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HIV/AIDS, In the News, Public Health

Free, one-minute HIV testing…while you shop for clothes?

Free, one-minute HIV testing...while you shop for clothes?

outoftheclosetPerhaps you’re familiar with cafe-laundromats or sushi restaurants with tap dancing. But did you ever visit a second-hand clothing and furniture store to take care of your health-care needs? An audio segment and post on the KERA News (Dallas) blog features a local Out of the Closet shop with a free HIV testing site, and soon a community pharmacy, inside their thrift store – making it the 22nd branch of the U.S. chain to have both.

Bret Camp, the Texas regional director of the AIDS Healthcare Foundation, which operates the thrift stores, said in the post, “Our pharmacy will have everything from blood pressure meds to diabetes supplies…How many places can you go and look at jeans while you’re waiting for your medication?”

More from the post:

It’s an innovative idea, says [Douglas Owens, MD,] a professor of medicine at Stanford University who also serves on the U.S. Preventive Services Task Force.

A number of organizations, including the CDC and U.S. Preventive Services Task Force recommended universal HIV testing. Of course testing is only the first step, Owens says.

“When people get an adequate treatment for HIV, the drugs reduce their infectivity and so treatment for HIV not only benefits the person who has HIV; it also provides a very important public health benefit that reduces transmission,” Owens explains in the audio segment.

Previously: Task force recommends HIV screening for all people aged 15 to 65, Using Facebook to prevent HIV among at-risk groupsTask force issues draft recommendation for universal HIV screening and National HIV screening and testing could be very cost-effective
Photo by Marilyn Roxie

Addiction, Emergency Medicine, Public Health, Research, Technology

Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent

Text messages after ER visit could reduce young adults' binge drinking by more than 50 percent

Bar_texting_0701414Researchers have demonstrated that text message programs can, among other things, help diabetes patients better manage their condition, assist smokers in kicking their nicotine habit, and encourage expecting mothers to get flu shots.

Now new findings published in the Annals of Emergency Medicine show that text messages can also be an effective tool for reducing binge drinking among young adults whose hazardous alcohol use has resulted in an emergency room visit. During a 12-week study, 765 patients who were treated in the emergency room and screened positive for a history of hazardous drinking were divided into three groups. The first group received text messages prompting them to respond to drinking-related queries and received text messages in return offering feedback aimed at either strengthening their low-risk drinking plan or promoting reflection on their drinking plan or decision not to set a low-risk goal. Another group received only text queries about their drinking, and the remaining individuals received no text messages.

A story published today on PsychCentral reports on the researchers’ results:

The group receiving both text message queries and feedback decreased their self-reported binge drinking days by 51 percent and decreased the number of self-reported drinks per day by 31 percent.

The groups that received only text messages or no text messages increased the number of binge drinking days.

“Illicit drugs and opiates grab all the headlines, but alcohol remains the fourth leading cause of preventable death in the U.S.,” said [Brian Suffoletto, MD, assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine].

“If we can intervene in a meaningful way in the health and habits of people when they are young, we could make a real dent in that tragic statistic. Alcohol may bring them to the ER, but we can do our part to keep them from becoming repeat visitors,” [he added].

Previously: CDC explores potential of using smartphones to collect public health data, Could better alcohol screening during doctor visits reduce underage drinking?, Personality-based approach can reduce teen drinking and The costs of college binge drinking
Photo by Anders Adermark

Parenting, Public Health, Research, Sleep

The high price of interrupted sleep on your health

The high price of interrupted sleep on your health

dad_baby_nap_time

As the mother of a 10-month-old, I’m constantly answering the question: Is your son sleeping through the night? And, much to my dismay, I have to repeatedly answer, “No.” So I was interested, and considerably alarmed, to read about new findings showing that interrupted sleep could be as harmful to your physical health as a lack of sleep.

A Time article published today describes the study and the Tel Aviv University researchers’ results:

Students slept a full eight-hours one night followed by a night of interrupted sleep in which they received four phone calls directing them to complete a brief computer exercise before returning to bed. The morning after both nights, the volunteers completed tasks to measure their attention span and emotional state — results proved that just one night of interrupted sleep had negative effects on mood, attention span and cognitive ability.

[Lead researcher Avi Sadeh, PhD,] believes that several nights of fragmented sleep could have long-term negative consequences equivalent to missing out on slumber altogether. “We know that these effects accumulate and therefore the functional price new parents — who awaken three to ten times a night for months on end — pay for common infant sleep disturbance is enormous,” he said in a statement.

In addition to parents with young children, the findings are applicable to people in certain age groups that experience fragmented sleep, as well those with jobs where frequent night wakings are common.

Previously: Stanford expert: Students shouldn’t sacrifice sleep, What are the consequences of sleep deprivation? and Study: Parents may not be as sleep-deprived as they think
Photo by Christina Spicuzza

Cancer, Clinical Trials, Pediatrics, Public Health, Research

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Researchers call for broader age limits for cancer trials to increase participation of teenage patients

Findings published today in the Lancet Oncology highlight the need to increase the flexibility of age limits for cancer trials so that more teenage patients have access to experimental treatments. “Right now too many of our young patients are needlessly falling through the gap between paediatric and adult cancer trials,” said Lorna Fern, PhD, who led the study and co-ordinates research for the Teenage and Young Adult Clinical Studies Group of the UK-based National Cancer Research Institute.

In the study (subscription required), researchers examined strategies to boost participation of teens and young adults diagnosed with cancer in clinical trials. The study involved 68,275 patients, aged 0-59 years, who were diagnosed with cancer within a five-year window. According to a release:

The study showed [trials designed with broader age limits] led to a 13 per cent rise in 15-19 year old cancer patients taking part in clinical trials between 2005 and 2010 (from 24 to 37 per cent), and a five per cent rise in 20-24 year olds (from 13 to 18 per cent). Children under 14 taking part in trials rose by six per cent (from 52 to 58 per cent).

This rise was due to the increase in availability and access to trials for young people, increased awareness from healthcare professionals, patients and the public about research and importantly the opening of trials with broader age limits which allow older teenagers and young adults to enter trials.

Fern added, “By encouraging doctors to take into account the full age range of patients affected by individual types of cancer, we’ve shown that it’s possible to design trials that include teenage cancer patients and, importantly, that better match the underlying biology of the disease and the people affected.”

Previously: High rates of incarceration among black men could be skewing study results, Stanford researchers examine disparities in use of quality cancer centers and NPR explores the need for improving diversity in clinical trials

Public Health

Another reason to skirt traffic: health risks associated with noise pollution

trafficMapping out a 4th of July weekend adventure, I’m scheduling my drive down the I-5 by counting backward from arrival in time for a 10:30 a.m. yoga class. And, like many Californians, while planning my life around yoga I’m also thinking about alternate driving routes and factoring in time for road congestion. With tomorrow’s commute front-of-mind, I was interested to read about a recent report on the unhealthy effects of noise pollution from traffic – something I hadn’t considered. (But yoga seems like a good return to center following a sympathetic nervous system-stimulating drive.)

Scientists at Chalmers University of Technology in Sweden have recommended strategies to improve urban environments in ways that reduce traffic noise and stress-related health effects such as stroke and heart disease that may be linked with it, according to a release.

More from the release:

Last fall, [Tor Kihlman, PhD,] and [Wolfgang Kropp, PhD,] initiated a meeting between international experts from the automotive industry, universities and government agencies in Innsbruck to discuss technical possibilities to achieve better urban environments.

“Many of the needed measures are ideal for implementation in dense cities. They are often in line with what is required to tackle climate change. Here are double benefits to point to,” says Tor Kihlman, mentioning three examples: the procurement of quiet public transport, reduced speed, and the usage of buildings as as effective noise barriers, through good urban planning.

The new report describes the first steps needed, politically, for society to move towards substantially reduced health effects caused by traffic noise.

Previously: Study shows link between traffic noise, heart attackCan commuting by car or public transit negatively impact your health? and The hazards of sitting in traffic
Photo by Samantha Bilodeau

Immunology, In the News, Infectious Disease, Parenting, Pediatrics, Public Health

Side effects of childhood vaccines are extremely rare, new study finds

Side effects of childhood vaccines are extremely rare, new study finds

Pneumococcus-vaccineAs you may have heard about elsewhere, a new paper published today on the safety of childhood vaccines provides reassurance for parents and pediatricians that side effects from vaccination are rare and mostly transient. The paper, a meta-analysis appearing in Pediatrics, updates a 2011 Institute of Medicine report on childhood vaccine safety. It analyzed the results of 67 safety studies of vaccines used in the United States for children aged 6 and younger.

“There are no surprises here; vaccines are being shown over and over again to be quite safe,” said Cornelia Dekker, MD, medical director of the vaccine program at Lucile Packard Children’s Hospital Stanford, who chatted with me about the study earlier today. “The safety record for our U.S.-licensed vaccines is excellent. There are a few vaccines for which they document that there are indeed adverse events, but the frequency is quite rare, and in almost all cases they are very easy to manage and self-limited.”

A Pediatrics commentary (.pdf) accompanying the new study puts the value of immunization in context:

Modeling of vaccine impact demonstrates that routine childhood immunizations in the 2009 US birth cohort would prevent ~42,000 deaths and 20 million cases of disease and save $13.5 billion in direct health care costs and $68.8 billion in societal costs.

