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Children with autism spectrum have immediate and long-term benefits from therapeutic horseback riding, researchers show

In the first large, randomized study of its kind, researchers at the University of Colorado Anschutz Medical Campus have shown a lasting reduction in irritability and other positive social and communication impacts on children with autism spectrum through therapeutic horse riding.

“There is growing evidence that human-animal interventions can improve emotional health and social wellness in youth, particularly those with autism spectrum disorder,” said the study’s principal investigator and lead author Robin Gabriels, PsyD, professor of psychiatry at the University of Colorado School of Medicine. “Our study was rigorous and the findings remarkable.”

The initial report of the researchers’ randomized study of therapeutic horseback riding (THR) with 127 children ages 6 to 16 years was published in the Journal of the American Academy of Child & Adolescent Psychiatry in 2015. It was the first to show that participating in 10-weeks of THR resulted in significant improvements in irritability, hyperactivity, social skills and word fluency compared to a barn activity control group that met at the riding center to learn about horses, but had no direct interaction with horses.

The researchers then did a 6-month follow-up of 44% of the participants from that initial study, published in a recent special issue of Frontiers in Veterinary Science. The study was the first to demonstrate that the initial benefits of 10-weeks of THR in this same population can have lasting benefits.

Reductions in irritability

Specifically, this follow-up study revealed that the THR group maintained their reductions in irritability, but not hyperactivity compared to the children who just learned about horses at the riding center. At the same time, when examining just the THR group, the results indicated that children sustained their initial significant improvements in social communication and word fluency.

The research provides evidence to show that THR may be an intervention that leads to the longer-term maintenance of initial benefits gained from equine therapy.

Yet the physiological mechanisms behind this remain to be discovered.

Some theorize that children diagnosed with autism spectrum might gravitate toward horseback riding because they are more comfortable with familiar routines.

“Horses are known to prefer the same routine, the same stall, the same path or route, and the same habits, similar to children with autism,” wrote L. Eugene Arnold, MD, MEd, of The Ohio State University in an editorial in the Journal of the American Academy of Child & Adolescent Psychiatry about Gabriels’ 2015 study. “More importantly, horses are content to be guided by nonverbal communication but are amenable to verbal instruction, allowing children to experience and practice the power of communication by controlling a much stronger force than themselves in ways within their repertoire.”

Calming gait

He also noted that a horse’s rhythmic stride can have a calming effect on the brain.

The study reflects that human interaction with animals can be beneficial on a number of levels.

“Most pet owners are only too aware of the ‘feel-good factor’ associated with pets in their lives. The important thing is that there is also a growing body of measurable scientific evidence showing the emotional, social and psychological benefits of interacting with animals,” said Dr. Darren Logan, Head of Research at the WALTHAM Centre for Pet Nutrition, a division of Mars Petcare that has partnered with the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for the past 10 years to study human-animal interaction. “This impressive study, part of our partnership with NICHD, adds to this evidence and provides a positive indicator of how animal-assisted therapy can play a role in improving the developmental outcomes of children and youth in the future.”

Dr. Gabriels, a licensed clinical psychologist who practices at Children’s Hospital Colorado, said that based on these findings, THR might be a safe and effective adjunct intervention for treating children with autism, and one that might help reduce the need for higher medication doses to address symptoms of irritability within this population.

“This is just the beginning,” she said. “We hope to conduct additional studies aimed at getting a better understanding of how exactly this form of therapy seems to benefit those with autism.”

The study can be found here: https://www.frontiersin.org/articles/10.3389/fvets.2018.00156/full

The study’s co-authors include: Zhaoxing Pan; Noemie A. Guerin; Briar Dechant and Gary Mesibov.

 

 

 

 

 

 

 

 

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Researchers find gene that makes some susceptible to middle ear infections

Researchers at the University of Colorado Anschutz Medical Campus have found multiple genetic variants within the FUT2 gene that makes some people especially susceptible to middle ear infections.

“Middle ear infections are very common in kids,” said the study’s lead author, Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine. “By the time they are 1-year-old around half have fever, ear pain or pus/fluid in the middle ear due to infection. Some of these infections may recur or become chronic thus requiring surgery.”

The FUT2 gene is expressed in the salivary gland, colon and lungs but its expression in the middle ear has not been described previously.

Santos-Cortez and her colleagues discovered the role the gene played in middle ear infections or otitis media by initially examining DNA samples from 609 multi-ethnic families with the condition.

