Xin She is a Global Health pediatrician with 15 years of experience working in low-resource settings. She speaks 5 languages and is committed to creating interdisciplinary, equitable solutions for all vulnerable children to thrive. She is a national representative at the Women Physicians Wellness, Equity and Leadership Alliance (WEL).
She has published on mental health epidemiology and health inequity in Chinese children, early childhood development and quality improvement in pediatric care for Haitian Children. She has presented nationally and internationally on Social Medicine and Global Health, youth mental health, early childhood development, Wellness and professional development. She has collaborated with academic, governmental and non-profit partners in inner city US, Canada, Mexico, Guatemala, Haiti, DR Congo and China.
She has mentored more than 100 youth globally, ranging from rural Chinese children, inner city American youth, to medical trainees in Haiti, at Harvard and at Stanford. She is a mentor at national programs for underrepresented minority students and for international junior researchers. She has been twice awarded the AAP national Advocacy conference scholarship and regularly advocates for underserved communities locally and nationally.
She chairs the Pediatric Wellness Committee at CPMC regional site and serves as a Wellness Champion for the department of Pediatrics. She is certified in Mindfulness-based Stress Reduction and Reiki (Master). She is also a Cordon Bleu graduate in Spanish cuisine and loves hosting friends from all over the world.
Dr. Singh is Associate Professor of Psychiatry and Behavioral Sciences and her multidisciplinary research investigates the neurobiology underlying mood disorders and related psychiatric conditions. Her team uses a clinical translational approach to examine neural circuit dynamics in the human brain in order to ascertain neurobiological correlates of behavior. A major focus of the research is directed to risk factors of mood disorders including genetics as well as developmental exposure and adaptation to early life and family environmental stress. Her team also conducts human clinical trials in developing novel therapies for youth onset mood disorders.
The Stanford Pediatric Mood Disorders Research Program promotes healthy brain development across the lifespan through a deeper understanding of how youth adapt to mood symptoms and stress to have successful transitions into adulthood. The program's bold vision is to prevent chronic and progressive mood disorder and to improve the mental health of children, adolescents, young adults, and families through globally recognized research, education, and innovation. The program’s research is multidisciplinary, bringing together experts from the fields of psychiatry, psychology, neuroscience, computer science, biostatistics, genetics, regulatory, and industry to seek answers for complex questions related to brain-behavior-environment relations in developing youth with and at risk for mood disorders, and to accelerate discovery of novel therapeutic strategies.
Jason Wang and his team working on a project to prevent preterm births received a $150,000 grant from the Richard King Mellon Foundation to complete their randomized control trial testing a digital app that tries to prevent recurrent preterm births.
PretermConnect uses a digital strategy for prevention and follow-up of preterm births in Allegheny County, PA, to optimize the health and well-being of mothers and children. Instead of the standard care, Stanford Health Policy is collaborating with the University of Pittsburg Medical Center (UPMC) in the randomized control trial with women who have delivered a preterm baby. The women are invited to participate and then randomly put into the group that uses the digital or a control group who received paper-based discharge packets with supplemental health education on postpartum care.
“This grant allows us to continue recruiting participants through UPMC and expanding PretermConnect’s features to enhance user engagement, including a function to search for resources by geography and topic,” said Wang, MD, a professor of pediatrics and health policy. “We also intend to scale the project with additional content on high-risk infant follow-up and preterm-specific developmental care guidelines, additional engagement features — and eventually support for different languages, starting with Spanish.”
In the long term, we hope to see an overall decrease in infant morbidity and mortality, by way of reducing preterm births.
Professor of Pediatrics and Health Policy
The women in the digital app group receive in-app health education and resources to improve well-being for mothers and their infants. The app includes a social interaction feature designed to foster social connections and promote self-care. They have enrolled 30 women during the pilot phase and 15 mother-infant dyads in the randomized control trial, with a goal of reaching 250.
“The digital approach also allows us to administer brief surveys and gather information on dynamic social determinants of health more frequently than can be done through traditional means,” said Shilpa Jani, an SHP project manager. She said social determinants of health — such as persistent housing instability, food insecurity and concerns of personal safety — contribute to chronic stress and health issues as well as an increased risk of pregnancy and birth complications.
