Global Health Research

The National Heart, Lung and Blood Institute (NHLBI) sponsored Center of Excellence at the Universidad Peruana Cayetano Heredia begin_of_the_skype_highlighting     end_of_the_skype_highlighting begin_of_the_skype_highlighting     end_of_the_skype_highlighting (UPCH) in Lima, Peru is a joint effort between UPCH and the Johns Hopkins School of Public Health. The mission of this Center is to build a long-term sustainable research infrastructure in Peru, with a focus on non-communicable cardiovascular and pulmonary diseases.

Our study has two main objectives: 1. Investigate the geographical variation in cardiovascular disease (CVD) risk factors and disease incidence over a period of 4 years. 2. Estimate the disease burden and influence of outdoor and indoor air pollution on chronic obstructive pulmonary disease (COPD).

Specific Aims are: 1. Determine the CVD risk factors in three sites at different stages of urbanization: peri-urban Lima (Capital, coastal Peru), Tumbes (northern semi-urban coastal Peru) and Puno (southern rural highlands). 2. Estimate disease progression to hypertension and diabetes from a baseline disease-free status among participants in all three study sites. 3. Estimate the prevalence of COPD in three cities with varying degrees of urbanization, altitude and sources of energy for cooking. 4. Characterize the longitudinal rate of decline in lung function (measured by spirometry) over a 4-year period in the three study-populations described.

We hypothesize that there are differences in: 1) the...

The study of altitude-related illnesses is an important field of investigation relevant to the 140 million people worldwide who live at altitudes > 2500 meters above sea level. The most commonly fatal altitude-related illnesses are chronic mountain sickness (CMS) and pulmonary hypertension (PH). Previous reports estimate that 5–15% of high-altitude residents may develop CMS; however, the prevalence of altitude-related cardiopulmonary illnesses is not well characterized in large population-based studies and the influence of other risk factors such as exposure to biomass fuels are not well understood. In rural populations of the Peruvian Andes, the use of biomass fuels for cooking is highly prevalent if not exclusive. Biomass fuel exposure has been shown to increase the risk of pulmonary and cardiovascular diseases, but its effect on the risk of altitude-related illnesses has not been previously investigated. Since 90% of rural households worldwide use biomass fuels as the main source of domestic energy, the population attributable risk may be of public health significance. We hypothesize that the prevalences of CMS and PH and the average carotid intima-media thickness is greater in high-altitude populations exposed to daily use of biomass fuels than in those who are not. To test this hypothesis we will...

This training grant utilizes the existing research infrastructure that is already available in Peru to train and expand the capabilities of scientists and health professionals from developing countries to engage in infectious disease research. This well established program of over 20 years has already trained over 45 Peruvians and 200 students from other nations. In Peru a mentor program will be used to train students in research methodology. The specific aims are to (1) train two students at the master’s level at Cayetano Heredia in either public health or biochemistry; (2) to set up a series of 2-day research seminars that will focus on training individuals from outside Lima in research methodology and on responsible research; (3) to train over a 5-year period 7 students at the Tropical Medicine and Public Health Summer Institute at Johns Hopkins University; (4) to train over a 5-yeard period 2 PhD candidates. This is a broad-based infectious disease program that has diarrheal disease, cysticercosis, and tuberculosis as its main emphasis. Researchers have a long history of working on Helicobacter pylori. Funding is also available to work in leptospirosis and malaria.

The purpose of this grant proposal is to delineate improved non-invasive or minimally invasive biomarkers to characterize the disease activity of environmental enteropathy in a birth cohort of closely followed children living in an area with high diarrheal illness rates and stunting in rural Peru. A balanced approach to measuring the physiologic alterations of malabsorption, altered intestinal mucosal permeability, intestinal inflammation, systemic immune activation, and metabolic changes related to bone growth are proposed. These determinations are to be associated with environmental enteropathy utilizing data and specimens that include extensive personal illness histories, nutritional indicators, and growth trajectories in a group of 200 children.

The lab acts as a biological reference lab for the NIMH Collaborative HIV/STD Prevention Trial in charge of overseeing site laboratories in Zimbabwe, Peru, India, Russia, and China. The reference lab generated protocols and trained lab managers and technicians at the various sites at the beginning of the trial. Sites are continuously inspected with the intention of raising the operating standards of the labs, increasing quality, enhancing adherence to study protocols, and educating on appropriate and current lab safety. The reference lab is also charged with transfering technology to the study sites.

Background: Non-communicable diseases kill people at economically and socially productive ages, and exert their greatest effects in the developing world: 80 percent of chronic disease deaths occur in low- and middle-income countries. In 2000, in the Latin American and Caribbean regions the leading cause of mortality was cardiovascular diseases (CVD), which accounted for 31 percent of all deaths. In Peru, a low- and middle-income country, years of life lost to non-communicable disease is 42 percent, as a proportion of the total years of life lost due to premature mortality in the population.

In 1975, only 27 percent of people in the developing world lived in urban areas. By 2000, the proportion was 40 percent, and projections suggest that by 2030 the developing world will be 56 percent urban. Urbanization – heavily influenced by migration – poses a considerable challenge for public health, especially in developing countries. Understanding the effects of urbanization is one of the grand challenges concerning chronic non-communicable diseases.

Globally, approximately 50 percent of all households and 90 percent of rural households use solid fuels as the main domestic source of energy. Use of biomass fuels is the most important source of indoor air pollution worldwide. Biomass fuel exposure is...