Wednesday, March 6, 2013

Stressed proteins can cause blood clots for hours

Mar. 5, 2013 ? New research from Rice University, Baylor College of Medicine (BCM) and the Puget Sound Blood Center (PSBC) has revealed how stresses of flow in the small blood vessels of the heart and brain could cause a common protein to change shape and form dangerous blood clots. The scientists were surprised to find that the proteins could remain in the dangerous, clot-initiating shape for up to five hours before returning to their normal, healthy shape.

The study -- the first of its kind -- focused on a protein called von Willebrand factor, or VWF, a key player in clot formation. A team led by Rice physicist Ching-Hwa Kiang found that "shear" forces, like those found in small arteries of patients with atherosclerosis, cause snippets of nonclotting VWF to change into a clot-forming shape for hours at a time. The finding appears online this week in Physical Review Letters.

"When I first heard what Dr. Kiang's team had found, I was shocked," said blood platelet expert Dr. Joel Moake, a study co-author who holds joint appointments at Rice and BCM. Moake, whose research group was the first to describe how high shear stress could cause platelets to stick to VWF, said, "I had thought that the condition might last for such a short time that it would be unmeasurable. No one expected to find that this condition would persist for hours. This has profound clinical implications."

Kiang, associate professor of physics and astronomy and of bioengineering, studies the forces involved in protein folding. Proteins are the workhorses of biology. Tens of thousands are produced each second in every living cell, and each of these folds into a characteristic shape within moments of its creation. Despite its ubiquity, protein folding is an immensely complex process that is shrouded in mystery.

Kiang is a pioneer in the use of atomic force microscopes (AFM) to shed light on the fundamental physical processes involved in protein folding. The AFM has a tiny needle with a tip measuring just a few atoms across. The needle is suspended from a tiny arm that bobs up and down over a surface. Kiang's team uses the bobbing needle to grab and pull apart individual protein molecules. By stretching these like rubber bands, her team has shown it can measure the precise physical forces that hold them in their folded shape.

"In this study, we did more than just measure the forces; we used those measurements to see what state the molecule was in," Kiang said. "In this way, we were able to study the dynamics of the molecule, to see how it changed over a period of time."

Moake, a senior research scientist in bioengineering at Rice and professor of medicine at BCM, said the work is vitally important because it helps explain the workings of VWF.

"VWF is synthesized in the cells that line the walls of blood vessels, and it's stored there until the cells get signals that the vessels are in danger of injury," Moake said. "In response to those stimuli, the cell secretes VWF. It's a long protein, and one end remains anchored to the cell while the rest unfurls from the wall like a streamer."

The act of unfurling makes VWF sticky for platelets, and that begins the process of hemostasis, which prevents people from bleeding to death when blood vessels are damaged by cuts and wounds.

"The body recognizes when clotting must stop -- when there are too many strings, too much sticking, too many platelet clumps -- and it uses an enzyme to clip the long VWF strings," Moake explained. "First, it makes large, soluble versions of the strings that remain somewhat sticky, and then these large soluble portions of VWF are reduced into smaller subunits of VWF that circulate in the plasma."

Under normal conditions, these circulating subunits, which are called PVWF, fold into compact shapes and cease to be sticky to platelets. However, previous research had shown that a type of physical stress called "shear" -- which can arise in partially occluded arterial blood vessels with high flow rates -- could cause PVWF to become sticky to platelets.

"That's all we knew," Moake said. "We didn't know how the conformation of the PVWF protein changed. That is why Dr. Kiang's research is so important and makes it more likely that therapeutic interventions can be more rationally designed."

To study the problem, Kiang's lab worked closely with Moake's team at Rice's BioScience Research Collaborative and with researchers from the laboratory of co-author Jing-fei Dong, formerly of BCM and now at PSBC in Seattle. Moake's and Dong's groups prepared samples of PVWF, subjecting some to the shear stresses known to induce clot formation. Kiang's team used AFMs to test the samples. Through a combination of experiments and deductive reasoning, her team determined exactly which portion of PVWF changed its conformation during shear stress. They also determined how long the protein remained partially unfurled before relaxing into its natural shape.

