A sampling of news media stories involving UC Health:

Medical center commits to giving Oakland father a kidney transplant, Contra Costa Times

UC San Francisco Medical Center said Thursday that it is committed to providing an illegal immigrant from Oakland the kidney transplant he needs to live. The announcement followed the nationwide response to a story in this newspaper last week about the man’s plight.

See additional coverage: San Francisco Chronicle

Study: Uninsured face similar debt as Medi-Cal beneficiaries, California Healthline

More Californians are borrowing money to pay for health care services — and two-thirds of them have medical insurance, according to a new study by the UCLA Center for Health Policy Research.

UCSF study: Boosting cigarette tax could bolster California economy by $2 billion, San Francisco Business Times

A June 5 ballot initiative designed to boost the tax on cigarettes by $1 a pack could create 12,000 new permanent jobs right away and add nearly $2 billion in economic activity in the Golden State annually, according to a new study by UC San Francisco.

Nurses flex their political muscle in Sacramento and across California, The Sacramento Bee

This article about nursing quotes Ken Jacobs, chairman of the UC Berkeley Labor Center, and Joanne Spetz, a professor at the Center for the Health Professions at UCSF.

Op-ed: New beach water rules: Enough to make you sick, Los Angeles Times

Mark Gold, associate director of UCLA’s Institute of the Environment and Sustainability, write about beach water rules.

UCLA assistant professor of nursing heads program to increase physical activity among Los Angeles youth.

Kynna Wright-Volel, UCLA

Funded by a $1.2 million grant, Kynna Wright-Volel, Ph.D., R.N., F.A.A.N., assistant professor and Robert Wood Johnson Nurse Faculty Scholar at the UCLA School of Nursing, and the Los Angeles Unified School District (LAUSD) are launching Project SHAPE LA, a coordinated school-health program to increase physical activity among youth in Los Angeles County schools.

Project SHAPE LA targets 24 middle schools in underserved areas of Los Angeles and will touch nearly 12,000 students.

“As a pediatric nurse practitioner, I see the health consequences when children are overweight or obese; however, the clinic visit is but one part of the solution,” said Wright-Volel. “Research shows that school-based programs that are supported by collaborations among universities, schools, businesses and parents can decrease obesity and obesity-related behavior. We believe that Project SHAPE LA will do just that!”

According to the Los Angeles County Department of Public Health, one in five children in the LAUSD are considered obese. Obesity during childhood has immediate consequences, including hypertension, high cholesterol and the development of metabolic syndrome, as well as psychosocial problems such as low self-esteem and poor body image. Childhood obesity, if left unchecked into adulthood, can lead to a variety of chronic diseases, such as type 2 diabetes, heart disease and certain types of cancer, including breast and colon.

“This is an important component of an overall strategy for improving the health and well-being of our community, which includes physical activity, improved nutrition and nutrition education, and health education,” said Rene Gonzalez, assistant superintendent of student health and human services for the LAUSD.

Engaging in regular physical activity is widely accepted as an effective preventative measure. Project SHAPE LA (Shaping Health for Adolescents through Physical/Nutrition Education Los Angeles) uses three components: SPARK PE, an evidence-based physical education program; educational training of PE teachers in the areas of nutrition, physical education, curriculum development and professional development; and up to $2,000 per year of PE equipment per school.

Anticipated outcomes from this program include:

• Increased moderate to vigorous physical activity.
• Increased scores on the California State Board of Education’s FitnessGram Test in the areas of aerobic fitness, body composition and muscular strength/endurance.
• Increased academic achievement, as evidenced by higher scores on California standardized tests.

“Support for our PE teachers is imperative at this crucial time in our state’s budgetary crisis,” said Chad Fenwick, LAUSD physical activity adviser.

The five-year grant will give approximately 85 PE teachers a monetary stipend and intense, evidence-based training in physical activity, nutrition and physical education curriculum.

The grant is jointly funded by the National Institutes of Health’s National Institute of Nursing Research and Office of Behavioral Social Science Research, both of which are committed to preventing disease and promoting the health of individuals, families and communities.

Another component of the grant supports the recruitment of 100 minority high school students a year. These students will be provided education and mentoring in the areas of obesity prevention, leadership and careers in health and allied health professions. This leadership program will be piloted at Belmont High School.

According to Los Angeles City Councilman Eric Garcetti (District 13), “This partnership with Belmont High School shows a strong commitment by Dr. Wright-Volel and the UCLA School of Nursing to the investment in our youth as they learn to be the next leaders of our city.”

