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Category Archives: Health

Malaria Mosquitoes like People With Malaria|Why ?

Malaria mosquitoes prefer to feed — and feed more — on blood from people infected with malaria. Researchers from Stockholm University, the Swedish University of Agricultural Sciences and KTH Royal Institute of Technology have discovered why. The findings can lead to new ways to fight malaria without using poisonous chemicals. The results will be published in the next issue of the journal Science.

“The malaria parasite produces a molecule, HMBPP, which stimulates the human red blood cells to release more carbon dioxide and volatile compounds with an irresistible smell to malaria mosquitoes. The mosquito also eats more blood,” says Ingrid Faye at Stockholm University.Ingrid Faye and her colleagues from the Swedish University of Agricultural Sciences and KTH Royal Institute of Technology discovered that most malaria mosquitoes, were attracted by HMBPP-blood, even at very low concentrations.

The mosquitoes are also attracted more quickly and drink more blood. Moreover, these mosquitoes acquire a more severe malaria infection, i.e. higher numbers of parasites are produced. This indicates that the extra nutrients from the larger meal of blood are used to produce more parasites, researchers believe. Neither humans nor mosquitoes use HMBPP themselves, but the parasite needs the substance to be able to grow.”HMBPP is a way for the malaria parasite to hail a cab, a mosquito, and successfully transfer to the next host,” Noushin Emami explains. She has worked over three years in the project and has performed a large part of the complicated practical work with the parasites and the mosquitoes at Stockholm University and at the Swedish University of Agricultural Sciences in Alnarp.

“This seems to be a well-functioning system, developed over millions of years, which means that the malaria parasite can survive and spread to more people without killing the hosts,” says Ingrid Faye at Stockholm University.

These results may be useful in combatting malaria. Today the most efficient way is to use mosquito nets and insecticides to prevent people being bitten. Resistance against the insecticides require new control methods to be developed to tackle the mosquitoes. In addition, medicines, even the drug awarded with the 2015 Nobel Prize, become progressively inefficient when the parasite becomes resistant to them and new drugs must be developed constantly. A vaccine seems far away, Ingrid Faye says. A major step forward in the fight against malaria would be to create a trap that uses the parasite’s own system for attracting malaria mosquitoes.

Why We Get Hangovers?

Pounding headache, dry mouth, queasy stomach: You feel like you’re dying. But if you had a few too many drinks last night, you probably just have a hangover.

Beyond the fatigue and massive headache, physical symptoms of a hangover include increased sensitivity to light and sound, muscle aches, eye redness, and thirst, according to the National Institute on Alcohol Abuse and Alcoholism. You may also find yourself feeling sweaty, dizzy, and extra- irritable.

Such side effects usually set in several hours after you’ve stopped drinking, as your blood alcohol level (BAC) falls, and they peak when your BAC reaches zero. Some researchers explain the correlation as a “kind of mini withdrawal,” Robert Swift, PhD, professor of psychiatry and human behavior at Brown University and director of research at the Providence Veterans Administration Medical Center, told Newsweek. Hangover symptoms, which can last the entire following day, are similar to those that alcoholics experience when they stop drinking.

Blame Your Hangover On the Congeners

Congeners are chemical byproducts of the alcohol fermentation process, found more prominently in darker liquor such as red wine, bourbon, brandy, whiskey, and dark-colored beers. Think of them as your worst hangover nightmare. While they enhance the taste and smell of the alcohol, researchers believe congeners, essentially toxins to the body, also lead to hangovers. A 2009 study found that people who drank bourbon (which contains 37 times more congeners than vodka) experienced a more severe hangover than those who drank similar amounts of vodka.

But that doesn’t mean you should go around slugging vodka sodas all night. You can still get a hangover from drinking clear alcoholic beverages (vokda, gin, white wine, light-colored beers) if you drink too much of it.

The Science Behind the Symptoms

Biologically, hangover woes mostly come down to dehydration. “Alcohol is a diuretic, which means that it helps the body get rid of fluids. When you have a severe hangover, you’re often severely dehydrated, and the body can’t get rid of the byproducts of metabolizing alcohol (metabolites). And those metabolites are irritating,” Brandon Browne, MD, a staff physician in the department of emergency medicine at Scott & White Healthcare in Round Rock, Tex., told HealthDay. It’s the dehydration that causes the fatigue, dry mouth, nausea, and vomiting.

