Lippincott Williams & Wilkins

Research Links Abacavir Hypersensitivity Reactions to Attacks by Body’s Own Immune System

Philadelphia, Pa. (May 22, 2012) – Potentially severe hypersensitivity reactions to the anti-HIV drug abacavir occur through an autoimmune mechanism, resulting from the creation of drug-induced immunogens that are attacked by the body’s immune system, according to a study published online by the journal AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study is the first to explain how hypersensitivity reactions to abacavir develop in genetically predisposed patients—and suggests that similar autoimmune mechanisms might account for other types of drug reactions related to variants in the human leukocyte antigen (HLA) system.  The lead author is Dr Michael A. Norcross of the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research. The publish-ahead-of-print article is currently available on the AIDS journal homepage and will be available in the July 17^th print edition.

Abacavir Hypersensitivity Results from ‘Drug-Induced Autoimmunity’

Dr Norcross and colleagues performed a series of laboratory experiments to examine why some patients develop hypersensitivity reactions to the antiretroviral drug abacavir (Ziagen—also included in combination products such as Epzicom and Trizivir).  Developing a few weeks after the start of treatment, the reactions cause a wide range of symptoms including fever, rash, nausea, muscle soreness, and shortness of breath.

The reactions have been linked to a gene variant called HLA-B*57:01, found in up to eight percent of people of European descent (lower in other racial/ethnic groups).  However, the molecular basis by which people with the HLA-B*57:01 gene develop hypersensitivity reactions to abacavir has been unclear.

In model cells expressing the HLA-B*57:01 gene product, the researchers found that abacavir induced a set of unique changes.  Abacavir exposure led to the formation of new peptide molecules that bound to specific HLA-B*57:01 binding sites.  The result was the creation of new drug-induced immunogens, which could trigger attacks by immune cells.

These findings suggest that abacavir hypersensitivity reactions occur through an autoimmune mechanism—the immune system attacks cells it doesn’t recognize as “self.”  This is the same basic mechanism that causes autoimmune diseases such as lupus, inflammatory bowel disease, and type 1 diabetes.

This autoimmune mechanism helps to explain why abacavir hypersensitivity reactions can affect such a wide range of different organs and tissues.  It also helps in understanding why the reactions clear up promptly when abacavir is stopped, and why more severe reactions can rapidly develop if treatment is restarted.

“Our data support a model of drug-induced autoimmunity as a consequence of abacavir exposure,” Dr Norcross and colleagues write.  They believe that a similar molecular mechanism could potentially explain other types of drug reactions involving HLA gene variants. It’s also important to identify other factors influencing the development of hypersensitivity, since not all patients with the HLA-B*57:01 gene react to abacavir.

“This study provides important insight into why only certain people show this severe hypersensitivity to this valuable anti-HIV drug,” comments Dr J.A. Levy, Editor-in-Chief of AIDS.  “The finding represents an example of how approaches to personalized medicine can identify patients who would be sensitive to this side effect of abacavir.”
 
About AIDS

AIDS publishes the very latest ground-breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of even more significant advances. The Editors, themselves noted international experts who know the demands of HIV/AIDS research, are committed to making AIDS the most distinguished and innovative journal in the field. Visit the journal website at www.aidsonline.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Complication Rates Nearly Doubled for Morbidly Obese Patients

Philadelphia, Pa. (May 17, 2012) – Patients with morbid obesity are at nearly twice the risk of developing complications after spinal fusion surgery, reports a study in the May 15  issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Patients in the most severe category of obesity also have higher hospital costs for spinal fusion, according to the new research by Dr P.S.A. Kalanithi and colleagues of Stanford University.  They write, “Morbid obesity was associated with $20,000 more per admission in charges, and a 97 percent higher complication rate.”

Morbid Obesity Increases Costs and Complications of Spinal Surgery

The researchers analyzed data on nearly 85,000 hospital admissions for spinal fusion—an increasingly common operation for spinal pain—in California between 2007 and 2008.  Two percent of the patients were classified as morbidly obese, with a body mass index (BMI) of 40 or greater.  Patients with morbid obesity are generally 50 to 100 percent over their ideal body weight, or 100 pounds overweight.

