When it comes to life’s stressors, most people would put caregiving at the top of the list.

But according to Peter Vitaliano, a professor of psychiatry and psychology at the 91̽��, there never have been data actually showing caregiving causes psychological distress.�� So he, and other researchers at the 91̽��conducted a study of about 1,228 female twins, some were caregivers, and some were not. The results were somewhat surprising.

The , “Does caregiving cause psychological distress? The case for familial and genetic vulnerabilities in female twins,” was published in the Annals of Behavioral Medicine in January 2014 and showed that the associations between caregiving and different types of psychological distress (depression, anxiety, perceived stress and perceived mental health) depend largely on a person’s genes and upbringing – and less so on the difficulty of caregiving.

Did the person have a history of depression before being a caregiver? If so, “caregiving may be like putting salt on the wound,” said Vitaliano. If there’s no depression in the past, caregivers don’t seem more affected by depression than noncaregivers.

Depression and perceived mental health are the most influenced by genes, said Vitaliano.�� Anxiety is most related to caregiving, and people who don’t get relief from anxiety are more likely to become depressed, he noted.

Perceived stress, meanwhile, is almost exclusively related to the kind of environment a person was raised in, not genetics or caregiver status, he said. If a person grows up in a home where one’s parents show lots of avoidance and fear in response to a lost job or sickness , then he or she will likely model that behavior.

Vitaliano said these results break the long-held belief that caregiving directly causes distress. He noted that since 1953 there have been more than a thousand papers on distress among caregivers without any data showing causality.

By examining twin pairs – both monozygotic (identical from same fertilized egg) and dizygotic (fraternal from separate fertilized eggs) – 91̽��researchers assessed the extent psychological distress is related to caregiving, or confounded by common genes and environmental exposure.�� The study focused exclusively on female twins (408 monozygotic and 206 dizygotic pairs), of which 188 were caregivers. Not enough male caregivers were found to be included in the analyses.

The study comes out as chronic diseases are rising rapidly and Alzheimer’s disease is called “the disease of the century” – expected to rise from 5 million victims in 2008 to 12 million in 2030.�� As a result, more and more people will become caregivers.

Because health care funds are limited, Vitaliano hopes that treatment interventions and policies will be targeted towards caregivers who are at the highest risk.

A nationwide study among caregivers living with an Alzheimer’s patient validates the 91̽��researchers’ findings. The study, Resources for Enhancing Alzheimer Caregiver Health II or REACH II, looked at 642 caregivers in five sites: Birmingham, Memphis, Miami, Palo Alto and Philadelphia.

The intervention involved 12 individual sessions (nine at home and three by telephone) and five structured support-group sessions.�� Study participants with low, medium and high levels of depression were randomized in groups that received treatment and didn’t receive treatment.

An analysis of the findings published in the International Journal of Geriatric Psychiatry in August of 2013 found that those with the lowest levels of depression had little to no improvement, but those with the highest levels of depression improved dramatically.

Vitaliano said he had long predicted that caregiving doesn’t directly cause distress.

Based on findings for a paper he and colleagues wrote more than 20 years ago on diathesis – a Greek term for disposition or vulnerability, Vitaliano argues that psychiatric states and psychological outcomes are a function of exposure to stressors and vulnerabilities (early family environment, genetic factors, disposition). How one responds to stressors also depends on a person’s resources (coping, social supports, income).

Vitaliano said his past research has also shown that caregivers’ stress hormone levels are especially high relative to other caregivers if they are high in dispositions, such as neuroticism and disagreeableness.�� He has also found that caregivers with chronic illnesses such as heart disease or cancer have more physical problems with their illnesses than do noncaregivers with chronic physical illnesses.

Researchers, meanwhile, have also found genetic differences in empathy and distress in persons who have a certain combination of OXTR , a gene on the sixth chromosome, Vitaliano said. This gene is involved in the secretion of oxytocin and may predispose some people to both caregiving and higher levels of empathy.

Vitaliano said caregiving has existed since the Neanderthals, with the discovery of a blind deformed Neanderthal male who lived for 20 years and a female with a brain abnormality who lived between five and six years.

