Remote satellite methodology predicts cholera outbreaks months in advance with greater accuracy

Main Category: Tropical Diseases
Also Included In: Public Health
Article Date: 19 Aug 2013 - 0:00 PDT Current ratings for:
Remote satellite methodology predicts cholera outbreaks months in advance with greater accuracy

In two recently published papers, Tufts University School of Engineering researchers have established new techniques for predicting the severity of seasonal cholera epidemics months before they occur and with a greater degree of accuracy than other methods based on remote satellite imaging. Taken together, findings from these two papers may provide the essential lead time to strengthen intervention efforts before the outbreak of cholera in endemic regions.

Cholera is an acute diarrheal disease caused by the bacterium Vibrio cholerae. It occurs in the spring and fall in the Bengal delta. In past research, scientists have used chlorophyll, a surrogate for phytoplankton, as a measuring stick for cholera. The cholera bacteria lives and thrives among phytoplankton and zooplankton.

In the June issue of Remote Sensing Letters, Antarpreet Jutla, then a doctoral student at Tufts School of Engineering and now on the faculty at West Virginia University, was lead author on a study that measured chlorophyll and other organic matter.

The team, which was led by Shafiqul Islam, Ph.D., professor of civil and environmental engineering at Tufts School of Engineering, used satellite data to measure chlorophyll and algae, organic substances, and flora that also support growth of the cholera bacteria.

Using satellite images, the researchers created a "satellite water marker" (SWM) index to estimate the presence of organic matter including chlorophyll and plankton based on wavelength measurements.

A predominance of green, plankton-rich water - which is measured at 555 nanometers - indicated the degree to which the waters contained chlorophyll, plankton, and other impurities. Clear, blue water - measured at 412 nanometers - indicated low levels of these impurities, according to the researchers.

The researchers targeted the spring epidemic, which is a coastal phenomenon caused by water flow into the delta from three principal rivers - the Brahmaputra, Ganges, and Meghna. Unlike the spring outbreak, the fall epidemic is linked to flooding which follows the monsoons and subsequent breakdown of sanitary conditions rather than coastal conditions.

In their study, the researchers correlated cholera incidence from the International Center for Diarrheal Disease Research, Bangladesh from 1997 to 2010 with satellite imaging data from the National Aeronautics and Space Administration for the same time period.

They discovered a relationship between SWM index measurements taken in early winter - from October to December - and the severity of cholera epidemics in the following spring. "In short, the index for chlorophyll along with readings for other biological matter in early winter indicated severity of cholera incidences in the spring," says Jutla.

The SWM is a more accurate predictor of cholera than the algorithm that measures strictly chlorophyll levels because it also measures a broader range of organic matter, says Islam.

"The probability for error in this index-based estimate is less than 10 percent while the error in using the chlorophyll-based algorithm is about 30 percent," says Islam. To validate their hypothesis that the index can be used in coastal areas outside of the Bengal Delta, the team applied the SWM to coastal waters around Mozambique's capital city, Maputo.

Additional authors on this paper are Abu Syed Golam Faruque, and Rita Colwell of the Center for Bioinformatics and Computational Biology at the University of Maryland, and Anwar Huq of the Maryland Pathogenic Research Institute at the University of Maryland. Another member of the team, Ali Shafqat Akanda, was with the Center for Bioinformatics and Computational Biology at UM and is now on the faculty at the University of Rhode Island. He was a doctoral student at Tufts during the research.

In a separate paper that was published online in the journal Environmental Modeling and Software, ahead of the September 1 print edition, Jutla, Islam, and Akanda showed that air temperature in the Himalayan foothills can also be a factor in predicting spring cholera.

The researchers collected air temperature data during the early winter months (October-December) in the foothills. In seasons of warm temperature, the foothills experienced higher than normal precipitation and early snow melt. This caused higher than normal water flow in the Ganges, Brahmaputra and Meghna Rivers and eventually into the Bay of Bengal during the drought period. Higher river flow into the delta impedes plankton-carrying seawater from moving inland

When correlated with satellite data on chlorophyll levels, the researchers found that air temperatures could lessen the extent of cholera even when chlorophyll levels were high.

