Todd Wyatt, PhD: Research into the Effects of Agricultural Dust Exposures on Chronic Inflammatory Lung Disease

Todd Wyatt, PhD

Todd Wyatt, PhD

Spotlight on Research at COPH – A former popular tagline for the American Lung Association is “When you can’t breathe, nothing else matters.” Unfortunately, this statement is true for too many Americans. Between 35-40 million people in the United States have been diagnosed with asthma and chronic obstructive pulmonary disease (COPD). In fact, these kinds of ongoing, progressive lung diseases are now the third leading cause of death in the United States. Treatment and management of chronic lung disease costs our nation in excess of $50 billion each year. There are no cures for chronic lung disease; therefore, prevention is an important strategy in the fight against this public health problem.

Cigarette smoking is the greatest cause of COPD. However, approximately 15%-20% of COPD is associated with workplace and environmental exposures. Nebraskans are exposed to a variety of workplace and environmental causes of lung disease. For example, agricultural dust exposures can lead to chronic inflammatory lung disease in some people. The research that Dr. Todd Wyatt and his colleagues conduct in the Central States Center for Agricultural Safety and Health (CS-CASH) addresses the nature of agricultural organic dust exposure that leads to chronic lung disease. Researchers in Dr. Wyatt’s lab are particularly interested in understanding why dust exposure is more likely to cause lung injury in some people than in others. Thus, their studies are centered on understanding the lung’s innate defense mechanism, or its ability to protect itself, against environmental dusts.

It is estimated that the average person inhales approximately 1 pound of dust every month! This dust is trapped by secreted mucus and moved out of the lungs through the coordinated action of the cilia, small whip-like hairs projecting from the cells lining the airways. This process keeps most people healthy and safe from disease, as the lungs are kept clean and sterile. However, under certain exposure conditions, the protective action of the cilia can be compromised, leading to sustained injury from direct inhalation of toxins, or to reactive inflammation from viral or bacterial infection.

Cilia respond to environmental challenges by speeding up or slowing down. Dr. Wyatt’s lab studies the molecular, cellular, and biochemical pathways that cause cilia to slow in response to agricultural organic dust inhalation in hopes of understanding who might be at risk for chronic lung disease. Furthermore, they examine whether multiple exposures, such as cigarette smoking and alcohol consumption, worsen inhalational lung injury. With this research, they hope to enhance worker health and safety in Nebraska’s agricultural sector.

Todd Wyatt, PhD, is a professor in the UNMC COPH Department of Environmental, Agricultural and Occupational Health; a professor in the UNMC College of Medicine Department of Internal Medicine Division of Pulmonary, Critical Care, Sleep & Allergy; and deputy director of the Central States Center for Agricultural Safety and Health

Eleanor G. Rogan, PhD

Eleanor G. Rogan, PhD

Eleanor G. Rogan, PhD

Faculty Highlight – Dr. Rogan sees her main mission as facilitating opportunities for students and faculty in the Environmental, Agricultural and Occupational Health Department, from teaching to research to service.  She has played an integral role in the growth of the college, its programs, and its research agenda. In her lectures in professional and graduate student courses, she tries to engage the students to see possibilities for them to use their talents, skills, and interests. Her goal is for students to learn the essential knowledge and to begin to think about it creatively. She is facilitating the establishment of joint degree programs with UNO and UNL, as well as promoting some of the department’s courses that relate to other educational programs. Dr. Rogan is well-respected by her students. She was a 2010 recipient of the college’s Excellence in Teaching Award.

Dr. Rogan’s research involves environmental health, especially with regard to cancer-causing substances.  She investigates how estrogens start the process leading to cancer, with the goal of preventing cancer. She finds Nebraska interesting because of all the agrichemicals used throughout the state. She also spends time working to develop research or service projects relevant to environmental, agricultural, and occupational health in Nebraska and the developing world. As part of these efforts, she works with the Daugherty Water for Food Institute at UNL and with the National Park Service, which has a regional office here in Omaha.  Despite the short time since the department was formed, with six part-time faculty members, faculty are engaged in environmental and occupational health projects that literally span the globe.

Dr. Rogan serves as chair of the Department of Environmental, Agricultural and Occupational Health, chair of the college’s Teaching Award Committee, and chair of the UNMC Academic Freedom and Tenure Committee. She liaises with the Daugherty Water for Food Institute and UNL, and facilitates interactions with the National Park Service. She also facilitates collaboration between the College of Public Health, UNL and UNO.

Eleanor G. Rogan, PhD, is a professor and chair of the UNMC COPH Department of Environmental, Agricultural and Occupational Health, and a professor in the UNMC Eppley Institute for Research in Cancer and Allied Diseases.

