Health Reform Needs Enforceable National Workforce Strategy

/PRNewswire/ -- Congressional leaders must ensure that health reform includes a health workforce planning body with sufficient authority to ensure implementation of an integrated, coordinated national health workforce policy, according to Dr. Steven A Wartman, president and CEO of the Association of Academic Health Centers (AAHC). "With each step in the legislative process, the Congress has progressed toward a more effective health workforce planning process," Wartman said. "Still missing from both House and Senate bills is a mechanism -- such as national health workforce commission recommendations that automatically go into effect unless overridden by Congress -- to ensure timely implementation of the recommendations," added Wartman, urging Congress to address this concern before finalizing the legislation.

An updated analysis of the current House and Senate bills released today by the AAHC identifies additional strengths and weaknesses in the bills when measured against the AAHC's own health workforce recommendations:

-- The AAHC recommends that development and implementation of an
integrated, coordinated, strategic national health workforce policy be
the primary objective of any advisory committee or national
commission. The House bill contains a clear statement that the
purpose of its advisory committee is "to develop and implement an
integrated, coordinated, and strategic national health workforce
policy reflective of current and evolving health workforce needs,"
while the Senate bill only lists national health workforce policy as
one of several priorities.
-- The AAHC recommends the list of enumerated issues to be addressed by
the advisory committee or national commission include the
harmonization of conflicting national and state-based regulatory and
private self-regulatory standards (e.g., licensure, scope of practice,
accreditation). The Senate bill expressly directs its national
commission to "identify barriers to improved coordination at the
Federal, State, and local levels," but the House bill does not
expressly address the need for harmonization.
-- The AAHC recommends the creation of a permanent, independent advisory
committee or national commission that serves as a continuously
available policy research and consultative resource. The Senate bill
creates an independent national commission composed of members
appointed by the Comptroller General, while the House bill only
creates an advisory committee appointed by and reporting through the
Secretary.

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FDA Researchers Contribute Insights into Avian Flu Virus

An in-depth analysis of blood from patients recovering from the H5N1 avian influenza virus has provided important insights into how to combat the potentially lethal virus.

The findings by U.S. Food and Drug Administration scientists and collaborators better explain what part of the “bird flu” virus is seen by the immune system once a person becomes infected. As one result of this research, a protein of the bird flu virus called PB1-F2 was identified as a potentially potent target for attack by immune systems to stop the spread of the virus.

“Analysis of blood from patients recovering from the H5N1 avian influenza virus can lead to new tools for testing the potential protective activity of vaccines under development,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research (CBER). “The findings could also lead to new tests to detect infections, and improved therapies.”

Since 2003, more than 400 people worldwide have been infected with the bird flu virus. About 60 percent of them have died. No cases of avian flu have been reported in the United States. Most of the avian flu infections in humans involve people who have had direct contact with infected poultry. However, there is a potential risk for a global influenza pandemic should the virus acquire the ability to spread directly from person to person.

The study, titled “Antigenic Fingerprinting of an H5N1 Avian Influenza Using Convalescent Sera and Monoclonal Antibodies reveals Potential Vaccine and Diagnostic Targets,” appears in the April 20, 2009, edition of the online journal PLoS Medicine. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000049

The researchers adapted an existing technique using genetically modified viruses (phages) to create a library of fragments representing all of the proteins found in the H5N1 virus. Scientists mixed these fragments with antibodies from five Vietnamese patients recovering from the H5N1 infection and observed which fragments attracted the patient’s antibodies.

Several targets that are likely to trigger strong antibody responses to the H5N1 virus were identified, including PB1-F2, a protein that researchers believe contributes significantly to the virus’s ability to cause disease.

“We believe this is the first evidence of the human immune system reacting this strongly against PB1-F2,” said Hana Golding, Ph.D., chief of CBER’s Laboratory of Retrovirus Research and senior author of the article. “This is an indication that it may be a good target for a drug or vaccine.”

The study’s other authors include first author Surender Khurana, Yonaira Rivera, Jody Manischewitz, and Lisa R. King (FDA); Kanta Subbarao, Amorsolo L. Suguitan Jr. (National Institute of Allergies and Infectious Diseases); Cameron P. Simmons (Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam); and Antonio Lanzavecchia (Institute for Research in Biomedicine, Bellinzona, Switzerland).

