UC Davis partnership aims to provide strategic advice and mentoring services to facilitate better care.

Kenneth Kizer, UC Davis

The California Department of Health Care Services (DHCS) announced today (Feb. 9) that it has established a partnership with the Institute for Population Health Improvement (IPHI) at UC Davis Health System to improve the quality of care provided by the state’s $46 billion per year Medi-Cal program.

“This partnership will provide strategic advice and mentoring services to guide our capacity for quality improvement, population health management and organizational change,” said Neal Kohatsu, DHCS’ medical director. “It will help strengthen our relationships with partner hospitals by emphasizing bi-directional communication, education and interventions that drive improvement in population health.”

The five-year, $4.25 million agreement calls for, among other things, the IPHI to design and support a statewide Medi-Cal quality improvement plan, develop a systems-level strategy for DHCS to assess hospitals’ success in achieving the goals set forth by the Medicaid Section 1115 waiver’s Delivery System Reform Incentive Pool (DSRIP) program, convene a Medi-Cal Performance Advisory Committee of experts in clinical sciences, system thinking, quality improvement and organizational change, and provide quality improvement training and mentoring for DHCS managers.

“The department is focused on improving and enhancing quality care and reducing health care-related costs,” said DHCS Director Toby Douglas. “Our agreement with IPHI will help us achieve these interconnected goals.”

Medi-Cal is a joint state-federal health insurance program that serves more than 7.6 million low-income and medically high-risk Californians. The DSRIP program is a new component of Medi-Cal that provides federal funds to public hospitals that have demonstrated success in expanding capacity and making services more coordinated, efficient and patient-centered. DSRIP is part of California’s five-year, $10 billion “Bridge to Reform” Medicaid Section 1115 waiver, which aims to strengthen the Medi-Cal program and prepare safety net providers for nearly one million newly eligible Medi-Cal beneficiaries in 2014. The 1115 waiver is an agreement between the state of California and the federal Centers for Medicare & Medicaid Services (CMS) that “waives” certain Medicaid requirements in order to test new strategies for improving care and service delivery.

Kenneth W. Kizer, one of the nation’s preeminent authorities on public health and health care quality improvement and founding director of IPHI, will lead the effort.

“This partnership will result in better health care for millions of Californians and better value for taxpayers who fund the program,” said Kizer, who also is a distinguished professor at the UC Davis School of Medicine and Betty Irene Moore School of Nursing. “We will be developing a clearly defined quality improvement plan for the Medi-Cal program that will include specific quantitative goals and performance measures to track improvement in health care processes and health outcomes, equitable access to care, the prudent use of resources and appropriate matching of resources with needs. In evaluating the DSRIP program and helping develop a systems-level strategy, we expect to make specific recommendations for DHCS and individual hospital systems that will help them achieve DSRIP program milestones and more.”

The plan’s goals and performance measures will reflect the shared values and best practices of the federal Department of Health and Human Services’ National Quality Strategy. DSRIP program evaluations will address interventions in each hospital system plan, including the implementation of electronic health records and use of other health information technology, implementation of patient-centered medical homes, use of evidence-based population health management methods and integration of clinical services to improve the coordination and continuity of care. Kohatsu believes that “Dr. Kizer’s extensive knowledge and history of transforming health care in California and across the nation make him an outstanding director of this statewide initiative.”

Kizer is a member of the Institute of Medicine of the National Academy of Sciences and a fellow of the National Academy of Public Administration. As director of the former California Department of Health Services for Gov. George Deukmejian from 1984 to 1991, he pioneered Medi-Cal managed care, led California’s response to the HIV/AIDS epidemic, launched California’s famed Tobacco Control Program and established a number of leading programs that have become national models of excellence. Some of these include the “5 a Day for Better Health” nutrition program, the California Cancer Registry and California’s birth defects monitoring program.

As undersecretary for health in the U.S. Department of Veterans Affairs (VA) for President Clinton from 1994 to 1999, Kizer engineered the internationally acclaimed transformation of the VA health care system, which included the most rapid and largest ever deployment of a system-wide electronic health record and a comprehensive quality improvement and performance management system that has been cited as a model by Harvard University and others. As founding president and chief executive officer of the National Quality Forum (NQF), Kizer led efforts to establish national standards for reporting of health care quality. Today, NQF-endorsed performance measures are widely used by the federal government and throughout American health care.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

By curbing consumption, funding treatment, tens of thousands of lives could be saved.

Kirsten Bibbins-Domingo, UC San Francisco

Every year, Americans drink 13.8 billion gallons of soda, fruit punch, sweet tea, sports drinks, and other sweetened beverages — a mass consumption of sugar that is fueling soaring obesity and diabetes rates in the United States.

