Parents, Coaches and Trainers Have a Major Role in Education and Prevention

As high school and college wrestlers return to the mats in preparation for February tournaments and post-season championships, their risk for the skin infection Methicillin-Resistant Staphylococcus Aureus (MRSA) increases significantly. In fact, wrestlers that participate in tournaments and teammates of wrestlers who participate in tournaments are 16 times more likely to be exposed to MRSA(1).

An analysis by Molnlycke Health Care shows that based on a potential MRSA colonization rate of 25 percent(2), the average number of matches each wrestler participates in at a tournament (three) and the number of wrestlers exposed to the tournament wrestler when he or she returns to a practice room (six), the potential exposure rate of MRSA from the tournament increases by approximately 16. As an illustration, the 1,200 wrestlers who attended the recent wrestling national duals had as many as 16,200 MRSA exposures (see table 1 for further details).

With more than 250,000 high school wrestlers(3) and 6,000(4) collegiate wrestlers in the U.S., parents, coaches and trainers are an integral part of providing education, awareness and prevention support to help stop the spread of deadly skin infections such as MRSA.

“We understand the importance of keeping our coaches and their wrestlers educated and aware of skin infections, especially during this important championship season,” said Mike Moyer, executive director of the National Wrestling Coaches Association (NWCA). “Last week, we provided our members with simple, practical tips to help decrease their wrestlers’ chances of MRSA infection.”

Tips provided by the NWCA and Molnlycke Health Care include:

  • Wrestlers should shower with an antimicrobial antiseptic soap that contains chlorhexidine gluconate (CHG) prior to the start of the tournament.
  • If a shower is not reasonable, at least have wrestlers wash hands, arms and face with an antimicrobial antiseptic soap that contains CHG prior to wrestling. This represents the primary areas of skin to skin contact during the match.*
  • Use wipes that contain CHG between or during the match when water is not available.

Molnlycke Health Care manufactures and distributes Hibiclens®, an antiseptic antimicrobial skin cleanser that contains four percent CHG. Hibiclens binds to the skin and continues to actively kill germs for up to six hours without leaving a residue. This is just one way to protect skin between and during competition.

“Hibiclens has become an integral part in our wrestling program at West Virginia University. It is the first line of defense for the prevention of skin-related diseases that are so common to our sport. Our wrestlers have seen first-hand the effectiveness of Hibiclens by showering with it on a daily basis after practice. We have seen a significant drop in the number of our practices and matches lost to skin diseases,” said Kevin Kotsko, assistant athletic trainer, West Virginia University.

Wrestlers are at higher risk for skin infections than other athletes due to the constant skin-to-skin contact and exposure to cuts, sores, bodily fluids and shared equipment, such as mats. MRSA is spread through direct skin contact or contact with shared items or surfaces that have come in contact with the bacteria. MRSA infections are usually manifested as skin infections, such as pimples and boils that are red, swollen and painful.

“We know through clinical testing and from wrestlers themselves that washing with a cleanser that contains CHG prior to a wrestling match can dramatically reduce MRSA infections(5),” said Jack Doornbos, executive director, Molnlycke Health Care.

While Hibiclens can be purchased in bulk through distributors nationwide, it is also now available over-the-counter at drug stores and pharmacies in the first aid section. Additionally, Hibistat® provides the same cleanser with alcohol in a wipe format for on-the-go needs. For more information about Hibiclens, Hibistat or CHG or to download free educational materials about MRSA and sports, visit hibiclens.com/athletes.html.

* Avoid contact with the eyes, ears, and mouth when using Hibiclens on the face.

(1) Molnlycke Health Care, Analysis of MRSA Exposure Rates, 2009

(2) Staph colonization rate in the general population is 30 percent and MRSA is typically 77 percent of staph infections; wrestlers have higher than average MRSA rates based on skin-to-skin contact (biomed.com and birdmd.com)

(3) National Federation of State High School Associations, 2007-08 High School Athletics Participation Survey. Accessed on January 25, 2010 through www.nwcaonline.com, National Wrestling Coaches Association Wrestling Facts

(4) NCAA® Sports Sponsorship and Participation Rates Report, 1981-82 through 2006-07, www.ncaa.org, April 2008. Accessed on January 25, 2010 through www.nwcaonline.com, National Wrestling Coaches Association Wrestling Facts

(5) MHC study #061123-150.01

Source: Molnlycke Health Care


Paul Wellstone, Pete Domenici Parity Act prohibits discrimination

The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.

“Today’s rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services,” said U.S. Secretary of Labor Hilda L. Solis. “The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it’s the right thing to do.”

“The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care,” said Secretary of Health and Human Services Kathleen Sebelius. “I applaud the longstanding and bipartisan effort that made these important new protections possible.”

“Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment,” said Deputy Treasury Secretary Neal Wolin. “These rules expand on existing protections to ensure that people don’t face unnecessary barriers to the treatment they need.”

The new rules prohibit group health insurance plans — typically offered by employers — from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.

The new law requires that any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review. These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits. For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit. MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits. The new rules are effective for plan years beginning on or after July 1, 2010.

The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Sen. Paul Wellstone, D-Minn., who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici, R-N.M., who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy, D-R.I., and former Rep. Jim Ramstad, R-Minn.

The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Sen. Edward Kennedy.

The interim final rules released today were developed based on the departments’ review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited. Sections where further comments are being specifically sought include so-called “non quantitative” treatment limits such as those that pertain to the scope and duration of covered benefits, how covered drugs are determined (formularies) and the coverage of step-therapies. Comments are also being specifically requested on the regulation’s section on “scope of benefits” or continuum of care.

Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov/. Comments directed to HHS should include the file code CMS-4140-IFC. Comments to the Department of Labor should be identified by RIN 1210-AB30. Comments to the Treasury’s Internal Revenue Service should be identified by REG-120692-09. Comments may be sent to any of the three departments and will be shared with the other departments. Please do not submit duplicates.

Source: U.S. Department of Labor


Despite initiatives, level of diversity among faculty, practitioners still remains markedly low when compared with U.S. population, U-M researchers say

The number of underrepresented minorities among U.S. medical school faculty remains low, even as the U.S. population becomes increasingly diverse.

And the level of underrepresented minorities currently being trained in medicine is unlikely to reverse those trends, according to a U-M analysis and commentary published this month in the journal Gastroenterology.

Underrepresented minorities that were primarily addressed include Black or African Americans, Hispanics or Latinos, American Indians, Alaskan or Hawaiian natives and other Pacific Islanders.

“The low representation and the stagnation of the numbers of Black and Hispanic faculty in U.S. medical schools is troubling,” said Juanita Merchant, M.D., Ph.D., professor in the departments of Internal Medicine and Molecular & Integrative Physiology at the University of Michigan.

“We need to plug the leaky pipeline that allows underrepresented minorities to escape before they can complete the process that allows them to go on to becoming medical or research faculty,” says Merchant, who co-authored the study with M. Bishr Omary, Ph.D., M.D., chair of the Department of Molecular & Integrative Physiology.

The underrepresented minority categories mentioned above only comprise about 7 percent of practicing physicians in the U.S., but those populations make up about 27 percent of the U.S. population. Similarly, in 2008, only 7.3% of all medical school faculty are underrepresented minorities.

A national effort led by the Association of American Medical Colleges sought to enroll 3,000 underrepresented minorities annually into U.S. medical schools by the year 2000. As of 2007, the number of admitted underrepresented minorities in medical schools was only 2,500. Of those, 6.4 percent were black, 7.2 percent were Hispanic and 0.5 percent were American Indians, Alaskan or Hawaiian natives and other Pacific Islanders.

“Academic medical faculty who are training the next generation of physicians as well as those delivering health care should reflect the diverse populations they will be serving,” Merchant says.

Another important point is that the percentage of male faculty outnumber female faculty dramatically. The percent of female faculty also declines from the instructor to professor rank, Merchant says.

“We have a huge number of women at the entry level, who just don’t make it up the ladder,” Merchant says.

Some of this is a preparation problem, Merchant says, and students in underrepresented communities need to be encouraged to study science and pursue biomedical fields. Once that pool has increased, strategies must be developed to retain trainees and potential faculty members.

“We know that Black physicians care for significantly more Black patients, and the same holds true for Hispanic physicians,” Merchant says. “We also know that minority populations may be more likely to have more serious health care problems, either because they delay care because of financial constraints or access to providers.

“So enhancing the pool of underrepresented minorities among faculty and physicians will likely help alleviate some of the disparities in the quality of care among those populations. Medical schools and government officials need to make this a priority.”

The article by Merchant and Omary provides detailed data from a variety of sources and also includes specific recommendations to both institutions and the underrepresented minorities themselves on how to reverse the current situation.

“We made a strong effort not only to highlight the problem but to also highlight specific recommendations that were assembled after consultation with several thought leaders nationally and locally,” Omary says.

Source: University of Michigan Health System


Bone marrow is a leading source of adult stem cells, which are increasingly used for research and therapeutic interventions, but extracting the cells is an arduous and often painful process. Now, researchers have found evidence that fat tissue, known as adipose tissue, may be a promising new source of valuable and easy-to-obtain regenerative cells called hematopoietic stem and progenitor cells (HSPCs), according to a study prepublished online in Blood, the official journal of the American Society of Hematology.

“It’s not outside the realm of possibility that a donor graft of adipose tissue-derived HSPCs might be able to partially replace the need for bone marrow transplantation within 10 years,” said lead study author Gou Young Koh, MD, PhD, of the Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST) in Daedeok Science Town, Daejeon, South Korea.

HSPCs are powerful cells that have the ability to regenerate and develop into many different kinds of cells. With advances in technologies and understanding of cell functions, HSPCs are now used to repair damaged tissue and are being studied for their potential to treat a vast array of chronic and degenerative conditions. HSPCs are found in high quantities in the bone marrow, but a certain portion known as extramedullary tissue, found outside of bone marrow, circulate between the marrow and the peripheral blood.

Previous research has found that adipose tissue contains many different types of adult stem cells. In this study, researchers hypothesized that the adipose tissue might be a valuable alternative source of HSPCs as an extramedullary tissue but questioned whether the tissue could provide a sufficient quantity of cells to be used for research and therapeutic purposes.

“We know that adipose tissue and bone marrow tissues share similar properties, so we suspected that valuable stem cells might be found in the adipose regions, offering a unique resource for stem cells that might be easier and less costly to extract,” said Dr. Koh.

Within the adipose tissue is a special cell population known as the stromal vascular fraction (SVF), which consists of other undefined stem cells as well as immune, endothelial (blood vessel lining), progenitor (undifferentiated or premature precursor cells), and stromal (connective tissue) cells. Cells in the SVF share similar properties to those in the bone marrow. Both contain a population of cells that have the ability to differentiate into several cell types. In addition, both adipose tissue and bone marrow offer similar environments for optimal stem cell growth and reproduction, including a smaller amount of circulating oxygen and specialized vascular systems as compared with other organs.

The research team characterized the HSPCs in the SVF of mouse adipose tissue with both in vitro and in vivo analyses. They studied the origin of the HSPCs to better predict their behavior and determine whether the quantity of cells could be increased by promoting more frequent HSPC movement between the bone marrow and peripheral blood using granulocyte colony-stimulating factor, or G-CSF, a growth hormone used to encourage development of stem cells. The team found that the more they could mobilize the HSPCs between the bone marrow and the peripheral blood, the more HSPCs they would find in the SVF.

The study results provide compelling evidence that the SVF derived from adipose tissue contains functional HSPCs capable of generating hematopoietic (blood-forming) cells. Importantly, researchers found that the cells were able to differentiate into a variety of hematopoietic cells when tracked for at least 16 weeks post-transplantation, which reflects long-term and permanent reconstitution of donor hematopoietic cells in recipients.

The frequency of HSPCs in the adipose tissue found in the study was significantly less than that found in bone marrow (approximately 0.2 percent of the HSPCs found in total bone marrow). Therefore, researchers wanted to determine whether the SVF might be used practically as an alternative source of HSPCs. Fortunately, according to the researchers, a vast amount of the SVF in adipose tissue can be easily obtained from patients using conventional liposuction and isolation methods that are safe and relatively pain-free.

“These study results suggest that more HSPCs might be obtained from the stromal vascular fraction through increased mobilization of these cells from the bone marrow using G-CSF,” said Dr. Koh. “So once a technology can be defined to purify HSPCs from the stromal vascular fraction, we believe adipose tissue may be a good alternative and novel resource for obtaining functional and transplantable HSPCs.”

The research team is actively extending their research in this area, including plans for a human clinical study. They also emphasize the need for a clinically safer and more efficient method for isolating the HSPCs from the adipose tissue.

Source: American Society of Hematology


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