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Events, Grand Roundup, Health Disparities, Rural Health

A quest to cure the world’s blind

A quest to cure the world's blind

Geoff TabinI recently had the pleasure of organizing a global-health seminar with a special visitor to campus: Geoff Tabin, MD. A renowned ophthalmologist, world-class climber and humanitarian, Tabin shared his circuitous road through global medicine and his vision to eradicate unnecessary world blindness.

“Most of the blindness on our planet could have been prevented or is easily treated,” Tabin told the audience. “It’s one of the few areas of global public health that we can really do a lot about – and, when you cure someone, they’re 100 percent cured.”

Blindness disproportionately impacts people in developing countries where malnutrition, poor water quality and lack of sanitation and health-care infrastructure lead to high incidence of eye disease. It comes with a heavy economic burden – Tabin explained that in the developing world, blindness is associated with a two-thirds reduction in life expectancy, or typically less than 10 years.

But tackling world blindness is also a story of hope. Cataract – which accounts for more than half of world blindness, according to the World Health Organization – can easily be treated with a low-cost, one-time procedure that restores full sight. A person who undergoes cataract surgery can go from being blind to being able to pass his or her driver’s test the next day.

Through a serendipitous series of events, Tabin co-founded the Himalayan Cataract Project with Nepali ophthalmologist Sanduk Ruit, MD, with the vision of restoring sight to as many of the world’s 18 million cataract patients awaiting care as possible. Since 1995, the organization’s doctors have performed over 445,000 cataract surgeries in the developing world.

Ruit had started an intraocular lens factory in Kathmandu that dramatically reduced the cost of cataract surgery. In the 1980s, the standard procedure for cataract surgery in the U.S. involved replacing the eye’s natural lens with an intraocular lens. However, the costly implants were not accessible to cataract patients in the developing world. That was until Ruit who, seemingly overnight, brought the cost of an intraocular lens from $200 to $4 on the world market. Today, the life-changing procedure can be completed in less than 10 minutes at a cost of just $25 per surgery.

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Mental Health, Patient Care, Rural Health

Horse therapy could help people cope with early-onset dementia

Duell and Paula HertelAs a kid growing up in rural Minnesota, I spent many of my waking hours searching for a reason to be near the five horses that roamed the 40 acres behind our house. Their methodical munching and tail-swishing put me at ease and learning how to ride a 1,200-pound animal that could easily wipe me off on a fence post taught me much of what I know about courage and persistence.

A similar sense of calm, accomplishment and fortitude are among the potential benefits of a new pilot study at Stanford University’s Red Barn called the Connected Horse Project. This project aims to help people learn how to manage the symptoms of early-stage dementia through a series of workshops where they participate in supervised activities with horses.

The project is the brainchild of Paula Hertel, Nancy Schier Anzelmo and Elke Tekin, three senior care practitioners and equestrians who work at the Senior Living Consult. For this study they worked with Stanford’s Dolores Gallagher Thompson, PhD, and Nusha Askari, PhD, and Jacqueline Hartman at the Stanford Red Barn Leadership Program.

In the pilot study, five individuals and their care partners participated in a three-week workshop. The study measures the workshop’s effect on the participants’ stress levels, their quality of sleep and their ability to relate to and communicate with others. The results will be presented at Stanford’s Annual Community Health Symposium on Jan. 14 and will be used to develop programs that can be implemented throughout the country, including in rural areas where support services are often lacking.

Hertel and Schier Anzelmo told me more about the program and its potential applications in an email interview:

What prompted you to start the Connected Horse Project?

A shared passion is the simple answer. We are practitioners in senior care and know firsthand that traditional models of care are not adequate. We have also experienced the power of the human/horse connection on a personal level.

Why horses? Do you think a program that pairs humans with dogs or cats could work as well or in the same way? 

Many of us smile when we think about our favorite dog or cat, or in my [Paula’s] case, my first pony. Interactions with animals spark emotional memories that stay intact. Horses can be particularly therapeutic for people because they have an innate ability to sense what others around them feel; they depend on the herd for survival.

In the workshop, the equine facilitators guide the participants through activities that showcase the horses’ characteristics and abilities. This helps the participants recognize their own strengths and the power of their relationships with others.

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Global Health, Nutrition, Obesity, Parenting, Rural Health

Chinese children face obesity risk

Chinese children face obesity risk

69186639_e78742d08a_zWith the parents gone away, the children have time to play — and eat, according to new research that examines the health of the millions of Chinese children left with families when their parents move to urban centers.

Researchers from the University of Manchester in England analyzed the dietary choices of 975 children from 140 rural villages. Led by graduate student Nan Zhang, the team found children living with their grandparents or a single parent ate more fat and less protein than children living with two parents. The research appeared in Public Health Nutrition.

The diets of boys particularly worsened, a finding that has complex implications in a society where males are favored, Zhang said in a news release.

The study did not examine why the childrens’ diets changed, but Zhang has several theories. From the release:

The researchers speculate that mothers moving away from home generally earn less, and that these lower earnings act in combination with grandparents’ poorer dietary knowledge or willingness to spend more on food…

Another factor at work could be that prices of protein-based foods such as eggs and meat have increased faster than many households’ incomes.

The study highlights the need for increased public education on nutrition, she said.

