Author: Arshya Gurbani

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 ūüôā

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:

Switchpoint Conference-2017

Switchpoint is an annual conference brought to North Carolina by IntraHealth.

With a massive stage that hosted a diverse array of speakers and presenters, the energy in the Haw River Ballroom last week was almost tangible last Thursday and Friday, for the 7th annual conference.

The day I attended was filled to the brim–speakers ranging from behavioral economics to digital epidemiology to “Artivism”, break-out sessions with hands-on activities, and live music. One of the main goals of the conference was to allow speakers of similar mindsets, from across the country, to network and connect. That’s a cool thing to see happen before your eyes.

I’ll leave it to you to check out the speakers’ profiles¬†and the microlab sessions made available to participants, form your own opinions or get inspired as the case may be. But I will say that as a Health Communication student, it was a nifty experience and definitely provided some food for thought. I’d highly recommend it to other students in this field or in public (especially global) health.

And on that note, to the other students: good luck finishing of the semester strong!

 

 

Summer Tanning

With summer just around the corner, the beach calls: sun, sand, and a chance to get the long-awaited tan. Carefree, however, doesn’t mean careless. It’s important to remember that, as our first defense against the outside world, the skin is subject to a lot of damage. About 90% of melanoma cases are caused by UV exposure (which can occur with indoor tanning or unprotected exposure to the sun).

The Journal of Health Communication reported in a March 2017 article that one way to more effectively convey the long-term negative impact of tanning beds was by pairing them with images of skin cancer or wrinkles. The study showed that these messages were more effective than images depicting short term effects. A 2008 study reports a 75% increase in risk for melanoma with use of artificial tanning devices, and a higher risk when first UV exposure via indoor tanning is in the teenage years. Looking at two decades of targeted campaigns, it attributes, in part, an increase in indoor tanning to a failure of messages to influence tanning attitudes.

The CDC defines indoor tanning as using a tanning bed, booth, or sunlamp–all of which expose users to UVA and UVB rays. This may lead to increased risk for melanoma, basal cell carcinoma, squamous cell carcinoma as well as cancers of the eye and cataracts. Their site also cites a 2014 article that estimates more than 400,000 of indoor tanning related cancer cases per year in the United States.

This is a significant burden–in fact, the FDA proposed a rule that would restrict minors from participating in indoor tanning.

Sources:

http://www.news-medical.net/news/20170425/Images-showing-impacts-of-indoor-tanning-may-be-effective-in-communicating-health-risks.aspx

Robinson JK, Kim J, Rosenbaum S, Ortiz S. Indoor Tanning Knowledge, Attitudes, and Behavior Among Young Adults From 1988-2007. Arch Dermatol. 2008;144(4):484-488. doi:10.1001/archderm.144.4.484

Sontag, J. M., & Noar, S. M. (2017). Assessing the Potential Effectiveness of Pictorial Messages to Deter Young Women from Indoor Tanning: An Experimental Study. Journal of Health Communication, 1-10.

Wehner, M. R., Chren, M. M., Nameth, D., Choudhry, A., Gaskins, M., Nead, K. T., … & Linos, E. (2014). International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA dermatology, 150(4), 390-400.

 

 

Next Level Data Presentation

By Arshya Gurbani

It’s probably safe to guess that lot of people studying Health Communication feel strongly about data, how it’s presented, and the “story” it has to tell. I thought it was about time to re-watch this, one of my favorite TED talks, about using statistics effectively. Hans Rosling presents data on child mortality, but in doing so he layers it with context and bias and paints a picture that is remarkably clear and moving. ¬†It’s good stuff–seriously, get some popcorn and a handkerchief before you watch/re-watch it!

Naming Flu Viruses-Nothing to Sneeze At!

By Arshya Gurbani

I’m sorry about the title, too. I heard a pretty ridiculous pun today, and I guess they’re just contagious…much like the flu.

That’s right–sure as the sun rising each morning and the certain as the pride every Tarheel felt following last week’s momentous basketball victory…flu season is back again. In the US, flu season tends to peak somewhere between December and March. A highly variable virus, influenza strains are often different than the previous years’, which leads to the need to constantly update and refine ¬†recommended vaccines for the year. It’s why you have to go back to get a flu shot every year.

