Free Content about the Zika Virus Now Available


Just 8 days after the public health emergency was declared, this content regarding the Zika virus has been written, reviewed, edited, and released as a freely available resource.

On February 1st, the World Health Organization declared a Public Health Emergency of International Concern related to clusters of microephaly cases in some areas affected by the Zika virus. Like the Ebola virus, there had been very little funding and research on Zika until the recent emergency and associated media and scientific attention – there is therefore a dearth of information and there is neither a vaccine nor prophylactic pharmacotherapy available to prevent Zika virus infection.

In response to concern over the effects of Zika virus infection in pregnant women, the medical publishing team at Cambridge University Press commissioned a brief summary of current evidence and recommendations. Just 8 days after the public health emergency was declared, this content has been written, reviewed, edited and released as a freely available resource. The content has been provided by Professor Bernard Gonik, Fann S. Srere Chair of Perinatal Medicine, Wayne State University School of Medicine.

Released in advance as a freely accessible public resource, this content is part of High-Risk Pregnancy: Management Options – a forthcoming updateable online product from Cambridge University Press. Like all of the content in High-Risk Pregnancy: Management Options, the Zika section will be regularly updated as new information arises.

Read about the Zika Virus Here


Announcing the publication of the first papers in GHEG

GHG blog image - cover
We are delighted to announce the publication of the first papers in Global Health, Epidemiology and Genomics. As GHEG is fully Open Access, these papers, and all papers published in the future, are freely accessible online. Here we provide a brief summary of our first three publications.

 A forum for global population health, technological advances and implementation science
 Manjinder Sandhu

A welcome editorial by our Editor in Chief, marking the launch of Global Health, Epidemiology and Genomics. Dr Sandhu highlights the strengths of the broad interdisciplinary scope of the journal and its international editorial board and invites the global health community to engage and contribute to the journal so that it becomes a valuable, practical and informative resource.
Read the full article here


favicon Study Profile: The Durban Diabetes Study (DDS): a platform for chronic disease research
 Thomas Hird et al.

A study profile of The Durban Diabetes Study (DDS), an on-going population-based cross-sectional survey of an urban black population in Durban, South Africa. The DDS was established to investigate a broad range of lifestyle, medical and genetic factors and their association with diabetes. It provides a rich platform for investigating the distribution, interrelation and aetiology of other chronic diseases and their risk factors, which can be utilised for other research studies.
Read the full article here


Favicon long Capitalizing on Natural Experiments in Low- to Middle- Income Countries to Explore Epigenetic Contributions to Disease Risk in Migrant Populations
 J. Jaime Miranda et al.


A commentary on the value of epigenetics as a tool for understanding differential disease risk in migrant populations. The authors highlight the merit of exploring migrant chronic disease risk in low- to middle-income countries, particularly in the context of rural-to-urban migration, with increasing urbanisation in this setting.
Read the full article here
More articles will be published in the coming weeks, and you can be notified when new articles are published by signing up to content alerts here. Here’s a preview of what’s coming soon:

  • H3Africa Multi-Centre Study of the Prevalence and Environmental and Genetic Determinants of Type 2 Diabetes in Sub-Saharan Africa: Study Protocol
    Kenneth Ekoru et al.
  • Regulatory Developments in the Conduct of Clinical Trials in India
    Dhvani Mehta and Ranjit Roy Chaudhury

GHEG accepts original research articles, brief reports, structured reviews and commentaries as well as protocols, research resources and analysis. We are waiving the Article Processing Charge for all articles submitted to GHEG before the end of 2016. We invite contributions from a range of disciplines:
Epidemiology, Clinical trials, Genetics, Observational studies, Qualitative studies, Anthropological studies, Social science, Community intervention, Health systems, Health services, Population genetics, Population history.
For further information on the journal and how to submit please visit our website. Or if you wish to submit your manuscript directly please visit:

Mental health implications for older adults after natural disasters

cyclone yasi_earthquake2

The January International Psychogeriatrics Article of the Month is entitled “Mental health implications for older adults after natural disasters – a systematic review and meta-analysis” by Georgina Parker, David Lie, Dan J. Siskind, Melinda Martin-Khan, Beverly Raphael, David Crompton and Steve Kisely. This blog piece was written for us by one of the paper’s authors, David Lie.

Our interest in the susceptibility of older adults to disaster arose in the context of an unprecedented spate of natural disasters and dramatic events affecting the Australia- New Zealand region between 2009 and 2011.

