TAG: "Global health"

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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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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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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Breakthrough in managing yellow fever disease


UC Riverside-led research could lead to antiviral therapeutics, better diagnostics.

Ilhem Messaoudi (right) is an associate professor of biomedical sciences in the UC Riverside School of Medicine. (Photo by L. Duka)

By Iqbal Pittalwala, UC Riverside

Yellow fever is a disease that can result in symptoms ranging from fever to severe liver damage. Found in South America and sub-Saharan Africa, each year the disease results in 200,000 new cases and kills 30,000 people.  About 900 million people are at risk of contracting the disease.

Now a research team led by a biomedical scientist at UC Riverside has determined that the yellow fever virus, a hemorrhagic fever virus, replicates primarily in the liver. Therefore, other organ failures that often follow in people with the disease are due to secondary effects.

When the virus targets the liver, it replicates rapidly causing significant damage to liver cells. In the process, inflammatory cytokines – proteins secreted by cells especially of the immune system – are made in massive amounts, which soon gain access to the blood stream.  These cytokines are most likely responsible for the damage to distant organs, the research team’s findings suggest.

The research team also identified a clinical parameter that could greatly help in managing yellow fever cases.

“Yellow fever causes severe loss of lymphocytes,” said Ilhem Messaoudi, an associate professor of biomedical sciences in the UC Riverside School of Medicine, who led the research project. “This process, called lymphopenia, occurs before any measurable changes in liver enzymes can be detected – that is, about a day or so before we see changes in the liver. It could provide an earlier clinical outcome measure of subsequent disease severity, giving doctors a good prognostic tool for offering more aggressive supportive care for these patients.”

Study results appear today (Nov. 20) in PLOS Neglected Tropical Diseases.

The research, performed on rhesus macaques (currently, the best model for studying human yellow fever infection) at Oregon National Primate Research Center, is the first study on yellow fever in non-human primates in more than 20 years.

“Yellow fever is truly a neglected tropical disease,” Messaoudi said. “Even though it continues to cause fatality, it remains understudied. While it is true there is a highly effective vaccine, it remains extremely challenging to get comprehensive vaccine coverage in sub-Saharan Africa and Latin America.  Moreover, the vaccine works well if you are between one and 55 years old.  It is not safe for babies or the elderly, who could develop yellow fever from the vaccine.”

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Are children better off than they were 25 years ago?


UCLA publishes comprehensive analysis of children’s rights around the world.

Jody Heymann, UCLA

Twenty-five years ago this month, the countries that compose the United Nations reached a landmark agreement that laid the foundation for much-needed strengthening of children’s rights and protections in nearly every country around the world.

Today, the Convention on the Rights of the Child remains the only formal global effort to improve children’s rights and the most widely ratified human rights treaty in history. Only three U.N. member nations have not ratified the treaty: Somalia, South Sudan and the United States.

“The Convention on the Rights of the Child is a promise from our global community to all children,” said Dr. Jody Heymann, founding director of the World Policy Analysis Center and dean of the UCLA Fielding School of Public Health. “Everyone deserves to know whether their country is fulfilling that promise and how it compares to other countries facing similar opportunities and constraints.”

To mark the 25th anniversary of the CRC on Nov. 20, the center assessed 190 U.N. countries’ progress toward fulfilling the CRC’s commitment to children in critical areas such as the right to education, protection from child labor and child marriage, and discrimination of children with disabilities.

How are the world’s children faring?

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Global dietary choices show disturbing trends


UC Santa Barbara professor co-authors paper that examines global impact of what we eat.

David Tilman

The world is gaining weight and becoming less healthy, and global dietary choices are harming the environment.

Those are among the findings of a paper co-authored by David Tilman, a professor in the UC Santa Barbara Bren School of Environmental Science & Management, and Michael Clark, a graduate student at the University of Minnesota, where Tilman also is a professor. In “Global Diets Link Environmental Sustainability and Human Health,” published today (Nov. 12) in the journal Nature, the researchers find that rising incomes and urbanization around the world are driving a global dietary transition that is, in turn, diminishing the health of both people and the planet.

“These dietary shifts,” they write, “are greatly increasing the incidence of Type 2 diabetes, coronary heart disease and other chronic non-communicable diseases that lower global life expectancies.”

The paper is the first to show the global links among the elements of what Tilman refers to as the “tightly linked diet–environment–health trilemma.”

