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Aging, In the News, Public Health, Sleep

Nothing to snort over: Why snoring should be taken seriously

Nothing to snort over: Why snoring should be taken seriously

6258904896_ec4a6f155a_zIt’s the middle of the night—or maybe the middle of the day—and all seems well. Then, you hear it: a low, rumbling, animalistic sound. It could be a snort or a growl or even a snarl. But it’s not an animal at all. It’s a person who is snoring far too loudly for your liking, and the sound only seems to be getting worse.

It’s safe to say we all know someone who snores – or we may even do it ourselves. A Huffington Post article puts a spotlight on snoring and features Stanford’s Rafael Pelayo, MD, who explains why it occurs, why it becomes increasingly worse with age, and, most importantly, why it could signal a potentially serious health problem.

“Think of fire and a fire alarm,” Pelayo says. “The snoring is the alarm. If there’s a fire and the fire alarm goes off and I disconnect the alarm, it doesn’t mean I put out the fire. The fire could still be burning.”

Snoring could be a symptom of sleep apnea, a disorder in which a person’s breathing repeatedly stops and starts during sleep. Apnea is a legitimate medical issue that can be harmful if gone unchecked, and Pelayo encourages anyone who snores to get tested for it.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.

Previously: New recommendation: Adults need at least 7 hours of sleep each night, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and How insufficient sleep can lead to weight gain 
Photo by Marc Lewis

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

Walking on sunshine: How to celebrate summer safely

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

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

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

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

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

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

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

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

Addiction, Mental Health, Pain, Public Health, Technology

Student engineers unveil tamper-proof pill bottle

Student engineers unveil tamper-proof pill bottle

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

Global Health, HIV/AIDS, Infectious Disease, Public Health, Research, Rural Health

Drought causes spike in HIV infections in Africa

Drought causes spike in HIV infections in Africa

75148497_50e081cd5b_zHere in California, the drought is plenty serious. Shortages mean short showers, brown lawns, empty reservoirs and fallow fields.

But in sub-Saharan Africa, drought spreads disease, including the still-rampant HIV virus. The phenomenon is more sociological than ecological: Slim harvests slash farmers’ incomes, forcing them to find new ways to earn money. Some turn to sex, according to a new study in The Economic Journal.

As described in a recent article from Stanford’s Center on Food Security and the Environment (FSE):

Analyzing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behavior, a year of very low rainfall can increase local infection rates by more than 10 percent.

That means condoms and sex education aren’t all that’s needed to thwart the epidemic’s spread, the study’s authors say. Affected farmers also need economic support and alternatives to help them weather the dry period, without sacrificing their health.

“These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet,” co-author Marshall Burke, PhD, a fellow at the FSE, said in the piece.

Previously: Spread of drug-resistant HIV in Africa and Asia is limited, Stanford research finds, Stanford study: South Africa could save millions of lives through HIV prevention and Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa 
Photo by Jon Rawlinson

Health Policy, In the News, Medicine and Society, Public Health

On King v. Burwell and the survival of the Affordable Care Act (and an unexpected birthday present)

On King v. Burwell and the survival of the Affordable Care Act (and an unexpected birthday present)

5362318849_dd1527d632_zToday is my birthday – and the Supreme Court (or, at least, two-thirds of it) just gave me, most people who follow health policy, and millions of now still-insured Americans a present: King v. Burwell.

There’s a lot to say about this decision, but I want to focus on three things: the strength of the conflicting substantive arguments, the possible internal Court dynamics that resulted in the majority and dissenting opinion, and a guess at some deeper meanings of the case for the future of health care in America.

On the substance, this is a case that really could have gone either way. The idea that the Court should apply the words as written, no matter how silly, has precedent in the Court’s history; so does the idea that the Court should try to interpret laws in ways that make them work as intended. The majority — at the end, Chief Justice John Roberts’s opinion — does recognize this conflict; the dissent, from the more textualist end of the Court, rejects the idea of a tension. The majority has it right in the sense that sometimes the Court applies the words as written, sometimes it requires interpretation, and that both are legitimate responses to cases – both are within the culture of legal interpretation that the Court has included over the last two-and-a-quarter centuries.

I do think the Court could have legitimately gone the other way, though I think it would have been foolish and harmful, to the country and even to the conservatives who will now bemoan this outcome. I am glad they did not. I prefer judges who try, when the law – or more accurately its interpretative culture – will allow them to, to make things work in a sensible way. The dissent’s position would have upended a major government program and harmed millions of people for a technicality – like a ticky-tack penalty or foul call deciding the Super Bowl or the World Cup. The Court could have done that, but it would have been wrong.

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Health Policy, In the News, Medicine and Society, Public Health

Supreme Court upholds Affordable Care Act with a 6-3 vote

Supreme Court upholds Affordable Care Act with a 6-3 vote

Supreme Court picUpdated 4:07 PM: “Obamacare lives to fight another day,” writes David Studdert, ScD, a core faculty member at CHP/PCOR and an expert in health law, in a Stanford Law School blog post. In his piece, he offers more legal details of the ruling.

***

Updated 1:51 PM: Stanford law professor Hank Greely, JD, has this to say:

Today is my birthday – and the Supreme Court (or, at least, two-thirds of it) just gave me, most people who follow health policy, and millions of now still-insured Americans a present: King v. Burwell

I do think the Court could have legitimately gone the other way, though I think it would have been foolish and harmful to the country and even to the conservatives who will now bemoan this outcome. I am glad they did not. I prefer judges who try, when the law – or more accurately its interpretative culture – will allow them to, to make things work in a sensible way. The dissent’s position would have upended a major government program and harmed millions of people for a technicality – like a… foul call deciding the Super Bowl or the World Cup.  The Court could have done that, but it would have been wrong…

What does it mean about the future of Obamacare? Well, I think it means the Supreme Court is done with it, at least with its fundamental, life or death issues.

Greely will expand on these thoughts in a longer piece on Scope later today.

***

Updated 12:45: Mello goes into detail on the ruling in a just-published Stanford Law School blog post.

***

Updated 11:51 AM: Stanford’s Laurence Baker, PhD, who has done extensive research on the economic performance of the U.S. health-care system, has also weighed in, saying, “This ruling, affirming the intent of the Affordable Care Act, is a relief for millions of Americans who have gained coverage under the law. It also provides important stability for insurers and the health-care system more broadly, avoiding what would have been tumultuous disruption in health-insurance markets in many states. We can now turn full attention back to the important work of improving health-insurance markets and expanding coverage, from which this court case was such a distraction.”

***

Updated 11:04 AM: Some thoughts now from Stanford health economist Jay Bhattacharya, MD, PhD, a core faculty member at the Center for Health Policy and the Center for Primary Care and Outcomes Research (CHP/PCOR):

Today’s Supreme Court ruling preserves the Obama administration’s implementation of the ACA’s subsidy scheme to all qualified people (between 133 and 400 percent of the poverty line). The Supreme Court essentially ruled for the status quo.

Had the plaintiffs won the case, such subsidies would only have been legal in states, like California, that have established their own insurance exchange (or marketplace). The immediate effect of the ruling, then, would have been to eliminate federal subsidies for the people living in states without a state-established insurance exchange. Families with income between 133 and 400 percentof the poverty line in such states who purchased their insurance through a federally-established exchange would have had to pay the full costs of their insurance premiums. This would have made insurance unaffordable for many of these families.

The ruling would not have directly affected people who get insurance through their employers or through the government in some other way, such as through Medicare (health insurance for the elderly and disabled) or through Medicaid (health insurance for the poor).

It is difficult to imagine, had the ruling gone the other way, that it would be a stable political equilibrium for people in one state to be eligible for federal subsidies, while similar people in another state to be not eligible. There would have been a lot of pressure on Democrats and Republicans at both state and federal levels to reform Obamacare, and either reestablish the subsidies or make some other arrangement to make insurance affordable. With the Supreme Court ruling the way it did, there will be substantially less impetus or desire for the reform of Obamacare, especially on the Democratic side.

***

Updated 10:45 AM: Stanford’s Michelle Mello, JD, PhD, professor of law and of health research and policy, has just provided her insight on the ruling, which she said offered strong claims by both sides:

The Court was profoundly influenced by its desire to avoid an interpretation of the law that would defeat Congress’s purpose in passing it. That purpose was to create a functional market through which individuals could buy insurance… The Court found it “implausible” that Congress intended for States that opted not to set up their own Exchanges to suffer the foreseeable, well-understood consequence of a “death spiral.”

The spiral occurs because without the tax credits, a very large proportion of the people who would otherwise be required to buy insurance get exempted from the individual mandate because the insurance cost exceeds a set amount of their income. That means too few people — and in particular, too few healthy people — buying insurance now… People know they can buy insurance later when they get sick. Their decisions to do so push premiums up for everyone, and the adverse selection makes the market unsustainable…

The trio writing in dissent could hardly have shown greater disgust with the majority’s approach. They disputed the majority’s threshold claim that the four little words were ambiguous — and everything that followed from it. The length and complexity of the majority’s justification for its holding, they claimed, is just proof that (once again) the justices are contorting the law in order to achieve a political objective — upholding the Affordable Care Act…

But on balance, I think the majority got it right in pointing to the well-understood consequences of withholding tax credits as evidence that Congress didn’t intend the reading the challengers urged. The decision is on firm legal ground, and to public-health advocates, is an enormous relief.

