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When veterans face emotional trauma

Emory researcher Barbara Rothbaum, PhD, professor of psychiatry and behavioral sciences, Emory School of Medicine,  and director of the Trauma and Anxiety Recovery Program, has been treating military personnel with posttraumatic stress disorder (PTSD) for more than a decade, helping them to learn how to deal with troubling memories. Through therapy, the service members are taught that by re-living the traumatic event, they can begin to learn how to control the effect those memories have when they surface.

Barbara Rothbaum, PhD, demonstrating virtual reality exposure therapy used to help veterans with PTSD.

PTSD is treatable and treatments vary from exposure therapy to medication to meditation techniques. Symptoms include reliving the event; avoiding situations that stir up memories of the event; discomfort expressing feelings; being constantly on the lookout for danger; irritability; drinking or drug problems; and employment, social and relationship problems.

Many times it’s the family members, friends or co-workers who are first to identify a change in the veteran or service member. Symptoms can arise abruptly and begin to interfere with every day activities. When those symptoms last for more than four weeks, it is likely that individual has posttraumatic stress disorder (PTSD).

Rothbaum emphasizes that treatment for PTSD is very effective.  She encourages active duty military personnel, veterans and others who have been exposed to trauma to seek diagnosis and treatment for problems that persist.  Symptoms can worsen with time, or cause social and employment problems that complicate recovery, but treatment can help.

More information on PTSD is available from the U.S. Department of Veterans Affairs. A clinical trial taking place at Emory uses virtual reality therapy for military personnel who have served in Iraq and Afghanistan and have been diagnosed with PTSD.

Emory PTSD research by Dr. Rothbaum and her colleagues is featured on GE’s Healthymagination website.

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Cholera in the time of disaster

Alex Larsen couldn’t make it to the 2010 International Association of National Public Health Institutes (IANPHI) annual meeting. That’s because Larsen, Haiti’s minister of health, was attending to an outbreak of cholera in this impoverished republic.

Vibrio cholerae bacteria

Larsen was scheduled to speak on NPHIs’ role in disaster preparedness and response. Instead, Scott Dowell, director of the CDC’s division of global disease detection and emergency response, updated attendees about goings-on in Haiti since the massive January 12 earthquake and the recent outbreak of cholera.

The first two weeks after the tremblor and its immediate aftershocks, human and monetary resources were spent on search and rescue, including emergency trauma care, orthopedic surgery and amputations, says Dowell.

The number killed now stands at 200,000. The number displaced: 1.3 million. In addition to an initial lack of safe drinking water, hunger and poor sanitation, anecdotal accounts of diphtheria and tetanus outbreaks circulated. The headquarters housing the ministry of public health was itself devastated when it collapsed, killing most of the minister’s staff who had remained inside.

Since the earthquake, Dowell says the water supply has slowly improved with long-term sources coming on line. Efforts to better separate sewage and water are coming to fruition, too.

As far as the cholera outbreak is concerned, this chapter of Haiti’s public health challenges is just beginning thanks in part to Haiti having never before experienced a known cholera epidemic, says Dowell. That is, its population is most likely immunologically naïve to cholera, making people vulnerable to the bacteria’s devastating ways: severe diarrhea, vomiting, and abdominal pain culminating in overwhelming dehydration and even death.

Despite its troubles, Dowell says there’s long-term hope for Haiti. As found in other countries affected by cholera, an aggressive program to provide clean water and keep sewage and water separate, can eventually squelch the bacteria’s rampage—and in the meantime prevent other diseases from taking hold.

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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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Anticipating approval from a renowned scholar

Charles Raison, MD, with the Dalai Lama

When Charles Raison hosted a fundraising dinner for Jestun Pema, the sister of His Holiness the Dalai Lama some years ago as a faculty member at the University of California at Los Angeles, little did he know his future would become intertwined with His Holiness.

Raison, who is a psychiatrist and an associate professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, began his career at Emory in 1999. Since that time, he has emerged as one of the leaders in Emory’s remarkable relationship with the Dalai Lama through the Emory Tibet Science Initiative (ETSI) and his research on the potential health benefits of compassion meditation.

The Dalai Lama recently visited Emory in his role as Emory Presidential Distinguished Professor and presided over a series of conferences related to ETSI.  Raison made a presentation to His Holiness during the Compassion Meditation Conference.

