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Stanford Medicine

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April, 2012

Health Disparities, Men's Health

Study calls for increased awareness for minorities and gay men following prostate cancer treatment

A better awareness of ethnic and sexual preference-related factors is needed to improve quality of life for gay men and minorities treated for prostate cancer, according to a review published in an upcoming Nature Reviews Urology.

Researchers from the Thomas Jefferson University Hospital in Philadelphia analyzed several studies that showed differences in treatment outcomes, sexual function and coping among subpopulations including African Americans, Latin Americans, Asians and men who have sex with men (MSM). According to a release, findings showed:

  • African Americans are less likely to initiate and complete treatment and less likely to trust a physician.
  • Latin American men who underwent radiation therapy or a radical prostatectomy demonstrated greater levels of severe sleep dysfunction.
  • Gay men are often diagnosed with prostate cancer later in life and may be reluctant to reveal their sexual preference.

Co-author Edouard J. Trabulsi, MD, commented in the release on the significance of the findings in improving the quality of life in gay men and minorities treated for prostate cancer.

Different communities of men view the effects of prostate cancer treatments very differently … It’s in the patient’s best interest for caregivers to acknowledge perceptions and expectations during the treatment decision process. They should take specific demographics, socioeconomic status, and sexual preference into consideration, and tailor an approach based on a patient’s specific concerns about the implications of various treatments.

Researchers noted that one reason for poorer quality of life among these subpopulations may also be attributed to a lack of social support group. For example, gay men typically don’t have long-term partners and may not have the same level of support at home. As a result they seek out support from other sources, but with the limited number of support groups specifically tailored for MSM with prostate cancer is limited this community may rely on Internet-based groups and could have an increased risk of becoming socially isolated.

Previously: New study advocates exercise to improve prostate cancer outcomes

In the News, Pediatrics, Surgery

Twins update: Formerly conjoined twins strong and healthy

Twins update: Formerly conjoined twins strong and healthy

Watching Angelina and Angelica Sabuco run, play and chase each other like any other pair of two-year-olds, it’s hard to believe the twin sisters  were born conjoined at the chest and abdomen.

The girls, who were separated in a 10-hour surgery Nov. 1 at Lucile Packard Children’s Hospital, have bounced back quickly from the surgery that required cutting apart their livers and completely reconstructing their chest walls. They returned to the hospital today to meet the local media for an update on their progress.

From a Packard Children’s press release about the girls’ continued recovery:

“They have really bounced back,” said lead surgeon Gary Hartman, MD, of his sixth conjoined twins surgery. “Each time I see them in the clinic, they are more mobile and better adjusted. It’s been a very smooth recovery.”

“They love to run around, go out, and play with other children now,” said mother Ginady Sabuco. “We are so grateful to Packard Children’s.” …

As part of their recovery, the girls had physical and occupational therapy to build their strength, endurance, gross- and fine-motor skills. They also continue to see Hartman and plastic surgeon Peter Lorenz, MD, to monitor the healing of their abdomens and chests.

“They are healing right on track,” said Lorenz, who implanted a custom-made resorbable plate in each girl’s chest where the sternum should be. The plates are expected to dissolve later this year as the grafted bones fuse. “We expect their chests to become more normally shaped as they grow, and have already seen a good improvement,” added Lorenz.

Previously: Formerly conjoined twins get ready to head home

Addiction, Neuroscience, Pediatrics

Are some teens' brains pre-wired for drug and alcohol experimentation?

A study involving approximately 1,900 14-year-olds found that differences in adolescents’ brain activity may put some at higher risk for drug and alcohol experimentation than others, even they are exposed to drugs or alcohol.

In that Nature Neuroscience study (subscription required), researchers examined data from an ongoing study of European teens where participants completed behavior testing and underwent magnetic resonance imaging. Participants were also asked about symptoms of attention deficit hyperactivity disorder and if they had tried alcohol, cigarettes or other drugs. ABC News reports:

Interestingly, [researchers] were able to identify teens who had prior exposure to alcohol, nicotine, or other illicit drugs and were able to identify specific brain patterns associated with early experimentation with these substances. Furthermore, teens with poor impulse control but no prior substance use had brain images similar to those who had already admitted use.

The findings suggest that there may be an opportunity to identify teens at risk before they indulge. “While identifying those at greatest risk of addiction is a complex process with many different factors involved, identifying brain networks specific to impulse control represents the first step” says [lead researcher Robert Whelan, PhD.]

In agreement with prior studies, both adolescents with a history of ADHD or a history of alcohol or drug use had poor impulse control scores. But researchers found that the brain networks activated in teens with ADHD were different than the ones associated with early drug use.

“This suggests that these two conditions may be unnecessarily tightly coupled together,” says Whelan. This knowledge may help guide doctors’ treatment strategies.

