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Farley Center brief: What are potential solutions to the gun violence epidemic?

This timely report from the Eugene S. Farley, Jr. Health Policy Center at CU Anschutz examines current gun safety policies throughout the United States and presents evidence-based opportunities to strengthen gun safety legislation.

The health policy brief, “Protecting Colorado Youth from Gun Violence,” reviews the impact of gun violence on youth in Colorado and across the nation. It notes that addressing the epidemic will require a multi-pronged approach. The brief assesses opportunities and potential legislation to protect Colorado youth from suicide, homicide and accidental gun death.

The report is the work of Jennifer Mijer, pediatric senior resident, and Shale Wong, professor of pediatrics and family medicine, in the CU School of Medicine.

Click here to read the full brief.

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Chronic kidney disease epidemic may be result of high heat, toxins

farm workers

A mysterious epidemic of chronic kidney disease among agricultural workers and manual laborers may be caused by a combination of increasingly hot temperatures, toxins and infections, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published today in the New England Journal of Medicine.

Professor Lee Newman, MD, MA
Professor Lee Newman, MD, MA

In recent years, chronic kidney disease has emerged as a major illness among workers in hot climates. It was first identified in the 1990s by clinicians treating sugar cane workers in Central America. In 2012, it claimed roughly 20,000 lives and has now been identified in California, Florida and in Colorado’s San Luis Valley.

But the exact cause has been hard to determine.

“We looked at all the available literature on the subject and asked, `What do we know today? Where are the gaps?” said the study’s lead author Lee Newman, MD, MA, director of the Center for Health, Work & Environment  and professor in the  Dept. of Environmental & Occupational Health at the Colorado School of Public Health. “We were hoping to synthesize everything we know so far for a framework for moving forward.”

The disease is more prevalent in sugar cane workers and other agricultural employees including cotton and corn workers, shrimp farmers and miners. It is less common at higher elevations.

Newman and study co-author Richard Johnson, MD, of

the University of Colorado School of Medicine, said the disease could be caused by heat, a direct health impact of climate change, as well as pesticides like glyphosate.

“Some pesticides are nephrotoxic, and these could possibly contaminate the water supply,” Johnson said. “Indeed, there are studies showing the epidemic in Sri Lanka is greatest in areas where there are shallow wells in which toxins might become concentrated.”

Dr. Rick Johnson of CU Anschutz
Professor Richard Johnson, MD

Sri Lankan farmers exposed to glyphosate showed an increased risk for chronic kidney disease. Still, the levels in wells were very low and studies in Central America turned up little glyphosate. Along with pesticides, the researchers looked at heavy metals as a possible culprit. Lead and cadmium, known to cause kidney injury, have been reported in the soils of Sri Lanka and Central America.

Other potential causes include infectious diseases that can hurt the kidneys such as the hanta virus and leptospirosis, common in sugar cane workers. Genetic factors are also a possibility.

“The common factors are heat exposure and heavy labor,” Newman said.

Heat stress and persistent dehydration can cause kidney damage.

The disease is moving into the U.S. with agricultural workers in Florida, California’s Central Valley and Colorado’s San Luis Valley reporting incidences of the illness.

“This is not the usual kidney disease we see in the U.S.,” Newman said. “It is not caused by high blood pressure or diabetes. The usual suspects are not the cause.”

Johnson pointed out that CU Anschutz has two major efforts underway that are investigating worker health and the impact of climate change on disease.

“This disease is not confined to the southern hemisphere, it is coming here and in fact it is already here,” Johnson said. “It is my opinion that climate change plays a role in this epidemic.”

Those impacted are mostly agricultural workers, the people who grow and harvest the world’s food.

“They are the people who feed the planet,” Johnson said. “If climate change continues like this who is going to feed us?”

Newman and Johnson believe the epidemic is caused by a combination of heat and some kind of toxin and they recognize the need to take preventative action immediately.  That means ensuring workers get adequate breaks, drink enough fluids and spend time in the shade. It also means maintaining a clean water supply, free of chemicals toxic to the kidneys.

“When clinicians detect clusters of patients with chronic kidney disease who work for the same employer or in similar jobs,” the authors said, “they should contact occupational health and safety and public health professionals to promote investigations of workplace conditions.”