Previously: Building the case for a national hepatitis B treatment program in China, Seeking solutions to childhood anemia in China and  “We should act now”: Stanford expert calls for more targeted anti-obesity policies
Photo by T Chu

Global Health, Pediatrics, Public Health, Rural Health, Stanford News

Helping newborns through song

Helping newborns through song

Instead of drugs or fancy devices, a small village in India is using dhollak and dafali — drums traditional to the region — to spread awareness about post-natal care and to battle infant mortality. As Becky Bach explains in the latest issue of Stanford Medicine magazine, the effort started as part of a public-health research project led by researchers Gary Darmstadt, MD, and Vishwajeet Kumar, MBBS, who partnered with community leaders in an effort to communicate evidence-based health practices:

In a groundbreaking endeavor, [Darmstadt’s] team worked with communities to slash newborn mortality by 54 percent in less than two years in a large, impoverished area in northern India called Shivgarh.

Their strategy was simple, in principle: embrace the local culture, seek to understand its newborn-care practices, and partner with the community to translate evidence-based recommendations into meaningful communications — metaphors, songs — that could change behavior.

“Songs have traditionally played a key role in the community as a medium for transferring cultural knowledge inter-generationally and within groups,”  Vishwajeet Kumar, director of the Community Empowerment Lab in Shivgarh, told me. In the above video, a group of women, some holding infants, sing about the importance of skin-to-skin care:

Pregnant women and mothers-in-law, who play a critical role in perpetuating the community’s childbirth traditions, were shown how to provide skin-to-skin care, a simple practice that involves placing the bare-skinned baby on the caregiver’s skin, providing love, warmth and access to nourishment. The practice produces immediate, tangible benefits: It improves babies’ color and temperature, and reduces crying and startle responses. The villagers interpreted these signs as the absence of evil spirits, reinforcing their willingness to embrace the change.

A talented local songwriter named Santosh Kumar is responsible for many of these songs, which combine global knowledge with local wisdom, said Vishwajeet Kumar. He works in collaboration with the community to organize gatherings where important early care practices, from sanitation to breastfeeding, are conveyed through his songs.

The story of Shivgarh is a reminder that sometimes health is about more than doctors and big facilities. Sometimes the final puzzle piece can take the form of knowledge and a dedicated community.

Lindzi Wessel is a former neuroscience researcher and current student in the UC Santa Cruz Science Communication Program. She is an intern in the medical school’s Office of Communication and Public Affairs.

Previously: Stanford Medicine magazine tells why a healthy childhood matters and Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survival

Education, Patient Care, Rural Health, Stanford Medicine Unplugged

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Hamsika among trees

As part of the family medicine clinical rotation here at Stanford, students have the option of spending two weeks doing a “rural medicine” track in Humboldt, a small 150,000-person county that is about a 5- to 6-hour drive north of Palo Alto. Each month, up to two medical students can volunteer to be in Humboldt, and Stanford takes care of arranging for hosts, clinic preceptors, and pretty much everything else. I had heard from upperclassmen that this track was “amazing” and “unique” and that I should “do it!!!” And so, three weeks ago, I found myself downloading an audiobook version of Aziz Ansari’s Modern Romance to keep me company as I made the long drive to Fortuna, California.

I’m not sure what I expected to see when I got there. For some reason, I had this dramatic idea that I would be spending two weeks with no cell phone service, spotty access to Internet, no Starbucks visible in a 10-mile radius, and paper medical records instead of an EMR. The reality wasn’t quite so bleak (in fact, the very first sign I saw in Fortuna pointed toward a Starbucks, and I had zero trouble with cell phone service and Internet access), but it was still a jarringly different experience from my first three months of rotations, spent in Palo Alto and Santa Clara.

First and most noticeable was the shortage of physicians. Everyone talks about the physician shortage and the need for primary care physicians, but it wasn’t until I got to Humboldt that I first saw this need manifest. In the clinic where I was working, there was one family medicine physician – total. Each day, he saw 25 or more patients and did everything from diabetes care to trigger point injections to skin cancer. There were poignant moments in clinic, when it was clear that a patient needed specialist care, but there simply wasn’t anyone to refer the patient to. The nearest specialist care center was UCSF, five hours away. Moreover, it was sometimes difficult to access patients’ past medical records, or records from other clinics. The EMR in Fortuna was just a few years old, and in fact, there was one day of clinic when my preceptor and I explicitly dedicated time to transferring patients’ past medical history from paper records into the EMR.

Contrast this to the second half of my family medicine rotation, which I spent at a Stanford-affiliated clinic. Over the course of 1 week in this clinic, I worked with five different family medicine preceptors, and there were still more physicians at the clinic with whom I had not worked with directly. We saw between 12 and 15 patients a day and had the luxury of scheduling in 40-minute time blocks whenever a patient needed the extra time. I had no trouble accessing patient’s medical records, not only within Stanford but from outside institutions they had been seen in in the past. Test results popped up in Epic (Stanford’s EMR) in a timely manner, with lovely color-coded labels and notifications whenever a patient was due for a vaccine. And when we needed specialist care, it was just a click away.

If I’m honest with myself (and I hope I don’t regret saying this publicly), I felt much more at ease in the latter clinic environment, where I was able to pend orders for any test I thought a patient needed, trend patients’ lab values, and declare confidently that I thought a patient could benefit from such-and-such specialist care, knowing that it was a viable option rather than a hopeful suggestion. My first two years of medical school trained me to think about what diagnoses were possible, then immediately what labs and imaging studies were needed to work these diagnoses up. I was lost in the world of rural medicine when sometimes the test to work something up was not an option. My time in Humboldt gave me much-needed perspective – not only into how far medicine has come but also what medicine was once like, and where I stand in the middle of it all.

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo of Hamsika Chandrasekar by John and Jean Montgomery

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

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

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