TAG: "Global health"

Event showcases UC’s global health efforts

UC Global Health Day videos of presentations will soon be available on UCTV.

UC Global Health Institute Co-director Tom Coates and keynote speaker Patrick Soon-Shiong discuss the applications of new technologies in global health at the 2015 UC Global Health Day. (Photo by Margaret Molloy)

Nearly 300 people from across the 10 UC campuses attended the 2015 UC Global Health Day on April 18 at UCLA.

The fifth Global Health Day, sponsored by the UC Global Health Institute with support from UCLA, featured a keynote speech from Patrick Soon-Shiong, founder and CEO of NantHealth, chairman of the Chan Soon-Shiong Family Foundation, and chairman and CEO of the Chan Soon-Shiong Institute of Molecular Medicine. Plenary speakers included Claire Brindis (UC San Francisco), Michael Rodriguez (UCLA), Reshma Shamasunder (California Immigrant Policy Center) and Steven Wallace (UCLA).

Videos of the keynote and plenary presentations will soon be available on UCTV.

For more information, view a UC Global Health Day slideshow, poster presentations and submissions from the Video Challenge and Plenary Contest.

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Binational police program in Tijuana targets HIV reduction

Effort also aims to improve safety of officers.

binational team from UC San Diego and the U.S.-Mexico Border Health Commission, Mexico Section, will train Tijuana law enforcement officers on needle handling and HIV prevention.

By Heather Buschman, UC San Diego

Research consistently shows that policing practices, such as confiscating or breaking needles, are key factors in the HIV epidemic among persons who inject drugs. Police officers themselves are also at risk of acquiring HIV or viral hepatitis if they experience needle-stick injuries on the job — a significant source of anxiety and staff turnover.

A binational team from the UC San Diego School of Medicine and the U.S.-Mexico Border Health Commission, Mexico Section, has launched a new research project aimed at promoting prevention of HIV and other blood-borne infections. The effort is led by Steffanie Strathdee, Ph.D., professor and director of the UC San Diego Global Health Initiative; Leo Beletsky, J.D., M.P.H., associate professor; and Gudelia Rangel, Ph.D., deputy general director for migrant health and executive secretary of the Mexico Section of the Mexico-United States Border Health Commission, in partnership with the Tijuana Police Department and Police Academy. The binational team will offer and evaluate Proyecto ESCUDO (Project SHIELD), a police education program designed to align law enforcement and HIV prevention in Tijuana.

“Our unprecedented partnership with the Tijuana police department enables us to evaluate ESCUDO as a binational effort,” said Strathdee, who is also associate dean of global health sciences and chief of the Division of Global Public Health at UC San Diego’s Department of Medicine.

“Research by our team and others shows that police practices are fueling HIV risks among drug users,” noted Rangel. “This project serves a dual purpose by aiming to reduce the risk of blood-borne infections among the police and people who inject drugs in the community.”

Proyecto ESCUDO will monitor trends in occupational needle-sticks and the attitudes, behaviors and safety precautions taken by Tijuana police. ESCUDO’s impact on people who inject drugs will be externally validated through a parallel study of Tijuana drug injectors.

“We are very excited by this unique partnership,” said Secretario Alejandro Lares, Tijuana’s chief of police. “Proyecto ESCUDO will be the first study of its kind in the world.”

“These findings are expected to inform future international efforts to bring police education programs to scale in the growing number of countries where policing is a documented driver of HIV infection,” said Beletsky, an associate professor of law and public health at UC San Diego and at Northeastern University.

Funding support for this project comes from the UC San Diego Center for AIDS Research, Open Society Foundations and National Institute on Drug Abuse (grant R01DA039073).

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Microclinics help keep Kenyan HIV patients in care

Activating patients’ existing social networks reduces stigma.

A community meeting to support HIV/AIDS health services for FACES (Family AIDS Care and Education Services), a joint program of UCSF and the Kenya Medical Research Institute. (Photo by Rachel Burger)

By Jeff Sheehy, UC San Francisco

A team led by researchers from UC San Francisco, Organic Health Response and Microclinic International is reporting results of a study that showed significant benefits of microclinics – an innovative intervention that mobilized rural Kenyan HIV patients’ informal social networks to support their staying in care.

The results showed that microclinics cut in half the normal rate of disengagement from care, which was defined as missing a clinic appointment by 90 days or more, when compared to the control group, and reduced the perceived stigma of HIV by 25 percent within the larger community.

“When HIV patients fall out of care, they lose access to their medications, and untreated HIV patients will eventually develop AIDS. Keeping patients in care is not only a challenge in resource limited settings, but even in the U.S. where the CDC estimates that only 40 percent of HIV patients are regularly engaged in care,” said the study’s lead author, Matthew D. Hickey, a graduating UCSF medical student who will be starting residency in UCSF’s internal medicine/primary care program at San Francisco General Hospital and Trauma Center.

“Microclinics are a novel approach in solving this problem, he said, “in large part because they directly and innovatively address the issue of stigma.”

The research is available starting May 12 online ahead of print in the Journal of Acquired Immune Deficiency Syndromes.

The intervention took place on Mfangano Island in Lake Victoria, which is surrounded by the countries of Uganda, Kenya and Tanzania. The island has a population of about 21,000 living in small villages of 500 to 1,500 people. Almost 30 percent of the population is HIV infected. FACES (Family AIDS Care and Education Services), a joint program of UCSF and the Kenya Medical Research Institute, has been supporting HIV care, treatment and prevention in western Kenya, including the island, in collaboration with the Kenya Ministry of Health since 2004.

FACES researchers and clinicians partnered with Microclinic International and the Organic Health Response to assess whether its social network model would help retain HIV patients in care. The Microclinic Social Network Model works with individuals and communities to identify existing social networks and use those to address wide spread and deadly diseases in communities. The Organic Health Response coordinates a solar-powered community center on Mfangano Island that served as the headquarters for this intervention.

