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Global Health, Pediatrics, Public Safety, Research, Stanford News, Women's Health

Working to prevent sexual assaults in Kenya

Working to prevent sexual assaults in Kenya

Kenyan slumsThe little girl bounded up to us, wearing a filthy pink sweater, with a beaming smile on her face, and gave me a huge hug. Surprised at the reception, I hugged her back and swung her gently back and forth. She giggled and ran to hug my colleagues, then, hopping over an open sewer, darted into an alley that lead to her home. We followed as quickly as we could over the slippery mud, down one alleyway than another. Within a few minutes we reached her house, a 5’ by 10’ structure made of mud and wood, without windows, electricity, or locks. The girl, named Lianna*, lives here with her two year-old brother, who calls her “Mama”, as she is his primary caretaker. Their mother is a bartender and likely also a sex worker, and returns home only occasionally. The home is filthy, smells bad, and is without food or water. Yet this beautiful child, brimming with energy and intelligence, is proud to show it to us and to introduce us to her sibling.

Lianna is a resident of Korogocho, one of the poorest informal settlements (known to many as slums) in the Nairobi region of Kenya. Korogocho itself has about 52,000 residents, and it borders on other, larger informal settlements such as Dandora. Poverty and lack of sanitation are the norm in these communities, and crime is extremely high. Girls in these settlements may be especially vulnerable, with 18-25 percent of adolescent girls reporting being sexually assaulted each year, often by friends and relatives.

A multidisciplinary team at Stanford has been working in these communities on a sexual assault prevention project with two Kenyan non-governmental organizations (NGOs), Ujamaa and No Means No Worldwide (NMNW), for about two years. This past July, my colleague Mike Baiocchi, PhD, and I traveled to Kenya to meet the local NGO staff, become familiar with the communities they work in, and advance their research capacity.

Ujamaa, led by Jake Sinclair, MD, a pediatrician from John Muir Hospital, has been working in these and other settlements, including Kibera, Mathare, Huruma, Kariobangi, for more than 14 years, and has partnered with NMNW for several years. NMNW, led by Lee Paiva Sinclair, developed a curriculum to reduce sexual assault by teaching empowerment and self-defense, and works with Ujamaa to implement this curriculum in the slums. The Stanford team became involved in order to research the effectiveness of this intervention.

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Health Policy, In the News, Public Safety, Rural Health

The Navajo-Native Nexus: A chance to make history and improve health

The Navajo-Native Nexus: A chance to make history and improve health

Navajo kids

For the sake of history in the making, not another Tobacco Settlement disaster, please.

A month ago, the Obama Administration released the $554 million of “no-strings-attached” money to the Navajo Nation — the largest settlement to a tribe in history — as part of the resolution to a long-running land dispute. The Navajo Nation, with its size and political connections, is perfectly poised to demonstrate best practices for how tribes can leverage such funds after years of inadequate support. I know I’m not someone who’s in the place to suggest what would be best for the Navajo Nation, but I hope to see this community benefit from settlement money catalyzing positive change.

I write as a first-year medical student who lived on the Navajo reservation in Sanders, Arizona for the past two years as a high-school teacher. In Sanders, I’ve seen how access to preventive services, behavioral health services, and assistance navigating health-care service provision can have life or death implications. In our small school, every few weeks at least one of my students would miss class because of a funeral that could have been avoided. The 2014 report on a proposed Medicaid expansion for the Navajo Nation cites that for Navajos on the reservation, 60 percent have no phones, 32 percent live without plumbing, 28 percent without kitchen facilities, and many without electricity. Seventy-eight percent of roads are unpaved, so air emergency transport is used, and there is no accredited residential substance abuse treatment program. The Navajo Nation mortality rate is 31 percent higher than in the U.S.

If the Navajo Nation wants a lesson in what not to do with the money, it can look at the poor outcomes of another historic settlement for the U.S. back in 1998: The Tobacco Master Settlement Agreement. Recent reports indicate several states chose to invest in bonds when using settlement money from the tobacco industry, though the funds were intended to fuel prevention initiatives. Only 1.9 percent of funding per year was devoted to preventive services; unsurprisingly, today preventable tobacco-related deaths remain high in the U.S. Tempting as it may be for the Navajo Nation to use this money for miscellaneous expenses, this is a chance for the Navajo to set the precedent for other indigenous groups who might find themselves similarly empowered with a large sum of unmarked money.

