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Global health: from autism screening to neglected tropical diseases

A partnership of more than 40 universities, the Consortium of Universities for Global Health held its second annual meeting at the University of Washington in Seattle this week, with a wide range of presentations centered on the theme Transforming Global Health: The Interdisciplinary Power of Universities.  Emory Global Health Institute presentations ranged from neglected tropical diseases to autism in Chinese populations to changes in medical school curricula.

Carlos Franco-Paredes, MD

Emory’s Carlos Franco Paredes, MD, MPH, associate professor of medicine (infectious disease) talked about a troublesome global health issue—one that hits close to home—the effect of neglected tropical diseases in the immigrant and refugee communities living in Atlanta. Neglected tropical diseases are disabling, disfiguring, and deadly diseases impacting more than one billion people worldwide, says Paredes. Atlanta’s immigrant populations show a high prevalence of intestinal parasitic infections, schistosomiasis, strongyloidiasis, and hepatitis B.

Meanwhile, Joseph Cubells, MD, associate professor of human genetics at Emory, shared his experience with the Mandarin Chinese Autism Spectrum Screening Questionnaire in urban Mandarin Chinese-speaking communities. Cubells says large-scale, community-based studies of autism spectrum disorders require effective tools for screening potential cases. So, to meet the need for such tools in Chinese populations, he and his colleagues translated and back-translated The Autism Spectrum Screening Questionnaire, a 27-item parental checklist originally published in English.

And what about incorporating global health education into the medical curriculum as a way of transforming universities’ role in advancing global health? Emory’s Henry Blumberg, MD, professor of infectious disease and his colleagues have done just that. Now, global health is a part of Emory’s innovative new medical curriculum, which was launched in 2007. After all, global health is becoming ever more important to the world at large, garnering more interest from future physicians.


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Health sciences on the A-List

Parade magazine’s back-to-school survey in the August 22 issue and website included Emory on its A-list of colleges with excellent programs in the health sciences.

“Good health programs combine strong academic preparation with a hands-on approach and offer a wide variety of choice,” said the magazine.

“Emory University, a stand-out in health sciences, has the Centers for Disease Control virtually next door.”

Emory also made the A-list for its pre-med programs:

“At Emory, students interested in the field of medicine have the opportunity to gain first-hand exposure to the daily routine of the physician through their House Staff Assistant program. Students witness all aspects of the job and become integral parts of the medical team, which consists of attending physicians, resident physicians, and medical students.”

The list of outstanding schools was based on the recommendations of 43 top guidance counselors across the country.

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Preterm infants born at unspecialized hospitals face higher risk of death

Very low-birth-weight (VLBW) and very preterm (VPT) infants not born in highly specialized, level III hospitals have a higher risk of neonatal and pre-discharge death compared to similar infants born at level III hospitals, according to a recent Journal of the American Medical Association (JAMA) study.

Lead study author Sarah Lasswell, MPH, and colleagues at the Rollins School of Public Health conducted a large-scale analysis of previous research to examine the relationship between hospital level at birth and neonatal (generally the first four weeks after birth) or pre-discharge mortality for VLBW (weighing 53 ounces or less) and VPT (32 weeks or less gestation) infants to determine the importance of level of care at birth to survival.

Lasswell and colleagues found that VLBW infants born in non-level III hospitals had a 62 percent increase in odds of neonatal/pre-discharge death compared with VLBW infants born in level III hospitals. In addition, VPT infants born in lower-level hospitals had a 55 percent increase in odds of neonatal/pre-discharge mortality compared with those born in level III facilities.

“The results of this review confirm a primary premise on which perinatal regionalization systems are based: high-risk infants have higher mortality rates when born outside hospitals with the most specialized levels of care,” Lasswell and colleagues write.

“Strengthening perinatal regionalization systems in states with high percentages of VLBW and VPT infants born outside of level III centers could potentially save thousands of infant lives every year.”

About 13 million babies are born prematurely every year – nearly 10 percent of all newborns – and more than 1 million premature babies die each year, according to the March of Dimes.

The study, “Perinatal Regionalization for Very-Low-Birth-Weight and Very Preterm Infants: A Meta-Analysis,” was published in the Sept. 1, 2010, issue of JAMA. It was conducted as part of Lasswell’s graduate research at the Rollins School of Public Health under the direction of Roger Rochat, MD. Lasswell is now a researcher at the U.S. Centers for Disease Control.

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Higher education linked to improved heart disease outcomes in richer countries

A higher level of education is associated with reduced risk of heart disease and stroke for people who live in rich countries, but not for those in low- and middle-income nations, according to the findings of a recent study led by Emory epidemiologist and cardiologist Abhinav Goyal, MD, MHS.

Abhinav Goyal, MD, MHS

The study published in the Sept. 7, 2010, issue of the journal Circulation, a publication of the American Heart Association, is one of the first international studies to compare the link between formal education and heart disease and stroke. It examined data on 61,332 people from 44 countries who had been diagnosed with heart disease, stroke, or peripheral arterial disease, or who had cardiovascular disease risk factors such as smoking or obesity.

