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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • November 30, 2021

    By MedStar Team

    Heart disease disproportionally effects American Indians and is double that of the general US population. The Strong Heart Study has been examining why there is such disparities in health in this population for more than 30 years. Lessons learned from the Strong Heart Study are being applied to improve the health of the American Indians and other underserved communities across the nation.

    Since 1988, MedStar Health Research Institute has been one of the three main collaborating institutions of the Strong Heart Study. Funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), the Strong Heart Study is the largest and longest study of heart disease among American Indians. It includes more than 7,600 participants representing 12 communities across three main field centers in Arizona, Oklahoma, and the Dakotas. Analysis of more than 30 years of data has allowed MHRI investigators and collaborators to better understand how cardiovascular disease risk factors vary among American Indians, offering insights into how clinicians and public health groups might evolve and adapt disease prevention and treatment approaches to be more equitable and impactful across populations. 

    Some of the key findings produced by this study include:

    • Heart and vascular disease among American Indians has increased over the past 50 years and is now double that of the general U.S. population.
    • While recent data shows slow improvement, there is still work to be done to reduce rates among this population, including continued investment in public health programs to raise awareness about lifestyle and other risk factors. 

    • Known cardiovascular disease risk factors, including high blood pressure, cholesterol, and smoking are all important in American Indians, even though levels may be lower than in other populations. Strong Heart data showed that having type 2 diabetes is the strongest risk factor for cardiovascular disease in American Indians and did so before this was recognized in other groups. 
    • Genetic risk factors have also been identified among American Indians, some of which mirror risks in other populations and others which have been discovered first in the Strong Heart Study, underlining the importance of genetic studies in diverse populations. 
    • Environmental factors may also play a role in cardiovascular disease development, with research finding that exposures to arsenic and cadmium, at levels thought previously to be safe, are prospectively associated with higher risk.

    As one of our longest continuous research initiatives, the Strong Heart Study is one of the Institute’s foundational efforts into understanding the root causes of health disparities among underserved populations. We know that addressing health disparities involves understanding the needs of the community beyond those typically addressed in the medical care system, such as housing, nutrition, transportation, and culture. In addition to conducting important data collections about cardiovascular disease, the Strong Heart team has worked to develop strong, trusted relationships within tribal communities that honor each participant’s culture. 

    Using community ties to fight COVID-19

    Strong Heart program leaders have stepped up to help American Indian communities fight the COVID-19 pandemic. In partnership with the participating tribal communities, the Strong Heart field center teams have pivoted their efforts to prevent the spread of the virus among local tribes. The staff has volunteered to help distribute masks and educational materials, and most recently, collaborated with local public health officials on encouraging uptake of the COVID-19 vaccine among younger tribal members. 

    Investigators in the Strong Heart Study have also recently partnered with the NHLBI-funded Collaborative Cohort of Cohorts for COVID-19 Research (C4R), an observational study of more than 50,000 individuals nationwide to determine factors that predict disease severity and long-term health impacts of COVID-19.

     
  • November 26, 2021

    By MedStar Team

    My goal for every patient with epilepsy is to improve their quality of life. So, it’s been gratifying to see more treatment options become available in recent years and help patients live longer, healthier lives.

    But even as we learn more about epilepsy, patients and providers continue to face many challenges:

    • Epilepsy remains incurable but can be treated and managed.
    • Stigma surrounds the condition, causing a lack of understanding in the general public and reluctance in some patients to discuss their symptoms or seek treatment.
    • The risk of sudden unexpected death in epilepsy patients (SUDEP) persists with no identifiable cause, and families are often unaware of this risk.

    SUDEP refers to the death of a patient with epilepsy that is not caused by a known incident, such as drowning or an injury. It most often occurs during sleep. Studies have indicated that breathing, heart rate, or brain function complications during or after a seizure may contribute, but we still have more questions than answers.

    Here’s what we do know about SUDEP:

    • Frequent generalized tonic-clonic seizures are a risk factor. These are what typically come to mind when you think of a seizure: You lose consciousness for a minute or two and your limbs stiffen and jerk.
    • Uncontrolled seizures increase your risk. This is why it’s important to seek treatment or to consistently take your medication if that is your primary treatment method. Seizure management is the best way to prevent SUDEP.

    In the U.S., nearly 3.5 million people have epilepsy. At least 1 in 1,000 of these patients will die from SUDEP, likely between age 21 and 40. I’ve seen patients who have had epilepsy for 10 or 20 years before hearing about SUDEP for the first time. It’s an uncomfortable topic, but talking about it can help.

    As providers and scientists continue to seek a cure for epilepsy, I’m very passionate about what I can do now: increase awareness and understanding of basic epilepsy knowledge—especially about SUDEP.

    Getting better control of #epilepsy #seizures reduces the risk of #SUDEP. Priyanka Sabharwal, MD, discusses the importance of raising awareness about this rare but devastating event: https://bit.ly/3COVwCE.
    Click to Tweet

     

    Defining epilepsy.

    Anyone can have a seizure—when electrical activity in your brain “short circuits” and behaves abnormally. The types of seizures are categorized as either generalized, involving the entire brain, or focal, involving a specific area of the brain.

    During a seizure, some patients lose consciousness and experience rapid muscle contractions. Others stop whatever they’re doing and stare for several seconds, appearing “out of it.”

    Patients are diagnosed with epilepsy after they have experienced two or more seizures. In half of these patients, the cause is unknown. Commonly known causes include:

    • A head injury
    • A brain condition, such as a stroke or tumor
    • Birth complications
    • Infection in the central nervous system

    Epilepsy typically is diagnosed in children and in adults over 65. Some children grow out of it, but for others epilepsy is a lifelong condition. Our goal is to help these patients limit or eliminate their seizures through treatment, which often involves one or more of the following options:

    • Medication
    • Brain surgery to remove tissue where seizures occur
    • Surgical implantation of a device to help prevent seizures

    How to respond to a seizure.

    In over one-third of SUDEP occurrences, someone had recently witnessed the patient have a seizure. Educating more providers and loved ones about the risk of SUDEP may increase the likelihood of preventing possible deaths; if someone they know recently had a seizure they’ll be more likely to check on them as they sleep.

    If you or a loved one have epilepsy, record notes about what happens before each seizure to help recognize patterns and track triggers, such as lack of sleep, specific times of the day, alcohol use, or stress. Share this information with people you frequently spend time with to alert them to warning signs as well.

    Seizure alert devices can act as an additional layer of awareness. Many watches, mobile apps, and even mattress devices will measure your movement and alert others when you are having a seizure. However, these tools cannot prevent a seizure from happening and only work for seizures that involve a lot of movement.

    If you see somebody having a seizure, ensure they have plenty of space, free of sharp objects. Wait calmly for the seizure to end; it shouldn’t be more than a couple of minutes. When the seizure is over, turn them on their side and loosen any clothing around their neck so they can breathe more easily. Do not stick anything in their mouth (they won’t choke) or let them drive or operate equipment following the seizure. Let them rest. If their behavior does not return to normal within an hour, call for emergency care.

    ERASE SUDEP.

    I’m working on an ERASE SUDEP (Evaluating and Raising Awareness of SUDEP in Epilepsy Patients) initiative to help educate MedStar Health providers, patients, and local communities. I want to understand what people know about SUDEP and develop ways to fill the knowledge gaps.

    Many caregivers take a cautious approach to sharing information about SUDEP with patients. They may want to avoid triggering anxiety and depression, which are prevalent in many people with epilepsy.

    However, research shows that providing SUDEP information to epilepsy patients can improve medication adherence without negatively affecting their mood or quality of life. Better adherence means lower risk of seizures. A 2018 survey of adult epilepsy patients revealed that 100% of respondents wanted to be informed of their SUDEP risk because it motivated them to better manage their seizures.

    Controlling seizures with customized treatment.

    Several medications can minimize seizures in patients with epilepsy. But about one-third of patients do not respond to medication. This is called refractory or drug-resistant epilepsy. Providers at MedStar Washington Hospital Center can monitor patients’ seizures over the course of a few days to better understand their seizures and recommend more effective treatment.

    If medications alone do not control seizures well enough, surgery may be a possible option. Surgery can be resective at times and may involve removing a part of or an entire lobe within the brain where seizures typically start. Other times, it might be possible to implant an epilepsy device that can detect abnormal electric activity in the brain and send electric signals to stop it before a seizure occurs.

    Advances in technology continue to make surgery safer and more effective. Our epileptologists and surgeons will partner with you and your care provider to discuss your health and determine which type of surgery may be best for your type and pattern of seizures.

    Epilepsy can be frustrating and confusing, but it doesn’t have to control your life and it is nothing to be ashamed about. Understanding its risks and prevention strategies can help you better control future seizures and improve your quality of life.

     

    Improve seizure control with help from MedStar Health.

    Our epilepsy experts will recommend and provide advanced, effective treatment based on your unique health condition and lifestyle.

    Call 202-877-DOCS (3627) or Request an Appointment

  • November 24, 2021

    By Gina Meletakos, DO

    The holiday season is magical, especially if you view it through the eyes of a child—twinkly lights strewn on the outside of houses, festive parties at home and school, and of course, decorating and eating an abundance of sugar-laced cookies. Many holiday memories are centered around fancy feasts and sweet treats, and it can be hard to prioritize eating healthy around all of the tasty food.

    But if you have kids, you know that it can be easy for them to get carried away with foods loaded with sugar. Refined flours, sugar, unhealthy fats can negatively affect your child's health and energy levels, which is why it's important to teach them how to make healthy choices regardless of what's on the holiday table.

    This winter season, try these five tips for encouraging your family members and kids to eat healthy during the holidays.

    Fill their plates with protein, healthy fats, and colorful produce.

    The same guidelines for a healthy plate still apply to the holidays. Lean proteins, like chicken or fish, help our bodies function at their best. And, healthy fats, like avocados and olive oil, give us the energy we need without the crash that comes from refined carbohydrates, like mashed potatoes.
    There is an abundance of antioxidant-rich fruits and vegetables in season over the winter that add color to our plate and unique health benefits to our bodies.


    Challenge your kids to eat the rainbow every day—or as much color as possible. Foods that are naturally colorful are filled with vitamins and fiber, which helps regulate a healthy gut and can reduce the risk of autoimmune diseases and chronic diseases, such as type 2 diabetes, obesity, and cancer. Encourage your kids to limit white foods, which tend to offer little nutrition. Rice, potatoes, pasta, bread, and other starchy foods spike blood sugar, causing mood and energy to fluctuate.


    Encourage your family to #EatHealthy over the #Holidays by challenging them to fill “eat the rainbow.” Read more easy and fun tips from pediatrician Dr. Meletakos: https://bit.ly/3cNrXH4.
    Click to Tweet


    Limit added sugars by making naturally sweet foods enticing.

    Added sugar found in favorite holiday treats, like sugar cookies or pecan pie, contributes to hyperactivity and mood disorders. Instead, try recipes with sweet potatoes, carrots, and other foods that are naturally sweet. Or, consider adding cinnamon which adds a sweet flavor to any food.

    While it's okay to indulge over the holidays within reason, too much sugar can affect your child's sleep quality and significantly increase their calorie intake. Consider lowering the amount of sugar added to sweet treats or swapping out ingredients for those that are naturally sweet, like fruit. Frozen fruit popsicles, fruit kabobs, or creative fruit desserts, can entice kids for dessert. Just setting out a variety of fruit where your family can easily see it and grab it increases the likelihood that they'll reach for something healthy during the holidays when they feel hungry.

    Try this: Thinly slice strawberries and add a dab of whipped cream along the bottom edges to make festive and tasty Santa hats.

    Consider portion sizes and remember, "everything in moderation."

    Healthy eating doesn't demand that you completely eliminate fatty or sugary foods from your diet over the holidays. Instead, enjoy indulging in a few favorite dishes and treats while being mindful of how much you're eating. Typically, portion sizes are smaller than the size of your palm (relative to each of your family members). If you're having a sweet treat, the portion size may be smaller.

    Encouraging your family to fill up their plate with smaller portions allows them to try a variety of enjoyable foods that they may not get other times of the year without overdoing it. Kid plates often come with dividers that encourage both appropriate portion sizes and variety. Make balanced choices by filling up on the good-for-you foods first and eating "fun foods" every once in a while without associating them with any guilt.

    Involve your kids in the holiday meal prep.

    Eating healthy can be easy when there are tasty and nutritious choices readily available. One way to create more interest in eating healthy is by getting your kids involved in the kitchen. They can choose a new healthy dish to make or learn a family recipe, like grandma's famous green bean casserole, which gives them an opportunity to learn about the ingredients going into all the food. If your kids are little, try to shed the anxiety about the mess and invite them to join in on mixing, stirring, or setting the table.

