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Global Health, HIV/AIDS, Infectious Disease, Public Health, Research, Rural Health

Drought causes spike in HIV infections in Africa

Drought causes spike in HIV infections in Africa

75148497_50e081cd5b_zHere in California, the drought is plenty serious. Shortages mean short showers, brown lawns, empty reservoirs and fallow fields.

But in sub-Saharan Africa, drought spreads disease, including the still-rampant HIV virus. The phenomenon is more sociological than ecological: Slim harvests slash farmers’ incomes, forcing them to find new ways to earn money. Some turn to sex, according to a new study in The Economic Journal.

As described in a recent article from Stanford’s Center on Food Security and the Environment (FSE):

Analyzing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behavior, a year of very low rainfall can increase local infection rates by more than 10 percent.

That means condoms and sex education aren’t all that’s needed to thwart the epidemic’s spread, the study’s authors say. Affected farmers also need economic support and alternatives to help them weather the dry period, without sacrificing their health.

“These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet,” co-author Marshall Burke, PhD, a fellow at the FSE, said in the piece.

Previously: Spread of drug-resistant HIV in Africa and Asia is limited, Stanford research finds, Stanford study: South Africa could save millions of lives through HIV prevention and Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa 
Photo by Jon Rawlinson

Emergency Medicine, Nutrition, Pediatrics, Rural Health

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Malnutrition is a leading cause of mortality in children under the age of five, contributing to approximately 3.5 million child deaths worldwide each year. Currently, the World Health Organization and Doctors Without Borders recommend using calculations based on the patient’s body weight or arm circumference to assess their nutritional status. But, it’s not known if they are reliable measures of malnutrition in children that suffer from diarrhea and dehydration — two symptoms that can affect body weight and are common in undernourished kids.

Now, a study (subscription required) published this month in the Journal of Nutrition shows that mid-upper arm circumference can accurately assess malnutrition in children with diarrhea and dehydration and it’s better at assessing malnutrition than weight-based measures.

In the study, Rhode Island Hospital emergency medicine physician Adam Levine, MD, and his team analyzed 721 records of children (under the age of five) who were examined at an urban hospital in Dhaka, Bangladesh for acute diarrhea. They found that measurements based on a child’s mid-upper arm circumference accurately diagnosed malnutrition, but measurements based on weight were unreliable and misdiagnosed about 12-14 percent of the cases when the patient had diarrhea and dehydration.

“Because dehydration lowers a child’s weight, using weight-based assessments in children presenting with diarrhea may be misleading,” Levine said in a press release. “When children are rehydrated and returned to a stable, pre-illness weight, they may still suffer from severe acute malnutrition.”

Since poor nutrition is a common problem in areas where medical resources are limited, the best tools to diagnose malnutrition are effective and inexpensive. Tape measures are cheaper and are often easier to come by than scales, so the results of this study are especially encouraging for people who want the best and most affordable way to measure malnutrition in children. “Based on our results, clinicians and community health workers can confidently use the mid-upper arm measurement to guide nutritional supplementation for children with diarrhea,” said Levine.

Previously: Stanford physician Sanjay Basu on using data to prevent chronic disease in the developing worldMalnourished children have young guts and Seeking solutions to childhood anemia in China
Photo by European Commission DG ECHO

Mental Health, Neuroscience, Rural Health

Seven ways laughter can improve your well-being

Seven ways laughter can improve your well-being

3336353424_df38db0c8a_zEveryone enjoys a good laugh, but who actually makes time for it in their lives? Sure, we like hearing a funny joke, talking to people with a good sense of humor and watching comedies. But few of us take our laughs seriously (no pun intended!) nor do we make a concerted effort to laugh more. But we should! The science of laughter – though still preliminary – suggests that it has tremendous benefits for our health and psychological well-being.

Laughter can improve your relationships. According to a recent study led by research assistant Alan Gray of University College London, the act of laughing can make you more open to new people and can help you build relationships.

Laughter may also boost memory and lower stress. A study by researchers at Loma Linda University found that laughter can sharpen your ability to remember things while also reducing the stress hormone, cortisol, especially in older people.

Laughter may make you more resilient. Ever had nervous laughter in an awkward or difficult situation? That’s because laughter may help you regulate your emotions in the face of challenge, according to a study led by Yale psychologist Erica J. Boothby, PhD.

Laughter can improve your health. A study of diabetic patients by Lee S. Berk, PhD, and Stanley A. Tan, MD, of Loma Linda University found that laughing can lower stress and inflammation and increase good cholesterol. Ever found yourself laughing while telling a joke or funny story? Maybe you were anticipating the ending and laughed your way through the end of the joke? Another study by Berk and Tan suggests that just anticipating a funny event boosted immune function while decreasing stress-related hormones.

Laughter can make you a better learner. When we are trying to learn something new, we usually are pretty serious, but research by Mark Shatz, PhD, and Frank LoSchiavo, PhD, of Ohio University show that a good laugh while learning new material will help you engage with it more!

Laughter can make you more attractive.  Another recent study by Shatz and LoSchiavo shows that humor and playfulness are highly valued traits in potential romantic partners.

Laughter can help you make the world a better place. Why? It’s contagious. At least on the level of the brain, according to research by Sophie Scott, PhD, of University College London.

Emma Seppala, PhD, is associate director of Stanford’s Center for Compassion and Altruism Research and Education and a research psychologist at the School of Medicine. She is also a certified yoga, pilates, breath work and meditation instructor. A version of this piece originally appeared on Psychology Today.
Photo by Arnet Gill

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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Medical Education, Rural Health, Stanford News

Stanford internships provide Bay Area students with work experience, opportunity to discover passions

Stanford internships provide Bay Area students with work experience, opportunity to discover passions

14093-internyu_newsThis summer high school students from around the Bay Area are interning at labs and departments across Stanford. A recent Stanford Report story highlights the type of projects students are working on and how the internships provide them with valuable work experience and the opportunity to discover their passion. From the article:

Palo Alto High School student Catherine Yu [pictured to the right], for example, is interning at the Stanford Blood Center in the immunology and pathology lab. She described her task as gathering data to help her supervisor’s research project.

“Every intern is assigned to a supervisor who is working on an experiment, which will hopefully be turned into a paper submitted for a journal,” said Yu, who will be a senior in September. “My work consists of separating blood into T cells, monocytes, dendritic cells, and then culturing them together; it’s very neat.”

Yu said being the only high school student in her lab presents her with a series of challenges.

“It’s definitely a different dynamic where they expect you to learn a lot of information at a very fast pace,” Yu said. “I have to stay on my toes so I don’t fall behind.”

Previously: Internships expose local high-schoolers to STEM careers and academic life, Residential learning program offers undergrads a new approach to scientific inquiry, The “transformative experience” of working in a Stanford stem-cell lab and Stanford’s RISE program gives high-schoolers a scientific boost
Photo by L.A. Cicero

Global Health, Nutrition, Parenting, Pediatrics, Research, Rural Health, Stanford News

Seeking solutions to childhood anemia in China

Seeking solutions to childhood anemia in China

Chinese boyHow can health and nutrition education needs in rural China be addressed? Start by examining infant-feeding practices.

Scott Rozelle, PhD, director of the Rural Education Action Program, part of the Freeman Spogli Institute for International Studies (FSI) Center on Food Security and the Environment at Stanford, conducted a study on 1,800 babies in China’s Shaanxi province to address high rates of anemia and cognitive delays in children owing to poor nutrition, though not necessarily lack of funds for healthy food.

A recent piece on the FSI website describes the ongoing study:

One third of households were given a free daily supply of nutritional supplements for their children. Another third were given the same free supplements, and were enrolled in a text message reminder program. A final third of households served as a control group. The study is ongoing through April, 2015, but 12 months into the program, the researchers have found that the supplements have reduced anemia rates by 28 percent, although cognitive delays have persisted.

Text message reminders appear to have been modestly effective in improving program compliance. Caregivers who received the reminders gave their baby the micronutrient supplements, on average, 10 percent more often over the course of the first six months of the study. So far, however, this improved compliance has not led to a corresponding fall in anemia rates.

Rozelle commented in the piece, “To reach all of China’s at-risk babies – that’s our ultimate objective. And to do that, we need an effective government program.”

Previously: Who’s hungry? You can’t tell by lookingFeeding practices and activity patterns for babies vary with families’ race and ethnicity, study shows and Student inventors create device to help reduce anemia in the developing world
Photo by Kris Krüg

Public Health, Research, Rural Health, Stanford News

Stanford study finds Lyme disease among ticks in California parks

Stanford study finds Lyme disease among ticks in California parks

hikingHikers, beware: Ticks infected with the bacterium at the root of Lyme disease have been found roaming California parks, as described in a study to be published in Emerging Infectious Disease. The same paper by Stanford researchers, including ones associated with the university’s Woods Institute for the Environment, also identified a human pathogen, Borrelia miyamotoi, in black-legged ticks, which are carried by western gray squirrels in California and white-footed mice back east.

From a Stanford Report article:

The findings raise the question of whether B. miyamotoi has gone undetected in California residents. The research results are “an important step toward dispelling the perception that you cannot acquire Lyme disease in California,” said Ana Thompson, the executive director of the Bay Area Lyme Foundation.

B. miyamotoi has been known for some time to infect ticks; the first known human case of B. miyamotoi infection in the U.S. was discovered in 2013. Beyond Lyme-like symptoms such as fever and headache, little is known about its potential health impacts. In the Bay Area, low awareness of tick-borne diseases such as Lyme could heighten the risk of infection with B. miyamotoi for users of the region’s extensive natural areas and trails.

The piece notes that the School of Medicine’s interdisciplinary Lyme Disease Working Group “is exploring ways to improve diagnostic tests and medical understanding, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness.”

