TAG: "Global health"

UC Global Health Day deadline nears for abstracts, proposals


Submissions due Jan. 30.

The deadline is 11:59 p.m. Friday (Jan. 30) to submit abstracts for posters and proposals for breakout sessions at UC Global Health Day.

Presented by the UC Global Health Institute, UC Global Health Day — which will be April 18 at UCLA –  is an annual conference that showcases the research, training and outreach in global health being undertaken across the University of California.

This event is an opportunity 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.

Interdisciplinary and cross-campus collaborations are strongly encouraged. All presenters will receive complimentary registration to UC Global Health Day. Students selected to present at UC Global Health Day will receive funding to offset travel and poster expenses. Read the calls for posters and breakout sessions for more information.

Submit your abstract or proposal today.

UC Global Health Day also will feature a student video contest and student plenary contest, which have Feb. 27 deadlines for submission.

Visit the UC Global Health Institute website for more information.

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UCSF expert appointed UN Special Envoy on Tuberculosis


Drug-resistant TB poses threat to global health security.

Eric Goosby, UC San Francisco

By Laura Kurtzman, UC San Francisco

UC San Francisco’s Eric Goosby, M.D., who led the Obama administration’s efforts on HIV/AIDS, has been appointed to a new position as United Nations Special Envoy on Tuberculosis. He will remain at UCSF while he takes on his new duties with the UN.

Goosby’s appointment comes amid an epidemic of drug-resistant forms of TB that is posing a significant threat to global health security. Every year, nearly 9 million people become ill with TB, which has long been among the world’s top killers, and about 1.5 million die. A third of those with TB also have HIV, and TB is a leading cause of death for HIV-positive people.

New technology can rapidly diagnose drug-resistant strains of TB, even in remote and poorly equipped clinics, so patients do not waste time taking ineffective drugs. But curing these patients requires a long and arduous therapeutic regimen, which is difficult to sustain, especially in the low-income countries where the vast majority of infections are occurring.

“We know how to prevent, diagnose, treat and cure TB, but many programs have not yet been able to implement the effective measures that identify, enter and retain people in care for the time that is needed to give them a cure,” Goosby said.

Goosby, who attended medical school and did his residency and fellowship at UCSF, was ambassador-at-large and global AIDS coordinator from 2009 to 2013 in the Obama administration. He returned to UCSF in 2013 as a professor in the Department of Medicine and in Global Health Sciences, where he is the director for Global Health Delivery and Diplomacy.

“I will engage in international dialogue around direction and resource allocation for TB and HIV/AIDS, two of the largest killers on the planet, which is a core mission of UCSF Global Health Sciences,” he said. “UCSF affords a wonderful platform that combines the basic sciences with clinical and public health knowledge. Faculty members here have been leaders globally for years. I hope to amplify and catalyze more involvement from UCSF faculty.”

As UN envoy, Goosby will encourage countries to adopt and implement the World Health Organization’s global End TB Strategy after 2015, and its international targets for tuberculosis prevention, care and control, while also pursuing the tuberculosis targets outlined in the Millennium Development Goals.

“Eric will be fundamental to our efforts to promote the new WHO global strategy with member states, donors and all stakeholders,” said Dr Hiroki Nakatani, assistant director-general at the WHO. “His profound knowledge of global health challenges, the AIDS epidemic and the fight against TB will be a tremendous asset for our work and will make the difference. WHO is enthusiastic about this appointment.”

He will work closely with the World Health Organization to carry out the ambitious new targets agreed to at last year’s World Health Assembly: to reduce TB deaths by 95 percent and cut new cases by 90 percent by 2035.

In his new role, Goosby expects to focus on both TB and HIV/AIDS, an important driver of the tuberculosis epidemic, especially in Africa, which has 80 percent of the HIV-associated TB patients around the world.

He will focus on identifying and expanding the best TB programs, while improving those already in place. Although the science of how to treat TB is well established, little is known about what interventions work best in the real world.

Michel Sidibé, executive director of UNAIDS, worked with Goosby when he was head of the President’s Emergency Plan for AIDS Relief (PEPFAR) to cut the number of HIV infections among children by almost half in 21 countries. He said Goosby brings a wealth of practical experience to his new role.

“Dr. Goosby’s knowledge and experience working on HIV and TB, together with his dynamic and committed leadership, will further strengthen our collaboration and bring us closer to ending the dual epidemics of HIV and TB,” Sidibé said.

Through interdisciplinary education, service and research programs, Global Health Sciences harnesses UCSF’s scientific strengths to train global health leaders and develop solutions to today’s toughest health challenges. GHS faculty, staff and students are on the cutting edge of research, treatment, public health practice and policy development for HIV/AIDS, malaria, tuberculosis, neglected tropical diseases, immunizations, women’s reproductive and children’s health, and other conditions that have a devastating impact both globally and locally. They work in more than 50 countries and partner with academic centers, international organizations, ministries of health and private industries to improve the health of vulnerable populations.

