This post is the first in a new series highlighting the successes of alumni of Emory's Center for the Study of Human Health. Our graduates go on to work in a variety of fields and partake in a variety of further training. This semi-regular series will demonstrate these outstanding alumni outcomes.
By: Salima S. Makhani
This fall, I was the first in my family to start my journey as a medical student. I have recently begun Mercer University School of Medicine’s Problem-Based Curriculum (PBL), which has exposed me to a different style of learning, such as stimulating intimate discussions among classmates, encouraging interactions in small groups, and sharing our thoughts on each patient’s case. Cases we review range from discussing nutritional and lifestyle aspects of a diabetic patient to analyzing lab findings consistent with a myocardial infarction. This case-based approach reminds me of my undergraduate years at Emory University in the Center for the Study of Human Health.
I initially started college focusing my studies on Biology, similar to many of my pre-med peers. Although I was following the path I carved out for myself, I was still searching for a more holistic understanding of medicine and health. After my first class with Dr. Lampl in Predictive Health and Societies, I knew that The Center for the Study of Human Health would prepare me best in my aspiration of being a physician.
As a rising Junior at Emory in 2013, I was determined to be a part of the first cohort of students to graduate with the Human Health major. I took part in all the Center had to offer including, for example, going to the study abroad program with Human Health professors in Paris, France in the summer of 2014. The combination of my foundational science and preventative medicine courses served an integral role in applying my knowledge from the classroom to volunteer services with Emory Emergency Medical Service (EMS).
Equipped with this unique perspective on health and medicine, I pursued a Masters of Science in Preclinical Sciences at Mercer University School of Medicine in 2015. I then trained as a medical scribe at various Emergency departments in Georgia and Illinois. In addition to scribing, I decided to revisit Emory, coordinating clinical research with Emory’s Department of Urology. Emory surgeons served as my mentors, training me to not only learn the foundations of clinical research, but also to analyze data, draft a manuscript and become published as a first author of a major study in the Journal of American College of Surgeons.
I am so grateful for the undergraduate and post-graduate experiences that have prepared me for where I am today. The Center for the Study of Human Health lies at the roots of my journey. I will continue to integrate this knowledge into my education as I aspire to be a physician serving one of the many under-served communities in Georgia.
By: Jackie Glodener
With the rising rates of both acute and chronic disease, as well as the associated astronomical costs of healthcare, preventative healthcare is becoming our future. The Center for Health Discovery and Well-Being (CHDWB) is part of the Emory/Georgia Tech Predictive Health Institute and is working to further the field of predictive health, which is closely tied to preventative healthcare. The Center was established in 2005 as part of the Emory University Strategic Plan to integrate predictive health principles and health research.
The CHDWB was originally located at Emory Midtown until 2013 when the study moved over to the Emory University Hospital on the Clifton Road campus. Approximately 900 healthy people were invited to join the study, and over 750 people consented and were enrolled, most of who are Emory faculty, staff and some students. Enrollment closed in 2012. The remaining participants that signed up in 2012 will continue to participate in the study through 2017.
Participants in this longitudinal 5-year study are seen for annual visits. They complete online questionnaires and surveys before each visit to report health history, physical activity, medication and supplement use, spirituality, mental health, quality of life, stress, sleep issues, and others. The annual visit includes many health assessments including vital signs, a blood draw, and a urine sample. The visit measures more factors than a standard annual visit would. Skin caliper measurements are taken (pictured below) and waist-hip ratio is calculated, which can be used to predict disease risk. Other health measures taken at each visit include a cardiovascular ultrasound, treadmill test, bone density scan, and body composition measures (using the DEXA scanner). After the visit, participants receive a comprehensive Health Assessment report of all their data from all of their visits, which they can share with their Primary Care physician. These data points are interesting to look at over the length of the study, and allow the study participants to look at their personal health trends over time and evaluate their own health in a more holistic way.