Patients with morbid obesity had an overall complication rate of 13.6 percent, compared to 6.9 percent in other patients.  This represented a 97 percent relative increase:  nearly double the risk of complications.  The greatest increases were in lung-related complications and problems with wound healing.  But severe obesity was also linked to increases in heart- and kidney-related complications, among others.

Morbidly obese patients also had higher average hospital costs:  approximately $109,000 versus $85,000.  In addition to the increase in complications, the higher costs reflected a longer hospital stay:  4.8 versus 3.5 days.

Although the overall risk of death after spinal fusion was low, it was somewhat higher for morbidly obese patients.  The difference became significant for one type of spinal surgery:  posterior lumbar (lower spine) fusion, with a mortality rate of 0.56 percent for morbidly obese patients versus 0.16 percent for other patients.

With adjustment for other factors, morbid obesity was the most important risk factor for complications of spinal fusion surgery—even stronger than older age or accompanying (comorbid) medical problems.

Spinal surgeons can expect to see increasing numbers of morbidly obese patients—not only because their number is increasing in the population, but also because severe obesity is an important risk factor for back pain and spinal degeneration.  Morbidly obese patients are known to be at increased risk of complications of other kinds of surgery.

The new study provides important information on the additional risks and costs of spinal fusion surgery in patients with severe obesity. “Hospital charges, length of stay, and mortality were all increased in morbidly obese patients,” Dr Kalanithi and coauthors write.

And yet, they emphasize that—while surgeons and patients should be aware of the excess risks—the results do not mean that spinal fusion should not be performed in patients with severe obesity, when indicated.  “Indeed, in-hospital mortality in morbidly obese patients in this study was less than one percent, and in-hospital complication rates…were under fifteen percent,” according to the authors.  Dr Kalanithi and colleagues call for further studies to evaluate the impact of morbid obesity and improve the safety of spinal surgery for this group of patients—possibly including new minimally invasive surgical approaches.

About Spine

Recognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Thirty Percent of Patients Show Improved Functioning after Stem Cell Therapy

Philadelphia, Pa. (May 17, 2012) – One of the first long-term studies of stem cell treatment for spinal cord injury shows significant functional and other improvements in three out of ten patients, reports a study in the May issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The results support the safety of mesenchymal stem cells (MSCs) derived from the patient’s own bone marrow, showing “continuous and gradual motor improvement” in at least some patients with disability caused by spinal cord injury. The lead author of the new study was Dr. Sang Ryong Jeon of University of Ulsan College of Medicine, Seoul, South Korea.

Evidence of Improved Function after MSC Treatment for Spinal Cord Injury

The researchers performed MSC transplantation in ten patients with permanent motor (movement) deficits or paralysis (paraplegia or quadriplegia) after spinal cord injury. Mesenchymal stem cells are a type of “multipotent” cell that can be cultured from adult bone marrow and induced to develop into many different types of cells.

The cultured MSCs were injected directly into the injured spinal cord and the surrounding (intradural) space. Additional cells were injected after another four and eight weeks. The results were assessed by measuring improvement in the patients’ ability to move their arms and hands and to perform key activities of daily living. Imaging scans and tests of muscle activity were performed as well.

During the first six months after MSC transplantation, six of the ten patients showed improvement in motor power of the arms and hands. Of these, three patients had gradual improvement in the ability to perform daily activities—for example, preparing meals and typing on a keyboard.

These three patients also showed significant changes on MRI scans of the spinal cord, including evidence of healing around the injured area of the spine. They also had improvement in electrophysiologic studies of muscle electrical activity.

No Long-Term Safety Problems of MSC Transplant

None of the ten patients had any permanent complications related to MSC transplantation. This helps to alleviate concerns that MSC injection could lead to later problems like the development of tumors or calcifications.

