HJAR Jul/Aug 2019

Healthcare Journal of ARKANSAS I  JUL / AUG 2019 35 For weekly eNews updates and to read the journal online, visit HealthcareJournalAR.com range of viruses and in inhibiting cancer cells from arising. With this five-year phase of funding, Liu’s goals are to understand how SAMD9 contributes to host immunity, how SAMD9 can be blocked by MYXV, and how SAMD9 can play a role in prevent- ing a pathogen from spreading from one spe- cies to another. Understanding these details of host immunity and host-virus interactions is important for many reasons. In this globally connected world, out- breaks of diseases, especially those that are new to a population — like MYXV was to the European rabbits — can be devastating. Diseases in one species that adapt to attack a new species are of particular concern. Global health crises like bird and swine flu, severe acute respiratory syndrome (SARS), and Ebola viruses are examples. Vaccines are a main line of defense against viral pathogens and work by awakening the immune system. Better understanding this dynamic through work like Liu’s will improve the ability to develop effective vaccines and keep up with the ever-changing adaptations in both hosts and pathogens. Additionally, Liu’s work could ultimately improve cancer treatments. Many of the advances that led to modern immunotherapies in cancer began with molecular-level research like hers. Oncolytic immune-virotherapy is a novel concept that intro- duces viruses that can directly kill cancer cells, and activate and usher the host’s immune system to attack cancer cells. “Many believe the future of such therapies for cancer lies in viruses such as MYXV that do not cause diseases in humans,” Liu said. “If we can come to a clear understanding of how viruses such as MYXV interact with human immune sys- tem, we could confidently use these them in can- cer treatments for humans, perhaps providing a better option than what is currently available.” Liu’s story is another successful example from the UAMS Center for Microbial Pathogenesis and Host Inflammatory Responses, directed by Mark Smeltzer, PhD. The center has earned $21 mil- lion in funding through the NIH’s Centers of Bio- medical Research Excellence (COBRE) program, which aims to provide funding and mentoring to researchers who are early in their careers. Liu was supported by the center for the first three years of her research, since she joined UAMS in 2013. UAMS has six COBRE centers, which are launch- ing new scientific careers, attracting top talent and creating concentrations of expertise on top- ics like neuroscience, cancer therapy, childhood obesity prevention, and pediatrics. Medicaid Expansion States See Decline in LowBirth Weight for Black Infants States that expanded Medicaid showed a sig- nificant reduction in low-birth-weight and pre- term births for black infants, but no significant difference in those rates overall, researchers at the University of Arkansas for Medical Sciences (UAMS) reported in an article published in JAMA. Since 1990, states have been required to pro- vide Medicaid coverage to low-income pregnant women with family incomes up to 133 percent of the federal poverty level. Under the Affordable Care Act, states may expand Medicaid to adults with household incomes at or below 138 percent of the federal poverty level. “We wanted to see if adverse birth outcomes would be reduced in expansion states relative to non-expansion states,” said Clare Brown, PhD, MPH, instructor in the Fay W. Boozman College of Public Health and lead author on the study. “We hypothesized that there would be greater declines among black infants because of the much higher rates of preterm birth and low birth weight among this population.” JAMA is a peer-reviewed medical journal pub- lished by the American Medical Association. This publication makes it the first time in history that a study originating in the College of Public Health has been published in JAMA. “The important thing to highlight here is that without a doubt, the biggest declines were in out- comes for black infants,” said Mick Tilford, PhD, professor and chair of the Department of Health Policy and Management in the College of Pub- lic Health and co-author on the study. “Medicaid expansion means continued health insurance for many low-income women. Insurance can lead to healthier mothers, and healthier mothers can lead to healthier babies.” The study examined 15.6 million births from 2011 to 2016 in states that expanded Medic- aid and in states that did not expand Medicaid. Specifically, the study looked at the association between Medicaid expansion and rates of low birth weight and prematurity overall, and among racial/ethnic minorities compared to non-His- panic white infants.  The data came from 18 states that expanded Medicaid and 17 states that did not. Researchers looked at preterm birth (a baby born less than 37 weeks), very preterm birth (a baby born less than 32 weeks), low birth weight (a baby weight less than five pounds, eight ounces), and very low birth weight (a baby weighing less than three pounds, five ounces). These evaluations were made among all births, as well as among Medic- aid-covered births and Medicaid-covered births to women with at most a high school diploma. “We used women with at most a high school diploma as a proxy for income,” said Mick Til- ford, PhD, professor and chair of the Department of Health Policy and Management in the College of Public Health and co-author on the study. “We assume that education is linked to income, so these are likely the most vulnerable groups.” There was an improvement in all four outcomes for black infants in expansion states. Among black infants of mothers with at most a high school diploma, rates of very low birth weight declined 14.8 percent in expansion states and increased 2.1 percent in non-expansion states. Rates of low birth weight declined 8.3 percent among expan- sion states and increased 5.6 percent in non- expansion states for this subgroup. “Babies born with a low birth weight are at much higher risk for developing chronic condi- tions, such as neurological, respiratory, behav- ioral, or educational deficits,” said Brown. “These not only lead to increased infant mortality, but they can also result in increased risk of chronic conditions throughout infancy and into adult- hood, which can lead to increased medical costs and reduced proactivity.” Brown is a 2018 graduate of the Health Sys- tems and Services Research doctoral program in the College of Public Health and completed this study for her dissertation. “Our findings should be considered by policy makers in their calculus of whether to expand or uphold Medicaid expansion.” Tilford said. “These results show the potential for Medicaid expan- sion to reduce disparities for black individuals.”