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Happy Fourth of July from Stanford Medicine

Happy Fourth of July from Stanford Medicine

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Happy Fourth of July! Our office is closed in honor of the holiday, and we’ll resume posting Monday.

Photo by Michael Dougherty

Behavioral Science, In the News, Medicine and Society, Pregnancy, Public Health

Walking on sunshine: How to celebrate summer safely

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Normally, I spend the Fourth of July on the shores of a Wisconsin lake, getting eaten alive by mosquitos, burning to a bright shade of pink, lighting sparklers and eating potato salad that has sat in the sun for hours. Heaps of fun, but also plenty of opportunities to fall ill.

This year, I’ve been barred from that fun trip by my oh-so-practical doc, who thinks unnecessary travel isn’t the smartest option for someone who is eight-months pregnant. Instead, I’ll have to be satisfied with reading a Washington Post article, published earlier this week, about all the summer health hazards I’m avoiding by celebrating the holiday in my coastal California home.

First is athlete’s foot, a fungus that “lingers on warm, wet surfaces such as poolside pavement and the floors of locker rooms and public showers” that produces an oozing pus. Or its relative, a toenail fungus that leads to yellow, thickened nails. And I thought a big belly was a bit of bother.

There’s also coxsackie virus, known for causing hand, foot and mouth disease, which thrives in kids’ wading pools courtesy of the occasional leaky diaper. The virus usually causes blisters; in rare cases it can lead to heart failure, says Stanford pediatrics professor Bonnie Maldonado, MD. Note to self: Keep baby out of unchlorinated kiddie pools.

We’re just getting warmed up here. There’s the summertime regulars of food poisoning, heat exhaustion and heat stroke. So yeah, that potato salad, while still yummy, probably isn’t a good idea, nor is the all-afternoon exposure to 95-plus degrees.

Don’t forget swimmer’s ear, an infection of the ear canal that, according to otolaryngologist Richard Rosenfeld, MD, from New York can “really, really, really hurt and ruin a vacation.” And a walk in the woods can quickly yield a ravaging rash from poison ivy or oak.

Throw in insect-borne plagues like West Nile and Lyme disease and gee, I guess my front porch isn’t looking so bad after all.

Previously: As summer heats up, take steps to protect your skin, This summer’s Stanford Medicine magazine shows some skin and Stanford nutrition expert offers tips for a healthy and happy Fourth of July
Photo by Jordan Richmond

Medicine and Society, Stanford News

Actor Anna Deavere Smith on getting into and under the skin of a character

Actor Anna Deavere Smith on getting into and under the skin of a character

ADS - smallThe “skin” issue of Stanford Medicine magazine is out and online. In it, I have a Q&A with actor and playwright Anna Deavere Smith. TV audiences came to know Anna through her work as Nancy McNally, the White House national security advisor on the famed series “The West Wing.” And now, after seven seasons, she’s ending another acclaimed role, hospital administrator Gloria Akalitus on Showtime’s “Nurse Jackie.” Bur her seminal work has been in the theater, in two groundbreaking plays early in her career: “Twilight Los Angeles” and “Fires in the Mirror.” Her last theatrical piece, “Let Me Down Easy,” was a paean to the human body in its strength and fragility.

There are few actors who get into and under the skin of their characters more acutely than Anna. We thought it would be interesting (and different) for this issue of the magazine, which focuses on skin diseases, to talk with Anna and get another sort of take on skin. “In the early part of my career [my skin color] was a big stumbling block,” she told me. “There were stereotypes. As a woman, if you didn’t fit into the idea of a tragic mulatto or mammy it was really hard to situate yourself.”

Read on in the Q&A.

