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Overcoming a health challenge and finding purpose

Seven years ago, Courtland Keteyian rolled into an operating room, excited by the prospect of running the way he once did as a star athlete on the track team in college. He imagined running on an outdoor trail and alongside gurneys in an emergency room.

Post-surgery, a few hours later, nurses wheeled him out of the operating room. He has been in a wheelchair ever since.

His surgeon made the operation sound fairly routine. A first-year resident at the time, studying emergency medicine, Keteyian was aware of the litany of things that can go wrong on the operating table. But he went in with confidence and assurances that the risks of the operation were minimal. He felt certain that his bothersome running injury would finally be healed.

But after this surgery, he could not even walk.

Finding meaning in work

Keteyian admits that dealing with the complications of his surgery was not easy. But instead of turning away from medicine, his desire to become a doctor grew stronger. He decided he wanted to become a different kind of doctor — one focused on prevention and who avoids unnecessary medical interventions as much as possible.

He finished his internship in emergency medicine and went on to complete his residency in preventive medicine at the University of Michigan. Today, he is an occupational and environmental medicine fellow at the Colorado School of Public Health (ColoradoSPH) on the CU Anschutz Medical Campus.

With BS, MD, MBA, and MPH degrees, experience as the CEO of his own startup company, and time spent as the medical director of a county health department under his belt, Keteyian brings a unique set of skills to the fellowship. He is the first fellow to matriculate into the program, one of the only one-year fellowships in the country that offers a path for physicians to become board certified in occupational medicine. The program was designed by faculty in the ColoradoSPH’s Center for Health, Work & Environment and is funded by the center’s Mountain & Plains Education and Research Center and an educational grant from Pinnacol Assurance, the largest workers’ compensation insurer in Colorado.

“I take a lot of pride in going to work each day. I think most people do. I wanted to work with people who experience disability and help them be functional at work so they can continue to experience that sense of value,” said Keteyian.

While his current career path is not exactly what he would have imagined as an intern at the University of Michigan, he has found purpose. Specializing in occupational medicine has offered him the opportunity to help others overcome their health challenges, get back to work, and hopefully regain the sense of identity that their job symbolizes.

Prevention-first approach

The fact that he was able to customize the program to fit his career goals, focus on his interest in prevention, and gain hands-on training in a clinical setting was a major draw of the fellowship.

When he is not treating patients, Keteyian is conducting research that will help prevent injuries and illnesses from occurring in the first place. Currently, he is investigating what factors cause repeat job-related injuries by analyzing workers’ compensation claims. He and his co-investigators in the Center for Heath, Work & Environment envision using the findings of this work to help employers and employees prevent repeat injuries, a topic that has not been studied extensively in the past.

“Seeing patients is important work, but it’s impact is mainly limited to the present,” said Keteyian. “It is critically important to understand why workers experience injuries and what can be done to prevent them. Research is essential to answer this question, and has the potential to improve health outcomes for workers long into the future.”

Connecting with patients who experience disability

Keteyian’s experiences as a frustrated patient and as a physician with a disability have informed both his research focus on prevention as well as his interactions with patients.

“Regardless of who the patient is, I think just seeing someone in a wheelchair can be very disarming for patients,” he said. “It can create a bridge that wasn’t there before. They think, ‘This guy gets it. He’s had some sort of challenge.’”

After years of hard work, Keteyian is now able to walk to some extent. But most of his time is spent in a wheelchair. The way Keteyian sees it, everyone will cope with disability in their lifetime in some way. Our ability to do everyday activities, on the job or at home, may change over time. Keteyian often conveys to patients that they are not alone in facing challenges and that they can still contribute to society, even if they need to adjust their work tasks or lifestyle to accommodate an illness or injury.

“Just because you have an injury or a disability doesn’t mean you can’t be very productive in other ways,” said Keteyian. “I treat patients and do research to contribute in ways that I feel are meaningful to society.”

