Kerry Ludlam

Smoking’s reach – and risk – even broader than we thought

Smoking’s link to lung cancer has been well-known for decades, but we are still learning about its cancer-causing effects on other organs.

An article in the Journal of the American Medical Association (JAMA) provides solid epidemiological evidence that smoking’s link to bladder cancer is even higher than previously believed. And, the elevated risk factor appears to be the same for men and women.

Viraj Master, MD, PhD

“This is something I see in my practice every day,” says Viraj Master, associate professor of urology, Emory School of Medicine and director of urology clinical research at the Winship Cancer Institute of Emory University. “The dangers of smoking are pervasive. Patients are often surprised to hear of the link between smoking and bladder cancer, but it’s there, and it’s a very real risk.”

The bladder may not be the first organ you think about when you think about the harmful effects of cigarette smoking. After all, when a person inhales cigarette smoke, the mouth, throat and lungs are the primary destination. But, a lethal change in the composition of cigarettes makes the bladder a target for cancer.

Written by researchers at the National Cancer Institute, the study explains that while there is less tar and nicotine in cigarettes now that in years passed, there also has been “an apparent increase in the concentration of specific carcinogens,” including a known bladder cancer carcinogen and tobacco-specific nitrosamines. The study authors also note that epidemiological studies have observed higher relative risk rates associated with cigarette smoking for lung cancer.

“The take-home message, of course, is the same as it long has been – don’t start smoking, and if you do smoke, stop,” says Master. “We need to do everything in our power to both stop people from starting to smoke and to help those already addicted to stop.”

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Americans cutting sugar – but it’s still not enough

In America’s battle against obesity, there is some good news. According to a study conducted by Emory researchers, Americans consumed nearly a quarter less added sugars in 2008 than they did 10 years earlier.

The study, published in the American Journal of Clinical Nutrition in July 2011, found that the consumption of added sugars, such as those found in sodas, sports drinks, juices and sweetened dairy products, decreased among all age groups over a decade. The largest decrease came in the consumption of sodas, traditionally the largest contributor to added sugar consumption, according to Jean Welsh, MPH, PhD, RN, study author and post-doctoral fellow in pediatric nutrition at Emory University School of Medicine.

“While we were hopeful this would be the case, we were surprised when our research showed such a substantial reduction in the amount of added sugar Americans are consuming,” said Welsh. “We’re hopeful this trend will continue.”

So, why the change? One of Welsh’s partners in the study, Miriam Vos, MD, MSPH, an assistant professor of pediatrics in the Emory University School of Medicine, and a physician on staff at Children’s Healthcare of Atlanta, attributes much of the shift to public education.

“Over the past decade, there has been a lot of public health awareness about obesity and nutrition, and I think people are starting to get the message about sugar,” says Vos. “We’re not trying to send a message that sugar is inherently bad. It’s more that the large amounts of sugar we consume are having negative effects on our health, including increasing our risk of obesity, diabetes and cardiovascular disease.”

The study interpreted data of 40,000 people’s diets collected by the Centers for Disease Control and Prevention (CDC) over 10 years.  From the surveys, researchers were able to calculate how much added sugar – that is sugar that is not originally part of a food – that Americans are consuming. In 1999-2000, the typical person’s daily diet included approximately 100 grams of added sugar, a number that had dropped to 77 grams by 2007 and 2008.

While the study shows that the amount of added sugar Americans are consuming is lower, it doesn’t mean the amount is low enough.

“The American Heart Association recommends that we get about five percent of our calories from added sugars,” says Vos. “In 1999 to 2000, people were consuming about 18 percent of their calories from added sugars. Over 10 years, that amount decreased to 14.5 percent of our daily calories, which is much better. But, clearly, 14.5 percent is still three times more than what is considered a healthy amount. We’re on the right track, but we still have room for improvement.”

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Emory experts weigh in on obesity at AACC Annual Meeting

The obesity epidemic took center stage at this year’s American Association of Clinical Chemistry (AACC) Annual Meeting. Several Emory experts took the podium to further explore obesity not only as a public health problem, but also as an issue that is changing the way we diagnose diseases and treat health issues in children.

Jeffrey Koplan, MD, MPH

Jeffrey Koplan, MD, MPH, director of the Emory Global Health Institute, led one of the meeting’s plenary sessions, emphasizing that obesity must be fought with changes in both public policy and personal decision-making. Koplan also noted that strategies to address obesity must be localized to fit each community because eating and exercise habits are often culturally specific.

Rising rates of obesity also are changing the way physicians and researchers define and diagnose certain diseases, including metabolic syndrome, a cluster of risk factors including insulin resistance, high blood pressure, cholesterol abnormalities and an increased risk for clotting. The common thread among patients with metabolic syndrome is that they are often overweight or obese.

