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Week of February 1, 2010

Scholarship & Creative Work

Alzheimer caregivers: Help us help ourselves, too

Alzheimer caregivers say their emotional and physical health along with sleep quality improved when they received a comprehensive skills training program that included a self-care component, according to a new study.

These caregivers felt less stressed and burdened in their caregiving role, and their loved one received better care, says Louis Burgio, a professor in the School of Social Work and study’s co-author.

“When caregivers receive knowledge and skill training including positive health and health behaviors, they are able to incorporate these practices into their daily routine,” says Burgio, a research professor in the Institute of Gerontology. “This not only improves their self-reported physical health, but also decreases their levels of depression and lessens the stress and burden associated with the caregiving role.”

Burgio and researchers at the University of Alabama examined the outcomes from 495 caregivers who used the Resources for Enhancing Alzheimer’s Caregiver Health intervention. It involved nine in-home and three telephone sessions in a six-month span. In recent research, Burgio has incorporated community feedback to make the intervention more feasible.

Caregivers responded to questions in four areas: self-rated health, sleep, mood improvement and physical improvement in each category. Those involved in intervention had better results than those who did not participate in the program.

The study also reported data showing racial/ethnic differences. Hispanics and whites, the study showed, were more likely to report better health after receiving the intervention than African Americans, although all racial groups benefitted. In addition, Hispanics were less likely to report strains of caregiving before receiving the intervention, whereas whites were more likely to report higher emotional burden in caregiving roles.

The study’s other authors are Amanda Elliott and Jamie DeCoster.

The findings appear in the current issue of the Journal of the American Geriatrics Society.

Doctors drive H1N1 vaccination rates

Patients and parents expect health care providers to have information about new vaccines. So, when a new H1N1 vaccine became available in October 2009, the question was: Would health care providers recommend it?

Results from the latest C.S. Mott Children’s Hospital National Poll on Children’s Health indicate health care providers play a critical role in influencing parents and patients to vaccinate their children and themselves against H1N1 flu.

The poll found that 29 percent of children and 16 percent of adults have received H1N1 vaccine, as of January. Vaccination levels were more than two to three times as high when parents thought their children’s providers strongly recommended the vaccine (66 percent) and when adults perceived strong recommendations from their own providers (57 percent).

“For H1N1 vaccination among kids and adults, it looks like the advice of health care providers is tremendously important,” says Dr. Matthew Davis, director of the poll and associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the Medical School.

“Our study indicates that the impact of provider recommendations on H1N1 vaccination goes in both directions,” he says. “For patients and parents whose health care providers strongly favored H1N1 vaccination, immunization rates were much higher than average. But if providers were negative about the vaccine or even neutral — then H1N1 vaccination was much less likely.”

Among parents who had communicated with providers about H1N1 vaccine, only 38 percent reported that providers strongly recommended H1N1 vaccine for their children; 35 percent of parents perceived that the providers were neutral. Among adults who had spoken with providers about H1N1 vaccine, 22 percent reported that providers strongly recommended the vaccine, while 55 percent perceived that their providers were neutral.

Rules governing RNA’s anatomy revealed

U-M researchers have discovered the rules that dictate the three-dimensional shapes of RNA molecules, rules that are based not on complex chemical interactions but simply on geometry.

The work, done by a team led by Hashim M. Al-Hashimi, is described in the journal Science.

“RNA is a very floppy molecule that often functions by binding to something else and then radically changing shape,” says Al-Hashimi, who is the Robert L. Kuczkowski Professor of Chemistry and a professor of biophysics. These shape changes, in turn, trigger other processes or cascades of events, such as turning specific genes on or off.

Because of the RNA molecule’s mercurial nature, “you can’t really define it as having a single structure,” Al-Hashimi says. “It has many possible orientations, and different orientations are stabilized under different conditions, such as the presence of particular drug molecules.”

A major goal in structural biology and biophysics is to be able to predict not only the complex three-dimensional shapes that RNA assumes (which are dictated by the order of its nucleic acid building blocks), but also the various shapes RNA takes on after binding to other molecules such as proteins and small-molecule drugs. Further, researchers would like to be able to manipulate the 3-D structure and resulting activity of RNA by tweaking the drug molecules with which it interacts. But to do that, they need to understand the rules that govern the anatomy of RNA.

Al-Hashimi’s coauthors on the Science paper were graduate students Maximillian Bailor and Xiaoyan Sun.

Blocking inflammation receptor kills breast cancer stem cells, study finds

Scientists at the Comprehensive Cancer Center have uncovered an important link between inflammation and breast cancer stem cells that suggests a new way to target cells that are resistant to current treatments.

The researchers identified a receptor, CXCR1, on the cancer stem cells, which triggers growth of stem cells in response to inflammation and tissue damage. A drug originally developed to prevent organ transplant rejection blocks this receptor, killing breast cancer stem cells and preventing their metastasis in mice, according to the study.

Cancer stem cells, the small number of cells that fuel a tumor’s growth, are believed to be resistant to current chemotherapies and radiation treatment, which researchers say may be the reason cancer so often returns after treatment.

“Developing treatments to effectively target the cancer stem cell population is essential for improving outcomes. This work suggests a new strategy to target cancer stem cells that can be readily translated into the clinic,” says senior study author Dr. Max Wicha, Distinguished Professor of Oncology and director of the Comprehensive Cancer Center. Wicha was part of the team that first identified stem cells in breast cancer.

Results of the current study appear online in the Journal of Clinical Investigation and will appear in the journal’s February print issue.

Additional U-M authors include Christophe Ginestier, Suling Liu, Mark Diebel, Hasan Korkaya, Ming Luo, Marty Brown, Jun-Lin Guan and Gabriela Dontu.

Value-based insurance design can improve health at no added cost

Value-based insurance design programs — which reduce patient co-payments for highly effective treatments — can break even financially or possibly save money, according to a new study from U-M, Harvard and other researchers.

In an article published today by Health Affairs, the researchers analyzed data from a large corporation that implemented a VBID program in 2005. Co-payment rates were reduced for employees using five classes of drugs used to treat several serious but common chronic conditions, including diabetes, hypertension and heart disease.

In this VBID program, patients using the specified medications were offered at least a 50 percent co-payment reduction. The study’s authors examined both the amounts spent on the high value services and overall spending by the employer using the VBID plan.

“From a total cost perspective, the VBID program likely broke even, and possibly saved money,” said Dr. A. Mark Fendrick, co-director of the Center for Value-Based Insurance Design.

The financial returns from an employer perspective will be less favorable, but significant savings from reduced use of non-drug services are likely and will substantially offset the added employer spending on prescription drugs, the researchers found.

“But even if the VBID program were to slightly increase employers’ medical costs, our expectation is that as people increase the use of high-value services, their health will not only improve, but overall medical costs will decline.”

An additional U-M author is Dr. Allison Rosen, assistant professor of Internal Medicine and Health Management & Policy.



Teresa Herzog Mourad, on her favorite part of her job: “I am constantly inspired by changes people make in their alcohol-related attitudes and behaviors.”