Author Archives: Anna Vinogradova

About Anna Vinogradova

Publications Abstracts: -Oral cavity manifestations among HIV patients; -HIV among women drug users in Drop-in center and Bus for Harm Reduction at XIV International AIDS Conference, July 2002, Barcelona, Spain -Treatment of oral candidiasis at1st Medical Mycological Congress, February 2003, Moscow, Russia -Dynamics of epidemic process in St. Petersburg; -Analysis of HIV-1 gp41 HR1 and HR2 regions of Different genetic forms from Russia and in relation to natural resistance-associated mutations to T-20 and polymorphism at 3rd IAS Conference, July 2005, Rio de Janeiro, Brazil - Oral manifestations among HIV patients failing antiretroviral therapy at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007), Sydney, Australia,2007 Journals: 1. Viral and Bacterial infections in immunocompromised patients “Infections of XXI century"(2001) 2.Oral lesions as a complication of HIV infection in dental scientific-practical journal Parodontology No.4(26) 2001 3. Oral candidiasis among HIV patients with various T(CD4) cells count in Parodontology No.1(26) 2003 4.Analysis of Drug-Resistance Associated Mutations in Treatment-Naïve Individuals Infected with Different Genetic Forms of HIV-1 Circulating in Countries of the Former Soviet Union. Journal of Medical Virology 77:337-344 (2005) http://www.linkedin.com/ppl/webprofile?gwp=&id=6649012&pvs=pp&authToken=dmp2&authType=name&locale=en_US&trk=ppro_geturl&lnk=sign_in

The Internet of Things and Public Health

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I have just started another class called healthcare innovation and entrepreneurship, I dig a bunch of new terms like the Internet of Things, diffusion of innovations, healthcare engineering, the innovation process, and biodesign.

The Internet of Things is a novel, path-breaking technology that brings interaction in our world to a new level. Healthcare does not stand aside from technological revolution, but absorbs all innovations (e.g. internet and mobile communication network, infrared sensors, GPS, laser scanners, etc.).

How it will impact public health?

The Internet of Things can offer tremendous benefits like receiving updates on the latest status of healthcare information of remotely cared patients (as a part of emergency or healthcare monitoring service for chronic/elderly patients)

to assist in real time patient management that can save time & lives, as well as minimize costs to healthcare system by reducing the number of unnecessary visits, treatment prescription & refills, and real-time temperature monitoring for vaccine storage.

From the epidemiological perspective it could mean new capabilities like disease surveillance, collection of environmental data and its fast processing (tracking disease outbreaks/assisting in care coordination during natural disasters), basic and behavioral research, rapid dissemination of effective health care interventions, fueling data sharing between public health and clinical care systems.

Lei Yu et al., 2012 from Hefei University (China) envision application of the Internet of Things and write about its main elements: internet technology, non-contact automatic identification technology, sensor network technology, wireless communication and embedded technology, providing an architecture and a framework of a new “smart hospital” with several layers of interaction within the hospital and its clients.
Architecture of a smart hospital

Application framework of a smart hospital

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eric Dishman (general manager of Intel’s Health Strategy & Solutions Group) gives an inspirational presentation about “creating personal, networked, home-based health care for all” with demonstrations in his TED talk, titled “Health Care Should Be a Team Sport” hopefully this modern technology will be soon translated into action.

However, when we are talking about data in internet, the issues of ethics, concerns (data sharing, control,usage) are raised and the most important component security. I was genuinely excited about Google Health, unfortunately it was closed possibly due to consumer issues and online data management.

Can automated healthcare be secure? This topic is constantly discussed in numerous blogs and has many opponents. This issue needs debate and a public workshop will take place in Washington D.C this November.

I surely agree the system needs all possible protection, security measures in place, maintain the level of connectivity to provide constant service, protection of private data, prevention of unauthorized access or data deletion, etc, this poses new challenges for engineers  and they are addressing it now. Roman et al., 2011 examine the Internet of Things security by blocks: Protocol and network security; Data and privacy; Identity management; Trust and governance; Fault tolerance; Privacy protection and present first steps of work in security mechanisms. More about The Internet of Things security in Cisco news site by L. Cruz.

I would like to finish with an optimistic quote from MIT technology review post, titled 2013:The year of the Internet of Things :”The Internet of Things probably already influences your life. And if it doesn’t, it soon will”!!

Critical Thinking in Global Challenges class @ Coursera

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critical-discussion1The name itself caught my attention and in my opinion, it is worth taking as usually the practical skill of critical thinking is absent from some school`s curriculum.

The class focuses on developing step by step critical thinking, introducing essential components like fact, assertion, opinion, theory, hypothesis, and evidence.

The second part of the course is divided in assessing arguments in various topics to choose: obesity, climate change, infectious diseases, population, that perhaps makes the course appealing to a wider audience of students.

