From the category archives:

Global health

Ibeziako,PatriciaPatricia Ibeziako, MD, directs the Boston Children’s Hospital Global Partnerships for Psychiatry Observership Program and the Psychiatry Consultation Service at Boston Children’s Hospital.

Children and adolescents constitute almost a third of the world’s population—2.2 billion individuals—and almost 90 percent live in low-income and middle-income countries, where they form up to half of the population. Yet, for many years, child mental health has largely been glossed over—with long-term negative effects on educational attainment in addition to chronic disability and lost productivity.

Major international non-governmental organizations and United Nations agencies work in settings where children are at risk for mental health difficulties. However, with the exception of the World Health Organization (WHO), these agencies often fail to acknowledge or focus on child mental health issues. In 2005, the WHO Atlas of Child and Adolescent Mental Health Resources reported that less than one third of 66 countries surveyed had an entity with sole responsibility for child mental health programming, and that national budgets rarely had identifiable funding for child mental health services. Full story »

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Last week, Boston Children’s Hospital’s Innovation Acceleration Program hosted a jam-packed Innovators’ Showcase where teams from around the hospital networked, traded ideas and showed off their projects. Here are a few Vector thinks are worth watching.

isotropic diffusion reveals information on axons on DTI1. An imaging ‘biomarker’ after concussion

Thirty percent of people who suffer a mild traumatic brain injury—a.k.a. concussion—have ongoing symptoms that can last months or years. If patients at risk could be identified, they could receive early interventions such as brain cooling and anti-seizure medications. New MRI protocols that can measure free, non-directional diffusion of water, coupled with sophisticated analytics, are achieving unprecedented pictures of what happens inside the brain after injury. Full story »

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Judith Palfrey, MD, is director of the Global Pediatrics Program in the Department of Medicine at Boston Children’s Hospital.

Diarrhea is a bigger global killer than HIV and malaria combined. It accounts for more than 800,000 deaths each year among children 0-5 years. And how tragic this is when the simple intervention of hand washing can prevent some of these deaths. Results of a trial, published in the March edition of The Lancet Global Health, indicate that teaching families in under-resourced areas of the world about hand washing is not only possible but also scalable, sustainable and successful—if it’s done the right way.

Hand washing is a simple intervention, but the prevalence of the behavior is as low as 1 to 2 percent in some under-resourced global settings. A London School of Hygiene and Tropical Medicine group, led by Adam Biran, PhD, decided to try to improve these statistics by devising an effective intervention.

However, the route to simple solutions is often complex. The researchers used very sophisticated methodology to identify the levers of behavioral change. They realized that health messages about hand washing have not worked. The idea that what I do today may prevent diarrhea down the road just did not have enough oomph to motivate people to adopt a new routine.

The researchers hypothesized that emotional drivers (including nurture, status, disgust and belonging) would be strong pushes to get families to wash their hands. And they were right. Full story »

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A project that set out to build better shunts ended with potential ways to help kids avoid them altogether.

A project that set out to build better shunts ended with potential ways to help kids avoid shunts altogether.

Shunts often are surgically placed in the brains of infants with hydrocephalus to drain excess cerebrospinal fluid. Unfortunately, these devices eventually fail, and the problem is hard to detect until the child shows neurologic symptoms. CT and MRI scans may then be performed to check for a blockage of flow—followed by urgent neurosurgery if the shunt has failed.

Early detection of shunt failure was the problem pitched last fall at Hacking Pediatrics in Boston. Two bioengineers, Christopher Lee, a PhD student at Harvard-MIT Health Sciences and Technology program, and Babak Movassaghi, PhD, an MBA candidate at MIT Sloan, took the bait.

“We heard that parents would not take vacations in areas without an experienced neurosurgeon around,” says Movassaghi, a former Philips Healthcare engineer with 32 patents in cardiology and electrophysiology. “We were intrigued to solve that.” Full story »

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Newborn baby neonatal sepsis developing world

Courtesy Anne Hansen, MD, MPH

Reducing child mortality is high on the list of the United Nations’ Millennium Development Goals—the eight global health, economic and development benchmarks set by the U.N. in 2000 for 2015.

While mortality among children under age 5 has improved greatly, the gains have largely been among children at the older end of that grouping. When it comes to mortality in the first week of life, little has changed.

“Early neonatal mortality rates haven’t decreased in the last two decades,” says Grace Chan, MD, PhD, a pediatrician at Boston Children’s Hospital, who conducts global health research at Harvard School of Public Health. “In developing countries, they still hover near 30 deaths per 1,000 live births.”

Early-onset infections—ones that arise within a week of birth—account for a significant portion of those deaths. Such infections may arise when a newborn picks up bacteria present in the mother’s birth canal during delivery, or from maternal infections during pregnancy.

In developed countries, interventions like prophylactic antibiotics and quick diagnoses help to keep neonatal infection rates low. But these kinds of interventions are less available in developing nations, where they could have the most impact. And while risk factors for neonatal infections have been well studied in developed nations, they are less  well known in resource-poor environments, where the infections most frequently occur.

To put it another way, when it comes neonatal sepsis in developing countries, there’s a lot we don’t know.