New Zealand was affected by an air crash, earthquakes (notably Christchurch) and the Pike River Mine accident. A number of bushfires affected most regions of Australia notably the Black Saturday fires, which itself had followed a heatwave. Flood and cyclone preoccupied other parts of the country (e.g. Cyclone Yasi) amidst economically disruptive events such as volcanic ashclouds. Taken together these events killed hundreds of people and injured or displaced thousands more.

The broad psychological impact of the Tohoku earthquake, tsunami and nuclear disaster complex was the closing parenthesis for a period that demanded we knew more about the psychiatry of extreme events and particularly for older adults. Very little seemed to have been written as overview with the exception of a narrative review by Cherniak (2008) and a book on geriatric aspects of disaster psychiatry (2010).

As we explored the literature, contradictory themes emerged suggesting that older people were as likely, more likely or less likely than younger counterparts in their susceptibility to serious mental health sequelae after disasters.

Four broad theories to explain age-related resilience or vulnerability are outlined in the introduction to our paper which can be summarised as:

  • Experience counts
  • You don’t react emotionally as much as you age which is protective
  • The middle aged are stressed most, caring for their children and parents
  • As you age you become more vulnerable

We chose to analyse the highest quality research to determine broad patterns but much more needs to be learned. Our research (Parker et al., 2016 this issue) showed increased relative risk for PTSD and adjustment disorder but is based on particular disasters in particular contexts and only on natural disasters. Our included studies were characteristically events which were sudden, unheralded and producing significant physical destruction comprising four earthquakes and two tsunamis.

It could be that older adults actually have better outcomes in disasters where evacuation and/or preparation are possible or in areas where natural disasters such as hurricanes or cyclones are recurrent and an eventual part of life for those who live long enough.

We would certainly recommend further development of standardised, validated tools and research protocols for deployment in future disaster psychiatry studies to expedite our understanding. Whatever the reality of climate change, the world is indisputably ageing and increasingly living closer to shorelines and other places that put people “in harm’s way”.

The full paper “Mental health implications for older adults after natural disasters – a systematic review and meta-analysis” is available free of charge for a limited time here.

The commentary paper “Natural disaster, older adults, and mental health–a dangerous combination” by Meaghan L. O’Donnell and David Forbes is also available free of charge here.


Cherniack EP.. The impact of natural disasters on the elderly. Am J Disaster Med. 2008 May-Jun;3(3):133-9.

Parker G, Lie DC, Siskind DJ, Martin-Khan M, Raphael B, Crompton D and Kisely S. Mental health implications for older adults after natural disasters – a systematic review and meta-analysis. Int Psychogeriatrics 2016 (2016), 28:1, 11–20

Geriatric mental health disaster and emergency preparedness. John A. Toner,
editor ; Therese M. Mierswa, associate editor, Judith L. Howe, associate editor.

The Relationship Between Sleep and Alzheimers

Oregon Health & Science University in Portland has begun a research project to better understand the how relationship between sleep and Alzheimer’s disease. The research will focus on a “key process” in the brains of sleeping humans which will be the first of its kind and will hopefully illuminate the ways in which sleep and Alzheimer’s are intertwined.

In the early stages of Alzheimer’s sleep problems are very common for patients. Sometimes even years before patients develop more noticeable cognitive problems or memory loss they will suffer from disrupted sleep.

In the last five years studies have found that people, and mice, that were suffering from poor sleep patterns had a buildup of beta amyloid plaque in their brains. Beta amyloid plaque, a sticky mixture of proteins, collects in synapses. It is also a key characteristic in people with Alzheimer’s disease.

Researchers think that sleep might sweet toxins in the brain which would prevent beta amyloid from collecting in synapses. However, it is still not clear if the disrupted sleep is caused by the beta amyloid buildup or the beta amyloid buildup causes the disrupted sleep, “It may be a vicious cycle,” Miroslaw Machiewicz from the National Institute on Aging told the AP.

In order to help further solve this mystery, the team at the Oregon Health & Science University plans to observe people’s brains in a hyper-sensitive MRI machine while they sleep. They hope to see when the sweeping in the brain occurs in the sleep cycle. This new study could further illuminate, and possibly highlight, the relationship between sleep and Alzheimer’s which could help find new treatments and preventative measures in the future. Despite this excitement, scientists do acknowledge that participants may have a hard time sleeping in a noisy and small MRI machine. Good luck sleeping!