"The next step will be to design new experiments that allow us to monitor the proteins as they bind to platelets and initiate clot formation," Kiang said. "That will tell us even more about the physical properties of the proteins and provide more clues about potential therapies."

The research was supported by the National Institutes of Health, the National Science Foundation, the Alliance for NanoHealth, the Welch Foundation, the Mary R. Gibson Foundation and the Everett Hinkson Fund. Study co-authors include Rice graduate students Sithara Wijeratne and Eric Frey, former Rice graduate student Eric Botello, BCM researchers Hui-Chun Yeh and Angela Bergeron, Rice undergraduate Jay Patel, PSBC's Zhou Zhou and Rice senior research technicians Leticia Nolasco and Nancy Turner.

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The above story is reprinted from materials provided by Rice University. The original article was written by Jade Boyd.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Sithara S. Wijeratne, Eric Botello, Hui-Chun Yeh, Zhou Zhou, Angela L. Bergeron, Eric W. Frey, Jay M. Patel, Leticia Nolasco, Nancy A. Turner, Joel L. Moake, Jing-Fei Dong, and Ching-Hwa Kiang. Mechanical Activation of a Multimeric Adhesive Protein Through Domain Conformational Change. Physical Review Letters, 2013 DOI: 10.1103/PhysRevLett.110.108102

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/wWpqEdbBShI/130305145815.htm

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Photos: Shanghai's poor find 'home' in shipping containers

(Reuters) - Rory McIlroy has admitted he was wrong to withdraw from the Honda Classic last week, saying he now regretted his decision to stop playing. The world number one was heavily criticized after he quit the tournament midway through Friday's second round with what was initially a mysterious explanation. The Northern Irishman was playing badly and appeared certain to miss the cut when he shook hands with his playing partners after just eight holes. Before leaving the course, McIlroy told reporters he was in a "bad place mentally. ...

Source: http://news.yahoo.com/photos/shanghai-s-poor-find-home-in-shipping-containers-slideshow/

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Walking away from back pain | Science Codex

Lower back pain is a common complaint, and treatment often requires many hours of physical therapy over multiple weekly clinic visits ? a costly commitment. Now Dr. Michal Katz-Leurer of Tel Aviv University's Stanley Steyer School of Health Professions at the Sackler Faculty of Medicine says that a simple aerobic walking program is as effective in alleviating lower back pain as muscle strengthening programs that require specialized equipment in rehabilitation clinics. The program includes walking two to three times a week for a period of 20 to 40 minutes,

Dr. Katz-Leurer and her colleague Ilana Shnayderman, a graduate student at the Department of Physical Therapy and a practicing physiotherapist at Maccabi Health Care, say that their treatment option fits easily into a daily routine and allows those with back pain to be more responsible for their own health.

Their study was published in the journal Clinical Rehabilitation.

A simple solution

According to Dr. Katz-Leurer, research has shown that when people walk actively, abdominal and back muscles work in much the same way as when they complete exercises that target these areas. And unlike muscle strengthening programs, which often call for specific equipment and can involve exercises that require expert supervision, walking is a simple activity that can be done alone.

For the study, the researchers recruited 52 patients with lower back pain to participate in a randomized control trial. Through questionnaires, they were initially assessed for pain levels, feelings of disability, and avoidance of daily activities, as well as muscle and walking endurance.

Then, half of the participants completed a typical clinic-based muscle strengthening program, with two to three exercise sessions a week for six weeks. The other half completed a six-week aerobic walking program, walking two to three times weekly. Participants started with 20 minutes of walking, then progressed to 40 minutes as their endurance improved.

Results showed that both groups improved significantly in all areas of assessment, demonstrating that the walking program was "as effective as treatment that could have been received in the clinic," says Dr. Katz-Leurer.

The path to a healthier lifestyle

Dr. Katz-Leurer says that the walking program has the additional advantage of encouraging patients to follow a healthier lifestyle overall. In terms of physical fitness, those in the walking group were able to walk an average of 0.05 miles farther during a six-minute walking test at the end of the program compared to the pre-program assessments.

