Circadian rhythms go both ways: in and from retina

Removal of Bmal1 accelerates the deterioration of vision that comes with Read more

Genomics plus human intelligence

The power of gene sequencing to solve puzzles when combined with human Read more

'Master key' microRNA has links to both ASD and schizophrenia

Recent studies of complex brain disorders such as schizophrenia and autism spectrum disorder (ASD) have identified a few "master keys," risk genes that sit at the center of a network of genes important for brain function. Researchers at Emory and the Chinese Academy of Sciences have created mice partially lacking one of those master keys, called MIR-137, and have used them to identify an angle on potential treatments for ASD. The results were published this Read more

CDC

Global climate change and health risks

Public health experts, including researchers, practitioners and policy makers from Emory, CARE, the Centers for Disease Control and Prevention (CDC), and other public and private organizations met at Emory recently for a symposium focusing on the health risks associated with global climate change.

Climate change is affecting the growth of crops, access to water, floods, malnutrition, and the prevalence of disease.

The goal was to form an agenda to develop the tools, policies, and approaches needed to address climate health risks and incorporate climate change adaptation into global health and development work.

And for good reason: right now climate change is contributing to the destruction of livelihoods and the aggravation of social inequalities, said speaker Jean-Michel Vigreux. Vigreux, CARE’s senior vice president of program quality and impact, said climate change is affecting the growth of crops, access to water, floods, malnutrition, and the prevalence of disease–especially climate sensitive disease. All this, he says, disproportionately affects the poor and other vulnerable populations.

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Linking science and action through national public health institutes

As public health leaders from nearly 50 countries gathered this week at the Emory Conference Center, they had a common goal: strengthening individual public health institutes and establishing partnerships to significantly reduce death and disease globally.

The International Association of National Public Health Institutes (IANPHI) held its fifth annual meeting – and the first in the United States – in Atlanta, jointly hosted by IANPHI, located in the Emory Global Health Institute, and by the CDC. IANPHI is not a typical organization, pointed out IANPHI President Jeff Koplan. It’s a partnership of more than 80 members who are directors of CDC-like institutes around the world, and it exists for the partners to build relationships and actively support each other. IANPHI is funded by the Bill & Melinda Gates Foundation.

Jeffrey Koplan, MD, MPH, president of IANPHI

As the world “shrinks” due to easier and more frequent air travel and migration, the effects on public health can be both positive and negative. On the negative side, communicable diseases and lifestyles that contribute to non-communicable diseases are transmitted much more rapidly around the world. But on the positive side, nations can work together much more efficiently to address public health challenges as committed partners.

Tom Frieden, director of the CDC, emphasized the importance of a national focus in each country on public health problems, and linking national efforts with local programs. Having adequate resources for public health will be essential in successful monitoring and disease response as well as driving down healthcare costs around the world, he said.

A major theme of the IANPHI conference was non-communicable diseases (NCDs) in addition to communicable diseases (CDs), which traditionally have been the focus of global public health efforts.  NCDs now kill far more people than CDs throughout the world, Frieden pointed out.  Significant progress can be made against NCDs with the right approach. Frieden gave the example of Uruguay, where 1 in 4 smokers quit smoking after a major public health effort.

Kevin DeCock, director of the CDC’s new Center for Global Health, pointed out the fundamental changes in public health that have come about because of new technologies, such as cell phones and computers as well as new public health networks that allow much quicker responses. Only a few decades ago, information about disease outbreaks in less developed countries was communicated only after the disease had already peaked. Now that information can be sent almost instantaneously.

Public health leaders from four countries – Nigeria, Guinea-Bissau, Tanzania, and Ethiopia – gave examples of successful IANPHI-funded projects. Despite extremely limited resources in many countries, Koplan pointed out, these countries have made extraordinary and concrete progress in improving public health infrastructure and in decreasing disease and death from challenging public health problems.