Aside from the severe lack of water in your body, Yul Ejnes, MD, chair of the American College of Physicians Board of Regents, notes that drinking heavily irritates the stomach lining, relaxes the muscles of the lower esophagus (causing reflux), and has a depressing effect on brain cells (hence the lack of coordination, decreased response time, and dizziness). It also lowers your blood sugar, and being hypoglycemic can also leave you feeling weak.

Why Do Some People ‘Never’ Get Hangovers?

Everyone has at least one friend who claims to never get hangovers. While it might be genetic, it’s more likely those people simply drink smartly. Individuals respond differently to alcohol, based on factors like body size, how fast you drink, and the amount of food and water you consume during a night out. Metabolism has something to do with it, too, Dr. Ejnes points out. The speed at which alcohol and its byproducts are metabolized can affect your level of drunkenness and the severity of your hangover.

On the other hand, some people may be genetically prone to get hangovers. “Some people break down a product of alcohol metabolism called acetaldehyde slowly, resulting in flushing and nausea from drinking alcohol,” says Ejnes. Research shows that this genetic trait occurs in almost half of people of Asian descent.

So, How Do You Prevent a Hangover?

The only surefire way not to get a hangover is to watch how much you drink (sorry). But chugging a glass of water between each alcoholic beverage is a great way to combat the dehydration. And it makes things a lot more bearable if you don’t have to wake up early the next morning. Getting enough sleep after a night of drinking can also help mitigate symptoms such as fatigue and headache, given the disruption of sleep caused by the alcohol, Ejnes says. You should also try to eat a meal before you hit the bar, so your body doesn’t absorb the alcohol as quickly as it would on an empty stomach. In the morning, drink lots water and eat something high carb and high sugar, such as toast with honey, to boost your blood sugar. Don’t overdo it on caffeine, but if you’re a java-addict, remember to have your morning cup of joe to avoid going through coffee withdrawal on top of your hangover.

A number of so-called hangover cures and preemptive products, from patches to effervescent tablets, have also hit the market. They claim to ease and prevent the dreaded morning after, but the health benefits aren’t proven.

Why Asparagus Make Pee Smell Funny?

For all of its health benefits (it has plenty of fiber and protein, and it acts as a diuretic to help beat bloating),asparagus can have one major downfall: It can make your pee smell funky.

So what’s to blame for the cooked-cabbage aroma? “Your body breaks down asparagus during digestion into sulfur-containing chemicals that give your urine a distinctive odor,” explains Roshini Raj, MD, assistant professor of medicine at New York University Langone Medical Center and author of What the Yuck?!.

Not everyone is affected, though: Dr. Raj says that only about half of people complain about, er, report the funny smell.

Scientists have developed two theories to explain why asparagus-tainted urine only affects some people. One posits that only some people metabolize asparagus’ sulfuric compounds in a way that produces the aroma. The other holds that while everyone makes the smell, only some people can actually detect the odor.

In a study published in the journal Chemical Sense, researchers from the Monell Chemical Senses Center in Philadelphia sought to determine which explanation was the more likely. They collected urine samples from 38 participants before and after they ate asparagus, then asked whether the participants could detect the smell.

They found that both theories held true: 8 percent of the participants did not produce funny-smelling pee, and 6 percent of the participants could not smell it (even though some produced it).

While you may think not smelling the asparagus pee is a good thing, the researchers suggest that failing to pick up on the scent might be potentially dangerous, because it may indicate an inability to detect other important odors. “This is one of only a few examples to date showing genetic differences among humans in their sense of smell,” study co-author Danielle Reed, PhD, a Monell behavioral geneticist, said in a press release. “Specifically, we have learned that changes in an olfactory receptor gene can have a large effect on a person’s ability to smell certain sulfurous compounds. Other such compounds include mercaptan, the chemical used to add odor to natural gas so that people are able to detect it.”

So is there any way to minimize the offensive aroma? In a word, no, that is unless you avoid eating the stalky vegetable altogether. Given the abundance of fiber, folate, and vitamins A, C and K in asparagus, it may be worth putting up with a few unpleasant whiffs to reap all of its healthy advantages.

