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Study shows prenatal cannabis use associated with low birth weights

With marijuana use during pregnancy on the rise, a new study led by the Colorado School of Public Health shows that prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight, setting the stage for serious future health problems including infection and time spent in Neonatal Intensive Care Units.

Cannabis Sativa leaf
New study shows association between prenatal cannabis use and low birth weights.

“Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy,” said the study’s lead author Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

The study was published last month in The Journal of Pediatrics.

Crume and her colleagues utilized survey data from 3,207 women who participated in the Colorado Pregnancy Risk Assessment Monitoring System in 2014 and 15. They found the prevalence of marijuana use in the state of Colorado was 5.7 percent during pregnancy and 5 percent among women who were breastfeeding.

Tessa Crume, assistant professor of epidemiology at the Colorado School of Public Health
Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health

They also discovered that prenatal marijuana use was associated with a 50 percent increased chance of low birth weight regardless of tobacco use during pregnancy. Prenatal marijuana use was three to four times higher among women who were younger, less educated, received Medicaid or WIC, were white, unmarried and lived in poverty.

Crume said the numbers are surprising but also reflect changing attitudes toward marijuana, especially in a state like Colorado where it is legal.

“There is increased availability, increased potency and a vocal pro-cannabis advocacy movement that may be creating a perception that marijuana is safe to use during pregnancy,” Crume said.

The National Survey on Drug Use and Health suggests that cannabis use among pregnant women has increased as much as 62 percent between 2002 and 2014. At the same time, the potency of the drug has increased six or seven fold since the 1970s along with the ways it is consumed – eating, vaping, lotions etc.

“Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring brain function starting in the toddler years, specifically issues related to attention deficit disorder,” Crume said. “But much of the research on the effects of prenatal cannabis on neonatal outcomes was based on marijuana exposures in the 1980s and 1990s which may not reflect the potency of today’s cannabis or the many ways it is used.”

The study found that 88.6 percent of women who used cannabis during pregnancy also breastfed. The risk of cannabis to the infant through breastmilk remains unknown. Various studies have found that cannabinoids are passed to the baby in this way. One of the study’s co-authors, Dr. Erica Wymore, MD, MPH, from Children’s Hospital Colorado and the CU School of Medicine, is currently conducting a study to evaluate this issue.

The researchers recommend that health care providers ask pregnant women about their cannabis use and advise them to stop during pregnancy and lactation.

“Obstetric providers should refrain from prescribing or recommending cannabis for medical purposes during preconception, pregnancy and lactation,” Crume said. “Guidance and messaging about this should be incorporated into prenatal care. And screening of pregnant women at risk for cannabis dependency should be linked to treatment options.”

The study co-authors include Ashley L. Juhl MSPH, of the Colorado Dept. of Public Health and Environment; Ashley Brooks-Russell, PhD, MPH, of the Colorado School of Public Health; Katelyn E. Hall, MPH, of the Colorado Dept. of Public Health and Environment; Erica Wymore, MD, MPH of the University of Colorado School of Medicine and Children’s Hospital Colorado and Laura M. Borgelt, PharmD, of the CU Skaggs School of Pharmacy and Pharmaceutical Sciences.

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Those living near oil and gas facilities may be at higher risk of cancer and other diseases

Study says health risks increase closer to oil and gas facilities.
Study says health risks increase closer to oil and gas facilities.

People living near oil and gas facilities along Colorado’s Northern Front Range may be exposed to hazardous air pollutants, including carcinogens like benzene, that could pose health risks above levels deemed acceptable by the U.S. Environmental Protection Agency, according to researchers at the Colorado School of Public Health, Boulder County Public Health, CU Boulder, the National Aeronautics and Space Administration (NASA) and the University of California Irvine.

The study, led by the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus, used ambient air samples to estimate and compare risks for four residential scenarios. They found the lifetime cancer risk of those living within 500 feet of a well was eight times higher than the EPA’s upper level risk threshold.

“We found that air pollutant concentrations increased with proximity to an oil and gas facility, as did health risks,” the study said. “Acute hazard indices for neurological, hematological and developmental health effects indicate that populations living within 152 meters (500 feet) of an oil and gas facility could experience these health effects from inhalation exposures to benzene and alkanes.”

Dr. Lisa McKenzie
Dr. Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health

The cancer risk estimate of 8.3 per 10,000 for populations living within 500-feet of an oil and gas facility exceeded the U.S. EPA’s 1 in 10,000 upper threshold, according to study published recently in the journal Environmental Science & Technology.