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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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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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NIH director visits Emory, Atlanta Clinical & Translational Science Institute

David Stephens, MD, Jim Wagner, PhD, Earl Lewis, PhD, Francis Collins, MD, PhD

Dr. Francis Collins, director of the National Institutes of Health, and chief of staff Dr. Kathy Hudson, paid a daylong visit to Emory’s Woodruff Health Sciences Center, including Yerkes National Primate Research Center, and Morehouse School of Medicine on April 14.

The purpose of Collins’ visit was to view the activities of the Atlanta Clinical and Translational Science Institute, one of 46 national CTSAs funded by the NIH through the National Center for Research Resources (NCRR).  Collins also will visit CTSAs at Duke, UNC, and Vanderbilt in the future.

Collins asked that his visit focus on “how CTSAs are enabling science.” It was an opportunity for the ACTSI, a partnership among Emory, Morehouse School of Medicine, Georgia Institute of Technology and others, including Children’s Healthcare of Atlanta, Georgia Research Alliance, Georgia BIO, Kaiser Permanente, CDC, the Atlanta VA Medical Center and the Grady Health System, to showcase the unique contributions the ACTSI makes to enabling clinical and translational research.

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WHO Director Chan highlights global health changes, challenges

Dr. Margaret Chan

On World TB Day, March 16, Dr. Margaret Chan, director-general of the World Health Organization, addressed public health professionals at the Centers for Disease Control and Prevention in Atlanta at the eighth annual Jeffrey P. Koplan Global Leadership in Public Health Lecture. In introducing Chan, Koplan noted their long-term friendship, which grew from their work together in China.

While in Atlanta, Chan also visited Emory to meet with President James Wagner and Emory Global Health Institute Director Koplan. She heard presentations about global health field projects by students in public health, medicine, and theology.

Chan recalled the “lost decade for development,” the 1980s, a dismal time for public health. The 1979 energy crisis followed by a recession made for tighter public health resources and few health care improvements worldwide, she explained. Some developing countries have still not recovered.

In contrast, public health has faired better in the new millennium, when the world has benefited from financial commitments backed by substantial resources, often from innovative sources, says Chan.
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Nia Project: Helping victims of violence

Nadine Kaslow, PhD, Emory School of Medicine professor of psychiatry and behavioral sciences, founded in the early 1990s the Grady Nia Project for abused and suicidal African-American women. Named for the Kwanzaa term that means “purpose,” Nia serves countless numbers of abused women who come through Grady Memorial Hospital’s emergency department each year.

The program is funded by grants from the Centers for Disease Control and Prevention and the National Institute of Mental Health, and Kaslow serves as principal investigator. Kaslow also serves as chief psychologist at Grady Memorial Hospital and holds a joint appointment in the Departments of Psychology, Pediatrics and Emergency Medicine, and the Rollins School of Public Health.

Nadine Kaslow, PhD

Kaslow says the women in the Nia program, who either feel suicidal or have attempted suicide because of stress associated with violence, are victims of intimate partner violence and are usually black, minimally employed, with children and addicted to drugs and alcohol. Many are homeless.

Nia is staffed 24/7. Some staffers may make a trip to the emergency department in the middle of the night when a woman comes in with injuries or a story consistent with intimate partner violence or when she has attempted suicide. If a woman enrolls in the program, she will join approximately 50 to 75 other women who are going through it at any given time.

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Students and faculty aid CDC for H1N1 response

Last spring, as H1N1 avian influenza spread across the globe, the Centers for Disease Control and Prevention put out a call asking students to assist. Within three days, 85 students from Emory’s Rollins School of Public Health (RSPH) had volunteered.

RSPH students Nick Schaad (left) and Michael Marrone

RSPH students Nick Schaad (left) and Michael Marrone

Nick Schaad was among the students authorized to help man the CDC’s Emergency Operations Center at the height of the novel H1N1 outbreak. Once the CDC began to identify influenza clusters, students began conducting phone surveys.

