Global Health Research

The goal of the proposed 4-year interdisciplinary multi-method project is to establish an empirically informed normative account of researchers’ obligations to provide ancillary care in community-based research in low-resource settings. Ancillary care (AC) is defined as health care needed by research subjects, but not necessary for safety or scientific validity. In community-based research, by contrast with facility-based research conducted in a clinic or hospital setting, semi-skilled local study workers often carry out research activities in people’s homes and other functional living spaces. Host communities in low-resource settings may lack adequate nutrition, clean water, sanitation, and basic preventive and therapeutic health services. Our preliminary study indicates that researchers often encounter serious and sometimes desperate unmet health needs in their interactions with subjects. Such situations present a perplexing ethical challenge as researchers must decide what to do. To what extent do researchers have an ethical obligation to provide AC? The NIH identifies AC as an important issue in international research ethics, and calls for research to assess how stakeholders respond to requirements or requests to provide it (PA-07-277).There is a lack of empirical data on the extent to which researchers actually provide AC, and how they decide whether to do so. The...

Using a combination testing methods to improve accuracy of identifying samples from newly infected individuals based on biologic properties of the immune system that evolve over the course of infection. The goal is to generate a widely applicable assays for the use in HIV incidence monitoring on a population and intervention trial level

The prevalence of tobacco use among urban African American persons aged 18 to 24 years not enrolled in college is alarmingly high and a challenge for smoking cessation initiatives. Data from inner-city neighborhoods in Baltimore, Md, indicate that more than 60% of young adults smoke cigarettes.

The overall objective of this study was to describe community-level factors contributing to this problem. Data from focus groups and surveys indicate that the sale and acquisition of “loosies” is more pervasive than previously thought and may contribute to the high usage and low cessation rates. In addition to cigarettes, the study found that little cigars, which are sold individually for less than $1 each, may also be contributing to the high percentage of young adult African Americans who smoke.

The study served as a wake-up call for Baltimore public health officials, who have stepped up efforts to raise the price of little cigar products to the same level as cigarettes. The city is also working on restricting the sale of single little cigars.

The major goal of this center is to examine how exposures to environmental pollutants and allergens may relate to airway inflammation and respiratory morbidity in children with asthma living in the inner city of Baltimore.

CKiD is a chronic kidney disease pediatric cohort in which we are studying the natural history of chronic kidney disease. We have made strides in characterizing the endpoints of transplant and dialysis and the risk factors for renal replacement therapy. We have also developed new estimating equations for glomerular filtration rate using our iohexol plasma disappearance protocol, which gives us a direct measure of kidney function.

Study Aims To determine risk factors for progression of pediatric chronic kidney disease (CKD) To examine the impact of CKD on neurocognitive development To examine the impact of CKD on risk factors for cardiovascular disease To examine the impact of CKD on growth

Clinical Coordinating Centers Children''s Mercy Hospital, Kansas City, Missouri (Bradley Warady, MD) Johns Hopkins School of Medicine, Baltimore, Maryland (Susan Furth, MD, Ph.D.)

Data Coordinating Center Johns Hopkins Bloomberg School of Public Health (Alvaro Muñoz, Ph.D.)

Central Laboratory at the University of Rochester School of Medicine (George Schwartz, MD)

To learn more about CKiD visit statepi.jhsph.edu/ckid/

Coming soon.

Dengue is arguably one of the most important arthropod-borne viral infections. It has been estimated that at least 2.5 billion people live in dengue-endemic areas and are at daily risk of infection (WHO). The increasing incidence in morbidity and mortality in the tropics and subtropics are only adding to the public health impact throughout the world. The innate immune system of arthropods has been shown to aggressively fight pathogen infections through the production of antimicrobial peptides, phagocytosis, encapsulation, and melanization . This research project will contribute to our understanding of the mosquito innate immune defenses against dengue virus infection. Specifically, this research project will provide insightful information on the relative importance of the fat body and hemocytes in the response to dengue virus infection and contribute towards the elucidation of the molecular mechanisms that underlie an immune response-dependent midgut infection barrier. Lastly, the assessment of tripartite interactions (endogenous bacteria – dengue virus- mosquito) on dengue transmission will provide us with insights on factors that might determine transmissibility. From the stand of public health, the knowledge gathered from this research will greatly contribute to our understanding of dengue transmission and other important arboviral pathogens of great public health significance, such as the...

