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Jul 2, 2018 · California: State's big population means more mosquito-borne infections

 

James Gathany/Centers for Disease Control and Prevention

Despite its dry, temperate climate, California had more mosquito-borne infections than any U.S. state from 2004 to 2016, according to new data from the U.S. Centers for Disease Control and Prevention.

The California numbers are primarily attributable to the state’s large population (more than 39 million) and strong public health reporting system, said Dr. Claire Panosian Dunavan, professor of medicine emeritus/recalled in the division of infectious diseases at the David Geffen School of Medicine at UCLA.

“What’s not known, of course, is how many mosquito-borne infections occur that are never diagnosed,” she said. “After all, it takes an astute doctor to suspect a mosquito-borne infection in the first place and order the proper test.”

California reported 9,254 locally transmitted and travel-related cases, according to state figures. Other states with the highest number of cases were New York (7,167), Texas (6,648), Florida (3,822) and Colorado (2,818).

According to the California Department of Public Health, the most common disease-carrying mosquitoes in the state are Culex tarsalis (common name: western encephalitis mosquito); Culex pipiens/ Culex quinquefasciatus (northern/ southern house mosquito); Aedes aegypti (yellow fever mosquito); Aedes albopictus (Asian tiger mosquito); Aedes sierrensis (western tree-hole mosquito); and Anopheles freeborni (western malaria mosquito).

Mosquitos typically breed in ponds, agricultural areas, vegetated pools, standing water, tree holes, tires and other containers. Among the diseases they carry are West Nile virus, the St. Louis encephalitis and Western equine encephalitis viruses, malaria, Zika, dengue, chikungunya, and yellow fever.

Zika virus, which has been linked to birth defects in newborns, is not a significant risk in California, nor are other tropical diseases such as chikungunya or dengue, which are carried by the Aedes aegypti and albopictus mosquitoes.

“Chances [of infection] are extremely low, since California’s infected human reservoir for Zika, chikungunya and dengue is tiny to nonexistent,” Panosian said. “What we should be more worried about is West Nile virus, which is also mosquito-borne and has a large reservoir in local birds.”

The Culex mosquitoes carry West Nile.

In contrast to other high-population states like Texas and Florida, California spends more on mosquito abatement projects, she noted.

Meanwhile, there are other ways to protect yourself from pesky mosquito bites. The American Mosquito Control Assn. suggests:

  • Empty out water containers at least once a week
  • When outside, wear long sleeves, long pants, and light-colored, loose-fitting clothing
  • Properly apply an EPA-registered repellent such as DEET, picaridin, IR 3535 or oil of lemon-eucalyptus
  • Dispose of old tires that can collect water in which mosquitoes breed
  • Drill holes in the bottom of recycling containers
  • Clear roof gutters of debris
  • Clean pet water dishes regularly
  • Check and empty children’s toys
  • Repair leaky outdoor faucets
  • Change the water in bird baths at least once a week.

Jun 6, 2018 · Online training videos provide coping skills for caregivers of people with dementia

Family and professional caregivers are key to ensuring that people with Alzheimer’s disease and other forms of dementia live safely, comfortably and with dignity. Given the nation’s rapidly aging population, more people in the coming years will develop Alzheimer’s and dementia with the memory loss, agitation, behavior changes and other symptoms that come with them. Recent UCLA research suggests that the number of Americans with Alzheimer’s will more than double to about 15 million by 2060.

Dementia also has a profound effect on caregivers, often family members whose lives are disrupted and who are challenged on how to best to care for their loved ones. Most caregivers do not receive education and training about how to provide competent and compassionate care.

To address this need, the UCLA Alzheimer’s and Dementia Care Program has developed a series of online videos to help caregivers understand how to care for persons with dementia. The videos, in which actors portray dementia patients and their caregivers, cover a range of issues and provide practical tools and techniques for managing challenging issues that caregivers will face.

“While the UCLA Alzheimer’s and Dementia Care program has served thousands of patients and caregivers living in Southern California, we realize that there are many more that we need to reach,” said Dr. Zaldy Tan, the program’s medical director. “We hope that this video series will empower not only patients and caregivers enrolled in our program, but also those beyond our reach in other parts of California and the U.S.”

