UCLA Public Health Magazine - Fall 1990

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International Health Challenges

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DEAN'S MESSAGE

The Future of Public Health Education in California

n April, an important statewide conference titled 路The 路ew Public Health: 1990" was held in Los An路 geles. This milestone capped a twoyear effort by the California Coalition for the Future of Pub lic Hea lth, a committee representing many professional and educational organizations charged with rhe assessment of public health in Cali fornia.

More than 1,000 pub lic health specialists attended the three-day conference. Commissioned papers focusing

on leadership, public involvement, integrating health services. dara needs and the education of public health professiona ls were presented in response to the 1988 report, "'The Fumre of Public H ealth,"' pub lished by the Institute of Medicine of the ational Academy of Sciences.

I had the p leasure of co-chairing the professio nal education committee with Dr. Ellen Alkon. medical director and deputy director of public hea lth pro路 grams for rhe Los Angeles County Department of llea lth Services, w ho also serves as an adjunct professor at the UCLA School of Public Health.

I wou ld like to take this opportunity to share w ith you some o f the recommendatio ns made and presented by our committee at rhe conference:

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Recruitment srrategies must be developed to attract commirced. culturally diverse students to the field o f public health beginning ar the high school level.

Incentives are essential to recruit and retain ethnically diverse public health professionals as role models for incoming students. Mechanisms for this purpose cou ld include netwo rking oppo1tunities, providing sabbatica ls for research, exposure to practice settings, and by providing financial, a well as organizatio nal incentives for advanced non-degree study.

Major in1provemenrs in areas

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versely affecting the practice of public health-lack of career ladders. deprofessionalization of the field , inability to hire the most qualified professionals, and noncompetitive salaries- must be made.

An assessment study on the current availability and future need for public health workers in California shou ld be undenaken. This study shou ld clearly identify the

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role of post-seconda1y educational institutions in meeting those needs.

Linkages between educational/ training institutions and health departments on state and local levels must be improved. Health depanmentsshould be used more often as educational field sires, possibly with full-time clin ical faculty serving as mentors. Joint research efforts between health departments and acad emic training programs should be greatly encouraged.

Conti nuing education and inservice upward mobility incentives are crucia l for the public health workforce because of rapid changes in rhe public health environment. This responsibility must be shared by professional organizations, employers and educational institutions. At the same rime, ways to increase the accessibility and availability of such programs should be developed.

l am sure you will agree that the aforementioned recommendations provide a sound beginning for a blueprint ro fu1ther public health education in California. The UCLA chool of Public Health and the California Coalition for the Future of Public I lealth remain commirted to working toward achieving these goals.

C. Dr. Abdelmonem A. Afifi

UCLA PUBLIC HEALTH

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Volume 9, Number 2, Fall 1990

Charles E. Young Cbancellor Abdelmonem A. Afifi. Ph.D. Dean ~ l ichael T. McManus Assista11t Vice Cba11cellor, U11iversity

Comm1111ications

Hieb Elbaum Directo1; Healtb Sciences Com mu11icatio11s

4 Editorial Board

CHALLENGES OF GLOBAL HEALTH CARE

Alxlclmonem A. Afi fi. Ph .D. Dean Peru,>y K. Convey. M.L.A. Associate Dem1for Ad111i11istration Susan C. Scri msh:1w. Ph.D. Associnte Dean for Academic Programs Linda Bourque, Ph.D. Professo1; Comm1111i()1Healtb Sciences

8 WATCHING OUT FOR WORKER SAFETY

Roben \YI. I laile. Dr.P.1 I. Associnte Professor. Hpidemiolog)I Larry L. Pilcher, Dr.P.A. Director of Development Lester C. Reams, M.P.H. Preside111. Alum11i Association Vicki Beck Assistalll Director. Healtb Sciences Comm1111icalio11s

14 HELPING NATURE MEND

Deborrah M. Wilkinson Associate Editor Persech in i & Comp:my Design Kathy Perdue. Ramon Ani nag

Administrative Assistants

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2+2=5 POPULATION MATH:WHEN THE NUMBERS DON'T ADD UP

UCLA PublicHealtb is published by Health Sciences Communications. UCLA Public Affairs and Development, for the alumni. faculty. students, staff and fri ends of the UCLA School of Public I l ealth.

Cop yright 1990 b)' The Regents of the University of California. Permission to reprint any portion of UCLA Public //ealtb must be obtained from the editor. Contact UCLA Health Sciences Communications. 1100 Glendon Avenue, Suite 1501 , Westwood Center, Los Angeles. California 90024- J708.

(213) 206- I 960.

Co ver Photo B)' Monon Beebe

18 NEWS 19 RESEARCH NOTES 19 FACULTY NOTES

21 ALUMNI NOTES

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l 'Cl.A Pl ' Ill.IC llEAL'll 1

The public heallll protesslonal's ''wlillnll

room" c• range rrom

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calllty helllh

The UCLA

clmlc to the K1lahlri Desert. The UCLA School ol Public H8111h hll llWIYI recognized the inport1nce ol both the domestic IDd the internltlonal persecttve In

Its teldllng

n

International Health

research. Fac"'Y n

students hive conducted resaarch •d

Challenges DI

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around the world. Yet 1110ther inportmit step In 1nt11,11tlollll heal1ll was llldertlllen recendy with the est1bllsllment ol the lnternatlonll Haith Program It the School, 11 the lolowtng two 1rdcles descrlle.

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Program

developed programs tor countless nations

Health Care

or several years, AIDS has dominaced the international spotlighc, and rightfully so. This devastating disease has shown up on every continent, and no cu re is in sight.

Nevertheless, AIDS is by no means the only disease that looms frighteningly over the world. Tuberculosis and malaria have resurged dramatically in recent decades.

For example, worldwide there are an estimated 3 million TB-related deaths every year. And because o f the sudden increase in international travel - due in pan to the large number of immigranrs and refugees who come to the United States from Third World countries - tubercu losis is threatening to spread in this country, according to Dr. Derrick j elliffe, d irector of the new International Health Program at the UCLA School of Public Health .

Dealing w ith the rise in TB is just

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L:CLA PUl3LIC llEA LTll

o ne of the problems that the new inrerclisciplinary program wi ll handle.

Ar the same rime, public healrh specialists will be trained to address present-clay problem s and po licies o f in rernatio nal health affecting technicall y less develo ped natio ns, as wel l as changing hea lth needs in the United Stares.

Althoug h health conditions in some pan s o f the Unired Stares are deplo rable, an d the soaring cost o f medica l treatment prevents millions o f un insured Americans from seeking basic healrh care services, j c lliffe. a professor o f community hea lth sciences. stresses that w hat is rermecl " i nternational health" must become a prio rity. ·Just look around in your own back ya rd. Poorer areas i n the Unired Stares are becoming ·thi rd world. · Our needs. probl em s and prio rities have ro change," he expl ains.

"Tuberculosis is a disease of the poor and underserved , traditio nall y found in endemic countries like Africa. Latin America and Asia. The bacteria spreads easil y thro ug h the coughing of in fected sputum and rhis can occur in the United Stares. especiall y in con gested. poorer communi ties.

As evidence, .Jelliffe notes that rhere have been approximately 17.000 Tl3related deaths in the United Stares since the micl-80s. In Los Angeles Cou nty. 1,735 cases w ere reported last yea r. compared w ith 1.1 88 in 1988. w hi le 740 cases h<td been reported by rhe end of l\il ay this year.

Duri ng his 18 years al UCLA. Jelliffe. w ho also serves as a consultant lo U 11CEF, \XII 10 and USAI D , says the inrernational health program concept had been considered several rimes b y previ o us sc hool admin ist rations.

H owever . he c red its D ean Abclelmo nem A. Afifi for havi ng the

foresight to actually in itiate and support such an activ ity . .Jelliffe predicts the program - only the second on the W est Coast - wi l l enh ance the un iversity's reputatio n as a leader i n scientific research in health care abroad , as well as in the United Stares.

In h is new role, .Jelliffe heads an advisory committee comprised o f faculty an d graduate studen ts. and he repo rts di rectl y to the clean . The program has been designed to make the school's existing master of public health curri culum more rel evant ancl appropriate for i nternational health students b y making minor changes in core courses and through the identification o f facilities in Los Angeles for practi cum training sites.

Fo r the nex r academic year. the adviso1y committee has reco mmended the crearion of a course on inrernational health aspects of vario us disciplines. ranging from epidemio logy to enviro nm ental hea lth to nutritio n.

Another novel aspect o f the program w ill be the d eve lo pment of sh ort co urse~ (two to six w eek s), including leadership courses especiall y designed for mid-leve l professionals w ho w i ll be futu re leaders in their coun tries but lack formal training in public health.

"If one visits a fo reign mini stry it isn't uncommon to find a se ni o r administrator w h o has not had the trainin g in the significance of practical co mmunity rese arch o n p ro gram development an d evaluation ," he says. .Jelliffe. editor o f the journal Ad11a 11ces i11l11/er11 a lional 1\1a1ernal and Child I l ea/th. poin ts o ut that telecom-

municatio ns and audio-visua l techniques wil l be used increasingly in short courses wirh cen ters abroad in the coming years. These courses will

vary with need , as ~ve ll as the school's strengths an d ava ilabl e funding. Topics w i ll include research methodol ogies, p roblems of urbanizatio n, AIDS, integrated famil y planning and famil y health programs, recent developments in nutritio nal assessment and bio logical advances in human la ctatio n .