“Our results suggest that Colorado’s current regulations that specify a 500 foot distance between a newly drilled oil and gas well and an existing home may not protect people from exposures to hazardous air pollutants that could impact their health,” said the study’s lead author Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health. “Our previous work shows that thousands of people along the Front Range of Colorado live closer than 500 feet from a well and related infrastructure and that the population living close to these facilities continues to grow.”

The previous study examined the expansion of oil and gas wells along Colorado’s Northern Front Range. In the Denver Julesburg Basin, the industry is rapidly growing along with housing construction. As a result, 19 percent of the population or about 356,000 people, live about a mile from an active oil and gas site.

Colorado requires a new oil and gas well to be 500 feet from a residence and 1,000 feet from high occupancy buildings serving more than 50 people like schools and hospitals.

The study focused on the emission of non-methane hydrocarbons (NMHCs) that the wells emit into the air. These include benzene, toluene, ethylbenzene and xylenes, all considered hazardous.

Dr. John Adgate, PhD, MSPH, of the Colorado School of Public Health
Dr. John Adgate, PhD, MSPH, of the Colorado School of Public Health

The highest concentrations of hazardous air pollutants were measured in samples collected nearest to an oil and gas facility,” McKenzie said. “For example, average benzene concentrations were 41 times higher in samples collected within 500 feet of an oil and gas facility than in samples collected more than a mile away.”

The researchers noted that due to high atmospheric stability, nighttime emissions do not disperse as easily as they do during the day. That means benzene levels might be twice as high at night compared to daytime levels.

“The study provides further evidence that people living close to oil and gas facilities are at the greatest risk of acute and chronic health issues due to air pollutants emitted by those facilities,” said study co-author Pam Milmoe, Boulder County Public Health Air Quality Program Coordinator. “The results underscore the importance of having policies that require effective monitoring and reducing emissions from oil and gas facilities, particularly those near homes, schools, and recreation areas.”

Previous studies in Colorado observed that infants with congenital heart defects and children diagnosed with leukemia are more likely to live in the densest areas of oil and gas wells. Studies in Pennsylvania and Texas found associations between fetal death, low birthweight, preterm birth, asthma, fatigue, migraines and chronic rhinosinusitis and proximity to oil and gas wells.

The study acknowledged substantial uncertainties and the need for more research. Nonetheless, there is considerable evidence that benzene can cause cancer in those who work in and around it, but less evidence about its impact on non-occupational populations. The researchers also noted that air pollutants from other sources can contribute to the elevated risks, but stressed that because risks increased with proximity to wells, mitigation strategies should focus on controlling emissions from oil and gas facilities.

The study is available here https://pubs.acs.org/doi/10.1021/acs.est.7b05983.

The study co-authors include John Adgate, Colorado School of Public Health; Benjamin Blair, Colorado School of Public Health; John Hughes, Colorado School of Public Health; William Allshouse, Colorado School of Public Health; Nicola Blake, University of California Irvine; Detlev Helmig, University of Colorado Boulder; Pam Milmoe, Boulder County Public Health; Hannah Halliday, NASA Langley; Donald Blake, University of California Irvine.

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Shaping behavior, not changing minds, more effective in boosting vaccination rates

A comprehensive review of scientific literature surrounding the psychology of vaccinations has shown that shaping behavior rather than trying to change minds is far more effective at persuading people to get immunized.

“There is very little evidence to suggest that we can change people’s beliefs or knowledge in a way that will lead to increased immunizations,” said study co-author Allison Kempe, MD, MPH, professor of pediatrics at the University of Colorado School of Medicine. “What the evidence shows is that interventions tied to directly facilitating vaccination and changing behavior without trying to change beliefs are the most effective.”

Those interventions, she said, include things like sending vaccination reminders by calls, mail or texts, using standing orders and presumptive announcements that patients are due for vaccination in the primary care site and generally reducing barriers to immunizations. At the policy level, school and daycare vaccine requirements and more stringent criteria for vaccination exemptions have been very effective.

Increased outbreaks

The study, published Wednesday in Psychological Science in the Public Interest, a journal of the Association of Psychological Science, comes at a time when outbreaks of influenza and other communicable diseases are cropping up with seemingly increased frequency.

While less than 3 percent of parents refuse to vaccinate their children, they can have an outsized impact on others via the media and other social networks. Others accept the science of vaccination, but fail to get the full course or get them on time.

Allison Kempe, MD, MPH, professor of pediatrics at the University of Colorado School of Medicine
Allison Kempe, MD, MPH, professor of pediatrics at the University of Colorado School of Medicine

Kempe, who directs the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) at the CU School of Medicine, said the study illustrates that trying to change people’s minds or worse, arguing with them, rarely works to increase vaccinations.

“Changing behavior and making vaccination as easy as possible have been shown to be effective at increasing vaccination rates,” she said. “Simply providing educational information to people about vaccines or trying to confront myths they might have heard about vaccines tend to be ineffective at changing vaccination behaviors and can sometimes backfire.”