“Previous analyses have looked at the effects of diet in individual countries, but we are the first to examine the global impacts on both human health and the environment of diet as it is now and as it is becoming,” he says. “We gathered information on dietary trends and environmental impacts for 90 percent of the global population. Our data let us see how diets, health and the environment have been changing and where they are going.”

“Some of what we found is not surprising, but the global implications are frightening,” Tilman adds. “Most of us have heard that some diets are healthier, that eating too many calories is bad for you and that red meat harms the environment. We were surprised at how rapidly and consistently diets were changing around the world, how massively this would impact global health and how much it would increase global greenhouse gas emissions and the destruction of tropical forests and other ecosystems.”

Unhealthful diets linked to urbanization

The links between urbanization, increased wealth and unhealthful diets are clear, Tilman explains. When a country industrializes, the transition from a traditional rural diet to one that includes more processed meats and more empty calories can occur quickly. “People move to cities, leaving behind their own gardens where they grew fruits and vegetables,” Tilman said. “They’re working in a factory 12 hours a day, six or seven days a week, so they need food that’s cheap and fast. The cheapest, fastest food you can get is filled with starch, sugar, fat and salt. Almost overnight, they go from a healthy diet to one that has way too many calories and leads to diabetes and heart disease.”

Also, because people tend to eat more meat as they become wealthier, much of the expected 100-percent increase in crop production that will be required by 2050 would be used to feed not humans but livestock. To do that, much more land will need to be cleared, with the result that more habitat will be lost, more species will likely become extinct and increased runoff of agricultural fertilizers and pesticides will degrade streams, rivers, lakes, groundwater and oceans.

Alternative diets offer health benefits

Tilman suggests that hope — and help — lie in the widespread adoption of alternative diets that offer substantial health benefits and could reduce global agricultural greenhouse gas emissions, reduce land clearing and resultant species extinctions and help prevent a variety of diet-related chronic noncommunicable diseases.

Comparing conventional American omnivorous diets to the Mediterranean diet, a pescetarian diet (in which fish is the only animal protein) and a vegetarian diet, the compiled research showed that the three alternatives to the omnivorous diet decreased Type 2 diabetes by 16 to 41 percent, cancer by 7 to 13 percent and morality rates from coronary heart disease by 20 to 26 percent. Moreover, the authors show that these alternative diets could reduce global greenhouse gas emissions from food production by about 40 percent below what they would be if dietary trends continued.

To reach their conclusions, the researchers gathered all published life-cycle assessments covering “cradle to farm gate” greenhouse gas emissions for production systems of food crops, livestock, fisheries and aquaculture — some 500 studies, of which about 220 were useful. They also gathered 50 years of data for 100 of the world’s more populous nations to analyze global dietary trends and their drivers, using that information to forecast future diets should past trends continue.

To quantify the effects of alternative diets on mortality and on Type 2 diabetes, cancer and chronic coronary heart disease, they summarized results of eight major long-term studies on diet and health. Finally, they combined those relationships with projected increases in global population to forecast global environmental implications of current dietary trajectories and calculate the environmental benefits of diets associated with reduced rates of chronic noncommunicable diseases.

“Better diets are the solution to these big problems,” Tilman says. “Only better diets can prevent a massive global epidemic of chronic noncontagious disease. These same diets would also protect the environment. Since big food companies produce so much of what is eaten, we need them to be part of this solution. By developing, producing and advertising foods that are healthy and tasty, these companies can help their customers, the earth and their bottom line. It is a niche waiting to be filled.”

Tilman wonders if unhealthy foods laden with fats or sugars might grow into a health issue somewhat like smoking. “Throughout history, foods that tasted good were almost always healthy but scarce. Now we have thousands of inexpensive manufactured foods that taste good because of an overabundance of sugar, fat or salt but are bad for us. What is the ethics of selling such foods now that we know how bad they are for heath and the environment?”

The research generated a number of nuanced findings about the environmental impacts of various dietary choices. The following are among them:

  • While the difference in greenhouse gas emissions for animal-based versus plant-based foods is well known, emissions per gram of protein for beef and lamb are about 250 times those of legumes; pork, chicken, dairy, and fish have much lower emissions;
  • Twenty servings of vegetables have fewer greenhouse gas emissions than one serving of beef.
  • Fish caught by trawling, which involves dragging fishnets along the ocean floor, can have three times the emissions of fish caught by traditional methods.
  • And among cereal grains, rice has five times the emissions per gram of protein as wheat.

