move away from left-right cognition."

This moderated ideological state does not last, however, and the researchers are not sure how long it does.

"If elites acted decisively at this point, genuine policy changes would result," Joslyn said. "The anxious public is ready - and this represents a significant proportion of the public after mass shootings."

The researchers said more research is needed on anxiety and its effects.

"Given the increased frequency and magnitude of mass shootings," Joslyn said, "such events merit greater attention from social scientists."

Fontainebleau (France), Singapore, Abu Dhabi, 18 September, 2018 - Busyness is often thought of as a modern day affliction, but it can also help you delay gratification and make decisions that benefit you in the longer-term, according to new research from the global business school INSEAD.

"Every day, we make many decisions that involve choosing between our immediate and future well-being. For instance, do we go to the gym after work, or do we just go home to relax in front of the television? Do we save money for retirement, or do we splurge on a trip? Do we eat fruit or cake for dessert? When we perceive ourselves to be busy, it boosts our self-esteem, tipping the balance in favour of the more virtuous choice," said Amitava Chattopadhyay, Professor of Marketing at INSEAD.

In a new paper, Chattopadhyay and his co-authors, Monica Wadhwa, Associate Professor of Marketing and Supply Chain Mangement, Fox School of Business at Temple University and Jeehye Christine Kim, Assistant Professor of Marketing at HKUST, show that the mere perception of self as a busy person, or what they call a busy mindset, is a "badge of honor" that can be leveraged to promote better self-control. Their paper, titled "When Busy Is Less Indulging: Impact of a Busy Mindset on Self-Control Behaviors", is forthcoming in the Journal of Consumer Research.

This paper shows there can be a flip side to being busy. While people who feel under significant time pressure tend to get anxious and make hedonic decisions, those who simply think of themselves as busy tend to make virtuous choices as a result of their perceived self-importance.

Busyness as a way to boost self-esteem

Across a series of studies, the researchers activated the busy mindset of participants through various means. Sometimes they exposed them to messaging that subtly suggested that they were busy individuals. In other experiments, they asked participants to write what had been keeping them busy recently.

Participants were then asked to make decisions in different self-control domains related to food, exercise or retirement savings, for example. Participants who had been reminded of their busy lifestyle were consistently more inclined than control participants to make virtuous decisions.

Importantly, the studies proved that a heightened sense of self-importance was the key reason behind the increase in self-control. "When we temporarily dampened the sense of self-importance of participants who otherwise felt busy, the self-control effect vanished," said Chattopadhyay.

Implications for marketing and policymaking

It is common for marketers to use busyness as a campaign concept, as many consumers can relate to it. However, if the advertised product is an indulgent one - such as fast food - the campaign could backfire. "Busyness appeals should be more effective for products that require people to assert self-control, as would be the case for a gym chain, for example," said Chattopadhyay.

In addition, these findings could find societal applications in the spheres of health promotion or food waste reduction. Policymakers may want to consider ways to activate a busy mindset as a nudge to increase relevant self-control behaviors in the population.

Long before bacteria had to contend with antibiotic drugs, they had to survive extreme temperatures as Earth warmed and cooled over millennia. Could the adaptations they evolved to temperature -- especially heat -- help explain why certain strains are resistant to certain drugs? A new study by a research team at the University of California-Los Angeles that includes Santa Fe Institute External Professors Pamela Yeh and Van Savage suggests that defenses against extreme temperatures, do, indeed, give E. coli bacteria an advantage in fending off certain drugs.

"Our code name for this paper was 'temperature as drugs.' Because we found that different temperatures had to act as a stressor just as a drug acts as a stressor to a bacterial population," says Yeh. "So it came from a real basic question: Do drugs affect bacteria in some of the same ways that temperature affects bacteria?"

It turns out that the same mechanisms E. coli evolved to deal with temperature endowed it with a built-in defense against drugs. But this advantage only goes so far: while heat-tolerant bacteria may be better able to resist drugs that stress bacteria in the same way high temperatures do, that also makes them more sensitive to drugs that mimic the effect of cold.