Research shows that the best way to confront misinformation about vaccinations is to reiterate the facts clearly.

“Countering misinformation directly can actually reinforce false beliefs so we need to be careful how we do it,” Kempe said. “When correcting misinformation, research shows it is best to state clearly and often what is true in a way that matches people’s intuitive beliefs rather than directly countering their beliefs.”

One way of doing this, she said, is through motivational interviewing techniques which have shown promise as a way to better counter misinformation and possibly change vaccination behavior. These techniques involve first acknowledging a parent’s concern, then identifying potential motivations for vaccinations based on the parent’s own feelings.

Three propositions for intervening

According to the study, psychology offers three general propositions for understanding and intervening to increase vaccine rates. The first is that thoughts and feelings can motivate getting vaccinated.

“We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake,” the study said.

The second proposition is that social processes can motivate vaccination. Studies have shown that social norms can in fact influence immunizations, few interventions examined whether they increase vaccination rates.

The third idea is that interventions can directly facilitate vaccinations by leveraging, but not trying to change, what people think and feel. These interventions are the most influential and common in current scientific studies.

“To increase vaccine uptakes, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts and primes) and reducing barriers (through logistics and health defaults),” the study said. “These interventions also shape behavior (through incentives, sanctions and requirements.)”

‘More work to do’

Kempe said she was surprised by how little information is available in the scientific literature about what actually works to persuade people to get vaccinated.

“There haven’t been a lot of good studies on how to influence parents to vaccinate their children, especially interventions that might work in a busy primary care setting, where most of the discussions are going on” she said. “I think we have a lot more work to do in this area.”

The study is accompanied by a commentary by Victor J. Dzau, President of the United States National Academy of Medicine.

He said the authors offered psychological insights into why people engage in behaviors like vaccinations.

In publishing this study, he writes, the authors “are performing a service to society by integrating the disconnected literature on psychological theories and vaccination, which can inform practical interventions to address the challenges of vaccination.”

The first author of the study is Noel Brewer of the Gillings School of Public Health at the University of North Carolina and co-authors include Gretchen Chapman, Rutgers University; Alexander Rothman, University of Minnesota; Julie Leask, University of Sydney.

A link to the study is here:
“Increasing Vaccination: Putting Psychological Science Into Action”
http://journals.sagepub.com/stoken/default+domain/10.1177/1529100618760521-free/full

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Students devise strategies to combat prevalence of suicide

The fifth Rocky Mountain Region Public Health Case Competition was held at the Health Science Library at the CU Anschutz Medical Campus earlier this month.

Fifteen teams received a realistic case-study about suicide prevalence, a public health issue especially relevant to Colorado. Each team had approximately 24 hours to analyze the case, create a public health solution and present it to a panel of judges.

First-place team in Public Health case competition
The first-place winning team in this year’s competition focused on veteran suicide prevention. Team members are, from left, Sujeith Barraza, Kacy Lorber, Phuong Banh, Elizabeth Ko and Morgan Nestingen. Photo by Katie Brumfield, Colorado School of Public Health.

The prizes for the top three teams were varying amounts of scholarship money up to $1,000. Three teams were chosen as the people’s choice recipients, with each member receiving $100.

The teams were specifically chosen to include different disciplines surrounding healthcare, including the Colorado School of Public Health (Colorado SPH), the CU School of Medicine, College of NursingCollege of Engineering and Applied Sciences, the Skaggs School of Pharmacy and Pharmaceutical Sciences, School of Public Affairs, College of Liberal Arts and Sciences and the Graduate School.

“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”

This year’s winning team included three graduate public health students from the ColoradoSPH — two from its program at CU Anschutz and one student from their program at the University of Northern Colorado — as well a graduate student in pharmacy and another in nursing. Fitting for Veterans Day, their focus was on veteran suicide prevention with a project title of “Serve and Support: You Stood for Us, Now Let Us Stand for You.” Their project included media outreach ads and posters with grabbing headlines like “It’s Okay to Not Be Okay” and a peer navigation program that enrolls veterans at the time of discharge. Their case competition plan also included a mobile app and social media outreach to stay top of mind for veteran health.

First-place team member, Kacy Lorber (ColoradoSPH) posted photos of her experience on Instagram and said: “I got to present to so many important people but specifically two House Representatives in Colorado! The highlight was when state Rep. Dafna Michaelson Jenet told us that she got bill ideas from our presentations. I am so grateful for this experience.”

