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Infectious Disease, Parenting, Pediatrics, Pregnancy, Public Health

Cocooning newborns against pertussis

Cocooning newborns against pertussis

Grandparent hand with babyAt my last prenatal visit, I got a booster shot for whooping cough (sometimes called pertussis). The Centers for Disease Control and Prevention recommends women get a booster in the third trimester of every pregnancy. Whooping cough has been on the rise for years, and there’s an outbreak happening in California, where we live.

Newborns are especially vulnerable to severe complications from the disease, so doctors suggest that anyone who’s going to be in close contact with newborns and isn’t up-to-date also get a booster: fathers, siblings and even visiting grandparents. The strategy is called “cocooning.”

But what do you do when a grandparent doesn’t want to get a shot? A lot of people don’t like getting vaccinations, either because they want to avoid the discomfort of a shot in the arm or they don’t believe vaccines are effective. (They are.) It’s a question that comes up more often than I expected in online communities. Many pregnant women insist that grandparents who won’t get pertussis shots won’t be allowed to see the new grandchild. Others argue that you can’t force a medical decision like that on someone else. Throw in the added complication that if you’re a first-time parent, it might be the first time you’ve had to confront your parents about how you plan to raise your child. What a mess.

I’m lucky that most of my daughters’ grandparents are already vaccinated for pertussis: My parents and my mother-in-law came to stay and help us with the baby a few years ago and all got vaccinated at the time. But with all the things occupying us as new parents, we didn’t even think to ask my father-in-law, who lives nearby but didn’t have any extended stays in our home. As it turns out, he’s not a fan of vaccinations, and he insists that he got the flu from his last flu shot. (He didn’t.) Obviously, he hadn’t gotten the pertussis booster.

For this baby, we’re planning on bringing up the shot with him, but we’re not expecting him to actually get one. So what will we do? I surprised myself by deciding that I won’t insist he get one in order to see the baby, as long as he doesn’t have any cold symptoms when he visits. (Pertussis usually starts as a mild cold that gets progressively worse; by the time most people are diagnosed, they’ve been sniffling and shedding pertussis bacteria for weeks since they first showed symptoms.) But, who knows? Maybe Grandpa Lesko will surprise us and get the shot for the baby’s sake – or just to avoid the sniffle quarantine policy.

We’ll see.

Previously: Failure to vaccinate linked to pertussis deathsCDC: More U.S. adults need to get recommended vaccinations, and Whooping cough vaccine’s power fades faster than expected
Photo by Ashley Grant

Complementary Medicine, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

kids_yogaManaging stress and making healthy choices is a daily struggle for many of us. But what if way back in elementary school we had learned resiliency skills and mind-body practices to cope with anxiety, reduce incidents of bulling and violence, and boost our cognitive ability? Would this training have helped us keep our flight-or-fight response in check and live healthier lives?

A four-year study conducted by researchers at Stanford aims to answer these questions. The project will evaluate a yoga-based health and wellness program involving 3,400 students at the Ravenswood City School District. The program, which has been funded for three years by the Sonima Foundation, includes exercise-based on yoga, basic fitness regimes, relaxation techniques, mindfulness practices and nutrition. As the San Jose Mercury News reports:

The plan is to employ a multi-method approach that involves biology, physiology and psychology — a complete bio-psychosocial assessment — to measure [students’] emotions and behavior, academic and cognitive strengths and weaknesses, brain activity and structure, stress-related hormone levels, and sleep patterns.

“We’re really looking forward to a year from now — when I tell you this is effective — for you not to only take it on my word, but for you to also have data,” said Dr. Victor Carrion, a professor of psychiatry and behavioral sciences at [Stanford].

Carrion is also the director of the Stanford Early Life Stress and Pediatric Anxiety Program at Lucile Packard Children’s Hospital.

In 2012, he launched a mindfulness program in the Ravenswood City School District to treat post-traumatic stress disorder in teens that was featured on a PBS NewsHour segment. Jones and his wife happened to catch the broadcast, and because Carrion has done pro bono work with students and parents in the community for years, the partnership between the district, Stanford and the Sonima Foundation was forged.

The four-year study is also in partnership with the Center for Education Policy and Law at the University of San Diego.

“This is something that for years has been a gap in our educational system,” Carrion said. “There’s nothing… that teaches children to socialize and to be in touch with their emotions and to take care of their inner health.”

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focus, Yoga classes may boost high-school students’ mental well-being and Study shows meditation may lower teens’ risk of developing heart disease
Photo by Nicole Mark

Patient Care, Pediatrics, Public Health, Research, Stanford News

Study finds gaps in referring California’s tiniest babies to follow-up care

Study finds gaps in referring California's tiniest babies to follow-up care

preemie feet2When very fragile babies go home from the hospital after birth, they often require special follow-up care. But a new Stanford study has found that some high-risk infants aren’t receiving referrals to the follow-up care they need.

