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Behavioral Science, Public Health, Sleep

Six simple ways to improve your sleep for the holidays

Six simple ways to improve your sleep for the holidays

IMG_5595The holiday season is usually one of the busiest – and often most stressful – times of the year. It’s also a season that often brings poor sleep. To improve your health and your mood, consider six simple ways that you can maintain healthy sleep during the hustle and bustle of the holidays and even discover the resolve to improve your sleep in 2015.

1. Go to bed when you’re sleepy.

It seems obvious, but it isn’t always easy to do: Sleep most easily comes when we are feeling sleepy. Insomnia, characterized by difficulty falling or staying asleep, can plague us throughout the year. With the added stress of the holidays, it can be even harder to fall asleep.

Many insomniacs will start to go to bed earlier, or stay in bed long after waking, to make up for lost sleep. This desperation often thins out sleep and makes it less refreshing. Imagine showing up for a holiday feast after having snacked all day. You wouldn’t have much of an appetite. If you spend too much time in bed, or take naps, you similarly will show up for the eight-hour feast of sleep without much interest.

Prolonged wakefulness helps to build our drive for sleep and staying up a little later until you feel sleepy can ease insomnia.Preserving 30 to 60 minutes to relax before bed can also aid this transition.

2. Ease yourself into a new time zone to prevent jet lag.

If you’re flying across the world, or even across the country, you may find that your sleep suffers. This is due to our body’s natural circadian rhythm, which regulates the timing or our desire for sleep. This rhythm is based in genetics, but it is strongly influenced by environmental cues, especially morning sunlight exposure.

If you suddenly change your experience of the timing of light and darkness by hopping on a jet plane, your body will have to play catch up. As a general rule: “West is best and east is a beast.” This points out that westward travel is more tolerated because it’s nearly always easier to stay up later than it is to wake up earlier.

Another rule of thumb is that it takes one day to adjust for each time zone changed. If you travel across three time zones, from San Francisco to New York City, it will take about three days to adjust to the new time zone. This adaptation can be expedited by adopting the new time zone’s bedtime and wake time before you depart. If you’re like most people, your best intentions might not lead to pre-trip changes.

Never fear: To catch up once you arrive, delay your bedtime until you are sleepy, fix your wake time with an alarm, and get 15 minutes of morning sunlight upon awakening.

3. Put an end to the snoring.

Whether you’re staying in grandma’s spare room or sharing a hotel suite, close quarters during the holidays may call attention to previously unnoted snoring and other sleep-disordered breathing like sleep apnea.

Remember that children should never chronically snore; if they do, they should be seen by a sleep specialist. Adults don’t have to snore either. Snoring is commonly caused by the vibration of the soft tissues of the throat. If the airway completely collapses in sleep, this is called sleep apnea. This may lead to fragmented sleep with nocturnal awakenings and daytime sleepiness. It is also commonly associated with teeth grinding and getting up to urinate at night.

When sleep apnea is moderate to severe, it may increase the risk of other health problems including hypertension, diabetes, heart attack, stroke, and dementia. It’s more than a nuisance, and if you or a loved one experience it, further evaluation and treatment is warranted.

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Behavioral Science, Health and Fitness, Nutrition, Obesity, Public Health, Research

Perceptions about progress and setbacks may compromise success of New Year’s resolutions

3336185391_60148a87fa_zMy physical therapist is constantly telling me to pause during the workday and take stretch breaks to counter act the damage of being hunched over a computer for hours on end. After every visit to his office, I vow to follow his advice, but then life gets busy and before I know it I’ve forgotten to keep my promise.

So I decided that one of my New Year’s resolutions will be to set an alarm on my phone to serve as a reminder to perform simple stretches throughout the day. Keeping in mind that a mere eight percent of people who make resolutions are successful, I began looking for strategies help me accomplish my goal. My search turned up new research about how the perception of setbacks and progress influence achievement of behavior change. According to a University of Colorado, Boulder release:

New Year’s resolution-makers should beware of skewed perceptions. People tend to believe good behaviors are more beneficial in reaching goals than bad behaviors are in obstructing goals, according to a University of Colorado Boulder-led study.

A dieter, for instance, might think refraining from eating ice cream helps his weight-management goal more than eating ice cream hurts it, overestimating movement toward versus away from his target.

“Basically what our research shows is that people tend to accentuate the positive and downplay the negative when considering how they’re doing in terms of goal pursuit,” said Margaret C. Campbell, lead author of the paper — published online in the Journal of Consumer Research — and professor of marketing at CU-Boulder’s Leeds School of Business.

Given these findings, researchers suggest you develop an objective method for measuring your progress and monitor it regularly.

Previously: Resolutions for the New Year and beyond, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, To be healthier in the new year, resolve to be more social and Helping make New Year’s resolutions stick
Photo by Laura Taylor

Nutrition, Parenting, Public Health

“Less is more”: More holiday eating tips from a Stanford nutrition lecturer

"Less is more": More holiday eating tips from a Stanford nutrition lecturer

cake-buffet-58682_1280My grandmother is fortunate enough to live within an easy drive of the Shady Maple Smorgasbord, a Pennsylvania Dutch-style dining extravaganza in Lancaster County. It’s the size of a large auditorium, packed with tables and two gigantic buffet lines. It’s the biggest restaurant, serving the most food, to the most people, that I’ve ever seen.

For dinner, each day the buffet includes: “46 salad bar items, 3 soups, 8 homemade breads & rolls, 4 cheeses, 8 meats, 14 vegetables, 10 cold desserts, 3 hot desserts, 8 pies, 6 cakes, sundae bar & many beverages.” Plus the daily specials. On Tuesday, for example, there’s also: “salmon, Cajun catfish, cod, oyster stew, beef brisket, New York strip steak and baked potatoes.”  A surfeit of tastiness, abundance beyond words — mmmm, mmmm, let’s go!

Not so fast, Stanford-based dietician, Maya Adam, MD, would say. “Size matters. We can enjoy absolutely any food, as long as its consumed in moderation,” she writes in a Healthier, Happy Lives Blog post, published today by Stanford Children’s Health.

That means no King Size KitKat and no seconds at the smorgasbord dessert line, either. Try using smaller dishes, Adam suggests. Cut servings in half, eat half, save some for later or share with a friend. And pay attention to the food. No texting, TV watching or mindlessly shoveling food into your mouth. Savor each bite, Adam writes:

The truth is, when we eat real, fresh food in modest amounts (even if it’s cooked with a pat of butter and a sprinkle of salt) it doesn’t take much to leave us feeling completely satisfied.

Don’t flip out if you just can’t resist that smorgasbord. But practice moderation — that’s the real way to think big about food.

Previously: Diabetes and nutrition: Healthy holiday eating tips, red meat and disease risk, and going vegetarian, Where is the love? A discussion of nutrition, health and repairing our relationship with food and “Less is more”: Eating wisely, with delight, during the holidays 
Photo by Hans

Nutrition, Parenting, Pediatrics, Public Health

Tips on how parents with a history of eating disorders can enjoy the holidays

Tips on how parents with a history of eating disorders can enjoy the holidays

5294777976_8eb6ae86d9_zThe holiday season is often a joyful time when friends and family hit pause on their busy schedules to enjoy each other’s company. There’s also lots and lots of food involved, which can be challenging for parents with a history of eating disorders.

Recent research has found that parental eating disorders (either a past or current condition) are associated with numerous problems in child feeding, including difficulties in transitioning to solid foods and deciding which types of foods to offer and in what quantities. Studies observing the interactions of mothers with eating disorders and their young children noted greater conflict and more controlling behavior over eating, appetite, and food choices. Mothers with eating disorders often tell researchers and clinicians that their children’s troubling eating patterns are associated with their own eating habits, and shape and weight concerns  too often intervene in the decisions parents make in feeding their children.

Holiday celebrations can make these feeding relationships even more complex. Traditions of eating together with family or friends may create additional stress for parents. Additionally, family gatherings can reawaken memories of negative experiences parents may have had as children at the dinner table, adding another layer of worry and hyper-vigilance.

So what should parents with a history of eating disorders, or those concerned about their children overeating, do during the holidays? Here are some tips for having a more pleasurable and relaxing time:

