HHS SAYS $212 MILLION WILL BE GOING TO PREVENT CHRONIC DISEASES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

September 25, 2014

HHS announces nearly $212 million in grants to prevent chronic diseases
Funded in part by the Affordable Care Act, grants focus on preventing tobacco use, obesity, diabetes, heart disease, and stroke

Health and Human Services Secretary Sylvia M. Burwell today announced nearly $212 million in grant awards to all 50 states and the District of Columbia to support programs aimed at preventing chronic diseases such as heart disease, stroke and diabetes.  Funded in part by the Affordable Care Act, the awards will strengthen state and local programs aimed at fighting these chronic diseases, which are the leading causes of death and disability in the United States, and help lower our nation’s health care costs.

A total of 193 awards are being made  to states, large and small cities and counties, tribes and tribal organizations, and national and community organizations, with a special focus on populations hardest hit by chronic diseases. The Centers for Disease Control and Prevention will administer the grants.

“These grants will empower our partners to provide the tools that Americans need to help prevent chronic diseases like heart disease, stroke, and diabetes,” said Secretary Burwell. “Today’s news is important progress in our work to transition from a health care system focused on treating the sick to one that also helps keep people well throughout their lives.”

The goals of the grant funding are to reduce rates of death and disability due to tobacco use, reduce obesity prevalence, and reduce rates of death and disability due to diabetes, heart disease, and stroke.

“Tobacco use, high blood pressure, and obesity are leading preventable causes of death in the United States,” said CDC Director Tom Frieden, M.D., M.P.H. “These grants will enable state and local health departments, national and community organizations, and other partners from all sectors of society to help us prevent heart disease, cancer, stroke, and other leading chronic diseases, and help Americans to live longer, healthier, and more productive lives.”

This is one of many ways the Affordable Care Act is improving access to preventive care, and coverage for people with pre-existing conditions. Under the Affordable Care Act, 76 million Americans in private health insurance have gained access to preventive care services without cost-sharing and issuers can no longer deny coverage to anyone because of a pre-existing condition.

Chronic diseases are responsible for 7 of 10 deaths among Americans each year, and they account for more than 80 percent of the $2.7 trillion our nation spends annually on medical care.

CDC REPORTS THAT DISABLED HAVE LESS ACTIVITY AND MORE CHRONIC DISEASE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Inactivity Related to Chronic Disease in Adults with Disabilities
Half of adults with disability get no aerobic physical activity
Working age adults with disabilities who do not get any aerobic physical activity are 50 percent more likely than their active peers to have a chronic disease such as cancer, diabetes, stroke, or heart disease, according to a Vital Signs report released today by the Centers for Disease Control and Prevention (CDC).
Nearly half (47 percent) of adults with disabilities who are able to do aerobic physical activity do not get any. An additional 22 percent are not active enough. Yet only about 44 percent of adults with disabilities who saw a doctor in the past year got a recommendation for physical activity.

“Physical activity is the closest thing we have to a wonder drug,” said CDC Director Tom Frieden, M.D., M.P.H. “Unfortunately, many adults with disabilities don’t get regular physical activity.  That can change if doctors and other health care providers take a more active role helping their patients with disabilities develop a physical fitness plan that’s right for them.”

Most adults with disabilities are able to participate in some aerobic physical activity which has benefits for everyone by reducing the risk of serious chronic diseases. Some of the benefits from regular aerobic physical activity include increased heart and lung function; better performance in daily living activities; greater independence; decreased chances of developing chronic diseases; and improved mental health.

For this report, CDC analyzed data from the 2009-2012 National Health Interview Survey and focused on the relation between physical activity levels and chronic diseases among U.S. adults aged 18-64 years with disabilities, by disability status and type.  These are adults with serious difficulty walking or climbing stairs; hearing; seeing; or concentrating, remembering, or making decisions. Based on the 2010 data, the study also assessed the prevalence of receiving a health professional recommendation for physical activity and the association with the level of aerobic physical activity.