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"A Water Marker Monitored by Satellites to Predict Seasonal Endemic Cholera," Antarpreet Jutla, Ali Shafqat Akanda, Anwar Huq, Abu Syed Golam Faruque, Rita Colwell, and Shafiqul Islam, Remote Sensing Letters, published on line before print June 3, 2013, Vol. 4, No. 8, 822.http://dx.doi.org/10.1080/2150704X.2013.802097

The research reported in this paper was supported, in part, from National Institutes of Health (NIH) grants 1RCTW008587-01 and 2R01A1039129-11A2.

"A framework for predicting endemic cholera using satellite derived environmental determinants," Antarpreet S. Jutla, Ali S. Akanda, Shafiqul Islam, Environmental Monitoring and Software, published online before print http://dx.doi.org/10.1016/j.envsoft.2013.05.008

The research reported in this paper was supported through NIH funding under award number 1RCTW008587-01. Dr. Jutla acknowledges the support from Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV.

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The rising toll of obesity: Mortality greater than previously thought

Main Category: Obesity / Weight Loss / Fitness
Article Date: 18 Aug 2013 - 0:00 PDT Current ratings for:
The rising toll of obesity: Mortality greater than previously thought

Obesity is a lot more deadly than previously thought. Across recent decades, obesity accounted for 18 percent of deaths among Black and White Americans between the ages of 40 and 85, according to a study funded by the Robert Wood Johnson Foundation. This finding challenges the prevailing wisdom among scientists, which puts that portion at around 5%.

"Obesity has dramatically worse health consequences than some recent reports have led us to believe," says first author Ryan Masters, PhD, who conducted the research as a Robert Wood Johnson Foundation Health & Society Scholar at Columbia University's Mailman School of Public Health. "We expect that obesity will be responsible for an increasing share of deaths in the United States and perhaps even lead to declines in U.S. life expectancy."

While there have been signs that obesity is in decline for some groups of young people, rates continue to be near historic highs. For the bulk of children and adults who are already obese, the condition will likely persist, wreaking damage over the course of their lives.

In older Americans, the rising toll of obesity is already evident. Dr. Masters and his colleagues documented its increasing effect on mortality in White men who died between the ages of 65 and 70 in the years 1986 to 2006. Grade one obesity (body mass index of 30 to less than 35) accounted for about 3.5% of deaths for those born between 1915 and 1919 - "a grouping known as a birth cohort. For those born 10 years later, it accounted for about 5% of deaths. Another 10 years later, it killed off upwards of 7%.

When the obesity epidemic hit in the 1980s, it hit across all age groups, so older Americans have lived through it for a relatively short period of time. But younger age groups will be exposed to the full brunt for much longer periods.

"A 5-year-old growing up today is living in an environment where obesity is much more the norm than was the case for a 5-year-old a generation or two ago. Drink sizes are bigger, clothes are bigger, and greater numbers of a child's peers are obese," explains co-author Bruce Link, PhD, professor of epidemiology and sociomedical sciences at Columbia University's Mailman School of Public Health. "And once someone is obese, it is very difficult to undo. So it stands to reason that we won't see the worst of the epidemic until the current generation of children grows old."

A New Way of Looking at a Growing Problem

This study is the first to account for differences in age, birth cohort, sex, and race in analyzing Americans' risk for death from obesity. "Past research in this area lumped together all Americans, but obesity prevalence and its effect on mortality differ substantially based on your race or ethnicity, how old you are, and when you were born," says Dr. Masters. "It's important for policy-makers to understand that different groups experience obesity in different ways."

The researchers analyzed 19 waves of the National Health Interview Survey linked to individual mortality records in the National Death Index for the years 1986 to 2006, when the most recent data are available. They focused on ages 40 to 85 in order to exclude accidental deaths, homicides, and congenital conditions that are the leading causes of death for younger people. The study builds on earlier research by Dr. Masters that found, contrary to conventional wisdom, that risk for death from obesity increases with age. The new study is also influenced by previous work by co-authors Eric Reither, PhD, associate professor at Utah State University, and Claire Yang, PhD, associate professor at the University of North Carolina-Chapel Hill, which showed significant cohort differences in U.S. obesity rates.

