Boston, MA – A new discovery about how cells move inside the body may provide scientists with crucial information about disease mechanisms such as the spread of cancer or the constriction of airways caused by asthma. Led by researchers at Harvard School of Public Health (HSPH) and the Institute for Bioengineering of Catalonia (IBEC), investigators found that epithelial cells—the type that form a barrier between the inside and the outside of the body, such as skin cells—move in a group, propelled by forces both from within and from nearby cells—to fill any unfilled spaces they encounter.

The study appears June 23, 2013 in an advance online edition of Nature Materials.

“We were trying to understand the basic relationship between collective cellular motions and collective cellular forces, as might occur during cancer cell invasion, for example. But in doing so we stumbled onto a phenomenon that was totally unexpected,” said senior author Jeffrey Fredberg, professor of bioengineering and physiology in the HSPH Department of Environmental Health and co-senior investigator of HSPH’s Molecular and Integrative Cellular Dynamics lab.

Biologists, engineers, and physicists from HSPH and IBEC worked together to shed light on collective cellular motion because it plays a key role in functions such as wound healing, organ development, and tumor growth. Using a technique called monolayer stress microscopy—which they invented themselves—they measured the forces affecting a single layer of moving epithelial cells. They examined the cells’ velocity and direction as well as traction—how some cells either pull or push themselves and thus force collective movement.

As they expected, the researchers found that when an obstacle was placed in the path of an advancing cell layer—in this case, a gel that provided no traction—the cells moved around it, tightly hugging the sides of the gel as they passed. However, the researchers also found something surprising—that the cells, in addition to moving forward, continued to pull themselves collectively back toward the gel, as if yearning to fill the unfilled space. The researchers dubbed this movement “kenotaxis,” from the Greek words “keno” (vacuum) and “taxis” (arrangement), because it seemed the cells were attempting to fill a vacuum.

This new finding could help researchers better understand cell behavior—and evaluate potential drugs to influence that behavior—in a variety of complex diseases, such as cancer, asthma, cardiovascular disease, developmental abnormalities, and glaucoma. The finding could also help with tissue engineering and regenerative medicine, both of which rely on cell migration.

In carcinomas, for instance—which represent 90% of all cancers and involve epithelial cells—the new information on cell movement could improve understanding of how cancer cells migrate through the body. Asthma research could also get a boost, because scientists think migration of damaged epithelial cells in the lungs are involved in the airway narrowing caused by the disease.

“Kenotaxis is a property of the cellular collective, not the individual cell,”  said Jae Hun Kim, the study’s first author. “It was amazing to us that the cellular collective can organize to pull itself systematically in one direction while moving systematically in an altogether different direction.”

Other HSPH authors included James Butler, senior lecturer on physiology in the Department of Environmental Health and co-senior investigator of the lab; and researchers Dhananjay Tambe, Enhua Zhou, Chan Young Park, Monirosadat Sadati, Jin-Ah Park, Bomi Gweon, and Emil Millet.

Support for the study came from the Spanish Ministry for Science and Innovation (BFU2012-38146 and FPU fellowship XS), the Swiss National Science Foundation (PBEZP2-140047), the National Research Foundation of Korea (2012R1A6A3A03040450), the European Research Council (Grant Agreement 242993), Parker B. Francis (Fellowship RK), American Heart Association (13SDG14320004), and the National Institutes of Health (R01HL102373, R01HL107561).

“Propulsion and navigation within the advancing monolayer sheet,” Jae Hun Kim, Xavier Serra-Picamal, Dhananjay T. Tambe, Enhua Zhou, Chan Young Park, Monirosadat Sadati, Jin-Ah Park, Ramaswamy Krishnan, Bomi Gweon, Emil Millet, James Butler, Xavier Trepat, Jeffrey J. Fredberg, Nature Materials, online, June 23, 2013

Illustration by Mark Lefkowitz

For more information:
Marge Dwyer
617.432.8416
mhdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

HSPH on Twitter:http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

Boston, MA — Women in the U.S. exposed to high levels of air pollution while pregnant were up to twice as likely to have a child with autism as women who lived in areas with low pollution, according to a new study from Harvard School of Public Health (HSPH). It is the first large national study to examine links between autism and air pollution across the U.S.

“Our findings raise concerns since, depending on the pollutant, 20% to 60% of the women in our study lived in areas where risk of autism was elevated,” said lead author Andrea Roberts, research associate in the HSPH Department of Social and Behavioral Sciences.

The study appeared online June 18, 2013 in Environmental Health Perspectives.

