Chronic Health Conditions Common for Stem Cell Transplant Survivors

/PRNewswire/ -- Although hematopoietic cell transplantation (HCT) cures many blood diseases, two-thirds of long-term survivors report at least one chronic health condition after the procedure, according to a recent study published online in Blood, the journal of the American Society of Hematology. Overall, these patients were three and a half times more likely to develop a severe or life-threatening health condition, such as cardiovascular, endocrine, or musculoskeletal problems, as well as new cancers, when compared with their cancer-free siblings.

"Although hematopoietic cell transplants have helped thousands of patients survive cancer, the burden of chronic illnesses borne by these survivors is substantial," said senior study author Smita Bhatia, MD, MPH, professor and Ruth Ziegler Chair in Population Sciences at City of Hope Comprehensive Cancer Center in Duarte, CA. "We hope the results of this study build awareness of the problem to help ensure a continued high quality of life among transplant survivors through life-long follow-up and proactive care."

It is estimated that more than 45,000 patients undergo HCTs each year to combat life-threatening diseases such as leukemia, lymphoma, and aplastic anemia. The procedure restores blood-forming cells in the patient's bone marrow that have been destroyed by anti-cancer treatments, such as chemotherapy. Although previous studies have shown that more than 70 percent of those who survive the first two years after HCT are expected to become long-term survivors, the elimination of the cancer has not always led to a full restoration of health. The high-intensity chemo- and radiotherapies needed prior to transplantation can damage many organs and have a negative impact on the overall health of HCT survivors.

The researchers for this study examined the prevalence and severity of chronic health conditions reported by 1,022 HCT survivors who received their transplants at City of Hope or the University of Minnesota between 1974 and 1998 for a blood cancer or severe aplastic anemia. The results were compared to those of 309 siblings of the participants. Each of the HCT survivors and siblings completed a questionnaire, which included questions regarding physical health conditions, access to and use of medical care, and sociodemographic characteristics.

The results showed that chronic health conditions were widespread in the HCT survivors. Sixty-six percent of these patients reported at least one chronic condition, half reported at least two chronic health conditions, and more than a third (35 percent) reported three or more conditions. In comparison, 39 percent of the siblings reported at least one chronic health condition, but only 15 percent had two or more conditions, and 6 percent had three or more. A severity score of grade 1 (mild) through 4 (life-threatening) was also assigned to each health condition. Mild and moderate conditions include ocular issues, hearing impairment, hypertension, and sensory problems while severe conditions include cardiovascular, gastrointestinal, and muscuskeletal problems, as well as new malignancies. In the HCT cohort, 18 percent reported conditions of the severest level (grade 3 or 4), while only 8 percent of the sibling group had grade 3 or 4 conditions.

Additionally, 53 percent of the HCT survivors who had received grafts from a donor experienced chronic graft-versus-host disease (GVHD), a complication in which the foreign transplanted cells attack the cells in the recipient's body. Although GVHD is treatable, this complication contributed significantly to the increased risk of multiple severe or life-threatening conditions in these patients. Among the survivors with GVHD, nearly one-quarter had severe or life-threatening conditions such as cardiovascular and gastrointestinal disorders, and more than half had two or more health conditions.

The researchers concluded that HCT survivors have a high rate of illness due to chronic health conditions, especially those with chronic GVHD, and recommended that health-care providers conduct systematic and targeted follow-up of these high-risk patients.

-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter:  @GAFrontPage

Care Management Improves Physical Health of Patients with Mental Illness

Connecting mental health patients with care managers responsible for coordinating their health care significantly improves their overall health and wellbeing, according to a study by Emory University public health researchers.

The study, the first of its kind, tested a population-based medical care management intervention aimed at improving medical care in community mental health settings. Recent studies show that people with severe mental illness die 25 years younger than the general population largely due to medical causes such as heart attacks.

"There is a growing concern about the epidemic of premature morbidity and mortality among persons with serious mental illnesses," says lead study author Benjamin Druss, MD, MPH, professor of health policy and management and the Rosalynn Carter Chair in Mental Health at Emory's Rollins School of Public Health. "This model provides one of the first evidence-based approaches for addressing that problem by helping patients access high-quality medical care."

A total of 407 people with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. The patients were all ages 18 and older, considered economically disadvantaged, and experienced serious and persistent mental illness.

For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education and support in overcoming system-level fragmentation and barriers to primary medical care. Patients in the usual care group were given a list with contact information for local primary care medical clinics and were permitted to obtain any type of medical care or other medical services without the assistance of a care manager.

At a 12-month follow-up evaluation, researchers found that medical care management was associated with significant improvements in the quality and outcomes of primary care. The intervention group received an average of 58.7 percent of recommended preventive services compared with a rate of 21.8 percent in the usual care group.

In addition, patients in the intervention group received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9 percent versus 27.7 percent) and were more likely to have a primary care provider (71.2 percent versus 51.9 percent). The group showed significant improvement in mental health functioning, and at one-year follow-up, had a substantially lower risk for heart disease than those in the usual care group.

These findings suggest that care management is a promising approach for improving quality and outcomes of medical care for patients with serious mental illnesses, says Druss.

The study titled, "A randomized trial of medical care management for community mental health settings: The Primary Care Access, Referral, and Evaluation (PCARE) study," was published in the Dec. 15 online edition of The American Journal of Psychiatry. It was funded by a grant from the National Institute of Mental Health of the National Institutes of Health.

In addition to Druss, study authors were: Silke Von Esenwein, PhD, director of research projects, Kimberly Rask, MD, PhD, associate professor of health policy and management, and Liping Zhao, MSPH, senior biostatistician, of the Rollins School of Public Health; and Michael Compton, MD, MPH, assistant professor of psychiatry and Ruth Parker, MD, professor of medicine, of the Emory School of Medicine.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

FDA, CDC, and States Investigating Norovirus Illnesses Linked to Oysters

The U.S. Food and Drug Administration is advising consumers to avoid eating oysters harvested from the San Antonio Bay on or after Nov. 16 due to reports of norovirus-associated illnesses in some people who had consumed oysters harvested from this area, which is located on the Gulf of Texas.

The FDA, along with the Centers for Disease Control and Prevention (CDC) and the states of North Carolina, South Carolina and Texas, are investigating about a dozen reports of norovirus-related illnesses from South Carolina and North Carolina consumers who ate oysters recently harvested from the San Antonio Bay.

Consumers who purchased oysters on or after Nov. 16 that have a label showing they came from San Antonio Bay are advised to dispose of the oysters and not eat them. At restaurants, consumers can ask about the source of oysters offered as menu items. Restaurant operators and retailers should not serve or offer for sale oysters subject to this advisory. Restaurant operators and retailers who are unsure of the source of oysters on hand should check with their suppliers to determine where the oysters were harvested. No other seafood is affected by this advisory.

The Texas Department of State Health Services has ordered a recall of all oysters harvested from the San Antonio Bay between Nov. 16 and Nov. 25.

Noroviruses are a group of viruses that cause gastroenteritis. Symptoms of illness associated with norovirus include nausea, vomiting, diarrhea and stomach cramping. Affected individuals often experience low-grade fever, chills, headache, muscle aches and a general sense of tiredness. Most people show symptoms within 48 hours of exposure to the virus. The illness typically lasts one to two days. Norovirus typically is not life-threatening and does not generally cause long-term effects.

Consumers who ate oyster products on or after Nov.16 and have experienced symptoms of norovirus are encouraged to contact their health care provider and local health department.

The implicated oyster beds in the San Antonio Bay were closed by the Texas Department of Health Services on Nov. 26, 2009, and remain closed.

The FDA and CDC will continue working with health officials in the affected states to track any additional cases of norovirus illness.

Persons with weakened immune systems, including those affected by AIDS, and persons with chronic alcohol abuse, liver, stomach or blood disorders, cancer, diabetes or kidney disease should avoid raw oyster consumption altogether, regardless of where the oysters are harvested.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

CHS and Georgia Tech Announce Completion of Workforce Health Assessment Model

(BUSINESS WIRE)--Workforce illnesses are among the most costly expenses for employers, with billions of dollars lost each year in time, productivity and associated treatment.

Determining the most common illnesses affecting the workplace—and the best strategies to reduce these risks—is the goal of a new health assessment model developed by Comprehensive Health Services, Inc. (CHS), a leading national workforce health management company, and the Health Systems Institute (HSI) at Georgia Tech and Emory University.

A first-of-its-kind project, the Workforce Health Assessment Model (WHAM) is currently in use with select CHS clients. WHAM provides the ability to estimate various health risks in the workplace and assists in finding cost-effective strategies to reduce those risks and the burdensome long-term costs.

“By identifying the prevalence of the most expensive medical conditions faced by employees, our model enables organizations to proactively analyze the cost-effectiveness of various health programs and strategies, in particular, programs designed to prevent and/or reduce those risks,” said Leanne Metcalfe, Ph.D., a research engineer with HSI whose thesis work formed the basis for the model.

WHAM represents an opportunity not only for employers, but researchers aiming to map out research models that analyze and anticipate various trends.

“For the academic community, it provides a template of how abstract statistical research in predictive modeling meets challenges of real-life tests for its quality and performance,” said Brani Vidakovic, Professor of Bioengineering Statistics at The Wallace H. Coulter Department of Biomedical Engineering and an HSI researcher notes. “I am pleased to see that WHAM meets these challenges and we at HSI are committed to support and further fine-tune the model.”

With the project now complete, the model will enter its second phase of development, which involves CHS and Georgia Tech researchers enhancing and refining the model. Planned improvements include incorporating richer demographic data, enabling meta-analysis by geographic region and industry type, and support for real-time updates.

“CHS is investing in this remarkable project because we believe that onsite health centers can greatly impact the cost and quality of care for employees, retirees and dependents,” said Mel Hall, CEO of CHS. “Armed with this important tool, our customers are discovering new ways to utilize preventive measures and improve the health of an employee population, such as lowering the rate of chronic diseases. We are proud to offer WHAM to our clients as we expand into our high-growth international market.”

-----
www.fayettefrontpage.com
Fayette Front Page
Community News You Can Use
Fayetteville, Peachtree City, Tyrone
www.georgiafrontpage.com
Georgia Front Page

FDA Clears for Marketing Real-Time Test for Respiratory Viruses

Molecular biology device detects four viruses, including influenza; results available in about 3 hours

The U.S. Food and Drug Administration has cleared for marketing a test that simultaneously detects four common respiratory viruses, including the flu, in a patient’s respiratory secretions. The ProFlu+ test provides results in as few as three hours. Other diagnostic tests for respiratory viruses are fast but not as accurate or are accurate but not as rapid.

The real-time test employs a multiplex platform that allows several tests to be processed using the same sample to detect influenza A virus, influenza B virus, and respiratory syncytial virus A and B (RSV).

These viruses can cause influenza, an infection of the airways called bronchiolitis, and pneumonia. All are among the leading causes of lower respiratory tract infections.

“Antiviral drugs are most effective when initiated within the first two days of symptoms,” said Daniel Schultz, M.D., director of FDA’s Center for Devices and Radiological Health. “This new test, which is part of the new era of molecular medicine, can help the medical community quickly determine whether a respiratory illness is caused by one of these four viruses and initiate the appropriate treatment.”

ProFlu+ uses a molecular biology process to isolate and amplify viral genetic material present in secretions taken from the back of the throat in patients.

While ProFlu+ is faster than conventional tests, it is specific to the four viruses, and is more accurate when used with other diagnostics, such as patient data, bacterial, or viral cultures, and X-rays, in diagnosing a patient. Positive results do not rule out other infection or co-infection and the virus detected may not be the specific cause of the disease or patient symptoms.

An estimated 5 percent to 20 percent of the U.S. population contracts influenza each year, resulting in more than 200,000 hospitalizations and up to 36,000 deaths. Influenza A, one of three types of human influenza, is the most severe and has been the cause of major epidemics. Influenza B is less severe than influenza A.

Bronchiolitis usually affects children under the age of 2, and is a common, sometimes severe illness. A common cause of the disease is RSV.

Pneumonia is a common illness that affects millions of people each year in the United States and is usually caused by an infection. People most at risk are older than 65 or younger than 2 years of age, or already have health problems.

ProFlu+ is manufactured by Prodesse, Inc. of Milwaukee.