Obesity's Varying Effects by Sex and Race

In the groups studied, Black women had the highest risk of dying from obesity or being overweight at 27 percent, followed by White women at 21 percent. Obesity in Black women is nearly twice that of White women. White men fared better at 15%, and the lowest risk for dying from being obese was 5%, for Black men. While White men and Black men have similar rates of obesity, the effect of obesity on mortality is lower in Black men because it is "crowded out" by other risk factors, from high rates of cigarette smoking to challenging socioeconomic conditions. There were insufficient data to make estimates for Asians, Hispanics, and other groups due to the highly stratified nature of the methodology.

In sum, by using a new, more rigorous approach, the new research shows that obesity is far more consequential than previously recognized, that the impact of the epidemic is only beginning to be felt, and that some population groups are affected much more powerfully than others.

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Daniel Powers of the University of Texas at Austin and Andrew E. Burger of Utah State University also contributed to the paper.

The study, "The Impact of Obesity on U.S. Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates," was published online in the American Journal of Public Health. doi: 10.2105/AJPH.2013.301379

Columbia University's Mailman School of Public Health

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Children of obese mothers at greater risk of early heart death as adults

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Cardiovascular / Cardiology
Article Date: 14 Aug 2013 - 0:00 PDT Current ratings for:
Children of obese mothers at greater risk of early heart death as adults

Children of obese and overweight women have a higher risk of early cardiovascular death as adults, finds a study published on bmj.com.

The findings highlight the urgent need for strategies to prevent obesity in women of childbearing age and the need to assess the offspring of obese mothers for their cardiovascular risk, say the authors.

Rates of maternal obesity have risen rapidly in the past two decades. In the United States, about 64% of women of reproductive age are overweight and 35% are obese, with a similar pattern in Europe.

Many studies have shown a link between maternal obesity and disease later in life, but it is still not clear whether maternal obesity is associated with increased death in offspring from cardiovascular causes.

Using birth and death records from 1950 to the present day, a team of researchers from the Universities of Edinburgh and Aberdeen in Scotland identified 28,540 women - whose body mass index (BMI) was recorded at their first antenatal visit - and their 37,709 offspring who were aged between 34 and 61 at the time of follow up.

BMI was defined as underweight (BMI 18.5 or less), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI 30 or more).

Relevant details about the pregnancy were collated, including the mother's age at delivery, number of previous pregnancies, mother and father's social class and infant sex, birth weight and gestation at delivery.

Among the mothers, 21% were overweight and 4% were obese. Among the 37,709 offspring there were 6551 premature deaths from any cause and, among the deceased, 294 had had obese mothers at birth.

The researchers found that the risk of premature death was 35% higher in the adult offspring of obese mothers compared to those whose mothers had had normal weight. This was after adjusting the results for factors including the mother's age at delivery, number of previous pregnancies, mother and father's social class and infant sex, birth weight and gestation at delivery.

They also found a 42% increased risk (adjusted for the same factors) of a hospital admission for a cardiovascular event in the adult offspring of obese mothers compared with offspring of mothers with normal BMI.

The offspring of overweight mothers also had a higher risk of adverse events later in life.

It is thought that being overweight in pregnancy may cause permanent changes in appetite control and energy metabolism in the offspring, leading to a greater risk of heart problems later in life.

With rising rates of excess weight among pregnant women, the authors say their findings are "a major public health concern" and indicate that the offspring of obese mothers are a high risk group who should be assessed for cardiovascular risk, and actively encouraged to maintain a healthy lifestyle.

"As one in five women in the UK is currently obese at antenatal booking, strategies to optimise weight before pregnancy are urgently required," they conclude.

Dr Sohinee Bhattacharya, of the University of Aberdeen, said: "This study highlights the importance of weight management in mothers and their offspring. We need to find out how to help young women and their children control their weight better so that chronic disease risk is not transmitted from generation to generation."

Jacqui Clinton, Health Campaigns Director at Tommy's, said: "This new study adds to a growing body of evidence that obesity during pregnancy can have a long term impact on children, affecting their adult weight, health and even their life expectancy. If we are to tackle obesity in the UK, we need to start at conception and help mums to limit the impact of their weight on their babies - research shows that eating a healthy diet and taking moderate exercise while pregnant can make a big difference. Looking after a baby's health while in the womb may not only increase the chances of a healthy birth, but of a longer, healthier life."

In an accompanying editorial, Dr Factor-Litvak from the Department of Epidemiology in New York, says that this study leaves open two questions. Firstly, what is the role of the early post natal environment and secondly, what is the role of parental obesity? She asks what the implications of the study are, concluding that along with recommended weight gain for overweight and obese women, "interventions should begin before pregnancy".