The commentary goes on to contrast the risks of vaccines with the potential complications of vaccine-preventable diseases:

The adverse events identified by the authors were rare and in most cases would be expected to resolve completely after the adverse event. This contrasts starkly with the natural infections that vaccines are designed to prevent, which may reduce the quality of life through permanent morbidities, such as blindness, deafness, developmental delay, epilepsy, or paralysis and may also result in death.

The study found evidence against suspected links between vaccines and several acute and chronic diseases. For instance, the researchers found high-quality evidence that several different vaccines are not linked to childhood leukemia and that the measles, mumps and rubella (MMR) vaccine is not linked to autism. The DTaP vaccine is not linked to diabetes mellitus, and the Hepatitis B vaccine is not connected to multiple sclerosis, according to moderate-quality evidence.

The evidence does connect a few vaccines to side effects. For instance, the MMR, pneumococcal conjugate 13 and influenza vaccines are linked to small risks of febrile seizures, with the risk of such seizures increasing slightly if the PCV-13 and flu vaccines are given together.

“A febrile seizure can be quite alarming, but fortunately it does not have long-lasting consequences for child,” Dekker said, noting that the risk of such seizures from vaccines is around a dozen per 100,000 doses of vaccine administered.

The rotavirus vaccine is linked to risk of intussusception, an intestinal problem that can also occur with rotavirus infection itself. But the benefits of rotavirus vaccination “clearly outweigh the small additional risk,” Dekker said.

The study confirmed earlier research showing that some vaccines, including MMR and varicella, cause problems for immunocompromised children, such as kids who have HIV or who have received organ transplants. Since they can’t safely receive vaccines, this group of children relies on the herd immunity of their community to protect them.

“It’s not as if the parents of immunocompromised kids have a choice about whether to vaccinate,” Dekker told me. “They have to depend on others to keep immunization levels high, and that starts breaking down when more people hold back from having their healthy kids fully immunized.”

Dekker hopes the new findings will encourage more parents to have their healthy kids fully vaccinated.

Previously: Measles is disappearing from the Western hemisphere, Measles are on the rise; now’s the time to vaccinate, says infectious-disease expert and Tips for parents on back-to-school vaccinations
Photo by Gates Foundation

Global Health, Public Health, Stanford News

NIH Director “particularly impressed by the practicality” of Stanford-developed Foldscope

During the White House’s first-ever Maker Faire, Francis Collins, MD, director of the National Institutes of Health, was among those vying for a chance to test out a Foldscope, the 50-cent origami microscope invented by Stanford bioengineer Manu Prakash, PhD. In a post published yesterday on his blog, Collins said, “While I saw many amazing inventions and met many incredible inventors at this event, I came away particularly impressed by the practicality of this device and the ingenuity of its maker.”

Collins goes on to explain the design components of the Foldscope, his experience testing out the device and Prakash’s plans to open up the wonders of the microscopic world to future generations of scientists and engineers. He writes in the piece:

So, how do you use the Foldscope? It turns out that this bookmark-size device uses the same glass slides that one uses in a regular microscope. So, the preparation of blood or tissue samples remain the same. In the simplest version of the scope, the slide is inserted between the microscope’s paper layers and the user, with a thumb and forefinger grasping either end of the microscope strip, holds the lens close to one eye and flexes the strip to find the target object and bring it into focus. I had the chance to try this at the White House event, and found that learning how to use it is very easy. In more advanced versions, the device can project the image onto a wall or any other flat surface—a great, low-cost tool for educating healthcare workers and others in low-income nations about various infectious diseases.

Prakash is currently fine-tuning Foldscopes so they can be field tested in Ghana, Uganda, Nigeria, and Peru for diagnosis of malaria, microfilariasis, leishmaniasis, schistosomiasis, and sleeping sickness. His team at Stanford is also busy designing Foldscopes to help diagnose 30 other diseases, and drawing up plans for a next generation of Foldscopes that will utilize microfluidic components rather than glass slides—a step that should make sample collection and analysis even easier.

Not only will Foldscope give healthcare workers around the globe better ways to detect, and thereby treat, disease, it will also place magnifying power within the reach of all the world’s students, enabling them to ask and answer a great many scientific questions. To this end, Prakash has launched the Ten Thousand Microscopes Project to entice inquiring minds to beta test these devices and design experiments that can then be compiled into a crowd-sourced microscopy text. Imagine a world in which every kid carries around a 50-cent portable microscope, and brings science out of the lab and into real-world biology.

Previously: Manu Prakash on how growing up in India influenced his interests as a Maker and entrepreneur, Dr. Prakash goes to Washington and Stanford microscope inventor invited to first White House Maker Faire and The pied piper of cool science tools

Chronic Disease, Public Health, Stanford News

Stanford alums aim to bring back a community approach to treating chronic disease

Inspired by shared medical appointments and Blue Zones, areas in the world where people live measurably longer lives, fourth-year medical student Sohan Japa, MBA, and Stanford alumna Bansi Shah are striving to bring back a community approach to treating chronic disease and enable better care that is efficient and evidence-based.

