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Week of March 11, 2013

Scholarship & Creative Work

Healthy intervention reduces depression for pregnant Latinas

Latina women in a diabetes-prevention program show fewer signs of depression during pregnancy and in early postpartum, a U-M study indicates.

Untreated depression can negatively affect both mothers and children. Research indicates that sometimes minority women — when compared to their white counterparts — don’t seek help for their depression.

If their mother or other female friends are absent, women feel increasingly isolated and stressed, says Edith Kieffer, the study’s lead author and an associate professor of social work. They find it challenging to maintain healthy practices during and after pregnancy.

About 275 pregnant Spanish-speaking Latinas participated in Healthy Mothers on the Move, a culturally and linguistically tailored clinical trial designed to reduce risk factors for obesity and Type 2 diabetes. The Detroit-based program is led by community health workers.

The percentage of women at risk for depression at the follow-up interview was significantly less in the intervention group (19 percent) than in the control group (34 percent). The researchers found that the effect of the intervention on depressive symptoms was strongest during pregnancy. At six weeks postpartum, the intervention remained effective only for the 83 percent of study participants who spoke no English.

“The significance of social support to a group of immigrant women who tend to be socially isolated cannot be ignored,” Kieffer said. “The results suggest that a healthy lifestyle intervention may be well-suited to assist in preventing or reducing depressive symptoms among Latinas during pregnancy, with the stigma often attached to mental health treatment in the Latino community.”

Among the study’s other authors: U-M colleagues Cleopatra Caldwell, Diana Welmerink, Kathleen Welch and Brandy Sinco, and J. Ricardo Guzman of the Community Health and Social Services Center Inc.

Patients’ access to bariatric surgery may be limited by Medicare rule, study finds

Medicare’s attempt to send patients to the safest hospitals for bariatric surgery may be limiting access to the common weight loss procedures.

A new U-M Health System study shows a 2006 Medicare rule restricting coverage to Center of Excellence hospitals accredited by a professional organization has had no impact on the rate of surgical complications or reoperations.

Instead, the rule may be creating an unnecessary burden for patients seeking a hospital where they can use their Medicare benefits, according to the study appearing in the Journal of the American Medical Association.

“If patients seeking this procedure are forced to travel further to find a Center of Excellence, the policy might actually be limiting their access to care,” says lead author Dr. Justin Dimick, associate professor of surgery. “These results suggest the benefits of going to a Center of Excellence are minimal and that Medicare should reconsider this policy.”

The researchers analyzed Medicare patient data from 12 states before and after the coverage decision went into effect. After accounting for patient factors, changes in procedure type and preexisting trends toward improved outcomes, they found no significant improvements after the policy change.

The rate of serious complication after the change was 3.3 percent compared to a similarly low rate of 3.6 percent before it.

The study does indicate better safety for bariatric surgery over the analyzed time period, but the improvement can be attributed it in part to a shift toward lower risk procedures, not the Medicare policy.

Between 2004 and 2009, there was a general shift away from open to laparoscopic surgery and an increase in the use of laparoscopic gastric banding — a safer albeit less effective procedure — both of which contributed to safer outcomes.

Doctors who adopt electronic health records may lose money

Physician offices that move to electronic health record systems, but don’t make additional changes in the practice to enhance revenue and cut costs for services no longer needed, stand to lose money, a University of Michigan researcher says.

And a $44,000 federal incentive to encourage conversion to EHRs may not be enough to prevent losses, particularly for small practices.

In an article published in the March issue of Health Affairs, Julia Adler-Milstein, assistant professor at the U-M School of Information and School of Public Health, and colleagues report on a study of 49 community practices in a large EHR pilot program.

They found that the average physician lost $43,743 over five years, and only 27 percent of practices showed a positive return on investment.

Doctors have expressed reluctance to adopt electronic systems out of concern about the impact on their bottom line, the researchers say.

“What our research shows is that a substantial fraction of physicians who adopt these systems don’t make the additional changes in the practice that they need to recoup the cost of adoption,” Adler-Milstein said.

The largest difference between those that lost money and those with a positive return on investment was whether or not they used the new system to increase revenue, she says. Offices that experienced a positive return saw more patients or improved billing to achieve fewer rejected claims and higher reimbursement from insurance companies.

