Philadelphia, Pa. (March 11, 2013) – For HIV-infected patients whose disease is well-controlled by modern treatment, the risk of death is not significantly higher than in the general population, according to a study published in AIDS, official journal of the International AIDS Society. AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study suggests that patients with undetectable viral loads and near-normal levels of immune cells on state-of-the art antiretroviral therapy (ART) can expect to have about the same risk of death as people without HIV.  The article is available on the AIDS journal homepage and in the March 13 print edition.

What’s the Risk of Death with Well-Controlled HIV?

Dr Alison Rodger of University College London and colleagues assessed mortality rates in a group of patients with “optimally treated” HIV, drawn from two major trials of treatment for HIV infection:  the ESPRIT and SMART trials.  The analysis included nearly 3,300 patients who were not injecting drug users and who received continuous ART.  On treatment, all had achieved undetectable HIV levels and had relatively high levels of CD4+ cells, a key population of immune cells—at least 350 cells/mm³.  (A CD4+ cell count of 500 to 1,000 cells/mm³  is considered normal.)

The patients’ average age was 43 years; 80 percent were men.  Rates and causes of death in these patients with well-controlled HIV were compared with those in the general population.

During a median follow-up of about three years, 62 of the patients died.  The most common causes of death were cardiovascular disease or sudden death, responsible for 31 percent of deaths; and non-HIV-related cancers, 19 percent.  Only two deaths (three percent) were considered AIDS-related.

Patients with below-normal CD4+ cell counts (350 to 499 cells/mm³) were at elevated risk of death.  Based on the standardized mortality ratio, the risk of death in this group was 77 percent higher than in the general population.

With Normal CD4+ Cell Counts, No Increase in Mortality

However, in HIV-infected patients with a CD4+ cell count of 500 cells/mm³ or higher, the risk of death was not significantly higher than in the general population.  For this group, the risk of death was essentially normal regardless of how low the CD4+ cell count dipped during treatment, as long as it returned to normal.

Over the years, effective ART regimens for HIV infection have become simpler, less toxic, and more effective.  “Due to the success of ART, it is relevant to ask if death rates in optimally treated HIV are higher than the general population,” the researchers write.

Previous studies have suggested that, with successful treatment, mortality risk approaches that of people without HIV.  However, these studies have had important limitations, including a lack of complete information on patient outcomes.  The use of comprehensive follow-up data from the ESPRIT and SMART trials overcomes this limitation.

The new study provides the best evidence yet that, with effective ART that achieving good disease control, the mortality rate for people with HIV is essentially the same as in the general population.  Dr Rodger and colleagues conclude, “Our data support the importance of early diagnosis and treatment to improve clinical outcomes and it is likely that much of the excess mortality associated with HIV would be preventable with timely diagnosis of HIV and initiation of ART.”

Further studies will be needed to clarify the implications for HIV treatment, including the best time to start ART based on CD4+ cell counts.  The researchers also note that other causes of illness or death emerge as the current generation of treated HIV-infected people continues to age.

“Rodger and colleagues add to the considerable body of evidence on which early treatment initiation guidelines are based,” commented Veronica Miller, PhD, Director of the Forum for Collaborative HIV Research.  “Together with studies indicating equal benefit across risk groups, including injecting drug users, as long as individuals are maintained in care, this study further validates universal testing with immediate linkage and retention in care policies.”

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 & WilkinsLippincott 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 2012 annual revenues of €3.6 billion ($4.6 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

2. Study Says Heavy Drinking Leads to Increased HIV Risk for Men Who Have Sex with Men

Philadelphia, Pa. (March 4, 2013) –The results of two important studies have been published in the March issue of AIDS, the official journal of the International AIDS Society. One study notes that screening for HIV should be performed more frequently—up to every three months for the highest-risk patients, while low-risk groups to be tested every three years. A second study demonstrates a link between heavy drinking and risky behaviors for men who have sex with men (MSM). AIDS is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Northwestern University Study Researches the Most Cost-Effective Approach to HIV Screening

The mathematical modeling study was performed to assess “optimal testing frequencies” for HIV screening in different risk groups.  Current Centers for Disease Control and Prevention (CDC) guidelines recommend annual testing for high-risk groups, such as people with HIV-positive partners, people with multiple partners, injection drug users, and sex workers and once-in-a-lifetime testing for low-risk groups (whose annual risk of acquiring HIV is only one-hundredth of one percent).