Previous studies have shown promising results with MSC transplantation in animals and humans with spinal cord injury. Mesenchymal cells have some important potential advantages for stem cell therapy, as they are a relatively easily accessible source of the patient’s own cells. The ten patients treated by Dr. Jeon and colleagues represent the first attempt at direct spinal injection of MSCs for the treatment of spinal cord injury in humans.

Following up on a previous study reporting initial improvement in six patients, the new paper describes continued improvement—including meaningful gains in the ability to perform everyday functional tasks—in three patients. Dr. Jeon and colleagues note that all three patients with progressive improvement had some “residual neurological function.” They write, “Therefore, MSC treatment is more likely to enhance the remaining neurological function rather than rengeneration.” They call for further studies to understand the mechanism of improvement after MSC treatment and to clarify which patients with spinal cord injury are most likely to benefit.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomesLWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Even at 80 or Older, Age Shouldn’t Be a Barrier to Surgery for ‘C2′ Fractures

Philadelphia, Pa. (May 16, 2012) – For older adults with “C2″ fractures of the upper (cervical) spine, surgery and nonsurgical treatment provide similar short- and long-term outcomes, reports a study in the May issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Although the patients were at significant risk of complications and death in the year or two after C2 fracture, these risks are similar with surgical and nonsurgical treatment. “[T]hus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures,” concludes the study by Dr. Maxwell Boakye of University of Louisville, KY, and colleagues.

Surgery vs Immobilization for C2 Fractures

The researchers analyzed the outcomes of 56 older adults—average age 80 years—treated for fractures of the second cervical vertebra, or “atlas,” over a ten-year period. Older adults are at increased risk of C2 fractures, a serious injury that requires prompt treatment to prevent injury to the cervical (neck) portion of the spinal cord. None of the patients had evidence of spinal cord damage at the time they were treated.

Options for treatment for C2 fractures are surgery to stabilize the fracture or nonsurgical treatment (immobilization) to allow the fracture to heal. In the study, 28 patients were treated with surgery and 28 with immobilization. (The treatments weren’t randomly assigned, but were up to the choice of the treating physician.) Dr. Boakye and colleagues compared the short- and long-term outcomes of the surgical and nonsurgical treatment groups.

The two groups were similar in terms of age and other characteristics. Most had two or more accompanying (comorbid) medical problems. The fracture fragments were more displaced (four versus one millimeters)—indicating somewhat more severe fractures—for patients undergoing surgery.

Surgery generally consisted of an operation to fuse the fractured C2 vertebra to one or more adjoining vertebra. Nonsurgical treatment consisted of several weeks of immobilization, usually in a hard cervical collar. The surgical patients spent more time in the hospital—averaging about twelve versus four days—but both groups had good fracture healing. None of the patients in the nonsurgical group required later surgery

Both groups of elderly patients with C2 fractures had significant but similar rates of death and complications. Within 30 days, one patient died in the surgical group and two in the nonsurgical group. Complication rates were 18 versus 25 percent.

Age Is No Barrier to Surgery

Especially with the aging of the population, there’s a need for information on the outcomes of surgical versus nonsurgical treatment for elderly patients with C2 fractures. Some previous studies have suggested increased rates of death or complications, including failed fracture healing, in older adults receiving nonsurgical treatment for C2 fractures.

Although not a formal randomized trial, the new study suggests similar outcomes of the two approaches to treatment for C2 fractures in older adults. “The data…demonstrate equivalent complications and mortality, where both groups were of similar age and overall health,” the researchers add.

There was also no evidence that younger, healthier patients were more likely to undergo surgery. Dr. Boakye and coauthors conclude, “Surgery should not be excluded as an intervention if the physician believes it to be the better treatment option, especially for unstable fractures.” They emphasize the need for further studies, including cost-effectiveness comparisons of surgical versus nonsurgical treatment for stable C2 fractures.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

New Techniques Provide Researchers with “Real-Life” Data on Key Health Measures

Philadelphia, Pa. (May 14, 2012) – New techniques of ambulatory assessment are providing researchers with valuable sources of data for understanding the psychiatric and psychological factors affecting health and disease.  The May special issue of Psychosomatic Medicine, the official journal of the American Psychosomatic Society, is devoted to reports on recent advances in computer technology, medical devices, and data analysis that are enabling ever-greater sophistication in the research monitoring of people in their natural habitats.

