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In the News, Public Health

Healthy gut bacteria help chicken producers avoid antibiotics

Healthy gut bacteria help chicken producers avoid antibiotics

chicks for productionIf you watch TV, you’ve probably seen actress Jamie Lee Curtis selling Activa, Dannon’s probiotic yogurt – or perhaps you’ve  taken probiotic supplements to help you recover after a nasty intestinal infection. Probiotics are microorganisms that are thought to help improve the bacterial balance in our guts. It’s not clear whether they are effective in humans, but they do appear to work in chickens.

Recently, the third-largest chicken producer in the nation, Perdue Farms, announced that it had eliminated almost all antibiotics from its farm operations – a move that has been in the works at the company for a dozen years. As NPR’s The Salt blog recently reported, the company has turned, instead, to probiotics to help keep the chickens healthy:

“As we took antibiotics out of the feed, we put some other things in, such as probiotics,” says Bruce Stewart-Brown, an executive at Perdue Farms. “We’ve increased the amount of probiotics by five times over the past five years. It’s a significant part of our program.”

Since the 1970s, farmers have given low doses of antibiotics to livestock animals to help them grow faster and bigger, a practice called “sub-therapeutic” use. And for almost as long, the practice has been viewed with suspicion by many concerned that it may encourage antibiotic resistance. Approximately 15-17 million pounds of antibiotics are given to livestock in the U.S. every year, according to Stuart Levy, MD, of Tufts University, director of the Alliance for the Prudent Use of Antibiotics.

In December, the FDA asked antibiotic producers to label their drugs so that they did not promote “sub-therapeutic” doses to fatten animals and earlier this month, the White House issued a report on combatting antibiotic resistance. One of the criticisms of the plan was that it didn’t make strong recommendations for reducing sub-therapeutic use of antibiotics in livestock animals.

Probiotics are a more expensive intervention than sub-therapeutic antibiotics, but offer an alternative – at least in chickens, as The Salt reports:

Stewart-Brown says that he was initially skeptical about probiotics. “Eight years ago, I would have said that they’re not working in poultry. They’re not very useful. Today, I’m saying that they are useful. Expensive, but useful. “Chickens that got probiotics stayed healthier and grew faster than birds that didn’t.

Perdue’s experiment with probiotics is probably the largest of its kind among commercial producers. How they fare may be a bell weather of what’s to come for other agricultural livestock producers and provide them with a route away from antibiotic overuse.

Previously: Interactive online map helps researchers track spread of antibiotic-resistant bacteria and Some unlikely sources for antibiotics
Photo by Loaf

Ask Stanford Med, In the News, Infectious Disease, Public Health, Stanford News

A conversation on West Nile virus and its recent California surge

A conversation on West Nile virus and its recent California surge

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Ebola isn’t the only virus commanding media attention: West Nile virus, now in its 15th year in the United States, may be surging to unprecedented levels in California, fueled in part by the state’s earth-parching drought.

It’s a big deal elsewhere as well, with parts of Texas, Louisiana and Midwestern states like Nebraska are also being hit. But California – and its 237 cases as reported by the CDC –  has taken the lead, in part because the drought brings birds and mosquito together at the scarce sources of water, according to reports by the Wall Street Journal and San Francisco’s NPR-affiliate KQED. Some regions, including a few communities close to Stanford, are now spraying for the mosquitoes.

I recently chatted with infectious disease expert Lucy Tompkins, MD, PhD, about the disease and how to prevent it. (Tompkins, a fly fisherwoman, knows quite a bit about mosquitoes).

What are the symptoms of West Nile?

The majority of people who get bitten don’t have any symptoms. About 20 percent of those bitten develop what is called West Nile fever with a fever, aches, fatigue, maybe a headache and sometimes a rash. It was previously felt this was completely benign but there may be long-term effects. Less than one percent are  the serious  cases with involvement of the brain and nervous system, which has a high mortality rate. That’s particularly common in people who are immunosuppressed due to transplants or high use of prednisone or even to those over 50 years. It can be a very disabling infection.

What can people do to protect themselves?

Reduce standing water such as in bird baths and wear protective clothing with long sleeves, long pants and socks covering your pants. Use insect repellents containing DEET - not low-potency insecticides. If possible, avoid being out during the times of day mosquitoes are active such as early in the morning and at sunset. It’s all about prevention.