Exposure to diesel particulates, lead, manganese, mercury, methylene chloride and other pollutants are known to affect brain function and to affect the developing baby. Two previous studies found associations between exposure to air pollution during pregnancy and autism in children, but those studies looked at data in just three locations in the U.S.

The researchers examined data from Nurses’ Health Study II, a long-term study based at Brigham and Women’s Hospital involving 116,430 nurses that began in 1989. Among that group, the authors studied 325 women who had a child with autism and 22,000 women who had a child without the disorder. They looked at associations between autism and levels of pollutants at the time and place of birth. They used air pollution data from the U.S. Environmental Protection Agency to estimate women’s exposure to pollutants while pregnant. They also adjusted for the influence of factors such as income, education, and smoking during pregnancy.

The results showed that women who lived in the 20% of locations with the highest levels of diesel particulates or mercury in the air were twice as likely to have a child with autism as those who lived in the 20% of areas with the lowest levels.

Other types of air pollution—lead, manganese, methylene chloride, and combined metal exposure—were associated with higher autism risk as well. Women who lived in the 20% of locations with the highest levels of these pollutants were about 50% more likely to have a child with autism than those who lived in the 20% of areas with the lowest concentrations.

Most pollutants were associated with autism more strongly in boys than girls. However, since there were few girls with autism in the study, the authors said this finding should be examined further.

Senior author Marc Weisskopf, associate professor of environmental and occupational epidemiology at HSPH, said, “Our results suggest that new studies should begin the process of measuring metals and other pollutants in the blood of pregnant women or newborn children to provide stronger evidence that specific pollutants increase risk of autism. A better understanding of this can help to develop interventions to reduce pregnant women’s exposure to these pollutants.”

Other HSPH authors included Alberto Ascherio, professor of epidemiology and nutrition; Kristen Lyall, visiting scientist in the Department of Nutrition; Jaime Hart, instructor in the Department of Environmental Health; Francine Laden, Mark and Catherine Winkler Associate Professor of Epidemiology in the Department of Epidemiology; Allan Just, research fellow in the Department of Environmental Health; and Jennifer Bobb, research fellow in the Department of Biostatistics.

Support for the study came from DOD W81XWH-08-1-0499, USAMRMC A-14917, NIH T32MH073124-08, P60AR047782 and R01ES017017-04. The Nurses’ Health Study II is funded in part by NIH CA50385.

“Perinatal air pollutant exposures and autism spectrum disorder in the children of Nurses’ Health Study II participants,” Andrea L. Roberts, Kristen Lyall, Jaime E. Hart, Francine Laden, Allan C. Just, Jennifer F. Bobb, Karestan C. Koenen, Alberto Ascherio, and Marc G. Weisskopf, Environmental Health Perspectives, online June 18, 2013

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

photo: iStockphoto/acilo

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

For immediate release: June 4, 2013

Princeton, N.J. – A new poll released today finds that nearly half (44%) of employed African Americans are very or somewhat concerned that they or someone in their household might be out of work and looking for a job in the next 12 months. In addition, almost half (45%) are not confident that they would have sufficient money or health insurance to pay for a major illness. Also, about one-third (36%) of all African Americans report that, at least a few times a year, they have had specific experiences of racism.

Overall Life Satisfaction

The majority of African Americans (86%) still say they are satisfied with their lives, including almost half (48%) who say they are very satisfied. A similar number report being satisfied with the communities in which they live (82%), including 44% who are very satisfied. The highest levels of satisfaction in the current poll are reported by married people, those with incomes of $75,000 or higher, and those aged 65 or older.

Health and Economic Problems

Some encounter significant problems paying for or accessing health care. Three in ten African Americans (30%) report that in the past 12 months, they or a family member has had a serious problem paying  doctor and hospital bills. About one in four (24%) say they had a serious problem with paying for prescription medicines. About one in six (16%) report a serious problem getting health care that was needed, and one in ten (10%) report a serious problem getting mental health care.

High blood pressure/stroke and diabetes are the top health concerns for African American families. When asked to say in their own words what is the biggest health problem for their family, one in five African Americans cite high blood pressure/stroke (20%) and diabetes (19%). The next two most frequently cited problems, cancer (7%) and heart disease (6%), were mentioned by fewer than one in ten.

“To make living healthy easier for our diverse society, we need to acknowledge that health starts where we live, work, learn and play. If we’re going to create a national culture of health, we need to focus as much on factors such as education and employment as we do on providing affordable and equal access to high-quality, high-value care,” said RWJF President and CEO, Risa Lavizzo-Mourey, MD.