The work could help doctors administer antibiotics in a more precise way.

"I think it's an interesting first step, because if we think about how we treat a patient with an infection, depending on where it is, your body has different temperatures at different locations," says Tina Manzhu Kang, a first co-author of the study. "We found some antibiotics work better with lower temperatures. So that's something you might want to consider when deciding on a treatment."

The team is now looking at how other stressors may have affected E. coli. "There have been a number of other stressors that have been there since the beginning of life, such as pressure. We think the bacteria may have also adapted its resistance to these stressors to help deal with more recent forms of stress, like antibiotics," says Mauricio Cruz-Loya, the paper's other first co-author.

DALLAS - Sept. 17, 2018 - UT Southwestern researchers today report the first use of CRISPR genome-wide screening to identify a gene that helps cells resist flavivirus infection. That nasty class of pathogens includes West Nile virus, dengue fever, Zika virus, and yellow fever.

In a study published in Nature Microbiology, the team led by Dr. John Schoggins, Assistant Professor of Microbiology, used the cutting-edge CRISPR technology to identify the IFI6 gene as a potent antiviral gene targeting flaviviruses. The researchers then used traditional cell culture studies to confirm the gene's role in protecting against infection by Zika, West Nile, dengue, and yellow fever viruses.

"Other studies have used CRISPR genetic screens to identify cellular genes that are required for flavivirus infection. Our study is the first to use this technology to identify cellular genes that inhibit infection," said Dr. Schoggins, a Nancy Cain and Jeffrey A. Marcus Scholar in Medical Research, in Honor of Dr. Bill S. Vowell, and a Clayton Foundation Investigator.

"In mammals, cells naturally defend against viral infection through interferon, a molecule that sets off a warning system that a virus has been detected and that the cells need to engage their viral defense systems. The cells do this by activating hundreds of interferon-stimulated genes," he said. "Flaviviruses cause substantial human disease, and interferon is involved in the body's innate immune response to these viruses."

Dr. Schoggins said the team used recently developed genome-wide CRISPR screening technology to identify which of the interferon-induced genes played a major role in suppressing flavivirus infection. He praised the work of graduate student and lead author Blake Richardson and of co-author Dr. Maikke Ohlson, a senior research scientist in his laboratory. "Blake performed all the phenotypic and mechanistic work on how IFI6 inhibits flaviviruses and Dr. Ohlson performed the CRISPR screen that allowed us to uncover IFI6 as a potent suppressor of flavivirus infection," he said.

"In the CRISPR screen, we used human liver cells and knocked out every gene in the genome - about 19,000 genes - one at a time. We then stimulated the cells with interferon, knowing that this stimulation would normally allow the cells to resist viral infection. For the cells that did not resist infection - because they were missing a gene due to the CRISPR knockout - we used next-generation sequencing to figure out the identity of the relevant genes," he said.

Dr. Schoggins explained that the CRISPR gene-editing technology made such a study extremely efficient, uncovering the prominent flavivirus-inhibiting role of IFI6.

"The brilliance of the technology is that all of these CRISPR-targeted cells are pooled together in just a few big cell culture dishes. The cells are also bar-coded so you know which gene is missing from each cell when you observe how they respond to the addition of interferon," he said.

"The technology is super cool," he added.

In cell culture studies, the IFI6 gene - apparently working via its protein product, also called IFI6 - inhibited yellow fever, a flavivirus known to infect the liver. Cells with a working IFI6 gene also inhibited dengue, Zika, and West Nile viruses, he said. The researchers confirmed those results in liver cells by repeating the experiment in kidney and skin cell lines and in neurons.

Future work will entail drilling down into the molecular mechanism of the IFI6 protein, with the hope that this knowledge may provide a foundation for developing therapies that could target flavivirus infection.

Sporadic West Nile cases have been reported this summer in the United States, he said, adding, "Zika has waned, but I think people still remember it quite well; dengue is an ongoing problem in tropical climates, and there's currently an outbreak of yellow fever virus in Brazil."