“Adverse effects of social determinants of health along with health complications of preterm deliveries may exacerbate morbidities for the mother and child,” Jani said, adding that preterm-related causes of death accounted for two-thirds of infant deaths in 2019 in the United States.
Wang and Jani said the immediate project goals include increasing health education for preterm baby care, improving postpartum maternal health, and encouraging usage of local resources in Allegheny County. They eventually hope to see reductions in risk for subsequent preterm delivery and infant mortality and postpartum depression, as well as increases in mother-infant bonding and larger proportions of breastmilk feeding.
Professor of Pediatrics and Health Policy
Develops tools for assessing and improving the quality of health care
New Study Shows Support for Paid Family Leave Grew During Pandemic
In a blow to arguments that a federal paid leave law would harm small businesses, a new study co-authored by SHP's Maya Rossin-Slater finds that support for paid leave among small employers is not only strong, but also increased as the pandemic added new strain to the work-life juggle.
Babies Born Too Early Likely to Face Educational and Lifelong Behavioral Setbacks
SHP's Lee Sanders and his Stanford colleagues found that after adjusting for socioeconomic status and compared with full-term births, moderate and late preterm births are associated with increased risk of low performance in mathematics and English language arts, as well as chronic absenteeism and suspension from school.
Mustafa is a Research Data Analyst at the Center on Food Security and the Environment, where he supports Marshall Burke's work on estimating the impacts of environmental degradation on social and health outcomes. He has previously led a research project investigating the impact of Cleft Lip and Palate and CLP surgeries on the life outcomes of adolescent patients in India. Most recently, he worked as a Data Analyst on projects surrounding Medicare delivery. He holds a BA in International Studies and an MS in International and Development Economics from the University of San Francisco.
Empirical evidence suggests that the uptake of maternal and child health (MCH) services is still low in poor rural areas of China. There is concern that this low uptake may detrimentally affect child health outcomes. Previous studies have not yet identified the exact nature of the impact that a conditional cash transfer (CCT) has on the uptake of MCH services and, ultimately, on child health outcomes. The objective of this study is to examine the relationship between CCT, uptake of MCH services, and health outcomes among children in poor rural areas of western China.
We designated two different sets of villages and households that were used as comparisons against which outcomes of the treated households could be assessed. In 2014, we conducted a large-scale survey of 1522 households in 75 villages (including 25 treatment and 50 comparison) from nine nationally designated poverty counties in two provinces of China. In each village, 21 households were selected based on their eligibility status for the CCT program. Difference-in-difference analyses were used to assess the impact of CCT on outcomes in terms of both intention-to-treat (ITT) and average-treatment-effects-on-the-treated (ATT).
Overall, the uptake of MCH services in the sample households were low, especially in terms of postpartum care visits, early breastfeeding, exclusive breastfeeding, and physical examination of the baby. The uptake of the seven types of MCH services in the CCT treatment villages were significantly higher than that in the comparison villages. The results from both the ITT and ATT analyses showed that the CCT program had a positive, although small, impact on the uptake of MCH services and the knowledge of mothers of MCH health issues. Nonetheless, the CCT program had no noticeable effect on child health outcomes.
The CCT program generated modest improvements in the uptake of MCH services and mothers’ knowledge of MCH services in poor rural areas of Western China. These improvements, however, did not translate into substantial improvements in child health outcomes for two potential reasons: poor CCT implementation and the low quality of rural health facilities.
Nearly 120 million children in 37 countries are at risk of missing their measlescontaining vaccine (MCV) shots this year, as preventive and public health campaigns take a back seat to policies put in place to contain coronavirus disease 2019 (COVID-19). In March, the World Health Organization (WHO) issued guidelines indicating that mass vaccination campaigns should be put on hold to maintain physical distancing and minimize COVID-19 transmission. The disruption of immunization services, even for short periods, will lead to more susceptible individuals, more communities with less than the 95% MCV coverage needed for herd immunity, and therefore more measles outbreaks globally. A mere 15% decrease in routine measles vaccinations—a plausible result of lockdowns and disruption of health services—could raise the burden of childhood deaths by nearly a quarter of a million in poorer countries. Solutions for COVID-19, especially among the global poor, cannot include forgoing vaccinations.