Why isn’t there a vaccine for West Nile?

The chances of any one person getting West Nile are pretty remote. There’s no market, honestly. There’s a much bigger demand in the veterinary market for a vaccine like this. There is a vaccine for horses – West Nile can be fatal in horses. It also affects dogs and cats. There are some experimental treatments – last year at Stanford we gave a patient an experimental treatment and he awoke from a coma.

Do you expect the virus to continue spreading?

It’s hard to predict from year to year what communities will be affected. It all depends on what happens in the environment. The best information is available at the CDC.

Becky Bach is a former park ranger who now spends her time writing about science or practicing yoga. She is a science-writing intern in the Office of Communications and Public Affairs.

Previously: Should local residents be worried about West Nile virus?, Image of the Week: West Nile virus and Close encounters: How we’re rubbing up against pathogen-packing pests
Photo by: CulexNil

Ebola, Events, Global Health, Health Policy, In the News, Infectious Disease, Public Health

Interdisciplinary campus panel to examine Ebola outbreak from all angles

Interdisciplinary campus panel to examine Ebola outbreak from all angles

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Scientists have estimated that the West Africa Ebola epidemic will take another 12-18 months to control and will infect hundreds of thousands of more people during that time. In an opinion piece published last week in the Los Angeles Times, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, discussed how the outbreak got so out of control and explains why the “world needs a new approach to solving massive international health crises and preventing future ones.”

Tomorrow on the Stanford campus, Barry will participate in an interdisciplinary forum focusing on the health, governance, security and ethical dimensions of the epidemic. Additional speakers include Doug Owens, MD, a general internist and director of the Center for Health Policy/Primary Care Outcomes Research; microbiologist David Relman, MD, a fellow at the Center for International Security and Cooperation; Stephen Stedman, deputy director at the Center on Democracy, Development and the Rule of Law; and Paul Wise, MD, MPH, a child health specialist and core faculty member of the Center for Health Policy/Primary Care Outcomes Research. Drawing on their diverse backgrounds, the panelists will offer unique perspectives from their respective fields on the latest developments in addressing the outbreak.

The event will be held at 4 PM local time at the Bechtel Conference Center in Encina Hall and is free and open to the public. Conference organizers will also be live tweeting the panel; you can follow the coverage on the @FSIStanford Twitter feed, or by using the hashtag #EbolaForum.

Previously: Expert panel discusses challenges of controlling Ebola in West AfricaShould we worry? Stanford’s global health chief weighs in on Ebola, Biosecurity experts discuss Ebola and related public health concerns and policy implications and Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia
Photo by European Commission DG ECHO

Aging, Health and Fitness, Public Health, Research

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

free_weightsPast research has shown that strength training can benefit older adults’ health in numerous ways including arthritis relief, alleviating back pain, increasing bone density, improving sleep and boosting mental health. But despite these findings, a new study from Centers for Disease Control and Prevention (CDC) has found that few U.S. adults age 45 and older adhere to the Department of Health and Human Services’ muscle-strengthening recommendations.

The guidelines advise middle-aged and older adults to do moderate or high intensity muscle-strengthening activities that involve all major muscle group two or more days a week. Training can involve hand weights or weight machines, basic exercises such as sit-ups and push-ups or yoga and similar fitness practices.

In the latest study, researchers examined data from a telephone health survey conducted in 2011 by the CDC known as the U.S. Behavioral Risk Factor Surveillance System. For the survey, respondents provided information about the types of physical activities they engage in and frequency, as well as answered questions about if they specifically did exercises to strengthen their muscles. HealthDay reports:

Of all those who answered the questions on muscle strengthening, about 24 percent said they met the government’s recommendations.

Among those less likely than others to meet these guidelines were women, widows, those age 85 or older, people who were obese, and Hispanics. Participants who didn’t graduate from high school were also less likely to meet U.S. strength-training recommendations.

Jesse Vezina, of Arizona State University, and his fellow researchers concluded that interventions designed to encourage people to participate in strength training should target these high-risk groups.

Previously: Moderate exercise program for older adults reduces mobility disability, study shows, Help from a virtual friend goes a long way in boosting older adults’ physical activity and Do muscles retain memory of their former fitness?
Photo by Positively Fit

Health Costs, Health Policy, In the News, NIH, Public Health, Science Policy

Research investment needed now, say top scientists

Top scientists made the case for continued investment in basic science and engineering earlier this week by unveiling a new report, “Restoring the Foundation: The Vital Role of Research in Preserving the American Dream” by the American Academy of Arts and Sciences.

Here’s why this is important: Federal investment is needed to power innovation engines like Stanford’s School of Medicine, and if that money gets funneled to roads, the military, Medicare, or any of a variety of other uses, fewer jobs, and fewer discoveries, could result. From the report:

Unless basic research becomes a higher government priority than it has been in recent decades, the potential for fundamental scientific breakthroughs and future technological advances will be severely constrained.

Compounding this problem, few mechanisms currently exist at the federal level to enable policy-makers and the research community to set long-term priorities in science and engi­neering research, bring about necessary reforms of policies that impede progress, or facilitate stronger cooperation among the many funders and performers of research…

Stanford President John Hennessy, PhD; biochemist Peter S. Kim, PhD; and physicist (and former U.S. Secretary of Energy) Steven Chu, PhD, are among the scientific rock-stars who co-authored the report.

For an excellent piece on the political debate surrounding the report’s release, check out the coverage in Science here. NPR also recently aired a series that colorfully illustrates the effects of research cutbacks, including a piece on a patient suffering from ALS, and a profile of several underemployed scientists.

Becky Bach is a former park ranger who now spends her time writing or practicing yoga. She’s a science writing intern in the Office of Communications and Public Affairs. 

Previously: More attention, funding needed for headache care, “Bold and game-changing” federal report calls for $4.5 billion in brain-research funding, Federal investments in research and higher education key to U.S. maintaining innovation edge

Chronic Disease, Pediatrics, Public Health, Stanford News

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes_coaches_classThe prevalence of Type 2 diabetes among Americans ages 12 to 19 has grown from nine percent to 23 percent in less than a decade. In an effort to reduce U.S. adolescents’ diabetes risk, researchers at Stanford developed a school-based program where medical residents train healthy at-risk teens to be self-management coaches for family members diagnosed with Type 2 diabetes.

Researchers tested the initiative, called the Stanford Youth Diabetes Coaches Program, over the course of a year at three Bay Area high-schools serving primarily ethnic minority youth of low socioeconomic status. The study involved 97 adolescents – 49 student coaches and 48 non-participant students. Student coaches participated in an eight-week training course that was taught by family medicine residents and modeled after the Stanford University Diabetes Self-Management Program for adults. All participants completed pre- and post-study questionnaires and a select group of student coaches and family members gave in-depth interviews.

The program emphasized communication skills, problem solving and setting achievable goals using action plans. Beyond providing basic diabetes knowledge, the program also included guidance on nutrition, healthy meal planning, physical activity, weight management and stress management and on developing relationships with health-care providers. Student-coaches engaged with their family members during weekly 30-minute sessions where they shared information about topics they learned in class, discussed their relatives’ experiences and goals and helped them make an action plan for the week. In discussing their findings, study authors’ wrote:

The results of the study indicate that the Stanford Youth Diabetes Coaches Program increases knowledge and psychosocial assets of participant youth … Youth participants also reported positive changes in their own lives as the coached family members, and family members emphasized the importance of student coaches’ role in encouraging healthy behaviors. Additionally youth participants reported high program satisfaction.

These results substantiate current work suggesting that school-based programs benefit adolescents and that children have potential to support the self-management of family members with diabetes. Evidence strongly suggests that school-based programs hold promise to improve the health of at-risk adolescents.

“This study really speaks to the question of: How do you engage teens about their health?,” said first author Liana Gefter, MD, a research associate in Stanford’s Center for Research and Education in Family and Community Medicine. “The effectiveness of the program is rooted in the idea of empowering students to be a leader in a setting where they are traditionally only told what to do. A lot of the students really had a transformation during the eight-week course. Our findings demonstrated that after only eight weeks, compared to non-participants, students had significant increases in self-worth and belonging – assets that have been shown to be necessary precursors for adopting healthy behaviors. In this way, we believe the program could lay the foundation for sustainable health improvement.”

During interviews with researchers, student coaches and diabetes patients said the program inspired them to improve their diet and increase their regular physical activity. Additionally, they noted that the program strengthened their relationships with each other, and students reported their appreciation for having a physician come into their classroom.

