Researchers find genetic biomarker that could indicate mental illness in women

Patients' behaviors and feelings often serve as identifying factors for psychiatric disorders, which can make diagnoses difficult. Researchers at the University of California San Diego School of Medicine have discovered that the over-production of specific genes may indicate mental illness in female psychiatric patients, according to a study published in the journal EBioMedicine.

The gene XIST, which deactivates one of the two X chromosomes in cells responsible for storing genetic material, works too hard in female patients who have mental illnesses such as bipolar disorder, major depression and schizophrenia. According to the study, over-production of XIST and genes from the inactive X chromosome are common factors in patients with psychiatric disorders and rare chromosome disorders like Klinefelter syndrome and Triple X syndrome.

"There has been an utmost urgency to identify biomarkers for mental illness that could significantly impact research and drug development, said XianJin Zhou, assistant professor in the UCSD Department of Psychiatry and lead author of the study.

About half of the participants—most of whom had a family history of mental illness—had unusually higher levels of XIST and other genes related to the X chromosome. Zhou and his team said stopping the abnormal activity of the inactive X chromosome may be a new strategy for treating those with psychiatric disorders. "These results are powerful in that early diagnosis of mental illness could possibly happen with a simple blood test, leading to better interventions, therapy and treatment options," Zhou said.

Most women are unaware of female-specific stroke symptoms and risks, according to a national survey by Ohio State

Most women are unaware of the symptoms and risks of stroke for females, according to a national survey by the Ohio State University's Wexner Medical Center. The survey found that just 11 percent of the 1,000 respondents knew that pregnancy, lupus, migraine headaches and oral contraception or hormone replacement therapy are female-specific stroke risks.

Also, only 10 percent of those surveyed knew that hiccups and atypical chest pain with or followed by typical stroke symptoms are early warning signs. According to the National Stroke Association, stroke is the third leading cause of death for women, and Diana Greene-Chandos, a neurologist and director of the neuroscience critical care at Ohio State's Wexner Medical Center, said, "We have a ways to go when it comes to educating women about stroke and their unique risk factors."

Other symptoms unique to women include dizziness that is not class vertigo, headaches, atypical chest pain and/or numbness of the body, especially if one side is more numb than the other. Early recognition and treatment are key for strokes.

"Women do not think they are going to have a stroke," said Greene-Chandos. "They think of it as a man's disease." The reality is that 60 percent of stroke deaths occur in females and 40 percent for males. Every year, 137,000 Americans die from a stroke. Smoking, failing to exercise and having high blood pressure are risk factors for both men and women. To take an assessment created by Ohio State's stroke experts to determine risk of stroke, click here.

Doctors don't tell most patients or caregivers about a diagnosis of Alzheimer's until the disease advances, advocacy group says

Every 67 seconds someone in the U.S. develops Alzheimer’s disease and most don't find out they have it until their disease becomes more advanced, according to a report by the Alzheimer's Association.

The organization's 2015 Alzheimer's Disease Facts and Figures report says only 45 percent of people with the disease, or their caregivers, were told their diagnosis by their doctor.

One reason, the report says, is that they don't want to cause the patient emotional distress, but the report says studies have found that "few patients become depressed or have other long-term emotional problems" when they learn of their diagnosis.

The Alzheimer's Association says early disclosure of the diagnosis "should be standard practice" because it allows the patient to participate in early decision making about their care plans, deal with legal and financial issues, decide if they would like to participate in research, and gives them time to fulfill lifelong plans. The association said in the release that not enough resources and education are in place to help medical providers with "best practices for telling patients and their families."

"Telling patients the truth about their diagnosis allows them to seek treatment early, when it’s likely to be more effective, and gives them a voice in planning how they want to live the rest of their lives," DeeAnna Esslinger, executive director of the Greater Kentucky and Southern Indiana Chapter of the Alzheimer’s Association, said in a press release.