African Americans are almost evenly divided on the state of their personal finances. Half (50%) say their finances are not so good or poor, while about half (49%) say they are excellent or good. Those who feel their financial situation is not so good or poor differ significantly on a wide range of measures from those who feel their financial situation is excellent or good.

“We find that the economic situation facing African Americans has an impact across a range of issues in their lives. The half who report that they are doing well financially say that things are better in many different aspects of their lives,” said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Those who rate their finances as not so good or poor are more likely to be concerned that they or someone in their household will be out of work in the next 12 months (58% vs. 32%). They are also more likely to say they are not confident they could pay for a major illness (60% vs. 28%) in the future and were more likely to report having had a serious problem in the last year paying medical bills (39% vs. 20%) or paying for prescription medicine (32% vs. 17%). They were less likely to give their communities an A or B rating on many aspects rated, including safety from crime (41% vs. 64%) and parks and sports facilities (48% vs. 72%).

The poll is part of a series developed by NPR, the Robert Wood Johnson Foundation, and Harvard School of Public Health.

Click here to read the poll summary.

Click here to see the charts.

NPR is reporting on the findings in a multi-part series, “The View From Black America,” beginning today on Morning Edition, All Things Considered and Tell Me More. Stories in the series are at www.NPR.org.

The research team consists of the following members at each institution:

Harvard School of Public Health: Robert J. Blendon, Professor of Health Policy and Political Analysis and Executive Director of HORP; John M. Benson, Research Scientist and Managing Director of HORP; Kathleen J. Weldon, Research and Administrative Manager; Alecia McGregor, Research Fellow.

Robert Wood Johnson Foundation: Fred Mann, Associate Vice President, Communications; Debra Joy Pérez, Assistant Vice President, Research and Evaluation; Carolyn Miller, Senior Program Officer, Research and Evaluation; and Ari Kramer, Communications Officer.

NPR: Anne Gudenkauf, Senior Supervising Editor, Science Desk; Joe Neel, Deputy  Senior Supervising Editor, Science Desk; Vickie Walton-James, Deputy Senior Supervising Editor, National Desk; Matt Thompson, Editorial Product Manager.

Interviews were conducted via telephone (including both landline and cell phone) January 10 – February 7, 2013 among a nationally representative sample of 1081 African Americans age 18 and older. The interviews were conducted in English and Spanish. The margin of error for total respondents is +/- 4.3 percentage points at the 95% confidence level. The interviews were conducted by SSRS of Media (PA).

Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases and for variations in probability of selection within and across households, sample data are weighted by household size, cell phone/landline use and demographics (sex, age, education, marital status and census region) to reflect the true population. Other techniques, including random-digit dialing, replicate subsamples, and systematic respondent selection within households, are used to ensure that the sample is representative.

Visit the HSPH website for the latest news, press releases and multimedia offerings.

# # #

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health. For more information on the School, visit www.hsph.harvard.edu.

HSPH on Twitter: http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and healthcare of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter at www.rwjf.org/twitter or Facebook at www.rwjf.org/facebook.

NPR is an award-winning, multimedia news organization and an influential force in American life. In collaboration with more than 900 independent public radio stations nationwide, NPR strives to create a more informed public – one challenged and invigorated by a deeper understanding and appreciation of events, ideas and cultures. NPR reaches a growing audience of 27 million listeners weekly; to find local stations and broadcast times for NPR programs, visit www.npr.org/stations

For more information:
Marge Dwyer
617.432.8416
mhdwyer@hsph.harvard.edu

The study appears online May 16, 2013 and will appear in the July 2013 print edition of the American Journal of Public Health.

Standards set by the American Association of State Highway and Transportation Officials (AASHTO) in its Guide for the Development of Bicycle Facilities generally serve vehicles well but overlook most bicyclists’ needs, according to lead author Anne Lusk, research scientist in the Department of Nutrition at HSPH, who has been studying bicycling patterns in the U.S. and abroad for many years. “In the U.S., the default remains the painted bike lane on the road,” she said, which is problematic since research has shown that women, seniors, and children prefer not to ride on roads with traffic.