Previously: Study offers insights on how alcohol affects the brain, National survey shows teen girls more vulnerable to drug and alcohol abuse and Study estimates hospitalizations for underage drinking cost $755 million per year
Photo by Heidi Cartwright, Wellcome Images

Ask Stanford Med, Cardiovascular Medicine, Women's Health

Ask Stanford Med: Cardiologist Jennifer Tremmel taking questions on women’s heart health

It may surprise you to learn that more than 432,000 women die each year from heart diseases, which is ten times as many women who die from breast cancer. Moreover, previous research has shown that a significant percentage of women have a limited knowledge of heart disease and are unfamiliar with the tell-tale signs of heart attack, including sharp pain in the back, neck or jaw and shortness of breath.

To continue the conversation on women’s heart health, we’ve asked Stanford interventional cardiologist Jennifer Tremmel, MD, to respond to your questions on the growing body of research on women and cardiovascular disease, and how women differ from men.

Founding clinical director of the Women’s Heart Health program at Stanford, Tremmel is an instructor and interventional cardiologist in the Division of Cardiovascular Medicine at the medical school. Her research interests include gender differences in coronary artery disease, the determinants of vascular access complications and the effects of weight on coronary physiology and cardiac outcomes. She has also completed research exploring the role of negative emotion on the heart health of women.

Questions can be submitted to Tremmel by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Friday, May 4 at 5 pm. When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses

Tremmel will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: A focus on women’s heart health, Understanding and preventing women’s heart disease and Gap exists in women’s knowledge of heart disease
Photo by Gabriela Camerotti

Image of the Week

Image of the Week: Malaria developing

This incredible scanning electron micrograph shows the reproductive cells, called oocytes, of a malaria parasite developing on a mosquito’s intestinal wall. Malaria parasites are protists and members of the genus Plasmodium. In humans malaria is caused by several species, of which P. vivax is the most common and P. falciparum the most deadly. This image actually shows a species that infects rodents. When these oocytes rupture, they release sporozoites that travel to the mosquito’s salivary glands. From there, they can infect a vertebrate host.

The micrograph is part of a Flickr set published earlier this week by to mark World Malaria Day 2012.

Image by Hilary Hurd, PhD, and Wellcome Images

Grand Roundup

Grand Roundup: Top posts for the week of Apr. 22

The five most-read stories on Scope this week were:

Time-lapse video captures childhood from birth to 12 years: Filmmaker Frans Hoffmeester recorded his daughter, Lotte, every week for 12 years and distilled that footage in a touching little two-minute video.

A shocking look at “blood farming”: Wired Science previously hosted an excerpt from The Red Market, a book by investigative journalist Scott Carney that looks at the underground trade in biological matter.

Can yoga help women suffering from fibromyalgia?: A study published in the Journal of Pain Research shows that practicing yoga boosts levels of the stress hormone cortisol and could help ease some symptoms of fibromyalgia such as pain, fatigue, muscle stiffness and depression.

Ask Stanford Med: Answers to your questions on health-care innovation: Stanford Graduate School of Business professor and founding director of the new Program in Healthcare Innovation, Stefanos Zenios, PhD, responds to questions about health-care innovation and entrepreneurship.

Cord blood donation program turns medical waste into a lifesaving resource: A new program at Lucile Packard Children’s Hospital will give all its new moms the option to donate their baby’s cord blood to an international stem cell registry that can be searched by hematologists and oncologists whose patients need stem cell transplants.

Women's Health

Study shows women may overestimate the effectiveness of common contraceptives

New research suggests women may not fully understand the effectiveness of the most popular forms of birth control: the Pill and condoms. The study found that after women were given comprehensive contraceptive counseling, 71 percent chose an intrauterine device (IUD) or contraceptive implant.

The study, to be published in an upcoming American Journal of Obstetrics and Gynecology, surveyed 4,144 St. Louis-area women. Subjects were asked to rate different birth control options. The researchers found that 45 percent overestimated the effectiveness of the Pill, condoms, the hormonal path, the hormonal vaginal ring and the injection hormone Depo-Provera.

I was surprised by the numbers in a Reuters Health article about the study:

It’s estimated that between 0.2 percent and 0.8 percent of women who use an IUD will have an unplanned pregnancy within a year. The rate is just 0.05 percent with a contraceptive implant.

The advantage is that unlike birth control pills and condoms, the IUD does not rely on perfect use.

With the Pill, the pregnancy rate with “typical use” is about nine percent per year. With condoms, it’s between 18 and 21 percent.

In the News, Research

Researchers gain new insights into skin's waterproof properties

Researchers gain new insights into skin's waterproof properties

A New Scientist story published today highlights work by Swedish researchers to identify the basic molecular structure of the skin layer that forms our body’s watertight barrier. The findings may help further efforts to develop new technology to deliver drugs directly through the skin.