Judges panel at public health case competition
Judges in the final round of the case competition are, from left, Carol Runyan, PhD, director of PIPER in the ColoradoSPH; state Rep. Kim Ransom; state Rep. Dafna Michaelson Jenet; Larry Wolk, MD; and Jon Samet, MD. Photo by Katie Brumfield, Colorado School of Public Health.

Diana Ir, current president of the case competition planning committee and student in the ColoradoSPH, participated in the competition last year.

“I had such a great experience,” said Ir. “I enjoyed it so much that I wanted to be a part of putting it together this year. I encourage everyone to participate in the future. Between the potential scholarship money and the awesome collaborative environment, you shouldn’t miss it!”

RESULTS – Rocky Mountain Regional Case Competition 

1st Place ($1,000 each student scholarship)

“Serve and Support

You Stood for Us, Now Let Us Stand with You!

Comprehensive Veteran Suicide Prevention”

Team Members and Affiliations

Sujeith Barraza, ColoradoSPH (UNC home campus)

Phuong Banh, ColoradoSPH

Elizabeth Ko, Skaggs School of Pharmacy and Pharmaceutical Science

Kacy Lorber, ColoradoSPH

Morgan Nestingen, College of Nursing

2nd Place ($500 scholarship to each student):

“PACT: Patience Assistance Continuing Treatment: Expanding CDPHE’s Warm Handoff

Team Members and Affiliations

Angie Kim, Skaggs School of Pharmacy and Pharmaceutical Science

Alison Hoffman, ColoradoSPH

Cheryl A. Jones, ColoradoSPH (UNC home campus)

Randy Xun, ColoradoSPH

3rd Place ($250 scholarship to each student):

“PRIDE ALIVE”

Team Members and Affiliations

Charlotte Whitney, School of Public Affairs

Naga Srinija Gummadi, ColoradoSPH

Johnny Williams, ColoradoSPH

Vikasini Mahalingam, School of Medicine

Three teams received People’s Choice Awards ($100 scholarship to each student):

People’s Choice

“Hometown Platoon: A Mobile Mentorship Program”

Team Members and Affiliations

Heather Hergert, ColoradoSPH (CSU home campus)

Hailee Griffin, Skaggs School of Pharmacy and Pharmaceutical Science

Isaiah Francis, ColoradoSPH

Hannah LaDow, ColoradoSPH

Scott Cao, School of Medicine

People’s Choice ($100 scholarship to each student):

“Welcome to My Life: CO Health Care Workers’ Wellness Program”

Team Members and Affiliations

Jenny Duong, ColoradoSPH

Heather Marshall, ColoradoSPH (CSU home campus)

Meena Mattamana, Skaggs School of Pharmacy and Pharmaceutical Science

Hailey Hyde, ColoradoSPH

People’s Choice ($100 scholarship to each student):

“It’s Okay, To Not Be Okay”

Team Members and Affiliations

Madeline Huey, School of Medicine

Victoria Laskey, School of Public Affairs

Allison Seidel, ColoradoSPH

Katie Schweber, ColoradoSPH

Mackenzie Wilderman, College of Engineering and Applied Science (Bioengineering)

Editor’s note: Tonya Ewers, director of communications and alumni relations for the Colorado School of Public Health, contributed to this report. 

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Enough vitamin D when young associated with lower risk of diabetes-related autoimmunity

Getting enough vitamin D during infancy and childhood is associated with a reduced risk of islet autoimmunity among children at increased genetic risk for type 1 diabetes, according to a study published this week in the journal Diabetes.

The study’s lead author, Jill Norris, MPH, PhD, of the Colorado School of Public Health, and her co-authors examined the association between vitamin D levels in the blood and islet autoimmunity. Islet autoimmunity, detected by antibodies that appear when the immune system attacks the islet cells in the pancreas that produce insulin, is a precursor to type 1 diabetes.

Professor Jill Norris, PhD, MPH, is lead author of the study.
Professor Jill Norris, PhD, MPH, is lead author of the study.

“For several years there has been controversy among scientists about whether vitamin D lowers the risk of developing of islet autoimmunity and type 1 diabetes,” said Dr. Norris.

Type 1 diabetes is a chronic autoimmune disease that is increasing by 3-5 percent annually worldwide. The disease is now the most common metabolic disorder in children under age 10. In younger children, the number of new cases is particularly high. And the risks seem to be greater at higher latitudes, further north from the equator.

Vitamin D represents a candidate protective factor for type 1 diabetes as it regulates the immune system and autoimmunity. Moreover, vitamin D status varies by latitude. But associations between vitamin D levels and islet autoimmunity have been inconsistent. This may be due to different study designs, population variation in vitamin D levels, or a failure to account for the combined effect of exposure and underlying genetic variation in the vitamin D pathway.