When the study was based at Emory Midtown, the participants would meet with a Health Partner and set health goals. Participants were asked, “What do you want to focus on regarding your health?” Some participants might have wanted to lose weight, and others maybe wanted to control their diabetes or exercise more. The Health Partner would set up a schedule to keep in contact with the participant on a regular basis to see how they were doing with their health goals. Most participants had 3 or 4 years with a Health Partner, before that part of the program ended. Though participants don’t have the health partners anymore, they still come in for their annual visits and enjoy receiving the comprehensive Health Assessment report.
The study has had many positive effects so far. According to a recent report, the study participants showed improved health after only one year of participation- this included weight loss, lower blood pressure, decreased LDL- cholesterol, and improved mental health. This program contributed to the development of Emory’s Predictive Health minor, housed in the Center for the Study of Human Health. Undergraduate students pursing this minor can take classes related to preventative and predictive health. On the other end, the data and samples from the study are being used to make new discoveries. Researchers at Georgia Tech perform genetic analysis of the samples, analyze data from the study, and study metabolomics using the samples. Over 50 peer-reviewed papers and 2 books have resulted from the CHDWB study. Since the data request form has become available online, researchers can ask an endless number of questions by using the data from the CHDWB. By using the data from this study, we can learn how to change the paradigm of health in the United States and integrate preventative and predictive health into our daily lives.
I would like to thank both Greg Martin and Jane Clark, of the CHDWB, for their contributions to this blog.
Today's video features the work of Dr. Krish Sathian, Department of Neurology.
Student Producers: Naomi Maisel, Junior -Human Health and Anthropology & Sarah Howar , Senior- Biology, Anthropology and Human Biology
By: Mamta Jhaveri, MD
Ethnobotany is a multi-disciplinary study of human interactions with plants, ranging from its usage in food to medicine. This fall, we had the opportunity to create a truly multi-disciplinary, multinational dialogue about ethnobotany in Kosovo. Funded by the US Embassy in Kosovo for University capacity development, Dr. Cassandra Quave (Assistant Professor, Emory University Department of Dermatology and Center for the Study of Human Health) and myself (a medical resident in the Department of Dermatology) collaborated with Dr. Andrea Pieroni (University of Gastronomic Sciences, Italy) and Dr. Avni Hajdari (University of Prishtina, Kosovo) to help teach and conduct ethnobotanical field research in Kosovo. We worked with 12 motivated students from the University of Prishtina.
Our itinerary included a brief 4-day introductory course on ethnobotany. The purpose of this course was not only to introduce the students to practice of ethnobotany, but also raise awareness of future research opportunities in this field for these students. The 12 students that were chosen for this course were either masters or PhD students of biology, chemistry, physics or pharmacy. Their primary language was Albanian, with a few of them also speaking Serbian and Gorani. Although most of them understood basic English, this was not their primary language. Despite the language barrier, the students were very motivated to engage in this new opportunity – to learn more about botany, biology, anthropology and the traditional knowledge within their own country.
When learning about the meaning of traditional knowledge, these students were shocked to learn that most students in America do not know how to make their own jams or ferment their own vegetables, which is performed in nearly all their homes.
After the introductory class, we traveled as a group to different small villages in Kosovo to interview local inhabitants about their usage of plants for skin care and skin diseases. In addition to the students, this was my first time conducting ethnobotanical field research and it was fascinating to hear locals tell you about their knowledge about the wild and cultivated plants in their area. Most of the locals would initially say, “oh no, I don’t use any medicinal plants.” However, after a few more questions, they would come out with a basket full of dried plants and herbs that they commonly use for tea and skincare. We documented commonly used plants and the formulations that they used for dry skin, hair care, eczema, psoriasis, impetigo, and tinea. One of the plants that was universally used for dry skin, eczema or skin infections in our interviews was topical St. John’s Wart. Most of the interviewees prepared this by immersing dried flowers and leaves in oil for ~30 days and exposing it to direct sunlight. Topical St. John’s Wart has been shown in randomized control trials to be an effective antimicrobial and anti-inflammatory agent.
Kosovo was not only rich in traditional plant knowledge, but it was fascinating to see how different ethnic and religious groups had different usages for similar plants. One added bonus during this trip is that many of the locals invited us into their homes while conducting their interview. This was a very enlightening opportunity to hear the untold stories about Kosovo’s history, either through their personal stories or by observation of their life.
