Author: Arshya Gurbani

Guest Speaker: Dr. Allison Lazard talks about eHealth Design

The UpstreamDownstream Health Communication blog is run by students enrolled in a seminar class within the Interdisciplinary Health Communication program at UNC Chapel Hill. A core aspect of this class is the opportunity provided studentes to hear about the work and the journey of leaders and leaders-to-be in the field. Dr. Allison Lazard, an Assistant Professor at the School of Media and Journalism at UNC, started off our semester of guest speakers with an engaging and informative presentation on the importance of communicable materials in interactive interventions.

Dr. Lazard sees opportunities in the world to use design manipulation to create a subjective experience for individuals with needs and wants, in order to influence better health outcomes. To prioritize the user experience, she asks specific questions about aesthetics, usability and content. She has found that tone matters, users respond well to interactive design features, and that the importance of images that match a health message cannot be understated. Her research findings also indicate that responsive websites (that automatically react to be readable for a phone screen vs a computer or tablet screen) are increasingly valuable, and that there is a clear preference for classical aesthetics when it comes to delivery of health information.

As more and more people turn to web or app-based sources of information, designing effective information sources is central to effective health communication. eHealth is a new but quickly expanding field, informed by the innovative work of researchers like Dr. Lazard. We loved hearing from her, and are excited for a semester of inspiring talks!

The Aftermath of a Hurricane– public health concerns after a storm

Hurricane Harvey hit Texas hard last week. CNN says it was the strongest hurricane since Charlie hit the Southeast in 2004 (they have also shared some striking images of the damages and flooding if you want to click that link). New sources today have the current casualty total at least 70. As entire communities of people regather and begin to rebuild their lives, there are concerns to consider beyond immediate damage. Times of chaos, grief, and mass movement are ripe for poor health conditions. What health problems do hurricanes leave behind?

NPR interviewed Dr. Ruth Berggren, an infectious disease specialist who has had a lot of experience treating patients post-natural disasters. After all, she was a physician in New Orleans when Hurricane Katrina hit in 2005, and has been dealing with the aftermath of Hurricane Harvey this week. She talks about violence, mental health, and infectious diseases issues as being of particular concern in the immediate aftermath of such a storm.

According to the New York Post, Harvey sunk the crest of the Earth by about 0.75 inches! Combine that heavy water burden with people living in close proximity in emergency shelters in less than ideal hygienic conditions, and you can see why the IDSA (Infectious Diseases Society of America) is concerned with the spread of viruses. In particular, they are worried about infections that spread quickly like norovirus, and those that might affect unvaccinated populations who now have more exposure to pathogens. This is especially concerning as mosquitoes, temporarily scared off by the storm, come back to stagnant water, possibly carrying diseases with them. Access to medications to treat chronic illnesses is also expected to be more difficult. For some populations, like those living with HIV, it’s really important not to disrupt treatment. Finally going home to mold and disarray increases the likelihood of asthma and respiratory tract illnesses.

The Carribean Islands, currently facing similar conditions as Hurricane Irma unfolds, are witnessing similar public health crises.

As we hope for a quick and wholesome recovery to those affected by these storms, consider donating if you can—this NYT article links to some organizations, both local and national, that are gathering funds.

Looking at the Hunter-Gatherer Gut

There are anywhere from 10-100 trillion microbes that thrive in the human body. They help maintain normal body conditions, facilitate with digestion, and are really important to our immune systems. Some of these are permanent whereas others are transient. Your own microbiota will change over the course of your life, strongly influenced by diet among other factors. An article published last week in Science magazine says these changes may even have once been seasonal.

Their logic is based on a study conducted with the Hadza community in Tanzania. These hunter-gatherers have a diet that must be much closer to that of our earliest ancestors, rooted in foraging as opposed to agriculture. The Hadza suffer much less from digestive illness–Chron’s, colitis, colon cancer–than do modern Westerners. Though the pattern of gut microbes found have yet to be more seriously researched, there seems to be health benefits of eating seasonally. Some scientists are tentatively naming this synchronization of food ingested and microbes in the gut a biorhythm of sorts.

This is certainly not the first time the hunter-gatherer diet has been looked to for inspiration. The Paleo Diet fad/trend is based in this vein of thought. It’s rich in natural proteins and fats, carbs from fruits and roots, and eliminates dairy, grains, and the cheap highly processed foods that so conveniently line our grocery stores. It has its critics certainly, but it would be interesting to see if the Paleo dieter’s microbiota is more similar to that of the Hadza.

As research in this field continues, it’ll be interesting to see how parallels in diet and its effects on the gut will continue to inform our favorite apt saying: You are what you eat.

