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Global Health, In the News, Infectious Disease, Podcasts

Talking about the Zika virus

Talking about the Zika virus

The Zika virus has been reported in 23 countries and territories in the Americas. Brazil is the hardest hit nation so far with more than 1 million infections. In the continental U.S. the 35 known cases of Zika have been the result of people who have traveled to infected areas and returned to the U.S. No local mosquito-borne transmission has been reported.

Globalization has changed the rapid nature in which viruses spread. To that end, broad calls for action have been engaged. The World Health Organization has declared Zika an international health crisis, and the U.S. Centers for Disease Control and Prevention declared it a Level 1 alert – the highest activation. Earlier this week, President Obama asked Congress to allocate $1.8 billion in emergency finding to vaccine research, surveillance and rapid response programs. The request also includes foreign aid to countries most impacted by Zika.

While the virus is not known to be deadly and most people who contact it will have no symptoms at all, pregnant women are most at risk. To protect their babies, the CDC is warning pregnant women not to travel to areas affected by the virus. There is no vaccine to prevent the disease.

The New York Times yesterday provided an interesting detailed history of the virus’ path since its discovery in 1947, and new information about the virus is emerging every day. Just yesterday, CDC Director Thomas Frieden told the House Foreign Affairs Committee that the CDC has uncovered new evidence supporting the link between Zika and microcephaly, a birth defect in which infants are born with unusually small heads and incomplete brain development.

In this new 1:2:1 podcast I spoke with Stanford infectious disease expert Yvonne Maldonado, MD, about Zika and the latest on the virus. She’s a professor of pediatrics at the school of medicine and the chief of pediatric infectious disease at Stanford Children’s Health.

Previously: Zika outbreak shares key traits with Ebola crisis, Stanford experts point out

Global Health, Health Policy, In the News, Public Health

Zika outbreak shares key traits with Ebola crisis, Stanford experts point out

Zika outbreak shares key traits with Ebola crisis, Stanford experts point out

An op-ed co-authored by global-health physician Michele Barry, MD, calls attention today to alarming parallels between the outbreaks of Ebola and Zika. In the Los Angeles Times, she and co-author Yanbai Andrea Wang, JD, PhD, write:

Both were detected late… Both disease outbreaks generated sluggish international responses… And in both outbreaks, the heaviest burden fell on vulnerable populations least able to bear it…

These mistakes will continue to repeat, they write, unless significant changes are made:

To build an effective global system for containing infectious diseases like Zika and Ebola, we need to make sure that countries around the world have the surveillance capacity to identify outbreaks before they spiral out of control. That means giving technical and financial assistance to developing countries and having external monitoring and incentives to make sure that capacity is built. We also need to make sure that WHO — the only organization with the representation and legitimacy to do so — is up to the task of leading outbreak response when local forces are overwhelmed.

Zika is a mosquito-borne virus that can cause fever and joint pain and, in some cases, severe birth defects such as microcephaly. Recent cases have been concentrated in South and Latin America, particularly northern Brazil, and on Feb. 1, the World Health Organization declared the outbreak an international public health emergency.

Photos of babies with tiny heads have captured global attention, Barry and Wang note. “Let’s remember the broader systemic shortcomings that got us here in the first place.”

Previously: Ebola: It’s not over, Ebola: This outbreak is different and Stanford team develops a method to prevent the viral infection that causes dengue fever
Photo courtesy of USDA

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

Ethics, Genetics, In the News, Research

Cautious green light for CRISPR use in embryos in the U.K.; Stanford’s Hank Greely weighs in

Cautious green light for CRISPR use in embryos in the U.K.; Stanford's Hank Greely weighs in

balance-154516_1280Big news out of the United Kingdom today about the gene editing technology known as CRISPR/Cas9. Stanford law professor Hank Greely, JD, posted a brief take on his blog this morning applauding the move by the British Human Fertilisation and Embryology Authority to allow researcher Kathy Niakan, PhD, of the Francis Crick Institute to conduct gene editing experiments in early human embryos.

The BBC News and Nature each have good summaries of the science side of the ruling. Greely, who directs Stanford’s Center for Law and the Biosciences, breaks down the ethics. From his post:

This is important research that can only be done with human embryos, it is being done with surplus IVF embryos whose prospective parents agreed to this kind of use, and the researchers are forbidden to to try to produce human gene-edited babies.

Niakan’s experiments, tailored to increase our understanding of the very earliest stages of human development, will allow the modified embryos to develop for only 14 days, or until they consist of just a few hundred cells. She hopes that her findings will shed light on infertility and miscarriage.

Previously: Using CRISPR to investigate pancreatic cancer, CRISPR marches forward: Stanford scientists optimize use in human blood cells and CRISPR critters and CRISPR conundrums
Image by OpenClipartVectors

In the News, Pediatrics, Stanford News, Videos

“The need is out there”: A look at the new Teen Van

"The need is out there": A look at the new Teen Van

It’s big, blue and beneficial to hundreds of San Francisco Bay Area teens who don’t have the means or the motivation to visit a traditional doctors’ office.

