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Published on Leave a comment on Science Cafe’ 360: Using Data to Build Strong Partnerships Between Schools and Health Systems

Science Café 360

GW-CHIPR and the Clinical and Translational Science Institute at Children’s National (CTSI-CN) have partnered to bring you an overview of the latest café in the Science Café 360 series. The objective of the Science Café 360 is to promote bi-directional conversations between researchers and local communities by creating an atmosphere where participants can build trust, co-mingle, and engage in open dialogue.

The topics for the science café’ series focus on four priority areas determined by the DC Healthy Communities Collaborative (DCHCC) 2016 Community Health Needs Assessment.


Using Data to Build Strong Partnerships Between Schools and Health Systems

This café’s featured speakers included:

  • Dr. Olga Acosta Price, Director of the Center for Health and Health Care in Schools, Associate Professor at the Milken Institute School of Public Health at the George Washington University and an expert in the development, evaluation and sustainability of school health programs.
  • Dr. Michael Long, Assistant Professor in the Department of Prevention and Community Health in the Milken School of Public Health at the George Washington University and an expert in obesity prevention.
  • Marisa Parella, School Based Mental Health Program Manager at Mary’s Center and an expert in community, school and health system partnerships to enhance mental health care for children and families.
  • Dr. Chioma Oruh, a member of the Chancellor’s Parent Cabinet for DC Public Schools and the DCPS Early Childhood Education Policy Council.
  • The event was moderated by Tonya Vidal Kinlow, Vice President for Community Engagement, Advocacy and Government Affairs and leader of the Child Health Advocacy Institute at Children's National. Ms. Kinlow is an advocate for health-education partnerships and has served on the DC Board of Education and as the first Ombudsman for DC Public Schools.

Dr. Price opened the panel with a frank discussion on the need for equity and strengthening community partnerships within schools. Particularly in DC, where in some wards 29% of families are living in poverty[i]. Along with poverty, experiences of chronic stress and trauma are also prevalent in these communities. Nearly half of young people in these communities have experienced a traumatic event. Among DC high school students’ the rate of attempted suicide is double the national average[ii]. Schools are often the first source of mental health care, but they lack the training and resources to deal with the severity and pervasiveness of the problem.

Dr. Oruh’s experiences with school officials has been tumultuous to say the least. She has family members with mental illness, two sons diagnosed with autism, and has seen how ill-equipped some schools are in addressing the need for extra care. She states how many parents feel isolated from schools and school decisions, and how they often feel as though they are “treated like the enemy”. Trauma is not a singular experience of individuals, but felt by entire communities, particularly minorities and those with disabilities who have disproportionately higher rates of chronic stress and poverty.

Dr. Parella gave a personal account of a family she encountered in her work with Mary’s Center. One child that was having behavioral problems in school had actually fled with his family from Honduras. In Honduras he had witnessed the murders of close family members, had survived periods of starvation and extreme violence, and upon arriving in the US had seen his father deported. His mother did not speak English, was unemployed, and without health insurance. Mary’s Center helped to get the family access to healthcare, English lessons, and offered other resources for the mother including job skills. Immediate access to healthcare and employment resources helped address some of the causes of stress in this household. This leads to more sustainable change and improves the boy’s prospects for the future. In fact, Mary’s Center programs that connect families with healthcare and employment resources have been shown to improve student performance and improve the quality of the relationships with their families[iii].

Healthy child development cannot be left to the schools alone, and is dependent on providing members of this community with the resources they need to learn how to better cope with the stress and conditions of poverty, often circumstances that they cannot control or prevent. Schools are nested within these communities and are a perfect location to target for a lasting and permanent impact on community health. Although, existing public policies in schools vary dramatically by region and have the potential to either help or hinder schools’ efforts to implement successful programs. This presents an opportunity for research teams and health policy experts to test and evaluate new programs and hopefully make policy changes at the city, state, or even national scale.

To help accomplish this, Dr. Long suggests the use of a Strategic Science Framework[iv].

Framework Graphic

 

Essentially, this framework is used by researchers to ensure evidence-based policies are implemented. Those in educational settings are not researchers, and neither are policy makers, but the goal of the framework is to bring research findings to policy makers and bridge that knowledge gap. Researchers, policy makers, and school officials should also try to work with parents and community members that deal with these kind of challenges every day.

Listen to our podcast with each of the speakers or check out our previous Science Cafe CHIPR Podcast here!

 

[i] http://www.dchealthmatters.org/content/sites/washingtondc/2016_DC_CHNA_062416_FINAL.pdf

[ii] https://www.urban.org/sites/default/files/publication/81731/2000833-health-needs-in-the-washington-metropolitan-area-potential-intiaitives-for-investment-by-carefirst.pdf

[iii] http://www.maryscenter.org/sites/default/files/HSHF_Year_14_Report%20Final.pdf

[iv] http://www.sciencedirect.com/science/article/pii/S0140673614623977?via%3Dihub#fig1

Caitlin Carter, MPH  is a research associate and program manager for Urgent Matters. She also assists with program management for the Criminal Justice Health Initiative and provides qualitative research expertise on other research projects at CHIPR.