The program has produced 18 training videos on the following topics:

Aggressive Language/Behavior

Agitation and Anxiety

Depression/Apathy

Hallucinations

Home Safety

Refusal to Bathe

Refusal to Take Medications

Repetitive Behaviors

Repetitive Phone Calls

Repetitive Questions

Sexually Inappropriate Behaviors

Sleep Disturbances

Sundowning

Wandering

Videos covering common challenges are:

Alcohol Abuse

Driving

Lack of Eating

Paranoid Thoughts

The program also offers free educational webinars ranging from “What is dementia?” to protecting loved ones who have dementia from falling prey to scammers.

 

Nov 16, 2017 · Exploring the impact of HIV/AIDS on black women

The impact of HIV/AIDS on black women has received little attention over the years, which has prompted Gail Wyatt to try to do something about it.

Wyatt, a professor of psychiatry and biobehavioral sciences at the UCLA Semel Institute for Neuroscience and Human Behavior, and an associate director of the UCLA AIDS Institute, recently helped spearhead a major conference in Atlanta about the impact on black women of HIV, sexually transmitted diseases, and reproductive health – a seldom-explored topic, she says.

Gail Wyatt

“There has not been this kind of attention given to HIV-positive African American women or women at risk for HIV/AIDs infection for 30 years,” Wyatt said. “We are advocating for women-centered approaches and offering to address reproduction and sexually transmitted infections (STIs) in the same clinic. We also are advocating for women to conduct research on women. Decades ago this was the goal, but now women investigators are underrepresented.”

HIV rates have not improved significantly for black women in more than a decade, Wyatt said. Yet the same approaches developed for men are still being used with women, and are often ineffective.

“Services for reproductive health are often not available at an HIV clinic and yet reproduction is a part of a woman’s body,” she said.

The Atlanta conference, called “A Paradigm Shift: The Impact of HIV/AIDS on African American Women and Families,” tackled the many problems that these women face. For instance, women often have to travel miles to receive a pelvic exam to protect and care for their reproductive health, Wyatt said.

“STIs are sometimes described in terms of transmission and not the effects on an unborn child if women remain untreated and deliver vaginally,” she said. “Unintended pregnancies are women’s primary concern, yet the literature assumes that HIV transmission is.”

A woman-centered approach would integrate their health concerns, testing and treatment, and mental health, she said. Women with a history of disease transmission should be counseled about becoming pregnant and delivering a child that is not infected with a transmittable disease. This information should be offered to all women, not just those who might be at risk for HIV transmission.

“Women’s sexual health has been overlooked for over 30 years in an attempt to treat one size to fit all,” she said. “It doesn’t, and women’s health has suffered.”

Nov 7, 2017 · As hepatitis A cases grow in California, prevention requires both personal and public actions

The number of hepatitis A cases in California just keeps growing.

Some 633 cases have been detected as of Oct. 27, with 416 hospitalizations and 21 deaths linked to the outbreak, according to the California Department of Public Health. It is the largest person-to-person hepatitis A outbreak – not stemming from a common source or contaminated food – since 1996, and has even led Gov. Jerry Brown to declare a state of emergency.

But all is not lost, says Dr. Jeffrey Klausner, professor of medicine in the division of infectious diseases at the David Geffen School of Medicine at UCLA and of public health at the UCLA Fielding School of Public Health.

“There are things that the county or state can do, but also things that you can do to protect yourself and the community at large,” Klausner says.

Hepatitis A

Here are some of the best ways to keep yourself safe:
1. Get vaccinated. The hepatitis A vaccine is safe and highly effective – and has been available since 1996, the date of the last major outbreak. (That’s no coincidence.)
2. Avoid potentially contaminated food or water – that is, food and water from questionable sources.
3. When sexually active, be sure to wash up before and after.
4. Use restrooms (not outdoor areas) and wash your hands after use.

And here’s what the county or state can do to reduce hepatitis A outbreaks, says Klausner:
1. Provide clean public restrooms in areas of high density.
2. Add hepatitis A vaccination to the list of vaccines required for school entry.
3. Educate the community and providers about the safety and efficacy of hepatitis A vaccination.
4. Provide free hepatitis A vaccination through community pharmacies.
5. Ensure clean water and sanitation services for group encampments, homeless congregation areas and shelters.

Klausner is a frequent advisor to the federal Centers for Disease Control and Prevention and the World Health Organization. From 1998-2009, Klausner was a deputy health officer and director of sexually transmitted disease prevention and control services at the San Francisco Department of Public Health; from 2009-2011, he was branch chief for HIV and TB at the Centers for Disease Control, South Africa.