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New disease discovered by CU Anschutz researchers

A new immunodeficiency disease caused by a novel genetic mutation has been identified by researchers at the University of Colorado Anschutz Medical Campus providing unique insights into cell biology.

The findings were published last week in The Journal of Experimental Medicine.

Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.
Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

The researchers made the discovery while investigating why an infant was suffering from inflammatory bowel disease along with other conditions including eczema, food allergies, lung disease, and persistent CMV (cytomegalovirus) infection.

“Other than a specialized elemental formula, he was unable to eat any food and his gut inflammation persisted despite numerous therapies,” said the study’s co-author Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado (CHCO).

The young boy’s sister suffered from similar problems, and their collective symptoms were consistent with an immune dysregulation syndrome.  Patients suffering from these syndromes have poorly functioning immune systems which can result in serious, recurrent, or unusual infections, as well as autoimmune/inflammatory complications affecting the gastrointestinal tract, skin, lungs, and circulating blood cells.  This defective (or dysregulated) immune system may also lead to increased risk for cancer.

Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado
Cullen Dutmer, MD, assistant professor of pediatrics specializing in allergy and immunology at the CU School of Medicine and CHCO.

The researchers found that the siblings had the first known human defect in a gene called IL2RB (encoding interleukin-2 receptor beta, IL-2Rb), resulting in decreased numbers of immune cells called regulatory T cells which prevent autoimmunity. At the same time, the children had an accumulation of ‘natural killer’ cells which, if functioning normally, help protect against viral infections and cancer.

“But the mutation meant the natural killer cells were incapable of maturing properly and could not clear CMV, resulting in a persistent and debilitating infection,” said study co-author Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

“We tracked this disease down to a single gene and that is a fairly rare event,” Hsieh said. “Prior to our findings, there had been no documented cases of a mutation in this particular gene leading to human disease.”

Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine
Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine

Dutmer said it’s likely that others suffer from this condition but it has never been identified.

“Although clearly a rare disease, it has likely been missed in other children,” he said. “Now that it is out there, we know to look for it.”

Study co-author Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine agreed.

“The discovery also means that the defect could be addressed through gene therapy,” Kedl said. “We could feasibly go in, manipulate the gene, and get it back in the right sequence.”

Recent advancements in identifying genetic causes of immunodeficiency diseases have led to innovative treatments.  Gene therapy, a therapeutic approach that corrects specific genetic defects, is emerging as a viable treatment option for some immunodeficiency diseases.

A recent study showcased the use of gene therapy to treat severe combined immune deficiency or SCID caused by mutations in the gene IL2RG (Mamcarz et al., New England Journal of Medicine 2019).

“Identifying the underlying genetic causes of immunodeficiency diseases and other disorders can reveal targets for promising personalized treatment strategies like gene therapy,” Dutmer and Hsieh said. “That would allow for therapeutic interventions that are uniquely tailored to meet the needs of the individual.”

Kedl noted that this discovery illustrates the ‘bench-to-bedside’ research capacities on the CU Anschutz Medical Campus and in its graduate training programs.

One of the first authors of the study, Isabel Fernandez, is an MD/PhD student the CU School of Medicine, pursuing a PhD in Immunology in the Kedl lab. Her co-first author is Ryan Baxter, MS, who is a research assistant in the Hsieh lab.

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CU School of Medicine scientist helps create international database of women scientists

AURORA, Colo. (April 23, 2019) – A database of women scientists that was created a year ago by a team led by a CU School of Medicine postdoctoral fellow has grown to list more than 7,500 women and is featured in an article published today in PLOS Biology.

The “Request a Woman Scientist” database was created to address concerns that women’s scientific expertise is often excluded at professional gatherings.

“The idea came from repeated experiences of seeing all men panels (‘manels’) and women’s scientific expertise often excluded in the public realm,” writes Elizabeth McCullagh, PhD, a postdoctoral fellow in the Department of Physiology and Biophysics on the Anschutz Medical Campus, and her co-authors.

The article, “Request a woman scientist: A database for diversifying the public face of science,” is published today in the peer-reviewed journal PLOS Biology.