At the sa me time. .J elliffe says the sh ort co urses will establish valuable links with universities abroad b y providing o pportunities for collab o rative research efforts and training experiences for students. j el li ffe. the former d i rector of the Caribbean Food and Nutritio n Insti tute. dislikes the terms underdevelo ped and developed. ·· "Develo ped' is an arrogant term . I t sou nds as if w e (the United States) know w hat we are d oing an d are aware of the consequences. A modern l echnocenlric society ca n he socially . spiritually and en vironmentally w orse o ff than a less technicall y developed coun try,·· he says. " In fact, w e ca n learn from each other. The United States and similar countries are caught in a vicious cycle known as high techno logy. O ur society m ust lea rn to minimize and m odify techno logy beneficially to insure a livable future w o rld for coming generatio ns. Only b y doing so can we change the lemming-li ke rush of less technically developed countries to follow o ur ow n self-destru cti ve goals."

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6 l'CLA Pl'lll.IC 1IEALTI I

The UCLA International Health

Program

Trailblazing with the Jelliffes

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"All genuine knowledge originates in direct experience."

erri ck and Patrice .Jelliffe know first hand the horrors of desriturion that plague many poverty stricken nat i on~. They have seen and worked in remote \'illages struggling to survive the ravages of se\'ere drought and con stant battles against ma laria and intestinal infections.

Dr. Derrick .Jelliffe. a professor of community hea lth sciences and pediatrics al the UCL/\ School of Public I lealth. has worked and lived in de\'doping countries for 2"1 years. As a professor of child health in uni\'ersit ies on four cont inents. colleagues say his name has beco me synonymous \\'ith international, maternal and child healt h.

As the son of a British naval officer. he was educa ted abroad and adm its that an " itch y feet" travel syndrome inOuenced his decisio n n ot to pu rsue a more cushy o ffice job.

Sho rtl y after receiving his basic medical and pediatric specialty degrees from the U niversit y of London, the newl ywed headed for tropical Afri ca. Alt ho ugh he was hired by the Sudan t-ledical Sen·ice as a pediatrician, .Jelli!Te soon began to work as a surgeon. public health administral or. prison docto r, con sultant l o the Sudan Defense Force and even as a ,·eterinary adviser of newly captured wildlife designated for international zoos. "/\l 26 years o ld I was very wet behind the cars. It didn't take lon g to discover that m y formal and practica l medical trai ning \Vas marginall y usefu l. I was not prepa red at all for the leve l of poverty, strange diseases and the unsa nitary conditions ex isting in the real world ... he recalls.

A year later his French-horn wife.

Patrice, a registered nurse w it h train-

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ing in practical parasitology and public health , joined the small medical staff. The young couple learned from practical experience, direct contact and frequentl y by lrial and error he say~.

By necessity. they devised alternative~ to costly medications and medical supplies. For example, gi\'ing groundup sulfa tablets by intramuscular injection to cu re meningitis, or using a simple, cheap ~t ring to measure the arm circumference as an indication of malnutrition \\'hen weighing sea !es are nor a\'ailable.

When asked to describe their li fe abroad. the.Jelliffes. both of whom arl' World Hea lth O rganization consultants and chairs of committees of till· Internationa l Union of Nutritional Sciences. simply referred to a Chinese saying: "/\II genui ne knowledge originate~ in direct experience ...

Since they did not have books to refer to, the couple documented their research findi ngs and practica l experience and began \~Tiling boob o,·cr the years. At the same time. their collaborative partnership took an increasing practica l and preventive thrust.

"Regardless of the country. our patients were mostly chi ldren. who came back to the clinic and hospital again and aga in. There was an obvious connection between good health and nutritio n, so our publications have mo\'ed increasingly to practical issues to prevent and manage infectious malnutrition,.. says Derrick)clliffc. who founded the Journal of Tropical Pediatrics in 1955 and has se1Yed as the ed itor since then.

T o date. the couple has coauthored and edited 19 books. In order to reduce the cost to potential user~. specificall y nurses and midwives, they have wai,·ed royalties for book sales, says Patrice .Jell iffe. a lecturer and

l"CLA l'l -l3LIC llEALTll -

Derrick and Patrice Jellme a~soci:ne

researcher of commun ity health sciences at the UCLA School of Public I l ealth.

Iler most recent publication. G'11ide/i11esfor .\'11rses and .\/idll'il'es as lactatio11 Co1111selors. would have sold for over 550. 1l owever LJ 1ICEF agreed to xerox 500 copies for foreign distribution ro schoo ls for nurses and midwives where English was the language of instruction. "What good is re:,earch if the practical information is not av:iilable to the people who really need it the mostr she asks.

In Derrick .Jelliffe's UCLA office. severa l floor-to-ceil ing bookcases bulge co capacity and artifacts from Pakistan, India. East Africa , West Indies and the Caribbean arc scattered throughout che room, giving off a global :imbiance_ Sitting behind a paper-cluttered dt:sk, .Jt:lliffe exa mines va rious "anti-evil eye .. devices collected from different parts of the world. --western public he:ilth specialists working in another cou n11y always need to t:ike into account all cultural faccors of che communit y, including witchcraft, as chese influence che treatment and prevention of disease and illness ... he says.

The Jelli ffes point our that ongoing contact with rea lity is crucia l and

advocate field activites and research in the summer and during sabbatica ls for public hea lch specialist w ho \\-alll to stay current in their field. especially in international health.

Experience becomes outd<lled more quickly than one imagines. We need to stay current to make va luable contacts in our field and to recruit and place students who are energeti c. innovative and committed. Without these ¡b ooster doses, \Ye rapidly become fossilized. out-of-touch and not really much use to preselll clay stud ents, .. he says. â&#x20AC;˘

UCLA PUilLIC HEALTH 9

Watching Out for

Worker Safety

ve1y yea r an eslimated 100,000 people die in the United States from \vork-related illnesses, and an es1imated 2.5 million workdays are lost due 10 occupa1io nal injuries.

With 10 percent of 1he nation's population, California has a fair share of 1he country's occupa1iona l illness and inju1y burden.

The ha za rds of chemica l exposu re among Ca lifornia's workers ha ve lo ng been ca use for concern. A 1978 case highlighted 1hc risk s and resulted in legislative acti on to improve research o n workplace health ha za rds in the State.

The case involved seve n men who worked for a pesticide manufacwrer in Lathrop, Ca lif. The men were exposed 10 the pesticide DBCP (dibromochloropropane), w hi ch ca used severe health effecls - including sterility. The furor surro unding this case prompted the Cal ifornia State Legislature to pass a b ill cs1ablishing the only state-funded occupational hea lth centers in the nation.

When 1he centers were founded, they includcd a no rthern and a southern componenl. UCLA and UC Irvine fo rmed the southern center, while the northern center combined the UC Berkeley, UC D avis and the UC San Francisco campuses. Las1 spring, C presidenl David Gardner made UCLA and UC Irvine autonomous centers.

These resea rch facilities were mandated to provide gradua le level training. com municaie research findings to occupational hea lth professionals and the worker communi ly, and provide

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clinical referral se1vices for individuals with occupmional injuries, illnesses, and diseases.

Under the leadership o f Dr. john H. Froines, the UCLA Occupational I lealth Center. housed with in the UCLA School of Publ ic Hea lth , operates on an annual budget of $900.000. The center has a faculty of eigh1 F1Ts, including the disciplines o f toxicology, industrial hygiene. epidcmiology, medicine and nursing from the Schools of Publ ic I lealth, Medicine and ursing.

Some current resea rch projects al UCLA include s1udies o f respira1ory disease from chem ical exposure, back injuries in the nursing profession and the possible ca rcinogeniciry of fiberglass. The center's industrial hygiene research p rogram is federally funded by the l\ational Institute for Occupational Safety and I lea lth.

Froines. an associa1e professor of environmental health sciences, said Southern California has many occupational health problems need ing attentio n , rangi ng from worker exposure to lead. to ch ronic musculoske leta l disorders from repetitive 11101ion.

Within the I lispan ic population in Los Angeles. he notes unclcx:umented workers are at risk because gain fu l employment often means substandard working conditions and exposure to

10 UCLA PCBLIC H EALTH

health hazards wh ich exceeds that of o ther workers.

Trainin g and educatio n of work ers are important i n reducing occupational illness. s~1 ys Fro ines. "Although a significant proport ion of i ll hea lth resu lts from the work place. federa l do llars allocated fo r worker safety and tra ining are mini mal at best. Unfortunately, o ur society doesn 't have a high social con sciousness i n terms of helpin g resolve health and sa fety issues in the workplace," he says.

Earlier th is year . the center conducted a six-part forum for faculty members and students titled "The Impact of Technological Change o n Health and Safety in the Work Place ...

Froines considers the interactio n between technological innovation and its potential hea lth effects on work ers and the environment to be an area of specia l importance.

"Occupational hea lth and employee interests usually are not the pri mary concerns during the development of new techno logy,.. he says. "Technological ad vancements aim a l creating more efficient and cost effective meth ods to get a job done. What is also needed is a sense of ergon omi cs - an effort to be sure new techn o logy considers the wa y in w hich workers will us<: the equipm<:n t h<:f'o re it is designed. rather than forci ng workers to adap t after the fact." f roines mai nLain s that fa ilure to co nsider the work er's needs prod uces aclclitional stress on employees. as well as stress-related and cardiovascular disorders. Ca rpal tunnel syndrome has been recogni zed for many years.

However, the rapid growth of r<:ported cases among com puter users, ticket reservation agents, cash register clerk s, telephone operators and meat cutters

has ra ised concern among health o fficials and regulato rs.

In the near future, the center will publish a rep o rt o n tox ic use reductio n w hich examines efforts to remove toxic chem icals from the work place. The repo rt w i ll also review ex isting legislation and eval uate the potential impact o f haza rdous waste strea m s and work place pollution.

Fro ines says that the Ca li forni a Leg islature an d env iron ment<il groups

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"Occupational health and employee interests usually are not the primary concerns during the development of new technology." are i nt<:rested in source redu ction decreasing the use of toxic chemica ls in the work place. He mainta ins the best way to reduce work er exposure to chemicals is by eliminating the use of hazardous agents (and substituting less hazardous o nes) in stead of implementing costl y con trols.

"I wou ld lik e to sec the center underta ke a major effort to study how certai n carci nogens an d toxic substances, such as chromium, bery llium , tel one. asbestos. tol uene di isocya na te, n on ess<:ntial lead pigmen ts and certain halogenated solvents (trichlorocthylene, perchlo roeth ylene, methylene ch lo ride) could be eliminated fro m the work p lac<:. If we can do that. the effect o n wor kers and our environment w ill b<: profound ... he asserts.

W ith Sou thern Ca lifornia's estimated popu latio n of 12 million . there is a

need for mo re activity in clin ical occupatio nal medicine. T he center and the UCLA School of Medicine are in the p rocess o f developi ng a plan for an occupat ional medicine center at UCLA wh ich wi ll train physicians. provide clinica l services for patients and conduct surveillance resea rch.

Increasi ng medi ca l survei ll ance activities and more resea rch conducted in actual industrial settings would provide UCLA public hea lth studen ts add itional training opp ortunities and lead to a closer working relationship between industry and labor. he says.

Fro ines is also in terested i n markedl y ex panding the activities and membersh ip in the center. To that encl the UCLA Occupational Health Center w i ll be developi ng a small grants program Lo in volve more faculty and students in the cen ter. an d associat<: mem berships w ill be created to enable other university faculty. as well as members of the occupational health com munity i n Southern California , to be active partici pants i n the center.

During the next yea r, the center will increase its efforts in occupational health educatio n and outreach. as well as continuing ed ucation. in order to establ ish better relatio nsh ips w ith the worker and corporate community in Southern California.

Finally, the center intends to develop a strategic plan this year \Yhich defines Southern Cal ifornia 's occupational health needs and which wi ll serve as a bl ueprint for future CCLA Occupational H ealth Center activities.

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UCLA PUBLIC HEALT ll 11

PROFILE: significant po rtio n o f ill health or iginates from the w o rk place.

I lo w ever , w o rker health and safety are not p riorities in o ur society," says Dr . Jo hn R. Froines, director of UCIA"s Occupational I lealth Center.

Froines sees the role o f occupatio nal health experts as w o rking to improve the health and quality o f life fo r workers, whom he says have little political clout in this co unu-y"s socioecono mic structure.

"UCLA 's Occupatio nal 1lea lth Center has an interdisciplinary approach to resea rch that is crucial to it uccess.

Occupatio nal health is not a singular d iscipline, but encompasses medicine, industrial hygiene, toxicology, nursing, labo r education, epidemiology and engineering,., he says.

Froines envisio ns drawing upo n the wealth of the resources in the university to broaden the Center's research in occupatio nal health. For example. a joint effo rt between the School of Public H ealth and the School o f Architecture and U rban Planning is cu rrently u nder w ay, look ing at w ays to reduce the use of toxic chemicals in Ca lifornia . Froines says tox ic use reductio n benefits the enviro nment and minimizes worker exposure.

Froines is an associate professor of environ mental and occupatio nal health at the UCLA Scho ol of Public I lealth.

As d irecto r o f the UCLA Occu patio nal Health Center, he brings a wealt h of experience to the po ition, having served as deputy director o f the ational Institute for Occupatio nal afety and Health.

He also held the post of d irecto r o f toxic substa nces stand ards for the Occu pa t io na l Safety an d H ea l t h Administratio n (O SH A) from 1977 to 1979 and was respo nsible for developing new federal standards regular-

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Dr. John R. Fruines

Dr. John R. Frolnes ing w o rkers' exposure to cotton d ust and lead .

Earlier, as head o f the occupatio nal and radio logical health div isio n o f the Vermo nt I lealth Department, Froines established health regu latio ns for the nuclear po w er industry wh ich were tougher than federal standa rds.

Si nce arriving at UCLA in 1981, Froines, w ho earned his M.S. and Ph .D. in physical o rganic chem istry fro m Y ale University, has cond ucted research o n industrial chemica l that cause neuro logica l damage, and has stud ied the interactio n o f chemicals w ith D 1A in living cells to form cancer .

His research interests incl ude ha zard surveillance, chemical carcinogenesis, neu rologic d iseases derived from chemical exposure and lead toxicity.

Froines is particularly interested in ex posure assessment, especially as it relates to the estimatio n o f the dose required for d isease causation . He is activel y involved in both occupatio nal and environmental risk assessment.

Froines calls lead exposure a problem o f epid emic pro portio ns in Southern Cali fornia. He cites state studies show ing it is a particularly serious problem amo ng Latino workers, who often receive no job tra ining about the health effects o f working w ith lead and who m ay not be provided proper respiratory protectio n equip ment.

Lead is an ancient p roblem still afflicting the modern world, but Froines predicts that occu patio nal asthma and repetitive mo tio n d isorders w ill be two of the "new .. occupati onal health problems of the 1990s. Fro ines describes a surge d uring the last few years in the reporting of musculoskeletal disorders, such as ca rpal tunnel syndrome, amo ng ce1tain groups o f w orkers.

O ver the next five years, he hopes to put together a multidiscip linary occupationa l hea lth center effort to develo p expertise o n musculoskeletal d isorders and cumulative trauma diso rders.

Froines w as recently app ointed to a Natio nal Academy of Sciences Committee on Enviro nmental Ep idem iology. Fo r the la t 5 yea rs, he has also been an appo inted member o f the Scienti fic Review Panel of the Ca liforn ia Air Resources 13oa rd. T he pa nel reviews chem icals for consideration as "toxic air contaminants. " Froines, 51, is a g raduate of UC Berkeley. He lives in Santa Mo nica with h is wife Andrea H ricko, a KCBS-TV producer, and his son Jo nathan, 6. â&#x20AC;˘

J 2 l.:CLA Pl lllLIC I IEALTM

Research Projects ofthe UCLA Occupational Health Center Marianne Parker

Brown, M.P.11. , program di rector of 1he UCLA Labor Occupaliona l Safety and I l eal th Program ( LOSI 0. is 1he princ ipal invest igaior o f a fi ve-year. '' million projecl funded by the Nationa l Institute o f Environmen1al I lea lth Sciences.

'JZ?e / /azardo11s l'(laste l'(lorker Tini11 i11p, G rant: develop and implemenl health an d safety programs fo r hazardo us w aste workers in the state. This is a consortium effon of UCLA¡s I.OSI I, UC 13erk eley's Lahm Occupational I lea hh Program, University of So uthern Ca lifornia's Continuing Educatio n Program, the Los Angeles Commill ee on Occupatio nal Safety and I l ea Ith. as well as the UCLA, l 'C Irv ine an d UC Davis Extension p rograms.

Linda K. Glazner, Dr. P . II .. ~ l.P . 1 1.. R.N. . assistant professor o f occ upation a I health, at the UCLA School o f l\'ursing, and directo r o f the Occupationa l H ea l th lurse Practition<:r Program.

Sb(/i l'(lork and its t;jfe ct 0 11 !Iealtb and Circadia11 Rbytb111 i11 Fire Fip,bt-

ers a11d ill .V11rses: identi fy and study the effects of shifrw ork on circadian rhythm and health of fi re fight<:rs and nurses. Impacts o n sleepi ng and eating patterns, fatigue and i njuries are considered.

St11c()' of !11)11ries il1 llispclllic Carde11ers: exa m ine the nature, frequen cy and cost o f worked-rclat<:d injuries among I l ispa nic ga rdeners. tht.: majority of whom have newly immigrated to Los Angeles.

the p erforman ce of industrial respirators to protect against toxic aerosols. /11~pirable Particle Researcb: study and assess the en vi ronmental hazards associated wit h large particles of occupational dust. such as wood dust. lead. cadmium and pt.:sticide sprays.

I lealtb Ejfects of l'(lood Dust: conduct a literature review and an alysis o f the hea lth effects o f wood dust to determine \vhether a n<:w hea lth standard for workplace exposure is warranted.

Philip I. Harber,

M.D.,M. J>.11., a ssoc iate professor o f medicine at t he CC L A Sc h oo l o f Medicin e.

