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Health and Fitness, Nutrition, Public Health

Why establishing a health baseline is a “critical starting point for achieving future health goals”

Why establishing a health baseline is a "critical starting point for achieving future health goals"

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Raise your hand if you want to be more successful at achieving health goals, such as losing weight or lowering your cholesterol levels, and maintaining a healthy lifestyle. Perhaps it’s time to consider creating a health baseline. “A health-care baseline is essentially where you are “at” on the broad, complex spectrum of physical, mental and emotional health,” explains Mary James, MD, an internal medicine physician at Stanford. “This can be a critical starting point for achieving future health goals.”

On Thursday, James will deliver an in-depth talk on the benefits of partnering with your primary care provider to establish a health baseline as part of the Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In anticipation of the event, I contacted James to learn more about why its important to have a basis for comparison, beyond the ever-fluctuating number on your bathroom scale or if you’re able to fit into your skinny jeans, to use in measuring progress in meeting your health goals. Below she discusses how assessing the state of your health now can pay off in a longer, more active life in the future.

What is a health baseline?

Your baseline has two basic components: existing illness and potential future illness. Your current baseline has been shaped by your medical, social and family history and is constantly being influenced by common factors in everyday life. Although some components of your healthcare baseline are more modifiable than others, it is important to have an accurate understanding of your current health status.

Why is it important to determine your personal health baseline?

You may be thinking, “I’m healthy – I take no medications and never go to the doctor. Why should I start now?” There are two fundamental components to good health. They are: appropriate treatment for current illness and appropriate preventative care to reduce health decline in the future. While most people actively seek care for the former, we often forget about the latter. Although the data is mixed on whether “routine check ups” are beneficial, there is strong evidence behind many of the preventative maneuvers that are typically discussed and ordered at these visits. Taking appropriate preventative health-care steps can help you avoid the need for prescription medications, hospitalizations and procedures and can help ensure a longer, healthier life.

How can establishing a health baseline help you be more successful in reaching personal wellness goals?

Many wellness goals start with changes in diet and exercise. Your primary care provider can help determine how to start making these changes in a safe, effective manner. Are there exercises you should avoid due to chronic back pain? Is it okay to start running if you have high blood pressure? Is it safe for you to start a vegan diet? What is a safe amount of weight to lose?

Wellness also includes mental and emotional health. Your primary provider can help determine what treatment is most appropriate for common conditions such as depression and anxiety. Maybe you’ve been feeling “down” lately – is this true depression that warrants medical treatment, or is it safe try a new yoga or meditation class first? These are just a few of the many things that can be assessed and addressed as part of your health baseline. Together, you and your primary care provider can prioritize health problems and determine effective interventions.

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Complementary Medicine, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

kids_yogaManaging stress and making healthy choices is a daily struggle for many of us. But what if way back in elementary school we had learned resiliency skills and mind-body practices to cope with anxiety, reduce incidents of bulling and violence, and boost our cognitive ability? Would this training have helped us keep our flight-or-fight response in check and live healthier lives?

A four-year study conducted by researchers at Stanford aims to answer these questions. The project will evaluate a yoga-based health and wellness program involving 3,400 students at the Ravenswood City School District. The program, which has been funded for three years by the Sonima Foundation, includes exercise-based on yoga, basic fitness regimes, relaxation techniques, mindfulness practices and nutrition. As the San Jose Mercury News reports:

The plan is to employ a multi-method approach that involves biology, physiology and psychology — a complete bio-psychosocial assessment — to measure [students’] emotions and behavior, academic and cognitive strengths and weaknesses, brain activity and structure, stress-related hormone levels, and sleep patterns.

“We’re really looking forward to a year from now — when I tell you this is effective — for you not to only take it on my word, but for you to also have data,” said Dr. Victor Carrion, a professor of psychiatry and behavioral sciences at [Stanford].

Carrion is also the director of the Stanford Early Life Stress and Pediatric Anxiety Program at Lucile Packard Children’s Hospital.

In 2012, he launched a mindfulness program in the Ravenswood City School District to treat post-traumatic stress disorder in teens that was featured on a PBS NewsHour segment. Jones and his wife happened to catch the broadcast, and because Carrion has done pro bono work with students and parents in the community for years, the partnership between the district, Stanford and the Sonima Foundation was forged.

The four-year study is also in partnership with the Center for Education Policy and Law at the University of San Diego.

“This is something that for years has been a gap in our educational system,” Carrion said. “There’s nothing… that teaches children to socialize and to be in touch with their emotions and to take care of their inner health.”