In the spring of 2015, to continue the collaboration, we will be hosting Dr. Avni Hajdari and Bledar Pulaj (PhD student) as visiting scientists in Dr. Quave’s laboratory, where they will teach lab members about essential oil extraction and analysis. We will also continue in the phytochemical and antimicrobial analysis of the plant specimens collected during our fieldwork. For photographs from our trip, please visit http://etnobotanica.us/photos/fieldwork-in-kosovo.
Dr. Jhaveri is at Emory's Department of Dermatology.
By: Amanda Mummert
There has been a resurgence of preventable diseases due to increasing anti-vaccination sentiments that partly stems from a 1998 study that claimed that the vaccine for measles, mumps, and rubella (MMR) was linked to autism. International efforts have attempted to dispel this fraudulent report after it was retracted from The Lancet, yet distrust in immunizations have persisted and led to dramatic increases in diseases such as whooping cough and measles, which had been nearly eliminated in developed countries like the United States. While in the United States and Europe fear of vaccines has driven these increases in the prevalence of preventable disease, access to preventive immunizations remains the primary obstacle in the rest of the world. In combination, these factors have led to a global increase in childhood morbidity and mortality as visualized by this map produced by the Council on Foreign Relations.
Vaccine Nation: American’s Changing Relationship with Immunization (University of Chicago Press, 2015) is a new book by Dr. Elena Conis, Assistant Professor in the Department of History at Emory University and an affiliate faculty member with the Center for the Study of Human Health. The book chronicles the history of vaccines in the United States since the 1960s and concentrates on how immunizations are simultaneously a pinnacle accomplishment of the public health system and deep-seated topic of moral controversy. The Atlantic recently featured an excerpt from her book that highlights public perception of a link between poverty and disease. As Dr. Conis relates, “the 1960s campaigns against polio and measles took place in the context of a national war on poverty, widespread anxiety about the decline of American cities, and the civil-rights movement; worries about poverty, urban transformation, and race were thus subtly inscribed upon the nation’s efforts to immunize against these infections. The decade was also marked by growing scientific enthusiasm for disease eradication, which inspired a push not just to vaccinate against diseases, but eliminate them entirely.” Dr. Conis' book is important for understanding the recent decline in adherence to recommended vaccine guidelines, which is occurring in a context of increasing distrust in science and biomedicine and tide of racial and urban violence.
To read an extended excerpt from Vaccine Nation, please read the article “How the Poor Get Blamed for Disease” in The Atlantic. Alternatively, Dr. Conises book is available for purchase through Amazon.
By: Sheela Sinharoy
When people think of nutrition, they probably think first of food, not of toilets. However, sanitation could be linked to nutrition in several ways. Poor sanitation infrastructure means more feces and hence more pathogens in the environment. These pathogens can spread through direct contact, through vectors like flies, or by entering the water system. Any of these scenarios can lead to illness, which in turn affects people’s nutritional status through decreased appetite and malabsorption of nutrients.
The question, then, is whether improved sanitation infrastructure leads to improved nutrition. Several groups of researchers have been studying this in India, where 597 million people practice open defecation. Here at Emory, a group of researchers led by Dr. Thomas Clasen published a paper on their research last month in The Lancet. The study examines the effectiveness of a rural sanitation program on several outcomes, including child malnutrition.
The intervention took place in Odisha, India, in the context of the national Total Sanitation Campaign, through which the government of India promotes latrine construction. The campaign focuses on households that fall below the poverty line; it provides them with a latrine but requires that households provide the necessary sand, bricks, and labor for construction. For this study, the researchers focused on 100 rural villages where sanitation coverage was below 10% and enrolled households with pregnant women or children under age four. Implementation took place between January 2011 and January 2012, and data collection took place through household visits every three months from June 2011 to October 2013.