Read more

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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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Shedding light on the vitamin D-Parkinson’s connection

Vitamin D may be called a vitamin, but it’s not. That’s because we can make it by exposing our skin to sunshine. So, technically that makes vitamin D a hormone–a steroid hormone to be exact. In fact, we get most of our exposure to vitamin D directly from sunshine and some from foods such as milk, fortified orange juice and oily fishes like salmon.

But no matter what you call it or where you get it, vitamin D is vital to growth, development and maintenance of our cells. Doctors have known for decades that vitamin D promotes calcium uptake and bone formation, but evidence is accumulating that it regulates the immune system and the development of the nervous system. Growing evidence suggests a link between low vitamin D levels and Parkinson’s disease, but whether this is a cause-and-effect relationship is unknown.

Marian Evatt, MD

That’s why Emory neurologist Marian Evatt, MD, and her colleagues are conducting a clinical trial exploring the effects of vitamin D supplementation on patients with Parkinson’s disease who have low vitamin D levels. The study also includes further epidemiological studies of vitamin D in Parkinson’s disease.

Parkinson’s disease affects nerve cells in several parts of the brain, particularly those that use the chemical messenger dopamine to control movement. The most common symptoms of Parkinson’s disease are tremor, stiffness and slowness of movement.

“Vitamin D has become associated with many chronic diseases: diabetes, hypertension, cardiovascular disease, and some of the autoimmune diseases, including multiple sclerosis,” says Evatt. “But we haven’t yet determined the specific effect of vitamin D in specific conditions because it has such broad effects.”

To hear Evatt talk about what vitamin D is, what it does, and why we need it, please go to Emory’s latest Sound Science podcast.

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Re-energizing AIDS vaccine research

Emory President James Wagner welcomed participants Wednesday to the AIDS Vaccine 2010 conference in Atlanta, hosted by the Global HIV Vaccine Enterprise and locally hosted by the Emory Center for AIDS Research.

“Only occasionally are there scientific challenges that unite people powerfully towards a common goal,” Wagner said. “We are proud for the role we’ve been able to play in the pursuit of vaccine research. I am particularly pleased that so many students and young investigators have been able to participate in this conference.”

John Mascola from the Vaccine Research Center at the NIH gave the day’s first scientific talk, describing the discovery of broadly cross-reactive neutralizing antibodies to HIV and the ability to isolate those antibodies. This is the kind of recent discoveries that has re-energized the HIV vaccine research community.

Bette Korber of the Los Alamos National Laboratory noted that HIV mutations that escape immune response in some infected people are frequently susceptible in others. New “mosaic vaccines” can expand the breadth and depth of these immune responses, she said. She also described the effort underway in her laboratory to re-examine results of an earlier vaccine trial, VAX004, in light of new analytic strategies.

Giuseppe Pantaleo of the Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland expressed the need to implement adaptive clinical trial study design. This theme — the need to examine clinical trial results early and often, and then adapt, rather than waiting for all results at the very end of a years-long trial — has been echoed often at the conference.

At a midday press briefing, Peter Kwong of the NIH Vaccine Research Center discussed his research with broadly neutralizing antibodies, one of which attacks the initial site of vital attachment to CD4 T cells.

Hendrik Streek from Harvard’s Ragon Institute described how vaccines induce antibody and CD4 response and contraction. Even though CD4 cells are the ones attacked during HIV infection, Streek believes CD4 responses may be a missing link to effective vaccine development

Alan Bernstein, executive director of the Global HIV Vaccine Enterprise, led a discussion of the new Enterprise Scientific Strategic Plan. Less than two out of five people who need treatment for HIV are receiving it, said Bernstein, which underscores the importance of an effective vaccine.

The new plan arrives at a time of great momentum and excitement in the field. A year of important advances has included discoveries about broadly neutralizing antibodies, new technologies, and a vaccine that demonstrated an immune response. The plan emphasizes novel clinical trials design, a strong commitment and engagement by many partners, and expanded diversity of funding by many stakeholders.

Jose Esparza, senior advisor on HIV vaccines to the Bill & Melinda Gates Foundation, emphasized the need to rapidly capitalize on new science, and said HIV vaccines are one of the foundation’s top priorities. High risk, high reward projects will be funded through the Gates Grand Challenges Explorations grants.

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AIDS Vaccine 2010 conference brings global research focus to Atlanta

This week’s AIDS Vaccine 2010 conference, Sept. 28-Oct. 1, is underway at Atlanta’s Omni Hotel. Under the auspices of the Global HIV Vaccine Enterprise, the international meeting is hosted by the Emory Center for AIDS Research (CFAR).

Over 1,100 scientists, advocates, funders, and policy makers are attending 500 sessions about scientific discoveries and future directions for developing an effective HIV/AIDS vaccine. This goal is considered critical in fighting the ongoing epidemic, which newly infects 50,000 people each week around the world.

Emory HIV/AIDS researchers are playing a significant role in the meeting. The four co-chairs are Eric Hunter, PhD, co-director of the Emory CFAR; James Curran, MD, MPH, dean of Emory’s Rollins School of Public Health and co-director of the CFAR; Carlos del Rio, MD, chair of the Hubert Department of Global Health and co-chair of the CFAR; and Harriet Robinson, PhD, formerly of Yerkes Primate Center and Emory Vaccine Center and now at GeoVax, Inc.

Hunter led the opening press conference and opening session on Tuesday afternoon.

A fellowship program hosted 21 journalists from media outlets around the world.

Alan Bernstein, executive director of the Global HIV Vaccine Enterprise, emphasized the need to build a bridge between basic science and clinical research. On Wednesday, Bernstein will talk about the Enterprise’s new strategic plan for an HIV vaccine.

Dazon Dixon Diallo, director of the African-American women’s organization Sisterlove, noted that the South has been particularly hard hit by the AIDS epidemic, with over half the HIV cases in the United States. The human rights dimensions of the disease are enormous, she said, and engagement with community partners is essential in fighting HIV. Researchers need to solve the problem with the help of people who know the most about it.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases of the NIH, said that even though the road to an HIV vaccine has been a rocky one over the past 23 years, the limited success reported last year with the RV144 trial was the first signal that it is possible for a vaccine to block HIV acquisition, a finding that has re-energized the vaccine community.

Future directions for HIV vaccine research, said Fauci, will include research that builds on insights from the success of RV144, multiple clinical trials conducted as scientific tools and not just all-or-nothing aims for vaccine licensing, more research into the early events of HIV infection that could provide targets for vaccines, and new structure-based vaccines using newly discovered neutralizing antibodies.

“I don’t think there is any question we are going to get there,” said Fauci. “The light at the end of the tunnel is the science we are now implementing.”

Press conferences are streamed live and available for playback at the conference website:

For more information on Emory’s role in the conference and Emory HIV/AIDS research, including video, see the website.

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Initial Results of Heart Valve Study Encouraging

 

Emory heart patient, Glenrose Gay of Vidalia was the first person in GA to receive a new aortic valve via catheter. Pictured here in 2007 with Emory cardiologists, Drs. Peter Block (left) and Vasilis Babaliaros.

Since October 2007, Emory University Hospital has been one of approximately 20 hospitals nationwide, and the only site in Georgia, studying a new non-surgical treatment option for patients with failing aortic valves. The life threatening heart condition,aortic stenosis, affects tens of thousands of Americans each year when the aortic valve tightens or narrows, preventing blood from flowing through normally.

As part of the Phase II clinical trial, researchers have been performing transcatheter aortic valve implantation (TAVI) comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis.

During the TAVI procedure, doctors create a small incision in the groin or chest wall and then feed the new valve, mounted on a wire mesh on a catheter, and place it where the new valve is needed. This offers a non-invasive way for doctors to treat patients who are too ill or frail to endure the traditional open-heart surgical approach.

The study, published Wednesday in The New England Journal of Medicine (NEJM) followed 358 patients who received either catheter-delivered valves or standard non-surgical treatment.

The findings showed that patients who had replacement heart valves delivered by catheter were more likely to survive a year than patients who were treated without replacing their original valves. According to the authors, catheter-delivered valves “should be the new standard of care” for patients who are not able to undergo surgery.

“These results show great promise for patients with severe aortic stenosis and help us make a giant step forward in our battle against this common disease,” says Peter Block, MD, professor of medicine, Emory School of Medicine and principal investigator of the study at Emory. “They are especially important since the number of people with failing valves is expected to greatly increase as baby boomers continue to age.”

Aortic valve stenosis often occurs with age, most commonly among elderly patients over 70 years of age, but can surface earlier in life in those with rheumatic heart disease or congenital abnormalities of the valve.

Approximately 90 patients have received new valves at Emory since the clinical trial started in 2007. Researchers hope to receive FDA approval in late 2011.

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