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A storied look at HIV/AIDS in Africa

At a recent Emory global health seminar series, Kate Winskell showed how fiction penned by young Africans can help inform the response to HIV and AIDS. Since 1997, more than 145,000 young Africans have participated in scriptwriting contests as part of Scenarios from Africa HIV communication process.

The resulting archive of stories is a unique source of cross-cultural and longitudinal data on social representations of HIV and AIDS. The archive now spans 47 countries and a critical 12-year period in the history of the epidemic. Winskell’s presentation analyzed the stories that were part of the 2005 Scenarios contest. Six African countries were represented.

The seed for Scenarios was planted more than a decade ago–before the rise of the Internet—when Winskell, a public health educator, and her husband, Daniel Enger, were searching for innovative ways to reduce the spread of HIV/AIDS. The old ways of trying to stop the spread of the disease, focusing only on medical aspects of the epidemic or relying on educational materials that were not culturally adapted, were clearly limited.

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Predicting individual risk for heart failure

Javed Butler, MD, MPH, and colleagues

Javed Butler, MD, MPH, director of heart failure research at Emory Healthcare and associate professor of medicine at Emory University School of Medicine, says heart failure is any condition in which the heart is unable to pump enough blood for the metabolic needs of the body, but that does not mean that the heart is not pumping or the heart has stopped working.

Heart disease is not a disease but a syndrome, so a whole family of different diseases can precede this condition. Diabetes, obesity, heart valve problems, lung disease, heart attack and irregular heartbeats are only some factors that can cause heart failure. “Pinning down the roots of heart failure can be confusing,” says Butler, who serves as deputy chief science advisor for the American Heart Association. “Unlike some heart problems, heart failure is not one disease. It has a few common causes, and a few less common, even rare, causes.”

Finding new ways to identify people at risk for developing heart failure—before damage is done—is his raison d’etre and primary research focus, according to Emory Medicine magazine.

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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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Chronic diseases drive up Medicare costs, study shows

A new study by Emory University public health researchers finds that outpatient treatment for chronic diseases such as diabetes, hypertension and kidney disease are to blame for the recent rise in Medicare spending. Kenneth Thorpe, PhD, chair, Health Policy and Management, Rollins School of Public Health, presented study findings today at a briefing of the National Press Club in Washington, DC.

The report, “Chronic Conditions Account for Rise in Medicare Spending from 1987 to 2006,” was published Feb. 18 by the journal Health Affairs.

Kenneth E. Thorpe, PhD

Thorpe and colleagues analyzed data about disease prevalence and about level of and change in spending on the 10 most expensive conditions in the Medicare population from 1987, 1997 and 2006.

Among key study findings:

  • Heart disease ranked first in terms of share of growth from 1987 to 1997.  However, from 1997 to 2006, heart disease fell to 10th, while other medical conditions – diabetes the most prevalent – accounted for a significant portion of the rise.
  • Increased spending on diabetes and some other conditions results from rising incidence of these diseases, not increased screening and diagnoses.

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Eye diseases and immune system link studied

Drawing shows areas of the eye

Emory Eye Center researchers are looking at the role of the immune system in the inflammation of the eye and the progression of eye diseases.

Santa Ono, PhD, professor of ophthalmology, Emory School of Medicine and researcher at the Emory Eye Center, and Emory senior vice provost for undergraduate education and academic affairs, and his team at the R. Howard Dobbs Jr. Ocular Immunology Lab, focus on the immune component of age-related macular degeneration (AMD), ocular cancer (melanoma and retinoblastoma) and ocular inflammation.

Santa J. Ono, PhD

Macular degeneration is the leading cause of sight impairment and blindness in older people. The macula, in the center of the retina, is the portion of the eye that allows for the perception of fine detail. AMD gradually destroys a person’s central vision, ultimately preventing reading, driving, and seeing objects clearly

In a recent article of Emory Magazine, Ono, an ocular immunologist, says, “If a person with AMD looks at graph paper, some of the lines will be wavy instead of straight. Certain parts of the image are no longer being transferred to the brain.”

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Palliative care: Addressing suffering and quality of life

The palliative care program at Emory University is working to improve quality of life and wellness by addressing the physical, psychological, ethical, spiritual and social needs of patients with serious, life-threatening or progressive chronic illnesses, and provides support to their families and caregivers.

Tammie E. Quest, MD

Often mistakenly confused with hospice care, palliative care is appropriately provided to patients in any stage of serious illness – whereas hospice care is primarily used for those approaching the end stage of life, says Tammie Quest, MD, interim director of the Emory Center for Palliative Care.

A typical palliative care “team” consists of physicians, nurses, social workers, chaplains, mental health professionals, therapists and pharmacists, assisting patients through a wide array of illnesses, including stroke, heart and lung disease, cancer and HIV.

The palliative care teams work closely with primary physicians to control pain, relieve symptoms of illnesses – such as nausea, fatigue and depression. Teams help provide counseling in making difficult medical decisions and provide emotional and spiritual support, coordinate home care referrals and assist with identifying future care needs.

