Whitney Palmer

Healthcare. Politics. Family.

Treatment and prevention in the ‘buckle’ of the stroke belt

Published in the Spring 2011 Carolina Public Health Magazine

By Whitney L.J. Howell

During the last 20 years, North Carolina has edged toward the top of an ignominious list. The state currently has the sixth highest incidence of stroke mortality in the nation. There’s no time to waste in turning this trend around.

Annually, 27,000 North Carolinians suffer strokes; one dies every two hours. These statistics led researchers to label certain North Carolina counties as part of the “buckle” of the Stroke Belt, which runs through the southeastern United States. Stroke risk in the region is two to three times greater than the national average.

Recognizing stroke risks and symptoms and providing appropriate and timely treatment are critical to preventing stroke and lessening its long-term impacts. For more than a decade, UNC Gillings School of Global Public Health researchers have dedicated themselves to reducing the impact of the nation’s third highest killer. They identify “best practices” in stroke treatment and prevention, help hospitals implement quality of care improvement programs, and train medical personnel to recognize and respond quickly to stroke symptoms.

“We want to improve patients’ care – wherever they may be – should they have a stroke in North Carolina,” says Wayne Rosamond, PhD, epidemiology professor and principal investigator for the North Carolina Stroke Care Collaborative (NCSCC).

The NCSCC works with 56 of the state’s 102 hospitals, from Henderson County’s Park Ridge Health in the west to Carteret County General Hospital in the east. Participating hospitals range from the 25-bed Transylvania Medical Center to Pitt County Memorial (745 beds, affiliated with East Carolina University’s Brody School of Medicine), Duke University Medical Center (989 beds) and Greensboro-based Moses Cone Health System (529 beds).

With Centers for Disease Control and Prevention funding, the collaborative created an interactive database so that a hospital’s stroke care performance can be monitored and compared to similar facilities. Each month, NCSCC hosts webinars for stroke experts to address specific quality improvement topics, and they assist hospitals in giving emergency medical technicians and caregivers advanced education in both identifying and reacting appropriately to a stroke.

NCSCC annually awards up to 12 grants to fund initiatives that meet individual hospital needs. For example, for 2009–2010, Catawba Valley Medical Center received $15,000 for a stroke nurse coordinator. NCSCC also collaborates with the Registry of the Canadian Stroke Network. In February, the NCSCC joined with UNC’s Department of Emergency Medicine to participate in a seminar, presented at the International Stroke Conference 2011, about integrating a stroke registry into EMS data sources.

However, ensuring that patients receive appropriate services is only part of the stroke-prevention equation, says June Stevens, PhD, nutrition and epidemiology professor and nutrition department chair. Health care providers also should focus on helping individuals tackle obesity – a substantial, preventable stroke risk factor.

“Obesity increases the risk of stroke, because it raises the likelihood of high blood pressure,” Stevens says. “In fact, we’ve found that if you have a significant weight gain over an extended period of time, your risk is substantially higher than if you maintain your weight.”

In a soon-to-be published study of 15,000 people from North Carolina, Mississippi and Minnesota, Stevens and her colleagues found that a 10- to 30-percent weight gain between age 25 and middle age resulted in a 29 percent increase in stroke risk. Individuals who gained more than 30 percent of their body weight had a 64 percent higher risk. These results were compared to individuals who maintained their weight within 3 percent of the initial measurement.

“People already know obesity isn’t healthy,” Stevens says. “They also need to know about evidence that shows they’re at high risk for stroke – so they can do something about it.”

To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2011_spring/documents/howell_stroke.pdf


June 2, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Swa Koteka ‘It is possible’ to prevent HIV

Published in the Spring 2011 Carolina Public Health Magazine

By Whitney L.J. Howell

Even without engaging in risky behaviors, young girls and women who live in South Africa have a 1-in-3 chance of contracting HIV.

Audrey Pettifor, PhD, assistant professor of epidemiology at UNC Gillings School of Global Public Health, launched a study in March 2011 to examine the factor known to have the greatest impact on reducing HIV infection risk – education. Pettifor partners with University of the Witwatersrand researchers  Catherine MacPhail, PhD, and Kathleen Kahn, MD, PhD.

