Summer Restoration in a Bolivian Winter

                                 El Hospital Pietro Gamba in Anzaldo, Bolivia Credit: Duke

My biggest accomplishment this summer was being able to call the mountains of Bolivia home. Far away from the lecture halls of Duke, I encountered a profound, alternative education that included everything from learning traditional dances to working in a rural hospital laboratory to raising pigs.

Of course, living in Bolivia for two months had its challenges, like a diet in which potatoes were considered vegetables, repeated food poisoning from chicha, the local alcoholic drink consisting of fermented corn, lack of a consistent water source, many near-car accidents, and most of all a deep-seated machismo, but I feel that these were all almost inextricable aspects of a culture that left such a positive impression upon me.

Of course, the inextricability of such factors posed a problem for me as an intern at El Hospital Pietro Gamba encouraging sustainable development to promote public health. Although 80% of children had head lice, a vast majority contracted repeated gastrointestinal bacterial infections, and countless had scabies, the community seemed to get along contentedly. Regardless, with support from the Foundation for Sustainable Development and DukeEngage, my sponsor organizations, I leveraged the relatively new running water system, implemented only 25 years ago, to set in motion a comprehensive lice campaign, to obtain government funding of soap in public restrooms for at least two years, and to create preventative medicine informational materials.

The majority of my education, though, occurred outside the scope of my project. Most importantly, I’ve learned to openly embrace different forms of learning, like relaxation or soccer, that energize me to wholeheartedly pursue my rigorous biophysics career, which I am so fortunate to have at one of the best universities in the world.

The idea of the Aymara New Year illustrates my mentality poignantly: on the first day of the Aymara New Year, traditional Bolivians wish for health, prosperity, and happiness, just as we do in the United States. However, they have a deeper connection with Pachamama, or Mother Nature: on New Year’s Day, they wake up early in the morning to stand on the ground barefoot, awaiting the first rays of the sun. They believe that watching these rays rise above the horizon and light the earth will bring them energy for the entire year. In this, the Aymara New Year represents both personal aspiration and attenuation with the environment.

Similarly, I now aim to maintain a balance between self and surroundings: I hope to be more attuned to the world around me rather than single-mindedly submersing myself in quantum physics, as I believe that varied experiences will infuse me with energy in whatever I pursue. Now, back at Duke for the start of my junior year, I’m excited to begin blogging again and to continue my adventures and education here on campus.

Source: Duke University

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Johns Hopkins student's neuroscience major inspires her first novel

First-time author Marlene Kanmogne IMAGE: MARSHALL CLARKE

One night, Marlene Kanmogne had a dream. She dreamed that she could change reality and shift what was happening around her just by thinking about it.

When Kanmogne awoke, she was overcome by a feeling of power and control, emotion and energy that was so vivid and captivating that she didn't want it to end.

So the junior neuroscience major, who grew up in Cameroon and Oklahoma, decided to write it down. Over the next four years, she transferred the ongoing dream of the girl who could make things happen with her mind into a series of spiral notebooks.

"When I write, it's like there's a film in my head that I transcribe to paper as quickly as I can so that I don't lose the film," Kanmogne says.

It wasn't easy. When school was in session and there was class or volunteering or work with the African Students Association, she was far too busy to write as much as she wanted. But she persevered, completed her story, and this summer even got it published. "I'm a planner—I like to set goals and complete them," she says. "Not finishing was not an option."

The result is The Mind Wanderer (Solstice Press, 2014), a 305-page young adult novel about a 15-year-old girl named Melissa who realizes she has a powerful mind-transforming ability that's much bigger than she is and must adapt to it and accept its consequences.

Kanmogne, 20, hopes to become a physician. She always viewed the book as a personal project. Even after its publication, she has some difficulty accepting notice for being a novelist. Instead, she'd rather discuss the intricacies of the brain. "I do like writing—it's a great hobby of mine. But I think what really drives me is the mind part, the brain part. It all starts and ends with the brain," she says.

Yet, with a year and a half of college, medical school, and residency still ahead, she's not willing to leave her writing hobby behind. The Mind Wanderer, she says, is only book one of three.

"I still have dreams that further the story, and I know what Melissa will do," Kanmogne says. "I see the path of her life, and I want to follow it. And that just keeps picking at me to the point where I have to put it down on paper."

Source: JHU

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

Students and faculty from the UCLA School of Nursing visit Casa de Maternidad, where women with high-risk pregnancies can live to receive special care. Credit: UCLA

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

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

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

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

Ties between Westwood and Havana

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

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

How do they do it?