“With this grant, we want PE teachers to ignite a passion for physical activity — to teach kids that by being active they can be healthy and achieve their dreams,” added Wright-Volel.

The UCLA School of Nursing is redefining nursing through the pursuit of uncompromised excellence in research, education, practice, policy and patient advocacy. Rated among the nation’s top nursing schools by U.S. News & World Report, the school also is ranked No. 4 in nursing research funded by the National Institutes of Health and No. 1 in NIH stimulus funding. In 2009-10, the school received $18 million in total research grant funding and was awarded 26 faculty research grants. The school offers programs for undergraduate (B.S.), postgraduate (M.S.N. and M.E.C.N.) and doctoral (Ph.D.) students.

UCSF’s Ling Zhan is an emerging leader in use of xylitol to prevent tooth decay in children.

Ling Zhan, UC San Francisco

Pediatric dentist Ling Zhan, D.D.S., Ph.D., an assistant professor in the UCSF School of Dentistry, is building a path to something children and parents the world over welcome: fewer cavities.

Cavities are the number one infectious disease in children in the U.S. Every year, nearly $4.5 billion is spent to treat them and about 1.6 million school days are missed annually related to dental decay. The prevalence of this disease is five times higher than asthma.

Zhan is an emerging leader in the use of xylitol, a naturally occurring sugar alcohol, to prevent tooth decay in children. Research shows that the sweet-tasting substance, which is extracted from the fibers of fruits, vegetables and other vegetation, have the potential to prevent cavities. Xylitol, commercially used as a sugar substitute, is lower in calories than sucrose and appears to diminish the negative dental effects of oral bacteria.

Many of the children Zhan sees in her research and clinic are suffering from significant tooth decay.

“In the traditional dental clinic, we’re normally only fixing the cavities, but not treating the cause,” Zhan said. “I’m a dentist, but also a dental scientist. Cavities can be readily prevented, and I want to see if there’s anything I can apply from basic science to fix this.”

In a recent study, Zhan and her team found that xylitol can prevent cavities in infants. In the findings, which Zhan presented in the 2nd International Conference on Novel Anticaries and Remineralizing Agents, infants whose gums were wiped daily with xylitol by their parents had nearly eight times fewer dental carries after one year than those who used wipes without xylitol. The study will be published in the Journal of Dental Research later this year.

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UC Irvine co-authored study indicates results of newly enacted reforms.

David Neumark, UC Irvine

Enrollment of uninsured patients in a program with benefits comparable to those offered under the Affordable Care Act of 2010 resulted in significant health care cost savings, a new study finds. Published in the February issue of Health Affairs, the research sheds light on the potential outcomes of newly enacted health care reforms.

“In a case study involving low-income people enrolled in a community-based health insurance program, we found that use of primary care increased but use of emergency services fell, and — over time — total health care costs declined,” said study co-author David Neumark, UC Irvine Chancellor’s Professor of economics and director of UC Irvine’s Center for Economics & Public Policy study.

Working with researchers from the Virginia Commonwealth University Health System, Neumark tracked the emergency room, inpatient, outpatient and primary care service utilization of about 26,000 previously uninsured Richmond residents between 2000 and 2007 whose household incomes fell 200 percent below the federal poverty level. Qualified enrollees were granted health insurance and assigned a primary-care provider for one year. They were required to proactively re-enroll for subsequent annual coverage.

The demographics of these participants paralleled those of the population that will be affected by changes under the Affordable Care Act of 2010, Neumark said. The legislation is set to extend Medicaid benefits to about 16 million uninsured, low-income adults and children by the end of 2014.

The study found that primary-care visits for patients who enrolled continuously over three years rose from 1.06 in year one to 1.60 annually, while emergency-room visits fell from 1.02 in year one to 0.74 by year three. Costs per visit for both inpatients and outpatients also decreased, as did the length of inpatient stays. On average, total health care costs per enrollee per year for this subset were cut nearly in half — from $8,899 in year one to $4,569 in year three. Overall costs per enrollee per year for all participants with at least one year of enrollment declined from $7,604 to $4,726.

“A lot of the debate about health care reform surrounds the issue of whether we’re setting up something that’s going to cost us more by increasing use of medical services or something that will cut costs through more appropriate and timely use of medical services,” Neumark said. “Our research shows that, over time, costs can be reduced through increased use of primary care and reductions in emergency-department visits and hospital admissions, but it may take several years of coverage for substantive savings to occur.”

