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Tampa, FL, United States

Health Integrated is an American health care management company based in Tampa, FL, that addresses health, productivity and cost challenges by integrating behavioral health and behavior change into medical and diseasemanagement activities. Health Integrated works with commercial health plans and employers serving more than 5 million members. Wikipedia.

Lee H.-M.,University of Washington | Bautista J.,University of Washington | Scott-Browne J.,Health Integrated | Mohan J.,University of Washington | Hsieh C.-S.,University of Washington

The degree of T cell self-reactivity considered dangerous by the immune system, thereby requiring thymic selection processes to prevent autoimmunity, is unknown. Here, we analyzed a panel of T cell receptors (TCRs) with a broad range of reactivity to ovalbumin (OVA323-339) in the rat insulin promoter (RIP)-mOVA self-antigen model for their ability to trigger thymic self-tolerance mechanisms. Thymic regulatory T (Treg) cell generation in vivo was directly correlated with in vitro TCR reactivity to OVA-peptide in a broad ∼1,000-fold range. Interestingly, higher TCR affinity was associated with a larger Treg cell developmental "niche" size, even though the amount of antigen should remain constant. The TCR-reactivity threshold to elicit thymic negative selection and peripheral T cell responses was ∼100-fold higher than that of Treg cell differentiation. Thus, these data suggest that the broad range of self-reactivity that elicits thymic Treg cell generation is tuned to secure peripheral tolerance to self. © 2012 Elsevier Inc. Source

Younossi Z.,Center for Liver Diseases | Henry L.,Health Integrated
Alimentary Pharmacology and Therapeutics

Background Treatment for chronic hepatitis C (CH-C) is rapidly changing and moving away from an interferon and ribavirin-based therapy to interferon-free ribavirin-free all oral regimens. These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles. As advances in the treatment of CH-C occur, it is imperative to capture both clinical outcomes (efficacy and safety) as well as patient-reported outcomes (PROs). In fact, PROs assesses and quantifies the impact of these regimens on patient experience. PROs assess patients' health-related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity. Aim To review the literature related to PRO's in HCV patients and summarise the impact of CH-C and its treatment on PROs. Methods Databases Ovid MEDLINE and PubMed were searched from 1990 to October 2014 using a combination of MEsh, thesaurus terms and relevant text words: hepatitis C, CH-C, treatment, quality of life, health-related quality of life, fatigue, work productivity, adherence, patient-reported outcomes, direct acting anti-viral agents and second generation direct acting anti-viral agents. Each manuscript was assessed for pertinence to the issue of PROs in CH-C as well as the quality of study design and publications. Results From the literature, it is evident that CH-C patients have baseline PRO impairment. Furthermore, treatment with interferon with or without ribavirin and first generation DAAs causes additional PRO burden which can negatively impact treatment adherence and indirectly, treatment efficacy and work productivity. The new treatment regimens with interferon- and ribavirin-free regimens not only have very high efficacy, but also result in the improvement of PRO scores as early as 2 weeks into treatment as well as possibly better adherence to treatment regimens. Conclusions CH-C and its treatment have been associated with patient-reported outcome impairment. The new IF-free and RBV-free regimens are associated with high efficacy and substantial improvement of patient-reported outcomes in clinical trial setting. Although very encouraging, more data are needed to assess patient-reported outcomes, adherence and work productivity of CH-C patients in the real world setting of clinical practice. © 2015 John Wiley & Sons Ltd. Source

Alper S.,Health Integrated
Communicative and Integrative Biology

In humans, there is an interdependent relationship between aging and immune system function, with each process affecting the outcome of the other. Aging can trigger immune system dysfunction, and alterations in the immune response can in turn affect human lifespan. Genetic experiments in model organisms such as C. elegans and Drosophila have led to the identification of numerous genes and signaling pathways that can modulate organismal lifespan and immune system function. Importantly, many of these signaling pathways exhibit conserved function in multiple species, including mammals, suggesting that the research in these simpler models could one day pave the way for the modulation of aging and immunity in humans. Here, we review the recent progress in our understanding of aging, innate immunity and the interaction between these two processes using these simple model systems. Additionally, we discuss what this may tell us about aging and the innate immune system in humans. © 2010 Landes Bioscience. Source

Johnson C.E.,Health Integrated
Journal of Sexual Medicine

Introduction. Pregnancy and childbirth is a special period in a woman's life, which involves significant physical, hormonal, psychological, social, and cultural changes that may influence her own sexuality as well as the health of a couple's sexual relationship. Aim. To comprehensively review the literature on the effects of pregnancy and the postpartum period on a couple's sexual health and well-being. Main Outcome Measures. Evidence from the published literature of the impact of pregnancy, childbirth, and the postpartum period on sexual function. Methods. Medline and PubMed search for relevant publications on the effects of pregnancy and childbirth on sexual health and function, with particular focus on the physical, hormonal, psychological, social, and cultural changes that may occur during the antepartum, intrapartum, and postpartum period. Results. Despite fears and myths about sexual activity during pregnancy, maintaining a couple's sexual interactions throughout pregnancy and the postpartum period can promote sexual health and well-being and a greater depth of intimacy. Conclusions. Clinicians must seek to engage in an open discussion and provide anticipatory guidance for the couple on expected changes in sexual health as well as promote the design of rigorous, evidence-based studies to further elucidate our understanding of sexual function during pregnancy and the postpartum. © 2011 International Society for Sexual Medicine. Source

An traditional-diagnosis-bypassing method for improving a mental health patient-therapy program through incorporating in it, centrally, a patients expressed therapy goals, including (a) accessing an electronic information system which is programmed with information-capturing and related-question-based, guiding software associated with patient-personalizing therapy planning, structuring and implementing, (b) encouraging a collaboration dialogue between patient and professional to capture information relating to the patients mental health symptoms and associated, patient-expressed therapy goals, and collaboratively entering related dialogue information into the system, and (c) based upon such information entering, and through professional-and-patient interactive engagement with the system, and functioning expressly in a conventional-diagnosis-bypassing, question and answer mode which is bottomed centrally upon recognizing the patients expressed therapy goals, collaboratively designing, building, and thereafter implementing, a patient-specific therapy.

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