Scientists identify mechanisms

A study led by UT Southwestern Medical Center researchers has uncovered key molecular pathways behind the disruption of the gut’s delicate balance of bacteria during episodes of inflammatory disease.

“A deeper understanding of these pathways may help in developing new prevention and treatment strategies for conditions such as inflammatory bowel disease (IBD) and certain gastrointestinal infections and colorectal cancers,” said Dr. Sebastian Winter, Assistant Professor of Microbiology and a W.W. Caruth, Jr. Scholar in Biomedical Research at UT Southwestern, who led the study.

More than 1 million people in the U.S. suffer from IBD, a chronic, lifelong inflammatory disorder of the intestines that has no cure or means of prevention.

The findings, published online today in Cell Host & Microbe, explain a critical mechanism behind the changes in the gut during intestinal inflammation, an issue that had previously been unclear to scientists.

“We found that gut inflammation correlates with a change in the nutrients available to the bacteria,” said Elizabeth Hughes, a graduate student in the Winter Lab and co-first author of the study.

A healthy human gut is teeming with microbes, with bacterial cells outnumbering other cells in the body by 10-to-1. For most of a person’s life, these microbial communities, or microbiota, facilitate digestion, protect against infections, and orchestrate the development of a healthy immune system.

During episodes of intestinal inflammation — which can occur during IBD and gastrointestinal infections and cancers — the composition of these gut microbial communities is radically disturbed.

“Beneficial bacteria begin to dwindle in numbers as less beneficial, or even harmful, bacteria flourish,” said Ms. Hughes. “This imbalance of microbiota is believed to exacerbate the inflammation.”

A healthy gut is devoid of oxygen. The beneficial bacteria that live there are well-adapted to the low-oxygen environment and break down fiber through fermentation. Unlike these beneficial bacteria, potentially harmful E. coli grow better in high-oxygen environments.

“Inflammation changes the environment so that it is no longer perfect for the commensal anaerobes, but perfect for opportunistic E. coli, which basically wait for an ‘accident’ like inflammation to happen,” Dr. Winter explained.

The increased availability of oxygen during inflammation helps E. coli thrive in an inflamed gut through a metabolic “trick,” Ms. Hughes said.

“Through respiration, the abundant waste products generated by the beneficial microbes can be ‘recycled’ by commensal E. coli — which do not grow well on fiber — and turned into valuable nutrients, thus fueling a potentially harmful bloom of the E. colipopulation,” she explained.

Learning more about the forces behind disease-related shifts in the gut’s bacterial composition provides insights into treatment targets and diagnostic resources. This understanding could lead to more effective treatments for IBD and inflammation-associated colorectal cancers. New drugs might, for example, inhibit this particular metabolic function of E. coli.

“If we interfere with the production of waste products by the beneficial commensal bacteria, then we impede their metabolism, which causes them to grow more slowly and throw off the entire ecosystem,” Dr. Winter said. “The most effective strategy may be to inhibit commensal E. coli‘s unique metabolism to avoid the bloom and negative impacts.”

Dr. Winter and his research team continue to study these mechanisms.

Sitting Too Long Raises Death Risk

According to a new study published in the Archives of Internal Medicine, sitting for long periods increases your risk of all-cause early death. (Now would definitely be the time to stand up.)

In the study, researchers followed 222,497 Australian adults for several years. Over the course of the study, participants who sat for more than 11 hours a day had the highest risk for all-cause mortality, followed by those who sat between 8 and 11 hours daily. Those who sat for less than four hours a day had the lowest risk of all-cause mortality.

The revelation that sitting can kill isn’t necessarily new. In the past several years, study after study has confirmed that living a sedentary life — going from your bed to your desk to the couch and back to bed every day — can damage our health in a variety of ways. In fact, it has been shown to increase risk for heart disease, obesity, diabetes, dementia, and some cancers.

Another recent study actually found that sitting is so detrimental, its effects are almost impossible to exercise away. The study followed 27 Finnish men and women over two days. On the first day, they exercised; on the second day, they did not. When researchers measured the muscle activity and heart rate of the participants, they found that though they burned calories through exercise, it did not increase their overall muscle activity. Researchers also found that desk workers’ muscles are inactive for about 70 percent of the day — regardless of whether the day includes any fitness training.

