Michele Barry, MD, FACP

All Publications

• Minimally Symptomatic Infection in an Ebola 'Hotspot': A Cross-Sectional Serosurvey PLOS NEGLECTED TROPICAL DISEASES Richardson, E. T., Kelly, J. D., Barrie, M. B., Mesman, A. W., Karku, S., Quiwa, K., Marsh, R. H., Koedoyoma, S., Daboh, F., Barron, K. P., Grady, M., Tucker, E., Dierberg, K. L., Rutherford, G. W., Barry, M., Jones, J. H., Murray, M. B., Farmer, P. E. 2016; 10 (11)

  Abstract

  Evidence for minimally symptomatic Ebola virus (EBOV) infection is limited. During the 2013-16 outbreak in West Africa, it was not considered epidemiologically relevant to published models or projections of intervention effects. In order to improve our understanding of the transmission dynamics of EBOV in humans, we investigated the occurrence of minimally symptomatic EBOV infection in quarantined contacts of reported Ebola virus disease cases in a recognized 'hotspot.'We conducted a cross-sectional serosurvey in Sukudu, Kono District, Sierra Leone, from October 2015 to January 2016. A blood sample was collected from 187 study participants, 132 negative controls (individuals with a low likelihood of previous exposure to Ebola virus), and 30 positive controls (Ebola virus disease survivors). IgG responses to Ebola glycoprotein and nucleoprotein were measured using Alpha Diagnostic International ELISA kits with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. A cutoff of 4.7 U/mL for the anti-GP ELISA yielded 96.7% sensitivity and 97.7% specificity in distinguishing positive and negative controls. We identified 14 seropositive individuals not known to have had Ebola virus disease. Two of the 14 seropositive individuals reported only fever during quarantine while the remaining 12 denied any signs or symptoms during quarantine.By using ELISA to measure Zaire Ebola virus antibody concentrations, we identified a significant number of individuals with previously undetected EBOV infection in a 'hotspot' village in Sierra Leone, approximately one year after the village outbreak. The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak. Further studies are needed to understand the potential risk of transmission and clinical sequelae in individuals with previously undetected EBOV infection.

  View details for DOI 10.1371/journal.pntd.0005087

  View details for Web of Science ID 000392154400022

  View details for PubMedID 27846221

• Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011. BMJ open Hastings, K. G., Eggleston, K., Boothroyd, D., Kapphahn, K. I., Cullen, M. R., Barry, M., Palaniappan, L. P. 2016; 6 (10)

  Abstract

  With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.

  View details for DOI 10.1136/bmjopen-2016-012201

  View details for PubMedID 27793837

  View details for PubMedCentralID PMC5093623

• Sex differences in obesity, dietary habits, and physical activity among urban middle-class Bangladeshis. International journal of health sciences Saquib, J., Saquib, N., Stefanick, M. L., Khanam, M. A., Anand, S., Rahman, M., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2016; 10 (3): 363-372

  Abstract

  The sustained economic growth in Bangladesh during the previous decade has created a substantial middle-class population, who have adequate income to spend on food, clothing, and lifestyle management. Along with the improvements in living standards, has also come negative impact on health for the middle class. The study objective was to assess sex differences in obesity prevalence, diet, and physical activity among urban middle-class Bangladeshi.In this cross-sectional study, conducted in 2012, we randomly selected 402 adults from Mohammedpur, Dhaka. The sampling technique was multi-stage random sampling. We used standardized questionnaires for data collection and measured height, weight, and waist circumference.Mean age (standard deviation) was 49.4 (12.7) years. The prevalence of both generalized (79% vs. 53%) and central obesity (85% vs. 42%) were significantly higher in women than men. Women reported spending more time watching TV and spending less time walking than men (p<.05); however, men reported a higher intake of unhealthy foods such as fast food and soft drinks.We conclude that the prevalence of obesity is significantly higher in urban middle-class Bangladeshis than previous urban estimates, and the burden of obesity disproportionately affects women. Future research and public health efforts are needed to address this severe obesity problem and to promote active lifestyles.

  View details for PubMedID 27610059

  View details for PubMedCentralID PMC5003579

• Medical "Brain Drain" and Health Care Worker Shortages: How Should International Training Programs Respond? AMA journal of ethics Karan, A., DeUgarte, D., Barry, M. 2016; 18 (7): 665-675

  Abstract

  The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.