Rising risk of obesity among China’s ‘left behind children’

Boys in Rural ChinaThe December Nutrition Society paper of the month, is from Public Health Nutrition and is entitled, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China.’

Some 61 million rural children left behind by parents moving to China’s booming urban centres are at risk from increased fat and reduced protein in their diets.

The study of 975 children from 140 rural villages in nine provinces carefully analysed nutritional intake and showed a particular risk to boys who were left behind in the care of grandparents or a mother who sought work away from home.

There are sound financial reasons why so many people move from rural to urban areas in China, but the benefits that more money brings to a family can often be at the expense of child nutrition. The Chinese government needs to recognise this growing problem among rural communities and this research provides some evidence to target health policies on encouraging a balanced diet.

The study finds that ‘left behind’ boys in particular consumed more fat and less protein than those from complete families, which potentially leaves them at increased risk of obesity and stunted growth. This has important policy implications in a specific cultural-context where son preferences are powerful.

Although the results of the study don’t provide reasons for this change in diet, we speculate that mothers moving away from home generally earn less, and that these lower earnings act in combination with grandparents’ poorer dietary knowledge or willingness to spend more on food.

Another factor at work could be that prices of protein-based foods such as eggs and meat have increased faster than many households’ incomes – meaning that even though money is being sent home from one or both parents, nutrition doesn’t always improve.

The process of parental migration is complex and the reasons for problems in boys’ nutrition are not straightforward, however we can see that both parents and grandparents in rural areas need to be educated about good diet.

Because raising children can fall on all members of the family, good care-giving practice needs to become more widespread.

The paper, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China,’ was published in the journal, Public Health Nutrition and is available to read in full at

Authors Nan Zhang, Laia Bécares and Tarani Chandola

Funding- Economic and Social Research Council (ESRC) Postgraduate Scholarship

Global Health in 2015 – via Global Health, Epidemiology and Genomics

Global health review word cloud

This post was written by Anna Louise Barr andoriginally posted on the Global Health, Epidemiology and Genomics blog – read more at:

A review of the year’s most notable global health news stories, events and research breakthroughs, and a look towards future challenges in 2016 and beyond.

This year has seen a number of milestones achieved in the fight against infectious diseases. For the first time, a malaria vaccine has been approved and recommended by the World Health Organization (WHO) for pilot implementation. If deemed safe and effective, the vaccine will be a positive step forward in the fight against malaria in Africa, where the specific species that the vaccine targets is most prevalent and is responsible for the deaths of 500,000 people annually. In June, Cuba became the first country in the world to eliminate mother-to-child transmission of HIV and syphilis. Furthermore, UNAIDS announced that, globally, the spread of HIV has been halted and reversed, with 15 million people now currently receiving antiretroviral therapy. These two achievements represent an important breakthrough in the prevention of HIV transmission and realising the goal of an AIDS-free generation. In September, WHO announced that Nigeria was no longer a polio-endemic country; just two countries (Pakistan and Afghanistan) have yet to stop polio transmission.

In West Africa, transmission of Ebola has ended in Sierra Leone, however, 19 months after the first case was reported, cases are still arising in Guinea and Liberia, and vigilance remains high in the region. Recent studies have detected the virus in semen, and other immune privileged sites, several months after infection, leading to some concern regarding possible sexual transmission of the virus. The risk is deemed low, but considering the unprecedented scale of the epidemic and numbers of survivors, the WHO and the US Centre for Disease Control and Prevention have continued to encourage the promotion of safe sex practices. A vaccine for Ebola has also been developed and is close to approval.

2015 marked the end of the Millennium Development Goals (MDGs). During the 15 year initiative, the MDGs successfully galvanised political will, resulting in unprecedented efforts to reduce global poverty. Extreme poverty declined by more than half and reductions were seen in the proportion of undernourished people in developing regions and the number of out-of-school children of primary school age. Globally, the mortality rate of children under-five more than halved and maternal mortality fell by 44% worldwide. Yet not everyone has benefitted equally; the poorest and most disadvantaged in society have quite often been left behind.

