From the category archives:

Global health

Shining light on jaundice in the developing world

by Tom Ulrich on April 16, 2013

Babies with newborn jaundice need phototherapy. In the developed world that's easy; in the developing world, not so much. (Bruce R. Wahl/Beth Israel Deaconess Medical Center)

Family lore has it that when I was born, I had to spend a couple of extra days in the hospital for jaundice, the distinctive yellow tint to the skin that shows that a baby’s liver isn’t fully up and running yet. For me—and most of the newborns that develop jaundice every year in the developed world—the treatment was simple: spending some time lying under bright blue lights (aka phototherapy).

Note that I said “developed world.” The story in the developing world is quite different. Sometimes the nearest hospital with phototherapy equipment is hours’ or days’ travel away. Even though it’s simple, phototherapy is power intensive; no power, no treatment.

And untreated jaundice can have devastating consequences. The yellow pigment, called bilirubin, can accumulate in the brain and cause permanent brain damage or death.

The best solution for regions with few resources would have to be small and portable, run on batteries or other off-grid power sources, cost little, but still be safe and deliver the right wavelength and intensity of light. This is where Donna Brezinski, MD, wants to make a difference. And the Bili-Hut is her answer. Full story »

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A vaccine that works in newborns?

by Nancy Fliesler on March 12, 2013

If we could immunize infants at birth, far more could be protected from infections.(DFID-UK Dept for International Development)

Right now, immunizations against most infections begin at 2 months of age. But that leaves newborns at risk for infections like rotavirus, whooping cough and pneumococcus during a highly vulnerable time.

In resource-poor countries, this is a serious problem: Many children see a health care provider only at birth, so may miss their chance to be protected. Worldwide, each year, more than 2 million infants under 6 months old die from infections, especially pneumonia. If we could immunize infants at birth, it would be a huge win for global health.

Unfortunately, though, newborns don’t respond to most vaccines. Their immune systems are too immature—which is why few vaccines for newborns exist. Full story »

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Participatory surveillance in public health: Sharing is caring

by Tom Ulrich on February 27, 2013

Sharing via social media is a great opportunity for collecting better public health data and encouraging healthy behavior changes. (bengrey/Flickr)

We humans are sharing creatures. We talk about ourselves, what we think, what we know. If we weren’t like this, cocktail parties would be really boring, and Facebook and Twitter wouldn’t exist.

Nor would health care. At the most basic level, health care relies on give-and-take between patients and doctors—patients sharing their symptoms and concerns with doctors, and doctors sharing their knowledge with patients.

The same holds true for public health. Prevention and control efforts require lots of patients and doctors to share information so that public health agencies know where to target their resources.

But the give-and-take in public health is often slow and cannot always detect conditions or complications at rates that reflect reality. And usually it’s one-way—from the patient or public to surveyors. Full story »

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Telemedicine brings expert blindness screenings to preemies

by Nancy Fliesler on February 7, 2013

ROP screening in the NICU

Gretchen Hamn (L) and Margie Young screen a premature infant for retinopathy of prematurity. (Photos: Katherine C. Cohen)

We’re in the Neonatal Intensive Care Unit at South Shore Hospital. Six tiny, swaddled preemies are ready to be examined, their eyes numbed and their pupils dilated with special drops.

Gretchen Hamn, NNP, and medical assistant Margie Young go from isolette to isolette. Young tends to the first baby and gently positions him for his exam. Hamn pulls over a cart and extends a kind of hose with a camera at the tip. This she places directly on each of the baby’s eyes, taking a digital video of his retinas. Full story »

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Moving in on what makes malaria move

by Tom Ulrich on January 2, 2013

The exceedingly complex life cycle of malaria. Within it lies the key to developing a vaccine against the parasite. (CDC)

The malaria parasite (or parasites: four species of Plasmodium can cause malaria in people) has a really complex life cycle.  That complexity has allowed this mosquito-borne parasite from bringing untold misery to the human race for millennia. The World Health Organization thinks it causes 216 million cases of disease every year, while the U.S. Centers for Disease Control and Prevention estimates that some 3.3 billion people live at risk of malaria infection around the globe. Even in the United States, where malaria was officially eradicated 60 years ago, there are still about 1,500 cases every year.

All these numbers add up to one fact: we need a vaccine, badly. This is where malaria’s complexity becomes a problem. Full story »

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Climate on the brain: Neurosurgeon’s work in Africa links hydrocephalus with rainfall

by Nancy Fliesler on October 2, 2012

Ed. note: Ben Warf, MD, was just named a 2012 MacArthur fellow, receiving a five-year, $500,000, “genius” award from the John D. and Catherine T. MacArthur Foundation.