Navajos are in the spotlight and could seize this timely chance to show how spending on one focused initiative implemented with outside partnerships could positively affect outcomes of societal welfare. Using settlement funds to more seamlessly integrate services that are starting to be provided by other health resources (like from a new potential Navajo Medicaid) into a navigable health infrastructure could enhance an entire sector of life on the Navajo Nation in measurable ways.

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Medicine and Society, Neuroscience, Public Safety, Research, Stanford News

Smooth, safe landings stem from senior pilots, study shows

Smooth, safe landings stem from senior pilots, study shows

passenger-plane-19469_640Sometimes planes thump onto the runway. The wheels smack into the ground — bam! Other times planes bounce down — ka-thump, ka-thump, ka-thump. And once in awhile, in those most beautiful of landings, planes simply float down, the wheels gently stroke the runway, the transition from air to ground seamless and smooth.

Those landings are more likely to occur when an experienced pilot is at the helm. The experience allows top pilots to accurately assess their surroundings, while displaying less brain activity than less experienced pilots, according to a study published recently in PLOS One.

A team led by Stanford and VA Palo Alto Health Care System researchers used an fMRI machine to examine the mental activity of 20 pilots as they landed planes using a flight simulator. A Stanford release explains the study:

The trial started the pilots at 350 feet of altitude. They were instructed to begin their descent based only on their instrument readings, as would be typical in most real-life flights. Once they reached 200 feet — the altitude at which the Federal Aviation Administration mandates you must be able to clearly see the runway in order to land — the program would display the runway, either clearly or obscured by varying degrees of fog.

The pilots would then need to flash their gaze from the instruments to the runway and back to make a snap decision about whether or not it would be safe to continue the approach.

Landings are the most dangerous part of a flight.  The study showed that the more experienced pilots made correct landing decisions 80 percent of the time, while displaying only half as much brain activity. The newer pilots made correct landing decisions 64 percent of the time:

“The data show that the expert pilot seems to just know what to look for, where to look and when to look,” said Stanford psychiatrist Maheen Adamson, PhD… “And we’ve been able to trace that skill back to the caudate nucleus.”

This is an area of the brain involved in regulating gaze as the eyes quickly shift their focus to different fixed objects. The work needs to be replicated to confirm the caudate nucleus’s role in instrument scanning, Adamson added.

Adamson noted that pilot training programs may be able to improve performance using brain imaging techniques in the future.

Previously: Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms, Being bilingual “provides the brain built-in exercise” and Image of the Week: Uncovering brain-imaging inaccuracies
Photo by PublicDomainPictures

Global Health, Pediatrics, Public Health, Public Safety, Research, Stanford News

Child-mortality gap narrows in developing countries

Child-mortality gap narrows in developing countries

MATERNAL & INFANT MORTALITY IN DEVELOPING COUNTRIESChild-mortality rates in developing countries are decreasing. In 2012, the United Nations estimated that worldwide mortality rates for children under the age of five have dropped by 47 percent since 1990. But what does this decline indicate about the mortality gap between the poorest and wealthiest families within those countries?

Stanford researcher Eran Bendavid, MD, answers this question in a study published today in Pediatrics. As our press release describes:

To compare wealth status and under-5 child-mortality within a country, Bendavid used data from the demographic and health surveys for 1.2 million women living in 929,224 households in 54 developing countries. The women provided information about their children’s survival status.

His findings showed that the child-mortality gap has narrowed between the poorest and wealthiest households in the majority of over 50 developing countries between 1995 and 2012.

The converging mortality gap was mostly driven by the fact that under-5 child-mortality rates declined the fastest among the poorest families. Bendavid said the finding supports international aid efforts that target communicable diseases such as malaria, diarrhea and respiratory illness that disproportionately affect the poorest families in developing countries. Davidson Gwatkin, a senior fellow at the Results for Development Institute who was not involved in the study, agreed saying:

Dr. Bendavid’s study is an important contribution to knowledge about child health improvements in the developing world … It makes a persuasive case that these improvements have often begun to benefit the poor even more than the better-off.

Yet not all the developing countries experienced this positive trend. In a quarter of the countries involved in the study, under-5 mortality inequality actually increased. Bendavid found a common theme among these countries: poor governance.

Bendavid noted in the release that his findings are important for making decisions about how to effectively promote health equality by prioritizing global health investments. He said:

We have the technologies, we have the means, we have the know-how to reduce child mortality dramatically … Even for such low-hanging fruit, however, implementation is not always easy. You have to have government that enables basic safety, and the ability to reach poor and rural communities that benefit from these kinds of programs.