Art!f/cial /11te ffige11ce Ocrnpatio11al /fistor)': develop computer-based artificial i;1telligence m ethods to faciliute recognition of occupational lung dis<:ase d erived from workplac<: exposures.

Respirator'/'o lem11ce: swdy of physiologic and psychophysica l factors affecting the abil ity ro safely and comfortably use industrial respirators to limit exrosure to toxic chemicals.

Occ11pat io 11a l Rbe11111C1tolop,y: i nvestigate ergonomic and epidemiologic approac hes to p ro blems of upper extremity cumulati\¡e trauma disorders. such as carral tunnel syndrome.

These disorders m ay resu lt from repetitive motio ns, such as using the same w rist m ovements over and over \\"hen checking groceries.

William C. Hinds, Sc.D .. M.S .. professor of e n v ir o n m e n t a I he alth sc i ences al the UCLA Sch ool of Pub lic I l<:alth, and supervisor of the Industria l I lygienc Program.

NespirC1tor Pe1fo r111a11ce M odel fo r Partic 11IC1tes: develop a comprehensive comput<:r model for pred icting

Jess F. Kraus, l'h.D .. M.P.11., M .S.. professor o f epidemio lo gy at th e UCLA Schoo l Publ i c of I l ea lth and director of the Southern Ca li fornia Injury Prevention Research Center. l'(lork-Related Fatal l11)11ries ll'itbi11 tbe Cal(/omia Ocwpatio11al ,l/ortC1li()' St11c( )': analysis o f common \vork-related fatal injuri<:s as compared to fatal injuries o ff the job in the California w o rk fo rce from 19-9 to 1988. Research focus includes older (retirem ent age) w orkers, as well as the you ng ( I 0 to 16 yea rs of age) workl!rs.

Case Control St11c()' of Work-NelC1ted A.':m11lt: stud)' risk factors. incidences and causes of \\'Ork-related assaults using data fro m th<: coroner's office. loca l pol ice, death cert ificates and hospital admission r<:cords. \lalidatio 11 of \l?ork-Related11ess of Fatal !11)11ries: examine the incidence o f work-related deaths. accuracr of recording work-relatedness on death c<: rt i ficates . and develop criteria for unifo rm reporting .

l'CL.A Pl'BLIC llEALTll

Hal Morgenstern, Ph.D., associate professo r of epidemiology al 1h e UCLA School of Publi c llealth a nd principal i1wcs1iga1or on a study of carpal 1unncl syndrome.

Occ11palio11al hjJide111iologyo.fCarpal T111111el y11dro111e: st ud y CT S

among employed members of selected clerical and 1rade unions in Los Angeles. The project involves a questionnaire. pe rsonal intervie\\'S and physical exa111 ina1io ns 10 de1cr111ine occurrence and severity of CTS. lo ich::ntify occupatio nal and ergonomic risk fac1ors for CTS, and to understand the rela1io nship be1wccn cli nical symp10111s and c lcc1rod iagnost ic ahnorma Ii 1ies.

Shane Que Hee, Ph.D .. M.S., associate professor of environmental health sciences, L:CLA School of P u b I i c I lealth. and head of 1hc Gas Chro111a1ograph y- Liquid C hromatograph y/ .\lass Spec1rometer Facil iry. !11d 11slrial I ~)1p, ie11 e Sa111pli11.r~ w1d

r L

7

< >~ =<

A11a~)•sis: s1udy of passive sampling tech niques and direcl reading instruments 10 identify 1ox ic chemical exposure leve ls in workers. This requires a gas chro ma1ograph y. liquid chromatography-mass spectrometry facil ity to obia in valid, accura1e quantificalion of ,,·orkpl:ice contaminants. and to charac1c rize environmenta l hazards such as toxics in drinking \\'ater. ll'lorker Pro1ec1io11: study permea1ion and penetrat ion of protective ma1erials to determine 1heir effectiveness. Forexample. loxic solvents leak-

ing 1hrough g loves, and resp irator protectio n aga inst vapo rs and gases.

Biol op, i cal 1l lo 11i/ori11p,. s1udy exposure via the mout h, lungs and skin thro ugh levels fo und in blood. bre 11h and urine 10 predict roxicity. Exa mples include de1ermin:11ion of'lead in b lood, arsenic in urine, chlorin:11cd ca rcinogens in fa1 !issues, and chlorinated solvents in brea1h.

Dr. John R. Frolnes, Ph.D .. l.S.,associate professor o f environmernal and occ up ation a I heal 1h sc i ences al lhc UCLA School o r Public I lealth , and director of rhc UCLA Occupati onal Health Ce nt er.

Che111ical Car c i11oge11esis: s1udy of biomarkers in 1he assessment of chemica l ca rcinogenesis. Studies o r the 1oxicokine1ics of DNA adduct formation for aromatic ni1ro and amines in 1he initiation phase of chc mic rl ca rcinogenesis. Hisk asscssmcnl of toxic air contaminants such as chromium . £\pos11re Assess111e111 a 11d I l azar d S11 rl'eilla 11ce: assessment of exposure

to toxic agents in 1he workplace and the use o f ex posure data O\'Cr time to iden1i fy and ch;1rac1erize workrlace problems. Exposu re to l c~t d in the work p lace is an example.

Ne11ro10.Yicol op,y: s1udies of 1he biochem ica l mechanism or the neu roloxicity o f certai n indusrri all y impo rra111 ncurotoxica111s such as DMAPN and Lucel-7.

Fiberg lass: inves1iga1ions to determine whe1 her small diameter fiberglass is carcinogenic in humans.

•

OCCUPATIONAL HEALTH-RELATED FACTS The 1DLeading Work·Related Diseases and Injuries In the U.S. I. 2.

3.

4.

5.

8.

7.

8.

9.

10.

Occupa1ional lung disease Musculoskele1al injuries Occupational cancer • Severe Lraumatic injuries Cardiovascular d iseases Reproduction disorders 'eurotoxic disorders 'oise-induced hearing loss Dermatologic conditions Psychologic disorders

•Occupational cancers which rc~ult in 40.000 10 50,000 clc:uh~ per year account for approxim:ucly IO pcrccnr of all cancers.

Industries Identified by Hazard Surveillance As Problematical* 1.

2.

3.

4.

5.

8.

7.

8.

9.

10.

Secondary lead smelters (lead) Bauery manufacturing ( lead and arsenic) Brass-Bronze foundries (lead) Radiator repair (lead) Grey iron fou ndries (silica, carbon monoxide, polycylic aroma1ic hydrocarbons, formaldeh yde and asbestos) Ship bu ilding (lead , sil ica. asbestos, beryllium, arsenic, polycyclic aromatic hydrocarbons) Plastics manufacturing (organic solvenrs. vinyl ch loride, acrylonitrile, butadiene, sryrene) Pouery manufacturing (sil ica, metals such as lead, chro mium and cadmium) PainL manu facturing (fonnaldchyde. metals, silica, isocyantes, heavy metals, organic solvents such astoluene and xylene) Dry cleaners (perchloroe1hylcne exposure)

• As identified by the lJCLA Occupario nal l leahh Center.

1.~

I 1 l 'CI./\ Pl ' lll.IC

111'/\l.Tll

P1IR11 1of1•.~qp 1

11

1

111111~!1 111 u

Mend he Santa ,\ Jonica Bay is a picrure postcard sporting l'ast. untouched beaches an d brill iant blue "atcr:>.

Cal ifornia gray \\'hales dart along the ..,urf:ice and sails of rainbo\\' color:-. drift \\'ith the \\'i nd. The coastline stretching from ,\lalibu to Palos \ 'erde.'> - lur<:s sightseers and sponsm<:n from around th<: \\'oriel. l l ut in the 19L1Qs. the Pacific Ocean was so bad ly pollut<:d tha1 th<: slale hea ll h clepanment quarantined the bay :ind swimmi ng ,,·as forbidden. Condilions ha1·c improved si nce then. In facl , lhe bay is cleaner now than it was -10 years ago.

I IO\\'el'er. portions of the 26-mile long co;1..,t l in<: arc srill pollured with rubbi~h. toxic \\':tste and poisoned !>lorm drain runoff. And there remains a need to document a number of al l<:ged reports o f beachgocrs clel'cloping ear and int<:srinal infections. skin rashes and other illnesses.

Addressi ng th is problem. the Santa 1\lon ica ll:1y Hestoration Project, a partnersh i p of ·18 member organ izalions. h as recent ly complered the first st<:p in a multip hase project to study bacterial indicators in rhe surf zone. ·This is the first study of its kind in the nation w ith a specific focus on storm drai n contamination and health hazartb ... says ,\lark Gold. a doctoral candidate in the enl'ironmental science and engineering program at the l 'Cl.A School of Public Health and a

T

Mark Gold at Santa Monica Beach

l 'CLA Pl ' BLIC llEALTll 15

staff scientist for l-leal-1he-l3ay. a nonpro fit en vi ronm ental public interest group.

Go ld, the principal investigator . and 15 01her scientists panicipawd in the 16-mo nth stu d y 10 collect da1a needed ro launc h a m assive cleanup effort. I le says 1hc task , w hich normall y would cost S 125.000. was accompl ished for only S15.000 i n funding fro m the resto ration project. because o f the research ream·s in- kind volunteer services.