 

Ebola vaccine-preliminary trials

Ebola is a severe virus disease that spreads to humans from wild animals (often those found in rain forests), and can then be transmitted from human to human. The virus will onset between 2 to 21 days of exposure, and can cause fever, muscle pain, headaches and sore throats, followed by vomiting, diarrhea, impaired kidney/liver function, and bleeding. Though there are treatments, and re-hydration helps, there is as of yet no cure or licensed treatment to neutralize the virus.

In March of 2014, the World Health Organization recognized an outbreak of Ebola in West Africa–the largest one to date, and fatal in an estimated 40% of cases. It spread quickly in both rural and urban communities. The CDC reported, as of April 2016, 11,325 deaths.

An article published in The Lancet-an infectious disease academic journal- this month says that this outbreak “highlighted the need for a safe, effective vaccine with a rapid onset of protection”. A phase 1 study (the stage of vaccine development in which a vaccine is administered to what is considered a small group of adults) was completed in June of 2015 and demonstrated some success. Nearly 500 participants finished the study, which lasted 360 days, and most of them showed promising amounts of lasting immunity starting about two weeks into the study. The study was led by scientists at the World Health Organization.

Of course, the study was just short of a year, and in a relatively small sample size, so there is future research to be done. Still, the potential protection offered by a successful vaccine is an exciting thought.

Sources-

World Health Organization: http://www.who.int/mediacentre/factsheets/fs103/en/

Lancet article: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30313-4/fulltext

CDC, Infectious Disease Adviser

GOP Bill Halts in Senate

Remember back in May when the GOP health bill passed in the House? The momentum stopped there.
The Senate failed to pass a GOP-proposed Health Law yesterday. Senate Majority Leader Mitch McConnell says they’re going to try again early next week, though it doesn’t seem like this will be a promising attempt either. Analysts attribute this to many deep-rooted factors:  the Republican party as a whole not unified behind an action plan other than repealing the ACA, the taking away of funding and resources without a viable exchange, and a severe lack of public hearings and drafting.
Provisions included in a draft of the bill last week including capping funding for Medicaid, and giving states the power to opt out of insurance regulations substantiated in the Affordable Care Act. This fielded much opposition from more moderate Republicans. They cite problems  such as too “deep cuts” to Medicaid, and an insufficient means to account for the expenses of changing the insurance system. This opposition was especially strong in Republican states like Ohio that had expanded Medicaid under the ACA.
Now, Republican Senators are working on re-drafting a “repeal and delay” bill that would phase out aspects of the ACA over a two year time frame–a version of this bill passed in 2015. Of note, the draft of this bill to be debated does not include an amendment proposed by Senator Ted Cruz. According to a report conducted by the Department of Health and Human Services, this amendment might actually result in broader coverage and lower premiums. The quality and correctness of this report is already under great criticism by healthcare and insurance analysts.
Sources: The New York Times, Kaiser Health News

Physiology and Space Travel

Next week will mark the 48th anniversary of the first manned moon landing, conducted by Apollo 11 on July 20th, 1969. It marked a momentous and patriotic moment for the United States, which remains the only country to have successfully accomplished this task, and for the field of aeronautics as a whole. Indeed, “a giant leap for mankind”! (more information about the landing itself here).

Long space missions like Apollo 11 are also a huge physiological feat. Conditions on Earth aren’t the same as they are in space, or on other celestial bodies. Microgravity and radiation effects, just to name two, are really different on the moon than they are here at home. When you go on a mission to Mars, for instance, your body goes through three separate gravity fields. And when you are in the spacecraft, you are exposed to a very contained and unique ecosystem. Scientists back home monitor saliva, urine and blood content to ensure latent viruses, like herpes or Epstein-Barr, are not reactivated.  Astronauts are also subject to about ten times more radiation than normal when they visit the space station, which can have immediate as well as longer term effects on the central nervous system.

As one article published in the Canadian Medical Association Journal sums it up, “astronauts are people with normal physiology who live in an abnormal environment”. Here are some changes the body makes in order to adapt, or acclimatize, to space travel (summarized from this nifty table here):

  • Fluid re-distribution (a temporary in-flight decreased flow to the legs, and increased flow to the head and torso)
  • Neurovestibular effects (the motion sickness astronauts can expect to feel when traveling)
  • Muscle mass changes (mass will decrease up to 30% and will regain/recover post-flight)
  • Bone demineralization (a loss of almost 60-70% in calcium, as well as decreased thyroid activity and Vitamin D production, which recovers upon returning to Earth)
  • Psychosocial effects (Weariness and emotional effects)
  • Immune dysregulation

There are some measures that can be taken to counter these effects, including the following: exercise, negative pressure space suits, anti-nausea medication, resistance training, diet supplements, and exposure to artificial gravity during flight.

Curious to learn more? Here are a few more fascinating reads to get you started from Harvard, the Smithsonian, and StatNews.