She also notes that that regularly active people are less likely to suffer typical aches and pains over their lifetime. Walking, a low-impact activity, also lowers blood pressure, boosts brain and immune system functioning, and reduces stress, she says.

Source: http://www.sciencecodex.com/walking_away_from_back_pain-107949

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Tuesday, March 5, 2013

Green tea extract interferes with the formation of amyloid plaques in Alzheimer's disease

Green tea extract interferes with the formation of amyloid plaques in Alzheimer's disease [ Back to EurekAlert! ] Public release date: 5-Mar-2013
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Contact: Laura J. Williams
laurajw@umich.edu
734-615-4862
University of Michigan

ANN ARBORResearchers at the University of Michigan have found a new potential benefit of a molecule in green tea: preventing the misfolding of specific proteins in the brain.

The aggregation of these proteins, called metal-associated amyloids, is associated with Alzheimer's disease and other neurodegenerative conditions.

A paper published recently in the Proceedings of the National Academy of Sciences explained how U-M Life Sciences Institute faculty member Mi Hee Lim and an interdisciplinary team of researchers used green tea extract to control the generation of metal-associated amyloid-? aggregates associated with Alzheimer's disease in the lab.

The specific molecule in green tea, ()-epigallocatechin-3-gallate, also known as EGCG, prevented aggregate formation and broke down existing aggregate structures in the proteins that contained metalsspecifically copper, iron and zinc.

"A lot of people are very excited about this molecule," said Lim, noting that the EGCG and other flavonoids in natural products have long been established as powerful antioxidants. "We used a multidisciplinary approach. This is the first example of structure-centric, multidisciplinary investigations by three principal investigators with three different areas of expertise."

The research team included chemists, biochemists and biophysicists.

While many researchers are investigating small molecules and metal-associated amyloids, most are looking from a limited perspective, said Lim, assistant professor of chemistry and research assistant professor at the Life Sciences Institute, where her lab is located and her research is conducted.

"But we believe you have to have a lot of approaches working together, because the brain is very complex," she said.

The PNAS paper was a starting point, Lim said, and her team's next step is to "tweak" the molecule and then test its ability to interfere with plaque formation in fruit flies.

"We want to modify them for the brain, specifically to interfere with the plaques associated with Alzheimer's," she said.

Lim plans to collaborate with Bing Ye, a neurobiologist in the LSI. Together, the researchers will test the new molecule's power to inhibit potential toxicity of aggregates containing proteins and metals in fruit flies.

###

Other authors of the paper, all from U-M, are: Sanghyun Lee and Jung-Suk Choi of the Life Sciences Institute; Alaina DeToma, Suk-Joon Hyung, Akiko Kochi and Brandon Ruotoloa of the Department of Chemistry; and Jeffrey Brender, Ayyalusamy Ramamoorthy and Subramanian Vivekanandan of the Department of Chemistry and Biophysics.

The work was supported by the National Institutes of Health, Alzheimer's Association, Alzheimer's Art Quilt Initiative, American Heart Association, and a Graduate Research Fellowship from the National Science Foundation Study: http://www.pnas.org/content/early/2013/02/19/1220326110.abstract


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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Green tea extract interferes with the formation of amyloid plaques in Alzheimer's disease [ Back to EurekAlert! ] Public release date: 5-Mar-2013
[ | E-mail | Share Share ]

Contact: Laura J. Williams
laurajw@umich.edu
734-615-4862
University of Michigan

ANN ARBORResearchers at the University of Michigan have found a new potential benefit of a molecule in green tea: preventing the misfolding of specific proteins in the brain.

The aggregation of these proteins, called metal-associated amyloids, is associated with Alzheimer's disease and other neurodegenerative conditions.

A paper published recently in the Proceedings of the National Academy of Sciences explained how U-M Life Sciences Institute faculty member Mi Hee Lim and an interdisciplinary team of researchers used green tea extract to control the generation of metal-associated amyloid-? aggregates associated with Alzheimer's disease in the lab.