There is general consensus among experts that K-12 schools should aim to reopen for in-person classes during the 2020-2021 school year. Globally, children constitute a low proportion of coronavirus disease 2019 (COVID-19) cases and are far less likely than adults to experience serious illness. Yet, prolonged school closure can exacerbate socioeconomic disparities, amplify existing educational inequalities, and aggravate food insecurity, domestic violence, and mental health disorders.The American Academy of Pediatrics (AAP) recently published its guidance on K-12 school reentry. However, as many school districts face budgetary constraints, schools must evaluate their options and identify measures that are particularly important and feasible for their communities.
Estimation of pollution impacts on health is critical for guiding policy to improve health outcomes. Estimation is challenging, however, because economic activity can worsen pollution but also independently improve health outcomes, confounding pollution–health estimates. We leverage variation in exposure to local particulate matter of diameter <2.5 μm (PM2.5) across Sub-Saharan Africa driven by distant dust export from the Sahara, a source uncorrelated with local economic activity. Combining data on a million births with local-level estimates of aerosol particulate matter, we find that an increase of 10 μg m–3 in local annual mean PM2.5 concentrations causes a 24% increase in infant mortality across our sample (95% confidence interval: 10–35%), similar to estimates from wealthier countries. We show that future climate change driven changes in Saharan rainfall—a control on dust export—could generate large child health impacts, and that seemingly exotic proposals to pump and apply groundwater to Saharan locations to reduce dust emission could be cost competitive with leading child health interventions.
Most of the stillbirths that occur around the world are among women who live in low- and middle-income countries. Some 2.5 million women suffer the heartbreaking loss each year.
Yet determining the causes and prevention of stillbirths has largely been ignored as a global health priority — the incidence not even included in the WHO Millennium Development Goals.
Stanford Health Policy’s Rosenkranz Prize Winner, Ashley Styczynski, MD, MPH, discovered the alarmingly high level of stillbirths while working in Bangladesh as a 2019-2020 Fogarty Fellow, studying antimicrobial resistance in newborns in the hospitals there.
The $100,000 Rosenkranz Prize is awarded to a Stanford researcher who is doing innovative work to improve health in the developing world.
“I was surprised to learn that the rates of stillbirths were comparable to sub-Saharan Africa and that in many cases they had no idea of the cause,” Styczynski said in a Skype call from Dhaka, where she has been living for eight months while conducting her antimicrobial resistance research.
The South Asian nation is among the top 10 countries with the highest number of stillbirths, with an average of 25.4 stillbirths per 1,000 births. Studies have implicated maternal infections as the cause; one ongoing study in Bangladesh has recovered bacteria from blood samples in stillborn babies in whom no prior maternal infection was suspected.
Styczynski believes intrauterine infections may be an underrecognized factor contributing to the excess stillbirths in Bangladesh. She intends to perform metagenomic sequencing on placental tissues of stillborn babies, a process that will allow her to examine the genes in the organisms of those tissues and evaluate the bacterial diversity.
“The alternative hypothesis would be that stillbirths are caused by non-infectious etiologies, which I will be assessing through interviews,” Styczynski wrote in her Rosenkranz application.
Those interviews will be with mothers to evaluate for frequency of infectious symptoms during pregnancy, including fever, rash, cough, dysuria and diarrhea, as well as possible toxin exposures. She will compare the findings with the metagenomic sequencing results to determine how frequently potential pathogens may be presenting as subclinical infections.
My goal is to reduce excess stillbirths by identifying risk factors and pathogens that may be contributing to stillbirths and, ultimately, to design prevention strategies.
Rosenkranz Prize Winner
“By applying advanced technologies and software platforms, this research will not only enhance our understanding of causes of stillbirths in Bangladesh, but it may also provide insights into causes of early neonatal deaths," Styczynski said.
Bangladesh, one of the poorest and most densely populated nations in the world, offers a rich variety of emerging and known diseases that go undetected.
“The panoply of infections that could contribute to stillbirths is really unknown,” Styczynski said. “That’s why metagenomics is a great tool here. It just hasn’t been accessible here because of the expense. Now this tool will begin to unpack what’s causing these stillbirths.”