The Mobile Adolescent Health Services Program operated by Lucile Packard Children’s Hospital Stanford — aka the Teen Van — was featured on this recent Bay Area Proud segment from NBC Bay Area.

Spearheaded by Seth Ammerman, MD, clinical professor of pediatrics, the van provides a host of health services to teens — 40 percent of whom are currently homeless or have been in the past year, Ammerman says.

Although the program has been around since 1996, the van itself is new, offering more space and enhanced technology. And there’s plenty of work to be done.

“The need is out there, unfortunately, for more programs like this,” Ammerman says.

Previously: Adolescent Health Van wins community award for aiming to “help kids turn their lives around” and Packard Children’s Adolescent Health Van celebrates 15 years
Video courtesy of NBC Bay Area

In the News, Public Health, Sleep

How to tell if you’re sleep deprived

How to tell if you're sleep deprived

mad cartoonAre you chronically cranky or hungry (or, worse, hangry)? Are you clumsy or prone to nodding off during a show? Those are just a few of the signs that you may be sleep-deprived — signs that are hilariously depicted through a series of TV and movie clips in a fun new Bustle piece. The article caught my attention because it includes comments from Stanford sleep expert Rafael Pelayo, MD, (who explains why being short on z’s can make it difficult to fall asleep at one’s normal bedtime), but I also quite like the wise words of writer Chrissa Hardy:

Functioning isn’t thriving, just as surviving isn’t really living. The bare minimum is never the goal, and sleeping the shortest amount of time in order to get through the following day is no way to present your best self to the world.

In other words, go get some sleep.

Previously: Stanford doc gives teens a crash course on the dangers of sleep deprivationStanford docs discuss all things sleepExploring the effect of sleep loss on health and What are the consequences of sleep deprivation?
Photo by Ben Piddington

Aging, In the News, Medicine and Society, Palliative Care, Patient Care

End-of-life discussions the focus of PBS piece

End-of-life discussions the focus of PBS piece

For many, end-of-life discussions are either unpleasant, brief, or unlikely to happen at all. But, as a recent episode of PBS’ Religion and Ethics NewsWeekly emphasized, it is critically important that patients have open and honest conversations on the topic with their family members and doctors.

The piece featured Philip Pizzo, MD, former dean of Stanford’s medical school and co-author of the 2014 Institute of Medicine’s 500-page report titled “Dying in America,” and VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training. Through the Stanford Letter Project, Periyakoil is on a quest to empower patients and help stimulate a broad national discussion on what matters most at life’s end. She says in the piece:

I think the biggest challenge is people don’t want to make plans and have discussions because the topic is so threatening to them. So what happens is because they don’t plan for it, they are subjected to treatments that are A, not helpful and B, not what they want.

I helped facilitate the interviews with Periyakoil and Pizzo last October; coincidentally around that time, my older sister suddenly fell ill and died unexpectedly. One of the things that came up was whether or not she had an advance directive and, fortunately for my family, my sister (who was just 46 years old) had written down her wishes and no one was left wondering or tasked to make a difficult decision. I know firsthand how beneficial the work of Periyakoil and others can be.

Previously: No one wants to talk about dying, but we all need toStudy: Doctors would choose less aggressive end-of-life care for themselvesHow would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues and Medicare to pay for end-of-life conversations with patients

Global Health, Health Policy, In the News, Pediatrics, Pregnancy, Women's Health

Ending preventable stillbirth: A Q&A with Stanford global-health expert Gary Darmstadt

Ending preventable stillbirth: A Q&A with Stanford global-health expert Gary Darmstadt

Today, prominent medical journal The Lancet publishes “Ending Preventable Stillbirth,” a series of articles calling for global efforts to greatly reduce fetal deaths that occur late in pregnancy or during labor. The series brings much-needed attention to a medical and societal problem that often goes ignored.

“Millions of women and families around the world have suffered the pain of stillbirth in silence,” said series adviser Gary Darmstadt, MD, a Stanford global-health expert who studies how to improve medical care for pregnant women, infants and children in developing countries.

Darmstadt recently answered my questions about why we should break the silence and work to lower stillbirth rates. “Many of the interventions that avert stillbirths also avert deaths of mothers and newborns,” he said. An edited version of his responses is below.

What’s the biggest misconception about stillbirth?

Perhaps the biggest misconception is that stillbirths don’t matter. There is a tradition of social stigma and lack of awareness of stillbirths that makes it easy to keep them out of sight and out of mind. But an estimated 1.2 million women around the world every year have an intrapartum stillbirth: They enter into labor after a normal pregnancy, with great expectations for a healthy baby and one of the most joyous experiences of a lifetime, only to face sudden devastation when the baby dies during birth. Their experiences matter.

A related misconception is that nothing much can be done to prevent stillbirth, or that prevention will divert scarce resources from other important issues. In fact, three fourths of intrapartum stillbirths around the world could be prevented through means that we take for granted in high income societies — such as skilled medical care before and during delivery — and that also benefit mothers, surviving newborns and children.

