Category Archives: Public Health

Lyme Disease update: A second deer tick microbe causes Lyme in North America

Guest post by Alan Barbour, MD

(With Lyme disease on the move and in news, we invited Lyme Disease author Dr. Alan Barbour to contribute regular updates to the JHU Press blog. His posts will highlight the latest findings on Lyme and other deer tick-associated infections and share insights on diagnosis, treatment, and prevention that are reported in the medical literature and other sources. For more frequent short updates and tips, follow Dr. Barbour on Twitter: @alanbarbour.)

Adult_deer_tickFrom the time of our discovery of it in 1981 and for the next 34 years, B. burgdorferi was the only known cause of Lyme disease in North America. That’s no longer the case. A second species–named B. mayonii after Minnesota’s Mayo Clinic–has been identified as a human pathogen in patients in the upper Midwest. In Europe and Asia, a more complicated situation has been the norm for many years. Besides B. burgdorferi, three other species cause Lyme disease on the Eurasian continent. As discussed in the book, this is of more than academic interest because the two most common Eurasian species, B. afzelii and B. garinii, differ in important ways. Both are transmitted by ticks, but B. afzelii more commonly has a rodent as a carrier, while B. garinii has a greater predeliction for birds. In addition, B. garinii is more associated with invasion of the nervous system while B. afzelii is more likely to be confined in its manifestations to the skin. In comparison to those two species, B. burgdorferi more commonly results in arthritis in infected people.

There is only one medical journal article to date about B. mayonii in humans, so there is still much to be learned. But so far, there is evidence that B. mayonii may achieve higher levels of bacteria than B. burgdorferi in the blood during infection. This may be associated with a higher frequency of multiple skin rashes and a greater likelihood of hospitalization. The report focused on cases from the upper midwestern United States. In this region B. mayonii was identified in deer ticks, but it was less common than B. burgdorferi in ticks collected at the same locations and time. Whether B. mayonii occurs in other parts of the United States or Canada is not yet known.

Effective antibiotic treatment of Lyme disease caused by B. mayonii probably will not differ from treating disease caused by B. burgdorferi. But the discovery of a second Lyme disease species may cause a re-evaluation of some diagnostic assays. There may be enough differences between the two bacteria that an antibody test that solely uses B. burgdorferi cells as the target for the patient’s antibodies may have somewhat lower sensitivity when the patient has been infected with B. mayonii.

Since both B. mayonii and B. burgdorferi are carried by the deer tick Ixodes scapularis, the effective measures for reducing the risk of tick bites (which are described in the book) should suffice for protection against both pathogens. A possible exception among prevention options may be canine Lyme disease vaccines that are based on B. burgdorferi or one of its purified protein. Whether there is cross-protection is not known.

barbourAlan G. Barbour, MD, is a professor of medicine and microbiology at the University of California, Irvine School of Medicine, a co-discoverer of the cause of Lyme disease, and a leading Lyme disease researcher. He is the author of Lyme Disease: Why It’s Spreading, How It Makes You Sick, and What to Do about It.


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Filed under Animals, Health and Medicine, Nature, Public Health

Spring books preview: politics and policy

We’re excited about the books we’ll be publishing this spring—and we’re pleased to start off the new year with a series of posts that highlight our forthcoming titles. Be sure to check out the online edition of JHUP’s entire Spring 2016 catalog, and remember that promo code “HDPD” gets you a 30% discount on all pre-publication orders. Today we feature spring books on policy and politics; click on the title to read more about the book or to place an order:

taylorJust and Lasting Change
When Communities Own Their Futures
second edition
Daniel C. Taylor and Carl E. Taylor

diamondAuthoritarianism Goes Global
The Challenge to Democracy
edited by Larry Diamond, Marc F. Plattner, and Christopher Walker

rojeckiAmerica and the Politics of Insecurity
Andrew Rojecki

sovacoolFact and Fiction in Global Energy Policy
Fifteen Contentious Questions
Benjamin K. Sovacool, Marilyn A. Brown, and Scott V. Valentine

whiteheadIlliberal Practices
Territorial Variance within Large Federal Democracies
edited by Jacqueline Behrend and Laurence Whitehead

Use discount code “HDPD” to receive a 30% discount on pre-publication orders for JHUP’s spring 2016 titles.
To order, click on the book titles above or call 800-537-5487.

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Filed under Current Affairs, Politics, Public Health, Publishing News

Spring books preview: health & medicine

Seasonal catalog cover spring 2016We’re excited about the books we’ll be publishing this spring—and we’re pleased to start off the new year with a series of posts that highlight our forthcoming titles. Be sure to check out the online edition of JHUP’s entire Spring 2016 catalog, and remember that promo code “HDPD” gets you a 30% discount on all pre-publication orders. Today we feature spring books on health and medicine; click on the title to read more about the book or to place an order:

dawes150 Years of ObamaCare
Daniel E. Dawes
foreword by David Satcher, 16th US Surgeon General

Guinan_jkt.inddAdventures of a Female Medical Detective
In Pursuit of Smallpox and AIDS
Mary Guinan, PhD, MD
with Anne D. Mather

grantWhy Can’t I Stop?
Reclaiming Your Life from a Behavioral Addiction
Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, PhD, MPH, and Samuel R. Chamberlain, MD, PhD

goldenOvercoming Destructive Anger
Strategies That Work
Bernard Golden, PhD

trainorCalming Your Anxious Child
Words to Say and Things to Do
Kathleen Trainor, PsyD

noonanWhen Someone You Know Has Depression
Words to Say and Things to Do
Susan J. Noonan, MD, MPH
foreword by Timothy J. Petersen, PhD, Jonathan E. Alpert, MD, PhD, and Andrew A. Nierenberg, MD

grimesSeductive Delusions
How Everyday People Catch STIs
second edition
Jill Grimes, MD

trimbleThe Intentional Brain
Motion, Emotion, and the Development of Modern Neuropsychiatry
Michael R. Trimble, MD

slavney16Psychiatric Polarities
Methodology and Practice
Phillip R. Slavney, M.D., and Paul R. McHugh, M.D.

Use discount code “HDPD” to receive a 30% discount on pre-publication orders for JHUP’s spring 2016 titles.
To order, click on the book titles above or call 800-537-5487.

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Filed under Consumer Health, Health and Medicine, Neuroscience, Psychiatry and Psychology, Public Health, Publishing News

Considering the HIV Care Continuum on World AIDS Day

Guest post by Cathy Maulsby

jainTremendous progress has been made in the fight against HIV since the first World AIDS Day in 1988. Thanks to advancements in antiretroviral therapy (ART), HIV can now be a manageable chronic disease, and in the U.S., the average life expectancy for people living with HIV (PLWH) continues to increase towards that of the general U.S. population. However, significant work remains to be done to reach the goal of ending HIV in this country. Today, approximately 1.2 million people in the U.S. are living with HIV, and certain populations (including gay, bisexual and other men who have sex with men, Black women and men, Latino men and women, people who inject drugs, youth aged 13 to 24, and transgender women) continue to be disproportionately affected. Additionally, of the 1.2 million PLWH in the country, far too many lack access to ART—the lifesaving drugs that reduce HIV transmission by lowering the level of virus in the blood (viral suppression).

In the field of HIV, we refer to the HIV care continuum—a model of the consecutive stages of HIV medical care, from initial diagnosis to achieving viral suppression—to identify gaps in services and improve engagement in care and health outcomes for PLWH. The Centers for Disease Control and Prevention (CDC) estimates that among PLWH, only 41% are retained in HIV care, 36% are prescribed ART, and 28% are virally suppressed. This means that the majority of PLWH do not have access to regular HIV medical appointments (approximately 60%), and even more (approximately 70%) are not virally suppressed. Clearly, there is significant work to be done to reduce these gaps across the continuum of care.

In July 2015, the White House released an updated National HIV/AIDS Strategy (NHAS) to guide the nation’s response to the epidemic through 2020. The updated NHAS sets specific goals to achieve the vision of a country where new HIV infections are rare, and every person living with HIV has access to high-quality care. If we are to meet these goals, it is critical that HIV programs combine effective behavioral and biomedical programs to boost linkage and retention in HIV care. Evidence-based program models—such as patient navigation, coordinated care teams, and strengths-based case management—save lives by providing the tools and support to maintain regular HIV care engagement, but reimbursement and coverage for these services needs to be expanded. In addition, there is a dearth of information on how to implement these interventions in real-life practice settings, and too few evidence-based interventions exist for some of the populations most heavily impacted by HIV, such as Black gay, bisexual and other men who have sex with men.

Through research that my colleagues and I conducted on Improving Access to HIV Care, a national HIV linkage and retention in care program funded through AIDS United with generous support from the Corporation for National and Community Service, M·A·C AIDS Fund, and Bristol-Myers Squibb, we found that a lack of support services—such as long waitlists for housing and insufficient resources for mental health and addiction services, and employment-related services—created a significant barrier to HIV program implementation. And while case management reimbursement through the federal Ryan White HIV/AIDS program provides much needed support, the demand for these services often far surpasses the available resources.

Scientific advances have given us the tools to effectively prevent HIV infection and disease progression. But HIV is a social disease, and the root causes—and the largest barriers to HIV medical care and HIV medication adherence for many PLWH—are the complex and competing needs, such as housing insecurity, addiction, mental health conditions, incarceration and unemployment. To realize the full benefit of the tools available to fight HIV, coverage for much needed case management and social support services must be expanded, and we must address, at the systems-level, the social factors that place individuals at increased risk for HIV transmission. Otherwise, the disparities we see today across the HIV continuum of care are likely to persist.

Cathy Maulsby is an assistant scientist at the Johns Hopkins Bloomberg School of Public Health and co-author of Improving Access to HIV Care: Lessons from Five U.S. Sites, which JHU Press will publish early next year.

Use promo code “HDPD” to receive a 30% discount when you place your pre-publication order for Improving Access to HIV Care.

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Filed under Health and Medicine, Public Health

Religion, politics, and Charlie Sheen

By Kathryn Marguy

Of all the celebratory hullabaloo surrounding the release of Adele’s latest album, my favorite has to be Saturday Night Live’s “A Thanksgiving Miracle” sketch. The scene opens with a family gathered around the table for Thanksgiving. As they pass around the sweet potato casserole, various members of the family start bleating close-minded, occasionally racist commentary about current events. As tensions rise, a young girl, the smallest guest at the table, slowly rises and walks to the nearby stereo to blast Adele’s single, “Hello.” The adults immediately abandon their griping and sing along in synchrony. In typical SNL fashion, the scene unravels into absurdity, and it is glorious and I love it.

But (also in typical SNL fashion) the sketch raises an issue that is all too real: how is one to cope with the strong, often incorrect commentary of those you’re spending Thanksgiving with? Without Adele’s sultry siren’s call, how can you successfully traverse a conversation with your family’s Archie Bunker?

The answer? Cold, hard facts.

That’s where America’s Oldest University Press comes in. We’ve compiled a list of six books that will help you drop some knowledge on those Thanksgiving guests who might need an extra nudge toward reality. Within the pages of these books are many quotable quips to use in discussion. They’d also make great presents for those seeking more answers (bonus: they’re easy to wrap). We can’t guarantee these books will smooth a kerfuffle, but it’s always a good idea to go into a situation prepared with evidence-based reasoning. Plus, you can use the code “HDPD” for 30% off these enlightening texts!

Already on the road? You’ll be happy to know all of these books are available in an electronic format for on-the-go reading.

The holiday season is upon us, curious readers. Spread good cheer and a little bit of knowledge this year.

callahanThe Science of Mom, by Alice Callahan, PhD

It seems everyone has an opinion about proper parenting (this includes those with and without children). Whether you face discussions of co-sleeping, baby’s nutrition, or the absurdly volatile matter of immunizations, Dr. Alice Callahan has you covered.

formisano15Plutocracy in America, by Ronald P. Formisano

This is a big one. Dr. Formisano’s data-driven book gets to the root of inequality in America. After reading its easy-to-digest chapters, you’ll be able to share relevant statistics and information about legislation without batting an eye as you ladle gravy over your potatoes.

paulImmunity, by William Paul

Let’s face it, the topic of Charlie Sheen is ripe for conversation, no matter how dignified your dinner guests. It’s easy to caricature his situation to make assumptions about HIV. Shut down erroneous chatter with a comprehensive look at immunology from the man who led innovation in the field for the past three decades.

smithDiversity’s Promise for Higher Education, second edition,
by Daryl G. Smith

Beyond flashy headlines and dramatic images, the lack of diversity in higher education identifies a problem not with football players or student protesters, but with institutional leadership. Dr. Daryl Smith provides tangible solutions to the growing issues with diversity on college campuses.

prasadEnding Medical Reversal,
by Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD

We’d like to think new treatment and tests represent advances in the field of medicine. But what happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base? Medical reversal, that’s what. Drs. Prasad and Cifu help readers discern best medical practices based on facts, not Cousin Brittney’s assurances.

dowdGroundless, by Gregory Dowd

The elephant at every Thanksgiving table is the genocide of Native Americans that shortly followed the first Thanksgiving. Groundless looks at rumors and tall tales that pervaded early-American culture, many of which cast aspersions on Native Americans. In this fascinating book, historian Gregory Dowd refutes numerous folk stories, including the legend that the English gave smallpox blankets to Powhatan’s people.

Kathryn Marguy (@pubkat) is a publicist at Johns Hopkins University Press.


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Filed under Cultural Studies, Current Affairs, Education, For Everyone, History, Holidays, Politics, Public Health, Publishing News, University Presses

Preparing surgeons to work overseas

JHUP author Dr. Adam L. Kushner will be signing copies of Operation Health in Chicago next week at the American College of Surgeons’ Clinical Congress 2015. Meet Adam and get your signed copy of  at the Exhibit Hall Resource Center Book Signing Booth on Monday, October 5, from 1:00 p.m. to 3:00 p.m. and on Tuesday, October 6, from 1:00 p.m. to 2:00 p.m.  The book signing is hosted by Operation Giving Back, a resource designed to help surgeons find volunteer opportunities best suited to their expertise and interests.

Guest post by Adam L. Kushner, MD, MPH, FACS

kushnerIn low-resource countries 288.2 million people need surgical care. Reducing this burden requires improving local health systems and building capacity, but volunteer surgeons can also help. As interest by surgeons in volunteering overseas increases, proper preparation is important. Below is a modified outline based on a guide for surgical residents and students.


  1. Determine why, where, and for how long you can go.
  2. Choose an organization or a country and site, establish goals and connections, and plan a budget and adequate financing for the trip.
  3. Prepare items to bring along: these include personal items, personal medical equipment, and any items to donate after consulting the host facility.
  4. Be a smart traveler: arrange visas, vaccinations, flights, food, water, living, and travel arrangements.

The visitor’s role at the hosting facility:

  1. Ensure that adequate clinical supervision is available.
  2. Remember that local training programs take priority.
  3. Work within the local system(s) and protocols.
  4. Take care of your own health.
  5. Maintain a surgical case log (end of each day).
  6. Consider opportunities for using/establishing blogs or mass e-mails.

Activities after returning:

  1. Continue communication with hosts after your experience.
  2. Provide a written summary to your sponsor(s).
  3. Share your experiences through a variety of channels (acknowledge and, when possible, include international colleagues in your reports).
  4. Volunteer as an advisor to others who wish to follow you.

Another good source of volunteer information for surgeons is available from the American College of Surgeons at Operation Giving Back.

Adam L. Kushner, MD, MPH, FACS is an associate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, a lecturer in the Department of Surgery at Columbia University, and the founder and director of Surgeons OverSeas. He is the editor of Operation Health: Surgical Care in the Developing World.

Read a review of Operation Health in The Lancet.


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Filed under Health and Medicine, Medical Education, Public Health

Measles is serious (a history lesson from my Grandmother)

Guest post by Alice Callahan

Today’s post is an excerpt from a longer piece that first appeared on the author’s blog, Science of Mom: The Heart and Science of Parenting.  The blog was the inspiration for her new JHU Press book, Science of Mom: A Research-Based Guide to Your Baby’s First Year.

Measles is back. The outbreak of this highly contagious viral illness that started at Disneyland in December has spread across the country and shows no signs of slowing. As of February 6, the CDC reported 121 cases in 17 states in this year alone, most linked to Disneyland. In 2014, we had 644 cases of measles in the U.S. This is a striking increase compared to the last 15 years, when we usually saw less than 100 cases in an entire year.

I’m sorry that so many people have been sickened in this outbreak and hope that it is reined in soon. This is no easy task given our mobile society and the fact that we like to congregate in places like theme parks, schools, doctors’ offices, hospitals, airplanes, and shopping malls. Add to that the pockets of unvaccinated people where measles can easily spread, and we have a recipe for still more outbreaks until we can improve vaccination rates. In this situation, I particularly feel for those who can’t be vaccinated. Babies under 12 months of age and people who are too immunocompromised to get the MMR vaccine, like cancer patients receiving chemotherapy, are counting on the rest of us to get vaccinated and reduce the spread of this disease. Right now, we’re letting them down.

callahanOne positive outcome to this outbreak is that it has sparked lots more conversation about vaccines. It inspired me to be more public about proudly stating that our family is fully vaccinated. And I wrote an op-ed piece for my local paper, the Register-Guard, about the risk of measles in our community, given the low vaccination rates in our schools.

(Our baby, of course, has so far only received the newborn Hepatitis B dose. He won’t receive the MMR shot, which includes the measles vaccine, until 12 months of age.)

I spent a lot of time researching vaccines last year for my book. The result is an in-depth look at vaccine development, risks and benefits, and safety testing and monitoring. I also cover some specific vaccine concerns, like whether or not we give too many too soon (we don’t) and if we should be worried about aluminum in vaccines (we shouldn’t). (I don’t just tell you these things, though; I break down the science for you.) I read hundreds of papers about childhood vaccines, talked with researchers, and felt more confident than ever about vaccinating my kids on the recommended schedule.

There was one other bit of vaccine research that may have been the most meaningful to me: I flew to Florida to interview my grandmother, now 90 years old. She raised seven children before most of today’s vaccines existed. She was a mother during the 1952 polio epidemic that killed 3,145 and paralyzed more than 21,000 people in the U.S. She was having her babies before a vaccine for rubella was available. That disease caused 11,250 miscarriages, 2,100 stillbirths, and 20,000 children to be born with birth defects in a 1964–1965 outbreak in the U.S.

Three brothers (from left to right): Richard (the author's father), Frankie, and Larry Green, circa 1953, in Princeton, New Jersey. Frankie died in 1956, at age 6, of encephalitis caused by measles. Photo by Margaret Green, used with permission.

Three brothers (from left to right): Richard (the author’s father), Frankie, and Larry Green, circa 1953, in Princeton, New Jersey. Frankie died in 1956, at age 6, of encephalitis caused by measles. Photo by Margaret Green, used with permission.

My grandmother also nursed her children through the measles. Before the vaccine, nearly every child suffered through a case of measles at some point in childhood. During the current measles outbreak, I’ve seen some comments downplaying the seriousness of this disease. After all, most kids did survive measles without long-term consequences. However, many didn’t. Among those who didn’t survive was my grandparents’ second child, Frankie. In 1956, at the age of 6, he died of encephalitis, or inflammation of the brain, a complication of measles.

* * * * * *

We live in a privileged time. Just a few generations ago, our grandparents had no choice but to nurse their children through painful diseases, knowing there was a chance of serious complication and even death. Worldwide, measles still killed 122,00 people in 2012, mostly in parts of the world with limited access to the vaccine.

But here in the U.S., our generation of parents has a choice. We get to choose whether or not to vaccinate our children. And oh, how we treasure that choice. The trouble is that we’re so far removed from the pre-vaccine era that we can make the mistake of ignoring the stories of our grandparents and great-grandparents, stories of kids like Frankie. And we can make the mistake of believing that we make our choices in a vacuum. When we’re talking about infectious diseases, nothing can be further from the truth. Sure, a few can choose not to vaccinate, in addition to those who have a medical reason not to, so long as the rest of us do our part to maintain herd immunity. However, when too many make that choice, the disease regains its strength, and its first victims are often the most vulnerable.

I wrote most of this post while holding my 7-week-old baby boy. He is fighting his first cold right now. It’s just your run-of-the-mill cold virus, but his nose is filled with snot, and he has a sad little cough. I know he’ll be better soon, but I hate to watch him suffer. Mothers and fathers will always be nursing their babies through illness, but I’m glad to be a parent in the vaccine era, when herd immunity and my baby’s own immunizations can protect him from the worst of the world’s infectious diseases. Let’s hope we can keep it that way.

Alice Callahan holds a PhD in nutritional biology from the University of California, Davis, and is the author of Science of Mom: A Research-Based Guide to Your Baby’s First Year. She spent two years investigating fetal physiology as a postdoctoral scholar, and, after giving birth to her first child in 2010, she put her scientific training to work answering the big questions about caring for a baby. The creator of the blog Science of Mom: The Heart and Science of Parenting, she writes and teaches in Eugene, Oregon.




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Filed under Consumer Health, Health and Medicine, Pediatrics, Public Health