Full story »

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Smokestacks-toxins-brain-shutterstock_142235569Maitreyi Mazumdar, MD, MPH, practices pediatric neurology at Boston Children’s Hospital. She leads a research program in Bangladesh that studies the effects of the epidemic of arsenic poisoning on neurological outcomes in children.

Neurodevelopmental disorders, including autism and attention deficit/hyperactivity disorder (ADHD), affect many millions of children and appear to be increasing in frequency worldwide. Improved diagnosis and changes in diagnostic criteria explain a portion of the rise, but not all. In other words, the increase in neurodevelopmental disorders seems to be “real.”

To date, research has mainly invested in finding genetic causes, implicating biological pathways that affect, for example, the formation of synapses and the production of neurotransmitters. Such discoveries improve our understanding of the basic biology of neurodevelopmental disorders and may ultimately lead to new therapies. But genetic variants alone cannot explain the recent rise; if they did, population rates of neurodevelopmental disorders would be expected to stay the same, or even decrease over a 30- to 40-year period, due to affected people likely having fewer children. Instead, reported rates have steadily increased over the past several decades. Something else is going on. Full story »

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OP-Smile-IThroughout the world, a child is born with a cleft lip or palate nearly every three minutes. In resource-poor areas, many of these children die before their first birthday, and those who survive have difficulty eating, speaking and being accepted by their peers.

Lauren Mednick, PhD, a pediatric psychologist at Boston Children’s Hospital, knows this all too well. As a child life specialist with Operation Smile, she was part of a medical missionary team that traveled the world providing safe, effective reconstructive surgery and treatment to children with clefts and other facial deformities.

Working closely with these children and their families, Mednick was amazed at how many of them blamed the child’s condition on themselves, the supernatural or a combination of the two. She listened as a mother in Morocco “confessed” that her baby had been born with a cleft lip, because she looked at an animal with a cloven hoof during her pregnancy. She sat with a Haitian woman who attributed her child’s cleft lip to an afternoon when she spent too long looking at a child in her village with a facial deformity. Full story »

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Google logo with applesAlexandra Pelletier is the Digital Health Program Manager in the Innovation Acceleration Program at Boston Children’s Hospital. She manages the FastTrack Innovation in Technology Award, an initiative to accelerate, rapidly develop and deliver innovative clinical software solutions to improve patient experience and operational efficiency.

When the largest and most innovative technology companies in the world invest, radical disruption follows. Google and Apple, multibillion-dollar companies operating across the globe, are already deeply embedded into most of our lives. They now want to bring their network and reach to health care.

Their new investments could completely transform how patient data are captured and how information is shared. Through their big data capabilities, they’re well placed to rapidly evolve health care delivery processes. In the very near future, I expect we will see connected sensors or “smart” devices of all kinds begin to integrate into our lives, weaving a web of quantified data into actionable health information and changing how patient and care providers engage together.

Consider some recent events. First, there was Google’s buzz-generating meeting with the FDA. Full story »

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africa trio kidsBeginnings—whether a new year or a new century—offer an optimal time for evaluating goals. Quality improvement literature reminds us that goals should be specific, measurable and timely, and that progress checks are crucial. With one year left to achieve the ambitious Millennium Development Goals (MDGs), global child health stakeholders are assessing gains and gaps.

In 2000, the United Nations set the MDGs, and homed its sights on child mortality in MDG 4, aiming to cut mortality among children younger than age 5 by two-thirds by 2015, from the 1990 base figure of 12 million.

By 2012, the figure was nearly halved to 6.6 million.

“There’s a hopeful sense,” says Judith Palfrey, MD, director of Boston Children’s Hospital’s Global Pediatrics Program in the Department of Medicine. At the same time, the goal remains “seriously off target for many countries,” wrote Zulfiqar Bhutta, MB, BS, PhD, from the Hospital for Sick Children in Toronto, and Robert Black, MD, from Johns Hopkins University in Baltimore, in The New England Journal of Medicine in December.

Palfrey agrees, noting that while some countries are on track to meet the goal, some have stagnated and some have regressed. “It may be that there are some intractable issues,” she says. The countries that have failed to make progress are marked by corrupt governments, armed conflict or both. Full story »

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Children’s Cancer Hospital Egypt 57357Geography can be cruel. An 8-year-old diagnosed with leukemia in Europe or North America can expect a challenging but curable course. Her care, provided by a team of pediatric specialists, includes state-of-the-art imaging, thorough infection prevention and, often, multiple options for treatment.

Her peers in the Middle East and North Africa face a dramatically different prospect. Laboratory and imaging infrastructure can be limited, so diagnoses are made at later, less curable stages. Some patients can’t access acute care because hospital beds are in short supply. Available beds may be occupied by outpatients who can’t return home or palliative patients without access to hospice care. At many hospitals, pediatric inpatients are cramped into 10- to 15-patient wards, raising the risk of infection and other complications for children with compromised immune systems.

The overall lack of medical infrastructure and dearth of providers contribute to a substantial disparity in childhood cancer survival rates between high-income countries and the developing world. While many countries in Europe and North America have achieved cure rates in the 80 percent range, survival rates hover near 20 percent in low- and moderate-income countries. Full story »

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