In earlier studies, Dr. Schoggins and other researchers identified other possible flavivirus resistance proteins using non-CRISPR screening techniques, but the CRISPR technology makes IFI6 appear to play a more prominent role, he said.

Questions still to be answered include whether CRISPR screens in other cell types would give different results. This study focused on liver cells because it began as an investigation of yellow fever, which is known to attack the liver. Zika is known to affect cells in the brain but CRISPR genetic screening in neurons presents logistical challenges, he explained.

Paris, France: Babies exposed to higher levels of organochlorine compounds in the womb go on to have worse lung function in childhood, according to new research presented today (Tuesday) at the European Respiratory Society International Congress [1].

These compounds, which include the pesticide DDT, as well as electrical insulators and other industrial products, are now banned in most parts of the world. However, because they degrade very slowly, they are still present in the environment and in foods.

Previous research has suggested links between exposure to these chemicals in the womb and parents reporting childhood respiratory diseases such as wheezing, asthma, and chest infections. The new study is the first to show a link with objective measures of lung strength and capacity in relation to low-level exposure to these chemicals.

The researchers behind the study say this finding is important in terms of trying to improve the health of all children through monitoring and controlling harmful substances, but that the effect on individual children's lungs is small.

The study was presented by Dr Maribel Casas, assistant research professor at the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, Spain. She explained: "We already have evidence that exposure to environmental chemicals including organochlorine compounds can have an impact on children's health. Even though this group of chemicals were banned in the 1970s, low but detectable levels are still present in pregnant women and in children. That means current populations and future generations are still exposed to these compounds."

Organochlorine compounds are thought to disrupt the hormone system and have been linked to a wide range of conditions including cardiovascular disorders, cancers and low birth weight babies. The main source of exposure is through the foods we eat but foetuses and newborns can be exposed via the placenta and breastfeeding.

Dr Casas and her colleagues studied 1,308 babies who were born in the Valencia, Gipuzkoa, and Sabadell regions of Spain between 2004 and 2008. They measured the levels of seven different organochlorine compounds [2] in the pregnant mother's blood or in blood taken from the umbilical cord.

As the children grew older, they were asked to take part in tests to measure their lung function at the age of four years, and again at seven years. This was done by trained nurses or by paediatric pulmonologists using a spirometer to measure children's lung volume and check for any signs of obstruction in the airways.

In particular, the researchers found that levels of DDE - a chemical formed when DDT breaks down - were linked with poorer lung function in children at both four and seven years old. For example, exposure to maternal concentrations of DDE between 0.23 and 0.50 nanograms per millilitre was associated with a 50-millilitre reduction in how much air children could blow out in one second (FEV1). Among those in the study the average (median) level of DDE was 0.28 nanograms per millilitre.

Dr Casas said: "A reduction of this size in the amount of air a child can blow out would not be considered clinically relevant for a healthy child, but these smaller changes are highly relevant at population level and can be important in children with respiratory conditions.

"To reduce exposure to these chemicals, women of reproductive age can try to moderate consumption of foods with high levels of organochlorine compounds, such as fatty meats and oily fish.

"We know that this group of chemicals can interfere with the body's hormone system and we also know that hormone receptors play an important role in foetal development of the lungs, so this could be the mechanism for a link."

The researchers hope to study the impact of exposure to organochlorine compounds in the womb on older children and teenagers to understand whether this effect persists in the longer term.

Professor Mina Gaga is President of the European Respiratory Society, and Medical Director and Head of the Respiratory Department of Athens Chest Hospital, Greece, and was not involved in the study. She said: "We know organochlorine compounds are still in our environment so it's important that we continue to monitor their levels and try to learn more about their effects. Babies and children are the most susceptible population since their organs are still under development, and damage to the lungs at birth can have a huge impact in later life. A clear link has been demonstrated between low lung function in early adulthood and respiratory, cardiovascular and metabolic issues in later life, and ultimately premature death.