Audrey Pettifor, Ph.D., assistant professor of epidemiology at the UNC-Chapel Hill Gillings School of Global Public Health

“We know young girls who finish high school are four times less likely to become infected with HIV than those who don’t complete school,” Pettifor says. “Condom use and number of partners simply don’t explain the high levels of HIV infection we observe in young South African women.”

To keep girls in school, Pettifor and her team will randomize 2,900 young women and their  parents/guardians to receive a monthly cash transfer, based on whether they attend school 80 percent of the time over the next three years. Then, they will determine whether girls receiving the cash  transfers are less likely than girls in the control group to become infected with HIV.

The study, funded by the National Institute of Mental Health and the National Institutes of Health’s (NIH) HIV Prevention Trials Network, also will measure HSV-2 (genital herpes), sexual behavior, mental health, school outcomes, socio-economic status and other key social factors. It is referred to locally as Swa Koteka, which means “it is possible” in the native language, Shangaan.

Educating girls is only half the battle, however, Pettifor says. Cultural norms that impinge upon a woman’s right to resist sex or insist on condom use also have to change if young women’s HIV risk is to be decreased. Therefore, half of the young women’s villages also will be randomized to receive an intervention focused on changing negative gender norms and HIV risk among men ages 18 to 35. The team partners with a local nongovernmental organization, Sonke Gender Justice, which aims to challenge and reshape negative gender norms in South Africa.

Pettifor also directs two NIH-funded pilot projects in Lilongwe, Malawi, to help those with acute HIV infection (AHI) lessen the likelihood of transmission. AHI is a highly infectious phase of the disease.

One of Pettifor’s projects, co-led with Amy Corneli, PhD, of FHI,* will compare the effect of four intensive counseling sessions in the first two weeks after AHI diagnosis to standard counseling in reducing transmission risk to partners.

In the second project, co-led with Bill Miller, MD, PhD, UNC associate professor of epidemiology and medicine, Pettifor’s team will compare effects of three interventions – antiretroviral treatment for the first 12 weeks after infection, in combination with intensive alone and standard counseling.

“This is a behavior change intervention through which we’re asking people to change behavior for a defined and short period of time,” Pettifor says. “If we get them through this really risky time, then we can talk about a longer-range risk reduction plan.”

To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2011_spring/documents/howell_HIV.pdf


June 2, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

She’s growing models of human skin

Published in the Dec. 6, 2010, Raleigh News & Observer and the Dec. 6, 2010, Charlotte Observer


CHAPEL HILL — Lab experiments may never look the same if a local researcher succeeds in growing 3-D models of human skin that could replace animals in scientific testing.

Leena Nylander-French, an environmental sciences and engineering researcher in the UNC-Chapel Hill Gillings School of Global Public Health, uses foreskins from circumcisions performed at UNC Hospitals to create quarter-size human skin samples to test how chemicals penetrate and affect the skin.

“The biggest benefit is that it provides a more detailed understanding of human skin and its mechanisms,” Nylander-French said. “The knowledge will help protect us and show us how to get rid of various toxins.”

Mouse skins – those most common in testing – cannot accurately demonstrate how chemicals permeate human skin, she said. For example, mouse skin’s uppermost layer is two to five cells thick. Human skin’s uppermost layer is roughly 20 cells thick.

Nylander-French said her lab will build its first skin models this month. To construct the models, the team will separate

Scientists at UNC-Chapel Hill use skin cells from discarded circumcision tissue as an alternative to animal testing for cosmetics and other products. Photo Courtesy: MATTEK EPIDERM

the epidermis (the skin’s outer layer) from the dermis (the second skin layer) with enzymes. Then they’ll isolate cells selected to grow the model and attach them to a Petri dish. 

They will cover the cells with a collagen layer infused with fibroblasts – cells that prompt new dermis growth – as well as another cell layer of melanocytes and keratinocytes to give the new epidermis pigment and a protective coating.

To map where chemicals travel in human skin, Nylander-French said the team will embed models in wax and dye the layers different colors. Over several days, the team will drop small amounts of chemicals onto the models and track their migration.

