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Global Health, Nutrition, Research, Stanford News

Stanford researchers address hunger in new book on food security

Stanford researchers address hunger in new book on food security

riceA piece from Stanford’s Freeman Spogli Institute for International Studies notes how experts across campus are working together to address the complex global problem of hunger. A new book, The Evolving Sphere of Food Security (Oxford University Press, August), discusses the problem from numerous perspectives, including medicine, in its 14 chapters. The book’s editor, Rosamond Naylor, PhD, is director of the Center on Food Security and the Environment, which is housed jointly within the FSI and the Woods Institute for the Environment.

From the piece:

“This book grew out of a recognition by Stanford scholars that food security is tied to security of many other kinds,” said Naylor, who is also William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment. “Food security has clear connections with energy, water, health, the environment and national security, and you can’t tackle just one of those pieces.”

Stanford has a long history of fostering cross-disciplinary work on global issues. It is in this spirit that the idea for the book was born, Naylor said. The book weaves together the expertise of authors from the fields of medicine, political science, engineering, law, economics and climate science.

A recurring theme throughout the book – also reflected in its title – is the evolving nature of the food security challenges countries face as they move through stages of economic growth. At low levels of development, countries struggle to meet people’s basic needs. For example, Naylor’s chapter on health, co-authored with Eran Bendavid [MD] (medicine), Jenna Davis [PhD] and Amy Pickering [PhD] (civil and environmental engineering), describes a recent study showing that poor nutrition and rampant disease in rural Kenya is closely tied to contaminated, untreated drinking water. Addressing these essential health and sanitation issues is a key first step toward food security for the poorest countries.

Previously: Seeking solutions to childhood anemia in ChinaWho’s hungry? You can’t tell by lookingCould a palm oil tax lower the death rate from cardiovascular disease in India? and Foreign health care aid delivers the good
Photo by Thomas Wanhoff

Events, Medicine and Society, Stanford News

On death and dying: A discussion of “giving news that no family members want to hear”

On death and dying: A discussion of "giving news that no family members want to hear"

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including “Lost in Translation”:

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk… You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care,” Feldstein responded. “And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

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Grand Roundup

Grand Roundup: Top posts for the week of July 13

The five most-read stories this week on Scope were:

“As a young lung cancer patient, I had to find my own path”: Fighting stage IV with full forceInspire contributor Emily Bennett Taylor, a Stage IV lung cancer survivor and spokesperson/patient advocate, discusses her choice to pursue aggressive treatment following diagnosis at age 28.

The woman in the elevator: dealing with death in medical training: In the latest installment of SMS Unplugged, medical student Jennifer DeCoste-Lopez shares her insight on dealing with death and loss in medical training.

Mourning the loss of AIDS researcher Joep Lange: Stanford researchers specializing in HIV/AIDS are among those around the world mourning the loss of Dutch scientist Joep Lange, MD, PhD, a leading AIDS researcher who died in the recent Malaysian Airlines crash in Ukraine.

Stanford bioengineer develops a 50-cent paper microscopeManu Prakash, PhD, assistant professor of bioengineering, has developed an ultra-low-cost paper microscope to aid disease diagnosis in developing regions. The device is further described in a technical paper.

Stanford team develops nanotech-based microchip to diagnose Type 1 diabetes: Researchers here, including pediatric endocrinologist Brian Feldman, MD, PhD, have invented a cheap, portable, microchip-based test for diagnosing type-1 diabetes. The test could speed up diagnosis and enable studies of how the disease develops.

And still going strong – the most popular post from the past:

Researchers explain how “cooling glove” can improve exercise recovery and performance: The “cooling glove,” a device that helps people cool themselves quickly by using their hand to dissipate heat, was created more than a decade ago by Stanford biologists Dennis Grahn and Craig Heller, PhD. This video demonstrates the device and explains how it can be used to dramatically improve exercise recovery and performance.

HIV/AIDS, In the News

Mourning the loss of AIDS researcher Joep Lange

Stanford researchers specializing in HIV/AIDS mourned the loss today of Dutch scientist Joep Lange, MD, PhD, a leading AIDS researcher who died in the Malaysian Airlines crash yesterday in Ukraine. Lange, a virologist, was particularly well-known for his work in helping expand access to antiretroviral therapy in developing countries. He was among dozens of people on the ill-fated flight who were heading to the 20th International AIDS Conference that opens Sunday in Melbourne, Australia.