One of the lectures “How to assess evidence” reminded me of several exercises I had at the School of Public Health: debates (addressing a certain topic by finding evidence for pros and cons), essay to support causation, connecting ideas in articles. With confidence I can say they were very useful in every way for real life situations.

As today with an immerse amount of information it can be challenging to identify reliable evidence and make conclusions. Moreover, even well-established printing journals/magazines have distorted data written by people who have no or little knowledge in the subject.

0054-critical-thinking

 

The final week is dedicated to misleading drug research, including evaluation of magazine and peer-review articles as well as TED talk by Dr Ben Goldacre presenting his analysis of evidence-based publications flaws.

 

To conclude, I hope the mind map below helps you to go over the important concepts.

Picture-7

 

About a week ago I finished online class “Principles of Public Health“. I have taken it out of curiosity as this course is taught differently at each University and to practice writing reports where you describe and analyze a specific public health problem in the community and on a global scale and suggest investigation/research strategy or policies to address/solve the problem. In my opinion, this class will be useful for those who are doing a master in public health and also for general public to learn what is public health about, who stand behind prevention/policies and achievements. In case you are interested the following blog post has a list of public health(PH) achievements.

 

Professional Development Online: Cousera.

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What working professionals can do to acquire new knowledge, learn new skills, new programs /applications?

Perhaps many of us asked this question. The Decision of going to graduate school needs serious evaluation, but there are always certificates and courses, that can help you to become a T-shaped person. “The vertical bar on the T represents the depth of related skills and expertise in a single field, whereas the horizontal bar is the ability to collaborate across disciplines with experts in other areas and to apply knowledge in areas of expertise other than one’s own.”(David Guest,1991).

You can google and find many links to education online, but, in my opinion, an innovative solution is Cousera. It is a company created by two computer science professors Andrew Ng and Daphne Koller from Stanford University.

Coursera offers free online courses in the fields of Computer Science; Healthcare, Medicine, and Biology; Society, Networks, and Information; Humanities and Social Science; Mathematics and Statistics; and Economics, Finance, and Business. Classes are offered by a total number of 62 educational institutions from the US (Stanford University,Princeton,Duke University, Johns Hopkins University); Europe (University of Copenhagen,University of Edinburg, Autonomous University of Barcelona), and Asia (The Hong Kong University of Science,Technology The University of Tokyo).

As a public heath professional I have selected and taken a couple courses last year:

1. Vaccines with Paul Offit, MD (the Pennsylvania State University)

2. Writing in Sciences with Kristin Sainani (Stanford University)

Classes consist of short 15-30 min videos that will grab you from the start and keep you interested throughout the session. This is optimal time to study the material well while being concentrated. Many videos contain small quizzes to make sure you understand the main idea. Weekly there are home-works and multiple-choice quizzes that challenge you. Overall I have a positive experience with these classes as well as interacting in the forums with other online students from around the world.

This year I am taking Principles of Public Health with Zuzana Bic (University of California,Irvine)

Critical Thinking in Global Challenges with Celine Caquineau and Mayank Dutia (The University of Edinburgh)

and AIDS with Kimberley Sessions Hagen


I hope these classes will keep me on my toes for future challenges in my current and future job.
In today`s rapidly developing world no one’s job is secure and Kate Ashford`s post is worth checking. She offers 10 Ways to Get Your Job Skills in Shape and the steps you should take today if you want to be competitive tomorrow.

Barriers to Care Adoption at the HIV dedicated facility in Russia

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 Many studies are devoted to adoption and retention in  HIV care. Here is short presentation in Prezi on barriers to care adoption, a version of possible factors that lead to drop-outs and lack of patients engagement at the HIV Center in St.Petersburg, Russia.

Barriers to Care Adoption at St. Petersburg AIDS Center, Russia on Prezi

It was presented as an abstract at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (CDD018) - Barriers to care adoption at St. Petersburg AIDS Center, Russia

The methodology: System dynamics model was used to understand the complexity of patient-physician, patient-patient, physician-Center`s administration-government-educational institution-civil society interactions.

The model served as a tool to analyze current HIV care service adoption at and provide assistance in its further development (e.g., quality care standards, new recruitment strategies, patient-centered treatment).

Systems Thinking approach has been adopted by WHO as a powerful tool in health policy design analysis to increase the quality of program evaluation.

Here is one of the systems projects from 2011 MIT SDM conference on Systems Thinking for Contemporary Challenges: Alex Shih talks about his project with Harvard medical school for Sustainable Household Income.

and a powerful short talk from Richard Tafel on social entrepreneurship and systems:

 

Oral health in HIV positive women

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This a short post mainly to share a Prezi link of my project`s presentation:

I included only main slides, more will be in the publication that I submited to Community Dentistry and Oral epidemiology journal.
Here is a video explaining the issues related to HIV & Oral Health, that is not always covered in media, when the disease is mentioned.

and in Spanish:

Haas Business School’s Health Care Conference:Entrepreneurial Solutions to Health Care Challenges

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Annual Business of Health Care Conference, a one-day conference organized by fellows of  a dual degree program (MBA/MPH) of Haas Business School deserves attention as it has attracted entrepreneurs, health care practitioners, industry professionals and investors.

