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Number of diabetic Americans could triple by 2050

As many as 1 in 3 U.S. adults could have diabetes by 2050, federal officials recently announced.

The Centers for Disease Control and Prevention (CDC) estimate that 1 in 10 have diabetes now – approximately 24 million Americans – but that number could grow to 1 in 5 or even 1 in 3 by mid-century if current trends continue.

The report was published in the Oct. 22 issue of Population Health Metrics. Edward Gregg, Emory adjunct professor of global health, and David Williamson, Emory visiting professor of global health, were co-authors.

The CDC’s projections have been a work in progress. The last revision put the number at 39 million in 2050. The new estimate takes it to the range of 76 million to 100 million.

The growth in U.S. diabetes cases has been closely tied to escalating obesity rates. A corresponding rise in diabetes has even prompted researchers to coin a new hybrid term: diabesity.

“There is an epidemic going on that, if left unchecked, will have a huge effect on the U.S. population and on health care costs,” says K. M. Venkat Narayan, MD, MSc, MBA, professor of global health and epidemiology at the Rollins School of Public Health, who came to Emory from the CDC’s Division of Diabetes Translation. “The numbers are very worrying.”

K. M. Venkat Narayan, MD, MSc, MBA

Narayan also heads the Emory Global Diabetes Research Center, which aims to find solutions to the growing global diabetes epidemic. The Center serves as the research leader and hub for population-based research and large intervention trials throughout South Asia and globally.

“Whatever we do, the fruits of our research have to be available to people everywhere,” says Narayan.

Read more about Dr. Narayan’s global efforts and diabetes research underway at Emory.

Hear Dr. Narayan talk about the Global Diabetes Research Center.

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New Emory center expands diabetes prevention

According to the CDC, an estimated 23.6 million Americans live with diabetes. The Diabetes Training and Technical Assistance Center (DTTAC), based at the Rollins School of Public Health, aims to reduce the burden of the disease.

Established with a $2 million grant from the CDC’s Division of Diabetes Translation, DTTAC is modeled after the Tobacco Technical Assistance Consortium. Both programs provide training, expertise, and materials to state public health departments to strengthen leadership, organizational capacity, and partnerships in prevention and control. DTTAC also works with the National Diabetes Prevention Program, the framework for community-based lifestyle intervention to prevent type-2 diabetes among those at high risk of the disease.

“We need to act with urgency to reach individuals and their families early if we are to prevent and reduce suffering from diabetes,” says Linelle Blais, DTTAC director and associate research professor at Rollins. “By developing services that build capacity, our goal is to better equip local, state, and national partners to deliver evidence-based community interventions and effective diabetes programs.”

Linelle Blais, DTTAC director

DTTAC is helping spearhead the national rollout of a lifestyle intervention program modeled on research from the NIH’s Diabetes Prevention Program (DPP) clinical trial. The program seeks to prevent diabetes by helping participants adopt healthy lifestyle habits such as being physically active at least 150 minutes per week and losing 7 percent of their body weight. In the DPP clinical trial, participants who made these changes saw their diabetes risk drop by 58 percent.

The success of diabetes prevention programs at Indiana University, the University of Pittsburgh, and YMCAs around the country will also shape DTTAC training. Experts regard these examples as cost-effective models.

Read more about DTTAC in the fall 2010 issue of Public Health magazine.

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Preterm infants born at unspecialized hospitals face higher risk of death

Very low-birth-weight (VLBW) and very preterm (VPT) infants not born in highly specialized, level III hospitals have a higher risk of neonatal and pre-discharge death compared to similar infants born at level III hospitals, according to a recent Journal of the American Medical Association (JAMA) study.

Lead study author Sarah Lasswell, MPH, and colleagues at the Rollins School of Public Health conducted a large-scale analysis of previous research to examine the relationship between hospital level at birth and neonatal (generally the first four weeks after birth) or pre-discharge mortality for VLBW (weighing 53 ounces or less) and VPT (32 weeks or less gestation) infants to determine the importance of level of care at birth to survival.

Lasswell and colleagues found that VLBW infants born in non-level III hospitals had a 62 percent increase in odds of neonatal/pre-discharge death compared with VLBW infants born in level III hospitals. In addition, VPT infants born in lower-level hospitals had a 55 percent increase in odds of neonatal/pre-discharge mortality compared with those born in level III facilities.

“The results of this review confirm a primary premise on which perinatal regionalization systems are based: high-risk infants have higher mortality rates when born outside hospitals with the most specialized levels of care,” Lasswell and colleagues write.

“Strengthening perinatal regionalization systems in states with high percentages of VLBW and VPT infants born outside of level III centers could potentially save thousands of infant lives every year.”

About 13 million babies are born prematurely every year – nearly 10 percent of all newborns – and more than 1 million premature babies die each year, according to the March of Dimes.

The study, “Perinatal Regionalization for Very-Low-Birth-Weight and Very Preterm Infants: A Meta-Analysis,” was published in the Sept. 1, 2010, issue of JAMA. It was conducted as part of Lasswell’s graduate research at the Rollins School of Public Health under the direction of Roger Rochat, MD. Lasswell is now a researcher at the U.S. Centers for Disease Control.

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Higher education linked to improved heart disease outcomes in richer countries

A higher level of education is associated with reduced risk of heart disease and stroke for people who live in rich countries, but not for those in low- and middle-income nations, according to the findings of a recent study led by Emory epidemiologist and cardiologist Abhinav Goyal, MD, MHS.

Abhinav Goyal, MD, MHS

The study published in the Sept. 7, 2010, issue of the journal Circulation, a publication of the American Heart Association, is one of the first international studies to compare the link between formal education and heart disease and stroke. It examined data on 61,332 people from 44 countries who had been diagnosed with heart disease, stroke, or peripheral arterial disease, or who had cardiovascular disease risk factors such as smoking or obesity.

Goyal and team found that highly educated men in high-income countries had the lowest level of cardiovascular disease. However, their findings suggest that research conducted in richer nations can’t always be applied to poorer countries.

“We can’t simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries,” says Goyal, assistant professor of epidemiology and cardiology at Emory’s Rollins School of Public Health and Emory School of Medicine. “We need dedicated studies in those settings.”

The research team was surprised to find that despite decreased heart disease risk among the higher educated in industrialized nations, nearly half of the highly educated women from high-income countries smoked, compared with 35 percent for those with the least amount of schooling. For men, smoking rates were virtually the same across educational groups in low- and middle-income countries.

“Everyone needs to be educated about the risk of heart disease in particular, and counseled to adopt healthy lifestyles and to quit smoking,” Goyal says.

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Study: Prescription and OTC drugs leading culprits of kids’ poisonings

A study published online Aug. 4, 2010, by the journal Pediatrics found that prescription and over-the-counter drugs are the leading cause of accidental poisonings among American children.

Each year, more than 71,000 U.S. children ages 18 and younger are seen in emergency rooms for unintentional overdoses of prescription and over-the-counter drugs, according to the study authors.

More than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications — that’s more than double the rate of childhood poisonings caused by household cleaning products, plants and the like, the researchers noted.

Robert Geller, MD, Emory professor of pediatrics and medical director of the Georgia Poison Control Center

“The number of children seen in the emergency room due to overdoses that are unintentional or medication errors is remarkable,” says Robert Geller, MD, professor of pediatrics in the Emory University School of Medicine and medical director of the Georgia Poison Center, who was not a part of the study.

The study team used 2004 and 2005 data from the National Electronic Injury Surveillance System to estimate the number of emergency department visits resulting from unintentional medication overdoses for children aged 18 and younger.

The most common medications accidentally taken by children are acetaminophen, opioids or benzodiazepines, cough and cold medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants, researchers found.

Geller says the study highlights the growing need to improve packaging to cut the number of cases of unintended ingestion.

“If you could make it harder for a kid who came upon a package to get the contents of the package, it would make it more likely they would never need to go to the emergency room,” Geller noted.

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Nursing students provide health services to migrant farmers in south Georgia

Emory University Nell Hodgson Woodruff School of Nursing faculty and students traveled to Moultrie, Ga., June 13-25 to provide valuable health care services to migrant farm workers and their families. Nursing faculty and students make the trip annually to the rural, agricultural community three hours south of Atlanta as part of the Farm Worker Family Health Program.

There are more than 100,000 migrant and seasonal farm workers in Georgia. Migrant farm workers face more complex health issues than the general population because of the physical demands of their jobs, pesticide exposure, poor access to health care services, and substandard housing conditions.

“Our clinics may be the only health care they get during the year,” says Judith Wold, a visiting professor in Emory’s School of Nursing and director of the Farm Worker Family Health Program. “The farm workers are very hardworking people and they are so appreciative of the health care we give them.”

By day, the students worked at Cox Elementary School with farm worker children. Each evening, they set up mobile clinics to treat adult farm workers. The students worked alongside other Georgia allied health students in physical therapy, psychology, pharmacy and dental hygiene.

Wold, who has participated in the project since its launch in 1994, estimates that the program has treated more than 14,000 farm workers over the course of its 16-year history.

Read more about the students’ Moultrie experiences on the Emory Nursing blog.

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Gulf residents and workers face heat exhaustion, mental stress

Residents and relief workers along the oil-ravaged Gulf of Mexico could experience a host of short- and long-term health problems, including respiratory ailments, neurological symptoms, heat exhaustion and mental stress.

Emory University environmental health expert Linda McCauley, RN, PhD, is one of more than a dozen national scientists participating in a two-day Institute of Medicine (IOM) workshop in New Orleans exploring some of the potential health risks that people in the Gulf could face.

Short term, McCauley says, there could be reports of respiratory problems from people who’ve inhaled gas fumes as well as neurological issues such as dizziness, headaches, nausea and vomiting. In addition, exposure to oil may cause eye and skin irritation.

Heat stress is also a major concern for workers in the Gulf, says McCauley, dean of Emory’s Nell Hodgson Woodruff School of Nursing.

“On some of the days it’s been so hot they’ve only allowed workers to work 12 minutes out of the hour,” she says. “A lot of new workers are being brought in [to clean up the oil]. These are workers who don’t do this for a living and may never have been exposed to this type of heat before and that’s a serious issue.”

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Rollins School of Public Health describes Haiti experiences

Emory University’s Rollins School of Public Health recently collected stories of experiences that students and faculty had in Haiti after the earthquake, and the contributions were featured in the newest Emory Public Health magazine. Read excerpts and view a video below.


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Study: ADHD linked to pesticide exposure

A study published in the May 17, 2010, issue of the journal Pediatrics found that one type of pesticide commonly used on fruits and vegetables may be contributing to attention deficit hyperactivity disorder, or ADHD, in children.

The study measured the levels of pesticide byproducts in the urine of 1,139 children from across the United States. Children with the highest concentration of pesticides in their urine were more likely to have symptoms of ADHD.

Dana Boyd Barr, PhD, a research professor in the Rollins School of Public Health at Emory, spent more than 20 years studying pesticide exposure at the Centers for Disease Control and Prevention (CDC). Barr was not a member of the research team that published these findings on pesticides and ADHD, but data generated in her former CDC lab was analyzed for this particular study.

Barr says while the study doesn’t prove causality between pesticide exposures and ADHD, it does shed light on how even low level daily exposures to pesticides could potentially impact cognitive health.

“It seems very plausible that low-level daily exposures to pesticides can produce some subtle effects like ADHD or other neurological delays,” she says.

Barr notes that additional research is needed to confirm a connection to pesticides and ADHD, but says there are tips for limiting your exposure to commonly used pesticides.

“We’ve done studies here at Emory and also at CDC that have indicated that if you use organic food or if you wash your food properly prior to preparation, you can reduce the levels of these metabolites in your urine.  Eat as much organic produce as possible, or wash your fruits and vegetables very well and that likely could decrease the chances of your children developing ADHD,” says Barr.

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Coping with seasonal allergies

Are you one of 50 million Americans who suffer from allergies? Allergies are the fifth-leading chronic disease in the U.S. among all ages, and the third most common chronic disease among children under age 18, according to the Asthma and Allergy Foundation of America.

Allergy is characterized by an overreaction of the human immune system to a foreign protein substance (“allergen”) that is eaten, breathed into the lungs, injected or touched. This immune overreaction can result in symptoms such as coughing, sneezing, itchy eyes, runny nose and scratchy throat. In severe cases it can also result in rashes, hives, lower blood pressure, difficulty breathing, asthma attacks, and even death.

In a series of new videos, Emory University pediatric allergist and immunologist Karen DeMuth, MD, discusses seasonal allergies, allergy triggers, coping methods, treatments and common allergy myths.

In another video series, DeMuth explores the link between asthma and allergies and the impact of air pollution on people with asthma.

DeMuth is an assistant professor of pediatrics in the Emory School of Medicine.  She practices at the Emory-Children’s Center and Children’s Healthcare of Atlanta.

Hear Dr. DeMuth talk more about allergies and the link between asthma and allergies.

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