The combination of Keteyian’s background in emergency medicine and his own personal health journey has led him down a career path focused on prevention and helping workers. He looks forward to continuing to build on his clinical and research expertise to move prevention-first approaches forward in the field of occupational and environmental medicine.

Learn more about the fellowship and how to apply. 

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Existing drug may be effective at preventing onset of type 1 diabetes

A drug commonly used to control high blood pressure may also help prevent the onset of Type 1 diabetes in up to 60 percent of those at risk for the disease, according to researchers at the University of Colorado Anschutz Medical Campus and the University of Florida (UF) in Gainesville.

The study was published online this week in the Journal of Clinical Investigation.

Dr. Aaron Michels of the Barbara Davis Center for Childhood Diabetes.
Dr. Aaron Michels of the Barbara Davis Center for Childhood Diabetes.

“This is the first personalized treatment for Type 1 diabetes prevention,” said Aaron Michels, MD, a researcher at the Barbara Davis Center for Childhood Diabetes and associate professor of medicine at CU Anschutz. “We made this discovery using a supercomputer, on the lab bench, in mice and in humans.”

The drug, methyldopa, has been used for over 50 years to treat high blood pressure in pregnant women and children. It is on the World Health Organization’s list of essential drugs.

But like many drugs used for one condition, Michels and his colleagues found it useful for something totally unrelated.

Molecule blocking

Some 60 percent of people at risk of getting Type 1 diabetes possess the DQ8 molecule which significantly increases the chance of getting the disease. The researchers believed that if they could block specifically the DQ8 molecule they could also block the onset of the disease.

“All drugs have off-target effects. If you take too much acetaminophen you can hurt your liver,” Michels said. “We took every FDA-approved small molecule drug and analyzed HLA-DQ8 binding through a supercomputer. We searched a thousand orientations for each drug to identify those that would fit within the DQ8 molecule binding groove.”

After running thousands of drugs through the supercomputer, they found that methyldopa not only blocked DQ8, but it didn’t harm the immune function of other cells like many immunosuppressant drugs do.

The research spanned 10 years and its efficacy was shown in mice and in 20 Type 1 diabetes patients who took part in a clinical trial at the Barbara Davis Center at the University of Colorado School of Medicine.

“We can now predict with almost 100 percent accuracy who is likely to get Type 1 diabetes,” Michels said. “The goal with this drug is to delay or prevent the onset of the disease among those at risk.”

The drug is taken orally, three times a day.

Implications for treatment

Michels and UF Health researcher David Ostrov, PhD, hope this same approach of blocking specific molecules can be used in other diseases.

“This study has significant implications for treatment of diabetes and also other autoimmune diseases,” said Ostrov, associate professor of pathology, immunology and laboratory medicine in the UF College of Medicine and a member of the UF Health Cancer Center, Genetics Institute and Center for NeuroGenetics. “This study suggests that the same approach may be adapted to prevent autoimmune diseases such as rheumatoid arthritis, coeliac disease, multiple sclerosis, systemic lupus erythematosus and others.”

The next step will be a larger clinical trial sponsored by the National Institutes of Health in spring.

“With this drug, we can potentially prevent up to 60 percent of Type 1 diabetes in those at risk for the disease,” Michels said. “This is very significant development.”

The other authors include: Aimon Alkanani of the Barbara Davis Center at CU Anschutz; Kristen McDaniel of the Barbara Davis Center; David Ostrov of the University of Florida in Gainesville; Stephanie Case of the Barbara Davis Center; Erin Baschal of the Barbara Davis Center; Laura Pyle of the Barbara Davis Center and Colorado School of Public Health; Sam Ellis of the Barbara Davis Center and Dept. of Clinical Pharmacy at CU Anschutz; Bernadette Pollinger at the Novartis Institutes for Biomedical Research in Basel, Switzerland; Katherine Seidl at Novartis; Viral Shah at the Barbara Davis Center; Satish Garg at the Barbara Davis Center; Mark Atkinson at the University of Florida and Peter Gottlieb at the Barbara Davis Center.