Now a group of scientists at the University of California, San Francisco, San Francisco General Hospital and Trauma Center (SFGH) and Columbia University have analyzed the effect of a nationwide tax on these sugary drinks.

They estimate slapping a penny-per-ounce tax on sweetened beverages would prevent nearly 100,000 cases of heart disease, 8,000 strokes, and 26,000 deaths over the next decade.

“You would also prevent 240,000 cases of diabetes per year,” said Kirsten Bibbins-Domingo, M.D., Ph.D., an associate professor of medicine and of epidemiology and biostatistics at UCSF and acting director of the Center for Vulnerable Populations at the UCSF-affiliated SFGH.

In addition to $13 billion per year in direct tax revenue, Bibbins-Domingo and her colleagues estimated that such a tax would save the public $17 billion over the next decade in health care-related expenses due to the decline of obesity-related diseases.

“Our hope is that these types of numbers are useful for policy makers to weigh decisions,” she said.

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UCSF part of major research initiative to improve safety, effectiveness of blood transfusions.

Edward Murphy, UC San Francisco

UC San Francisco and its affiliate Blood Systems Research Institute (BSRI) have been awarded nearly $33 million in research contracts for four projects as part of a major new research initiative designed to improve the safety and effectiveness of blood transfusions in the United States and abroad.

Suported by the National Institutes of Health (NIH) National Heart, Lung and Blood Institute, the multicenter collaboration project, titled “Recipient Epidemiology and Donor Evaluation Study III (REDS-III),’’ will span seven years.

“For decades, transfusion safety research has focused on blood donors and infectious disease testing — now for the first time, we will be looking at the patients who receive blood transfusions,’’ said Edward L. Murphy, M.D., M.P.H., professor in the UCSF Departments of Laboratory Medicine and Epidemiology/Biostatistics and senior investigator with the BSRI.

More than five million patients in the United States undergo transfusion therapy annually.

REDS-III will entail the creation of four “hubs,’’ each consisting of a regional blood center and affiliated hospitals. The San Francisco hub will involve the Blood Centers of the Pacific, UCSF Medical Center, San Francisco General Hospital & Trauma Center, and the San Francisco Veterans Administration Medical Center. Blood Centers of the Pacific supplies more than 90 percent of the blood used by the three hospitals.

One of the new projects will focus on improving the practice of blood transfusion and evaluating the positive and negative effects of blood transfusion in the hospital setting. As many as 200,000 patients annually at the assorted hubs who receive blood transfusions, and up to 500,000 blood donors a year will be studied to determine, among other things, pulmonary edema after transfusion, transfusion-related lung injury, alloimmunization and other immunological effects of transfusion, Murphy said.

Another project will look at use of plasma, currently thought to be overused for clotting disorders, Murphy said.

UCSF and BSRI also feature prominently in the international component of the initiative:  collaborative research will be conducted in Brazil and South Africa (Johns Hopkins will partner with China for the third site). International projects will focus on prevention of transfusion-transmitted infectious diseases such as HIV, dengue virus and Chagas disease. The researchers also will study obstetric hemorrhage and increased recruitment of black blood donors in South Africa as well as the treatment and genetics of sickle cell disease in Brazil.

BSRI was additionally awarded the contract for a central laboratory that will provide laboratory support and expertise to the seven clinical centers in the U.S. and overseas.

“One of the things that enabled these projects to occur is the partnership between UCSF and BSRI,’’ said Murphy. “The collaborative culture of UCSF has helped enormously.’’

The project will also use resources of the UCSF Clinical and Translational Sciences Institute.

The overall research initiative totaling $87.2 million is funded by the NIH’s National Heart, Lung, and Blood Institute (NHLBI). The research program will build upon and extend the findings of prior projects that began in 1989 in response to the emerging HIV/AIDS epidemic. As the risk of transfusion-transmitted HIV, Hepatitis B and C viruses and West Nile virus has diminished, REDS-III will shift focus toward several new research areas including health outcomes in transfused patients, health screening of blood donors and even genetic studies in the blood bank setting.

“This research effort will protect both blood donors and recipients from existing and future risks, benefitting both the United States and countries struggling to ensure blood safety and availability,’’ said Susan B. Shurin, MD, acting director of the NHLBI.

Murphy said that the nature of blood transfusions has changed dramatically in recent decades since the advent of HIV.

“Before then, physicians used to transfuse much more liberally,’’ he said. “But HIV and other diseases changed transfusion practice — blood should be given based upon evidence-based guidelines, not just because there is a drop in hemoglobin.’’

For more information, go here.

UC Berkeley professor shines a light on human exposure to chemicals.