Previously: Add a tick check to your vacation checklistAsk Stanford Med: Answers to your questions about wilderness medicine and Piecing together the clues: Diagnosing and treating autonomic disorders
Photo by Ray Bouknight

Global Health, In the News, Medicine and Society, Rural Health

From the Stanford Medicine archives: A Q&A with actor Matt Damon on water and health

Water, water, every where,
And all the boards did shrink;
Water, water, every where,
Nor any drop to drink.

Old it may be, but The Rhime of the Ancient Mariner reminds us of our current global water crisis. As Californians batten down the hatches in the face of severe drought, progress is being made to distribute clean water elsewhere in the world.

Actor Matt Damon was recently honored by the World Economic Forum for his work with fellow Water.org co-founder Gary White to make clean water more accessible in developing countries. Last year, the two talked about their efforts and the connection between water and disease in a Stanford Medicine  Q&A. Read on to learn how their organization empowers women and girls to lead clean-water initiatives.

Previously: Factoring in the environment: A report from Stanford Medicine magazine and “Contagion” spreads across the nation on Friday. Will Hollywood get the science right?

Global Health, Orthopedics, Pediatrics, Rural Health, Stanford News, Technology, Videos

Two Stanford students' $20 device to treat clubfoot in developing countries

In the video above, Stanford graduate students Jeff Yang and Ian Connolly demo their design for a brace to correct clubfoot in a way that’s comfortable and functional for the children who need it, and reasonable for their families to afford. The $20 device uses injection molded plastic attached to cleats to hold a child’s legs in an upright position so that they can strengthen the muscles they need eventually to maintain the posture without assistance. It also allows them to stand and move around with ease, and the device looks more like a toy than a restraint.

Yang and Connelly visited Brazil to learn more about the birth defect that affects one in 1,000 children whose feet appear to be rotated internally. There, clubfoot is commonly treated using rigid, ineffective metal braces, notes this video and an article on Wired.com. The students began working with the organization Miraclefeet during a Stanford D.School course titled “Design for Extreme Affordability” and put their design into action at a hospital in São Paulo.

Previously: Support for robots that assist people with disabilities, New documentary focuses on Stanford’s Design for Extreme Affordability courseBiotech start-up builds artful artificial limbs and Improving treatment for infant respiratory distress in developing countries
Photo in featured entry box from Design for Extreme Affordability

Global Health, Infectious Disease, Public Health, Research, Rural Health, Stanford News

Stanford bioengineer developing an “Electric Band-Aid Worm Test”

Stanford bioengineer developing an “Electric Band-Aid Worm Test”

uganda-kids“Those children are sitting on the graves of their siblings,” said a Ugandan colleague, in a tragic reminder of the impact of childhood diseases in rural Africa.

Stanford bioengineering professor Manu Prakash, PhD, took this picture two weeks ago while conducting clinical field evaluations of his lab’s various ultra-low-cost disease diagnostics inventions.

His latest project is an electromagnetic patch that non-invasively detects live parasitic worms in infected patients.

To help test this novel idea, Prakash and co-investigator Judy Sakanari, PhD, a research pathologist at the UC San Francisco School of Medicine, received a $100,000 Grand Challenges Explorations award from the Gates Foundation.

The first prototypes will be used to detect the worm that causes onchocerciasis, or “river blindness,” which afflicts approximately 37 million people in Africa, Central and South America, and Yemen. Transmitted through repeated bites of blackflies, it is a major cause of preventable blindness.

Current diagnostic methods require the use of expensive ultrasound equipment to determine whether parasitic worms are alive under the skin or inside lymph nodes. Prakash’s more frugal design consists of a Bandaid-sized patch embedded with a sensitive sensor that detects minute electrical changes when worms wiggle under the skin or form calcified cysts. He expects that the final device will cost less than $10 and will be easier to use in rural settings.

Prakash and Jim Cybulski, a Stanford mechanical engineering PhD student, were also working at several sites to clinically evaluate “Foldscope,” an inexpensive microscope made of folded paper that is being mass produced and used for diagnosing diseases like malaria, schistosomiasis, African sleeping sickness, tuberculosis and various filarial diseases in field conditions. Cybulski recently won a Global Health Equity Scholars Fellowship (NIH-funded) for field testing this device.

The magnitude of the malaria problem in Uganda, which has one of the highest rates of infected mosquitoes in the world, became crystal clear during their trip.

“There was one hut where we trapped 400 mosquitoes in one night,” said Prakash. “And some public health centers that we visited had almost 100 malaria cases per day, with mothers of large families bringing in at least one child a week for testing.”

He added, “Being in the field gives meaning to working in global health. It teaches you empathy, a driving force so strong that transforms ideas into actions.”

Prakash’s lab is also exploring how to develop “human capital” in these resource-constrained settings, a strategy that would generate more jobs and build the infrastructure to provide these services locally. “We are looking at various ways to bring appropriate tools and training to these young college graduates who don’t have much to do,” he said.

Previously: Is the worm turning? Early stages of schistosomiasis bladder infection charted, Compound clogs Plasmodium’s in-house garbage disposal, Using cell phone data to track and fight malaria and Image of the Week: Malaria developing
Photo by Manu Prakash

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