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Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk

Main Category: Cardiovascular / Cardiology
Article Date: 13 Aug 2013 - 13:00 PDT Current ratings for:
Earlier surgical correction of heart valve disorder associated with greater long-term survival, lower risk of heart failure risk

In a study that included patients with mitral valve regurgitation due to a condition known as flail mitral valve leaflets, performance of early surgical correction compared with initial medical management was associated with greater long-term survival and lower risk of heart failure, according to a study in the August 14 issue of JAMA.

"Degenerative mitral regurgitation [backflow of blood from the left ventricle to the left atrium due to mitral valve insufficiency] is common and can be surgically repaired in the vast majority of patients, improving symptoms and restoring normal life expectancy. Despite the safety and efficacy of contemporary surgical correction, an ongoing international debate persists regarding the need for early intervention in patients without American College of Cardiology (ACC)/American Heart Association (AHA) guideline class I triggers (no or minimal symptoms and absence of left ventricular dysfunction). This is in part propagated by discordant views of the prognostic consequences of uncorrected severe mitral regurgitation; considered as benign by those supporting medical watchful waiting (nonsurgical observation until a distinct event is encountered) vs. conveying excess mortality and morbidity (including heart failure and atrial fibrillation) by those advocating early surgical intervention," according to background information in the article.

To understand the comparative effectiveness of early surgery vs. initial medical management strategies, Rakesh M. Suri, M.D., D.Phil., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues conducted a study to ascertain the comparative effectiveness of initial medical management (nonsurgical observation) vs. early mitral valve surgery following the diagnosis of mitral regurgitation due to flail leaflets (an abnormality of the mitral valve in which a portion of the valve has lost its normal support). For the study, the researchers used data from the Mitral Regurgitation International Database (MIDA) registry, which includes 2,097 patients with flail mitral valve regurgitation (1980-2004) receiving routine cardiac care from 6 tertiary centers (France, Italy, Belgium, and the United States). Of 1,021 patients with mitral regurgitation without ACC and AHA guideline class I triggers, 575 patients were initially medically managed and 446 underwent mitral valve surgery within 3 months following detection.

Within 3 months following diagnosis, 8 patients died, 5 (1.1 percent) after early surgery vs. 3 (0.5 percent) during initial medical management; 9 patients developed heart failure, 4 (0.9 percent) after early surgery vs. 5 (0.9 percent) during initial medical management; and 30 patients developed new-onset atrial fibrillation, 6.2 percent after early surgery vs. 1.2 percent during initial medical management.

Ninety-eight percent of patients were followed up from diagnosis until death or at least 5 years. A total of 319 deaths were observed during an average follow-up time of 10.3 years. "Survival among the entire unmatched cohort for early surgery was 95 percent at 5 years, 86 percent at 10 years, 63 percent at 20 years vs. 84 percent at 5 years, 69 percent at 10 years, and 41 percent at 20 years for initial medical management, favoring early surgery," the authors write. Early surgical correction of mitral valve regurgitation was associated with a 5-year reduction in mortality of 53 percent.

With class II triggers (atrial fibrillation or pulmonary hypertension), survival was again better with early surgery, both overall and in the matched cohort at 10 years.

During follow-up, 167 patients incurred at least 1 incident episode of heart failure representing a rate of 16 percent at 10 years and 27 percent at 20 years. In the overall cohort, heart failure was less frequent after early surgery (7 percent for early surgery vs. 23 percent for initial medical management at 10 years and 10 percent for early surgery vs. 35 percent for initial medical management at 20 years), with a heart failure risk reduction of approximately 60 percent.

Reduction in late-onset atrial fibrillation was not observed.

"These findings emanate from institutions that together provide a very high rate of mitral valve repair (>90 percent) with low operative mortality, emphasizing that such results might also be achieved in routine practice at many advanced repair centers," the authors write. "The advantages associated with early surgical correction of mitral valve regurgitation were confirmed in both unmatched and matched populations, using multiple statistical methods."

In an accompanying editorial, Catherine M. Otto, M.D., of the University of Washington School of Medicine, Seattle, comments on how the findings of this study may influence patient care.

