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Sunscreen: Looking Beyond the Numbers

Carl Washington, MD

Seems pretty obvious – if a sunscreen with an SPF of 30 is good, then an SPF of 100 should be at least three times as good.

Unfortunately, that is not the case.  There are other important details to consider when you are purchasing a sunscreen.

“People have become much more educated about the importance of using sunscreen, and manufacturers have responded with an abundance of products,” says Carl Washington, MD, associate professor of Dermatology at Emory University School of Medicine. “Unfortunately, the labeling can be confusing and many of the current sunscreens only contain the ingredients necessary to offer protection against sunburn, but not skin cancer or aging.”

Recently, the Food and Drug Administration created new regulations to establish standards for sunscreen manufacturers to follow before they label their products.

Under the new regulations, which will go into effect in 2012, sunscreen products that protect against all types of sun-induced skin damage will be labeled “broad spectrum” and “SPF 15” or higher on the container. Only products that have been tested to ensure they protect against both UVA (ultraviolet radiation A) and UVB (ultraviolet radiation B) radiation will be allowed to use this labeling.  Broad-spectrum sunscreens of SPF 15 and higher can also be labeled as protective against skin cancer and premature aging. The maximum SPF value is set at 50-plus because the FDA says anything higher doesn’t provide a significant amount of additional protection.

Manufacturers will have to include warning labels on products that are not broad spectrum. Products that claim to be water resistant must indicate how long the consumer should expect to be protected in the water, and using such language as “waterproof” or “sweat proof” will not be allowed.

“Skin cancer is the most common form of cancer in the United States, and the number of people affected keeps rising. Simply getting into the habit of using a sunscreen every day – with the appropriate levels of protection – can make a significant difference in preventing many skin cancers, as well as premature aging,” says Washington.

“These new regulations will help consumers understand the difference in degrees of sun protection, and choose carefully.”

Washington also suggests staying out of direct sunlight between 10 am and 2 pm, seeking shade when you are outdoors, remembering to reapply sunscreen every two hours and wearing protective clothing.

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Fertility: a new frontier in treating those with HIV

HIV

Not long ago, physicians who treated those with HIV focused only on helping their patients stay well. Today some physicians are also beginning to focus on helping those patients conceive.

“Most of the patients who are now diagnosed with HIV are in their reproductive years, and as many as a third express a desire to have children,” says Emory reproductive endocrinologist Vitaly Kushnir, MD.

This emerging area of treatment has been made possible thanks to the growing effectiveness of a combination of drugs known as Highly Active Antiretroviral Therapy, or HAART, used for years to treat retroviruses, including HIV.

“Now that people with HIV are living longer, fertility and HIV is an emerging area of interest,” says Kushnir. “Several studies have indicated that HIV drugs if given early in the course of the disease can reduce the risk of transmission from an HIV-positive person to an HIV-negative person.”

But researchers and physicians know very little yet about how treatments for HIV, the virus itself, and the comorbidities associated with HIV affect fertility. So, Kushnir and his colleague, Emory pathologist William Lewis, MD, decided it was time to explore existing data on how HIV and its treatment affect fertility, especially in women. Their review paper on the subject appears in the August 2011 issue of Fertility and Sterility.

Because there are safety concerns and legal restrictions on fertility treatments in couples in which one partner is HIV positive and the other is not, treatment options often are limited.

“This is becoming more and more of an issue,” says Kushnir. “It’s probably time for us to have a more open discussion about the access these patients have to fertility treatment. I think the current system probably discourages these patients from pursuing treatments that are a lot safer than trying to get pregnant on their own.”

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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 Cardiologist Weighs in on U.S. News Diet Ranking

 

Laurence Sperling, MD

U.S. News & World Report recently announced the results of its first-ever Best Diets rankings evaluating some of the country’s most popular diets.

Emory Heart & Vascular Center cardiologist Laurence Sperling served on a panel of 22 health experts selected by U.S. News to help develop the rankings. Sperling is the medical director of the Emory Heartwise Risk Reduction Program and professor of medicine at Emory University School of Medicine.

Sperling and his panel colleagues reviewed information about 20 well-known diets, from Atkins to Zone, and rated each one on specific measures such as safety, easiness to follow and nutritional completeness.

Using the experts’ ratings, U.S. News developed five diet categories to address a broad range of consumers’ dieting goals and needs including Best Diabetes Diets, Best Heart Diets, Best Weight Loss Diets and Best Overall. “The goal of the Best Diets rankings is to help consumers find authoritative guidance on healthful diets that will work for them over the long haul,” said Lindsay Lyon, U.S. News‘s Health News Editor.

