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Fertility, Pediatrics, Public Health, Research, Sexual Health, Stanford News, Women's Health

IUD is overlooked as excellent birth control for teens, Stanford expert says

IUD is overlooked as excellent birth control for teens, Stanford expert says


When teenagers think of birth control, the pill and condoms are likely the first to come to mind – and indeed the pill is the number one choice of contraceptive among adolescents. But according to Stanford ob/gyn expert Paula Hillard, MD, the IUD is a long-acting reversible contraception (LARC) excellently suited for adolescents. In an editorial published in the October issue of Journal of Adolescent Health, Hillard urges doctors to consider the benefits of LARCs for young women.

The IUD and other LARCs don’t require consistent, correct daily use, so they’re easier to use and less likely to fail. In addition to being extremely effective, IUDs have a high rate of satisfaction among adolescents. Some types of IUDs can also be used therapeutically for problems like heavy bleeding or cramping. LARCs are also cost-effective over time, and the initial investment is no longer a barrier in California due to the Family PACT program, which allows teens to confidentially access birth control at no cost. In addition, the Affordable Care Act mandates that contraceptive methods must be covered in most cases without a co-pay.

So what are the barriers to use? They include misconceptions and lack of information on the part of both teens and providers, as well as provider concerns about the insertion procedure in young women who haven’t given birth.

In an email, Hillard told me:

Many physicians and most adolescents are unaware that modern IUDs provide contraception that is 20 times more effective than birth control pills, the patch or the ring. IUDs are a method of birth control that is very safe, very effective, and “forgettable”.  IUDs are considered to be “top tier” contraceptive methods (along with subdermal implants and sterilization, which is not appropriate for typical adolescents) by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics.

IUD use has increased from 0.5 percent to 2.5 percent among teens 15-19 years old over the past decade. Still, around 50 percent of obstetrician-gynecologists don’t consider an IUD as a first-line contraceptive for adolescents.

Hillard closes her piece with a discussion of the challenges and importance of counseling for adolescents. Proper counseling includes giving the most effective options priority, and discussing side-effects up front (which improves adherence to contraceptive regimens, including in adults). She writes:

It remains important for us as clinicians to fight for reproductive justice and contraceptive access for all women, with the elimination of barriers including costs. In our counseling, we need to honor principles of informed consent, be aware of power differences between ourselves and our patients, be certain that our counseling is not coercive, and carefully respect our patients’ choices.

Previously: Research supports IUD use for teens, Will more women begin opting for an IUD?, Study shows women may overestimate the effectiveness of common contraceptives and Study: IUDs are a good contraceptive option for teens
Photo by Liz Henry

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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Autoimmune Disease, Chronic Disease, FDA, Immunology, Pediatrics, Research, Stanford News

Can a safe, cheap pill prevent type 1 diabetes?

Can a safe, cheap pill prevent type 1 diabetes?

happy pillType 1 diabetes, an autoimmune disorder once known as juvenile diabetes because it tends to strike during adolescence or earlier, affects one in every 300 people. With the diagnosis comes the certainty of a lifetime of insulin injections, made necessary due to the destruction of insulin-producing cells in the pancreas by a misguided immune system.

Insulin is a hormone that alerts the body to the presence of glucose in the blood, typically after a meal. In insulin’s absence, the body’s tissues fail to take up glucose, a key energy source. Without several-times-daily insulin shots, type 1 diabetes patients’ blood sugar levels can shoot up to dangerous heights – a condition called hyperglycemia.

There’s never been any way to prevent type 1 diabetes, although it can be predicted based on the detection of self-targeting antibodies in a blood test. But screening for type 1 diabetes this way hasn’t been particularly useful, because there’s been nothing to be done for patients diagnosed in the asymptomatic phase except wait for them to become hyperglycemic and put them on insulin.

Now, an elaborate mouse study by Stanford immunologist and structural biologist Paul Bollyky, MD, PhD, shows that it might be possible to intervene during the asymptomatic stage of type 1 diabetes – using a pharmaceutical compound that’s been on the global market for more than 40 years and has a terrific safety record – thereby stopping the immune system’s stupid but relentless destruction of the pancreas’s vital insulin-producing cells, and stave off hyperglycemia indefinitely.

Bollyky and his colleagues first showed that a particular substance, hyaluronan, builds up near insulin-producing cells in mice developing the murine equivalent of type 1 diabetes, confirming earlier findings in postmortem human pancreatic tissue that had been supplied to Bollyky’s team by the Juvenile Diabetes Research Foundation.

“We wondered what would happen if we prevented that buildup,” Bollyky told me when I interviewed him for my news release on the study. “And we knew a drug that does that.”

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Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

Neuroscience, Pediatrics, Research, Stanford News

Stanford team shows that one-on-one tutoring relieves math anxiety in children

Stanford team shows that one-on-one tutoring relieves math anxiety in children

Math-worksheetKids who suffer from anxiety about doing math problems can find relief in a program of one-on-one tutoring, which not only improves their math skills but also fixes abnormal responses in the fear circuits in their brains.