Side Note–if you’re a local NC reader, I hope you’ve visited Morehead Planetarium, on UNC’s Chapel Hill campus! Apollo mission astronauts Neil Armstrong, Buzz Aldrin, and Michael Collins all trained here–as well as other space giants.

 

Turmeric’s Health Benefits

To this day, if I’m feeling a little under the weather, my parents will prescribe a healthy dose of turmeric. Sore throat? Teaspoon of turmeric in warm milk. Acne acting up? Make a turmeric paste. Feeling weary? Add some more turmeric in your veggies when you cook.

Turmeric is a naturally bitter spice, but my ma and pa are right–it’s somewhat of a super food! It’s an anti-oxidant as well as an anti-inflammatory agent. It’s also been known to have anti-fungal and anti-cancer properties.

Curcumin, the phytochemical that gives turmeric it’s trademark yellow color, makes up about 2-5% of turmeric, but is responsible for most of its recognized therapeutic effects. It was first extracted from turmeric in the early 1800s and since then has been used extensively in Asian cooking, religious ceremonies, and for medicinal purposes. It works by regulating transcription factors (proteins that are important in converting DNA to RNA, which then codes for genes). It is also thought to bind to cellular proteins, and to be able to help stop the growth of tumor cells.

But wait, there’s more! With that strong yellow color, it makes a very effective natural food coloring, and can function as a preservative of sorts. All in all, not a bad spice to throw in the mix every now and again.

I think I may just roll my eyes a little less the next time my mom tells me drink a warm cup of haldi (Hindi for turmeric) milk before bed.

Potato & Peas Stew

In the heat of June you wouldn’t expect to crave a warm stew. The summer storming we had last week, though, got me thinking about my mom’s comforting potato and pea stew. It’s warm, just a tad spicy, filling, and pretty healthy! Try it out next time the clouds look gloomy:

Ingredients:

4 tbsp oil

1 tbsp cumin seeds

3 large potatoes

1 12 oz bag of frozen peas

3 medium tomatoes

4 cloves garlic

2-4 oz water

Seasoning: turmeric, coriander powder, salt

Fresh cilantro, for garnish

 

Heat oil, then add in cumin seeds and minced garlic. Saute until golden brown. Add in cubed potatoes, and some water. Then cover and let cook until potatoes are almost done. Add in chopped tomatoes, mushing and mixing until well combined. Add in frozen peas. Season with salt, turmeric, and coriander powder, to taste.

When potatoes are cooked through, garnish with chopped cilantro.

Serve over rice or with naan/roti.

Enjoy 🙂

Transparency during Outbreaks-a Balancing Act?

Communicating about a potential public health concern can put a national voice in a tricky position. This was the situation the Indian government found itself in earlier this year when isolated cases of Zika broke out in the state of Gujarat.

Some argue that it is absolutely essential for the government to keep the public aware of even threats deemed low, as a step towards increased preparedness in the event of an outbreak (Scroll.In). The New York Times cites Dr. Swaminathan, the director-general of the Indian Council of Medical Research, as justifying the lack of communication as rooted in a need to prevent undue panic. Similarly, the Wire interviewed Dr. Ravindran, the director of emergencies in the Ministry of Health and Welfare , who reports that as the WHO did not declare ZIKA as a continued PHEIC (Public Health Emergency of International Concern), the government was not obligated to report these cases, as noted in the International Health Regulations. The cases were reported after being further investigated.

Which brings us back to a question of responsibility: What guides risk communication?

A document published in March 2016 by the WHO provides some guidance. They define risk communication as “the real-time exchange of information, advice, and opinions between experts, community leaders, or officials and the people who are at risk”. It goes on to identify who the at-risk populations are, the best channels for communication, and guidelines on content. By and large, it stresses the point that risk communication has the goal of empowering, above and beyond informing.

Social media have had a significant positive impact in real-time health communication in recent years. For instance, SMS/Tweets were used to identify vaccination locations during the 2009 H1N1 outbreak. On the other hand, such a large volume of information can be difficult to manage. An example of this chaos was witnessed in the Fall of 2014, when the United States saw an Ebola outbreak (Ratzan, 2014).

All to say…risk communication requires deliberation and thoughtful consideration. While the Zika cases in India continue to be a story that sparks a lot of push-back, rightfully so, it’s important to see the flip side of that coin.

 

 

 

 

What’s Ruining Healthcare, Again?

Forbes published an article earlier this week titles “10 Ways Lack of Communication is Ruining Healthcare”. If you’ve been following healthcare at all since January, “ruining healthcare” is not an unfamiliar term to hear tossed around, but wouldn’t you think that was all due to politics.

It may or may not be surprising to you that the tragedy they’re referring to is lack of communication–between hospitals, between health care workers, between patients and providers, between institutions…..gaps, all around!

If you need a little inspiration after reading that article, check out this TED talk by Eric Dishman, on why and how healthcare is a team sport: