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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

Health Disparities, History, Medicine and Society, Public Health, Rural Health, Stanford News

Broken promises: The state of health care on Native American reservations

Broken promises: The state of health care on Native American reservations

RosebudI traveled to Haiti a month after the 2010 earthquake to report on what was happening there for Stanford Medicine magazine. So when I went to the Rosebud Indian Reservation in South Dakota this year with a group of Stanford students, I was incredulous to learn that the average life expectancy in this community was one year lower than Haiti’s – 46 versus 47 - and a full 33 years shorter than the average American.

Statistically speaking, the poor health of Native Americans living the Great Plains of the United States rivals many developing countries. I had no idea. Diabetes, alcoholism, and depression rates are frighteningly high. Suicide rates are 10 times the national average.

My goal in writing my in-depth story, which appears in the current issue of Stanford Medicine and was just recommended as a Longreads pick, was to try to understand how this could possibly be true, and to lend some perspective as to what could be done to change it. What I found was a toxic mix of causative factors: isolation, poverty, poor nutrition, poor education - each of which has its roots in history. What became strikingly clear during my visit to the federally funded Rosebud Indian Health Service Hospital on the reservation was that the United States government has never kept its promises, made in multiple treaties, to provide health care to Native Americans in exchange for land.

From my piece:

One afternoon during a visit to the hospital, I walk from the ER to a separate wing to find the CEO, [Sophie Two Hawk, MD, who also happens to be the first Native American to graduate from the University of South Dakota's medical school]. Her door’s ajar, and she waves me in. She’s dressed in the military-style uniform of the U.S. Public Health Service Commissioned Corps, her long, gray hair pulled back in a braid that drops down her back. She’s doing paperwork — denying a pile of requests from her physicians for additional care for their patients. The requests are appropriate, she says, but the hospital just doesn’t have the money to pay for the care. “If someone shows up with a torn ACL, we can’t afford to fix it,” she says. “He will walk with a limp.” Two Hawk, like many others, links the poor health statistics of Native Americans not only to the lack of adequate (federal) funding but to the community’s tragic history. The hopelessness, the despair — it’s rooted in history.

The story delves into some of that history, including the forced relocation of Native American children to faraway boarding schools, another particularly ugly chapter in history that I knew nothing about. This forced relocation led to “cultural distortion, physical, emotional and sexual abuse, and the ripple effect of loss of parenting skills and communal grief,” a government study states. Hope on the second poorest county in the country – neighboring Pine Ridge Indian Reservation comes in first place – is a struggle to find. But it’s there, particularly in the strong bonds of the community itself:

Leaving Two Hawk, I head to the office next door where another Native American hospital employee, psychologist Rebecca Foster, PhD, works. When I knock on her office door, she’s taking a break to cradle her week-old grandson. Foster and her husband, Dan, also Native and a psychologist at the hospital, have 14 children — seven of those adopted from relatives on the reservation who were unable to care for them. All seven of those children are special needs, like the baby’s father, who was born with fetal alcohol syndrome… ” I see a lot of kids who are depressed, who talk about suicide,” she says, then pauses to look into the eyes of her grand baby. “And yet, kids are still resilient. They still have a desire to have a good life, to be happy, to accomplish things. No matter where you come from, you can never completely destroy that. There are very few kids here who don’t have a dream. What I tell young people is that there is a difference between having to stay here because you are trapped and choosing to be here because you have something to give. One’s a prison, the other is a home.”

Previously: Finding hope on the Rosebud Indian Reservation, Getting back to the basics: A student’s experience working with the Indian Health Service, Lessons from a reservation: Clinic provides insight on women’s health issues, Lessons from a reservation: South Dakota trip sheds light on a life in rural medicine and Lessons from a  reservation: Visit to emergency department shows patient care challenges
Illustration by Jeffrey Decoster

Men's Health, Public Health, Research, Rural Health, Stanford News

A guide to coping with a common male birth defect

A guide to coping with a common male birth defect

One of the most common birth defects in boys occurs when the urethral tube fails to completely close, leaving the urethral opening somewhere along the underside of the penis, rather than the tip. Approximately one in 200 males is born with the condition, but the cause is usually unknown. It’s been suggested that exposure to pesticides might be the culprit in some cases, but no definitive studies have been done.

A paper from Stanford researchers, which came out today in the journal Pediatrics, presents results of analyses they conducted of several hundred pesticides commonly used in commercial applications. They found weak links with 15 of the chemicals, but emphasize that further studies need to be done before anyone can say there’s a link between any of the chemicals and the condition, called hypospadias. You can read more of the details in our press release.

Causation aside, parents of a baby boy born with the condition have to make decisions about how to treat the condition.

“Any birth defect is concerning to parents, and a defect in the genital structure often causes special concern,” William Kennedy, MD, associate professor of urology at Stanford and associate chief of pediatric urology at Lucile Packard Children’s Hospital, told me.