In light of the program’s success, Gefter and colleagues Nancy Morioka-Douglas MD, MPH; Eunice Rodriguez, MPH, DrPH, and Lisa Rosas, MPH, PhD, are working to expand the program to underserved schools at other sites in California and around the country. Pilots are currently underway, or will begin, at campuses in Delaware, Georgia, Washington, Ohio and Michigan.

Previously: Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, Have you voted in the Healthy Living Innovation Awards?, Diabetes prevention program trains youth in chronic disease self-management and Stanford Diabetes Coaches Class selected as 2011 Healthy Living Innovation Awards finalist
Photo by Stanford Youth Diabetes Coaches Program

Big data, Chronic Disease, Clinical Trials, Health and Fitness, Public Health

Stanford to launch Wellness Living Laboratory

Stanford to launch Wellness Living Laboratory

1200px-Female_joggers_on_foggy_Morro_Strand_State_BeachIf you’re the kind of person who wears a heart monitor while jogging, tracks your sleep with an app or meditates to lengthen your lifespan, then a new Stanford project, called WELL, just might be for you.

WELL, which stands for the Wellness Living Laboratory hasn’t started quite yet — it will launch in 2015 — but when it does, it will unleash a variety of cutting-edge tools in an effort to define health.

Health seems like a no-brainer, but it is more than the absence of disease, says John Ioannidis , MD, DSc, the head of the Stanford Prevention Research Center. Ioannidis wants to find out how people can be “more healthy than healthy.”

To do that, he secured $10 million and laid out plans for the project. WELL plans to enroll thousands of volunteers — who Ioannidis calls “citizen scientists” — in two initial locations: Santa Clara County, Calif., and China, with plans to expand to other sites in the future.

Participants may be able to select which health factors to track and to report much of their information remotely and digitally, although some in-person visits may be required. Participants will also have the opportunity to enroll in a variety of clinical trials to test various interventions, such as nutrition counseling or smoking cessation programs.

The program will focus on wellness, rather than diseases, with the hypothesis that promoting wellness thwarts diseases, Ioannidis said.

Volunteers who would rather not provide health information will also have the opportunity to benefit from access to a program-wide social networking effort that will spread news of successful practices, he said. “This outer sphere could reach out to tens of millions of people,” Ioannidis told me.  Stay tuned to learn how to sign up.

The $10 million came as an unrestricted gift to Stanford University from Amway’s Nutrilite Health Institute Wellness Fund.

Previously: Medicine X explores the relationship between mental and physical health, Stanford partnering with Google [x] and Duke to better understand the human body, New Stanford center aims to promote research excellence and Teens these days smoking less but engaging in other risky behaviors
Photo by: Mike Baird

Ebola, Global Health, In the News, Infectious Disease, Public Health

Expert panel discusses challenges of controlling Ebola in West Africa

The rapidly growing Ebola outbreak in West Africa is not only overwhelming the health systems of the countries involved, but the World Bank recently warned that it could trash the economies of Liberia, Guinea, and Sierra Leone – the countries that have seen the most cases. Since the first confirmed case in December 2013 in Guinea, almost 5,000 people have become infected with the virus in five countries and about half of them have died. On September 16, President Obama committed 3,000 military personnel to help fight the outbreak, along with other resources.

This morning, KQED’s Forum hosted a panel of Ebola experts, including Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health. The panel discussed some of the challenges this outbreak poses. One issue is the enormous need for resources to control an outbreak of this momentum and magnitude. The WHO estimates it will take about a billion dollars to contain and by some estimates, it will require 1,000 international health care workers to train national, local clinicians.

Barry discussed the prospects for Zmapp, an experimental drug to treat Ebola -“a cocktail of monoclonal antibodies” according to Barry – for helping to curb the disease. She said that besides the lack of human clinical data on the effectiveness of this drug, the difficulty producing the drug also slows down plans to use the medication in the field. She went on to say:

I do have optimism for containing the virus. What I don’t have optimism for is the long-term trajectory of the Liberian healthcare workforce. It’s been actually decimated. I think there are wonderful people there working on it on the ground, but actually, there’s only a only a couple hundred doctors and a serious percentage of them have died—as well as nurses, in this battle against Ebola.