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Cuba opens doors to its health care system for visiting nursing students


Cubans embrace UCLA visitors after news of closer ties between two countries.

Students and faculty from the UCLA School of Nursing visit Casa de Maternidad, a maternity home for women with high-risk pregnancies.

By Laura Perry, UCLA

The timing couldn’t have been better for 18 UCLA School of Nursing graduate students and two faculty members headed for Cuba on an educational mission. As they were boarding a flight to Havana from Miami on Dec. 17, big news was breaking: The U.S. was re-establishing diplomatic relations with Cuba, mending a break that has lasted more than 50 years.

One hour later, the UCLA group arrived in Havana, where they were greeted with exuberant hugs, kisses and tears of joy by an excited group of Cuban health leaders over the historic turn of events.

That was the auspicious beginning of a five-day, action-packed visit for the UCLA group. To learn about Cuba’s health care system, they met with physician-nurse teams, engaged in Pan American Health Organization-based discussions on major causes of illness and death, among other topics; and visited community-based consultorios, polyclinics and sex education centers as well as nursing and medical schools.

Eager to see different health care settings, they spent time at a home for seniors and a residence where women with high-risk pregnancies went to live to receive special care.

Ties between Westwood and Havana

This was not the first time that UCLA nurses have connected with their counterparts in Cuba. In 2011, Maria Elena Ruiz, assistant adjunct professor at the school, attended an International Health Conference in Cuba as a member of the American Public Health Association. Through those meetings, she saw firsthand how a first-world, prevention-focused primary health care system functions with third-world economics.

When she returned to UCLA, Ruiz, together with Adey Nyamathi, associate dean for international research and scholarly activities, developed a program that would provide similar experiences for nursing students, who would receive partial credit for a public health course, complete required readings, participate in pre- and post- conferences, and write daily reflective papers.

How do they do it?

Cuba, the UCLA nurses learned during their visit last December, is a third-world country with some impressive health outcomes, including an overall life expectancy that rivals that in the U.S. (78.4 years for Cubans versus 78.6 years for Americans), immunization rates that are nearly 100 percent and low infant mortality. Yet their health care costs per capita are nearly 15 times lower than that of the United States.

Primary care and an emphasis on prevention are key to the success of the Cuban health care system.

“Their system shows how primary care really does work,” said student Vladimir Camarce.  “And when implemented correctly, you can see great outcomes. Historically, the U.S. system has been focused on acute and tertiary care, but we are now starting to see a shift with the Affordable Care Act.”

In Cuba, public service announcements about health are shown daily on television. “They don’t have traditional television commercials like we do here, so the government uses the opportunity to deliver messages about hygiene or reminders on vaccines,” observed student Stephanie Phan.

Another reason for Cuba’s success is its focus on personalized, community-based care. Doctors and nurses work as a team and live in the communities they serve.  They might see patients in a clinic in the morning, said graduate student John Scholtz, and then visit patients who can’t get to the clinic at home “to ensure that they are receiving their checkups and following through with the recommendations.”

The students also noted the personal nature of health care in Cuba. “Patients are referred to by name,” said Phan, “not by ‘the patient in room 11′ …  They told us, ‘They’re not patients, they’re people.”

There is also a strong integration of traditional, herbal and western medicine. It’s all considered good health care. “I believe we should find a way to incorporate that integration into our practices because we do get a lot of patients who use complementary therapies,” said Camarce.

What amazed the students was that the Cubans achieve all this with a scarcity of equipment and health resources. “They don’t have the equipment we have, the technology we have or the pharmaceutical industry,” noted student Jacqueline Marroquin. “They make do with so little, but they are able to accomplish so much.”

“What medical equipment is available resembles a scene from the old MASH television series,” said Ruiz. “And yet we were overwhelmed with the kindness and eagerness of our hosts to share their health experiences with us.”

Also surprising: On average, nurses and doctors make only $20-$30 a month.  But their education and housing are free or subsidized, and they don’t have student loans to pay off.

“In the U.S., you wouldn’t have a lot of people pursuing these professions for that kind of pay,” said Scholtz. “But in Cuba, you have a lot of people interested in being doctors or nurses. They go into it because they want to make a difference in their community.”

Part of the reason why the Cuban system works is the collectivist-based culture and the population perspective, the students said. Many things that have been adapted in Cuba, however, wouldn’t work in the U.S.  “We might be able to integrate some of the ideas in a micro-community,” suggested Marroquin.

Leaving behind impressions — and hand sanitizers

While the students were there to learn, they also taught Cubans something about Americans.  “Our interactions showed them that we were open to ideas and willing to learn from them,” said Scholtz. On a more tangible note, the group left behind hand sanitizers.  And pens. Lots of them.  “There is a real need for basic hygienic supplies, everything we take for granted,” added Ruiz.

But more importantly, the UCLA visitors came away with a new resolve. “As nursing students, as nurses, we really need to understand what is going on across our borders,” said Marroquin.