Ambulatory monitoring—the science of health and disease measurements in daily life—involves real-life assessment of moods, stress and symptoms, as well as blood pressure, hormone levels, and a wide range of other biological or environmental measures. The special issue reports on new and emerging techniques that allow scientists to listen in on ambient sounds, test glucose levels round-the-clock, and periodically “beep” research participants to remind them to complete brief questionnaires about their mood or pain, or to produce a saliva sample that can be tested for stress hormones. 

New Technologies, New Uses for Ambulatory Monitoring

“There have been so many exciting developments in recent years,” said Thomas Kubiak, PhD, of Johannes Gutenberg University in Mainz, Germany, who served as guest editor of the special issue along with Arthur A. Stone, PhD, of Stony Brook (N.Y.) University.  “To highlight just one, there is the availability of unobtrusive monitoring, behavioral observation of the social context, like the EAR method.”

Matthias R. Mehl, PhD, of University of Arizona and colleagues performed a study using the EAR, or “Electronically Activated Recorder”—a smartphone App programmed to periodically collect snippets of audio from research participants’ environment. The recordings are transcribed and analyzed after research participants are given the opportunity to delete audio segments that they would like to remain private.

One potential use is to study how levels of social support affect the progression of chronic diseases, such as cancer and heart disease.  By providing a tool for objectively registering interactions, the EAR method might help to overcome bias related to the use of questionnaires asking people to rate their level of social support.

Other topics covered in the special issue include:

• The use of continuous glucose monitoring in diabetes, revealing fluctuations in blood sugar that otherwise go unnoticed. These new systems hold promise “for answering key questions regarding the relationship of glucose to mood, stress, health behaviors, and behavioral interventions,” according to research led by Julie Wagner, PhD, of the University of Connecticut.
• The use of ambulatory assessment techniques to improve research into the genetic basis of behavioral disorders. Patrick H. Finan, PhD, of the Johns Hopkins University and colleagues believe that studies using ambulatory assessment may help to reduce the bias inherent in asking research participants to recall past events.
• The use of ambulatory methods for documenting fluctuations in pain, rather than just pain averages over time. Dr. Stone and colleagues suggest that average pain scores may not always capture what is most important to patients themselves. Some patients may value spending more of their time symptom-free and others may wish to reduce “the roller coaster of symptom level variability,” they wrote.

The special issue also includes articles on new statistical techniques for handling ambulatory assessment data. “A very important point in my view is that statistical methods have developed considerably compared to the 1990s,” Dr. Kubiak added. “Ambulatory monitoring yields incredibly rich data, and in the past years there has been vast progress in statistical methods to deal with this kind of data to answer hypotheses, to examine processes, and to take the full advantage of the method.”

About Psychosomatic Medicine

Psychosomatic Medicine, Journal of Biobehavioral Medicine, founded in 1939, is the official peer-reviewed journal of the American Psychosomatic Society. It publishes experimental and clinical studies dealing with various aspects of the relationships among social, psychological, and behavioral factors and bodily processes in humans and animals.  Psychosomatic Medicine, Journal of Biobehavioral Medicine is an international, interdisciplinary journal devoted to experimental and clinical investigation in behavioral biology, psychiatry, psychology, physiology, anthropology, and clinical medicine. The print journal is published nine times a year; most articles are published online ahead of print.

About the American Psychosomatic Society

The mission of the American Psychosomatic Society is to promote and advance the scientific understanding and multidisciplinary integration of biological, psychological, behavioral and social factors in human health and disease, and to foster the dissemination and application of this understanding in education and health care.