According to the researchers, the AASHTO guidelines discouraged or did not include cycle tracks due to alleged safety concerns and did not cite research about crash rates on cycle tracks. This study analyzed five state-adopted U.S. bicycle guidelines published between 1972 and 1999 to understand how the guidelines have directed the building of bicycle facilities in the U.S. They also wanted to find out how crash rates on the cycle tracks that had been built compared with bicycle crash rates on roadways in the U.S. They identified 19 cycle tracks in 14 cities in the U.S. and found these cycle tracks had an overall crash rate of 2.3 per one million bicycle kilometers ridden, which is similar to crash rates found on Canadian cycle tracks and lower than published crash rates from cities in North America for bicycling in the road without any bicycle facilities.

Anne Lusk stressed the new overlap of transportation and public health. “Bicycling, even more than walking, helps control weight and we need to provide comfortable and separate bicycle environments on existing roads so everyone has a chance for good health.”

The authors concluded AASHTO bicycle guidelines should be based on more rigorous and up-to-date research. If policies could allow for easier construction of cycle tracks, studies have indicated that more individuals would be willing to bicycle. Encouraging more cycling would be helpful for weight control, heart function, and would boost physical fitness for children and adults in addition to helping to reduce traffic congestion and air pollution from vehicles, said the authors.

“We believe this research is a major step toward urban bicycle networks that are safer and more inviting for riders across all demographics,” said Steven Bercu of the Helen and William Mazer Foundation, which funded the study. “As cities promote bicycling, it is critical that planners, engineers and others have access to research that points to the safest options, rather than just repeating designs based on assumptions that were never properly studied.”

Additional support for the study included a Ruth L. Kirschstein National Research Service Award (F32 HL083639) from the National Institutes of Health. Luis Miranda-Moreno was supported by the Natural Sciences and Engineering Research Council of Canada.

“Bicycle Guidelines and Crash Rates on Cycle Tracks in the United States,” Anne C. Lusk, Patrick Morency, Luis F. Miranda-Moreno, Walter C. Willett, Jack T. Dennerlein. American Journal of Public Health, online May 16, 2013; July 2013 print edition.

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

HSPH on Twitter: http://twitter.com/Harvard
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

The study appears in the online May 7, 2013 issue of Cell Metabolism.

“Although it has long been recognized that a key event leading to development of type 2 diabetes is uncontrolled glucose production from the liver, underlying mechanisms have been elusive,” said senior author Gökhan S. Hotamisligil, chair of the Department of Genetics and Complex Diseases and J.S. Simmons Professor of Genetics and Metabolism at HSPH. “We now have identified aP2 as a novel hormone released from fat cells that controls this critical function.”

The ability of one organ—in this case, the adipose tissue—to so directly and profoundly control the actions of another—the liver —is in itself very exciting, said Hotamisligil. “We suspect this communication system between adipose tissue and liver may have evolved to help fat cells command the liver to supply the body with glucose in times of nutrient deprivation. However, when the engorged fat cells lose control over this signal in obesity, the blood levels of aP2 rise, glucose is poured into the bloodstream and cannot be cleared by other tissues. The result is high blood glucose levels and type 2 diabetes.

Type 2 diabetes is a metabolic disease that impacts at least 26 million Americans and is linked to heart disease, stroke, and other serious health complications. The disease is often linked to obesity and insulin resistance and a loss of control of glucose production in the liver and insulin production in the pancreas, resulting in too much glucose in the blood.

The majority of cases of type 2 diabetes are related to failure of insulin action in the body. However, for decades researchers and physicians have been faced with a conundrum: not all who are obese or resistant to insulin develop type 2 diabetes. In fact, many patients who are severely obese never develop the disease. As a result scientists have theorized that an unknown factor is involved in regulating glucose metabolism in the liver, and perhaps the presence or absence of this element might determine who gets the disease.

“It was surprising to find that a critical hormone playing a pathological role in diabetes turned out to be the secreted form of aP2, which for decades has been considered a protein that resides inside the fat cells,” said Hotamisligil. In the new study, HSPH researchers first increased the levels of aP2 in normal, healthy mice to match the high blood aP2 levels seen in obese mice and humans. This resulted in impaired glucose metabolism. Next, they reduced the blood aP2 levels in obese and diabetic mice to low levels seen in lean healthy mice. This intervention restored glucose metabolism to its normal status. Therefore, the investigators reached the conclusion that the amount and action of aP2 in blood was critical for diabetes, opening up new avenues for potentially being able control or prevent type 2 diabetes. The researchers also identified a potential therapeutic role for a novel aP2 antibody that neutralizes aP2 activity and corrects type 2 diabetes in mice.

“The consequences of this discovery are profound, and the potential therapeutic applications by switching this protein off have the capability to reshape the way physicians treat diabetes,” said lead author Haiming Cao, postdoctoral fellow in the Department of Genetics and Complex Diseases at HSPH.

This research was funded in part by National Institutes of Health grant DK064360. Individual authors were supported by fellowships from the NIH Roadmap (DK71507-04) and the American Diabetes Association; the Roadmap Grant R90 DK071507 from NIH, and fellowships from the Manpei Suzuki Diabetes Foundation and the Japan Society for the Promotion of Science. The technology described in this study is licensed to the biopharmaceutical company UCB, Union Chimique Belge.

“Adipocyte Lipid Chaperone aP2 is a Secreted Adipokine Regulating Hepatic Glucose Production,” Haiming Cao, Motohiro Sekiya, Meric Erikci Ertunc, M. Furkan Burak, Jared R. Mayers, Ariel White, Karen Inouye, Lisa M. Rickey, Baris C. Ercal, Masato Furuhashi, Gurol Tuncman, and Gökhan S. Hotamisligil, Cell Metabolism, online May 7, 2013 —Vol. 17, 1-11

For more information:

Marge Dwyer
617.432.8416
mhdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

HSPH on Twitter: http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

For immediate release: Sunday, May 5, 2013

Boston, MA — A new study led by researchers from Harvard School of Public Health (HSPH) and the Wellcome Trust Sanger Institute in the UK has, for the first time, used genome sequencing technology to track the changes in a bacterial population following the introduction of a vaccine. The study follows how the population of pneumococcal bacteria changed following the introduction of the ‘Prevnar’ conjugate polysaccharide vaccine, which substantially reduced rates of pneumococcal disease across the U.S. The work demonstrates that the technology could be used in the future to monitor the effectiveness of vaccination or antibiotic use against different species of bacterial pathogens, and for characterizing new and emerging threats.

The study appears online May 5, 2013 in Nature Genetics.

“This gives an unprecedented insight into the bacteria living and transmitting among us,” said co-author William Hanage, associate professor of epidemiology at HSPH. “We can characterize these bugs to an almost unimaginable degree of detail, and in so doing understand better what helps them survive even in the presence of an effective vaccine.”

Pneumococcal disease is caused by a type of bacteria called Streptococcus pneumoniae, which is present in many people’s noses and throats and is spread by coughing, sneezing, or other contact with respiratory secretions. The circumstances that cause it to become pathogenic are not fully understood. Rates of pneumococcal disease—an infection that can lead to pneumonia, meningitis, and other illnesses—dropped in young children following the introduction of a vaccine in 2000. However, strains of the bacteria that are not targeted by the vaccine rapidly increased and drug resistance appears to be on the rise.

The research, led by HSPH co-senior authors Hanage; Marc Lipsitch, professor of epidemiology; and Stephen Bentley, senior scientist at the Wellcome Trust Sanger Institute, aimed to better understand the bacterial population’s response to vaccination. Whole genome sequencing—which reveals the DNA code for each bacterial strain to an unprecedented level of detail—was used to study a sample of 616 pneumococci collected in Massachusetts communities from 2001 to 2007.

This study confirmed that the parts of the bacterial population targeted by the vaccine have almost disappeared, and, surprisingly, revealed that they have been replaced by pre-existing rare types of bacteria. The genetic composition of the new population is very similar to the original one, except for a few genes that were directly affected by the vaccine. This small genetic alteration appears to be responsible for the large reduction in the rates of pneumococcal disease.

“The widespread use of whole genome sequencing will allow better surveillance of bacterial populations — even those that are genetically diverse — and improve understanding of their evolution,” said Lipsitch. “In this study, we were even able to see how quickly these bacteria transmit between different regions within Massachusetts and identify genes associated with bacteria in children of different ages.”

“In the future, we will be able to monitor evolutionary changes in real-time. If we can more quickly and precisely trace the emergence of disease-causing bacteria, we may be able to better target interventions to limit the burden of disease,” said Bentley.

Support for the study was provided by the National Institutes of Health, the Wellcome Trust, and the AXA Foundation.

“Population Genomics of Post-Vaccine Changes in Pneumococcal Epidemiology,” Nicholas J. Croucher, Jonathan A. Finkelstein, Stephen I. Pelton, Patrick K. Mitchell, Grace M. Lee, Julian Parkhill, Stephen D. Bentley, William P. Hanage, Marc Lipsitch  Nature Genetics, online May 5, 2013

For more information:

Todd Datz
Harvard School of Public Health
tdatz@hsph.harvard.edu
617.432.8413

Mark Thomson
Wellcome Trust Sanger Institute
Press.office@sanger.ac.uk
Tel +44 (0)1223492384
Mobile +44 (0)7847302595

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

The Wellcome Trust Sanger Institute is one of the world’s leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease.