According to a 2017 study that analyzed colloquium speakers at 50 prestigious universities, men were invited to give twice as many talks about their research as women. When asked why, the event organizes often repeated the same explanation: “We tried to find a women to speak on this panel, but we didn’t know any women who work on this topic.”

To combat the misperception that women are not engaged in a range of scientific activities, McCullagh and her colleagues created the Request a Woman Scientist database to connect educational institutions, policymakers, the media, the public, and others with women scientists across disciplines around the world.

Women listed in the database have indicated their willingness to speak with students or the media, consult on a project, sit on a panel or serve as a conference keynote speaker.

Between its launch in January 2018 to November 2018, when data was generated for the PLOS Biology article, more than 7,500 women from 133 countries have signed up and the platform has been accessed more than 100,000 times by journalists, conference organizers, school teachers, and other scientists. Already, journalists from The Atlantic, Grist, and online National Geographic have relied on the database for sources.

To be listed, women scientists fill out an online form and members of the group 500 Women Scientists vet the entries by verifying that the submitted information is accurate. The database lists women who are in a science, technology, engineering, math and medicine (STEMM) field.

500 Women Scientists is a grassroots organization started by four women who met in graduate school at CU Boulder and who maintained friendships and collaborations after jobs and life took them away from Boulder. The group’s mission is to make science open, inclusive, and accessible. When they published an open letter in November 2016, the group’s founders set an aspirational goal of collecting 500 signatures, which they surpassed within hours of posting the letter. More information about 500 Women Scientists is available at www.500womenscientists.org.

“Our goal is to increase representation of women scientists in society and change perceptions of what a scientist looks like,” said McCullagh. “As our database grows, we plan to make it easier to use so that women scientists are recognized for their significant contributions to science and our understanding of the world.”

Six authors, including McCullagh, are listed as authors of the article.

Guest contributor: Mark Couch, CU School of Medicine

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Women dominate OBGYN field but make less money than male counterparts

While women outnumber men as OB-GYN practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the OB-GYN field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into OB-GYN were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes. Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Department of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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Women dominate Ob/Gyn field but make less money than male counterparts

Pregnant patient

While women outnumber men as Ob/Gyn practitioners, they still make significantly less money and the pay gap extends to subspecialties like reproductive endocrinology and infertility (REI), according to researchers at the University of Colorado Anschutz Medical Campus.

“It’s interesting that the Ob/Gyn field is dominated by women and yet this gender inequality in pay persists,” said the study’s senior author Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine. “Why the discrepancy?”

The study was published on-line this month in the journal Fertility and Sterility.

It showed that even after adjusting for variables like hours worked, years in practice, location, academic vs. private practice, female reproductive endocrinology and infertility subspecialists make on average $67,000 less than male REIs per year.

Pay inequity among physicians in well-documented. According to Doximity, an online social network for health care professionals, women doctors make about 27.7 percent less than male physicians or about $105,000.

Dr. Skaznik-Wikiel | CU ARM
Malgorzata Skaznik-Wikiel, MD, assistant professor of obstetrics and gynecology at the University of Colorado School of Medicine.

A recent commentary in the journal Obstetrics and Gynecology noted that 82 percent of those going into Ob/Gyn were women, yet the field is the fourth worst of 18 specialties in pay inequity among the sexes.  Skaznik-Wikiel and her colleagues sent surveys to 796 board-certified or board-eligible Society for Reproductive Endocrinology and Infertility members. Of those, 215 responded, an above average response for such surveys.

The study noted that although women were more likely to practice less than five days per week, there were no significant differences in the number of hours they spent per week seeing patients, doing research or being involved in other academic activities.

The researchers reviewed a number of reasons given for the pay gap – women working fewer hours, taking more personal leave, practicing in specialties that pay less or practicing in academia rather than privately.

Yet they found little to substantiate these suggestions.

For example, the study said it’s unlikely that a woman taking more personal leave, like maternity leave, would affect a base salary. Also, they said, more and more men are taking paternity leave as well.

One possible culprit is `salary compression.’ That’s when the market rate for a job outpaces pay increases for those already in those positions. New hires may get bigger salaries.