Goyal and team found that highly educated men in high-income countries had the lowest level of cardiovascular disease. However, their findings suggest that research conducted in richer nations can’t always be applied to poorer countries.

“We can’t simply take studies that are conducted in high-income countries, particularly as they relate to socioeconomic status and health outcomes, and extrapolate them to low- and middle-income countries,” says Goyal, assistant professor of epidemiology and cardiology at Emory’s Rollins School of Public Health and Emory School of Medicine. “We need dedicated studies in those settings.”

The research team was surprised to find that despite decreased heart disease risk among the higher educated in industrialized nations, nearly half of the highly educated women from high-income countries smoked, compared with 35 percent for those with the least amount of schooling. For men, smoking rates were virtually the same across educational groups in low- and middle-income countries.

“Everyone needs to be educated about the risk of heart disease in particular, and counseled to adopt healthy lifestyles and to quit smoking,” Goyal says.

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Healing gardens provide beautiful therapy

Geriatric and chronic care patients at Wesley Woods Geriatric Hospital often need help improving their fine motor skills, muscle tone, range of motion, strength, and even peace of mind.

Master gardener Kirk Hines considers the Wesley Woods greenhouse another clinical space where patients can improve their skills through growing plants in therapy sessions or just enjoying the relaxation gardening can bring. For patients who can’t come to the garden, Hines brings gardening inside or even to their bedside.

“We want our patients to be successful,” says Hines. “Gardening draws on long-term memory for many of them. While they are planting tomato seeds or digging in the dirt, it takes away the anxiety they feel away from home. They don’t feel like they are in a hospital environment.”

Hines is a registered horticultural therapist who founded the program at Wesley Woods in 1993. Over those 17 years he has turned the gardens into a showpiece for sensory stimulation, with healing gardening spaces including courtyards with handrails, special walkways, and shady seating areas with fountains and goldfish.

When patients are discharged they often take the plants they have grown home with them, and many appreciative families have pitched in with their own labor and materials to keep the gardens beautiful.

Visit Emory Health magazine for more information about the healing gardens.

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NASCAR weekend full of health care success stories

Terry “Mr. 500” Green

This weekend’s slate of racing at the Atlanta Motor Speedway, including the marquee Emory Healthcare 500 NASCAR Sprint Cup race Sunday night, will have a uniquely Emory flavor that exceeds far beyond just the naming rights for the event that will be watched by millions of fans around the country. Emory Healthcare is the official healthcare partner for the Atlanta Motor Speedway and this year’s Emory Healthcare 500 NASCAR Sprint Cup Series Race.

Mr. 500

When Emory Healthcare and Atlanta Motor Speedway officials began searching for the grand marshal of this year’s Emory Healthcare 500 Sprint Cup Series race, they didn’t have to search long or far to find the perfect candidate – and one who already possessed the perfect tailor-made nickname for such an occasion.

Lawrenceville native Terry “Mr. 500” Green has been named the grand marshal for this year’s race.

Green first came to be known as “Mr. 500” in March 2008, after he became the 500th heart transplant recipient at Emory University Hospital in Atlanta.

Keeping his motor running

Wayne Reese has been racing motocross and super late model cars on dirt tracks for more than 11 years, and he knows the risks. One risk he won’t take, however, is with his health.

Reese, a prostate cancer survivor, will be the Honorary Starter at the Emory Healthcare 500.  In this role, Reese will drop the Green Flag to start the race.  In addition, his son Brian will drive his Reese Motorsports Super Late Model Number 33 in the pre-race parade.

Reese, 55, recently completed therapy at Emory University Hospital’s Department of Radiation Oncology.  He says he knew he wanted to be treated at Emory because his wife was treated at Emory’s Winship Cancer Institute.  “We appreciate all the help we’ve gotten there.”

Reese recently demonstrated his appreciation by putting the Winship Cancer Institute of Emory University logo on his race cars.

Emory’s own pit crew

When more than 150,000 race fans, visitors and support crews flood Atlanta Motor Speedway this Labor Day weekend, they may learn a thing or two about their health – possibly saving their own lives in the process.

Emory Healthcare will bring its own pit crew team of volunteers to Henry County this weekend to provide free health care screenings including:
•    Blood pressure screenings
•    Smoking cessation help and information
•    Head, neck and skin cancer screenings
•    Body Mass Index (BMI) screenings
•    General health and wellness information

“Having this incredible opportunity to reach out to so many men and women to provide potentially life-saving cancer screenings, blood pressure checks, and informative ways to live a longer and healthier life, is a perfect way for us to thank those in our community who have allowed us to serve them over the years, while also supporting this special event that means so much to our region,” says Dane Peterson, chief operating officer for Emory University Hospital Midtown. “At the end of the day, we hope to make a difference in the lives of more than a few individuals and ensure that they will be able to return for many more exciting Labor Day weekends at the Atlanta Motor Speedway.”

