It's Flu Season!

While it isn’t possible to put a date on when it starts and ends, influenza (the viruses that cause the flu) activity often increases in October/November and peaks between December and March. When it hits your home, school or work, it may seem easy to observe how effortlessly the virus spreads.

While vaccination coverage among health care professionals that work directly with patients in a traditional care facility is rising, focus on increasing that rate can help reduce the rate of infection even further.

Flu Facts	Flu Vaccine Facts
Anyone can get sick from the flu. Seriousness can be mild to severe and in some cases lead to death. The virus is most commonly spread through fluid droplets of an infected person talking, coughing or sneezing. Symptoms appear 1-7 days after becoming sick. Some may not have any symptoms. The virus can be spread to others even before symptoms appear.	Flu vaccines are safe and serious problems are very rare. The most common is soreness around the injection. Flu vaccines are made with either killed or weakened viruses and cannot cause the flu. Although viruses are unpredictable, the vaccine protects against those that research indicates to be most common during the upcoming season.
Download the CDC’s Everyday Prevention Actions That Can Help Fight Germs, Like Flu informational flyer.	Download the CDC’s informational flyer outlining the benefits of the flu vaccination.

Does the influenza virus change?

Constantly changing, influenza may do so by “drift” or by “shift.”

Antigenic Drift – Small genetic changes can occur during the virus replication cycle. Often, if a person has already been exposed to a particular virus, their antibodies will still recognize and fight this slightly different virus. This called cross-protection. However, if enough changes accumulate, the previous antibodies may not be effective.

To keep up with antigenic drift, the composition of flu vaccines is continually reviewed, predictions made about which should be addressed and regional recommendations made based on prevalence.

Antigenic Shift – An abrupt or major change in the virus—resulting in a new combination of genes in the virus—can shift a virus that previously infected animals to being able to infect people. Often when a shift occurs, most people have little or no antibody protection against the virus. This fact is what allows the virus to spread quickly and can result in a pandemic.

To avoid antigenic shift, strategies such as limiting exposure to diseased animals, vaccinating livestock and vaccinating farmers for similar viruses to promote cross-protection are in place.

Flu vaccination recommended for healthcare providers.

As of November 1, 2016, the Centers for Disease Control and Prevention’s (CDC), Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers* get vaccinated annually against influenza. Unfortunately, the two most common reasons reported for not getting vaccinated include thinking that the flu vaccine doesn’t work or not thinking it is important to get.

Breaking the chain of infection through health care workers can help decrease the spread of the virus to vulnerable individuals that come under their care as well help limit antigenic drift. During the 2014-15 flu season, 64.3% of health care personnel were vaccinated. Unfortunately, those that worked in long-term care facilities—generally providing care to the elderly or other vulnerable individuals—had the lowest coverage at 54.4%. Across all types of facilities, vaccine coverage was 85.8% for those whose employers who required it, 68.4% when recommended by the employer and only 43.4% when there was no policy or recommendation in place.

Does the facility you work at have a policy or provide incentives regarding the flu vaccine? 

If not, share this article now! Helping to dispel myths about the flu vaccine and promote its purpose among health care professionals and facility managers is an important step in flu prevention. Explore at http://www.cdc.gov/flu/healthcareworkers.htm. 

*Health care workers include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from health care workers and patients.

• Frequently Asked Flu Questions 2016-2017 Influenza Season (2016). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/flu/about/season/flu-season-2016-2017.htm
•  How the Flu Virus Can Change: “Drift” and “Shift” (2016). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/flu/about/viruses/change.htm
• Influenza Vaccination Information for Health Care Workers (2016). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/flu/healthcareworkers.htm

Learning the Value of International Research in Ghana

Over the summer of 2016, four MPH students, one medical student and one MPH faculty took part in ongoing research projects over five weeks in Ghana. Staying on campus at the teaching hospital, Kuomfo Anokye, in Kumasi, students worked to

• collect data to help predict risk of Metabolic Syndrome (MetS);
• examine water quality across a gold mining region; and
• investigate factors associated with Hepatitis C (HCV).

Matt McHugh recounts the experience.