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focus, Yoga classes may boost high-school students’ mental well-being and Study shows meditation may lower teens’ risk of developing heart disease
Photo by Nicole Mark

Events, Pain, Stanford News

Advances in diagnosing and treating a painful and common jaw disorder

Advances in diagnosing and treating a painful and common jaw disorder

3439490784_46b2cfd9e3_zOn New Years Eve, Australian rapper Iggy Azalea shared with her Twitter followers that she was diagnosed with a temporomandibular joint dysfunction (often referred to as TMD or TMJ). The singer is among the estimated 10 million Americans who suffer from the condition, which is more common in women than men and people ages 20 to 40.

Symptoms of the disorder include a stiffness of jaw muscles, limited movement, clicking or locking of the jaw and radiating facial pain. It was previously believed that problems with how the teeth fit together or the structure of the jaw caused the condition. But in talking to Michele Jehenson, DDS, a clinical assistant professor at the Pain Management Center at Stanford, I was told, “There is still a lot we do not know about what causes [temporomandibular joint dysfunction] but one thing we do know is that they are not caused by upper and lower teeth misalignment or improper jaw position. We now believe that TMD susceptibility is, at least, partly genetic.”

Since the causes of the TMD are not clear, diagnosing the condition can be challenging. Currently, there is no standardize test for providers to use to diagnose patients, so physicians continue to rely on the clinical evaluation, including palpation, range of motion and auscultation. But imaging technologies are starting to play a more important role. Jehenson noted, “We now have more accurate imaging such as cone beam CT scans or MRIs. Some dentists use joint vibration analysis or EMG, but these electronic sensors have been shown to be unreliable and lead to over diagnosis.”

Over the past two decades, there as been a significant amount of research on the outcomes of TMD treatments. As Jehenson told me:

Evidence is very clear that aggressive and non-reversible treatments for TMD (braces, jaw surgery, crowns, full time wear of appliance, jaw repositioning) are rarely indicated. The best treatments should be conservative. Depending on the case, treatments are usually a mix of medication (oral or topical), nighttime appliance wear, injections, physical therapies, behavior modification and counseling, sleep and stress management.

To learn more about the diagnosis and treatment of TMD, join Jehenson for a Stanford Health Library talk on Thursday at 7 PM Pacific Time. During the event, she’ll l further discuss evidence based versus non-evidence based treatments. Those unable to attend in person can watch the talk online.

Photo by Eric Allix Rogers

Health Costs, Pain, Public Health, Research

Study examines trends in headache management among physicians

Study examines trends in headache management among physicians

4175034274_63cd0d4a7c_zAn estimated 12 percent, or 36 million Americans, suffer from migraines, resulting in an economic loss of $31 billion each year due to lost productivity, medical expenses and absenteeism.

Making lifestyle changes, such as exercising regularly, getting adequate sleep, reducing stress and cutting food triggers from your diet, have been shown (.pdf) to be effective ways to manage headache symptoms. But research recently published in the Journal of General Internal Medicine shows that physicians are increasingly ordering medical tests and providing referrals to specialists instead of offering counseling to patients on how changing their behavior could relieve their pain. Medical News Today reports:

The study, which analyzed an estimated 144 million patient visits, found a persistent overuse of low-value, high-cost services such as advanced imaging, as well as prescriptions of opioids and barbiturates. In contrast, the study found clinician counseling declined from 23.5 percent to 18.5 percent between 1999 and 2010.

The use of acetaminophen and non-steroidal anti-inflammatory drugs like ibuprofen for migraine remained stable at approximately 16 percent of the medications. Meanwhile, the use of anti-migraine medications such as triptans and ergot alkaloids rose from 9.8 percent to 15.4 percent. Encouragingly, guideline-recommended preventive therapies – including anti-convulsants, anti-depressants, beta blockers and calcium channel blockers – rose from 8.5 percent to 15.9 percent.

Unlike with the treatment of back pain, researchers found no increase in the use of opioids or barbiturates, whose usage should be discouraged, although they were used in 18 percent of the cases reviewed.

Researchers also found a significant increase in advanced imaging such as CT scans and MRIs, from 6.7 percent of visits in 1999 to 13.9 percent in 2010. The use of imaging appeared to rise more rapidly among patients with acute symptoms, compared to those with chronic headache.

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Big data, In the News, Patient Care, Pediatrics, Stanford News

Examining the potential of big data to transform health care

Examining the potential of big data to transform health care

Updated 1-6-15: The piece also aired this week on NPR’s All Things Considered.

***

9-29-14: Back in 2011, rheumatologist Jennifer Frankovich, MD, and colleagues at Lucile Packard Children’s Hospital Stanford used aggregate patient data from electronic medical records in making a difficult and quick decision in the care of a 13-year-old girl with a rare disease.

