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Nutrition, Pediatrics, Public Health, Stanford News

Stanford pediatrician and others urge people to shun raw milk and products

Stanford pediatrician and others urge people to shun raw milk and products

rawmilkAs you may have seen elsewhere today, the American Academy of Pediatrics has published a formal policy statement on raw or unpasteurized milk and milk products. It urges that pregnant women and children avoid consuming these products on the grounds that raw milk offers no proven benefits over pasteurized milk – nutritionally or otherwise – but does offer a significantly greater chance of contracting a range of bacterial and viral illnesses, some of which can be severe and occasionally deadly. The risks hold true regardless of whether the raw milk is from cows, goats or sheep, according to the statement.

I talked about the new policy statement, which appears in the journal Pediatrics,with its lead author, Yvonne Maldonado, MD, a Stanford infectious disease expert and pediatrician at Lucile Packard Children’s Hospital.

While acknowledging that raw milk has its devotees, Maldonado said a host of scientific studies simply don’t back up the claims of health benefits. And there are some serious diseases associated with raw milk consumption, including salmonella, E. coli, campylobacter and norovirus, which the Centers for Disease Control and Prevention says is the most common cause of acute gastroenteritis in the U.S.

“It used to be that one of the major causes of childhood disease and death, before we had pasteurization, was drinking raw milk because we didn’t have a way to decontaminate it,” Maldonado told me. “Children got tuberculosis from drinking raw milk. That’s why we invented pasteurization – to prevent these horrible diseases.”

Since I spoke with her for our press release, which provides a lot more detail on all this, another study has been published in the CDC journal Emerging Infectious Diseases on the incidence of illnesses contracted by consumption of raw milk. That study comes from the Minnesota Department of Health and is based on data reported between 2001 and 2010. I haven’t been able to access the full study yet, but the one-line summary for the article that I found on the EID web site states: “The risk of illness associated with raw milk consumption is far greater than previously realized.”

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Education, Patient Care, Stanford News, Technology

Diagnosis: Electronic Medical Record myopia

Diagnosis: Electronic Medical Record myopia

A few years ago I had an appointment with a doctor who got so deeply absorbed in reading and updating my electronic medical record, there was precious little in the way of eye contact during the appointment. As he sat there staring at the screen and tickling the keys on his laptop while he talked, I was tempted to say, “Hey, doc, my eyes are up here.”

Without eye contact, I felt as though I was talking to someone immersed in a crossword puzzle, only speaking to me absentmindedly in hopes I could cough (please) up an answer to help him fill in the blank squares.

Yes, I want my doctor to be conversant with the latest medical technology, but not at the expense of conversing with me.

The problem of electronic absorption in the doctor’s office seems to be common, as evidenced by a Viewpoint article (subscription required) published online today by the Journal of the American Medical Association.

In the piece, two medical school physicians and a colleague at another university make the case that appropriate integration and use of electronic medical records needs to become part of the standard curriculum in medical education.

Natalie Pageler, MD, MEd, clinical assistant professor in pediatrics, and Christopher Longhurst, MD, MS, clinical associate professor in pediatrics, while extolling the many benefits of EMRs in enhancing communication among doctors and patients, point out that, “the introduction of the EMR has also introduced a wide range of unintended negative consequences.”

They cite papers from medical literature describing pitfalls such as medical trainees paying more attention to a patient’s EMR than information gleaned first-hand from the patient’s physical exam, as well as the ease with which doctors can inhibit the readability of appointment notes by overstuffing them with large amounts of cut and pasted data.

The authors recommend a number of ways in which appropriate use of EMR can be broadly incorporated into medical education. Pageler is medical director of clinical informatics at Lucile Packard Children’s Hospital and Longhurst is chief medical information officer at Packard Children’s, so they’re well acquainted with the promise and pitfalls of EMR.

If you’re interested in this – and every health care consumer probably should be – check out the article.

Previously: A conversation about smart-device use among resident physiciansA new view of patient data: Using electronic medical records to guide treatmentAbraham Verghese on health-law battle: “We’ve worried so much about the process, not the patient” and A call for extended bedside-manner training

Mental Health, Pediatrics, Research, Stanford News

Anxious children’s brains are different from those of other kids

Anxious children’s brains are different from those of other kids

worriedkidEvery little kid has anxieties, whether it’s the monsters under the bed or the big fierce dog around the corner. Most of us consider such childhood fears a normal part of growing up and assume they have no lasting effects, since they usually fade as kids get older.