The 2030 Agenda for the Sustainable Development Goals (SDGs), which were launched this year, hopes to build on the MDGs and address these inequalities. It is an ambitious set of new goals, 17 in total with 169 targets altogether, centred on the vision of development through equality and the implementation of sustainable economic, social and environmental policies. Unlike the MDGs, health no longer takes centre stage, with only goal three, ‘ensure healthy lives and promote well-being for all at all ages’, specifically addressing it. Whilst other goals have health related targets, addressing risk factors such as poor sanitation and malnutrition, there is some concern that there is no coherent vision for health in middle- and high-income countries where the health burden is predominantly from non-communicable diseases; risk factors such as unhealthy diet, obesity and inadequate physical exercise are not addressed.(1) The overall successes of the MDGs inspires hope that the same collective action and funding commitment will be directed towards the SDG agenda maintaining the momentum required to take on the global health challenges ahead.


1. Murray CJ. Shifting to Sustainable Development Goals–Implications for Global Health. The New England Journal of Medicine. 2015;373(15):1390-3.


Perspectives on HIV/AIDS and “getting to zero” – via Global Health, Epidemiology and Genomics

shutterstock_330865073 credited

HIV/AIDS is a global killer that affects an estimated 37 million people worldwide.(1) Despite success in reducing the burden of HIV, we are now facing treatment challenges due to resistance and are still without a cure or a vaccine for HIV. These issues must be addressed if we are to realise the goal of “getting to zero” HIV cases and deaths.(2)

Sub-Saharan Africa (SSA) has the highest global burden of HIV, with an estimated 25.8 million adults and children living with the condition. Asia, the Pacific region, Eastern Europe and Central Asia also have a considerable burden of HIV. Of the 1.2 million global AIDS-related deaths in 2014, 790,000 occurred in the SSA region and 240,000 occurred in the Asia and the Pacific region.(1) Thus HIV remains a major cause of ill-health and premature death globally, disproportionately affecting low- and middle-income countries.

Access to antiretroviral therapy (ART) has rapidly increased over the past decade, which has led to a notable decline in HIV associated morbidity and death in SSA. It is also believed that overall HIV incidence has been reduced. However, this is not the case for some high risk groups, such as men who have sex with men, where incidence is thought to be on the rise.(3) Thus, it is important to galvanise education and prevention strategies, particularly targeted to these high risk groups to reduce the number of new HIV cases.

There are currently more than 30 antiretroviral drugs approved for use in the majority of developed countries.(4) The latest therapies have improved efficacy, fewer side effects and are easier to administer. However, despite these improvements, there remain issues surrounding drug-specific side effects and interactions with other drugs. We are still without a cure or a vaccine for HIV and treatment of HIV is further hindered by the emergence of drug-resistant pathogens. The development of novel drugs is therefore central to the continued success of HIV therapy, globally. Several drug strategies have been developed or proposed, including antibody therapies and newer classes of antiretrovirals. A better understanding of biological processes underlying HIV disease progression would facilitate efforts to develop novel HIV treatment strategies. It is clear that combinations of current and novel drugs will be required for effective long-term HIV control.

Surveillance will be instrumental in the identification of new and existing cases of HIV to enable the targeting of treatment and control interventions. Fortunately, we have the tools to rapidly detect cases of HIV at the point of care. HIV rapid diagnostic tests (RDTs) are non-invasive and provide results in less than 30 minutes. Scaling-up the use of RDTs will help to identify new cases of HIV and will be particularly valuable in the detection of hotspots of epidemic infection. However, more sensitive and specific tests are still needed, particularly to detect cases of acute infection.

In order to achieve the target of “getting to zero”,(2) integration of surveillance, case detection and diagnosis, treatment and case management will be essential. In light of ART resistance, it will be evermore crucial to incentivise vaccine development initiatives to prevent establishment of infection in the first instance. New treatment strategies, novel HIV therapeutics and the scaling-up of HIV prevention strategies will also be essential if we are to reduce HIV infections and deaths to zero.

Key references:
1. Joint United Nations Programme on HIV and AIDS (UNAIDS). 14 July 2015.
2. Joint United Nations Programme on HIV/AIDS (UNAIDS). Getting to Zero 2011-2015 Strategy. Geneva, Switzerland, 2010.
3. World Health Organization. Global Update on the Health Sector Response to HIV, 2014. Geneva, Switzerland, 2014.
4. FDA. 2014. Antiretroviral Drugs Used in the Treatment of HIV Infection. (Accessed 22 August 2015)


This post was originally posted on the Global Health, Epidemiology and Genomics blog – read more at:



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