Key findings include:

Working age adults with disabilities are three times more likely to have heart disease, stroke, diabetes or cancer than adults without disabilities.
Nearly half of adults with disabilities get no aerobic physical activity, an important protective health behavior to help avoid these chronic diseases.
Inactive adults with disabilities were 50 percent more likely to report at least one chronic disease than were active adults with disabilities.
Adults with disabilities were 82 percent more likely to be physically active if their doctor recommended it.

The Physical Activity Guidelines for Americans recommend that all adults, including those with disabilities, get at least 150 minutes (2.5 hours) of moderate – intensity aerobic physical activity each week. If meeting these guidelines is not possible, adults with disabilities should start physical activity slowly based on their abilities and fitness level.

Doctors and other health professionals can recommend physical activity options that match the abilities of adults with disabilities and resources that can help overcome barriers to physical activity. These barriers include limited information about accessible facilities and programs; physical barriers in the built or natural environment; physical or emotional barriers to participating in fitness and recreation activities, and lack of training in accessibility and communication among fitness and recreation professionals.

“It is essential that we bring together adults with disabilities, health professionals and community leaders to address resource needs to increase physical activity for people with disabilities,” said Coleen Boyle, Ph.D., M.S. hyg., director of CDC’s National Center on Birth Defects and Developmental Disabilities.

CDC has set up a dedicated resource page for doctors and other health professionals with information to help them recommend physical activity to their adult patients with disabilities, www.cdc.gov/disabilities/PA.  

Through the Affordable Care Act, more Americans have access to health coverage and to no-cost preventive services. Most health insurance plans cannot deny, limit, or exclude coverage to anyone based on a pre-existing condition, including persons with disabilities. To learn more about the Affordable Care Act, visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325).

Vital Signs is a CDC report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on key health indicators. These are cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, health care-associated infections, cardiovascular health, teen pregnancy, food safety and developmental disabilities.

CDC SAYS FIVE MAJOR DIABETES-RELATED COMPLICATIONS HAVE DECLINED SUBSTANTIALLY

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION

CDC data show declines in some diabetes-related complications among US adults
Despite progress continued efforts needed to combat diabetes complications
Rates of five major diabetes-related complications have declined substantially in the last 20 years among U.S. adults with diabetes, according to a study by the Centers for Disease Control and Prevention, published in the current issue of the New England Journal of Medicine.

Rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined.  Cardiovascular complications and  deaths from high blood sugar decreased by more than 60 percent each, while the rates of both strokes and lower extremity amputations – including upper and lower legs, ankles, feet, and toes – declined by about half.  Rates for end stage kidney failure fell by about 30 percent.

“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

Because the number of adults reporting diabetes during this time frame more than tripled – from 6.5 million to 20.7 million – these major diabetes complications continue to put a heavy burden on the U.S. health care system.  Nearly 26 million Americans have diabetes and an additional 79 million have prediabetes and are at risk of developing the disease.  Diabetes and its complications account for $176 billion in total medical costs each year.

CDC researchers used data from the National Health Interview Survey, National Hospital Discharge Survey, U.S. Renal Data System, and Vital Statistics, to examine trends in the occurrence of diabetes-related complications in the United States between 1990 and 2010.

Although all complications declined, the greatest declines in diabetes-related complications occurred for heart attack and stroke, particularly among people aged 75 years and older. The study authors attribute the declines in diabetes-related complications to increased availability of health care services, risk factor control, and increases in awareness of the potential complications of diabetes.

ENGINEER LOOKS AT DIABETES AND HEART DISEASE

FROM:  NATIONAL SCIENCE FOUNDATION 
Mechanical engineer studies flow of blood vessels related to diabetes and resulting heart disease
Research could lead to development of new drugs and tissue engineering applications

People with diabetes develop early and severe heart disease, specifically atherosclerosis, a condition in which plaque builds up inside the arteries. Alisa Clyne, a mechanical engineer by training, wants to better understand the biomechanics of this process.