  View details for DOI 10.1001/journalofethics.2016.18.7.ecas1-1607

  View details for PubMedID 27437816

• The Global Health Implications of e-Cigarettes. JAMA Chang, A. Y., Barry, M. 2015; 314 (7): 663-664

  View details for DOI 10.1001/jama.2015.8676

  View details for PubMedID 26284714

• Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8)

  View details for DOI 10.1371/journal.pntd.0003961

  View details for PubMedID 26270343

• Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8)

  View details for DOI 10.1371/journal.pntd.0003961

  View details for PubMedID 26270343

• Effects of Land Use on Plague (Yersinia pestis) Activity in Rodents in Tanzania AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE McCauley, D. J., Salkeld, D. J., Young, H. S., Makundi, R., Dirzo, R., Eckerlin, R. P., Lambin, E. F., Gaffikin, L., Barry, M., Helgen, K. M. 2015; 92 (4): 776-783

  Abstract

  Understanding the effects of land-use change on zoonotic disease risk is a pressing global health concern. Here, we compare prevalence of Yersinia pestis, the etiologic agent of plague, in rodents across two land-use types-agricultural and conserved-in northern Tanzania. Estimated abundance of seropositive rodents nearly doubled in agricultural sites compared with conserved sites. This relationship between land-use type and abundance of seropositive rodents is likely mediated by changes in rodent and flea community composition, particularly via an increase in the abundance of the commensal species, Mastomys natalensis, in agricultural habitats. There was mixed support for rodent species diversity negatively impacting Y. pestis seroprevalence. Together, these results suggest that land-use change could affect the risk of local transmission of plague, and raise critical questions about transmission dynamics at the interface of conserved and agricultural habitats. These findings emphasize the importance of understanding disease ecology in the context of rapidly proceeding landscape change.

  View details for DOI 10.4269/ajtmh.14-0504

  View details for Web of Science ID 000352828200018

  View details for PubMedID 25711606

  View details for PubMedCentralID PMC4385772

• International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in leogane, haiti. American journal of tropical medicine and hygiene Kligerman, M., Barry, M., Walmer, D., Bendavid, E. 2015; 92 (2): 448-453

  Abstract

  The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

  View details for DOI 10.4269/ajtmh.14-0379

  View details for PubMedID 25510716

  View details for PubMedCentralID PMC4347354

• Innovations to Enhance the Quality of Health Professions Education at the University of Zimbabwe College of Health Sciences-NECTAR Program ACADEMIC MEDICINE Ndhlovu, C. E., Nathoo, K., Borok, M., Chidzonga, M., Aagaard, E. M., Connors, S. C., Barry, M., Campbell, T., Hakim, J. 2014; 89 (8): S88-S92

  Abstract

  The University of Zimbabwe College of Health Sciences (UZCHS) is Zimbabwe's premier health professions training institution. However, several concerns were raised during the past decade over the quality of health education at UZCHS. The number of faculty and students declined markedly until 2010, when there was a medical student intake of 147 while the faculty comprised only 122 (39%) of a possible 314 positions. The economic and political crises that the country experienced from 1999 to 2009 compounded the difficulties faced by the institution by limiting the availability of resources. The Medical Education Partnership Initiative funding opportunity has given UZCHS the stimulus to embark on reforms to improve the quality of health education it offers. UZCHS, in partnership with the University of Colorado School of Medicine, the University of Colorado Denver Evaluation Center, and Stanford University, designed the Novel Education Clinical Trainees and Researchers (NECTAR) program to implement a series of health education innovations to meet this challenge. Between 2010 and 2013, innovations that have positively affected the quality of health professions education at UZCHS include the launch of comprehensive faculty development programs and mentored clinical and research programs for postgraduate students. A competency-based curriculum reform process has been initiated, a health professions department has been established, and the Research Support Center has been strengthened, providing critical resources to institutionalize health education and research implementation at the college. A core group of faculty trained in medical education has been assembled, helping to ensure the sustainability of these NECTAR activities.

  View details for DOI 10.1097/ACM.0000000000000336

  View details for Web of Science ID 000340290200023

  View details for PubMedID 25072588

• Treating hepatitis C in lower-income countries. New England journal of medicine Jayasekera, C. R., Barry, M., Roberts, L. R., Nguyen, M. H. 2014; 370 (20): 1869-1871

  View details for DOI 10.1056/NEJMp1400160

  View details for PubMedID 24720680

• High prevalence of chronic kidney disease in a community survey of urban Bangladeshis: a cross-sectional study. Globalization and health Anand, S., Khanam, M. A., Saquib, J., Saquib, N., Ahmed, T., Alam, D. S., Cullen, M. R., Barry, M., Chertow, G. M. 2014; 10 (1): 9-?

  View details for DOI 10.1186/1744-8603-10-9

  View details for PubMedID 24555767

• Meeting the Challenges of Global Health; pages 37-41 Stanford Social Innovation Review Denend, L., Lockwood, A., Barry, M., Zenios, S. 2014; 12 (Number 2)
• An ethics curriculum for short-term global health trainees GLOBALIZATION AND HEALTH Decamp, M., Rodriguez, J., Hecht, S., Barry, M., Sugarman, J. 2013; 9

  Abstract

  Interest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues.We developed and evaluated an introductory curriculum, "Ethical Challenges in Short-term Global Health Training." The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum.The ten case curriculum is freely available at http://ethicsandglobalhealth.org. An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably.The curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.

  View details for DOI 10.1186/1744-8603-9-5

  View details for Web of Science ID 000315939700001

  View details for PubMedID 23410089

• Reflecting on Short-Term International Service-Learning Trips ACADEMIC MEDICINE Crump, J. A., Decamp, M., Barry, M., Sugarman, J. 2013; 88 (1): 10-11

  View details for DOI 10.1097/ACM.0b013e3182753f25

  View details for Web of Science ID 000312795900009

  View details for PubMedID 23267221

• High prevalence of type 2 diabetes among the urban middle class in Bangladesh. BMC public health Saquib, N., Khanam, M. A., Saquib, J., Anand, S., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2013; 13: 1032-?

  Abstract

  The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.In this cross-sectional survey (n = 402), we randomly selected consenting adults (≥ 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ≥ 7.0 mmol/L or hemoglobin A1C ≥ 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ≥12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

  View details for DOI 10.1186/1471-2458-13-1032

  View details for PubMedID 24172217

• Reuters - Opinion, The Great Debate Internet access is a vital healthcare tool Barry, M. 2013
• Transient Facial Swellings in a Patient With a Remote African Travel History JOURNAL OF TRAVEL MEDICINE Richardson, E. T., Luo, R., Fink, D. L., Nutman, T. B., Geisse, J. K., Barry, M. 2012; 19 (3): 183-185

  Abstract

  We present a case of Loa loa infection in a patient, 21 years after visiting an endemic area for only 4 days. To our knowledge, this case represents the longest time for the diagnosis of loiasis to be made post-exposure in a traveler and emphasizes that even short exposures can place travelers at risk.

  View details for DOI 10.1111/j.1708-8305.2012.00612.x

  View details for Web of Science ID 000303197900009

  View details for PubMedID 22530826

• Tb in a Global Health Exchange Program JOURNAL OF GENERAL INTERNAL MEDICINE Decamp, M., Crump, J. A., Rodriguez, J., Richardson, G., Barry, M., Sugarman, J. 2012; 27 (1): 7-7

  View details for DOI 10.1007/s11606-011-1908-1

  View details for Web of Science ID 000298883900004

  View details for PubMedID 22012345

• Health Technologies and Innovation in the Global Health Arena NEW ENGLAND JOURNAL OF MEDICINE Sinha, S. R., Barry, M. 2011; 365 (9): 779-782

  View details for Web of Science ID 000294405200002

  View details for PubMedID 21879894

• Short-Term Global Health Research Projects by US Medical Students: Ethical Challenges for Partnerships AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Provenzano, A. M., Graber, L. K., Elansary, M., Khoshnood, K., Rastegar, A., Barry, M. 2010; 83 (2): 211-214

  Abstract

  Recent interest in global health among medical students has grown drastically, and many students now spend time abroad conducting short-term research projects in low-resource settings. These short-term stints in developing countries present important ethical challenges to US-based students and their medical schools as well as the institutions that host such students abroad. This paper outlines some of these ethical issues and puts forth recommendations for ethically mindful short-term student research.

  View details for DOI 10.4269/ajtmh.2010.09-0692

  View details for Web of Science ID 000280694300003

  View details for PubMedID 20682858

• GLOBAL HEALTH Fifty Years of US Embargo: Cuba's Health Outcomes and Lessons SCIENCE Drain, P. K., Barry, M. 2010; 328 (5978): 572-573

  View details for DOI 10.1126/science.1189680

  View details for Web of Science ID 000277159800024

  View details for PubMedID 20430999

• Ethics and Best Practice Guidelines for Training Experiences in Global Health Am J Trop Med Hyg Crump JA, Sugarman J, Barry, M et al 2010; 83 (6): 1178-1182
• Talking Dirty-The Politics of Clean Water and Sanitation NEJM Barry M, Hughes J. 2008; 359 (8): 784-787
• The Tail End of Guinea Worm - Global Eradication without a Drug or Vaccine NEJM Barry M 2007; 356 (25): 2561-2564
• Suburban Leptospirosis: Atypical Lymphocytosis and Gamma-delta T cell response. Clinical Infectious Diseases Barry M, Wisnewski A, Matthias M, Inoye S, Vinetz J. 2006; 43 (Nov 15): 1306
• Presidential Address - Disease without borders: globalization's challenge to the American Society of Tropical Medicine and Hygiene: A call for public advocacy and activism. Am J Trop Med Hyg Barry M 2003; 69 (1): 3-7
• The International Health Program: The fifteen year experience with Yale University's Internal Medicine Residency Program. Am J Trop Med Hyg Gupta A, Wells C, Horwitz R, Bia F, Barry M. 1999; 61 (6): 1019-1023
• Treatment of a Laboratory Acquired Infection of Sabiá Virus. NEJM Barry M, Armstrong L, Russi M, Dembry L, Geller D, Tesh R, Gonzalez JP, Khan A, Peters CJ. 1995; 333: 294-296
• Zimbabwe: Health care changes after independence and transition to majority rule. JAMA Barry M, Cullen M, Thomas JEP, Loewenson R. 1990; 263 (5): 638-640
• Ethical considerations of human investigation in developing countries: The AIDS dilemma. NEJM Barry M. 1988; 319 (16): 1083-1086