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In the News, Parenting, Pregnancy, Public Health, Public Safety, Women's Health

Exploring new recommendations to diagnose prenatal and postpartum depression

Exploring new recommendations to diagnose prenatal and postpartum depression

Although having a child is usually considered a happy event, an estimated 10 to 15 percent of women living in the U.S. develop some form of maternal depression. In response to new research and increased awareness about the problem, the U.S. Preventive Services Task Force revised their 2009 recommendations for screening procedures to diagnose and treat prenatal and postpartum depression.

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The guidelines, published last week in the Journal of the American Medical Association, now recommend screening for depression in the general adult population and they highlight the potential benefits of screening for pregnant and postpartum women.

Earlier this week, KQED Forum delved into the basis and potential implications of these new recommendations by exploring the topic with a panel of experts including Katherine Williams, MD, director  of Stanford’s Women’s Wellness Clinic.

Williams (who begins speaking at the 10:25 mark) stated that one of the most important aspects of the revised recommendations is its discussion of psychotherapy and how it can and, as Williams says, should be used as the first form of treatment for pregnant or nursing moms who are suffering from depression. The entire hour-long discussion is worth a listen.

Previously: A telephone lifeline for moms with postpartum depression“2020 Mom Project” promotes awareness of perinatal mood disordersAh…OM: Study shows prenatal yoga may relieve anxiety in pregnant women and Helping moms emerge from the darkness of postpartum depression
Photo by Sarah Zucca

Chronic Disease, Global Health, Medical Apps, Public Health, Public Safety, Research

The right tool for the job: Creating a waterborne disease reporting system for Nepal

Fig 3When I last spoke with cholera expert Eric Jorge Nelson, MD, PhD, he was about to field test a tool to help doctors in Bangladesh diagnose, treat and report cholera outbreaks in real time using a smartphone app. Now that this reporting system is up and running, he’s working to create similar reporting systems for doctors elsewhere. But, as he learned in the remote regions of Nepal, a high-tech approach isn’t always the best approach.

Nelson was invited to Nepal by his colleague Jason Andrews, MD, an infectious disease expert who works with the Dhulikhel Hospital, to share his expertise on recognizing, responding to and containing cholera outbreaks.

Like Bangladesh, Nepal has seasonal outbreaks of waterborne diseases, including cholera, Typhoid, viral hepatitis and dysentery, that ebb and flow with the monsoon seasons. What made the situation in Nepal urgent, Nelson told me, is that waterborne diseases can also arise after natural disasters, and a 7.8 magnitude earthquake struck Nepal last spring and more than 100 aftershocks have hit the region since.

An added complication, Andrews explained, was that Nepal’s government wasn’t scaling up waterborne disease surveillance in the rural areas following the earthquakes. “Our colleagues at Dhulikhel Hospital, by contrast, were extremely proactive and committed to setting up a system before an outbreak hit,” Andrews said.

Nelson was only in Nepal for about 48 hours, but during those two days he and Andrews began to tackle the problem of how to prevent a large-scale cholera outbreak there. At first, it seemed plausible that the smartphone app designed for Bangladesh would work in Nepal — but Nelson said they quickly realized that Nepal’s post-earthquake infrastructure wasn’t suited to a smartphone reporting system.

“There were few resources in Nepal and little time to ramp-up a reporting system,” Nelson said. “Charging a smartphone requires a stable power supply, and although the 3G networks within the city were fine, they weren’t good in the canyons.”

This is where Andrews’ expertise came in. His knowledge of Nepal and experience building surveillance systems with “just the bare bones” (as he put it) helped the team reverse engineer the smartphone app Nelson used in Bangladesh and use elements of it to create a paper-based surveillance system that’s better suited to the post-earthquake situation in rural Nepal.

“This was a risky endeavor,” Andrews said. “We didn’t have funding so we drew upon our own existing resources. Funding takes a while, the earthquake was in April and the monsoon hits in June. If we had waited, the monsoon season would have passed. We realized we could scale this up really quickly with minimal resources and it was worth the risk.”

Now, the team’s paper-based system has been working for several months and Nepal’s government is interested in replicating the model at a larger level.