The specific molecule in green tea, ()-epigallocatechin-3-gallate, also known as EGCG, prevented aggregate formation and broke down existing aggregate structures in the proteins that contained metalsspecifically copper, iron and zinc.

"A lot of people are very excited about this molecule," said Lim, noting that the EGCG and other flavonoids in natural products have long been established as powerful antioxidants. "We used a multidisciplinary approach. This is the first example of structure-centric, multidisciplinary investigations by three principal investigators with three different areas of expertise."

The research team included chemists, biochemists and biophysicists.

While many researchers are investigating small molecules and metal-associated amyloids, most are looking from a limited perspective, said Lim, assistant professor of chemistry and research assistant professor at the Life Sciences Institute, where her lab is located and her research is conducted.

"But we believe you have to have a lot of approaches working together, because the brain is very complex," she said.

The PNAS paper was a starting point, Lim said, and her team's next step is to "tweak" the molecule and then test its ability to interfere with plaque formation in fruit flies.

"We want to modify them for the brain, specifically to interfere with the plaques associated with Alzheimer's," she said.

Lim plans to collaborate with Bing Ye, a neurobiologist in the LSI. Together, the researchers will test the new molecule's power to inhibit potential toxicity of aggregates containing proteins and metals in fruit flies.

###

Other authors of the paper, all from U-M, are: Sanghyun Lee and Jung-Suk Choi of the Life Sciences Institute; Alaina DeToma, Suk-Joon Hyung, Akiko Kochi and Brandon Ruotoloa of the Department of Chemistry; and Jeffrey Brender, Ayyalusamy Ramamoorthy and Subramanian Vivekanandan of the Department of Chemistry and Biophysics.

The work was supported by the National Institutes of Health, Alzheimer's Association, Alzheimer's Art Quilt Initiative, American Heart Association, and a Graduate Research Fellowship from the National Science Foundation Study: http://www.pnas.org/content/early/2013/02/19/1220326110.abstract


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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Source: http://www.eurekalert.org/pub_releases/2013-03/uom-gte030513.php

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Banned From Baby Showers: BFBS Changes Priorities

This is personal post. ?I've had moments over the last few weeks that have brought me to a new point. ?I feel compelled to share them with you.

First and foremost, I am a wife (18 years) and mother of 4 children (16, 14, 11, 7). ?I have taught natural childbirth classes for the last 10 years. ?I love what I do. ?It's the best job on the planet!

As you may or may not know, I founded the Tarrant County Birth Network with a couple of amazing ladies over 3 years ago. ?Our leadership grew, as did membership. ?In fact, we grew it to be the largest chapter of BirthNetwork National in the country. ?We put together so many awesome events and meetings. ?I am so proud of all that we accomplished. ?It was a very busy, rewarding time for me personally.

Last January, I agreed to join the BirthNetwork National Board. ?That entailed a lot of phone conversations and emails. ?It took a considerable amount of time, but I had the opportunity to connect with so many women advocating for better birth around the country.

March 24, 2012 we launched Birth Boot Camp childbirth classes. ?I wrote a workbook with the help of Sarah Clark and a few other Birth Boot Camp Board members. We've seen incerdible growth in less than a year. ?We'll do a full report on our anniversary. ?That is not the point of this post.

I cannot begin to tell you what my family has suffered over the last 3 years. Lots of take-out, and fast easy microwaveable meals. ?They've learned to make a few dishes, as a result of me being so busy, like pasta and grilled cheese. ?Even when I'm here, I'm extremely distracted with all that I have to do. ?I'm not really present. ?I'm on the phone or the computer almost non-stop. ?How's this for full-disclosure?

Did I mention that I never talk to my family and close friends anymore - unless they are working on these projects with me, of course! ?I literally haven't had time. ?Those relationships have suffered.

It's like a train moving so fast, you can't get off. ?I could see life going on for my kids and I have barely been a part of it - only the mechanics of getting through the day - just so you can get them to bed and keep working. ?I really love my work. ?Did I mention that?

