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Archive - 04 - 2011

Ongoing Relationship with Care Provider Key for Patients with a Chronic Condition

Posted by dlife on Fri, Apr 29, 11, 02:08 PM 0 Comment

April 29, 2011 (Universtiy of British Columbia) People with a chronic condition such as diabetes or arthritis may find themselves taking on a more active role in maintaining or improving their own health if there is an ongoing relationship with a primary healthcare (PHC) provider, according to University of British Columbia research.Appearing in the current issue of Medical Care, the study is the first in Canada to investigate the links between having a regular primary healthcare provider and patient activation, a growing direction in healthcare that aims to increase peoples skills, confidence and knowledge so they can better manage their own health.Primary care refers to the first level of contact with healthcare for individuals. These include clinical services from doctors, nurses or nurse practitioners as well as health promotion activities.The idea is that we need to do the best we can with our current healthcare dollars to provide sustained quality care for individuals who in some cases are living with one or more chronic conditions, says Assoc. Prof. Sabrina Wong, lead author and a researcher in the School of Nursing and Centre for Health Services and Policy Research.What were seeing across North America is a policy direction that links patient-reported outcome measures such as patient activation to the quality of services and care provided by primary healthcare, especially in chronic disease management, says Wong.Previous U.S.-based studies have shown that having a strong primary healthcare system in place pays dividends for patients, and ultimately the taxpayer. For example, individuals with one or more chronic conditions experience reduced risk, and reduced duration and effects, of acute and episodic conditions. As well, they report reduced risk and effects of continuing health conditions,For their study, Wong and the research team looked at relationships between patient activation and multiple dimensions of primary healthcare in B.C. including access, utilization, responsiveness, interpersonal communication and satisfaction for patients, both with and without a chronic condition.Taking part in the study were 504 B.C. residents with an average age of 46. Fourteen per cent of participants reported their health as being fair or poor, and 44 per cent reported having at least one chronic condition such as arthritis, high blood pressure or diabetes.The results suggest there is a strong relationship between patients ability to self-manage their health and having a positive relationship with at least one PHC provider, says Wong.With the typical primary care visit lasting between 10 and 12 minutes, one aspect of care especially important to those with a chronic condition was having enough time to talk with their family physician or nurse practitioner.Other aspects of care such as communication, patient-centered decision-making and being treated as a whole person also appear especially important for those with a chronic condition.Findings also show that for patients with a chronic condition, high quality PHC was more about a strong connection with the place of care than whether it was delivered through group practice, solo practice or a walk-in clinic.What was most important, however, for physically healthy adults who may visit doctors or clinics less frequently was the quality of the interpersonal interaction.

Researchers Discover Mechanism that Could Convert Certain Cells into Insulin-Making Cells

Posted by dlife on Fri, Apr 29, 11, 01:12 PM 0 Comment

April 29, 2011 (UCLA) Simply put, people develop diabetes because they don't have enough pancreatic beta cells to produce the insulin necessary to regulate their blood sugar levels.But what if other cells in the body could be coaxed into becoming pancreatic beta cells? Could we potentially cure diabetes?Researchers from UCLA's Larry L. Hillblom Islet Research Center have taken an important step in that direction. They report in the April issue of the journal Developmental Cell that they may have discovered the underlying mechanism that could convert other cell types into pancreatic beta cells.While the current standard of treatment for diabetes insulin therapy helps patients maintain sugar levels, it isn't perfect, and many patients remain at high risk of developing a variety of medical complications. Replenishing lost beta cells could serve as a more permanent solution, both for those who have lost such cells due to an immune assault (Type 1 diabetes) and those who acquire diabetes later in life due to insulin resistance (Type 2)."Our work shows that beta cells and related endocrine cells can easily be converted into each other," said study co-author Dr. Anil Bhushan, an associate professor of medicine in the endocrinology division at the David Geffen School of Medicine at UCLA and in the UCLA Department of Molecular, Cell and Developmental Biology.It had long been assumed that the identity of cells was "locked" into place and that they could not be switched into other cell types. But recent studies have shown that some types of cells can be coaxed into changing into others findings that have intensified interest in understanding the mechanisms that maintain beta cell identity.The UCLA researchers show that chemical tags called "methyl groups" that bind to DNA where they act like a volume knob, turning up or down the activity of certain genes are crucial to understanding how cells can be converted into insulin-secreting beta cells. They show that DNA methylation keeps ARX, a gene that triggers the formation of glucagon-secreting alpha cells in the embryonic pancreas, silent in beta cells.Deletion of Dnmt1, the enzyme responsible for DNA methylation, from insulin-producing beta cells converts them into alpha cells.These findings suggest that a defect in beta cells' DNA methylation process interferes with their ability to maintain their "identity." So if this "epigenetic mechanism," as the researchers call it, can produce alpha cells, there may be an analogous mechanism that can produce beta cells that would maintain blood sugar equilibrium."We show that the basis for this conversion depends not on genetic sequences but on modifications to the DNA that dictates how the DNA is wrapped within the cell," Bhushan said. "We think this is crucial to understanding how to convert a variety of cell types, including stem cells, into functional beta cells."According to the American Diabetes Association, 25.8 million children and adults in the U.S. 8.3 percent of the population have diabetes.The National Institute of Diabetes and Digestive and Kidney Diseases, the Juvenile Diabetes Research Foundation, and the Helmsley Trust funded this study.Additional co-authors of the study are Sangeeta Dhawan, Senta Georgia, Shuen-ing Tschen and Guoping Fan, all of UCLA.

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