The researchers modeled various scenarios in an attempt to “optimize the tradeoff” between the societal costs of testing versus the benefits of earlier HIV diagnosis over a patient’s lifetime. Frequent testing is shown to be an effective method for identifying new HIV infections.  In the past, people with new HIV infections weren’t treated until they had significant declines in immune functioning, as measured by the CD4 cell count.  But there’s a growing consensus that antiretroviral treatment is beneficial for all HIV-infected patients, regardless of CD4 count.  Starting treatment immediately after diagnosis also reduces the risk of transmitting HIV.

Within its limitations, the study suggests that current recommendations for HIV testing are “too conservative, especially for low risk groups who would benefit from more frequent testing,” according to Lucas and Armbruster.  They conclude, “These results should encourage policymakers and medical professionals to reconsider how often adolescents and adults should be tested for HIV.”

The full article is available on the AIDS journal homepage and in the March 13 print and online edition.

University of North Carolina Study Reveals Heavy Drinking Affects HIV Risk for MSM

Researchers analyzed long-term follow-up data on MSM from a large study of HIV risk factors.  All men were HIV-negative at the beginning of the study.  Using special statistical weighting techniques, Dr Cole and colleagues analyzed the joint effects of alcohol consumption and sexual behavior on the risk of acquiring HIV (seroconversion) during follow-up. Findings show that for men who have sex with men (MSM), heavy drinking may lead to an increased risk of acquiring HIV.

Overall, 529 cases of HIV seroconversion were identified during follow-up.  Thirty percent of the men reported having unprotected sex with multiple partners in the two years before the study.

Risk is especially high for men who are heavy drinkers and have multiple partners, suggests the study by Stephen R. Cole, PhD, of University of North Carolina, Chapel Hill, and colleagues.  They write, “These findings suggest that alcohol interventions to reduce heavy drinking among MSM should be integrated into existing HIV prevention activities.” 

The full article can be read by visiting the AIDS journal homepage and can also be found in the March 13 print edition.

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 2012 annual revenues of €3.6 billion ($4.6 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

Philadelphia, Pa. (February 21, 2012) – The Veterans Health Administration (VHA) is aiming to become a leader in using health information technology (HIT) to change the way patients experience medical care, to decrease medical mistakes, and to improve health outcomes. A special March supplement of Medical Care highlights new research into the many and varied types of HIT projects being explored to improve the quality of patient care throughout the VHA system.  Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue also maps out key areas for future research to develop and evaluate effective approaches for using HIT for ongoing quality improvement in healthcare.  “Our research infrastructure is critical to supporting the type of HIT innovation that can support changes in the way we organize and deliver care,” according to an editorial comment by the VHA’s Dr. David Atkins, Acting Director of Health Services Research and Development, and Dr. Theresa Cullen, Director of Health Informatics.

VHA Provides Leadership in HIT Research for Quality Improvement

Health information technology’ is a loose term describing an ever-increasing range of tools and technologies.  “The unifying element is not that they involve technology but that they introduce novel ways to collect and analyze health data and to extract knowledge from the data to inform decisions,” Drs. Atkins and Cullen write.  Since the early development of health information systems in the 1980s, the VHA has played a leadership role in health informatics.

But the HIT landscape continues to change rapidly, with increased computing power, changing HIT platforms, and changing expectations of patients, health care providers, and payers.  “To map out a meaningful research agenda, we must think forward five to ten years,” according to Drs. Atkins and Cullen.