“I learned two important lessons during my trip to Nepal,” Nelson told me. “I learned the power of winnowing a complicated process, like our smartphone app, down. I also learned how we can broaden what we did in Bangladesh for a wider community.”

He continued: “Hopefully we are emerging from the idea that mobile technology is a panacea. We need to be open to considering high — or low — tech strategies depending on what the on-the-ground situation is. We happened to have two very different design challenges in Bangladesh and Nepal: Mobile was best for Bangladesh and paper was best for Nepal. You have to build what the end-user desires, is feasible and is viable. I think the mhealth field is waking up to this reality.”

Previously: A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disastersReporting and treating cholera: Soon, there could be an app for thatDay 1: Arriving in Nepal to aid earthquake victims and Using social media to fight cholera
Photo courtesy of U.u.H. Schmel and R.K. Mahato

Mental Health, Research

A look at how people endure a winter of Polar Night by embracing it

A look at how people endure a winter of Polar Night by embracing it

5235620899_00642f6d27_zWhen the weather is bad, many people seek solace in a good book or cup of marshmallow-speckled hot cocoa until brighter days return. But when gloomy weather swallows a whole season of the year, a bit of chocolate and a few paperbacks often aren’t enough to keep depression at bay.

Nearly 200 miles north of the Arctic Circle in Tromsø, Norway winters are, by my standards, brutal. This is not because of the cold (temperatures are often mild ranging from 20-35 degrees F) but because of a lack of sunlight. Every November to January Tromsø’s bit of earth is tipped away from the sun and the city is cloaked in Polar Night.

Despite the darkness, studies have shown that the people of Tromsø have lower rates of wintertime depression predicted for people living at this latitude (69°N). To learn how they fend off seasonal depression and if their strategies could be applied elsewhere, Stanford graduate student Kari Leibowitz traveled to Tromsø to conduct a series of interviews and surveys.

What she found surprised her, Leibowitz explains in a recent Christian Science Monitor article. The people she surveyed often failed to understand her questions about wintertime depression because they actually enjoyed the season.

Leibowitz states that further research is needed, but her work thus far suggests that the attitude people have about a stressful situation may dictate whether it causes mental distress or if it enhances their mood.

Her findings are in line with the work of Stanford psychologists Carol Dweck, PhD, and Alia Crum, PhD. Their research investigates the way people perceive a situation and how their mindset can help them flourish in what some may see as an undesirable situation, such as a long, sunless winter.

“Norwegians have a saying that ‘there’s no such thing as bad weather, only bad clothing,’ which typifies their ingrained belief that being active is part of a happy life – and, especially, a happy winter,” Leibowitz writes.

Image by Shandi-lee Cox

Mental Health, Patient Care, Rural Health

Horse therapy could help people cope with early-onset dementia

Duell and Paula HertelAs a kid growing up in rural Minnesota, I spent many of my waking hours searching for a reason to be near the five horses that roamed the 40 acres behind our house. Their methodical munching and tail-swishing put me at ease and learning how to ride a 1,200-pound animal that could easily wipe me off on a fence post taught me much of what I know about courage and persistence.

A similar sense of calm, accomplishment and fortitude are among the potential benefits of a new pilot study at Stanford University’s Red Barn called the Connected Horse Project. This project aims to help people learn how to manage the symptoms of early-stage dementia through a series of workshops where they participate in supervised activities with horses.

The project is the brainchild of Paula Hertel, Nancy Schier Anzelmo and Elke Tekin, three senior care practitioners and equestrians who work at the Senior Living Consult. For this study they worked with Stanford’s Dolores Gallagher Thompson, PhD, and Nusha Askari, PhD, and Jacqueline Hartman at the Stanford Red Barn Leadership Program.

In the pilot study, five individuals and their care partners participated in a three-week workshop. The study measures the workshop’s effect on the participants’ stress levels, their quality of sleep and their ability to relate to and communicate with others. The results will be presented at Stanford’s Annual Community Health Symposium on Jan. 14 and will be used to develop programs that can be implemented throughout the country, including in rural areas where support services are often lacking.