Eric Strachan in the Department of Psychiatry and Behavioral Sciences, Elizabeth Dansie in the Department of Anesthesiology and Pain Medicine and Jack Goldberg and Dedra Buchwald in the Department of Medicine at the 91̽��were co-authors on the study.

Great progress has been made in easing suffering around the world. HIV/AIDS is no longer a death sentence, polio is almost contained, guinea worm is being wiped out, malaria is decreasing and childhood mortality is dropping. But achieving real equity in accessing health care will take more than idealism, money, and control of diseases.

It will take political will to support policies that favor the poor and working class, according to Dr. Stephen Gloyd, 91̽��professor of global health and health services. Gloyd will deliver ��the 38^th Annual University Faculty Lecture at 7 p.m., Thursday, Feb. ��6 in Kane Hall Room 130. His talk is ��titled, “Achieving Health for All in the 21^st Century: Globalization, Growing Inequity and Creative Responses.”�� The talk is free and open to all. A reception will follow in the Walker Ames Room.

In conjunction with the Office of the Provost, members of the 91̽��faculty choose one of their peers to deliver the University Faculty Lecture. This award honors faculty whose research, scholarship or art has been widely recognized by their colleagues ��and whose achievements have had a substantial impact on their profession and perhaps on society as a whole.

Gloyd joins a distinguished roster of Nobel laureates, historians, artists, scientists and authors who have presented this series each year since 1976. On choosing his topic, Gloyd said, ��“This is the most important topic in global health right now. We are doing a fabulous job as a global health community, especially at the 91̽��and in Seattle, in developing new technologies around HIV, malaria and other diseases. But we are not addressing the really important issues involving determinants of equity – education, jobs income, nutrition, water and sanitation.”

Gloyd said that many U.S. government policies are actually making it harder for people in poor countries to access public services, because these policies have imposed austerity measures and unfair trade agreements. ��Some policies, he said, undermine local efforts to combat unequal power relationships.

Gloyd’s lecture will look at these policies systematically. In most of sub-Saharan Africa for example, Gloyd said, austerity measures ��to reign in debt have crippled the government’s efforts to support the poor and working class. The government ends up cutting education, social safety nets, pensions and salaries. Gloyd said free trade has tied the hands of low-income countries who want to regulate sweatshops and create safer conditions for workers. The United States, he said, continues its history of targeting leaders who promote equity, for example, in Guatemala, Angola, Honduras and Venezuela, and has engaged in ways of overthrowing these leaders.

“The specifics of these policies are very clear and very well-documented,” he said.

Gloyd’s lecture will look at creative responses to assuring greater equity, such as rethinking trade policies, supporting living wages and decreasing military campaigns.

Gloyd said these issues have been largely ignored by the global health community because they are “inconvenient” and require ��taking a stand that is anti-corporate and that questions the motives of U.S. foreign policy.

He will also discuss why he believes achieving equity is more possible than ever before. One reason, he said, is that the 91̽��Department of Global Health has graduated hundreds of students who understand these issues and are now working in more than 30 countries. Many of these graduates hold high-level positions.

A native of Seattle, Gloyd did his residency at the 91̽��and became a faculty member in 1986. He was also active in promoting Zimbabwean music and sending material aid to Mozambique.�� These interests ��lead to his initial work there with the Ministry of Health in the late 1970s and 80s.

In 1987, he founded Health Alliance International. This nonprofit organization has worked for decades in solidarity with the ministries of health of Mozambique, Côte d’Ivoire, Timor-Leste and Sudan to strengthen primary health care and to improve approaches to global health assistance.�� Health Alliance International, now a center in the Department of Global Health, played a key support role for the Mozambique government to make AIDS treatment universal and free throughout ��its ��country.

Gloyd is associate chair for education and curriculum in the UW’s Department of Global Health, where he directs the M.P.H, and Ph.D. programs.

Gloyd received his bachelor’s and master’s degrees in public health from Harvard University and his medical degree from the University of Chicago. His many awards include the American Public Health Association’s International Health Mid-Career Award, the 91̽��Distinguished Teaching Award and the Edward K. Barsky Award for global health activism.

 

The results, from the first population-based survey since 2006 to estimate war-related deaths in Iraq and the first covering the conflict’s full timespan, are published Oct. 15 in the open-access journal PLOS Medicine.

The researchers found, with 95 percent certainty, that there were some 461,000 more deaths during the study period than would have occurred naturally, but the actual number could be as low as 48,000 or as high as 751,000. (For comparison, three years after the 2010 earthquake in Haiti, the death toll has been estimated anywhere between 46,000 and 316,000).

Researchers with UW’s Department of Global Health, UW’s Institute for Health Metrics and Evaluation, Johns Hopkins University, Simon Fraser University and Mustansiriya University were part of the study team.

The researchers found that for every three people killed by violence during the U.S.-led invasion and occupation of Iraq from 2003 to 2011, two more died as a result of the collapse of the infrastructure that supports health care, clean water, nutrition and transportation.

“Policymakers, governments and the public need better data on the health effects of armed conflict,” said lead author Amy Hagopian, a 91̽��associate professor of global health.�� “Without this information, it’s impossible to assess the true human costs of war.”

Researchers detailed improvements in estimating mortality during the Iraq war�� and emphasize the public health consequences of armed conflict.

More than 60 percent of those deaths were directly attributable to violence while the rest were associated with indirect, but war-related, causes.

To conduct this study, researchers went to 2,000 randomly selected households in Iraq in 100 clusters throughout the country to ensure the sample of households was nationally representative. They asked every household head about births and deaths since 2001, and all household adults about mortality among their siblings. According to survey results, researchers estimated about 405,000 excess Iraqi deaths attributable to the war through mid-2011. Researchers also used secondary data sources to estimate rates of death among 2 million emigrants and conservatively estimate 55,805 total deaths in that group. Only 24 households refused to participate in the study.

Researchers also detail the limitations of their study and the uncertainty intervals, similar to confidence intervals, in their analysis.

The study analyzed death rates before the war and, through surveys and statistical analyses, estimated excess deaths that were above pre-war rates. Deaths attributable directly to violence were primarily from gunshots, car bombs and explosions. Cardiovascular conditions were the principal cause of about half of nonviolent deaths. War-induced excess deaths not caused by violence include those caused by diversion medical care to focus on crisis care, interruption of distribution networks for crucial supplies and the collapse of infrastructure that protects clean water, nutrition, transportation, waste management and energy.

Based on household survey responses, gunshots caused 62 percent of violent deaths, 12 percent came from car bombs, and other explosions accounted for 9 percent. Cardiovascular conditions were the main cause of nonviolent death, accounting for 47 percent of nonviolent deaths over the entire study period. Other common sources of nonviolent deaths included infant or childhood deaths other than injuries (12.4 percent), chronic illnesses (11 percent) and cancer (8 percent).

Deaths increased to twice expected levels at the onset of the war, plateaued briefly at the end of 2003, then rose again to a new peak in 2006. Thereafter, deaths dropped until 2008, when they leveled off and then rose again slightly in 2011.

Previous estimates had covered different periods up to 2006 and arrived at a significant range of findings. Hagopian and colleagues say their new study offers considerable methodological improvements, both with regard to sampling procedures and the amount of data collected from all adults in the households. They also adjusted their results to account for the migration of an estimated 2 million people from Iraq during the war.

“There were two big reasons to do this study: to cover the entire period of the war and to improve on the groundwork laid by earlier studies,” said Gilbert Burnham, professor and co-director of the Center for Refugee and Disaster Response at Johns Hopkins. “By broadening the sources of information we used and by covering the full length of the conflict, this study provides a more complete picture of mortality during the Iraq war.”

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The study is

The study is accompanied by a written by Salman Rawaf of Imperial College London.

(Note: Support for this study came from pooled internal resources by the American and Canadian researchers without external funding. No funding bodies had any role in study design, data collection and analysis, decision to publish or preparation of the manuscript).

The scientists have found that some people in these urban areas are concurrently infected with multiple strains of simian foamy virus, including recombinant strains — those from more than one source — originally detected in the monkeys.

“These Asian rhesus macaques are Darwinian superstars,” said Lisa Jones-Engel, a primatologist with the National Primate Research Center at the 91̽��and the project leader. “They are very responsive to change and, unlike many other species of primates, they are going to continue to thrive in human-altered habitats.”

Simian foamy viruses, which are ubiquitous in nonhuman primates, are retroviruses that exhibit high levels of mutation and recombination – a potentially explosive combination.

In a paper published Sept. 4 in the journal Emerging Microbes & Infections, the scientists characterize the simian retroviral strains that are being transmitted between species and provide a glimpse into the behaviors of humans and monkeys contributing to the infections.

By analyzing what is happening at the human-primate interface, the researchers hope to protect humans from another deadly outbreak similar to HIV. ��They focus on Asia because that continent has witnessed the emergence of several infectious diseases in the past decade. Asia also has a volatile combination of a population that is increasingly mobile and with a compromised immune response living in proximity with animals.

In the study, researchers collected biological samples from hundreds of people and macaques in five urban sites, as well as from a group of nomadic people who travel throughout Bangladesh with their performing monkeys.

The research team found that transmission of simian foamy virus between species occurred most commonly through bites. Simian foamy virus replicates in oral tissues and is secreted in the saliva of infected primates.�� In their study, more than half of the�� subjects reported having been bitten at least once by a rhesus macaque, but the percentage of subjects reporting having being bitten at each site varied significantly by subjects’ sex and religion. Researchers also found that primates, both human and nonhuman, can be infected with more than one strain of simian foamy virus, which is significant because co-infection can lead to viral recombination.

Among those infected with more than one strain of simian foamy virus – humans or macaques – recombination between the strains could occur.

Maxine Linial, a retrovirologist at the Fred Hutchinson Cancer Research Center, said successful viruses are readily transmitted and viruses evolve to be successful. She said viruses sometimes have effects on hosts to aid in transmission and these effects can have potential disease-causing consequences.

Simian foamy virus is not currently known to cause disease, but that was also the case for simian immunodeficiency virus before recombination and mutation allowed infection of and transmission between new hosts, Linial said.

“The possibility that a pathogenic SFV strain could arise makes it essential to monitor natural infections.�� If a viral strain with pathogenic potential arises, we will know about it early rather than too late, which was the situation with the emergence of HIV,” she said.

By using mutations in the viruses that differentiated them from one another, the researchers were able to group the viruses into strains. They found that these strains showed a strong geographic signal, where monkeys from each given area primarily had strains characteristic of that site. However, deforestation and human transport of monkeys concentrated the strains and then moved them.

The data show a population in transition, said Frederick Matsen, a computational biologist at Fred Hutchinson.

“If we were to sample 25 years earlier or 25 years later we would have seen a completely different story,” he said.

Since more humans have been shown to have been infected with simian foamy viruses through primate contact more than with any other simian-borne virus, the researchers reason that pinpointing the factors that influence transmission and infection are important to a general understanding of how viruses can jump the species barrier.

“If we want to understand how, where and why these primate viruses are being transmitted, we need to be looking at (simian foamy virus) in Asia where millions of people and tens of thousands of macaques are interacting every day and where we estimate that thousands of people could be infected with strains of SFV,” said 91̽��researcher Jones-Engel.

Jones-Engel said if researchers had been on the ground 50 years ago, they may have seen how simian immunodeficiency viruses crossed the species barrier resulting in HIV.

“We have been playing catch up with the SIV-HIV question for years,” she said. “We still don’t know why only some viral strains are capable of establishing persistent infections in humans.”

Jones-Engel said long-term surveillance is needed in the areas where humans and primates come into contact, since it’s unlikely that SIV-HIV will be the last primate virus to emerge into the human population.

Regardless of whether simian foamy virus becomes a significant pathogen, researchers called for continued monitoring of the virus at the human and nonhuman primate interface.

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91̽�� researchers headed a recent study on genetic association. ��Their report, “GRIN2A mutations cause epilepsy-aphasia spectrum disorders,” is published in the Aug. 11 issue of Nature Genetics.

The scientists sequenced genes in 519 patients with severe seizure disorders. Within the group, 44 patients had epilepsy aphasia and four of those — or 10 percent — and their affected family members had mutations in the GRIN2A gene.

“For a long time, people have debated whether this type of epilepsy had�� a genetic component, mostly because ��so few families have the disorder. To find a genetic cause is really interesting,” said Gemma Carvill, a 91̽��senior fellow in pediatrics and lead author of the study.

Carvill said to find 10 percent of patients with a genetic mutation for a particular epilepsy disorder “is quite sizable.”

“In the families we looked at, multiple individuals were affected with epilepsy aphasia and all had a mutation in GRIN2A,” she said.

Heather C. Mefford, assistant professor of pediatrics, said clinical testing for this gene could be done for individuals with epilepsy aphasia disorders who are wondering if they will pass on epilepsy to a child. In families with a mutation in GRIN2A, the risk of passing on a genetic mutation carrying the disorder is 50 percent.

Mefford said two other studies report similar findings.

Mefford said a lot of work is being done now to identify genes that cause epilepsy, Researchers ��know about only a small percentage of genes that, when mutated, result in epilepsy.

“The thought is there is probably a large number of genes with mutations that could cause epilepsy.

We now have the tools to look for genetic mutations in large numbers of patients to identify the genetic cause,” said Mefford.

91̽��researchers collaborated with Ingrid Scheffer and Sam Berkovic at the Epilepsy Research Centre at the University of Melbourne, which has been collecting DNA on epilepsy patients for a long time. Other 91̽��investigators contributing the study were Jay Shendure and Brian O’Roak in genome sciences and Joe Cook, Adiba Khan and Eileen Geraghty in pediatrics.

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The project was supported funding from the National Institute of Neurological Disorders and Stroke at the National Institutes of Health (grant 1R01NS060605, a Burroughs Wellcome Fund Career Award for Medical Research, the National Health and Medical Research Council of Australia, a Practitioner Fellowship, the Health Research Council of New Zealand, Agence Nationale de Recjerche, and INSERM (Institut National de la Santé et de la Recherche Médicale).

The Lacks’ family has never been compensated for the use of the cells that created a multimillion-dollar industry. And they have never had a say in how the information is used — until now.

“The generated whole-genome sequence of the HeLa cell line is a valuable resource that may lead to new biomedical insights based on research that use these cells,” said Eric D. Green, director of the National Human Genome Research Institute within the NIH. “We are grateful to the Lacks’ family for agreeing to a framework that makes these valuable data available to researchers.”

The 91̽��study, published in the Aug. 8 issue of Nature, pieced together the complicated insertion of the human papillomavirus, or HPV, genome, which contains its own set of cancer genes, into Lacks’ genome near an “oncogene,” a naturally occurring gene that can cause cancer when altered. The researchers showed that the proximity of the scrambled HPV genome and the oncogene resulted in its activation, potentially explaining the aggressiveness of both Lacks’ cancer and the HeLa cell line.

“This was in a sense a perfect storm of what can go wrong in a cell,” said Andrew Adey, a PhD student in genome sciences at 91̽��and a co-first author on the study.�� “The HPV virus inserted into her genome in what might be the worst possible way.”

Scientists had long tried to reproduce cells in a culture, but they eventually died. The HeLa cells – taken from Lacks in 1951 — however, reproduced an entire generation every 24 hours and never stopped.

HeLa cells have since been named in nearly 76,000 PubMed abstracts and are considered one of the biggest medical miracles in the last century. The cells allowed scientists to perform experiments without using a living human and led to major medical breakthroughs, including the polio vaccine, cloning and helping develop drugs for treating major illnesses such as herpes, leukemia, influenza, hemophilia and Parkinson’s disease.

Just why Lacks’ cells replicated in a culture where others never could has been a mystery.

The authors said their study might explain – at least in part – why HeLa is unique. In addition, they discovered that the genome of the HeLa cell line, which has been replicated millions, if not billions of times, has remained relatively stable. They also said their results can help other researchers investigating cancer by studying immortalized cell lines.

“We demonstrated the value of comprehensive analysis – through what are called haplotypes – in characterizing cancer genomes and epigenomes,” said researcher Jay Shendure, a 91̽��associate professor of genome sciences and senior author of the paper in Nature, “The haplotype-resolved genome and epigenome of the aneuploid HeLa cancer cell line.”

Haplotypes, in short, provide a more complete description and interpretation of genomes, genetic diversity and genetic ancestry, by separating out which genetic variations are present on each copy of each chromosome. ��Although individual human genome sequencing is increasingly routine, nearly all such genomes are unresolved with respect to haplotype. In this study, haplotypes were crucial for revealing the initial events that drove Lacks’ cancer.

To publish their study in Nature, the 91̽��team needed to make their data available to other researchers. ��And this is where the NIH, the funder of the study, intervened and initiated discussions with Lacks’ family.

The genome – a string of billions of letters that detail the genetic information that makes up a HeLa cell – can be translated into personal genetic information, such as a person’s propensity to develop a disease, including alcoholism, Alzheimer’s and bipolar disorder.

In March, a team from Europe sequenced the genome of a different HeLa strain, publishing the results and depositing the data in a publically accessible website. This lead to scientific outcry sparked by an op-ed in The New York Times by the book’s author Rebecca Skloot.

“Imagine if someone secretly sent your DNA to one of many companies that promise to tell you what your genes say about you,” Skloot wrote in the March 23 editorial, The Immortal Life of Henrietta Lacks, the Sequel. “Now imagine they posted your genetic information online with your name on it.”

Skloot noted that life insurance, disability coverage and long-term care can discriminate against people for certain conditions.

The European group later apologized and took down the data.

The controversy pushed the NIH into setting standards, which will be announced Aug. 8 as well. ��The NIH met with members of the Lacks’ family and two members will now be sitting on an advisory committee within the NIH to grant approval, said Larry Thompson, chief of communications at the National Human Genome Research Institute within the NIH.

He said the younger generation of the Lacks’ family realizes that the technology has advanced so much that anyone can now sequence the cells to get genetic data.

“There’s no way to put the genie back in the bottle,” Thompson said.

Wylie Burke, a renowned bioethicist and chair of UW’s Department of Bioethics and Humanities, said the NIH has done a great thing to reach out to the Lacks’ family and understand their concerns. She said many people probably don’t understand what it means that their genetic data will be available in a federal repository.

“We can’t do research without participants giving their materials,” she said. “We’ve done focus groups and people want to understand how data is going to be used. They value that opportunity to contribute but want to be respected.”

Other researchers who contributed to this work include co-first authors Jacob Kitzman and Joshua Burton, and Joseph Hiatt, Alexandra Lewis, Beth Martin, Ruolan Qiu and Choli Lee.

This project was made possible through support from the National Institutes of Health and the Washington Research Foundation.

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But a randomized controlled study of 405 rape survivors in eastern Democratic Republic of Congo proves that short-term therapy delivered by paraprofessionals is effective at reducing mental health symptoms, according to a study released June 6 in the New England Journal of Medicine.

The study, “Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence,” provided 154 women with cognitive processing therapy�� (one individual session and 11 group sessions) and 248 women with individual supportive counseling. The therapy was conducted between April and July in 2011 by Johns Hopkins University and 91̽�� researchers working with the International Rescue Committee and local psychosocial workers.

Six months after treatment, just 9 percent of women in the therapy group met criteria for probable depression and anxiety, compared to 42 percent of women in the individual-support group, according to the study.

“We saw women, who once felt too stigmatized to be part of their community, re-engage after receiving cognitive processing therapy,” said Judith K. Bass, lead author of the study and assistant professor with the Department of Mental Health at Johns Hopkins Bloomberg School.

The great success of group therapy shows that a manual for ��treatment — a step-by-step guide for therapists — helped both the therapists and the survivors, said Debra Kaysen, an associate professor of psychiatry and behavioral sciences at the 91̽��, and an author on the study.

Kaysen said cognitive processing therapy was developed in the mid-1980s by Patricia Resick, the director of the Women’s Health Sciences Division of the National Center for PTSD, part of the U.S. Department of Veterans Affairs and located in Boston.

Kaysen said the therapy has been used in six randomized trials – three among veterans suffering post-traumatic stress disorder and three among civilians who have experienced sexual or physical victimization – and is now being used widely throughout the Veterans Administration and the Department of Defense to treat post-traumatic stress disorder among active-duty military.

Kaysen said while there has been a great push for this therapy to be available to veterans, there are not the same mechanisms to get the therapy to survivors of sexual violence in community settings.

“I hope this study will make this therapy more available to survivors of sexual violence globally,” Kaysen said. “There is such a huge need out there.”

While most rapes are not reported and estimates vary widely, the U.S. Department of Justice in 2006 estimated that in the United States alone one in six women and one in 33 men have experienced a rape or attempted rape. Eastern Democratic Republic of Congo, where the trial was conducted, has experienced conflict for more than 20 years. In that country rape and sexual violence rates are described as among the worst in the world. A recent study showed that 40 percent of its women – two out of every five – had experienced rape.

Kaysen said researchers now have data five to 10 years out from people receiving this therapy.�� Their symptoms of post-traumatic stress disorder, anxiety and depression have remained low. She said cognitive processing therapy goes after the root of symptoms. In the case of survivors of sexual violence, this form of mental health therapy deals with how the person’s outlook and sense of self was affected by the trauma in such areas as safety, trust, power, control, esteem and intimacy.

In the study in the Democratic Republic of Congo, women were chosen among villages being served by three Congolese non-governmental organizations. Qualitative studies in different languages were used to identify locally important psychosocial issues among sexual violence survivors. Abandonment and rejection by friends, concerns about providing for self and family, and fear and stigma were major issues.

The women were then evaluated for depression and anxiety by using the Hopkins Symptoms Checklist and for post-traumatic stress syndrome by using the PTSD Checklist-Civilian Version, both of which were adapted to the local culture. Women were also scored on their ability to perform important tasks of daily living. Participants were chosen for the study based on their scores.

The U.S. Agency for International Development Victims of Torture Fund and the World Bank sponsored the project.

In addition to Bass and Kaysen, the project researchers were Jeannie Annan, Sarah McIvor Murray, Shelly Griffith, Talita Cetinoghu, Karin Wachter, Laura K. Murray, and Paul Bolton.

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The researchers screened 35 veterans with blast injuries. They found that 42 percent had irregular hormone levels indicative of hypopituitarism, a condition that can often be controlled by replacing the deficient hormones.

“This could be a largely missed opportunity for successful treatment,” said Charles W. Wilkinson, study leader and a 91̽��research associate professor in psychiatry and behavioral sciences.

He said up to 20 percent of veterans returning from Afghanistan and Iraq have experienced at least one blast concussion. He said many of these veterans have a problem so under-recognized that even military physicians may fail to look for it.

Results from the study, “Prevalence of chronic hypopituitarism after blast concussion” by Wilkinson, Elizabeth A. Colasurdo, Kathleen F. Pagulayan, Jane B. Shofer, and Elaine R. Peskind, were presented at the Experimental Biology 2013 Meeting April 22 in Boston. The results were published in Frontiers in Neurotrauma last year, but the presentation included new data as well and the results be published again.

Wilkinson said studies in the past few years have suggested that 25 to 50 percent of people who suffer traumatic brain injuries later have low pituitary hormone levels — a decrease in the concentrations of at least one of eight hormones produced by the pituitary, a gland beneath the base of the brain.

Wilkinson said these studies focused on head injuries that civilians are more likely to receive, such as an automobile accident. He and his team decided to investigate whether veterans returning from Afghanistan and Iraq who suffer blast injuries show a similar frequency of hypopituitarism.

They collected blood samples from 35 veterans diagnosed with a blast concussion about a year prior — enough time for hormone changes to become evident. They then did a screen to compare blood concentrations of the eight hormones produced by the pituitary with the documented normal levels of these hormones.

The researchers found that about 42 percent of these veterans showed abnormally low levels of at least one of these hormones. The most common low hormone was human growth hormone, which can cause behavioral and cognitive symptoms similar to PTSD and depression. Low levels can also cause increases in blood lipids and changes in metabolism and blood pressure that can raise the risk of heart attack and stroke. The second most common problem was hypogonadism, changes in sexual hormones that can affect body composition and sexual function.

The researchers saw that some veterans had abnormal levels of vasopressin and oxytocin. Low levels of these hormones make it harder for people to bond with others and are linked to other mental health issues. Problems with these hormone levels, in addition to growth hormone, could contribute to difficulties with personal relationships, Wilkinson said.

He said the prevalence of hypopituitarism in the general population is estimated at 0.03 percent, a value far lower than that found in veterans with blast concussions. Therefore, more research is needed into victims of blast concussions.

“We’re screening hormone levels, not diagnosing definite disorders in this study,” he said. “These individuals would still need a clinical evaluation.” But, he said, if even 10 percent of these veterans have hypopituitarism, it’s a problem that physicians should be aware of.

The Departments of Defense and Veterans Affairs supported the study.

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A Community Cafe will take place from 6:30-8:30 p.m., Monday, April 15 in Parnassus Café. The event�� will feature ACT Theatre performances, including a reading from “Middletown.” The play touches on themes of mental health and depression.

A visual arts exhibit will showcase work from several local artists. Among them are Ellen Garvens, a 91̽��photography professor whose pictures capture the people who make and use prosthetics in Indonesia; John Blalock, a student in a masters of fine arts program and ��an artist-in-residence at Seattle Children’s: ��Phil Borges, a social documentary photographer; ��and Consuelo Echeverria, a global health graduate student and artist.

Later in the week, the UW’s Global Health Resource Center will host a Global Health and the Arts Symposium with local artists. The symposium will be held from noon to 6 p.m., Saturday, April 20 in Foege Auditorium, located in the 91̽��Foege Building

Kevin Shaw, a 91̽��undergraduate minor in global health and one the event organizers, said beauty and aesthetics is important for human health, but is often lost in contemporary discourse.

“We need to explore what makes humans healthy and what makes them thrive in the absence of disease. That’s communities,” he said.�� “Art builds communities and builds complete people. There is so much potential for people in the arts to make a difference in public health.”

The symposium will include three panels and several performances, including the Seattle Fandango Project, which brings people together through music, dance, and verse.

A dozen guest speakers are lined up. They include Borges, known for his work with indigenous communities; Jacque Larrainzar, policy director for the Seattle Office of Civil Rights, who helped organize a queer feminist collective in Mexico; Carlo Scandiuzzi, director of ACT Theatre in Seattle; and several students and faculty working at the intersection of the arts and global health, including Sutapu Basu, director of the 91̽��Women’s Center, whose dramas address worldwide women’s health issues, particularly human trafficking.

The panels will explore existing partnerships and the possibilities of additional collaboration between art and global health. There also will be discussions on how art can advance women’s health.

The symposium will feature 10-minute live performances. Film clips from UCLA’s Art and Global Health Center also will be shown, including a project in which HIV-positive people document their lives.

Daren Wade, director of the Global Health Resource Center within the Department of Global Health, said reaching out to the arts community is long overdue.

“As a global health resource center, our charge is to intersect with all parts of campus and throughout the years, we have touched most of campus,” he said. “But we and the campus as a whole need to reach out more to the creative arts. This is how to connect best with the community.”

To find out more about Global Health Week and the Global Health and the Arts Symposium, please go to:
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, professor and chair of the 91̽��Department of Global Health, won the prestigious 2013 Canada Gairdner Global Health Award for his work in sexually transmitted diseases, the Gairdner Foundation March 20.

The award, valued at $100,000 Candian (about $97,300 U.S.) is one of the world’s most esteemed prizes for medical research. Since 1959, of the 312 individuals presented with a Canada Gairdner Award, 80 have gone on to receive a Nobel Prize. Holmes said he would contribute the money to the 91̽��.

Holmes was awarded the prize for his “global scientific contributions to the field of sexually transmitted disease and their effective treatment and prevention.” He becomes the 10th 91̽��faculty member to win a Gairdner Award.

The Gairdner Foundation, in citing the award, said that today more than 35 sexually transmitted diseases have been discovered. Holmes and the scientists he mentored are working on approximately 20 of these.

“Dr. Holmes assisted in defining the causes of many major diseases and through leading numerous clinical trials, has paved the way for many standard-of-care therapies used to treat STDs today,” the foundation said in a release.

John Dirks, president and scientific director of the Gairdner Foundation, told The Lancet that Holmes “brought to medicine and public health the proper means of diagnosing, treating, and preventing STDs and of understanding their epidemiology. In addition, his amazing gift of mentorship launched so many trainees to the forefront of the global health scene, which, thanks in great measure to their achievements, is now a flourishing discipline in its own right. Holmes’ huge lifetime contribution has no parallel. Among the many mountains on the public health landscape he stands out as an Everest.”

Holmes holds the He founded and directs the , which provides patient care, training and education, research and international technical assistance in the field of sexually transmitted diseases. Holmes is also head of Infectious Diseases at Harborview Medical Center.

Read The Lancet .

Watch a brief of Holmes on advances in AIDS survival.