Why did the scientists involved in The Lancet’s new series think it was important to break the common pattern of silence, stigma and fatalism around stillbirth?

Stillbirth is a taboo topic in many societies, or worse yet, mothers are blamed for failing to deliver a healthy baby and feel intense social pressure to keep quiet about stillbirth. Their sense of loss and isolation may lead to depression, which in turn has many adverse consequences, including for subsequent pregnancies. On the other hand, many women who have the opportunity to talk about their experience with stillbirth and work through their grief express great relief and renewed hope. When the last Lancet stillbirth series came out five years ago, and women shared their experiences online or in parent support groups — often the first time they had ever shared their experience with stillbirth with anyone — many found this to be immensely healing and empowering. Thus, it was both the science showing the adverse effects of unexpressed and unresolved grief, and the testimonials of women who had experienced the benefits of breaking the silence that I believe influenced the scientists involved in The Lancet series to highlight this issue.

Continue Reading »

Health Disparities, History, In the News, LGBT, Medicine and Society

Film honors transgender pioneers

Film honors transgender pioneers

pride-828056_1920I knew little about the film “The Danish Girl” last weekend when, diverted from a sold-out showing of the Oscar favorite the “Revenant,” my husband and I disappointedly walked down Pacific Avenue in Santa Cruz to another theater to see the film about a transgender woman instead.

It proved to be a fortuitous diversion. “The Danish Girl” is artistically gorgeous and well acted, as today’s Academy Award nominations point out. The film received nominations for Eddie Redmayne as best actor in his role as a transgender artist, best supporting actress for Alicia Vikander, his wife who stands by him as he confesses that he believes he was born in the wrong gender and begins to dress as a woman they call Lili — and nods for costume design and production design as well.

But the film struck a more personal chord, halfway through its viewing, when I sucked in a short gasp realizing that, in addition to being a love story with a socially relevant message, the film was recounting a piece of medical history. And suddenly, the film took on a frightening edge.

I knew from my research for a story I wrote for Stanford Medicine magazine in 2012 titled “Transition point: The unmet needs of transgender people,” something of the challenges facing transgender people today as they navigate the medical world trying to get the care they need. The story describes the paucity of evidence-based medicine for transgender health care and the lack of training for physicians on how to provide care. As I wrote in the story:

The problem is that in the United States, most physicians don’t exactly know what treatment for the transgender patient entails. For an untrained professional, it’s a challenge to provide care to a patient with a penis who wants a vagina, or to a patient who has been tortured emotionally by being told she’s a boy when she knows she’s a girl. General practitioners — the majority of doctors who treat patients in the United States — are equally unprepared to care for those transgender patients after they have begun to take hormones and have undergone genital-reconstruction surgery. The lack of medical education on the topic, a near-total absence of research on transgender health issues and the resulting paucity of evidence-based treatment guidelines leave many at a loss.

The film, as I suddenly realized sitting in the darkened theater, must have been inspired by those transgender pioneers in 1920s Europe who chose to undergo the first experimental sex reassignment surgeries. Of course, as with any surgery, there had to be those first patients. I’d just never thought about it before.

In fact, I later learned, the film was inspired by the real life Lili Elbe, a Danish transgender woman born in 1882, who was one of those first patients. The film honors the memory of these brave transgender pioneers, and, perhaps, will prod others to consider the continued inadequacies of medical care today, and what can be done to improve them.

Previously: Stanford study shows many LGBT med students stay in the closet, Study shows funding for LGBT health research lacking, offers solutions and Gay, lesbian, bisexual and transgendered health issues not being taught in medical school
Photo by nancydowd

Health Policy, In the News, Women's Health

Breast screening recommendations — finalized?

Breast screening recommendations — finalized?

mammogramThe simmering national debate over how often and at what age women should get mammograms has come to a full boil once again.

This week, the U.S. Preventive Services Task Force reaffirmed its 2009 guidelines that said women in their 40s with an average risk of breast cancer should discuss mammography with their clinicians and make individual decisions about whether to have the screening.

The panel members said their final recommendation is that women 50 and older only get the screening every other year.

This has provoked an outcry from some medical associations and cancer-awareness advocates who fear the advice would lead some women to delay having mammograms and put them at greater risk of death. A task force editorial explains:

In 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate.

Many of these stakeholders focused on the need for women to be able to make more informed health care choices about when to start screening without having to worry about the cost of an insurance copayment.

Douglas Owens, MD, director of the Center for Health Policy and the Center for Primary Care and Outcomes Research, is a member of the task force.

The task force determined that while screening mammography in women aged 40 to 49 may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.

The balance of benefits and harms is likely to improve as women move from their early to late 40s, the task force said.

Breast cancer is the second-leading cause of cancer death among women in the United States, according to the National Cancer Institute. In 2015, an estimated 232,000 women were diagnosed with the disease and 40,000 women died.

Previously: A new way of reaching women who need mammograms, Education reduces anxiety about mammography and Screening could slash number of breast cancer cases
Photo by Getty iStock

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