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Health Disparities, Health Policy

A quiz on the social determinants of health

Given the topic of today’s SMS-Unplugged entry, during which Moises Humberto Gallegos discusses how things like housing insecurity and financial hardship can contribute to poor health, I was interested to come across this Covering Health quiz on the social determinants of health. Writer Joe Rojas-Burke asks 10 true-or-false questions, and I think some of the answers may surprise you. For example:

Expanding health insurance coverage and access to medical care (the focus of the federal Affordable Care Act) is unlikely to reverse the health disparities caused by the social determinants of health.

TRUE: In countries that established universal health coverage decades ago, lower social status still correlates with worse health and shorter lives. The research on social determinants suggests that progress is likely to require broader social changes, such as improving access to education, boosting economic opportunity and making disadvantaged neighborhoods safer and and more vital.

And:

Food deserts – neighborhoods with few or no grocery stores selling fresh, affordable produce – are a well-defined root cause of obesity and other health problems in disadvantaged communities.

FALSE: There is evidence showing that low-income and minority Americans are more likely to live in food deserts. But it’s not at all clear to what extent the lack of supermarkets and grocery stores contributes to obesity or other health outcomes.

Previously: In medicine, showing empathy isn’t enough, Should the lack of access to good food be blamed for America’s poor eating habits? and Hopkins researchers find place, rather than race, may be greater determinant of health

Patient Care, Stanford News, Videos

More on the Navy pilot with mysterious symptoms – and the Stanford doctors who diagnosed him

More on the Navy pilot with mysterious symptoms - and the Stanford doctors who diagnosed him

Last week, we blogged about a Navy pilot whose mysterious symptoms were diagnosed by clinicians here. A just-published Stanford Hospital video shares more of Robert Buchanan’s compelling story.

Previously: Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms

In the News, Pain, Patient Care, Research, Stanford News

More attention, funding needed for headache care

More attention, funding needed for headache care

In case you missed it, the San Francisco Chronicle ran a story over the weekend on migraines – and researchers’ ongoing search for a cause and universal treatment. Robert Cowan, MD, director of the Stanford Headache Clinic, was one of the people featured and told writer Stephanie M. Lee:

Headache care is 50 years behind things like diabetes and cancer… It just hasn’t had the attention, hasn’t had the funding, in order to get to the answers we need.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disorders and New Stanford headache clinic taking an interdisciplinary approach to brain pain

In the News, Stanford News

A curated selection of news from Dean Lloyd Minor

A curated selection of news from Dean Lloyd Minor

What should you be reading today? Over on OZY’s Presidential Daily Brief, Lloyd Minor, MD, dean of the medical school, points readers to some of the most interesting stories in medicine, bioscience and beyond. Among his picks as guest curator are a recent Atlantic article on creativity and a Guardian piece on hill climbing. Of the latter he writes:

Climbing and walking in the hills provides beneficial exercise, relaxation and renewal. Hope Whitmore, a writer living outside Edinburgh, Scotland, describes her journeys as well as her struggles with rheumatoid arthritis. As someone who loves to walk two dogs in the foothills of the Santa Cruz Mountains, I can certainly relate to Whitmore’s description of her evening walks as “a healing, a cleansing of the soul, drawing a line between the workaday world and the night time.”

Previously: A closer look at Stanford medical school’s new dean

Ethics, Events, Health Policy, Stanford News, Transplants

How can we end the donor organ shortage?

How can we end the donor organ shortage?

organ donorOur country’s organ shortage is an issue of critical importance – especially to the more than 100,000 Americans currently waiting for an organ transplant. In the words of Stanford’s Keith Humphreys, PhD, “Everyone agrees that 18 people dying each day on transplant waiting lists is unacceptable, but there is fierce disagreement about what to do about it.”

Next week, Humphreys will moderate a panel discussion that delves into the issue. He’ll be joined by three experts – including Stanford bioethicist David Magnus, PhD – who will discuss the effect of the organ donation on our country’s overall health and debate the ethical and practical aspects of proposals to solve the problem. Among the most controversial proposed approach and something that will be vigorously debated: paying people to donate their organs.

The event, part of Stanford’s Health Policy Forum series, will be held on July 28 at 11 AM at the Li Ka Shing Center for Learning and Knowledge, in room LK130. For those local readers: It’s free and open to the public, but space is limited. More information can be found on the forum website.