Today on San Francisco’s KQED, Frankovich discusses the unusual case and the potential of big data to transform the practice of medicine. Stanford systems-medicine chief Atul Butte, MD, PhD, also weighed in on the topic in the segment by saying, “The idea here is [that] the scientific method itself is growing obsolete.” More from the piece:

Big data is more than medical records and environmental data, Butte says. It could (or already does) include the results of every clinical trial that’s ever been done, every lab test, Google search, tweet. The data from your fitBit.

Eventually, the challenge won’t be finding the data, it’ll be figuring out how to organize it all. “I think the computational side of this is, let’s try to connect everything to everything,” Butte says.

Frankovich agrees with Butte, noting that developing systems to accurately interpret genetic, medical or other health metrics is key if such practices are going to become the standard model of care.

Previously: How efforts to mine electronic health records influence clinical care, NIH Director: “Big Data should inspire us”, Chief technology officer of the United States to speak at Big Data in Biomedicine conference and A new view of patient data: Using electronic medical records to guide treatment

Health and Fitness, Parenting, Pediatrics, Pregnancy, Public Health

Exercising during pregnancy may reduce children’s risk of hypertension

Exercising during pregnancy may reduce children's risk of hypertension

7619293834_c18e2bee15_zRegular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

Previously: Extreme pregnancy: A look at exercise and expectant moms, Could exercise before and during early pregnancy lower risk of pre-eclampsia?, Are women getting the message about the benefits of exercising during pregnancy? and Pregnant and on the move: The importance of exercise for moms-to-be
Photo by Nathan Rupert

Big data, Events, Stanford News

Registration for Big Data in Biomedicine conference now open

Registration for Big Data in Biomedicine conference now open

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Last spring, in a blog post on a study from Stanford systems-medicine chief Atul Butte, MD, PhD, National Institutes of Health Director Francis Collins, MD, PhD, noted that “we are at a point in history where big data should not intimidate, but inspire us.”

The theme of how large-scale data analysis and technology can inspire ways to improve disease prevention, diagnosis and treatment will take center stage at Stanford this spring for the annual Big Data in Biomedicine conference.  The event, which is co-sponsored by Stanford and Oxford University, will be held May 20-22 at the School of Medicine’s Li Ka Shing Center for Learning & Knowledge. Registration is now open on the website.

More than 40 speakers will participate in the conference, including Margaret Hamburg, MD, commissioner of the U.S. Food and Drug Administration; Nobel laureate and Stanford professor Michael Levitt, PhD; Peter Norvig, PhD, director of Research at Google; and 23andMe founder Anne Wojcicki. The three-day event will also include a technical showcase where attendees can browse displays and demos highlighting public and private companies’ innovations related to big data.

For those interested in viewing the keynotes and panel discussions from the 2014 conference, the videos are available to watch online.

Previously: Big Data approach identifies new stent drug that could help prevent heart attacks, Examining the potential of big data to transform health care, Stanford’s Big Data in Biomedicine chronicled in tweets, photos and videos and Videos of big data in biomedicine keynotes and panel discussions now available online
Photo, of 2014 conference speaker Colin Mahony, by Saul Bromberger

Neuroscience, Stanford News, Videos

A detailed look at latest advancements in treating brain tumors

A detailed look at latest advancements in treating brain tumors

Advancements in radiology and imaging combined with the increasing use of robotics and computers in neurosurgery have dramatically changed the way physicians treat brain tumors. Steven Chang, MD, director of the Stanford Neurogenetics Program and the Stanford Neuromolecular Innovation Program, offers an overview of these revolutionizing techniques in this Stanford Health Care video.

During the lecture, Change provides specific examples of how cutting-edge technologies and therapies have improved patient outcomes. One such technology is intraoperative MRI (iMRI), which allows surgeons to image the patient while on the operating room table to achieve a more complete removal of the brain tumor. He also addresses how radiosurgery can overcome challenges in treating tumors near the optic nerve, which pose a threat to individuals’ vision, or in other high-risk cases, such as patients likely to experience cardiac complications during or after surgery. Watch the full talk to learn more about what the future of neurosurgery holds.

Previously: A Stanford neurosurgeon discusses advances in treating brain tumors, Stanford celebrates 20th anniversary of the CyberKnife and Stanford brain tumor research featured on “Bay Area Proud”

Genetics, In the News, NIH, Public Health, Research

The genomics revolution and the rise of the “molecular stethoscope”

The genomics revolution and the rise of the “molecular stethoscope”

ATCGBack in 2012, Stanford bioengineer Stephan Quake, PhD, and colleagues sequenced the genome of a fetus using only a maternal blood sample for the first time. Technology Review later recognized the work as one of the “10 Breakthrough Technologies 2013.”

In a recently published opinion piece (subscription required) in the Wall Street Journal, Quake and Eric Topol, MD, a professor of genomics at the Scripps Research Institute, discuss the method and how it exemplifies the potential of the genomics revolution to provide scientists and clinicians with a new type of stethoscope that allows one to see “inside the body at the molecular level.” They write:

The prenatal molecular stethoscope is the first truly widespread clinical application to result from the human-genome project. The National Institutes of Health has an opportunity to build on this new knowledge of “alien” DNA in healthy individuals, and determine whether it may change their clinical course—the molecular-stethoscope approach. Meanwhile, whole genome sequencing of the germ-line, or native, DNA from populations is under way, with seven ongoing world-wide projects, each sequencing the native DNA from 100,000 or more individuals. It’s projected that nearly two million people will be sequenced by 2017.

Already, the scientific literature is brimming with new applications of the molecular stethoscope. Two studies in the New England Journal of Medicine in December showed that more than 10% of healthy people over age 65 carried so-called somatic mutations in their blood cells, and that these individuals had more than a tenfold increased risk of subsequently developing a blood-based cancer.

Previously: Stanford-developed eye implant could work with smartphone to improve glaucoma treatmentsA simple blood test may unearth the earliest signs of heart transplant rejection and Step away from the DNA? Circulating *RNA* in blood gives dynamic information about pregnancy, health
Photo by Stefano

Ask Stanford Med, Health and Fitness, Nutrition, Obesity

How to keep New Year’s resolutions to eat healthy

How to keep New Year's resolutions to eat healthy

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New Year’s Day always offers the opportunity to hit pause, reflect on our lives and set goals to improve our health and well-being. For many of us, this year also involved making promises to eat healthier and lose weight. To help you achieve your nutrition goals, I reached out to Stanford health educator Jae Berman. Below she shares how to select New Year’s resolutions that you’ll actually keep (perhaps you’ll have to tweak the ones you made last week!), offers strategies for eating healthy even when you’re pressed for time, and explains why cooking for yourself is a key factor in changing nutritional habits.

What are some examples of smaller, more manageable, goals that could help someone make better food choices?

People often jump in too hard, too fast when creating New Year’s resolutions. This perfectionist and “all or nothing” attitude tends to result in grand, lofty goals that we quit if we have a setback or don’t see immediate results. When considering health and weight loss-related goals make sure they are realistic and sustainable.

Instead, closely examine your routine and note one thing you can improve. This behavior may be something obvious, such as you drinking soda every day and wanting to stop. Or, it could be an aspiration to make healthy habits more sustainable, for example, bringing your lunch to work so you can lose weight and save money. Those who already eat well and exercise regularly may want to adopt a goal on a larger scope and learn to cook or try a new form of exercise.

Pick one thing (just one!) and make sure it is SMART – specific, measurable, achievable, results-focused and time-bound. Pick a resolution that is within reach, yet a bit of a stretch so that it’s a challenge. Additionally, goals should lead towards creating a sustainable habit. Some ideas include: Bring your lunch to work Monday-Thursday for the entire month of January; eat five fist-sized servings of vegetables every day; drink coffee only at breakfast; go to sleep at at the same time every night and wake up at the same time every morning for the month of January; or do 30 minutes of weight training three times a week.

In an effort to slim down in the New Year, some individuals may go on the Atkins diet and other popular weight-loss plans, or decide to do a juice fast, like the Master Cleanse. What’s your advice for those considering these approaches?

It’s very difficult to change someone’s mind when they decide to try these types of weight loss plans. So I usually say, “Go for it!” After a few days, the person often feels miserable and wants to create a long-term plan for managing their weight. I will say the one benefit of these quick fixes and fad diets, which I do not endorse, is that they teach a person what it feels like to be hungry. This may sound strange, but this awareness is an important lesson.

Many people overeat and are used to eating to avoid being hungry. We also tend to mindlessly eat out of boredom, or simply because food is in front of us. Going on a restrictive diet results in some feeling hungry for the first time in long time and, as a result they learn their hunger cues. When you experience a hunger cue, which is right when you think “I could eat,” then you should eat just enough food to get through the next three to four hours. You don’t need a huge meal to feel stuffed and small; unsatisfying snacks aren’t helpful either. Understanding what it feels like to be satiated is very important for long-term success.

Ongoing research at the Stanford Prevention Research Center shows that “one diet really does not fit all.”  So I can’t tell you exactly what to eat, but I can tell you that creating a long-term sustainable plan is key.

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