According to Thomas Hartung, director of Johns Hopkins University’s Center for Alternatives to Animal Testing, the cosmetics industry has used artificial human skin models for nearly 20 years to test what substances irritate the skin. Nylander-French’s work could take this research a step further, he said.

“Artificial skin hasn’t been a strong barrier,” Hartung said. “We still need to optimize models because there are some substances that pass through the current models that wouldn’t pass through natural human skin.”

To read the Raleigh News & Observer article: http://www.newsobserver.com/2010/12/06/845738/shes-growing-models-of-human-skin.html


December 6, 2010 Posted by | Science | , , , , , , , , | Leave a comment

A healthy start to life

Published in the Fall 2010 UNC-Chapel Hill Gilling School of Global Public Health Alumni Magazine: Carolina Public Health

By Whitney L.J. Howell

For 30 years, the number of overweight children has crept higher and higher. In 2008, the Centers for Disease Control and Prevention reported 10 percent of children ages 2 to 5 had an unhealthy body mass index. Those children have a 70 percent chance of being overweight or obese adults.

Establishing good health habits early can reverse this trend and help children have healthy lives. The UNC Gillings School of Global Public Health leads the fight against the obesity epidemic and promotes healthy behaviors locally, nationally and globally.

“Combating obesity is a key strategic area for the School,” says Peggy Bentley, PhD, nutrition professor and the School’s associate dean for global health. “UNC is playing a major role in obesity research. We have faculty and graduate student expertise from the molecular level through epidemiology, economics, interventions and policy.”

You are what your mother eats

Society’s advice to expectant mothers historically has been to “eat for two.” However, contemporary research shows that eating unhealthy, high-calorie foods during pregnancycan put children at risk for weight struggles and health complications before they are born.

For 15 years, Anna Maria Siega-Riz, PhD, RD, nutrition and epidemiology professor and associate dean for academic affairs at the School, has analyzed prenatal nutrition data to determine which health habits give children the best start in life.

“Pregnancy is a happy moment in life, but it’s also when women are most concerned about the health of their child,” she says. “If they have bad health habits, many women are more likely to modify their behavior, at least in the short term.”

Although most women know to limit weight gain during pregnancy, 60 percent still gain more weight than they should, based on Institute of Medicine recommendations.(Siega-Riz was a member of the prestigious IOM panel that developed those guidelines, available at http://tinyurl.com/iom-guidelines.) Fewer than 25 percent receive guidance from their doctors about physical activity. Making and maintaining behavioral changes is difficult unless women have positive, consistent support.

Siega-Riz’s team uses the Internet, podcasts, chat rooms and cell phones to provide health information and online support for pregnant women. One podcast includes a skit in which four women, all at different parenthood stages, advise an expectant mom about choosing nutritious foods.

Women with healthy habits may avoid having a baby who is too large for gestational age (often leading to C-section births), prevent shoulder dystocia for the baby during birth, and limit the child’s risk for developing diabetes and obesity.

“Women who aren’t eating right or exercising need assistance,” Siega-Riz says. “We must help them find balance and give them all the support they require.”

Choosing healthful foods during pregnancy could reduce the burden of chronic diseases later in life, says Mihai Niculescu, MD, PhD, nutrition assistant professor. Whether the “fat gene” exists is debatable (see page 14), but Niculescu’s epigenetic work – research that determines how outside influences alter our DNA – shows that high-fat diets and maternal obesity in mice alter DNA, shutting down some genes and accelerating others. Developmental brain delays in offspring are the result.

When maternal obesity exists, the neurons in mouse fetal brains at 17 days of pregnancy appear less developed, according to Niculescu’s observations. The implications are worrisome, he says, because the effects are evident after three or four generations.

“This may have profound consequences for an offspring’s life, including his or her mental development and ability to learn,” he says. “A high-fat, less nutritious diet can also create food preferences in unborn offspring that lead them to choose unhealthy foods later in life.”

Open the hangar –here comes the airplane!