“There is some evidence that men switch jobs more often than women and sometimes new jobs will pay more to attract new employees,” Skaznik-Wikiel said.

She also said women are often reluctant to negotiate hard over salary for fear of being seen as overly aggressive, traits many do not associate with men who do the same thing.

Ultimately, Skaznik-Wikiel said, there is no good reason for the discrepancy.

“The first step in addressing the gender gap is acknowledging it exists,” she said. “Ignorance of this issue is no longer acceptable.”

The second step is opening a frank and honest discussion about income, salary negotiations and implementation of academic institutional and private practice policies addressing potential gender biases, the study said.

Salaries, raises and bonuses should be more transparent, said Skaznik-Wikiel.

“Women also need to step into mentorship roles now more than ever,” she said. “An opportunity exists for practitioners in the field of obstetrics and gynecology and its subspecialties to lead by example in establishing new transparent norms and better policies that create an environment of equity in pay.”

The study co-authors include: Sara Babcock Gilbert, MD, Division of Reproductive Endocrinology and Infertility, Dept. of Obstetrics and Gynecology at the CU School of Medicine and Amanda Allshouse, MS, Dept. of Biostatistics and Informatics at the Colorado School of Public Health at CU Anschutz.

 

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Study: Most Catholic hospitals don’t advertise religious restrictions

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In a survey of Catholic hospitals throughout the country, researchers at the University of Colorado Anschutz Medical Campus found many did not advertise their religious affiliation and the majority did not explain how that affiliation results in health care restrictions.

The research letter was published today in the Journal of the American Medical Association (JAMA).

Maryam Guiahi, MD, associate professor of Obstetrics and Gynecology at the University of Colorado School of Medicine, analyzed the websites of all hospitals listed in the Catholic Health Association of the United States’ Health Care Directory.

Study reveals 79 percent reported Catholic identity

Out of 646 hospitals examined, 507 or 79 percent reported their Catholic identity. The other 21 percent did not explicitly disclose it on their website. More concerning, only 28 percent specified how their religious affiliation might influence patient care.

Maryam Guiahi, MD, associate professor of Obstetrics and Gynecology at the University of Colorado School of Medicine
Maryam Guiahi, MD, associate professor of Obstetrics and Gynecology at the University of Colorado School of Medicine

“Patients need to know if they are going to a Catholic hospital and if that is going to affect the care they receive,” Guiahi said. “They may realize that a Catholic hospital might not provide abortions, but many do not realize that preventative services like contraceptives and tubal ligations are also restricted.”

The U.S. Conference of Catholic Bishops expects hospitals affiliated with the Catholic Church to abide by the Ethical and Religious Directives for Catholic Health Care Services. These directives interpret medical care based on the church’s moral teachings and limit aspects of reproductive and end-of-life-care.

One in five do not report their identity

“A basic cornerstone of medical ethics is to support patient autonomy,” said Guiahi. “One way to do this is to be transparent. It was surprising to find that one in five of these Catholic hospitals do not even report their identity and that the vast majority do not explain to patients what being Catholic means.”

Guiahi said hospitals may avoid transparency about restrictions to avoid losing patients.

“This means that many patients may waste their time at Catholic facilities when they encounter restrictions to common health services,” she said.

At the same time, some Catholic hospitals that openly cite the directives may actually provide restricted services using workarounds.

For example, rather than say they are giving a patient an intrauterine device for birth control, they might say it is being placed for heavy menstrual bleeding.

“There appears to be a lot of variability across Catholic sites in terms of what they provide and whether or not they use workarounds, which compounds health care consumer confusion,” explained Guiahi.  “Websites provide an opportunity to inform consumers about which services are provided and which ones are restricted and can thereby avoid conflicts in care.”

Ultimately, she said, greater transparency about religious affiliation and care restrictions may allow patients to make informed choices.

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Gender-based salary gap persists among academic emergency medicine physicians

Emergency doc

Although overall salaries for emergency physicians have increased over the past four years, and despite a call to end gender disparities in salary, men still make 18 percent more than women, and a $12,000 gender salary gap remains essentially unchanged. That is the finding of a study to be published in a March 2019 special issue of Academic Emergency Medicine (AEM) titled: “Influence of Gender on the Profession of Emergency Medicine.”

In what is likely the first study that evaluates this trend over such a long time period and considers both traditional academic and academic-community salaries by gender, researchers found that the salary disparity is greatest among more senior faculty, that is, associate and full professors.

The lead author of the study is Jennifer L. Wiler, MD, MBA, executive vice chair and associate professor of the department of

emergency medicine at the University of Colorado School of Medicine, and executive medical director and cofounder, UCHealth CARE Innovation Center.

Conscious and unconscious biases

According to Wiler, et al., the reasons for salary disparities by gender are unclear and unexplained, but may include the

Jennifer Wiler, MD, MBA, executive vice chair and associate professor of the department of emergency medicine at the University of Colorado School of Medicine
Jennifer Wiler, MD, MBA, executive vice chair and associate professor of the Department of Emergency Medicine at the University of Colorado School of Medicine

presence of conscious and unconscious biases or initial recruitment negotiation skills despite the medical specialization. They recommend that deliberate strategies be developed to train academic emergency medicine employers how to prevent gender bias with regards to salary. Further, as more women enter the field and are promoted, they suggest that conscientious chairs prioritize pay parity as one way to change this persistent trend.

Dr. Esther Choo, MD, MPH, guest editor for the special issue of AEM, discussed the findings of the study in an AEM podcast, She Works Hard for the Money – Time’s Up in Healthcare.

Dr. Choo, an emergency physician and researcher, is also an associate professor at Oregon Health & Science University. She is a nationally-recognized expert in gender bias in medicine and a founding member of the nonprofit Time’s Up Healthcare, whose aim is to tackle discrimination, harassment, and inequality across the health care industry.

Also commenting on the study was Kathleen Clem, MD, senior vice president for AdventHealth, and professor of emergency medicine, College of Medicine, University of Central Florida:

A radical salary adjustment needed

“Shining a bright light on a verified academic emergency medicine gender salary gap is a powerful step to create change. This inclusive study follows a long-term trend and thus provides motivation for institutions to look deeply into their salary practices and insure pay parity going forward.”

“Dr. Wiler and collaborators demonstrate concerning, gender-based differences in compensation that are not explained by measured factors that would reasonably be expected to influence pay. This work sheds a bright light on patterns that have persisted in darkness and, hopefully, this is a step towards both the identification of the underlying causes of these disparities in compensation and working together towards their elimination,” added Roger J. Lewis, MD, PhD, professor and chair, department of emergency medicine, Harbor-UCLA Medical Center.

Gail D’Onofrio, MD, professor and chair in the Department of Emergency Medicine at Yale University School of Medicine and physician-in-chief of emergency services at Yale-New Haven Hospital concluded:

“Assuming that salary equity will right itself over time without definitive action is magical thinking. A radical one-time salary adjustment based on rank, position and years of service, followed by ongoing vigilance, is needed. We have run out of excuses.”

This press release first appeared on EurekaAlerts from The Society for Academic Medicine.

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New study shows hidden genes may underlie autism severity

Scientists at the University of Colorado Anschutz Medical Campus  have implicated a largely hidden part of the human genome in the severity of autism symptoms, a discovery that could lead to new insights into the disorder and eventually to clinical therapies for the condition.

James Sikela, PhD, professor in the Department of Biochemistry and Molecular Genetics at the CU School of Medicine.
James Sikela, PhD, professor in the Department of Biochemistry and Molecular Genetics at the CU School of Medicine.

The researchers found the critical genes are a part of the human genome that is so complex and difficult to study that it has been unexamined by conventional genome analysis methods.

In this case, the region encodes most copies of the Olduvai (formerly DUF1220) protein domain, a highly duplicated (~300 copies in the human genome) and highly variable gene coding family that has been implicated in both human brain evolution and cognitive disease.

The researchers, led by James Sikela, PhD, a professor in the Department of Biochemistry and Molecular Genetics at the University of Colorado School of Medicine, analyzed the genomes of individuals with autism and showed that, as the number of copies of Olduvai increased, the severity of autism symptoms became worse.

While the Sikela lab has shown this same trend previously, the discovery has not been pursued by other researchers due to the complexity of the Olduvai family.