“We are all in a state of shocked disbelief here in Melbourne at the tragic loss of one of the giants in the global fight against AIDS and HIV,” Andrew Zolopa, MD, professor of medicine at Stanford, told me in an e-mail from the conference site. “I have known Joep Lange for more than 25 years – he was a friend and a colleague.  Joep was one of the early leaders in our field to push for expanded treatment around the globe – and in particular treatment for Africa and Asia… The world has lost a major figure who did so much good in his quiet but determined manner.  I am shocked by this senseless act of violence. What a terrible tragedy.”

David Katzenstein, MD, also an HIV specialist at Stanford, learned of the death while in Zimbabwe, where he has a long-standing project on preventing transmission of HIV from mother to child. He said Lange, a friend and mentor, had been a “tireless advocate for better treatment for people living with HIV in resource-limited settings. He was universally respected and frequently honored as a real pioneer in early AIDS prevention and treatment.” In 2001, Lange founded the PharmAccess Foundation, a nonprofit organization based in Amsterdam, which aims to improve access to HIV therapy in developing countries. He continued to direct the group until his death.

Lange served as president of the International AIDS Society from 2002 to 2004 and had been a consultant to the World Health Organization, the federal Centers for Disease Control and Prevention and the National Institutes of Health. He led several important clinical trials in Europe, Asia and Africa and played a key role in many NIH-sponsored studies, said Katzenstein, a professor of medicine.

“He was a gentle, thoughtful and caring physician-scientist with a keen sense of humor and a quick and gentle wit. He was constantly absorbing, teaching and thinking about the human (and primate) condition and psychology,” Katzenstein told me. “He was much loved and will be sorely missed.”

Behavioral Science, Health and Fitness, Mental Health, Research

Exercise and relaxation techniques may help ease social anxiety, study finds

Exercise and relaxation techniques may help ease social anxiety, study finds

TrishWardMeditationPicPhysical exercise and relaxation techniques are common forms of stress-relief. Now, a new study has found that both may help people with social anxiety perceive their surroundings as less threatening environments.

Researchers from Queen’s University in the U.K. conducted two experiments measuring anxiety in participants. In both experiments, the participants were shown point-of-light displays describing a human but not indicating which way the stick figure was facing or whether it appeared to be approaching or receding. Facing-the-viewer bias, a possible biological protective mechanism, may lead people to assume the figure is approaching and posing a threat. And, according to the study, people who are more anxious may place their attention on more threatening stimuli, thereby increasing anxiety.

The researchers tested two means of altering participants’ perception of threat when looking at the stick-figure displays. From a release:

“We wanted to examine whether people would perceive their environment as less threatening after engaging in physical exercise or after doing a relaxation technique that is similar to the breathing exercises in yoga (called progressive muscle relaxation),” researcher [Adam Heenan, a PhD candidate,] said in a statement. “We found that people who either walked or jogged on a treadmill for 10 minutes perceived these ambiguous figures as facing towards them (the observer) less often than those who simply stood on the treadmill. The same was true when people performed progressive muscle relaxation.”

“This is a big development because it helps to explain why exercising and relaxation techniques have been successful in treating and mood and anxiety disorders in the past,” Heenan said.

The research was published in PLOS ONE.

Previously: Research brings meditation’s health benefits into focusAh…OM: Study shows prenatal yoga may relieve anxiety in pregnant womenStudy reveals initial findings on health of most extreme runners and The remarkable impact of yoga breathing for trauma
Photo courtesy of Trish Ward-Torres

Medicine and Society, Pregnancy, Research

Study offers clue as to why parents of daughters are more likely to divorce

Study offers clue as to why parents of daughters are more likely to divorce

poppy2Here’s something that caught my attention this morning (likely because I’m the mom of two girls): A new study provides a possible reason behind reports that parents with firstborn daughters are more likely to divorce than those with firstborn sons. According to researchers from Duke and University of Wisconsin-Madison, it could be due to girls being “hardier than boys, even in the womb.”

A recent university release further explains:

Throughout the life course, girls and women are generally hardier than boys and men. At every age from birth to age 100, boys and men die in greater proportions than girls and women. Epidemiological evidence also suggests that the female survival advantage actually begins in utero. These more robust female embryos may be better able to withstand stresses to pregnancy, the new paper argues, including stresses caused by relationship conflict.