Co-authors of the study include Cathy Bradley, professor and chair of health care policy & research at Virginia Commonwealth University; Sabina Gandhi, who earned a Ph.D. in economics at UC Irvine and is now a VCU assistant research professor; Sheryl Garland, vice president of health policy and community relations at the VCU Health System; and Dr. Sheldon Retchin, VCU professor of internal medicine, gerontology and health administration and CEO of the VCU Health System.

A full copy of the study is available at http://content.healthaffairs.org/content/31/2/350.full.

About the University of California, Irvine: Founded in 1965, UC Irvine is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UC Irvine is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UC Irvine contributes an annual economic impact of $4.2 billion. For more news, visit www.today.uci.edu.

UC Davis partnership aims to provide strategic advice and mentoring services to facilitate better care.

Kenneth Kizer, UC Davis

The California Department of Health Care Services (DHCS) announced today (Feb. 9) that it has established a partnership with the Institute for Population Health Improvement (IPHI) at UC Davis Health System to improve the quality of care provided by the state’s $46 billion per year Medi-Cal program.

“This partnership will provide strategic advice and mentoring services to guide our capacity for quality improvement, population health management and organizational change,” said Neal Kohatsu, DHCS’ medical director. “It will help strengthen our relationships with partner hospitals by emphasizing bi-directional communication, education and interventions that drive improvement in population health.”

The five-year, $4.25 million agreement calls for, among other things, the IPHI to design and support a statewide Medi-Cal quality improvement plan, develop a systems-level strategy for DHCS to assess hospitals’ success in achieving the goals set forth by the Medicaid Section 1115 waiver’s Delivery System Reform Incentive Pool (DSRIP) program, convene a Medi-Cal Performance Advisory Committee of experts in clinical sciences, system thinking, quality improvement and organizational change, and provide quality improvement training and mentoring for DHCS managers.

“The department is focused on improving and enhancing quality care and reducing health care-related costs,” said DHCS Director Toby Douglas. “Our agreement with IPHI will help us achieve these interconnected goals.”

Medi-Cal is a joint state-federal health insurance program that serves more than 7.6 million low-income and medically high-risk Californians. The DSRIP program is a new component of Medi-Cal that provides federal funds to public hospitals that have demonstrated success in expanding capacity and making services more coordinated, efficient and patient-centered. DSRIP is part of California’s five-year, $10 billion “Bridge to Reform” Medicaid Section 1115 waiver, which aims to strengthen the Medi-Cal program and prepare safety net providers for nearly one million newly eligible Medi-Cal beneficiaries in 2014. The 1115 waiver is an agreement between the state of California and the federal Centers for Medicare & Medicaid Services (CMS) that “waives” certain Medicaid requirements in order to test new strategies for improving care and service delivery.

Kenneth W. Kizer, one of the nation’s preeminent authorities on public health and health care quality improvement and founding director of IPHI, will lead the effort.

“This partnership will result in better health care for millions of Californians and better value for taxpayers who fund the program,” said Kizer, who also is a distinguished professor at the UC Davis School of Medicine and Betty Irene Moore School of Nursing. “We will be developing a clearly defined quality improvement plan for the Medi-Cal program that will include specific quantitative goals and performance measures to track improvement in health care processes and health outcomes, equitable access to care, the prudent use of resources and appropriate matching of resources with needs. In evaluating the DSRIP program and helping develop a systems-level strategy, we expect to make specific recommendations for DHCS and individual hospital systems that will help them achieve DSRIP program milestones and more.”

The plan’s goals and performance measures will reflect the shared values and best practices of the federal Department of Health and Human Services’ National Quality Strategy. DSRIP program evaluations will address interventions in each hospital system plan, including the implementation of electronic health records and use of other health information technology, implementation of patient-centered medical homes, use of evidence-based population health management methods and integration of clinical services to improve the coordination and continuity of care. Kohatsu believes that “Dr. Kizer’s extensive knowledge and history of transforming health care in California and across the nation make him an outstanding director of this statewide initiative.”

Kizer is a member of the Institute of Medicine of the National Academy of Sciences and a fellow of the National Academy of Public Administration. As director of the former California Department of Health Services for Gov. George Deukmejian from 1984 to 1991, he pioneered Medi-Cal managed care, led California’s response to the HIV/AIDS epidemic, launched California’s famed Tobacco Control Program and established a number of leading programs that have become national models of excellence. Some of these include the “5 a Day for Better Health” nutrition program, the California Cancer Registry and California’s birth defects monitoring program.

