Eco-friendly inhalers will cost kids with asthma more green
For the 6.5 million American children with asthma, newly mandated environmentally friendly inhalers will come at a greater cost to low- and middle-income families. Most will see a significant increase in their prescription co-payments or out-of-pocket costs, especially since a generic version of the medication will not be available.
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The transition from chlorofluorocarbon (CFC) albuterol metered dose inhalers to hydroflouroalkane (HFA) inhalers is an important one, but it could amount to a 200- to 400-percent increase in out-of-pocket costs for insured patients, Dr. Harvey Leo, a pediatric allergist at C.S. Mott Children’s Hospital, writes in the current issue of the Journal of Allergy and Clinical Immunology.
Federal programs that help low-income families obtain asthma medications also are expected to see a two- to three-fold increase in cost since no generic medication will be available, he says.
With increased costs and more than 650,000 children with asthma who are uninsured, Leo, adjunct clinical professor in the Department of Pediatrics and Communicable Diseases at C.S. Mott Children’s Hospital and assistant research scientist at the Center for Managing Chronic Disease, School of Public Health, worries that patients may try to save money by purchasing less effective medications or using their medications less frequently than prescribed. He says such changes in recommended treatment plans ultimately would lead to increased risk for children with asthma, and the need for more urgent and costly care.
Even families with insurance that once paid $5 or $10 co-pays for generic prescriptions may find themselves paying $20-$50 per prescription, since no generic HFA inhalers will be available.
Additional authors include Dr. Kevin Dombkowski and Noreen Clark, of the C.S. Mott Children’s Hospital Child Health Evaluation and Research Unit.
Coating for biomedical devices lets them interact with live cells
A new type of plastic coating made from vapor could lead to better biomedical devices such as stents and catheters that are “bioactive,” meaning they can interact with the living cells around them in unique ways.
The coating binds to a broad range of materials including glass, stainless steel, Teflon and silicon. More like a paint layer than a blanket, it is able to preserve the precise shape of the device it covers. The outer surface of the coating can be made to attract or repel certain molecules such as platelets or proteins.
“You need to have biological signatures that can actively mitigate the response of the body to the implant,” says Joerg Lahann, the Dow Corning Assistant Professor of Chemical Engineering. “In order to do that, you need to be able to bring biomolecules onto a substrate surface and immobilize them in a stable way. Think of these biomolecules as little anchors. Depending on what you choose as your anchors, you can produce a certain response.”
Stents that prop open arteries for heart patients don’t always effectively repel platelets, which could, in a worst-case scenario, lead to a blood clot. Catheters — tubes that drain fluid from the body — often are used temporarily after surgery. Doctors don’t want proteins to bind to the catheter. If binding occurs, the tube, in a sense, starts to grow into the body. This new coating can help prevent proteins from binding, Lahann says.
These applications call for the coating to be non-stick for proteins or cells. With different biomolecules dotted through the coating, it could act as a sensor, attracting certain molecules to it.
Lahann also is an assistant professor in the departments of Materials Science and Engineering, Biomedical Engineering, and Macromolecular Science and Engineering.
— Nicole Casal Moore, News Service
Potential association of type 2 diabetes genes with prostate cancer
Scientists have identified six new genes that play a part in the development of type 2 diabetes, and among the group is the second gene known also to play a role in prostate cancer.
The new findings bring the total number of genes or genomic regions implicated in diabetes to 16, says Laura Scott, assistant research scientist in the Department of Biostatistics. Researchers from U-M made up one of three teams of scientists in Europe and North America that led the multi-group collaboration.
The findings, which are published in the journal Nature Genetics, provide new insights into the mechanisms that usually are responsible for the control of glucose, or sugar, levels in the blood, and to the derangements that can result in type 2 diabetes, which impacts more than 170 million people worldwide.
One of the newly discovered genes, known as JAZF1, contains a separate variant that recently has been shown to play a role in prostate cancer, and is the second gene that appears to involve both conditions. The first identified overlap between genes for prostate cancer and type 2 diabetes was with HNF1B, which also is involved in an early onset form of diabetes discovered at U-M in an unrelated study, called Maturity Onset Diabetes of the Young (MODY). In HNF1B, the same variant associated with increased risk of diabetes is linked with decreased risk of prostate cancer. In JAZF1, the diabetes and prostate cancer variants reside in different parts of the gene and there is no known relationship between them.
“The remarkable recent progress in identifying regions of the genome that increase risk to diabetes — from 3 to 16 in only a year — will help us unravel the complex basis diabetes and may suggest new and better tailored methods to prevent or treat this disease,” says Michael Boehnke, Richard G. Cornell Collegiate Professor of Biostatistics and professor of biostatistics, the lead scientist on the Finland-United States Investigation of Non-Insulin-Dependent Diabetes Mellitus Genetics (FUSION) study group.
— Laura Bailey, News Service
Childhood leukemia survivors struggle with long-term side effects
Survival rates of childhood cancers, especially leukemia, have improved greatly in the past three decades, but survivors of this disease still seem to face many health and lifestyle challenges as young adults, according to a study in Blood, the official journal of the American Society of Hematology.
Each year about 3,000 new cases of acute lymphoblastic leukemia (ALL) are diagnosed in the United States and the estimated five-year survival rate is now greater than 80 percent. While therapies generally are very effective, previous studies have shown survivors still face chronic health conditions and quality of life challenges.
The population evaluated in this study was part of the Childhood Cancer Survivor Study (CCSS), a National Cancer Institute funded, multi-institutional cohort of 4,151 survivors.
The analysis found that for the five-year ALL survivors, the survival after 25 years was 87 percent. The treatment method as well as whether the cancer had relapsed in the first five years seemed to affect survival. Survivors treated with radiation therapy had an overall survival of 87 percent compared with 96 percent for those without radiation, and overall survival in those who relapsed within the first five years after diagnosis was just 63 percent, compared with 93 percent for those who did not relapse early.
At least half of survivors reported one or more chronic medical conditions compared with only 38 percent of their siblings. Importantly, survivors were 3.7 times more likely to have a severe or life-threatening medical condition and 2.8 times more likely to suffer from multiple chronic conditions than their siblings. These most often included musculoskeletal, cardiac and neurological conditions.
Survivors’ social and economic outcomes, including rates of marriage, college graduation and health insurance coverage, also were significantly lower than those of their siblings.
“As therapeutic interventions improve and more children beat leukemia, it’s important to work toward not only higher survival rates, but also improved overall wellness,” says Dr. Rajen Mody, assistant professor of pediatrics at the Medical School.
— American Society of Hematology news release