From their perspective at the leading edge of HIT, they outline some of the broad trends affecting HIT, now and in the future.  These include:

• The emergence of “connected health”—technology will play a central role in medical decision-making, and will supplant an increasing proportion of in-person health care visits.
• Patients’ increasing control over their health information and who has access to it.
• The increased role of HIT tools to promote and assist patient behavior change.
• Standardized data allowing the performance of health care systems to be assessed in “real time,” for the entire population of patients.

Drs. Atkins and Cullen also identify and discuss “distinct sets of questions that are ripe for research” in using HIT for quality improvement, from the standpoint of patients, health care teams, and health care managers.

New Research on HIT to Improve Quality of Care

The special issue also presents eight original research papers using HIT for quality improvement within the VHA system.  The studies “highlight a range of specific HIT approaches, including innovative and interactive uses of the VA’s electronic health record, databases, and information systems; and applications of automated systems for intervention, evaluation and tracking patient care,” writes Denise M. Hynes, MPH, PhD, RN, Research Career Scientist and Director of the VA Information Resource Center, in an introductory overview.

For example, one study evaluates the use of electronic kiosks as a way to help improve care outcomes for veterans with schizophrenia.  Other HIT approaches evaluated include a system for secure messaging between patients and health care providers, a “home telehealth” monitoring intervention for recently homeless veterans, and programs to increase veterans’ access to and ability to use their personal health records.

“These articles highlight the value of a systematic approach in incorporating and evaluating HIT as part of quality improvement efforts,” Dr. Hynes adds.  She is also lead author of a paper exploring the challenges and keys to “sustained effects” of HIT projects in the Quality Enhancement Research Initiative—a major part for the VHA’s systemwide quality improvement program.

The authors of the supplement papers hope their efforts will illustrate the scope of what’s possible through the use of HIT for quality improvement, and help to set the research agenda for continued efforts in the years ahead.  As new and practical research designs emerge, Dr. Hynes writes, “Other healthcare quality improvement efforts that rely on HIT can learn from the VHA experience.

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care.  This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care.  Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.  In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume.  Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Lippincott Williams & WilkinsLippincott 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

Philadelphia, Pa. (January 16, 2012) – Efforts to correct false beliefs about health care reform may backfire, depending on individuals’ political views and level of knowledge, suggests a study in the February issue of Medical Care.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In the study, more politically knowledgeable people with positive views of Sarah Palin were likely to harden their opposition to the Affordable Care Act (ACA) when presented with information debunking Palin’s “death panel” claim, according to the study by Brendan Nyhan, PhD, of Dartmouth College and his colleagues Jason Reifler, PhD, of Georgia State University and Peter Ubel, MD, of Duke University.  They write, “These results underscore the difficulty of reducing misperceptions about health care reform among individuals with the motivation and sophistication to reject corrective information.”

Can Aggressive Fact-Checking Correct Health Care Misinformation?

The researchers conducted an online experiment to determine if more aggressive media fact-checking could help to correct false beliefs about the ACA.  The study focused on “perhaps the most prominent example of misinformation about health reform”—Palin’s 2009 claim that the ACA would create a “death panel” in which bureaucrats would determine whether seniors are “worthy of health care.”

One group of survey participants read a news article reporting on Palin’s “death panel” claim.  The other group read the same article, but with an additional paragraph stating that “non-partisan health care experts have concluded that Palin is wrong.”

Participants were then asked about their belief in death panels and support for the ACA.  Responses were compared for participants with favorable versus unfavorable views of Palin and for those with differing levels of political knowledge, which was measured using a simple five-question test (e.g., How many times can a person be elected President?).

The participants’ feelings toward Palin and their political knowledge both affected their responses to the correction.  Among participants who viewed Palin favorably but had low political knowledge, the paragraph correcting the death panel myth led to reduced misperceptions and increased support for the ACA.

But the correction had the opposite effect among Palin supporters who scored higher on political knowledge.  “Specifically, among high-knowledge respondents with very positive Palin feelings, corrective information about death panels made misperceptions worse and opposition to ACA stronger,” Nyhan and colleagues write.