The report says an estimated 5.3 million Americans have Alzheimer’s disease, including 68,000 Kentuckians. And barring the development of medical breakthroughs, the report says the number of Americans with the disease will rise to 13.8 million by 2050. Other items from the report:

• Almost half a million people age 65 or older will develop Alzheimer’s in the U.S. this year.
• By 2050, an American will develop the disease an average of every 33 seconds.
• Two-thirds of Americans over age 65 with Alzheimer’s (3.2 million) are women.
• Alzheimer’sis the sixth-leading cause of death in the U.S.
• In Kentucky, 1,462 people died with Alzheimer’s in 2012, a 74 percent increase since 2000.
• Nationwide from 2000-2013, the number of Alzheimer’s deaths increased 71 percent, while deaths from other major diseases decreased.

The cost to care for Americans with Alzheimer's and other dementias in 2015 are estimated at $226 billion, of which $153 billion is the cost to Medicare and Medicaid alone, making Alzheimer's the costliest disease to society, the release says. The report projected this cost will increase to more than $1 trillion in 2050.

“Alzheimer’s is a triple threat unlike any other disease — with soaring prevalence, lack of effective treatment and enormous costs. Promising research is ready for the pipeline, but there’s an urgent need to accelerate federal funding to find treatment options that effectively prevent and treat Alzheimer’s," Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association, said in a release.

How has the federal health-reform law changed your care?

Despite the controversy that continues to surround the Patient Protection and Affordable Act five years after its passage, it has probably changed the way your health care is delivered as it drives new models of payment, forces providers to approach care differently, and changes how health care is evaluated, Kavita Patel and Domitilla Masi report for the Brookings Institution.

Here are five ways the authors say that your health care might be different than it was five years ago because of the reform law:

Your physician might be part of a patient care team. New payment models in the ACA encourage an interdisciplinary team-based approach, which evidence shows "can lead to higher quality care and better health outcomes for patient." This approach allows the physician to spend more time diagnosing and devising a treatment plan, while the patient may spend more time interacting with non-physician staff for support care.

Prevention and wellness are more important than ever. The ACA requires health plans to cover all preventive screenings, immunizations and well visits for women at no cost, as part of the minimum benefits required in order for health-insurance plans to participate in exchanges like Kynect. The new payment models also pay physicians who work toward keeping their patients healthy, instead of just treating them when they are sick. " Since the policy took effect in September 2010 it is estimated that an additional 76 million people now receive preventive care," the authors write.

You may have better access to care on evenings and weekends. New payment models are driving this change as practices are often required to offer extended hours to decrease the overuse of emergency departments. Many offices now offer clinical advice around the clock with a clinician who has immediate access to their medical records.

Chances are your health information is being stored in an electronic health record, not a paper file. A separate law encouraged the use of EHRs, but "participation in the new ACA-promoted delivery models is practically impossible" without them. And while EHRs can be used to greatly improve patient care, not all EHRs are created equal and it will take time before patients see seamless integration and exchange between different doctors and settings in "real-time".

You can access care remotely, wherever you are. Doctors are using mobile technology and tele-health in rural and remote areas to provide more efficient care to patients. Insurance companies and employers are beginning to recognize this mode of treatment not only as a way to save money, but to also provide timely access to care, that does not involve the emergency room.

Heroin bill finally passes and is signed into law; Naloxone program put into motion; dating-violence bill sent to Beshear

By Melissa Patrick
Kentucky Health News

The long-negotiated bill to tackle Kentucky's heroin-overdose epidemic passed in the final hours of the 2015 legislative session.

Almost immediately after the heroin bill passed the Senate, a bill to offer immediate civil protections to dating partners who are victims of dating violence was passed after being held in the chamber since February 13 -- likely because Democratic Rep. John Tilley of Hopkinsville, chair of the House Judiciary Committee, was the original sponsor of both bills.

Tilley told reporters that the passage of the two bills meant it had been a successful session.

