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Finkelstein, Julia

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Finkelstein

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Julia

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Finkelstein, Julia

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2009 - 200912010 - 20124

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Author's Publications: search.filters.isAuthorOfPublication.4d59203a-0b4c-4b77-a335-800b67c3422f

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    Maternal Vitamin D Status and Child Morbidity, Anemia, and Growth in Human Immunodeficiency Virus-exposed Children in Tanzania
    (Ovid Technologies (Wolters Kluwer Health), 2012) Finkelstein, Julia; Mehta, Saurabh; Duggan, Christopher; Manji, Karim P.; Mugusi, Ferdinand M.; Aboud, Said; Spiegelman, Donna; Msamanga, Gernard I.; Fawzi, Wafaie
    Background Vitamin D may help prevent adverse pediatric outcomes, including infectious diseases and growth failure, based on its role in immune and metabolic functions. We examined the association of maternal vitamin D status and pediatric health outcomes in children born to HIV-infected women. Methods Vitamin D status was determined in 884 HIV-infected pregnant women at 12 to 27 weeks of gestation in a trial of vitamin supplementation (not including vitamin D) in Tanzania. Information on child morbidities, anemia and hypochromic microcytosis, and anthropometry was recorded through monthly clinic visits. Generalized estimated equations and Cox proportional hazards models were used to assess the relationships of outcomes with maternal vitamin D status. Results A total of 39% of women had low vitamin D levels (<32 ng/mL). Children born to women with low vitamin D status were 1.11 times more likely to report cough during follow-up (RR: 1.11; 95% CI: 1.02-1.21). No significant associations were noted for other respiratory symptoms, diarrhea, or anemia outcomes. Low maternal vitamin D status was associated with significantly increased risk of stunting (height-for-age z-score <-2; RR: 1.29; 95% CI: 1.05-1.59) and underweight (weight-for-age z-score <-2; RR: 1.33; 95% CI: 1.03-1.71). Conclusions Maternal vitamin D status may be an important risk factor for respiratory infections, and ensuring optimal growth in HIV-exposed children.
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    Predictors of anaemia and iron deficiency in HIV-infected pregnant women in Tanzania: a potential role for vitamin D and parasitic infections
    (Cambridge University Press (CUP), 2011) Finkelstein, Julia; Mehta, Saurabh; Duggan, Christopher; Spiegelman, Donna; Aboud, Said; Kupka, Roland; Msamanga, Gernard I; Fawzi, Wafaie
    Objective Anaemia is common during pregnancy, and prenatal Fe supplementation is the standard of care. However, the persistence of anaemia despite Fe supplementation, particularly in HIV infection, suggests that its aetiology may be more complex and warrants further investigation. The present study was conducted to examine predictors of incident haematological outcomes in HIV-infected pregnant women in Tanzania. Design Prospective cohort study. Cox proportional hazards and binomial regression models were used to identify predictors of incident haematological outcomes: anaemia (Hb < 110 g/l), severe anaemia (Hb < 85 g/l) and hypochromic microcytosis, during the follow-up period. Setting Antenatal clinics in Dar es Salaam, Tanzania. Subjects Participants were 904 HIV-infected pregnant women enrolled in a randomized trial of vitamins (1995–1997). Results Malaria, pathogenic protozoan and hookworm infections at baseline were associated with a two-fold increase in the risk of anaemia and hypochromic microcytosis during follow-up. Higher baseline erythrocyte sedimentation rate and CD8 T-cell concentrations, and lower Hb concentrations and CD4 T-cell counts, were independent predictors of incident anaemia and Fe deficiency. Low baseline vitamin D (<32 ng/ml) concentrations predicted a 1·4 and 2·3 times greater risk of severe anaemia and hypochromic microcytosis, respectively, during the follow-up period. Conclusions Parasitic infections, vitamin D insufficiency, low CD4 T-cell count and high erythrocyte sedimentation rate were the main predictors of anaemia and Fe deficiency in pregnancy and the postpartum period in this population. A comprehensive approach to prevent and manage anaemia, including micronutrient supplementation and infectious disease control, is warranted in HIV-infected women in resource-limited settings – particularly during the pre- and postpartum periods.