Hertel and Schier Anzelmo told me more about the program and its potential applications in an email interview:

What prompted you to start the Connected Horse Project?

A shared passion is the simple answer. We are practitioners in senior care and know firsthand that traditional models of care are not adequate. We have also experienced the power of the human/horse connection on a personal level.

Why horses? Do you think a program that pairs humans with dogs or cats could work as well or in the same way? 

Many of us smile when we think about our favorite dog or cat, or in my [Paula’s] case, my first pony. Interactions with animals spark emotional memories that stay intact. Horses can be particularly therapeutic for people because they have an innate ability to sense what others around them feel; they depend on the herd for survival.

In the workshop, the equine facilitators guide the participants through activities that showcase the horses’ characteristics and abilities. This helps the participants recognize their own strengths and the power of their relationships with others.

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Education, Medicine and Literature, Podcasts

Recommended holiday reading for the medicine and science enthusiast

Recommended holiday reading for the medicine and science enthusiast

Waiting and Reading at Bryant ParkA good book can transform boredom into bliss in the amount of time it takes to buckle yourself into an airplane seat. Yet all too often we find ourselves stranded without a good book in sight. Reading is good for your brain’s health, so don’t get caught without a book you cannot wait to read. Here are a few page-turners to have in your back pocket this holiday season:

Mindset: Bill Gates recommends this bestseller by Stanford psychologist Carol Dweck, PhD, in his list The Best Books I Read in 2015 and in a separate book review. Mindset also made the list of 58 Books Recommended by TED Speakers.

Jonas Salk: A Life: This book by Charlotte DeCroes Jacobs, MD, professor of medicine, was named one of the 100 Notable Books of 2015 by the New York Times Book Review. This book was also the subject of a 1:2:1 podcast.

A Well Designed Life: Author Kyra Bobinet, MD, MPH, blends brain science and design thinking to address why it’s sometimes hard to get ourselves to do what we know is best for us and what we can do about it. In this recent podcast with Paul Costello, Bobinet, a behavior change expert, discusses her book and shares tips on designing a healthier life.

The Good Gut: This book by Stanford microbiologists Justin Sonnenburg, PhD, and Erica Sonnenburg, PhD, explores how gut bacteria affect physical and mental health. The Sonnenburgs discuss their book here on Scope.

Food Love Family: A Practical Guide to Child Nutrition: This book by Stanford child nutrition expert Maya Adam, MD, highlights how cooking simple, home-cooked meals can nourish and teach children about eating right at a young age.

The book that made me go to medical school: In this Scope blog post, medical student Natalia Birgisson talks about the book that inspired her to pursue a career in medicine and lists a few of her other favorite books related to the realm of medical science.

Previously: Stanford study shows how the brain responds to different types of reading instructionStanford Storytellers: Medical students write a children’s book to comfort and educateUsing texting to boost preschool reading skills and Reading, book sharing less common in immigrant families, Stanford study finds
Photo by Jens Schott Knudsen

Cancer, Pain, Palliative Care, Patient Care, Public Health, Stanford News

Ernest and Isadora Rosenbaum Library: A free, comprehensive guide to living with cancer

Ernest and Isadora Rosenbaum Library: A free, comprehensive guide to living with cancer

Spiegel in office - 600“What’s it like to be told you have cancer?” I asked a friend recently. She told me she was shocked to have received the news, and that this shock quickly gave way to a seemingly endless string of questions. How did I get cancer? What’s the best treatment? What will my care be like? What will the rest of my life be like?

As we talked, I learned that getting her the best care possible, although important, wasn’t the only thing she needed to survive. An equally important need was the peace of mind she regained when her doctors, caregivers and loved-ones helped her tackle her unanswered questions.

Addressing the questions and needs of cancer patients, like my friend, is the primary aim of the web-based Ernest and Isadora Rosenbaum Library at Stanford’s Center for Integrative Medicine.

Recently, I had the opportunity to talk about the library with the center’s medical director, psychiatrist David Spiegel, MD. Spiegel first came to know the late Ernest Rosenbaum, MD, through Rosenbaum’s work at San Francisco’s Mt. Zion Hospital. Rosenbaum treated cancer by addressing the patient as a whole – considering not just patients’ physical needs, but their emotional ones as well – and, at the time, his approach was groundbreaking. He wrote Everyone’s Guide to Supportive Cancer Care, Everyone’s Guide to Cancer Therapy and The Inner Fire decades before such support was recommended by the Institute of Medicine in its report, Lost in Transition, long before the National Cancer Institute had an Office of Cancer Survivorship, and before palliative care was widely talked about.

When Spiegel opened the Stanford Center for Integrative Medicine in 1998, Rosenbaum brought his cancer supportive care program to Stanford. There, Rosenbaum and colleagues gave and recorded talks and penned articles that address the many scientific and emotional aspects of cancer care.

Ernie and IzzyRosenbaum bequeathed his writings to Stanford when he passed away in 2010. Volunteer Vahe Katros did the hard work of bringing this material to the web, donating hundreds of hours to bring the website to life. “Vahe represents the best in those who volunteer to help cancer patients, and he shows how we can all help one another,” Spiegel said.

Visitors to the online library will find information on such things as coping with cancer, sources of support, the value of forgiveness and the role of creativity – “topics [that] Rosenbaum selected due to his being personally being involved in the struggles of thousands,” Spiegel explained. The library contains excerpts from Rosenbaum’s book, The Inner Fire, and will be expanded in 2016 to include writings from his unpublished final work and additional content.

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Health and Fitness, Mental Health

Tips to survive — and thrive during holiday family events

Tips to survive — and thrive during holiday family events

6982000222_6fff88e3c8_zEvery year, in the interim between the last bites of my Thanksgiving meal and my first cup of coffee on Black Friday, a gnawing uneasiness begins in the pit of my stomach. The holiday season has now, undeniably, begun and it’s time to start the mental Jenga that is arranging my vacation travel so I can visit multiple families in different states.

I know a perfect holiday with each family isn’t possible. I also understand that I’ll burn myself out if I try to please everyone. Yet, every year, I struggle to put this knowledge into practice.

So, to bolster my resolve to have a healthier holiday, I did some research on the topic and found this post by BeWell @Stanford. In the Q&A, marriage and family therapist Mary Foston-English, explains that the holidays are hard for many people because they’re often coupled with uncomfortable situations, reminders of a lost loved one or unpleasant memories. She also describes how unrealistic expectations can can contribute to holiday stress. We may think:

  • “Holidays are supposed to be joyous and happy.”
  • “Holidays are times when families come together.”
  • “If you don’t have family, then there’s no reason to celebrate.”
  • “There’s no place like home for the holidays.”
  • “The bigger the gift and/or the more we spend, the better.”
  • “Everything has to be perfect.”

And we couldn’t be more wrong.

Foston-English offers several sanity-saving tips on how to communicate better with our families, how to deal with ‘that’ relative and how to avoid overextending ourselves emotionally, financially and emotionally. Here are a few of Foston-English’s nuggets of wisdom:

  • Have realistic expectations of yourself and others.
  • Become aware of how unhappy/traumatic memories impact the holidays. If you associate the holidays with unhappy times, then the holidays can bring it all back.
  • Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. It’s not a good idea to use the holidays to “confront.”
  • Establish “healthy” boundaries for yourself: It’s OK to say “no.”

I highly recommend reading and sharing the article. Here’s to a healthier holiday season for all of us.

Previously: Health psychologist responds to questions on coping with holiday stress and Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression
Photo by eren {sea+prairie}

Global Health, Infectious Disease, Public Health, Public Safety

Stanford team develops a method to prevent the viral infection that causes dengue fever

Stanford team develops a method to prevent the viral infection that causes dengue fever

327708441_433edf50d4_zDengue fever is the most widespread and fastest growing mosquito-borne virus in the world. It infects an estimated 390 million people each year — nearly twice the number of people infected annually by malaria — and unlike malaria, there is no vaccine or treatment.

Despite the severity and worldwide frequency of the disease, dengue fever receives relatively little press in the United States. But soon this trend may change. Just recently an outbreak of dengue fever struck Hawaii’s Big Island and the reach of this tropical disease is expected to spread.

Now, a team of Stanford researchers led by Judith Frydman, PhD, have developed a new way to target the disease by using a drug compound that tinkers with a critical cellular pathway in the host, blocking the virus at multiple steps. Frydman is a professor of biology and of genetics.

A Stanford News story explains:

Frydman’s group focused on Hsp70, a type of protein found in most organisms and known as a “chaperone.” Hsp70’s main job is to help other proteins fold into their functional shape, and to then protect them from damage by environmental stresses. DENV (dengue fever), like many other viruses, also relies on Hsp70, to help replicate the viral genome, and ultimately produce the viral proteins it needs to take control of the host cells and spread infection.

Frydman’s team discovered that using a specific compound to inhibit Hsp70 in human blood cells blocks the virus without harming the cells. This compound is effective against different strains and types of dengue fever and it blocks other insect-borne diseases, including West Nile virus, yellow fever and tick-borne encephalitis.

“Our findings have major implications for our understanding of the interface between viral and chaperone biology, and provide a new way of thinking about strategies to develop a novel class of antivirals,” Frydman said.

Previously: Exploiting insect microbiomes to curb malaria and dengueFighting fire with fire? Using bacteria to inhibit the spread of dengue and Dengue fever in New Caledonia
Photo by Andy Simonds

Aging, Events, Stanford News, Videos

Former medical school dean discusses learning and longevity at Stanford 125 event

Former medical school dean discusses learning and longevity at Stanford 125 event

The year-long celebrations for Stanford University’s 125th anniversary are in full swing, and Philip Pizzo, MD, former dean of Stanford’s medical school, recently helped kick off the festivities. Earlier this month, he and experts in the fields of psychology, computer science, education, physics and the humanities drew a crowd of more than 550 people to Stanford’s Cemex Auditorium to discuss the theme “Thinking Big About Learning.”

In his talk, Pizzo, founding director of the Stanford Distinguished Careers Institute, explored the topics of learning, aging and longevity and how traditional views of education and career (learn when young and do the same job for life) no longer apply now that people are living and working longer than ever.

If you missed the event, you can watch video of Pizzo’s talk here. Other videos from the symposium, including talks from Stanford psychology professor Carol Dweck, PhD, and Jeremy Bailenson, PhD, director of the Virtual Human Interaction Lab, are available on the Stanford 125 website.

Previously: Living long and living well: A conversation on longevity at Medicine XA look at aging and longevity in this “unprecedented” time in history and Living loooooooonger: A conversation on longevity

 

Bioengineering, Cancer, Imaging, Public Safety, Research, Stanford News, Technology

A new way to scan for plastic explosives could someday detect cancerous tumors

A new way to scan for plastic explosives could someday detect cancerous tumors

14591799636_128fbe50ee_zSci-fi shows and superhero films are full of gadgets and beings that have the power to remotely scan their environment for hidden things. For us mere mortals this superability may sound unachievable, but now Stanford engineers are working to develop a safe and portable way to detect concealed objects by scanning with microwaves and ultrasound.

As this Stanford Report story explains, the idea began with a challenge posed by the Defense Advanced Research Projects Agency: Design a way to detect buried plastic explosives from a safe distance without touching the surface of the ground.

A team of electrical engineers led by assistant professor Amin Arbabian, PhD, and research professor Pierre Khuri-Yakub, PhD, took up the challenge, paying homage to the scanning device made popular by sci-fi show Star Trek in the process. They created a tricorder-like device that senses the ultrasonic waves created by objects as they expand and contract when warmed by electromagnetic energy (e.g., light and microwaves).

Here’s the really interesting part: Because everything expands and contracts when heated — but not at identical rates — this scanning tool could have medical applications as well. For example, blood vessels that sprout from cancerous tumors absorb heat differently than surrounding tissue. So, blood vessels radiating from tumors could appear as “ultrasound hotspots” when scanned with the tricorder device.

The team is working to make this device ready to detect the presence of tumors and other health anomalies sometime within the next decade or so.

Previously: Beam me up! Detecting disease with non-invasive technology and Tiny size, big impact: Ultrasound powers miniature medical implant
Photo by Joe Haupt

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