Duke Research Blog

Following the people and events that make up the research community at Duke.

Author: Lola Sanchez-Carrion (Page 1 of 2)

Linking Climate Change, Air Pollution and Public Health

We often view climate change and air pollution as two separate entities. But, the two issues are united by one common driving factor: human emissions. Nicholas School of the Environment Earth Sciences Professor Drew Shindell reminds us how interconnected these issues truly are, and how we must begin viewing them as such to create change.

Shindell argues that climate change and air pollution are often misrepresented. Air pollution is a problem that seems elusive to the individual, and yet it is the

Dr. Shindell with Marcelo Mena (far left), Vice Minister of the Environment of Chile, and Governor Jerry Brown (CA) at the COP21 in Paris.

number one cause of premature death. The problem is often polarized from us, and we forget that we are largely at fault for its increasing effect. We place the blame on the emissions of large corporations, when our own car emissions are just as detrimental. Shindell argues that it is the “othering” of these issues that makes it hard for us feel a need to create change.

But, by clearly linking climate change and air pollution together, and linking those two to human health, Shindell believes we will develop a greater sense of responsibility for our environment. He gives the example of Pakistan, where increased ozone levels due to human emissions have severely decreased the air quality. As a result, there has been a 36% decline wheat and rice production. This dent in Pakistan’s agricultural systems poses a great threat on food security for the entire nation, and could potentially create a wave of health issues.

But policy often blurs the line between air pollution, climate change and human health. Shindell says he doesn’t know of a single jurisdiction that explicitly mentions the scope of negative effects air pollution and climate change can have on our health (stroke, lung cancer, new disease vectors, to name a few). He suggests expanding our metrics and developing a broader-based impact analysis so that humans are well-informed of the interconnectedness of these issues.

Is it easier to blame a big factory for pollution than to look at your own travel habits?

If we included public health in our impact estimates for methane emissions, for example, the cost would be much larger than anticipated. But, Shindell highlights that to bring these emissions down requires a change that is not easy to ask of our energy-dependent, consumer-driven world. Decreasing our meat consumption by 48%, for example, would save us billions of dollars, but to trigger such a change would demand a desire from the public to alter their behavior, which time and time again has proven to be challenging.

At the end of the day, this scientific issue is a largely psychological one. We assume our contributions make a negligible difference, when in reality it is our consumer behavior that will drive the change we wish to see in our environment. But, how are we expected to feel the burden of air pollution on our health, when policy isn’t directly linking the two together? How can we see climate change as an issue that threatens the security of global agricultural systems when legislation fails to draw the two together explicitly? It is here where we must see a change.

Post by Lola Sanchez-Carrion

 

Bass Connections and GHANDI – Understanding Disability from a Global Perspective

Duke prides itself on being a research institution that is not only intellectually curious, but also extremely interdisciplinary. Through Duke’s Bass Connections initiative, students and faculty come together in project teams that tackle complex issues using multiple disciplines and approaches. The program held its annual fair last week to showcase its work and to get new students connected with these exciting projects.

How does it work?

Graduate students, undergraduates, and faculty members apply for a research project in any of these five areas: Brain and Society, Information Society & Culture, Global Health, Education & Development, and Energy. Once accepted, group members work on a year-long research project, that often includes a field work component. One project in particular that combines many disciplines and interests to address an issue of global importance GANDHI, a Global Health project that studies disability from multiple cultural perspectives.

What is GANDHI?

GANDHI team members meet with Dr. Rune Simeonsson at UNC to discuss the WHO ICF-CY (International Classification of Functioning – Children and Youth), a document he helped co-write that provides a framework for diagnosing and addressing disability.

The Global Alliance on Disease and Health Innovation (GANDHI) was created in 2016 to support disabled individuals by providing them with the community reintegration tools necessary to live a healthy, comfortable life. Yukhai Lin, a Duke undergrad and GANDHI team member, shared that many hospital systems are not good at helping those the disabled reintegrate themselves in their community, and often forget about their patients after they are released. The research team recognized this flaw, and began a thorough data collection process to understand the reason for this lack of care. In the fall of 2016, team members took a seminar course, “Living with Disability Around the Globe”, in which they were paired with global partners in ten different countries to examine disability from a more specific context. In this interdisciplinary class, team members not only strengthened their knowledge of disability and its implications on global societies, but they were also able to develop strong research skills, for they ultimately synthesized their findings by creating a thorough comparison of disability in each of the countries studied.

The team also attended a conference in New Orleans to network with organizations that were conducting similar research. Lin said she interviewed doctors from The Netherlands, as well as leaders of influential health organizations to holistically understand the issues that come with helping the disabled. The team hopes to present their findings at a forum this spring, and, like many other Bass Connection projects, will continue throughout the 2017-2018 academic year. They encourage all to apply, and hope to broaden the scope of their research by adding countries in Southeast Asia and creating new opportunities for fieldwork. Some eager students have already showed interest in going to China to interview families with disabled members, says Lin.

Other Bass Connections projects at the fair spread across all disciplines, ranging from the development of effective chemotherapy drugs to the study of urban development in cities across the globe. But, what all projects share in common is a strong emphasis on research that is hands-on, collaborative, and relevant to society.

 

Post by Lola Sanchez-Carrion

José Jerónimo – Innovations in Cervical Cancer Screening

José Jerónimo and his team are transforming the face of cervical cancer screening. Jerónimo is a physician and senior advisor for the women’s cancers branch of PATH, an international nonprofit organization that uses innovative technologies to improve health outcomes in developing countries. Jerónimo, who’s work at PATH has facilitated the prevention and treatment of cervical cancer for thousands in the developing world, spoke at the Duke Institute for Global Health on Dec. 2.

Cervical cancer testing has been a point of conflict in the medical community for quite some time now, for the pap smear — for many years, the only test available to detect cervical cancer — is not very sensitive to abnormal tissue. Since skepticism with the pap smear arose a few decades ago, doctors like Jerónimo have been working tirelessly to find more effective screening strategies.

José Gerónimo, Peruvian physician and public health advocate, received his specialty training in gynecologic oncology at the National Cancer Institute in Peru.

José Jerónimo, Peruvian physician and public health advocate, received his specialty training in gynecologic oncology at the National Cancer Institute in Peru.

Cervical cancer can be acquired through the presence of HPV (human papilloma virus). Chronic infections of HPV have been proven to increase the likelihood of contracting cervical cancer, so developing primary prevention initiatives to avoid developing HPV to begin with are essential to decrease the prevalence of cervical cancer. HPV testing, unlike the pap smear, can be self-collected and does not require the complex, expensive machinery that the pap smear does. Initial self-sampling studies in India, Uganda, and Nicaragua indicated a willingness by the female community to self-test, so long as sanitary and private conditions were provided.

Studies in the Jujuy province of Argentina indicated that community health workers played a key role in facilitating the self-sampling process. When the health workers differed locals to clinics or sent them to facilities for testing, only 20 percent actually went. But, when they brought the self-sampling tests to locals’ homes directly, testing was above 80 percent. The easy accessibility of self-sampling, along with encouragement by local health volunteers, clearly showed that self-sampling was much more effective.

A group of female community health workers in Lima, Peru, educating the community about HPV testing.

Jerónimo’s current work focuses on strengthening government screening systems for HPV that are already in place. By helping ministries introduce and scale up the testing, he and others at PATH hope to decrease HPV and cervical cancer rates.

But, it goes beyond testing. Jerónimo emphasizes the need for evaluation and follow-up mechanisms after testing positive. Although testing efforts have improved significantly, the treatment provided after for those who have tested positive is still lagging. Jerónimo claims that much of this is due to minimal efforts by the local governments to really follow through beyond the testing phase.

PATH is looking for innovative ways to treat HPV that are inexpensive and effective. They recently developed their own version of the thermal coagulator, a probe that treats infected tissue using heat. Their design runs on a battery, rather than needing constant electricity, and uses a progressive heating mechanism that is only activated upon touching the cervix. There is still progress to be made, in both testing and treatment of HPV and cervical cancer, but through efforts by both local and international communities, Jerónimo shows us that is possible.

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An Expert’s Perspective on Mental Health

In honor of Mental Health Awareness Week and Depression Awareness Month, I interviewed Rae Jean Proeschold-Bell,  an associate research professor of Global Health in the Duke Global Health Institute whose research focuses on positive mental health, clergy health, and the integration of care within health systems.

In 2007, Proeschold-Bell founded the Clergy Health Initiative, a program developed to improve health outcomes among the clergy of North Carolina. In their first study, they performed a longitudinal survey of nine Methodist churches in North Carolina to determine the clergy’s health status. It was found that the clergy had a far higher obesity rate (41%) than the rest of North Carolina (29%). High rates of chronic disease associated with overweight/obese individuals were also present. The most interesting find, though, was that depression rates were double that of the regional average. Why?

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Proeschold-Bell has conducted research in Kenya, Tanzania, Peru, India, and the U.S.

“Being the leader of an organization is difficult, says Proeschold-Bell. Churches are extremely underfunded and are constantly pressed for time. Pastors are expected to do all of the spiritual work that being a pastor entails, and also act as business managers for the church. But, thanks to donations from the Duke Endowment, Proeschold-Bell was able to develop three interventions to improve clergy health. Since then, she’s retrieved ten years of data that has allowed for further improvements in holistic health for the clergy of North Carolina.

When asked about depression specifically, Proeschold-Bell said that “the current model in place to treat depression does not work.” We focus strictly on treating the issue by mitigating its symptoms through an antidepressant, instead of pulling at the issue from multiple roots.

She says our efforts should be focused on increasing positive mental health. Positive mental health refers to the presence of positive emotions and good functioning (in both individual and social environments). Work being done by Corey Keyes at Emory has shown that individuals with high positive mental health are less likely to develop depression and chronic disease. By focusing our efforts towards improving one’s overall mental wellbeing, we can get individuals “ahead of the curve” and prevent them from even being depressed in the first place, says Proeschold-Bell.

Further research focusing on positive emotions has been conducted by Barbara Fredrickson at UNC, who suggests that positive emotions have been scientifically proven to increase people’s open-mindedness. Those with more positive emotions have been more willing to try new things and open up to other people, says Proeschold-Bell. These positive emotions connect greatly to one’s ability to be resilient, and there is research to be done in the overlap between possessing these emotions and being able to recover from situations of trauma and conflict that can be mentally straining.

To tackle mental health issues, we must look at them holistically and extensively. Not only do these issues need to be covered from all angles, but interventions need to be culturally competent and context-specific. Keeping these values in mind, will help improve global mental health outcomes.

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Post by: Lola Sanchez-Carrion

Economics and Health: The Biases Behind Our Decisions

Eric Finkelstein of the the Duke Graduate Medical School in Singapore studies how economic principles might be used to improve individual healthcare.

At a talk last Friday, Finkelstein, who was selected by Thomson Reuters as one of the world’s most influential scientific minds of 2015, argued that the same biases that affect our economic decisions could also influence our healthcare choices, and that understanding these biases could help motivate individuals to live healthy active lives.

In theory, people should be able to make healthy choices, Finkelstein said. Under the utility maximization model, individuals have the ability to rationalize and recognize the benefits of taking particular actions for themselves. But often we are not rational beings, he said, and there are several “deviations” that steer us away from maximizing our utility.

One of these deviations is the “present bias” preference, which leads us to make decisions in the present that our future self will regret. He discussed a particular experiment in which people are asked to choose what they will eat in one week’s time: a candy bar or an apple. Most choose the apple, but after a week, when they were given the opportunity to reevaluate their choice and change it, most switch to the candy bar.

This experiment shows not only the dynamic, unpredictable nature of our decisions, but also highlights our tendency to overestimate the will power of our “future selves.”