Previously: Foreign health care aid delivers the goods, Foreign aid for health extends life, saves children, Stanford study finds, Stanford researchers say evidence doesn’t support claims that international aid is wasted and PEDFAR has saved lives — and not just from HIV/AIDS, Stanford study finds,
Photo by: United Nations Photo

Podcasts, Public Safety, Science, Science Policy, Stanford News

The risks of tinkering with dangerous pathogens

The risks of tinkering with dangerous pathogens

In an effort to understand new and rare infectious diseases, researchers often use recombinant DNA technology to create novel strains in the lab. In 2012, researchers did just that, creating strains of the H5N1 influenza virus that were transmissible between mammals, setting off a debate about the ethics of creating viruses that were potentially more dangerous than those that occurred naturally.

Earlier this year, in July, a group called the Cambridge Working Group convened to continue discussing these questions. David Relman, MD, a biosecurity expert at Stanford, is a member of the group and spoke to Paul Costello about the risks and benefits of lab-created pathogens. Highlights of their conversation are in a piece in the most recent issue of Inside Stanford Medicine, where Relman notes:

My greatest fear is that someone will create a highly contagious and highly pathogenic infectious agent that does not currently exist in nature, publish its genetic blueprint, allow it to escape the laboratory by accident, or else enable a malevolent person or persons to synthesize the agent with the intention of releasing it in a deliberate manner. Although these may be unlikely scenarios, they could have catastrophic consequences, which is why I and others feel that we need to sensitize everyone to these possibilities and decide how to manage these risks ahead of time. I want to be clear: I am not opposed to laboratory work on dangerous pathogens, especially if they are known to exist in nature. Rather, I am opposed to high-risk experiments and, in particular, those that seek to create novel, dangerous pathogens that cannot be justified by well-founded expectations of near-term, critical benefits for public health — benefits that clearly outweigh the risks, and benefits that cannot be achieved through other means.

But not all researchers advocate the same level of caution. A few weeks after the Cambridge Working Group formed, another group called Scientists for Science to advocate in favor of using recombinant versions of pathogens in order to understand them better. Relman says that the two groups are probably not as far apart as they appear. He says he fully supports studying disease-causing bacteria, but:

The place where we may disagree is on whether we are willing to acknowledge that there may be experiments — probably few and far between — that perhaps ought not to be undertaken because of an unusual degree of risk. Just because a scientist can think up an experiment doesn’t mean it should be performed.

Relman elaborates on these topics in the 1:2:1 podcast with Costello above.

Previously:  How-to manual for making bioweapons found on captured Islamic State computer, Microbial mushroom cloud: How real is the threat of bioterrorism? (Very) and Stanford bioterrorism expert comments on new review of anthrax case

In the News, Mental Health, Public Safety

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Golden Gate BridgeThe Bridge Rail Foundation estimates that there have been almost 1,600 suicide deaths from the Golden Gate Bridge since it opened in 1937, and the San Francisco’s Golden Gate Bridge Board of Directors recently approved $76 million in funding to install a 20-foot-wide steel net to deter suicide jumpers.

In a piece on the Washington Post’s Wonkblog, Stanford’s Keith Humphreys, PhD, examined the effectiveness of bridge barriers on suicide prevention, writing that “a half century of experience and evidence supports an optimistic view.” He highlights several small studies before writing:

Because suicide by jumping is a mercifully rare event, most studies of barriers have small samples, making findings unstable and the difference between the Toronto study and other research unsurprising. Statistically, a more reliable result would come from combining the findings across all prior studies.  When Dr. Jane Pirkis of the University of Melbourne led such a “meta-analysis” in 2013, she and her colleagues found that on average barriers reduce suicides by 86% at the barrier site, and that jumping suicides at other nearby sites rise by 44%.  The net benefit is a 28% decrease in suicides by jumping per year.

Dr. Pirkis’ findings bode well for the success of San Francisco’s suicide barrier, which is expected to be installed in about three years.  Even if the net has only the average level of effectiveness, it would have saved a life a month in 2013 alone, as well as sparing the families of the deceased years of mental and emotional anguish.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults and Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets

Applied Biotechnology, In the News, Infectious Disease, Microbiology, Public Safety

How-to manual for making bioweapons found on captured Islamic State computer

Black DeathLast week I came across an article, in the usually somewhat staid magazine Foreign Policy, with this subhead:

Buried in a Dell computer captured in Syria are lessons for making bubonic plague bombs and missives on using weapons of mass destruction.