Brenda Eskenazi always had a thing for brains. By the age of 12, she was carving up cow and chicken brains to explore their anatomy. As a young woman at the 1969 Woodstock festival, surrounded by people on hallucinogens, she saw a man dive off a car headfirst into the concrete, thinking it was water. “Of course, at first, I was just horrified,” she recalls. “But then I remember walking back from Woodstock for miles in the rain, and wondering what happened to his brain? How had those chemicals distorted his brain?”

Eskenazi went on to study everything she could about the brain until she picked up the scent of a whole new field in the late 1970s – environmental health. At the time, many scientists thought “environmental factors” affecting human health involved things like social class and nutrition.

But Eskenazi put chemicals in the picture. In the 30 years of research that followed, she explored the impacts of everything from cigarette smoke, caffeine and chemotherapy to pesticides and flame retardants on brains, child development and reproductive health.

As a professor of public health at UC Berkeley, Eskenazi also spearheaded a study of 536 children born to farmworker families in the Salinas Valley between 2000 and 2001. Her research group began this long-term study during pregnancy and has been tracking development of the children ever since. In two recent papers, they found, for example, that children exposed to prenatal pesticides had lower IQs, and those exposed to flame retardants had lower birth weights.

Discussing her career trajectory, Eskenazi described some of the turning points and how she developed her passion for environmental health. Next year, this passion will take her to Africa to take part in one of the first studies of DDT exposure levels on the continent and its effects on human health.

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Studies spotlight human health effects of exposure to smoke from open fires, dirty cookstoves.

An estimated 3 billion people in the world still cook with open fires and dirty cookstoves, including this mother in Guatemala.

Two new studies led by University of California, Berkeley, researchers spotlight the human health effects of exposure to smoke from open fires and dirty cookstoves, the primary source of cooking and heating for 43 percent, or some 3 billion members, of the world’s population. Women and young children in poverty are particularly vulnerable.

In the first study, the researchers found a dramatic one-third reduction in severe pneumonia diagnoses among children in homes with smoke-reducing chimneys on their cookstoves. The second study uncovered a surprising link between prenatal maternal exposure to woodsmoke and poorer performance in markers for IQ among school-aged children.

The findings on pneumonia, the chief cause of death for children five and under, will be published in the journal The Lancet on Thursday, Nov. 10, two days before World Pneumonia Day. While previous research has linked exposure to household cooking smoke to respiratory infections, the latest results come from the first-ever randomized controlled trial – the gold standard of scientific experiments – on air pollution.

“This study is critically important because it provides compelling evidence that reducing household woodsmoke exposure is a public health intervention that is likely on a par with vaccinations and nutrition supplements for reducing severe pneumonia, and is worth investing in,” said Kirk Smith, professor of global environmental health at UC Berkeley’s School of Public Health and principal investigator of the RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) study.

“There is a huge burden of disease and death due to child pneumonia, and there aren’t a lot of good interventions out there,” added Dr. Arthur Reingold, a UC Berkeley professor of epidemiology and an internationally recognized expert on infectious diseases, who was not part of the RESPIRE trial. “Randomized controlled trials are frequently demanded by funding agencies and decision makers before they are willing to make substantial investments in new technologies or strategies, and this study provides the needed evidence of an intervention that works.”

In the RESPIRE study – which includes partners from Guatemala’s Universidad Del Valle, the U.S. Centers for Disease Control and Prevention, University of Liverpool, Norway’s University of Bergen and the World Health Organization – researchers worked with rural communities in the Western Highlands of Guatemala. Households with a pregnant woman or young infant were randomly assigned to either receive a woodstove with a chimney or to continue cooking with traditional open woodfires.

The researchers found that using chimneys to vent cooking smoke outside homes led to a more striking decrease in cases of severe pneumonia compared with total pneumonia cases, possibly because the reduction in smoke with the chimney stoves was insufficient to significantly reduce all risk.

“The amount of smoke exposure babies were getting from the open woodfire stoves is comparable to having them smoke three to five cigarettes a day,” said Smith, whose research in this field began 30 years ago. “The chimney stoves reduced that smoke exposure by half, on average.”

In all there were 265 children in the chimney-stove homes and 253 children in the control homes. During the study, the researchers reported 149 children in the chimney-stove homes and 180 in the open-fire homes with physician-diagnosed pneumonia. For severe pneumonia, characterized by low blood oxygenation, there were 72 cases in the chimney-stove group and 101 in the control group.

In the second study, published online Sept. 24 in the journal NeuroToxicology, Smith led the research team that followed up with some of the families in the RESPIRE trial, which officially ended in 2005 when the infants were 18 months old. In 2010, when the children were 6-7 years old, the researchers recruited 39 mother-child pairs for the study.

The results found, for the first time, a link between exposure to woodsmoke – as determined by carbon monoxide levels measured individually – during the third trimester of pregnancy and lower performance on neurodevelopmental tests when the children were ages 6 and 7. Specifically, the researchers found impairments in visuo-spatial perception and integration, visual-motor memory, and fine motor skills.

“I was surprised because woodsmoke was always considered a risk for respiratory health, but not IQ,” said study lead author Linda Dix-Cooper, who conducted the study for her master’s thesis in UC Berkeley’s Global Health and Environment graduate program. “The implications of our findings are highly worrisome. Neurodevelopmental impacts have societal costs, such as impacts on an individual’s future lifetime earnings and educational attainment.”

Dix-Cooper added that similar cognitive impacts among children have been noted in previous case reports of childhood acute carbon monoxide poisonings and in epidemiological investigations of other prenatal air pollutant exposures in developed countries’ urban centers. However, larger studies are needed to confirm the link with pollution from woodsmoke, she said.

The new studies come amid growing worldwide attention to the need for cleaner, more fuel-efficient cookstoves. Just last year, the United Nations Foundation launched the Global Alliance for Clean Cookstoves, an international public-private initiative championed by Secretary of State Hillary Clinton.

In addition to the health consequences of burning wood, charcoal, dung or crop residue for cooking and heating, the alliance noted that use of traditional cookstoves increases pressures on local natural resources, contributes to climate change and puts women in danger when they forage for fuel in conflict zones.

Finding cleaner alternatives to traditional cookstoves has been an area of active research at UC Berkeley and the Lawrence Berkeley National Laboratory (LBNL) for decades. Some current projects are part of the UC Berkeley-based Blum Center for Developing Economies. They include one led by Smith to replace unhealthy coal stoves in rural China through carbon offsets, and another led by Daniel Kammen, Class of 1935 Distinguished Professor of Energy at UC Berkeley, to develop cost-effective methods to disseminate improved cook stoves throughout Tanzania.

“The biggest collection of people working in the area of cookstoves in the world is at UC Berkeley and LBNL,” said Kammen, who co-authored a 2001 study linking smoke from cookstoves and health in Kenya that also appeared in The Lancet. “We are the center of this field in the academic community.” Kammen just returned to campus from a one-year stint as the first clean-energy czar at the World Bank, one of the biggest sources of funding for cookstove projects and technology

Funding for The Lancet study was provided by the U.S. National Institute of Environmental Health Sciences (NIEHS) and the World Health Organization. The NeuroToxicology study was supported by the Northern California Center for Occupational and Environmental Health, NIEHS and the Center for Environmental Research and Children’s Health at UC Berkeley.

Related information:

• Household Energy, Climate, and Health Project (School of Public Health project)
• Cutting greenhouse pollutants could directly save millions of lives worldwide (UC Berkeley press release)
• UC Berkeley, Princeton team demonstrates cheap way to reduce toll of respiratory illness from indoor cooking fires in Third World (UC Berkeley press release)
• Cookstoves, Climate Change & Health (Blum Center project)
• Fuel Efficient Stoves for Darfur Refugees (Blum Center project)
• Establishing Effective Cookstove Dissemination Strategies in Tanzania (Blum Center project)
• Ghana Cookstoves Feasibility Study (Blum Center project)

UCLA helps convert East L.A. corner stores to offer healthier food choices; local leaders celebrate first store’s reopening.

Michael Prelip, UCLA

To determine whether stores that prominently display healthy food items while relegating chips, soda and candy to the back of the store can be financially sustainable and improve the health behaviors of a community, the UCLA–USC Center for Population Health and Health Disparities at the UCLA School of Public Health, along with Los Angeles County Supervisor Gloria Molina, announced Oct. 29 the conversion of the first of four corner stores in East Los Angeles to offer healthier food choices.

The conversion was funded by the National Institutes of Health as part of an ongoing effort to reduce cardiovascular disease risk among Latinos in East Los Angeles, where high rates of obesity-related chronic diseases are the norm. East L.A. is a neighborhood that is considered by many to be a “food desert” due to its poor access to comprehensive grocery stores and foods recommended for a healthy and balanced diet and its preponderance of fast food restaurants.

The first converted store to be reopened was the YASH La Casa Market on Hammel Street, which underwent a substantial overhaul to both the exterior and interior, including the removal of boards and re-bar that covered the front of the store, the removal of all soda and beer advertising posters, new paint, and larger windows to allow for natural light to the interior.

Inside, displays were rearranged to more prominently display healthier food items at the front of the store, including canned fruits and vegetables, fresh produce, bottled waters and healthy snacks. A juice bar with high tables and stools will also be a new feature, along with free Wi-Fi.  An empty lot at the back of the store was converted into a vegetable garden with a sitting area for customers.

Los Angeles County Supervisor Gloria Molina (District 1) was on hand, along with UCLA faculty and community members, to celebrate the reopening of the converted store.

