Jan Dyer

In a modern twist on clinical data gathering, crowd-sourcing has helped researchers identify “weak genetic signals” of depression. By combining data from the genetic information website 23andMe.com and previous genetic research, researchers identified for the first time 15 regions of the genome that may be associated with depression in people of European ancestry. Their findings should help “make clear that this is a brain disease,” said Roy Perlis, MD, MSc, a lead investigator and associate professor of psychiatry at Harvard Medical School, “which we hope will decrease the stigma still associated with these kinds of illnesses.”

Other studies have, of course, investigated genetic components of depression. But they may have been too small to uncover the subtle effects of the many genes influencing the risk of depression, these researchers say.

In their first analysis, using data from > 300,000 people of European ancestry who had purchased genetic profiles on 23andMe.com (and who consented to share their information with researchers), the researchers identified 2 genomic regions significantly associated with depression risk, including 1 previously associated with epilepsy and intellectual disability.

They then combined that information with data from genomewide association studies of 9,200 people with a history of depression and 9,500 controls, along with another group of 151,800 people with and without depression. That analysis revealed 15 genomic regions, including 17 specific sites, significantly associated with a diagnosis of depression. Several of the sites are located in or near genes known to be involved in brain development.

“The neurotransmitter-based models we are currently using to treat depression are more than 40 years old,” says Dr. Perlis. “We really need new treatment targets. We hope that finding these genes will point us toward novel treatment strategies. “[T]he traditional way of doing genetic studies is not the only way that works. Using existing large datasets or biobanks may be far more efficient.”

In a modern twist on clinical data gathering, crowd-sourcing has helped researchers identify “weak genetic signals” of depression. By combining data from the genetic information website 23andMe.com and previous genetic research, researchers identified for the first time 15 regions of the genome that may be associated with depression in people of European ancestry. Their findings should help “make clear that this is a brain disease,” said Roy Perlis, MD, MSc, a lead investigator and associate professor of psychiatry at Harvard Medical School, “which we hope will decrease the stigma still associated with these kinds of illnesses.”

Other studies have, of course, investigated genetic components of depression. But they may have been too small to uncover the subtle effects of the many genes influencing the risk of depression, these researchers say.

In their first analysis, using data from > 300,000 people of European ancestry who had purchased genetic profiles on 23andMe.com (and who consented to share their information with researchers), the researchers identified 2 genomic regions significantly associated with depression risk, including 1 previously associated with epilepsy and intellectual disability.

They then combined that information with data from genomewide association studies of 9,200 people with a history of depression and 9,500 controls, along with another group of 151,800 people with and without depression. That analysis revealed 15 genomic regions, including 17 specific sites, significantly associated with a diagnosis of depression. Several of the sites are located in or near genes known to be involved in brain development.

“The neurotransmitter-based models we are currently using to treat depression are more than 40 years old,” says Dr. Perlis. “We really need new treatment targets. We hope that finding these genes will point us toward novel treatment strategies. “[T]he traditional way of doing genetic studies is not the only way that works. Using existing large datasets or biobanks may be far more efficient.”

In a modern twist on clinical data gathering, crowd-sourcing has helped researchers identify “weak genetic signals” of depression. By combining data from the genetic information website 23andMe.com and previous genetic research, researchers identified for the first time 15 regions of the genome that may be associated with depression in people of European ancestry. Their findings should help “make clear that this is a brain disease,” said Roy Perlis, MD, MSc, a lead investigator and associate professor of psychiatry at Harvard Medical School, “which we hope will decrease the stigma still associated with these kinds of illnesses.”

Other studies have, of course, investigated genetic components of depression. But they may have been too small to uncover the subtle effects of the many genes influencing the risk of depression, these researchers say.

In their first analysis, using data from > 300,000 people of European ancestry who had purchased genetic profiles on 23andMe.com (and who consented to share their information with researchers), the researchers identified 2 genomic regions significantly associated with depression risk, including 1 previously associated with epilepsy and intellectual disability.