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Behavioral Science, Global Health, In the News, Public Health, Research, Sleep, Technology

Electricity access shortens sleep, study shows

Electricity access shortens sleep, study shows

Radium_Dial_UVGrowing up, my engineer father always told me to move my flowery glow-in-the-dark clock farther from my bedside. “You’re nuts, Dad,” I would respond, equating his concern with his conviction that he was dropped off by aliens in the New Mexican desert in 1947.

But now it turns out he may have had a point (although I’m still quite sure he came from a hospital in Pennsylvania, not a spaceship).

A new study published in the Journal of Biological Rhythms has shown that access to artificial light at night has shortened the amount of time we sleep each night. A recent University of Washington release describes the study:

The researchers compared two traditionally hunter-gatherer communities (in Argentina) that have almost identical ethnic and sociocultural backgrounds, but differ in one key aspect – access to electricity…

In their usual daily routines, the community with electricity slept about an hour less than their counterparts with no electricity. These shorter nights were mostly due to people who had the option to turn on lights and go to bed later, the researchers found. Both communities slept longer in the winter and for fewer hours in the summer.

This is the first study to examine differences in communities, rather than relying on artifically manipulating light in a laboratory.

“In a way, this study presents a proxy of what happened to humanity as we moved from hunting and gathering to agriculture and eventually to our industrialized society,” said lead author Horacio de la Iglesia, a University of Washington biology professor. “All the effects we found are probably an underestimation of what we would see in highly industrialized societies where our access to electricity has tremendously disrupted our sleep.”

So douse those lights, turn off the TV, push back your glowing clock, and embrace the dark — with a nice, long snooze.

Previously: New recommendation: Adults need at least 7 hours of sleep each nightMobile devices at bedtime? Sleep experts weigh in and Can adjusting your mobile device’s brightness help promote better sleep?
Via Medical News Today
Photo by Arma95

Addiction, Parenting, Pediatrics, Public Health, Research, Stanford News

Teens confused about harms of marijuana and e-cigarettes, Stanford study finds

Teens confused about harms of marijuana and e-cigarettes, Stanford study finds

smoking-skaterToday’s teenagers are familiar with the dangers of smoking conventional cigarettes, but they’re much less sure of the risks posed by marijuana and e-cigarettes, according to a Stanford study published today in the Journal of Adolescent Health.

The researchers asked 24 high-school students in one Northern California school district about the benefits and risks they perceived from cigarettes, e-cigarettes and marijuana, and where they were getting information about each. The good news is that teens have clearly absorbed the message – from parents, teachers and public health campaigns – that cigarettes are bad for their health. And the kids surveyed saw no benefit to smoking cigarettes, suggesting that conventional cigarettes have lost the “cool” factor they once had among the young.

But there was a big gap in teens’ understanding of e-cigarettes and marijuana, as our press release about the research explains:

“Kids were really good at describing the harmful things that happen with cigarette smoking, but when we asked about other products, there was a lot of confusion,” said the study’s lead author, Maria Roditis, PhD, a postdoctoral scholar in adolescent medicine.

“We’re good at delivering messaging that cigarettes are harmful, but we need to do a better job with other products that teens may smoke,” added Bonnie Halpern-Felsher, PhD, professor of pediatrics in adolescent medicine and the study’s senior author. “We don’t want the message kids get to be ‘cigarettes are bad, so everything else might be OK.’”

Teens need to hear about the risks of marijuana, including its damaging effects on the adolescent brain; its addictive potential; and its ability to damage the lungs, which is similar to that from inhaling smoke from any form of plant matter, Halpern-Felsher said. They also need to hear about the risks of e-cigarettes, which include the addictive properties of nicotine and the fact that flavor compounds in e-cigarettes can cause obstructive lung disease.

In a story about the research on LiveScience.com, Halpern-Felsher speculated on some of the factors that may be affecting teens’ views of marijuana and e-cigarettes:

There are several possible reasons why teens may view the risks of smoking cigarettes differently than using marijuana or e-cigarettes. One reason involves advertising — although the tobacco industry can’t advertise on TV, in some print media or in any youth venue, similar restrictions don’t apply to e-cigarettes, Halpern-Felsher told Live Science.

Young people are seeing e-cigarettes in cool colors and cool flavors. They are also seeing celebrities use them, and that gives these products more exposure and makes them appealing, she said.

Previously: With e-cigarettes, tobacco isn’t the only danger, How e-cigarettes are sparking a new wave of tobacco marketing and To protect teens’ health, marijuana should not be legalized, says American Academy of Pediatrics
Photo by James Alby

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