Nyamathi added:  “These students are now motivated to make a difference, to learn more about other countries and to question our health system, health care costs, disparities, and what we can learn from others to improve health and health care in the U.S.”

It’s also a hope that, with the dawning of warmer relationships with Cuba, the U. S. health care community may be able to learn a lot more from their neighbor, they said.

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Common human protein linked to adverse parasitic worm infections


UC Riverside-led research could lead to new therapies for parasitic worm infections.

Hookworms infect the lung and cause severe inflammation. This image shows immunofluorescent staining of infected mouse lung tissue for worm antigen (green), worm and macrophage bound lectin (red) and cell nuclei (blue). (Credit: Nair Lab, UC Riverside)

By Kathy Barton, UC Riverside

Worm infections represent a major global public health problem, leading to a variety of debilitating diseases and conditions, such as anemia, elephantiasis, growth retardation and dysentery. Several drugs are available to treat worm infections, but reinfection is high especially in developing countries.

Now, scientists at UC Riverside and colleagues around the world have made a discovery, reported in this month’s issue of PLOS Pathogens, that could lead to more effective diagnostic and treatment strategies for worm infections and their symptoms. The researchers found that resistin, an immune protein commonly found in human serum, instigates an inappropriate inflammatory response to worm infections, impairing the clearance of the worm.

“Targeting this inflammatory pathway with drugs or antibodies could be a new therapeutic strategy to treat worm infections and the associated pathology,” said Meera Nair, an assistant professor of biomedical sciences in the UC Riverside School of Medicine, whose laboratory made the discovery.  “Additionally, our data point to the diagnostic potential for resistin as a new biomarker for impaired immune responses to worms.”

Jessica Jang, the lead author of the research paper and a third-year UCR graduate student in microbiology, explained that resistin regulates the recruitment of innate immune cells called monocytes to the site of infection to produce inflammatory cytokines (small proteins that are important in cell signaling).

“Future work in my Ph.D. research will focus on further investigating the activation of monocytes so we can clinically exploit this immune pathway,” she said.

Parasitic worms, known scientifically as helminths, include filarial worms and hookworms. They cause diseases such as elephantiasis, which produces extreme swelling of extremities, and necatoriasis, which causes abdominal pain, diarrhea and weight loss. The infections are often associated with life-long morbidity, including malnutrition, growth retardation and organ failure.

In many developing countries where parasitic worms are prevalent due to substandard sanitation facilities, infections in humans are common, as are reinfections. Some infected patients develop immunity, but others remain susceptible to infections when they are re-exposed or develop chronic infections. Currently, no vaccine is available against human worm pathogens.

The research directed by Nair’s lab combined mouse studies with human data to demonstrate that resistin is actually detrimental, causing excessive inflammation that impedes the body’s ability to clear parasitic worms.

In the animal studies, mice containing the gene expressing human resistin and infected with a parasitic worm similar to the human hookworm experienced excessive inflammation, leading to increased weight loss and other symptoms. Clinical samples from two groups of individuals from the south Pacific island of Mauke and from Ecuador – one group infected with filarial worms causing lymphatic filariasis and a second group infected with intestinal roundworms Ascaris – revealed increased levels of resistin in the infected individuals compared to those who were uninfected or immune.

A better understanding of human resistin may also reveal new knowledge about obesity and diabetes. Resistin has been mapped to the pathway of immune-mediated inflammation that promotes diabetes and other obesity-related disorders and Nair hopes to combine her lab’s basic science expertise with the developing clinical research enterprise in the UCR medical school as a future avenue to research new diagnostic or treatment strategies.

Collaborating in the study were scientists from: the Malaghan Institute of Medical Research in New Zealand; Pontificia Universidad Católica del Ecuador in Quito, Ecuador; St. George’s University of London; the Laboratory of Parasitic Diseases at the National Institutes of Health; and the Perelman School of Medicine at the University of Pennsylvania.

Funding for the research at UCR was provided by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the Division of Biomedical Sciences (UCR School of Medicine) and a UCR Academic Senate Regents Faculty Fellowship.

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UC Davis heart surgeon publishes his model for medical humanitarian aid


J. Nilas Young details a quarter century of establishing cardiac surgery sites in Russia.

J. Nilas Young, UC Davis

By Karen Finney, UC Davis

J. Nilas Young, UC Davis chief of cardiothoracic surgery, has published a landmark article on medical humanitarian aid, detailing his 25 years of experience establishing six cardiac surgery sites in Russia.

The article appears in the December 2014 issue of the prestigious Journal of Thoracic and Cardiovascular Surgery and is also available online.

Young’s UC Davis co-authors were pediatric cardiac surgeon Gary Raff and pediatric critical care physician James Marcin, and his collaborators included colleagues at the Mayo Clinic, Emory University, Childrens Hospital of Wisconsin, Nationwide Childrens Hospital and the Siberian Branch of the Russian Academy of Medical Science.