That got my attention. Just months ago, I’d written my own article on bioterrorism for our newspaper, Inside Stanford Medicine. So I was aware that, packaged properly, contagious one-celled pathogens can wipe out as many people as a hydrogen bomb, or more. Not only are bioweapons inexpensive (they’ve been dubbed “the poor man’s nuke”), but the raw materials that go into them – unlike those used for creating nuclear weapons – are all around us. That very ubiquity, were a bioweapon to be deployed, could make fingering the perp tough.

The focal personality in my ISM article, Stanford emergency-medicine doctor and bioterrorism expert Milana Trounce, MD, had already convinced me that producing bioweapons on the cheap – while certainly no slam-dunk – was also not farfetched. “What used to require hundreds of scientists and big labs can now be accomplished in a garage with a few experts and a relatively small amount of funding, using the know-how freely available on the internet,” she’d said.

This passage in the Foreign Policy article rendered that statement scarily apropos:

The information on the laptop makes clear that its owner is a Tunisian national named Muhammed S. who joined ISIS [which now calls itself “Islamic State“] in Syria and who studied chemistry and physics at two universities in Tunisia’s northeast. Even more disturbing is how he planned to use that education: The ISIS laptop contains a 19-page document in Arabic on how to develop biological weapons and how to weaponize the bubonic plague from infected animals.

I sent Trounce a link to the Foreign Policy article. “There’s a big difference between simply having an infectious disease agent and weaponizing it,” she responded in an email. “However, it wouldn’t be particularly difficult to get experts to help with the weaponization process. The terrorist has a picked a good infectious agent for creating a bioweapon. Plague is designated as a Category A agent along with anthrax, smallpox, tularemia, botulinum, and viral hemorrhagic fevers. The agents on the Category A list pose the highest risk to national security, because they: 1) can be easily disseminated or transmitted from person to person; 2) result in high mortality rates and have the potential for major public-health impact; 3) might cause public panic and social disruption; and 4) require special action for public-health preparedness.”

Islamic State’s interest in weaponizing bubonic plague should be taken seriously. Here’s one reason why (from my ISM article):

In 1347, the Tatars catapulted the bodies of bubonic-plague victims over the defensive walls of the Crimean Black Sea port city now called Feodosia, then a gateway to the Silk Road trade route. That effort apparently succeeded a bit too well. Some of the city’s residents escaped in sailing ships that, alas, were infested with rats. The rats carried fleas. The fleas carried Yersinia pestis, the bacterial pathogen responsible for bubonic plague. The escapees docked in various Italian ports, from which the disease spread northward over the next three years. Thus ensued the Black Death, a scourge that wiped out nearly a third of western Europe’s population.

Previously: Microbial mushroom cloud: How real is the threat of bioterrorism? (Very) and Stanford bioterrorism expert comments on new review of anthrax case
Photo by Les Haines

Public Health, Public Safety, Research, Technology

Mining Twitter to identify cases of foodborne illness

During this year’s Big Data in Biomedicine conference at Stanford, Taha Kass-Hout, MD, chief health informatics officer for the U.S. Food and Drug Administration, talked about the potential of social media to monitor food safety saying, “You are what you eat, and in this world, you are what you tweet.” Taking this concept into a real-world setting, officials at the Chicago Department of Public Health developed an algorithm to mine Chicago-based tweets for sentiments of food illnesses and, as a result, were able to investigate incidents of food poisoning that would have otherwise gone unnoticed. According to a recent article in Popular Science:

… in a recent project, the city of Chicago sought food poisoning cases by setting an algorithm to mine Chicago-area tweets for complaints. The Chicago Department of Public Health’s Twitter bot, plus a new online complaint form, helped the department identify 133 restaurants for inspections over a 10-month period. Twenty-one of those restaurants failed inspection and 33 passed with “critical or serious” violations. Not a bad haul.

Chicago is now working with the health departments of Boston and New York to see if its system could work in those cities, according to a report city researchers published with the U.S. Centers for Disease Control and Prevention. Plus, Twitter isn’t the only social media platform cities are looking to mine for public health violations. In May, New York City’s department of health reported on using an algorithm to spot Yelp reviews that point to food poisoning cases. New York’s Yelp project led the city to discover three restaurants that had multiple violations. All the Yelp cases the city inspected had otherwise gone unreported, New York officials wrote in their own CDC report.