The study, which appears in the February issue of The Journal of Pediatrics, analyzed statewide data on more than 10,000 California babies born in 2010 and 2011 who were considered high risk because they had very low birth weights. Of those who survived to hospital discharge, 20 percent did not receive referrals to the state’s high-risk follow-up program.

From our press release on the research:

Babies who weigh less than 3.3 pounds at birth, nearly all of whom are born prematurely, are at risk for a variety of neurologic and developmental problems in childhood. In California, all babies with a very low birth weight who received care in a California Children’s Services-approved neonatal intensive care unit qualify for a state-supported, follow-up program that provides diagnostic assessments and services until they turn 3.

“If we cannot succeed in that first step of getting these babies referred to follow-up, we’re at a critical disconnect for what we can offer them as they grow and develop,” said Susan Hintz, MD, professor of neonatal and developmental medicine and lead author of the study.

The study analyzed which very-low-birth-weight babies were receiving referrals. Neonatal intensive care units that treated more of these babies referred a higher proportion of such patients to follow-up care, and babies with several types of medical problems were more likely than others to receive referrals. Babies whose birth weights were on the higher end of the low-weight category were less likely to get referrals, as were those of African-American and Hispanic descent.

The good news, however, is that the data was collected just after California revamped its high-risk follow-up program. Hospitals with low referral rates are already receiving feedback to help them improve, and those with high referral rates are being studied to see how their successes can be transferred to other settings. More from our release:

“We’ve already made substantial improvements in site-specific online tools and resources available to hospitals for nearly real-time feedback, and referral rates now appear to be higher than they were during 2010 and 2011,” Hintz said.

California is ahead of other states in having a comprehensive, statewide program to help high-risk infants, [she] added. “The expectation that all our high-risk infants will be referred is enormously innovative in this country,” she said.

Previously: Preemies face increased risk of death in early adulthood, Stanford study finds, NICU trauma intervention shown to benefit mothers of preemies and How Stanford researchers are working to understand the complexities of preterm birth
Photo by Jenny

In the News, Medicine and Society

The medical community and complicity: Our role in the Eric Garner case

The medical community and complicity: Our role in the Eric Garner case

die-in photo2Last week, more than one hundred Stanford graduate and medical students gathered to commemorate Martin Luther King, Jr. Day and remember the lives of Mike Brown and Eric Garner. On a white board that proclaimed “Black Lives Matter,” attendees wrote their thoughts. On the board, I wrote “Keep the conversation going,” and as part of that effort I’d like to examine one instance where the practice of medicine is deeply entwined, for good and bad, in the movement for equality.

Over the past several months, the role of racial bias in policing practices and the judicial system has been the subject of extensive discussion and protest, but what hasn’t been adequately discussed is the lesson in this for medical professionals. A catalyzing event for our national discussion has been the video footage of police use of a chokehold and its role in the death of Garner. However, there is a second video from the same incident that warrants scrutiny, particularly from the medical community.

The second video follows the minutes after Garner’s death. After prolonged moments of police prodding and the encouraging of his motionless handcuffed body to cooperate, emergency medical services arrive on the scene. In gloved hands and comforting voices, they appear to very briefly check for a pulse and then encourage Garner, unconscious, to cooperate with getting onto a stretcher.

In the background an observer asks why Garner is not receiving CPR, and a police officer replies, “He’s still breathing.” Given the video, it’s unclear whether or not Garner was actually breathing. What is clear is that progressing from a witnessed loss of consciousness, he eventually entered respiratory arrest followed by cardiac arrest in the presence of multiple medical and police personnel trained in CPR. To perform CPR in such an instance is standard of care and may have saved his life, but basic life support was not performed. Why? And I wonder: Would CPR have been administered if Garner had been white?

There were likely a complex mixture of assumptions, prejudices, and biases that led these health-care workers to not act to save Garner. There is no evidence of overt malice, but race, socio-economics, and deference to the authority of the police all likely played a role in influencing the medics’ actions, or lack of action. As they arrived on the scene, did the medics believe that CPR would just delay the inevitable? Were they worried of offending the authority of the police and exposing the police’s failure to initiate CPR? As medical professionals, we must learn from this incident and begin to recognize and dismantle our own prejudices and biases, wherever we may find them.

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Applied Biotechnology, Bioengineering, Biomed Bites, Cancer, Imaging, Technology, Videos

Beam me up! Detecting disease with non-invasive technology

Beam me up! Detecting disease with non-invasive technology

Here’s this week’s Biomed Bites, a feature appearing each Thursday that introduces readers to Stanford’s most innovative biomedical researchers.

Star Trek fans rejoice! Stanford radiologist Sam Gambhir, MD, PhD, hopes that someday he’ll be able to scan patients using a handheld device — similar to the one used by Bones in the popular sci-fi series — to check their health.

“Our long-term goals are to be able to figure out what’s going on in each and every one of you cells anywhere in your body by essentially scanning you,” Gambhir said in the video above. “We’ve been working on this area for well over three decades.”

This is useful because it will help doctors diagnose diseases such as cancer months or even years before the symptoms become apparent, Gambhir said.

And these advances aren’t light-years away. “Many of the things we’re doing have already started to move into the hospital setting and are being tested in patients. Many others will come in the years to follow,” he said.

Gambhir is chair of the Department of Radiology. He also directs the Molecular Imaging Program and the Canary Center for Cancer Early Detection.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Stanford partnering with Google [x] and Duke to better understand the human body, Nano-hitchhikers ride stem cells into heart, let researchers watch in real time and weeks later and Developing a new molecular imaging system and technique for early disease detection

In the News, Medicine and Society, Parenting, Pediatrics, Pregnancy, Stanford News

Grandparents update their baby skills at children’s hospital

Grandparents update their baby skills at children's hospital

2057241787_0f89a0276f_zThe past century has been flooded with trends and new information surrounding pregnancy, birth, and infant care. From doctors Spock, Lamaze, and Bradley in the ’50s, to the promotion of new technologies such as epidural anesthesia and formula feeding in the ’60s, through various iterations of the natural birth movement in the 70’s and 80’s… From the licensing of non-hospital midwives in the 90’s, to the boom in doulas in the 2000s, through the proliferation of maternity apps in this decade, the “right way” to bring a baby into the world has evolved.

To get grandparents updated on their baby knowledge, Lucile Packard Children’s Hospital sponsors a “Grandparents’ Seminar” as part of its course offerings. As a recent San Francisco Chronicle article notes,”Hospitals commonly offer classes in labor, lactation and baby CPR. But adding grandparents to the mix is a modern twist. It used to be that grandparents didn’t go to classes for advice. They dispensed it.”

The two-hour course covers infant safety, sleep, and feeding. Though most of the class participants were conscientious and up-to-date when they were raising their own children, some accepted practices have changed – babies are now swaddled tightly like burritos, laid to sleep on their backs without pillows, and exclusively breastfed when possible. Umbilical cords are cleaned with water instead of alcohol, the specifications for car seats have changed dramatically, and there is a potentially overwhelming array of new products on the market. Medical communities are increasingly becoming aware of perinatal mood disorders, and informing patients about practices that were once “fringe” – like co-sleeping and intervention-free birth.

The course also touches on the complex emotional issues that come with becoming a grandparent, and offers advice on etiquette – which the course instructor, Marilyn Swarts, a labor and deliver nurse and nurse manager quoted in by the Chronicle, sums up with “Seal your lips.” Parents want their parents involved with the baby, but they also want autonomy and to incorporate modern care practices. Indeed, many people who take the course learned about it through their children.

Swarts has been teaching the course for the nearly ten years it has been offered. In a 2009 interview with a grandparenting blog, she said:

It’s so hard because we’re still in the parent mode and just want to help our children, but they must learn for themselves. Better to ask them: What do you think would be a good solution? I want grandparents to empower the new parents, help them believe they’re the best parents for their child and make them feel comfortable and confident in their new roles.

Related: Classroom catch-up for expectant grandparents
Photo by surlygirl

Scope Announcements

Introducing the Scope magazine on Flipboard

Introducing the Scope magazine on Flipboard

Are you a Flipboard user? The mobile app allows readers to collect content from the web and view it in a beautiful magazine-style format. We recently created a Scope magazine on Flipboard (it’s essentially an RSS feed, but displayed differently), and you can “flip” through it here. And good news: Even if you’re not a user of the app, you can still view our magazine on the web. Just bookmark it and return often.

Previously: Introducing the @ScopeMedBlog Twitter feed

Cancer, Complementary Medicine, Events, Patient Care

Knitting needles cancer while helping patients

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It may sound unusual, but knitting is one way to cope with difficult experiences, such as undergoing cancer treatment. Rhythmic and relaxing, knitting can sooth the mind and soak up the downtime that’s a big part of cancer treatment, according to Holly Gautier, RN, a nurse and director of the Cancer Supportive Care Program at Stanford.