The study, led by Katherine Baicker, professor of health economics at Harvard School of Public Health and Amy Finkelstein, Ford professor of economics at MIT, appears in the May 2 issue of the New England Journal of Medicine.

“This study represents a rare opportunity to evaluate the costs and benefits of expanding public insurance using the gold standard of scientific evidence—the randomized controlled trial.  Without a randomized evaluation, it’s difficult to disentangle the effects of Medicaid from confounding factors like income and health needs that also affect outcomes,” said Baicker, co-principal investigator of the study.

In 2008, Oregon held a lottery to give additional low-income, uninsured residents access to its Medicaid program; about 90,000 individuals signed up for the lottery for the 10,000 available openings. Approximately two years after the lottery, the researchers conducted more than 12,000 in-person interviews and health examinations of lottery participants in the Portland, Oregon metropolitan area, and compared outcomes between those randomly selected in the lottery and those not selected in order to determine the impact of Medicaid.

Some of the key findings:

Physical health

• Medicaid had no significant effect on measures of hypertension or high cholesterol, or on the rates of diagnosis or use of medication for these conditions.
• Medicaid increased the probability of being diagnosed with diabetes after the lottery by 3.8 percentage points (compared to the 1.1% of the control group who were diagnosed with diabetes) and increased the use of diabetes medication by 5.4 percentage points (compared to the 6.4% of the control group who used diabetes medication), but had no effect on glycated hemoglobin (a measure of diabetic blood sugar control).

Mental health

• Medicaid reduced rates of depression by 9 percentage points (compared to the 30% of the control group screening positive for depression) and increased self-reported mental health.

Financial hardship

• Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures (defined as out-of-pocket medical expenditures in excess of 30% of household income) and reduced other measures of financial strain.

Utilization and access

• Medicaid increased health care use, including use of physician services, prescription drugs, and preventive care.

“The study highlights the important financial protections that Medicaid provides, as well as the substantial improvements in mental health, but does not provide evidence that Medicaid coverage translates to measurable improvements in physical health in the first two years,” said Finkelstein, co-principal investigator of the study.

The current study is part of an ongoing research program gathering a wide array of data sources to examine many different effects of Medicaid, and represents a collaboration between non-profit and academic researchers and state policy makers. A previous study looking at data collected about a year after the lottery found that Medicaid substantially increased health care use, increased self-reported health, and reduced financial strain. More information can be found at www.nber.org/oregon.

Support for the study was provided by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services; the California HealthCare Foundation; the John D. and Catherine T. MacArthur Foundation; the National Institute on Aging (P30AG012810, RC2AGO36631, and R01AG0345151); the Robert Wood Johnson Foundation; the Alfred P. Sloan Foundation; the Smith Richardson Foundation; and the Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration); and by the Centers for Medicare and Medicaid Services.

“The Oregon Experiment—Effects of Medicaid on Clinical Outcomes,” Katherine Baicker, Sarah L. Taubman, Heidi L. Allen, Mira Bernstein, Jonathan H. Gruber, Joseph P. Newhouse, Eric C. Schneider, Bill J. Wright, Alan M. Zaslavsky, Amy N. Finkelstein, NEJM, May 2, 2013, 368;18

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

MIT
Sarah McDonnell
617.253.8923
s_mcd@mit.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter: http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

The study appears in the April 17, 2013 issue of the Journal of the American Medical Association (JAMA).

“We found clear evidence that reducing harm and improving quality is perversely penalized in our current health care system,” said Sunil Eappen, the lead author and chief medical officer of Massachusetts Eye and Ear Infirmary.

“It’s been known that hospitals are not rewarded for quality. But it hadn’t been recognized exactly how much more money they make when harm is done,” said senior author Atul Gawande, director of Ariadne Labs, professor in the Department of Health Policy and Management at HSPH and a surgeon at BWH.

An estimated $400 billion is spent on surgical procedures each year in the U.S. While effective methods to reduce complications have been identified, hospitals have been slow to implement them. Financial incentives may be a reason. The goal of the study was therefore to evaluate the hospital costs and revenues associated with having one or more major complications with surgical patients covered by four primary insurance types—private insurance, Medicare, Medicaid, and self-payment.

The researchers analyzed data from 34,256 surgical inpatients discharged in 2010 in a non-profit, 12-hospital system in the southern U.S. They looked at ten severe, preventable surgical complications and the contribution margin—revenue minus variable expenses—per patient. A total of 1,820 procedures were identified with at least one complication.

The results showed that, for privately insured patients, complications were associated with a $39,017 higher contribution margin per patient ($55,953 vs. $16,936). For Medicare patients, the contribution margin per patient was higher by $1,749 ($3,687 vs. $1,880). For Medicaid and self-payment, complications were associated with significantly lower contribution margins than those without complications.

What that means, say the researchers, is that who pays for patients’ care determines the financial implications of surgical complications. In this hospital system, private insurers covered 40% of patients, Medicare covered 45%, Medicaid covered 4% and 6% were self-pay, a breakdown that is comparable to the average U.S. hospital in 2010. Overall in this hospital system, complications were associated with a more than $8,000 higher contribution margin per patient.

At safety-net hospitals, which treat patients primarily covered by Medicaid or self-pay, reducing complications could improve financial performance. However, the study shows that at most U.S. hospitals, programs to reduce complications would worsen their financial performance.

“This is clear indication that health care payment reform is necessary,” said Gawande. “Hospitals should gain, not lose, financially from reducing harm.”

The research was funded through support from the Boston Consulting Group and from Texas Health Resources.

“The relationship between occurrence of surgical complications and hospital finances,” Sunil Eappen, Bennett Lane, Barry Rosenberg, Stu Lipsitz, David Sadoff, Dave Matheson, William Berry, Mark Lester, Atul Gawande, JAMA, April 17, 2013—Vol. 309, No. 15

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

photo: iStockphoto.com/Abel Mitja Varela

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter:http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

Boston, MA – Older adults who have higher blood levels of omega-3 fatty acids—found almost exclusively in fatty fish and seafood—may be able to lower their overall mortality risk by as much as 27% and their mortality risk from heart disease by about 35%, according to a new study from Harvard School of Public Health (HSPH) and the University of Washington. Researchers found that older adults who had the highest blood levels of the fatty acids found in fish lived, on average, 2.2 years longer than those with lower levels.

“Although eating fish has long been considered part of a healthy diet, few studies have assessed blood omega-3 levels and total deaths in older adults,” said lead author Dariush Mozaffarian, associate professor in the Department of Epidemiology at HSPH. “Our findings support the importance of adequate blood omega-3 levels for cardiovascular health, and suggest that later in life these benefits could actually extend the years of remaining life.”

The study—the first to look at how objectively measured blood biomarkers of fish consumption relate to total mortality and specific causes of mortality in a general population—appears online April 1, 2013 in Annals of Internal Medicine.

Previous studies have found that fish, which is rich in protein and heart-healthy fatty acids, reduces the risk of dying from heart disease. But the effect on other causes of death or on total mortality has been unclear. With this new study, the researchers sought to paint a clearer picture by examining biomarkers in the blood of adults not taking fish oil supplements, in order to provide the best assessments of the potential effects of dietary consumption of fish on multiple causes of death.

The researchers examined 16 years of data from about 2,700 U.S. adults aged 65 or older who participated in the Cardiovascular Health Study (CHS), a long-term study supported by the National Heart, Lung, and Blood Institute. Participants came from four U.S. communities in North Carolina, California, Maryland, and Pennsylvania; and all were generally healthy at baseline. At baseline and regularly during follow-up, participants had blood drawn, underwent physical examinations and diagnostic testing, and were questioned about their health status, medical history, and lifestyle.

The researchers analyzed the total proportion of blood omega-3 fatty acids, including three specific ones, in participants’ blood samples at baseline. After adjusting for demographic, cardiovascular, lifestyle, and dietary factors, they found that the three fatty acids—both individually and combined—were associated with a significantly lower risk of mortality. One type in particular—docosahexaenoic acid, or DHA—was most strongly related to lower risk of coronary heart disease (CHD) death (40% lower risk), especially CHD death due to arrhythmias (electrical disturbances of the heart rhythm) (45% lower risk). Of the other blood fatty acids measured—eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA)—DPA was most strongly associated with lower risk of stroke death, and EPA most strongly linked with lower risk of nonfatal heart attack. None of these fatty acids were strongly related to other, noncardiovascular causes of death.

Overall, study participants with the highest levels of all three types of fatty acids had a 27% lower risk of total mortality due to all causes.

When the researchers looked at how dietary intake of omega-3 fatty acids related to blood levels, the steepest rise in blood levels occurred when going from very low intake to about 400 mg per day; blood levels rose much more gradually thereafter. “The findings suggest that the biggest bang-for-your-buck is for going from no intake to modest intake, or about two servings of fatty fish per week,” said Mozaffarian.

Support for the study came from the National Heart, Lung, and Blood Institute (NHLBI) and the Office of Dietary Supplements of the National Institutes of Health (R01-HL-085710).

“Plasma Phospholipid Long-Chain Omega-3 Fatty Acids and Total and Cause-Specific Mortality in Older Adults,” Dariush Mozaffarian, Rozenn N. Lemaitre, Irena B. King, Xiaoling Song, Hongyan Huang, Molin Wang, Frank M. Sacks, Eric B. Rimm, and David S. Siscovick, Annals of Internal Medicine, online April 1, 2013

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter:http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu

Boston, MA — Women who experienced physical, emotional, or sexual abuse as children are more likely to have a child with autism than women who were not abused, according to a new study from Harvard School of Public Health (HSPH). Those who experienced the most serious abuse had the highest likelihood of having a child with autism — three-and-a-half times more than women who were not abused.

“Our study identifies a completely new risk factor for autism,” said lead author Andrea Roberts, research associate in the HSPH Department of Social and Behavioral Sciences. “Further research to understand how a woman’s experience of abuse is associated with autism in her children may help us better understand the causes of autism and identify preventable risk factors.”

The study appears online March 20, 2013 and in the May 2013 print issue of JAMA Psychiatry. It is the first to explore the relationship between a mother’s exposure to childhood abuse and risk of autism in her children.

The authors examined data from more than 50,000 women enrolled in the Nurses’ Health Study II. They found that it was not just women exposed to the most serious levels of abuse who had higher risk of having a child with autism, but also a large number of women who experienced moderate abuse. While about 2% of women reported the most serious abuse, even women in the top 25% of abuse severity—which included mostly women who experienced more moderate levels of abuse —were 60% more likely to have a child with autism compared with women who did not experience abuse. These results suggest that childhood abuse is not only very harmful for the person who directly experiences it, but may also increase risk for serious disabilities in the next generation, the authors said.

Delving further, the researchers looked at nine pregnancy-related risk factors to see if they were linked to higher risk of having a child with autism in women who were abused as children. These nine risk factors—including gestational diabetes, preeclampsia, and smoking—have been previously associated with an increased likelihood of having a child with autism.

The researchers did find that women who had experienced abuse as children had a higher risk for each of the pregnancy-related risk factors that were examined. Surprisingly, though, those risk factors accounted for only 7% of the increased likelihood of having a child with autism among women who were abused.

Given that these factors accounted for so little of the association between mother’s experience of abuse and risk of autism in her children, the authors speculated that other factors may be playing a role. One possibility, they said, is that long-lasting effects of abuse on women’s biological systems, such as the immune system and stress-response system, are responsible for increasing their likelihood of having a child with autism. More research is needed to tease out the mechanisms involved in the maternal childhood abuse-autism link, the authors said.

“Childhood abuse is associated with a wide array of health problems in the person who experiences it, including both mental health outcomes like depression and anxiety, and physical health outcomes like obesity and lung disease. Our research suggests that the effects of childhood abuse may also reach across generations,” said senior author Marc Weisskopf, associate professor of environmental and occupational epidemiology at HSPH.

Given the findings in this study, the authors suggest increasing efforts to prevent childhood abuse, and suggest that clinicians focus more strongly on limiting pregnancy-related autism risk factors, particularly among women who experienced abuse in childhood.

Other HSPH authors included Alberto Ascherio, professor of epidemiology and nutrition; and Kristen Lyall, visiting scientist in the HSPH Department of Nutrition.

Support for the study was provided by DOD W81XWH-08-1-0499 and W81XWH-08-1-0497, USAMRMC A-14917, NIH 5-T32MH073124-08 and Autism Speaks 1788. The Nurses’ Health Study II is funded in part by NIH CA50385.

“Association of maternal exposure to childhood abuse with elevated risk for autism in offspring,” Andrea L. Roberts, Kristen Lyall, Janet W. Rich-Edwards, Alberto Ascherio, Marc G. Weisskopf,” JAMA Psychiatry, online first March 20, 2013, in print May 2013

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter: http://twitter.com/HarvardHSPH
HSPH on Facebook: http://www.facebook.com/harvardpublichealth
HSPH on You Tube: http://www.youtube.com/user/HarvardPublicHealth
HSPH home page: http://www.hsph.harvard.edu