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Global Health, Health Disparities, Pediatrics, Stanford News, Technology

Sunshine solves a life-threatening newborn health problem — with a little help from Stanford experts

Sunshine solves a life-threatening newborn health problem — with a little help from Stanford experts

jaundice-greenhouseWhen pediatrician Tina Slusher, MD, began caring for newborns in Nigeria in 1989, she saw two big threats to the babies’ health: severe jaundice and tetanus.

“I thought, ‘Tetanus will go away with immunization, but nobody really seems to understand this jaundice problem,'” Slusher, a global pediatrics expert at the University of Minnesota, told me recently. In developing countries, well over 150,000 babies a year currently die or suffer severe brain damage from jaundice. “They still aren’t getting treated,” Slusher says.

But now, thanks to Slusher and her colleagues, that is set to change. She is the lead author on a scientific paper in the New England Journal of Medicine that evaluated a low-tech, inexpensive method for treating jaundice with filtered sunlight. The technology was conceived and built at Stanford, by a team led by neonatal jaundice expert David Stevenson, MD.

Newborn jaundice is caused by a delay after birth in development of the baby’s ability to metabolize compounds released in the breakdown of red blood cells. In the U.S. and other developed countries, most cases are treated with phototherapy. But putting a baby under a blue-light-emitting lamp isn’t feasible in places that lack steady electricity. The team members, who also included doctors and researchers at the Massey Street Children’s Hospital in Lagos, Nigeria, wondered if they could safely use filtered sunshine instead.

From our press release about the new study:

Some mothers and babies sat under outdoor canopies that filtered out harmful wavelengths from sunlight, but still allowed jaundice-treating blue wavelengths to reach the babies’ skin. The filtered-sunlight treatment was as safe and effective as the blue-light lamps traditionally used to treat infant jaundice.

“This research has the potential for global impact,” said the study’s senior author, David Stevenson, MD, the Harold K. Faber Professor in Pediatrics and senior associate dean for maternal and child health at Stanford. “All babies can get jaundice. In settings with no access to modern devices, we’ve shown we can use something that’s available all around the planet — sunlight — to treat this dangerous condition.” Stevenson also directs the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford.

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Clinical Trials, Health Disparities, Mental Health, Research, Stanford News

How people with mental illness get left out of medical research studies

How people with mental illness get left out of medical research studies

One of the enduring challenges of evidence-based medicine is that the characteristics of people who participate in clinical trials can differ markedly from those of patients who ultimately access the treatment which the trial evaluates. One of the many reasons this occurs is that researchers often exclude patients with certain characteristics from participating in clinical trials.  In a new study in Journal of Psychiatric Research, my colleagues Laura Roberts, MD; Janet Blodgett, and I examine a particular population to whom this occurs: People with mental health and/or substance use disorders.

If scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to more consistently include people with psychiatric problems in studies

In a sample of 400 highly-cited randomized trials across 20 common chronic disorders, we found that half had eligibility rules that prevented people with psychiatric problems from enrolling.   Those disease research areas with high rates of reported psychiatric exclusion criteria in clinical trials included low back pain (75 percent), osteoarthritis (57 percent), COPD (55 percent), and diabetes (55 percent).  People with conditions such as depression, anxiety disorders, alcohol problems and schizophrenia thus may face some added risk when they seek health care: People like them were often left out of the research that tells doctors what medical treatments work.

The study also raises questions about whether some clinical trials make much of a contribution to knowledge. For example, now that psychiatric and other substance use problems are virtually normative among smokers, what is the point of smoking cessation studies that continue to exclude the very populations that do most of the smoking?

Including people with psychiatric problems in medical research may require extra resources for researchers (e.g., people with serious mental illness may be harder to follow up) or pose other challenges in completing clinical trials. But if scientists are to live up to their laudable commitment to sharing the benefits of health research with all citizens, they’ll have to meet these challenges and more consistently include people with psychiatric problems in medical research studies.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He has served in the past as a senior advisor in the Office of National Drug Control Policy in Washington, DC. He can be followed on Twitter at @KeithNHumphreys.

Health Disparities, Medicine and Society, Parenting, Pediatrics, Public Health, Stanford News

Stanford med student helps turn pediatrics waiting room into a center for school-readiness

Stanford med student helps turn pediatrics waiting room into a center for school-readiness


For many low-income children, a pediatrician is the only professional they interact with before they start kindergarten. This fact inspired Jecca Steinberg, a second-year Stanford medical student and Schweitzer Fellow, to think about how that interaction could improve these children’s school readiness, which often lags behind that of their peers. If these kids could be equally well-prepared for kindergarten, their potential for economic mobility would skyrocket.

