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A $1 Pill That Could Save Thousands Of Lives: Research Suggests Cheap Way To Avoid U.N.-Caused Cholera

(United Nations Photo/Flickr)

(United Nations Photo/Flickr)

By Richard Knox

Here’s a way to get a big bang for a buck:

If a few hundred United Nations peacekeeping troops had taken a $1 antibiotic pill five years ago before they were deployed to Haiti, it may well have prevented a cholera outbreak that has so far sickened 753,000 Haitians and killed more than 9,000.

That’s the takeaway of a new study by Yale University researchers in the journal PLoS.

The authors believe their evidence should prompt the U.N. to adopt a simple and incredibly cost-effective strategy: Make sure all the 150,000 peacekeepers it sends out into the world each year from cholera-afflicted countries get preventive doses of antibiotics before deployment.

It’s not the first time the U.N. has gotten that advice. It was first suggested by a panel of outside experts the agency appointed back in 2011 to investigate the Haitian epidemic. But so far the U.N. has rejected the panel’s recommendation on preventive antibiotics.

It’s not clear whether that will change. The U.N.’s chief medical officer, Dr. Jillian Farmer, said in an interview Friday that she welcomes the new study. But she noted it does not address “the biggest barrier to implementing the antibiotic recommendation” — a concern that what she calls “mass administration” of antibiotics would give rise to antibiotic-resistant strains of cholera.

“It may be we will be able to do this [administer pre-deployment antibiotics to U.N. peacekeepers],” Farmer said. “I don’t have a closed mind.”

The Yale researchers and others argue that the concern about generating resistant cholera strains is overblown because the antibiotics would be targeted — not administered massively. They further argue that the U.N. should sponsor research to answer that question, given the urgency of the question.

“When we have a case as extreme as Haiti showing the status quo doesn’t work, we should be working to build evidence for a solution that does, not using a lack of proven solutions as an excuse not to act,” said Adam Houston, who works with the Boston-based Institute for Justice and Democracy in Haiti.

The new study is the latest chapter in a tragic story that’s been unfolding since mid-October of 2010, when, researchers say, a single U.N. peacekeeper from Nepal most likely introduced cholera to Haiti, touching off the most explosive cholera epidemic in modern times. Before the outbreak. Haiti had been cholera-free for at least a century; thus, its citizens had no immunity to the disease.

“Based on DNA evidence, this outbreak was probably started by one or very few infected, asymptomatic individuals — I would guess one,” said Daniele Lantagne, a Tufts University environmental engineer who was one of four independent experts appointed by the U.N. in 2011 to investigate the outbreak.

Since none of the 454 Nepalese peacekeeping troops deployed to Haiti in late 2010 showed any symptoms of cholera, all of them would have had to take a prophylactic dose of antibiotic to prevent any one of them from starting the outbreak. That would have cost around $500 — a tiny price to pay to avoid a devastating epidemic that — absent the investment of billions of dollars in clean water and sanitation — will continue into Haiti’s indefinite future.

The new analysis finds that prophylactic antibiotics would have reduced the chances of the Haitian epidemic by 91 percent. When antibiotics are combined with cholera vaccination, the risk of an outbreak goes down by 98 percent.

The U.N. began requiring cholera vaccination of all its field personnel late last year. But the new study says vaccination by itself isn’t very effective; it reduces the risk of an outbreak by only 60 percent at best.

That’s because vaccination can prevent someone from falling ill from cholera, but it doesn’t prevent infection — so a vaccinated person can still carry the cholera bacterium and pass it on to others.

“Vaccination alone is not enough,” said Virginia Pitzer, who led the Yale research team. “Vaccination plus antibiotic prophylaxis would be best.”

“Antibiotics are far and away the most effective and the least expensive,” added epidemiologist Joseph Lewnard, the study’s first author. “It hits the problem from two angles. It not only prevents those exposed to cholera from experiencing an infection, but if they do get infected it shortens the duration of shedding the bacteria. So once they arrive [at their deployment destination] they would no longer have bacteria in their stools.” Continue reading

Calls For Better Pain Relief Measures For Newborns, Premature Infants

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

What could be more heartbreaking than witnessing some of the smallest, sickest babies undergoing painful medical procedures?

Yet that’s precisely the population subject to some of the most intrusive prodding and pricking, the “greatest number of painful stimuli” in the neonatal intensive care unit, or NICU.

Now the American Association of Pediatricians is calling for better, more comprehensive pain relief measures for newborns, including those born prematurely — both with medications and through alternative, non-drug measures — and for more research on effective treatments.

The AAP’s updated policy statement, published in the journal Pediatrics, asserts that “although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures.”

The AAP calls for new measures, specifically:

Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

If you’ve ever been in a NICU, you may have seen these types of procedures take place: suctioning of various secretions from the nose and throat; blood draws from veins, arteries, feet or heels; IVs being placed; adhesive tape — used to keep all those tubes and IVs in place — removed.