“The conversion of this corner store is an important step in the right direction for the residents of East Los Angeles,” Molina said. “I would like to applaud the Songu Family, owners of the YASH La Casa Market, for allowing this wonderful transformation that will help improve the health of the residents of our community.”

In addition to the store conversions, the community-based projects also include an intensive home-environment intervention involving families in which one member is newly enrolled in a diabetes clinic, as well as an evaluation of vascular function and cardiovascular disease risk biomarkers among individuals of various generational and immigrant statuses in order to increase understanding of the basis for the Latino “acculturation paradox” in cardiovascular disease risk.

“These store conversions are part of a comprehensive intervention to understand the effects of immigration and acculturation on health outcomes,” said Michael Prelip, principal investigator for the Corner Store Makeover in East Los Angeles and a professor of community health sciences at the UCLA School of Public Health. “We hope our findings will lead to improvements in the overall health of underserved communities.”

The project is also working with high school students from various East Los Angeles high schools to promote corner store conversions and encourage healthier food options and meal-preparation strategies.

As part of the project, the four converted stores will be evaluated over two years using community surveys, patron surveys and observations. Final results of entire evaluation will be available in two to three years.

The UCLA School of Public Health is dedicated to enhancing the public’s health by conducting innovative research; training future leaders and health professionals; translating research into policy and practice; and serving local, national and international communities.

UC Davis study shows that fast-food dining is most popular for those with middle incomes, not those with lowest incomes.

J. Paul Leigh, UC Davis

>>Read release in Spanish

A new national study of eating out and income shows that fast-food dining becomes more common as earnings increase from low to middle incomes, weakening the popular notion that fast-food should be blamed for higher rates of obesity among the poor.

“There is a correlation between obesity and lower income, but it cannot be solely attributed to restaurant choice,” said J. Paul Leigh, professor of public health sciences at UC Davis and senior author of the study, which is published online in Population Health Management. “Fast-food dining is most popular among the middle class, who are less likely to be obese.”

In conducting the study, Leigh and co-author DaeHwan Kim, specialists in health economics, used data from the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the accompanying Diet and Health Knowledge Survey. The nationally representative sample of nearly 5,000 people in the U.S. included data about food consumption patterns, including restaurant visits, over two nonconsecutive days, which was compared with demographic variables such as household income, race, gender, age and education.

They found that eating at full-service restaurants, which involve a range of food choices and sit-down service, followed an expected pattern: as income rose, visits increased. In contrast, eating at fast-food restaurants, characterized by minimal table service and food preparation time, followed a different pattern. Fast-food restaurant visits rose along with annual household income up to $60,000. As income increased beyond that level, fast-food visits decreased.

Leigh noted that the fast-food industry attracts the middle class by locating restaurants right off freeways in middle-income areas and by offering products that appeal to a large proportion of Americans.

“Low prices, convenience and free toys target the middle class — especially budget-conscious, hurried parents — very well,” said Leigh.

Additional correlations revealed in the study included:

• Men were more likely than women to go to both fast-food and full-service restaurants.
• People with more education were more likely to go to full-service restaurants.
• People who worked more hours were more likely to go to both fast-food and full-service restaurants.
• Smokers were more likely to go to fast-food rather than full-service restaurants.

The study was limited by the fact that the data came from the mid-1990s, the most recent information available on this subject. Although incomes have changed considerably since then, Leigh believes that the eating-out patterns found in this study would still hold if more up-to-date data were available.

“It has traditionally been difficult to define patterns of restaurant consumption for Americans according to their incomes,” said Leigh. “By using a very large, nationally representative database that includes detailed information on income, we have solved that puzzle.”

Based on his findings, Leigh, who is affiliated with the UC Davis Center for Healthcare Policy and Research, suggests that policymakers and researchers look beyond restaurant type for reasons for and solutions to the obesity epidemic. He will study the effects of food pricing on food choices.

“Pricing is critical to low-income families, and over the past 30 years the costs of less healthy options have dropped compared to healthier fare,” said Leigh. “One potential way to encourage healthier eating could be to charge taxes that increase based on the number of calories in food. Proceeds from the taxes could then be used to subsidize and reduce the costs of healthy foods.”

Co-author DaeHwan Kim, who earned his doctorate in economics at UC Davis, is currently with the Korea Insurance Research Institutes in Seoul.

Kim and Leigh’s study — “Are Meals at Full-Service and Fast-Food Restaurants ‘Normal’ or ‘Inferior’?” — will be published in the December print issue of the journal. A copy can be requested by emailing kruehle@liebertpub.com.

The research was funded in part by the National Institute of Occupational Safety and Health.

About the UC Davis Center for Healthcare Policy and Research:
The Center for Healthcare Policy Research conducts research on health-care access, delivery, costs, outcomes and policy to improve the practice of medicine, especially primary care. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and epidemiology to psychiatry and pediatrics. For more information, visit the center’s website.