Schaad says he was involved in the St. Francis prep school survey in New York. Students and staff member who were sick with any flu-like symptoms were identified. The team called them and asked about the size of their household, what they might have done to protect themselves, and any recent travel. The goal was to learn as much possible about H1N1 in advance of the fall flu season.

Like the students they teach, RSPH faculty became engaged in the H1N1 epidemic. Last spring, Emory physician and microbiologist Keith Klugman, MD, PhD, was recruited to join the CDC’s Team B, which includes experts from outside the CDC to quickly review and inform the agency’s efforts. CDC created Team B in the early 2000s to cope with the growing complexity of public health emergencies.

Keith Klugman, MD, PhD

Keith Klugman, MD, PhD

Klugman says his role included the bacterial complications of influenza. Evidence from 1918, notes Klugman, clearly shows that the great majority of deaths were due to bacterial complications of the flu. In other words, the flu itself could occasionally cause death on itss own. But it caused death mostly by facilitating a synergistic lethality between itself and bacteria.

Although much has changed since 1918, the bacteria that caused so many deaths still exist but are susceptible to antibiotics.

Klugman notes the evolution of the flu. He says so far it’s generally been moderate. However, by mixing with the circulating flu in the Southern Hemisphere, it could mutate and become resistant to the first line of flu drugs. It could also become more severe. Says Klugman, “We must remain ever vigilant.”

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Obesity ups risk for endometrial cancer

Increasing numbers of obesity in both men and women nationwide are resulting in a growing rate of multiple health consequences. Recent research suggests that overweight women are at an increased risk of developing endometrial cancer, especially if menopause occurs in women younger than age 45.

One study has found that women with a body mass index (BMI) of greater than 35, who experienced their last menstrual period at an age younger than 45, had more than 20 times the risk of developing endometrial cancer than normal-weight women.

BMI is a measure of body fat based on height and weight that applies to both adult men and women. A BMI of 18.5 to 24.9 is considered normal weight, 25 to 29.9 is considered overweight and a number over 30 is considered obese.

Mary Dolan, MD, MPH, assistant professor of gynecology and obstetrics, Emory School of Medicine, notes that experts already know that obesity is linked to cardiovascular disease, high blood pressure, diabetes, joint complications and other diseases. Now the connection between obesity and endometrial cancer is on experts’ radar.

Mary Dolan, MD, MPH

Mary Dolan, MD, MPH

Endometrial cancer forms in the tissue lining the uterus or endometrium – the lining that is “shed” monthly during menstruation. Endometrial cancer is more common in older women and fortunately is usually diagnosed early since it causes abnormal bleeding, says Dolan.

In a report published recently, Dolan and colleagues from the Centers for Disease Control and Prevention (CDC) discuss findings from a review of data from the Cancer and Steroid Hormone study from the 1980s. This study examined the relationship between oral contraceptive use and breast, ovarian and endometrial cancers in women ages 20-54 years.

Since many of the study patients with endometrial cancer were overweight, the study gave researchers an opportunity to look at the risk for endometrial cancer among younger, overweight women using BMI.

The study found that women who were younger than 45 when they had their last period and had a BMI over 35 had a 21.7 times greater risk of developing endometrial cancer than a woman of normal weight.

In comparison, older women with a BMI of 35 or higher, who had their last period at age 45 or older, had a 3.7 times greater risk of developing endometrial cancer than a woman of normal weight.

Elevated risks were also seen for women who had been overweight or obese at age 18 and who had their last period before age 45.

Dolan says obesity can lead to higher levels of estrogen because of chronic “anovulation,” where a woman fails to ovulate. Because the condition brings on irregular or no menstruation, estrogen levels remain high while opposing progesterone levels remain low. Experts believe this combination leads to an increased risk of endometrial cancer.

Dolan says physicians need to counsel patients even more to maintain a healthy weight. By both losing weight and then maintaining it, a woman’s risk for endometrial cancer likely decreases.

This study is one of only a few which have focused on younger women and the relationship between obesity and endometrial cancer. The results were published in the July 2009 issue of Obstetrics & Gynecology

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