The findings are part of The Environmental Determinants of Diabetes in the Young (TEDDY) study, a large, multi-national study funded by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases.

TEDDY’s effort began in 2004 with children from six clinical centers: three in the U.S. (Barbara Davis Center for Childhood Diabetes at CU Anschutz, the Pacific Northwest Research Institute in Seattle, and Augusta University in Georgia) and three in Europe (Universities of Turku, Oulu, and Tampere in Finland, Helmholtz Zentrum München in Germany, and Lund University in Sweden). The aim of the study is to search for triggers and protective factors for type 1 diabetes in 8,676 children with elevated type 1 diabetes risk.

The TEDDY children were followed with blood samples drawn every three to six months from infancy, to determine the presence of islet autoimmunity, as well as levels of vitamin D.

The authors compared 376 children who developed islet autoimmunity with 1,041 children who did not.  The authors found that in children with a genetic variant in the vitamin D receptor gene, vitamin D levels in infancy and childhood were lower in those that went on to develop islet autoimmunity compared with those that did not develop autoimmunity.

This study is the first to show that higher childhood vitamin D levels are significantly associated with a decreased risk of IA.

“Since this association does not prove cause-and-effect, we look to future prospective studies to confirm whether a vitamin D intervention can help prevent type 1 diabetes,” Dr. Norris said.

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Researchers find creosote bush could treat Giardia and brain-eating amoeba infections

Compounds produced by the creosote bush, a desert shrub common to American Southwest, exhibit potent anti-parasitic properties against two deadly parasites responsible for Giardia infections (Giardia lamblia) and the amoeba that causes an often-lethal form of encephalitis (Naegleria fowleri), according to researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at CU Anschutz and UC San Diego.

Daniel LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at Skaggs School of Pharmacy and Pharmaceutical Sciences.
Daniel LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at Skaggs School of Pharmacy and Pharmaceutical Sciences.

The findings, published online this month in PLOS Neglected Tropical Diseases, may give scientists the chance to widen their arsenal of antimicrobial agents effective against deadly parasitic infections. The current standard treatment for both infections involve antibiotics and anti-parasitic drugs.

The World Health Organization estimates giardiasis, a diarrheal illness, is linked to approximately 846,000 deaths worldwide each year. Infection usually occurs through ingestion of contaminated water or food. Though rarely lethal in the United States, it’s estimated there are more than a million cases of giardiasis in the country annually. Infections due to N. fowleri, sometimes called the `brain eating amoeba,’ are much less common than Giardia.

Compounds from the creosote bush may fight two deadly parasitic infections.
Compounds from the creosote bush may fight two deadly parasitic infections.

“However, it is a far deadlier parasite that is found in warm fresh waters and infects the central nervous systems of their victims through the nasal passages causing lethal brain damage known as primary amoebic meningoencephalitis (PAM),” said principal investigator Dan LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at the Skaggs School of Pharmacy and Pharmaceutical Sciences at CU Anschutz.

Due to its rapid infection cycle and high mortality rate, the CDC has been given special approval to provide the drug miltefosine to clinicians as a treatment option for N. fowleri infection. But it is still not FDA approved and has limited availability in the U.S. This new compound potentially provides a less expensive, more effective treatment option.

Scientists from CU Anschutz and UC San Diego collaborated as part of the Skaggs Scholars program, which matches investigators from Skaggs-funded schools of pharmacy with complementary expertise to discover potential drug breakthroughs. UC San Diego scientists provided expertise in parasitology, while the CU Skaggs School of Pharmacy provided expertise in natural products, compound libraries and active compounds from plants. The researchers investigated these tropical diseases because of their occurrence in Mexico and South America and found indigenous peoples treating infections with creosote compounds.

“The significance and intrigue about our study is that it shows the value of prospecting for new medicines from plants traditionally used by indigenous people as medicine,” said co-principal investigator Anjan Debnath, Ph.D., an assistant adjunct professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego.

The creosote bush (Larrea tridentata), is a tough evergreen bush with small waxy leaves, yellow flowers and a distinctive turpentine-like scent. Native Americans in both the United States and Mexico have long used the plant for a variety of ailments, including intestinal complaints. There is also an existing body of scientific work documenting the plant’s pharmacologically active compounds, notably nordihydroguaiaretic acid (NDGA). NDGA has antiviral, antibacterial, anti-inflammatory and anticancer properties.  The study is the first to show that NDGA and five other compounds are active against both pathogenic parasites.

In other studies, NDGA has been shown to be a neuroprotective agent. It protects human monocytes and other cells and tissues through its powerful antioxidant activity.

“In our study the creosote natural product, NDGA, proved to be a more potent anti-parasitic agent against N. fowleri compared to miltefosine,” LaBarbera said. “Therefore, NDGA may lead to a more effective drug therapy option for N. fowleri infection.”