But now Stanford researchers have determined that young children who experience levels of anxiety that are relatively high – but still within the range of normal – show differences in a region of the brain associated with perception and regulation of emotion when compared to other kids.

The region – called the amygdala – was significantly larger and more strongly connected to certain other parts of the brain in the anxious children.

I talked recently with Vinod Menon, PhD, professor of psychiatry and behavioral sciences, and senior author of the study, which was published online today in Biological Psychiatry.

Menon explained to me that children who experience prolonged stress and anxiety during childhood are at increased risk of developing anxiety disorders and depression later in life. He also said that adults with such disorders have amygdalas that are larger and more strongly connected than average.

But it’s a bit of a chicken or egg situation at this point, he said, since it’s unclear whether the anxiety alters the amygdala, or if an altered amygdala causes the anxiety.

What surprised Menon and the lead author of the study, postdoctoral researcher Shaozheng Qin, PhD, was that the alterations to the structure and connectivity of the amygdala were so pronounced in children who were relatively young – ages 7 to 9 – and whose anxiety didn’t rise to the level of being considered clinical.

They emphasized that children with enlarged amygdalas aren’t necessarily condemned to mood disorders later in life. But they hope that as more insights are gained into the influence of childhood anxiety on the amygdala, it will aid in the early identification and treatment of children at risk for anxiety disorders.

You can read more details about the study in our press release.

Previously: How does your body respond to stress?, New research tracks “math anxiety” in the brain and Fear leads to creation of new neurons, new emotional memories
Photo by chefranden

Autism, Clinical Trials, Neuroscience, Pediatrics, Research, Stanford News

Volunteers sought for autism drug study

Volunteers sought for autism drug study

There is no known cure for autism, and there are no medications approved for treating the social aspects of the condition, such as difficulty interpreting nonverbal cues in face-to-face conversations, or maintaining eye contact.

The only medications approved for treating autism are antipsychotics, which don’t target the social deficits.

But efforts are underway to explore whether certain molecules used by neurons in the brain to communicate with one another – called neuropeptides – might have a moderating effect on some of the behavioral traits that characterize autism.

I recently talked with Dean Carson, PhD, a postdoctoral research fellow in the Department of Psychiatry and Behavioral Sciences, who told me that one neuropeptide, oxytocin, is currently being studied as a treatment for autism in a number of studies around the world. Some early stage, single dose trials showed oxytocin was effective in moderating the social deficits of people with autism, but so far subsequent studies haven’t produced a consensus.

Carson also told me about a study that he’s involved with looking at another neuropeptide, vasopressin, which is closely related to oxytocin. Carson thinks vasopressin has some promise, as it’s been shown to enhance social functioning in laboratory mice with a genetically induced form of autism. It’s already approved for use in humans by the FDA and has been shown to improve social cognition and memory in people who do not have autism.

Researchers are currently seeking volunteers – children ages 6 to 12 years old – for this trial. If you’re located near Stanford and interested in learning more, this link provides details. I also explain more in a press release.

Previously: Greater hyperconnectivity in the autistic brain correlates to greater social deficits, More Stanford findings on the autistic brain, Director of Stanford Autism Center responds to your questions on research and treatment and New autism treatment shows promising results in pilot study

Chronic Disease, Pediatrics, Stanford News

A tale of two Shelbys: The true story of two diabetes patients at Lucile Packard Children’s Hospital

A tale of two Shelbys: The true story of two diabetes patients at Lucile Packard Children’s Hospital

Meet the Shelbys.

Shelby #1: 9-years-old, avid soccer player, recently diagnosed with type 1 diabetes at Lucile Packard Children’s Hospital. Has a sister named Sydney who also plays soccer but is not diabetic.

Shelby #2: 20-years-old, avid soccer player, has type 1 diabetes and gets treated at Packard Children’s. Has a sister named Sydney who also plays soccer but is not diabetic.

Cue theme from The Twilight Zone.

Okay, maybe it’s not that eerie, but you have to admit that’s a lot of coincidences shared by two people. But that’s not what this story is really about – rather, it’s the story of two young people with type 1 diabetes who aren’t about to let the disease slow them down or keep them from doing what they want in life.