“Most of our involvement had to do with expanding previous MetS study work. Processing data via a 6-part survey (Anthropometric measures/Health risk factors/Food diary/SES interview) gave us a hands-on look at the complexities of conducting research in underserved communities.

After collecting water and soil samples in three different towns (Kumasi, Obuasi and Nkwantakese), it was tested to measure the heavy metal content that varied due to the distance of area gold mines. We were able to see how the mining practices affected the health of area communities.  

Additionally, we participated in a collaboration between Gilead Sciences, LUC and NYU. Tailoring a survey to protect the dignity and modesty of participants—but still gain important knowledge pertaining to hygiene and sexual behaviors that contribute to HCV transmission—we surveyed 25 people in Nkwantakese with translators. The work gave us great insight into HCV transmission factors that would help develop effective treatment plans utilizing the new pan-genotypic drug.”

But why Ghana? Why conduct research abroad at all?

In addition to gaining practical working knowledge on how to conduct complex research, strengthening their ability to see patterns between environmental issue and health effects, and becoming more cognizant of how sensitive topics can affect research outcomes, the students also expanded their understanding of community. This field experience broadened their social and cultural experience which will have a profound effect on their future research, practice and advocacy work.

The power of international education and research is immense. The MPH program is proud to have so many professionals that understand the benefits of this unique type of collaboration. 

Report on Life Expectancy - Chicago Tonight - December 12, 2016

What does it mean when we talk about life expectancy? Does the data point to a decrease in life expectancy in the United States? What improvements have been made? Where should additional attention be directed?

These questions and more are addressed in Chicago Tonight's segment "Are Americans Dying Younger?" that aired December 12, 2016. The segment runs from approximately 28 minutes in through 39 minutes in.

Click to launch Chicago Tonight - Full Episode - video.

Video Features:

• Diane Lauderdale, PhD
  University of Chicago, Epidemiology, Department Chair & Professor
• Richard Cooper, M.D.
  Loyola University Chicago, Public Health Sciences, Department Chair & Professor

2016 Junior Scientist of the Year Award

During the 37^th annual St. Albert’s Day reception on November 3, 2016, Dr. Lara Dugas, PhD, MPH—Assistant Professor with the LUC Department of Public Health—received the 2016 Junior Scientist of the Year Award.

Who was St. Albert? Called the “Doctor Universalis” (Universal Doctor), St. Albert was born at the beginning of the 13th century, joined the Order of St. Dominic in 1223 and was canonized in 1931. During his life, St. Albert dedicated his life to learning, exploring science and philosophy and teaching. It is no surprise that LUC had adopted his name for their annual research symposium featuring presentations across any multitude of topic areas.

St. Albert’s Day, hosted by the Health Sciences Division, is a celebration of all the research taking place at the Stritch School of Medicine. Throughout the day, research students make presentations concerning their area of focus. Dr. Dugas noted, “There are not many opportunities to see all the research that is going on. It is really eye opening to see the level of research being conducted as well as the diversity of the material.” 

Many of the students that presented that day are part of LUC’s Student Training in Approaches to Research (STAR) Program. This eight-week, research intensive is an opportunity for first year medical students to gain an in-depth understanding of the scientific approach, interpreting results and presenting findings. Dr. Dugas has mentored over 45 students during her time at Loyola, many of which are part of the STAR Program.  

At the conclusion of the event, Dr. Dugas was honored with the 2016 Junior Scientist of the Year Award. As her biography is studded with research achievements, honors and grant awards, it is no wonder she was nominated by her peers. When asked what she believes most contributed to her success—without hesitation—she answered, “collaboration.”

Explaining that her knowledge is the culmination of her past work, Dr. Dugas’ pursuits have been aided by her self-diversification. However, identifying and working with new collaborators has been just as important as her own development. It is what has kept her passion fueled. Her advice to those in research, “find people who inspire you and that you enjoy working with. Success will happen naturally.”

Poverty Simulation Workshop Recap

As we lead into the winter months, it is a good time to reflect on the broad spectrum of socioeconomic dimensions in America. To broaden students’ understanding, Poverty Simulation Workshops were conducted across the three LUC campuses. Students and faculty from all programs were invited to attend and approximately 109 participated.