These and other facts demonstrate that there are many diets that are both good for the environment and healthy.

While Tilman does not expect to see quick societal changes in diet, he hopes that the paper will be seen by the right people who can influence the food supply and that it “can encourage people to think about this challenge and have a dialogue it.”

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L.A. leaders to celebrate UCLA Health/CTI lab in China


Advanced medical lab to open in Shanghai early next year.

Los Angeles Mayor Eric Garcetti will escort a delegation of Los Angeles leaders in tourism, business and medicine to China to attend a Nov. 19 ceremony celebrating UCLA Health’s partnership with Centre Testing International (CTI), a Chinese firm, to launch an advanced medical laboratory in the Zhabei district of Shanghai.

The new facility, to be named the UCLA Health/CTI Medical Laboratories, is expected to open in early 2015.

“Our laboratory will bring UCLA’s state-of-the-art clinical diagnostic testing and pathology expertise to China to support pharmaceutical companies’ local clinical trial programs, and offer advanced diagnostic services and companion testing at the highest international standards,” said Dr. Serge Alexanian, the facility’s chief medical officer.

The partnership advances UCLA Health’s international outreach efforts aimed at strengthening Sino-U.S. relationships in order to enhance patient care around the world. It also acts as a bridge between Chinese patients, research and development professionals and world-class pathologists from UCLA.

“Los Angeles is a hub for medical excellence and innovation, and the UCLA Department of Pathology is on the cutting edge of clinical testing,” said Garcetti.  “Through this partnership with CTI, UCLA can share its expertise with fellow scientists while improving health care and the quality of life for the people of China.”

The partnership is the first between a Chinese company and a U.S. academic medical center to create a specialized laboratory in China. The 25,000-square-foot facility will offer genetic and molecular diagnostics and other sophisticated tests that exceed the scope of the average lab in China. UCLA pathologists will train Chinese lab specialists to accurately interpret the tests with an information-technology platform that will generate reports in both Mandarin and English.

“This joint venture is founded on UCLA’s desire to build strong global relationships that improve the health of people and communities through education, research and service,” said Michael Burke, director of international development for UCLA Health. “UCLA has a genuine interest in elevating the level of medicine around the world.”

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Betting big on women, girls


Melinda Gates explains Gates Foundation’s strategy to lift countries out of poverty.

Melinda Gates talks with NPR’s Morning Edition co-anchor Renee Montagne about the source of her passion for improving conditions for people in undeveloped countries.

By Peggy McInerny, UCLA

The Bill and Melinda Gates Foundation is betting big on women and girls to help developing countries lift themselves out of poverty, foundation co-chair Melinda Gates told a UCLA audience that filled Korn Convocation Hall on Nov. 5.

Gates sat down to talk with NPR’s Morning Edition co-anchor Renee Montagne at the 2014-2015 Arnold C. Harberger Distinguished Lecture on Economic Development of the UCLA Burkle Center for International Relations. Co-sponsored this year by UCLA’s Center for World Health and the Health and Human Rights Law Project of the School of Law, the annual event is intended to bring economic policy experts to discuss their views with UCLA students and faculty.

UCLA Distinguished Professor Emeritus of Economics Harberger, who founded and supports the lecture series, was in attendance. A pioneer in the field of development economics, he has trained scores of Latin American economists over his 30 years at UCLA, where he continues to teach.

Gates has worked assiduously to restore contraception to a major place on the global health agenda. Her efforts in this direction led to the 2012 London Summit on Family Planning, which brought together donors, national governments and the development community from around the world. The summit adopted the goal of providing contraception to 120 million women in the developing world by 2020.

Today, 15 developing nations have created national family planning action plans. “We funnel our money through those action plans,” said Gates, which includes support at both the policy and the project levels.

Yet, said the speaker, she quickly realized that contraception alone could not resolve culturally ingrained gender inequality. Soon she began to advocate a holistic approach to cultivate the “other half” of the population of developing countries and, in the process, reduce poverty levels and promote economic growth.

Gates’ focus on gender inequality has led the Gates Foundation to “bet big” on three core areas: health, decision making power and economic empowerment. Saying she saw incredible opportunities in these areas to change things for the better for women and girls, she emphasized that the contributions of many individuals to these causes could create palpable change in our lifetimes.