Ross Molinaro, PhD

Pathologist Ross Molinaro, PhD, medical director of the Core Laboratory at Emory University Hospital Midtown and co-director of the Emory Clinical Translational Research Laboratory, presented insights into the important role of lab testing in the definition and diagnosis of metabolic syndrome.  In addition to new markers, Molinaro addressed the global prevalence of metabolic syndrome and the evolving criteria for diagnosis.

Miriam Vos, MD, MSPH

Responding to their members’ demand for more information on how obesity affects children, the AACC hosted a full-day symposium on pediatric obesity and related health complications such as diabetes and high blood pressure.  Miriam Vos, MD, MSPH, assistant professor of pediatrics in  Emory School of Medicine and a physician at Children’s Healthcare of Atlanta described non-alcoholic fatty liver disease as an increasingly common complication of childhood obesity that can cause inflammation and scarring of the liver.

Stephanie Walsh, MD

Stephanie Walsh, MD, assistant professor of pediatrics in Emory School of Medicine and medical director of child wellness at Children’s Healthcare of Atlanta, leads Children’s efforts in preventing and treating childhood obesity in Georgia, which currently has the second highest rate of childhood obesity in the country. Walsh addressed the effect of Children’s wellness initiative, called Strong4Life, on childhood obesity prevention in Georgia.

“From those in the lab, to those in clinic, to those who strategize and implement public health campaigns, we’re all going to need to work together to protect our children’s future,” says Walsh.

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Exercise, changes in diet alter course for pre-diabetics

The D-CLIP Study staff in Chennai, India

A type 2 diabetes intervention program developed by researchers from Emory and the Madras Diabetes Research Foundation (MDRF) in India is showing promising results in improving risk factors, such as lowering weight and decreasing blood pressure and glucose levels.

The ongoing study, called the Diabetes Community Life Improvement Program, (D-CLIP) was designed to test the benefits of a low-cost community program for people at increased risk for type 2 diabetes, most commonly associated with obesity. The curriculum integrates exercise, nutrition education and dietary changes. The study is being conducted in Chennai, India with hopes of expanding the program into other parts of South Asia.

Six-hundred participants with prediabetes were randomly assigned to either a standard of care control treatment or weekly D-CLIP classes for six months, where they learned about making healthy choices in real life situations such as restaurants and grocery stores. They also learned how to incorporate exercise into their daily routines with the goal of completing 150 minutes of physical activity a week.

Of the 200 participants who have completed the course to date, 83 percent have lost between five and 13 pounds. There also was improvement in blood glucose, serum cholesterol and blood pressure levels in participants.

“This initial research is quite encouraging because it shows we can turn the tide of type 2 diabetes onset by promoting simple lifestyle changes through well-structured community programming,” says Venkat Narayan, MD, Hubert Professor in Emory’s Rollins School of Public Health and a professor in Emory School of Medicine. “Attendance at the lifestyle classes is 85 to 90 percent, with lifestyle changes strongly evident. More than anything, we have formed strong partnerships with the local community that will ultimately lead to the implementation of more successful programs like this.”

The study is conducted by the Global Diabetes Research Center, a collaboration between Emory University and MDRF in Chennai, India. The center received its initial support from the Emory Global Health Institute, with funding from BRiDGES (Bringing Research in Diabetes to Global Environments and Systems), an International Diabetes Federation program supported by an educational grant from Eli Lily. Currently, the 17th session of D-CLIP classes is in progress, with the study set to close in early 2013.

Participants in the D-CLIP study learned to incorporate exercise into their lives to stave off type 2 diabetes.

“We have always known that the right diet and exercise can improve health,” says V. Mohan, MD, president of the Madras Diabetes Research Foundation. “But there has been no scientific community-based program to quantify this until now. We hope this is just the beginning of efforts to reduce the incidence of the type 2 diabetes epidemic worldwide.”

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Emory’s nursing students and faculty span the globe to provide medical care to those in need

This summer, students of Emory’s Nell Hodgson Woodruff School of Nursing’s  accelerated BSN (ABSN) program are embarking on a two-week immersion experience at five sites around the world—the City of Refuge in Atlanta, Moultrie, Ga., West Virginia, the Bahamas and the Dominican Republic. From June 12 to 24, ABSN students will work with local health care providers and community partners to provide health care, community assessments, program evaluations and a sustainability project in each location. Though service learning has long been a pillar of Emory’s School of Nursing, this is the first time the nursing school has offered an immersion experience of this magnitude.