“The rural communities on Mfangano Island where we are working have tremendous stores of social capital.  People help each other when an individual or family is in need. If someone gets sick or injured, needs help farming or getting together the money for school fees, friends and family pitch in to help. But, that often was not true when the need was due to HIV. For example, a breadwinner became sick with AIDS and everyone knew what was going on, but no one talked about it. He fell through the cracks of his social network and, without support, he was lost to care and did not manage to take his medications faithfully. Eventually, he died of AIDS,” said study co-lead author, Charles R. Salmen, M.D., M.Phil., the founding director of Organic Health Response.

The intervention was introduced into one set of communities served by the Sena Health Center; other similar neighboring communities in the clinic’s catchment area served as controls. Patients on antiretroviral medications were invited to form microclinic groups. These groups included five to 15 family members, close friends or other members of the patients’ social network, regardless of HIV status. Pre-existing social groups such as churches, soccer teams and money lending clubs were also invited to form microclinic groups and participate. Each microclinic group was assigned a community health worker and a facilitator. All participants received confidential HIV testing and counseling.

“Microclinics are not a traditional support group composed of people confronting a similar challenge, many of whom may not know each other. Instead, microclinics use organic networks to drive positive behavior. And since patients receive support from existing networks, support is sustained,” said study co-author Daniel Zoughbie, M.Sc., D.Phil., chief executive officer of Microclinic International.

The participants attended 10 group-discussion sessions over five months. The sessions educated participants about HIV prevention and treatment, promoted group support through discussions about confidentiality and HIV status disclosure, encouraged group support to assist in taking anti-HIV medications faithfully and making clinic appointments, and encouraged participants to outreach to the community to promote HIV testing and clinic enrollment. At the end of the intervention, participants were invited to take part in voluntary group HIV testing.

“Previously, stigma blocked access to social support because patients didn’t disclose. Microclinics opened up discussion and became the catalyst for destigmatizing HIV. This led to access to support within social networks. Friends and family supported patients in getting to clinic appointments and, in turn, expected appointments to be kept. They supported patients’ taking medications as directed and expected patients to take them. Silence was replaced by active support,” said Hickey.

“UNAIDS has set a goals aiming to have 90 percent of people with HIV in the world successfully treated and retained in care by 2020. The microclinic intervention, which redefines the unit of care from an individual to an individual and his/her social network, is a cost effective, scalable initiative that could help governments meet their targets,” said study co-author, Craig Cohen, M.D., M.P.H., UCSF professor of obstetrics, gynecology and reproductive sciences.

Co-authors include Elvin Geng, M.D., M.P.H., Peter Bacchetti, Ph.D., Cinthia Blat, M.P.H., Robert A. Tessler, M.D., Monica Gandhi, M.D., M.P.H., and Starley Shade, Ph.D., M.S. from UC San Francisco; Betty Njoroge, M.B.Ch.B., M.P.H. and Elisabeth A. Bukusi, M.B.Ch.B., M.Med., M.P.H., Ph.D., P.G.D., from the Kenya Medical Research Institute; Dan Omollo, B.Sc., Brian Mattah, Gor Bernard Ouma, Marcus R. Salmen, M.D., from the Mfangano Island Research Group, Organic Health Response, Kenya; Kathyrn J. Fiorella, M.P.H., from UC Berkeley; and Harold Campbell, Ph.D., from Microclinic International.

Funding for the research was provided by Google Inc via the Tides Foundation, the Craigslist Foundation, the Mulago Foundation, the Rise Up Foundation, Horace W. Goldsmith Foundation, the Segal Family Foundation, the National Institute of Allergy and Infectious Diseases, the Doris Duke Charitable Foundation, and the UCSF School of Medicine’s Dean Research Fellowship.

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Smartphone video microscope automates parasite detection in blood

UC Berkeley’s CellScope technology could help efforts to eradicate filarial diseases.

By Sarah Yang, UC Berkeley

A research team led by UC Berkeley engineers has developed a new smartphone microscope that uses video to automatically detect and quantify infection by parasitic worms in a drop of blood. This next generation of UC Berkeley’s CellScope technology could help revive efforts to eradicate debilitating filarial diseases in Africa by providing critical information to health providers in the field.

“We previously showed that mobile phones can be used for microscopy, but this is the first device that combines the imaging technology with hardware and software automation to create a complete diagnostic solution,” said Daniel Fletcher, an associate chair and professor of bioengineering, whose UC Berkeley lab pioneered the CellScope. “The video CellScope provides accurate, fast results that enable health workers to make potentially life-saving treatment decisions in the field.”

The UC Berkeley engineers teamed up with Dr. Thomas Nutman from the National Institute of Allergy and Infectious Diseases (NIAID), and collaborators from Cameroon and France to develop the device. They conducted a pilot study in Cameroon, where health officials have been battling the parasitic worm diseases onchocerciasis (river blindness) and lymphatic filariasis.

The video CellScope, which uses motion instead of molecular markers or fluorescent stains to detect the movement of worms, was as accurate as conventional screening methods, the researchers found. The results of the pilot study are reported today (May 6) in the journal Science Translational Medicine.

“This research is addressing neglected tropical diseases,” said Fletcher. “It demonstrates what technology can do to help fill a void for populations that are suffering from terrible, but treatable, diseases.”

Battling parasitic worms

River blindness is transmitted through the bite of blackflies and is the second-leading cause of infectious blindness worldwide. Lymphatic filariasis, spread by mosquitoes, leads to elephantiasis, a condition marked by painful, disfiguring swelling. It is the second-leading cause of disability worldwide and, like river blindness, is highly endemic in certain regions in Africa.

The antiparasitic drug ivermectin, or IVM, can be used to treat these diseases, but mass public health campaigns to administer the medication have been stalled because of potentially fatal side effects for patients co-infected with Loa loa, which causes loiasis, or African eye worm. When there are high circulating levels of microscopic Loa loa worms in a patient, treatment with IVM can potentially lead to severe or fatal brain or other neurologic damage.