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

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

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

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

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

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

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

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

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

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

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

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

Leaving hehind impressions — and hand sanitizers

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

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

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

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

Source: UCLA

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Small change in blood acidity could prove detrimental to kidney disease patients

A University of Manchester scientist has discovered that very small changes in the level of acidity in blood may have a detrimental impact on the health of patients with kidney disease.

Chronic Kidney Disease (CKD) is common in the UK.  It is estimated that about one in five men and one in four women between the ages of 65 and 74 has some degree of CKD. The leading single cause of CKD is diabetes which is increasing so it’s expected that more patients will be diagnosed with CKD in the future.

Dr Donald Ward from the Faculty of Life Sciences has been studying the impact of kidney disease on the body. He has found that very small changes in the pH (acidity) level in the blood prevents the body from being able to accurately monitor calcium levels. This leads to too much of the hormone PTH being released which is likely to lead to a greater risk of calcium and phosphate from the bone damaging the arteries. This often proves fatal to patients with CKD. His research has been published in the Journal of the American Society of Nephrology. 

Dr Donald Ward

He says: “It was not realised before that the blood pH changes we see in patients with kidney disease can have an impact on their ability to monitor blood calcium levels. My research has demonstrated that the effect of those changes may be more significant than previously thought and thus might need to be looked at more carefully by clinicians.”

Dr Ward’s research focussed on the high level of parathyroid hormone (PTH) in patients suffering from CKD. This causes the body to release calcium and phosphate from the bones which can then damage their blood vessels. 

Dr Ward explains why this is so harmful: “The diseased kidneys prevent the body getting rid of both excess phosphate and excess acidity. So if that acidity also causes the body to release more PTH then this could compound the problem by releasing further phosphate from the bone. This vicious circle might accelerate the potentially fatal calcification of the arteries.” 

He continues: “What is so important about this research is that we have demonstrated that changes in PTH release can be prompted by very small changes in blood pH level. Before, it was assumed that only a larger change in acidity would cause problems for patients.”

The research was funded by Kidney Research UK. Elaine Davies, Director of Research Operations, from the charity says: “Donald’s work has used novel pharmacological and molecular tools in generating these new findings which increase our knowledge about the complex balance that clinicians need to consider when treating patients with CKD.”

Dr Ward is hoping to take his research to the next step, testing for therapeutic targets that could lead to better treatments for CKD.

Source: Manchester University

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Smart device delivers results for kids with asthma

Smart device

A new smart asthma inhaler with an audio-visual function has dramatically improved child and adolescent use of preventative asthma medication.

The users also experienced significant improvements to their symptoms, well-being and quality of life and needed their reliever medication less frequently.

The University of Auckland study, funded by Cure Kids and the Health Research Council, showed a significant improvement in night time awakening, coughing and wheezing.

Clinical pharmacist, Amy Chan, a doctoral student with the University of Auckland, is the lead author on the paper.  

“We know one of the key reasons for children not taking their medication is parent and patient forgetfulness.  The Smartinhaler reminder system is now clinically proven to be a real solution to the problem,” she says.

“What we’ve been able to establish for the first time with this study is that the ringtone Smartinhaler significantly improves adherence to preventative medication, which results in improved quality of life for children with asthma. It’s hugely exciting,” says Ms Chan.

Children in the study were also given a Smartinhaler tracker for their rescue or ‘blue’ inhaler to measure the amount of rescue medication they used. The device was able to objectively count date and time of rescue medication use. This provided a good indication of asthma being out of control.

When symptoms worsened participants used their rescue reliever inhaler (blue inhaler), which is also known as a rescue medication because it provides immediate relief.  Recent studies have shown that overuse of the blue inhaler is a predictor of worsening asthma and general morbidity.

The study found that use of the rescue medication was significantly reduced in the group using the Nexus6 Smartinhaler reminder device.

Cure Kids Chair of Child Health Research and Ms Chan's supervisor on the study, Professor Ed Mitchell, says he is “absolutely staggered by the size of the effect. To see the improvement in the lives of these children is astounding.”

The participants also reported taking part in more sports and family activities. Parents reported feeling less frightened by their child’s asthma.

New Zealand has the second highest rates of asthma in the world and one in four Kiwi children experiences asthma symptoms. Despite this, regular adherence to asthma medication is poor.

New Zealand digital health company Nexus6 Ltd created the new Smartinhaler device called the SmartTrack, which was used in the study. The device has 14 different ringtones, which are cycled so users don’t get reminder fatigue. The SmartTrack reminder is only triggered when a dose is missed.

The results were published this month in The Lancet Respiratory Medical Journal.  To the researchers’ knowledge, this is the largest study in the world to investigate the effects of an inhaler device with audio-visual reminder function on asthma adherence and outcomes in children and adolescents.

It is also the first to show significant benefits in asthma outcomes and quality of life. The results are expected to gain international interest.

The controlled trial recruited 220 children between the ages of six and 15 who presented to emergency departments with asthma symptoms.

The study was randomised with half of the participants receiving a SmartTrack device for use with their preventative or ‘orange’ inhaler that had the audiovisual elements turned on, and the other half receiving the same device with the audiovisual elements turned off.

Participants were followed up every two months for six months and general asthma control was checked.

Key findings from the study were:

Medication adherence rate for the patient group given the audiovisual enabled SmartTrack inhaler were 84 percent compared to 30 percent for the control group. This equals a 180% increase in medication adherence.
The use of emergency medication or the ‘blue’ inhaler was significantly reduced. The median percentage days on which a reliever was used in the intervention group was 9.5 percent compared to 17.4 percent in the control group. This equals a 45percentreduction in rescue medication use.
Symptoms, well-being and quality of life for the children was significantly improved.

Source: Auckland University

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Expect higher grass pollen, allergen exposure in coming century

A study provides the first evidence that pollen production is significantly stimulated by elevated carbon dioxide in a grass species as a result of climate change, which may have significant impact on human health. Credit: UMass Amherst

Results of a new study by scientists at the University of Massachusetts Amherst strongly suggest that there will be notable increases in grass pollen production and allergen exposure up to 202 percent in the next 100 years, leading to a significant, worldwide impact on human health due to predicted rises in carbon dioxide (CO2) and ozone (O3) due to climate change.

While CO2 stimulates reproduction and growth in plants, ozone has a negative impact on plant growth, the authors point out. In this study in Timothy grass, researchers led by environmental health scientist Christine Rogers of the UMass Amherst School of Public Health and Health Sciences (SPHHS) determined the interactive effects of CO2 and ozone at projected higher levels on pollen production and concentrations of a Timothy grass pollen protein that is a major human allergen. Findings are reported in the current issue of PLOS ONE.

Rogers and plant science colleagues at UMass Amherst, with postdoctoral researcher and first author Jennifer Albertine, write, "The implications of increasing CO2 for human health are clear. Stimulation of grass pollen production by elevated CO2 will increase airborne concentrations and increase exposure and suffering in grass pollen-allergic individuals."

Rogers notes that, "This is the first evidence that pollen production is significantly stimulated by elevated carbon dioxide in a grass species and has worldwide implications due to the ubiquitous presence of grasses in all biomes and high prevalence of grass pollen allergy. These results are similar to our other studies performed in other highly allergenic taxa such as ragweed but with more extreme outcomes and wider impacts."

For these experiments, the researchers exposed grass plants in specially designed continuously stirred tank reactor chambers that allow researchers to expose plants to different atmospheric gas concentrations. They established four experimental atmospheric treatments:

• control, current atmosphere (30 ppb O3 and 400 ppm CO2)
• elevated O3, current CO2 (80 ppb O3, 400 ppm CO2)
• current O3, elevated CO2 (30 ppb O3, 800 ppm CO2)
• elevated O3, elevated CO2 (80 ppb O3, 800ppm CO2)

At the appropriate plant development stage, Albertine and colleagues bagged flowers, captured and measured pollen amounts and extracted the allergen protein Phl p 5 from pollen samples for measurement by enzyme-linked immunosorbent assay (ELISA).

They found that elevated CO2 of 800 ppm, increased pollen production per flower by 53 percent while the different ozone levels had no effect on the amount of pollen produced. There was also a trend of increased number of plants flowering in response to elevated CO2 further increasing pollen production up to 200 percent. While elevated ozone did decrease the Phl p 5 allergen content in pollen, "the strong CO2-stimulation of pollen production suggests increased exposure to Timothy grass allergen overall," even if O3 projections are realized, the authors note.

They add that the health implications of increased ozone are "more complex" because higher levels of this greenhouse gas irritate mucous membranes and worsen the allergic airway response. Projected ozone increases "would likely elicit negative respiratory health effects independent of any health effects as a result of increased pollen by elevated CO2."

Source:  University of Massachusetts at Amherst

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Artisanal gold mining and its health risks

searchers from the UPM have characterized the health risks derived from the usage of mercury in artisanal gold mining in Colombia through probabilistic models.

Researchers from the UPM have characterized the health risks derived from the usage of mercury in artisanal gold mining in Colombia through probabilistic models.