    Maintain a normal eating schedule.

    It can be tempting for your family to think they need to skip meals and "save up" calories before a holiday party or large family gathering. Doing so will only lead to overeating later on and slower metabolisms over time. Regular meal schedules keep your family filled with nutrients that leave them feeling satisfied and energized. Kids get hungry between meals, so having healthy snack options on hand and accessible can ensure they don't grab processed junk when their stomach rumbles.

    Model nutritious choices in your own eating habits.

    If we want our families to eat healthy during the holidays, it's important that we serve as role models by doing it ourselves. As much as we expect kids to do what we say, they're more likely to "do what we do." Whether they're conscious of it or not, our children are watching what we do at the dinner table and in between meals. If we want our kids to choose healthy eating when faced with tempting treats, the best way we can encourage them to do so is by making nutritious choices ourselves. This holiday season, try to set a healthy example for your family by taking a balanced approach that involves filling yourself with nutritious, colorful foods while allowing room to indulge in the occasional slice of pumpkin pie or an extra helping of mashed potatoes. Your family will likely do the same!



    Would you like to talk to a pediatrician about your child’s eating habits?

    Consider scheduling an appointment with a MedStar Health pediatrician today.

    Find a MedStar Health Pediatrician Nearby

  • November 19, 2021

    By MedStar Team

    One of the best ways to protect your overall health is to protect your lungs. While smoking is a well-known cause of lung damage, many other preventable factors contribute to poor lung health. Knowing what proactive steps to take—and actions to avoid—can help keep your lungs healthy and lower your risk of lung cancer.


    The American Cancer Society estimates that lung cancer will cause nearly 132,000 U.S. deaths by the end of 2021, making it the leading cause of cancer death. Over 235,000 new cases are expected to be diagnosed by year-end.


    Cigarette smoking continues to be the biggest risk factor for developing lung cancer. However, healthcare providers worldwide are diagnosing lung cancer in more people who have never smoked cigarettes—about 15% of men and 40% to 50% of women who have lung cancer are never-smokers. In the United States, these numbers trend lower: about 9% of men and 19% of women.


    While we don’t yet know the exact cause of lung cancer, we know it’s linked to inflammation, environmental factors, and often ethnicity. Many—but not all—risks can be significantly lowered by patient behavior, such as avoiding smoking, vaping, and pollutants, and getting lung screenings as recommended. Here are five ways you can protect your lung health.


    1. Get a lung cancer screening if you meet updated screening criteria.

    The earlier lung cancer is detected, the more treatable it is. Screening can reduce the risk of dying from lung cancer by as much as 20%.


    In March 2021, the U.S. Preventive Services Task Force updated its lung cancer screening guidelines to include patients who:

    • Are between ages 50 and 80
    • Currently smoke or have quit smoking in the past 15 years
    • Have a 20-pack-per-year smoking history 

    If you meet the criteria above—or if you are within the age range and have regularly been exposed to secondhand smoke—request a screening from your primary care provider. You will likely receive a low-dose CT scan, which captures an image of your lungs and nearby organs to help your doctor detect any abnormalities that should be monitored for cancer development.

     

    2. Quit smoking cigarettes.

    With at least 80% of lung cancer deaths linked to tobacco smoke, I can’t go without reinforcing this. 

     

    In 2018, cigarette smoking among U.S. adults reached a record low of just under 14%. But in 2020, the COVID-19 pandemic appeared to pause the ongoing decline, even though smokers are at a higher risk of COVID-19 complications. Calls to the national portal that helps people quit smoking steadily declined and cigarette sales slightly increased.

     

    If you have tried to quit smoking in the past, I encourage you to try again. Talk to your doctor about smoking cessation resources that will work best for your lifestyle. MedStar Health offers free virtual and in-person counseling and support, and many prescription medications for quitting smoking are covered by insurance.


    When combined with lung cancer screening,
    successful smoking cessation can reduce the risk of dying from lung cancer by 38%. Once you make the decision to quit, we’re here to help you every step of the way.

    Despite advances in #LungScreening and treatment, #LungCancer remains the leading cause of cancer death. Here are 5 ways to prevent #LungDamage caused by behavioral and environmental lung cancer risk factors: https://bit.ly/30E1iKe.
    Click to Tweet
     

    3. Don’t vape—it causes lung inflammation that can lead to cancer.

    Vaping has become more popular over the years, and some vaping products have even been approved by the U.S. Food and Drug Administration. This has led to understandable confusion about the safety of vaping. 