Today health care faces great challenges costs, demographics, adoption of new tratement types, etc. , but mainly reducing the burden chronic illnesses, and foster advances in health care delivery.  Mike Buck, president of Abbott Ventures Inc., has guided us through the transformations of a large Abbott company that had created venture division to invest in research and development companies.

Among the most impressive panels were “Health and Wellness-Mobile and Web-Based Technology” with

  • Ron Gutman (HealthTap): Healthtap, is a virtual waiting room for an answer from 10,000 U.S. licensed physicians. This is not only convenient, but reduces thousands of unnecessary visits and costs. A great service with a public health impact.
  • Colleen Yoo (Keas): Keas is a health startup, a healthy lifestyle game for companies. Some organizations already realized the the connection between employee challenges/work productivity and work related stress and work/life imbalance. A well designed wellness program has its rewards for both parties in a long run just by maintaining healthy employees.

I instantly recalled of  GBC’s HEALTH@WORK Employee Education Program  to raise awareness among employees,  on HIV/AIDS,TB and other preventable diseases.

  • Karan Singh (Ginger.io) a creation that came out of MIT media lab that monitors lifestyle of mobile application user through his phone, data is formed by statistical (bayesian) modeling and machine learning analysis.
  • Nabil Aidoud (FiVi.com) a website tracking your physical activity (from yoga to running).

The solutions that arise everyday are impressive and transformations and their accessibly is truly amazing. New companies create new jobs and now directions in science.However, some presenters did not  focus on the incorporation in existing systems, metrics of tracking and success, that I assume is essential in any health care related innovation and activities. In addition, not every start-up has a staff with clinical/public health experience.

Similar opinion and more on Health IT start-ups: go to Anne DeGheest`s blog.

The closing speech from Daniel Kraft, MD  summarized the most recent innovations in health care: “As a cancer doctor, I’m looking forward to being out of a job.”

Dental care for HIV positive women

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This summer time was challenging due to data collection for my research project Prognostic implications of oral health status in HIV positive women.

Why focus on women? Women are often excluded  from studies or not enrolled in the studies for various reasons and now global epidemiological data shows that almost half of HIV positive individuals are female.

The situation in Russian Federation is similar. Russia has one of the largest HIV epidemics in Europe, with 589 581 registered cases and 58 633 new HIV cases in 2010(HIV Federal Center report), an incidence 20% higher than during the previous years. The prevalence of HIV-infection in the country is still dominated by men (64.9%), however, this gap is closing due to increased incidence among women in recent years. In fact, during the period 2004-2010, 41-43% of new HIV infections were among women, double the 20.6% among women in 2000. New cases among women are predominantly caused by heterosexual contact (64.7% of new cases), and among men the primary mode of transmission is injecting drug use (74.5% of new cases). There has also been a notable rise in HIV transmission during sexual contact among reproductive-age women, from 7.6% in 2006 to 38.0 % in 2010.

In St. Petersburg, the second largest city in Russia, 39 809 cases of HIV have been reported since 1987, including 13 144 women (33% of all cases). Consequently, St. Petersburg also has the unfortunate distinction having the most HIV-positive pregnancies in Russia.

The age group most affected by HIV infection is those 18 to 30 years of age. The majority of these patients are, or soon will be, in the secondary stage of disease progression with diverse clinical manifestations, and are seeking surgical, dermatovenerological, and dental care.

The total number of female patients visiting a dentist at the St. Petersburg City AIDS Center (CAC) has increased 71% from 255 (Jun-Dec2009) to 436 (Jun-Dec2010). The number of HIV-positive pregnant women has skyrocketed from 4 to121 during the same period.

Limited access to a full range of dental care services for HIV-infected women results in poor dental hygiene, a risk factor for transmission of oral bacteria, including cariogenic, as well as the risk to the fetus of premature delivery and low birth weight.

High caries prevalence  was observed with a few oral lesions . This may have a substantial impact on health and quality of life in this vulnerable population.

Next study focused on unmet dental needs among HIV positive women. The self-administered survey was developed to assess information about demographic and perceived oral health status, along with dental needs of HIV-positive women.

Public Health in Films

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Public Health in Film & Fiction Course  organized by Carol Whittaker,who has combined the works of writers, and filmmakers with public health themes in different life scenarios. In my opinion, it was a great idea for the graduate students to see the public health challenges from other professional point of view, even though without the scientific preciseness.  The course  has allowed to observe and provide feedback from a public health professional’s view through discussions.

One of the most important take-out from the course is learning and understanding  ” the usefulness of art in creating public health awareness” and thinking how others might view the health problem and what significance they put into difference diseases or public emergency situations. Here are some of the movies I watched, dropping by: Upton Sinclair’s The Jungle.; A Paralyzing Fear: The Story of Polio in America; Philip Roth’s novel Nemesis. The most touching and impressive story of polio in the US from outbreaks  and constant fear among population to finding vaccine, trials, and eradication.

Vaccine awareness project

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Topics in Infectious diseases (Vaccines concentration) class taught by Louise-Anne McNutt  was memorable as it was a mix of immunology, behavioral social change theories, staging the National Vaccine Committee workshop, social media application in public health and several group tasks.

I had a pleasure of working with Madhu Anand and Megan Mitchell for a final project where we have designed web-based educational campaign for new or newly expectant mothers basically a health blog called My MMR (measles mumps and rubella vaccine).

Among all vaccines we have chosen Measles, Mumps, and Rubella (MMR) vaccination due to recent  anti-vaccination moods and several outbreaks in the US. The summary of the project was made in Prezi, that has allowed us to present the project more vividly.

I took the lead to encourage my colleagues to use new type of presentation and  analyse and transform the existing knowledge in the way to address patients fears, beliefs and attitudes. The website and auxiliary sources offer young women take their time to think over important decision.

Our project is meant to provide information, discuss their rights, options, decisions and what they mean for the child and other children in the community.

Benjamin Domenech (editor of Health Care News and a research fellow at The Heartland Institute) in his blog write about his  straightforward opinion about the vaccine choices parents are making today: “Parents who refuse to allow their children to be vaccinated must understand they are deciding to teach their children at home or in schools that will allow unvaccinated children to enroll.The rest of the community should not have to bear the risk of a rise in preventable disease.The role of government in the matter should be to ensure people aren’t allowed to impose their choices on others, which means if we’re going to have public schools and children are required to attend, we can’t allow them to admit unvaccinated children.”

Anti-vaccine movement is hard to address disregarding where it takes place. To support some arguments public health expert can always turn to history of medicine and in the US to the Founding Fathers of the nation, here are some examples from  New York Times essay by  Dr. Howard Markel (a professor of the history of medicine at the University of Michigan): ”John Adams was inoculated in 1764. George Washington ordered his soldiers to be inoculated in 1777 because more men were falling to smallpox than to Redcoat muskets. Thomas Jefferson, who avidly followed the scientific literature on the subject, inoculated himself and his children in 1782. Benjamin Franklin was an advocate of smallpox inoculation.”

Other group of students (Lia Gvinjilia,Patel Nimish, Mingzeng Sun) came up with a video for yellow fever vaccine.

These are  academic public health projects, but a demonstration of how various means of mass communication can create awareness as well as provide accurate knowledge for population to make decisions. This is the right time for research, especially when “half  of America is using social networks” and already this week I was reading research by E. Miller and  A. Pole  and their article where they take a close look at  Health blogs, its influence, usage and current perspectives.

Dr. Shah, the current NYS Commissioner of Health is a social media supporter, who gave a guidance speech encouraging to focus on patient-centered approach and use of modern technology.

I hope social media will help bridge the access gaps to health care providers, and to high quality health care services. I sincerely believe it is possible through the combined efforts from committed healthcare and IT professionals.

Finally, I would like to post a video from the Gates Foundation that explicitly explains the history and values of vaccines:

and the most recent Eurosurveillance report that focuses on MMR vaccination in Europe.

“attending to the whole person, in context of personal & medical history and life circumstances”

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This Fall I took a Genetic Epidemiology class taught by Prof. Roxana Moslehi. We covered a lot of various topics ( linkage analysis, genetic counseling, genome-wide studies, microarrays,etc)  in a quite a short period if time. One of the most fascinating was watching a film about DNA discovery, how genetic research was banned at MIT, the dialog about ethics, legal and biotechnology perspectives between scientists and society which still continues nowadays. The giant leaps that have been done in the past 30 years with Human Genome project and numerous genetic test, public awareness, specialized web resources, one of them that I found useful is Huge Navigator to search cancer, stroke, Crohn`s disease and other disease with genetic association, track the evolution in human genome epidemiology as well as find investigators in a particular field of human genome epidemiology.

It seems to me that some of us still do not realize that genomics and personalized medicine already has an enormous impact on public health by providing a better understanding of diseases pathogenesis, accurate assessment of disease susceptibility and prediction of drug response.  For example, screening of newborns for elevated phenylalanine to identify the affected babies to prescribe diet in order to prevent mental retardation; prevention of adverse and costly drug reactions by pharmacogenomics approach.