This research was funded in part, by a grant from The ALSAM Foundation and National Institutes of Health.

 

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Dr. Jonathan Samet is new dean of Colorado School of Public Health

Following an extensive national search, the chancellor of the University of Colorado Anschutz Medical Campus, Don Elliman, announced Tuesday the hiring of Dr. Jonathan Samet, MD, MS, as the new dean of the Colorado School of Public Health.

Dr. Samet, an accomplished medical professional and administrator, has occupied top positions in leading universities around the country.

Dr. Jonathan Samet, new dean of the Colorado School of Public Health
Dr. Jonathan Samet is the new dean of the Colorado School of Public Health

He is currently distinguished professor and chair of the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California. He also directs both the USC Institute for Global Health and the Workforce Development and KL2 Program of the Southern California Clinical and Translational Science Institute.

“I am honored by being selected as the third dean of the Colorado School of Public Health,” Dr. Samet said.  “A key goal will be to enhance the school’s impact on public health in the state and region through our research and training activities.”

Previously, he chaired the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and was clinical division chief for Pulmonary and Critical Care Medicine at the University of New Mexico.

Chancellor Elliman said the new dean will strengthen and deepen the impact of the Colorado School of Public Health (ColoradoSPH).

“Since its establishment just nine years ago, the ColoradoSPH – a partnership of CU Anschutz, Colorado State University and the University of Northern Colorado – has made remarkable strides toward becoming one of the country’s premier institutions of public health,” Elliman said. “As its third dean, Dr. Samet, who brings the experience of a long and distinguished career in academic medicine and public health, is uniquely qualified to take the ColoradoSPH to new heights.”

Dr. Samet comes to ColoradoSPH with nearly 40 years of experience in education, health care and research.

Throughout his career, he’s fostered and mentored faculty members, created new lines of research, initiated curricular advances and maintained fiscal stability.

Along with teaching everyone from undergraduate to postdoctoral students, Dr. Samet has conducted a wide array of research into health issues.  In many cases, he’s translated that research into action. His work led to advancing tobacco controls nationally and around the world, tightening air quality regulations and winning compensation for underground uranium miners suffering health problems.

The new dean is past-president of the American College of Epidemiology and the Society of Epidemiologic Research. He was elected to the National Academy of Medicine, one of the highest honors in medicine, and holds a bachelor’s degree from Harvard College, an MD from the University of Rochester and a master’s degree from the Harvard School of Public Health.

“We are fortunate to have someone as accomplished and versatile as Dr. Samet taking the helm of the Colorado School of Public Health at this critical juncture in its growth,” Chancellor Elliman said. “I am grateful to Dr. Elaine Morrato who, as interim dean since December, has helped the school continue to build on its momentum while ensuring we are set up for a smooth handoff to new leadership.”

Dr. Morrato, DrPH, MPH, will continue as interim dean until Dr. Samet assumes his new post in October.

 

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Researchers to study neurological effects of Zika virus in young children

Researchers at the University of  Colorado Anschutz Medical Campus and the Baylor College of Medicine will join with Guatemalan investigators in a major study examining the clinical outcomes of children infected with the Zika virus after being born, focusing on long-term brain development.

“We now know the severe effects of Zika in the fetus and the unborn child if the mother gets the infection during pregnancy,” said Edwin Asturias, MD, co-principal investigator of the study and director of Latin American Projects at the Center for Global Health at the Colorado School of Public Health. “But if the virus is able to affect the developing brain of an infant or a child, this will have enormous consequences to a generation of children in areas where the virus has spread.”

Dr. Edwin Asturias of the Center for Global Health at the Colorado School of Public Health.

 

The study, funded by the National Institutes of Health, has been approved by the Ministry of Health in Guatemala and will take place in the rural southwestern coast of that country. Along with the Zika virus, the region is also endemic for the dengue and chikungunya virus transmitted by the same mosquito that carries Zika.

“We are enrolling infants in the first year of life and children up to 5 years of age who will be followed over one year to see if they become infected with Zika virus, and then we will be looking at the effects of the infection in the infants’ and children’s neurodevelopment,” said Dr. Flor M. Muñoz, associate professor of pediatrics in the section of infectious diseases at Baylor and principal investigator of the study. “We will look for neurologic or neurodevelopmental effects specifically, including effects on hearing and eye problems, because we know that the virus has the potential to cause central nervous manifestations.”

Zika virus has been known to affect babies in utero when the mother is infected during pregnancy, but little is known about what happens when infants are infected in early life, Muñoz said.

