Frontlines: Spring 2017

Airline Pilots’ Depression Flying Under the Radar

A passenger plane taxiing toward the terminal.Hundreds of commercial airline pilots currently flying may be clinically depressed, according to an anonymous online survey conducted by Harvard Chan researchers. Pilots from more than 50 countries—nearly half from the U.S.—answered questions about their jobs and health. Out of the nearly 3,500 who participated in the survey, 1,848 completed the questions about mental health. Within this group, 12.6 percent met the criteria for likely depression, and 4.1 percent reported having suicidal thoughts within the previous two weeks. Of those who reported working as an airline pilot in the last seven days at the time of the survey, 13.5 percent met the criteria for depression. “There is a veil of secrecy around mental health issues in the cockpit,” says Joseph Allen, assistant professor of exposure assessment science and senior author of the study. “We found that many pilots currently flying are managing depressive symptoms, and it may be that they are not seeking treatment due to the fear of negative career impacts.”

High Blood Pressure Now a “Condition of Poverty”

More than a billion people are now living with high blood pressure worldwide, with most in low- and middle-income countries, according to a study led by Majid Ezzati, adjunct professor of global health. He and his colleagues found that the number of people with high blood pressure has nearly doubled in the past 40 years, with the burden shifting to poorer countries— particularly in Asia, which was home to half of the world’s adults with high blood pressure in 2015. The United States, Canada, and South Korea had the lowest rates in the world. “When you look at this globally, blood pressure is a condition of poverty, not affluence,” says Ezzati. He attributes the trend to differences in early childhood health, availability of fruits and vegetables, use of salt, and access to health services.

Fatal Drug-Resistant Bacteria Stealthily Spreading

A highly drug-resistant family of bacteria that can cause fatal bloodstream infections may be spreading more widely—and more stealthily—than previously thought. Researchers examined 250 samples of carbapenem- resistant Enterobacteriaceae (CRE) from hospitalized patients, who are particularly at risk of such infections. They found what senior author William Hanage, associate professor of epidemiology at Harvard Chan School, termed a “riot of diversity,” both among CRE species and among genes that make them resistant to antibiotics. The scientists also found that resistance traits are easily transferred among various CRE species. “While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease,” says Hanage. “We need to look harder for this unobserved transmission within our communities and health care facilities if we want to stamp it out.”

Removing Harmful Chemicals Doesn’t Mean Safer Products

Empty frying pan isolated on white backgroundThe harmful, hormone-disrupting chemical BPA, or bisphenol-A, has been removed from baby bottles and other plastic products—but that doesn’t mean consumers should rest easy, according to Joseph Allen, assistant professor of exposure assessment science. In an opinion piece published in December in The Washington Post, he wrote that BPA may simply have been swapped for BPS, or bisphenol-S, a similar chemical thought to be even more toxic to children. This tactic—which researchers call “regrettable substitution”—has been used in the formulation of products such as pesticides, flame-retardant furniture, nonstick pans, and nail polish. According to federal regulations, the chemical replacements need only be different enough to be considered distinct by regulators; they don’t have to be proven safer. “Innocent until proven guilty may be the right starting point for criminal justice, but it is disastrous chemical policy,” Allen wrote. He is the faculty adviser to the newly launched Harvard Healthy Building Materials Academy, which is working on this issue on campus with Harvard’s Office for Sustainability.

Scientists Hit the Road to Gather Parkinson’s Data

Last fall, four researchers from Harvard Chan School and Massachusetts General Hospital in Boston hopped into a 32-foot-long RV and motored down the East Coast to meet with 51 participants from the Nurses’ Health Studies and Health Professionals Follow-Up Study. Their mission: to conduct neurological examinations to learn more about the early symptoms of Parkinson’s disease, which include loss of smell and color vision. The subjects are among the thousands of health professionals who have dutifully been filling out questionnaires about their health and habits for decades, providing data that has formed the basis of numerous research studies on risk factors for chronic diseases. For them, as well as the researchers, it was exciting to finally meet in person, says Alberto Ascherio, professor of epidemiology and nutrition. “It is their work as much as our work—they have been associated with the cohort for much longer than have I and almost all active investigators. One of the participants told me she felt honored to be able to contribute to this decades- long collective effort for the common good.”

Gun Owner Groups, Health Professionals Team Up to Prevent Suicides

Guns are seen inside a display case at the Cabela's store in Fort Worth, Texas June 26, 2008. Individual Americans have a right to own guns, the Supreme Court ruled on Thursday for the first time in history, striking down a strict gun control law in the U.S. capital. REUTERS/Jessica Rinaldi (UNITED STATES) - RTX7DP7With half of all suicide deaths in the U.S. related to guns, public health practitioners and gun owners are working together to find ways to keep people who may harm themselves away from firearms. Catherine Barber, director of the Harvard Injury Control Research Center’s (HIRC’s) Means Matter project, began working with the New Hampshire Firearm Safety Coalition in 2009. In a recent viewpoint article in JAMA Internal Medicine, she described similar suicide-prevention projects underway in more than 20 states. “Often, guys don’t feel comfortable asking a friend in distress how they can help,” she says. “But saying, ‘How about I hold onto your guns while you’re going through this?’ is a concrete way to lend a hand.”

Read Harvard Public Health’s special report on guns and suicide.

Another recent paper from HIRC found that the percentage of people in the U.S. purchasing firearms without a background check appears to be significantly lower than the most recent estimate more than two decades ago. However, according to the researchers, millions can still buy guns without background checks through private and online gun sales.

Foreign-Trained Doctors in U.S. Provide Quality Care

Doctors practicing in the U.S. who graduated from foreign medical schools appear to provide quality medical care that exceeds that of doctors who graduated from U.S. medical schools. Analyzing data for approximately 1.2 million Medicare beneficiaries admitted to hospitals between 2011 and 2014, the researchers found that patients treated by general internists who were foreign medical graduates had lower 30-day mortality than those cared for by U.S. medical graduates, after adjusting for patient and physician characteristics and for the hospital where treatment occurred. Senior author Ashish Jha, K.T. Li Professor of Health Policy and director of the Harvard Global Health Institute, says, “America has a history of attracting the best and brightest from around the world, and that appears to be true in medicine as well.”

Educating Kids in Rural South Africa May Help Keep Their Parents Alive

In rural South Africa, the more years of formal schooling children have, the better their parents’ life expectancy, according to researchers Jan-Walter De Neve and Guy Harling of the Department of Global Health and Population. Over a 13-year study period, the risk of death among parents of children with 10–12 years of schooling dropped faster—by 26 percent for mothers and 35 percent for fathers—compared with parents of children with seven or fewer years of schooling. The results suggest that children are sharing resources acquired by being at school—such as skills, health information, or money—with their parents. Having better educated children was particularly protective for mothers at risk for communicable diseases, fathers at risk of injuries, and those at risk for HIV and tuberculosis in both genders.