“It took us several years to develop accurate methods for studying these sequences, so we fully understand why other groups have not joined in.” Sikela said. “We hope that by showing that the link with autism severity holds up in three independent studies, we will prompt other autism researchers to examine this complex family.”

Image result for genome

In order to provide more evidence that the association with autism severity is real, the Sikela lab used an independent population and developed a different, higher resolution measurement technique. This new method also allowed them to zero in on which members of the large Olduvai family may be driving the link with autism.

Though autism is thought to have a significant genetic component, conventional genetic studies have come up short in efforts to explain this contribution, Sikela said.

“The current study adds further support to the possibility that this lack of success may be because the key contributors to autism involve difficult-to-measure, highly duplicated and highly variable sequences, such as those encoding the Olduvai family, and, as a result, have never been directly measured in other studies of autism,” Sikela said.

The study was published today in the American Journal of Psychiatry, and included CU Anschutz co-authors Jonathan M. Davis, PhD and Ilea Heft, PhD. Work was performed in collaboration with Dr. Stephen Scherer of The Hospital for Sick Children (SickKids) and University of Toronto and used whole genome sequences generated by the Autism Speaks MSSNG Open Science project. The work was supported by grants from the National Institute for Mental Health (NIMH) and the Simons Foundation for Autism Research (SFARI).

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Over half of home health care clinicians say they lack adequate information from hospitals

Home health care clinician

A survey of Colorado home health care clinicians (HHCs) revealed that 60 percent said they had not received enough information to guide patient treatment while 52 percent said patients often had unrealistic expectations of the kind of care they would receive.

The study, conducted by researchers at the University of  Colorado Anschutz Medical Campus, also showed major gaps in communication between hospital and home health care staff, some that could have serious medical consequences.

The study was published today in the Journal of the American Medical Directors Association.

“We have heard of medication errors occurring between hospitals and home health care providers,” said the study’s lead author Christine D. Jones, MD, MS, assistant professor at the University of Colorado School of Medicine.  “As a result, patients can receive the wrong medication or the wrong dose. Some home health providers don’t get accurate information about how long to leave a urinary catheter or intravenous line in.”

Jones and her colleagues surveyed nurses and staff at 56 HHC agencies throughout Colorado. Participants were sent a 48-question survey covering communication between hospitals and HHCs, patient safety, pending tests, medication schedules, clinician contact and other areas.

More than half said hospitals did not adequately prepare patients for home health care upon discharge. They also said patients often expected a level of home care that was simply not available including extended hours, housekeeping and help with transportation.

Dr. Christine Jones, assistant professor of medicine and lead author of the study.
Dr. Christine Jones, assistant professor of medicine and lead author of the study.

Home health care workers with access to electronic health records (EHRs) for referring providers had fewer problems relating to a lack of information about patients, including critical medication data.

They were able to electronically access notes, orders, lab and radiology results and referrals. Some 12 percent of respondents reported positive experiences when accessing the Colorado Regional Health Information Organization (CORHIO, www.corhio.org) about hospital admissions.

Yet many did not have access to such information.

“Although almost all (96 percent) indicated that Internet-based access to a patient’s hospital record would be at least somewhat useful,” Jones said. “Fewer than half reported having access to EHRs for referring hospitals or clinics.”

She said the survey revealed problems getting medication doses right due to conflicting information.

“Notably, additional studies have found extremely high rates of medication discrepancies (94 percent – 100 percent) when referring provider and HHC medications lists are compared,” Jones said.

The study suggested targeted education of hospital staff about what home health clinicians actually provide to patients and caregivers to avoid frustration.

Jones noted that if these issues are arising in Colorado, they could signify a national problem.

“For hospitals and HHC agencies seeking strategies to improve communication, this study can provide targets for improvement,” she said. “Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.”

The study’s co-authors include: Jacqueline Jones, PhD, RN, FAAN; Kathryn H. Bowles, PhD, RN, FAAN, FACMI; Linda Flynn, PhD, RN, FAAN; Frederick A. Masoudi, MD, MSPH; Eric A. Coleman, MD, MPH; Cari Levy, MD, PhD and Rebecca S. Boxer, MD, MS.

 

 

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