Gov. Steve Beshear signed the heroin legislation, Senate Bill 192, into law Wednesday, March 25, less than 12 hours after it passed, so that its emergency clause could put it into effect immediately. The dating violence bill, House Bill 8, has been delivered for his signature.

"Senate Bill 192 is tough on traffickers who bring these deadly drugs into our communities, but compassionate toward those who report overdoses or who admit they need help for their addiction," Beshear said in a release. "I applaud our legislators for putting aside partisan interests for the greater good of all Kentuckians who have been affected by this devastating drug."

The bill passed the Democrat-controlled House 100-0 and the Republican-controlled Senate 34-4. Republican senators John Schickel of Union, Joe Bowen of Owensboro, Chris Girdler of Somerset and Paul Hornback of Shelbyville voted against it.

The stickiest issues were a needle-exchange program, which many senators opposed, and tough new penalties for drug traffickers, which Tilley and many House members said would not be effective. The new law allows needle-exchange programs of approved by local governments, and the tough penalties, but allows the judge to be lenient in sentencing if the defendant is an addict.

The bill also allocates money for drug treatment programs; includes a "good Samaritan" provision that allows a person to seek medical help for an overdose victim and stay with them without fear of being charged; access for addicts and their families to the drug Naloxone, a drug that reverses the effects of an overdose; and allows the Department of Corrections to provide an approved medication to inmates to prevent a relapse in their addiction.

"The bill includes provisions that are important to law enforcement and me: increasing penalties for large volume traffickers, expanding access to treatment, and getting heroin overdose reversal kits into the hands of our first responders. I know this legislation will save lives," Attorney General Jack Conway said in a news release.

Hornback argued that "forced rehab doesn't usually work," providing addicts with Naloxone and free needles simply enables them and the bill does not allow addicts any "consequences for their actions."

He said that while he knows there are people dying from heroin overdoses,"I didn't make that decision for them and I for one, and a lot of my constituents are tired of paying for people's bad decisions and that is what this (bill) does."

Tilley said in an interview after the vote that needle exchange programs are proven to work, will save taxpayers money and are absolutely necessary to "stem the tide of two tidal-waves that are headed Kentucky's way: HIV and Hepatitis C and Hepatitis B."

"The cost of treating someone with HIV is $350,000. The cost of treating someone with Hepatitis C is $85,000. The budget now had a $55 million hit just with the explosion of Hepatitis C last year. We can't afford that in Kentucky," he said. Advocates say the programs can be a gateway to treatment and rehabilitation.

Meanwhile, Conway and first lady Jane Beshear announced that funding for Naloxone kits would be made available to the hospitals in Kentucky with the highest rates of heroin overdose deaths. The kits will be provided free to every treated and discharged overdose victim at the pilot-project hospitals.

They made the announcement at the University of Louisville, which treated 588 people in 2013 for heroin overdoses, a news release said. In 2013, the latest data available, 230 of the 722 autopsied overdose deaths, or 32 percent, were caused by heroin, according to the Kentucky Office of Drug Control Policy.

Tilley and Republican Sen. Whitney Westerfield, also of Hopkinsville, "forged a friendship that allowed the two men to work out differences on a pair of high profile bills fraught with political pitfalls," Adam Beam reports for The Associated Press. "Westerfield, a former prosecutor, is running for attorney general against the son of Democratic Gov. Steve Beshear, giving Democrats all the reason in the world not to work with him."

The AP notes that Republican Sen. Chris McDaniel wrote the first draft of the heroin bill that passed the Senate in January, but it omits McDaniel's other role: candidate for lieutenant governor on a slate headed by Agriculture Commissioner James Comer. As the Senate prepared to give the final bill final passage, Republican Floor Leader Damon Thayer accused the House of not passing McDaniel's bill because of his candidacy.