As undersecretary for health in the U.S. Department of Veterans Affairs (VA) for President Clinton from 1994 to 1999, Kizer engineered the internationally acclaimed transformation of the VA health care system, which included the most rapid and largest ever deployment of a system-wide electronic health record and a comprehensive quality improvement and performance management system that has been cited as a model by Harvard University and others. As founding president and chief executive officer of the National Quality Forum (NQF), Kizer led efforts to establish national standards for reporting of health care quality. Today, NQF-endorsed performance measures are widely used by the federal government and throughout American health care.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

UC Riverside-led research describes mechanism by which some people may be more susceptible to colon cancer.

Karthikeyani Chellappa (left) and Frances Sladek, UC Riverside

An international research team led by cell biologists at the University of California, Riverside, has uncovered a new insight into colon cancer, the third leading cause of cancer-related deaths in the United States.  The research provides potential new avenues for diagnosing and treating the disease.

Led by Frances Sladek at UC Riverside and Graham Robertson at the University of Sydney, Australia, the team analyzed about 450 human colon cancer specimens and found that in nearly 80 percent of them the variants of a gene, HNF4A, are out of balance.

Human beings express several variants of the HNF4A gene, classified as P1 and P2 variants. Some tissues, like liver, have just one type of variant but the colon has both P1 and P2 variants.  The P1 variant is found in the nuclei of cells in the normal colon but in the human colon cancer samples this variant is frequently either absent or located outside of the nucleus and, presumably, no longer functional.

Using human colon cancer cell lines and in vitro assays, the researchers found that the imbalance observed in the human tumor tissues seemed to be the result of a complex, multi-step process by an enzyme, Src kinase. Src kinase has been known to be activated in colon cancer but, until now, it was not known to act on the HNF4a protein (HNF4A is the gene, a stretch of DNA; HNF4a is the protein encoded by HNF4A). The UCR group found that activated Src modifies the P1 but not the P2 variant. The net result is loss of the P1 variant in the nuclei of cells in the colon.

Study results appeared online last week in the Proceedings of the National Academy of Sciences.

“Loss of nuclear P1 HNF4a protein in the colon may be an early sign of colon cancer,” explained Sladek, a professor of cell biology and toxicologist. “A healthy colon has a good but delicate balance of the two HNF4a variants. If you could prevent the loss of the P1 variant via drugs, you might be able to maintain a normal colon and prevent colon cancer.”

The researchers found another factor that increases a person’s susceptibility to the disease:  certain “single nucleotide polymorphisms” or SNPs located in the HNF4A gene.  An SNP is a DNA sequence variation — a minor change in the genomic sequence that accounts for the variations we see between individuals.  SNPs are the most common type of genetic variation among people.

“Individuals with certain SNPs may be more susceptible to colon cancer,” said Karthikeyani Chellappa, a postdoctoral researcher in Sladek’s lab and the first author of the research paper.  “That’s because these SNPs result in a greater amount of modification and a faster degradation of HNF4a by Src, at least in cell-based assays. It still needs to be investigated, though, whether individuals carrying these SNPs are indeed more susceptible to colon cancer.”

Sladek noted that drugs are already available for inhibiting the activity of Src kinase.

“Some of these drugs are in clinical trials for colon cancer,” she said. “It would be exciting to determine whether these drugs can maintain the P1 HNF4a protein levels, as well as inhibit the Src kinase activity.”

A multifactorial disease influenced by genetics and the environment, colon cancer starts as a small polyp in the large intestine (colon) or the rectum (end of the colon). While most of the polyps are benign, some do turn cancerous.  With proper screening, the disease can be detected early, when it is most curable.

Sladek, Chellappa and Robertson were joined in the research by Songqin Pan and Jake M. Schnabl at UCR; Lucy Jankova, Caroline L-S. Fung, Charles Chan, Owen F. Dent and Stephen J. Clarke at the University of Sydney, Australia; and Yann Brelivet of the Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch, France.  Robertson and the Australian members of the team performed all the analysis of the human tumor samples.

The research was supported in part by a National Institutes of Health grant to Sladek.

UC Riverside scientists identify a protein that plays a crucial role in learning and memory.

Iryna Ethyll (left) and Crystal Pontrello, UC Riverside

Biomedical scientists at the University of California, Riverside, have identified a new link between a protein called beta-arrestin and short-term memory that could open new doors for the therapeutic treatment of neurological disorders, particularly Alzheimer’s disease.