The American Psychosomatic Society is a worldwide community of scholars and clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health.  The organization is devoted to biopsychosocial research and integrated clinical care, and to providing a forum via its website, Annual Meeting and journal, Psychosomatic Medicine, for sharing this research. Its members are from around the world, including specialists from all medical and health-related disciplines, the behavioral sciences, and the social sciences.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts: 

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com 

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Reports Summarize ‘Challenges and Lessons Learned’ in Responding to Unprecedented Nuclear Emergency

Philadelphia, Pa. (May 11, 2012) –This special issue of Health Physics, official journal of the Health Physics Society (HPS) offers 16 articles on various response activities by a number of US Agencies and their personnel following the tsunami and the events at the Fukushima Daiichi nuclear power plant. These articles began as presentations at a Special Session at the Health Physics Society’s 2011 Annual Meeting.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The issue presents papers developed from presentations made at a special session of the 2011 HPS annual meeting, focusing on the U.S. radiological response to the Fukushima accident.  “The response was unique in that it occurred overseas and involved a wide range of organizations and large number of participants,” according to an introductory article by Daniel J. Blumenthal of the U.S. Department of Energy/National Nuclear Security Administration (DOE/NNSA).  Blumenthal was guest editor of the special issue, along with Stephen V. Musolino of the Brookhaven National Laboratory.

Planning Enabled Swift Response to Unprecedented Emergency

On March 11, 2011, a 9.0 magnitude earthquake off the northeast coast of Japan generated a tsunami that caused extensive damage to the region—including the Fukushima Daiichi plant.  As a result of the initial damage and subsequent loss of electrical power, the reactor cores overheated, leading to the release of radioactive material.

The Department of Defense responded immediately with conventional and specialized units to provide assistance.  The DOE/NNSA provided personnel and equipment to monitor radiation in the environment and determine the extent of the releases from the damaged plant.  DOE/NNSA sent a response team to Japan to help protect U.S. personnel and assets. The team arrived on March 16 and began making environmental measurements and providing data from the field the next day.

The U.S. Environmental Protection Agency was responsible for assessing the potential impact on U.S. territories, with monitoring from the RADNET system of monitoring stations, while the U.S. Nuclear Regulatory Commission provided support in atmospheric dispersion modeling.  Articles in the special issue of Health Physics provide detailed information on the radiation monitoring and dispersion modeling activities—which became increasingly complex as more data were collected.

The interagency Advisory Team for Environment, Food and Health, or “A-Team,” provided advice both in the United States and at the U.S. Embassy in Japan.  This included providing help in interpreting the environmental radiologic assessment and making appropriate recommendations for public health and safety.

“The success and effectiveness of the U.S. response was the result of decades of preparing, planning, and training,” Blumenthal writes.  The Fukushima accident provided challenges that were never considered in previous plans and training exercises—not only working in another country, but dealing with the simultaneous effects of two natural disasters.  Blumenthal adds, “The ability of the various teams to adapt their prior plans to an emerging, dynamic situation was critical to the success of the response.”

The 15 articles in the special issue provide comprehensive, detailed information on these and other aspects of the response, which included ongoing assistance with long-term recovery efforts.  The editors of Health Physics, along with the HPS leadership, believe the information presented will be of interest not only to radiation safety professionals but also to policymakers and other individuals working in the fields of energy, environmental protection, public health, and national security.

“It is contributions like this that that help make Health Physics a well-respected journal in the field of radiation protection,” writes Michael T. Ryan, PhD, CHP, in an Editor’s note.  While in Glasgow for the 13th International Congress of the International Radiation Protection Association, be sure to stop by the HPS exhibit (stand #9) to pick up a copy of the Fukushima special issue of Health Physics.

About Health Physics

Health Physics, first published in 1958, has provided information to a wide variety of radiation safety professionals including health physicists, nuclear chemists, and physicians with interest in nuclear and radiological medicine. Health Physics is an important source of information for these professionals.

About the Health Physics Society

The Health Physics Society, formed in 1956, is a scientific organization of professionals who specialize in radiation safety. Its mission is to support its members in the practice of their profession and to promote excellence in the science and practice of radiation safety. Today its nearly 5,000 members represent all scientific and technical areas related to radiation safety including academia, government, medicine, research and development, analytical services, consulting, and industry in the United States and a number of other countries. 