Whether or not the county or state will ultimately follow Klausner’s good advice remains to be seen. But we can all take responsibility for ourselves.

Oct 6, 2017 · Kids with diabetes can still enjoy Halloween

 

 

It’s October, when summer heat gives way to autumn crispness and kids’ thoughts turn to costumes, candy and the other sweet-tasting goodies of Halloween.

There’s one group of children, however, who can’t splurge like most others: those with type 1 and 2 diabetes. The good news is that they don’t have to miss out entirely on treats, says Dr. Steven Mittelman, chief of pediatric endocrinology at UCLA Mattel Children’s Hospital. Careful monitoring of their health can help them enjoy a safe and happy Halloween.

“Let your child enjoy some candy, making sure they monitor their blood glucose and take their medications as prescribed,” says Mittelman. “For children who take insulin with all meals and snacks, combining candy with a meal can reduce the need for extra injections, and help reduce the blood glucose spikes from candy alone.”

Other Halloween strategies parents can use to help their kids include adding low-carb and healthy snacks, such as popcorn or sugar-free candy, to their treat bags.

Dr. Steven Mittelman, chief of pediatric endocrinology at UCLA Mattel Children’s Hospital

Other strategies to keep children with diabetes from feeling left out include:
• Plan other Halloween activities such as pumpkin decorating, arts and crafts, and creating costumes, taking the focus off the candy.
• Work with your child to agree on reasonable rules for the evening. Ask your child for their input and include their idea in the plan.
• Make sure to treat all kids in the house with the same guidelines.
• Have your child keep their favorite candy and give away the rest. Many dentists will buy back extra candy. Or look for a buy-back location here.  Alternatively, you could offer to “pay” your child for the extra candy with stickers, coins or small toys.

But there are some things to be wary of, says Mittelman.

“The candy you don’t know your child is eating can be particularly concerning,” he says. “Make sure you and your child are on the same page with the plan and why it is important. For children who have a hard time resisting, remove extra candy to a safe location your child can’t get to. And consider checking your child’s blood glucose an extra time or two during the night, to make sure you can get them back on target.”

Also, be sure to call your doctor if your child appears ill or is vomiting, or if you are concerned for any other reasons.

Most of all, he says, “make sure that you and your children have fun.”

 

Jul 12, 2017 · New book outlines two-step process for long-term behavior change

The three types of behavior

When Sean Young was in graduate school, he received a visit one day from his brother. During the visit his brother became so overcome with pain that he had to be rushed to the hospital, where physicians discovered a burst intestine. The emergency surgery saved his life.

The doctors told his brother, who suffered from Crohn’s disease, an often painful chronic inflammatory bowel condition, to make important lifestyle changes for his health. When his brother didn’t make some of the lifestyle changes, Young pondered why an intelligent and health-conscious man like his brother–who came from a family of doctors–would fail to do something beneficial for his health?

“I didn’t understand. I was really scared and worried. I started to study the psychology of why people don’t follow through with things that are good for them,” said Young, founder and executive director of the UCLA Center for Digital Behavior and UC Institute for Prediction Technology.

Many people struggle with how to make lasting behavior changes in their lives, Young said. And too often the “problem” is blamed on the individual person being too undisciplined or lazy to help solve their problem.

“Conventional wisdom teaches us to believe that if we don’t eat right, stick to an exercise routine, or adhere to prescribed medications that it’s because we’re lazy, unmotivated, or undisciplined,” said Young, who is also an associate professor in the Department of Family Medicine at the David Geffen School of Medicine at UCLA. “We’re taught that the only way to make a lasting change in our behavior is if we can fundamentally change our personality to have more willpower, discipline, or become a different person.”

Young’s research has produced “Stick with It,” a new book that explains common behavioral issues, such as how to stick to a fitness routine, avoid junk food, curb digital addiction, and follow through on plans that are good for you. The process is based on understanding that there isn’t a one-size-fits-all solution to behavior change.

The answer is not to change the personality, but to change the process. The book describes a process for creating lasting behavior change based on decades of research from psychologists and scientists. It also provides proactive exercises at the end of each chapter to help readers apply this process to their own lives.

Young describes three types of behaviors, which differ based on someone’s awareness of what they’re doing and when.  The first is “Automatic,” which one does unconsciously, such as forgetting to take medication, habitual nail biting or impulsively interrupting someone. The second is “Burning,” such as an addiction that one is aware of but can’t seem to stop doing, like compulsively playing video games or checking email. The third is “Common,” which are motivational, like sticking to an exercise routine, adhering to prescribed medications, or learning to stop procrastinating.

Once one determines which type of behavior needs to change, they can turn to a set of seven tools –or forces as Young calls them –that he groups under the acronym SCIENCE.

Stepladders: Break things up into small steps that lead you to your goal. Instead of focusing on that endpoint, which could overwhelm you. For instance, if you want to organize your home office, commit to tackling a shelf or drawer at a time.

Community: Communities are a powerful tool for change because other people can provide you with the emotional support that can keep you going. Support groups for substance abusers are an example.

Important: People will be more likely to change if it’s important for them to change. Smokers who see the damage that cigarettes do to their lungs have been found to have higher quit rates because it makes it more real–and important–to them to quit.

• Making it Easy to Change: This can take many forms. For example, make it a habit to keep prescription medications on you at all times, which makes it likelier that you’ll adhere than you would by leaving them home.

Neurohacks: These are quick mental shortcuts that can reset the brain. Want to start exercising but keep making excuses for not going to the gym? Simply slip into your gym clothes. Once they’re on you’ll be more motivated to go because you’ve already dressed and taken a step toward going to the gym.

Captivating rewards: Not all rewards are the same. They need to be based on things that people care about and that are captivating. Participants in Young’s Harnessing Online Peer Education (HOPE) online community have said the forums have been an engaging way to keep them talking about and caring about health behavior change.

Engrained: Make something a routine so that it becomes ingrained and easy to do. If you suffer from stress, regular meditation can instill a new set of healthier and calmer behaviors.

Jun 15, 2017 · A few facts about rheumatology at UCLA

Most people think of rheumatology as the study of joint disorders, such as arthritis, but they may not know just how broad the field really is. Because rheumatologic disorders also affect blood vessels, organs and a host of other body parts, rheumatology research delves down into the effects on those systems as well.

At UCLA, rheumatology research has taken some  interesting directions—for instance, examining the role that cholesterol and the microbiome plays. Dr. John Fitzgerald, interim chief of the UCLA Division of Rheumatology at the David Geffen School of Medicine at UCLA, where more than 30 faculty members are investigating better ways to treat rheumatologic conditions, recently answered some questions about the topic.

Dr. John Fitzgerald is interim chief of the UCLA Division of RheumatologyDr. John Fitzgerald, interim chief of the UCLA Division of Rheumatology at the David Geffen School of Medicine at UCLA., where more than 30 faculty members are actively investigating better ways to treat rheumatologic conditions – and better ways to help patients.

 

WHAT IS RHEUMATOLOGY?
Rheumatology is the study of arthritis and types of inflammatory disease. For instance, rheumatoid arthritis and lupus arthritis are both inflammatory arthritis, but lupus can do a lot of other things, too, like damage organs. We also treat myositis, which is inflammatory muscle disease and vasculitis, an inflammatory blood vessel or vascular disease. It also covers musculoskeletal conditions, regular osteoarthritis, fibromyalgia and gout. However, rheumatology is non-surgical, so orthopaedics would cover surgical issues, but not musculoskeletal issues.

WHAT ATTRACTED YOU TO THE FIELD?
Rheumatology is interesting because it goes across different systems, so you have to approach it like an internist where you think about the multiple organs it’s affecting. Basically it’s the body’s immune system attacking itself. Treatments weren’t as innovative when I joined, but now treatments are very specific and targeted. One of the reasons I decided to specialize in rheumatology was because of the mentors I had at UCLA. They were some of the best teachers, such as Ken Kalunian (now at UC San Diego’s division of rheumatology, allergy and immunology) and Bevra Hahn (emeritus professor of medicine).

WHAT ARE THE MOST COMMON AILMENTS IN RHEUMATOLOGY?
Arthritis is probably the most common condition, but most arthritis patients are managed by their internist and they don’t need specialty consultation. We treat conditions that are more inflammatory, a little bit more complex, like rheumatoid arthritis. Also, UCLA receives many referrals, so we see a lot of lupus and scleroderma, as well as vasculitis, myositis and gout.