 

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trial commencing for Elipse Balloon

Enrollment for ENLIGHTEN, a United States clinical trial for the Elipse® Balloon – the world’s first and only procedureless™ gastric balloon for weight loss, has started at University of Colorado Hospital at the CU Anschutz Medical Campus.

The study is designed to evaluate the safety and efficacy of the Elipse Balloon in 400 individuals. It is administered by Allurion Technologies, a leader in the development of weight loss therapies. The study will be conducted at up to twelve sites in the United States. Dr. Shelby Sullivan, associate visiting professor of gastroenterology at the CU School of Medicine and a specialist in endoscopic bariatric weight-loss procedures is leading the trial in Colorado.

“We are excited to be the only center in Colorado enrolling patients in the ENLIGHTEN study, the first completely procedureless gastric balloon for weight loss,” Sullivan said. “A device like this which doesn’t require a procedure will lower the barriers for patients who need help with weight loss.”

The Elipse Balloon received its European Union CE mark in 2015 and is currently available in more than 40 weight loss centers in countries across Europe and the Middle East. Over 4,000 individuals have already been treated. Unlike other weight loss balloons, the Elipse Balloon is placed and removed without surgery, endoscopy, or anesthesia. It is swallowed in a capsule during a brief, outpatient office visit and remains in the stomach for approximately four months, after which it opens and passes naturally from the body.

“We are looking forward to adding to our global clinical trial experience with the Elipse Balloon,” said Ram Chuttani, M.D., Chief Medical Officer of Allurion. “Starting ENLIGHTEN is the first step toward bringing our flagship product to the United States where we can build upon the success we have had abroad.”

“The Elipse Balloon has the potential to revolutionize the way obesity is treated in the United States,” added Shantanu Gaur, M.D., Chief Executive Officer of Allurion. “Millions of Americans are struggling to lose weight, and they are calling for new options that are safe and effective. The ENLIGHTEN study is the next step in meeting this consumer need.”

The Elipse Balloon is made of a thin, flexible polymer film. The device is swallowed in a capsule and filled with liquid through a thin delivery catheter, which is then detached. The balloon remains in the stomach for approximately four months, after which it opens, allowing it to empty and pass naturally from the body without the need for a removal procedure.

A pilot clinical study and recent 135-patient clinical trial conducted outside the United States in overweight and obese individuals demonstrated an average weight loss of 29 to 33 pounds, approximately 15% of total body weight. Participants also saw improvements in their triglycerides, hemoglobin A1c (HbA1c) and quality of life.

Study visits will occur at the CU Anschutz Health and Wellness Center. Interested participants can learn more about the study, eligibility and how to register at http://balloontrial.com and http://clinicaltrials.gov/ct2/show/NCT03261453.

Image Source: Allurion Technologies

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Depression and fatigue increase women’s risk of work-related injuries

Women who suffer from depression, anxiety, and fatigue are more likely to be injured at work, according to a new study published in the Journal of Occupational and Environmental Medicine led by researchers from the Colorado School of Public Health’s Center for Health, Work & Environment on the CU Anschutz Medical Campus. The study found that these health factors significantly affected women’s risk of injury but not men’s risk.

“The findings of our study demonstrate that keeping workers safe requires more than your typical safety program. It requires an integrated approach that connects health, well-being, and safety,” said Dr. Natalie Schwatka, the study’s lead author and assistant professor in the ColoradoSPH’s Center for Health, Work & Environment and Department of Environmental and Occupational Health.

The authors collaborated with Colorado’s largest workers’ compensation insurer, Pinnacol Assurance, to examine the claims data of 314 businesses from a range of industries. Close to 17,000 employees ranging from executives to laborers were represented in the study. The researchers found that men were more likely to sustain a work-related injury but behavioral health factors, like poor sleep and anxiety, did not directly affect their risk of injury. Women were more likely to report experiencing mental and behavioral health issues and these conditions increased their risk of getting hurt on the job. Almost 60% of women with a work injury reported experiencing a behavioral health condition before they were injured, compared to 33% of men.

Yet, Dr. Schwatka cautions that further research is needed to understand why there are differences in women’s and men’s risk of work-related injuries. Overall, workers who had an injury in the past were more likely to be injured again, regardless of their gender.

“There a number of social and cultural factors that may explain why women reported having more behavioral health concerns than men did. Men generally admit to fewer health concerns,” said Dr. Schwatka. “And women may face different stresses at work and at home. It’s something that is worth exploring in future research.”

This study is part of a broader, longitudinal research project ColoradoSPH researchers conducted with Pinnacol Assurance to understand the relationship between employee health and workers’ compensation and whether integrated safety and health promotion programs at work improve employee health. Researchers from Segue Consulting, the Johns Hopkins Bloomberg School of Public Health, and the Integrated Benefits Institute also contributed to this study.

Guest contributor: This story was written by Avery Artman, communications manager for the Center for Health, Work & Environment at the Colorado School of Public Health. Contact her at avery.artman@ucdenver.edu

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Immune system dysfunction may occur early in Alzheimer’s disease

An association between inflammation biomarkers in both blood plasma and cerebrospinal fluid (CSF) and markers of Alzheimer’s disease (AD) associated pathology, has been found by researchers at the University of Colorado Anschutz Medical Campus working with the University of Wisconsin Alzheimer’s Disease Research Center and the University of California San Francisco Memory and Aging Center.

The discovery sheds new light on the pathology of AD as well as on the communication between the brain and the rest of the body. The findings were published today in the Journal of Alzheimer’s Disease.

Brianne Bettcher, PhD, assistant professor of neurosurgery and neurology at CU Anschutz
Brianne Bettcher, PhD, assistant professor of neurosurgery and neurology at CU Anschutz.

Scientists have long known that AD-related pathology may develop long before clinical symptoms of AD appear, and that inflammation is a core component of the disease. Previous studies have linked levels of inflammatory markers in CSF and blood to Mild Cognitive Impairment (MCI), and research shows that elevations in inflammatory markers may be present decades before any AD symptoms appear.

However, whether markers of inflammation in the blood (i.e., ‘peripheral’ inflammation) were related to known measures of AD-related pathology, even after accounting for CSF levels of inflammation (i.e., ‘central’ inflammation), remained unclear. Researchers also wanted to know whether markers of inflammation in blood plasma reflected inflammation of the central nervous system.

“One of the two primary goals of our study was to assess the association between inflammatory markers in CSF and plasma to clarify how well plasma inflammatory markers reflect central nervous system inflammation,” said study author Brianne Bettcher, PhD, assistant professor of neurosurgery and neurology at the University of Colorado School of Medicine. “Even more importantly, we were interested in determining whether inflammatory markers in plasma were independently linked to CSF markers of AD-related pathology and neuronal damage in a group of healthy, community dwelling older adults.”

Her team tested blood and CSF samples from 173 middle-aged and older adults enrolled in the Wisconsin Alzheimer’s Disease Research Center. Participants were healthy adults in that they had no clinical symptoms of Alzheimer’s disease, although some had family histories of dementia presumed due to AD.

The scientists had expected inflammation markers in the CSF to be more robust predictors of AD-related pathology and neuronal damage than those in the blood due to the `blood brain barrier.’

“Results from our study suggest that although CSF markers of inflammation are strong predictors, both plasma and CSF markers of inflammation independently relay information about AD-related pathology and neuronal damage in head-to-head comparisons,” Bettcher said.

The finding was unexpected.

“From my perspective, there has been a perception in the field that the blood and the ‘periphery’ are not related to the brain – that the brain and the rest of the body are completely separate,” Bettcher said. “I think increasing evidence suggests that the brain and body communicate. Our study shows that inflammation markers in the blood may be telling us about what is going on inside the brain.”

Recent animal studies have shown a strong relationship between elevated inflammation and the propagation of tau proteins, which are associated with AD.

Bettcher said the new findings could possibly serve as the focus of more in-depth studies aimed at developing a blood test to detect inflammation biomarkers years before symptoms of Alzheimer’s appear.

She says the study also points to a potentially early role for inflammation in aging and AD. Bettcher also emphasized that although participants had detectable levels of AD-related markers and markers of neuronal damage in their CSF, the presence of these markers alone does not indicate a diagnosis of AD, nor does it mean that they will develop AD in the future.

“These findings add to a growing body of literature underscoring an increasingly important relationship between systemic inflammation, central inflammation, and pathological outcomes,” she said.

Full Reference:
Bettcher, B.M., Johnson, S.C., Fitch, R., Casaletto, K.B., Heffernan, K.S., Asthana, S., Zetterberg, H., Blennow, K., Carlsson, C.M., Neuhaus, J., Bendlin, B.B., & Kramer, J.H. (2018). Cerebrospinal fluid and plasma levels of inflammation differentially relate to CNS markers of Alzheimer’s disease pathology and neuronal damage. Journal of Alzheimer’s Disease, 62(1). DOI 10.3233/JAD-170602

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Research Uncovers Risk Factors for Mysterious Kidney Disease in Farm Workers

Researchers from the Center for Health, Work & Environment at the Colorado School of Public Health (ColoradoSPH) on the University of Colorado Anschutz Medical Campus have identified new risk factors for a mysterious kidney illness affecting tens of thousands of farm workers worldwide. Their findings have been published in the Journal of Occupational and Environmental Medicine.

Partnering with Pantaleon, one of the largest sugar producers in Central America, ColoradoSPH researchers examined 330 sugarcane cutters in Guatemala over the course of a six-month harvest season. More than one-third of the workers showed a decline in kidney function over the course of the harvest, while the other two-thirds of the workers’ kidney function remained the same or improved. The researchers discovered that factors including smoking, living in the local community, and low kidney function before employment were associated with a decline in kidney function. The researchers found no association with other health conditions, the amount of water workers drank, sugary drink consumption, or home use of pesticides.

Following worker protection guidelines for rest and hydration set forth by the World Health Organization (WHO), Pantaleon already provides rest breaks, shade, water and electrolyte solutions similar to sports drinks to their employees. Based on the findings of this study, these preventive measures are not sufficient to protect all workers from kidney injury.

Previous studies have identified an illness called “Mesoamerican Nephropathy,” also referred to as Chronic Kidney Disease of Unknown Origin (CKDu). Notably, this new study shows that when a workforce has access to water, rest, and shade, the rates of CKDu onset and kidney injury are lower, and the injury is less severe than that seen in previous studies.

Hydration, rest, shade ‘probably not enough’

“Water, rest and shade are important for anyone doing heavy labor in hot climates. It’s vitally important that employers continue to focus on that. But our study shows that hydration, rest and shade are probably not enough to stop the global epidemic of kidney disease,” explained Dr. Jaime Butler-Dawson, lead author of the study and researcher at the Center for Health, Work & Environment. “We now have a better idea of some strategies to help keep workers safe and healthy,” she said.

Pantaleon has long prided itself on its commitment to worker health and sustainability. The company initially sought the input of Dr. Lee Newman, director of the Center for Health, Work & Environment in 2016 to conduct a rigorous third-party evaluation of their workplace health programs. The partnership has grown since and they have launched multiple studies. The goals of the collaboration are to evaluate Pantaleon’s progress towards achieving its sustainability goals and to help identify and eliminate the health risks of agricultural workers.

Researchers at the Center for Health, Work & Environment see these findings as part of a larger picture of evolving science in the field of Total Worker Health®, an integrated approach to workplace health and safety coined by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention.

Requires more holistic approach

“What we are seeing in our research is that protecting workers from hazards and supporting their health requires a more holistic approach, what NIOSH refers to as Total Worker Health. That is why we are examining work-related factors and personal risk factors. Both need to be addressed together,” said Butler-Dawson.

Dr. Butler-Dawson and her team are focusing future research on delving deeper into understanding the factors that contribute to declining kidney function, such as why workers who live closer to the sugarcane field are more likely to have impaired kidney function at the end of the harvest season. They are also examining why two-thirds of the workers in this study maintained healthy kidney function or improved their kidney function. Her team is collaborating with researchers in the Colorado School of Public Health’s Center for Global Health to design and test ways to improve the health of sugarcane workers and other agricultural workers in the region.

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Changes to rating system caused consumers to choose better providers

Health care report cards and quality ratings are intended to give consumers more information when choosing a care provider like a hospital or nursing home. Health economist Marcelo Perraillon of the Colorado School of Public Health at CU Anschutz evaluated whether a simplified rating system used by the website Nursing Home Compare motivated consumers to choose better-rated nursing homes.

It has been a difficult problem in health economics and policy whether public reporting of quality information actually works in the absence of experimental data.

Perraillon, lead author and a professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health at CU Anschutz, said, “Essentially, we used a statistical design that allowed us to create an experiment in order to show that consumers and their families do respond to public reporting of nursing homes quality information. It has been a pesky thing to show because policy changes are not designed as experiments.”

The main problem, researchers say, is that no control group exists to help evaluate the effectiveness of the policy, which is intended to help people choose the best providers by improving the quality and accessibility of information about nursing homes and other providers. The authors used a statistical method called regression continuity to show that consumers are indeed using the data to inform better decisions about care.

“At face value, it seems reasonable that consumers or their families will respond by choosing providers (hospitals, nursing homes, etc.) of better quality,” Perraillon said. “That’s the purpose of the policy, since it creates incentives for providers to improve quality of care, but this has been hard to prove.”

In a regression discontinuity study design, participants are assigned to a comparison group on the basis of a cutoff score on a quality measure. Health economists used this design to estimate changes in new nursing home admissions six months after the publication of the new ratings, which went into effect in 2008.

Their results also show that nursing homes that obtained an additional star on the one-to-five scale gained more admissions. They also identified that not all consumers responded to the change the same way, including low-rated nursing homes providing service in poorer areas which take mostly Medicaid patients.

“Disparities in quality of care and access is an ongoing problem in the nursing home market. Our results suggest that potential patients of lower rated nursing homes have fewer choices and they not benefit from ratings. In fact, ratings could lead to even more disparities,” Perraillon said. “These nursing homes tend to be crowded already so managers don’t care much about their ratings. Poorer patients don’t have a lot of options.”

Researchers conclude that the form of quality reporting matters to consumers and that the increased use of composite ratings like the five-star system is likely to cause more people to use the system to compare and choose providers that better fit their needs.

Consumer Response to Composite Ratings of Nursing Home Quality,” was published Dec. 28 in the American Journal of Health Economics. The study joins two earlier works by Perraillon. A July 2017 study evaluated provider perspective on Nursing Home Compare, and a 2016 study found that use of the Nursing Home Compare website was limited by lack of awareness and a mistrust of the data. Another study on the provider-side perspective is expected in 2018.

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Colorado Consortium for Prescription Drug Abuse Prevention at CU Anschutz Receives $1.5 Million

The Colorado Health Foundation has invested more than $1.5 million to advance Colorado’s efforts to fight substance abuse and the opioid epidemic plaguing the state.

The grant supports the Colorado Consortium for Prescription Drug Abuse Prevention, housed at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus.

Robert Valuck, PhD, a professor at the CU Skaggs School of Pharmacy and Pharmaceutical Science, directs the consortium, which was established by Gov. John Hickenlooper in 2013 to coordinate the state’s response to the misuse of medications including opioid painkillers.

Professor Rob Valuck, PhD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences
Professor Rob Valuck, PhD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences

“Our mission is to reduce the misuse and abuse of prescription drugs in Colorado through policy work, programs and partnerships throughout the state,” Valuck said. “This tremendous support from the Colorado Health Foundation will speed our efforts to create lifesaving change throughout our communities and to stem the rising tide of opioid abuse in Colorado.”

Since the Colorado Consortium’s establishment five years ago, this innovative collaboration has leveraged state and institutional investments to attract more than $30 million to advance its collective mission.  The Consortium and its staff have reached 19 of Colorado’s 64 counties through partnerships with state agencies, organizations and community coalitions, and have elevated Colorado as a leader in successful community engagement for opioid addiction prevention.

“The Consortium led by Dr. Valuck has laid a strong foundation and has had early success in addressing the opioid epidemic,” said Ralph J. Altiere, Dean of the CU Skaggs School of Pharmacy and Pharmaceutical Sciences.  “The Colorado Health Foundation investment will help us build on these successes and make a major impact on this epidemic in Colorado and nationally.”

The Colorado Consortium’s achievements include launching a statewide TakeMedsSeriously public awareness campaign, installing medication safe disposal boxes in 36 counties, distributing 2,500 lifesaving naloxone kits to first responders in high-risk counties, and training 2,500 health care providers about safe prescribing and pain management practices. This grant from the Foundation enables the Colorado Consortium to further expand its reach throughout the state and to build a model of prevention that is replicable nationwide.

“Prescription drug abuse is not just a Colorado problem. It is a national epidemic,” said Karen McNeil-Miller, president and CEO of the Foundation. “We are interested in helping change the destructive trajectory of this epidemic and want to ensure that future efforts spearheaded by the Colorado Consortium are as impactful as possible.”

Combined with a $1 million grant from the state of Colorado, this funding from the Foundation will accelerate efforts to combat the growing substance abuse crisis through a Center for Substance Abuse Prevention, established last May at CU Anschutz as a result of Senate Bill 17-193 to build on the Colorado Consortium’s successes in prevention, education and research.

CU Anschutz Medical Campus Chancellor Donald M. Elliman, Jr. said the university is committed to leveraging the momentum built through the consortium and the center to help Colorado effectively address the opioid epidemic.

“Addressing the opioid epidemic and preventing substance abuse are top priorities, not only for the CU Anschutz Medical Campus but for the entire state of Colorado,” he said. “The Colorado Health Foundation’s investment in this effort represents a critical milestone in our progress, and I am confident that we will build upon our shared commitment and early successes to save lives.”

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Powerful food-derived antioxidant can halt, prevent fatty liver disease

As obesity continues to rise in the U.S., non-alcoholic fatty liver disease (NAFLD) has become a major public health issue, increasingly leading to cancer and liver transplants.

But new research from the University of Colorado Anschutz Medical Campus has discovered that a powerful antioxidant found in kiwi fruit, parsley, celery and papaya known as pyrroloquinoline quinone, or PQQ, can halt or prevent the progression of fatty liver disease in the offspring of mice fed a high-fat Western-style diet.

Dr. Karen Jonscher
Karen Jonscher, PhD, associate professor of anesthesiology and a physicist at CU Anschutz.

Growing evidence suggests that childhood obesity and fatty liver disease is influenced by maternal diet and the infant’s microbiome, the community of microorganisms inhabiting the body.

Jonscher and her colleagues found that mother mice fed a Western-style diet passed on the negative impacts of that diet to their offspring.

Jonscher’s earlier work on PQQ showed it helped turn back these detrimental effects in newborn mice in milder forms of liver disease. In this study, she demonstrated that it also works on the early offspring microbiome to prevent the development of fatty liver disease.

Over the past decade, it has become clear that the developing infant gut microbiome affects maturation of the immune system and gastrointestinal tract, metabolism, and brain development.

“Increasingly, evidence suggests that exposure to maternal obesity creates an inflammatory environment in utero. This leads to long-lasting postnatal disruptions of the offspring’s innate immune system and gut bacterial health, which may increase the risk for development of fatty liver disease,” Jonscher said.

Obesity, which often stems from a high-fat, high-cholesterol, sugary diet, is a major cause of NAFLD. According to the Journal of the American Medical Association, nearly 60 percent of American women of childbearing age are overweight or obese. Numerous studies suggest their children tend to have increased liver fat and a higher risk of becoming obese.

Kiwi fruit, among others, contains a powerful antioxidant shown to halt or prevent fatty liver disease in young mice.
Kiwi fruit, among others, contains a powerful antioxidant shown to halt or prevent fatty liver disease in young mice.

“Fatty liver disease is the number one liver disease in the world,” Jonscher said. “It is now the leading cause of liver transplants, eclipsing hepatitis in many areas of the U.S.”

The researchers found that they could halt and prevent liver disease from developing in young mice by feeding their mothers PQQ.

“Our results highlight the importance of the neonatal period as a critical developmental window to protect obese offspring from the harmful effects of diet-induced lipotoxicity and potentially halt the devastating trend of increasing pediatric NAFLD associated with childhood obesity,” the study said.

Jonscher noted that more work is required to determine if these studies might apply to humans.

“But there is a possibility that people with fatty liver disease could potentially benefit,” she said. “The supplement is available online and in grocery stores but individuals should consult their doctors first before using it.”

 

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Method to assess early intervention programs for America’s youngest is flawed

The US Department of Education’s Office of Special Education Programs (OSEP) should change the way it evaluates state early intervention programs for infants and toddlers with developmental delays, according to research from the University of Colorado Anschutz Medical Campus.

In a study published in the American Journal of Evaluation, researchers from the CU School of Medicine and the Colorado School of Public Health at CU Anschutz show that the evaluation method OSEP uses to gauge effectiveness of early intervention (EI) programs for children under three years of age is scientifically invalid and produces misleading results.

“Millions of dollars and thousands of hours have been put into the OSEP evaluation process and states are being encouraged to use the child outcome results produced by this design to inform their efforts at quality improvement,” said Steven Rosenberg, lead author and associate professor of psychiatry at the University of Colorado School of Medicine at the Anschutz Medical Campus in Aurora. “Neither the states nor OSEP seem to understand that the results of their evaluation process should not be used to assess the quality of early intervention services.”

OSEP administers Part C of the Individuals with Disabilities Education Act (IDEA) which authorizes the provision of EI services in the US for children ages 0-3 who have developmental delays. Early intervention programs are administered at the state level and evaluated using OSEP’s evaluation process. OSEP reports these evaluation results to Congress to demonstrate the effectiveness of Part C EI nationally. These findings are also used to judge the quality of state programs.

OSEP’s evaluation uses a design called a single group pre-post comparison to assess program outcomes. Investigators say it is a poor method of evaluation because the evaluation design cannot distinguish between child progress produced by EI and changes that result from normal variability in child growth.

Researchers say that to justify the use of a single group pre-post design, OSEP has had to assume that children’s delays only improve in response to treatment and considers all child progress to be evidence of effectiveness. Not so, say the authors of this article.

“Real babies show variability in their rates of skill acquisition,” Rosenberg said. “OSEP’s approach incorrectly assumes that all improvements are due to intervention – that’s not the way young children work.”

“States need to understand the problems with this process — it shouldn’t be used to compare one state to another,” he said.

To show how drawing valid information about EI program effectiveness using the single group pre-post comparison evaluation design is flawed, the researchers examined the development of thousands of infants in a national sample of children who did not receive EI services. About 80 percent of children who had delays at nine months were found to have no delays at 24 months, even though they did not receive EI. The authors believe that the fact that children who received no EI appeared to make substantial progress raises serious questions about the extent to which the gains reported for children who received EI can be attributed to the effects of early intervention.

“The fact that Part C EI programs are expected to draw conclusions about their program’s quality based on the results of a single group pre-post comparison design does a disservice to Part C administrators, practitioners, families and other stakeholders who are invested in improving outcomes for infants and toddlers with developmental delays,” the authors wrote.

 

 

 

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