They then combined that information with data from genomewide association studies of 9,200 people with a history of depression and 9,500 controls, along with another group of 151,800 people with and without depression. That analysis revealed 15 genomic regions, including 17 specific sites, significantly associated with a diagnosis of depression. Several of the sites are located in or near genes known to be involved in brain development.

“The neurotransmitter-based models we are currently using to treat depression are more than 40 years old,” says Dr. Perlis. “We really need new treatment targets. We hope that finding these genes will point us toward novel treatment strategies. “[T]he traditional way of doing genetic studies is not the only way that works. Using existing large datasets or biobanks may be far more efficient.”

Native American tribes have the right to assume responsibility for providing health care to their members and to operate and manage health care programs or services previously provided by IHS, subject to certain requirements. As part of an annual IHS cooperative agreement to support this, IHS has awarded $767,000 to 7 tribes and tribal organizations for self-governance planning and negotiation activities.

The Planning Cooperative Agreement funding will go to Salt River Pima-Maricopa Indian Community, Arizona; Ak-Chin Indian Community, Arizona; White Earth Band of Chippewa Indians, Minnesota; Northwest Portland Area Indian Health Board, Oregon; Pinoleville Pomo Nation, California; and Lake County Tribal Health Consortium, Inc, California. The money will be used for legal and budgetary research and internal tribal government planning related to the administration of health care programs.

The Negotiation Cooperative Agreement funding goes to the Ponca Tribe of Indians of Oklahoma. That money helps defray costs related to preparing for the self-governance program negotiations. Negotiations provide an opportunity for the tribal and federal negotiation teams to work together in good faith to enhance each self-governance agreement, IHS says.

More than one-third (about $1.8 billion) of the total annual IHS funding for American Indian and Alaska Native health is now transferred directly to tribes to operate and manage health programs or services. Of the 567 federally recognized tribes, 354 participate and have negotiated 90 compacts and 115 funding agreements.

The partnership between IHS and self-governance tribes, says IHS Principal Deputy Director Mary Smith, is a “shining example of cooperation in providing access to quality health care.”

Native American tribes have the right to assume responsibility for providing health care to their members and to operate and manage health care programs or services previously provided by IHS, subject to certain requirements. As part of an annual IHS cooperative agreement to support this, IHS has awarded $767,000 to 7 tribes and tribal organizations for self-governance planning and negotiation activities.

The Planning Cooperative Agreement funding will go to Salt River Pima-Maricopa Indian Community, Arizona; Ak-Chin Indian Community, Arizona; White Earth Band of Chippewa Indians, Minnesota; Northwest Portland Area Indian Health Board, Oregon; Pinoleville Pomo Nation, California; and Lake County Tribal Health Consortium, Inc, California. The money will be used for legal and budgetary research and internal tribal government planning related to the administration of health care programs.

The Negotiation Cooperative Agreement funding goes to the Ponca Tribe of Indians of Oklahoma. That money helps defray costs related to preparing for the self-governance program negotiations. Negotiations provide an opportunity for the tribal and federal negotiation teams to work together in good faith to enhance each self-governance agreement, IHS says.

More than one-third (about $1.8 billion) of the total annual IHS funding for American Indian and Alaska Native health is now transferred directly to tribes to operate and manage health programs or services. Of the 567 federally recognized tribes, 354 participate and have negotiated 90 compacts and 115 funding agreements.

The partnership between IHS and self-governance tribes, says IHS Principal Deputy Director Mary Smith, is a “shining example of cooperation in providing access to quality health care.”

Native American tribes have the right to assume responsibility for providing health care to their members and to operate and manage health care programs or services previously provided by IHS, subject to certain requirements. As part of an annual IHS cooperative agreement to support this, IHS has awarded $767,000 to 7 tribes and tribal organizations for self-governance planning and negotiation activities.