Through a recent five-year award from the U.S. Agency for International Development (USAID), the “Accelovate” program is promoting Jhpiego’s leadership of global health innovation efforts under USAID’s flagship “Technologies for Health” program.” “Accelovate” will accelerate the introduction of technological and other innovations that have the potential to impact global health, especially in maternal and newborn health. Jhpiego is working in partnership with schools and centers from Johns Hopkins University, particularly the Center for Bioengineering Innovation and Design (CBID) and the Center for Global Health (CGH), as well as with Population Services International (PSI). This program will break new ground through collaborations with development, academic and industry partners to move the most promising innovations, primarily in maternal and newborn health, forward from conception to scale-up. The anticipated program result is accelerated uptake worldwide of crucial technologies with the promise of transformational change.

About Jhpiego:

For nearly 40 years, Jhpiego, (pronounced "ja-pie-go"), has empowered front-line health workers by designing and implementing simple, low-cost, hands-on solutions that strengthen the delivery of health care services, following the household-to-hospital continuum of care. We partner with community- to national-level organizations to build sustainable, local capacity through advocacy, policy and guidelines development, and quality and performance improvement approaches.

For more...

Under a new partnership, and through funding from the United Nations Population Fund (UNFPA), Jhpiego, UNFPA and the World Health Organization (WHO) are working to strengthen the skills of midwives and community health workers by leveraging Intel technology and creating global training materials.

This project builds on Intel’s 1Mx15 Health Program, which seeks to bring information and communication training to one million health care workers in developing countries by the end of 2015. This global initiative is increasing the capacity of health care workers around the world through software provided by Intel, and ensuring wider availability of evidence-based education through training and materials created by Jhpiego in collaboration with UNFPA and WHO.

Jhpiego is coordinating activities for the preparation of an initial set of e-learning modules: four modules based on the WHO Integrated Management of Pregnancy and Childbirth (IMPAC) series, along with modules targeted for community health workers. Each module will be produced in English for the African context. In addition to developing e-learning modules, Jhpiego will provide implementation guidance from country experiences. These modules are created to be delivered via Intel’s open-access offline/online learning platform called Skoool,™ which allows learners to learn anytime and anywhere.

Anticipated project results include...

Through a sub-award of $25 million over five years, Jhpiego is working to help implement the U.S. Agency for International Development’s (USAID’s) global TB CARE II Project, a five-year, cooperative agreement with a $225 million ceiling, awarded to the University Research Co., LCC (URC)-led consortium on September 30, 2010. Jhpiego is specifically contributing to TB CARE II’s TB/HIV technical strategy, as well as assisting in ensuring that women-centered health approaches are considered.

The award is designed to improve the quality of and access to TB prevention, diagnosis and treatment; improve coordination of TB/HIV activities; improve prevention, diagnosis and treatment of multi-drug resistant TB; and strengthen health systems. The project will complement existing and planned projects in USAID’s Bureau for Global Health to provide global leadership and support to National TB Programs and other in-country partners.

TB CARE is the main global mechanism for implementing USAID’s TB strategy. Potential countries include the 40 TB focus countries listed under: http://www.usaid.gov/our_work/global_health/id/tuberculosis/countries/index.html, as well as countries receiving aid under the President’s Emergency Plan for AIDS Relief. USAID Missions will buy into the global mechanism based on TB assistance needs and Mission funding availability.

Jhpiego is a member of the TB CARE II consortium, working with multiple partners,...

This transdisciplinary research center will improve cardiovascular outcomes and reduce racial and ethnic disparities in care in Baltimore, Maryland by using community-based participatory research principles to build strong ties among researchers, healthcare provider networks, community members, and policy-makers. We are building on prior work and established relationships with the large African American population in Baltimore, and we will initially focus on hypertension. The Center includes 3 separate but related intervention studies to improve the identification, treatment, and outcomes of African Americans with hypertension; 3 integrated and complimentary Cores; an Internal Steering Committee; and a Community and Provider Advisory Board. Study 1 is a pragmatic clinical trial that examines the implementation of a multi-method quality improvement intervention in 6 community-based primary care practices. Study 2 is a randomized controlled trial to test the effectiveness and long-term sustainability of self-management and problem-solving training for patients, family and community members. Study 3 is a 3-arm randomized controlled trial of culturally-tailored nutritional advice and a mineral supplement containing potassium, magnesium, and Vitamin C. Primary outcomes for all 3 studies are systolic and diastolic blood pressure and blood pressure control. The Administrative Core carries out the overall administration of the grant, guiding and coordinating shared...

CWH researchers are using polymerase chain reaction and mass spectrometry technologies to develop a microbial isolation and detection protocol for quantitative and qualitative identification of waterborne pathogens such as E.coli, Norovirus and Cryptosporidium.

Collaborations with John Groopman (Biomarkers) and Thomas Kensler (Oltipraz), from Environmental Health Sciences Department, as the epidemiology/biostatistics core of several projects on liver cancer. These studies, which started in 1993, seek to enhance the development, validation and application of molecular biomarkers to the prevention of environmental carcinogenesis in high-risk populations. This study, started in 1993, is composed of 3 projects on molecular biomarkers for environmental carcinogens.

The Anal Health Study evaluates the utility of anal cancer screening among men who have sex with men. This multi-site U.S. study includes annual anal Pap screening for HIV-infected men and screening every other year for HIV-uninfected men, as well as anal HPV testing every six months. Predictors of interest in screening, abnormal cytologty and histology and progression from low grade to high grade anal disease are explored.

Malaria, AIDS and tuberculosis are three infectious diseases that cause the largest numbers of deaths worldwide. Of these, only malaria requires an intermediate vector for transmission to occur. Therefore, the mosquito vector is a potential weak point in the transmission cycle. A better understanding of parasite development in the mosquito may translate in the discovery of new strategies to fight this deadly disease.

Magnetically labeled, luciferase transfected and/or lysine-rich protein transfected ESC-derived motor neurons and glial restricted precursor cells are investigated for their potential in rescuing motor neuron disease, using both a focal ricin-induced MND model and global, neurotropic Sindbis virus model. Cellular imaging will be combined with muscle mass MRI and electrophysiologic and behavioral analysis.

Study to design, test, field, and disseminate a new National Study of Disability Trends and Dynamics. The new study will be a platform for scientific inquiry to guide efforts to reduce disability, maximize functioning, and enhance older adults’ quality of life.

The major goal of this project is to develop novel imaging biomarkers to address fundamental controversies in TB pathogenesis.

POPS is a longitudinal cohort study which collects oral rinse and gargle samples every six months to test for HPV DNA. The study includes 600 HIV-infected and 400 HIV-uninfected individuals who are part of the MACS and WIHS studies. This is one of the first studies to explore oral HPV natural history, the effect of HIV on this natural history, and risk factors for persistent HPV infection.

Building on promising pilot data, we plan to study the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant adolescent major depressive disorder (MDD). The study will evaluate changes in depression, suicidality and anxiety after administration of 20 sessions of rTMS treatment.

The Studies of the Ocular Complications of AIDS Research Group is dedicated to understanding and improving the outcomes of the ocular complications of AIDS. The Longitudinal Study of the Ocular Complications of AIDS (LSOCA) is a prospective cohort study of these complications and their outcomes in the era of highly active antiretroviral therapy (HAART)

To establish a Global Center of Excellence of childhood obesity and chronic disease research and training based on a transdisciplinary systems science framework and systems-based methodologies, including the use of systems modeling to capture the complexity of the etiology of childhood obesity and the potential impact of environmental and policy interventions. Over 40 well established investigators from 15 leading US and international institutions bring transdisciplinary expertise to bear in highly relevant areas. The Center will build upon a solid research and training base with ongoing NIH funded projects directly related to childhood obesity and systems analysis. The center, structured as U.S. institutions in partnership with international institutions, will undertake epidemiological research linking biological with environmental and macrosocial factors of childhood obesity, conduct and provide developmental research funding for environmental and policy evaluations and/or interventions, and establish an infrastructure for postgraduate systems-oriented research and training in the field of obesity and chronic disease prevention and control.

The Johns Hopkins ACG Case-Mix / Predictive Modeling effort is the largest technology transfer project in the Johns Hopkins University''s history. The Bloomberg School based team supports the development of a suite of health IT /software tools used for health care management and financing in numerous nations around the globe. (See map). The software is used to categorize persons and populations based on diagnosis and pharmacy information contained in electronic medical records and computerized insurance claims data. The ACG development effort Is supported by contracts from governments and from tech transfer royalties paid by users. More information available at: ACG.JHSPH.EDU