Difficulties in Overcoming ‘Motivated Reasoning’

Factual misperceptions are a major problem in debates over controversial health issues, especially health care reform.  Several years after passage of the ACA, many people still believe Palin’s claim about death panels, even though it has been repeatedly debunked.

Some have argued that the media should be more aggressive in correcting misinformation about health policy.  One problem is the difficulty of overcoming “motivated reasoning”—people have a bias toward uncritically accepting claims that agree their pre-existing attitudes and beliefs, while resisting information that contradicts those attitudes.

The new results suggest that, even with more aggressive fact-checking, it’s hard to overcome motivated reasoning.  Among partisans who are more politically sophisticated, attempting to correct misperceptions may have opposite of the intended effect, increasing misperceptions about death panels and disapproval of the ACA.

The study has some important limitations, especially the fact that the Internet survey was not representative.  “Nonetheless, our findings raise questions about whether corrections can successful overcome entrenched misinformation about health care reform and other controversial health issues,” Nyhan and colleagues write.

“As we have seen with issues ranging from diabetes to vaccines, providing correct information may not be effective for members of the public who are inclined to reject the information that is being offered,” Nyhan and coauthors add.  “It is therefore essential to improve our understanding of misperceptions and how to most effectively correct them.”

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care.  This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care.  Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.  In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume.  Medical Care is the official journal of the Medical Care Section of the American Public Health Association

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

Philadelphia, Pa. (January 7, 2013) – Surveys suggest that while most US physicians are willing to play a role in responding to natural and manmade disasters, most do not feel adequately prepared to fulfill that role. Toward helping physicians and health care systems understand and fulfill their obligation to provide medical care in disasters, the January Southern Medical Journal is a special issue on disaster medicine and physician preparedness. The official journal of the Southern Medical Association, the SMJ is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue includes 22 reviews and original papers on preparing for the medical response to disasters and catastrophic events. Dr. G. Richard Holt, Editor-in-Chief of the Southern Medical Journal, writes: “I take the position that it is a professional and an ethical responsibility to potential patients and society for physicians to engage in sufficient self-learning that would provide them with at least an acceptable level of clinical preparation to meet the demands of caring for victims of a disaster in their town, city, county, or state.”

‘Lessons Learned’ from Experts in Disaster Preparedness

The articles were prepared by experts in the medical response to disasters—including those with real-life experience with patient care in disaster situations. The special issue is freely available on the journal website: http://www.smajournalonline.com/

Adding authoritative commentary in the special issue is Dr. Harold Timboe, a leading expert in disaster preparedness and medical response. A retired US Army Major General, Dr. Timboe’s experience includes coordinating the health response to the September 11 terrorist attack on the Pentagon and leading a team of volunteer physicians and nurses on a US Navy hospital ship responding to the 2004 tsunami in Indonesia. He writes, “Each of us in our own specialty, subcomponent of our local health system, and building to the aggregate capabilities at the community, regional, state, and national levels contribute to a growing sense of confidence in our overall preparedness.”

The special issue opens with a section on physician preparedness, emphasizing the need for doctors to play an active role in planning and supporting the response to catastrophic events. By being prepared, physicians can help to mitigate the impact of disasters in their community.

A section on healthcare system preparedness emphasizes measures to plan disaster-response measures on the local and regional level. Contributions include informative experiences with drills and simulations to build and assess preparedness for catastrophic events.

The concluding section on patient care preparedness discusses disaster preparation and response for specific patient populations and types of care—including mental health aspects of disasters and the importance of psychiatric consultation. Professionals involved in responding to Katrina and other recent Gulf Coast hurricanes and to the 2011 tornado in Joplin, Mo., share lessons learned in preparing for future disasters.