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts: 

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com 

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

A New Way of Looking at How Culture Affects ‘Access, Availability, and Appropriateness’ of Preventive Services

Philadelphia, Pa. (May 8, 2012) – The disproportionately high impact of breast cancer on African American women may be related to cultural factors affecting perceived access to screening and other breast health care services, according to a paper in the May issue of Advances in Nursing Science. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In the article, “Theory of perceived Access to Breast Health Care in African American Women,” Sandra Bibb, DNSc, RN, of the Uniformed Services University of the Health Sciences outlines a theory of “perceived access to breast health care”—and how it may help in understanding the increased breast cancer risks among African American women.  In her paper, Dr. Bibb “proposes an alternative view of access to care based on an African American woman’s perception of the necessity, availability, and appropriateness of breast health care.”

An Alternative View of Breast Cancer Disparities

Breast cancer is a major health problem for all American women, but has a disproportionate impact on African American women, who face higher risks of developing and dying from breast cancer than other racial/ethnic groups.  Data suggest that breast cancer mortality rates among African American women are about 40 percent higher than for non-Hispanic white women.

Poor access to breast health care and delayed diagnosis have been viewed as the main reasons for this disparity.  But even after accounting for disease stage and improved access to screening, breast cancer mortality rates remain higher for African American women.  “These continuing health inequities indicate that the disparity in breast cancer mortality rates in African American women may also be the consequence of a social dynamic,” according to Dr. Bibb.

Based on a synthesis of research and theory related to breast cancer, Dr. Bibb has developed a new way of thinking about perceived access to health care in African American women.  The best way to reduce breast cancer risk and increase the chances of survival is a “breast health care” approach, which includes health-promotion and disease-prevention behaviors; routine screening and early detection; and early treatment to stop breast cancer progression and prevent complications.

Dr. Bibb believes that interactions between culture and “the shared experience of being an African American woman” have unique effects on perceived access to health care—which in turn affects the likelihood of participating in “clinical preventive services” related to breast health care (such as regular mammograms).  Her theory offers a new way of exploring the differences in culture that may lead to a lack of participation in these services.

Cultural Definitions of Health Are Key Starting Point

In Dr. Bibb’s view, the many different factors that combine to make up culture all influence the definition of health.  To enable early diagnosis of breast cancer, the cultural definition of health must include health promotion and disease prevention practices.  In addition, access to breast health care must be perceived as “necessary, available, and appropriate.”  If any one of these elements is missing, the result may be delayed diagnosis of breast cancer—resulting in fewer treatment options and an increased risk of death.

Thus asking African American women about their definitions of health—as shaped by cultural beliefs, values, and practices—is a critical starting point.  Dr. Bibb outlines a research approach using her perceived theory of access to breast health care, including some suggested questions for examining the relationships between culture and definitions of health.

“Understanding how health is defined by African American women is…key to understanding and eliminating barriers which move beyond financial and structural availability of care,” Dr. Bibb writes.  She believes that acknowledging these perceptions is an essential step toward improving African American women’s participation in clinical preventive services to promote breast health—and thus in improving breast cancer outcomes.

“Nurses have a long tradition of focus on culture as a factor in health and well-being,” comments Peggy Chinn, RN, PhD, FAAN, Professor Emerita, University of Connecticut School of Nursing and Editor-in-Chief of Advances in Nursing Science.  “Dr. Bibb’s work is a major contribution to understanding the complex relationships of culture and health, and provides evidence that that guides nursing practice.”