"We know people with diabetes get these plaques but not why they are more severe with diabetes," says Clyne, an associate professor of mechanical engineering and mechanics at Drexel University. "Could there be a mechanical aspect to it?"

The National Science Foundation (NSF)-funded scientist specifically is studying the behavior of endothelial cells, which form the inner layer of blood vessels, and which "sense the mechanics of their environment and respond to it," she says. "They are exposed to a variety of mechanical forces, mostly from blood flow."

Moreover, blood flow, specifically shear stress--the force of flowing blood on the endothelial surfaces--cause the cells to react in multiple ways. "Atherosclerosis occurs in locations where there are disturbances in the blood flow," she says. "We want to know if the relationship between atherosclerotic plaque development and endothelial response to fluid flow is altered in diabetic conditions."

With normal flow, "your endothelial cells should not be dysfunctional, and you should not get plaque," she adds. "So the question for us is, if you change the endothelial cell environment to simulate a diabetic condition, such as high blood sugar, would there be a change in the way the cells are able to respond to fluid flow?"

Insights into the role of these cells in plaque development potentially could provide new ideas for drug development, as well as tissue engineering applications, such as designing new blood vessels.

"This information about how the cell mechanisms respond to blood flow is important," Clyne says. "For example, you could tissue engineer a better blood vessel for coronary artery bypass surgery by understanding how the endothelial cells respond to flow in a diabetic environment."

Clyne is conducting her research under an NSF Faculty Early Career Development (CAREER) award, which she received in 2009. The award supports junior faculty who exemplify the role of teacher-scholars through outstanding research, excellent education, and the integration of education and research within the context of the mission of their organization. NSF is funding her work with about $400,000 over five years.

Endothelial cells align and elongate in the direction of the shear stress, and change some of their functions as well. For example, in response to increased shear stress, endothelial cells produce more nitric oxide, a vasodilator which causes the blood vessels to expand. This physiological response decreases blood velocity and thereby reduces shear stress down to the original level. Nitric oxide also scavenges reactive oxygen species and reduces inflammation, both of which are factors that contribute to atherosclerotic plaque development. If endothelial cells do not produce nitric oxide in response to shear stress in a diabetic environment, this could contribute to atherosclerosis in people with diabetes.

In her experiments, Clyne cultures endothelial cells in a parallel plate flow chamber, which allows her to put "flow" over the cells to simulate the stresses they would experience in the human body. "We added high sugar levels to see how the cells would respond in normal flow," she says.

"One thing high sugars do is change the structure of proteins," she explains. "There are proteins underneath the endothelial cells, and the cells attach to them. The one we study in particular is collagen. As we age, or if you have high sugar levels, the collagen becomes glycated, meaning that sugar attaches to one of the collagen amino acids. When the cells are attached to glycated collagen, rather than normal collagen, it changes how they respond to fluid flow. "

The researchers measured the responses, including the release of nitric oxide, and found that the cells "don't align in the flow direction or release nitric oxide when they are on glycated collagen," she says. " The way in which cells adhere to the substrate proteins changes many signaling pathways in the cells. Our cells adhere to glycated collagen in a different way from native collagen, and this changes the way that they are able to respond to mechanical forces from fluid flow."

The researchers also looked at the effects of increasing sugar levels in the cultured cells and found that high sugar levels--and low sugar levels--also changed the way the cells respond to fluid flow. "So if you are at either extreme, you're in trouble," she says. "Sugar can either directly affect the cells or affect the proteins the cells adhere to, so it has two effects."

As part of the CAREER educational component, Clyne's lab is conducting an outreach program with the Girl Scouts, including a "Science Saturdays" program at Drexel, bringing in junior high school-age scouts for up to six Saturdays to teach them about different kinds of engineering, and how engineering applications can solve human health problems. The scouts are paired with mentors, who are Drexel engineering undergraduate students.

They engage in hands-on activities that relate to engineering. For example, they constructed robot cars (mechanical engineering), made lip gloss (chemical engineering) and participated in a water filtration project (civil engineering).

"Over the course of the program, they also worked on a design project related to biomedical engineering. One year, the girls created solutions that would help soldiers coming home from the war without a limb," she says. "One group made a gripper hand to help with eating, whereas another group made a device to improve balance using a prosthetic leg. The girls learned about how engineering contributes to helping others, which hopefully will encourage them to consider engineering careers."

-- Marlene Cimons, National Science Foundation
Investigators
Alisa Morss Clyne

SURGEON GENERAL SAYS SMOKING RATES MUST DROP TO SAVE MILLIONS OF LIVES

FROM:  DEPARTMENT OF HEALTH AND HUMAN SERVICES
 Surgeon General report says 5.6 million U.S. children will die prematurely unless current smoking rates drop

Report also finds cigarette smoking causes diabetes and colorectal cancer

Approximately 5.6 million American children alive today – or one out of every 13 children under age 18 – will die prematurely from smoking-related diseases unless current smoking rates drop, according to a new Surgeon General’s report.

Over the last 50 years, more than 20 million Americans have died from smoking. The new report concludes that cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. It puts the price tag of smoking in this country at more than $289 billion a year in direct medical care and other economic costs.

Today’s report, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, comes a half century after the historic 1964 Surgeon General’s report, which concluded that cigarette smoking causes lung cancer. Since that time, smoking has been identified as a cause of serious diseases of nearly all the body’s organs. Today, scientists add diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and other conditions to the list of diseases that cigarette smoking causes. In addition, the report concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.

“Smokers today have a greater risk of developing lung cancer than they did when the first Surgeon General’s report was released in 1964, even though they smoke fewer cigarettes,” said Acting Surgeon General Boris Lushniak, M.D., M.P.H. “How cigarettes are made and the chemicals they contain have changed over the years, and some of those changes may be a factor in higher lung cancer risks. Of all forms of tobacco, cigarettes are the most deadly – and cause medical and financial burdens for millions of Americans.”

Twenty years ago male smokers were about twice as likely as female smokers to die early from smoking-related disease. The new report finds that women are now dying at rates as high as men from many of these diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), and heart disease. In fact, death from COPD is now greater in women than in men.

“Today, we’re asking Americans to join a sustained effort to make the next generation a tobacco-free generation,” said Health and Human Services Secretary Kathleen Sebelius. “This is not something the federal government can do alone. We need to partner with the business community, local elected officials, schools and universities, the medical community, the faith community, and committed citizens in communities across the country to make the next generation tobacco free.”

Although youth smoking rates declined by half between 1997 and 2011, each day another 3,200 children under age 18 smoke their first cigarette, and another 2,100 youth and young adults become daily smokers. Every adult who dies prematurely from smoking is replaced by two youth and young adult smokers.

The report concludes that the tobacco industry started and sustained this epidemic using aggressive marketing strategies to deliberately mislead the public about the harms of smoking. The evidence in the report emphasizes the need to accelerate and sustain successful tobacco control efforts that have been underway for decades.

“Over the last 50 years tobacco control efforts have saved 8 million lives but the job is far from over,” said HHS Assistant Secretary for Health Howard K. Koh, M.D., M.P.H. “This report provides the impetus to accelerate public health and clinical strategies to drop overall smoking rates to less than 10% in the next decade. Our nation is now at a crossroads, and we must choose to end the tobacco epidemic once and for all.”

The Obama Administration’s ongoing efforts to end the tobacco epidemic include enactment of the landmark Family Smoking Prevention and Tobacco Control Act, which gives FDA regulatory authority over tobacco products; significant expansion of tobacco cessation coverage through the Affordable Care Act to help encourage and support quitting; new Affordable Care Act investments in tobacco prevention campaigns like the “Tips from Former Smokers” campaign to raise awareness of the long-term health effects of smoking and encourage quitting; and increases in the cost of cigarettes resulting from the federal excise tax increase in the Children’s Health Insurance Program Reauthorization Act.

HHS ON DIABETES RESEARCH

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Fruits of the diabetes research


From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

Like sweets? Fruits are sweet, and a study indicates these sweets can lower the risk of diabetes. At the Harvard School of Public Health, researcher Qi Sun saw signs of this in data from 1984 to 2008 on more than 187,000 people.

He compared people who ate at least two servings a week of certain whole fruits – particularly blueberries, grapes and apples – with people who ate less than one serving a month. The fruit eaters had a 23 percent lower risk of diabetes.

So Sun says:

“We recommend people to increase consumption of whole fruits intake to facilitate prevention of type 2 diabetes.”

The study in the journal BMJ was supported by the National Institutes of Health.

Learn more at healthfinder.gov.

HHS HealthBeat is a production of the U.S. Department of Health and Human Services. I’m Ira Dreyfuss.

FITNESS, AGING AND DIABETES

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS HealthBeat is a production of the U.S. Department of Health and Human Services.

From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

Even if we’re healthy, we still lose about 10 percent of our aerobic ability each decade after about age 40 or 50. But diabetes takes an extra toll on our cardiovascular system, and makes it look older than it should. At the University of Colorado School of Medicine, Amy Heubschmann looked at data on people with diabetes:

"There’s been about 20 percent worse fitness levels in adults with diabetes as compared to adults without diabetes. That’s the case in teenagers, middle aged adults and older adults."

However, she says moderate physical activity can raise fitness levels to close to what moderately active people without diabetes should have.

The study presented at a joint meeting of physiology organizations was supported by the National Institutes of Health.

NEARLY A QUARTER OF VETERANS RECEIVING VA CARE HAVE DIABETES



Credit:  U.S. Department Of Veterans Affairs

FROM: U.S. DEPARTMENT OF VETERANS AFFAIRS

American Diabetes Month — Time to Take Action

Nearly one in four Veterans receiving care from VA has diabetes.
This is partly attributable to the older average age of Veterans compared to the general US population. Veterans should know all the risk factors listed in the box on the right.

The Centers for Disease Control and Prevention estimate that nearly 26 million people, or about 8 percent of the US population, have diabetes.

That includes about 11 million persons 65 and older, or about 27 percent of seniors.

In the United States, about one-in-four persons with diabetes are not aware that they have the condition.

While exact numbers are not available, it is likely that the number is lower for Veterans receiving regular VA primary care.

However, many Veterans of all ages are at risk for diabetes because of the high rate of obesity and those who are overweight, estimated at over 70 percent of Veterans receiving VA care.

Weight Loss and Physical Activity

An individual does not have to achieve drastic weight loss. Losing about five percent of one’s weight will help.

In recent studies, a weight loss and exercise program was more effective than medication in both younger and older individuals. The medication was not effective in persons older than 60.

The VA’s MOVE! Weight Management Program is available to all Veterans who are overweight or obese and for whom weight management is appropriate. It supports Veterans in developing plans that work for them to lose or maintain weight through balanced diet, physical activity, and behavior change approaches.

For the MOVE! program to be tailored to the individual’s needs, the Veteran can complete a 23 item questionnaire. More information is available at www.move.VA.gov.

Diabetes and Agent Orange

Diabetes mellitus type 2 is one of the diseases VA presumes is associated with exposure to herbicides, such as Agent Orange. Veterans who were exposed to Agent Orange do not have to prove a connection between their type 2 diabetes mellitus and military service to be eligible for VA benefits. Healthy eating habits and exercise can help prevent this chronic disease.

Visit the Agent Orange home page to learn more about Agent Orange and VA benefits.