Mathematical models can be used to characterize, quantify these effects.

Food supply and environmental conditions affect the growth rates of organisms, which in turn influence future survival and reproduction. A new study by researchers at the University of California, Santa Cruz, and the University of Glasgow shows how mathematical models can be used to characterize and quantify these effects.

“Over the last fifteen years, we have recognized that events early in the life of organisms, including people, can have great consequences for health in later life,” said Marc Mangel, distinguished professor of applied mathematics and statistics in the Baskin School of Engineering at UCSC and senior author of the study, published in the journal American Naturalist.

The paper describes complex patterns of feeding, growth rates, and reproductive success in fish. First author Who-Seung Lee worked on the study as an associate specialist at UC Santa Cruz and a graduate student at the University of Glasgow. He is currently a postdoctoral researcher at the University of Quebec in Montreal.

The researchers investigated the optimal rates of growth under different environmental conditions for fish and other “cold-blooded” animals (known as ectotherms). In these animals, growth is sensitive to ambient temperature even when food is not limiting. Compensatory growth can make up for a period of slow growth early in life, resulting in normal adult size, but the costs of an accelerated growth rate can reduce fitness. Costs may include increased exposure to predators due to more active foraging behavior, as well as increased accumulation of biomolecular damage during periods of higher metabolic rates.

“One expected consequence of climate change is that fish will experience growth conditions quite different from the ones in which they evolved. Our work suggests that even if it appears that a fish has ‘caught up’ when a period of poor growth is followed by one of good growth, there may be unforeseen consequences for its survival and reproduction, and our work provides a framework for assessing these consequences,” said Mangel, who directs the Center for Stock Assessment Research (CSTAR), a collaboration between UCSC and NOAA Fisheries Service labs.

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UCLA epidemiologist has worked around the world, focusing on Congo the past decade.

Anne Rimoin, UCLA

In the Democratic Republic of the Congo (DRC), they call her Mama Etete — The Woman Who Never Gives Up. UCLA assistant professor of epidemiology Anne Rimoin is a virus hunter and an American archetype: the brave and resourceful scientist/adventurer. She’s worked in India, Nepal, Egypt, Brazil, Croatia, Ethiopia, Eritrea and, since 2002, Congo. Rimoin talked to Jack Feuer of UCLA Magazine about her work and a life that’s anything but ordinary.

Why Africa?

I was always fascinated with Africa. My undergraduate degree was in African history at Middlebury College in Vermont. Before I was born, my dad [David Rimoin, professor of pediatrics, medicine and human genetics at UCLA and director of the Medical Genetics Institute at Cedars-Sinai] spent time in Africa studying pygmies, and my mom went with him. I grew up with maps of Africa in the house and things from their trips and so there was a romantic association with it. I didn’t find Africa through epidemiology; I found epidemiology through Africa.

And then you went into the Peace Corps?

After I graduated from Middlebury. I was put by chance into a public health program in Benin in West Africa. I was seconded to UNICEF, and they gave me a motorcycle and taught me how to do disease surveillance. And I’ve been doing the same thing ever since.

How did you end up in Congo?

When I graduated from Johns Hopkins (where she earned her Ph.D.), I was offered a job at the National Institutes of Health in a program called the Global Network for Women and Children’s Health Research. When they offered me the job, they said, ‘We have to warn you that we’re going to need you to set up clinical sites in some really hard places, and one of them is Congo.’ Of course, they expected me to run out the door screaming. (The Second Congo War, which began in 1998 and officially ended in 2003, claimed more than 5 million lives. In some parts of the country, fighting continues to this day.) But I was like, ‘OK, I’m in, how do I start?’ Congo was a place I had been dreaming about my whole life. It’s the best and the worst of Africa, all rolled up into one.

And when you’re there, you are the embodiment of the phrase, “You’re not from around here.” So how do you get things done?

When I started working in DRC (Democratic Republic of the Congo), I already understood a lot about the culture and political history, and I spoke French [widely spoken in the country], and it was very easy for me to learn Lingala, the most commonly spoken language. So I could communicate with people and work with them. And I’ve been very concerned about capacity building in DRC and making sure the Congolese are trained, getting people into doctoral programs, bringing equipment and infrastructure to DRC.

At the end of the day, the goal of what we do is to empower them to take control of their own health agenda. I think they realize I mean what I say, and I don’t promise what I can’t deliver — and I always put the Congolese first.

How often do you go?

In general, three or four times a year for visits that are anywhere from two to six weeks long.

What do you do on a typical trip?

If it’s a short trip, I spend a lot of time in Kinshasa [the capital and largest city] where I have a lab and an office, supervising activities, working up new studies, analyzing data, making sure the administration is happening appropriately and negotiating agreements with other NGOs or Congolese entities and ministries. But often, we’ll spend time in our field site, which is literally right in the middle of Congo. We have a clinical research center with trucks and motorcycles, satellite phones, etc. The only way you can get there is by chartering a plane. No other way in or out.

Is it true that villagers participating in one of your studies thought you were stealing their blood for white Europeans to stay young?

There was one study in which we took blood from every human being over the age of 1 — 4,000 people in 15 villages. And they legitimately wondered what we were doing with their blood. These were very remote villages. It’s easy for rumors to get started and that was one of them. I said, “I’ve aged at least 15 years doing this study so if that were the case, I would be feeling a lot better than I do right now.”

And what do you typically do out in the field?

I’ll go out with my staff and do disease surveillance and case investigations and collect samples. We’re also doing a lot of work now looking at cross-species transmission of disease, from animals to people, so we are doing a lot of sampling of bush meat — monkeys, squirrels, rodents, bats, all the different animals that are their main sources of food.

What was your most satisfying moment working in Congo?

There are so many of them. I think what I am most proud of in general is getting my former lab manager in Congo, Neville Kisalu, into the doctoral program at the Department of Microbiology here at UCLA. He’s in his fourth year and he’s doing very well. He was able to bring his five children and his wife here.

Most unsatisfying moment?

Having to chase after funding all the time. People look at the work that I do — looking for new viruses, crossing species from animals to humans, surveillance — and they think of it as needle-in-a-haystack work. It’s very easy to get funding to analyze samples. But not to actually collect the samples. They don’t magically appear in a place like DRC where there are no roads, no communication, and no infrastructure. I’ve been looking for these diseases in the places where it’s most difficult to look for them — places where you have to spend days walking, or riding motorcycles, or taking canoes.

If most people are going to traditional healers and informal health providers, then those are the people you need to focus on, but there is no formal structure to reach them. You have to work in the communities, figure out what their value systems are, how to motivate them to report things, so that to me are the most challenging and interesting things. Coming up with innovative ways to do disease surveillance is important work. It’s kind of the basis for epidemiology.

Memoir tells how early years shaped academic work.

S. Leonard Syme

S. Leonard Syme, professor emeritus of epidemiology and community health at the UC Berkeley School of Public Health, has recently published a memoir. Titled “Memoir of a Useless Boy,” the book describes how his difficult early years shaped an interest in social forces that eventually led to pioneering work in developing the new field of social epidemiology. He also tells of the way in which his commitment to this radical way of thinking about health helped him to train a whole new generation of young scholars to further develop these ideas.

Syme was born and raised in Manitoba, Canada, in a stifling and discouraging environment with no role models or encouragement from his family. He tells the story of a skinny 12-year-old boy whose father challenged him to squish the caps of soda pop bottles. He regularly failed. He clearly remembers feeling bruised every time his father walked away muttering about his “useless boy.” Looking back, he realized that he devoted his life to proving his father wrong. The lessons he learned in successfully dealing with his father’s rejections and disapprovals helped him to better mentor and encourage his students to achieve their potential. In spite of these early hardships, his memoir is an optimistic one: It describes his humorous and revealing journey from squeezing bottle caps to changing the way we as a society understand health and well-being. The message of the book is that the obstacles we face in our lives can actually be a motivating force for good.

It was Syme’s daughter who urged him to write the book. After some initial hesitation, he decided to take on the project for two reasons. “One reason,” he writes, “is that, as a public health researcher, I have for years been interested in understanding how children from disadvantaged backgrounds were able to survive to lead healthy and fulfilling lives. In my research field, this is one of the most compelling issues we must think about. What allows some to escape and thrive? I thought that my story might be useful in shedding some light on this important question.

“The second reason is more personal. I am curious to know how a useless kid became useful, and I hope that my story may be of interest to my grandchildren as they attempt to understand their family origins.”

Syme joined the Berkeley faculty in 1968. His major research interest has been the study of such psychosocial risk factors as job stress, social support and poverty. In conducting this research, he has studied San Francisco bus drivers; Japanese living in Japan, Hawaii and California; British civil servants; and people living in Alameda County. He has written two books and 170 published papers. He has been a visiting professor at universities in England and Japan. Syme was elected to the Institute of Medicine of the National Academy of Sciences and has received several honors related to his teaching and research, among them the Lilienfeld Award for Excellence in Teaching; the J.D. Bruce Award from the American College of Physicians for Distinguished Contributions in Preventive Medicine; the University of California Distinguished Emeritus Professor Award; and the most prestigious honor given in public health, the Wade Hampton Frost Lectureship Award. Along with Linda Neuhauser, Syme is principal investigator of Health Research for Action (HRA) at the UC Berkeley School of Public Health. HRA is focused on research and interventions that empower people to take more control over their health.