The Rosenkranz Prize was started and endowed by the family of the late Dr. George Rosenkranz, who devoted his career to improving health-care access across the world and helped synthesize the active ingredient for the first oral birth control pill.
“No one is more deserving of the Rosenkranz Prize than Dr. Ashley Styczynski”, said Dr. Ricardo Rosenkranz. “Because of her tenacity, originality and focus, Dr. Styczynski exemplifies the ideal Rosenkranz Prize recipient. She has chosen an often overlooked adverse outcome that may prove to be mitigated by her findings. As a neonatologist interested in health disparities, I fully realize the potential relevance and urgency of her work and am excited to see it come to fruition. As the son of George Rosenkranz, for whom this prize is lovingly named, I know that my father would appreciate Dr. Styczynski’s pioneering spirit as well as her desire to affect global positive change by improving medical outcomes in vulnerable communities. We can’t wait to celebrate her work back at Stanford in the near future."
Sheltering in Place
Styczynski spoke from her flat in Dhaka, where she has been confined for three weeks as the world’s third-most populated city prepares for the onslaught of the coronavirus. The country is on lockdown; no international flights in or out.
But Styczynski believes that’s about 1% of the actual disease activity in the country because testing was so slow to start. She said there is great stigma in the country over testing — red flags are put on the homes of those who have been diagnosed with COVID-19 — because it breaks up the unity of families and the surrounding community. Health-care workers are being kicked out of apartments by frightened landlords and people are afraid to use the health-care system for fear of infection.
“So, the hospitals are quite empty — more so than they’ve ever been,” she said.
Styczynski likened it to waiting for the tsunami that you know is coming.
“That’s why I wanted to jump in to stave off the morbidity and mortality that will be inundating one of the most populated countries in the world,” she said. Some 165 million people are packed into 50,250 square miles — a land mass about the same size as New York State, which has some 19.5 million people.
The Centers for Disease Control and Prevention (CDC) has a small team of four people working in Bangladesh. Having spent two years as an Epidemic Intelligence Service Officer at the CDC, Styczynski has now joined its Bangladesh team and is also working with the infection prevention and control team of the International Centre for Diarrhoeal Disease Research, Bangladesh.
“Many people here in Dhaka live in high-density apartments with six to 12 people living in the same room,” she said. “How do you isolate when you have a one-room home?”
Ninety percent of the population are daily wage earners, Styczynski noted, who say they’d rather take their chances with coronavirus than die of starvation.
They take those chances at great risk. There is one ventilator for every 100,000 people in Bangladesh and the district hospitals have maybe one to two days of oxygen supply, Styczynski said.
They started out training military hospitals on medical triage, quarantine and isolation, and infection prevention strategies.
“We’ve also been going to some district hospitals to assess some of the challenges they are facing and to identify some of the gaps in preparedness so that we can communicate back to the Ministry of Health how they can better support these district hospitals,” she said.
Her pandemic travels to the district hospitals and preparedness work has allowed her to gather contextual data for her colleagues back at Stanford who are working to address the lack of personal protective equipment (PPE) in low-resourced countries.
“We hope we can generate some evidence very quickly so that we can share some of this information to better protect health-care workers in other low-resource countries,” she said.
Despite her research being temporarily sidelined, Styczynski is upbeat.
“This is what I signed up for as a Fogarty fellow, to help build local capacity,” she said. “But I am also an infectious disease specialist, and these are the types of situations we run towards rather than away from. We build our career for moments like these.”
Rosenkranz Prize winner to launch microbiome research project in Africa
Stanford postdoc Ashley Styczynski will investigate the epidemiology behind the alarmingly high rate of stillbirths in Bangladesh while helping prepare for the coming onslaught of coronavirus in the densely populated South Asian nation.
Yian Guo is a project manager at the Rural Education Action Program (REAP), working primarily on the Healthy Future project. She holds a B.S. in Applied Psychology from New York University and an M.A. in International Education Policy Analysis from Stanford University. Yian's research interests are informed by her volunteering experience in rural Inner Mongolian schools and her involvement in research on Chinese adolescents. From the impact of teacher's perception on students' academic performance to early childhood development and education, Yian is exploring and refining her topic of interest while doing her part to bridge research to practice.