The Chicago bot was pretty simple, as Twitter-reading computer programs go. It searched for tweets geo-located to Chicago and its surrounding suburbs that mentioned “food poisoning.” Human staff then read the tweets to determine if they were relevant. (Sounds fun.) Staff marked tweets as relevant or not relevant, to give the algorithm data to better learn what tweets to pull in the future. Then staff members responded to relevant tweets themselves.

Previously: Videos of Big Data in Biomedicine keynotes and panel discussions now available online, Discussing access and transparency of big data in government and Improving methods for tracking flu trends using Twitter

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Ebola, Global Health, Infectious Disease, Public Health, Public Safety, Stanford News

Biosecurity experts discuss Ebola and related public health concerns and policy implications

Biosecurity experts discuss Ebola and related public health concerns and policy implications

ebola_081214

More than 1,800 people in the West African nations of Liberia, Sierra Leone and Guinea have contracted the Ebola virus since March and the death toll has surpassed 1,000, according to the latest figures from the World Health Organization. As the number of cases and death continue to climb many are concerned about what can be done to curtail the outbreak and the likelihood of it spreading to the United States.

In a Q&A recently published by the Center for International Security and Cooperation and The Freeman Spogli Institute for International Studies, Stanford biosecurity experts David Relman, MD, and Megan Palmer jointly answer these questions and others related to the public health concerns and policy implications of the outbreak. On the topic of broader lessons about the dynamics and ecology of emerging infectious diseases that can help prevent or respond to outbreaks now and in the future, they respond:

These latest outbreaks remind us that potential pathogens are circulating, replicating and evolving in the environment all the time, and human action can have an immense impact on the emergence and spread of infectious disease.

We are starting to see common factors that may be contributing to the frequency and severity of outbreaks. Increasing human intrusion into zoonotic disease reservoir habitats and natural ecosystems, increasing imbalance and instability at the human-animal-vector interface, and more human population displacement all are likely to increase the chance of outbreaks like Ebola.

The epicenter of this latest outbreak was Guéckédou, a village near the Guinean Forest Region. The forest there has been routinely exploited, logged, and neglected over the years, leading to an abysmal ecological status quo. This, in combination with the influx of refugees from conflicts in Guinea, Liberia, Sierra Leone, and Cote d’Ivoire, has compounded the ecological issues in the area, potentially facilitating the spread of Ebola. There seems to be a strong relationship between ecological health and the spread of disease, and this latest outbreak is no exception.

While forensic analyses are ongoing, unregulated food and animal trade in general is also a key factor in the spread of infectious diseases across large geographic regions. Some studies suggest that trade of primates, including great apes, and other animals such as bats, may be responsible for transit of this Ebola strain from Central to Western Africa.

Overall, Relman and Palmer remind the public, “It’s important that we not lose sight of more chronic, but less headline-grabbing diseases that will be pervasive, insidious long-standing challenges for Africa and elsewhere.”

Previously: Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia and Health workers use crowdsourced maps to respond to Ebola outbreak in Guinea
Photo by European Commission DG ECHO

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Addiction, In the News, Public Health, Public Safety

Can the "24/7 sobriety" model reduce drunken disorderly conduct and violence in London?

beer_london_pubIn an article published yesterday in the Telegraph, Stanford addiction expert Keith Humphreys, PhD, discusses how public officials in London are turning to the United States’ “24/7 sobriety” model in an effort to reduce repeat offenders convicted of alcohol-related crimes. The program, which combines mandatory sobriety and daily breathalyser tests, was created under Humphreys’ guidance. He writes:

Research by the RAND Corporation – a US-based non-profit global policy think tank – found that 24/7 sobriety dropped repeat drink driving arrests by 12 per cent. The same study also yielded a pleasant surprise: domestic violence arrests dropped by 9 per cent, despite not being a focus of the programme. Removing alcohol from the lives of criminals can apparently have radiating benefits beyond those directly related to their most recent offence.

In light of its positive results, judges across the U.S. have been adopting the 24/7 sobriety approach. This week, under the leadership of Mayor Johnson and his team, a pilot of the programme will be launched in South London. Leaping the pond will come with some challenges, particularly around delivering sanctions swiftly within the constraints of British law, but local tailoring of innovations is always an essential part of making them spread.

In any event, with over one million alcohol-related assaults occurring nationally each year and many London boroughs being regularly marred by violence and disorder on weekend evenings, the time for new approaches to binge drinking criminal offenders has clearly arrived. The judges and probation officers who are undertaking this pilot should be applauded for refusing to accept the status quo.

Previously: Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent, Study shows legal drinking age of 21 saves lives and reduces health risks for young adults, Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by Paul Downey

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