But I also love my kids. ?Oddly, my relationship with my husband has not suffered. ?He's been?extremely?supportive and my best friend through it all.

A few weeks ago I was on the verge of starting a huge project for BirthNetwork National. ?I had that moment when I stepped back and thought about whether my family could handle another big project, where mom is totally absorbed in something outside the home, even when she is at home? I've nearly got 3 teenagers in the house and they really need me to be more present. ?One is homeschooled, but I haven't had time to take her to do anything extra. ?In fact, my kids haven't been able to?participate?in extracurricular activities because I literally haven't had time to take them. Sad.

I love birth advocacy and working with these women to improve birth, not only locally, but nationally. ? This weekend I've seen so many people I've worked with over the years posting about the CIMS conference and it's been hard to know that I'm not there.

And yet, I am so at peace with my decision. ?I've stepped back from TCBN leadership as well as the BNN Board. ?I've enjoyed my kids over the last few weeks. ?I've made my family dinner! ?I canned beans (I'll tell you how to do it if you really want to know). ?I talked to my mom for over an hour and it was great! ?I chatted with my niece over Facebook this week about a cowboy she's dating (!!!!) and it was so fun. ?I'm totally stalking her page now (shhhh!), whereas I would never have had time for that in previous months. ?It feels so good to reconnect with people I love.

So now I have one job. ?Birth Boot Camp. ?As Founder/President, I have an obligation to our instructors to make this the best company possible. ?Like I mentioned, we are growing so fast because there's nothing else out there like what we're doing. ?I am not pulled between 3 different jobs. ?I have one job and will do it well. It's much easier to set business hours for one job than it is for three!
My family is happier. ?I am happier. I am able to live in the moment, which is something I haven't done in a long time. ?My church calling might actually get the attention it deserves. ?(I'm in charge of SIXTEEN 14-15-year-old girls, which is a huge responsibility and we've got Girls Camp around the corner!) I'm grateful for all that I have and I'm grateful for the realization that it's OK to step away from birth activism for now. ?Between all the kids activities we've recently signed up for, I might even do some long overdue home organization! ?I can't wait!

Source: http://banned-from-baby-showers.blogspot.com/2013/03/bfbs-changes-priorities.html

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Machete-wielding gangs kill 15 as Kenyans vote

Goran Tomasevic / Reuters

Five years after more than 1,200 people were killed in election-related violence, Kenyans went to the polls in a nationwide election seen as the most important in the country's 50-year history since independence.

By Joseph Akwiri, Reuters

NAIROBI, Kenya - At least 15 people were killed in attacks by machete-wielding gangs on Monday as Kenyans lined-up to vote in a presidential election they hope will rebuild the nation's image after a disputed 2007 poll unleashed weeks of tribal bloodshed.

Just hours before the start of voting and with long queues across the east African country, at least nine security officers in Kenya's restive coastal region were hacked to death, and six attackers were also killed, regional police chief Aggrey Adoli said. The total toll had earlier been put at 17.


There were two separate attacks which senior police officers blamed on a separatist movement - which, if confirmed, would suggest different motives to those that caused the post-2007 vote ethnic killings and could limit their impact.

Officials and candidates have made impassioned appeals to avoid a repeat of the tribal rampages that erupted five years ago when disputes over the poll result fuelled clashes between tribal loyalists of rival candidates.

More than 1,200 people were killed, shattering Kenya's reputation as one of Africa's most stable democracies and bringing its economy to a standstill.

As in 2007, the race has come down to a high-stakes duel between two candidates, this time between Deputy Prime Minister Uhuru Kenyatta and Prime Minister Raila Odinga, the loser in 2007 to outgoing President Mwai Kibaki. Both contenders will depend heavily on votes from tribal loyalists.

The United States and Western donors are worried about the stability of a nation that is an ally in the fight against militant Islam in the region but are also fretting what to do if the victor is Kenyatta, who faces charges by the International Criminal Court of orchestrating violence five years ago.

