From the category archives:

Global health

Three teenagers wearing hospital masks flu influenza healthmap social media twitter digital epidemiology digital disease detectionElaine Nsoesie, PhD, is a research fellow at Boston Children’s Hospital’s HealthMap, Harvard Medical School and Virginia Bioinformatics Institute. In this post, which originally appeared on HealthMap’s Disease Daily, Nsoesie looks at the trend of detecting disease digitally by monitoring mentions on social media. She delves into one of the major limitations of this technique—namely telling those who are curious about a disease apart from those who actually have it.

There are plenty of studies about tracking diseases (such as influenza) using digital data sources, which is awesome! However, many of these studies focus solely on matching the trends in the digital data sources (for example, searches on disease-related terms, or how frequently certain disease-related terms are mentioned on social media over time, etc.) to data from official sources such as the Centers for Disease Control and Prevention. Although this approach is useful in telling us about the possible utility of these data, there are several limitations. One of the main limitations is the difficulty in distinguishing between data generated by healthy individuals and individuals who are actually sick. In other words, how can we tell whether someone who searches Google or Wikipedia for influenza is sick or just curious about the flu?

Researchers at Penn State University have developed a system that seeks to deal with this limitation. We spoke to the lead author, Todd Bodnar, about the study titled, On the Ground Validation of Online Diagnosis with Twitter and Medical Records. Full story »

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(Photo: Crossroads Foundation https://creativecommons.org/licenses/by/2.0/legalcode)

(Photo: Crossroads Foundation https://creativecommons.org/licenses/by/2.0/legalcode)

The United Nations global Millennium Development Goals (MDGs) for 2015 aim to cut mortality among children younger than 5 by two-thirds. As 2015 approaches, there’s a sense of hope: By 2012, the 1990 base annual figure of 12 million was nearly halved, in part through curbing infectious diseases.

However, two under-recognized, highly preventable chronic conditions—spina bifida and hydrocephalus—have not declined in low- and middle-income countries. Each year, there are an estimated 200,000 new cases of infant hydrocephalus in sub-Saharan Africa alone, and 100,000 neural tube defects in India alone. As other causes of death and disability recede, data suggest that spina bifida and hydrocephalus are gaining a larger share of mortality in young children.

A multi-institution conference at Boston Children’s Hospital on April 11 sounded a global call to action, convening a mix of surgeons, pediatric neurologists, international patient advocacy groups, food fortification proponents, health economists, obstetricians, neuroscientists and others. Many innovative approaches are being explored, including two that caught Vector’s eye. Full story »

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medical costsCan putting a price tag on childhood obesity propel treatment and prevention efforts into comprehensive action? Perhaps, says David Ludwig, MD, PhD, of Boston Children’s Hospital.

Although the U.S. Task Force on Childhood Obesity set a goal of dropping obesity prevalence among youth to 5 percent by 2030, efforts have failed to make a significant dent. Recent data indicate only slight dips in obesity prevalence among 6- to 19-year-olds in some states. And other data show that the prevalence of extreme obesity in children continues to rise.

With nearly 20 percent of U.S. children tipping the scales as obese, policymakers need not only to act but also to justify the investment in childhood obesity treatment and prevention programs.

Duke University researchers offered a helping hand in a review article in the April 7 online Pediatrics, estimating the incremental lifetime direct medical cost of childhood obesity. Their economic model showed a $19,000 incremental lifetime medical cost of an obese child relative to a normal-weight youth.

Ludwig, who directs the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital, provides insights into the next steps. Full story »

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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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superamma

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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