Harvard School Of Public Health Research Articles

IJCM_170A: Exploring 10-year cardiovascular risk assessment through the utilization of the Framingham Risk Score(FRS): A Cross-Sectional Study

Background: Cardiovascular diseases (CVDs) are a major global health concern, causing significant morbidity and mortality. A joint report by the Harvard School of Public Health and World Economic Forum highlights a substantial economic burden of $47 trillion due to CVD from 2010-2030. Predictions suggest 23.6 million deaths from CVD by 2030. Identifying individuals at CVD risk is crucial for prevention. The Framingham Risk Score (FRS) is a key tool for estimating 10-year CVD risk. Objective: To estimate the ten-year risk of developing cardiovascular disease using Framingham heart risk assessment score. Methodology: In the period from January to July 2023, a cross-sectional study spanning six months was conducted at the Community Medicine OPD of LLRM Medical College, Meerut. Adult residents were interviewed, and data, comprising anthropometric measurements and blood investigations (fasting blood sugar and lipid profile), were gathered using a pretested semi-structured questionnaire. The Framingham Risk Score, a gender-specific algorithm, was employed to assess the 10-year cardiovascular risk for each individual. Results: Among 298 participants, 13.3% had an intermediate risk, and 4.2% had a high risk of cardiovascular disease in the next 10 years. Higher prevalence of intermediate and high risk was observed in males. Urban adults exhibited prevalent cardiovascular risk factors, projecting a 2.8% high-risk prediction. Conclusion: In this study, males exhibited a higher prevalence of intermediate and high risk than females. The projected high-risk prediction for CVD in the next 10 years among participants was 2.8%.

Transport ecology in the context of the coronavirus pandemic

The work is devoted to the analysis of the latest data on the study of socio-hygienic and environmental consequences, a pandemic in conditions of a high level of atmospheric air pollution, the effect of solid and gaseous components of exhaust gases from automobiles and industry on human health and the environment.The object of the study is the atmospheric air polluted by the viral infection COVID-19. Action to tackle air pollution is particularly relevant in the wake of the outbreak of the coronavirus pandemic, according to research from the Harvard School of Public Health (USA), which Bellona has already written about, as well as reports from European scientists at the University of Siena School of Medicine (Italy). The dependence of health and mortality rates on air quality is a fact repeatedly confirmed. According to the World Health Organization (WHO), currently 9 out of 10 people in the world breathe polluted air, and this leads to 7 million additional deaths annually. WHO officials say that one third of deaths from stroke, lung cancer and heart disease are due to air pollution: “This death is caused by exposure to fine particulate matter 2.5 microns or less (PM 2.5) in diameter, which leads to the development of cardiovascular, respiratory and oncological diseases".

Compliance with U.S. Government Nutrition Advice and Concurrent Obesity Trends Using Nurses' Health Study Data, 1980–2011

BackgroundBeginning in 1977, the U.S. Government began formally issuing dietary advice, a main objective of which was to reduce and prevent the prevalence of obesity in the American population. Concurrently, the Harvard School of Public Health began conducting dietary intake surveys and collecting body mass index (BMI) (kg/m2) data on female nurses in the Nurses’ Health Study I (NHSI) and II (NHSII). ObjectivesWe aimed to assess whether compliance with the nutrition guidance from the U.S. Government to restrict dietary intake regarding total fat, saturated fat, and cholesterol was meaningfully associated with the prevalence of obesity. MethodsWe analyzed nutrition survey data from 1980 to 2011, grouping the sample into “compliers,” those who complied with guidance on the intake of total fat, saturated fat, and cholesterol, and “noncompliers,” those who did not. We then compared the means, medians, and distributions of BMI for compliers and noncompliers over the period for both the full survey population and an age-controlled sample. Finally, we plotted raw NHS data to examine respondents’ Fat Proportion intake of energy and concurrent BMI. ResultsThe mean and median BMI for both compliers and noncompliers increased throughout the sample period, and the BMI distributions shifted toward obese and severely obese overall and for an age-controlled subset compared with the 1980 NHSI and 1990 NHSII baselines. Compliers had slightly lower mean BMI increases than noncompliers but saw a relatively higher increase in the growth of the prevalence of those with BMI >30. We also found no linear relationship between Fat Proportion of energy intake and concurrent BMI. ConclusionsGuidance from the U.S. Government to limit fat, saturated fat, and cholesterol consumption was widely adopted by American female nurses during the study period. Our results show that compliance with this guidance had little if any effect in mitigating population-wide BMI increases during our study period.

Editorial introductions.

Current Opinion in Rheumatology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Rheumatology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS W. Joseph McCuneW. Joseph McCuneDr W. Joseph McCune, MD, is Michael and Marcia Klein Professor of Rheumatic Diseases and Director of the Lupus Program at the University of Michigan. Following an Internal Medicine residency at the University of Michigan and a fellowship in Immunology and Rheumatology at Harvard Medical School and the Brigham and Woman's Hospital, Dr McCune has been a member of the faculty at the University of Michigan where he specializes in the epidemiology, diagnosis, and treatment of lupus and systemic vasculitis. Sara K. TedeschiSara K. TedeschiDr. Sara K. Tedeschi, MD, MPH, received her medical degree from Vanderbilt University, USA and her MPH degree from the Harvard School of Public Health, USA. She joined the rheumatology faculty at Brigham and Women's Hospital, USA, after completing her internal medicine residency and rheumatology fellowship there. Her clinical research on calcium pyrophosphate crystal deposition disease is supported by the National Institutes of Health. David FoxDavid FoxDr. Fox is a graduate of the Massachusetts Institute of Technology and Harvard Medical School. Following internal medicine residency and rheumatology fellowship at the Brigham and Women's Hospital, he joined the faculty of the University of Michigan School of Medicine in 1985. Dr. Fox is Professor of Internal Medicine and, from 1990 to 2018, was Chief of the Division of Rheumatology. In 2013, Dr. Fox became the Frederick G. L. Huetwell and William D. Robinson, M.D. Professor of Rheumatology. He is currently a Deputy Director of the Immune Tolerance Network. Dr. Fox's research focuses on defining and characterizing pathways of human T cell activation, determining the role of these pathways in the pathogenesis of autoimmune disease, investigating T cell interactions with synovial fibroblasts, and exploring novel approaches to the treatment of rheumatoid arthritis and scleroderma. He is author of more than 260 scientific papers and book chapters. Dr. Fox is also active in the clinical care of patients with rheumatic diseases and in teaching students and fellows in both clinical and research settings. From 2007–2008, Dr. Fox served as the seventy-first President of the American College of Rheumatology and the sixth ACR President from the University of Michigan

Commentary: You Can Lead from Anywhere.

Harvard School of Public Health, Boston, MA (Dr Goodspeed). Correspondence: Ron B. Goodspeed, MD, MPH, SciD, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 ([email protected]). The author has disclosed that he has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Editorial

Editorial

Editorial introductions.

Editorial introductions.

Synergy of Biostatistics and Epidemiology in Air Pollution Health Effects Studies.

The extraordinary advances in quantifying the health effects of ambient air pollution over the last five decades have led to dramatic improvement in air quality in the United States. This work has been possible through innovative epidemiologic study designs coupled with advanced statistical analytic methods. This paper presents a historical perspective on the coordinated developments of epidemiologic designs and statistical methods for air pollution health effects studies at the Harvard School of Public Health.

Niels Keiding (1944–2022)

Niels Keiding (1944–2022)

Without Commitment to an Ontology, There Could Be No Causal Inference.

Without Commitment to an Ontology, There Could Be No Causal Inference.

Editorial introductions.

Current Opinion in Lipidology was launched in 1990. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of lipidology is divided into six sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Frank M. SacksFrank M. SacksDr Sacks is Professor of Cardiovascular Disease Prevention in the Nutrition Department of Harvard Chan School of Public Health; Professor of Genetics & Complexes Diseases; and Professor of Medicine at Harvard Medical School. Dr Sacks led the panel designing the DASH Study, which crafted a healthful eating pattern and demonstrated that it lowered blood pressure more effectively than any previous dietary treatment. Subsequently Dr Sacks led the DASH-Sodium study, which determined the dose-response effect of dietary sodium on BP. These multi-center National Heart Lung and Blood Institute trials found major beneficial additive effects of low salt and a dietary pattern rich in fruits and vegetables on blood pressure. He also led the seminal PoundsLost trial which showed the percentage of calories from fat or carbohydrate had no effect on long term weight loss. Currently, he is co-investigator of the MIND study, a randomized trial of a diet that combines features of the Mediterranean and DASH diets to preserve cognition in older people, funded by the National Institute on Aging. Dr Sacks's laboratory has studied the role of apolipoproteins in atherogenic lipoprotein metabolism in obesity and hypertriglyceridemia. He authored over 30 research papers on apoC-3 and/or apoE. Recently he discovered that a type of HDL that contains apolipoprotein C-III predicted higher rates of heart disease and diabetes, the opposite to the protective relation for the total HDL; and impaired HDL function in reverse cholesterol transport. Dr Sacks teaches at Harvard School of Public Health as course director for nutritional metabolism and biochemistry. Dr Sacks received the 2011 Research Achievement Award of the American Heart Association for lifetime research accomplishment. Majken K. JensenMajken K. JensenMajken K. Jensen, PhD, is Associate Professor of Nutrition and Epidemiology at Harvard T. H. Chan School of Public Health. Dr Jensen's primary research interests include novel metabolic markers, nutrition, and genetics, in relation to chronic lifestyle diseases. In ongoing collaborations with Dr Frank Sacks, they investigate how the presence of a small proinflammatory protein (apolipoprotein C-III) on HDL particles marks a potentially dysfunctional type of HDL that is not inversely associated with risk of cardiometabolic health, such as IMT, diabetes and cardiovascular disease. Other currently funded work is focused on lipoprotein metabolism and Alzheimer's disease and stroke. Her research predominantly utilizes large-scale observational studies (including the Health Professionals Follow-Up Study, the Nurses’ Health Study, the Danish Diet, Cancer and Health study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study) where cost-efficient prospective case-control studies are nested within for purpose of measuring novel biomarkers or genome-wide markers. Dr Jensen's research has been published in leading scientific journals and has been recognized with numerous awards. She received the Trudy Bush Fellowship for Cardiovascular Disease Research in Women's Health from the American Heart Association in 2011 and originally came for research studies at Harvard T. H. Chan School of Public Health as a Fulbright scholar. Dr Jensen has published over 80 original research articles and 5 reviews, editorials, and letters.

An Interview with Professor Florence Bourgeois: on Policy and Regulation of Clinical Trials

For more than 20 years, Dr. Florence Bourgeois, MD, MPH has held multiple positions at the intersection of pediatrics, therapeutics, regulatory science, health informatics and research integrity. A graduate of Yale University, Harvard School of Public Health and Washington University School of Medicine in St. Louis, Dr. Bourgeois’ record transcends academia and medicine. In addition to being a faculty member at Harvard Medical School and the Division of Emergency Medicine and the Computational Health Informatics Program (CHIP) at Boston Children’s Hospital, she is the Director of PedRx, which aims to advance the development and evidence-based use of novel therapeutics for children globally. As the Scientific Director of the Boston Children’s Hospital Biobank, Dr. Bourgeois’ efforts focus on expanding physicians’ capacity to conduct research in pediatric populations. As the Co-Director of the Harvard-MIT Center for Regulatory Science, Dr. Bourgeois also spearheads cross-disciplinary collaborations between academia, biotechnology and pharmaceutical companies, and regulatory agencies. She is the recipient of an Innovation in Regulatory Science Award from the Burroughs Wellcome Fund and has served as an Expert Visitor to the European Medicines Agency to analyze the EU’s pediatric drug legislation. As part of this interview, we examine the relationship between clinical trials and drug development in pediatrics as well as their ethical and social impacts.

The Ecology of Meat

The Ecology of Meat

Kaposi sarcoma among adults enrolling for HIV care in a large HIV clinic in Nigeria: 2006-2017.

e18539 Background: Expanded access to antiretroviral therapy (ART) has led to a dramatic decline in Kaposi sarcoma (KS) among people initiating HIV care globally. In Nigeria, the country with the second-largest global HIV population, ART coverage increased from 11% in 2006 to 57% by 2017. The impact of Nigeria’s ART expansion of KS risk is unclear. We examined trends in KS risk among patients enrolled for HIV care in a large clinic in Nigeria from 2006-2017. Methods: We analyzed data of 16,431 adults (age ≥18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among three periods: 2006-2009, 2010-2013, and 2014-2017 (Mean national ART coverage 16%, 33%, and 50% respectively), using the Chi-test trend test and logistic regression models to identify factors independently associated with KS. The study was approved by the local institutional Institutional Review Board (IRB) and ruled exempt by the IRBs of Northwestern University and Harvard School of Public Health. Results: The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n= 10,788). The median first CD4 cell count was 192 (IQR 84-320), 215 (IQR 98-344), and 222 (IQR 94-353) in 2006-2009, 2010-2013, and 2014-2017, respectively. The overall KS prevalence at entry was 0.59 % (95% CI 0.48-0.72). KS prevalence was lowest for patient entering care during 2006-2009 (0.39%, 95% CI 0.29-0.53), increased to 1.12% (95% CI 0.82-1.52) in 2010-2013 and declined to 0.72% (95% CI 0.42-1.20) from 2014-2017 (Chi2 for trend, 12.14, p<0.01). Adjusting for age, sex, and CD4 T-cell count KS prevalence was significantly higher in 2010-2013 compared to 2006-2009 (Table). Conclusions: Despite ART expansion, KS at enrollment showed no significant decline. The low CD4+ cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART are critical to KS risk reduction in this population. Factors associated with Kaposi sarcoma at HIV care enrollment in Jos, Nigeria (2006-2017).[Table: see text]

Advances in lupus research in Latin América

"In this video blog, we will talk with José Gómez-Puerta, head of the Rheumatology Service at the Hospital Clinic de Barcelona, associate professor at the University of Barcelona and master's degree in Public Health from the Harvard School of Public Health, about the research carried out in Latin America on lupus by the GLADEL group and the key messages for patients and families, as well as existing relationships with covid-19." "Lupus is a treatable, controllable disease, where every day better treatment and better markers are being developed for its diagnosis and control. Consult a specialist for any warning sign or symptom out of the ordinary,"" he says."

Jason Hall, MD, FACS, MPH

It is my pleasure and honor to introduce Dr Jason Hall as this volume's guest editor. Jason is the Chief of the Division of Colon and Rectal Surgery at Boston University (BU), Boston, MA. He was born in Worcester, MA, and grew up in northern Mexico and central Massachusetts. He received his undergraduate at the College of the Holy Cross and medical school training at Harvard Medical School, Boston, MA, prior to completing his General Surgery Residency training at Massachusetts General Hospital, Boston, MA. Following this, he completed his fellowship in Colorectal Surgery at the Lahey Clinic, Burlington, MA. Jason stayed at Lahey for a few years, serving as the Program Director for the Colorectal Surgery Residency program, before leading the colorectal division at BU. Along the way, he also received his MPH at the Harvard School of Public Health, Boston, MA.

Rising Gold Prices Threaten the Feasibility of Malaria Elimination in Guyana

Guyana reported a significant rise in malaria nationwide between 2008-2014. The surge was attributed by public health authorities to a temporal increase in gold mining activity in forested regions, without evidence of impairment of national control strategies. However, systematic analysis of the association remains lacking due to the remoteness of both malaria and mining, and collection of reliable data becomes exceptionally difficult. To overcome this challenge, we investigated the relation between international gold price and falciparum malaria transmission in Guyana between 2007-2019, using statistical inference and time series analysis. We also evaluated the association between falciparum cases and the El Nino-Southern Oscillation pattern, previously suggested as a major malaria driver. The proportion of falciparum malaria cases among temporary residents was highest during the years of peak gold price, consistent with circulation of individuals related to mining activity. Further, cases among all demographics showed a strong positive correlation with gold price but only in regions with mining camps. The highest cross-correlation occurred earlier among individuals representative of mining laborers, suggesting that transmission in mining camps is followed by infections in the community. Upon these findings, we were able to reliably forecast falciparum malaria trends using only gold price as the predictor variable. Last, the La Nina climatic events showed an additional, smaller positive correlation with malaria transmission. Our analyses evidence that the 2008-2014 falciparum malaria surge observed in Guyana was mainly driven by an increase in gold mining, while climate factors might have contributed synergistically. We propose that international gold price is a useful indicator of future cases of malaria. We conclude that the feasibility of malaria elimination in Guyana and in other areas in the Amazonian where malaria and gold mining overlap should be evaluated against the challenges posed by rapidly rising gold prices. Funding: PMD was supported by the Ramon Areces Foundation fellowship. PMD and COB were supported by NIH/NIGMS, grant number 5R35GM124715-02. Declaration of Interest: None to declare. Ethical Approval: Ministry of Public Health, Guyana granted access to non-identifiable surveillance data obtained from the Malaria Program /Vector Control Services under Institutional Review Board exemption. Further, Institutional Review Board exemption was obtained from Harvard School of Public Health (Boston, US), Human Research Protection Program, Protocol number IRB18-1638.

Impact of a Solar Lighting Intervention on Social Determinants of Health in Rural Uganda: A Mixed Methods, Randomized Controlled Trial

Background: Clinical trials to reduce household air pollution have largely focused on cookstoves and have been in part limited by suboptimal adoption of cleaner cooking technologies. Less is known about the adoption and perceptions of clean lighting interventions. Methods: As part of a randomized controlled trial of indoor solar lighting systems (ClinicalTrials.gov NCT03351504), we conducted a mixed methods study to identify contextual factors determining uptake and perception of the solar lighting intervention. Sensors were incorporated into the intervention solar lighting system to measure uptake and use over time. Health-related quality of life was measured with the EQ-5D-5L. Qualitative interviews were conducted with all trial participants. Findings: Uptake of the intervention solar lighting system was high with daily use averaging 8·23 ± 5·30 hours per day. In mixed effects regression models, the intervention solar lighting system increased the EQ5D index by 0·083 [0·024 - 0·141], p = 0·006. Qualitative data suggest that solar lighting was associated with numerous benefits to study participants, including improved household finances, improved educational performance of children, increased household safety, improved family and community cohesion, and improved perceived household health. Interpretation: Uptake of the solar lighting intervention was high and led to improved health-related quality of life. The solar lighting intervention was a transformative household energy technology which improve multiple domains of the Social Determinants of Health (SDOH). Trials focused only on traditional health outcomes may underestimate the overall value of clean household energy interventions to the end user. Trial Registration: ClinicalTrials.gov NCT03351504 Funding Statement: US National Institutes of Health, Harvard School of Public Health, American Thoracic Society, Massachusetts General Hospital Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was approved by the Mbarara University of Science and Technology (Protocol #02/11-16) and the Partners Human Research Committee (Protocol 2017P000306/PHS), the Ugandan National Council of Science and Technology (Protocol #PS 42) and the Ugandan President’s office.

Precisely, with William Haseltine, Ph.D.: COVID Control American Style

Clinical OMICsVol. 8, No. 1 Precisely, with William Haseltine, Ph.D.Precisely, with William Haseltine, Ph.D.: COVID Control American StyleWilliam HaseltineWilliam HaseltineWilliam A. Haseltine, Ph.D., is known for his pioneering work on cancer, HIV/AIDS, and genomics. He was a professor at Harvard Medical School, the Harvard School of Public Health and founder of its Division of Biochemical Pharmacology and Division of Human Retrovirology. He has founded twelve biotechnology companies, including Human Genome Sciences, and is the author of several books, including his recently released autobiography My Lifelong Fight Against Disease: From Polio and AIDS to COVID-19.Search for more papers by this authorPublished Online:11 Feb 2021https://doi.org/10.1089/clinomi.08.01.31AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 8Issue 1Jan 2021 InformationCopyright © GEN PublishingTo cite this article:William Haseltine.Precisely, with William Haseltine, Ph.D.: COVID Control American Style.Clinical OMICs.Jan 2021.46-48.http://doi.org/10.1089/clinomi.08.01.31Published in Volume: 8 Issue 1: February 11, 2021PDF download

Nigeria aligns efforts for HIV epidemic control by 2030

Despite concerns about disruption to HIV care by COVID-19 and withdrawal of international funding, Nigeria eyes a sustainable, self-funded HIV programme. Paul Adepoju reports. AGHI: helping gay men in NigeriaWhen Peter found out about his HIV status, he was devastated because he knew he would be disowned by his parents, who had initially made him disavow homosexuality when he was caught in bed with his ex-lover. Full-Text PDF Tuberculosis and HIV responses threatened by COVID-19As the first cases of COVID-19 affect Nigeria's health-care workers, will the country's HIV and tuberculosis responses weather the pandemic? Paul Adepoju reports. Full-Text PDF APIN: a history of HIV management in NigeriaWhat started as a small project of the Harvard School of Public Health in 2000, focused on prevention of mother-to-child transmission of HIV, has become a prominent organisation for the management, treatment, and care of HIV in Nigeria. AIDS Prevention Initiative in Nigeria (APIN) now serves about a quarter of people with HIV in the country. Full-Text PDF