We know climate patterns can affect crop yields, fish populations in rivers, people’s allergies and more. Now, for the first time, research has linked weather patterns with a brain disorder in babies typically treated by neurosurgeons—one that causes cognitive impairment, spasticity and blindness.

In East Africa, twice a year, at the midpoint between the rainy and dry seasons, rates of hydrocephalus surge among newborn babies. It starts with a fever and sometimes convulsions; if they survive, the babies develop “water on the brain” and their heads enlarge dramatically.

Ben Warf, MD, a neurosurgeon at Boston Children’s Hospital, discovered this during his years as a medical missionary in Uganda. Working with a non-governmental organization called CURE International, he founded a pediatric neurosurgical hospital, doing about 1,000 operations a year—more than half of them for hydrocephalus—on children from Uganda and surrounding countries.

In the United States, hydrocephalus is typically part of a congenital disorder like spina bifida. But Warf found that 60 percent of the cases he and his Ugandan team were seeing arose from infections in newborns.

Working with mathematicians, Warf and colleagues crunched data from nearly 700 such cases against rainfall data for the children’s home villages, generated by the National Oceanic and Atmospheric Administration, Full story »

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Mind the gap in drug research for children

by Tom Ulrich on August 7, 2012

Diseases like malaria strike children harder than adults, but clinical trials for these diseases rarely include or focus on children. Why? (WHO/P. Virot)

We’re pretty focused on the safety of the things around us. Our drinking water gets checked for chemicals, bacteria and other things that could make us sick. Kids’ car seats are tested to make sure they’ll keep children safe in an accident.

But there’s one surprising arena where this focus on safety and testing often falls short: the medications we give our children. Not just in the United States, but globally.

There are lots of reasons why fewer drugs get tested for safety and efficacy in children than in adults. It’s time-consuming, expensive and, frankly, risky. The ethics of testing new medications in children are pretty thorny.

And, overall, the market for pediatric drugs is much, much smaller than that for drugs for adults, since children fortunately don’t get sick as often as us grown-ups.

But for some diseases like asthma and diarrheal diseases, children bear a greater burden than adults—one that’s not matched by the amount of research done on drugs for kids. Full story »

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There is a cure for sickle cell disease…for some

by Tom Ulrich on August 1, 2012

Maryam Idan (center), a young Iraqi girl with sickle cell disease, was lucky: she could be cured with a stem cell transplant. Leslie Lehmann, MD, wants to make such transplants an option for more sickle cell patients.

I was surprised when chatting recently with Leslie Lehmann, MD, clinical director of the Stem Cell Transplantation Program at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC). She turned to me and asked, “Did you know there’s been a cure for sickle cell disease for nearly 40 years?”

I had to admit that I didn’t. I’ve always thought of sickle cell—a painful and debilitating disease caused by an inherited mutation that makes red blood cells stiffen into a characteristic sickled shape—as a chronic disease to be managed, not one that could be cured.

I’m not alone in that belief. Lehmann often asks this question when she give talks for medical students, residents and other physicians. Their reaction is puzzlement, then a shaking of heads.

The cure is there, though. It’s a stem cell (aka bone marrow) transplant. The catch is that it’s not available to everyone—but for reasons that Lehmann thinks can be overcome. Full story »

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Blue-ear pig disease, the global economy and hospital medication shortages

by Al Patterson on July 26, 2012

This pig helped launch a drug shortage that is getting progressively worse. (Dingar/Wikimedia Commons)

Al Patterson, PharmD, is director of Pharmacy at Boston Children’s Hospital. Read his February 13, 2012 testimony before the Massachusetts Legislature’s Joint Committee on Public Health. 

More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.

But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs and a shortage of heparin. In order to preserve their market share, producers began creating fraudulent substitutes, including one that behaved chemically like heparin, but was actually a manmade compound known as oversulfated chondroitin sulfate (OSCS) derived from pig, sheep or cow cartilage. Full story »

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Healthy Olympics 2012: Disease surveillance and mass gathering medicine

by Katharina Schwan on July 24, 2012

In just a few short days, London will play host to more than 10 million sports fans from around the world. Is the city ready to keep them all healthy? (Ben Sutehrland/Flickr)

In the blockbuster Contagion, Gwyneth Paltrow travels to Hong Kong on business and returns to suburban Minneapolis with flu-like symptoms. Within days she is dead. Paltrow is the index case in a pandemic that sweeps across the world. Contagion is a dramatic example of how a series of mundane, every day activities—such as shaking hands, drinking from a glass and blowing on dice for good luck—can rapidly and effectively spread disease.

Starting Friday, this year’s summer Olympics will kick off in London, the international hub of Europe. Can you imagine the potential for disease spread in a city that will host ten million athletes and tourists from all over the world? Full story »

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