Poverty Facts
14.5%	Official U.S. poverty rate (approximately 45.3 million people).
25.4%	Average poverty rate for African-Americans and Hispanic/Latinos (compared to 9.6 for White non-Hispanic).
15.8%	Rate of females in poverty (compared to 13.1 of males).
Source: www.census.gov/hhes/www/poverty.html

During the 3-hour simulation, participants were asked to role-play. Each was given a random card with the photo, age and backstory of the person who they were to bring to life. Some found themselves sitting alone, assigned a chair in a homeless shelter. Many were greeted by members of their family, however, the structure of that family was often far from what would be called “typical.” Others were assigned roles as teachers, social workers, employers, retailers and part of other community entities.

At the start of each program, the participants worked to understand their situation, dependencies and resources. The challenge was to make it through one month of paying bills, maintaining a job, caring for family members, staying healthy, etc. As the interconnectedness of the community became clear, so did the unique individual struggles. It is impossible not to feel a bond with one’s character and real stress from the difficulties they are facing with each passing simulated week.

Before joining LUC’s MPH program, Chloe Cavida’s interest in public health grew during her time as a research assistant at UIC. While knowing that pursuing this area of study would help her achieve her goal of bettering those in communities around her, she found the simulation to be enlightening in many ways. Following her participation, Chloe writes:

“I found myself getting frustrated and stressed especially when I didn’t know where to get help and consistently failed to make ends meet. This, unfortunately, isn’t a simulation for many families; it’s reality. I encourage everyone to participate in this simulation to better understand how we—as individuals who wish to serve the community and the individuals who comprise them—can create more awareness among policymakers and community leaders.”

Takeaways from the program included reminders of what our responsibilities are as public health professionals as well as compassionate members of our communities. These include:

• Commit: Make a promise to yourself that you will take action to improve the lives of those living in poverty.
• Educate: Learn more about the real struggles and share those stories with your peers and community organizers.
• Volunteer: Give time or donate your skills to an organization that is helping to advance the lives of those at risk.
• Write: Share your knowledge of issues with government officials, businesses and the media to communicate their importance.
•  Socialize: Expand your network and understanding by making friends with people of all socioeconomic backgrounds.

It was apparent at the end of the simulation that all were inspired by the roles they played as well as the confidence they gained in better understanding the issues. This experience will definitely be one that is recalled many times and especially impactful for those pursuing a career in public health.

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The Poverty Simulation is designed by the Missouri Association for Community Action (MACA). Additional information is available at www.povertysimulation.net.

The Poverty Simulation Workshop is part of a HRSA Grant #UD7HP26040, called I-CARE-PATH, to integrate interprofessional collaborative education to include all who are interested in health of communities.

PHS Clinical Research

Loyola is poised to begin participation in the first two nationally funded observational studies funded by PCORI using the Clinical Data Research Networks (CDRNs).  Loyola Health System and Loyola University are part of the Chicago-area funded CDRN called CAPriCORN.  Both studies are focused on obesity and will take advantage of the rich data available through the electronic medical records.  One study will monitor the long term outcomes of 3 common types of bariatric surgery.  This study will be lead locally by Drs. Amy Lukeand Bipand Chand.  The second study will look at the relationship between antibiotic use in young children and growth/weight gain.  Dr. Lara Dugas will serve as the Loyola site PI for this study.  Several other studies utilizing CAPriCORN are anticipated in the near future.  The Loyola PI for CAPiCORN is Dr. Fran Weaver.

PHS Faculty Member and colleagues identify tumor gene

Department of Public Health Sciences Faculty member, Michael Zilliox Ph.D., and his colleagues have identified a tumor gene that may help to predict survival outcomes in patients with cancer of the mouth and tongue.

If the gene is expressed (turned on), patients are 4.6 times more likely to die at any given time, according to a their work.

Learn more about it here.

Michael Zilliox and lab manager Gina Kuffel working with next-generation sequencers

March 2016

The Chairman’s Blog

Race, Racism and Health

            Gross inequalities in health across populations have been recognized for centuries.  With modern health systems these inequalities can be measured in great detail.  The disadvantage experienced by black Americans is one of the best studied and most important inequalities in the US.  For example, death rates among black Americans have been 50% higher than for whites ever since vital statistics data were first collected in 1900, and life expectancy is 4 years shorter.  Despite the vast recounting of this experience, and the many interventions – most often on a small scale - that have been mounted to reduce the health gap, we can at best point to only modest progress in the last several decades.