Now, in an innovative collaborative effort, the pediatrics waiting room of Fair Oaks Health Center in Redwood City, Calif. is being turned into a learning center. According to previous research conducted by the Stanford Pediatric Advocacy Program, the clinic’s patient population includes more than 900 low-income children between the ages of 2 and 5; surveys indicate that only 31 percent participated in any kind of formal pre-school education and 82 percent were not school-ready by kindergarten.

In collaboration with Neel Patel, MD, the medical director at the clinic, Steinberg reached out to Stanford art practice lecturer Lauren Toomer, MFA, who volunteered her time and talent to produce a mural that will transform the drab waiting room into a space for learning opportunities. The mural incorporates letters, numbers, shapes, and images of the Redwood City community, as well as three interactive learning panels. Patel generously donated the funds for the supplies. See the prototype above; the actual mural will be finished by early October.

In a recent phone conversation, Steinberg explained to me that the mural project is one component of a larger project called Kinder Ready, which is part of Stanford’s Pediatric Advocacy Program led by Lisa Chamberlain, MD, MPH, and Janine Bruce, DrPH. (The work at Fair Oaks Clinic has been led by Stanford pediatrics residents Jaime Peterson, MD, and Ashley Case McClary, MD.) I asked her more about their efforts:

How did you get involved in this work?

I’d say my entire motivation for entering the field of medicine is centered on providing opportunities for socioeconomic mobility, and although health is an incredibly important aspect of that, it can’t be viewed in a vacuum as a solution. So these interdisciplinary efforts touch on everything I’m passionate about. For my first-year Stanford Medical Scholars research project, called community based participatory research, I set up a series of focus groups with low-income parents to talk to them about their conceptions of school readiness: what they think a role of a parent is, and how they think a pediatrician could help them.

Currently I help screen children for their school-readiness level, and I work with the parents to teach them different activities that they can do at home to promote their children learning. I’ve been working with Dr. Patel to include activities and interventions in well-child visits that parents can take home with them. We set them up with library cards, let them know about parent-child reading hours and mommy-and-me classes in the community, and make it easier to get a hold of books and other learning materials.

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Health Disparities, In the News, Nutrition, Public Health

Turning brown bananas into ice cream: Repurposing surplus food reduces hunger, creates jobs

Turning brown bananas into ice cream: Repurposing surplus food reduces hunger, creates jobs

8421632884_224d355c21_zAccording to a recent report, the United States is one of the most wasteful countries in the world. Up to 40 percent of American food is thrown in the trash, which seems absurd given that food insecurity and hunger are still such problems in this country. Adequate nutrition is a basic for preventing disease and promoting health.

But students at Drexel University are working on improving the situation. They developed a program to use would-be supermarket waste in producing value-added food products. Not only can these products be provided to hungry people, they can be sold back to the supermarket in a mutually-beneficial relationship that could also support new jobs.

The strategy – called a “Food System-Sensitive Methodology”, or FSSM – was developed as part of the Environmental Protection Agency’s Food Recovery Challenge, and is described in a recent Food and Nutrition Sciences article. Drexel culinary arts and food science students decided to reach out to supermarkets because these stores are some of the biggest producers of waste: They throw out produce that is bruised, marked, or misshapen, or remove food simply to make room for fresher shipments. For their pilot project in West Philadelphia, students collected thousands of pounds of fruits and vegetables from local supermarkets and improved their value and palatability by developing recipes in the student-run Drexel Food Lab, a research group that aims to address real-world food issues.

Americans are used to cosmetically pristine produce, and many won’t eat a brown banana even when they’re hungry. Jonathan Deutsch, PhD, director of Drexel University’s Center for Hospitality and Sport Management, explains in a press release how FSSM addresses this: “For example, we took those brown bananas, peeled them, froze them and food processed them to create banana ice cream, which is much more appealing.” Drexel has given facelifts to similarly lackluster items, like canned peas. This requires chefs to think in a new, more sustainable way: Instead of concocting a recipe and then buying ingredients, they must be creative with what’s given to them.

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Behavioral Science, Emergency Medicine, Health Disparities, Pain, Patient Care, Pediatrics, Research

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

crying-613389_1280When a child arrives in the emergency room complaining of a stomach pain, appendicitis is the last thing you want to miss, says KT Park, MD, assistant professor of pediatrics.

