Amazonia

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FORESTS

Amazonia: What’s Happening to the World’s Biggest Rain Forest?

By BRYAN WALSH | @bryanrwalsh | January 18, 2012 | 

Deforestation in the Brazilian rain forest is slowing, but it's still happening—with major consequences for the global environment.

I’d say you have to see the Amazon for yourself to understand how vast it is, but I’ve been there—and even I can’t imagine it. The rain forest is more than 2 million sq. miles—two-thirds the size of the continental United States—and the river system of the gigantic basin produces 20% of the world’s freshwater discharge. The forest holds 100 billion metric tons of carbon—equivalent to more than 10 years’ worth of global fossil-fuel emissions. And the Amazon is the global capital of wildlife biodiversity, with more species calling the forest and rivers home than scientists could ever hope to name. It’s safe to say that as the Amazon goes, so goes the planet’s environment./.../

Sympathetic Activity: Hypertension

From Medscape Education Cardiology

Sympathetic Activity in the Pathophysiology of Hypertension

Murray D. Esler, MBBS, PhD

The goal of this activity is to provide information on hypertensive patients and discuss issues and trial data as well as how sympathetic activity can be introduced in a patient's management.

Learning Objectives

1. Explain how the renal nerves can elevate central sympathetic drive and affect blood pressure control
2. Differentiate the role of afferent and efferent renal nerves
3. Review current treatments and experimental interventions aimed at the renal nerves to modulate blood pressure
4. Describe the scientific rationale behind how ablation of renal nerves can be applied to manage resistant hypertension

Sympathetic nervous system activation has been implicated in the development and progression of systemic hypertension related to a number of different etiologies. The degree of sympathetic nervous system activation correlates with the severity of blood pressure elevation and is more pronounced in the context of comorbid metabolic diseases including diabetes, obesity, and the metabolic syndrome. Dr. Murray Esler discusses the issues related to sympathetic activity pertaining to the pathophysiology of hypertension./.../

mental illness 1:5

National report finds one-in-five Americans experienced mental illness in the past year

Substance dependence and abuse rates higher among those experiencing mental illness

A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in the past year. The rate of mental illness was more than twice as high among those aged 18 to 25 (29.9 percent) than among those aged 50 and older (14.3 percent). Adult women were also more likely than men to have experienced mental illness in the past year (23 percent versus 16.8 percent).  Mental illness among adults aged 18 or older is defined as having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) in the past year, based on criteria specified in theDiagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994)./.../

EMPHYSEMA

EMPHYSEMA

Cigarette Smoke Induction of Osteopontin (SPP1) Mediates T_H17 Inflammation in Human and Experimental Emphysema

1. Ming Shan¹,², 
2. Xiaoyi Yuan¹,², 
3. Li-zhen Song¹, 
4. Luz Roberts¹, 
5. Nazanin Zarinkamar¹,
6. Alexander Seryshev¹, 
7. Yiqun Zhang³, 
8. Susan Hilsenbeck³, 
9. Seon-Hee Chang⁴, 
10. Chen Dong⁴,
11. David B. Corry¹,²,⁵,* and 
12. Farrah Kheradmand¹,²,⁵,* 
¹Department of Medicine, Section of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX 77030, USA

ABSTRACT

Smoking-related lung diseases are among the leading causes of death worldwide, underscoring the need to understand their pathogenesis and develop new effective therapies. We have shown that CD1a⁺ antigen-presenting cells (APCs) from lungs of patients with emphysema can induce autoreactive T helper 1 (T_H1) and T_H17 cells. Similarly, the canonical cytokines interferon-γ (IFN-γ) and interleukin-17A (IL-17A) are specifically linked to lung destruction in smokers, but how smoke activates APCs to mediate emphysema remains unknown. Here, we show that, in addition to increasing IFN-γ expression, cigarette smoke increased the expression of IL-17A in both CD4⁺ and γδ T cells from mouse lung. IL-17A deficiency resulted in attenuation of, whereas lack of γδ T cells exacerbated, smoke-induced emphysema in mice. Adoptive transfer of lung APCs isolated from mice with emphysema revealed that this cell population was capable of transferring disease even in the absence of active smoke exposure, a process that was dependent on IL-17A expression. Spp1 (the gene for osteopontin) was highly expressed in the pathogenic lung APCs of smoke-exposed mice and was required for the T_H17 responses and emphysema in vivo, in part through its inhibition of the expression of the transcription factor Irf7. Thus, the Spp1-Irf7 axis is critical for induction of pathological T_H17 responses, revealing a major mechanism by which smoke activates lung APCs to induce emphysema and identifying a pathway that could be targeted for therapeutic purposes.

• Copyright © 2012, American Association for the Advancement of Science

Citation: M. Shan, X. Yuan, L.-z. Song, L. Roberts, N. Zarinkamar, A. Seryshev, Y. Zhang, S. Hilsenbeck, S.-H. Chang, C. Dong, D. B. Corry, F. Kheradmand, Cigarette Smoke Induction of Osteopontin (SPP1) Mediates T_H17 Inflammation in Human and Experimental Emphysema. Sci. Transl. Med. 4, 117ra9 (2012).

Who Else Is Paying Your Doctor?

Published: January 20, 2012

It took longer than expected, but the Obama administration is finally poised to enact badly needed regulations requiring that the manufacturers of drugs, medical devices and medical supplies disclose all payments they make to doctors or teaching hospitals. The information, which would be posted on a government Web site, will allow patients to decide whether they need to worry about any possible conflicts of interest.

• U.S. to Force Drug Firms to Report Money Paid to Doctors(January 17, 2012)

Such payments can be for legitimate research and consulting. But there is also a lot of cash being spread around to pay for doctors’ travel and entertainment or for gifts or modest meals for a prescribing doctor’s staff.

As Robert Pear reported in The Times this week, some prominent doctors and researchers receive hundreds of thousands or even millions of dollars a year in exchange for providing advice to a company or giving lectures on its behalf. About a quarter of all doctors take some cash payments from drug or device makers and nearly two-thirds accept meals or food gifts. Analysts contend that even seemingly trivial gifts can influence doctors to prescribe expensive drugs that may not be best for a patient’s health or pocketbook./.../

Tobacco: costs & savings

The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts

• Article
• Metrics
• Related Content

1 Department of Health Policy, School of Public Health and Health Services, The George Washington University, Washington, District of Columbia, United States of America, 2 Center for Health Policy Research, School of Public Health and Health Services, The George Washington University, Washington, District of Columbia, United States of AmericaPatrick Richard^1¤, Kristina West¹,Leighton Ku^2*

Abstract Top

Background and Objective

A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.

Methods

A cost-benefit analysis approach was used to estimate the program's return on investment. Administrative data were used to compute annual cost per participant. Data from the 2002–2008 Medical Expenditure Panel Survey and from the Behavioral Risk Factor Surveillance Surveys were used to estimate the costs of hospital inpatient admissions by Medicaid smokers. These were combined with earlier estimates of the rate of reduction in cardiovascular hospital admissions attributable to the tobacco cessation program to calculate the return on investment.

Findings

Administrative data indicated that program costs including pharmacotherapy, counseling and outreach costs about $183 per program participant (2010 $). We estimated inpatient savings per participant of $571 (range $549 to $583). Every $1 in program costs was associated with $3.12 (range $3.00 to $3.25) in medical savings, for a $2.12 (range $2.00 to $2.25) return on investment to the Medicaid program for every dollar spent.

Conclusions

These results suggest that an investment in comprehensive tobacco cessation services may result in substantial savings for Medicaid programs. Further federal and state policy actions to promote and cover comprehensive tobacco cessation services in Medicaid may be a cost-effective approach to improve health outcomes for low-income populations.