Published on Leave a comment on How do you solve a problem like the opioid crisis?

Leah Steckler, MD
December 6, 2017

As we approach the end of the calendar year, lawmakers have been pushing to keep their promises and pass important legislation. This year, opioids have been a topic with less controversy than others in terms of bipartisan agreement that something must be done. To emphasize this need, the president even donated his third-quarter salary to the cause (1). However, how to accomplish this bicameral, bipartisan goal has been more of a challenge. The true question is, how federal funding be spent in order to have the greatest effect on this crisis? This is where the true innovation and thinking must happen.

Many strategies (summarized in Figure 1) have been suggested and implemented to combat the opioid crisis, however their success is limited. Everything from developing abuse deterrent drug formulations (2) to incinerating leftover medications has been attempted (3). Recently the focus seems to be on using alternative medications (4), treating opioid withdrawal symptoms (5), changing prescribing practices (6) and prevention of opioid use (7).

  • Regional pain blocking
  • Topical medications
  • Alternative medications
  • Alternative medicine (e.g. acupuncture)
  • Opioid-free practices
  • Pharmacy factors
  • E-prescribing
  • Medical school curriculum
  • Required physician education
  • Buprenorphine
  • Methadone
  • Clonidine
  • Addiction treatment programs
  • Adjunct medications
  • Novel drug development
  • Prescription drug monitoring
  • Policies to promote innovation
  • Research funding
  • Disposal of extra drugs
  • Prevention programs
  • Drug testing
  • Manage patient expectations
  • Medical devices
  • Patient education
  • Identify risk factors for opioid abuse

Figure 1. Summary of suggested strategies to solve the opioid crisis

Despite each of these attempts to help ameliorate this crisis, we have a long way to go. Even with decreasing the number of prescriptions (8), learning about these medications in medical school, promoting patient awareness, and coming up with several alternatives, many states have experienced increases in opioid deaths (Figure 2). None of these strategies are “new” however they are being applied in a novel way to this particular crisis. A recent New York Times article suggests that the answer is in education for school-age children (7) with the caveat that this may help us in the future, but currently, overdose rates are highest among individuals aged 25-54 years old (9).

Figure 2. Statistically significant drug overdose death rate increase from 2014 to 2015, US States (CDC) (9)

This crisis is pervasive and has proven to be a difficult problem for lawmakers and practitioners alike. Perhaps the best approach to this problem is to start from the beginning by thinking carefully about who it affects, understanding the risk factors for opioid abuse, providing safe alternatives, educating patients and practitioners, in evaluating data to guide policy. Perhaps if we identify where in this approach we are having trouble in the fight against opioids we can find a more comprehensive solution. Undoubtedly, what we learn from solving this problem will help solve the next health care crisis.

Resources

1. Trump Donates Third Quarter-Salary to Health Department. New York Times. 2017. https://www.nytimes.com/aponline/2017/11/30/us/politics/ap-us-trump-salary-donation.html

2. Changing course: A new approach to opioid pain medication at FDA. FDA Voice. 2016 https://blogs.fda.gov/fdavoice/index.php/2016/02/changing-course-a-new-approach-to-opioid-pain-medication-at-fda/

3. Four police departments across state receiving drug incinerator. MetroNews. 2016. http://wvmetronews.com/2016/10/25/four-police-departments-across-state-receiving-drug-incinerator/

4. Introducing the ALTO Alternatives to Opioids Program. EMResident. 2016. http://www.emresident.org/introducing-alto-alternatives-opioids-program/

5. Gowing L, Ali R, White JM, et al. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev. 2017;2:CD002025.

6. Barnett, ML, Olrnski, AR, and Jena AB. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. N Engl J Med 2017; 376:663-673.

7. Where is the Prevention in the President’s Opioid Report? New York Times. 2017. https://www.nytimes.com/2017/11/27/upshot/where-is-the-prevention-in-the-presidents-opioid-report.html

8. Annual Surveillance Report of Drug-Related Risks and Outcomes. CDC. 2017. https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf

9. Drug Overdose Death Data. 2014-2015 Death Increases. CDC. Available from: https://www.cdc.gov/drugoverdose/data/statedeaths.html

Published on Leave a comment on From Placenta to Preschool: The Developing Brain and What Communities Can Do to Support It
Caitlin Carter

November 20, 2017

Science Café’ 360 Overview

GW-CHIPR and the Clinical and Translational Science Institute at Children’s National (CTSI-CN) have partnered to bring you an overview of the latest café in the Science Café 360 series. The objective of the Science Café 360 is to promote bi-directional conversations between researchers and local communities by creating an atmosphere where participants can build trust, co-mingle, and engage in open dialogue.