Syme’s book can be purchased at Amazon, Barnes & Noble, or at his website. As he notes in his memoir, the local library in his poor community was a powerful inspiration and because of this, a major portion of any money realized from the sale of his book will be donated to libraries in similarly underprivileged communities.

For every tenfold increase in prenatal PBDE levels, there was a drop of 115 grams in baby’s birthweight.

Exposure during pregnancy to flame retardant chemicals commonly found in the home is linked to lower birthweight babies, according to a new study led by researchers at the University of California, Berkeley’s School of Public Health.

In the study, to appear today (Aug. 30) in the peer-reviewed publication American Journal of Epidemiology, researchers found that every tenfold increase in levels of PBDEs, or polybrominated diphenyl ethers, in a mother’s blood during pregnancy corresponded to a 115 gram (4.1 ounce) drop in her baby’s birthweight.

“This is the first, large population-based study to link PBDEs with babies’ birth outcomes,” said study lead author Kim Harley, adjunct assistant professor of maternal and child health and associate director of the Center for Environmental Research and Children’s Health (CERCH) at UC Berkeley. “A 115-gram decrease in weight is a fairly significant finding. By way of comparison, consider that smoking during pregnancy is associated with about a 150- to 250-gram decrease in birthweight.”

The researchers are careful to point out that, while the study found a decrease in birthweight overall, very few babies in the study were born weighing less than 2,500 grams (5.5 pounds), the clinical definition of low birthweight. Low birthweight babies are more likely to experience social and cognitive delays in development.

“This was a very healthy population, and we didn’t see many low birthweight babies. What we saw was a shift toward lighter babies among women with higher PBDE exposure rather than a dramatic increase in the number of low birthweight babies,” said Harley. However, she points out that a 115-gram shift could make a big difference for babies already at risk of being low birthweight, including low-income populations with poor access to prenatal care.

This is the latest finding from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) longitudinal study led by Brenda Eskenazi, UC Berkeley professor of epidemiology and of maternal and child health at the School of Public Health. Previous findings from the CHAMACOS study, which examines environmental exposures and reproductive health in an agricultural community, have associated PBDE exposure to reduced fertility and altered thyroid function in women.

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Advent of low-cost, generic drugs has shifted equation in managing lower-risk patients with high cholesterol levels.

Mark Pletcher, UC San Francisco

The advent of low-cost, generic forms of cholesterol-lowering drugs has shifted the equation in managing lower-risk patients with elevated cholesterol levels, according to a multicenter study led by researchers at UC San Francisco.

With powerful treatment now costing only pennies a day, the new analysis found that wider use of these drugs in as many as one in four adults could avert up to 27,000 deaths from heart disease each year, while actually cutting U.S. health care costs.

The study specifically addressed the question of whether generic statins — HMG CoA Reductase Inhibitors — could be a cost-effective way to prevent cardiac events among adults with modestly elevated cholesterol and moderate risk for heart disease.

As of this November, there will be only one remaining statin on the market that does not have a generic version. That effectively reduces the cost of the treatment from more than $100 per month to $4 per month or lower, the researchers said, which changes the way we assess the cost-effectiveness of the medication.

“As new evidence comes out that more and more people benefit from statins, we’ve shown in advance that those people can be treated cost-effectively,” said Lawrence D. Lazar, M.D., an interventional cardiology fellow at UCLA and lead author on the paper.

“The time to prevent coronary artery disease is not when you’re older and already burdened by disease,” he said. “The time to start preventing it is when you’re younger with better diet, exercise, lifestyle and, for a very large population, with statin therapy.”

Now that prices are lower, it makes sense to use statins more aggressively as a preventive medication for a lower-risk population, he said.

Statins, which block a chemical in the liver necessary to make cholesterol, can impede the buildup of artery-clogging plaques (atherosclerosis) in the coronary arteries. They have been shown to decrease the risk of heart attacks and other cardiovascular events by reducing cholesterol levels, particularly “bad cholesterol,” or low-density lipoprotein (LDL). These drugs have been available to the public since 1987, but the relatively high cost of brand-name statins has prevented greater use among some patients with high cholesterol, the authors said.

If aggressive statin use were implemented widely in the United States, the long-term impact to the health care system could be substantial, they said, reducing annual medical spending by as much as $430 million, while simultaneously improving patient health.

“Treating anyone with any heart disease risk factors and an LDL cholesterol greater than 130 could actually save money,” said Mark Pletcher, M.D., M.P.H., an associate professor of epidemiology and biostatistics at UCSF and corresponding author on the study.

While he said statins’ benefits to lower-risk people are still not fully defined, since that question has not been addressed by the gold-standard randomized drug trials, the known effects of the medication indicate that this could be very cost-effective, with few signs of long-term risk.

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