Another interesting bias that prevents us from being rational is our probabilistic assessment bias, which describes our tendency to overestimate the probability of very unlikely events, while underestimating the probability of those that are likely. This bias directly relates to health and our tendency to ignore the possibility of suffering a detrimental health problem like a heart attack, when in reality it’s quite commonplace.

Eric Finkelstein’s research, which focuses on the intersection between economics and global health, has gained him renowned success nationally and abroad. Source: Duke NUS Medical School.

To understand how these biases might influence individuals suddenly diagnosed with a terminal illness, Finkelstein and his medical team in Singapore conducted their own study on healthcare choices. In the experiment, both healthy and sick individuals were asked to identify what treatments they would prioritize if diagnosed with terminal cancer: level of pain, hours of care required, potential to extend life, cost of treatment and location of death.

Most healthy individuals said they would want whatever treatment was cheapest, but showed very little interest in investing in extending their life or selecting where they died. When sick patients were asked the same questions, on the other hand, they valued place of death (home was preferred) and survival time above everything else. Such information indicates just how difficult it is for us to predict where to invest in healthcare for cancer patients.

From this study and several others, Finkelstein concludes that we are not rational beings, but are instead irrational ones that feed off of biases and change our opinions constantly. But, he suggests that through the use of incentives, we can mediate these irrational biases and ultimately improve health outcomes.

 

Post by Lola Sanchez-Carrion

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Fostering a Collaborative Research Environment in Peru

We are told time and time again that Duke is a global university, one that transcends borders and takes interdisciplinary education to the next level.

On Monday, I was able to experience this international mindset firsthand at the Peru Health Symposium, a conference that celebrated a decade of culminating research efforts by Duke in Peru.

The symposium was organized by Dr. William Pan, a professor of Global Environmental Health at Duke who has worked on many research projects in Peru ranging from reproductive health to tuberculosis. In his opening remarks, Pan said the trademark interdisciplinary nature of Duke has allowed it to succeed as a research institution in Peru, along with its affiliation to pioneers in Peruvian health/environmental research, like John Terborgh.

“We are standing on the shoulders of giants,” said Pan. During the first panel, several research projects were presented.

Field Work in Peru

Helena Frischtak conducting research with Peruvian children in the field.

Helena Frischtak, a 4th year medical student at UVA and former Doris Duke Fellow spent a year studying the neurological effects of mercury exposure on children. She performed basic neurological exams, along with cognitive tests amongst 5-11 year-old children, and preliminary data suggests potential impacts of mercury exposure on cognitive development.

Marlee Krieger of the Center for Global Women’s Health Technologies presented a cervical cancer treatment that brings colposcopy into the primary care setting. When one is screened for cervical cancer, a pap smear is first conducted and if abnormalities are detected, a colposcopy is performed and tissue is biopsied from the cervix. This multiple-step process is tedious, and the number of patients that return for the colposcopy often declines. By combining the steps into one visit and performing it with a simpler and cheaper device, testing efficiency has increased.

Maria Lazo Porras of Cayetano Heredia University (Lima’s prominent medical university) presented findings on the effects of migration from rural to urban regions on chronic disease. Her findings suggest a correlation between urbanization and obesity, but provided surprising results that indicate higher rates of hypertension and diabetes in rural communities.

Peru amazon

Illegal mining scars the Amazon’s lush forests and flushes mercury runoff into streams.

Students doing research in the Amazon presented posters of their findings to faculty members of the Nicolas School and DGHI.

The main theme resonating throughout the conference was the need for collaboration not only to address public/environmental health concerns, but to organize symposiums like this one. The culmination of efforts by the Center for Latin American and Caribbean Studies (CLACS), DGHI, and the Nicholas School have fueled the Peru project’s palpable success.

Below is the link to the documentary shown at the symposium:

http://www.daughterofthelake.pe/ – “Hija de la Laguna” (Daughter of the Lake), 2015. The documentary tells the story of how a Peruvian woman used her powers to stop illegal mining from destroying the lake in her community; a lake that to her, represents her mother’s spirit.

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