She elaborated on her concerns for the long-term problems for controlling epidemics in general:

I think there are short-term problems, but then I would urge people to start – and I know many people are – to think about long term issues. The long term issues of when you have a WHO that’s had its budget decimated, and its pandemic and epidemic division disbanded. That needs to be strengthened. When you have a workforce in Africa of only – I mean they have 25 percent of the disease burden but only four percent of the workforce. That needs to be strengthened. So there are long term issues of control for future epidemics.

She also suggested that a global health worker reserve corps could be assembled, a fund to strengthen health systems could be established, much like The Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN could take a more active role in large infectious disease epidemics.

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Immunology, Microbiology, Public Health, Research

Gut bacteria may influence effectiveness of flu vaccine

Gut bacteria may influence effectiveness of flu vaccine

flu_shotPast research has shown that the microbes living in your gut can dictate how body fat is stored, hormone response and glucose levels in the blood, which can ultimate set the stage for obesity and diabetes. Now new research suggests that the colonies of bacteria in our intestine play an important role in your body’s response to the flu vaccine.

In the study, Emory University immunologist Bali Pulendran, PhD, and colleagues followed up on a unexpected finding in a 2011 paper: the gene that codes for a protein called toll-like receptor 5 (TLR5) was associated with strong vaccine response. Science News reports that in the latest experiment:

[Researchers] gave the flu vaccine to three different groups: mice genetically engineered to lack the gene for TLR5, germ-free mice with no microorganisms in their bodies, and mice that had spent 4 weeks drinking water laced with antibiotics to obliterate most of their microbiome.

Seven days after vaccination, all three groups showed significantly reduced concentrations of vaccine-specific antibodies in their blood—up to an eightfold reduction compared with vaccinated control mice, the group reports online … in Immunity. The reduction was less marked by day 28, as blood antibody levels appeared to rebound. But when the researchers observed the mice lacking Tlr5 on the 85th day after vaccination, their antibodies seemed to have dipped again, suggesting that without this bacterial signaling, the effects of the flu vaccine wane more quickly.

Previously: The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine and Tiny hitchhikers, big health impact: Studying the microbiome to learn about disease
Photo by Queen’s University

Ebola, Global Health, Public Health, Stanford News

Should we worry? Stanford’s global health chief weighs in on Ebola

Should we worry? Stanford's global health chief weighs in on Ebola

13717624625_c584569b9b_kAs Ebola rampages across western Africa, Stanford Magazine sat down with Michele Barry, MD, who directs Stanford’s Center for Innovation in Global Health. Barry knows Ebola well: she’s fought it when it appeared in Uganda several years ago.

In the interview, which is posted on Medium as part of an experiment with digital communications methods, Barry shared her surprise at the momentum of the epidemic. The disease has caused more than 2,200 deaths during the past nine months in West Africa and the Democratic Republic of Congo has seen cases of a separate strain double in past week. “I think this goes back to just a very fragmented health infrastructure in the West African countries affected, a lack of personal preventive equipment on the ground and the inability to quickly educate a population that is not health literate,” she said.

Should we be worried of the epidemic spreading stateside? She responds:

I think Ebola easily could be transported here by airplane by an infected patient. The Nigeria outbreak is a result of air transport of an infected individual. But I think we have the facilities to support such patients safely. We have personal protective equipment, easily mobilized mechanisms for decontamination and isolation. I think there is no reason to be worried about it spreading in the U.S.

Barry also recently launched a fundraising campaign to care for sickened healthcare workers. Many doctors and nurses are among the thousands of Ebola casualties, including her colleague who mentored residents in the Yale/Stanford Johnson & Johnson Scholars Program.

Later this month, the Center for Global Innovation in Global Health is hosting a panel discussion that will explore the Ebola outbreak from a multidisciplinary approach. The event will be held on Sept. 23 from 4 to 5:30 p.m. at the Bechtel Conference Center on campus.  Panelists include Barry: Doug Owens, MD, director of the Center for Health Policy in the Freeman Spogli Institute for International Studies; Stanford microbiologist David Relman, MD; Stephen Stedman, PhD, Senior Fellow at the Freeman Spogli Institute for International Studies, and Paul Wise, MD, MPH, a professor of pediatrics at Stanford.

Previously: Biosecurity experts discuss Ebola and related public health concerns and policy implications, Stanford global health chief launches campaign to contain Ebola outbreak in Liberia
Photo by: European Commission

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