"There are other chemicals present in the environment, such as phthalates or phenols for example, that may also have the potential to interfere with children's developing lungs. Studies on these individual compounds, and assessing combination of chemicals, are needed to understand their effects on childhood respiratory and overall health."

ANN ARBOR, MI - Low-income Michigan residents who enrolled in a new state health insurance plan didn't just get coverage for their health needs - many also got a boost in their financial health, according to a new study. People who gained coverage under the state's expanded Medicaid program have experienced fewer debt problems and other financial issues than they had before enrollment, the analysis of thousands of individuals shows.

Those who had the most health problems felt the most financial relief after enrolling in the Healthy Michigan Plan, which now covers more than 650,000 people in the state, according to the findings of a team led by a University of Michigan health economist

The study shows drops in unpaid debts -- especially medical debts and over-drawn credit cards - as well as fewer bankruptcies and evictions after people enrolled. Meanwhile, enrollees' credit scores and car loans rose. Those with chronic illnesses, or who had a hospital stay or emergency department visit after they enrolled, saw the largest financial effects.

Economist Sarah Miller, Ph.D., of U-M's Ross School of Business, published the paper on the site of the National Bureau of Economic Research with colleagues from the Federal Reserve Bank of Chicago, University of Illinois, Chicago and Northwestern University.

The team worked with the Michigan Department of Health and Human Services, which runs the Healthy Michigan Plan, to obtain information about more than 322,000 enrollees without the researchers' having access to any individual's identifiable data. Using a double-blind matching procedure, they then matched the data with enrollees' credit reports, and studied them as a group.

The researchers focused on people who enrolled in the program's first year, starting in April 2014, and hadn't had health insurance before they joined. The team looked at individual-level financial information from several years before, and at least a year after, each person enrolled.

"Across the board, we saw a pretty sizable effect, not just on unpaid medical bills, but also unpaid credit card bills, and on public records for evictions, bankruptcies, wage garnishments and other actions," says Miller. "Enrollees' financial well-being seems to improve when they can get the medical care they need without having to put it on a credit card. And the largest effects are among the sickest enrollees."

Miller, who is a member of the U-M Institute for Healthcare Policy and Innovation, notes that research from IHPI and other teams has shown that Medicaid expansion has resulted in more people having health insurance, getting access to care, receiving care.

An IHPI team recently reported that physicians say their patients who have Healthy Michigan Plan coverage are becoming healthier and more able to work, and previous IHPI research showed hospitals in Michigan have less uncompensated care than before.

In general, Miller notes, one of the main goals of health insurance of all kinds is to protect people from financial losses when they get sick or injured. But no studies have looked at the financial impacts of coverage across such a large population of Medicaid expansion enrollees, or allowed researchers to compare members of different sub-groups of enrollees.

Because the new study matched Medicaid records with individual credit reports, it gives a highly detailed picture of what was going on in enrollees' financial lives as a group, and allows for analysis of subgroups and relatively rare financial events that lead to public records.

It also allows the researchers to see the sharp and immediate drop in financial issues after the individual's enrollment date, which suggests that enrollment - not a gradually improving economy - was the key factor.

The study shows that enrollment in the Healthy Michigan Plan:

Reduced the amount of medical bills in collections that the average enrollee had by 57 percent, or about $515

Reduced the amount of debt past due but not yet sent to a collection agency by 28 percent or about $233

Led to a 16 percent drop in public records for financial events such as evictions, bankruptcies and wage garnishments; bankruptcies alone fell by 10 percent

Resulted in enrollees' being 16 percent less likely to overdraw their credit cards

Led to a rise in individual credit scores, including the number with a "deep subprime" rating falling by 18 percent, and the number listed as "subprime" falling by 3 percent

Allowed enrollees to engage in more borrowing to buy cars or other goods and services, which is consistent with better credit scores. Enrollees experienced a 21 percent rise in automotive loans. Other studies have found that Medicaid expansion reduced use of payday loans and reduced interest rates for low-income people.