Weight Watchers ranked first in the Weight Loss category. Tied for number two were Jenny Craig and the Raw Food Diet, an approach that challenges dieters to avoid foods that have been cooked.

The government-endorsed DASH Diet took the top spot as the best diet overall. Three diets tied at number two, excelling in all measures U.S News considered: the Mediterranean Diet, the TLC Diet, and Weight Watchers.

For a complete list of the new diet rankings, please visit:

http://health.usnews.com/best-diet

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Emory University Hospital Set to Be Launch Site for EPIC

Can it really be possible to transform a person’s own cells into a weapon against various forms of disease? And what if those very cells could be retrained to attack cancer cells or to prevent autoimmune diseases?

Answers to these questions and many more are about to soon be realized, as Emory University Hospital will serve as the launch site for the very appropriately-named EPIC (Emory Personalized Immunotherapy Center).

The new Center, which is the creation of Dr. Jacques Galipeau, MD, professor of hematology and medical oncology & pediatrics of Emory University, will soon be operational after final touches have been put on construction of the lab. This cell processing facility will foster development of novel personalized cellular therapies for Emory patients facing catastrophic ailments and unmet medical needs.

According to Galipeau, the premise of EPIC and its overlying mission will focus on cellular and biological therapies that use a patient’s own cells as a weapon to seek and destroy cells that actually make a person sick. In partnership with the Winship Cancer Institute of Emory University, Children’s Healthcare of Atlanta, Aflac Cancer & Blood Disorders Center and the Emory School of Medicine, EPIC seeks to improve the health of children and adults afflicted with cancer and immune disease.

“First and foremost, we seek to bring a level of care and discovery that is first in Georgia, first in human and first in child. Blood and marrow derived cells have been used for more than a quarter century to treat life threatening hematological conditions and are now established therapies worldwide. More recently, the use of specific adult somatic cells from marrow, blood and other tissues are being studied in cellular medicine of a wide array of ailments including heart, lung, neurological and immune diseases,” says Galipeau. “The use of blood borne immune cells can also be exploited for treatment of cancer, autoimmune disease, organ transplantation and chronic viral illnesses such as HIV.”

Galipeau said that once operational, EPIC will begin by working with Crohn’s disease in pediatric and adult patients, an inflammatory bowel disease. Symptoms of Crohn’s disease include severe abdominal pain, diarrhea, fever, weight loss, and the inability for a child to properly grow. Resulting bouts of inflammation may also affect the entire digestive tract, including the mouth, esophagus and stomach.  In some cases, a radical surgery involving the removal of part of the lower intestinal tract is required.

“There is no current answer for what specifically causes Crohn’s disease, nor is there a cure. But we hope that through our research and efforts, we will be able to first target the inflammatory mechanisms in these patients through immunotherapy, and in turn reduce the amount of flare-ups and limit  the damage that occurs from this disease,” says Galipeau.

Galipeau says the EPIC program could represent a powerful cornerstone to the launch and the development of an entirely new, Emory-based initiative which bundles the strengths of the School of Medicine, Emory University Hospital, Children’s Healthcare of Atlanta, and many Woodruff Health Sciences Center centers of excellence,” says Galipeau.

“My ultimate goal is to elevate the biomedical scientific and scholarly enterprise to a higher level – making a difference in the lives of people. The EPIC program and multi-levels of support could be a fundamental underpinning to our success.”

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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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Improving the lives of those with rare blood disorders

While many people have never heard of an eosinophil, most people do know what a white blood cell is and have some understanding of its disease and infection-fighting role in the human body.

While these strange-sounding cells play an incredibly important part of the immune system by helping to fight off certain infections, when eosinophils occur in higher than normal numbers in the body without a known cause, a rare eosinophilic disorder may be present.

Typically, eosinophils make up less than five percent of circulating white blood cells in healthy individuals and can vary over time, but when the body wants to attack a substance, , eosinophils respond by moving into the area and releasing a variety of toxins. When the body produces too many eosinophils, they can cause chronic inflammation, resulting in tissue damage within the body.

Emory cardiologist Wendy Book serves as president of the American Partnership for Eosinophilic Disorders (APFED), one of the organizations within the National Organization for Rare Disorders (NORD). Book recently accepted the Abbey S. Meyers Leadership Award on behalf of APFED. The award, named for NORD’s founding president, is presented each year to a NORD Member Organization for demonstrating outstanding leadership and representation of its members.

“I am honored to be part of a collaborative effort among patients, families, physicians, researchers, policy makers and others to develop diagnostics and therapeutics for rare diseases,” says Dr. Book. “We are grateful to work with NORD and other member organizations to provide a voice for those living with rare, and often poorly understood, diseases.”

The awards were presented at the annual NORD Partners in Progress Celebration.  Each year, NORD—a nonprofit organization that represents the 30 million Americans with rare diseases—celebrates pioneering achievements of individuals, organizations, and companies in public policy, patient advocacy, medical research, and product development.

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Fat distribution in black and white women may help predict heart disease

A woman’s body shape – often described as pear, apple or hourglass – is usually determined by the amount of fat in various regions of the body including the bust, waist, arms and hips. New research from Emory University School of Medicine suggests that these patterns of fat distribution may help predict arterial stiffness – a precursor to cardiovascular disease.

Stiff arteries make the heart work harder to pump blood and are associated with atherosclerosis, or the buildup of plaques in vessels that can block blood flow and cause a heart attack.

Noting that fat distribution generally differs between black and white women’s bodies, researchers enlisted 68 black women and 125 white women, all middle-aged, to see whether these patterns could help assess cardiovascular risk.

The study, conducted by Danny Eapen, MD, a cardiology fellow at Emory, used data from Emory’s Center for Health Discovery and Well Being. He presented his findings recently at the American Heart Association’s Arteriosclerosis, Thrombosis, and Vascular Biology 2011 meeting.

Using skin calipers, the researchers measured subcutaneous fat in seven sites: the upper chest; midaxillary, or the side of the torso just under the armpit; triceps, or the back of the arm; subscapular, or on the back just below the shoulder blade; abdominal; suprailiac, or just above the front of the hip bone; and the thigh.

“Black women have higher rates of cardiovascular disease than white women and are more likely to die from it,” says Eapen. “Black and white women also have different patterns of fat distribution, so we were interested in measuring these pockets of fat at various regions of the body to evaluate whether it might be helpful in predicting cardiovascular risk between the two groups.  Our hope was to evaluate whether a quick, easy-to-use clinical tool could aid in further risk stratifying our female patients.”

The study also assessed the arterial stiffness of the women, adjusting for heart rate.

As a group, the black women had greater arterial stiffness than the white women. They also had more subcutaneous fat in the armpit, triceps, shoulder blade and hip bone areas.

In addition, they also found specific race dependent pockets of fat that could be related to arterial stiffness – fat measurements in the triceps area could predict increased arterial stiffness in black women, while fat in the suprailiac areas was a predictor in white women.

Content contributed in part by Sarah Goodwin, Emory’s Center for Health Discovery and Well Being.

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Emory researchers receive grants to further work in pediatric brain tumor research

Dr. Castellino explains his research on medulloblastomas to participants attending the SBTF’s Grant Award Ceremony.

Two Emory researchers are being recognized by the Southeastern Brain Tumor Foundation (SBTF) for their work in pediatric brain tumor research.

Tracey-Ann Read, PhD, assistant professor in the Department of Neurosurgery, Emory University School of Medicine and director of the Pediatric Neuro-Oncology Laboratory at Emory was awarded a $75,000 grant for her work. She is studying the cell of origin that is responsible for the highly malignant pediatric brain tumor known as an Atypical Teratoid Rhabdoid Tumor (AT/RT). She is also developing a mouse model to study this very lethal brain cancer that occurs in early childhood.

Robert Craig Castellino, MD, assistant professor of pediatrics at Emory and pediatric hematologist/oncologist at Children’s Healthcare of Atlanta at Egleston received $50,000 to support his research efforts. He is studying how the childhood brain cancer, known as medulloblastoma, can metastasize from the brain to other sites in the body, specifically the spine. Medulloblastoma is the most common pediatric malignant brain tumor.

SBTF board members and researchers who were awarded grants pose following the April ceremony.

Read and Castellino received the awards at the SBTF’s Grant Awards Ceremony in April at Emory University Hospital Midtown. Two other researchers from Duke University were also presented with grant money for their contributions in brain tumor research in adults.

Emory neurosurgeon Costas Hadjipanayis, MD, PhD, is the president of the Southeastern Brain Tumor Foundation. He says research, from young investigators such as these, is crucial in the race to find a cure for brain tumors. As federal research funding becomes even more difficult to obtain with cuts in funding, private foundation grants, such as from the SBTF, can permit researchers to start important research projects that can provide preliminary data for bigger grant proposals.

The SBTF awards $200,000-300,000 each year to major medical centers throughout the Southeast in support of cutting-edge brain and spinal tumor research.

 

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