Kennedy has been counseling parents and performing corrective surgeries for years and has seen the difficulty parents often have in dealing with the condition.

“Parents are often reluctant to talk to anyone — even medical professionals — about the baby’s condition,” Kennedy added. “Fortunately, most corrective surgeries have positive outcomes.”

Kennedy says a lot of parents first turn to the Internet for information and, as we all know, sometimes what we find there can be misleading. That prompted Kennedy and Suzan Carmichael, PhD, associate professor of pediatrics and lead author of the Pediatrics study, to join with Matt Dorow, who has a son born with the condition, to write a book on
the subject for parents.

“Hypospadias – A Guide to Treatment,” is a slender volume of just over 100 pages, containing information and guidance on every aspect of hypospadias. The recently published book presents information in a clear, organized fashion and includes short pieces written by a man born with the condition and Dorow. If you have a boy born with hypospadias, or know someone who does, it could be immensely helpful.

Cardiovascular Medicine, Global Health, Nutrition, Research, Rural Health, Stanford News

Could a palm oil tax lower the death rate from cardiovascular disease in India?

Could a palm oil tax lower the death rate from cardiovascular disease in India?

palmoilHow could you encourage widespread adoption of a healthier eating habit? Not so much in the form of Justice Antonin Scalia’s broccoli comment, but something less controversial and more like a tax on, say, Pop-Tarts so that they’d be the same price as something healthier, like broccoli. And then it’s still your call which – if either – to choose to eat for dinner.

A recent study in the British Medical Journal tested a simulated 20 percent tax on saturated-fat-laden palm oil designed to reduce its consumption – and adverse health effects – in India. (Earlier this year, John Farquhar, MD, professor of medicine and health research policy, emeritus named palm oil among his top foods to avoid.) Authored by scientists from Stanford School of Medicine, Stanford Woods Institute for the Environment and collaborators in London, Oxford and Delhi, the study used an economic-epidemiologic model to predict whether increasing the price of palm oil would have an effect on the death rate from hyperlipidemia-induced cardiovascular disease in the years 2014-2023. It also considered a palm oil tax’s possible implications for food security – a measure of confidence about the availability of food and lack of fear of starvation.

As discussed in the paper, the researchers chose to study India because the country “is not only expected to face the greatest burden of cardiovascular disease mortality among low and middle income countries but is also considered a policy leader in the prevention of chronic disease among these countries.”

Looking at household expenditure data in subpopulations of Indian residents age 20-79, the researchers forecasted a 1.3 percent reduction in cardiovascular deaths over the next 10 years in people who were to stop using palm oil and not substitute another oil for it, and an additional benefit to those who introduced heart-healthier oils and the benefits of polyunsaturated fats to their diet.

The study’s findings predicted more benefit to males and urban-dwelling people than females and rural residents, owing to differences in consumption and cardiovascular risk. Researchers determined the palm oil tax would lead to a dietary reduction of about 13 calories a day, and an increase of food insecurity of about 0.59 percent, over the 10-year period.

I asked study author and Stanford internist Sanjay Basu, MD, PhD, to comment on the significance of these findings. He said, “the 1.3 percent reduction in cardiovascular deaths is huge because India has such a large number of these deaths.” Still, he said, “I think we’re cautious about recommending such a tax because of the potential for food insecurity among the rural groups.”

Asked whether the mathematical model he and his team developed could be used for other risk factors and health solutions within the Indian subpopulations studied, Basu replied that yes, “we’re looking at taxes on sugar sweetened beverages and large-scale subsidies for fruits and vegetables.” As for the study’s possible implications for the United States, he said, “palm oil is of limited consumption in the United States, but this is analogous to the sugar taxes in the U.S. where there’s a commonly-consumed good, primarily affecting obesity and type 2 diabetes among low-income groups.”

Previously: Can food stamps help lighten America’s obesity epidemic?, Stanford preventive-medicine expert: Lay off the meat, get out the sneaks and New evidence for a direct sugar-to-diabetes link
Photo by One Village Initiative

Health Costs, Health Disparities, Public Health, Rural Health

“Mountain Dew mouth” rots teeth, costs taxpayers

"Mountain Dew mouth" rots teeth, costs taxpayers

1527462651_903a291406“Blecch! Ew! Sheesh! I’ll take a crab juice,” replied a thirsty Homer Simpson to a vendor’s alternative offer of Mountain Dew. I side with Homer on most issues, including this one. But whatever you think of the taste, you’d be hard-pressed to argue in favor of the soft drink’s nutritional value.

Soda has a bad reputation for being high in empty calories that contribute to some of the nation’s public-health problems, such as obesity and diabetes. NPR’s The Salt blog reports today on a phenomenon widespread in Appalachia of rotting teeth owing to frequent consumption of soda. The incidence is called “Mountain Dew mouth” – “after the region’s favorite drink,” which was invented in Tennessee, the piece notes.