A landmark 2008 study from France found that the vast majority of newborns in the NICU didn’t get pain relief; researchers found only about 21 percent of infants were given either pain medication or non-drug pain relief before undergoing a painful procedure.

Why is this important? Continue reading

Investigating High C-Section Rates, Researchers To Examine Floor Plans

A woman’s chance of having a C-section can be almost three times higher from one hospital to the next in Massachusetts. But why? No one has the definitive answer. Researchers have looked at the ratio of doctors to nurses or midwives, at payment rates, at medical malpractice policies, at on-call schedules — and still the question lingers.

Could it be the layout of the labor and delivery unit?

Dr. Neel Shah, an associate faculty member at Ariadne Labs, began asking himself this question a little more than a year ago during a tour of hospitals. He watched nurses run down long hallways, from patient to patient. He noticed walls that divided patients, but also decision makers who might benefit from collaboration. And, he was struck by all the ways a labor and delivery floor mirrored an intensive care unit: one nurse per patient for women in active labor, machines that track vital signs in real time and medicines that are titrated minute to minute.

“The only difference between an ICU and a labor floor is that on the labor floor the ORs are attached,” Shah said. “So you’ve got the most intense treatment area in the entire hospital for the healthiest patients. It doesn’t take a rocket scientist to figure out why we overdo it.”

Lighting, furniture placement and waiting areas are not typically the focus of health care quality improvement projects, but maybe they should be.

Shah, working with architects at Mass Design Group, has a one-year grant from the Robert Wood Johnson Foundation to study how the design of a maternity ward affects C-section rates at 12 hospitals around the country. Continue reading

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Study: Maternal Obesity And Diabetes Bring ‘Multiple Hits,’ May Raise Autism Risk In Children

A provocative new study finds that children born to mothers with a combination of obesity and diabetes before and during pregnancy may have up to four times the risk of developing autism spectrum disorder.

On their own, obesity as well as pre-pregnancy diabetes or gestational diabetes increase the risk of autism slightly, researchers report. But the study suggests that co-occurring obesity and diabetes may bring “multiple hits” to the developing fetal brain, conferring an even higher risk of autism in the offspring than either condition on its own.

According to the U.S. Centers for Disease Control and Prevention, about 1 in 68 children has autism spectrum disorder, which also includes Asperger syndrome and other pervasive developmental disorders.

This new study — led by researchers at the Johns Hopkins Bloomberg School of Public Health and published in the journal Pediatrics — was based on analyzing the medical records of 2,734 children who have been followed from birth at the Boston Medical Center between 1998 and 2014. (Of that group, 102 of the children had a diagnosis of an autism spectrum disorder. )

So what might be leading to this increased autism risk? Researchers don’t really know, but they raise several theories in the paper. In general, the possible mechanisms relate to immune and metabolic system disturbances associated with maternal obesity and diabetes that might cause inflammation and other problems for the developing fetus.

One of the study authors, Daniele Fallin, an epidemiologist and chair of the Department of Mental Health at Hopkins’ public health school, said in an interview: “We know that both diabetes and obesity create stress on the body, generally, and a lot of that stress manifests in disruption of immune processes and inflammation. Once you have the disruption in the mom, that may lead to inflammation problems in the developing fetus, and inflammation during neurodevelopment can create problems that manifest as autism.” Continue reading

Dr. Donald Thea On What We Know About The Zika Virus

For the first time, a Massachusetts resident has been diagnosed with the Zika virus.

He or she is from Boston and traveled in a country where the virus is being transmitted. The symptoms were mild, the patient did not have to be hospitalized, and is expected to make a full recovery.

Dr. Donald Thea, professor of global health and director of the Center for Global Health & Development at Boston University, joined WBUR’s Morning Edition to discuss the virus and this case in Boston.

Related:

Salisbury Woman’s Death Shows The Complications In Responding To Opioid Crisis

Anna Jaques Hospital in Newburyport is seen on Friday. (Jesse Costa/WBUR)

Anna Jaques Hospital in Newburyport is seen on Friday. (Jesse Costa/WBUR)

The death of a Salisbury woman this month shows how difficult it can be to coordinate the response to the opioid addiction crisis.

Gretchen Fordham received the opioid overdose reversal drug Narcan in an emergency room. But she still left the hospital with a prescription for opioid pain pills.

Hours later, police say Fordham was found unresponsive in her home.

Here’s what happened:

It was shortly after 6 a.m. on Jan. 10 when police received a 911 call from the boyfriend of 44-year-old Fordham saying she was unresponsive.

“She was transported to the hospital but was pronounced dead at the hospital,” Salisbury police Chief Tom Fowler explained. “My detective speculates that it could possibly be an accidental overdose.”

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First Case Of Zika Virus In Boston Is Confirmed

BOSTON — A Boston resident has been diagnosed with the mosquito-borne Zika virus, the Boston Public Health Commission confirmed Thursday.