Previously: Students launch Stanford Life Savers initiative to boost organ donation, Full-length video available for Stanford’s Health Policy Forum on serious mental illness, Stanford forum on the future of health care in America posted online and Stanford Health Policy Forum focuses on America’s methamphetamine epidemic
Photo by Mika Marttila

Medicine and Society, Pregnancy, Research

Study offers clue as to why parents of daughters are more likely to divorce

Study offers clue as to why parents of daughters are more likely to divorce

poppy2Here’s something that caught my attention this morning (likely because I’m the mom of two girls): A new study provides a possible reason behind reports that parents with firstborn daughters are more likely to divorce than those with firstborn sons. According to researchers from Duke and University of Wisconsin-Madison, it could be due to girls being “hardier than boys, even in the womb.”

A recent university release further explains:

Throughout the life course, girls and women are generally hardier than boys and men. At every age from birth to age 100, boys and men die in greater proportions than girls and women. Epidemiological evidence also suggests that the female survival advantage actually begins in utero. These more robust female embryos may be better able to withstand stresses to pregnancy, the new paper argues, including stresses caused by relationship conflict.

Based on an analysis of longitudinal data from a nationally representative sample of U.S. residents from 1979 to 2010, Hamoudi and Nobles say a couple’s level of relationship conflict predicts their likelihood of subsequent divorce.

Strikingly, the authors also found that a couple’s level of relationship conflict at a given time also predicted the sex of children born to that couple at later points in time. Women who reported higher levels of marital conflict were more likely in subsequent years to give birth to girls, rather than boys.

“Girls may well be surviving stressful pregnancies that boys can’t survive,” Hamoudi said. “Thus girls are more likely than boys to be born into marriages that were already strained.”

The intriguing findings appear in the journal Demography.

Image courtesy of Michelle Brandt

Medical Education, Medical Schools

Does medical school debt cause students to choose more lucrative specialties?

Last week, we re-published a Wing of Zock post on medical school debt. Over on that same blog, Julie Fresne, director of student financial services for the Association of American Medical Colleges (AAMC), takes issue with one of the original writer’s points: that concern over medical school debt affects students’ decision about specialties. Fresne writes:

While many claim that debt leads medical students to choose more lucrative specialties, AAMC research indicates that debt does not play a determining role in specialty choice for most students. The report, “Physician Education Debt and the Cost to Attend Medical School,” includes a section outlining evidence on the “minor role of debt in specialty choice.” Studies show that specialty choice is a complex and personal decision involving many factors. Some students with high debt do in fact choose primary care and AAMC data suggests that there is no systematic bias away from primary care specialties by graduates with higher debt levels…

Previously: It’s time for innovation in how we pay for medical school, 8 reasons medical school debt won’t control my life and Will debt forgiveness program remedy doctor shortage?

Patient Care, Stanford News

Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms

Medical mystery solved: Stanford clinicians identify source of Navy pilot's puzzling symptoms

Navy pilotTalk about medical mysteries: For two years, Navy pilot Robert Buchanan was plagued with symptoms like an irregular heartbeat, a drooping eyelid, hypersensitive sinuses, jaw pain and neck swelling – and no one could figure out exactly what was wrong.

“I had never encountered anything quite like it before,” said Edward Damrose, MD, chief of the Division of Laryngology at Stanford, who has been seeing patients for nearly 20 years.

Damrose worked with a team of doctors from a variety of specialties to determine the source of the problems – ultimately identified as a kind of decompression injury following a 2006 flight accident – and treat Buchanan. An article in the current issue of Inside Stanford Medicine chronicles the long road to treatment and ends on a happy note:

This winter, eight years after his near-fatal flight and two years after he came to Stanford for help, after a slew of diagnostic tests and more than a dozen incremental surgeries to fix his injuries, Buchanan passed [the Navy's] tests and qualified to fly again. With that step, he can move toward commanding a squadron of fighter pilots. “That’s the pinnacle of an aviator’s career,” he said.

“This case taught me to never, never take it for granted that you know it all,” Damrose said. “The answers aren’t always in textbooks.” The literature search also revealed other patients suffering from similar symptoms, almost all related to decompression injury, he said. “And Cmdr. Buchanan spurred us to keep going.”

Previously: NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases
Photo by Todd Holland

In the News, Science

Stanford researcher on elephants: “We should value animals that have the same level of sophistication that we do”

Stanford researcher on elephants: “We should value animals that have the same level of sophistication that we do"

elephantsThe July issue of Smithsonian Magazine has a lengthy feature on the crisis facing elephants in Africa, with writer Joshua Hammer explaining, “Of the 50,000 elephants that roamed Chad 50 years ago, barely 2 percent are left. In the neighboring Central African Republic and Cameroon, the population may be even lower. Poverty, bribery and insecurity are all contributing factors in a region where a single large tusk can sell on the black market for $6,000—ten times the annual salary of a typical worker.”

Quoted in the piece is Stanford’s Caitlin O’Connell-Rodwell, PhD, a consulting assistant professor of otolaryngology, who has done extensive field work with the animals. She describes the connection between elephants and humans and expresses deep concern about the animals’ risk of becoming extinct:

“What is special about elephants is just how similar they are to us—socially and developmentally,” says Caitlin O’Connell-Rodwell, a Stanford ecologist who has written four books based on her Namibian field research on elephants. “If you watch a family group reuniting, their behavior is exactly like ours—the little cousins darting off together, the elaborate greetings of adults. Elephants offer a way of looking into the mirror, for better or worse,” she adds. “If we value human rights, we should also value animals that have the same level of sophistication that we do. We should keep those beings with us here on earth.”

Previously: Listening to elephants, communicating science, and inspiring the next generation of researchers, Elephants chat a bit before departing water hole, new Stanford research shows and Researcher dishes on African elephant soap opera
Photo by Caitlin O’Connell-Rodwell and Timothy Rodwell

Chronic Disease, NIH, Patient Care, Research

NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases

doctors' tools - smallVertigo, nausea, headache, fatigue, confusion. For years someone close to me has experienced severe and periodic bouts of these symptoms. It’s clear something is wrong and yet, despite countless tests and visits with specialists in cardiology, neurology, ophthalmology, pulmonology, otolaryngology, and immunology, no one has been able to figure out what that something is. At one of his last appointments – to the great disappointment of this patient and (perhaps even more so) his worried and frustrated wife – my loved one was gently told that he may have to face the very real possibility that he’ll never get a definitive diagnosis.

Unfortunately, this patient is far from alone: Plenty of people are living with mysterious symptoms that affect their quality of life (or worse), and it’s not uncommon for patients with rare diseases to have waited years for their diagnosis. With this in mind, the National Institutes of Health launched in 2008 its Undiagnosed Diseases Program, a pilot program designed to “provide answers to patients with mysterious conditions that have long eluded diagnosis” and “advance medical knowledge about rare and common diseases.” (Since that time, 600 children and adults have been evaluated, and approximately 100 patients were given a diagnosis.)

Now, the program is being expanded into the Undiagnosed Diseases Network, with the NIH announcing last week that six medical centers – including Stanford – will be joining and contributing local medical expertise. The NIH will work with experts from these centers (including Euan Ashley, MD, PhD, Stanford’s principal investigator) to, as described in a release, “select from the most difficult-to-solve medical cases and together develop effective approaches to diagnose them.” The physicians will “collect and share high-quality clinical and laboratory data, including genomic information, clinical observations and documentation of environmental exposures,” and they’ll “benefit from common protocols designed to improve the level of diagnosis and care for patients with undiagnosed diseases.”

In our online story on the network and the $7.2 million grant that Stanford received, Matthew Wheeler, MD, medical director for the grant, notes that “Stanford was chosen for our informatics expertise, our experience with clinical interpretation of whole-exome and whole-genome data, and our scientific potential to follow up any lead.” As my colleague Erin Digitale further explained:

The team will use cutting-edge genomics and medical phenotyping techniques to diagnose patients, and will also aim to understand the underlying biology of patients’ conditions so they can generate targets for new therapies, Wheeler said. “We aim to make a deep dive into each patient’s biology,” he added.

By the summer of 2017, each new clinical site is expected to see 50 or more patients per year. Referring clinicians can submit applications on behalf of undiagnosed patients on the program website.

Previously: Using crowdsourcing to diagnose medical mysteries, New search engine designed to help physicians and the public in diagnosing rare diseases and The road to diagnosis: How to be insistent, persistent and consistent
Photo by Adrian Clark

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