The 20-year-old, Shelby Payne, plays for the Stanford Women’s Soccer team and has helped Shelby Scott, now 10 years old, adjust to being diabetic, but it’s not a one-way interaction. Shelby the elder has also drawn inspiration from Shelby the younger. For those details, you’ll have to read the story.

Previously: Tips for parents on recognizing and responding to type 1 diabetes

Autism, Neuroscience, Pediatrics, Research, Stanford News

Greater hyperconnectivity in the autistic brain correlates to greater social deficits

Greater hyperconnectivity in the autistic brain correlates to greater social deficits

As researchers delve deeper into the wiring schemes of the brains of children with autism, more is being revealed about how the density of neural connections within the brain relates to the behavioral manifestations of autism.

New results from the lab of Vinod Menon, PhD, published today in Cell Reports, demonstrate that a greater degree of hyperconnectivity in the brains of children with autism correlates with greater severity of their social impairments.

I traded e-mails with the lead author of the Cell Reports study, Kaustubh Supekar, a postdoctoral researcher, who wrote, “A hyper- or over-connected brain may make it more difficult for children with autism to modulate brain activity levels in response to cognitive demands such as those required while navigating real-world social scenarios.”

Last June, scientists led by Menon, published research demonstrating hyperconnectivity in the brains of children with autism and showing that at least five major brain networks were hyperconnected. They were able to discern associations between some of the networks and certain behavioral traits.

Supekar also wrote, “Our findings suggest that from early ages the brains of individuals with autism develop differently from their neurotypical peers, and this atypical development might contribute to the observed atypical social behavior that is a core characteristic of the disorder.”

These study results may prove useful for diagnosing – and perhaps someday even treating – autism. Currently autism is diagnosed purely on behavioral criteria.

Previously: Unusual brain organization found in autistic kids who best peers at math, More Stanford findings on the autistic brain, Stanford study reveals why human voices are less rewarding for kids with autism, New public brain-scan database opens autism research frontiers, New imaging analysis reveals distinct features of the autistic brain

Nutrition, Patient Care, Pediatrics, Research, Stanford News

A growing consensus for revamping anorexia nervosa treatment

A growing consensus for revamping anorexia nervosa treatment

For decades the standard of care for anorexia nervosa has been to increase the undernourished patient’s caloric intake with caution, for fear that too sudden an increase would throw the body’s electrolytes out of balance, making a bad situation worse.

That cautious approach, which has been previously been discussed here, stemmed from experiences with malnourished survivors of World War II, when doctors observed that some patients responded to a sudden increase in food consumption by developing severe liver or heart problems, sometimes resulting in death.

Doctors discovered that the main cause of the counterintuitive response was a sudden crash in the levels of certain electrolytes, in particular phosphorus, that was triggered by the abruptly increased amount of food they consumed. The phenomenon became known as “refeeding syndrome” and gave rise to the guiding dictum of “start low and go slow” when it came to increasing a patient’s caloric intake.

That concern is not without validity, but a growing number of researchers are beginning to question just how cautious doctors need to be about the rate at which they feed an anorexic patient.

I talked with Neville Golden, MD, chief of adolescent medicine and a Lucile Packard Children’s Hospital pediatrician, about that question. In the November issue of the Journal of Adolescent Health, Golden and some colleagues report on a retrospective study of the caloric intake of anorexic adolescents hospitalized at Packard.

The prevailing recommendation for beginning refeeding has long been to not exceed 1400 calories a day, but Golden’s team compared the records of patients who received care under that guideline with those that were given between 1,400 and 2,000 calories daily.

The upshot: The patients who received the greater number of calories gained weight more quickly and spent less time in the hospital.

“The development of refeeding syndrome really depends on the degree of malnutrition, not the amount of calories you give them,” Golden told me.

In addition to Golden’s study, three others published in the same issue lend support to the idea that most anorexia patients can benefit from more than 1,400 calories a day. An accompanying editorial suggests that it may be time to alter the old dictum to “start high(er), advance fast(er)”.

The editorial, by Daniel Le Grange, PhD of the University of Chicago, cautions that more rapid discharge from the hospital will increase the importance of proper aftercare, or the gains from faster refeeding could be negated.