Adler-Milstein and colleagues from the University of Rochester and Brigham and Women’s Hospital collected survey data from practices participating in the Massachusetts eHealth Collaborative in order to project five-year returns on investment from EHRs.

The collaborative, established in 2004 by the American College of Physicians and the Massachusetts Medical Society, was charged with facilitating adoption of EHRs in three diverse communities and assessing the impact on health care cost and quality.

Mixed-race youth feel less cohesion with mothers, but greater independence

Multiethnic and mixed-race youth feel less satisfied with their moms—but more independent—compared to other youth, according to a new U-M study.

U-M researcher Elma Lorenzo-Blanco and colleagues compared parenting and family-related experiences between multiethnic/mixed-race youth and those from one racial/ethnic background.

Data came from the National Longitudinal Survey of Youth, which included responses from nearly 9,000 12- to 17-year-olds. Teens and preteens were first sampled in 1997 and assessed annually in several areas — such as education, drug use, mental health and family relationships/events — until 2008.

The youth assessed the quality of mother-adolescent and father-adolescent relationships, as well as parental monitoring, support and control.

Mixed-race youth had the lowest mean score and white youth the highest for mother-adolescent relationships and maternal support, the study showed. For father-adolescent relationships, African-American youth had the lowest score, while whites had the highest.

Mothers may be more affected by parenting challenges because they may spend more time with children and/or feel a greater sense of responsibility for their children’s welfare compared to men—due to gendered parenting roles and expectations, said Lorenzo-Blanco, a U-M graduate student in psychology and women’s studies.

And if these additional parenting responsibilities take a toll on the mother’s well-being, this “may hinder their ability to respond to their children’s needs and form closer bonds with them,” she said.

Mixed-race youth also indicated their parents exerted less control than other ethnic groups surveyed and reported the lowest score for daily family routines.

“Altogether, these findings may indicate that mixed race/multiethnic youth may generally experience less cohesion with and support from their mothers (but not fathers),” Lorenzo-Blanco said.

The study’s other researchers included Cristina Bares, assistant professor of social work at Virginia Commonwealth University, and Jorge Delva, professor and associate dean of research at the School of Social Work.

Genetic study of house dust mites demonstrates reversible evolution

In evolutionary biology, there is a deeply rooted supposition that you can’t go home again: Once an organism has evolved specialized traits, it can’t return to the lifestyle of its ancestors.

There’s even a name for this pervasive idea. Dollo’s law states that evolution is unidirectional and irreversible. But this “law” is not universally accepted and is the topic of heated debate among biologists.

Now a research team led by two U-M biologists has used a large-scale genetic study of the lowly house dust mite to uncover an example of reversible evolution that appears to violate Dollo’s law.

The study shows that tiny free-living house dust mites, which thrive in the mattresses, sofas and carpets of even the cleanest homes, evolved from parasites, which in turn evolved from free-living organisms millions of years ago.

“All our analyses conclusively demonstrated that house dust mites have abandoned a parasitic lifestyle, secondarily becoming free-living, and then speciated in several habitats, including human habitations,” according to Pavel Klimov and Barry OConnor of the U-M Department of Ecology and Evolutionary Biology.

Their paper, “Is permanent parasitism reversible? — Critical evidence from early evolution of house dust mites,” was published online March 8 in the journal Systematic Biology.

Mites are arachnids related to spiders (both have eight legs) and are among the most diverse animals on Earth. House dust mites, members of the family Pyroglyphidae, are the most common cause of allergic symptoms in humans, affecting up to 1.2 billion people worldwide.

Despite their huge impact on human health, the evolutionary relationships between these speck-sized creatures are poorly understood. According to Klimov and OConnor, there are 62 different published hypotheses arguing about whether today’s free-living dust mites originated from a free-living ancestor or from a parasite—an organism that lives on or in a host species and damages its host.

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FACULTY SPOTLIGHT

Dr. David Aronoff, an associate professor and medical doctor in internal medicine-infectious diseases, on what he can't live without: "My family. That’s the most important thing for me."

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Violinist Anne-Sophie Mutter, 7:30 p.m. March 14, Hill Auditorium, sponsored by the University Musical Society.

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