Read more here: http://www.kentucky.com/2015/03/25/3767938_political-compromises-brokered.html?rh=1#storylink=cpy

Bill to give civil protection to victims of dating violence is poised to become law, addressing a serious health issue for women

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Victims of violence between dating partners in Kentucky are about to get a law giving them civil court protection, after years of hitting roadblocks in the state Senate. Most of the argument has been among lawyers, about legal process, but domestic violence is also a major health issue.

"There is a strong association between the experience of victimization and physical and mental health problems," Carol Jordan, executive director of the Office for Policy Studies on Violence Against Women at the University of Kentucky, said in an interview.

Rep. John Tilley

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, would allow a civil protective order for victims of dating violence and stalking. Under current law, this immediate level of protection is only offered to people who are married, have a child in common or who have lived together. Kentucky is the only state that offers no such protections.

As of March 8, the bill was awaiting passage in the Senate after clearing the Judiciary Committee with a substitute version that addresses a key objection by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Senate President Robert Stivers, R-Manchester, had opposed previous bills on grounds that criminal protections exist for victims of dating violence. At the committee hearing, he said the new bill offers a "different tier of protection" and is a "solution that individuals want."

But Stivers added, "I don't want there to be an unjustified belief that a piece of paper will keep someone away" if they are intent on doing harm.

And Sen. Robin Webb, D-Grayson, declined to vote on the bill, saying it would do nothing to stop the abuser. "That perpetrator is really the one that needs some help and really needs to stop the cycle," she said. "Because if he or she can't find another victim, they're going to go create one."

But Marion Brown, director of Sanctuary Inc., a shelter, counseling and court-advocate center for victims of domestic violence in Hopkinsville, told the committee that victims of dating violence have no immediate civil protections if they are not married, don't live with or don't have a child with their abuser. These unprotected victims "walk out of our doors not feeling safe" she said. "Help us help them."

Tilley shared some chilling statistics at the hearing: 638,000 Kentucky women will experience physical violence, rape or stalking by an intimate partner; 345,000 will experience a forcible rape; and 420,000 will be stalked, which, he said, is the highest percentage in the nation.

Also in Kentucky, one in three women will be the victim of domestic violence in her lifetime and the most vulnerable population for this type of violence is females between 16 and 19, according to the Louisville-based Center for Women and Families.

Domestic violence and health

The National Intimate Partner and Sexual Violence Survey by the federal Centers for Disease Control and Prevention has found that victims of domestic violence, both men and women, are "more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health and poor mental health that men and women who had not experienced these forms of violence." It also found that women who had experienced domestic violence were also "more likely to report asthma, irritable bowel syndrome, and diabetes than women who did not experience these forms of violence."

""It is a women's health issue because the way women treat their bodies (is often) dependent on the abuser," Brown said in an interview. "The abuser degrades them so much that they don't maintain their health. Their self-confidence goes down, their self-esteem goes down and as a result, all of their health issues fall to the wayside."

"Domestic violence is a public health crisis of a staggering multitude," Marcia Roth, executive director of The Mary Byron Project, a non-profit that advocates for domestic violence issues, said in a phone interview. "It leads to $4.1 billion for direct medical and mental health services per year."

Jordan, of UK,  said she has been part of research that shows an association between breast cancer and domestic violence – not higher cancer rates, but delayed diagnoses, which can be fatal. "For many battered women, their partners are so controlling they won't let them go to the doctor," she said.

Jordan said that while physical injuries are the most obvious health issue, "it goes well beyond that," to physical stress and mental-health issues.

"There is a lot of research that would suggest that other systems within the body are also very much harmed by the experience of living in that constant fear, constant stress, constant tension that so many battered women do," she said. "Depression begins to sink in" when women feel they have no way out, get repeated messages that they are not worthy, or are in constant fear of harm.

Jordan said the bill will provide another escape outlet for victims. When they show up for help and answer no to these three questions: "Are you married? Are you living together? or Do you have a child together?" and can't get an immediate protective order, she said, their sense of helplessness is confirmed.