Previously: This summer’s Stanford Medicine magazine shows some skin and Let me down easy: A conversation with Anna Deavere Smith
Illustration by Tina Berning

Research, Sports, Stanford News

New research offers comprehensive picture of the lingering effects of sports injuries

New research offers comprehensive picture of the lingering effects of sports injuries

15403-injuries_newsIn an effort to better understand the lasting impact of sports injuries, Stanford physicians collaborated with the university’s athletic department to enroll nearly 1,700 student athletes in an electronic pre-participation evaluation (ePPE) program and track their health over a three-year period.

During the course of the study, which was published in the current issue of The American Journal of Sports Medicine, the researchers documented 3,126 injuries (1,473 for women and 1,653 for men) that caused athletes to miss an average of 31 days of competition each. Musculoskeletal injuries were the most common, but athletes also suffered from concussions, eating disorders and infectious illnesses. As reported in a Stanford news story today, the research provides new insights into the lasting impact of injuries in greater detail than ever:

Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.

[Gordon Matheson, MD, PhD, who led the study,] said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.

“We know that student-athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it’s difficult to measure trends and spot areas of concern applied to prevention,” said Matheson.

Researchers hope to partner with other universities to expand their data set and learn more about why some players are symptomatic at the time of follow-up evaluations and, ultimately, help make sports safer.

Previously: Female high-school athletes suffer more overuse injuries than their male counterparts, Director of Stanford Runner’s Injury Clinic discusses advances in treating six common running injuries, Lingering effects of injuries sideline many former college athletes later in life and Sports medicine specialists, educators endorse checklist to reduce injuries among youth athletes
Photo by Andrey Popov/Shutterstock

Addiction, Mental Health, Pain, Public Health, Technology

Student engineers unveil tamper-proof pill bottle

Student engineers unveil tamper-proof pill bottle

Pill-dispenserThe United States has been battling a prescription painkiller epidemic for years. The statistics from the Centers for Disease Control and Prevention are chilling: The number of painkillers prescribed has quadrupled since 1999; more than two million people abused painkillers in 2013; every day, 44 people die from a prescription opioid overdose.

In response, faculty at the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health issued a challenge to seniors in the university’s mechanical engineering program: build a pill bottle that would protect against theft and tampering.

One team of students came up with a design that worked so well that their team’s mentors Andrea Gielen, ScD, and Kavi Bhalla, PhD, submitted a proposal to the National Institutes of Health for further testing.

The device is about the size of a can of spray paint, much larger than the average pill bottle. It can only be opened with a special key, which pharmacists can use to refill with a month’s supply of OxyContin. A fingerprint sensor ensures only the prescribed patient can access the pills at prescribed intervals and doses. In a story on the Johns Hopkins website earlier this month, Megan Carney, one of the student engineers described how the pill dispenser works:

The device starts to work when the patient scans in his or her fingerprint. This rotates a disc, which picks up a pill from a loaded cartridge and empties it into the exit channel. The pill falls down the channel and lands on a platform where the patient can see that the pill has been dispensed. The patient then tilts the device and catches the pill in their hand.

A short video about the pill dispenser shows it in action, too. The dispenser still has to undergo additional testing, but the team hopes to bring it to market soon — and help prevent future opioid overdoses.

Previously: Unmet expectations: Testifying before Congress on the opioid abuse epidemic, The problem of prescription opioids: “An extraordinarily timely topic”, Assessing the opioid overdose epidemic, Why doctors prescribe opioids to patients they know are abusing them and Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse
Photo courtesy of Johns Hopkins University

Autoimmune Disease, Immunology, Public Health, Research, Sleep, Stanford News

Cause of 2009 swine-flu-vaccine association with narcolepsy revealed?

Cause of 2009 swine-flu-vaccine association with narcolepsy revealed?

syringesBack in 2001, in the wacko cinematic tour de farce “Rat Race,” British actor Rowan Atkinson – a.k.a. the iconic “Mr. Bean” – put a humorous face on narcolepsy, a rare, chronic, incurable and lifelong sleep disorder that can strike at any time, even in the heat of a foot race.

In 2009, narcolepsy suddenly became, for a time, not quite so rare.