The Planning Cooperative Agreement funding will go to Salt River Pima-Maricopa Indian Community, Arizona; Ak-Chin Indian Community, Arizona; White Earth Band of Chippewa Indians, Minnesota; Northwest Portland Area Indian Health Board, Oregon; Pinoleville Pomo Nation, California; and Lake County Tribal Health Consortium, Inc, California. The money will be used for legal and budgetary research and internal tribal government planning related to the administration of health care programs.

The Negotiation Cooperative Agreement funding goes to the Ponca Tribe of Indians of Oklahoma. That money helps defray costs related to preparing for the self-governance program negotiations. Negotiations provide an opportunity for the tribal and federal negotiation teams to work together in good faith to enhance each self-governance agreement, IHS says.

More than one-third (about $1.8 billion) of the total annual IHS funding for American Indian and Alaska Native health is now transferred directly to tribes to operate and manage health programs or services. Of the 567 federally recognized tribes, 354 participate and have negotiated 90 compacts and 115 funding agreements.

The partnership between IHS and self-governance tribes, says IHS Principal Deputy Director Mary Smith, is a “shining example of cooperation in providing access to quality health care.”

The prevalence of amyotrophic lateral sclerosis (ALS) seems to have gone up—from 4.7 cases per 100,000 in 2012 to 5.0 cases per 100,000 in 2013. But “seems” is the operative word, according to researchers writing in the August 5, 2016, Morbidity and Mortality Weekly Report. It is more likely that the increase is attributable to better detection methods, remarked Paul Mehta, MD, medical epidemiologist and principal investigator of the National ALS Registry and lead author of the report.

Related: A Combined Treatment Protocol for Patients With Diabetic Peripheral Neuropathy

He also credits greater public awareness of the registry, which is the only available data source that can be used to estimate the prevalence of ALS in the U.S. Because ALS is not a nationally notifiable disease, the registry uses administrative data from Medicare, Medicaid, and the VHA to determine “definite” cases. It also uses a secure web portal (https://wwwn.cdc.gov/als/) to identify cases not included in the national administrative databases.

Related: Amyotrophic Lateral Sclerosis, Nutrition, and Feeding Tube Placement

This fall, the registry will launch the National ALS Biorepository, which will store samples (eg, blood, hair, or saliva) from home visits and postmortem collection (eg, brain, bone, spinal cord). Currently, the few existing ALS biorepositories largely rely on samples from specific clinics or medical practices or clinical trials. The specimens for National ALS Biorepository will be collected from a geographically representative sample of people with ALS. The specimens will be used for research, such as genetic analysis, identification of biomarkers, and exposure to environmental toxic substances.

The full report is available at www.cdc.gov/mmwr/index2016.html.

The prevalence of amyotrophic lateral sclerosis (ALS) seems to have gone up—from 4.7 cases per 100,000 in 2012 to 5.0 cases per 100,000 in 2013. But “seems” is the operative word, according to researchers writing in the August 5, 2016, Morbidity and Mortality Weekly Report. It is more likely that the increase is attributable to better detection methods, remarked Paul Mehta, MD, medical epidemiologist and principal investigator of the National ALS Registry and lead author of the report.

Related: A Combined Treatment Protocol for Patients With Diabetic Peripheral Neuropathy

He also credits greater public awareness of the registry, which is the only available data source that can be used to estimate the prevalence of ALS in the U.S. Because ALS is not a nationally notifiable disease, the registry uses administrative data from Medicare, Medicaid, and the VHA to determine “definite” cases. It also uses a secure web portal (https://wwwn.cdc.gov/als/) to identify cases not included in the national administrative databases.

Related: Amyotrophic Lateral Sclerosis, Nutrition, and Feeding Tube Placement

This fall, the registry will launch the National ALS Biorepository, which will store samples (eg, blood, hair, or saliva) from home visits and postmortem collection (eg, brain, bone, spinal cord). Currently, the few existing ALS biorepositories largely rely on samples from specific clinics or medical practices or clinical trials. The specimens for National ALS Biorepository will be collected from a geographically representative sample of people with ALS. The specimens will be used for research, such as genetic analysis, identification of biomarkers, and exposure to environmental toxic substances.