About Advances in Nursing Science

Consistently ranked as one of the most-read and most assigned journals by faculties of doctoral programs in nursing, Advances in Nursing Science (ANS) is the most stimulating publication in nursing science and education today. ANS is intellectually challenging, yet readable; innovative, yet scientifically sound; reliable research without the tedious, traditional hard science approach found in so many other journals. Each issue features a single timely research topic with exciting implications for patient care. Articles in ANS are peer-reviewed and chosen for their pioneering approaches and perspectives, which set the direction for nursing practice today.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts: 

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com 

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Optometry and Vision Science Provides Updates on New Cellular-Level Imaging Techniques—and How They’ll Affect Vision Care

Philadelphia, Pa. (May 7, 2012) – The same technology used by astronomers to obtain clear views of distant stars is now being used by optometrists to perform incredibly detailed examinations of the living eye.  An update on new developments in ocular imaging techniques—and how they may affect clinical vision care in the not-too-distant future—is presented in an article titled “Adaptive Optics Scanning Laser Ophthalmoscope-based Microperimetry” published in a special May issue of Optometry and Vision Science, official journal of the American Academy of Optometry.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Cutting-edge techniques now allow researchers to visualize the fine structure of the eye in a way that was “not conceivable 20 years ago,” according to a guest editorial by Scott Read OD PhD FAAO (Candidate) and colleagues.  “As these advanced imaging methods continue to develop, the potential for imaging ocular structures down to the cellular level in everyday clinical practice has become a reality—and the potential to improve patient care is truly stunning,” Dr Read and coauthors add.

New Techniques Provide Cellular-Level Images of the Living Eye
The special issue presents 30 reports on the latest, most advanced techniques for imaging and measurement of various eye structures:  the retina and optic nerve, lens and ciliary body, and the anterior eye.   Written by leading researchers and clinicians, the contributions provide a fascinating look at these remarkable new technologies, with a glimpse of their likely extensions into clinical practice.

As just one example, William S. Tuten, OD, MS, and colleagues of the University of California, Berkeley, report on the development and use of an “adaptive optics scanning laser ophthalmoscope.”   Adaptive optics refers to the use of advanced techniques to correct for optical aberrations through any transparent media.  Originally developed for use in telescopes to correct for the distorting effects of the atmosphere, adaptive optics is now being applied to evaluating the structure and function of the human eye.

Dr. Tuten and colleagues have applied adaptive optics to perimetry—also known as visual field testing—on the microscopic scale.  Perimetry is an important part of evaluation for patients with vision disorders including macular degeneration, retinitis pigmentosa, and diabetic retinopathy.  Perimetry measures vision in all parts of the visual field, including the peripheral vision.

Promising Applications to Improve Clinical Vision Care

The new paper describes (and illustrates) the use of adaptive optics-guided microperimtery to assess visual fields at an unprecedented level of detail.  The technique can not only show limitations in visual fields, but can trace the defect to individual retinal photoreceptor cells.  High-speed tracking is used to correct for normal eye movement, or “jitter,” that is practically undetectable using conventional imaging techniques.

In addition, by using microscopic blood vessels as anatomical landmarks, the adaptive optics technique permits repeated studies to be repeated over time at a high level of precision.  This offers unique opportunities for studying how treatments work on the cellular level, as well as following the effects of treatment over time in individual patients.

“This technique opens new horizons for clinician-scientists, and later clinicians, to better understand, and plot out, the relationships between vision and the retinal photoreceptors at a microscopic level,” comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science.  “It enables a new understanding of vision loss in patients with retinal disorders where there are discrete photoreceptor losses—for example, macular degeneration.”

Adaptive optics-guided microperimetery and other advanced imaging technologies described in the special issue have the potential to revolutionize the management of eye diseases, Dr. Read and colleagues believe.  They conclude, “With ongoing improvements in imaging speed and resolution, and with the application of innovative methods to improve the clinical usefulness of ocular imaging techniques, the future of ocular imaging is bright!”

To read the article “Adaptive Optics Scanning Laser Ophthalmoscope-based Microperimetry”, please visit http://journals.lww.com/optvissci/Fulltext/2012/05000/Adaptive_Optics_Scanning_Laser.7.aspx.