Gates went even further, saying that development as a whole needs to be looked at through a gender lens. She explained, for example, that agricultural projects often do not take into account that the primary farmers in many countries are women, who frequently seek to avoid cash crops because they lose power over cash resources.

Longstanding development data show that investments in women’s health and education lead to smaller families with healthier, better-educated children. Where women have economic opportunity and decision-making power over resources, more of those resources are also invested in their families, promoting overall economic development.

“We need men and boys in the conversation on all of these issues,” said Gates. Only by educating men first about how contraception and women’s access to economic resources benefit the health and well-being of their children and their wives, she emphasized can these things become culturally acceptable. Moreover, the way in which health education is delivered must be culturally appropriate and respond to gender-specific circumstances.

Focusing on solving today’s problems

The Gates Foundation, which has an endowment of $42 billion and has already disbursed over $30 billion in grants, is focused on solving contemporary problems of the present generation — and perhaps the next — said the speaker.

The development aid provided by the foundation is not intended to endure indefinitely, noted Gates. Neither is the foundation itself. She and her husband do not expect it to have a shelf life much beyond their own — perhaps 15–20 years at most. “We want to spend our energy and our lives doing this work for the problems of today’s society,” she remarked.

“We are trying to build capacity now, so we can funnel more and more resources through those mechanisms,” she explained. “[And] as we learn what mechanisms work in one area, we take them and try to apply them to other areas.”

At present, the foundation is deeply engaged in the health sector in developing countries, supporting vaccination programs, building governmental and human capacity in health care, and developing ways to measure the impact of interventions, particularly those designed to improve gender inequality.

“The way that Bill and I think about this is that the only role [of] a foundation is to be a catalytic wedge,” said Gates. That is, foundations are able to take the risks needed to prove what does and doesn’t work. “But,” she added, “it takes government money to scale those things up.”

After helping create a global Vaccine Alliance (known as Gavi) and raising replenishment funds for it among wealthy nations, the Gates Foundation is now asking developing countries to make contributions to vaccination programs in their countries. Over time, these contributions are expected to increase until the programs become fully funded by those nations.

As a result of these programs, Gates noted that the governments of Ethiopia and Nigeria had built out basic-level primary health care systems in the form of “health posts.” (Ethiopia has built 15,000 such centers.)

“With basic supplies to help people and with basic trained health workers, usually two women, you can get unbelievable changes in maternal and child mortality,” observed Gates. The big lesson of the Ebola crisis is that investing in this primary level of health care provides an institutional bulwark against contagious diseases, which she predicted would continue to arise in perhaps more virulent form, she noted.

Nigeria, for example, was able to contain Ebola because after the first cases were reported, one of its polio clinics (supported by the Gates Foundation and the Centers for Disease Control and Prevention) was transformed into an Ebola emergency response clinic. Not only was the clinic able to trace the origin and spread of the disease in the country, the government was able to distribute appropriate behavior change messages throughout the system of health posts. In contrast, Liberia’s health system rapidly collapsed in the face of the Ebola crisis, having been greatly weakened by two decades of civil war.

Participating as an interlocutor, not an observer

Gates reflected that it was a great privilege to be able to travel for the foundation and learn firsthand about the concerns of men and women in the developing world. She traced her passion to making a difference in the world to the values of her parents, who encouraged all four of their children to attend college despite the serious financial burden this goal would impose.

A practicing Catholic, Gates said she attended a Catholic high school, but sought to transfer to an academically superior school in order to get into a good college. It took a while, she said, to understand that her parents sent her to the Catholic school because they believed in its values. “I was out serving in the courthouse … in the hospital, in a school two miles down the road,” she remarked. “These very liberal nuns showed us that we could make a change in the world.”

Asked if she had gotten pushback from Catholics about her support for contraception in developing nations, Gates said she had received surprisingly little criticism from people of faith. On the other hand, she noted, push back from Rome had been expected.

Whenever she travels to a development conference, the speaker said she makes a point to stop somewhere in Africa and meet people on the ground to remind herself what the work is about. Similarly, she takes a day or two to decompress after long stays in developing countries to let the stories she has heard wash through her, experience the grief sparked by them and decide what she wants to do.

“You don’t go to these countries and not let your heart break,” she said.

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