Provisional results could emerge hours after polls close at 5 p.m. local time (9 a.m. ET) although the election commission has seven days to announce the official outcome. Polls suggest the election could go to a run-off, provisionally set for April.

Jan 28, 2008: Ethnic clashes have killed more than 800 people across Kenya, and post-election violence threatens to engulf a country that has long been a model of stability in Africa. NBC's Ned Colt reports.

"If elected, we will be able to discharge our duties," said Kenyatta's running mate, William Ruto who also faces charges of crimes against humanity. "We shall cooperate with the court with a final intention of clearing our names."

'We want our own country'
One of the attacks on Monday took place outside Mombasa and another in Kilifi about 80 miles to the north. Senior police officers blamed them on a separatist movement, the Mombasa Republican Council (MRC), which wanted the national vote scrapped and a referendum on secession instead.

At the Kilifi site, Reuters footage showed a piece of paper on the ground with the words: "MRC. Coast is not Kenya. We don't want elections. We want our own country." But there was no formal claim and no independent confirmation of the assailants.

Even before the violence, many Kenyans were wary, notably in flashpoints last time. Some shopkeepers ran down stocks and some people in mixed tribal areas returned to their homelands.

Bernard Otundo, 36, queuing in Nairobi shortly before polls opened at 6 a.m. said he expected a peaceful vote.

Jan. 2, 2008: More than 100,000 people across Kenya have left their homes after riots and violence erupted following a disputed presidential election. NBC's Martin Fletcher reports.

"Some of us have been here as early as 2 a.m. this morning. I got here slightly after 3 a.m.," he said. "There have been a lot of awareness campaigns against violence and I don't think it will happen this time around, whatever the outcome."

Kenya's neighbors are watching nervously, after their economies felt the shockwaves when violence five years ago shut down trade routes running through east Africa's biggest economy. Some landlocked states have stockpiled fuel and other materials.

Adding to tension, the al Shabaab Islamist militant group battling Kenyan peacekeeping troops in Somalia, repeated calls on Nairobi to remove its forces, threatening retaliation.?

Related:

PhotoBlog: Kenya braces for elections

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Source: http://worldnews.nbcnews.com/_news/2013/03/04/17179248-machete-wielding-gangs-kill-at-least-15-as-kenyans-vote?lite

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Study: No quick savings from workplace wellness

The Barnes-Jewish Hospital is seen in St. Louis, Monday, March 4, 2013. Your bosses want you to eat your broccoli, hit the treadmill and pledge you?ll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money. In what?s being called the most rigorous look yet inside the wellness trend, independent researchers tracked the program at a major St. Louis hospital system for two years. Employee hospitalizations dropped dramatically, by 41 percent overall for six targeted conditions. But increased outpatient costs erased those savings. (AP Photo/Jeff Roberson)

The Barnes-Jewish Hospital is seen in St. Louis, Monday, March 4, 2013. Your bosses want you to eat your broccoli, hit the treadmill and pledge you?ll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money. In what?s being called the most rigorous look yet inside the wellness trend, independent researchers tracked the program at a major St. Louis hospital system for two years. Employee hospitalizations dropped dramatically, by 41 percent overall for six targeted conditions. But increased outpatient costs erased those savings. (AP Photo/Jeff Roberson)

The Barnes-Jewish Hospital is seen in St. Louis, Monday, March 4, 2013. Your bosses want you to eat your broccoli, hit the treadmill and pledge you?ll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money. In what?s being called the most rigorous look yet inside the wellness trend, independent researchers tracked the program at a major St. Louis hospital system for two years. Employee hospitalizations dropped dramatically, by 41 percent overall for six targeted conditions. But increased outpatient costs erased those savings. (AP Photo/Jeff Roberson)

The sign for the Barnes-Jewish Hospital is seen in St. Louis, Monday, March 4, 2013. Your bosses want you to eat your broccoli, hit the treadmill and pledge you?ll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money. In what?s being called the most rigorous look yet inside the wellness trend, independent researchers tracked the program at a major St. Louis hospital system for two years. Employee hospitalizations dropped dramatically, by 41 percent overall for six targeted conditions. But increased outpatient costs erased those savings. (AP Photo/Jeff Roberson)

(AP) ? Your bosses want you to eat your broccoli, hit the treadmill and pledge you'll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money.