The full report is available at www.cdc.gov/mmwr/index2016.html.

The prevalence of amyotrophic lateral sclerosis (ALS) seems to have gone up—from 4.7 cases per 100,000 in 2012 to 5.0 cases per 100,000 in 2013. But “seems” is the operative word, according to researchers writing in the August 5, 2016, Morbidity and Mortality Weekly Report. It is more likely that the increase is attributable to better detection methods, remarked Paul Mehta, MD, medical epidemiologist and principal investigator of the National ALS Registry and lead author of the report.

Related: A Combined Treatment Protocol for Patients With Diabetic Peripheral Neuropathy

He also credits greater public awareness of the registry, which is the only available data source that can be used to estimate the prevalence of ALS in the U.S. Because ALS is not a nationally notifiable disease, the registry uses administrative data from Medicare, Medicaid, and the VHA to determine “definite” cases. It also uses a secure web portal (https://wwwn.cdc.gov/als/) to identify cases not included in the national administrative databases.

Related: Amyotrophic Lateral Sclerosis, Nutrition, and Feeding Tube Placement

This fall, the registry will launch the National ALS Biorepository, which will store samples (eg, blood, hair, or saliva) from home visits and postmortem collection (eg, brain, bone, spinal cord). Currently, the few existing ALS biorepositories largely rely on samples from specific clinics or medical practices or clinical trials. The specimens for National ALS Biorepository will be collected from a geographically representative sample of people with ALS. The specimens will be used for research, such as genetic analysis, identification of biomarkers, and exposure to environmental toxic substances.

The full report is available at www.cdc.gov/mmwr/index2016.html.

In 2012, a survey found that 1 in 4 American adults had > 1 chronic health condition. In 2014, the National Health Interview Survey of 36,697 adults found the same thing. The stable prevalence of multiple chronic conditions (MCC) indicates a continuing public health issue, according to an article in the July 29, 2016 Morbidity and Mortality Weekly Report.

The prevalence varied across the country, from 19% in Colorado to 38% in Kentucky. Prevalence was higher than the national average percentage in Alabama, West Virginia, Mississippi, Montana, New Mexico, Maine, Michigan, Ohio, and Pennsylvania.

Several states with higher prevalence of MCC overlapped the so-called stroke belt, which includes much of the southern U.S. Similarly, MCC prevalence also overlapped the diabetes belt—again taking in much of the South and parts of the Midwest and West.

The survey covered 10 conditions: arthritis, asthma, cancer, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys. But those are only 10 of the 20 conditions HHS has identified for inclusion in studies of MCC. Moreover, no data on mental health conditions, undiagnosed conditions, or adults in long-term care or congregant facilities were included, so the findings are limited in generalizability. Nonetheless, the MMWR report authors say the findings further HHS research and surveillance objectives. Geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources.

In 2012, a survey found that 1 in 4 American adults had > 1 chronic health condition. In 2014, the National Health Interview Survey of 36,697 adults found the same thing. The stable prevalence of multiple chronic conditions (MCC) indicates a continuing public health issue, according to an article in the July 29, 2016 Morbidity and Mortality Weekly Report.

The prevalence varied across the country, from 19% in Colorado to 38% in Kentucky. Prevalence was higher than the national average percentage in Alabama, West Virginia, Mississippi, Montana, New Mexico, Maine, Michigan, Ohio, and Pennsylvania.

Several states with higher prevalence of MCC overlapped the so-called stroke belt, which includes much of the southern U.S. Similarly, MCC prevalence also overlapped the diabetes belt—again taking in much of the South and parts of the Midwest and West.

The survey covered 10 conditions: arthritis, asthma, cancer, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys. But those are only 10 of the 20 conditions HHS has identified for inclusion in studies of MCC. Moreover, no data on mental health conditions, undiagnosed conditions, or adults in long-term care or congregant facilities were included, so the findings are limited in generalizability. Nonetheless, the MMWR report authors say the findings further HHS research and surveillance objectives. Geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources.