“Our concern is that a developing brain in early life can be impacted significantly,” she said. “It’s an important question to address not just for children that live in the endemic areas, but also for children who travel to these areas.”

Recruitment for the study will take place through a clinic created by the University of Colorado’s Center for Global Health in Guatemala. The goal is to follow 500 infants and their mothers for one year to determine if they become infected by the Zika virus. Neurologic exams and age-appropriate neurodevelopmental testing will be run for the duration of the study to identify changes in children infected with Zika virus.

Researchers will also be enrolling 700 children between the ages of 1 and 5 years, including 300 children known to have been exposed to dengue or Zika viruses while participating in a previous dengue study, and 400 who are siblings of the infants in this study. They will be tested periodically and evaluated for symptoms of flavivirus-like illness to determine if they have been infected by Zika, dengue or chikungunya viruses. Investigators will monitor serial neurologic examinations and developmental milestones in the children to determine if the Zika virus infection is associated with any neurologic or developmental changes.

Dr. Edwin Asturias examining children in Guatemalan clinic.
Dr. Edwin Asturias examining a child in Guatemalan clinic.

Muñoz and Asturias will collaborate with colleagues from the Fundacion para la Salud Integral de los Guatemaltecos (FUNSALUD) clinic in Guatemala. The clinic, affiliated with the Colorado School of Public Health and Children’s Hospital Colorado, is led by Dr. Antonio Bolaños. It has a full complement of local investigators, nurses and laboratory technicians along with Emory University’s Vaccine Treatment and Evaluation Unit (VTEU) research laboratory led by Dr. Mark Mulligan.

Neurodevelopmental testing will be conducted by three local psychologists under the leadership of Dr. Amy Connery of Children’s Hospital Colorado in Aurora, Colo. The study will last three years and results will be reported throughout the study. More information can be found at the NIH Zika website.

 

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National study shows interventions like telephone calls can reduce suicides

In perhaps the largest national suicide intervention trial ever conducted, researchers at the University of  Colorado Anschutz Medical Campus and Brown University found that phone calls to suicidal patients following discharge from Emergency Departments led to a 30 percent reduction in future suicide attempts.

The study was published recently in JAMA Psychiatry.

The year-long trial, which involved 1,376 patients in eight locations nationwide, provided suicidal patients with interventions that included specialized screening, safety planning guidance and follow-up telephone calls.

Dr. Michael Allen, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz, co-authored the study.
Dr. Michael Allen, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center, co-authored the study.

“People who are suicidal are often disconnected and socially isolated,” said study co-author Dr. Michael Allen, MD, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz. “So any positive contact with the world can make them feel better.”

Allen is also medical director of Rocky Mountain Crisis Partners in Denver which has already implemented a similar program where counselors call suicidal patients following their discharge from Emergency Departments (EDs).

Suicide is the 10th leading cause of death in the U.S. In 2015, there were 44,193 deaths by suicide nationally. Over one million people attempt to take their own life every year.

Colorado routinely ranks among the top 10 states for suicide with about 1,000 deaths a year. Last year, it was number seven in the country. The state Legislature has set a goal of reducing suicides by 20 percent by 2024.

Allen said simply handing a suicidal patient a psychiatric referral when discharged isn’t enough.

“We call them up to seven times to check on them after discharge,” he said. “If they aren’t there we leave a message and call again. For many, this telephone call is all they get.”

The crisis center has worked with 17 of Colorado’s 88 EDs and is hoping to increase that number and eventually go statewide.

“We don’t need more brick and mortar buildings, we can reduce suicide risk by simply calling people on the phone,” Allen said.

Dr. Emmy Betz, associate professor of emergency medicine.
Dr. Emmy Betz, associate professor of emergency medicine.

His colleague and study collaborator Dr. Emmy Betz agreed.

“Telephone follow-up programs offer a great way to help bridge an ED visit to outpatient mental health care and hopefully save lives,” said Betz, an associate professor of emergency medicine at CU Anschutz who has conducted extensive research on suicide. “It would be great to see such programs become more widely implemented. Suicide is a leading cause of death, especially in Colorado, and a shortage of inpatient and outpatient mental health care options make innovative approaches like telephone counseling even more attractive.”

The study was led by Brown University and Butler Hospital psychologist Ivan Miller.

Miller, a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, said he was encouraged that they were able to impact suicide attempts among this population with a relatively limited intervention.

While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions are much rarer, Miller said.

“We were happy that we were able to find these results,” he said.

This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts and Dr. Carlos Camargo of Massachusetts General Hospital and Harvard University.

Dr. Betz was the principal investigator for Colorado’s ED-SAFE site.

The trial took place in three phases to create three comparison groups. In the first phase, 497 patients received each ED’s usual treatment as a control group. In phase two universal screening was implemented and 377 patients received additional attention in the ED. In the third phase, 502 patients received the experimental intervention.

