TAG: "Public health"

Harm-reduction program optimizes HIV/AIDS prevention


Stonewall Project helps decrease stimulant use, reduce sexual risk behavior, study shows.

Adam Carrico, UC San Francisco

New research from UC San Francisco and the San Francisco AIDS Foundation has found that clients participating in a harm-reduction substance use treatment program, the Stonewall Project, decrease their use of stimulants, such as methamphetamine, and reduce their sexual risk behavior.

Harm reduction is a public health philosophy and strategy designed to reduce the harmful consequences of various, sometimes illegal, human behaviors such as the use of alcohol and other drugs regardless of whether a person is willing or able to cease that behavior.

“We found that even when participants were using methamphetamine, they reported engaging in HIV risk-reduction strategies such as having fewer anal sex partners after enrolling in Stonewall,” said the study’s lead investigator, Adam W. Carrico, Ph.D., UCSF assistant professor of nursing.

The research findings appear online today (April 18) in the Journal of Urban Health. The Stonewall Project, a San Francisco AIDS Foundation program, serves substance-using gay and bisexual men as well as other men who have sex with men.  Stonewall implements evidence-based, cognitive-behavioral substance use treatment from a harm-reduction perspective. At Stonewall, clients have the option of abstinence, but also may use harm-reduction strategies such as transitioning to less potent modes of administration (e.g., injecting to snorting) or reducing sexual risk taking while they are under the influence.

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Community-based HIV prevention can boost testing


Prevention efforts also can help reduce new infections, study shows.

Thomas Coates, UCLA

Communities in Africa and Thailand that worked together on HIV-prevention efforts saw not only a rise in HIV screening but a drop in new infections, according to a new study in the peer-reviewed journal The Lancet Global Health.

The U.S. National Institute of Mental Health’s Project Accept — a trial conducted by the HIV Prevention Trials Network to test a combination of social, behavioral and structural HIV-prevention interventions — demonstrated that a series of community efforts boosted the number of people tested for HIV and resulted in a 14 percent reduction in new HIV infections, compared with control communities.

Much of the research was conducted in sub-Saharan Africa, which has particularly high rates of HIV. The researchers were interested not just in how the clinical trial participants’ behavior changed, but also in how these efforts affected the community as a whole, said Thomas Coates, Project Accept’s overall principal investigator and director of UCLA’s Center for World Health.

“The study clearly demonstrates that high rates of testing can be achieved by going into communities and that this strategy can result in increased HIV detection, which makes referral to care possible,” said Coates, who also is an associate director of the UCLA AIDS Institute. “This has major public health benefit implications — not only suggesting how to link infected individuals to care, but also encouraging testing in entire communities and therefore also reducing further HIV transmission.”

These findings were previously presented at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta.

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UCLA hospitals serve up antibiotic-free beef, chicken


New menu additions further medical center’s focus on healthier eating.

UCLA Health System's Patricia Oliver and Chef Gabriel Gomez with antibiotic-free menu items

Patients, staff and visitors to the Ronald Reagan UCLA Medical Center and UCLA Medical Center, Santa Monica can now enjoy a healthier version of the traditional burger-and-fries lunch. The hospitals’ menus now include burgers made from antibiotic-free, grass-fed beef and herb roasted potatoes, as well as antibiotic-free chicken breasts.

With the changes, the hospitals are helping lead the trend toward serving healthier, antibiotic-free meats.

This move is in line with other initiatives instituted recently by the health system to promote a healthier community, including banning fried foods, offering “meatless Mondays,” and using biodegradable utensils and plates.

The menu enhancements were spurred in part by concern about bacteria’s growing resistance to antibiotics. According to Dr. Daniel Uslan, an assistant clinical professor of medicine in the division of infectious diseases at the David Geffen School of Medicine at UCLA, an overuse of antibiotics in cows, chickens and other food-producing animals has helped make bacteria resistant to commonly used antibiotics, which in turn has led to more antibiotic-resistant infections in humans.

“With the effectiveness of key antibiotics dwindling, bacterial resistance presents a major public health challenge,” said Uslan, who also is director of the antimicrobial stewardship program at the UCLA Health System. “It’s critical that we reduce unnecessary antibiotic use in agriculture and support appropriate antibiotic use by clinicians and patients.”

According to the Food and Drug Administration, 80 percent of all antibiotics sold in the U.S. are used for food-producing animals. There is a growing public health concern that the antibiotics are being used mostly to promote faster growth in otherwise healthy animals and to compensate for unsanitary and overcrowded living conditions.

Meanwhile, the health care community is increasingly instituting policies to help combat antibiotic resistance in patient care and to minimize exposure to unnecessary antibiotics as part of broader environmental sustainability plans, including in food service.

“We are excited about this new initiative,” said Dr. David Feinberg, president of the UCLA Health System and CEO of the UCLA Hospital System. “Serving antibiotic-free beef and chicken is another way for us to do our part and support our vision of a healthier community.”

The UCLA Health System has been recognized nationally for its efforts to promote wellness and sustainability, receiving awards in 2013 from Practice Greenhealth and Health Care Without Harm for offering more vegetarian menu options, increasing its use of composting, reducing food waste, launching energy- and water-conservation programs, and other initiatives; and it participates in national campaigns including the Healthier Hospitals Initiative. The health system’s adoption of antibiotic-free beef and chicken complements University of California system-wide sustainability policies.

“We serve more than 3.4 million meals annually between our two hospitals and are always looking for ways to enhance and improve our services,” said Patricia Oliver, UCLA Health System’s director of nutrition services. Oliver also is the Los Angeles area coordinator for the Healthy Food in Health Care program, through which more than 30 local hospitals and 128 hospitals state-wide leverage their combined health expertise and purchasing power to promote healthier food systems.

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Most injuries and illnesses in agriculture are not counted


Study shows the problem is about three times bigger than previously suspected.

J. Paul Leigh, UC Davis

Federal agencies responsible for tracking workplace hazards fail to report 77 percent of the injuries and illnesses of U.S. agricultural workers and farmers, new research from UC Davis has found. The lack of complete data greatly reduces the chances that safety and health risks for the nation’s food suppliers will be corrected.

Published in the April issue of the Annals of Epidemiology and led by J. Paul Leigh, professor of public health sciences and researcher with the UC Davis Center for Healthcare Policy and Research, the study confirms the long-held belief that government reports dramatically and routinely undercount agricultural injuries and illnesses, ranging from chemical exposures to musculoskeletal injuries.

“Whatever anyone might have assumed about gaps in government statistics for agriculture, our study shows that the problem is actually about three times bigger than previously suspected,” said Leigh.

According to Leigh, the primary reasons for the discrepancy are the government’s focus on mid- to large-sized farming enterprises, which represent less than 50 percent of employment in the agricultural industry, along with the part-time nature of farm work and undisclosed information about injuries.

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Looking to the future


A conversation between deans of the UC Berkeley School of Public Health.

Stephen Shortell (left) and Stefano Bertozzi

Dr. Stefano Bertozzi began his service as dean of at the UC Berkeley School of Public Health in September 2013, succeeding Dean emeritus Stephen Shortell. Previously Bertozzi was at the Bill & Melinda Gates Foundation, where he directed the HIV program and led a team that managed the foundation’s portfolio of grants in HIV vaccine development, biomedical prevention research, diagnostics, and strategies for introduction and scaling-up of interventions. He serves on the scientific advisory boards for the President’s Emergency Plan for AIDS Relief, the National Institute of Health’s Office of AIDS Research, and the World Health Organization’s HIV Program.

Prior to joining the Gates Foundation, Bertozzi worked at the Mexican National Institute of Public Health as director of its Center for Evaluation Research and Surveys. He has also held positions with UNAIDS and the World Bank and was the last person to lead the WHO Global Program on AIDS before it metamorphed into UNAIDS. He holds a bachelor’s degree in biology and a PhD in health policy and management from the Massachusetts Institute of Technology. He earned his medical degree at UC San Diego, and trained in internal medicine at UC San Francisco.

Read the conversation between the deans.

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Study to examine social adversity, early puberty, risk-taking by teens


Researchers will work with a group of more than 600 youth and their parents in Salinas.

How does social adversity affect the timing of puberty? How do social adversity and early puberty influence risk-taking behavior in teens?

Julianna Deardorff, assistant professor in the UC Berkeley School of Public Health’s Maternal and Child Health program, recently received a $2.5 million grant from the National Institutes of Health to find out.

Deardorff and her team (which will include an M.P.H. student and a postdoctoral fellow) will work with a group of more than 600 youth and their parents in Salinas. The research will include analyzing pubertal hormones, stress hormones and cultural factors that may exacerbate or protect against the negative effects of stressful circumstances.

“My goal has always been to understand how stress gets under the skin and can lead potentially to earlier and faster puberty and to sexual risk-taking behaviors in Latino youth who are growing up in adverse circumstances,” says Deardorff, who will start working with this migrant farming community in April.

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Study: E-cigarettes a gateway to nicotine addiction for U.S. teens


First national analysis strongly associates e-cigarettes with smoking for many adolescents.

Lauren Dutra, UC San Francisco

E-cigarettes, promoted as a way to quit regular cigarettes, may actually be a new route to conventional smoking and nicotine addiction for teenagers, according to a new UC San Francisco study.

In the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said.

The study was published online today (March 6) in JAMA Pediatrics.

E-cigarettes are battery-powered devices that look like cigarettes and deliver an aerosol of nicotine and other chemicals. Promoted as safer alternatives to cigarettes and smoking cessation aids, the devices are rapidly gaining popularity among adults and youth in the U.S. and around the world. Unregulated by the U.S. Food and Drug Administration, e-cigarettes have been widely promoted by their manufacturers as a way for people to quit smoking conventional cigarettes. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

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Indian company licenses Berkeley Lab invention for arsenic-free water


Technology could help save millions of lives in India and Bangladesh.

When Lawrence Berkeley National Laboratory (Berkeley Lab) scientist Ashok Gadgil set out to solve an insidious public health problem afflicting South Asia, arsenic contamination of groundwater, he knew the hard part would not just be inventing the technology but also ensuring a way to sustain its long-term use on a large scale.

“A lot of technologies to remove arsenic on the community- and household- scale have been donated. But if you go to these villages it’s like a technology graveyard,” said Gadgil, who heads the Lab’s Environmental Energy Technologies Division and is also a professor of civil and environmental engineering at UC Berkeley. “One study found that more than 90 percent failed within six months, and then were abandoned to rust in the field.”

So Gadgil and his lab came up with ECAR, Electrochemical Arsenic Remediation, which binds arsenic using iron dissolved in water. Their innovation was twofold. They created a technology that is exceptionally effective, inexpensive and easy to maintain. And just as importantly, from the start they conceptualized a business model for implementing the technology in a way that creates incentives for its longevity.  Now Indian company Luminous Water Technologies has licensed ECAR and plans to bring it to arsenic-affected villages throughout India and Bangladesh.

“Technology alone is not enough. It has to fit within a sustainable system based on partnerships with local entities,” said Susan Amrose, who has worked on ECAR since 2008 as the lead project scientist in Gadgil’s lab. “Other technologies have failed because there is no system of incentives or money or knowledge to keep them running. The key difference with ECAR is that it was designed to fit within a local system aimed at achieving successful social placement — so a flow of funds pays for ongoing operation, maintenance and social marketing, without turning it into privatized water.”

Arsenic-contaminated groundwater can be found all over the world, including in the United States, but the problem is particularly acute in South Asia, where tens of millions of people in India and Bangladesh get their drinking water from tube wells highly contaminated with arsenic, almost all of it occurring naturally. Arsenic poisoning, or arsenicosis, can cause painful lesions, diabetes, cancer and blood vessel diseases that often lead to gangrene, amputation and premature death.

Amrose has seen the devastation first-hand in her travels to affected villages. “Over time you’ll see people get worse and worse,” she said. “There was one man who in 2009 had lost his right pinkie finger by amputation due to arsenic. In 2011 he lost his right hand, and in 2013 lost his entire arm. Earlier this year he committed suicide. In some areas, you’ll see a lot of people with black spots on their palms, an external sign of arsenicosis. And a lot of things you won’t see. People will be linked with arsenic and ostracized, or young people unable to marry because their family lives in an area that has arsenic.”

One of the aims of Gadgil’s lab is to reduce the time lag between invention and commercialization from 18 years, the current norm, to 10 years. “We’re actually quite on target with ECAR,” Amrose said.

They started work on the concept in 2005. They’re now preparing a 10,000 liter-per-day trial over 15 months. “As we get to larger-scale field trials we’re intent on conducting them with our field partners,” Amrose said. “By working on a common goal, we get to effectively transfer the technology know-how, while they guide us towards what needs to be done to effectively scale up.”

Luminous Water Technologies was founded by an Indian serial entrepreneur, Rakesh Malhotra, with the aim of providing clean drinking water and commercializing new technologies in the drinking water market. Luminous’ current focus is on reverse osmosis systems, and they were looking to diversify in other water technologies when they identified ECAR for licensing.

“Arsenic poisoning is an endemic problem in India and Bangladesh and is seen as a silent killer,” said Luminous Managing Director RS Rajan. “It is Dr. Gadgil’s conviction and perseverance which has been a key motivating factor in Luminous opting for this technology. Luminous Water, with its reach across India and longstanding business record, will work towards commercializing this technology along with Berkeley Lab and create a sustainable module to provide solutions to impacted communities.”

ECAR works by using electricity to quickly dissolve iron in water. This forms a type of rust that readily binds to arsenic; the rust can then be separated from the water through filtration or settling. For the remaining waste Gadgil’s lab is now working on partnerships with cement and concrete companies to do research on embedding the sludge in concrete.

“We find in early tests that it’s very well stabilized, and the arsenic is not getting back into the environment,” Amrose said. “We expect and hope this form of sludge management will be viable and pass environmental approvals for market scale-up. Until then Luminous will dispose of the waste according to prevailing pollution control guidelines.”

ECAR is envisaged to operate as a village-owned micro utility in the villages where it is installed. Luminous would operate and maintain the utility and sell the water, with concurrent support for social marketing and education.

Last year ECAR was awarded a UC Proof of Concept Program Commercialization Gap Grant to see if it could be used to remediate arsenic-contaminated groundwater in California. Rural communities in California are often too poor to afford commonly available arsenic remediation techniques, and most techniques are only cost effective on larger scales, such as the city water supply system. As a result, many California residents drink water with dangerous levels of arsenic every day. The burden falls disproportionately on minorities and residents of lower socioeconomic status, particularly migrant farming communities and Native American communities.

ECAR has yet to be proven in California groundwater, which is known to contain a different composition of interfering ions from that in South Asia. This grant funds a proof-of-concept demonstration of ECAR in California to reduce entry risk for potential licensees.

The ECAR effort was initiated at Berkeley Lab with internal seed funds (from Laboratory Directed Research and Development funding) in 2005. It is being further developed in part with funding from the Development Impact Lab at UC Berkeley. ECAR technology is available for licensing in the United States. For more on Gadgil’s arsenic removal research visit arsenic.lbl.gov.

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Acetaminophen use during pregnancy linked to ADHD in children


UCLA study raises concerns about use of acetaminophen during pregnancy.