Based on an analysis of longitudinal data from a nationally representative sample of U.S. residents from 1979 to 2010, Hamoudi and Nobles say a couple’s level of relationship conflict predicts their likelihood of subsequent divorce.

Strikingly, the authors also found that a couple’s level of relationship conflict at a given time also predicted the sex of children born to that couple at later points in time. Women who reported higher levels of marital conflict were more likely in subsequent years to give birth to girls, rather than boys.

“Girls may well be surviving stressful pregnancies that boys can’t survive,” Hamoudi said. “Thus girls are more likely than boys to be born into marriages that were already strained.”

The intriguing findings appear in the journal Demography.

Image courtesy of Michelle Brandt

CDC, Nutrition, Pediatrics, Public Safety, Research, Stanford News

“Happy Meal ban”: Where are we now?

"Happy Meal ban": Where are we now?

MuppetBabiesA newly released Centers for Disease Control report of a study conducted at Stanford has examined the effects of San Francisco’s 2010 “Happy Meal ban.” The ban prohibited the free distribution of toys with unhealthy meals; the fast-food restaurants McDonald’s and Burger King instead sold the toys for 10 cents. Though neither restaurant complied with the ordinance’s specific calls for changes in nutritional content, improvements have been made.

As reported by SFGate.com:

…over the study’s two-year period, McDonald’s in particular made big changes to its Happy Meals, said [Jennifer Otten, MD,] of the University of Washington School of Public Health — first in California, then nationally.

The fast food giant cut the amount of French fries it serves in Happy Meals in half, replacing them with apples; stopped serving caramel sauce with apples; and began offering nonfat chocolate milk to customers. Otten said those substitutions were “pretty dramatic,” — they reduced the calories in a Happy Meal by 110, and cut the sodium and fat content of the meal as well.

Otten and her colleagues, including senior author Abby King, PhD, concluded in the study, “Although the changes…  did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results… suggest that public policies may contribute to positive restaurant changes.”

Previously: How fast-food restaurants respond to limits on free toys with kids’ meals, Toying with Happy Meals, How food advertising and parents’ influence affect children’s nutritional choices and Living near fast food restaurants influences California teens’ eating habits
Photo by Ursala Urdbeer

Medical Education, Medical Schools

Does medical school debt cause students to choose more lucrative specialties?

Last week, we re-published a Wing of Zock post on medical school debt. Over on that same blog, Julie Fresne, director of student financial services for the Association of American Medical Colleges (AAMC), takes issue with one of the original writer’s points: that concern over medical school debt affects students’ decision about specialties. Fresne writes:

While many claim that debt leads medical students to choose more lucrative specialties, AAMC research indicates that debt does not play a determining role in specialty choice for most students. The report, “Physician Education Debt and the Cost to Attend Medical School,” includes a section outlining evidence on the “minor role of debt in specialty choice.” Studies show that specialty choice is a complex and personal decision involving many factors. Some students with high debt do in fact choose primary care and AAMC data suggests that there is no systematic bias away from primary care specialties by graduates with higher debt levels…

Previously: It’s time for innovation in how we pay for medical school, 8 reasons medical school debt won’t control my life and Will debt forgiveness program remedy doctor shortage?

HIV/AIDS, In the News, Public Health

Free, one-minute HIV testing…while you shop for clothes?

Free, one-minute HIV testing...while you shop for clothes?

outoftheclosetPerhaps you’re familiar with cafe-laundromats or sushi restaurants with tap dancing. But did you ever visit a second-hand clothing and furniture store to take care of your health-care needs? An audio segment and post on the KERA News (Dallas) blog features a local Out of the Closet shop with a free HIV testing site, and soon a community pharmacy, inside their thrift store – making it the 22nd branch of the U.S. chain to have both.

Bret Camp, the Texas regional director of the AIDS Healthcare Foundation, which operates the thrift stores, said in the post, “Our pharmacy will have everything from blood pressure meds to diabetes supplies…How many places can you go and look at jeans while you’re waiting for your medication?”

More from the post:

It’s an innovative idea, says [Douglas Owens, MD,] a professor of medicine at Stanford University who also serves on the U.S. Preventive Services Task Force.

A number of organizations, including the CDC and U.S. Preventive Services Task Force recommended universal HIV testing. Of course testing is only the first step, Owens says.

“When people get an adequate treatment for HIV, the drugs reduce their infectivity and so treatment for HIV not only benefits the person who has HIV; it also provides a very important public health benefit that reduces transmission,” Owens explains in the audio segment.

Previously: Task force recommends HIV screening for all people aged 15 to 65, Using Facebook to prevent HIV among at-risk groupsTask force issues draft recommendation for universal HIV screening and National HIV screening and testing could be very cost-effective
Photo by Marilyn Roxie

Health Disparities, LGBT, Mental Health, Patient Care, Stanford News

Stanford med student discusses his documentary on LGBT vets’ health

Stanford med student discusses his documentary on LGBT vets' health

doublelifeWhen Stanford anesthesiologist Audrey Shafer, MD, welcomed attendees to a screening of “The Camouflage Closet“ on campus recently, she noted the artistic accomplishments and service work of the film’s director, Michael Nedelman. (And also mentioned he was “a Stanford medical student in his spare time.”) Nedelman, who will be entering his third year here, conducted a project with nine LGBT veterans, all patients at the Veterans Affairs Palo Alto Health Care System, exploring their experiences of trauma and recovery.

Nedelman and his collaborators engaged in a community-based participatory method of film-making, allowing participants to tell their stories through art as a path toward empowerment. The participants were provided with cameras to document their stories; they also had a say in the editing process. And while the project was neither officially sanctioned research nor therapy, many of the participants found the process therapeutic. Christine Stout-Holmes said this in the film about sharing her story:

It’s healing. It makes me feel like, “Hey, I don’t have to be agoraphobic.” “Hey, I don’t have to isolate.”

Of course, I feel fists beating me on my back, but I know that that’s not now. And I know that what I’m doing now is going to benefit clinicians, and vets, and hopefully artists, and young girls to know that every story is important.

Since the film’s premiere last June, it has screened at the National Queer Arts Festival, the 31st annual Gay and Lesbian Medical Association conference, and at universities, film festivals and VA hospitals across the U.S. and in Mexico.

Below, Nedelman answers questions about his work.

You have a BA in film studies from Yale. How did you decide to attend med school, and have your interests in art and medicine always intersected?

It took me a while to understand exactly how my interests in art and medicine intersected, but it turned out they had a common ancestor in my love of story.

A few years out of college, I was working at Mount Sinai in New York City on both clinical research and documentary film studies. Whether or not there was a camera in the room, I loved hearing people’s stories, and turning those stories into something meaningful. But in a medical context, I also saw the opportunity to get involved in these stories – to reach past the lens and make a tangible difference.

Combining the two wasn’t really a new concept, though. My first major work in college was a photography project addressing preventable blindness in South India. As with “The Camouflage Closet,” I loaned out cameras to rural vision clinic patients who were able to document their restored sight through images that were important to them. But I had no idea that hyphenating doctor-filmmaker was even an option until I discovered, and later met with, filmmakers like Maren Grainger-Monsen, MD, and Gretchen Berland, MD. Something clicked when I figured out that patient care and digital media could go hand-in-hand.

What are some of the issues faced by this population that you’re most interested in exploring through storytelling?

Some of the issues I found most compelling are not just the unique challenges faced by some individuals (e.g. witch hunts of the pre-DADT – “Don’t Ask, Don’t Tell” – era, increased rates of military sexual trauma, barriers to accessing care), but also the creativity and strength that come from their recovery narratives. Alongside some of the heavier moments in the film, there’s some humor, too. I think I personally learned a lot from the veterans’ resilience, and how their pride – for being LGBT, and for being veterans – factors into their personal growth.

What do you hope viewers will take away from your film?

I hope viewers will come out of the film with a desire to learn more about the unique challenges, types of trauma, and sources of resilience among a previously silenced community. I think there’s a lot to identify with in the film, whether or not you identify as LGBT or a veteran, and there’s a lot to be said for turning empathy into action. This is partly why we also created an accompanying educational resource that summarizes previous research, evidence-based suggestions for culturally relevant care, and resources for clinicians and veterans.

The veterans were excited that clinicians and providers would see and learn from their work. But at the end of the day, I wonder if some of them might have answered this question a little differently. Something we often heard among the vets was, “Even if just one other veteran out there sees this and knows they aren’t alone, we’ve accomplished what we came here to do.”

Previously: Documentary on LGBT veterans’ PTSD, trauma and recovery premieres tomorrow and Photography and storytelling may help poor women with HIV cope with their illness
Film still from “The Camoflauge Closet” courtesy of Michael Nedelman

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