"The study group is atypical compared with most patients with chronic severe mitral regurgitation seen in clinical practice who are referred for surgical intervention at symptom onset or when serial imaging shows early left ventricular (LV) dysfunction. In patients with severe mitral regurgitation due to mitral valve prolapse, early surgery is reasonable if surgical risk is low and the likelihood of successful valve repair is high, which is often the case for patients with a flail leaflet; the new data support this recommendation."

"However, if surgical risk is high or if the likelihood of valve repair is low, it remains uncertain whether early surgical intervention is appropriate in the asymptomatic patient with severe mitral regurgitation due to a flail leaflet when LV size and systolic function are normal. Although the majority of these patients will develop clear indications for valve surgery within 2 years, it may be reasonable to postpone the risks of having an intervention and having a prosthetic valve as long as possible."

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Article - JAMA. 2013;310(6):609-616

Editorial - JAMA. 2013;310(6):587-588

JAMA

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Greater success in personalized medicine class by students who underwent genetic testing

Main Category: Medical Students / Training
Also Included In: Genetics
Article Date: 25 Jul 2013 - 0:00 PDT Current ratings for:
Greater success in personalized medicine class by students who underwent genetic testing

Students who had their genome tested as part of a groundbreaking medical school course on personalized medicine improved their knowledge of the class materials by an average of 31 percent compared with those who didn't undergo the testing, according to a study by researchers at the Stanford University School of Medicine.

While the sample size was small - 23 students sent their saliva to a commercial genetics testing company; eight did not - the results may encourage educators to consider this approach in the future, the authors said.

"These results indicate that learning principles of human genetics is more powerful, and learning is more sustained, when exploring your own data," said Keyan Salari, MD, PhD, a former Stanford student who initially proposed the course, called "Genomics and Personalized Medicine." Salari, who is the lead author of the study, is now a urology resident at the Massachusetts General Hospital in Boston. The study was published in PLOS ONE.

The eight-week elective course was the first in the country to give students in advanced-degree programs the option of personal genotyping as part of the curriculum. It was designed to teach them how the explosion of knowledge about genetics over the past 10 years could affect the treatment of patients. Since the course was first offered in 2010, the use of genetic testing in clinical care has grown.

The course, which is still being taught, was designed as a way to train future doctors and scientists in the skills necessary to use this new tool. The study, which was based on a pre- and post-course survey taken voluntarily by the majority of the students in the class, also showed that personal testing and the use of personal genotype data in the classroom did not appear to cause significant anxiety.

"This was a novel teaching approach," said Kelly Ormond, co-author of the study and associate professor of genetics. "There is always a lot of interest in whether personalized learning can influence education. ... What our study shows is that it might have benefits for some self-selected students, and is worthy of cautious consideration."

Initially controversial, the course was only approved after a campus task force met regularly for a year to debate the pros and cons of students undergoing genetic testing as part of a class. A number of concerns were raised, including the possible anxiety of learning they could be more susceptible to certain diseases, such as diabetes or Parkinson's. A number of safeguards were subsequently included as part of the course plan, including complete anonymity as to which students chose to undergo testing.

Salari conceived of the idea for the course in 2009 as a PhD student in genetics. He was working as a teaching assistant in the first-year human genetics course for medical students. At the time, the course curriculum consisted primarily of traditional genetics and didn't reflect the genomics revolution of the past 10 years. Salari had also recently undergone his own genetic testing, and saw the educational benefits.

"I was curious about what stories were hidden in my genome, what health risks, what responses to drugs that might be predicted," Salari said. "For instance, I learned I might have a higher risk for age-related macular degeneration. That led me to read and learn a lot more about the genetics of that disease than I probably would have otherwise."

He added: "I wanted to find a way to translate my passion for genomics to all these medical students."

Study results also showed that 83 percent of students who chose to undergo testing were pleased with their decision. Seventy percent of those who underwent the testing reported a better understanding of human genetics on the basis of having undergone testing. The post-course survey also asked students who underwent the testing whether they made any behavioral changes based on the results, such as lifestyle changes or making appointments with doctors. Some initial behavior changes were reported. Yet in a previous study involving face-to-face interviews with the same students, no behavior changes were reported six months after the end of the course.

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Other Stanford authors included Konrad Karczewski, a bioinformatics PhD student, and Louanne Hudgins, MD, professor of pediatrics and of medical genetics.

Stanford University Medical Center

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