The article emphasizes the approach of Heart to Heart International Children’s Medical Alliance in developing sustainable medical aid programs with high-quality outcomes, scalability and efficacy. Although focused on a specific class of diseases (congenital heart diseases), the authors believe the model is applicable to other medical humanitarian projects, particularly those that involve complex surgical interventions.

In 2012, Young received the the World of Children Health Award — hailed as the “Nobel Prize for child advocates” — for his international humanitarian efforts to improve pediatric heart care (read the press release).

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Combining social media, behavioral psychology could lead to more HIV testing


UCLA research suggests a valuable tool in fight against the virus that causes AIDS.

Sean Young, UCLA

By Enrique Rivero, UCLA

Social media such as Twitter and Facebook can be valuable in the fight against HIV in the United States, where research has demonstrated they can prompt high-risk populations to request at-home testing kits for the virus that causes AIDS, suggesting a way to potentially boost testing rates.

But does it lead to actual testing, and can it work outside the United States? A new study from the UCLA AIDS Institute and Center for AIDS Research published online today (Dec. 15) by the peer-reviewed journal Lancet HIV suggests that it can. The study, conducted in Peru among men who have sex with men, found that participants in the intervention arm of a randomized controlled clinical trial were more than twice as likely to be tested for HIV than those who joined a social media group and were provided with traditional HIV prevention services.

The intervention, called Harnessing Online Peer Education (HOPE), combines social media with behavioral psychology to encourage people in high-risk populations to get tested, said Sean Young, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and executive director of the UCLA Center for Digital Behavior.

“This shows that it’s not just social media that got people to test, but the HOPE social media interventions and the psychological ingredients it used for changing behavior,” Young said. “In other words, if you’re a public health organization or worker, don’t just think that throwing something on Facebook or Twitter will solve your problems and change people’s behaviors. Social media may be helpful, but the HOPE intervention was significantly more likely to change HIV testing behavior compared to traditional care through social media.”

Though there have been many experimental HIV testing interventions in international settings, none have used social media technologies, said Young, who is also a member of the UCLA AIDS Institute and Center for AIDS Research, the Center for HIV Identification, Prevention and Treatment Services and the UCLA Center for Addiction and Behavioral Medicine. This study was conducted in greater Lima, which reflects the low- and middle-income countries where low-cost interventions such as HOPE could help stem the spread of AIDS.

Previous research by Young and colleagues demonstrated that the HOPE intervention increased participants’ requests for testing, but was too small to determine the rates of actual testing. “That pilot study was a good enough start showing the potential of using the HOPE intervention to change testing behavior,” he said.

This study builds on the prior research by increasing the number of participants by about five times — 556 participants compared to  112 — and it was designed with a verifiable and observable endpoint allowing the researchers to gauge the rates at which participants followed through with requests for kits and got tested.

The 556 Peruvian men who have sex with men were randomly assigned to join control groups or private intervention on Facebook for 12 weeks, with 278 assigned to each group. The control group received an enhanced standard of care, which included standard offline HIV prevention and testing services offered by local clinics and organizations and participation in Facebook groups that provided study updates and HIV testing information.

The intervention group, by contrast, received the enhanced standard of care and also incorporated the HOPE intervention behavior change model, which utilized peer leaders who sent messages, chats and wall posts and engaged the participants in general friendly conversation. The peer leaders also communicated information about HIV prevention and testing to the participants.

Of the 278 participants in each group, 26 from the intervention group  did not complete the follow-up survey and 32 were lost to follow-up on the control side.  Of the 252 from the intervention group who provided complete data, 43 (17 percent) went on to take an HIV test, compared with 16 (7 percent) of the controls. In the study, seven participants who tested positive were linked to care at a local clinic.

Though this research provides evidence that the HOPE intervention can increase HIV testing in low- and middle-income countries, other settings are different from Peru, so the researchers can’t say for certain if these findings are applicable to other countries.

This study, however, suggests that the HOPE intervention and new technologies can be a low-cost solution for populations at risk for HIV in Peru and other similar low- and middle-income country settings, Young said.

“This could set the stage for important future work on being able to use these methods to treat people who have HIV, which is a tremendous issue in settings like sub-Saharan Africa,” Young added.

Grants from the National Institute of Mental Health (K01 MH090884) and the UCLA AIDS Institute and Center for AIDS Research funded this study.

Study co-authors are William Cumberland, Roch Nianogo, and Thomas Coates of UCLA; Luis Menacho of Universidad Peruana Cayetano Heredia (Peru), and Jerome Galea of Epicentro Gay Men’s Community Center (Lima, Peru).

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Hazy road to Mecca


Severe air pollution spikes during yearly pilgrmiage, UC Irvine and others find.