“The question is, ‘Does this patient have appendicitis – yes or no?,” he said. It is the most common immediate emergency that could bring a child into the emergency room with abdominal pain. If not treated in a timely manner, the appendix can burst, leading to infection or a host of other serious complications.

But kids arrive in the emergency room complaining of stomach aches all the time; most with perfectly healthy appendices. And what if you’re a doctor who has seen seven kids with more minor stomach problems one day? It might be tricky to spot that first case of appendicitis.

Unfortunately, misdiagnosis happens more often when the pediatric patient is black, Hispanic or low-income, according to a study published today in PLOS ONE led by Park and Stanford medical student Louise Wang.

“Our goal in this study is getting the word out about abdominal pain and appendicitis and the importance of the decisions made in the emergency room,” Wang said.

The researchers analyzed national data from 2 million pediatric visits to emergency rooms between 2004 and 2011 complaining primarily of abdominal pain. They found that blacks, Hispanics and low-income children were less likely to receive imaging that could help their physicians diagnose serious conditions like appendicitis. These patients were also less likely to be admitted to the hospital, but more likely to suffer perforated appendicitis, a clue that perhaps they didn’t receive adequate treatment in time, Park said. For example, low-income blacks were 65 percent more likely to have a perforated appendix compared to other children.

The study was not able to precisely determine why these disparities exist, Wang said. “What is the driving influence of these outcomes? Are these kids being mismanaged in the emergency department, or are they presenting at a later time in a more serious condition?,” she asked.

She and Park have a few ideas, based on other findings and their personal experience. Minorities and low-income families are more likely to use the emergency room as a first-stop for more minor conditions, rather than visiting their primary care doctor or pediatrician.

“This is a very delicate topic,” Park said. “Physicians are humans and there is potentially some intuitive thinking that goes on about the probabilities of various diagnoses more common in certain patient groups, potentially leading to differences in how clinicians perceive the acuity of a patient’s status.”

Appendicitis can be tricky to diagnose, a task made even harder when patients are young and unable to clearly describe their pain, Park said.

“The psychology of physicians is an area needing further evaluation,” Park said. “We have internal biases that we often are not even aware of. We want to be objective, but it’s never a black-and-white decision making tree.”

Previously: A young child, a falling cabinet, and a Life Flight rescue, New test could lead to increase of women diagnosed with heart attack and Exploring how the Affordable Care Act has affected number of young adults visiting the ER
Photo by amandacatherine

Health Disparities, Medical Education, Medicine and Society, Public Health, Science

Stanford Medical Youth Science Program for underrepresented students expands and deepens

Stanford Medical Youth Science Program for underrepresented students expands and deepens

unnamedThe Stanford Medical Youth Science Program (SMYSP) is a 5-week summer residential program for rising high school juniors and seniors interested in science and medicine. The students, who come from underrepresented and low-income backgrounds, have an opportunity to experience the medical profession from the inside out. This year’s program concluded late last month with a graduation ceremony in which the students presented their scientific research projects on health disparities and advocacy to an audience of their parents and supporters.

A few weeks ago, I had the chance to speak with the program’s longtime director, Judith T. Ned, EdD, who told me SMYSP has come a long way since it was co-founded 28 years ago by Stanford epidemiologist Marilyn Winkleby, PhD, MPH. This is Ned’s 14th year running the show. She has made lot of beneficial changes and expansions, many of which happened since we last featured SMYSP in 2010, without losing sight of the program’s purpose: to expose these kids to the fields of science and medicine while increasing workforce diversity in the health professions.

Each year, 12 boys and 12 girls are selected for the program, all of whom come from 20 counties surrounding Stanford. “The goal is to really provide services and opportunities to students who are in our backyard, if you will,” Ned told me. The students have a well-rounded curriculum – not only do they attend lectures by leading academics and industry professionals, anatomy lectures and labs (with cadavers!), and twice-weekly clinical internships, but they have non-clinical days where they investigate departments like hospital food service, security, and art therapy. “We want to show them that it takes multiple people in multiple areas to really make the hospital function. Most of the time, many of my students serve as translators for their parents when they go into the hospital. This is the flip side: the provider’s perspective, not the patient’s. It’s been an interesting experience to see them switch mindsets.”

Programming includes SAT prep, “game shows” to improve knowledge retention, and evening workshops that include leadership development and performing arts. Ned wants the students to know that “you can take a well-rounded liberal arts education, get into medical school, and still practice your craft, embracing both sides of your identity.” Community service is also a key feature of the program, such as the beautification project they did at the East Palo Alto YMCA the Saturday before our interview.