The topics for the science café’ series focus on four priority areas determined by the DC Healthy Communities Collaborative (DCHCC) 2016 Community Health Needs Assessment:

From Placenta to Preschool: The Developing Brain and What Communities Can Do to Support It

On Wednesday, November 1, 2017, the Science Café 360 series brought together Dr. Anna Penn, a neonatologist and developmental neuroscientist, Dr. Lee Beers, a pediatrician and the Director of DC Mental Health Access in Pediatrics, Gail Avent, the Executive Director and Founder of Total Family Care Coalition and community advocate, along with nearly 100 attendees from the community. In spirit of the Science Café’s mission, the room was warm and welcoming, with candlelit tables, hearty hors d'oeuvres, and cozy seating.

“Mental health begins in the womb”. A clear and concise introductory statement by Dr. Penn, who invented the field of neuroplacentology. Neuroplacentology, coined by Dr. Penn back in 2013, is an emerging field in placental research. There are still only a handful of neonatologists and neuroscientists currently studying the effect of placenta on the developing brain in-utero. This innovative research is crucial to neurodevelopment, because while we don’t understand the mechanism of how placental hormones affect the fetus we do know that they impact neurodevelopment. Pre-term birth, birth prior to 37 weeks gestational age, is associated with a nearly four-fold increased risk of psychiatric problems later in life[1]. Pre-term birth is also associated with learning and physical disabilities, such as autism and cerebral palsy[2]. Because we don’t understand the how placental hormones support neonate neurodevelopment, we don’t have any treatments to prevent these kinds of neurodevelopment problems from developing in pre-term infants.

However, we do know some of the causes of pre-term births, and how to prevent them. Prenatal care, good nutrition, low stress levels, and vaccines can help prevent pre-term deliveries[3].  Unfortunately, not all pregnant women have the resources to access prenatal care and ensure low stress or proper nutrition. We also know that there are a disproportionate number of pre-term births among minority women and women of lower socioeconomic status. Dr. Lee Beers’ goal is to decrease the impact of stress and adversity in these communities, by empowering community members and connecting them with available resources. Her work with the Early Childhood Innovation Network (ECIN) aims to bridge this gap and create new interventions for vulnerable youth to improve their academic, physical, and mental health trajectories. ECIN’s model incorporates the latest pediatric research and coalition-building to produce the best interventions in early childhood development.

Gail Avent shares a similar purpose with her advocacy work and development of the Total Family Care Coalition . Her work focuses on empowering families and youth so they can share their challenges, become their own advocates, and navigate the sometimes complex network of community services and resources. She encourages parents to speak out about their personal and unique challenges and to ask for help. She understands their perspective, because she’s been in their shoes before and faced some hardships of her own. During the café, Gail opened up to the audience and shared her story as a survivor of domestic violence. She’s not alone, nearly 1 in 3 women experience intimate partner violence in their lifetime[4]. She talked about the shame she felt in her marriage and the feelings of guilt that she had “failed” her four children. She mentioned that because of these feelings, she often found it difficult to ask for help and seek out community resources. After divorcing her husband, instead of “getting mad” at her circumstances she “became an advocate for [her] family.” Now she works to promote family healing, familial support, building trusting relationships, and teaching better communication skills so that families can “break that stress cycle” and reach out for the services and support they need.

Strong family and community relationships can serve as a buffer to stress, mental health issues, and adversity for both the mother and the child. Community empowerment and community engagement are crucial for developing new research priorities, incorporating the latest research into health policies, and improving the overall health of communities. Be sure to check out our CHIPR podcast with all of the panelists here to learn more! Don’t forget to subscribe to our listserv to hear more about the latest health research news and innovation! The next Science Café 360 – Coordination, Strength, and Flexibility, They’re Not Just for PE: Using Data to Build Strong Partnerships Between Schools and Health Systems – will be held on Tuesday, December 5th, 2017 from 6:00pm-8:00pm, at Busboys and Poets in Brookland. Register soon as space is limited: https://sciencecafe360_dec2017.eventbrite.com.

Presentation slides from the Science Café available here: Science Cafe 360 Opening Slides_110117-tu292x .

References:

[1] https://www.ncbi.nlm.nih.gov/pubmed/21289534

[2] https://www.ncbi.nlm.nih.gov/pubmed/23079774

[3] https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/Pages/who_risk.aspx

[4] https://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf

 

Caitlin Carter, MPH  is a research associate and program manager for the Urgent Matters program at CHIPR.