    Earlier this year, I co-authored a study examining the effectiveness of electronic cigarettes and vaping as smoking cessation tools. Our study showed that they are not effective smoking cessation tools and should be avoided at all costs. While e-cigarettes have lower levels of carcinogens (cancer-causing substances), they still deliver toxic substances to the body. 


    The chemicals within all smoking products create inflammation in the lungs. When lung tissue experiences inflammation, it tries to heal itself. If vaping or smoking continues, this ongoing healing process can cause scarring and lung damage—and lung cancer can arise from scar tissue. 


    If your doctor asks if you use vaping products, don’t be afraid of any repercussions if the answer is yes. Our goal is to help you be healthy and enjoy life, not shame you. But we can’t do that if you don’t tell us the truth. 


    4. Avoid exposure to pollution when you can.

    Air pollution continues to cause many health issues for people across the globe. And increasing evidence points to a link between air pollution and lung cancer deaths. Patients often wonder what is producing so much pollution—and if there’s anything they can do.


    Pollutants found outdoors are most often caused by factors outside of an individual’s control, such as:

    • Agricultural pesticides
    • Coal and fossil fuel combustion
    • Industrial emissions
    • Wildfires

    I encourage patients to focus on what they can control. For example, only exercise outdoors when air pollution levels are safe, and always avoid areas with lots of cars and traffic.


    If you live in a heavily polluted area, consider wearing a face mask outdoors—one that can filter air particles, such as an N95 or N99 mask. The American Lung Association also recommends using public transportation more often, using hand-powered or electric lawn care equipment, and not burning wood or trash.


    Indoor pollutants contribute to lung cancer risk as well. The two major offenders are:

    • Asbestos, a group of minerals used for building insulation in the past. Its risk was discovered decades ago, so it’s much less common today, but if you suspect exposure, talk to your doctor about tests you can get.
    • Radon, a radioactive gas that is found outside but seeps into buildings through floors or walls if high levels are within nearby soil or rocks. You can use a kit to detect radon levels in your home or hire a professional to conduct a test. If you’ve been exposed, talk to your doctor. And if you smoke, try to quit immediately, as cigarette smoking combined with radon exposure significantly increases the risk of lung cancer.

    Also avoid secondhand smoke as much as possible, which can be difficult if you live with a smoker. Though it may require an uncomfortable conversation, don’t allow smoking in your home or car.


    5. Get vaccines that protect against respiratory diseases. 

    Respiratory diseases, such as the flu, pneumonia, and COVID-19, cause inflammation in the lungs. Over time, chronic inflammation can change the way your cells divide, increasing the risk for cancer to develop. 


    Getting the flu vaccine every year protects you against four different flu viruses. Vaccination in adults has been shown to reduce influenza-related hospitalization by 26% and death by 31%.


    We still have much to learn about the long-term effects of COVID-19. Many patients who were hospitalized for COVID-19 have taken a very long time to recover—after six months to a year, they’re still not back to their baseline.


    What we do know is that all forms of the COVID-19 vaccine protect against all strains of the virus. Getting vaccinated is the best way to lower your chances of getting the virus—and of suffering long-term lung consequences we won’t fully understand for years.


    The future of lung cancer screening and care.

    Advancements in lung cancer screening and treatment have come a long way in recent years, helping to improve patient survival rates. But compared to other common cancers, lung cancer survival rates remain low.


    Lung cancer treatment typically involves radiation or chemotherapy, and surgery is also an option for early-stage cancer that has not spread beyond one lung. 


    However, we’re seeing impressive success with biologic therapies as well—drugs and other substances that reduce the growth and spread of tumors while limiting damage to the surrounding healthy cells. These newer treatments have fewer side effects than more traditional treatment options. Patients tend to tolerate them very well, and I’ve seen improvement in patients’ quality of life for longer periods of time.


    Biologic therapies are increasingly being used to treat women of Asian descent between ages 40 and 70—a population experiencing higher rates of lung cancer not linked to cigarette smoking. Many of these patients have a genetic mutation that is responsive to a specific type of biologic. 


    Unfortunately, there’s no way to test for this mutation before cancer develops, which makes early screening all the more important. If you are within this specific population and have a family member with lung cancer, request a lung cancer screening test so treatment can begin as soon as possible, if necessary.


    Take it one step at a time.

    Lung cancer is not 100% preventable. But if patients take the necessary steps to reduce their risk, healthcare providers have a better chance of making an early diagnosis and delivering more effective treatment. 


    The steps I’ve discussed today take effort and determination, but MedStar Health lung specialists are here to support you on your health journey, no matter where you begin.


    Lung cancer can spread fast- often before it's found.

    If you're between age 50 and 80 with a history of smoking, request a lung screening today.

    Call 202-877-DOCS (3627) or Request an Appointment

  • November 17, 2021

    By MedStar Health Research Institute

    Associates at the MedStar Health Research Institute at University Town Center gathered to celebrate the 2018 first quarter SPIRIT Award of Excellence recipient, Matt Hoffman. Matt supports the ambulatory and core services as the administrative manager in the office of financial management. The award was presented by Neil Weissman, MD, president of MedStar Health Research Institute.

    The nomination was submitted by Becky Montalvo, executive director of MedStar Community Clinical Research Center, Biostatistics & Bioinformatics and the B3 Core Lab, on behalf of several MHRI associates. She spoke at the reception noting that with the extended deadline for submission, she was able to gather notes on Matt’s SPIRIT from 17 different associates and what is “remarkable is that they are from all departments and all levels within the research institute, which highlights Matt’s efforts across the board.”

    “Matt is an active member of the team to support numerous investigators in their research work,” said Becky. “You will always find Matt ready & willing to help with whatever needs to be done to move the program forward.”

    Several associates noted how responsive Matt is to their requests. “I have always been impressed with how quickly he responds to questions and the amount of detail and thoroughness of his responses,” said one submission comment. Another mentioned that Matt always comes prepared, and frequently provides information before other associates even know they need the information, from billing codes to copies of documentation.

    The SPIRIT Award is given to recognize and reward one associate (management or non-management) each quarter, who excels in Service, Patient First, Integrity, Respect, Innovation, and Teamwork. Nominations for the second quarter of 2018 are due by May 15, 2018. Learn more on the SPIRIT StarPort page or contact MHRI-HR@medstar.net.

  • November 12, 2021

    By Nicholas Samuel Streicher, MD, MPH

    Chronic traumatic encephalopathy (CTE) is increasingly in the news—often in connection to severe mood and behavior changes in former athletes. You may be asking the same question as many people within and outside of the scientific community: Why?


    Like Alzheimer’s and Parkinson's disease, CTE is a neurodegenerative condition. This brain disease occurs when the nerve cells that help you think, feel, and move gradually break down. When these cells stop working, patients may experience personality changes and lose memory and muscle control. 


    Unique to CTE is what appears to cause this cell breakdown: recurring head trauma, compounded by age and genetics. Because of these factors, older athletes and veterans are more at risk.


    Our medical understanding of CTE has come a long way, but we have a lot to learn. Currently, CTE can only be diagnosed after death. As we study its symptoms and causes, our goal is to diagnose the disease in living patients and develop treatment options and more effective preventive strategies.


    The concussion link.

    Research continues to show that recurring concussions, in addition to blows to the head that don’t result in a concussion, can lead to neurodegeneration over time. These injuries are commonly sustained during contact sports such as football, boxing, soccer, and hockey, and military service, as soldiers are often exposed to multiple explosions.

    A 2017 study examined 111 brains from former NFL players and found evidence of CTE in 99% of them. Two years later, after studying more brains of former amateur and professional football players, researchers determined that for every 2.6 years of heavy contact sport play, the risk of CTE doubles. The cumulative effect of continuous head injuries throughout several years of play is what contributes to the deterioration of nerve cells.

     

    Less CTE-specific data exists for veterans, as symptoms are similar to those of post-traumatic stress disorder, a primary area of study. However, CTE continues to be found in veterans’ brains and the Defense and Veterans Brain Injury Center reported almost 414,000 traumatic brain injuries in U.S. service members between 2000 and 2019. The Department of Veterans Affairs is dedicating more research to the long-term impact of these injuries.

     

    CTE symptoms: Development and detection.

    CTE is characterized by four stages of symptoms:

    • Stage 1: Short-term memory loss; mild aggression and depression; headaches.
    • Stage 2: Severe depression, outbursts, and mood swings.
    • Stage 3: Aggression; apathy; memory loss; lack of spatial awareness; executive dysfunction (inability to successfully complete activities that require time management, organization, and problem-solving).
    • Stage 4: More severe Stage 3 symptoms; paranoia; difficulty with language and muscle movement.

    Symptoms occur when the nerve cells that control specific functions are damaged. Nerve cells use complex networks within the brain to send signals to each other to initiate different behaviors, thoughts, and actions. The damage caused by a concussion prevents some of these cells from sending signals and alters the structure of a protein within the cells called tau. 

     

    When tau proteins change shape, they detach from the cells and start moving along the brain’s networks, forcing other cells to stop functioning and causing more tau to break free and build up. Every form of neurodegeneration is like taking the yellow line or the red line on the subway; an abnormal protein gets a “ticket” to a particular brain network, and wherever it starts and stops determines a patient’s symptoms and disease course.

     

    All neurodegenerative diseases function this way—the difference is the pathway they follow. Think of starting at the Bethesda Metro stop and going to Union Station vs. starting at Shady Grove and going to Bethesda; it's the same red line, but you get there differently. Depending on the cells damaged by a disease’s pathway, some patients’ cognitive functions are heavily disrupted, while others experience more movement difficulties—and if it’s the same “line” or type of neurodegeneration, may end up with the same set of symptoms in the end.


    Neurons within the brain’s visual processing and coordination network are often damaged when a concussion occurs, which is why many people experience symptoms such as dizziness and vertigo in addition to cognitive dysfunction such as memory loss.
    Repetitive injury over time and evaluating the ‘pathway’ of a patient’s symptoms help us find patterns that match the stages of CTE and distinguish it from other conditions.

    Recurring #concussions can cause CTE, a #neurodegenerative disease that spreads through the brain in the same way you ride the train. Learn how it affects mood and movement over time: https://bit.ly/3o9G0Mt.
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    Aging and genetics can increase the risk of CTE.

    A key reason we see higher rates of neurodegeneration in older populations is because aging is a long, slow neurodegenerative process. It’s natural “wear and tear” on the brain. My 99-year-old grandmother, for example, does not have dementia but she can’t remember things as well as she did 20 years ago—however, she recalls the 1920s perfectly. 


    Not everyone who experiences recurring brain trauma develops CTE, so genetics are likely another factor. Research is underway to identify genes that increase a patient’s risk of CTE in the same way that the APOE-e4 gene increases the risk of Alzheimer’s disease; the same gene may also increase the risk of CTE.


    Humans are living longer than ever before, but natural selection hasn’t caught up with today’s average life expectancy. Gene variants that could protect against age-related diseases aren’t typically passed on because there hasn’t been a need until relatively recently, in respect to longevity. 


    A collaborative approach to cognitive care.

    Managing emotions can be difficult at any age. It gets even harder when concussions continually disrupt the networks your brain uses to help you control them—especially later in life when you’re living with more challenges.


    We can’t completely avoid the risk of concussion, but we can minimize it through safer sports equipment and practices, educating more people about the long-term effects of concussions, and providing exceptional concussion recovery care.


    A multidisciplinary approach is critical. With physical and occupational therapists, social workers, psychologists, and neurologists working together as a team, we have a better chance of catching early warning signs such as mood and memory changes.


    Neuropsychological testing is one of the best ways to assess brain function and help us understand which brain networks are being affected by cell degeneration. It evaluates everything from reasoning and reading to problem-solving and personality shifts. 


    Future goals: Biomarkers and better brain imaging.

    Several studies are looking to develop effective testing methods based on biomarkers such as spinal fluid and blood. Some research has found that people who have concussion damage have higher levels of certain proteins in their blood: tau, neurofilament light, and glial fibrillary acidic protein. Developing standard tests for these protein levels could help us detect CTE in living patients.


    Stronger imaging is important as well; if we had the ability to see a buildup of tau protein forming in a patient’s brain in a pattern reflecting the stages of CTE, we could prevent further cell breakdown that would push them into later stages of CTE. 


    As interest in CTE grows, so does our understanding. But until we develop the necessary tests and tools, it’s important to seek care that is already available and improving patients’ quality of life, from customized concussion treatments to neurological exams.



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