People with chronic illnesses, and those who had a hospitalization or emergency department visit during the study period, saw bigger reductions in their bills sent to collection, and bigger increases in their credit scores

Miller and her colleagues also cite survey data from the official evaluation of the Healthy Michigan Plan that another IHPI team is carrying out. The survey found that in the year before they enrolled in the Healthy Michigan Plan, 45 percent of the enrollees said they'd had trouble paying medical bills, and 25 percent said they'd skipped necessary care due to costs. After enrolling, these measures dropped.

Enrollment in the Medicaid expansion program is limited to adults with household incomes under 133 percent of the federal poverty level. The average household income for enrollees in the study was $4,400 for an individual and $7,500 for a family of three. Seventy percent had a chronic illness, and on average they had been to an emergency department once in the past year. More than 80 percent had credit scores in the subprime or deep subprime range. Their total debt in collections, medical debt in collections and past-due amount was higher than a random sample of credit reports nationally.

Miller cautions, "This study also suggests that people at risk of losing Medicaid because they don't complete a work requirement or paperwork could be at a great financial risk, even if they do not have a chronic illness or a major medical issue. They're the ones at risk of losing their coverage, and it won't just mean they can't go to the doctor."

The new study's results build on those from Oregon, which expanded Medicaid before the rest of the nation was able to under the Affordable Care Act. An evaluation of that program's effects also showed positive financial impacts.

Miller and her colleagues are continuing their work to quantify the financial impacts of Medicaid expansion in national data. They recently published one national study in the Journal of Public Economics that uses aggregate, not individual, data to show a positive impact of Medicaid coverage on debt in collections among people living in poorer areas with histories of high rates of uninsurance.

Commonly used household cleaners could be making children overweight by altering their gut microbiota, suggests a Canadian study published in CMAJ (Canadian Medical Association Journal).

The study analyzed the gut flora of 757 infants from the general population at age 3-4 months and weight at ages 1 and 3 years, looking at exposure to disinfectants, detergents and eco-friendly products used in the home.

Researchers from across Canada looked at data from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort on microbes in infant fecal matter. They used World Health Organization growth charts for body mass index (BMI) scores.

Associations with altered gut flora in babies 3-4 months old were strongest for frequent use of household disinfectants such as multisurface cleaners, which showed lower levels of Haemophilus and Clostridium bacteria but higher levels of Lachnospiraceae. The researchers also observed an increase in Lachnospiraceae bacteria with more frequent cleaning with disinfectants. They did not find the same association with detergents or eco-friendly cleaners. Studies of piglets have found similar changes in the gut microbiome when exposed to aerosol disinfectants.

"We found that infants living in households with disinfectants being used at least weekly were twice as likely to have higher levels of the gut microbes Lachnospiraceae at age 3-4 months; when they were 3 years old, their body mass index was higher than children not exposed to heavy home use of disinfectants as an infant," said Anita Kozyrskyj, a University of Alberta pediatrics professor, and principal investigator on the SyMBIOTA project, an investigation into how alteration of the infant gut microbiome impacts health.

Babies living in households that used eco-friendly cleaners had different microbiota and were less likely to be overweight as toddlers.

"Those infants growing up in households with heavy use of eco cleaners had much lower levels of the gut microbes Enterobacteriaceae. However, we found no evidence that these gut microbiome changes caused the reduced obesity risk," she said.

She suggests that the use of eco-friendly products may be linked to healthier overall maternal lifestyles and eating habits, contributing in turn to the healthier gut microbiomes and weight of their infants.

"Antibacterial cleaning products have the capacity to change the environmental microbiome and alter risk for child overweight," write the authors. "Our study provides novel information regarding the impact of these products on infant gut microbial composition and outcomes of overweight in the same population."

A related commentary provides perspective on the interesting findings.

"There is biologic plausibility to the finding that early-life exposure to disinfectants may increase risk of childhood obesity through the alterations in bacteria within the Lachnospiraceae family," write epidemiologists Dr. Noel Mueller and Moira Differding, Johns Hopkins Bloomberg School of Public Health, in a related commentary http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181134.