Published on Leave a comment on Genome Editing: The Future of Medicine

Hannah Caplan

Genome editing refers to a group of technologies that allow scientists to edit DNA sequences.1 Clustered regularly interspaced short palindromic repeats, CRISPR, is the newest genome editing technology. CRISPR provides scientists with a faster, less expensive, and more accurate means of modifying DNA than ever before.1 Genome editing in healthcare can offer patients new cures and potential cost-savings by treating the genetic source of a disease. CRISPR associated proteins, often CRISPR associated protein 9 (CRISPR-Cas9), interact with guide RNA (gRNA) to identify the segment of DNA that contains the mutated gene.2 Scientists can reprogram the guide RNA to identify a new target gene, making this technique simpler to execute than previous gene editing techniques, such as ZNF and TALENS.3 Once the guide RNA and Cas9 identify the segment of DNA, Cas9 binds to and slices both strands of DNA, effectively shutting off the expression of that gene.2 Scientists can then perform insertions and deletions at the site of the break to make changes in the DNA. More recent research has also demonstrated that CRISPR-Cas9 can be used to change DNA base pairs without cutting the DNA, reducing the possibility of technical errors.4

Graphic: How CRISPR Works

Scientists at Stanford University recently demonstrated the effectiveness of CRISPR technology to target and repair the genetic mutation responsible for sickle cell anemia.5 The scientists successfully modified the gene in blood stem cells, known as hematopoietic cells, that causes red blood cells to produce sickle shaped hemoglobin.5 Once the scientists replaced the mutated segment with the correct DNA sequence, the red blood cells produced normal-shaped hemoglobin.5 After the body produces enough normal-shaped hemoglobin, the red blood cells can properly circulate oxygen throughout the body, thereby curing the patient of sickle cell anemia.6

Genome editing has become a prominent topic among policy makers considering the potential long-term effects and ethical concerns associated with gene editing. While many scientists have so far demonstrated successful applications of genome editing techniques, little information is available on the long-term effects of genome interference. In addition, scientists could wrongly identify the point of mutation along a strand of DNA and in doing so, might alter an otherwise healthy DNA sequence. A variety of ethical concerns also arise when discussing the acceptability of genome editing. Genome editing techniques can be used to alter DNA in somatic cells also known as the body cells. However, genome editing techniques could also be used to alter other cells. Parents may be interested in genetically modifying their egg or sperm cells to prevent passing down an inheritable condition to their child. However, ethicists must consider the extent to which it is acceptable to genetically modify the human genome. Many of these concerns fall under the authority of the Food and Drug Administration (FDA).7 The FDA regulates gene editing in somatic cells under their existing framework for biologic products.7 Genetic modification of human embryos falls under a separate category and is subject to much stricter regulations.7 With this new technology we have the potential to create a healthier generation, but this also brings up concerns for designer babies and the limits to gene editing. Furthermore, the cost of genome editing technology and access to care issues are still unknown. This new technology could further exacerbate the health disparities already seen between socioeconomic classes in the United States.

References

  1. What are genome editing and CRISPR-Cas9? National Institutes of Health: Genetics Home Reference. Available at: https://ghr.nlm.nih.gov/primer/genomicresearch/genomeediting
  2. Questions and answers about CRISPR. Broad Institute. Available at: https://www.broadinstitute.org/what-broad/areas-focus/project-spotlight/questions-and-answers-about-crispr
  3. Gupta, R. M., & Musunuru, K. (2014). Expanding the genetic editing tool kit: ZFNs, TALENs, and CRISPR-Cas9. The Journal of clinical investigation, 124(10), 4154.
  4. New CRISPR gene editors can fix RNA and DNA one typo at a time. Science News. Available at: https://www.sciencenews.org/article/new-crispr-gene-editors-can-fix-rna-and-dna-one-typo-time
  5. Researchers take step toward gene therapy for sickle cell disease. Stanford Medicine. Available at: https://med.stanford.edu/news/all-news/2016/11/researchers-take-step-toward-gene-therapy-for-sickle-cell-disease.html
  6. What is sickle cell disease? National Institutes of Health. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/sca
  7. Califf, R. M., & Nalubola, R. (2017). FDA’s Science-Based Approach to Genome-Edited Products. US Food and Drug Administration. Available at: https://blogs.fda.gov/fdavoice/index.php/2017/01/fdas-science-based-approach-to-genome-edited-products/
  8. Ball, Philip. (2016). CRISPR: Implications for materials science [Digital image]. Retrieved from https://www.cambridge.org/core/journals/mrs-bulletin/news/crispr-implications-for-materials-science

Hannah is a senior majoring in Public Health at the George Washington University Milken Institute School of Public Health.

Unless otherwise indicated, the content and opinions expressed on this web site are those of the author(s). They are not endorsed by and do not necessarily reflect the views of the George Washington University.
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