The patient, who contracted the virus while traveling abroad, is expected to make a full recovery, BPHC said in a statement.

“The vast majority of people who contract Zika do not get seriously ill, and recover quickly when they do,” Scott Zoback, spokesman for the BPHC, said in a statement.

The Zika virus, which has been found in Africa, Southeast Asia, South America and the Pacific Islands, is spread to people through the bite of an infected mosquito. The Centers for Disease Control and Prevention is advising pregnant women to avoid traveling to countries where the virus is present because there are concerns it may be linked to severe birth defects.

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Landmark Gene Discovery Cracks Open ‘Black Box’ Of Schizophrenia

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

One November day in her senior year of high school, Sydney accidentally broke the full-length mirror leaning up against the wall of her bedroom.

She felt a gust of superstitious dread: “Oh my God, I have to put this mirror together or I’m going to have bad luck.” Then, it escalated oddly into religious terror: “The devil’s coming to get me!”

Something inside her seemed to snap, she said. She sensed demons invading through the broken glass.

Not long afterward, President Obama spoke to Sydney inside her head: “OK, this is how the world is now,” he told her. “Everyone is so in love with each other, we can hear each other in our heads.”

The menacing voices of demons started to torment her, especially at night. She became convinced that she was going out with the pop star Justin Bieber, that he was chatting with her on her phone and sending her hidden messages in his Twitter feed. She thought he set up paparazzi in her backyard on Boston’s North Shore, that he was sending planes over her house to let her know he cared.

“Is this really happening?” She would ask the voices in her head. “Is this?” Yes, they told her. Yes.

What was really happening? How does a sunny girl who’d never had psychiatric problems before, who grew up loving dance and Disney princesses, a good student who was rich in family and friends, how does that girl suddenly lose her hold on reality?

Schizophrenia affects about 1 in every 100 people, and one thing is clear: Genetics plays a role. Sydney’s uncle had schizophrenia, and scientists have identified more than 100 genes that can raise the risk for it.

Now, researchers based at the Broad Institute in Cambridge and Harvard Medical School have pinpointed the gene that is the biggest risk factor for schizophrenia discovered so far, and figured out how it does its damage: It makes the brain prune away too many of the connections between neurons.

“[I]t may be like you have an over-energetic gardener who prunes back so much that the bushes die off…”

– Bruce Cuthbert, of the National Institute of Mental Health

That finding, just published in the journal Nature, may also explain why schizophrenia tends to hit at such an odd age, in the late teens and early 20s. That pruning of connections is a normal process that ramps up during adolescence, but this genetic culprit may make it go overboard.

Pruning may sound bad, said Bruce Cuthbert, the acting director of the National Institute of Mental Health, but actually, it’s helpful: “It’s like clearing away the underbrush so your brain can function more efficiently.”

But, he said, “in people with this overactive version of the gene, it may be like you have an over-energetic gardener, who prunes back so much that the bushes die off because they don’t have enough branches.”

Cuthbert called the paper a “genetic breakthrough” and “a crucial turning point in the fight against mental illness.” Eric Lander, director of the Broad Institute, said it means we’re finally starting to understand what causes schizophrenia at the level of brain biology.

“For the first time,” Lander said, “we’re opening up the black box and looking inside and seeing, how does the disease really arise? That makes this, in my opinion, perhaps the most important paper in schizophrenia since the disease itself was ever defined,” over a century ago.

This scientific excitement does not mean, however, that the findings will lead to new treatments for schizophrenia any time soon, Lander and others said. It takes years for such basic science to translate into treatments — if it ever does.

But the new paper does suggest some promising new targets for drug development, some already being worked on for other diseases, said Harvard Medical School’s Steve McCarroll, who led the research team. Continue reading

SharingClinic, To Help Patients Tell Their Stories, Opens At Mass. General Hospital

Four years ago, Dr. Annie Brewster had a vision.

Brewster, a Boston internist, who was diagnosed with multiple sclerosis in 2001, had become frustrated that a crucial element of medicine — the human connection between patients and doctors — seemed to be lost in the modern era of 15-minute appointments and overly burdensome record-keeping. As a patient and a doctor, Brewster yearned for a therapeutic arena in which patients could tell their full health stories and feel they were actually heard, not rushed out the door; and where doctors, as well, could share a little more with patients.

Now, with the launch this week of the SharingClinic, an interactive “listening booth” stocked with audio stories from patients facing a range of illnesses, Brewster is a little closer to realizing her vision. Housed at the Paul S. Russell Museum of Medical History and Innovation at Massachusetts General Hospital, Brewster expects SharingClinic will continue to grow over time as more stories are collected and added to the kiosk. Eventually, she says, trained staff will begin to facilitate the storytelling in regularly scheduled “clinics” in a way that research suggests might offer an actual health boostContinue reading

Earlier:

Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
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