Previously: Higher caloric diets are safe and reduce length of stay in hospitalized teens with anorexiaExamining the benefits of estrogen therapy for girls with anorexiaEating-disorder hospitalizations declineExploring the connection between food and brain functionHow anorexia is striking what many consider to be an unlikely group: boys and young men and What a teenager wishes her parents knew about eating disorders

Men's Health, Public Health, Research, Rural Health, Stanford News

A guide to coping with a common male birth defect

A guide to coping with a common male birth defect

One of the most common birth defects in boys occurs when the urethral tube fails to completely close, leaving the urethral opening somewhere along the underside of the penis, rather than the tip. Approximately one in 200 males is born with the condition, but the cause is usually unknown. It’s been suggested that exposure to pesticides might be the culprit in some cases, but no definitive studies have been done.

A paper from Stanford researchers, which came out today in the journal Pediatrics, presents results of analyses they conducted of several hundred pesticides commonly used in commercial applications. They found weak links with 15 of the chemicals, but emphasize that further studies need to be done before anyone can say there’s a link between any of the chemicals and the condition, called hypospadias. You can read more of the details in our press release.

Causation aside, parents of a baby boy born with the condition have to make decisions about how to treat the condition.

“Any birth defect is concerning to parents, and a defect in the genital structure often causes special concern,” William Kennedy, MD, associate professor of urology at Stanford and associate chief of pediatric urology at Lucile Packard Children’s Hospital, told me.

Kennedy has been counseling parents and performing corrective surgeries for years and has seen the difficulty parents often have in dealing with the condition.

“Parents are often reluctant to talk to anyone — even medical professionals — about the baby’s condition,” Kennedy added. “Fortunately, most corrective surgeries have positive outcomes.”

Kennedy says a lot of parents first turn to the Internet for information and, as we all know, sometimes what we find there can be misleading. That prompted Kennedy and Suzan Carmichael, PhD, associate professor of pediatrics and lead author of the Pediatrics study, to join with Matt Dorow, who has a son born with the condition, to write a book on
the subject for parents.

“Hypospadias – A Guide to Treatment,” is a slender volume of just over 100 pages, containing information and guidance on every aspect of hypospadias. The recently published book presents information in a clear, organized fashion and includes short pieces written by a man born with the condition and Dorow. If you have a boy born with hypospadias, or know someone who does, it could be immensely helpful.


How to avoid a candy-coated Halloween

sleeping trick-or-treater

If you’re out trick-or-treating with the children this Halloween and you spot a snaggle-toothed jack-o-lantern grinning at you out of the darkness, consider using that leering visage for a teaching moment:

“Kids, that pumpkin used to have a full set of teeth just like you and me, but it ate too much Halloween candy when it was a wee sprat of a squash, and look at it now.”

Then give the little devils – or witches, ghosts or princesses – the news that there’s a limit on the candy content of the holiday this year and not every sugar-soaked piece plopped into their treat bags will make it to their mouths.

If you don’t think that object lesson will suffice to save them from a sugar orgy, then check out this list of suggestions from Lucile Packard Children’s Hospital on other ways to keep Halloween healthy and the candy consumption under control.

Previously: Debunking a Halloween myth: Sugar and hyperactivity
Photo by peasap

Infectious Disease, Pediatrics, Public Health, Stanford News

Measles are on the rise; now's the time to vaccinate, says infectious-disease expert

Measles are on the rise; now's the time to vaccinate, says infectious-disease expert

According to data from the Centers for Disease Control, cases of measles in the U.S. are on the rise, with this year looking to be the worst in more than 15 years. And if that news doesn’t disturb you, take a look at some statistics from the CDC on what the impact of measles was in the U.S. prior to the start of the measles vaccination program in 1963:

  • About 3 to 4 million people got the disease each year
  • Roughly 48,000 of those people were hospitalized
  • 1,000 suffered brain damage or became deaf
  • 450 died

If you want to learn more about measles and the importance of parents getting their children vaccinated, check out this Q&A with Hayley Gans, MD, an infectious-disease specialist at Lucile Packard Children’s Hospital.

Previously: Tips for parents on back-to-school vaccinationsA look at the causes and potential cost of the U.S. measles outbreaks and Unvaccinated children may pose a public health risk

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