In the (small) study, researchers shaved a layer of skin from volunteers’ arms, cooled the tissue to below -140 Celsius in a high-pressure freezer and then sliced the skin samples into layers 25-50 nanometers thick. The tissue was then examined using an electron microscope. Helen Thomson writes:

What the researchers saw surprised them. Lipids have a hydrophilic (water-attracting) head and two hydrophobic (water-repelling) tails. Normally, the two tails point in the same direction, giving the molecule a hairpin-like appearance.

A group of lipid molecules typically arrange themselves into a two-layered sheet – or bilayer – with all of the tails pointing inwards. However, the lipid molecules in between the cells of the stratum corneum are splayed outwards so that the two tails of each molecule point in opposite directions.

This uniquely structured fatty layer prevents any water from getting past in either direction – except where the skin layer is modified to form pores. “There’s no water present within this extracellular space,” says [study author Lars Norlen, MD, PhD.] “It cannot perturb the barrier so it’s completely robust to hydration, which is necessary for the changing environment that we live in.”

The research team now plans to use the findings to create a computer model to use in developing a method for screen drugs that could potentially be administered through the skin.

Photo by Monik Markus

Addiction, Events, Pain, Public Health

Turn in your old pills on April 28

In support of National Take Back Prescriptions Drugs Day on Saturday – April 28 – physicians and law-enforcement officials are asking patients to help prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs. Old medications can be brought for disposal to designated “Take Back” collection sites around the country.

From a Stanford Hospital release:

“Storing unwanted prescription drugs at home or disposing of them in the trash or down the toilet may seem harmless, but the reality is that by doing so you could be putting the health of your family at risk and potentially releasing hazardous chemicals into our environment,” said Sean Mackey, MD, PhD, chief of the Pain Management Division at Stanford Hospital and associate professor of anesthesia at Stanford University School of Medicine. “I urge all patients to put safety first by taking their old drugs to their nearest collection site.”

Organized by the Drug Enforcement Agency in partnership with state and local law enforcement agencies, the service is free and anonymous – no questions asked. The public can find a nearby collection site by visiting www.dea.gov, clicking on the “Got Drugs?” icon and following the links to a database, where they enter their zip code.

This initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse and abuse. Rates of prescription drug abuse in the United States are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs.

Last October, Americans turned in 377,080 pounds – 188.5 tons – of prescription drugs at over 5,300 sites operated by the DEA and nearly 4,000 state and local law enforcement partners. In its three previous Take Back events, the DEA and its partners took in almost 1 million pounds – nearly 500 tons – of pills.

Previously: Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds
Photo by Thirteen of Clubs

Events, Health Disparities, Medicine and Society, Stanford News

Anna Deavere Smith tells human stories during healthcare summit

Anna Deavere Smith tells human stories during healthcare summit

It’s not every healthcare innovation summit keynote address that can make a person cry–twice, in my case. But then, not every organizing committee brings Anna Deavere Smith to campus for the occasion.

“Shifting Paradigms in Healthcare,” as the 2012 GSB Healthcare Innovation Summit was titled, took a turn from talking technology to looking realities of health care straight in the human face. Smith, an actress, playwright and professor (formerly at Stanford), joined Paul Costello, the medical school’s chief communications officer, in a conversation about current health disparities. The speakers examined issues addressed in Smith’s one-woman show Let Me Down Easy, which premiered in 2009, and Smith brought some of the characters in her play to the attention of the summit attendees through performance.

During the keynote, Smith portrayed an optimistic cowboy, a cynical doctor, a distrustful patient, a wise South African orphanage director, and Philip Pizzo, MD, dean of Stanford’s medical school, to tell their health-care stories as she interpreted them. Drawing from the 320 interviews she conducted while developing her script, Smith detailed instances in which people who sought care instead found abuse or abandonment, and others that showed that the most comforting care for the dying might not be the most scientific.

The presentation balanced the summit’s focus on industry and government innovation by bringing to light aspects of health care that aren’t measured in studies or promised to be reformed by a congressional act. Smith’s straightforward delivery let the characters’ words speak for themselves, communicating personal experiences of hardship instead of pointing fingers of blame.

Smith said, “When you have a crisis, you create narratives to tell someone what this means to you.” Though case-specific, the narratives speak to larger truths. Smith finished her series of characterizations as Trudy Howell, director of Chance Orphanage, who explains death to terminally ill children and sits with them until they depart. The Howell character comments about her approach to working with sick people this way: “In any case, don’t leave them in the dark. Don’t leave them in the dark.”

Previously: Anna of 1,000 Faces: Let Me Down Easy on PBS’ Great Performances, Dean Pizzo’s concerns about healthcare featured in solo show by Anna Deavere Smith and Let Me Down Easy

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