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NIH at Emory to advance women’s heart health

NIH meets at Emory to discuss women's cardiovascular health and research

The National Institutes of Health (NIH) has convened a key meeting at Emory on women’s cardiovascular health and research. The meeting, co-hosted by the Office of Research on Women’s Health and Emory School of Medicine, is focused today and tomorrow on NIH planning of the women’s health research agenda for the next decade.

Vivian Pinn, MD, associate director for research on women’s health, and director of the Office of Research on Women’s Health at NIH, opened the meeting with Emory’s conference chair, Nanette Wenger, MD, professor of medicine (cardiology), Emory School of Medicine, and chief of cardiology at Grady Memorial Hospital.

Nanette K. Wenger, MD

In a career that spans more than 50 years, Wenger’s dedication to reducing women’s disability and death from cardiovascular disease has made her one of the country’s most-respected experts on coronary heart disease in women. In 2009, Wenger received the Lifetime Achievement Award from the American College of Cardiology.

Although Wenger has earned dozens of awards in her celebrated career, she says her greatest professional achievement has been to help change a major paradigm in cardiology: the assumption that heart disease affects only men. A half a century ago heart disease was thought of as a “man’s disease.”

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Stress increases health risks to mother and fetus

At Emory’s fifth annual predictive health symposium “Human Health: Molecules to Mankind,” Emory GYN/OB Sarah L. Berga, MD, discussed the state of childbirth in the United States and how maternal stress affects pregnant women and their fetuses.

Berga is McCord professor and chair of the Department of Gynecology and Obstetrics at Emory School of Medicine. Sadly, Berga has seen maternal mortality rise steadily since the 1980s when she entered her medical residency. Georgia, she says, has the worse maternal mortality in the country. And the United States fares worse than many countries when it comes to maternal mortality.

Despite the unfortunate rise in maternal mortality of late, the good news is physicians have now started to pay more attention to the effect of stress—both the physical and emotional kind—on women and their fetuses. Recent research shows stress has the same negative effect on the body as do organic diseases, such as thyroid disease. In fact, too much stress reduces thyroxine levels by about 50 percent, says Berga. But because there’s no clinical recognition of this, tests are needed to determine if thyroxine levels are indeed insufficient.

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Tailoring transplant drugs for children

For adult organ transplant recipients, juggling a lifetime regimen of immunosuppressant drugs is difficult enough, but for children it presents an even greater challenge.  These drugs, which also can have toxic side effects, must strike a delicate balance between preventing organ rejection and protecting from infections.

But children’s immune systems are still “learning” what distinguishes them from the world around them, and children are constantly developing and changing, both physically and emotionally. This puts them at greater risk for complications either through inappropriate medication or failure to take these drugs properly.

A grant from the National Institute of Allergy and Infectious Diseases (NIAID), through the American Recovery and Reinvestment Act (ARRA), will support new studies at Emory University and Children’s Healthcare of Atlanta to help clinicians tailor therapies specifically for children receiving transplants.  The project will include hiring of additional personnel to undertake these studies.

Allan D. Kirk, MD, PhD, is principal investigator of the project, which is supported by a two-year grant of nearly $1.65 million. Kirk is professor of surgery and pediatrics in Emory University School of Medicine and a Georgia Research Alliance Eminent Scholar. He also is vice chair of research in the Department of Surgery and scientific director of the Emory Transplant Center.

The ARRA-funded project will not only help determine which medications children should take, but also will give them the support to care for their transplanted organs.  The Emory scientists are studying new biological monitoring technologies that can identify unique ways to determine exactly how much medication a child really needs. These studies are being combined with a novel transition care clinic specializing in helping children cope with their illness and assuming responsibility for their care.

“This award indicates exceptional insight by the NIAID into the critical link between a child’s physical well-being and their emotional maturity,” says Kirk. “It will accelerate progress in this vital area of research for a very deserving subset of chronically ill children.”

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Intervention: preventing trips to the trauma unit

Jana MacLeod, MD

Drunk drivers have been known to walk away from auto wrecks—but that’s unusual. In fact, the norm is this: those who drink before an accident of any kind, particularly a motor vehicle accident, have a much higher chance of being injured or dying than if they hadn’t been drinking at all.

So, Jana MacLeod, MD, and her colleagues trained surgical interns to conduct brief interventions on patients with alcohol-related injuries. MacLeod is an associate professor of surgery, Emory University School of Medicine. She says brief interventions offer patients a way to talk about their alcohol use with their physician, and then make behavioral changes if they so choose.

MacLeod talks about the benefits of these interventions in an Emory Sound Science podcast.

“Recent studies have shown brief alcohol interventions with trauma patients who have a history of alcohol misuse successfully prevented future episodes of drunk driving,” says MacLeod. What’s more, it’s been shown a five-minute intervention reduces hazardous drinking patterns up to three years after injury and decreases recidivism.

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