The study was published online today in the American Journal of Human Genetics.

The researchers found common variants of the gene in Filipinos and South Asians and a rarer variant associated with recurrent middle ear infections in European-American children. The most common variant occurs in 30-50% of individuals in almost all population groups except East Asians.

Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine
Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine

“A number of things predispose people to getting these infections including a lack of vaccinations, lack of breastfeeding and being around smoking caregivers,” said Santos-Cortez, who is also with the Center for Children’s Surgery at Children’s Hospital Colorado.  “But even in the best case scenario, recurrent or chronic middle ear infections still happen in some kids, which may be due to genetic predisposition.”

Those who possessed the genetic variants had a much higher chance of getting the infection. The researchers believe the gene modifies the microbiome of the middle ear in a way that makes it more susceptible to infection by specific bacteria.

“If you have these mutations, you will have a slightly different microbiota which could elevate the risk of disease,” Santos-Cortez said.

The finding could eventually lead to new ways of determining who is likely to get the infection.

The study confirmed expression of FUT2 in the middle ear which is spiked within 24 hours of bacterial infection. But the FUT2 genetic variants decrease presentation of A antigen used by bacteria to gain access to the middle ear lining.

That causes a decrease in some bacteria while boosting the numbers of bacteria known to play a role in chronic or recurrent disease.

“The frequency of population-specific FUT2 variants makes this gene a potential target for preventative screening and future treatments for otitis media, including modulation of the middle ear microbiome,” the study said.

The study was performed in collaboration with 60 co-authors including 21 faculty and staff from the Departments of Otolaryngology and Medicine on the Anschutz Medical Campus, including Daniel Frank, Melissa Scholes, Norman Friedman, Todd Wine, Samuel Gubbels, Stephen Cass, Jeremy Prager, Patricia Yoon, Sven-Olrik Streubel, Herman Jenkins and Kenny Chan. Lead collaborators from other universities within the US, Europe and Asia are: Charlotte Chiong (U Philippines Manila); Allen Ryan (UCSD); Nanette Lee (U San Carlos); Michael Bamshad and Debbie Nickerson (U Washington); Karen Mohlke (U North Carolina); Suzanne Leal (Baylor College of Med); Lena Hafrén (U Helsinki); Tasnee Chonmaitree (UTMB); Michele Sale (U Virginia); and Zubair Ahmed (U Maryland).

 

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New discovery on T cell behavior has major implications for cancer immunotherapy

Scientists at the University of Colorado Anschutz Medical Campus have discovered that disease-fighting T cells, elicited from vaccines, do not require glucose for their rapid reproduction, a finding with major implications for the development of immunotherapies for cancer patients.

In the study, published today in the journal Science Immunology, researchers at CU Anschutz along with colleagues from the Mayo Clinic and the University of Pennsylvania, examined T cells that arose in the body’s immune system after they received a subunit vaccination – a vaccine that uses just part of a disease-causing virus.

They found that these critical white blood cells, which attack and kill infection, did not rely on glucose to fuel their rapid division which occurs every two to four hours. Instead, they used another cellular engine, the mitochondria, to support their expansion.

Developing vaccines

Ross Kedl, PhD
Ross Kedl, PhD

“The knowledge that this magnitude of cell division can be supported by mitochondrial function has a number of potential practical implications for the development of future vaccines,” said the study’s senior author Ross Kedl, PhD, professor of immunology and microbiology at the University of Colorado School of Medicine.

Kedl said T cells responding to infection usually depend on glucose for fuel. So do cancerous tumors. When T cells come up against tumors, they end up competing for glucose and the T cells often lose.

But when a T cell doesn’t need glucose, he noted, it has a better chance of defeating tumor cells.

“T cells generated by subunit vaccination are ideally suited for use against cancer in conjunction with drugs that block aerobic glycolysis, a metabolic pathway to which the cancer is addicted,” Kedl said. “Tumor growth can be inhibited while the T cells are free to attack the tumor instead of competing against it for access to glucose.”

Lead author Jared Klarquist, PhD, explained that scientists have historically studied T cell responses to infection with the idea that if they could understand how the cells respond, they could create better vaccines. Kedl and colleagues had already discovered a non-infectious vaccine method that could induce the same level of T cell immunity as those using infection.

Since then, researchers in Kedl’s lab have found that the rules governing T cell responses to an infectious agent are very different from the cell’s response to a subunit vaccine. And the fact that T cells derived from subunit vaccines don’t require glucose to reproduce is a major finding.

Understanding immune response

Jared Klarquist, PhD
Jared Klarquist, PhD

“Prior to these findings, it was generally thought that whereas the mitochondria are good at making energy, T cells need glucose to produce the raw materials like proteins, fats and nucleic acids (like DNA) required to turn one cell into two,” said Klarquist. “Knowing how the immune response is fueled after vaccination provides potential opportunities for metabolic or nutritional interventions for boosting a vaccine-elicited immune response.”

Kedl agreed. “Perhaps most intriguing, however, is the application of this knowledge to cancer immunotherapy,” he said.

The lab is currently exploring how these strategies might positively influence the outcomes of immune-based cancer treatments that are already in the clinic.

The study’s other co-authors include Alisha Chitrakar, Nathan Pennock, Augustus Kilgore, Trevor Blain, Connie Zheng, Thomas Danhorn, Kendra Walton, Li Jiang, Jie Sun, Christopher Hunter and Angelo D’Alessandro.

 

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Adolescents seeking abortions without a parent’s consent face numerous hurdles

Adolescents under the age of 18 seeking abortions without a parent’s consent often undergo a series of humiliating, burdensome and unpredictable hurdles as they try to navigate the legal system, according to a new study led by Kate Coleman-Minahan of the University of Colorado College of Nursing.

As part of the Texas Policy Evaluation Project, Coleman-Minahan, PhD, RN and other researchers investigated the judicial bypass experience by which adolescents seek legal permission to obtain an abortion without parental consent. The study was published online today in the Journal of Adolescent Health.

Currently, 37 states require parental involvement in obtaining an abortion. This study focused specifically on Texas.

Judicial bypass

“This is the first study to describe adolescents’ experiences with a judicial bypass,” said Coleman-Minahan, assistant professor at the CU College of Nursing and lead author of the study. “We found that the bypass process functions as a form of punishment for adolescents.”

The researchers conducted interviews with 20 adolescents between the ages of 16-19 about their experiences trying to obtain bypass. Those interviewed were 16-17 years old at the time they went to court. Many had experienced family trauma, adverse childhood experiences including household substance abuse, or a general fear for their own safety if they told their parents about their decision to seek an abortion.

Once they began the bypass process, they were confronted with more obstacles. Just arranging transportation to the courthouse was sometimes difficult. When they got inside, they faced an often unpredictable process. One young woman spoke of being intimidated by the criminal defendants sitting in the room. Judges, on occasion, would ask for a detailed sexual history which she had to explain within earshot of multiple court staff including a court reporter who records the hearing.

Personal opinion enters judges’ decisions

Each adolescent was issued a court-appointed guardian-ad-litem (GAL), ordered to act in her best interest. In four cases, the GAL appointed by the judge was a pastor or deacon at a church. One respondent recalled her GAL “telling me it’s never the right option to have an abortion.” This GAL also brought staff from an adoption agency to court with her, breaching the young woman’s anonymity and exposing her to more judgment, the study said.

The researchers found that several judges didn’t hide their personal disapproval of the adolescent’s decision to seek an abortion. Sometimes they denied the bypass request altogether.

“Some judges and GALs based their decision or treatment of adolescents on their own personal opinion of abortion,” Coleman-Minahan said. “Multiple participants cried during the interview when describing the hearing, saying they still think about it, even months later.”

The process, researchers said, seemed like punishment itself, for having sex, getting pregnant and having wanted an abortion.

Emotional harm

“Proponents of parental involvement and bypass laws claim they protect adolescents from alleged negative emotional consequences of abortion, yet our results suggest the bypass process itself causes emotional harm through unpredictability, humiliation and shame,” the study said.

According to Coleman-Minahan, the fact that this is happening in Texas means it’s probably happening in states with similar laws as well. Colorado requires parental notification and also has an option for a judicial bypass.

She said all of these findings should be weighed when considering forced parental involvement and judicial bypass policies. States, she said, should consider the real-life consequences of policies that are purportedly created to protect adolescents.

The study co-authors include: Amanda Jean Stevenson, PhD, University of Colorado Boulder; Emily Obront LMSW, University of Texas at Austin; Susan Hays JD, Law Office of Susan Hays, P.C. Austin, Texas.

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University of Colorado announces new dean to lead the College of Nursing

The University of Colorado Board of Regents approved the Sept. 1 appointment of Elias Provencio-Vasquez, RN, PhD, as the new dean of the CU College of Nursing at the Anschutz Medical Campus.

Elias Provencio-Vasquez, RN, PhD, new dean of the CU College of Nursing.
Elias Provencio-Vasquez, RN, PhD, new dean of the CU College of Nursing.

Provencio-Vasquez becomes the 11th dean and the second male dean in the history of the College, which is celebrating 120 years of educating nurses throughout Colorado. He is also the first Latino male to earn a doctorate in nursing and to head a nursing school in the U.S.

“We are thrilled that Dr. Provencio-Vasquez will be leading the College of Nursing,” said CU Anschutz Chancellor Don Elliman. “Not only is he a highly experienced nurse educator, eminent researcher and proven administrator, he’s the son of immigrants who was the first in his family to attend college. He is uniquely qualified to lead the College into the next phase of its history.”

Provencio-Vasquez got his start in the healthcare industry more than 40 years ago as a teenager organizing food trays in a Phoenix hospital. That experience helped inspire him to pursue a career in nursing. After receiving his associate’s and bachelor’s degrees, he went on to earn a doctorate.

“I know personally the power of education and appreciate the University of Colorado’s commitment to student access and diversity,” he said. “I never thought that having faculty or people that look like you would make a difference, but it does. If you see faculty whom you can identify with, that does make a difference.”

During his career, he has served as a clinical nurse, a nurse researcher, a nurse educator, school administrator, and a pediatric and neonatal nurse practitioner. He is internationally renowned for his pioneering work in neonatal and pediatric care and in women’s health. Provencio-Vasquez is also a Robert Wood Johnson Executive Nurse Fellow alumnus, a Robert H. Hoy III Distinguished Professor in Health Sciences and serves on several community and editorial boards.

Prior to his current position, Provencio-Vasquez served as dean of the nursing school at the University of Texas El Paso, associate dean at the University of Miami and director of the Neonatal Nurse Practitioner program at the University of Texas at Houston and the University of Maryland.

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Drug prices not always aligned with value, CU Anschutz researchers say

In many countries, health care reimbursements for drugs are directly related to their value or net health benefits in treating disease.

But a new study by researchers at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences , in collaboration with a group of international clinical and economic experts, shows that’s not the case in the U.S.

Jon Campbell, PhD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences is senior author of the study
Jon Campbell, PhD, associate professor at Skaggs School of Pharmacy and Pharmaceutical Sciences, is lead author of the study.

The study was published Monday in the August issue of the journal Health Affairs.

“In the United Kingdom, for example, cost effectiveness is a driver of decisions to pay for, or decline to pay for, health interventions,” said the study’s lead author Jon Campbell, PhD, associate professor of pharmacy. “They generally do not pay more than £30,000 to £40,000 per quality-adjusted life-year (QALY) for new medical interventions, thus signaling to manufacturers and other innovators what their country is willing to pay for additional health improvements.”

Melanie Whittington, PhD
Melanie Whittington, PhD, research faculty at the Skaggs School of Pharmacy and Pharmaceutical Sciences, is-co-author of the study.

QALY is used to measure one year of perfect health.

In the U.S., there is no formally agreed-upon cost-effectiveness threshold, due mostly to its fragmented health care system.

Using a forecasting model, they calculated the cost-effectiveness for commonly reimbursed cardiovascular drugs by estimating the cost per health outcome achieved. They wanted to see if the U.S. had an observed payment threshold, if even implicitly.

Instead they found a wide spectrum of cost-effectiveness, suggesting that drug prices are not consistently associated with what they produce in terms of health gains. Prices were, in short, not consistently aligned with value.

“When we purchase a medical treatment, we expect to get something in return, such as living a longer life or having fewer symptoms,” said study co-author Melanie Whittington, PhD, research faculty at the CU School of Pharmacy. “The results of our study show the amount insurance providers pay to get one more unit of health, such as one additional year of life in perfect health, varies considerably and can exceed what is considered good value in other parts of the world. This contributes to higher-priced medical treatments.”

She noted that the study used data from 1985-2011 and that in recent years health care leaders have been talking more about value-driven health care.

Campbell said the U.S. pays up to twice as much for branded drugs and health care services compared to other wealthy nations.

