Spring 2015 Frontlines

Quick updates about the latest public health news from across the School and beyond.

Trauma’s toll on women’s health

Women are more likely than men to develop post-traumatic stress disorder (PTSD), and new evidence suggests PTSD not only devastates women’s mental health, it also raises their risk for cardiovascular disease, diabetes, and obesity. Survey data from nearly 50,000 women gathered over 22 years found that those suffering PTSD are nearly twice as likely to develop type 2 diabetes, compared with women who don’t have PTSD. Antidepressant use and elevated body mass index accounted for nearly half the increased risk. Results were published online January 7, 2015, in JAMA Psychiatry. First author Andrea Roberts, research associate in the Department of Social and Behavioral Sciences, notes that with fewer than half of Americans with PTSD receiving treatment, “Our study adds urgency to the effort to improve access to mental health care to address factors that contribute to diabetes and other chronic diseases.”

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The heat is on

Extreme heat is the most common cause of weather-related deaths in the U.S., and older Americans are particularly at risk. In the largest and most comprehensive study of
heat-related illness to date, senior author Francesca Dominici, professor of biostatistics, and colleagues have identified the conditions most likely to land seniors in the hospital during a heat wave—including fluid and electrolyte disorders, renal failure, urinary tract infections, sepsis, and heat stroke. Risks rose when the heat wave periods were longer and more extreme, and remained elevated for up to five days after the hottest day. The study appeared online December 23, 2014, in the Journal of the American Medical Association.

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Eggs are ok in moderation

A new report from the federal 2015 Dietary Guidelines Advisory Committee recommends easing previous restrictions on dietary cholesterol, concluding that for most healthy people, cholesterol rich foods such as eggs do not raise blood cholesterol or harm the heart. The panel, which includes the School’s Frank Hu, professor of nutrition and epidemiology, also called for Americans to focus on healthy fats rather than restricting overall fat consumption, and to limit added sugar to 10 percent of daily calories—all of which Harvard Chan researchers have been saying for years.

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Vermont calls it quits on single-payer

Vermont Gov. Peter Shumlin announced in December that the state would not pursue a single-payer financing scheme for health insurance because of high projected costs. The widely publicized program was designed by William Hsiao, K.T. Li Research Professor of Economics, the subject of the Spring/ Summer 2012 cover story of Harvard Public Health.

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SWAT! Mosquito sex linked to malaria transmission

Sexual biology may be the key to uncovering why Anopheles mosquitoes are unique in their ability to transmit malaria to humans, and why species within this genus vary widely in their power to do so. Through analysis of 16 Anopheles genomes, researchers found that mosquito reproductive traits evolved along with their capacity to transmit the Plasmodium parasite that causes malaria. Four species that exchange the highest quantity of a steroid hormone known as 20E are all major carriers of malaria and are found in regions of Africa and India hit hard by the disease. Senior author Flaminia Catteruccia, associate professor of immunology and infectious diseases at the Harvard Chan School and the University of Perugia, Italy, believes that these findings may provide a new target for malaria control efforts. The study was published online February 26, 2015, in Science.

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Rethinking the role of DNA

Twins have long been the go-to population for scientists hoping to measure how genes shape individual differences, from height to cancer risk. But a new Harvard Chan–led study argues that other factors such as environment can bias the results of these studies. Senior author Alkes Price, associate professor of statistical genetics, and colleagues, studied the genomes of unrelated people with ancestry from two different continents, Africa and Europe. They found that only 55 percent of the variance in height and other traits could be attributed to genetics—far lower heritability than that found by most twin studies. According to Price, the finding is in line with research that has narrowed down the source of our significant differences to just 1 million DNA sequence variations known as single nucleotide polymorphisms (SNPs), out of more than 30 million. Price believes that researchers should focus on these SNPs to identify “which genes or pathways are biologically important so that drugs can be designed that can help cure or control disease.”

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Using drug coverage to discriminate

Some insurers offering health plans through the new federal marketplace may be tailoring drug coverage to deter people with HIV from selecting their plans. Harvard Chan researchers found that these insurers are placing all HIV drugs in the highest cost-sharing category in their formularies—which list the plans’ covered drugs and costs. As a result, patients with HIV must spend thousands more dollars per year than if they had enrolled in other plans. If left unchecked, the practice could partially undermine a central feature of the Affordable Care Act: protecting people with preexisting conditions against discrimination. It could also lead to sicker people clustering in plans that offer more generous prescription drug benefits—in turn creating a “race to the bottom” with insurers hiking their drug co-pays to avoid a large influx of sick and expensive enrollees.

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Amy Roeder is assistant editor of Harvard Public Health