Sixty-four storm drains con vey runoff and rain water into 1he bay from 1he 300-square-mile San ta 1vlonica Bay \Xfatershed Drainage Area. Currently, none o f th e urban runo ff is treated and no w ater quality sta ndards exist for run-

off.

Gold points OU! that m ost of the drain s fl ow intermillently during the summer months. I l o wever, the PicoKenter and Ashland Avenue storm drains in the Ci1y o fS:1n1a Mon ica flow year-ro und . I le says activities such as overw:n ering lawns, w:.tshing ca rs and hosing off drivewa ys adversely affect flow levels.

Rece ntly , Gold was co ll ect i n g sa mples al the beach when he noticed a young moth er washing sand o ff her small child . "Th e water pouring ou1 from the Pi co-Ken ter storm d rai n appeared clear. Unfortunately . the woman h ad n o idea that the water may h ave contained high levels o f indicator b acteria. animal fecal m allc r. detergents. motor o il. pesticides and a host o f hunwn disease-causing pathogens." he says.

Accordi ng to Gold . who received his 13.S. and M.A. degrees in biology from UCLA. bacteria and vi rus samples were la ken ;me.I an alyzed from the t wo storm drains adjacent lO the PicoKenter sto rm drain . T he findings revealed th:n high indica to r bacteria coums were nearly always found at

Dr.PaulPapanek ankle d ep th in the surf zone near 1he cl rains. while lower coun ts were found at chest depth.

H u man feca l waste !lows freely 1hrou ghou1 the Pico-Kenter drain as the rcsull of p ossible illega l sewer co nn ections. leaki ng se\\·er lines . block ed sewer o verflows and direct hu man inputs such as rc crealion al vehi cles and th e local ho m eless p opulation. "Ideally, there sho uld never be h um an sewage i n the storm drai n system ... G o ld says.

The study also i ndicated th al human i ntestinal viruses. k n own as c nteric viruses. were found. I lowcvc r, Dr. Paul Pap anek . ch ief o f the tox ics epidemiology program of th e Los Angeles Coumy DepartmenL o f I lea lth Services. stresses there is no cause for al ;1r111 and !hat 1he area o f concern is limited to the Pico-Kenter site . "Any resulting public health problems would be i nfrequent and li m ited ro mild gastroenteritis ;incl o ther mild illnesses," he says .

Pap anek , an assistant cl inical professor o f fami ly m edic ine and tox ic

epidemiology at th e L'CLA Sch ool of Medicine. also worked as a volunteer o n the srorm drain assessm ent pro ject. co -created the initial design for 1he project \\'ilh Gold and conducted most of th e statistical analysis.

Gold and Papanek arc also mem lx:rs or the Technical Advisory Com m i11ec, which consists of 35 scien tists :i nd engineers who provide technical support 10 th e n:storarion project. Alth ough they share a sense of accom pl ishment with 1he completion o f 1he initial phase. they stress more hard work lies ahead.

"This study was ,·cry i mportant b eca use it provided us w ith m o re in formation th at will enab le pub Iic health o fficia ls 10 determi ne if there is a significa nt h ealth risk from swimming in th e Santa Moni ca Bay ... Gold says, adding that additiona l studies m us! he clon e 10 determine if oth er storm drains h ave human sewage contamin atio n.

Researchers must also de termi ne 1he amounl of sewage in 1he storm drain and assess how many people S\\·im in runoff contamin ated water . in order for p ubli c hea lth o ffi cia ls to estimate the hea lth risks o f S\\'imming near 1he sto rm drai n. Papanck notes th ere is also a lack of documentation for increased rates of infectious disease among beachgoers because survei llance or this group has no t been comprehensi\·e.

At the same time. Gold says p o ten tial sources o f human sewage is 1he Pico- Ken ter storm drai n m ust be iden ti fied. as well as areas o f the surf zone affected b y summer storm d rai ns. "One o f the long-l erm goa Is of I he project is Lo find out the health risk s o r swimm ing in Santa Monica Ba y. Perhaps, in the near future. a large-sctl e epidemiology study on swimmers will be comp letecl. l fthe health r isks arc small. then swimming in the rest of the hay. wh ich is Ltr less pol luted . sh ou ld p ose :in i nsign ificant heal th risk ... G o ld says .

•

16 l"Cl.A Pl "ULIC I IEAl.TH

Ln

11

Population

uring the ea rl y part of the 18th century, census takers asked three simple questions of every h o usehold member - age. sex an d race -which determined who was inducted for milita1y service. paid taxes and worked.

But the Constitutional Con vention in 1787 marked a new beginning for the census process when delegates voted for equal representation in the House of Represen tatives and Congress proportionate to the population of each state and mandated an official cou nt once every ten yea rs.

T he modern pop ulation cen sus evolved from the first detailed account of 24 cities in colonia l Virginia w ith popu lations of 2,500 o r m ore i n 1790.

Today, it has become the most prolific and controversial source of informa-

I

Math:

When N I + the

"' Numbers Donâ&#x20AC;˘t Add Up

Dr. Nathaniel Schenker

tion about the United States.

In 1980, the United States Census Bureau failed to count an estimated 3. 1 million people, prompting at least 38 cities to file separate lawsu its against the federal government. Some critics even called the co unting process a subtle form of discriminatio n.

Under an agreement between the UCLA School of Public Health and the United States Census Bureau. Dr. Nathaniel Schenker, an assistant professor of biostatistics. is conducting research Lo address technical issues in the use o f the survey to estimate the undercount.

Accordi ng to Schenker, the undercou rn elates back al least several decades. For example. estimates indicate that African-A mericans ha\-c been missed in the census at about a 5

UCLA PUBLI C ll EALTll 17

percent higher rate than w hites si nce 1940. Schenker says the problem happens becau se someti mes entire households are omitted from the census and occasio nally only certa in members of a household are counted.

Schenker points out that the heaviest undercoun t occurs in urban areas w ith a high ethnic minority representation and large po pulations of il legal refugees and recent immigrants. T he growing number of homeless and nonEngl ish speaking people, as well as chose living in high crime areas, are difficu lt to count and often ign ored, he says. £3ased o n 1980 data, African -American s were missed at a rate o f 5.9 percent compared to a rate of :I .4 percent for the overall po pulatio n.

Schenker says African-American males in their 40's appeared to have undercou nts as high as 18 percen t.

"T he bureau goes out of the way to safeguard the confidentiality of the census. Un fortunatel y, many people are afraid that information about individuals wi ll be reported to the In ternal Revenue Service, Immigration and Taturalization Se1vice and social service agencies," says Schenker, a former mathematical statistician for the census bureau.

"They don 't realize that an undercount causes inequities and adversely affects their communities. And the stakes are hig h consideri ng that census figures are used co allocate representation in Congress and to determine the distributio n of mo re than S50 billion in federal aid to states and smaller areas."

The 1990 census in volved counti ng an estimated 250 million people in 106 millio n residences. D espite six yea rs of preparation an d several pre-census tests, bu reau officials admitted chat

Percent Net Undercount, by Race: 1940, 1950, 1980, 1970, and 1980 Percent :'\ct Undercount

1940

1950

0

:x;

'° '°

.,;

.,,."

n ""'

"'

:x;

"'·

~

.,.

0

Al l l<:t c~s

I

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i and Oilier Haces

Afri c::1 n-Arm.:ric;111

\Xl hilL'

African~Americ:in/

WhiTl' Diffcrcncl•

·.s.

Source: Ev;1 Ju:tt ion :tnd Hcsl'~lrch H\_'ports: Tht._· C<wer:1gl' o f Popul:ttio n in 1he 1980 Ccn~us. 1

Dep:irtrnent of Commc.:ro.:. Bureau of 1he Ccn~us.

Note: Es1 i111:1te~ include :1llowance for

5 m illion

nea rly twice as many America ns as ever before either failed or refused to return their forms. J\ll ost of these people were subsequently counted by doorto-door enumerators, bu t an undercount is sure to occur, Schenker says.

T o estimate the size of the undercoun t , a post-censussu1vey of l 50 ,000 ho useholds is being taken. From this survey, Schenker says the proportio n of people missed by the census in some 1,300 geographic and demographic subgroups of the population will be estimated .

The techn ique o f esti mating the population size using two surveys the 1990 census and the p ost-census survey - is similar to the "ca ptu remark -reca pture" method com m only used b y ecologists to determine the size of wildlife populatio ns.

Schenker , a missing data specialist, hel p eel to design the post-census survey w h ile working at the bureau . The resu lts o f the su1vey, which will be

unc.10<..'. umented resident s in 1980 .

ava ilable in early 1991, may be used by bureau officials to decrease the undercount i n the census.

Schenker, w h o received his S.M . and Ph .D . degrees i n statistics from the University o f Chicago, adm its that the appl ication of the ca pture- mark -recapture idea to human p o pul ations has some flaw s. 13ut he predicts it can produce m ore accurate data on individuals who failed to complete the census along with those w h o omitted vital informatio n .

"If w e continue to conduct the census as it h as been done througho ut histo1y by attemptin g a person-by-person enumeration o f the entire population , I doubt the underco unt problem will ever be el i minated because some g roups are just too hard to count that way," he says.

•

18 t 'Cl.A l'l Ill.IC l IEA LTI I

I

N

E

W

S

International Student Network Celebrates First Year he ln1ernational I lealth Student Ne1work celebraied the org:1niza1io n·s first year b y ga1hering in the UCLA School o f Public I lealth conference room fortheirtraditional weekly "brownbag .. lcclllre se ries.