Parental influence over children’s nutrition doesn’t end at birth, but little research exists on

Karina Agopian, research assistant at UNC’s Nutrition Research Institute in Kannapolis, works with a toddler to determine what and how much the child has eaten. Research shows that early eating habits influence later food preferences and health outcomes.

what increases obesity risk in children under two. In 2002, Associate Dean Bentley became a pioneer in this area when she launched “Infant Care, Feeding and Risk of Obesity,” a study of strategies used by first-time African-American mothers to feed their 3-month to 18-month-old children.

With National Institutes of Health funding, Bentley recruited 217 mother-child pairs in North Carolina through the Women, Infants and Children program and videotaped them at three-month intervals to identify feeding styles. She and her team identified five styles: controlling, laissez-faire, responsive, pressuring and restrictive. Responsive mothers, she says, are “perfect moms” who pay close attention to and correctly interpret child cues of hunger and satiety. They are very engaged during feeding and may provide verbal and physical encouragement and help, when needed. Other styles pressure or even force children to eat when they reject food or overly restrict the quality and quantity of what children eat, often because the mother is concerned about her child becoming fat.

“Many factors play a role in how we feed infants. However, we believe that it is not just what children are fed, but also how they are fed that makes a difference in the child’s acceptance of food and perhaps in later food preferences and health outcomes,” Bentleysays. “Understanding the role these styles play in growth and development outcome sis a big part of what drives our childhood obesity study.”

Meghan Slining, PhD, nutrition assistant professor, analyzed data from Bentley’s study while she was a UNC doctoral student. Overweight infants – those who measured greater than the 90th percentile for weight versus length – were nearly twice as likely as normal-weight infants to have delayed motor development, Slining found.

“While baby fat may be cute,” Slining says, “it increases the chance that a child could become an overweight adult. We also have seen more immediate consequences to extra pudginess. These children have lower gross motor development.” (See a video about Slining’s research at http://tinyurl.com/slining-baby_fat.)

Add a mother with an eating disorder to the mix, and feeding a child becomes even more complex. Jordan Distinguished Professor of Eating Disorders Cynthia Bulik, PhD, used data from the Norwegian Mother and Child Cohort Study, which followed more than 100,000 Norwegian mothers, some of whom had anorexia or bulimia nervosa or binge-eating disorder, to determine how they fed their children. Bulik followed the mothers from 17 weeks’ gestation through their children’s eighth birthdays.

Although some mothers with eating disorders experienced a reprieve from their conditions during pregnancy, this was not universally the case. In fact, a surprising number of women developed binge-eating disorder during pregnancy. Eating disorders during pregnancy expose babies to erratic eating, Bulik says.

“The impact of roller-coaster caloric intake certainly affects growth and development,” Bulik says. “It could also affect obesity and diabetes risk, as well as the weight trajectory for later in life.”

Mothers with eating disorders also abandoned breastfeeding earlier than did healthy mothers, Bulik says. After giving birth,women with eating disorders often feel they no longer “have a reason to be overweight” and choose not to consume adequate calories to support breastfeeding. Bulik’s study also shows that, as these children grow, they are more likely to develop eating problems, such as having stomachaches, vomiting without cause or not enjoying food.

According to Miriam Labbok, MD, Professor of the Practice of maternal and child health and director of the School’s Carolina Global Breastfeeding Institute, a breastfeeding baby will “stop when full,” but bottlefeeding can overpower a baby’s ability to recognize satiety. When a parent insists that the baby empty the bottle, the child learns the habit of overeating, Labbok says. Additionally, breastfed babies are exposed to the tastes of foods eaten by their mothers. For a formula-fed child, food flavors are new and strange, which could cause the child to be a picky eater.

Employing research to instill good eating habits early is paramount to changing the course of human health, Bentley says.

“It’s harder to intervene and prevent nutrition problems when a child is older. They have preferences and eating patterns that make changes more complicated and difficult,” she says. “But, with the research ongoing at the School, we know we’re leading a positive trajectory of implementing healthy habits early.”

To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2010_fall/documents/a_healthy_start.pdf

December 2, 2010 Posted by | Education, Family, Healthcare, Science | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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