UC Irvine and other researchers are testing air pollution in the Middle East, including in Mecca during the annual hajj, at burning landfills and elsewhere. Dangerously high levels of smog forming contaminants are being released, the scientists have found. (Photo by Dr. Azhar Siddique)

Dangerously high levels of air pollutants are being released in Mecca during the hajj, the annual holy pilgrimage in which millions of Muslims on foot and in vehicles converge on the Saudi Arabian city, according to findings reported today (Dec. 15) at the American Geophysical Union meeting in San Francisco.

“Hajj is like nothing else on the planet. You have 3 to 4 million people – a whole good-sized city – coming into an already existing city,” said Isobel Simpson, a UC Irvine research chemist in the Nobel Prize-winning Rowland-Blake atmospheric chemistry laboratory. “The problem is that this intensifies the pollution that already exists. We measured among the highest concentrations our group has ever measured in urban areas – and we’ve studied 75 cities around the world in the past two decades.”

Scientists from UCI, King Abdulaziz University in Saudi Arabia, the University of Karachi in Pakistan, the New York State Department of Health’s Wadsworth Center and the University at Albany in New York captured and analyzed air samples during the 2012 and 2013 hajjes on roadsides; near massive, air-conditioned tents; and in narrow tunnels that funnel people to the Grand Mosque, the world’s largest, in the heart of Mecca.

The worst spot was inside the Al-Masjid Al-Haram tunnel, where pilgrims on foot, hotel workers and security personnel are exposed to fumes from idling vehicles, often for hours. The highest carbon monoxide level – 57,000 parts per billion – was recorded in this tunnel during October 2012. That’s more than 300 times regional background levels.

Heart attacks are a major concern linked to such exposure: The risk of heart failure hospitalization or death rises sharply as the amount of carbon monoxide in the air escalates, the researchers note in a paper published in the journal Environmental Science & Technology. Headaches, dizziness and nausea also have been associated with inhaling carbon monoxide.

“There’s carbon monoxide that increases the risk of heart failure. There’s benzene that causes narcosis and leukemia,” Simpson said. “But the other way to look at it is that people are not just breathing in benzene or CO, they’re breathing in hundreds of components of smog and soot.”

The scientists detected a stew of unhealthy chemicals, many connected to serious illnesses by the World Health Organization and others.

“Air pollution is the cause of 1 in 8 deaths and has now become the single biggest environmental health risk globally,” said Haider Khwaja of the University at Albany. “There were 4.3 million deaths in 2012 due to indoor air pollution and 3.7 million deaths because of outdoor air pollution, according to WHO. And more than 90 percent of those deaths and lost life years occur in developing countries.”

Khwaja experienced sooty air pollution firsthand as a child in Karachi, Pakistan, and saw his elderly father return from the hajj with a wracking cough that took weeks to clear. He and fellow researchers braved the tunnels and roads to take air samples and install continuous monitors in Mecca.

“Suffocating,” he said of the air quality.

In addition to the high smog-forming measurements, the team in follow-up work found alarming levels of black carbon and fine particulates that sink deep into lungs. Once the hajj was over, concentrations of all contaminants fell but were still comparable to those in other large cities with poor air quality. Just as unhealthy “bad air” days once plagued Greater Los Angeles, research is now showing degraded air in the oil-rich, sunny Arabian Peninsula and elsewhere in the Middle East. Because the number of pilgrims and permanent residents is increasing, the scientists recommend reducing emissions by targeting fossil fuel sources.

Besides vehicle exhaust, other likely culprits include gasoline high in benzene, a lack of vapor locks around gas station fuel nozzles, and older cars with disintegrating brake liners and other parts. Coolants used for air-conditioned tents sleeping up to 40 people also contribute to greenhouse gas buildup. And the dearth of regulations exacerbates these problems.

The researchers said that Saudi officials are aware of the issues and taking steps to address them, such as working to reduce benzene in area gasoline supplies. Directing Mecca pedestrians and vehicles to separate tunnels would be optimal. In addition, clearing the region’s air with time-tested technologies used elsewhere in the world could sharply reduce pollution and save lives.

“This is a major public health problem, and the positive news is that some of the answers are very much within reach, like putting rubber seals on nozzles at gas stations to reduce leaks,” Simpson said. “It’s a simple, doable solution.”

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To stop spread of HIV, African governments should target hot zones


UCLA develops strategy using a complex mathematical model.

By Mark Wheeler, UCLA

While Ebola has attracted much of the world’s attention recently, a severe HIV epidemic rages on around the world and in sub-Saharan Africa in particular. Globally, more than 34 million people are infected with HIV; in sub-Saharan Africa alone, 3 million new infections occur annually.

In an attempt to stop the spread of HIV, governments in the region are considering providing antiretroviral drugs to people who do not have the virus but are at risk for becoming infected. Such drugs are known as pre-exposure prophylaxis, or PrEP.

Although the conventional strategy — attempting to attempt to distribute the drugs to people in every city and village — might seem logical and equitable, researchers at UCLA have devised a plan they say would be much more effective in reducing HIV transmission.

The strategy, developed using a complex mathematical model, focuses on targeting “hot zones,” areas where the risk of HIV infection is much higher than the national average. In South Africa, where 17 percent of the population is infected with HIV, the model predicted that targeting hot zones would prevent 40 percent more HIV infections than using the conventional strategy — and would therefore be 40 percent more cost-effective.

“Stopping the HIV pandemic is one of the greatest challenges facing the global community,” said Sally Blower, the paper’s senior author and the director of the Center for Biomedical Modeling at the UCLA Semel Institute for Neuroscience and Human Behavior.

The report appears in the current online edition of Nature Communications.

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Project uses tech to help boost vaccination rates in India


UC Berkeley students turn to crowdfunding to support further software development.

Emmunify co-founder Anandamoy Sen, now a UC Berkeley alumnus, holds a prototype of the portable record system. The chip, which contains vaccine records, is attached to a cell phone, ready to be synced to a health care worker’s mobile device. (Photo courtesy of Julia Walsh)

By Sarah Yang,  UC Berkeley

UC Berkeley students are creating a new tool that could soon make it far easier for children in developing nations to get life-saving vaccines.

As part of a project called Emmunify, the students simplify medical record-keeping by storing patient vaccination records on a portable chip that can then be accessed by a health care provider without the need for Internet access.

“Electronic health records are not new, but in developed nations, there is more IT infrastructure in place that allows some health providers and patients to have access to medical data,” says project team member Jennifer Sisto, a graduate student in public health. “We wanted something that would be effective in areas with limited healthcare data and IT resources, so we focused on providing crucial information, not setting up an entire electronic health record system.”

Emmunify was the brainchild of three Berkeley MBA students, who entered the project in the campus’s 2012 Hacking Health competition for the most innovative ideas in digital health. The project emerged as the grand prize winner, earning $2,000 in seed money to help build a better prototype and conduct feasibility testing.

With the leadership of faculty adviser Dr. Julia Walsh, adjunct professor of maternal and child health, the team connected with nonprofit health providers in India and began preparing to pilot-test the technology in New Delhi, where under half the children are fully immunized.

Rather than attempt to include a patient’s entire medical history on this chip, the Emmunify team kept the data focused on vaccination history.

“We know that raising vaccination rates among children raises school attendance, improves cognitive abilities, decreases malnutrition and increases earning power as adults,” says Walsh. “This is a simple tool to help get kids out of poverty.”

The Emmunify chip is attached to a user’s cell phone, and data is transferred to the health provider’s phone, tablet or other computer through near-field communication, a feature that is increasingly common in today’s mobile devices. A free app must be downloaded so the device can read the data on the chip. The researchers note that most families have access to at least one cell phone, and that the system is designed to be operable on various platforms.

“In many cases, families have to go to six different places at different times to get vaccinations for their children, and they are expected to keep the records on a form or other piece of paper that easily gets lost,” says Walsh. “This tool solves that problem by keeping the data on a phone and in an easily readable format.”

Emmunify could also be used to help direct resources where they are needed. Communities can track how many vaccines have been delivered and used, and health administrators will know when supplies are low and more vaccines are needed.

Ultimately, the system could help increase vaccination rates by sending patients automated voicemail reminders in their local language to remind them when their next shot is due.

“There is a lot of evidence from epidemiological studies that when it comes to basic healthcare, it’s not the new flashy gizmos that are important,” says Sisto. “We just want something basic that works. The tool can be really simple.”

The current team consists of two Berkeley alumni, including co-founder Anandamoy Sen, and six undergraduate and graduate students from Berkeley’s Department of Electrical Engineering and Computer Sciences and the School of Public Health.

Since Emmunify’s debut in 2012, the researchers have won additional funding through other contests, including Big Ideas@Berkeley, which is supported by several campus centers and institutes. This year, Big Ideas partnered with Indiegogo, a crowdfunding site, to help raise money for winning projects.

The Emmunify team hopes to raise $25,000 to support further software development and to deploy the technology in New Delhi.

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Is life in America hazardous to immigrants’ health?


Over time, the health status of immigrant groups tends to decline.

By Dan Gordon, UCLA

America is a nation of immigrants drawn from all parts of the world by the promise of freedom and a good life. But a substantial body of evidence suggests that for the newly arrived, life in the United States can be hazardous to their well-being.

When they get here, immigrants are on average healthier than their native-born American counterparts. But the longer they stay, the worse they fare on measures such as heart disease, hypertension, diabetes and mental health.

Faculty at the UCLA Fielding School of Public Health are working on identifying factors contributing to the declining health status of immigrant groups that’s occurring over time and through the generations.

Part of it has to do with an unfamiliarity with U.S. society and its complicated health care system. Many immigrants lack health insurance. But Marjorie Kagawa-Singer, a professor at the Fielding School who focuses on the delivery of care that appropriately considers a patient’s culture, notes that it’s more than just cost.

“If someone is new to this country, doesn’t speak the language and has to learn to navigate our system, it’s like plopping us in the middle of Siberia and expecting us to figure out what we need,” she said.