  • Plan ahead: Talk to your partner about your concerns and come up with a strategy for how to cope with stressful situations around eating. Talk about what you’ll do if there is food on the table that you typically don’t eat, or if your child asks for second and third servings of foods. A rule of thumb should be to allow the child to experience a variety of food to a certain extent, as long as it doesn’t contradict any significant beliefs or preferences (such as non-kosher food).
  • Talk with your child before things get out of hand: Walk your child through the social gathering beforehand and discuss potential conflicts that may arise. The discussion should be appropriate to the child’s age. With children ages 2-3, parents could talk about the meal, mention that it will be probably very tasty, and set some limits. For instance, one could say that after dinner the child can have one or two desserts, but not more. With older children, parents should encourage autonomous eating based on the child’s regulation of hunger and satiety. This is an opportunity to discuss with children the differences between families, as well as your normal routine and special events. You should also discuss general boundaries and choices of your household.
  • Add fun activities that don’t involve food: Many celebrations and traditions revolve around food. To participate with your family in more neutral activities that are less nerve-wracking, parents should think of supplementary pastimes that all family members will enjoy. Shifting the focus away from the meal for part of the time can help parents “lower the volume” of their eating disorder when they spend time with their children.
  • Unwind: Despite being worried that loved ones will gain excessive weight during the holidays, parents should remind themselves that in a healthy-eating style, people don’t become overweight following a few specific meals. In addition, you should focus on the positive aspects of the social gathering for them and for their children – meeting family members or friends you may have not seen in a while, catching up with things you do not have time for during the year, and strengthening your relationships with your children. Before anxiety-provoking situations, parents should use any method of relaxation and stress-reduction that works for them and fits the context – have a long relaxing shower, drink a hot tea, listen to music, or stay away from the dinner table until the meal begins.

The holiday season can be a better experience for you and your family once you work through and resolve any concerns involving children’s eating.

Shiri Sadeh-Sharvit, PhD, is a psychologist and a visiting instructor at Stanford. She’s now recruiting mothers with a history of eating disorders to a parenting program study at Stanford. For more information contact shiris@stanford.edu.

Photo by Micah Elizabeth Scott

Patient Care, Public Health, Research, Science

Finding cures for the most challenging diseases

640px-Drawing_Test_tubes_different_colorsThe recent Ebola outbreak and the subsequent race to find a vaccine and other treatment options has brought the topic of drug development back in the public spotlight. But despite the millions of dollars spent on these efforts and the technological advances in biomedical sciences in the last 20 years or so, the process is still time-consuming and prone to failure. A recent feature story from National Journal (which also appears on The Atlantic’s website today) describes the work of several scientists trying to find cures or treatments for some of the most challenging diseases, from infectious diseases, like AIDS and Ebola, to chronic diseases such as Alzheimer’s.

The first disease the article highlights is a rare disorder called progeria, which causes young children to age prematurely. Recent breakthroughs in treatment have come from a team led by Francis Collins, MD, PhD, who is more famous for leading the Human Genome Project and now serves as director for the National Institutes of Health. Collins worked briefly on progeria early in his career and the combination of Collins’s work and genomics made it possible for his team to crack the genetic secret of the rare disease: that it was caused by a single genetic mutation. That finding led to a treatment that extended the lives of patients with progeria by several years. But it also points to some of the overwhelming challenges of chasing down cures and treatments:

The doctors and scientists hunting for new cures and treatments work in a constant state of tension. They operate in a tremendously high-stakes environment, pouring years of their lives into research as the people who inspire them continue to suffer and even die. Drug hunters face failure after failure, almost never followed by success. Decades of work flame out. Promising ideas turn into dead ends. For every 10,000 compounds they explore, scientists wind up with just one drug approved by the Food and Drug Administration. Even when medical science moves as fast as it can—and today, it’s moving faster than ever before—it’s still an agonizingly slow process.

“As much as we say that failure is part of what we do—if you’re not failing, you’re probably not doing science that’s very interesting—it still hurts,” Collins says. “It is frustrating, because you want to come up with the answer. You want to save lives. That’s what we all get into this medical research area to try to achieve, and yet the challenges are immense. And we make progress, oftentimes, in very small baby steps, even though what we’re hoping for are big leaps.”

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Aging, Dermatology, Public Health, Videos

Don’t skip the sunscreen in wintertime

Don’t skip the sunscreen in wintertime

When you’re spending time outdoors during the wintertime, it’s easy to justify skipping the sunscreen when the sun isn’t beating down on you mercilessly and you’re bundled up instead of sporting a swimsuit. But UV rays from the sun can penetrate clouds and snow can reflect sun onto your face, hands and any other exposed skin. So it’s important to remember to take sun safety precautions even on cold or overcast days, too.

This  Stanford Health Care video featuring dermatologist Justin Ko, MD, MBA, includes important tips for preventing skin cancer year-round. As I, like many others, prepare for a family trip to Tahoe to take advantage of the recent snow, Ko’s reminder about sun safety habits during the winter comes at a good time. For example, I suspect I’ve been skimping on sunscreen: Ko says you need a shot glass-full to completely cover your body. If you’re using a spray-on sunscreen, you need to spray for a full 60 seconds.