The reason, he said, may be due to the difference in price paid with little difference in the quantity of drugs or health services actually used.

“The U.S. gets very little in terms of additional health outcomes for this added price paid,” said Campbell, director of the pharmaceutical outcomes research graduate track at the Center for Pharmaceutical Outcomes Research at CU Anschutz. “In the pharmaceutical space, the U.S. has done a poor job at signaling to manufacturers what we are willing to pay for improvements in health and what improvements in health we care about.”

He and Whittington hope the study will stimulate more debate in this country about what constitutes an acceptable cost per unit of health gained for drugs and how to achieve value-driven health care delivery in the U.S.

“Solutions toward fair drug pricing include the U.S. sending more signals about what we value in health and U.S. decision makers being willing and able to walk away from unfair pricing,” Campbell said.

The study co-authors include Vasily Belozeroff, health economist at Amgen Inc., Thousand Oaks, Calif.; Robert Rubin, distinguished professor of medicine at Georgetown University in Washington D.C.; Paolo Raggi, professor of medicine at the Mazankowski Alberta Heart Institute and the University of Alberta in Edmonton; Andrew Briggs, professor of health economics at the University of Glasgow in Scotland and visiting investigator at Memorial Sloan Kettering Cancer Center, New York, N.Y.

The study can be found here: Prices for common cardiovascular drugs in the U.S. are not consistently aligned with value

 

 

 

 

 

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Researchers develop model on how brain reward response may impact anorexia nervosa

Researchers at the University of Colorado Anschutz Medical Campus have found that the brain’s response to taste stimuli is linked to high anxiety and a drive for thinness that could play a role in driving anorexia nervosa.

The study was published last week in the journal JAMA Psychiatry.

The researchers, led by Dr. Guido Frank, MD, associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine, monitored a large group of patients with anorexia nervosa as they tasted sugar during brain imaging.

Dr. Guido Frank, associate professor of psychiatry, is an expert in eating disorders
Dr. Guido Frank, associate professor of psychiatry and neuroscience, is an expert on eating disorders

They found their brain response was higher than those in the control group, representing a biological marker for the illness. At the same time, this brain response was related to high anxiety and less weight gain for those being treated for anorexia nervosa.

Frank found that as these patients restricted their diet, a brain reward circuit associated with the neurotransmitter dopamine becomes more active but also triggers anxiety. This makes food avoidance worse and perpetuates the often deadly disease.

“When you lose weight your brain reward response goes up,” said Frank. “But instead of driving eating, we believe it elevates anxiety in anorexia nervosa, which makes them want to restrict more. This becomes then a vicious cycle.”

Using brain scans, the researchers examined 56 female adolescent and young adults with anorexia nervosa between the ages of 11 and 21 and 52 healthy control participants of the same age. They all learned to associate colored shapes with either getting or not getting a sugary solution. Sometimes when they expected sugar they got nothing, and sometimes when they didn’t expect sugar they received it.

Those with the eating disorder responded more strongly to the unexpected getting or not getting of sugar water, perhaps due to the release of dopamine.

The researchers found that the higher the brain response, the higher the harm avoidance in those with anorexia nervosa was. Harm avoidance is an anxiety measure for excessive worrying and fearfulness. In these patients, it pushes the drive for thinness and furthers body dissatisfaction.

Frank discovered that the higher the brain response, the lower the weight gain during treatment.

This brain reward response acted on the hypothalamus, which stimulates eating, in the anorexia nervosa group. The researchers hypothesized that this could make it possible to override and fend off signals to eat.

“An enhanced dopamine reward system response is an adaptation to starvation,” the study said. “Individuals vulnerable to developing anorexia nervosa could be particularly sensitive to food restriction and adaptations of reward response during the [mid-adolescence] development period.”

According to Frank, anorexia nervosa behavior could alter the brain circuits and impact its taste-reward processing mechanisms. Those who are already worried about shape and weight become even more concerned. And a strong response that says “feed me” might be overwhelming and trigger more food restriction instead of eating.

The study noted that while most people like sweet tasting things, those with eating disorders associate the taste with weight gain and try to avoid it. Frank found that the brain activation among the anorexia group was inversely connected with any pleasant experience of eating sugar.

“Our data raise the possibility that adolescents with anorexia nervosa in this study were negatively conditioned to sweet taste and may have developed an inverse association with dopamine release across the larger (brain) reward circuitry,” the study said.

Frank believes these insights could lead to new treatments for eating disorders.

“I hope we can use these findings to manipulate these biomarkers and design better treatments for this often-deadly disease,” he said.

The study’s coauthors include: Marisa C. DeGuzman, BA, BS; Megan E. Shott, BS; Mark L. Laudenslager, PhD; Brogan Rossi, BS, all from the University of Colorado Anschutz Medical Campus. And Tamara Pryor, PhD, of Eating Disorder Care, Denver, Colorado.

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Researchers find connection between viruses and inflammatory bowel disease

A study led by a University of Colorado Anschutz Medical Campus researcher reveals a key connection between viruses and inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.

Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine, and a team of scientists focused on viruses inhabiting bacteria in the intestine known as bacteriophages or simply phages.

Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine
Breck Duerkop, PhD, assistant professor of immunology and microbiology at the University of Colorado School of Medicine

“Phage numbers are elevated at the intestinal mucosal surface and increase in abundance during inflammatory bowel disease (IBD), suggesting that phages play an unidentified role in IBD,” said Duerkop, lead author of the study published Monday in the journal Nature Microbiology.

IBD poses significant health burdens worldwide and has inspired intense investigation into the environmental factors causing persistent inflammation of the intestine. Microbial communities are critical in maintaining intestinal health but changes in the composition of these organisms may cause an inflammatory response by the body.

According to Duerkop, most studies looking at how these microbial communities might spark inflammation have focused chiefly on bacteria rather than the viruses residing inside them.

When inflammation occurs, Duerkop found that phage communities change randomly leading to a genetic signature indicative of the inflammatory environment.

“We hypothesize that inflammation or other host defenses alter phage abundances during colitis,” the study said. “Such stresses could produce ecological disturbances in the intestinal environment, driving alterations within the viral community.”

Those disturbances could be the result of the viruses killing off beneficial bacteria in the intestine and allowing for `bad actor’ bacteria to cause inflammation and bowel disease.

The experiments were done with mice.

“What we see in mice is consistent with what we see in humans with IBD,” Duerkop said.

While the mechanics of how these phages operate will require further study, Duerkop said this discovery could lead to new kinds of treatment for these often debilitating diseases.

Clinicians could target certain bacteria with viruses to eliminate bacteria that lead to inflammation. Bacteria could be manipulated to circumvent the development of disease.

“We could promote the growth of good bacteria – a kind of phage therapy,” Duerkop said. “We could perhaps use phages as markers to identify someone predisposed to developing these diseases. While there is clearly more research to do, the potential is very exciting.”

The co-authors include Manuel Kleiner, North Carolina State University; David Paez-Espino of the Department of Energy, Joint Genome Institute; Wenhan Zhu, University of Texas Southwestern Medical Center; Brian Bushnell, Department of Energy, Joint Genome Institute; Brian Hassell, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center; Sebastian E. Winter, University of Texas Southwestern Medical Center; Nikos C. Kyrpides, Department of Energy, Joint Genome Institute; Lora V. Hooper, Howard Hughes Medical Institute, University of Texas Southwestern Medical Center.

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Researchers find little association between suicide and hypoxia

Following an extensive analysis of published studies, researchers at the University of Colorado Anschutz Medical Campus have found that while suicide rates are higher at higher altitudes, they are unlikely caused by hypoxia, (low oxygen) at these elevations.

The study, published in the June edition of the journal High Altitude Medicine & Biology, says suicide victims at high altitudes differ significantly from those at lower elevations in demographics, mental health and suicide-related characteristics.

Ben Honigman, professor of emergency medicine and associate dean for clinical outreach at the Altitude Research Center at the CU School of Medicine.
Dr. Ben Honigman, professor of emergency medicine and associate dean for clinical outreach at the Altitude Research Center at the CU School of Medicine.

“There other factors, rather than hypoxia, that are more likely and more plausible explanations for high suicide rates at high altitudes,” the study said.

This new research casts doubt on some longstanding theories seeking to connect the physiological effects of living at altitude with higher suicide rates.

“We looked at papers published through 2017,” said the study’s senior author Benjamin Honigman, MD, professor of emergency medicine and associate dean for clinical outreach at the Altitude Research Center at the University of Colorado School of Medicine. “Those that claimed a relationship to altitude and suicide also created a narrative that hypoxia was a significant cause.”

But when Honigman and his colleagues factored in social isolation, rural living, and access to guns into their analysis they arrived at a different conclusion.

“We found that there are higher suicide rates in some high altitude locations, but that the high altitude plays little or no role in suicide,” Honigman said.

Three of the studies reviewed speculated that suicide rates at higher altitudes could be tied to changes shown in mouse and rat brain chemistry related to hypoxia. The theory is that hypoxia causes lower levels of the neurotransmitter serotonin leading to depression, and increases in dopamine leading to impulsive behavior.

But Honigman said studies on mice showing changes in serotonin and dopamine levels were almost all done at simulated high altitudes of 18,000-25,000 feet where few people actually live, and beyond where any studies of high altitude and suicide have ever been conducted. Moreover, no studies have shown differences in these neurotransmitters in humans at high altitude.

Honigman explains this by saying suicide victims at high and low altitudes differed significantly by race, intoxication, firearms use, depressed moods prior to suicide and other financial and interpersonal problems. He also suggests that serious barriers to accessing mental health resources in crisis situations or low availability of emergency services including resuscitation often exist in these regions which may lead to higher mortality with suicide attempts.

“These issues appear to be more important reasons for differences in suicide rates than physiologic causes like hypoxia,” the study said.

Ultimately, Honigman said, many individual factors must be accounted for when assessing suicide in any setting.

“In this case, we do not believe that hypoxia plays a significant role in suicide,” he said. “Regardless of the cause, clinical professionals at high altitudes should be especially vigilant concerning this public health issue.”

The study’s other co-authors include: Elaine Reno, MD, CU School of Medicine; Talia Brown, MS, PhD, Colorado School of Public Health; Marian Betz, MD, MPH, CU School of Medicine; Michael Allen, MD, CU School of Medicine; Lilian Hoffecker, PhD, MS, MLS, CU Health Sciences Library; Jeremy Reitinger, Altitude Research Center, CU School of Medicine; Robert Roach, PhD, Altitude Research Center, CU School of Medicine.

 

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CU Anschutz hires Kathy Green as new communications chief

Kathy Green, a seasoned communications professional with over 25 years of experience in politics, health care and marketing, has been appointed chief communications officer at the University of Colorado Anschutz Medical Campus.

Kathy Green is the new chief communications officer at CU Anschutz
Kathy Green is the new chief communications officer at CU Anschutz

“We have a tremendous story to tell: one of groundbreaking research, world-class faculty educating a talented student body, excellent clinical care and a bold vision for the future,” said CU Anschutz Chancellor Don Elliman Jr. “I am delighted to announce that today, with the appointment of Kathy Green as our new chief communications officer, we are one step closer to telling that story to the world.”

Green brings decades of experience in multi-disciplinary marketing and communications along with strategic planning and partnership development to the new job.

As communications director for Colorado Gov. John Hickenlooper, she handled media relations, strategic planning and successfully redesigned and rebuilt the office’s communications division, increasing national rankings on social media, boosting citizen engagement and increasing media exposure.

“Kathy’s consistent grace, wit and intelligence, which had such a positive effect on everybody at the governor’s office, will undoubtedly serve CU Anschutz well,” said Governor Hickenlooper. “It’s great to see someone so talented join an institution that’s doing so much to improve health throughout Colorado.”

Prior to her work in the governor’s office, Green served as strategic marketing and communications director for the Colorado Office of Economic Development and International Trade. Before that, she was communications director for various agencies within the City and County of Denver. She also worked in advertising and public relations and started her career with University Hospital in Chicago. Green is currently a communications consultant.

“I’m thrilled to be joining the CU Anschutz team and the dynamic campus at a time of tremendous growth in everything from medical advancements to philanthropic support,” said Green. “The campus continues to gain momentum, and I will focus on sharing this story locally, national and globally.”

Chancellor Elliman noted that with its ground-breaking research, strong enrollment and increasing innovation, CU Anschutz is making major strides in all the right directions.

“Kathy is the right person at the right time to help our growing campus continue to build its reputation, brand and visibility as a leading academic medical center: where anyone who needs it can get the finest care in the world, where the science of that care is being pushed to new horizons, and where we train and prepare the health workforce of the future,” he said.

Green will join CU Anschutz on July 16 in a part-time role while finishing work with her current clients. She will begin full-time on Sept. 1.

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