Beta-arrestin is expressed in various cells of the body, including cells of the hippocampus, the region of the brain that is involved in learning and the formation of short-term memories. Beta-arrestin, the absence of which impairs normal learning in mice, is one of many “scaffolding proteins” — proteins that support the connections between neurons in the brain.

As our brain develops, new connections called synapses are formed between neurons. In the hippocampus, the formation of synapses is a continuous process. As we learn something new, new connections are formed and some old ones become stronger through a process known as long-term potentiation (LTP). But because brains have only a limited capacity, other old connections must disassemble through a process known as long-term depression (LTD) in order for new synapses to form.

The researchers report online last week in the Proceedings of the National Academy of Sciences that beta-arrestin plays an important role in the plasticity of synaptic connections and LTD by regulating the “actin cytoskeleton,” a dynamic filamentous network of proteins that forms the “backbone” of neurons and is involved in forming new and disassembling old synaptic connections.

“In some pathological conditions such as Alzheimer’s disease, loss of the old synaptic connections far exceeds the formation of new ones, resulting in overall loss of synapses and short-term memory loss,” said Iryna M. Ethell, an associate professor of biomedical sciences and the lead author of the research paper. “Our work, done on mice, shows that if beta-arrestin is removed from neurons, this loss of synapses is prevented.  But we also know that beta-arrestin is required for normal learning and memory; so a fine balance needs to be established. This balance could be easily achieved by pharmaceutical drugs in the future.”

This is the first time researchers anywhere have linked beta-arrestin to Alzheimer’s and learning/memory.

Ethell explained that beta-arrestin can be visualized as energy supplied to a puppeteer (actin cytoskeleton) controlling the strings of the puppets (inter-neuronal connections).  For normal learning to take place, the puppeteer needs to move the strings in a specific order.  But in patients with Alzheimer’s, this supply of energy over-activates and the strings are pulled in a disorderly fashion that results in the strings being broken (loss of synapses) and the puppets collapsing. While the removal of beta-arrestin would prevent this collapse, a complete loss of beta-arrestin would mean no movement of the puppets at all (that is, no learning in the brain), which is equally undesirable.

“A selective tuning of beta-arrestin activity is therefore necessary to partially reduce synapse disassembly,” said Crystal G. Pontrello, the first author of the research paper and a postdoctoral researcher in Ethell’s lab.  “What you want, ideally, is the elimination of only some unused old synaptic connections so that there is room to make new connections.”

Ethell and Pontrello were joined in the research by UC Riverside’s Min-Yu Sun, Alice Lin, Todd A. Fiacco and Kathryn A. DeFea.

The research was supported by a grant to Ethell by the National Institutes of Health.

“Here you can go and talk to anyone,” UC Merced student says.

Mufadhal Al-Kuhlani, UC Merced

Mufadhal Al-Kuhlani came to UC Merced to help reduce the threat of harmful diseases through innovative research.

Al-Kuhlani is studying immunology within the Quantitative and Systems Biology graduate program. He’s working with professor David Ojcius to better understand chlamydia.

More than 1.2 million cases of the disease were reported to the Centers for Disease Control and Prevention in 2009. Chlamydia represents the world’s leading cause of preventable blindness and is a common cause of respiratory and sexually-transmitted infections in humans.

“It touches so many lives; a lot of people get infected,” Al-Kuhlani said. “It’s preventable and treatable. There are many cases that shouldn’t happen in the first place.”

The lab is looking at the body’s immediate reaction when infected and for ways the disease could be controlled. The goal is understand what mechanisms are involved in manipulating the infectious activity of chlamydia in the human body and to see if they can limit the infectious activity in the human body.

Al-Kuhlani, who’s planning to graduate in May, is applying for postdoctoral fellowships at other universities. After that, he wants to go into academia to teach and continue researching. Al-Kuhlani, from Yemen, has seen how malaria has plagued his home country and is interested in shifting his research into addressing that disease.

Al-Kuhlani received his bachelor’s degree in clinical laboratory sciences from the University of Kansas before going to University of Missouri to work as a research specialist. He learned of UC Merced from a friend who thought he should consider it for graduate school. He said he was interested in attending a university that would give him close interaction with a variety of faculty members in different disciplines, and he’s found that at UC Merced.

“For a young researcher, it’s better to have more connections,” he said. “Here you can go and talk to anyone.”