In 2012, a survey found that 1 in 4 American adults had > 1 chronic health condition. In 2014, the National Health Interview Survey of 36,697 adults found the same thing. The stable prevalence of multiple chronic conditions (MCC) indicates a continuing public health issue, according to an article in the July 29, 2016 Morbidity and Mortality Weekly Report.

The prevalence varied across the country, from 19% in Colorado to 38% in Kentucky. Prevalence was higher than the national average percentage in Alabama, West Virginia, Mississippi, Montana, New Mexico, Maine, Michigan, Ohio, and Pennsylvania.

Several states with higher prevalence of MCC overlapped the so-called stroke belt, which includes much of the southern U.S. Similarly, MCC prevalence also overlapped the diabetes belt—again taking in much of the South and parts of the Midwest and West.

The survey covered 10 conditions: arthritis, asthma, cancer, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys. But those are only 10 of the 20 conditions HHS has identified for inclusion in studies of MCC. Moreover, no data on mental health conditions, undiagnosed conditions, or adults in long-term care or congregant facilities were included, so the findings are limited in generalizability. Nonetheless, the MMWR report authors say the findings further HHS research and surveillance objectives. Geographic disparities in MCC prevalence can inform state-level surveillance programs and groups targeting service delivery or allocating resources.

In 2014, more people died of drug overdoses than in any other year, and the majority of the deaths involved an opioid. In fact, “more Americans die from drug overdoses than car crashes,” said Sylvia Burwell, HHS secretary, in announcing new actions the department is taking to combat the opioid epidemic.

Related: Call for App to Help Opioid Rehab

The actions build on the HHS Opioid Initiative, launched March 2015, and the National Pain Strategy, the government’s first coordinated plan to reduce the burden of chronic pain in the U.S. The programs focus on 3 priorities: improving opioid prescribing practices, expanding access to medication-assisted treatment, and increasing use of naloxone to reverse overdoses.

Among the changes: SAMHSA finalized a rule to allow practitioners who can prescribe buprenorphine for up to 100 patients for a year or more now to treat up to 275 patients. Practitioners can obtain the waiver for the increase if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting.

Related: Lowering Veterans’ Opioid Use and Reducing Overdose Risk

Another important change was to the IHS Prescription Drug Monitoring Program (PDMP) policy. Although many IHS clinicians already use PDMP databases, opioid prescribers and pharmacists will now be required to check state PDMP databases before prescribing or dispensing any opioid for > 7 days. The goal is to help improve pain management care, identify patients who may have a misuse problem, and prevent diversion of drugs. The new policy is effective immediately for > 1,200 clinicians working in IHS federally operated facilities.  The IHS has also announced that it will train hundreds of  law enforcement officers of the Bureau of Indian Affairs on how to use naloxone and provide them with the drug.

The VA is releasing a new policy as well that requires health care providers who prescribe controlled substances to check State PDMPs before prescribing, at least once a year and/or when clinically indicated for renewal or continuation of therapy.

Related: Veterans’ Health and Opioid Safety–Contexts, Risks, and Outreach Implications

President Obama’s budget requests $1.1 billion in new mandatory and discretionary investments over fiscal years 2017 and 2018, to expand access to treatment and prevent opioid misuse and abuse.

In 2014, more people died of drug overdoses than in any other year, and the majority of the deaths involved an opioid. In fact, “more Americans die from drug overdoses than car crashes,” said Sylvia Burwell, HHS secretary, in announcing new actions the department is taking to combat the opioid epidemic.

Related: Call for App to Help Opioid Rehab

The actions build on the HHS Opioid Initiative, launched March 2015, and the National Pain Strategy, the government’s first coordinated plan to reduce the burden of chronic pain in the U.S. The programs focus on 3 priorities: improving opioid prescribing practices, expanding access to medication-assisted treatment, and increasing use of naloxone to reverse overdoses.