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A concussion is more than just a headache

 

Ken Mautner, MD

To ensure better management of sports concussions, physicians at Emory Sports Medicine Center have incorporated Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) into their program for high school athletes.

 

Concussions occur in about 10 percent of all athletes in contact sports.

They are caused by sudden and violent rocking of the brain inside the skull from a traumatic blow to the head or upper body.

Symptoms vary in length of time and may include amnesia, disorientation, confusion, fogginess, headache, blurred vision, nausea, fatigue and sometimes loss of consciousness.

Ken Mautner, MD, sports medicine physician and assistant professor in the Department of Orthopaedics at Emory University School of Medicine, says that most athletes recover completely from concussions as long as they are not returned back to play too soon.

Repeated concussions are cumulative and may cause critical damage to the brain.  Studies have indicated a possible association with frequent or untreated concussions and development of dementia, depression and, most recently, ALS (Lou Gehrig’s Disease).  Going back to the sport too soon, before the brain recovers, leaves athletes vulnerable to repeat concussions.

Athletes in the ImPACT program take a 20-minuted baseline test on a computer that measures brain processing such as speed, memory, and visual motor skills.

Each individual’s data are stored in a computer file. In the event of injury, the athlete will take the ImPACT test in the days following concussion.  Post-concussion data are then compared to baseline data to help determine the severity and effects of the injury.

Mautner says that data from ImPACT combined with a thorough history and physical exam is the best way to prevent athletes from getting “back in the game” too soon.

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First of its kind neurosurgery boot camp held at Emory

Emory’s Department of Neurosurgery recently hosted a two-day boot camp for first-year neurosurgery residents. The unique event was part of a new national course launched by the Society of Neurological Surgeons (SNS) in Atlanta and five other cities including Boston, Portland and Chicago.

The course focused on fundamental skills, patient safety, professionalism and communications. Day one was structured in a traditional lecture format, while day two placed participants in simulated operating room environments and neurosurgical procedures.

A first-year neurosurgery resident participates in the nation's first series of neurosurgery boot camps.

“This boot camp concept is the first of its kind in medicine providing interns with a strong foundation to learn basic concepts and procedures and helping to ultimately reduce the number of errors among training residents,” says Costas Hadjipanayis, MD, PhD, assistant professor of neurosurgery at Emory School of Medicine and chief of neurosurgery service at Emory University Hospital Midtown.

More than 90 percent of all incoming neurosurgery residents in the United States participated in the training at one of the sites. Emory neurosurgical faculty, fellows, and residents led intensive and interactive exercises oriented to fundamental bedside procedural and operative skills.

The exercises were designed to allow residents to familiarize themselves with the basics in an educational and risk-free environment. Skills relevant to all first-year residents were covered, such as line placement and suturing, as well as specific neurosurgical skills like drilling and performing a craniotomy.

According to Hadjipanayis, one of the Emory organizers and course directors, the group of 37 interns participating in the Atlanta training was the largest number nationwide. They were from universities across the region ranging from Virginia to Puerto Rico.

“This was definitely a great start to a course we will cultivate and enhance from year to year,” says Hadjipanayis. “Our goal is for continuous evaluation and improvement.”

Click here to view a CNN news story filmed at the Emory boot camp by CNN medical correspondent and Emory neurosurgeon, Sanjay Gupta, MD.

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When bone marrow goes bad

Plasma cells live in our bone marrow. Their job: to make antibodies that protect us from bacteria and viruses. But if those plasma cells grow unchecked, that unchecked growth leads to multiple myeloma.

Sagar Lonial, MD

Multiple myeloma is a type of cancer that results in lytic bone disease, or holes in the bones. What’s more, the cancerous cells crowd out normal bone marrow resulting in anemia or a low white count, leaving a person vulnerable to infections.

Sagar Lonial, MD, an oncologist at Winship Cancer Institute, Emory University, treats people with multiple myeloma. The prognosis for people with this type of cancer is poor; however, researchers are gaining on the disease. Twenty years ago, the survival rate was two to three years; now, it’s four to five.

Lonial says one of the keys to improving patients’ prognosis is increasing their enrollment in clinical trials and better access to life-extending drugs.

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Stem cell research center gets NSF support

Stem cell research is on the verge of impacting many elements of medicine, but scientists haven’t yet worked out the processes needed to manufacture sufficient quantities of stem cells for diagnostic and therapeutic purposes.

Todd McDevitt and Robert Nerem

The National Science Foundation (NSF) has awarded $3 million to Georgia Tech to fund a center that will develop engineering methods for stem cell production. The program’s co-leaders are Todd McDevitt, PhD, an associate professor in the Georgia Tech/Emory Department of Biomedical Engineering and Robert Nerem, director of the Emory/Georgia Tech Center for Regenerative Medicine (GTEC), which will administer the award.

“Successfully integrating knowledge of stem cell biology with bioprocess engineering and process development is the challenging goal of this program,” says McDevitt.

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