That’s the finding from a new study published today in the Journal of Neuroscience. The study is great news for those seeking relief from a common but often-overlooked problem.

From our press release about the research:

“The most exciting aspect of our findings is that cognitive tutoring not only improves performance, but is also anxiety-reducing,” said the study’s senior author, Vinod Menon, PhD, professor of psychiatry and behavioral sciences. “It was surprising that we could, in fact, get remediation of math anxiety.”

Even if they are good at math, many children feel anxious about doing math problems. For some, the anxiety persists throughout life, discouraging them from pursuing advanced math and science classes as well as careers that rely on mathematical expertise. Yet almost no attention has been paid to how to help alleviate this problem.

“Math anxiety has been under the radar,” said the study’s lead author, research associate Kaustubh Supekar, PhD. “People think it will just go away, but for many children and adults, it doesn’t.”

The researchers tested the idea that math anxiety could be helped with the same tactics used for phobias, which can be relieved by exposure therapy. In this approach, the person suffering the phobia is repeatedly exposed to the thing they fear, but in the context of a safe environment. The eight-week tutoring program, which covered a series of basic addition lessons, gave kids an opportunity to repeatedly tackle math concepts with the help of someone who could give positive, appropriate guidance to get past any bottlenecks in their understanding.

The team plans to conduct future research to find out what elements of the tutoring were most important in alleviating kids’ fear of math.

Previously: New research tracks “math anxiety” in the brain, Stanford team uses brain scans to forecast development of kids’ math skills and A not so fearful symmetry: Applying neuroscience findings t0 teaching math
Photo by Hana Tichá

Autism, Pediatrics, Research, Stanford News

Girls with autism show behavior and brain differences compared to boys, Stanford study finds

Girls with autism show behavior and brain differences compared to boys, Stanford study finds

Boy&girlLast week, a new Stanford study answered one of the oldest questions in autism research: Does autism differ between boys and girls?

Yes, the study found. According to the results published in Molecular Autism, girls tend to have less severe manifestations of one core feature of autism, repetitive and restricted behavior, and they show brain-scan differences from boys that help explain the discrepancy.

Hints of a gender difference in autism extend all the way back to the first clinical report of the disorder, published in 1943, which described eight boys and three girls. 70 years after that report, boys are still more commonly diagnosed; among kids with high-functioning autism, the ratio of boys to girls is four to one. But questions about the nature of the gender split have persisted, as our press release on the work explains:

“We wanted to know which specific clinical manifestations of autism show significant gender differences, and whether patterns in the brain’s gray matter could explain behavioral differences,” said the study’s senior author, Vinod Menon, PhD, professor of psychiatry and behavioral sciences. Knowledge of the difference could help clinicians better recognize and treat autism in both sexes, he added. “Understanding this is really quite crucial clinically.”

Prior studies of the gender difference have typically been small and inconclusive. So the Stanford team took a new approach, using two large public databases that capture information from patients all over the country. This allowed them to study almost 800 children who fit a fairly narrow set of criteria: age 7 to 13, evaluated by standard tests for autistic behavior, and with an IQ above 70.

Girls had lower (more normal) scores than boys on a standard evaluation of repetitive and restricted behavior, which includes preoccupation with narrow interests, inflexibility about routines and repetitive motions such as hand-flapping, the study found. Girls and boys did not differ on measures of autism’s other core features, which are social and communication deficits.

MRI brain scans on a subset of the children showed different grey-matter patterns between boys and girls in the motor cortex, supplementary motor area and part of the cerebellum. These areas help the brain plan and carry out motor functions, which the researchers said was noteworthy because many repetitive behaviors have a motor component.

“The discovery of gender differences in both behavioral and brain measures suggests that clinicians may want to focus diagnosis and treatments for autistic girls differently than boys,” [lead author Kaustubh] Supekar,PhD, added.

Previously: A new insight into the brain chemistry of autism, Unlocking autism’s secrets: Stanford researchers point fingers at a brain cell dark horse and Parents can learn autism therapy in groups to improve kids’ verbal skills, Stanford study shows
Photo by Barbara Abate

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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Patient Care, Pediatrics, Research, Stanford News, Surgery

Spanish-speaking families prefer surgical care in their native language, study finds

Spanish-speaking families prefer surgical care in their native language, study finds

Bruzoni-scrubsFive years ago, when Matias Bruzoni, MD, was a new pediatric surgical fellow at Lucile Packard Children’s Hospital Stanford, his fluency in Spanish meant that he often accompanied other surgeons to consult with Hispanic families who spoke little English.

“I went with the attending surgeon, and would help explain the operation in Spanish, and then the family would say to me ‘Great, would you mind being our surgeon?'” he recalled recently. “And I’d say, ‘But I’m a fellow’ and they would say ‘We’d rather stay with you.'”

The families greatly valued their linguistic and cultural connection to Bruzoni. As he had more of these interactions, Bruzoni realized the hospital’s entire pediatric general surgery team held a mostly untapped linguistic resource. Many of its members – including receptionists, nurse practitioners and triage staff – spoke fluent Spanish.

After Bruzoni finished his training, he organized this group of caregivers into the hospital’s Hispanic Center for Pediatric Surgery, which offers patients and families the ability to receive all of their pre- and post-surgical care in Spanish. Every interaction, from registering the patient to giving post-surgical instructions, happens in the families’ first language. Bruzoni wondered how this approach would compare to using trained medical interpreters, whose services are offered to all non-English-speaking families at the hospital.

A new study, published in the most recent issue of the Journal of Pediatric Surgery, shows what his research found. From our press release:

Spanish-speaking families that discussed their children’s care in Spanish reported a higher level of satisfaction and higher ratings of the quality of information they received compared with the families in the control group and those that worked through an interpreter. Spanish-speaking families rated the importance of discussing care in their native language more highly than English-speaking families, the study found.

Although socioeconomic status was not assessed in this study, Bruzoni noted that Hispanic families of low socioeconomic status may have an even greater need than others to receive care in their native language. “There is a big cultural barrier,” Bruzoni said. “Because of these patients’ circumstances, it is even more important to work with them using their own language.”

Bruzoni plans to continue studying how to deliver better surgical care to California’s growing population of Hispanic children.

Previously: Stanford student earns national recognition for research on medical communication, An app to break through language barriers with patients and Advice for parents whose kids need surgery
Photo courtesy of Lucile Packard Children’s Hospital Stanford

Big data, Pediatrics, Research, Stanford News

Rare gene variants help explain preemies’ lung disease, Stanford study shows

Rare gene variants help explain preemies' lung disease, Stanford study shows

double-helixBecause they’re born before their lungs are fully mature, premature babies are at risk for a serious lung disease. Over the last several decades, this disease, bronchopulmonary dysplasia, has evolved into both a great medical success story and a persistent mystery. But a new Stanford study, published this week, is helping clarify the mysterious part.

First, the success story: Today, doctors can prevent BPD in many babies who would have died of it in the past. Artificial surfactant, which helps keep the air sacs of the lungs open, and extensive research on when it’s appropriate and safe to put preemies on a respirator have both greatly reduced the risk of lung injuries after birth, which can contribute to BPD. The improvement has been especially remarkable for babies born on the later end of the premature spectrum.

However, BPD is still a big problem for infants who arrive more than 12 weeks early. Doctors still have trouble figuring out which of these early preemies are at risk, and why. An editorial accompanying the new Stanford study, which appears in the American Journal of Respiratory and Critical Care Medicine, explains how scientists’ understanding of BPD has evolved:

It is now widely appreciated that the persistence of BPD is strongly linked with factors far beyond postnatal lung injury alone. Importantly, the BPD and related respiratory outcomes clearly have antenatal origins… Growing data support the concept that BPD is at least partly a “fetal disease.”

The editorial names several factors in the prenatal environment that weigh into BPD risk, including certain pregnancy complications and also maternal smoking or drug use. It’s not just the environment that plays into risk, though; twin studies also hint that genes also factor in, and knowing which genes are involved would provide enormous clues to how the disease occurs.

A prior Stanford study that attempted to connect common human gene variants to BPD risk didn’t turn up any good candidates. So, in the new study, the Stanford team focused instead on rare genetic variants. Using data from California’s extensive repository of newborn blood spots (small blood samples collected as part of the state’s program to screen newborns for genetic diseases), they turned up 258 rare gene variants for further investigation, all of which are linked to cell processes that could plausibly be involved in BPD.

“We hope these results will guide future research that can determine the most important pathophysiologic pathways leading to BPD,” said Hugh O’Brodovich, MD, the study’s senior author. The idea isn’t to target the genes themselves for treatment, but rather to help researchers figure out what goes wrong at a molecular level in the lungs of babies who get BPD.

“We also hope this work will be used to discover how clinicians can minimize the chance that an extremely premature baby will develop the disease,” he added.

Previously: Study of outcomes for early preemies highlights complex choices for families and doctors, Stanford-led study suggests changes to brain scanning guidelines for preemies and Counseling parents of the earliest-born preemies: A mom and two physicians talk about the challenges
Photo by James Gaither

Patient Care, Pediatrics, Public Health, Stanford News, Surgery

Story highlights teens’ life-changing weight loss

Story highlights teens' life-changing weight loss

Over on the Healthy, Happier Lives blog today: A look at how bariatric surgery, combined with a strict diet plan and exercise regime, benefited two San Jose, Calif. teens. The siblings lost a combined total of more than 200 pounds and in the process have reduced their risk of obesity-related medical complications and improved their quality of life. “It’s been a life-changing transformation,” Sophia Yen, MD, an adolescent medicine specialist with Lucile Packard Children’s Hospital, commented.

Previously: The challenges of dieting and the promises of bariatric surgery and Bariatric surgery may help protect teen patients’ hearts

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