Chronic Care, Integrated Care & Mental Health: Moving the Needle Now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts

The Economic Impact of Payer Policies after the Rx-to-OTC Switch of Second-Generation Antihistamines* *Preliminary results of this analysis were presented at the 9th annual HMO Research Network Conference April 1-2, 2003

AbstractObjectiveAs a result of the over-the-counter (OTC) introduction of loratadine, health plans have been struggling to determine the best policy to incorporate this change within their existing drug benefit structure for second-generation antihistamines (SGA). The objective of this study was to examine the economic impact of payer policies in response to the Rx-to-OTC switch of loratadine.Study DesignDecision analysis was used to model the budgetary impact and cost-effectiveness of four policies for SGA benefits for the managed care organization (MCO), employer, and Medicaid perspectives separately.Patients and MethodsOutcomes included direct medical costs and lost productivity (employers only), discounted, quality-adjusted life-years (QALYs) saved because of amelioration of allergic rhinitis symptoms and avoidance of unintentional injuries associated with the use of first-generation antihistamines (FGA). Bayesian probabilistic sensitivity analysis was conducted using second-order Monte Carlo simulation.ResultsProviding limited OTC and second-tier prescription benefits would cost approximately $0.13 and$0.30 compared to third-tier prescription benefits for employers and MCOs, respectively, and would save Medicaid $.02 per member per month (PMPM). Providing limited coverage for OTC loratadine while retaining second-tier prescription benefits for SGA was the optimal policy for a willingness to pay below$26,200 per QALY for all payers.ConclusionsOffering second-tier prescription and limited OTC benefits provides greater effectiveness and is not significantly more expensive PMPM than discontinuation. Some of the drug savings from limiting coverage of prescription SGA may be attenuated by the cost of lost productivity and direct medical expenditures due to unintentional injuries associated with increased FGA use in addition to the increased cost of therapeutic substitutes

Recovery of Minerales Monclova Minas V

Methane issuing from a roof-bolt hole ignited when the hot bit was withdrawn. Similar ignitions have occurred in other mines. This one differed in that flames spread quickly, coal was ignited, and, after three futile hours of applying inadequate water and extinguishing agents, the mine was sealed. Fires are fuel and ventilation controlled. In this mine there was an abundance of methane, coal, and wood lagging. Recovery of the mine, therefore, depended on successful control of its ventilation. The recovery was done without anyone suffering a scratch; a remarkable feat considering the abnormal methane outflows and concentrations, the continuing evidence of on-going thermal reactions, and what once were inexperienced but now amongst the best mine rescuemen

Connective Tissue Fibroblasts from Highly Regenerative Mammals Are Refractory to ROS-Induced Cellular Senescence

A surveillance system in mammals constantly monitors cell activity to protect against aberrant proliferation in response to damage, injury and oncogenic stress. Here we isolate and culture connective tissue fibroblasts from highly regenerative mammals (Acomys and Oryctolagus) to determine how these cells interpret signals that normally induce cellular senescence in non-regenerating mammals (Mus and Rattus). While H2O2 exposure substantially decreases cell proliferation and increases p53, p21, p16, and p19 in cells from mice and rats, cells from spiny mice and rabbits are highly resistant to H2O2. Quantifying oxygen consumption and mitochondrial stability, we demonstrate that increased intracellular H2O2 is rapidly detoxified in regenerating species, but overwhelms antioxidant scavenging in cells from non-regenerative mammals. However, pretreatment with N-acetylcysteine (NAC) protects mouse and rat cells from ROS-induced cellular senescence. Collectively, our results show that intrinsic cellular differences in stress-sensing mechanisms partially explain interspecific variation in regenerative ability

Genetic Approach to Elucidate the Role of Cyclophilin D in Traumatic Brain Injury Pathology

Cyclophilin D (CypD) has been shown to play a critical role in mitochondrial permeability transition pore (mPTP) opening and the subsequent cell death cascade. Studies consistently demonstrate that mitochondrial dysfunction, including mitochondrial calcium overload and mPTP opening, is essential to the pathobiology of cell death after a traumatic brain injury (TBI). CypD inhibitors, such as cyclosporin A (CsA) or NIM811, administered following TBI, are neuroprotective and quell neurological deficits. However, some pharmacological inhibitors of CypD have multiple biological targets and, as such, do not directly implicate a role for CypD in arbitrating cell death after TBI. Here, we reviewed the current understanding of the role CypD plays in TBI pathobiology. Further, we directly assessed the role of CypD in mediating cell death following TBI by utilizing mice lacking the CypD encoding gene Ppif. Following controlled cortical impact (CCI), the genetic knockout of CypD protected acute mitochondrial bioenergetics at 6 h post-injury and reduced subacute cortical tissue and hippocampal cell loss at 18 d post-injury. The administration of CsA following experimental TBI in Ppif-/- mice improved cortical tissue sparing, highlighting the multiple cellular targets of CsA in the mitigation of TBI pathology. The loss of CypD appeared to desensitize the mitochondrial response to calcium burden induced by TBI; this maintenance of mitochondrial function underlies the observed neuroprotective effect of the CypD knockout. These studies highlight the importance of maintaining mitochondrial homeostasis after injury and validate CypD as a therapeutic target for TBI. Further, these results solidify the beneficial effects of CsA treatment following TBI

Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>Our objective was to determine the cost-effectiveness of Continuous Glucose Monitoring (CGM) technology with intensive insulin therapy compared to self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States.</p> <p>Methods</p> <p>A Markov cohort analysis was used to model the long-term disease progression of 12 different diabetes disease states, using a cycle length of 1 year with a 33-year time horizon. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in quality-adjusted life years (QALYs). Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3$23,552, resulting in an ICER of approximately $45,033/QALY. For a willingness-to-pay (WTP) of$100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations.</p> <p>Conclusions</p> <p>CGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.</p

Role of Social Support and Ego Network Characteristics on Quality of Life: Implications for Persons Involved with Mental Health Courts

Mental health courts offer alternatives to incarceration for persons with severe mental illness who are involved in the criminal justice system. These courts have the dual function of ensuring treatment for persons involved in the court as well as ensuring the safety of the public. Persons with severe mental illness who are involved in mental health courts rely on others for support, such as family members. Others may buttress the participant from engaging in criminal activities and provide for needs of the participant. The supportiveness as well as the composition of one’s network members may play a role in the success of mental health court participants, such as successfully completing the mental health court program and avoiding incarceration. Little research has explored how social support impacts mental health court participants. We explored how the composition and sense of support of network members were associated with mental health court participants’ quality of life. We regressed quality of life on social support and network characteristics of 80 participants in two mental health courts. Findings suggest that perceived support is positively associated with quality of life, and the proportion of family in one’s network was negatively related to quality of life. Findings suggest that persons involved in mental health courts need supportive others in their social networks in addition to family. More research is needed to explore the reasons having a higher proportion of family members in one’s network is associated with lower quality of life. Practitioners need to pay attention to and leverage mental health court participants’ social networks to help improve their quality of life

Antimicrobial susceptibility profiles of Staphylococcus aureus isolates recovered from humans, environmental surfaces, and companion animals in households of children with community-onset methicillin-resistant S. aureus infections

Our objective was to determine the antibiotic susceptibility profiles of Staphylococcus aureus isolates recovered from 110 households of children with community-onset methicillin-resistant S. aureus (MRSA) infections. Cultures were obtained from household members, household objects, and dogs and cats, yielding 1,633 S. aureus isolates. The S. aureus isolates were heterogeneous, although more than half were methicillin resistant. The highest proportion of MRSA was found in bathrooms. The majority of isolates were susceptible to antibiotics prescribed in outpatient settings

Differential Leukocyte and Platelet Profiles in Distinct Models of Traumatic Brain Injury

Traumatic brain injury (TBI) affects over 3 million individuals every year in the U.S. There is growing appreciation that TBI can produce systemic modifications, which are in part propagated through blood–brain barrier (BBB) dysfunction and blood–brain cell interactions. As such, platelets and leukocytes contribute to mechanisms of thromboinflammation after TBI. While these mechanisms have been investigated in experimental models of contusion brain injury, less is known regarding acute alterations following mild closed head injury. To investigate the role of platelet dynamics and bioenergetics after TBI, we employed two distinct, well-established models of TBI in mice: the controlled cortical impact (CCI) model of contusion brain injury and the closed head injury (CHI) model of mild diffuse brain injury. Hematology parameters, platelet-neutrophil aggregation, and platelet respirometry were assessed acutely after injury. CCI resulted in an early drop in blood leukocyte counts, while CHI increased blood leukocyte counts early after injury. Platelet-neutrophil aggregation was altered acutely after CCI compared to sham. Furthermore, platelet bioenergetic coupling efficiency was transiently reduced at 6 h and increased at 24 h post-CCI. After CHI, oxidative phosphorylation in intact platelets was reduced at 6 h and increased at 24 h compared to sham. Taken together, these data demonstrate that brain trauma initiates alterations in platelet-leukocyte dynamics and platelet metabolism, which may be time- and injury-dependent, providing evidence that platelets carry a peripheral signature of brain injury. The unique trend of platelet bioenergetics after two distinct types of TBI suggests the potential for utilization in prognosis