Of course, it’s important to know what you can do to prevent getting ill. If you need a refresher, quick shout-out to a fellow UpstreamDownstream blogger from the past: Surviving Flu Season. ¬†But I thought it’d be kind of fun to talk about the influenza virus itself. (You may roll your eyes at “fun” but you’re still reading…)

There are 4 types of the influenza virus, A-D. Influenza A and B are the most common causes of the seasonal epidemic known as the flu that afflicts the US. The A viruses has hemagglutinin and neuramidase surface proteins, also called H and N subunits. That’s where the name of a particular strain comes from. Remember the H1N1 pandemic in 2009? That’s right–the H1 refers to 1 of 18 known H subtypes, and N1 refers to one of 11 known N subtypes. Both of these proteins live on the outside layer of the virus, also known as the viral envelope. They act sort of like bridges, connecting the virus to our cell membranes by latching on to one of the sugars in our cell membranes, sialic acid–H helps the virus enter our cell, and N helps it leave. Pretty nifty, right? Here’s a helpful visual from David Goodsell’s “Molecule of the Month” blog featuring H and N:

 

 

As mentioned earlier, the strain of influenza virus most prevalent in any given season can change. Now that we have a vague idea of the naming system, let’s talk about which strains vaccines recommended for the 2016-2017 season protect against. There are 3-component and 4-component vaccines:

  • A/California/7/2009 (H1N1)pdm09-like virus
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)
  • B virus called B/Phuket/3073/2013-like virus (B/Yamagata lineage) –only in 4 component vaccines

So far this season, according to a Morbidity and Mortality report looking at data from Oct-Feb, the A(H3N2) virus has been the most prevalent. Around 94% of infections were caused by Influenza A, and 98% of these were attributed to the H3N2 strain. Overall, the report says, it’s been a pretty moderate season.

I hope you enjoyed that brief dip into biology–who knows, if enough of you did, maybe this post can go, you know ….viral.

References:

https://www.cdc.gov/flu/about/viruses/types.htm

https://www.cdc.gov/flu/about/season/flu-season-2016-2017.htm

http://blog.h1n1.influenza.bvsalud.org/en/2009/09/10/molecule-of-the-month-presents-hemagglutinin-and-neuramidase/

 

 

Why our perception of beauty is skewed

My friend asked me last night, seemingly out of the blue, “Do you ever wonder why stores separate their plus size clothes?”

The truth is, it didn’t cross my mind until she asked it. But I haven’t stopped thinking about it since because, really, ¬†it seems like a classic microagression–a small, perhaps mundane but not insignificant–manner by which to separate people who lie outside of what, at some point, became considered the norm. Not that it should matter, but a 2016 VCU article cited data claiming that over 60% of women in the US wear clothes that are plus or extended sized. Another article notes that plus size women account for 28% of the clothing market (Binkley, 2013). With an affected population that substantial, it’s even more glaring how insensitive we can be.

A 2016 ¬†article published in¬†Body Image¬†links anti-fat attitudes, body shaming, self-compassion, and fat-talk in female college students. They found that internalizing body-shaming led to engaging in fat-talk, among other negative anti-fat attitudes. They found the converse to be true as well–that self-compassion leads to better psychological well-being and less engagement with objectification and self-denigration. The health education and communication implication of all this, is to promote self-compassion (Webb, 2016). ¬†It isn’t hard to imagine that segregated stores don’t play into a healing cycle very well.

Though there has been a recent movement for models to that match all body types, the retail industry still largely caters to a frankly thinner than average body type. Consider the last mannequin you saw that wasn’t unrealistically proportioned. I can’t recall a single one…

One article says these social pressures, among others like harsh lighting and narrow spaces in dressing rooms, ¬†are driving plus-sized women to opt towards online shopping (Money, 2017). ¬†Despite some small successes, Money says, men and women of size “are clearly tired of limited options and unwelcome shopping experience”.

The thing is, it wasn’t a question out of the blue. She had gone shopping with her cousin. It should have been a fun ¬†outing– bonding, enjoying rare time together, catching up and picking out clothes for each other. Instead, they parted ways near the entrance of the store.

References:

Binkley, Christina (2013, June 12), “On plus side: New fashion choices for size 18,” The Wall Street Journal, Retrieved from http://online.wsj.com/news/articles/SB100014241278873 23949904578540002476232128.

Money, C. N. (2017). Do the Clothes Make the (Fat) Woman: The Good and Bad of the Plus-Sized Clothing Industry. Siegel Institute Ethics Research Scholars, 1(1), 1.

Webb, J. B., Fiery, M. F., & Jafari, N. (2016). ‚ÄúYou better not leave me shaming!‚ÄĚ: Conditional indirect effect analyses of anti-fat attitudes, body shame, and fat talk as a function of self-compassion in college women. Body image, 18, 5-13.

http://www.hercampus.com/school/vcu/problems-womens-plus-size-clothing

 

Promoting Healthy Habits? Tell a Story

Researchers at the University of Southern California have been studying how narrative influence health behavior. They wonder if it might not be more effective to present information as a story. Their results thus far show that, in fact, this may be the case.

Narrative communication has been defined “any cohesive and coherent story with an identifiable beginning, middle, and end that provides information about scene, characters, and conflict; raises unanswered questions or unresolved conflict; and provides resolution”.

A recent article published by the Contributor and re-published by US News  discusses a study that attribute the greater success of narrative-driven presentation to 2 key factors: 1) identification with characters and 2) transportation to and absorption in the story. Both of these psychological processes assist with retaining information. Harnessing this to create characters that are identifiable role models is the key, the author says, to reducing health disparity.

Not surprised by this finding? It does seem somewhat intuitive that something with a story-line is more appealing. The point is, it’s not necessarily how we think to present a message with a scientific or health-rooted concern. We tend to rely on facts, or on recommendations. The article suggests that collaboration across disciplines is important in reaching the most beneficial results.

Utilizing narrative can be tricky, however. A 2016 article on the subject, published in Health Affairs,¬†notes some possible limitations to incorporating narrative into clinical practice.¬†For instance, it may be hard to generalize data that is based on narrative–it may not appeal widely nor have equal effect in diverse populations. Confidentiality may be another barrier. These make it difficult, the authors say, to translate good narrative into practice. They do offer some recommendations on how to address the problem. However, it’s clear that there is a gap to be bridged.

It’s a good reminder that sometimes data collected is only a glimpse of the human it represents.

References:

Dohan, D., Garrett, S. B., Rendle, K. A., Halley, M., & Abramson, C. (2016). The importance of integrating narrative into health care decision making. Health Affairs, 35(4), 720-725.

Hinyard, L. J., & Kreuter, M. W. (2007). Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Education & Behavior, 34(5), 777-792.

https://www.usnews.com/news/healthcare-of-tomorrow/articles/2017-03-03/stories-are-better-than-lectures-at-teaching-us-about-health

 

GOP Proposal for the American Health Care Act in the works

The Huffington Post reported this morning that the American Medical Association (AMA) is joining other big names in health and patient advocacy to push back against the GOP proposed health bill to replace The Affordable Care Act.

The AMA has historically been a key voice in health care, often opposing national level reform in order to protect clinical practice. However imperfect the 2010 roll-out of the Affordable Care Act (ACA/ObamaCare was), they agree that certain aspects of the ACA should not be rolled back now. In particular, they agreed that the ACA allowed for Medicaid expansion to cover more lower income individuals. They make the argument that the newly proposed bill provides government subsidies based on age, rather than income, which would be  problematic and cause loss of coverage and higher costs.

Other groups that are pushing back against this reform include the American Health Care Association, the American College of Physicians, the American Hospital Association, the National Center for Assisted Living, and the National Health Council. So who actually agrees with the proposed bill? The medical device industry, who claim that cutting taxes on medical devices will allow for growth in innovation that will eventually lead to better care. The counter argument to this claim, it seems, is that though quality of care must indeed improvement, this is irrelevant if people who need it cannot even afford coverage.

If you’d like to read up more on the proposal, the American Health Care Act, and how it differs from what is currently in place, check out Kaiser Health News’ article on the subject. They explain the funding changes the proposal suggests: how tax credits for insurance will change, the addition of caps to the current Medicaid funding, benefits fort he wealthy, penalties for those who have gaps in coverage, and a change to a free market system.

As expected, much is still unclear, but the calls to slow down the repeal process while details are ironed out appears to be quite loud.

Sources (linked in text): The Huffington Post, Kaiser Health News, U.S. Department of Health and Human Services