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Health Disparities, Mental Health, Pediatrics, Public Health

Stanford study of mental illness in incarcerated teens raises policy questions

Stanford study of mental illness in incarcerated teens raises policy questions

depressionMental illness is an even bigger problem for jailed teenagers than experts previously realized.

That’s the take-away message from a Stanford study, publishing today in the Journal of Adolescent Health, which compared 15 years’ worth of hospital stays for adolescents in California’s juvenile justice system with hospitalizations of other California kids and teens. Experts already knew that juvenile inmates are more likely than other young people to have mental health problems, but the new study gives fresh perspective on the scope of the issue.

The research team, led by Arash Anoshiravani, MD, an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford, looked at 15 years of hospital-stay data for California’s 11- to 18-year-olds. From a total of almost 2 million hospitalizations, about 11,000 were for incarcerated youth.

Of these 11,000 hospital stays, 63 percent were due to mental-health diagnoses. In contrast, just under 20 percent of the hospital stays by adolescents from the general population were prompted by mental illness. Hospital stays were also longer for the incarcerated teens, suggesting more severe illness.

However, the kinds of diagnoses were pretty similar between the two groups, with depression and substance abuse the most common. From our press release about the new study:

The types of diagnoses suggest that many incarcerated teens’ mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.

“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new data will motivate social change around the problem.

“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”

Previously: Online health records could help high-risk teens, study finds, Lucile Packard Children’s Hospital partners with high schools on student mental health programs and Increasing awareness and advocacy of emotional disorders with mental health first-aid programs
Photo by ryan melaugh

Chronic Disease, Genetics, Health Disparities, Pediatrics, Research, Stanford News

Cystic fibrosis is deadlier for Hispanic patients, Stanford study finds

Cystic fibrosis is deadlier for Hispanic patients, Stanford study finds

Lungs-embroideryHow do physician-scientists select research projects? Sometimes, they’re prompted by the niggling feeling that something is not right.

That’s what happened to cystic fibrosis doctor MyMy Buu, MD, the lead author on a new paper that uncovers an important health disparity, a higher mortality rate for CF patients of Hispanic ethnicity. Buu, a pediatric pulmonologist who takes care of CF kids at Lucile Packard Children’s Hospital Stanford, launched the research because she noticed something worrying: It seemed to her that a lot of Hispanic children with CF were not doing well.

“…I didn’t know if this was just because we have more Hispanic patients in California, or if they were actually, really, sicker,” Buu said. CF is a genetic disease that causes serious breathing and digestive problems; Buu’s job is a mixture of trying to help her patients stay relatively healthy and dealing with complications of the disease.

“Because I’m interested in health disparities, I wanted to see if there were any differences in outcomes in the Hispanic group,” she said.

She turned to the Cystic Fibrosis Foundation‘s patient registry, focusing on 20 years of data that encompass every California child diagnosed with CF from the beginning of 1991 to the end of 2010. Of the children studied, Hispanic CF patients were almost three times as likely to die as their non-Hispanic counterparts.

Buu and her colleagues were able to use the data to eliminate several possible explanations for the disparity. Hispanic children were not being diagnosed later than non-Hispanic kids and did not have less access to health care, for instance. Our press release about the study describes the factors that may contribute to the disparity:

However, the researchers did find important clinical and social differences between the groups. At age 6, the earliest that lung function is routinely and reliably measured for patients with CF, Hispanic children with CF had worse lung function than non-Hispanic kids with the disease. The gap in lung function persisted as the children aged, although it did not widen. And although the same proportion of patients in both groups eventually developed CF complications, the complications struck Hispanic patients earlier in life. Hispanic patients lived in poorer neighborhoods and were more likely to be covered by public health insurance than their non-Hispanic counterparts.

The research also showed that, between the two groups, different mutations prevailed in the disease-causing gene, which is called the CF transmembrane conductance regulator gene. Hispanic patients tended to have rare and poorly characterized mutations in their CFTR gene, whereas non-Hispanic patients had more common mutations that have been more extensively researched.

The next steps, Buu said, are to make others aware of the increased risk for Hispanic CF patients and to figure out how the risk can be reduced.

Previously: Cystic fibrosis patient on her 20+ years of care, New Stanford-developed sweat test may aid in development of cystic fibrosis treatments and Film about twin sisters’ double lung transplants and battle against cystic fibrosis available online
Image by Hey Paul Studios

Global Health, Health Disparities, Health Policy, Stanford News

Rosenkranz Prize winners devoted to innovative health care in developing countries

Rosenkranz Prize winners devoted to innovative health care in developing countries

African girls studyingMarcella Alsan, MD, PhD, knows that the division of labor among men and women starts at a young age in the developing world.

“Anecdotally, girls must sacrifice their education to help out with domestic tasks, including taking care of children, a job that becomes more onerous if their younger siblings are ill,” Alsan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) within the Freeman Spogli Institute of International Studies, recently told me.

More than 100 million girls worldwide fail to complete secondary school, despite research that shows a mother’s literacy is the most robust predictor of child survival. So Alsan is analyzing whether medical interventions in children under 5 tend to lead their older sisters back to school. She’ll compile data from more than 100 Demographic and Health Surveys covering nearly 4 million children living in low- and middle-income countries. The surveys ask about episodes of diarrhea, pneumonia and fever in children under 5 and record data on literacy and school enrollment for every child in the household.

“My proposed work lays the foundation for a more comprehensive understanding of how illness in households and early child health interventions impact a critical determinant of human development: an older girl’s education,” Alsan, the only infectious-disease trained economist in the United States, said.

Alsan is one of two winners of this year’s Rosenkranz Prize for Health Care Research in Developing Countries, awarded by CHP/PCOR. Her Department of Medicine colleague, Jason Andrews, MD, is the other recipient of the $100,000 prize, which is given to young Stanford researchers to investigate ways to improve access to health care in developing countries.

In the current scientific climate, most National Institutes of Health grants go to established researchers. The Rosenkranz Prize aims to stimulate the work of Stanford’s bright young stars – researchers who have the desire to improve health care in the developing world, but lack the resources.

While Alsan is researching how older girls in poorer countries are impacted by the health of their younger siblings, Andrews is focusing his attention on cheap, effective diagnostic tools for infectious diseases.

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Big data, Health Disparities, Medicine and Society, Men's Health, Research, Stanford News

To live longer, men need to embrace their femininity, new research suggests

To live longer, men need to embrace their femininity, new research suggests

13938506188_faea591a9b_z (1)Scores of scholars have examined a fundamental truth of our time: Women live longer than men. But why?

After poring over data spanning centuries and continents, a team of Stanford researchers has discovered an overlooked aspect of that disparity. When there’s plenty to go around, the gap between men and women shrinks. But when adversity strikes, men die young.

And in cultures where women excel — racking up academic, professional and extracurricular accomplishments equalling or topping men — men live longer too, said Mark Cullen, MD, the first author of the recently published study that also appears in an abridged, reader-friendly form on Vox.

“The punchline is feminism is good for men too,” Cullen said.

The team posits that women are hard-wired to protect each other, an ingrained trait that goes beyond hormones and isn’t culturally dependent.

The researcher’s primary conclusion — that socio-economic stress hits men harder than women — is solid. Cullen and team looked at societies worldwide, finding that in poorer nations women live about 10 years longer than men, while in the United States the gap is closer to five years. When a social safety net is pulled out suddenly, such as following the fall of the Berlin Wall in Eastern Europe, the lifespan of men dropped nearly 15 years, Cullen said.

“Men were just dropping like flies. But that didn’t happen to women,” he said.

The team posits that women are hard-wired to protect each other, an ingrained trait that goes beyond hormones and isn’t culturally dependent.

“Women live differently,” Cullen said. “They seek each other, invest heavily in family and nurturing, which men do much less of. That’s the secret sauce — women have each other and this incredible support network.”

As women enter the workforce, and men invest in family relationships and social networks, the lifespan gap begins to lessen. “It’s the feminization of the way that men live that helps men,” he said.

As evidence, the team points to Alaska and highly developed Asian nations such as Japan and Korea. There, female lifespans far surpass male’s, probably because despite their economic success, their cultures embrace traditional gender roles. “These are places where men are men, and they die like men,” Cullen said.

Next, the team plans to continue their inquiry by investigating the hypothesis that equality helps men and search for policy programs that also boost men’s lifespans.

Cullen directs the Stanford Center for Population Health Sciences. His co-authors include Michael Baiocchi, PhD, assistant professor in the Stanford Center for Population Health Sciences; Karen Eggleston, PhD, director of the Asia Health Policy Program; Victor Fuchs, PhD, Henry J. Kaiser Professor, emeritus, of economics and of health research and policy; and statistician Pooja Loftus, MS.

Previously: “Are we there yet?” Exploring the promise, and the hype, of longevity research, Living loooooooonger: A conversation on longevity and Social factors better indicators of premature mortality than skin color or geography

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