Among the changes: SAMHSA finalized a rule to allow practitioners who can prescribe buprenorphine for up to 100 patients for a year or more now to treat up to 275 patients. Practitioners can obtain the waiver for the increase if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting.

Related: Lowering Veterans’ Opioid Use and Reducing Overdose Risk

Another important change was to the IHS Prescription Drug Monitoring Program (PDMP) policy. Although many IHS clinicians already use PDMP databases, opioid prescribers and pharmacists will now be required to check state PDMP databases before prescribing or dispensing any opioid for > 7 days. The goal is to help improve pain management care, identify patients who may have a misuse problem, and prevent diversion of drugs. The new policy is effective immediately for > 1,200 clinicians working in IHS federally operated facilities.  The IHS has also announced that it will train hundreds of  law enforcement officers of the Bureau of Indian Affairs on how to use naloxone and provide them with the drug.

The VA is releasing a new policy as well that requires health care providers who prescribe controlled substances to check State PDMPs before prescribing, at least once a year and/or when clinically indicated for renewal or continuation of therapy.

Related: Veterans’ Health and Opioid Safety–Contexts, Risks, and Outreach Implications

President Obama’s budget requests $1.1 billion in new mandatory and discretionary investments over fiscal years 2017 and 2018, to expand access to treatment and prevent opioid misuse and abuse.

In 2014, more people died of drug overdoses than in any other year, and the majority of the deaths involved an opioid. In fact, “more Americans die from drug overdoses than car crashes,” said Sylvia Burwell, HHS secretary, in announcing new actions the department is taking to combat the opioid epidemic.

Related: Call for App to Help Opioid Rehab

The actions build on the HHS Opioid Initiative, launched March 2015, and the National Pain Strategy, the government’s first coordinated plan to reduce the burden of chronic pain in the U.S. The programs focus on 3 priorities: improving opioid prescribing practices, expanding access to medication-assisted treatment, and increasing use of naloxone to reverse overdoses.

Among the changes: SAMHSA finalized a rule to allow practitioners who can prescribe buprenorphine for up to 100 patients for a year or more now to treat up to 275 patients. Practitioners can obtain the waiver for the increase if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting.

Related: Lowering Veterans’ Opioid Use and Reducing Overdose Risk

Another important change was to the IHS Prescription Drug Monitoring Program (PDMP) policy. Although many IHS clinicians already use PDMP databases, opioid prescribers and pharmacists will now be required to check state PDMP databases before prescribing or dispensing any opioid for > 7 days. The goal is to help improve pain management care, identify patients who may have a misuse problem, and prevent diversion of drugs. The new policy is effective immediately for > 1,200 clinicians working in IHS federally operated facilities.  The IHS has also announced that it will train hundreds of  law enforcement officers of the Bureau of Indian Affairs on how to use naloxone and provide them with the drug.

The VA is releasing a new policy as well that requires health care providers who prescribe controlled substances to check State PDMPs before prescribing, at least once a year and/or when clinically indicated for renewal or continuation of therapy.

Related: Veterans’ Health and Opioid Safety–Contexts, Risks, and Outreach Implications

President Obama’s budget requests $1.1 billion in new mandatory and discretionary investments over fiscal years 2017 and 2018, to expand access to treatment and prevent opioid misuse and abuse.

Patients who have had ischemic strokes often receive endovascular treatment along with tissue plasminogen activator (T-PA) to break up clots in the brain, but bleeding is a serious risk. T-PA has a distinct window of effectiveness, but less is known about endovascular treatment. A new imaging method may help resolve that by identifying stroke patients who are not likely to benefit from endovascular surgery.

Related: Percutaneous Endovascular Treatment of Subclavian Steal Syndrome

Researchers from the National Institute of Neurological Disorders and Stroke, Bethesda, MD; Stanford University, Palo Alto, CA; University of Melbourne, Australia, collected brain scans from more than 100 patients before they underwent endovascular therapy, within 12 hours of the stroke. Using a new method of image processing, the researchers got detailed measurements on just how much a stroke disrupts the blood-brain barrier and combined those measurements with findings from the DEFUSE-2 study (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution).