Other topics of special interest include:

• A description and evaluation of a one-day, competency-based emergency preparedness curriculum, which effectively enhances trainees’ skills and confidence in providing patient care in a disaster
• An introduction to the concept of “complete self-sufficiency planning,” outlining a comprehensive approach to designing and constructing hospitals to withstand and remain functional during disasters
• Insights into the unique health challenges facing older adults involved in disaster situations, focusing on mobilizing resources to improve health outcomes and recovery

Dr. Timboe encourages all physicians to familiarize themselves with resources on disaster response and responsibilities and to consider which aspects are most relevant to their training and experience. He concludes, “We hope this duty never calls, but if it does, we will demonstrate our readiness — the moral ethics of our profession, duty to the public good, and commitment to serve others require our utmost diligence.” 

About the Southern Medical Journal

As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients’ daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical subspecialties, surgery and surgery subspecialties, child and maternal health, mental health, emergency and disaster medicine, public health and environmental medicine, and bioethics and medical education. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.

About the Southern Medical Association

The Southern Medical Association (SMA) has been serving physicians’ needs since its inception in 1906. SMA’s mission is to promote the health of patients through advocacy, leadership, education, and service.

About Lippincott Williams & WilkinsLippincott 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

Philadelphia, Pa. (December 13, 2012) – Analysis of media portrayals of nursing homes finds that negative stories outnumber positive stories by five to one, reports a study in the December issue of Medical Care.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Negative news coverage of nursing homes may shape public perceptions and consumer care choices, suggest Edward Alan Miller, PhD, MPA, of University of Massachusetts Boston and Denise A. Tyler, PhD, of Brown University.  They write, “Our findings suggest that negative reporting predominates and its impact on public perceptions and government decision making may be reinforced by its prominence and focus on industry interests/behavior.”

News Stories Paint Negative Picture of Nursing Homes

Drs Miller and Tyler performed a database search to identify more than 1,500 articles related to nursing homes, published in four major American newspapers between 1999 and 2008.  Using a standardized approach, they categorized the tone of each news story as positive, negative, or neutral.  The characteristics of articles in the three categories were analyzed as well.

“Most articles were negative or neutral; comparatively few were positive,” Drs Miller and Tyler write.  Overall, 49.2 percent of articles were classified as negative and 10.5 percent as positive.  The remaining 40.3 percent were categorized as neutral in tone.

There were some prominent differences in the content of positive versus negative or neutral articles.  Positive articles were more likely to discuss the quality of nursing home care, while negative articles were often about cases involving negligence or fraud.

“Negative articles were more likely to focus on the nursing home industry; positive articles on the broader community and residents/families,” Drs Miller and Tyler write.  Many of the neutral articles covered financing and business/property issues.

Negative News More Likely to Make the Front Page

Negative articles involving negligence/fraud were more likely to be found on the front page, compared to positive or neutral articles.  “Editorial decisions about the placement of such articles make sense from a business perspective to the extent that negative, sensationalistic coverage sells newspapers,” according to the authors.

Other negative stores were related to natural disasters—particularly to several high-profile incidents in which nursing home residents endangered by Gulf Coast hurricanes.  Many of the positive stories were related to local quality-improvement initiatives—particularly ongoing “culture change” efforts seeking to make nursing homes more home-like environments.

The results draw attention to the overall negative depictions of nursing homes found in U.S. newspapers.  Such negative coverage has had a significant impact on public perceptions of nursing homes and the nursing home industry, Drs Miller and Tyler believe.

They also think that negative media coverage has probably influenced consumer behavior—especially at a time of increasing competition from “alternative care sources with more robust reputations,” such as home- and community-based care and assisted living.  Drs Miller and Tyler suggest that nursing homes and the nursing home industry may want to develop “more effective media strategies,” highlighting the culture change movement and other innovations to improve care and quality of life for nursing home residents.

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care.  This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care.  Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.  In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume.  Medical Care is the official journal of the Medical Care Section of the American Public Health Association

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

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Study in AIDS Journal Uses Advanced Mapping Techniques to Assess Role of ‘Spatial Accessibility’

Philadelphia, Pa. (December 4,  2012) – Road networks and geographic factors affecting “spatial accessibility” have a major impact on the spread of HIV across sub-Saharan Africa, 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.

Using sophisticated mapping techniques and detailed databases, Dr Andrew J. Tatem of the University of Florida and colleagues have found “coherent spatial patterns in HIV-1 subtype distributions” across Africa.  The researchers write, “A comprehensive understanding and evidence-base on accessibility, travel and mobility in resource poor settings would…provide a valuable resource for the strategic planning of disease control.”  The article is available on the AIDS journal homepage and in the November 28 print edition. 

Molecular HIV Data Overlaid on Spatial Accessibility Maps…

Dr Tatem and his team performed a spatial analysis of the distribution of HIV for the years 1998 to 2008 to explore the impact of transportation networks and geography on the spread of HIV.  Molecular data on specific HIV subtypes were obtained and analyzed in relation to “detailed and complete” spatial datasets on Africa-wide road networks.

In addition to roads, the data included a wide range of factors affecting “spatial accessibility,” such as land cover, settlement locations, bodies of water, and topography.  Sophisticated models were used to calculate not just the distance between locations, but also the ease of traveling from one place to another.

Even simply laying a chart of HIV subtypes over a map of travel times between settled areas makes the link between spatial accessibility and HIV subtype “clearly evident.”  Dr Tatem and coauthors write, “[C]lusters of similar subtype distributions are well connected and easily accessible from one another, whereas regions of low accessibility separate groupings of similar subtype distributions.” 

…Show Role of Travel in Spread of HIV Subtypes

Transport networks and ease of travel—rather than the straight-line distances between locations—provided a much better explanation for the distribution of HIV subtypes.  The data showed clustering of certain subtype distributions in well-connected regions—such as the western, eastern, and southern Africa and Ethiopia—that are separated by areas of “limited connectivity.”

In contrast, the difficulty of travel in certain areas of central Africa likely restricted the spread of HIV, the researchers suggest.  “The relatively poor connectivity in central Africa likely contributed to the slow initial growth of the epidemic in the first half of the 20th century,” according to Dr Tatem and colleagues.  The same factor may explain why HIV rates remained relatively low in central Africa, while soaring elsewhere.

Although the study has some important limitations, it adds important evidence for understanding how transport infrastructure and geography have affected—and will continue to affect—the spread of HIV.  The authors hope that the modeling techniques used can be extended to map cultural and other factors affecting HIV subtype distribution and transmissibility.  More accurate data on “actual volumes and flows of human travel” could also lend new insights.

“The increased travel and mobility of people may lead to the accelerated spread of new variants and the further diversification of the global HIV epidemic,” Dr Tatem and coauthors write.  They believe that ongoing efforts to monitor the spread of HIV subtypes could have important implications for developing effective prevention and treatment strategies.

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

Philadelphia, Pa. (December 4, 2012) – Can treatment with modern anti-HIV drugs help fight hunger for HIV-infected patients in Africa?  Starting antiretroviral therapy for HIV reduces “food insecurity” among patients in Uganda, suggests 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.

Treatment including antiretroviral therapy (ART) may lead to a “positive feedback loop” whereby improved functioning and productivity lead to increased ability to work—and thus to decreased food insecurity, according to the study by Kartika Palar, PhD and colleagues of University of California Los Angeles and RAND Corporation. The article is available on the AIDS journal homepage and in the November 28 print edition.

Food Insecurity Decreases in Year after Starting ART

The researchers studied 602 patients receiving first-time care for HIV disease at two clinics in Uganda.  At one clinic, patients were started on ART, the most effective drug treatment for HIV.  Patients at the other clinic were close to becoming eligible but not yet started on ART.

During the first year of treatment, the two groups were compared for changes in their level of food insecurity, defined as “the limited or uncertain availability of adequate food.”  Based on a simple questionnaire, about half of patients had severe food insecurity at the start of treatment (53 percent in the ART group and 46 percent of those not receiving ART).

In both groups, starting HIV treatment led to improved food security.  However, the trend was more pronounced in the group receiving ART.  By twelve months, the rate of severe food insecurity had decreased to 13 percent of the ART group versus 18 percent in the non-ART group.