Japa and Shah partnered with Stanford physician Bryant Lin, MD, earlier this year on a small study to test the effectiveness of using a private social network for diabetic patients and their care teams. Based on this pilot they developed HealthCrew, a secure online platform to help clinicians more effectively manage patient populations. In the following Q&A, Japa discusses the results from the pilot, the technology behind the platform and the next phase of the study.

What about the group health visit setting did you find particularly inspiring?

The way patients leaned on each other for support and guidance was very powerful. A doctor or nurse may remind you over and over about your diet, but when it comes from a peer, it is just much more convincing and impactful. And, every group had an unofficial leader who would do an amazing job in inspiring the group and mentoring others who may not be as empowered about the condition.

What did the preliminary results of the pilot show?

In this initial pilot, we were curious how patients would respond and whether they would see the value in it. And the overwhelming response was yes. Patient engagement and satisfaction rates were higher than we expected. We are doing a second pilot to test the results with a larger group and also start tracking the software’s impact on actual health outcomes. The participants in the initial pilot also gave us great feedback on how to make the platform even better.

Can you briefly explain how the platform works?

The platform is designed to deliver tailored education, which is something doctors don’t have time to provide in a typical 15-minute visit.

There are three key components to our platform. The first is a medical intake tool, which is able to assess a patient’s health literacy and social/emotional capacity. The second component is a content engine that takes the results of the medical intake to tailor education and materials. For example, a patient who scored low on our empowerment scale will get materials to help raise their confidence and skill set to tackle their condition. The last component of our platform is a peer-to-peer mentoring tool, which allows patients to confer securely with similar patients both online and offline.

The Affordable Care Act, in addition to healthcare reform at the state level, has put new attention on patient outcomes. Increasingly hospitals and clinics are on the hook for the health outcomes of their patients. So a platform like this is timely. Because it helps patients in between those semi annual visits they have with their doctors.

Continue Reading »

Cancer, NIH, Public Health, Research, Stanford News, Videos

NIH associate director for data science on the importance of “data to the biomedicine enterprise”

NIH associate director for data science on the importance of "data to the biomedicine enterprise"

The 2014 Big Data in Biomedicine conference was held here last month, and interviews with keynote speakers, panelists, moderators and attendees are now available on the Stanford Medicine YouTube channel. To continue the discussion of how big data can be harnessed to benefit human health, we’ll be featuring a selection of the videos this month on Scope.

During his keynote speech at Big Data in Biomedicine 2014, Philip Bourne, PhD, the first permanent associate director for data science at the National Institutes of Health, shared how the federal agency hopes to capitalize on big data to accelerate biomedicine discovery, address scientific questions with potential societal benefit and promote open science.

In the above video, he talks about how data “is becoming increasingly important to the biomedical enterprise” and the NIH’s effort to coordinate strategies related to computation and informatics in biomedicine across its 27 institutes and centers, which effectively form the basis of improvements in health care across every major medical condition. “Our goal is to create interoperability between these entities,” he says in the interview. “We see data as the catalyst to create this cross talk across these respective institutes.”

Previously: Rising to the challenge of harnessing big data to benefit patients, Discussing access and transparency of big data in government and U.S. Chief Technology Officer kicks off Big Data in Biomedicine

Public Health, Research, Science, Stanford News

John Ioannidis discusses the popularity of his paper examining the reliability of scientific research

Back in August 2005, Stanford professor John Ioannidis, MD, DSc, published “Why Most Published Research Findings Are False” in PLOS Medicine. The article surpassed one million views last April and, as recently reported in a Q&A on the journal’s Speaking of Medicine blog, it’s “the first PLOS article – research or other – to reach this milestone.”

In the interview, Ioannidis, co-director of the new Meta-Research Innovation Center at Stanford, discusses his motivation for writing about the issue and why he believes the article has remained relevant over the years. On the topic of the most surprising result or outcome of the paper, he says:

Possibly the most unexpected corollary is that more popular research fields are less credible. Several people have misunderstood this statement. This corollary holds when scientists work in silos, and each one is trying to outpace the others, finding significance in his/her own results without sharing and combining information.

The opposite holds true when scientists join forces to examine the cumulative evidence. Sadly, in most fields the siloed investigator writing grants where he promises that he/she alone will discover something worthy of the Nobel Prize is still the dominant paradigm. This sort of principal investigator culture is a problem, especially for popular fields where the literature is flooded with tens of thousands of irreproducible papers.

Previously: A discussion on the reliability of scientific research, New Stanford center aims to promote research excellence, The Lancet documents waste in research, proposes solutions and “U.S. effect” leads to publication of biased research, says Stanford’s John Ioannidis

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