They found that large degrees of blood-brain barrier disruption were associated with severe bleeding following endovascular surgery. Extensive breakdown of the blood-brain barrier was associated with parenchymal hematoma, which 24 of the 100 patients in the study experienced. The study also showed a link between the location of blood-brain barrier damage and posttreatment bleeding.

Related: Standard vs Intensive Emergency Stroke Treatment

“The biggest impact of this research is that information from MRI scans routinely collected at a number of research hospitals and stroke centers can inform treating physicians on the risk of bleeding,” said one of the study authors, Richard Leigh, MD, a scientist with the National Institute of Neurological Disorders and Stroke.

Patients who have had ischemic strokes often receive endovascular treatment along with tissue plasminogen activator (T-PA) to break up clots in the brain, but bleeding is a serious risk. T-PA has a distinct window of effectiveness, but less is known about endovascular treatment. A new imaging method may help resolve that by identifying stroke patients who are not likely to benefit from endovascular surgery.

Related: Percutaneous Endovascular Treatment of Subclavian Steal Syndrome

Researchers from the National Institute of Neurological Disorders and Stroke, Bethesda, MD; Stanford University, Palo Alto, CA; University of Melbourne, Australia, collected brain scans from more than 100 patients before they underwent endovascular therapy, within 12 hours of the stroke. Using a new method of image processing, the researchers got detailed measurements on just how much a stroke disrupts the blood-brain barrier and combined those measurements with findings from the DEFUSE-2 study (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution).

They found that large degrees of blood-brain barrier disruption were associated with severe bleeding following endovascular surgery. Extensive breakdown of the blood-brain barrier was associated with parenchymal hematoma, which 24 of the 100 patients in the study experienced. The study also showed a link between the location of blood-brain barrier damage and posttreatment bleeding.

Related: Standard vs Intensive Emergency Stroke Treatment

“The biggest impact of this research is that information from MRI scans routinely collected at a number of research hospitals and stroke centers can inform treating physicians on the risk of bleeding,” said one of the study authors, Richard Leigh, MD, a scientist with the National Institute of Neurological Disorders and Stroke.

Patients who have had ischemic strokes often receive endovascular treatment along with tissue plasminogen activator (T-PA) to break up clots in the brain, but bleeding is a serious risk. T-PA has a distinct window of effectiveness, but less is known about endovascular treatment. A new imaging method may help resolve that by identifying stroke patients who are not likely to benefit from endovascular surgery.

Related: Percutaneous Endovascular Treatment of Subclavian Steal Syndrome

Researchers from the National Institute of Neurological Disorders and Stroke, Bethesda, MD; Stanford University, Palo Alto, CA; University of Melbourne, Australia, collected brain scans from more than 100 patients before they underwent endovascular therapy, within 12 hours of the stroke. Using a new method of image processing, the researchers got detailed measurements on just how much a stroke disrupts the blood-brain barrier and combined those measurements with findings from the DEFUSE-2 study (Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution).

They found that large degrees of blood-brain barrier disruption were associated with severe bleeding following endovascular surgery. Extensive breakdown of the blood-brain barrier was associated with parenchymal hematoma, which 24 of the 100 patients in the study experienced. The study also showed a link between the location of blood-brain barrier damage and posttreatment bleeding.

Related: Standard vs Intensive Emergency Stroke Treatment

“The biggest impact of this research is that information from MRI scans routinely collected at a number of research hospitals and stroke centers can inform treating physicians on the risk of bleeding,” said one of the study authors, Richard Leigh, MD, a scientist with the National Institute of Neurological Disorders and Stroke.

Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.

The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.

Related: Meta-Analysis Examines Quality of VA Health Care

At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.

Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.

Related: Pharmacists in the Emergency Department: Feasibility and Cost

For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.

However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”

Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments

Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.

The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.