Examination of other variables gave insight into the “pathway” by which ART may lead to improved food security.  Patients starting antiretroviral drugs had greater improvements in work status and in mental health—particularly decreased scores for depression.  Although physical health also improved during treatment—with or without ART—this did not seem to contribute to the reduction in food insecurity.

Changing the ‘Vicious Cycle’ to an ‘Upward Spiral’

Researchers are just beginning to explore the socioeconomic and psychological benefits of ART for HIV-infected patients.  In developing countries such as Uganda, food insecurity is a common problem with important effects on health.  Previous studies have shown that patients with food insecurity are less likely to follow up with recommended treatment for HIV and have poorer treatment outcomes.

The new study provides evidence that starting treatment for HIV—especially treatment including ART—leads to improved food security.  The reductions in food insecurity were achieved even though neither of the study clinics offered food assistance.

“Our results suggest that greater ability to work and reduced symptoms of depression may be the primary pathways through which ART improves food insecurity,” Dr Palar and coauthors write.  They suggest a “bidirectional relationship” between ART and food insecurity.

While ART alone can’t solve the problem of food insecurity, the researchers believe that policymakers should consider interventions to halt the “vicious cycle” by which HIV leads to worsening social and economic outcomes.  Dr Palar and colleagues conclude, “Well-integrated and implemented interventions in the context of comprehensive care have the potential to produce an ‘upward spiral’ where food security and ART can mutually reinforce each other for the benefit of all those in treatment.”

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 

Philadelphia, Pa. (August 6, 2012) – In the Canadian healthcare system, patients with longer than recommended waitlist times for coronary artery bypass graft (CABG) surgery are at increased risk of dying in the hospital, reports Medical Care.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The risk of death is one-third lower for patients with shorter delays to CABG surgery, compared to those with “excessive delays,” according to the new report by Boris G. Sobolev, PhD, of the University of British Columbia and colleagues.  They write, “Our results have implications for health systems that provide universal coverage and that budget the annual number of procedures.”

Risk Increases with ‘Excessive’ CABG Waiting Times

The researchers analyzed data on approximately 9,600 patients undergoing CABG surgery in British Columbia between 1992 and 2006.  All procedures were performed on an elective basis—that is, not as an urgent or emergency procedure—after the patient was registered on a waiting list.

Waitlist time was analyzed for association with the risk of in-hospital death, accounting for the role of other known risk factors.  Risk was compared for patients with:

• Short delays—within two weeks for “semiurgent” and 6 weeks for “nonurgent” procedures—as recommended by the Canadian Cardiac Society (CCS).
• Prolonged delays—within 6 to 12 weeks—as recommended by British Columbia provincial guidelines.
• Excessive delays—longer than either set of recommendations.

Overall, about 12.5 percent of patients had short delays to CABG surgery, 21.5 percent had prolonged delays, and 66 percent had excessive delays.  Patients with shorter delays tended to be sicker and to have more risk factors.

The absolute risk of in-hospital death was relatively small:  1.2 percent.  However, risk increased from 0.6 percent for patients with short delays, to 1.1 percent for those with prolonged delays, to 1.3 percent for those with excessive delays.

Once other risk factors were taken into account, the odds of death were about two-thirds lower for the patients with short versus excessive delays.  There was no significant difference in risk for patients in the prolonged delay category.

In the Canadian healthcare system and similar systems, limited capacity requires “budgeting” the number of CABG surgeries (and other complex procedures) within a given time.  Guidelines for CABG waitlist times were made on the basis of expert opinion—with “little evidence to support the recommended target times,” the authors note.

The new study supports the stricter CCS guidelines for performing elective CABG surgery.  “We found that among patients who underwent the operation within the CCS target times, in-hospital death was one-third as likely among those who had to wait longer than provincial guidelines,” Dr Sobolev and colleagues write.  However, they note that two-thirds of patients had waiting times exceeding even the less-stringent provincial guidelines.

Dr Sobolev and colleagues believe their study provides evidence to inform decisions regarding capacity planning versus access time for CABG, with the goal of minimizing adverse outcomes associated with excessive waitlist time.  The results also have implications for other models of government-sponsored medicine providing universal coverage for eligible patients—including the U.S. Veterans Administration system. 

Read the full article

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care.  This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care.  Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.  In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume.  Medical Care is the official journal of the Medical Care Section of the American Public Health Association

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

Philadelphia, Pa. (July 2, 2012) – A special July/August issue of the Journal of Public Health Management and Practice (JPHMP), dedicated to public health financing, suggests that a rebalancing of the US healthcare investment in clinical care and public health initiatives is needed to improve the health of the population and reduce overall costs. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special issue includes 18 timely editorials, commentaries, and research on the challenges of public health financing — highlighting the need to increase investment in public health.  These articles are open access on the journal’s website.   ”If we fail to strengthen our public health system now, we can look forward to falling further behind other developed nations and it will become more and more difficult to restore our health and competitiveness,” according to Steven M. Teutsch, MD, MPH, of the Los Angeles County Department of Public Health and colleagues.

Investing in Public Health Is Imperative to National Health and the Economy

The lack of attention to public health and prevention has serious consequences not only for the nation’s health but also the economy.  A healthy workforce is essential to “sustain economic growth and continued gains in labor force participation and longevity,” Teutsch and colleagues believe.  Coverage for medical treatment is essential—but the dollars invested in clinical care far exceed its contributions to the nation’s health.  Medical care accounts for only 10 to 20 percent of the factors that shape health, but accounts for about 97 percent of all health spending, according to Teutsch and coauthors.

While total annual U.S. health spending is approximately $2.5 trillion, or about $8,100 per person, only $250 is related to public health.  And while the U.S. spends twice as much per year as any other industrialized country, Andrew S. Rein, MS, and Lydia L. Ogden, PhD, MPP, of the Centers for Disease Control and Prevention state that that its health system ranks 37th in the world—just behind Costa Rica. 

They outline a multi-pronged -pronged solution to the chronic problem of public health underfunding in the United States, starting with efforts to increase productivity and efficiency.  Suggestions include defining an essential minimum package of public health services and developing new approaches to address problems that contribute to poor health or stand in the way of health improvement, including high-cost but preventable conditions as obesity, diabetes, and smoking. 

According to Patrick Bernet, guest editor of this special edition, “The U.S. needs to get the most out of the public health investment by focusing on programs that pay for themselves by decreasing illness and death, and through new public health partnerships at the state, local, and community levels”.

Call to Increase Resources for Public Health

In addition, Teutsch and colleagues believe it’s essential to establish “sufficient, stable, and sustainable” revenue to support public health efforts.  To meet this end, they endorse the Institute of Medicine’s recent proposal to institute a national medical care services tax.  “A tax on medical services could slightly increase costs,” they write, “but it has the potential to begin turning the tide of patients pushed into the system by preventable conditions.”

Teutsch and coauthors add, “Although 2012 may not be a propitious time to increase spending, the United States cannot afford to delay as the costs of chronic conditions and an aging population skyrocket.  The status quo is not working and we cannot afford to maintain it.”

The special issue of Journal of Public Health Management and Practice also includes expert editorials on the importance of ensuring funding for public health research and measuring progress in public health finance. Rein and Ogden conclude, “This issue keeps us focused on critical issues of finance, so that public health can offer all it can for our future.”

About Journal of Public Health Management and Practice

Journal of Public Health Management and Practice the leading practice-based public health journal, focusing on evidence-based public health practice and research.  A bi-monthly peer-reviewed publication guided by a multidisciplinary editorial board of administrators, practitioners and scientists, the journal publishes in a wide range of population health topics including research to practice; emergency preparedness; bioterrorism; infectious disease surveillance; environmental health; community health assessment, chronic disease prevention and health promotion, and academic-practice linkages. The Journal of Public Health Management and Practice has recently published focus issues defining the public health workforce, performance management and bridging the research to practice gap.

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