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning.  All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts: 

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com 

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Medicare Reimbursement Changes May Contribute to Increased Rates of Breakdowns and Consequences

Philadelphia, Pa. (May 2, 2012) – Wheelchair users with spinal cord injury (SCI) report very high rates of wheelchair breakdowns—and the problem is getting worse, suggests a study in American Journal of Physical Medicine & Rehabilitation (AJPM&R), the official journal of the Association of Academic Physiatrists, AJPM&R is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study found that over 50 percent of wheelchair users experienced a breakdown in a six-month period, up from a previous report. “It is possible that this increase in the number of repairs is the result of a decrease in wheelchair quality resulting from changes in reimbursement policies and a lack of enforcement of standards testing,” write the researchers, led by Dr Michael Boninger of University of Pittsburgh’s Department of Physical Medicine and Rehabilitation.  They also found a significant increase in wheelchair breakdowns causing health and safety consequences.

For People with SCI, Wheelchair Breakdowns Becoming More Frequent

Dr Boninger and colleagues analyzed data from an ongoing survey study of more than 700 individuals with SCI who used wheelchairs at least 40 hours per week.  The participants provided routine data on wheelchair breakdowns requiring repairs, along with any consequences of breakdowns—for example, being stranded, missing a medical appointment, or being injured.

The data suggested that the rate of wheelchair breakdowns has increased in recent years.  From 2006 to 2011, about 53 percent of wheelchair users reported one or more breakdowns requiring repair per six-month period—a significant increase over the 45 percent rate from 2004 to 2006.  The average number of repairs per person also increased:  1.42 in 2006-11, compared to 1.03 in 2004-06.

The rate of adverse consequences of breakdowns increased as well:  30.5 percent in 2006-11, compared to 22 percent in 2004-06.  The total number of consequences per participant in 2006-11 was more than twice as high as in 2004-06.

Power wheelchairs had more problems than manual wheelchairs—nearly two-thirds of all consequences were reported by power wheelchair users.  These rates were especially high in wheelchairs equipped with power seat functions.

Differences by Race/Ethnicity and Funding Source

Rates of breakdowns and repairs appeared higher for individuals from a racial/ethnic minority background.  These same individuals were also less likely to have a backup wheelchair available.

Individuals whose wheelchairs were funded by Medicare or Medicaid had higher rates of breakdowns and consequences, compared to those covered by private insurance or other sources (such as the Veterans Administration or workers compensation).

More than 2.8 million Americans use a wheelchair for mobility, allowing greater independence in daily functioning, home life, and vocational settings.  Wheelchair users are at risk when breakdowns occur, with consequences ranging from minor inconveniences to significant injuries.

The new data raise concerns that wheelchair users with SCI are experiencing higher rates of wheelchair breakdowns.  The higher risk among people whose wheelchairs are funded by Medicare/Medicaid may be at least partly related to recent changes in insurance reimbursement policy. In addition, the lax requirements for testing don’t ensure that wheelchairs meet established standards for performance and safety.

“This paper should serve as a call to reevaluate and revise current policies and standards testing for wheelchair prescription in the United States,” Dr Boninger and coauthors conclude.  They also suggest that educating wheelchair users on the importance of routine maintenance—such as replacing cushions, caster wheels, and batteries at recommended times—might help to reduce the rates and consequences of breakdowns.

Read the full article at ajpmr.com before it appears in print. 

About AJPM&R

American Journal of Physical Medicine & Rehabilitation focuses on the practice, research and educational aspects of physical medicine and rehabilitation. Monthly issues keep physiatrists up-to-date on the optimal functional restoration of patients with disabilities, physical treatment of neuromuscular impairments, the development of new rehabilitative technologies, and the use of electrodiagnostic studies. The Journal publishes cutting-edge basic and clinical research, clinical case reports and in-depth topical reviews of interest to rehabilitation professionals.

About the Association of Academic Physiatrists

The AAP was founded in 1967 to serve as the national organization of physiatrists who are affiliated with medical schools. The AAP is a member organization of the Association of American Medical Colleges (AAMC).  The objectives of the Association are to promote the advancement of teaching and research in Physical Medicine and Rehabilitation within an academic environment. The organization acts as a sounding board and forum for the exchange of ideas and information relative to all phases of the art and science of Physical Medicine and Rehabilitation.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts: 

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com 

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com