Watch the video to learn more information about how to identify possible cancerous moles and preventing high-risk exposures, like tanning beds.

Previously: Skin cancer linked to UV-caused mutation in new oncogene, say Stanford researchers, Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer, Skin cancer images help people check skin more often and effectively, and The importance of sunscreen in preventing skin cancer

Global Health, Infectious Disease, Microbiology, Public Health, Videos

'Tis the season for norovirus

'Tis the season for norovirus

The week before Thanksgiving, some kind of stomach bug, which I suspect was norovirus, spread like wildfire among my daughter’s daycare. Several of her classmates became sick and like dominos so did the parents, including us.

So I was more than sympathetic when I came across this video by John Green (of the vlogbrothers fame and author of “The Fault in Our Stars”) about his family’s Thanksgiving troubles with a norovirus infection that seems to have left no GI system untouched in their household.

Winter, from about November to April, is prime norovirus season. The treacherous illness, which as Green says “has amazing superpowers,” spreads when you come into contact with feces or vomit of an infected person. It can take less than a pinhead of virus particles to make this happen. Unlike other viruses, it can live on surfaces for surprising long periods, which is how a reusable grocery bag caused an outbreak among a girls soccer team in 2012. Plus, an infected person can continue to shed the virus for about three or four days after recovering. It’s possible to disinfect after an infection, but it’s a pretty intense job.

Given these characteristics it’s not surprising that this tiny virus (even by virus standards) causes about 20 million illnesses each year. Although for most people it’s a mild illness, for the very young,  old or those with compromised immune systems—it can be severe. About 56,000-71,000 people are hospitalized and 570-800 die from norovirus infections.

The situation is worse in developing countries, where, as Green points out, rehydration therapy is harder to come by for the most vulnerable. About 200,000 deaths are caused by norovirus infections in poor parts of the world.

In his typical funny and thoughtful style, Green talks about what lack of simple—and cheap—rehydration therapy means for many on our planet. It’s one more thing that it’s easy to take for granted, and one more thing to be thankful for.

Previously: Stanford pediatrician and others urge people to shun raw milk and products and Science weighs in on food safety and the three-second rule

Infectious Disease, Parenting, Pediatrics, Public Health

How one mom learned the importance of the flu shot – the hard way

How one mom learned the importance of the flu shot - the hard way

tamiflu‘Wow, I’m a pathetic sight,’ I thought as I stepped out of the bright fluorescent light onto the rainy pavement, fumbling with my half-open umbrella and crying. I was coming from Walgreens, clutching on to a crisp white paper bag containing Tamiflu and bottles of Children’s Tylenol (cherry and grape) and re-playing in my head the comments a pharmacist had just made to me. “Did they not get their flu shots?” she had asked, not unkindly, as she packaged up my loot. “Is that why your kids got sick?” Hence my (guilty and big) tears.

My two girls – ages eight and five – had indeed not gotten their flu shot. I had meant to take them in – I’m a super-organized mama who usually follows doctors’ orders to a tee, the type who carefully monitored and recorded the contents of her newborns’ diapers for weeks and who typically schedules well-child exams as close to her kids’ actual birthday as possible. And yet time slipped away from me this fall, I hadn’t taken them in (no excuses – just life), and earlier that day my oldest had tested positive for a particularly nasty type of Influenza A. Hours later we were called by the girls’ school: The little one was now sick with a high fever (and likely the flu). The doctor suggested we start her on Tamiflu, too, and hope for the best.

My guilt, as I watched my kindergartener later cry out in pain (when my husband asked what she wanted for Hanukkah, in an effort to get her mind off her sickness, she moaned, “I just want to feel better”), was practically all-consuming. How could we have not taken them in? I kept asking myself. I go every year, and I always follow the pediatrician’s recommendations about vaccines. I believe in the importance of vaccines. So what was I thinking?

Later that evening, after the kids (following much negotiation and crying) agreed to take their “yucky”-tasting Tamiflu and had finally gotten to sleep, I took to Facebook, where friends and acquaintances sweetly tried to cheer me up and came to my defense. The girls might have gotten sick even if they had gotten a flu shot, some suggested. (Although: This year’s vaccine offers protection from this particular strain.) They could have had a reaction from the shot itself, someone pointed out. (Yet: My kids have never experienced side-effects from being vaccinated.) The pharmacist was just trying to fill a quota for flu shots or make you feel bad, one old college friend suggested. (But: The pharmacist actually wasn’t being pushy or judgmental with her question; she seemed more curious than anything.)