In what's being called the most rigorous look yet inside the wellness trend, independent researchers tracked the program at a major St. Louis hospital system for two years. Hospitalizations for employees and family members dropped dramatically, by 41 percent overall for six major conditions. But increased outpatient costs erased those savings.

The study in Monday's issue of the journal Health Affairs has implications for a debate now taking place at companies around the country: how much pressure can you put on workers to quit smoking, lose weight, and get exercise before it turns into unwelcome meddling, or worse, a slippery slope toward a new kind of health discrimination?

Wellness programs started out offering gym memberships and modest cash rewards for participating in a health assessment focused on changing bad habits. But employers have been upping the ante, linking the programs to insurance discounts or penalties that can add up to hundreds of dollars.

Most major companies now have wellness programs, and smaller firms are signing up. President Barack Obama's health overhaul law allows employers to expand rewards and penalties, provided workers are also given a path to address lifestyle issues that could undermine their health.

"The immediate payback in terms of cost is probably not going to be there," said economist Gautam Gowrisankaran of the University of Arizona at Tucson, lead author of the study. But he noted there could be other benefits not directly measured in the study, such as reduced absenteeism and higher productivity.

And there's also a risk. "It's definitely true that there is a downside," Gowrisankaran said. "You are going to be charging people different rates based on their wellness behavior, and that could limit their ability to buy health insurance."

Obama's law forbids insurers from charging more if you get sick. But wellness incentives could mean you'd be penalized for the questionable choices that might get you sick.

Some previous studies have shown savings from wellness programs, while others found little change or even higher spending.

Steven Noeldner, an expert with the Mercer benefits consulting firm says well-designed programs generally show a positive return of about 2 percent by the third year.

Gary Claxton of the Kaiser Family Foundation, which produces a widely-cited annual survey of workplace health plans, says the financial impact is difficult to measure. "A lot of employers think it's the right thing to do and they're not so much interested in measuring," said Claxton.

The new study provides an in-depth look at the experience of BJC HealthCare, a hospital system that in 2005 started a comprehensive program linked to insurance discounts. BJC currently employs 28,000 people and provides health insurance for about 40,000, including family members. The overwhelming majority participated in the wellness program.

The program focused on six lifestyle-influenced conditions: high blood pressure, diabetes, heart disease, chronic lung problems, serious respiratory infections, and stroke. Employees had to join the program in order to get the hospital's most generous level of health insurance, called the Gold Plan. For family coverage, for example, the hospital paid nearly $1,650 more of costs in the Gold Plan.

Employees in the wellness program had to complete a health risk assessment that included height, weight, blood pressure, cholesterol, blood sugar and other measurements. They also signed a pledge to maintain a healthy diet and exercise regularly. Smokers had to get help to quit. Spouses were also required to sign the health pledge and, if they smoked, get help.

The study tallied up BJC's medical costs before the wellness program and for two years after. It also compared those costs with expenses of two other big local employers that did not have wellness programs. That was done to control for the possible impact of new drugs or medical innovations.

The results were counter-intuitive: A surprisingly large drop in hospitalizations for the six conditions targeted by the wellness program, but increased costs for medications and outpatient visits. When those were added to the cost of the wellness initiative itself, "it is unlikely that the program saved money," the study concluded.

BJC President Steven Lipstein said he doesn't dispute the conclusion, but he remains committed to the wellness program and would invite the researchers to take another look now.

Is the program saving money? "I do not know that," said Lipstein. "I can tell you that our health benefit expenses go up every year."

Lipstein said encouraging employees to make healthy lifestyle decisions and rewarding those who do reflects corporate values, not just the bottom line.

"It's not easy to change human health outcomes in the short term," he added. "When you make an investment in wellness and prevention you shouldn't expect an immediate return."

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2013-03-04-Workplace%20Health/id-e6ae3d2e1af648588aec4fd5bf205d62

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