Beate Ritz, UCLA

Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. When used appropriately, it is considered mostly harmless. Over recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain.

Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficit/hyperactivity disorder and hyperkinetic disorder. The data raises the question of whether the drug should be considered safe for use by pregnant women.

ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

“The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute,” said Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. “We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well.”

“That gave us the motivation to search for environmental causes that are avoidable,” said the University of Aarhus’ Dr. Jørn Olsen, another senior author and former chair of the UCLA Fielding School’s epidemiology department. “Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at.”

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Using formula in hospitals deters breastfeeding


Mothers who planned to breastfeed did so far less when their babies received formula.

Caroline Chantry, UC Davis

When mothers feed their newborns formula in the hospital, they are less likely to fully breastfeed their babies in the second month of life and more likely to quit breastfeeding early, even if they had hoped to breastfeed longer, UC Davis researchers have found.

“We are a step closer to showing that giving formula in the hospital can cause problems by reducing how much women breastfeed later,” says Caroline Chantry, lead author and professor of clinical pediatrics at UC Davis Medical Center. “Despite being highly motivated to breastfeed their babies, in-hospital formula use limits this important practice. Given the benefits of breastfeeding for both mother and baby, this is a public health issue.”

“In-Hospital Formula Use Shortens Breastfeeding Duration” was published online in The Journal of Pediatrics today (Feb. 14). The study only included women who intended to exclusively breastfeed their babies for at least a week, meaning they did not plan to use formula in the hospital.

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Study connects smoke-free laws, dentists’ advice to quit


Smoke-free laws can help influence behavior and attitudes.

Cigarette buttsSmoke-free laws may help encourage dentists to recommend that their patients kick the smoking habit, according to new research co-authored by UC Merced professsor Mariaelena Gonzalez.

The paper, published in the American Journal of Public Health, suggests the societal change manifested by smoke-free laws can contribute to an atmosphere in which dentists pay more attention to patients’ smoking habits.

“Smoke-free laws can have strong effects – and not just on stopping individual-level behavior,” said Gonzalez, whose research focuses on tobacco control. “These laws can influence other behavior and attitudes, as our study shows with dentists. They can have a huge effect on people’s preferences, such as a preference for clean indoor air. Even smokers like clean indoor air.”

Gonzalez co-authored the study “Association of Strong Smoke-Free Laws with Dentists’ Advice to Quit Smoking, 2006-2007,” with Stanton A. Glantz, a professor of medicine at UC San Francisco, and Ashley Sanders-Jackson, a postdoctoral fellow at Stanford University. All three have been associated with the UCSF-based Center for Tobacco Control Research and Education, where Glantz is the director.

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In denial: Some who smoke say they’re not ‘smokers’


Why some “non-identifying smokers” face risks while denying the behavior.

While smoking among California adults has dramatically declined in recent decades, researchers at the UC San Diego School of Medicine report there is a surprisingly large number of people who say they use cigarettes, but don’t consider themselves to be “smokers.”

Writing in the Feb. 5 online issue of Tobacco Control, Wael K. Al-Delaimy, M.D., Ph.D., professor and chief of the Division of Global Health in the UC San Diego Department of Family and Preventive Medicine, and colleagues estimate that in 2011 almost 396,000 Californians (12.3 percent of the state’s population of smokers) smoked on a measurable basis, but rejected the characterization of “smoker.”

Almost 22 percent of these smokers consumed tobacco on a daily basis.

Al-Delaimy said the phenomenon has both individual and social ramifications. For individuals, the behavior puts them at many of the same health risks as identified smokers. “There is no safe level of smoking,” he said.

More broadly, non-identification of “non-identifying smokers” or NIS may be negatively impacting efforts to reduce tobacco consumption by overlooking a significant segment of the affected population, the researchers said. This is especially true at the clinical setting where physicians might ask patients if they smoke and patient fail to identify themselves as smokers.

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