The swine flu pandemic sweeping the world that year was no joke. In the United States alone, the H1N1 strain of influenza virus responsible for that pandemic resulted in 274,304 hospitalizations and 12,469 deaths, as mentioned in our news release on a just-published study in Science Translational Medicine.

There probably would have been far more hospitalizations and deaths had not several vaccines tailored to that particular influenza strain been rushed to the market. Two vaccines in particular — Focetria, manufactured by Novartis, and Pandemrix, made by GlaxoSmithKline — are credited with saving a lot of lives in Europe. But there was a dark side. As our news release notes:

Populations that had been immunized with GlaxoSmithKline’s Pandemrix vaccine showed an increase in narcolepsy, but those immunized with Novartis’ Focetria did not.

That’s not news; it’s been known for some time. But the findings in the new study, whose senior author is Stanford neuroimmunologist Larry Steinman, MD, may explain why.

Continue Reading »

Aging, Cancer, Dermatology, Genetics, Research, Stanford News

Genetic secrets of youthful skin

Genetic secrets of youthful skin

new hatEvery year, upwards of $140 billion a year gets spent on cosmetics. In the United States alone, says an authoritative report, a recent year saw upwards of 5.6 million Botox procedures, 1.1 million chemical peels, almost a half-million laser skin procedures, 196,286 eyelid surgeries and a whole bunch of face lifts.

If you’ve got the courage to compare your present-tense face with the one you were wearing 20 or even 10 years ago, you’ll see why. As I wrote in a just-published Stanford Medicine article, “Wither youth?”:

The terrain of aging skin grows all too familiar with the passing years: bags under the eyes, crow’s feet, jowls, tiny tangles of blood vessels, ever more pronounced pores and pits and pigmentation irregularities. Then there are wrinkles — long, deep “frown lines” radiating upward from the inside edges of the eyebrows and “laugh lines” that trace a furrow from our nostrils to the edges of our lips in our 40s, and finer lines that start crisscrossing our faces in our 50s. Sagging skin gets more prominent in our later years as we lose bone and fat.

“And,” I added wistfully, “it’s all right there on the very outside of us, where everyone else can see it.”

Stanford dermatologist Anne Chang, MD, who sees a whole lot of skin, got to wondering: Why does skin grow old? Armed with a sophisticated understanding of genetics, she went beyond lamenting lost youth and resolved to address the question scientifically, asking: “Can you turn back time? Can aging effects be reversed? Can you rejuvenate skin, make it young again?”

The answers she’s come up with so far – from hereditary factors to a possible underlying genetic basis for how some treatments now in common commercial cosmetic use (such as broadband light therapy) could potentially slow or even reverse the aging of skin – are described in my magazine article.

Previously: This summer’s Stanford Medicine magazine shows some skinResearchers identify genetic basis for rosacea, New study: Genes may affect skin youthfulness and Aging research comes of age
Photo by thepeachpeddler

Grand Roundup

Grand Roundup: Top posts of June

Grand Roundup: Top posts of June

It’s time to look back at this month’s five-most read stories on Scope. They were:

Eating for good blood: Tips for boosting iron levels and hemoglobin: This entry from the Stanford Blood Center discusses hemoglobin levels and offers ways to boost levels prior to blood donation.

New recommendation: Adults need at least 7 hours of sleep each night: How much sleep is needed for adults? A new set of recommendations was published in the journal SLEEP and developed by 15 sleep experts in a consensus panel assembled by the American Academy of Sleep Medicine and the Sleep Research Society.

CRISPR marches forward: Stanford scientists optimize use in human blood cells: CRISPR is a breakthrough way of editing the genome of many organisms, including humans — a kind of biological cut-and-paste function that is already transforming scientific and clinical research. New work in this area is detailed here.

To live longer, men need to embrace their femininity, new research suggests: Women live longer than men, but when faced with socio-economic adversity, that lifespan gap grows, according to new research from a team of Stanford scientists.