            There is no mystery lurking below the surface here – health is determined by where we group up, the school we attend, what job we hold, and our access to a secure and health-promoting life style.  What is all too often missing from this story, however, is a recognition of the vital importance of active, organized institutional racism within our society.  Discrimination against people of color cannot have gone undetected by anyone who lives in this society, or even the casual visitor from abroad.  Yet while discrimination is all too apparent in our daily experience - in residential segregation, police violence and the grossly skewed patterns of employment - just how the institutions of our society give racism its enormous impact as a living social force is often invisible.  No doubt historical practices of racism gain momentum on their own, and are passed down through collective behavior.  That alone, would not be sufficient to maintain the impregnable barriers to racial equality that have been with us for 500 years of US history. For the 300 years when that institution took the form of chattel slavery racism not only saturated every aspect of life in the US, it was applauded and fanatically defended; a “second revolution” and the deadliest war we have ever fought was required to bring down that barrier. Racial history since 1864 has been one of great progress, yet with continuity.  Our challenge today is to understand the much more complex structures that continue to limit life’s chances for people of color.  Understanding and confronting this reality is not a dry academic exercise; it is a life or death challenge faced by millions of our friends, work-mates and neighbors every day.  More. Racism is a poison that seeps into the interstices of every social domain – wreaking havoc on our cities, undermining the political will to support public education and insure that all employment offers a living wage.  Our founding document, still honored as a literal handbook for the operation of government, proclaims as a self-evident truth that “all men are created equal”.  The original sin of our society was yielding to the temptation to the vilest hypocrisy – defining “all men” and “equal” to mean precisely the opposite.  The pretense of moral authority enshrined in that document has granted us license to live a lie.  Yet you reap what you sow and, while perhaps not self-evident to the founding fathers, no matter what their skin color or ethnic background, “all men” -  and women – have an unalienable will to assert their demand for equality.  We continue to pay dearly for the choice to our build society on a foundation of injustice.  Illness and death have no respect for pretense.  Health inequalities demonstrate an inescapable truth about the state of justice and equality in our society. 

            The goals of this blog are 3-fold: 

1) To explore the structure and way of operating of those institutions that constantly rebuild, extend and modify the barriers to racial equality.

2)  To illuminate how those institutional practices rob black Americans and other minority groups of their good health. 

3) To generate an urgency, a “fire in the belly” outrage, that will move us all to fight racist institutions, their practices, and the people who promote them.  Only by taking up these challenges can we expect to win in the struggle against the immense power that racism wields in our society.

Public Health Seminar March 8th

Dr. Dmitriy Dligach, a newly hired assistant professor at the computer science department at the Loyola Lakeshore Campus, will present a seminar titled "Semantic Analysis of Clinical Texts” on March 8th for our department at the conference room.  The abstract is also attached. Before he joined Loyola in January this year, he was a researcher at Boston Children’s Hospital and Harvard Medical school doing work in electronic medical record data mining.

His abstract is as follows:

It is often estimated that 80% of clinical data today is stored in an unstructured form, mostly as electronic health records. Within this corpus of text lies a vast amount of valuable information that can be leveraged for phenotyping, pharmacogenomic studies, clinical studies, and clinical decision support, ultimately improving patient care and reducing healthcare costs. Until recently, this wealth of information could not be analyzed but with the advent of Natural Language Processing (NLP) it became possible to turn this data into a structured form which can be subsequently used for data mining. In this talk, I will discuss various approaches to semantic analysis of clinical narratives. I will begin by describing a coarse semantic analysis task known as phenotyping. The best-performing approaches to phenotyping currently heavily rely on manually annotated data. I will report on my experiments with active learning, a technique that has the potential to drastically reduce the reliance on manually annotated data. I will then go a level deeper and describe a more fine-grained approach to semantic analysis of electronic health records, which involves discovering UMLS relations between clinical entities. I will conclude with an outline of another relation extraction task which involves extracting temporal relations between clinical events and report on the availability of open-source software for deriving clinical timelines from electronic health records.