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New Analysis Shows Troubling Trend in Triglyceride Levels May Be Linked to Rising Rates of Obesity

PRNewswire -- A new 30-year analysis of the National Health and Nutrition Examination Survey (NHANES) database conducted by the National Lipid Association (NLA) indicates that while Americans are doing a better job of managing LDL or "bad" cholesterol, the percentage of adults with high triglycerides, a blood fat linked to heart disease, has doubled, leaving many people at risk for potentially life-threatening events such as heart attack or stroke. Results of the analysis were presented today at the American Heart Association's Annual Scientific Sessions in New Orleans.

Between 1976 and 2006 the number of Americans with unhealthy isolated LDL levels dropped from 43 percent to 40 percent, an improvement that researchers attribute to more aggressive educational initiatives and treatment. However, far less emphasis has been placed on controlling triglycerides. The rising rates of isolated high triglycerides seen over the last three decades underscore the need for physicians and patients to understand and treat all three key lipids, which include LDL, HDL or "good" cholesterol and triglycerides.

"Studies have shown that unhealthy levels of triglycerides and HDL can lead to heart attack and stroke," said study author Jerome D. Cohen, M.D., chairman of the National Lipid Association's consumer affairs committee and professor emeritus of internal medicine and cardiology at the St. Louis University School of Medicine. "As we continue our efforts to reduce the toll of heart disease in America, this study clearly shows the need for increased focus on controlling triglycerides, in addition to the other components of the lipid profile."

Along with LDL and HDL, triglycerides are the third component of the lipid profile and are an independent and compounding risk factor for heart disease, the leading cause of death in the U.S. Studies have shown that the risk of developing heart disease doubles when triglyceride levels are above 200 mg/dL. When triglycerides are above 200 mg/dL and HDL is below 40 mg/dL, a person is at four times the risk of developing heart disease. Other studies have shown that low HDL is predictive of cardiovascular events even when LDL is at goal.

While the percentage of the population with unhealthy HDL levels has remained relatively consistent over the past 30 years, the percentage of adults with a combination of high triglycerides and low levels of HDL doubled from two to four percent, further highlighting the need to simultaneously treat multiple lipids.

Obesity, Age and Triglycerides

The analysis cited dramatic increases in the number of obese Americans as one possible explanation for the spike in triglycerides over the last three decades. Data indicate a strong correlation between obesity (defined as a BMI greater than or equal to 30 kg/m2) and high triglycerides. Rates of obesity more than doubled from 15 percent in 1976 to 33.7 percent in 2006, while the percentage of Americans with isolated high triglycerides also doubled from 2.4 to 5.5 percent.

The study also revealed a strong increase in elevated triglyceride levels among people over the age of 60, with the likelihood of having unhealthy triglycerides increasing nearly five-fold from 1.8 percent in 1976 to 8.7 percent in 2006. This extensive analysis provides strong evidence of the connections between age, weight and lipid levels over the last 30 years.

"As Americans age and rates of obesity continue to grow exponentially, it is becoming more important to monitor and manage HDL and triglycerides, along with LDL," said Thomas Bersot, M.D., president of the National Lipid Association. "By elevating the need to address all three lipids, we hope to improve heart health in America."

Conclusions

Researchers involved with the study concluded that based on these findings, physicians and other healthcare professionals should closely monitor patients' triglyceride levels in an effort to improve preventive care. Patients, for their part, should be aware of all three lipids and work with their healthcare professionals to reach optimal lipid levels.

Study Methodology

Adults aged 20 to 74 years who took the blood lipid examination were selected from NHANES II (1976-1980), NHANES III (1988-1994), and NHANES 1999-2006. Adults missing values on total cholesterol, HDL cholesterol or triglycerides were excluded. Where LDL was missing, the Friedewald equation was used to calculate LDL for patients with TG < 400 and the Hattori equation was used to calculate LDL for patients with TG greater than or equal to 400.

Lipid levels were measured for the sample of adults with laboratory data who were examined in the morning and had fasted for 8.5 to 23 hours. High triglycerides and LDL and low HDL levels were characterized in the analysis as non-optimal, defined as greater than or equal to 150 mg/dL for triglycerides, < 40 mg/dL for HDL and greater than or equal to 100 mg/dL for LDL. Obesity was defined as BMI greater than or equal to 30 kg/m2.

This study was conducted by the National Lipid Association and analysis and research were performed by HealthCore, with the support of an independent grant from Abbott Laboratories.

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