Malnutrition was measured in two ways: through height-for-age z-score (HAZ) in children under two and weight-for-age z-score (WAZ) in children under five. HAZ is an indicator of chronic malnutrition, while WAZ is a measure of both chronic and acute malnutrition. The intervention had no effect on mean HAZ. Intention-to-treat analysis also showed no effect on mean WAZ, but per-protocol analysis showed a modest effect size of 0.10 (95% CI: 0.003-0.20). In other words, among the households that were compliant with the intervention, the children had slightly better WAZ scores. The lack of a stronger effect on child malnutrition was surprising enough to garner attention from The New York Times, which published an article titled, “Latrines May Not Improve Health of Poor Children”.
I wanted to learn more, and I was able to interview the lead author, Dr. Clasen. He explained that the intervention focused on latrine construction rather than latrine use, and, while it may seem counter-intuitive, some people prefer the culturally accepted practice of open defecation. In his words: “Coverage has to be almost exclusive. Use has to be almost exclusive.” Unfortunately, researchers do not have a good understanding of the factors that lead people to change their behavior and start using a latrine or how to incentivize this behavior.
Dr. Clasen further explained that his team’s findings are actually consistent with the findings of other studies in India. For example, Dr. Sumeet Patil and Dr. Benjamin Arnold have published separate studies, each of which similarly took place within the context of the Total Sanitation Campaign and, like Dr. Clasen’s study, found no effect on child nutrition. Both studies also found that many people continued to practice open defection despite having sanitation infrastructure.
A number of analyses are still underway, which the researchers hope will shed light on potential reasons for the lack of observed effects. For example, Dr. Clasen’s study found that “latrine use was nearly five times higher for women than for men or children.” It is not clear why men in particular had such low levels of compliance. Nor is it clear what role women play in the decision-making process around whether a household invests the resources necessary to build a latrine. If this decision is in the hands of men, and men are less likely to use a latrine, what are the implications for sanitation coverage and compliance?
The interest in this issue is such that UNICEF has recently held a three-day conference in New Delhi, India. The most recent national data show that almost 50% of children in India were chronically malnourished; identifying interventions to address this problem is therefore an urgent issue. Some researchers argue that one key to improving child nutrition in India lies in behavior change and achieving universal coverage and use of improved sanitation facilities
 Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, et al. Effectiveness of a rural sanitation programme on diarrhea, soild-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet. 2014 [cited 2014 Nov 3]. doi: http://dx.doi.org/10.1016/S2214-209X(14)70307-9.
 UNICEF, WHO (2014) Joint Monitoring Programme for Water Supply and Sanitation. Progress on Drinking Water and Sanitation: 2014 Update. New York and Geneva: UNICEF and WHO.
 Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM, et al. The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster-randomized controlled trial. PLOS Med. 11(8): e1001709. doi:10.1371/journal.pmed.1001709
 Arnold BF, Khush RS, Ramaswamy P, London AG, Rajkumar P, Ramaprabha P, et al. Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci USA. 2010 Dec 28;107(52):22605-10. doi: 10.1073/pnas.1008944107.
 India, Ministry of Health and Family Welfare. 2009. Nutrition in India: National Family Health Survey (NFHS-3) India, 2005–2006. Mumbai: International Institute for Population Sciences.
Sheela Sinharoy is a graduate student in Emory's Nutrition and Health Sciences in the Graduate Division of Biological and Biomedical Sciences. A version of this blog was also published on the American Society for Nutrition blog. This blog entry was arranged by Graduate Partner in Human Health, Ashley Holmes.
Emory student Gabe Gan reports on his attendance at the First Undergraduate Health Conference in Atlanta
By: Gabe Gan
On Saturday, November 15th, the first annual Atlanta Undergraduate Conference on Health and Society took place at Agnes Scott College in Decatur, GA. This year’s conference was titled “Healthy People, Healthy Societies,” and drew student speakers from Agnes Scott, Emory, Georgia Tech, and Georgia State. The conference began with a keynote address, given by Dr. Denise Koo of the U.S. Centers for Disease Control and Prevention, who also serves as an adjunct assistant professor in the Rollins School of Public Health. After the keynote, students broke up into four panels and presented on their research, internship experiences, and other public health related topics.