The standard method of screening for levels of Loa loa involves trained technicians manually counting the worms in a blood smear using conventional laboratory microscopes, making the process impractical for use in field settings and in mass campaigns to administer IVM.

The serious side effects of Loa loa and the difficulty of rapidly quantifying Loa levels in patients before treatment make it too risky to broadly administer IVM, representing a major setback in the efforts to eradicate river blindness and elephantiasis.

Next generation CellScope uses video, automation

For this latest generation of the mobile phone microscope, named CellScope Loa, the researchers paired a smartphone with a 3-D-printed plastic base where the sample of blood is positioned. The base included LED lights, microcontrollers, gears, circuitry and a USB port.

Control of the device is automated through an app the researchers developed for this purpose. With a single touch of the screen by the health care worker, the phone communicates wirelessly via Bluetooth to controllers in the base to process and analyze the sample of blood. Gears move the sample in front of the camera, and an algorithm automatically analyzes the telltale “wriggling” motion of the worms in video captured by the phone. The worm count is then displayed on the screen.

Fletcher said previous field tests revealed that automation helped reduce the rate of human error. The procedure takes about two minutes or less, starting from the time the sample is inserted to the display of the results. Pricking a finger and loading the blood onto the capillary adds another minute to the time.

The short processing time allows health workers to quickly determine on site whether it is safe to administer IVM.

“The availability of a point-of-care test prior to drug treatment is a major advance in the control of these debilitating diseases,” said aquatic ecologist Vincent Resh, a professor in UC Berkeley’s Department of Environmental Science, Policy and Management. “The research offering a phone-based app is ingenious, practical and highly needed.”

Resh, who is not involved in the CellScope project, has worked in West Africa for 15 years on the control of onchocerciasis.

The researchers are now expanding the study of CellScope Loa to about 40,000 people in Cameroon.

Co-lead authors of the study are Michael D’Ambrosio, UC Berkeley research scientist in bioengineering, and Matthew Bakalar, UC Berkeley graduate student in bioengineering. Other study authors included researchers from the University of Yaoundé in Cameroon and the University of Montpellier in France.

The Bill and Melinda Gates Foundation, UC Berkeley Blum Center for Developing Economies, U.S. Agency for International Development and NIAID helped support this work. The NIAID is part of the National Institutes of Health.

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Pancreatic cancer risk linked to weak sunlight

UC San Diego epidemiologists suggest harm may come from low vitamin D.

By Scott LaFee, UC San Diego

Writing in the April 30 online issue of the Journal of Steroid Biochemistry and Molecular Biology, researchers at the UC San Diego School of Medicine report pancreatic cancer rates are highest in countries with the least amount of sunlight. Low sunlight levels were due to a combination of heavy cloud cover and high latitude.

“If you’re living at a high latitude or in a place with a lot of heavy cloud cover, you can’t make vitamin D most of the year, which results in a higher-than-normal risk of getting pancreatic cancer,” said first author Cedric F. Garland, Dr.P.H., adjunct professor in the Department of Family Medicine and Public Health and member of UC San Diego Moores Cancer Center.

“People who live in sunny countries near the equator have only one-sixth of the age-adjusted incidence rate of pancreatic cancer as those who live far from it. The importance of sunlight deficiency strongly suggests – but does not prove – that vitamin D deficiency may contribute to risk of pancreatic cancer.”

Limited foods naturally contain vitamin D. Fatty fish, such as salmon and tuna, are good sources; beef liver, cheese and egg yolks provide small amounts. Vitamin D is often added as a fortifying nutrient to milk, cereals and juices, but experts say most people also require additional vitamin D to be produce by the body when skin is directly exposed to sunlight. Specifically, ultraviolet B radiation. Skin exposed to sunshine indoors through a window will not produce vitamin D. Cloudy skies, shade and dark-colored skin also reduce vitamin D production.

The UC San Diego team, led by Garland and Edward D. Gorham, Ph.D., associate professor, had previously shown that sufficient levels of a metabolite of vitamin D in the serum, known as 25-hydroxyvitamin D was associated with substantially lower risk of breast and colorectal cancer. The current paper is the first to implicate vitamin D deficiency with pancreatic cancer.

Researchers studied data from 107 countries, taking into account international differences and possible confounders, such as alcohol consumption, obesity and smoking. “While these other factors also contribute to risk, the strong inverse association with cloud-cover adjusted sunlight persisted even after they were accounted for,” said Garland.

UC San Diego researchers had previously identified an association of high latitude with a higher risk of pancreatic cancer. Garland said the new study advances that finding by showing that an estimate of solar ultraviolet B that has been adjusted for heavy cloud cover produces an even stronger prediction of risk of pancreatic cancer.

Pancreatic cancer is the 12th most common cancer in the world, according to World Cancer Research Fund International, with 338,000 new cases diagnosed annually. Incidence rates are highest in North America and Europe; lowest in Africa and Asia. It is the seventh most common cause of death from cancer.

Coauthors of the study include Raphael E. Cuomo, Kenneth Zeng and Sharif B. Mohr, all at UC San Diego.

Funding for this research came, in part, from UC San Diego Department of Family Medicine and Public Health.

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Is that pill really what the label says it is?

Report calls for improved detection, data collection, analysis to combat ‘pandemic.’

Credit: iStock

By Scott LaFee, UC San Diego

When you take a medication for, say, high cholesterol, do you know that pill is really what the label says it is? Depending upon the type of medicine and where you live, the threat of falsified medications (also referred to as counterfeit, fraudulent and substandard) can be quite real, yet the full scope and prevalence of the problem is poorly understood, say researchers at the UC San Diego School of Medicine in a new report published today (April 20) in the American Journal of Tropical Medicine and Hygiene.

Counterfeit medicines have traditionally been defined as those for which the identity or source is mislabeled in a way that makes them appear to be a genuine product when they are not, though definitions of the problem itself are the subject of international debate.

The UC San Diego report is part of a special journal supplement featuring a variety of studies examining aspects of the “global pandemic of falsified medicines.” Produced by diverse universities and institutions across the country and world, the supplement investigates the quality of vital, broadly sold drugs, such as anti-malarials and antibiotics; new tests and assays to detect counterfeit drugs; and proposed policy changes and laws to reduce the distribution and sale of falsified medications.

Global problem

The UC San Diego study looked at the depth of counterfeit drug penetration in global legitimate medicine supply chains.

“Our study was based on data from the Pharmaceutical Security Institute (PSI), a nonprofit organization with members from the pharmaceutical security community,” said lead author Tim K. Mackey, M.A.S, Ph.D., assistant professor of anesthesiology and global public health, director of the Global Health Policy Institute and associate director of the joint masters program in health policy and law. “PSI data is collected from its industry members, law enforcement, drug regulators, the pharmaceutical industry and media reports, and confirmed by a team of multilingual investigators. It’s the only study of its kind with global statistics on counterfeit medications. We limited the scope to legitimate supply chains, places where you expect to get legitimate medicines, such as hospitals and pharmacies.”

The primary finding and “surprise,” said Mackey, is how little is known about the precise scope of the problem and how few mechanisms exist to monitor it despite the availability of some data. During the period studied, 2009 through 2011, there were 1,510 total counterfeit incidence reports tabulated by the PSI. But “nobody has a good idea how big the problem really is,” said Mackey. “There are guesses, but it’s hard to get accurate statistics on a criminal activity of this magnitude.”

Lives at risk

The falsified drug problem is not new, just bigger than ever, say experts. It covers widely used drugs, notably anti-malarials and more high-value, high-demand drugs, such as medications to treat HIV/AIDS, serious cardiovascular disease and cancer. According to a 2000 World Health Organization report, almost one-third of identified counterfeit drugs contained no active ingredient; and more than 20 percent either had incorrect quantities of active ingredients or contained the wrong ingredients. Other fraudulent practices included false packaging and high levels of impurities.

Each year, it’s estimated between 100,000 and 1 million people die from using counterfeit drugs.

“The most important takeaway of our study is that we don’t have the necessary data or surveillance to effectuate meaningful public health interventions or policy change,” Mackey said. “As an example, more than half of our dataset was from four countries, not necessarily because these countries have the most counterfeits, but possibly because they are countries of transit or are the ones actively looking for them.”

The researchers also noted that scores of countries filed no counterfeit incidence reports during the study period.

“We hope this study will prompt key opinion leaders and policymakers to make necessary changes to surveillance, security and improvements to pharmaceutical governance of drug supply chains in order to prevent future falsified medicine incidents and protect patients worldwide,” said Mackey.

Study co-authors include Bryan A. Liang, Global Health Policy Institute; Peter York and Thomas Kubic, Pharmaceutical Security Institute.

This research was funded, in part, by the Partnership for Safe Medicines and the Pharmaceutical Security Institute.

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UCLA world health center sends faculty to teach, train, treat around globe

Its 170 projects in 65 countries aim to improve lives in resource-poor nations.

Dr. Luis Lovato explains airway anatomy to medical residents at the National Autonomous University of Nicaragua in Managua. UCLA physicians spent a week there teaching three courses to 50 local physicians. (Photo by Tranquilino Lomeli)

By Rachel Champeau, UCLA

UCLA physicians recently traveled to Nicaragua to teach life-saving techniques to more than 50 local doctors as part of a weeklong course on resuscitating a patient after cardiac arrest and using ultrasound to diagnose life-threatening conditions at the bedside, among other critical topics.

These classes were part of an education initiative by Project SEMILLA (Strengthening Emergency Medicine Investing in Learners in Latin America), a volunteer organization of emergency health care professionals and a partner of the UCLA Center for World Health.

“Our aim is to help improve emergency health capacity throughout Latin America,” said Dr. Breena Taira, an assistant professor of clinical emergency medicine at UCLA, who led colleagues from Olive View-UCLA Medical Center on the trip.

Partners around the world

Project SEMILLA is one of many partner organizations that work with the UCLA Center for World Health in its aim to foster and support education, research and clinical capabilities in resource-poor countries like Nicaragua.

A joint venture of the David Geffen School of Medicine at UCLA and the UCLA Health System, the 3-year-old center and its partners currently participate in 170 projects in 65 countries worldwide.  It focuses not only on education, training and capacity building, but projects also include research and clinical care initiatives.

Acting as a catalyst, the center helps UCLA faculty develop and run diverse projects around the globe. UCLA medical students and residents can also apply to the center to participate in international research projects and clinical electives. UCLA students, for example, have helped create a neonatal resuscitation program in Ghana. Others have opted to learn about traditional medicine in China.

“We hope to make a difference in people’s lives all over the world,” said Thomas Coates, director of the UCLA Center for World Health and the Michael and Sue Steinberg Endowed Professor of Global AIDS Research. “Sharing knowledge helps to educate and enrich our students’ understanding of the world. These young practitioners will become our future health care leaders and have an impact in addressing the world’s health disparities.”

Exporting HIV expertise

Many of the programs guided by the center embody this vision, such as an education project in South Africa to help prevent transmission of HIV. South Africa has less than one percent of the world’s population, but 16 percent of the HIV infections, Coates explained.

Teaming up with South Africa’s Human Sciences Research Council and Hivos, a nonprofit international development organization, the UCLA team is teaching community leaders about prevention, treatment and the latest science related to the infection, with the aim of reducing HIV-related stigma and discrimination. In 2014, 14 community leaders took a three-week intensive training course covering leadership skills, project management, HIV prevention and more. Using their newfound knowledge, participants developed pilot programs to address HIV prevention and HIV-related stigma in their communities. Dedicated mentors ensure that the pilot programs stay on track and have a measurable impact at the community level.

“The program has a uniquely transformative effect — for both the participants and the communities in which they work,” said Laurie Bruns, the center’s senior Africa regional director.

Because black South African men with HIV don’t get tested until it’s too late, Coates is also directing a research program to help this group and others gain early access to medical services. The initiative is evaluating innovative strategies to test for, diagnose and treat HIV in this critical population. Coates’ team is partnering with the Human Sciences Research Council in South Africa and Charles University in Prague on this project.

Reaching out to China and the Middle East

The UCLA center has found partners to advance medical care in China. The University of California and UCLA Department of Pathology are working with Centre Testing International Corp., a Chinese firm, to create a company that will operate a clinical laboratory in Shanghai. The new lab will support clinical trials and enhance medical care for Chinese patients with cancer and other diseases.

“Such joint ventures share UCLA’s vision of developing strong international relationships to help improve health worldwide,” said Dr. Tom Rosenthal, associate vice chancellor, chief administrative officer for the UCLA Health System and co-director of the Center for World Health.

Another important program under the center’s umbrella focuses on substance abuse treatment in the Middle East. A team from UCLA’s Integrated Substance Abuse Program is collaborating with Jazan University in Saudi Arabia to provide expertise to psychiatrists in addiction research.

“We are helping to change the paradigm of drug abuse approaches in the Middle East by providing hands-on experience with the latest treatment information,” said Rick Rawson, co-director of the UCLA program and professor-in-residence in the Department of Psychiatry and Biobehavioral Sciences.

In addition to addressing patient needs, another cornerstone of the UCLA Center for World Health’s mission is to educate future health care leaders.

This year, the center and its partners will send six UCLA pediatric residents to Thailand for a monthlong global health experience to learn about infectious diseases, hematology and pediatric intensive care there. In return, the UCLA Department of Pediatrics will host five visiting residents from Bangkok’s Siriraj Hospital who will learn about their specialties.

“This important cultural and medical exchange helps strengthen our worldwide knowledge and provides a good perspective for our future doctors,” said project leader Dr. Tanya Arora, assistant clinical professor of pediatrics at UCLA.

Global grand rounds

Along those same lines, Dr. Jorge Lazareff, director of international relations for the UCLA Center for World Health, is aiming to launch a project in 2016 that utilizes the latest Internet technologies so clinicians and surgeons across the globe can discuss patient cases during “real-time” grand rounds.

In addition, he has launched an online lecture series in Ecuador and Nicaragua to teach medical students and physicians how to understand, write and prepare medical journal articles.

Such critical thinking skills not only help advance young doctors’ development, but these doctors will help disseminate the latest health information to the medical community. “Often we don’t learn about emerging diseases in resource-challenged countries until a doctor from a Western nation visits and reports back,” said Lazareff. “We are helping train doctors to be on the frontlines in communicating early about these important developments firsthand.”

So far, the lectures have reached 60 students; the plan is to expand into other countries with versions in multiple languages.

Lazareff said the young physicians who can now better serve patients in their own countries have given them great feedback. One grateful student expressed his gratitude in a recent email: “Thank you for helping us believe in ourselves.”

On Saturday (April 18), UCLA faculty from the Geffen School of Medicine and the Fielding School of Public Health, among other health care experts, will participate in an all-day conference at UCLA sponsored by the UC Global Health Institute to mark 2015 UC Global Health Day. Coates, who is co-director of the institute, is chairing the event.

On April 23, UCLA Staff Assembly will present a Learn-at-Lunch event: “What Can We Do About Global Health: Priorities of the UCLA Center for World Health.”

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States’ policies put health of undocumented immigrants at risk

Ohio rules create greatest health risk for undocumented residents; California the fewest.

By Gwendolyn Driscoll, UCLA

California scored the highest in a new ranking of U.S. states’ public policies and laws that support the health and well-being of undocumented immigrants.

The report, by the UCLA Center for Health Policy Research and the UCLA Blum Center on Poverty and Health in Latin America, with support from the UC Global Health Institute, also found that Ohio had policies that were more exclusionary than those of any other state.

The report focuses on state policies as of 2014 in nine categories across five areas: public health and welfare, higher education, labor and employment, access to driver licensing and government ID card programs, and enforcement of the federal Secure Communities program — all of which influence the health of immigrants and their families.

The researchers rated each state’s policies as “inclusive” (supporting health and well-being) or “exclusive” (harming health and well-being). Scores, which ranged from +1 to -1 for each category, were then tallied for an overall rating for each state. The average total score was -2.5 points.

California scored a total of +9; liberal-leaning New York scored +1. Only six other states and Washington, D.C., had overall scores greater than 0. Other surprises: Texas, frequently in the news for its conservative policies, scored +2 overall, making it one of the five most inclusive states. And Florida, which has a large population of recent immigrants, earned a -3. In all, 41 states were in negative territory.

See the results in a sortable, state-by-state list.

States with the top five and bottom six overall scores:

Top 5
1. California +9
2. Illinois +7
3. Washington +4
4. (tie) Colorado +2
4. (tie) Texas  +2

Bottom 6
51. Ohio -7
50. (tie) Alabama -6
50. (tie) Arizona -6
50. (tie) Indiana -6
50. (tie) Mississippi -6
50. (tie) West Virginia -6

“It is frustrating that so many states have policies that ignore or exclude a group of people who work hard and contribute so much to our society,” said Steven P. Wallace, associate director of the UCLA Center for Health Policy Research and co-author of the report. “The neglect or outright discrimination of the undocumented does not just hurt workers and their families; it hurts the communities that rely on them for the basic labor that makes our society function.”

Policies affect millions

The states’ public policies — and how each responds to flexibility in federal laws — affect the estimated 11.2 million undocumented immigrants living in the country, according to the report. The policies evaluated in the study also affect about 4 million U.S.-born children who live in “mixed-status” families, in which at least one parent is undocumented.

Laws in Arizona — including its immigration status check provision — and in other states have attracted federal court challenges and much media attention. Yet many state laws that can either promote or complicate the health of undocumented immigrants receive little attention.

Examples of beneficial or harmful policy outcomes, by program area:

Public health and welfare. Some states offer child health insurance or similar benefits regardless of immigration status, and some offer full Medicaid to pregnant undocumented women, but many do not. Most states determine eligibility for food stamps (now known as Supplemental Nutrition Assistance Program, or SNAP) by factoring in the family’s income and the number of all family members, regardless of their immigration status. But five states, including Arizona and Ohio, calculate eligibility for assistance using the income of all family members, but determine “family size” based only on those who are citizens or lawful permanent residents. This makes it more difficult for families with undocumented members to qualify.

Higher education. Twenty states, including California, Illinois, Florida, New York and Texas, allow undocumented students who attended secondary school in the state to pay in-state tuition for colleges and universities. Five of those, including California and Texas, also offer scholarship funding for those students. The rest require undocumented college students to pay out-of-state tuition, even if they attended K-12 in-state. Among the most exclusive is Georgia, which bars undocumented students from attending many of its public colleges and universities — even if they graduated from high schools in the state.

Labor and employment. Ten states’ workers’ compensation laws classify undocumented workers as “employees,” which qualifies them for workers’ compensation if they are injured on the job. But many states encourage public and private employers making hiring decisions to use the federal employment tool, E-verify, to check if an immigrant is authorized to work. Twenty states require state agencies, state contractors and/or private employers to use E-Verify; only two — California and Illinois — limit its use.

Access to driver’s licenses and government IDs. While some undocumented people can obtain identifications cards from their consular offices, cities such as Chicago, Oakland and San Francisco offer municipal IDs, which allow more access to public and private services. As of 2014, six states — California, Colorado, Illinois, Oregon, Utah and Washington — have laws that provide driver’s licenses to undocumented residents. But a federal law, REAL ID, puts restrictions on states that grant driver’s licenses or other IDs to the undocumented. Half of the states have passed resolutions or statute opposing the law.

Secure Communities. This enforcement program required that local police share information with federal immigration authorities, and it has contributed to the deportation of roughly 400,000 people per year, according to Pew Research. This has separated families and put stress on immigrants’ finances and health, the authors write. California, Connecticut and Colorado have adopted policies that prevent some undocumented immigrants charged with low-level, nonviolent offenses from being turned over to federal immigration authorities. Secure Communities was replaced by the Priority Enforcement Program, which does not require local law enforcement agencies to share information gathered in an arrest with the federal government.

Even high-scoring states can improve

Even the states that earned positive scores have room for improvement. The authors recommend actions all states can take to create a better environment for undocumented immigrants:

• Strengthen laws that secure undocumented immigrants’ rights in the five areas reviewed in the report.
• Buffer federal laws that restrict undocumented immigrants’ rights or access to resources.
• Focus on passing laws that are inclusive, rather than laws that explicitly exclude residents based on their legal status.
• More closely examine public policies for their ultimate impact on undocumented immigrants’ health.

“State and national lawmakers must recognize the value undocumented immigrants have in our country,” said Dr. Michael Rodriguez, co-author of the report, of the Blum Center and a faculty associate at the UCLA Center for Health Policy Research. “States must understand the critical role their policies play in promoting or hindering the well-being of undocumented immigrants who are an important part of the economic, political and social fabric of our nation.”

A report launch seminar with the authors, “The Healthiest (and Most Unhealthy) States to Be an Undocumented Immigrant: A Review of State Health Policies,” will be held from 12-1 p.m. today (April 16) at 10960 Wilshire Boulevard, Suite 1550, Los Angeles.

A special plenary session, “No Federal Immigration Reform? What States Can Do to Improve the Health of Undocumented Workers,” will be held from 11:30 a.m.-12:15 p.m. Saturday, April 18, during UC Global Health Day at UCLA, Covel Commons, 200 De Neve Drive, Los Angeles. Registration for UC Global Health Day is required for admission. Onsite: general $75, student $50.

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UC Berkeley team takes top honors in Emory Global Health Case Competition

First-time entrants win prestigious international student competition.

The UC Berkeley team at the 2015 Emory Global Health Case Competition: Asha Choudhury, Chris Andersen, Jee Yun Kim, Richa Gujarati and Rosheen Birdie

By Linda Anderberg, UC Berkeley

When five UC Berkeley students assembled to enter the 2015 Emory Global Health Case Competition — the first time a Berkeley team had entered — they weren’t expecting to win. Nonetheless, they took the top prize at the prestigious international competition, which aims to promote awareness of and develop innovative solutions for 21st century global health issues. Twenty-four multidisciplinary teams from universities around the world competed in the challenge on Saturday, March 28, at the Rollins School of Public Health in Atlanta.

“The fact that they placed first among over two dozen elite universities in the United States and abroad is a testament to the innovative culture at Berkeley,” says Phuoc Le, assistant professor in the Interdisciplinary M.P.H. Program at the UC Berkeley School of Public Health, who served as a the team’s faculty adviser.

Rosheen Birdie, an undergraduate student majoring in public health and molecular and cell biology, was team captain and initially reached out to staff and faculty to find out how she would go about forming a team. She was put in touch with Hildy Fong, executive director of the UC Berkeley Center for Global Public Health, who connected her with Chris Andersen, a UC Berkeley School of Public Health student in the MS program in epidemiology who was also interested in the Emory competition. Birdie and Andersen then recruited more team members, using what Andersen describes as “a snowball approach.” Eventually, Asha Choudhury, a student in the UC Berkeley-UCSF Joint Medical Program; Jee Yun (Ashley) Kim, a molecular and cell biology undergrad; and Richa Gujarati, an M.B.A. student at the Haas School of Business, all joined the team.

“Our team represented more academic disciplines than some of our competitors, which I think gave us an advantage,” says Andersen. “This translated into ‘constructive friction’ between team members during our discussions on the case. Ultimately our differing perspectives produced a better product than any one of us could have come up with alone.”

The team prepared by reviewing cases from previous Emory competitions and going over proposed solutions. Le advised them on case format and presentation details. They also worked on fundraising for the five-person trip to Atlanta.

“Addressing global health challenges in the ‘real world’ requires collaboration, commitment, drive, and intelligence. This Berkeley team embodied all these traits from the moment they decided to participate, and they were tenacious and determined in preparing for the competition every step of the way — even when facing various logistical setbacks,” says Fong. “If this winning Berkeley team is a glimpse of the upcoming cadre of global health professionals, then our future is in good hands.”

The team received their global health case one week before the competition, finding out that they would be developing a strategy to reduce gun violence in Honduras. “I thought it seemed like a difficult problem to solve in a week,” Andersen recalls.

“The case subject was definitely surprising, but in a good way,” says Kim. “It challenged us to address gun violence as a multi-faceted public health issue and target its root causes. It was a great learning experience.”

Choudhury was impressed with the case because it was open to many different approaches. Birdie agrees. “It was a case with a lot of clues as to strategies you could take, but there wasn’t one obviously correct solution,” she says. “I’d recommend that future teams read it closely when they are preparing for the competition.”

After a week of preparation, the team traveled to Atlanta, where they had an intense day to finalize their strategy and presentation — working from noon on Friday to 2:30 a.m. on Saturday. The next morning, they made their last edits at 7:35 a.m., turned in their flash drive, and waited to make their 15-minute presentation followed by a 10-minute question-and-answer session with a distinguished panel of judges, including Rafael Flores-Ayala, team lead of the International Micronutrient Malnutrition Prevention and Control Program at the CDC and Asha Varghese, director of the Global Health Portfolio at the GE Foundation.

The Berkeley team’s strategy was titled “Breaking the Cycle of Violence” and involved a three-pronged approach that included the promotion of public safety, job production and economic development, and community building. The team segmented the drivers of violence into macro (lack of opportunity, poor education, U.S. demand for cocaine), meso (drug flow, corruption, culture of violence), and micro (access to firearms, conflict over territory) levels. They also categorized their strategies using these levels — for example, a cash transfer to incentivize education was at the macro level, while trading guns anonymously for cash was at the micro level.

“One of the most challenging aspects was getting all the relevant points into a 15-minute presentation,” says Birdie, “and ensuring that our solution was realistic, sustainable and scalable.”

After finishing in first place in their six-team round one, the UC Berkeley team continued on to the four-team finals, where they gave their presentation to all eight case competition judges and in front of many of the students from other universities. For winning the competition, they received a $6,000 award.

“One of the most rewarding aspects of the competition was learning how to work as a multidisciplinary team,” says Kim. “It was amazing to progress from each one of us having different ideas to forming one cohesive solution.”

Second place went to the team from the University of Kentucky, also first-time participants. The University of Miami team won third place, and Northwestern University earned Honorable Mention. Fourteen waitlisted teams competed in a video competition using the same case as the on-campus participants — with the University of Minnesota taking top honors.

Visit the Emory Global Health Institute website for more information about its global health case competitions.

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UC Davis to host town hall on proposed school of population, global health

Event will be April 16 in Sacramento.

By Carole Gan, UC Davis

A town hall meeting to discuss the proposed UC Davis School of Population and Global Health will be held on Thursday, April 16, from noon to 1 p.m., at the Education Building, 4610 X St., Room 1204, in Sacramento.

UC Davis Chancellor Linda Katehi recently assigned Kenneth Kizer the responsibility to lead an effort to create a new School of Population and Global Health at UC Davis. Kizer is the director of the Institute for Population Health Improvement at UC Davis Health System and a distinguished professor at the School of Medicine and the Betty Irene Moore School of Nursing. Kizer also serves as a member of the Institute of Medicine’s Board on Population Health and Public Health Practice.

Katehi asked Kizer to explore the creation of the new school based on a recognition of the trans-disciplinary approaches needed to address growing health challenges resulting from changing demographics, greater global connectivity, climate and other environmental changes, new technologies and modern society itself.

The proposed school envisions aligning education and training in human and animal health sciences, agriculture, environmental and life sciences, and the social sciences to better prepare leaders, scholars and practitioners to address the many health challenges of an increasingly crowded and connected planet.

Those planning on attending should RSVP by April 9 to Kathleen MacColl at kcmaccoll@ucdavis.edu or (916) 734-7722.

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Secondhand smog

Scientists determine amount of ozone pollution drifting to California from overseas.

Ian Faloona, UC Davis

By Kat Kerlin, UC Davis

Approximately 10 percent of ozone pollution in California’s San Joaquin Valley is estimated to be coming from outside of the state’s borders, particularly from Asia, according to preliminary research presented today (March 31) by the University of California, Davis.

Secondhand smog from Asia and other international sources is finding its way into one of the nation’s most polluted air basins, the San Joaquin Valley. UC Davis atmospheric scientist Ian Faloona shared his research with air quality regulators and scientists today at a transboundary pollution conference near Yosemite National Park. The issue serves as an example of how air quality is a global — not just local — problem.

“To me, it’s an exciting new chapter of how we think of air pollution,” Faloona said. “How do we deal with this not just as an air district of a couple of counties, but as a nation and a global citizen of the planet? Traditionally, air pollution has always been considered an issue to be handled locally, ‘It’s your backyard, it’s your problem.’ But we’re going to have to treat air pollution to some extent how we treat greenhouse gases.”