Oyewale Shiyanbola

Oyewale Shiyanbola

Oyewale Shiyanbola

Student Highlight – Oyewale Shiyanbola is a doctoral student in the department of Health Services Research and Administration. He is from Southwestern Nigeria and completed his MPH in Public Health Administration at the UNMC College of Public Health. He has a medical degree from the University of Ibadan, Nigeria, and has worked as a general medical practitioner in both urban and rural settings. His work with rural populations in Nigeria stimulated his interest in public health. The impact of preventive services in maintaining a healthy population and reducing the spread of disease became more apparent as he became increasingly involved in community vaccination and health education outreach programs. In some instances, administering preventive services in rural communities was challenging due to conflicting beliefs regarding certain health interventions, such as vaccine use. Additionally, he observed how inefficient health care organization and delivery led to poor health outcomes. Hence, he decided to pursue a degree in public health, focusing on the administration and policy track.

Working as a medical officer, particularly in rural settings, gave Wale the opportunity to work with multinational agencies such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Some of the rural communities where he worked were still dealing with childhood killer diseases such as polio, which had been eradicated in most parts of the country. Hence, these agencies assisted with preventive services by providing health care personnel training as well as medical supplies, such as vaccines. Most importantly, they collaborated with the government both at federal and local levels in combating health challenges.

Wale’s research interests include health outcomes, policy, and economic analysis of health interventions. He hopes that in the future, his research and expertise will be useful in the United States and Nigeria in achieving health care improvement by influencing public policy and organizational decision making.

According to Wale, the College of Public Health has “worked hard to establish a wonderful learning environment.” He is impressed at the amount of resources available for faculty and students to further their research and develop themselves intellectually. He notes that the faculty and students are appreciative of everyone’s cultural background and that this has helped international students like him to fit in well, both in the college and in the city of Omaha.

Plaza Partnership: Supporting Collaborative Health Sciences Research

source: plazapartnership.org

source: plazapartnership.org

Spotlight on Research at COPH – The scene: Ten tables of four are spread throughout a meeting room, covered with large pieces of paper, markers and post-its. At each table sit individuals who, regardless of occupation or discipline, share mutual interest in and passion for the health of the South Omaha community. The room buzzes with conversation around a single question posed to the group: What will it look like and feel like when a truly trustworthy relationship is in place that fosters the research we all want and need?

This question, one of several asked at World Café workshops, drives the Plaza Partnership model for supporting collaborative health sciences research. Funded by the National Institutes of Health (NIH) in 2010, the Plaza Partnership project aims to build the readiness, capacity, and data support systems for both community and academia to work together for health research in South Omaha.

The Plaza, a metaphorical reference to the community square found in many Latin American cities, is anchored by its four partners: Douglas County Health Department, South Omaha Community Care Council, OneWorld Community Health Centers, Inc., and the University of Nebraska Medical Center. Each partner contributes to the development of readiness, capacity, and data activities by providing their leadership, community advocacy, and first-hand knowledge of South Omaha.

In the summer of 2011, the Plaza Partnership held its first series of readiness events, including World Café workshops, which brought together community and academia representatives for thoughtful conversation around health research. Following these events, participants came forward to form the first cohort of community-linked research teams that would train together through the Research Action Learning (ReAL) Collaborative. Plaza Partners repeated the process in the summer of 2012, yielding a second cohort of teams.

Teams kicked-off their journeys in January of 2012 and 2013. Through the ReAL Collaborative training, teams increased their capacity to do collaborative health research. The Data Workgroup supported each team’s data needs, and continues to reach out to Plaza Partners for developing mutually beneficial tools for future health research in South Omaha. Ultimately, teams developed written proposals for community-based research projects.

As funding for the project draws to a close, Plaza Partners are investing time and resources into a modified ReAL Collaborative training, complete with online modules. With the curriculum made available to communities across the nation, the Plaza Partnership hopes this tool will support similar efforts working to foster truly trustworthy relationships for community-linked health research. Stay tuned! For more information, visit the Plaza Partnership website or e-mail Dr. Christopher Fisher at cfisherm@unmc.edu.

This article was written by Christopher Fisher, PhD, assistant professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health and principal investigator of the Plaza Partnership project, and by Molly McInturf, graduate assistant in the UNMC COPH Department of Health Promotion, Social and Behavioral Health.

Drugs and Lactation: Information You Can Trust!

source: nih.gov

source: nih.gov

Public Health Community Advisory – The websites of state breastfeeding coalitions are excellent sources of information and resources that women can trust. For example, the Nebraska Breastfeeding Coalition (http://nebreastfeeding.org/) includes information and resources on topics such as:

    • Learn to Breastfeed

    • Common Concerns

    • Family and Partner Support

    • Breastfeeding with Confidence

    • Return to Work and Continue Breastfeeding

    • Pumping and Storage

However, state breastfeeding coalition websites don’t include information on a nursing mother’s safe use of over-the-counter (OTC) medications or prescription medications. A mother may wonder whether a medication is safe for her baby, or whether it could harm the baby by transmission through the breast milk. While a woman is always advised to check with a medical professional, a trusted Internet resource is available any time of the day or night.

The US National Library of Medicine hosts a free online resource for mothers who choose to breastfeed their babies and for those who guide them in their effort to do so safely. Located under the TOXNET Toxicology Data Network, “LactMed” is a Drugs and Lactation Database.  LactMed may be searched at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. It is a “peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.” LactMed is geared to both the health care practitioner and the nursing mother, and contains over 450 drug records.

To conduct a substance search, the consumer may choose to enter one of three terms into the search box: either the name of the drug (commercial trade name or generic name), or the chemical name, or the chemical abstract services (CAS) registry number. Next, a list is provided of variations of that substance name. For example, the trade name of Tylenol is listed as Acetaminophen. Once the consumer selects a substance from the list, a Table of Contents is provided on the left-hand side of the screen for easy navigation to the section of interest.

The information for each substance in the database includes such things as drug levels in maternal breast milk, drug levels in the nursing infant’s blood, potential effects of the drug on breastfeeding infants and on lactation itself, the American Academy of Pediatrics category indicating the level of compatibility of the drug with breastfeeding, and alternate drugs to consider. References are included, as is nomenclature information, such as the drug’s CAS registry number and its broad drug class. In addition to the search option, other support pages are available, such as a glossary, fact sheets, and additional breastfeeding links.

Important information that is both trustworthy and available at the time of need is a very welcome addition to any family!

This article was written by Denise H. Britigan, PhD, assistant professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health.

Affordable Care Act Supports for Nursing Mothers in the Workplace

gb nursingmothersPublic Health in the National News –  Passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 improved the picture for breastfeeding women in the workforce. PPACA amends Section 7 of the Fair Labor Standards Act (FSLA) of 1938 by adding provisions requiring employers to provide reasonable break times for nursing employees to express milk and that they provide a place, other than a bathroom, shielded from view and free from intrusion in which to express milk (Section 7(f) of the Fair Labor Standards Act – Break Time for Nursing Mothers Provision).

This provision is the first federal law to explicitly require accommodation for mothers who wish to continue breastfeeding while working outside the home (Murtagh & Moulton, 2011).  By using the FSLA as the legislative vehicle for these provisions, Congress made accommodation for breastfeeding mothers an integral part of the US labor laws and thus provided protections for women in states that do not offer legal accommodation for breastfeeding employees.

While passage of the breastfeeding provisions in the PPACA was cause for celebration among breastfeeding advocates, there are still concerns. The provisions apply only to hourly wage workers and not to salaried employees or to certain classes of employees such as school teachers and agricultural workers (Murtagh & Moulton, 2011). The act also applies only to expressing breast milk or pumping and not feeding the child at the breast, a perspective that assumes pumping is the preferred option and insulates employers from developing alternatives that would allow mothers to feed their child at the breast while at work. Small employers with fewer than 50 employees are exempt if they can demonstrate hardship in complying with the law (Murtagh & Moulton, 2011).

The wording of the law is vague and does not provide guidance on what constitutes reasonable break time nor what a place other than a bathroom that is shielded from view and free from intrusion looks like. What constitutes hardship for small employers is also not clearly defined.

As with other vaguely worded legislation that could be interpreted as supporting nursing mothers in the workplace, the courts will become the final arbiter of how the provisions in the PPACA are implemented. The courts’ track record in supporting nursing mothers in the workplace is not good, but breastfeeding advocates hold out hope that the provisions of the PPACA are the start of a new perspective.

Murtagh, L., & Moulton, A. D. (2011). Working mothers, breastfeeding, and the law. Am J Public Health, 101(2), 217-223. doi: 10.2105/ajph.2009.185280

Section 7(f) of the Fair Labor Standards Act – Break Time for Nursing Mothers Provision.   Retrieved July 29, 2012, from http://www.dol.gov/whd/nursingmothers/Sec7rFLSA_btnm.htm

This article was written by Lea Pounds, MBA, instructor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health.