Dr. Koo, who serves as the Senior Advisor for Health Systems in the Office of Public Health Scientific Services (OPHSS), shared her personal story and journey from scientist, to physician, to public health practitioner. She outlined some of her key accomplishments at CDC, including working on the National Notifiable Disease Surveillance System, writing privacy rule guidance (HIPPA), and developing “A Practical Playbook—Public Health and Primary Care Together.” While her primary training is in epidemiology, Dr. Koo discussed her current focus on health systems transformation and its importance. Lastly, Dr. Koo highlighted the changing nature of public health and the directions she predicts the field taking in upcoming years.
This past summer, I served as an Emergency Care Policy Intern at the U.S. Department of Health and Human Services in the Office of the Assistant Secretary for Preparedness and Response (ASPR). Working with the Division of Health System Policy and the Emergency Care Coordination Center, I met with public and private stakeholders in emergency care to discuss research and current programming on topics including EMS data use, opioid/opiate surveillance, and active shooter preparedness. In addition, I assisted in document drafting and the creation of visual and information flowcharts for data collection.
At the conference, I presented on Mobile Integrated Healthcare, a concept that I am passionate about and discovered during my summer internship. Mobile Integrated Healthcare (MIH), also known as community paramedicine when delivered by an EMS system, serves a wide range of patients in the out-of-hospital setting by providing 24/7 needs-based at-home integrated acute care, chronic care and prevention services. My presentation, entitled “Mobile Integrated Healthcare: The evolving role of EMTs and Paramedics in community health,” shared an overview of the problems with the U.S. emergency care system and benefits of implementing community paramedicine programs on both cost and quality of care. After presenting the general principals and components of Mobile Integrated Health, I profiled two notable MIH programs: the CHF Readmissions Prevention Program at MedStar Mobile Healthcare in Fort Worth, TX and the Mobile Upstream Crisis Intervention Unit out of Grady EMS in Atlanta.
There were many other outstanding student presentations at the conference. In the panel I participated in, student speakers presented on the intersections of Western medicine and folk medicine, health disparities in Peru, the impact of medical NGOs in Guatemala, and the importance of cultural competency in international public health. In the afternoon, I attended the session on health disparities and chronic conditions. Three of the presentations in this session focused on local public health problems in Georgia, including diabetes, nutrition and obesity, as well as food insecurity.
Overall, I greatly enjoyed my experience at the conference. In addition to furthering my knowledge of public health topics, I relished the opportunity to meet students interested in health from other schools nearby in the metro Atlanta area. I look forward to presenting again next year, and hope that more students and faculty members from the Center for the Study of Human Health will participate in this amazing opportunity.
The Global Advances in Health and Medicine Journal (GAHMJ), is an international, peer reviewed, scholarly medical journal, launched in March 2012. The journal has three areas of primary focus: (1) global convergences in health and medicine, (2) whole systems approaches in healthcare, and (3) high quality case reports. The July issue features health and wellness coaching.
One of the articles in the journal, “Engaging Young Adults in Proactive Health Behaviors: A Goal Setting Process” features the CSHH Human Health Program and highlights the success for goal achievement by applying the skills learned in a one semester class that is a blend of academic health education and wellness coaching.
Read the full article here.
Congratulations to the Human Health faculty, staff and students!
How does your mood and innermost feelings affect your physical health? Numerous studies have been published on the subject, with the majority finding that positivity and happiness are associated with improved health and well-being.
However, a recent study published in PNAS finds contradictory results that highlight how study criteria - for example the definition of happiness - may affect conclusions about the link between happiness and well-being and points towards the meaningfullness that one feels as an important driver of this relationship. Read more about recent studies of health and happiness in this article by the Atlantic: http://www.theatlantic.com/health/archive/2013/08/meaning-is-healthier-than-happiness/278250/.
According to a new report published by a team from Bowling Green State University, obese applicants are less likely to be accepted to a graduate school program when an in-person interview is involved. Further, women were more likely to be accepted after an in-person interview when their BMI was lower. See this description of the study by the U.S. News & World Report, or read the article as it was published in the May 2013 issue of Obesity.