YOUR RESEARCHERS HAVE ALSO BEEN STUDYING THE ROLE OF CHOLESTEROL IN LUPUS. HOW DID THAT START?
It started with the observation that lupus patients were having heart attacks at much higher rates than non-lupus patients. Cardiologists were starting to figure out that heart attacks were an inflammatory condition; it wasn’t just plaque and blockages, but inflammation was associated with these that led to cardiac events. So it became a natural progression to look at lupus and how the inflammatory system relates to cholesterol.
What happens is that the so-called good cholesterol, HDL, should be gobbling up the so-called bad, or LDL, cholesterol. In lupus, the good cholesterol actually makes the bad cholesterol behave worse. It’s pro-inflammatory instead of anti-inflammatory. So a few of our researchers have been looking at pro-inflammatory HDL. They’ve looked at it in lupus and rheumatoid arthritis, and now they’re starting to look at it in gout.

WHEN SHOULD YOU SEE A DOCTOR BECAUSE OF JOINT PAIN?
You should see someone if it starts interfering with activity, your ability to get around and to be comfortable. Everybody has minor aches and pains and you don’t have to worry about the minor stuff that goes away. But if something’s not going away or something’s getting worse, that’s when it’s worth getting it evaluated.

Mar 28, 2017 · Kidney transplant and donation education goes national

Have you ever wondered why people choose to donate a kidney? And whether these donors regret their decision later?

Amy Waterman first became interested in organ donation over 20 years ago when she conducted surveys of kidney donors as a graduate student in social psychology at Washington University in St. Louis. “It was amazing that hundreds of living donors we surveyed not only told us that they didn’t regret their decision, but also found it to be one of the most profound decisions they had ever made,” said Waterman, now an associate professor-in-residence in the division of nephrology at the David Geffen School of Medicine at UCLA.

While they didn’t regret their decision, many said they wished they’d had more information before becoming a donor, Waterman said.

A seed was planted in Waterman that grew into a professional mission: educating kidney patients, potential donors and the public about the importance of organ donation. Her passion for donor education eventually led to notice from the White House and a key role in a national online education initiative.

Today, Waterman is director of the Transplant Research and Education Center (TREC), an interdisciplinary research and education center based at UCLA that puts findings from transplant-related clinical trials into practice. Among other things, Waterman designs new educational programs, including Explore Transplant and Explore Living Donation, to help individuals make informed transplant and living donation decisions. Besides training health care providers, her research and education efforts have helped more patients with kidney failure to move off dialysis toward eventual transplant.

Waterman works with UCLA transplant patients participating in clinical trials to help design education resources such as videos ,iPad mobile applications, and information on overcoming financial and practical barriers to transplant surgery.

In 2014, Waterman and Dr. Gabriel Danovitch, medical director of the UCLA Kidney and Pancreas Transplant Program, represented UCLA at a consensus conference that developed best practices to increase living donation rates. “We are now testing the effectiveness of the first individually tailored program of living donation education for kidney patients at UCLA,” she said.

However, the highlight of her efforts came in June 2016 when Waterman participated a White House Organ Summit spurred by President Obama’s call to reduce the organ transplant waiting list. Here’s how she describes her experience.

“What was it like to be at the White House that day? It was like locking arms with everyone in your field. It was like standing for being the national protector of patients and living donors. It was like standing for the possibility of the end of the organ donor shortage, an end only possible because of the ingenuity and kindness of the American people.”

Waterman’s address at the White House led to her appointment as the co-chair and UCLA representative to the Blue Ribbon Advisory Panel to create the United Network for Organ Sharing (UNOS) Kidney Transplant Learning Center. The Learning Center, which will be launched publicly at the end of 2017, will be an online hub containing educational resources about transplantation and living donation.

By coordinating the delivery of education and outreach, and promoting new collaborations between the nation’s leading health centers, hospitals, doctors and transplant organizations, the UNOS Kidney Transplant Learning Center aims to provide education to more than 670,000 patients suffering from kidney failure, the providers who serve them, and the family and communities that support them. This work is one additional way in which Dr. Waterman is furthering the mantra of her field: “Organ donation is the best of humanity and the best of healthcare.”

To learn more about TREC, Explore Transplant, and to receive updates about the UNOS Kidney Transplant Learning Center, go to http://www.exploretransplant.org or follow Waterman at @ExploreTxplant on Facebook and Twitter.