[Audio clip (1 min, 3 sec) ]

Up in the air

When someone smokes a cigarette next to you, you know that secondhand smoke is harmful to your lungs, even though you aren’t the smoker. But what about when your neighbor is thousands of miles away, and the pollution they are emitting is from an industrial plant, millions of cars, or a raging wildfire?

Scientists have long known that a portion of ozone pollution was coming from overseas, but attempts to quantify just how much were hamstrung by coarse computer models that overlooked or broadly simplified California’s complex terrain.

Faloona describes California as if it were a human body: The Golden Gate bridge is the mouth, breathing in air from across the Pacific Ocean, sucking it through the throat of the Bay Area and into the lungs of the San Joaquin Valley. Previously unknown is how much air comes over the coastal mountain range and mixes from above into the bathtub of the San Joaquin Valley.

UC Davis researchers have spent the past three years trying to measure that contribution from a mountaintop air quality monitoring station near California’s Point Sur. They’ve also gathered it from a plane equipped with scientific instruments that measure air pollutant levels — a flying air monitoring station of sorts. The combined data has allowed them to analyze the “signature” of the sources and quantify how much of the valley’s ozone pollution is locally produced, and how much is drifting across from international sources.

Every little bit counts

The research comes as the U.S. Environmental Protection Agency has proposed tightening ozone limits from 75 parts per billion to between 65 ppb and 70 ppb, later this year. (A final rule is due Oct. 1.) In the San Joaquin Valley, which includes the cities of Fresno, Stockton and Bakersfield, asthma rates are roughly twice that of the rest of the state. Such a change by the EPA is expected to push much of the valley further out of compliance.

Air districts are financially penalized and considered out of compliance for going over federal ozone pollution thresholds, known as National Ambient Air Quality Standards. As they continue to work to improve local air quality, regulators have an increasing stake in being able to account for how much pollution is within their local control and how much is not.

“In addressing the tremendous public health challenge we face in reducing ozone, it is critical to accurately identify the sources of ozone pollution so that solutions can be appropriately targeted,” said Seyed Sadredin, executive director of the San Joaquin Valley Air Pollution Control District. “The scientific information being discussed at the transboundary ozone conference will be invaluable to many regions throughout the nation.”

Share the air

Faloona notes that the majority of the air pollution in California is coming from local sources, which requires further work. His research is not about pointing fingers but about having a clearer picture of where pollution comes from — and how a global community can help reduce it.

“One of the reasons I was so drawn to atmospheric science is because we’re intimately sharing this substance that’s totally vital to us,” Faloona said. “Air is something that we have to share. To me, it’s always been an obvious connector of people. We’re becoming more cognizant of how connected we are and how all of our decisions have to be made on a global scale from here on in.”

[Audio clip (27 sec) ]

The research was funded by the San Joaquin Valley Air Quality Control District.

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UC Global Health Institute hosts policy briefing

Institute prepares for UC Global Health Day, second policy briefing, April 18 at UCLA.

Policy briefing presenters and UC Global Health Institute leadership (from left): Christopher Paige, Haile Debas, Joel Diringer, Marc Schenker, Yissel Barajas, Gil Ojeda and Thomas Coates.

The UC Global Health Institute hosted its first policy briefing March 17 with a focus on the health status of California’s largely immigrant, agricultural workforce.

The institute also is gearing up for UC Global Health Day, April 18 at UCLA, which will include a second policy briefing with a focus on undocumented workers and their families.

Farmworkers are a vulnerable population facing disparities in health and access to care, among many others. More than 80 people attended this policy briefing at UC Center Sacramento, which highlighted strategies on how to improve the health of this population. (View the briefing, courtesy of The California Channel.)

Speakers included Gil Ojeda, director of the California Program on Access to Care at the UC Berkeley School of Public Health; Tom Coates, director of UCLA’s Center for World Health and co-director of the UC Global Health Institute; and UC Davis public health sciences professor Marc Schenker, co-director of the Center of Expertise on Migration and Health within the UC Global Health Institute.

Schenker was lead author on the corresponding white paper. The paper included 11 policy recommendations to expand health insurance/access, improve public health infrastructure, increase the number of health workers and occupational safety employees, establish fairness across industry, improve living conditions, and promote agricultural safety and health education.

A panel including representatives from a nonprofit, social services organization; a farmworker advisory group; and a major California berry grower provided responses to the presentation.

The event launched the first of two policy papers from the UC Global Health Institute this year – with the second paper to focus on state-level policy and legislative changes to benefit undocumented workers and their families.

The second policy paper will be the topic of a special plenary session during UC Global Health Day, April 18 at UCLA. A diverse panel will engage in a dynamic discussion of a forthcoming white paper on this timely issue. The brief is sponsored by the UC Global Health Institute, with support from the UCLA Center for Health Policy Research.

Presented by the UC Global Health Institute, UC Global Health Day is an annual conference that showcases the research, training and outreach in global health being undertaken across the University of California.

It’s a chance for UC students, fellows, faculty, staff and visiting scholars to share their current work in global health. The day will feature plenary sessions, posters and concurrent breakout sessions covering a broad range of global health topics. The keynote speaker will be Patrick Soon-Shiong, founder and CEO of NantHealth, chairman of the Chan Soon-Shiong Family Foundation, and chairman and CEO of the Chan Soon-Shiong Institute of Molecular Medicine. Registration costs $75 for general admission and $50 for students. To register online by April 14, visit: https://www.eventbrite.com/e/uc-global-health-day-2015-tickets-15838746116.

For questions, email ucghi@globalhealth.ucsf.edu.

About the UC Global Health Institute
The UC Global Health Institute advances the mission of the 10-campus University of California system to improve the lives of people in California and around the world. By stimulating education, research and partnerships, the institute leverages the diverse intellectual resources across the university to train the next generation of global health leaders and accelerate the discovery and implementation of transformative global health solutions.

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