They call for further studies "to explore the intriguing possibility that use of household disinfectants might contribute to the complex causes of obesity through microbially mediated mechanisms."

Dr. Kozyrskyj agrees and points to the need for studies that classify cleaning products by their actual ingredients. "The inability to do this was a limitation of our study."

Paris, France: Children who take paracetamol during their first two years of life may be at a higher risk of developing asthma by the age of 18, especially if they have a particular genetic makeup, according to new research presented at the European Respiratory Society International Congress today (Monday). [1]

Ms Xin (Daisy) Dai told the meeting that the link between paracetamol use and asthma seemed strongest in those who had a particular variant of the glutathione S-transferase (GST) gene, GSTP1. However, she warned that the research showed only that there was an association between paracetamol and asthma, not that paracetamol caused the condition; further research was needed to confirm her findings and fully understand the link. She also found that another GST gene variant, GSTM1, was linked with reduced lung function.

GST genes contain the instructions for making enzymes that use an antioxidant called glutathione to mop up the effects of exposure to toxins in the body and the lungs. This mechanism helps to prevent damage to cells and inflammation. "Paracetamol, on the other hand, consumes glutathione, reducing the body's capacity to deal with toxic exposure," explained Ms Dai. "We hypothesised that people who did not have full GST enzyme activity because of common genetic variations or deletions may be more susceptible to adverse effects on the lungs from paracetamol use."

Ms Dai, who is a nurse and PhD candidate at the Allergy and Lung Health Unit at the University of Melbourne, Australia, and her colleagues investigated their hypothesis in 620 children who had been followed from birth to 18 years old as part of the Melbourne Atopy Cohort Study. The children had been recruited to the study before they were born because they were considered to be potentially at high risk of developing an allergy-related disease. They had at least one family member (mother, father or sibling) with a self-reported allergic disease (asthma, eczema, hay fever or a severe food allergy).

After their birth, a research nurse rang the family every four weeks for the first 15 months, and then at 18 months and at two years old to ask how many days in the previous weeks had the child taken paracetamol. When the children were 18 years old, they gave a blood or saliva sample, which was tested for variants of the GST genes: GSTT1, GSTM1 and GSTP1. They were also assessed for asthma, and a spirometry test was performed to measure the amount of air inhaled and exhaled when breathing through a mouthpiece.

One variant of the GSTP1 gene, GSTP1 Ile/Ile (in which the amino acid Isoleucine (Ile) is inherited from both parents), was associated with a higher risk of developing asthma.

"We found that children with the GSTP1 Ile/Ile variant had 1.8 times higher risk of developing asthma by the age of 18 years for each doubling of the days of paracetamol exposure when compared to children who were less exposed," said Ms Dai. "In contrast, increasing paracetamol exposure in children who had other types of GSTP1 did not alter the risk of asthma.

"We also found effects in children who had a variant of GSTM1 in which one part is not functioning. In these children increasing paracetamol use was associated with small, but significant reduction in the amount of air they could forcibly breathe out in one second at 18 years. It is not known if the relationship we found between paracetamol use and lung function is clinically important. In addition, we found some weak evidence that paracetamol use in the first two years of life may be associated with reduced lung function in adolescence regardless of which variants of the GST genes the children had."

She concluded: "Our findings provide more evidence that paracetamol use in infancy may have an adverse effect on respiratory health for children with particular genetic profiles and could be a possible cause of asthma. However, these findings would need to be confirmed by other studies and the degree of adverse effect better understood before this evidence could be used to influence practice and before guidelines on paracetamol use are altered.

"There is mounting evidence that the GST superfamily of genes, including three major classes -GSTM1, GSTT1 and GSTP1 - are associated with various diseases, including cancers, asthma, atherosclerosis, allergies, Alzheimer's and Parkinson's disease. Our study adds to this body of evidence."

Professor Guy Brusselle, from Ghent University, Belgium, is Chair of the European Respiratory Society Science Council and was not involved in the study. He said: "As we learn more about the genes involved in asthma, and how they interact with the environment and the medicines we use, we hope to learn more about what is best for individual patients. This study suggests that some people with particular variants of the GST genes may be more susceptible to adverse effects on their lungs from paracetamol use in infancy. This is intriguing and needs to be investigated further.

"Importantly, the observed association between paracetamol use in infancy and the increased risk of asthma in adolescents, especially in subjects with dysfunctional GST genetic variants, does not provide proof of a causal relationship. Indeed, the association could be due to confounding factors, such as lower respiratory tract infections caused by viruses in infancy, which are treated with paracetamol and have been linked to asthma."

In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability). Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health, were published online on September 16, 2018 in three papers in The New England Journal of Medicine.

ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a physical disability and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.

"Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease," said NIA Director Richard J. Hodes, M.D. "The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin's benefits and risks among healthy older persons."

The team of scientists was led by John J. McNeil, M.B.B.S., Ph.D., head of the Department of Epidemiology and Preventive Health at Monash University, Melbourne, Australia, and Anne M. Murray, M.D., director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis. The research was supported in part by the National Institute on Aging (NIA) and the National Cancer Institute (NCI), both parts of the NIH. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University. Aspirin and placebo were supplied by Bayer, which had no other involvement with the study.

In the total study population, treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.

The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance.

The researchers also analyzed the ASPREE results to determine whether cardiovascular events took place. They found that the rates for major cardiovascular events--including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke--were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.

Significant bleeding--a known risk of regular aspirin use--was also measured. The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding--hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization--occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.

As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

"The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes," said Leslie Ford, M.D., associate director for clinical research, NCI Division of Cancer Prevention. "Analysis of all the cancer-related data from the trial is under way and until we have additional data, these findings should be interpreted with caution."

"Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date," said Evan Hadley, M.D., director of NIA's Division of Geriatrics and Clinical Gerontology. "These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants."

As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin's effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE's findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.

Paris, France: People who suffer with persistent asthma from a young age are more likely to leave school at 16 years old and those who make it to university are more likely to drop out early, according to new research presented today (Sunday) at the European Respiratory Society International Congress [1].

The research also suggests that when this group of children grow up, they are less likely to work in certain non-manual occupations such as police officer, clerk or foreman.

Researchers behind the study say these results suggest children with asthma are disadvantaged in education and in their future work.

The research was presented by Dr Christian Schyllert, a clinician at Karolinska University Hospital in Stockholm, Sweden, and a PhD student at Umeå University. He explained: "Asthma is one of the most common chronic diseases among children and we know that it can interfere with daily life and affect school attendance. However, we know a lot less about the impact childhood asthma has on subsequent life chances in adulthood."

The research was based on children living in three districts in Sweden. In 1996, all children aged between seven and eight years were invited to participate in the study and 97% agreed. Participants were followed-up at age 11-12, 19 and 27-28 years. By 2015, researchers were still in contact with 2,291 (59%) of participants.

At the start of the study and at each follow-up, researchers noted whether children had asthma. This meant they had been diagnosed with the condition by a doctor, and suffered wheezing or had taken asthma medication during the previous 12 months. Children were considered to have 'early-onset, persistent asthma' if they were first diagnosed before the age of 12 years and were still suffering with asthma at 19 years old.

Researchers then compared this information with data on when children left education and which occupations they entered. They took into account other factors, such as sex, body weight and smoking, that could have an influence on education and work.

The analysis showed that children with early-onset persistent asthma were three and half times more likely than children without asthma to leave school at the age of 16 with only basic education. They were also twice as likely to drop out of university before completing three years of study.

In terms of their careers, children with early-onset persistent asthma were less than half as likely to enter non-manual occupations, including clerk, nursing assistant, police officer, musician and foreman.

Dr Schyllert said: "This study suggests that children who are diagnosed with asthma when they are young and continue to suffer with the condition as they grow up have worse life chances when it comes to their education and their future jobs.