Those patients received the same Phase 2 care including additional suicide screening from ED physicians, suicide prevention information from nurses and a personal safety plan they could fill out to prepare for times when they might begin harboring suicidal thoughts again.

Over the next year, they also received periodic phone calls from trained providers at Butler Hospital in Providence, R.I., who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving.

The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group.

“This is a remarkably low cost, low tech intervention that has achieved impressive results,” Dr. Allen said.

 

 

 

 

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Anowara Begum’s journey

Anowara Begum and three women from her village
Anowara Begum and three women from her village

Anowara Begum’s journey from a remote village in Bangladesh to the CU Anschutz Medical Campus is an inspiring tale of courage and determination. She enrolled in the Colorado School of Public Health after a chance conversation at a conference in Germany, which left her with a strong opinion about CU Anschutz.

“It will be a very supportive and accepting environment,” she said. “I can make a home away from home there.”

From Bangladesh to CU Anschutz

Women’s education is not a priority in Begum’s home village. The woman’s role is confined to cooking and raising children, and the cooking is completed inside using biomass fuels like grass, dung and leaves. Past research suggests that the smoke released from these types of fuels may lead to several types of respiratory diseases.

Anowara Begum
Anowara Begum in her home village

“I saw my mother cooking inside with different fuels like cow dung and straw,” Begum said. “She never questioned is the smoke from these fuels bad for me?”

Begum’s inquisitive nature led her to think about these health implications, and she envisioned that one day she could provide solutions. In order to follow her dream, she moved away from her family to a larger city in Bangladesh to complete her secondary education and undergraduate degree in Public Health.

After her undergraduate career, Begum was at a crossroads: Should she stay in Bangladesh? Should she go to another country to get more experience? She made her decision after a serendipitous encounter with a CU Anschutz student she met at a conference in Germany. Begum was enamored by the student’s amicable attitude. “I thought to myself, ‘Well, if this person is so nice from there, then maybe that place is nice as well,’” Begum explained.

She had never even visited the United States and yet, decided to make a leap of faith and apply exclusively to the Colorado School of Public Health.

Taking research back to Bangladesh

While studying at CU Anschutz, Begum realized a unique opportunity to cultivate her researching skills and passions. Ultimately, she wants to implement culturally appropriate public health solutions in Bangladesh.

Anowara Begum
Anowara Begum

“There is a great amount of research being done, but many researchers are missing that cultural appropriation aspect,” Begum said. “That part is the most important to me, because you can’t implement effective changes in public health unless you understand the big picture of the local culture.”

Begum believes she can change the way research has been applied in her home country because of her personal experiences growing up there. She believes her uniquely personal touch could make lasting impacts on communities in need. For her practicum, she was afforded the opportunity to apply her acquired skills by traveling back to Bangladesh.

In summer 2016, Begum received a grant to work with the University of Southern California to study biomass-fueled indoor air pollution exposure in Bangladesh. She helped develop culturally appropriate survey questions that consider regional specific housing characteristics. These considerations included the type of house the resident lives in, and what kind of stove they used.

The research was successful, but her real accomplishment lay in the new attitude of the women in her home village. She realized she had become a beacon of hope for other women in her village. “I am the first-generation woman with higher education in my family,” Begum said. “I realized when I went back home that I can be a role model beyond public health, that I can influence the society by showing how I am getting an education.”

That experience was overwhelmingly emotional for Begum. “I always said I would come back, but then I actually did,” she said. “It gave hope to the village to see me back.” It is Begum’s dream to return to Bangladesh after continuing her studies and practical training in Colorado.

A New Home in CU Anschutz

Begum’s experience at CU Anschutz has not only been rich in academics, but also in extracurricular activities. During orientation, the International Student Group approached her.  “I felt like I had known them for ages,” she said. “They guided me as an international student from the beginning. They hung out with me and kept me connected to campus. If I did not have that group, I would not be the person who I am today.”

Anowara Begum and women from the International Student Group
Anowara Begum and women from the International Student Group

Begum believes she must give back, so she now serves as president of the International Student Group. There are 50 members of international background and 20 members of domestic background. “Anyone who believes in diversity should be a part of this group,” she said. “You don’t have to be international; you just have to want friends.”

Begum’s determination led her to Colorado, and CU Anschutz provided her a beneficial, safe learning environment. She strongly believes that her experiences here will provide a great background to conduct future research in Bangladesh. “I’m very root-oriented,” she said. “I am drawn back to where I came from, my family. But I also have a great support system here; the professors and friends, they are family to me. They are going to be my lifelong friends. This is why I call it a home away from home.”

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