For example, many immigrants across the educational and cultural spectrum hold beliefs about disease and how the body works that diverge from the biomedical model practiced in the U.S., Kagawa-Singer added, and many health care practitioners are uneducated on those differences.

“When you have problems in both health literacy among patients and cultural competence among practitioners, you get this ‘perfect storm’ of people who will not be able to utilize the health care system even when it’s offered,” said Kagawa-Singer.

Since 2000, Kagawa-Singer has headed the Los Angeles site of the Asian American Network for Cancer Awareness, Research and Training, the first federally funded cancer prevention and control research initiative focusing on Asian Americans. In lectures and short courses on cultural competence, Kagawa-Singer advises health professionals to demonstrate their trustworthiness and compassion.

“It’s not the health problem you’re treating, it’s the person,” she said. “When patients recognize you’re making the effort and respecting their dignity, they’re going to be much more forgiving and willing to teach and learn.” The challenge, she noted, is that the U.S. health care system is designed for short encounters, despite the fact that it may take longer to get to know and understand patients from different backgrounds.

Adopting the American diet

Public health experts have postulated that immigrants decline in health as they assimilate and adopt the health habits of their new communities — including high-fat diets and processed foods, along with reduced physical activity. To some extent, though, that equation has changed with globalization of the food supply, said May C. Wang, a Fielding School professor who focuses on early childhood obesity.

“Most low-income countries now have access to the processed foods we’ve been eating for the past few decades,” Wang noted. But even when immigrants’ tastes are similar to those of non-immigrants, immigrants with minimal financial means face considerable challenges to eating well. “Education alone doesn’t work in a community that doesn’t have the ability to access healthy food,” Wang said. “And in the very poorest communities, trying to change the environment by placing healthier foods where people live, work and go to school is challenging.”

The problem is compounded for immigrant groups, she explained, because they tend to have fewer social ties, are constricted by language barriers and often lack the know-how to pursue resources that could help them.

Wang works closely with the Public Health Foundation Enterprises Women, Infants, and Children (WIC) Program, the largest local WIC agency in the country. It serves 300,000-plus families a year, the vast majority of them non-English-speaking immigrants. The overall childhood obesity rate has plateaued or declined in the U.S. in recent years, Wang noted, but the obesity rate among the mostly immigrant Latino children remains substantially higher than for other groups. Among the low-income, preschool-aged Latino children enrolled in L.A. County’s WIC program in 2011, nearly 22 percent were obese.

To better understand the impact of various strategies to improve diet and reduce early childhood obesity, said Wang, “We are examining the social and physical environments in which immigrants live and how these affect their ability to put into practice nutrition knowledge they acquire from participation in the WIC program.”

The work aligns with the University of California Global Food Initiative, which seeks to harness the resources of all 10 UC campuses to address a critical issue of our time: How to sustainably and nutritiously feed a world population expected to reach eight billion by 2025.

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UC Global Health Day seeks abstracts, proposals


Submissions due Jan. 9.

Note: The submission deadline has been extended to Jan. 30.

The UC Global Health Institute invites submissions of abstracts for posters and proposals for breakout sessions for UC Global Health Day, April 18, 2015, at UCLA. This annual conference is a showcase of the research, training and outreach in global health being undertaken across the University of California.

This event is an opportunity 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.

Interdisciplinary and cross-campus collaborations are strongly encouraged. All presenters will receive complimentary registration to UC Global Health Day. Students selected to present at UC Global Health Day will receive funding to offset travel and poster expenses. Read the calls for posters and breakout sessions for more information.

Submit your abstract or proposal today. Deadline for submissions is Jan. 9, 2015, at 11:59 p.m.

Details about the student video contest and the student plenary contest are forthcoming. Stay posted.

Visit the UC Global Health Institute website for more information.

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UC Davis awarded $100M to lead program to predict, prevent pandemic threats


Second phase of program will help attack problems like Ebola before they start.

The PREDICT program helps detect emerging viruses that move among people, livestock and wildlife, such as this macaque in Nepal. (Photo by One Health Institute, UC Davis)

The U.S. Agency for International Development has awarded up to $100 million for the second phase of the PREDICT project based at the UC Davis School of Veterinary Medicine. PREDICT is part of the Emerging Pandemic Threats, or EPT, program — an unprecedented international campaign to rapidly detect and respond to emerging viruses such as Ebola and SARS that move among people, wildlife and livestock.

PREDICT is managed by the school’s One Health Institute. The new award is one of the largest extramurally funded projects in UC Davis history.

“PREDICT and its partners have enabled a platform for effective collaboration across disciplines and geographic borders to promote global health problem solving,” said Jonna Mazet, director of the One Health Institute and principal investigator of the new award. “We can now attack problems, like Ebola, before they start — reducing fear and improving response and control.”