“It’s the repetitive motion that you have with knitting… You’re focused on the stitching and your mind becomes somewhat blank – it really feels good to be making something new,” Gautier explained to me recently.

Although she administers a slew of programs – from yoga to art – Gautier said she’s particularly excited about a new knitting class, which meets weekly at the Stanford Cancer Center.  It’s free and open to all cancer patients and their families — not just those being treated at Stanford.

The class is led by a volunteer knitters, who provide supplies and teach the basic stitches. They can even accompany patients to treatment rooms to answer questions or undo an error, Gautier said. And they’re happy to put together “knitting-to-go” care packages for those who can’t stay.

While participants are welcome to work on other projects, such as scarves and hats, the class is currently making squares to create a quilt to raffle off at an upcoming benefit for the Cancer Survivorship Program. Gautier said the quilt project provides patients with an opportunity to give back – something that nearly all patients yearn to do.

Although the first session last Tuesday drew eight female patient-knitters, Gautier said she hopes other patients and caregivers, particularly men, stop by in coming weeks. More details on the Knitting with Friends program can be found here.

Previously: Knitting as ritual — with potential health benefits?, Image of the Week: Personalized brain activity scarves and A look at how helping others can be healing
Photo by meknits

Infectious Disease, SMS Unplugged

The bacteria that nearly killed my grandmother

The bacteria that nearly killed my grandmother

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Staphylococcus aureauMagnification 20,000“Hefur þú lært um Staphylococcus aureus?” I almost don’t recognize the bacteria name because my grandmother pronounces it differently in Icelandic.

“Já–” I’m about to translate my microbiology flashcard for her when she interrupts, her hands busy kneading the cookie dough and her eyes on my little sister near the oven.

That’s the bacteria that almost killed her eleven years ago, she tells me. I can hear her words building up. This is a story that has been waiting to be told often enough to be reconciled.

They did not know what was wrong with her. They thought maybe cancer, maybe tuberculosis – and I almost interrupt her story to tell her about Pott disease. That’s when tuberculosis from the lungs goes through the blood to the vertebrae and causes back pain, fever, night sweats and weight loss. I memorized the flashcard a few weeks ago.

My little sister stops doing handstands in the middle of the kitchen and comes to stand next to my chair. Together we watch Grandma roll the cookie dough as she continues talking.

It took the doctors a whole long time to figure out what was wrong with her. In the meantime, she was in so much pain from her back that she had to be on high doses of morphine. Codeine.

She could hear them yelling at each other in the next room, my great uncle and the other doctor. The two internists had very different approaches. My great uncle wanted to identify what was going on before putting her up for surgery. The other doctor yelled at him that he was going to wait so long the woman would die.

My grandma stops her cookie cutting and sits across from me. She looks at me for a moment over her glasses and tells me how terrifying it is to know that your doctors don’t know what’s wrong with you.

My poor great uncle, I tell her – he was just trying to make sure that they didn’t make you worse by operating.

My grandma nods and describes how when they finally did agree to have her undergo surgery, my great uncle called the best surgeon in town and had him come back early from vacation to operate on her the next day. And good thing too, for when they did, they found that three of her vertebrae had been turned to dust.

With an infection like that, the surgeon said she was hours away from death.

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Behavioral Science, Health and Fitness, Medical Apps, Public Health, Technology

What needs to happen for wearable devices to improve people’s health?

What needs to happen for wearable devices to improve people's health?

15353072639_f3a79557df_z“Wearable devices” are pieces of technology that are worn in clothes or accessories, and they often have biometric functionality – they can measure and record heart rates, steps taken, temperature, or sleep habits. Numerous tech companies have begun manufacturing and marketing such devices, which are part of a larger movement often referred to as the “quantified self” – where data about one’s life is meticulously gathered and recorded. Only 1% to 2% of Americans have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.

Health and fitness apps are also proliferating, from software that maps where you run or provides a digital workout community, to programs that count calories or suggest how to improve your sleep. But what’s the real impact for people’s health?

Earlier this month, a report from the Journal of the American Medical Association called into question the idea that wearable devices will effect population-scale changes in health. There is a big gap, the authors claim, between recording health information and changing health behavior, and little evidence suggests that this gap is being bridged. Wearable devices might be seen as facilitating change, but not driving it. Mitesh Patel, MD, MBA, from University of Pennsylvania, and colleagues wrote:

Ultimately, it is the engagement strategies—the combinations of individual encouragement, social competition and collaboration, and effective feedback loops—that connect with human behavior.

The difficulty of population health is that changes have to be sustained to have meaningful effects, and that is quite difficult. The authors identify four steps that must be taken to bridge this gap towards sustained change.

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