Related: Meta-Analysis Examines Quality of VA Health Care

At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.

Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.

Related: Pharmacists in the Emergency Department: Feasibility and Cost

For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.

However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”

Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments

Despite staff and budget reductions, local health departments (LHDs) are finding ways to expand services in some areas, according to a survey by the National Association of County and City Health Officials (NACCHO). One-third of LHDs reported reducing services of at least 1 program area, such as immunization, diabetes screening, and high blood pressure screening. However, one-fourth said they were expanding population-based preventive programs for obesity, drug, alcohol, and tobacco.

The association has periodically surveyed LHDs since 2008 to assess the impact of the economic recession. In 2014, NACCHO renamed the survey “The Forces of Change” and expanded it to take in a wider range of factors. The 16-question online survey, distributed during January-February 2015, went to 948 LHDs in the U.S. (excluding Rhode Island and Hawaii, which have no LHDs), representing one-third of all LHDs. Of the 690 top executives who responded, 353 represented small, 271 medium, and 66 large LHDs.

Related: Meta-Analysis Examines Quality of VA Health Care

At the peak of budget cuts, in 2009, 45% reported budget decreases. Since then, about 1 in 4 LHDs is still reporting budget cuts compared with the previous year; 27% expect budget decreases to continue into the next year.

Since 2008, NACCHO says, 51,700 jobs have been lost. More than half the 3,400 lost in 2014 were due to attrition; the rest to layoffs. The number of lost jobs was “most marked” among large LHDs: Sixty-one percent of those reported at least 1 job lost, followed by 41% of medium and 26% of small LHDs.

Related: Pharmacists in the Emergency Department: Feasibility and Cost

For many LHDs, “the cumulative effects of budget cuts and job losses” have not been reversed as the economy recovered. Some are trying creative workarounds, such as collaborations with primary care providers (PCPs). For example, 61% report actively encouraging PCPs to use evidence-based public health services, such as interventions to reduce asthma triggers.

However, < 10% of LHDs were actively engaged in new systems of care with PCPs, such as State Innovation Models (multipayer health care payment and service delivery models), patient-centered medical homes, or accountable care organizations (networks of health care providers voluntarily responsible for providing coordinated care). And < 70% are engaged in or exploring partnerships with nonprofit hospitals, which NACCHO says “might benefit multiple stakeholders and the community at large.”

Related: Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments

The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.

Related: Are Periodic Endoscopies Useful for Patients Under 40?

To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024,  the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.

Related: Do Age and Gender Matter in Colorectal Cancer?

The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.

“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.” 

The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.

Related: Are Periodic Endoscopies Useful for Patients Under 40?

To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024,  the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.

Related: Do Age and Gender Matter in Colorectal Cancer?

The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.

“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.” 

The U.S. health care system has the capacity to screen as many as 80% of eligible adults for colorectal cancer, which would meet national goals for 2018. Unfortunately, not enough people are getting screened: Only half of adults in the U.S. are up-to-date on screening, according to the CDC.

Related: Are Periodic Endoscopies Useful for Patients Under 40?

To find out whether the screening capacity would be up to the task, CDC researchers estimated the number of colonoscopies or fecal immunochemical tests (FITs) that would be necessary every year to screen 80% of adults aged between 50 and 75 years. To accomplish this goal by 2024,  the researchers say a national screening program that began in 2014 would need about 47 million FIT procedures and 5.1 million colonoscopies annually, using FIT as the primary screening test. About 11 to 13 million colonoscopies would be needed if a colonoscopy-only screening program were used.

Related: Do Age and Gender Matter in Colorectal Cancer?

The researchers also used data from the 2012 Survey of Endoscopic Capacity, which estimated that about 15 million colonoscopies were performed in 2012 and 10.5 million more could be performed every year.

“Colorectal cancer is the second leading cancer killer for men and women in the U.S.,” said Djenaba Joseph, MD, MPH, medical director of CDC’s colorectal cancer control program and lead author of the study paper, “but it doesn’t have to be.”