At the City of Refuge in Atlanta, students are working in the HEALing Community Center, a community clinic that provides health care and various resources to Atlanta’s homeless population. During their time at the City of Refuge, nursing students are focusing on the maternal-child homeless population and interacting with more than 500 patients and residents of Eden Village at the City of Refuge, which also serves as transitional housing for mothers and their children. The HEALing Community Center provides primary care and outpatient surgery to patients who might not otherwise have access to medical care.

Just four hours from Atlanta in Moultrie, Ga., another team of nursing students is spending two weeks caring for farm workers and their families. The Migrant Farm Worker Family Health Program has allowed Emory nursing students to provide critical nursing care to more than 15,000 people. The nursing students will examine children by day and set up mobile clinics to treat adult farm workers in the evening, while evaluating the impact the program has had on the community since its inception in 1994.

For the first time, nursing students and faculty will be traveling to West Virginia to partner with Cabin Creek Health System. Students will evaluate how well the health system’s Medicaid disabled population’s mental health needs are being met. They will see patients in clinics and in their homes, asking them about their mental health needs and issues that drive patients to use other sources of care such as emergency departments and urgent care centers.

In the Bahamas, nursing students are stationed on the small island of Eleuthera to further develop partnerships with community organizations, educational institutions and The Bahamian Ministry of Health. Emory students are evaluating what Bahamian communities view as priorities for their health and then assessing what strengths and areas of growth exist. Nurses from Emory are working with local nurses to provide primary care to clinic patients and conduct health education seminars for primary and secondary school students.

In the Dominican Republic, Emory is partnering with two programs in Hospital San Vincente de Paul’s in San Francisco de Macoris. Students will evaluate the volunteer doula program and update the data collection tool of the Kangaroo Mother Care project, a method of caring for premature infants that involves constant skin to skin contact in place of an incubator. Infants who might otherwise spend their first days or weeks in an incubator are now with their mothers 24/7. Additionally students will visit hospitals at the provincial periphery and observe the workings of the referral system within the public health infrastructure.

Teaching students more than just clinical care, service learning trips offer nursing students the opportunity to develop respect for unfamiliar cultures while facing real-world health care challenges such as working with interpreters and facing medical supply shortages.

“We often hear that opportunities like this take both our students and faculty back to the start of why they wanted to become nurses,” says Corrine Abraham, RN, MN, a nursing instructor and the International Academic and Cultural Exchange Coordinator at Nell Hodgson Woodruff School of Nursing.“They not only enhance their clinical capabilities, but they also sharpen their caring skills, which are the heart our field.”

Follow Emory’s School of Nursing students in the field.

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Children with Food Allergies Offered Better Diagnosis and Treatment with New Guidelines

Twenty years ago, food allergies had barely been heard of. Now, they are a $500 million health problem that affects more than 12 million Americans, including three million children. New federal guidelines issued by the National Institute of Allergy and Infectious Diseases (NIAID) will help physicians better diagnose and treat food allergies, according to Karen Demuth, MD, an assistant professor of pediatrics in the Emory University School of Medicine, and a physician on staff at Children’s Healthcare of Atlanta.

Dr. Demuth was a key player in advancing legislation to call attention to the challenges of food allergies in children. She and several of her patients were on hand to witness Governor Nathan Deal signing a proclamation declaring May 8 to 14 Food Allergy Awareness Week in Georgia.

Dr. Demuth (pictured far right) was a key player in advancing legislation to call attention to the challenges of food allergies in children. She and several of her patients were on hand to witness Governor Nathan Deal signing a proclamation declaring May 8 to 14 Food Allergy Awareness Week in Georgia.

“The new NIAID guidelines help providers understand food allergies,” Demuth says. “They address when we should consider a food allergy and the utility of testing for food allergy. In addition, they address the management of food allergies, including acute reactions and follow-up of individuals with food allergy.”

The guidelines are comprised of input from a panel of 25 experts and draw the important distinction between food allergies and food intolerances. Food allergies are defined as “an adverse health effect arising from a specific immune response hat occurs reproducibly on exposure to a given food.” Food intolerances produce an adverse reaction but are likely not related to an immune response.

The most common food allergies are to milk, eggs, peanuts, tree nuts, shellfish, fish and soy. Fortunately, the understanding of food allergies and the best ways to manage them is expanding.

“The gold standard of treatment of food allergies – avoidance – has remained constant throughout the years,” Demuth says. “There are new therapies on the horizon such as oral immunotherapy, vaccines and a Chinese herbal extract; however, these therapies are still considered experimental. At the Emory-Children’s Center, we are active in research and advocacy in pediatric allergies so that we can bring new treatments to our patients when they are ready for widespread use. We are dedicated solely to the care of children with allergic and immunologic disorders and offer multidisciplinary clinics to offer a specialized level of care.”

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