The tools developed by researchers from the Environmental Geochemistry Research and Engineering Laboratory (LI2GA) of the Universidad Politécnica de Madrid (UPM) have given evidences of their quantitative efficiency to problems about occupational and environmental exposures to pollutants. These tools will allow researchers to categorize risk situations and to give priority to the intervention performances, especially in regions with limited financial resources where is more complex to conduct rigorous clinical studies.

Artisanal gold mining is common in Latin-American regions, Africa and Southeast Asia where there are large socio-economic inequalities and active or abandoned goldfields. This activity is performed outside of the workplace health and safety regulations. Therefore, miners can be at risk due to possible accidents during the exploitation of deposits and due to chronic exposure to mercury. This risk of mercury poisoning is not just limited to workers but also the entire population of the mining communities.

Mercury is a toxic element that can cause neurological disorders in humans or other organism. Common exposures include inhalation of elemental mercury or consumption of fish contaminated with mercury. Mercury from artisanal gold mining is used to concentrate gold in an amalgam of both elements. Later, it is burned in order to rid of the mercury and to recover the gold. During this amalgamation process, accidental and intentional discharges of mercury can occur.

Mercury eventually ends up in nearby rivers and, consequently, in the fish tissues. The problem is that fish constitutes an essential part of the diet for the mining communities included in this research. Likewise, amalgam burning is made in small workshops, sometimes in houses. All this can cause mercury pollution in the air of workplaces, houses and outer areas of these communities.

Researchers from LI2GA of UPM collected data about biometrics, lifestyle and consumption of 12 gold mining departments in Colombia. They also collected mercury concentration air data of in the amalgamation workshops, air data of the roads of these mining communities and also data of the diverse fish species of the area.

All this data along with the quantitative data of potential toxicity of mercury were conducted by probabilistic risk assessment. The results unveiled the mercury exposure dose in these mining communities exceeded the admissible values, even reaching 200 times higher of the reference values in certain maximum exposure situations.

The general population is also exposed to unacceptable risk to health (up to 50 times higher than the recommended values) due to consumption of contaminated fish and breathing mercury vapor in the air.

The probabilistic risk assessment cannot replace the clinical research to control public health and intervention. However, it can be a useful tool to characterize and to highlight these problems in order to give priority to corrective performances.

Source:  Universidad Politécnica de Madrid

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Many older adults still homebound after 2011 Great East Japan Earthquake

2011 Great East Japan Earthquake

A new study, published online in the journal Age and Ageing, shows that the homebound status of adults over the age of 65 in the aftermath of the 2011 Great East Japan Earthquake is still a serious public health concern. Of 2,327 older adults surveyed, approximately 20% were found to be homebound.

A team of researchers led by Naoki Kondo of the University of Tokyo's School of Public Health studied data from the city of Rikuzentakata, an area that was seriously damaged by the disaster. Of its total population of 23,302 before the events of 2011, 1,773 people died or are still missing. Of 7,730 houses, 3,368 (43.6%) were affected with 3,159 "completely destroyed." Much of the population had been concentrated in flat coastal areas, and since the community infrastructure was totally shattered, many people who lost their houses insisted on moving to areas in the mountains.

This study used home-visit interviews with 2,327 adults over 65 years old (1027 men; 1300 women), and was carried out between August 2012 and October 2013. Interviewers gathered information of current morbidity, socio-economic status, health behaviour (diet, smoking, and alcohol intake), frequency of going out, and social support. 19.6% of men and 23.2% of women were shown to be homebound, defined as only leaving the house every 4 or more days. Of those older adults who were classified as homebound, around 40% also had no contact with neighbours.

Information was also obtained on the locations of grocery stores, convenience stores, and shopping centres from the online community directory database in August 2012. Information on shopper bus stops and hawker sites was provided by a disaster support team, and the team also collated road network data. This geographical analysis indicated that distances to retail stores was associated with the risk of people being homebound.

Lead author Naoki Kondo says: "This study has important implications for public health, especially in the setting of post-disaster community reconstruction. First, community diagnoses in a post-disaster setting should cover the built environment, including access to shopping facilities. Second, to prevent older victims of a disaster such as the Great East Japan Earthquake being homebound, it is clearly essential to provide access to the facilities that fulfil their daily needs.

"Given the findings of this study, such access could be increased by the private sector, suggesting the importance of public-private partnerships for post-disaster reconstruction."

Key messages:

• The homebound status of older victims of the 2011 Great East Japan Earthquake is a matter of public health concern
• Geographical analysis indicated that distances to retail stores was associated with the risk of people being homebound
• Hawker and shopping bus services contributed to improved access, providing more opportunities for going out

Source: Oxford University Press (OUP)

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