Public-health advocates point out a burden of cost imposed by the Dew, which can be acquired with food stamps (now called the Supplemental Nutrition Assistance Program). Greater access to the drink and limited availability of dental care contribute to “Mountain Dew mouth,” which is reinforced by cultural issues in the area.

From the piece:

Many people don’t trust the well water in their homes because of pollution concerns and probably drink more soda because of it, [Priscilla Harris, JD, an associate professor at the Appalachian College of Law], says. She’s received a grant from the Robert Wood Johnson Foundation to study the problem.

And there’s another reason why soda mouth is so pervasive in Appalachia, Harris says: the region’s distinct culture of sipping soda constantly throughout the day. Singer adds, “Here in West Virginia, you see people carrying around bottles of Mountain Dew all the time — even at a public health conference.”

The article reports statistics about the region’s rate of tooth decay as 26 percent for pre-schoolers, and tooth extraction because of decay or erosion as 15 percent for 18- to 24-year-olds. In West Virginia, Centers for Disease Control and Prevention numbers show 67 percent of residents age 65 and over having lost six or more teeth from tooth decay or gum disease.

Previously: Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert and Dental health a major problem for many
Photo by uberculture

Cancer, Clinical Trials, Mental Health, Rural Health, Stanford News, Women's Health

Using video-based support groups for rural women with breast cancer

Using video-based support groups for rural women with breast cancer

rural California2Support groups can help women with breast cancer reduce pain and emotional distress, while providing a source of encouragement, camaraderie and advice. Yet, as I explained yesterday in a press release, joining support groups is often impractical for breast cancer patients who live in remote areas:

“Women in rural areas have a hard time finding other breast-cancer survivors,” said [Cheryl Koopman, PhD, a professor of psychiatry and behavioral sciences]. Many wish to communicate with one another, but they can face a number of challenges — such as snowed-in mountain passes, limited public transportation and high travel costs — simply getting to support groups, which frequently are located in major cities. Moreover, patients are often too fatigued from cancer treatments to make the trip.

This is what prompted the Sierra-Stanford Partnership, a collaboration between rural-community advocates Joanne Hild and Mary Anne Kreshka, of the Sierra Streams Institute, and Stanford’s Koopman. The collaborators are now seeking breast-cancer patients living in one of 27 northern California counties to participate in a study of the effectiveness of support groups conducted via video chat.

This form of support group is different from Internet support groups, because it’s more personal, Koopman told me:

Text-based, Internet support groups are already available, but many patients want a more interactive form of communication. “A lot of women tell us they would like to see the support-group leader and one another,” Koopman said. The strength of the video-based support group is that breast-cancer patients can see and interact with one another with minimal cost and effort, she said.

The ultimate goal is to help researchers design the best kind of support group for breast-cancer patients who live in rural areas. Information for volunteers interested in participating in the study can be found here.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Photo by Damian Gadal

Cancer, Global Health, Research, Rural Health, Stanford News, Women's Health

Stanford study: Women in developing world benefit from quick, effective cervical cancer test

Stanford study: Women in developing world benefit from quick, effective cervical cancer test

Stanford researchers have used a quick, effective test for cervical cancer among low-income women in Thailand – the first successful use of the test, which could be broadly applied in the developing world.

Cervical cancer rates have declined by 80 percent in the United States and other developed countries as a result of the commonly used Pap smear. But in the developing world, these kinds of prevention programs have failed, and the disease is a major public health problem, says Stanford ob-gyn Paul Blumenthal, MD, MPH.

Blumenthal has pioneered techniques for simple screening and treatment programs to prevent this potentially fatal cancer. He collaborated recently with a colleague in rural Thailand, as well as University of California, Berkeley medical student Lee Trope, in a study that used a test, called careHPV, which detects cervical cancers caused by the human papilloma virus. The test is inexpensive – about $5 – and can give women results almost immediately. A positive test can be combined with the application of acetic acid – simple household vinegar – to confirm that cancer is present (if there are pre-cancerous lesions, these will show up as opaque raised white patches, easily visible to a clinician).

In the study, Blumenthal told me, “We show that real-time HPV testing is feasible in a rural setting in a developing country, and in combination with the vinegar test and treatment with cryotherapy (freezing the malignant tissue), an approach to single-visit cervical cancer prevention is a realistic possibility.”

The testing was done among 431 women in a province in northeastern Thailand. The women did a vaginal self-swab, which was analyzed in three hours. Those who were positive for cancer were offered treatment on site. This is important, Blumenthal said, because if there isn’t an immediate link between testing and treatment, women often become lost to follow-up.

“To be sure this is a small, feasibility study, but no one has even ever attempted to use this test at the community level, and we showed that in rural Thailand, it’s possible,” he said. “This has important implications for the future of cervical cancer prevention in these kinds of settings.”

The study appears in the July issue of the Journal of Lower Genital Tract Disease.

Previously: Stanford ob-gyn Paul Blumenthal discusses advancing women’s health in developing countries and Ethiopia to benefit from low-tech cervical cancer screening

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