The takeaway: Reduce the amount of time you spend sitting however possible. Try these tips to up your daily activity:

  • Walk more. One of the simplest ways to offset the effects of sitting is to walk. If you can, walk or bike to work instead of driving. If you take public transportation, get off a few stops earlier to squeeze in more steps — experts recommend buying a pedometer and aiming for 10,000 daily steps.
  • Stand up at work. Experts estimate that standing burns 50 percent more calories than sitting, so whenever possible, think on your feet on the job. Stand during meetings, while you’re on the phone, and depending on the type of work you do, consider adding a standing desk to your office.
  • Fidget while you work. According to researchers at the Minnesota Obesity Center, fidgeting might be what separates thin people from overweight people. To increase your daily activity, make a point to get up and walk around your office every half an hour, if possible.
  • Make TV time active. Instead of vegging out on the couch when you get home, add activity to your evenings by doing jumping jacks, pushups, crunches, and other fat-blasting moves during commercial breaks of your favorite shows.

Global Warming May Pose Health Risks

Medical and public health groups are banding together to explain how global warming has taken a toll on human health and will continue to cause food-borne illnesses, respiratory problems, and deaths unless policy changes are enacted.

In a conference call with reporters, the heads of the American Medical Association (AMA) and the American Public Health Association (APHA) joined with a pediatrician and a scientist to lay out what they say is a major public health issue: climate change caused by global warming.

The “evidence has only grown stronger” that climate change is responsible for an increasing number of health ills, including asthma, diarrheal disease, and even deaths from extreme weather such as heat waves, said Dr. Georges Benjamin, executive director of the APHA.

For one, rising temperatures can mean more smog, which makes children with asthma sicker, explained pediatrician Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, in New York.

There is also evidence that pollen season is also getting longer, she said, which could lead to an increase in the number of people with asthma.

Climate change also is thought to lead to increased concentrations of ozone, a pollutant formed on clear, cloudless days. Ozone is a lung irritant which can affect asthmatics, those with chronic obstructive pulmonary disease, and those with heart disease, said Dr. Kristie Ebi, who is a member of the Intergovernmental Panel on Climate Change.

More ozone can mean more health problems and more hospital visits, she said.

Aside from air-related ailments and illnesses, extreme weather can have a devastating effect on health, Sheffield said.

“As a result of global warming, extreme storms including hurricanes, heavy rainfall, and even snowstorms are expected to increase,” Sheffield said. “And these events pose risk of injury and disruption of special medical services, which are particularly important to children with special medical needs.”

Extreme heat waves and droughts are responsible for more deaths than any other weather-related event, Sheffield said.

The 2006 heat wave that spread through most of the U.S. and Canada saw temperatures that topped 100 degrees. In all, 450 people died, 16,000 visited the emergency room, and 1,000 were hospitalized, said Dr. Cecil Wilson, president of the AMA.

Climate change has already caused temperatures to rise and precipitation to increase, which, in turn, can cause diseases carried by tics, mosquitoes, and other animals to spread past their normal geographical range, explained Ebi.

For instance, Lyme disease is increasing in some areas, she said, including in Canada, where scientists are tracking the spread of Lyme disease north.

Ebi also recounted the 2004 outbreak of the leading seafood-related cause of gastroenteritis, Vibrio parahaemolyticus, from Alaskan seafood, which was attributed to increased ocean temperatures causing infected sea creatures to travel 600 miles north.

Salmonella outbreaks also increase when temperatures are very warm, Sheffield said.

A 2008 study also projected that global warming will lead to a possible increase in the prevalence of kidney stones due to increased dehydration, although the link hasn’t been proven.

Wilson said the AMA wants to make doctors aware of the projected rise in climate-related illnesses. To combat climate change, Wilson says physicians and public health groups can advocate for policies that improve public health, and should also serve as role models by adopting environmentally-friendly policies such as eliminating paper waste and using energy-efficient lighting in their practices.

“Climate instability threatens our health and life-supporting system, and the risk to our health and well-being will continue to mount unless we all do our part to stabilize the climate and protect the nation’s health,” said Wilson.

Benjamin added that doctors should pay attention to the Air Quality Index. For instance, if there’s a “Code Red” day, which indicates the air is unhealthy, physicians should advise patients (particularly those with cardiac or respiratory conditions) that it’s not the day to try and mow the grass.

“ER docs are quite aware of Code Red days because we know that when those occur, we’re going to see lots of patients in the emergency room,” Benjamin said.

The conference call came as Congress is considering what role the Environmental Protection Agency (EPA) should have in updating its safeguards against carbon dioxide and other pollutants.

While the EPA has the authority to regulate levels of CO2, a budget bill passed by the House of Representatives last the weekend prohibited the EPA from exercising that authority. Meanwhile, other bills are pending in Congress that would significantly delay the agency’s ability to regulate air pollutants.

AMA has a number of policies on the books regarding climate change, including a resolution supporting the EPA’s authority to regulate the control of greenhouse gases, and a statement endorsing findings from the most recent Intergovernmental Panel on Climate Change report that concludes the Earth is undergoing adverse climate changes, and that humans are a significant contributor to the changing weather.

In that statement, the AMA said it supports educating the medical community about climate change and its health implications through medical education on topics such as “population displacement, heat waves and drought, flooding, infectious and vector-borne diseases, and potable water supplies.”

The statement also said the AMA supports physician involvement in policymaking to “search for novel, comprehensive, and economically sensitive approaches to mitigating climate change to protect the health of the public.”

Head Injuries Carry Long Term

The risk of death after head injury remained significantly increased for as long as 13 years, irrespective of the severity of the injury, results of a case-control study showed.

Overall, patients with a history of head injury had more than a twofold greater risk of death than did two control groups of individuals without head injury.

Among young adults, the risk disparity ballooned to more than a fivefold difference, Scottish investigators reported online in the Journal of Neurology, Neurosurgery and Psychiatry.

“More than 40% of young people and adults admitted to hospital in Glasgow after a head injury were dead 13 years later,” Dr. Thomas M. McMillan, of the University of Glasgow, and coauthors wrote in the discussion of their findings. “This stark finding is not explained by age, gender, or deprivation characteristics.”

“As might be expected following an injury, the highest rate of death occurred in the first year after head injury,” they continued. “However, risk of death remained high for at least a further 12 years when, for example, death was 2.8 times more likely after head injury than for community controls.”

Previous studies of mortality after head injury have focused primarily on early death, either during hospitalization or in the first year after the injury. Whether the excess mortality risk persists over time has remained unclear, the authors noted.

Few studies have compared mortality after head injury with expected mortality in the community. To provide that missing context, McMillan and coauthors conducted a case-control study involving 757 patients who incurred head injuries of varying severity from February 1995 to February 1996 and were admitted to a Glasgow-area hospital.

For comparison, the investigators assembled two control groups, both matched with the cases for age, sex, and socioeconomic status and one matched for duration of hospitalization after injury not involving the head.

One control group was comprised of persons hospitalized for other injured and other comparison group included healthy non-hospitalized adults.

The cases comprised 602 men and 155 women who had a mean age of 43, and almost 70 percent were in the lowest socioeconomic quintile.

At the end of follow-up, 305 of the head-injured patients had died, compared with 215 of the hospitalized control group, and 135 of healthy, non-hospitalized adults.

Mortality after one year remained significantly higher in the head-injury group—34 percent versus 24 percent among the hospitalized comparison group and 16 percent for the healthy non-hospitalized adults.

Overall, the head-injury group had a death rate of 30.99/1,000/ year versus 13.72/1,000/year in the community controls and 21.85/1,000/year in the hospitalized-other injury control group.

The disparity was greater among younger adults (15 to 54), who had a rate of 17.36/1,000/year versus 2.21/1,000/year in the community controls. Older adults in the head injury group had a death rate of 61.47/1,000/year compared with 39.45/1,000/year in the community controls.

“Demographic factors do not explain the risk of death late after head injury, and there is a need to further consider factors that might lead to health vulnerability after head injury and in this way explain the range of causes of death,” the authors wrote in conclusion. “The elevated risk of mortality after mild head injury and in younger adults makes further study in this area a priority.”

Time of Surgery Doesn’t Influence

The timing of an operation doesn’t affect a patient’s subsequent risk of complications or death, a new study finds.

For example, there’s no difference in death rates between elective surgery performed in the afternoon versus the morning or on Monday instead of Friday, the researchers said. Their findings should help to ease concerns that fatigue may lead to a higher rate of safety problems when operations are performed later in the day or week, they said.

The study included an analysis of the outcomes of more than 32,000 elective surgeries performed between 2005 and 2010. The overall complication rate before discharge was 13 percent, and the overall risk of death within 30 days of surgery was 0.43 percent.

After the researchers adjusted for other factors, the risk of complications or death was not significantly different for patients who had surgery at different times of the day — between 6 a.m. and 7 p.m. — or week.

The time of year also had no impact on the risk of complications or death. This included July and August, when most new residents start working in teaching hospitals.

The study appears in the December issue of the journal Anesthesia & Analgesia.

“Elective surgery thus appears to be comparably safe at any time of the workday, any day of the workweek, and in any month of the year in our teaching hospital,” Dr. Daniel Sessler, of the Cleveland Clinic, and colleagues concluded in a journal news release.

Some previous studies have suggested that patients are at greater risk if they undergo late-day surgery.

Health Reform Law Gaining

To be sure, Americans remain sharply divided over the legislation, with slightly more than one-third (36 percent) of adults saying they want the law repealed and 21 percent saying they want it to remain as is. Another 25 percent would like to see only certain elements of the law modified, the poll found.

“The public is still divided, mainly on partisan lines, as to whether to implement or repeal all, parts, or none of the health care reform bill,” said Harris Poll Chairman Humphrey Taylor.

The poll, conducted earlier this month, found that support for the legislation clearly breaks down along party lines. Almost two-thirds of Republicans (63 percent) said they wanted the Patient Protection and Affordable Care Act repealed, compared to 9 percent of Democrats.

But while poll respondents were split about the law as a whole, many strongly supported key elements of the bill, “with the notable exception of the individual mandate [the requirement that all adults purchase health insurance] which remains deeply unpopular,” Taylor said.

That support for certain components of the law seems to be increasing slowly with time. For instance, 71 percent of those polled now back the law’s provision that prevents insurance companies from denying coverage to those already sick. At the end of 2010, 64 percent supported this provision.

Other provisions that are showing a slow but steady rise in acceptance since November 2010 include:

  • Allowing children to stay on their parents’ insurance plans until they turn 26 — 57 percent in January 2012 versus 55 percent in November 2010.
  • Creating insurance exchanges where people can shop for insurance — 59 percent versus 51 percent.
  • Providing tax credits to small businesses to help pay for their employees’ insurance — 70 percent versus 60 percent.
  • Requiring all employers with 50 or more employees to offer insurance to their employees or pay a penalty — 53 percent versus 48 percent.
  • Requiring research to measure the effectiveness of different treatments — 53 percent versus 44 percent.
  • Creating a new Independent Payment Advisory Board to limit the growth ofMedicare spending — 38 percent versus 32 percent.

But the most controversial aspect of the law — the so-called individual mandate that requires all adults to have health insurance or face a fine — remains widely unpopular, with only 19 percent of those polled supporting it.

The U.S. Supreme Court is scheduled to hear arguments on the constitutionality of the law starting in late March.

“It’s clear that people really appreciate key reforms that are in the Affordable Care Act and it demonstrates how important it is for people to know that those reforms actually are embodied in the legislation,” said Ron Pollack, executive director of Families USA, a Washington, D.C.-based nonprofit, nonpartisan group that says it’s dedicated to quality, affordable health care for all Americans.

The problem is that many people don’t know what’s actually in the law, as previous polls, including some conducted by Harris Interactive/HealthDay, have shown.

“People do not understand the health reform bill,” said John Goodman, president of the National Center for Policy Analysis, a conservative public policy research organization in Dallas that says it backs private alternatives to government regulation and control. “This reflects a failure all the way around on the part of backers of the bill, critics and the health-care media. No one’s explained how this works.”

Pollack pointed out that some provisions of the Affordable Care Act aren’t scheduled to take effect until 2014.

The poll also found that, by a 55 percent to 45 percent margin, people think health care reform should be addressed by each state separately, rather than at the federal level.

A fair amount of the current Republican primary race to challenge President Obama in the November election has focused on pledges to repeal much or all of the health care act.

Slightly more than half of those polled — including 61 percent of Republicans — said they knew that when Mitt Romney was governor of Massachusetts he supported a law that provides health insurance to many people in the state. The law is similar to the federal law signed by Obama in March 2010.

Most poll respondents said they had little or no idea what the Massachusetts law has — and has not — accomplished. The legislation, which includes an individual mandate, has provided coverage to a majority of state residents, is popular with most people in the state, but has yet to contain costs.

The poll was conducted online Jan. 17-19 with 2,415 adults 18 years of age and older. Figures for age, sex, race/ethnicity, education, region and household income were weighted, where necessary, to bring them into line with their actual proportions of the U.S. population. So-called “propensity score weighting” was also used to adjust for respondents’ likelihood to be online.

How best to treat infections and tumors ?

In cases where drug resistance can lead to treatment failure, new research shows that therapies tailored to contain an infection or a tumor at tolerable levels can, in some cases, extend the effective life of the treatment and improve patient outcomes. In other cases, aggressive treatments aimed at eliminating as much of the infection or tumor as possible — the traditional approach — might be best. But how can we know which stands the better chance of working?

A new mathematical analysis by researchers at Penn State University and the University of Michigan, publishing February 9, 2017, in the Open-Access journal PLOS Biology, identifies the factors that determine which of the two approaches will perform best, providing physicians and patients with new information to help them make difficult treatment decisions.

“People die when their infections or tumors become drug resistant,” said Andrew Read, Evan Pugh Professor of Biology and Entomology and Eberly Professor of Biotechnology at Penn State and an author of the study. “We analyzed when it might be better to use drugs to contain rather than try to eliminate the infection or tumor. We find there are situations where containment would keep the patient alive longer, but also situations where it would make a dire situation even worse. That means using (and testing) the containment strategy needs to be done very carefully, but if done right, it could help patients with life-threatening infections and tumors live longer.”

The researchers compared the two treatment strategies with the goal of maximizing the amount of time until the treatment failed due to the development of drug resistance. For most infections and tumors, people can tolerate a certain amount of the pathogen without ill effects. For the analysis, a patient was considered healthy and the infection or tumor was considered to be managed if it was maintained at or below this level of “acceptable burden.” Treatment failed if the pathogen level rose above this level. The analysis showed that the treatment leading to the longest time until treatment failure will depend on the specific characteristics of the disease, or even of the patient being treated, but it provides a framework that doctors and patients can use to make more-informed decisions about treatments.

“There are situations where we can be relatively sure that treatment will completely eliminate the infection or tumor, so aggressive treatment is the obvious choice” said Elsa Hansen, a research associate at Penn State and an author of the paper. “On the opposite end of the spectrum, there are low-level situations like urinary-tract or ear infections where a doctor may decide not to treat at all. The majority of cases, however, are somewhere in between and require hard choices that balance the damage caused by the infection or tumor and the risk of mutation with the damage caused by the treatment itself and the risk of developing uncontrollable resistance. Our analysis provides guidance for making these decisions from a standpoint of maximizing patient well-being.”

The researchers focused on two main factors that influence whether or not an infection or tumor will develop drug resistance. The first is the rate at which cells that are initially sensitive to a particular treatment become resistant. The second factor is called “competitive suppression” and refers to the fact that the spread of resistance, once it appears, can be slowed through competition for resources with cells that are sensitive to treatment. More cells that still respond to treatment leads to more competition to prevent the spread of resistant cells, but it also means a greater risk of the sensitive cells developing resistance.

“The standard practice has been to treat infections and tumors as aggressively as possible to minimize the risk of cells becoming resistant,” said Read, “but our analysis shows that, in many situations, containing the infection or tumor to allow for competitive suppression of resistant cells can increase the time to treatment failure. Of course, the opposite can also be true, so determining which approach will be best has to be done carefully and on a case-by-case basis.”