Since 11 ISN's i ncept ion last spring. over 34 presentati ons have been made by student and faculty members with i111erna1ional health experience. as well as v isiting scholars, such as Dr. Victor Side! from the M o ntefiore Med ica l Center :1nd Dr. T amas Fulo p o f the World I lea lt h O rganization. T o pics have ranged fro m World I lea Ith Day to health systems and problems found in France . Gua1emala.

Brazil, Thailand, China and Columbia .

According lo Ahmed 1'vlandil. activities coo rdinator . the organizatio n's 165 internat ional studen l 1rn.:111hers represent 30 percent of thc student body al the UCLA School of Public I lcalt h. I le also said members arc commiucd to promoting :111 aw areness and better understand ing of i111ernalio nal hea lth issues and forming intcrdcpartmcntal and int c rdivisio nal collaborati ve netwo rking oppo rtunitics.

11 ISN alo ng with the Pu blic I kalth Swdcnt Association and the Pu blic I h.:alth Alumni Association hostcd an internatio nal pot luck dinne r au endcd b y 1·10 people. Currcntly. preparatio ns are

T i

'

underway for "O rientation Day" of new students fo r 1hc fall quarter.

In .June. three members made a pos1c r p resentatio n titled "llllernational I l ea lth Students As lnstru c1ors ... at the i\'a1ional Council of Internatio nal I lcalth Conferences. The o rganization also particip:llec.I in a workshop pn:ccding lhe annual meeting o f the American Public I lea lth Association l:.tst yea r.

11 ISl\''s future plans include establishing a database o f in tcrnatio nal alumn i and working closcly w ith thc International Stuc.lcnl Associalion o f UCLA. as we ll :.is Dr. Derrick Jelliffe, head o f the school's ne\\·ly created l111erna1io nal I l ca lth Program.

Board members fo r lhc '89-'90 academic yea r wc rc lbnc.l y Kirkendal l. Miguel M<ilo. Tercsa Tono, Francisco Vallejo, Lori Fbchbach, Ahmed ~ l a n dil and .Julie ~ l atsum:n o represcnting the Public I lealth Alumni Association.

Volvo Supports International Collaboration o lvo 1o rth Ame rica Corpo ra1io n has given $25.000 to the CLA School of Public I l c ahh and lhe Karolinska Institute. Kronan I lea lth Ccnlcr in Sweden to csl ablish a studclll and facu lry exchangc program.

Thc granr will be used lo support educatio n and resea rch-rel;11 ed lravel expenses for short visi1s he1ween both institutio ns.

Thc fund known as the Volvo Norlh America Fune.I for American/ Swedish I lealth Info rmatio n Exchange at the UCLA School of Publ ic I leahh wi ll subsidize at lease I 0 tra\'el requests ovcr the nex t 18 m o nths.

Dr. E. Richard Brown . associatc professor of community health scienccs and heahh serv iccs, was appointed b y Dean Ahdclmonem Afifi to chair a commillce to revicw all req uests.

V

Pilcher Appointed r. Lany L. Pilchcr was appoillled d i rec1or of dcvclopmelll for I he UCLA School of Publ ic I leahh. I l is major responsibilities are to dc\'clop and implement nev • and o n going programs that enhance financia l su pport. whil e pro 1110 1i ng a thorough unclcrstanding of th e school's programmatic thrust.

Pilcher bri ngs a wealth of experience to UCLA. For thc pasl 1hrec ycars, as executive v ice presidcnl for1hc consu lting firm ol} P. Chasc & Company/ MedComm Marketing. Inc.. he directed fund develo pment activi1ies for organizational programs. scr\'ices and projccb.

Al the same timc, he comple1cd his d octoral s1udic..:s i n pu b li c administration and heahh services administration al the l 'nive rsily of La Verne.

Pilcher also ~crvec.I as \'ice prcsidenl of development. planning and publ ic affairs for Doheny Eye Institute and I l ospital at thc Unive rsity of Sout hern Ca li forn ia, I l cahh Sciences Ca mpus. Earlier on. he held simi lar p ositions al Presbyte ri an ln te rcommuni ty I l ospiral and I leal th Ccnter and Daniel Freeman I lospital.

D

Grad Receives Presidential Internship isa G . Matras. B.S. 11. E. '90, was accepted illlo lhe Presiclelll ial .\lanagemelll Internshi p Program. a ,,,·o-year post gradua l e career dc"cl o pment progra m sponsored by the federa l government. 1\ilatras w ill work for the I lead Start 13ureau within 1he O fficc of I luman De,·elopment Sen ·ices. Departmcnt of I l eahh and I luman Sen·ices.

L

Breslow Lectureship Updates AIDS Pandemic r. Thomas Qu inn . director of the l n1c rn atio nal AIDS Research Program of the Na tional lnstitulc of Hea lth. dcliverec.l the 16th annual Lester Breslow Distinguished Lectu reship by addressing "T he G lobal Pandcmic of AIDS : An L:pdate and Public I lca hh Po licy Implication."

Qu i nn. an associate profe:-.sor of mec.licinc and international health at the.John Hopkins Schools of Med icine and School of Public Health and I lygiene, focused o n thc effects of Al DS in other countries. transmission method:-. and mcasures undertaken internatio nall y to slow the spread of the deadly disease.

I lis p resentatio n was followcd b y a question :tnd answer session with a panel of AIDS experls. Drs. Roger De1cls. ~ li cl1ad Gonlieh and German Maisonet.

The lectureshi p, cstablished in 1974 . is su pported by the Dean's Cou ncil , lhc Ra ymond and Bell)' Goodman Foundation and lhe CC LA Graduate Studen ts Association.

D

L'CLA P UlLIC llEALTll 19

Alumni Activities he UCLA School of Public Health Alumni Association has been active during the 198990 academic year. T he association sponso red its second spring semi nar. which addressed the m oral and ethical issues of euthanasia . hea lth care as a right o r privilege. and society ,·ersus the indi vidual.

Dr. Susan C. M. Scrimshaw, associa te clean for academic programs, \Yas the keynote spea k er at the association's annual dinner held in.June. Scrimshaw. a professorof population and family health. spoke o n ..Cu lture Shock I lits Health Care: Ethnicity and H ea lth Care in the '1 990s ...

In April. D r. Ellen Alk o n. medical di rector and deputy director of public healrh programs forrhe Los Angeles Count y Department of Hea lth Sciences. was honored at a breakfast duri ng "Public Health \'\leek ...

Alkon. an adjunct p rofessor of hea lth sciences. discussed the collaborative activities the UCLA School of Public H ealth and the Cou nty and how improvements could be made by both entiries. •

T

RESEARCH NOTES Response to Loma Prleta Earthquake Dr. Linda Bourque, professor of community hea lth sciences. has received a l'\ational Science Foundation grant to study the behavior of San Francisco Ba y area residents followi ng the October 17.

1989 Lo ma Priet<J ea rthquak e.

Funding \Viii co ver the cost o f half-ho ur telephone interv iews 'i\'ith 375 residents. Data collected will focus on behavior immedi ately fo ll owing the earthq uake. psychological status, use of media. damage. evacuation and injury experienced .Contact number (213) 825-3738.

Atmospheric Acid EUects

Concurrent Medical care

Dr. David Bradford, ad junct assistant professorofenv ironmental health sciences . is im·estigating the potential effects of atm osp heric acid dep osition on aq uatic bio ta in the Sierra 0:evacla using amphibian s as bioindicator species. Co ntact number (2 13) 825-0998.

Dr. Gerald F. Kominski, assistan t pro fessor of health sen ·ices, is examining the frequency an d rypeof physician services p rovided to Medicare patients by ph ysicians other than the attendi ng surgeon for se lected high ,·o lume surgical proced ures. T his project is being funded by the Health Ca re Financing Administratio n. Contact number ( 213 ) 206- 1632

Mlneral-Element Interrelationships In Alzheimer's Disease Dr. Edith Muriel Carlisle, adjunct professor and researcher in community health sciences, received a twoyear grant from the Stare of Cali fornia . Departmen t o f! lea Ith Services to determine ,,·hether rhe increased incidence of Alzheimer's pathological changes in the elderly simply reflect changes in mineral h omeostasis w hich occur i n the susceptible elderl y la1 e in life. resul ting in deficiencies or excesses of essential elements in the brai n. Contact number (21 3) 825-3266.

Zinc In Growth Dr. C. Elizabeth Castro, assistant prof<:ssor of co mmuniry health. is studying the role of zinc as an ess<:Illial nutrient in growth and pro per functioning of cells. The project is bein g funded by the March of Dimes Foundation. Contact number ( 213) 206-024 I.

Geriatric Follow-Up Dr. John M. Chapman, professor emeritus of epidemiology. is conducting a follow-up study to determine which mid-life characteristics predispose good health in civi l servants 80 to 85 years old, who were measu red during 19501953 and i n 1962-1 967 . Contact number (213) 825-5354 .

Cancer Dr.RobertW.Halle, associate professor of epidemiology. is conducting resea rch in the nutritional prevention of po lyps in the large b owel. as well as the genetic-epidemio logic stud y of b ilateral bre;1st ca ncer. Contact number ( 213) 8258193.

Cancer Prevention Dr.MatthewP.Longnecker, assistant p rofessor of epidemiology . is work ing to establish meth ods for determining protease inhibitor content of foods which may prevent ca ncer . Contact number ( 21 3) 2067458.

AIDS Research Program Dr. DonaldE. Morisky, associate professor of community hea lth sciences. has recei ved a university-wide Al DS Prev<:n tion and Educatio n Grant ro provide funding for two predoctoral trainees per yea r to undertak e multidisciplinary studies in the social and bc:haviora l aspects of AID S. Trainees must be Californ ia residents at time of appointment. Contact number (213) 825-8508

Native Americans Dr.AnredK.Neumam, professor o f community health sciences. is con ductin g a study o f successful American Indians in Los Angeles in an effort to lea rn wh ich services and activities sh ou ld be provided in childhood to ensure prosperity.

Comacl number 825-5081.

Energy Intake and Human Function Dr. Charlotte G. Neumam, professor of co mmunity health sciences. a coinvestigato ron the l'\utritio n CRSP Kenya Project fu nded by L!SAID .

and her fell ow collabo rators are anal yzing their findi ngs from field w o r k co ndu cted from 1983 through 1987 for pub lication.

Co nract number ( 21 3) 825-205 ·1.

Statistical Software Dr.NathanlelSchenker, assista nr professor o f biostatistics, is working on estimatio n w ith missin g data of small data sets for mental health research for the l'\ational Institute o f J\ll en tal H ealth. Contact nu mber ( 21 3) 825-5250.

•

FACULTY NOTES Dr. Abdelmonem A. Allll, clea n and professor of biostatistics. and Dr. Virginia A. Clark, p rofessor emeritus of biostatistics. completed the second ed itio n of .. Com purer - Aided Multi variate Analysis... to be published by Van Nosh and Reinhold in October. 1990. Dea n Afifi also chaired a session on the health needs of the elderly at the lnternati o na I Sy mposiu m on H ea lth .

En vironment and Social Change in Tai\Yan. and presen ted a lectu re o n "The Epidemiologica l Aspects of Electromagnetic Field Health Effects .. at the annual meeting of the Associatio n of Physicists in M ed ici ne.

Dr. Judith Blake, professor of community health sciences. has ,,·on the William Goode A\\·ard for her book. Fa 111i~)I Size a 11d Achiel'e111e111. She also publ ished ":\umberofSiblings and Educationa l Attainmen t,.. in Science.

Dr. Linda B. Bourque, professor of community health sciences , co-presented ·The D ecision to Have Second Eye Su rgery," "Reported Lens-Wearing ... and "Satisfaction and Side-Effects of PERK Patients Six Y ea rs After First Surgery ... at the Association of Research on

20 L'CLA l'l IJLIC I !EAi.Ti I

\ 'ision and Ophthalmology. She co-auiho n.:d "Correlate~ of SelfReporred Denial I kalth SialUs l 'pon Enrollmenl in 1he Rand I le:1hh In ~uran ce Experiment ... in 1he j o11 nwl of D e111a/ Ed11calio 11. \ 'ol. 5} Dr.EdlthMurleICarllsle, acljuncc professor and researcher in co111111uni1y health sciences, .~<.:1Yed :isa panelis1al 1he I n1ern:11io n:1 I Con ference o n Alum inum :tnd I Iealt h in O rlando . Flo rida . She also made the follo\\'ing presenlalions: " l n1ern.:l:uion~hips Bel\\'een Silicon.

Alu111inu111 and 1he T hyroid o n Zinc Conl enl in !he Brain" al !he Se\'(~n! h l ncerna1ional Symposium on Trace Ele111e111:- in .\ Ian and Animals TDIA-- in Yugosl:n·ia. ··curn.:111 Issue~ o f Concern in 1\'u1ri1ion ... al 1he Annual .\leering o flhe Socie1y for '\u1ri1io n Education. and "Sil icon-1\ luminurn In1Crrcla1ion.-.hips in the l3ra in" at the Second Internatio na l Confe rence o n Alzhei111er·s Disease and Rela ted Disorders.

Dr. Cllmls Davos, associate professor or en,·ironment al health sciences. \\'as appointed a:.soci:lle dean for student affairs for the 1990-9 1 school year.

Dr. Jonathan E. Aeldlng, profcs~or of healch sen·i ces . pub l i sh ed "\Vo rks ice Stress Management: J\a1ional Su rvey Resu l1s... in 1he jo11 ma/ q/Occ11pa1io 11a/.l /edici11e.

" \Xl o rksite I lea hh Pro m o1ion Programs in the L'n i1ecl Slates: Progress. Lessons and Challenges... i n Ilea/lb Pro111olio 11: A11 l111en1a/io 11al j u 11n1t1!. and "\Vorksite

I le:tlth Promotio n Sur'\'ey: Smoking Control Acti,·i1ies" in Pre1·e11lire ,\/edici11e.

dent of CC. I le also co-autho red "A Genetic Epidemiologic ln\'estigation of Breast Cancer in Families With Bilaceral l3reast Cancer II : Linkage Analysis." in Cli11icol Ce11elics. "Genetic Epidemiology of !1ilateral Breast Ca ncer: A Link age Ana h·sis Using the AffcctedPecl igree- 1\lembcr ,\ l cthod ," in Ce11e1ic tpide111iol ogy. and "Selection Bias In Case-Contro l S1uclies L'sing Relacives As Concrols." i n che l11temalio 11a/jo11mal q/ t'pi-

Dr. Gerald F. Kominski, assistant professor of healch sciences. published "lmprm·ing Paymems for .\ lcdicare Patiencs \Yith l ' nrelai ed Su rgical l'rocedures.··ror .llediw! Care and " Recent Trends in Length of Stay fo r 1\l edicareSurgical Patiems... for the RAi\'D Reporl.

Dr. VlrglnlaC. LI, professor of community health scie nces. published "CharacrerisricsofWomen l 'ndergo ing Abort io n in Selected Cl inics in China... in Social Sci e11ces a11d

Or. Jonathan E. Fielding Dr. JohnR.Frolnes, a:.:.ocia1e profe:.~or o fen\'ironmental and occupationa I healch science~. \\'a~ :1ppo inted to 1he :\'a1ional Academ y ofSciences.

Commiuee on Em·iro nmemal Epidemiology.

Dr. Sander Greenland, professor o f epidem iology.spoke on "J\ !eta-Ana lysis :incl O bserv:1tional Slue.lies ... :1t 1he American Association for the Advan cemenr of Sc i ence. I It: published "!1ias In The One-Step M erhod For Pooling Study Rcsults" in Slalislics 111 ,\/edici11e. and " lfandomiza1ion. Statistics and Casual Inference," in Epide111iolog1'.

Dr. c. Elizabeth Castro

Dr. Robert Halle, associate professor of ep iclemiologv. wa~ :tppo inted to 1he Prop 99 S1ucly Section to re,·ie"'· research progr:11ns in the epidemiology of 1ob:1cco-relared diseases fonhe Office o f th<.: l'r<.:si-

H ea/1b Polily.

de111 iol ogy.

,\ ledici 11e.

Dr. C. BllabethCastro, assis1:in1 professor of communi ty hea lth sciences. wa~ appoi 111ed 10 1he ne\\' state Legi~l:ll i\'(~ Council of i\ulrition Labding for I he S1:11e of Cal il'ornia. :tnd i~ one ol'l\\'o members represcming Ca lifornia posl~econdary educ:u ion in:.litutions. She presented "D i\'A Stability: Effect o f :'\utricm Deficiency" at che Intern:11ional Food Techno logy Symposium.

Dr. Alfred K.Neumann, professor of community health sciences. published "Paying for Family Planning in China: A Re!>ponse 10 Robin Bario" " .. in Ilea/lb Policy a11d Pla1111i11g I-le also co-aurhorcd "International ,·s. Domestic H ealth: An Ant iquated Dis1inctionr Oetter) in Tb e La11ce1and "The O bsolescence of Di stinct Domestic and Interna1ion:tl I Iealt h Sectors... (guest editoria l ) in the .fo11 mal of Public

Dr.MatthewP.Longnecker, assistant professor of epidemiology. co-authored " Protease Inhibito r Content o f I luman Diciary Samples ... in X11lrilio11 a11d Ca11cer .

Dr. Donald E. Morisky, associate profe~­ sor of community health ~ciences. sel'\'ec.I as a \'\1orkl Hea lt h Orga nization consultanl 10 1he People's Democratic Republic of Laos and \\':ts selected as a member to che Gm·erni ng Section o f the Public Health Ed ucation Section of the American Publ ic I-l ealch Association for 1990-1992. He also published "The Role O f Needs Assessment I n Designing A Commun i1yl3ased ii lammogra phy Ecluc:u ion Program For Lrban Women ... in /-/ea/1/J Ed11ca1io 11 Research. and "A Patient Educa tion Progr:1m To ltnprm·e Adherence Rates \'\'i1h Anci1uherculosis Drug Regimes ... in I lea/lb fr/11 calio11 Q11ar1er~) '.

Dr. Charlotte G. Neumann, professor of community health sciences. published ":'\u1ritio nal and Household Characteristics and School Performance in Rura l Kenya.·· in Cbild Del'elop111e111. and co-authored " I Iousd1o ld Impact of Drought in Embu. Ken ya." in f oodc111d.\'111rilio 11 B11//e1i11. and "Breast Feeding and l3inh lnten·al: A Three Country Study ... in che \\'arid Ilea/lb O rRt111izalio11 B11//eli11.

Dr. Shane Que Hee, associate professo r of en\'ironmen tal hea l ch sciences. o rganized a symposium o n sa fety and health in the electronics industry fo r the America n Chemical Society. I le published "I3iological :\lo ni1oring Screening of Parients Pro"ided Ant ineoplast ic Drugs Includ ing Adriamycin. Cyclophospham id e . 5-Fluoroura cil, ;\ lethotrexate and \ 'incrisline ... in Ca11cer Researcb. and ";\ lu tagene~ i :. Assa~·~ o n L'rine Produced by Pal iems Administered Adriamycin and Cyclophosphamide ... in E11l'iro11111e111al ,\/olec 11/ar ,11111ap,e11esis.

Dr. Ruth Roemer, ad junct professor in health services. presented "Tobacco Po licy : The Power of Law ... lo the Imerna1ional Symposium o n 1he Control o f Tobacco Related and O ther Cancers at 1he Tata Institute for Fu nda menta I Research in l3ombay. India.

Dr. Stuart O. Schweitzer, professor o f health services. presented "I leal1 h Promotion Among the Elderly ... at the Internatio nal 5,·mposium on I lealth. Etl\'ironment and Social Change. and "Doctoral Education

l 'CI. \ l'l llUC llEALTll 21

in Health Administration: Professional Training in an Academ ic etting or Academic Education in a Professio nal School. " at the Association o f niversiry Programs in Health Administration.

Dr. Jllllth M. Slegel, associate professor of community health sciences. published "Stre sful Life Events and Use of Physician Sen ·ices Among the Elderly: The Moderating Role of Pet Ownership,.. in the J ournal of Perso11alizv and Social P.S:)'Cbolog)iand "Loss, Widowhood and Depressed Mood Amo ng the Elderly,·· in the j oun1al ofCo11.wl1i11g and Clinical P.s:)'cbology.

Dr. Jane L Valanune, associate pro fcso r of environmental health sciences. presented "H ea lth Status of Arsenic Exposed Populations,"" at the Second Meeting of the Internatio nal Society for Trace Element Resea rch in H umans, held in Tokyo , and "Enviro nmental Arsenic Exposure and Sk in Disorders.·· at the Grand Rounds Dermatology Basic and Clinical Sciences Lecture Series for resident staff and clin ica l faculty members of the UCLA-VA Wadsw orch. UCLA- I !arbor and the Charles Drew/ Martin Luther King Dermatology Programs.

Dr. ArthUr Winer, professor of environmental health sciences and d irector o f the environmental science and engineering program, w rore a chapter titled ,·· Air Qua Iiry Impacts on Ca li fornia Agriculi ure: 1990-2010,"' in Agric ultural Issu es Center. U.C. Davis. He also presenred "Atmospheric Chemistry of 1Vlethanol Fuels and Their Emissions" at the I lealth Effects Institute, and "Recent Improvements in the D esign and Operatio n o f a Differential Optical Absorptio n Spectrometer for l n-Siru Measurements of Gaseous Air Pollutants," at the Air and Water Management Associatio n Annual Meeting. •

ALUMNI ~ N.0J;.tS Patricia Ialongo, 1\ l.P.H . '68. ha!> been employed with the Los Angeles City Planning Department fo r 22 years. Asa cit y planning associate, she makes revisions on amend ments to zoning codes.

Albert Sanchai, Dr. P.11. "68. is a professor of nutritio n at Loma Linda University and president of the Internationa l Nutriti on Research Foundation. Inc.. a nonprofit organi zation. add ressing nutrition and food issues o f the develo ping and industrialized worl d.

Lee A. Richman, Dr.P. J-1. 71. is the director of personnel relatio ns and regional clirectorofEBO:'\ Research Systems in \Xl ashington. D.C.

Murial Scholcha, M .P.A. 7 '1. is employed with the Los Angeles City Department of Communit y Develo pment and I !uman Sen ·icc::s Divisio n as a program analyst o f low income:: programs for the elderly, high risk groups and the homeless.

Lolsfrlss, Dr. l'.H . 74. is an associate clean of the graduate school and a professor of public administration/ health se1vices administration at USC. Friss has published a book . Stra leRiC Jlla11age111e111 of

N urses: A Policy Ori<!nled Approacb .

Hutton A. Addy, M. l'.11. '7-1. is an asso-

ciate professor and head of the community health department at the Cniversit yofScienceancl Techno logy, School of Medica l Sciences in Kumasi. Ghana .

Pam Rachootln, M.S.l'. 11. '77 and Rom Somers, M .P.11. '7"1, Ph.D . '79 are living in Somerton Park in South Au strali a 504 -1 Australi a. T hey would love to hear fro m former classmates and can be reached at 17 Eton Road. Somerto n Pa rk.

South Australia 500-1.

RlchardA. Jaloz, M.P.11., J.D . '77, is a sta ff director for the Select Com mittee on Aging of the U.S. H o use of Representatives.

hood H ealth Centers. a group of commu nity health and dental clinics. She Ji,·es in Seattle \\"ith her husband. George Edwards.

Wayne L. Stone, 1\ l.S.. D. Ell\-. '78. recently returned from a t \\"o year Peace Corps 1·01u ntccrassignment in 1\epal. While stationed in the:: eastern pa rt of the count ry. he fo rmu lated a community \Yatc::r supply maintenance program in the rural hills area. Stone 1i1·es in the District o f Colu mbia.

Blzabeth Shrader, .\ I. P.11 . ·s6. reccinxl an Uni1·ersity of J\ I ichigan Fello1Yship to \\·ork in :\lexico in popu lation studies and primary health care. In 1988. 'he met and married Stephen Cox in "\epal. Shrader \\·ork!> as a pri1·ate con~ultant" ith nongm·ernmcnta I organization.•,_ governmental agencies and international donor!> on \\'Omen ·::. c.k·,·elopment is::.ue1'. reprocluctin.> rights and d ome~tic ,·iolence re!>earch. The couple 1i1·e in Cuernavaca. ,\ lexico \\"ilh their daughter.

Katie.

Maureen Magers-Valentina, ,\I. I'. H . ·s 1. is employed by the Los Angeles Cou nt y Department o f I l e;tlth Sen ·ices as a hea hh educator at the:: North County I lealt h Centers 1\L'l\\"ork. She li,·es in the San Fernando \ 'alley.

Melvin A. Greenspan, l\ I. S. P .11. "82. received his D.D.S. degree fro m th e l 'niversity of Southern Ca lifornia in 1988 and completed a one-year residc::nc.yat LAC L.:SC.\kdicalCenter. I le is sched uled to complete a residency in endodontic:; al uses School of Dentistry in 1992. Greenspan is in pri1·ate practice in L3e,·erly 11ills. I l e is also on the auendingstaffat LAC l "SC 1\ lec.licalCenter and is a part-time clinica l faculty member al L.:SC. Dorena M. Emmrich, ivl. P.11. '83. is current I y employee.I a., a b iosta tistican at Syntex Re., earch in Palo Aho. California.

Elaine Yin, M.D .. M. l'.11. '8"1. ha s reached the m icl\\"ay point of her residency in ob~tet rics and gynecology at T emple llni1·ersiry.

M. Ricardo Calderon, M . D .. M.P. J-1. '8-1. returned t0 Guate111;1la after graduation and worked as a medical director for Leo Pharmaceutical Products. In 1988. he jo ined Project I lope as a program d irector and was assigned to I lo ndura s.

I le recently transferred to Ecua dor.

Jil!Slloemaker, ,\l.S.P.11. "8 1. is managing health benefit programs for Woyerhaeuser Company. She is also a board member and treasurerofthe Puget Sound 1\eighbor-

Karen AbramowBronsteln, \ I.I l.S..\ I. ·s-. is \\·orking a~ an aclministrati1 e manager for the:: Department of ,\hxlicine. I lenry Ford I !ospi1al in Detroit.

Nina Oyen, ,\I. I'. I I. ·8- . c::a rnc::d her ,\1.D. in 1986 from the L"ni\·er~ity of Bergen in "\or\\"ay and is emp loyed as a district doctor in I l ammesfest. 1\cnw:1y.

Sarah Harlan, .\l.l'.11. "88. li1·ed in London for 11 months \\·ith her hu!>hancl after graduation. \\ 'hill' there she 1·0Junteered at a national he:tlth hospital. :'\o\\' I l arlan i ~st;iyi ngar home " ·ith her daughter L3rill:my. \\"ho i!> eight month~ old.

Unda!SallylSlmpson, J\ 1. P.11. ·ss. is currently the manager of the maternal health section for the Arizona Department of 1leahh Sen·ice1' in Phoenix. She:: \\":11' formerly the directorofthe Indian T ribal I lea Ith Department in L1!> Vegas.

MaryKatherlneK.Lockwood, Ph.D. "89. b a faculty mc::mher in the biology department at Ri,·ier College in J\"c\\' llampsh ire. She teachc::!> nutril ion.genetic.-.. anaro my. physiology and microbiology.

•

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