"We can't tell from this study exactly why this is the case, but other research indicates that children with asthma have lower school attendance and this might lead to asthmatics being unable to remain in education. It could also be that people with poorly-controlled symptoms are less inclined to enter certain occupations, especially those requiring stamina, or jobs where they might be exposed to possible asthma triggers, such as dust or vapours."

Dr Schyllert and his colleagues will continue studying the link between asthma and socioeconomic status. He hopes to follow up the same group in another ten years, when the subjects will be 35 years old. He would also like to study a similar cohort born ten years later, to see if there have been any changes over time.

He added: "Although asthma can be effectively treated with inhaled medications, such as corticosteroids and bronchodilators, sticking to a treatment regime can be difficult, especially for teenagers.

"Until we know more about exactly why childhood asthma effects education and job prospects, the key message for families is try to ensure children stick to their asthma treatments and to speak to a doctor if symptoms aren't under control."

Professor Daiana Stolz of University Hospital Basel in Switzerland is Chair of the European Respiratory Society Education Council and was not involved in the study. She said: "Asthma is a common condition in children and it's important that we understand not only how it affects people in childhood, but also their health and their prospects in adulthood. This study suggests that being diagnosed with asthma at a young age and continuing to suffer with the condition puts children at a disadvantage in education and subsequently when they enter the workplace.

"We need more research to understand why this is the case and what we can do about it, but in the meantime, we need to support children and their families to ensure asthma symptoms are controlled with appropriate treatment and care."

A new tool developed by University of British Columbia researchers could help ensure limited conservation dollars are well spent by determining which actions would save the most species per dollar.

In a case study published in Conservation Letters, researchers from UBC and Environment and Climate Change Canada (ECCC) applied the tool to endangered species in Canada for the first time, focusing on 15 species at risk in southwestern Saskatchewan.

"Recovery of species at risk in Canada and around the world is failing--often we are spending our limited conservation resources on species with the lowest likelihood of recovery at the highest cost," said Tara Martin, lead author and professor in the faculty of forestry at the University of British Columbia. "We've developed the first scientific tool aimed at recovering as many species as possible within any given budget."

The tool--a mathematical equation that draws on both empirical data and expert knowledge-- helps prioritize conservation strategies for species at risk by answering key questions like how much it will cost to recover all endangered species, which management strategies are likely to achieve the greatest recovery of species per dollar invested, how many species can be recovered for a given budget and which species are unlikely to be recovered regardless of investment.

"We calculate the cost-effectiveness of different decisions every day, from what we're going to buy at the grocery store to which school we're going to send our children to, but in conservation we've been shopping with no price tags," said Martin. "This tool will help us make those calculations, put a price tag to conservation strategies and determine how effective they will be."

Martin and her co-authors applied the tool, called Priority Threat Management, to 15 species considered lost, endangered or threatened in southwestern Saskatchewan, including animals like the greater sage-grouse, the burrowing owl and the swift fox.

Thirteen of the species were included in a 2017 ECCC multi-species action plan that recommended 18 general management strategies and more than 200 actions to conserve the species. With insufficient resources to implement all recommended strategies, agencies found it difficult to discern which strategies would have the greatest impact across all species.

"This tool helps us make those conservation decisions in a more transparent, repeatable and defensible way," said Paul Smith, an ECCC researcher involved in the project.

By applying the tool, the researchers found that with minimal-to-no species management, only two of the 15 species were likely to achieve their recovery goals. However, if five of the 18 strategies were implemented, 13 of the 15 species were likely to meet their recovery goals.

"We estimate the overall cost of deploying those five management strategies would be $126 million over 20 years," said Martin. "We can't recover all the species but can achieve the best possible outcome for at least 13 of those species."

Martin points to the Canada Nature Fund--a $1.3 billion-dollar conservation fund announced by the federal government in February 2018--as an unprecedented opportunity for conservation in Canada.

"This is more money than has ever been earmarked for conservation by any government in Canada's history and my hope is that by using tools like ours, we can demonstrate the conservation return on investment and ensure the recovery and protection of as many species as possible."