The bottom line is that I messed up and didn’t come through in protecting my kids this time around. It was a hard pill to swallow. But what comforted me in the end was the thought that my daughters’ illness is temporary and in the grand scheme of things, not all that bad. I am blessed for my children’s overall good health (I know many parents have to face far, far worse things than the flu), and I am blessed to have the resources that enable us to see a good doctor and purchase not-inexpensive antivirals.

The experience, also, reminded me of some valuable lessons. A parent – or anyone, really – should never take good health for granted. And one should never become complacent about disease and illness prevention.

I’m fairly confident this is the last year my girls will ever go without a flu shot.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine, Ask Stanford Med: Answers to your questions about seasonal influenza and European experts debunk six myths about flu shot
Photo by kanonn

Big data, Cancer, Health Disparities, Imaging, Public Health, Women's Health

A new way of reaching women who need mammograms

A new way of reaching women who need mammograms

black Woman_receives_mammogramI’ve taken cancer screenings for granted since I’m one of those fortunate enough to have health insurance, and it didn’t occur to me that many uninsured women were going without regular mammograms to screen for breast cancer. A story today on Kaiser Health News mentions this fact and highlights a partnership that Chicago public-health officials have forged with a company named Civis. The private company includes staffers that helped with the Obama campaign’s get-out-the-vote efforts, and then moved on to help find people eligible to enroll for health insurance through the Affordable Health Care Act. The company used its expertise to identify women who were in the right age group (over 40) and were uninsured in Chicago’s South Side area; those women then were then sent fliers about free screenings available to them.

The article describes some other cities using similar “big data” efforts for public-health purposes:

This project represents a distinctive step in public health outreach, said Jonathan Weiner, professor and director of the Johns Hopkins Center for Population Health IT in Baltimore. But Chicago is not the only city investigating how population data can be used in health programs, he added, citing New York City, Baltimore and San Diego as other examples.

“It’s a growing trend that some of the techniques first developed for commercial applications are now spinning off for health applications,” he said. So far, he said, “these techniques have not been as widely applied for social good and public health,” but that appears to be changing.

The early signs say that the new effort in Chicago, which started earlier this year, is working. One hospital saw a big jump in the number of free mammograms, from 10 a month to 31, though the full impact may not be understood for a few months. It’s not “a silver bullet” as one expert cited in the story notes, but it’s a much more precise tool than most public-health outreach programs have had access to until now.

Previously: Screening could slash number of breast cancer casesDespite genetic advances, detection still key in breast cancerStudy questions effects of breast cancer screenings on survival rates and New mammogram guidelines echo ones developed by physicians group
Photo by National Cancer Institute

Chronic Disease, Health Disparities, Health Policy, Public Health, Research

Study shows former foster kids face higher risk of future health problems

Study shows former foster kids face higher risk of future health problems

2411929600_da793593b2_zAccording to a new study from the journal Pediatrics, adults who were raised in the foster-care system are more likely to have chronic-health problems than those not from foster backgrounds, even after controlling for economic security.

It has long been recognized that foster kids have high rates of health problems as children, but this study is the first to ask what happens when those kids reach adulthood. It considered cardiovascular risk factors and other chronic problems, and it compared three groups of young adults: those formerly in foster care, those from the general public with economically insecure backgrounds, and those from the general public with economically secure backgrounds. The results were graduated among the three groups, from foster care, to economic insecurity, to economic security.

In the paper, the authors explain why their findings are not surprising:

Foster youth are often exposed to poverty and many other adverse childhood experiences including abuse, neglect, domestic violence, and parental substance use, and many undergo frequent placement and school changes while in foster care. Several theories exist regarding the effects of chronic and early exposures to adversity, all of which suggest that the more stressors to which one is exposed, the higher the likelihood of a chronic physical or mental health condition later in life.

However, because these theories regarding adversity haven’t yet been adequately investigated, this study has important implications. Scientific evidence could influence policy-makers to address this problem, perhaps by continuing Medicaid access for former foster kids or granting it to those far below the poverty line, or by offering continued support from the foster-care system into young adulthood. Provisions for the first two changes were made in the Affordable Care Act, and the federal government does offer incentives for states to continue foster care until age 21, but due to technicalities and state-level laws, these benefits are not widely accessible.

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