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    Enabling Geographic Research Across Disciplines: Building an Institutional Infrastructure for Geographic Analysis at Harvard University
    (Informa UK Limited, 2011) Guan, Wendy; Burns, Bonnie; Finkelstein, Julia; Blossom, Jeffrey
    Founded in 1818, the Harvard Map Collection (HMC) is the oldest map collection in America, holding 400,000 maps, more than 6,000 atlases and thousands of reference books. HMC has a strong commitment to digital resources and manages the Harvard Geospatial Library, a foundation for geospatial data service at Harvard. The Center for Geographic Analysis at Harvard University (CGA) was founded in 2006, independent of the library system, to serve the entire university. This article presents the history, organizational structure, and operational model of CGA and HMC, reviews achievements, lessons learned, suggests future improvements, and reviews GIS-related medical research at Harvard.
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    Applying GIS Methods to Public Health Research at Harvard University
    (Informa UK Limited, 2011) Blossom, Jeffrey; Finkelstein, Julia; Guan, Wendy; Burns, Bonnie
    The Center for Geographic Analysis (CGA) at Harvard University supports research and teaching that relies on geographic information. This includes supporting geographic analysis for public health research at Harvard. This article reviews geographic concepts that apply to public health, pertinent data available in geographic format, and GIS analytical techniques. The work-flow methodology the CGA has developed for conducting research with geographic data will be presented, highlighting successful practices to follow and pitfalls to avoid. Applications of this work flow are illustrated through an in-depth discussion of specific case studies in public health research at the university.
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    Gender-Related Differences in the Prevalence of Cardiovascular Disease Risk Factors and their Correlates in Urban Tanzania
    (BioMed Central, 2009) Njelekela, Marina A; Mpembeni, Rose; Mligiliche, Nuru L; Mtabaji, Jacob; Muhihi, Alfa; Spiegelman, Donna; Hertzmark, Ellen; Liu, Enju; Finkelstein, Julia; Fawzi, Wafaie; Willett, Walter
    Background: Urban areas in Africa suffer a serious problem with dual burden of infectious diseases and emerging chronic diseases such as cardiovascular diseases (CVD) and diabetes which pose a serious threat to population health and health care resources. However in East Africa, there is limited literature in this research area. The objective of this study was to examine the prevalence of cardiovascular disease risk factors and their correlates among adults in Temeke, Dar es Salaam, Tanzania. Results of this study will help inform future research and potential preventive and therapeutic interventions against such chronic diseases. Methods: The study design was a cross sectional epidemiological study. A total of 209 participants aged between 44 and 66 years were included in the study. A structured questionnaire was used to evaluate socioeconomic and lifestyle characteristics. Blood samples were collected and analyzed to measure lipid profile and fasting glucose levels. Cardiovascular risk factors were defined using World Health Organization criteria. Results: The age-adjusted prevalence of obesity (BMI ≥ 30) was 13% and 35%, among men and women (\(p\) = 0.0003), respectively. The prevalence of abdominal obesity was 11% and 58% (\(p\) = 0.0001), and high WHR (men: > 0.9, women: > 0.85) was 51% and 73% (\(p\) = 0.002) for men and women respectively. Women had 4.3 times greater odds of obesity (95% CI: 1.9–10.1), 14.2–fold increased odds for abdominal adiposity (95% CI: 5.8–34.6), and 2.8 times greater odds of high waist-hip-ratio (95% CI: 1.4–5.7), compared to men. Women had more than three-fold greater odds of having metabolic syndrome (\(p\) = 0.001) compared to male counterparts, including abdominal obesity, low HDL-cholesterol, and high fasting blood glucose components. In contrast, female participants had 50% lower odds of having hypertension, compared to men (95%CI: 0.3–1.0). Among men, BMI and waist circumference were significantly correlated with blood pressure, triglycerides, total, LDL-, and HDL-cholesterol (BMI only), and fasting glucose; in contrast, only blood pressure was positively associated with BMI and waist circumference in women. Conclusion: The prevalence of CVD risk factors was high in this population, particularly among women. Health promotion, primary prevention, and health screening strategies are needed to reduce the burden of cardiovascular disease in Tanzania.