The award for the PREDICT project opens a second phase for the EPT program. Building on its long-standing efforts in disease surveillance and response, USAID is developing multiple initiatives to help prepare the world for emerging infectious diseases like pandemic influenza, SARS and Ebola. Other partners within USAID’s EPT program include the PREPAREDNESS & RESPONSE and ONE HEALTH WORKFORCE projects, the U.S. Centers for Disease Control and Prevention, the Food and Agriculture Organization, and the World Health Organization.

Building on success

For the past five years, the One Health Institute has led a global consortium of implementing partners in conducting pathogen surveillance, viral discovery and global health capacity strengthening in more than 20 countries. In that time, the PREDICT team:

  • Equipped, supplied and trained staff in 32 diagnostic laboratories around the world to safely and properly process and test wildlife samples for viruses of pathogenic potential.
  • Trained 2,500 government personnel, physicians, veterinarians, resource managers, laboratory technicians, hunters and students in biosafety, surveillance, laboratory techniques and outbreak investigations.
  • Discovered more than 800 novel viruses at high-risk pathogen transmission interfaces.
  • Responded to 24 disease outbreaks, including multiple Ebola outbreaks in central Africa.

The new award will build on the success of the first phase of PREDICT, funded in 2009. In collaboration with other U.S. government, international and host country partners, it will continue to strengthen health capacity and to intensify pathogen surveillance and risk assessment activities in geographic areas and animal-human interfaces identified as high-risk for the emergence and spread of disease.

Ebola response

Tragically, the world is currently responding to the worst Ebola outbreak in history. The extreme challenges faced in this response are amplified by the lack of public knowledge on the virus and its potential hosts and transmission. Unfortunately, the countries in West Africa were not expecting or prepared for this epidemic, primarily because there was previously no evidence that the Ebola virus was present in that region of Africa.

In contrast, during a separate Ebola outbreak in this same time period in the Democratic Republic of Congo, where the PREDICT team and other partners were actively engaged with the government and inserted into the public health infrastructure, sick individuals were detected much more quickly. Samples were tested and control measures implemented all within just days of the first signs of illness. The rapid response and significantly reduced death toll in DRC illustrate what can be achieved when a One Health workforce is trained, employed and able to be activated in the face of extreme health challenges.

In this second and new phase, PREDICT will continue to focus surveillance on viral families of epidemic and pandemic potential. These include coronaviruses, the viral family to which SARS and MERS belong, influenza viruses, and filoviruses, such as Ebola.

This second phase also will increase focus on the effects of human behavior and other drivers for disease emergence and spread, with a focus on livestock and people living in high-risk areas for disease spillover and transmission. By working with social and behavioral scientists in a transdisciplinary approach, PREDICT will integrate virus detection with investigations of human-animal interactions and the social and cultural reasons for those interactions. This One Health approach is designed to improve our understanding of the dynamics of zoonotic disease spillover, evolution, amplification and spread in order to inform future prevention and control measures.

Identifying and controlling emerging diseases

The One Health Institute will execute the project in a coordinated consortium with EcoHealth Alliance, Metabiota, Smithsonian Institution and the Wildlife Conservation Society, along with valued technical partners at Columbia University’s Center for Infection and Immunity, HealthMap at Boston Children’s Hospital, International Society for Infectious Disease, and UC San Francisco’s Viral Diagnostics and Discovery Center.

“Our work has shown that emerging diseases are on the rise and represent a growing threat to our health, our economies, and our global security,’ said Peter Daszak, president of EcoHealth Alliance, a partner in the PREDICT consortium. “This next phase of funding allows us to identify the activities that cause diseases to emerge in high-risk disease ‘hotspots’ so that we can minimize the impacts of a new virus spilling over and infecting people.”

The consortium will continue to work closely with partner organizations in each country, as well as with a network of laboratories, universities, government ministries and agencies in these global hotspots. PREDICT is engaged in the Africa, South Asia, and Southeast Asia regions, working in Bangladesh, Cambodia, Cameroon, China, Democratic Republic of Congo, Gabon, Indonesia, Laos, Malaysia, Myanmar, Nepal, Republic of Congo, Rwanda, Tanzania, Thailand, Uganda and Vietnam, along with a new focus in West Africa in response to the Ebola outbreak.

The consortium is united by its belief in the One Health approach, which employs the knowledge that the health of animals, people and the environment are inextricably linked to solve global health problems.

“The new funding for PREDICT will allow our One Health Institute investigators and their partners to continue to identify pandemic threats and build capacity in developing regions worldwide,” said Mazet. “The UC Davis School of Veterinary Medicine has an extensive history of excellence in public health programs that address societal needs. This new funding will ensure our research teams’ continued contributions to enhance capabilities to prevent future pandemics.”

“Attempts to date to control deadly viruses have been almost entirely reactionary due to structural and technological limitations,” Mazet said. “The world is now poised to be able to identify the key processes influencing the evolution, spillover, amplification and spread of pathogen threats in order to halt them at their source.”

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Ebola crisis

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