Stanford med student/HHMI fellow investigates bacteriophage therapy as an alternative to antibiotics: In this piece, second-year medical student Eric Trac discusses the work he’s doing for his year-long Howard Hughes Medical Institute fellowship.

Our most-shared story of the month: New recommendation: Adults need at least 7 hours of sleep each night

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Behavioral Science, Health and Fitness, Mental Health, Public Health, Research, Stanford News

Exposure to nature helps quash depression – so enjoy the great outdoors!

Exposure to nature helps quash depression - so enjoy the great outdoors!


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Walking is good for your health. But walking somewhere natural is even better, according to a new Stanford-led study.

Study participants who walked in a natural area for 90 minutes showed less activity in a brain region associated with depression than those who walked through a city or other urban area, a Stanford News story states. From the piece:

“These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world,” said co-author Gretchen Daily, the Bing Professor in Environmental Science and a senior fellow at the Stanford Woods Institute for the Environment. “Our findings can help inform the growing movement worldwide to make cities more livable, and to make nature more accessible to all who live in them.”

Even further, the research supports — but does not prove — a link between urbanization and growing rates of mental illness, said co-author James Gross, PhD, a professor of psychology.

The researchers had one group of participants walk in a grassland with oak trees and shrubs. The other group walked along a traffic-clogged four-lane road. They then measured heart and respiration rates, performed brain scans and had the participants answer a series of questions. The results showed that:

Neural activity in the subgenual prefrontal cortex, a brain region active during rumination – repetitive thought focused on negative emotions – decreased among participants who walked in nature versus those who walked in an urban environment.

Evidence that supports the knowledge you’ve had since grade school: The outdoors really can make you feel better.

Previously: To get your creative juices flowing, start movingA look at the effects of city living on mental health and Out-of-office autoreply: Reaping the benefits of nature
Photo by Linda A. Cicero/Stanford News Service

Health and Fitness, Pediatrics, Research, Sports

Female high-school athletes suffer more overuse injuries than their male counterparts

Female high-school athletes suffer more overuse injuries than their male counterparts

When I was younger, the prevailing parenting advice regarding athletics and children was to identify a sport your child would enjoy early on and have them focus on it throughout adolescent so she would have a competitive edge. Which is how I ended up playing on a boys soccer team at the age of five — there were no all-girls soccer teams in Austin, Texas in 1983. Soccer continued to be my sole sport throughout high school and college. Eventually, I had to give it up because the constant ankle injuries I endured meant I spent more time in rehab mode than training mode.

Never once did a physician or a trainer suspect that the injuries were related to overuse, despite the long hours I logged on running paths, in the weight room and on the field. So I was interested to read about recent research showing that girls are at a much higher risk than boys when it comes to overuse injuries in high-school sports.

In the study, researchers at the Ohio State University Wexner Medical Center reviewed 3,000 male and female injury cases over a seven year period across 20 high-school sports including soccer, volleyball, gymnastics and lacrosse. According to a release:

[Researchers] found the highest rate of overuse injuries occurred in girls track (3.82), followed by girls field hockey (2.93) and girls lacrosse (2.73). Overuse injuries in boys were most found in swimming and diving (1.3).

“These young people spend more time playing sports both in competition and in practice. So, there’s a correlation there between the amount of time that they’re playing and the increased incidence of injuries,” said [Thomas Best, MD, PhD,] who is also a professor and Pomerene chair in Ohio State’s department of family medicine.

The participation and intensity of high school athletics has increased over the past decade. According to Best, some high school athletes spend more than 18 hours a week participating in athletics and many participate in multiple sports concurrently.

Watch the clip above to learn more about researchers’ findings and recommendations.

Previously: Researchers call for improvements to health screenings for female college athletes and Stanford physician discusses prevalence of overuse injuries among college athletes

Stanford Medicine Resources: