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Infectious Disease, Public Health, Stanford News

Experts and 8-year-olds agree: It’s worth getting a flu shot

Experts and 8-year-olds agree: It's worth getting a flu shot

smiley faceIf you’re around my young daughters these days and happen to mention the flu shot, you’re likely to get an earful. “We got ours too late last year and got really sick,” they’ll tell you (as I look down in embarrassment). “It’s really important to get one.” They also, not surprisingly, were not at all upset when I made an appointment – nice and early! – for them to get vaccinated a few weeks ago. They knew it would hurt, but in the words of my 8-year-old, “it’s worth it.”

My girls – the walking pro-flu shot billboards that they are – were the first people I thought of when I came across a Stanford BeWell article this week on – you guessed it – the importance of flu shots. In the piece, infectious disease expert Cornelia L. Dekker, MD, answers questions about influenza and last year’s flu vaccine (which failed to protect people against several strains of the flu), and she reminds local readers that shots are being offered on campus for students, staff and faculty for free.

Previously: How one mom learned the importance of the flu shot – the hard way and Ask Stanford Med: Answers to your questions about seasonal influenza
Photo by cignoh

Patient Care, Public Health

Survey of e-patients offers insights on patient engagement and access to health care

Survey of e-patients offers insights on patient engagement and access to health care

6842253071_a9b35831c0_zPeople who seek out medical information and want to have a more active role in their health care are increasingly becoming the norm. To learn more about this growing community of engaged patients, Inspire, the largest online community of e-patients in the United States, surveyed 13,633 of their members, representing 100 countries on six continents.

The results of the company’s survey were recently released in the online report “Insights from Engaged Patients: An analysis of the inaugural Inspire Survey” (link to .pdf). Among the key findings:

  • About 55 percent of patients are “well-prepared for their doctor’s visits” and bring a buddy to assist with their appointment. (As one survey participant reported, “The more I inform myself with accurate information on the medications taken, or the medications available, the more I am able to have meaningful conversations with the doctors concerning treatment.”)
  • 52 percent of patients are largely responsible for initiating conversation with their physicians about potential new treatments.
  • Two-thirds of patients use social networks as a source of information and support for their health conditions.
  • Half of all patients reported having difficulty with the affordability of their medications at some point in their life.
  • 72 percent of U.S.-based patients reported experiencing some increase in their healthcare costs.

You might think that since the people surveyed were members of an online health community, they’d all be savvy, avid users of every kind of heath app and gadget. Nope. Instead, 72 percent of survey-takers reported they’d never used a smartphone app for their health-care needs. Moreover, less than half of the people surveyed reported feeling that such an app would be useful to them.

The rest of the report, which illustrates there are clear barriers that prevent people from adopting health-care technology and from getting the care and medications they need, is worth a read. (And, as a reminder, we’ve partnered with Inspire on a patient-focused series that appears here once a month.)

Previously: Engaging and empowering patients to strive for better health“What might they be interested in learning from me?” Tips on medical advocacy and A wake-up call from a young e-patient: “I need to be heard”
Photo by UW Health

Health and Fitness, Public Health, Research

Study shows taking short walks may offset negative health impact of prolonged sitting

Study shows taking short walks may offset negative health impact of prolonged sitting

3046594832_cc702e6266_zWhile most of us know that sitting for prolonged periods of time can be detrimental to our health, sometimes, despite our best intentions, we’re locked into our seats by other circumstances. Perhaps you’re on a long flight with lots of turbulence and, even though our activity tracker is buzzing us to stand up, the fasten seatbelt sign forces you to ignore the alerts. Or maybe you’re at a daylong workshop or training and the opportunities to stretch your legs are few and far between. But recent research suggests that you may be able to counteract such periods of prolonged sitting with a short walk.

In the small study published in Experimental Physiology, researchers at the University of Missouri and University of Texas at Arlington compared the vascular function of a group of healthy men at the beginning of the project, after sitting for six hours and again once they completed a short walk. Results confirmed that when you sit for the majority of an eight-hour work day, blood flow to your legs is significantly reduced. The findings also showed “that just 10 minutes of walking after sitting for an extended time reversed the detrimental consequences,” lead author Jaume Padilla, PhD, said in a release.

In addition to keeping your vascular system in good working order, walking can boost your creative inspiration. A past Stanford study showed a person’s creative output increased by an average of 60 percent when he or she was walking.

Previously: Does TV watching, or prolonged sitting, contribute to child obesity rates?, More evidence that prolonged inactivity may shorten life span, increase risk of chronic disease, Study shows frequent breaks from sitting may improve heart health, weight loss and How sedentary behavior affects your health
Photo by Laura Billings

Events, Medicine X, Patient Care, Precision health, Public Health

At Medicine X, talking about owning one’s data and about patient-tailored health care

At Medicine X, talking about owning one's data and about patient-tailored health care

Matthew Might on stage - 560Health care that’s tailored to you and taking ownership of your health data were the themes of the morning yesterday at Medicine XLloyd B. Minor, MD, dean of the medical school, got the conversation rolling by defining precision health, and in a session that followed, several speakers shared stories that illustrated various aspects of this area.

In a presentation cleverly called “Can medical ‘selfies’ save us?” Steven Keating, a graduate student at MIT, began by explaining to attendees why it’s important to monitor your own health. Several years ago doctors detected a slight abnormality in Keating’s brain; they told him to “monitor it” and he took this advice to heart. He requested copies of his medical records, learned about the brain and paid close attention to how he was feeling, he explained. “Then I started smelling whiffs of vinegar,” he said.

Keating urged doctors to conduct an MRI and discovered he had a brain tumor (about the size of a lemon) that would need to be surgically removed. Keating told the audience that his interest and engagement in his own health care wound up saving his life.

Next, Claudia Williams, senior advisor for health innovation and technology at the White House Office of Science and Technology Policy, took the stage to discuss the Precision Medicine Initiative that was launched this January by President Obama’s Administration. The initiative, she said, is “about moving away from the one-size fits all approach and moving toward one that tailors [care] to your specifics.” To do this, the National Institutes of Health is now inviting people to join a cohort of one million individuals (or more) that will contribute biological samples and data to advance researchers’ understanding of heath and disease.

Many people have said they would participate in this initiative if they could get their own medical records back, Williams said. “Building trust and accountability” is a key part of this initiative, she said, noting that “If you want encrypted email data, you have the right to it.”

Having access to data from this initiative, especially genomic data, could help patients learn which drugs will be most effective for them and help people with rare diseases learn more about their illness, Williams told me during a post-panel interview.

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FDA, Health Policy, Nutrition, Pediatrics, Public Health, Research, Stanford News

How much Bisphenol A is okay?

How much Bisphenol A is okay?


A new study came out this week that happened to remind me of one of my pet peeves about certain biomedical studies — choosing an “outcome” measure that doesn’t tell you what you really want to know. The study, which was led by Stanford postdoctoral fellow Jennifer Hartle, DrPH, and estimated the amount of BPA a child is exposed to in the course of a normal school day, was great. But her description of EPA safety tests on the plastics component Bisphenol A, or BPA — done back in the 1980s — made me think back to earlier work by University of California, Berkeley biologist Tyrone Hayes, PhD.

In the 1990s, the agricultural herbicide atrazine was safety tested by exposing frogs to low doses of atrazine as they developed from eggs to tadpoles to frogs. The adult frogs didn’t die or show obvious deformities such as extra legs, so the pesticide was deemed safe. But Hayes took a closer look and, in 2002, found that even at very low levels of atrazine exposure, male frogs were producing eggs instead of sperm.

So no gross deformities if you just looked at the frogs for 30 seconds. But in fact the animals had experienced a dramatic change in their health and biology. The lesson is that, in biology, sometimes the right outcome measure is something you have to really look for. There is a lot more to the Hayes-atrazine story.

But back to the current study: Hartle and her colleagues turned their attention to national school breakfast and lunch programs, which provide nutritious meals to 30 million kids every year but also deliver small amounts of BPA, an estrogen mimic that messes with hormones. Children’s meals are disproportionately packaged in tiny one-meal containers. Those tiny packages of apple sauce and juice have a greater BPA-emitting surface area than a big carton or can for the amount of food. And school kids often eat meals off plastic trays with plastic forks and spoons. For children who eat a lot of meals at school, it can add up.

According to Hartle’s paper, appearing today in the Journal of Exposure Science and Environmental Epidemiology, the question isn’t whether the kids are getting BPA in their meals — they are — but whether any of them are getting doses of BPA that could affect their long-term health. Based on those 1980s studies, the EPA estimates that BPA is safe at chronic exposure levels below 50 μg per kilogram of body weight per day. Happily, Hartle and her colleagues found that children are getting far less than that — as little as 0.0021 μg for a low-BPA breakfast to 0.17 μg for a high-BPA lunch. Everything should be hunky-dory, right?

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Fertility, Pediatrics, Public Health, Research, Sexual Health, Stanford News, Women's Health

IUD is overlooked as excellent birth control for teens, Stanford expert says

IUD is overlooked as excellent birth control for teens, Stanford expert says


When teenagers think of birth control, the pill and condoms are likely the first to come to mind – and indeed the pill is the number one choice of contraceptive among adolescents. But according to Stanford ob/gyn expert Paula Hillard, MD, the IUD is a long-acting reversible contraception (LARC) excellently suited for adolescents. In an editorial published in the October issue of Journal of Adolescent Health, Hillard urges doctors to consider the benefits of LARCs for young women.

The IUD and other LARCs don’t require consistent, correct daily use, so they’re easier to use and less likely to fail. In addition to being extremely effective, IUDs have a high rate of satisfaction among adolescents. Some types of IUDs can also be used therapeutically for problems like heavy bleeding or cramping. LARCs are also cost-effective over time, and the initial investment is no longer a barrier in California due to the Family PACT program, which allows teens to confidentially access birth control at no cost. In addition, the Affordable Care Act mandates that contraceptive methods must be covered in most cases without a co-pay.

So what are the barriers to use? They include misconceptions and lack of information on the part of both teens and providers, as well as provider concerns about the insertion procedure in young women who haven’t given birth.

In an email, Hillard told me:

Many physicians and most adolescents are unaware that modern IUDs provide contraception that is 20 times more effective than birth control pills, the patch or the ring. IUDs are a method of birth control that is very safe, very effective, and “forgettable”.  IUDs are considered to be “top tier” contraceptive methods (along with subdermal implants and sterilization, which is not appropriate for typical adolescents) by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics.

IUD use has increased from 0.5 percent to 2.5 percent among teens 15-19 years old over the past decade. Still, around 50 percent of obstetrician-gynecologists don’t consider an IUD as a first-line contraceptive for adolescents.

Hillard closes her piece with a discussion of the challenges and importance of counseling for adolescents. Proper counseling includes giving the most effective options priority, and discussing side-effects up front (which improves adherence to contraceptive regimens, including in adults). She writes:

It remains important for us as clinicians to fight for reproductive justice and contraceptive access for all women, with the elimination of barriers including costs. In our counseling, we need to honor principles of informed consent, be aware of power differences between ourselves and our patients, be certain that our counseling is not coercive, and carefully respect our patients’ choices.

Previously: Research supports IUD use for teens, Will more women begin opting for an IUD?, Study shows women may overestimate the effectiveness of common contraceptives and Study: IUDs are a good contraceptive option for teens
Photo by Liz Henry

Big data, Cardiovascular Medicine, Health Policy, NIH, Precision health, Public Health

The diagnostic odyssey

The diagnostic odyssey

Sick-girl-christian-krohg-1881Imagine developing some odd symptoms, like a rash and an ache. You go to the doctor and she shrugs it off and says they are probably unrelated and to come back if the rash doesn’t go away. Two months later, the rash is gone but the ache is worse. You go back and she sends you to physical therapy and suggests a specialist. A month later, neither has identified a problem. The physical therapist suspects you aren’t doing the exercises and the specialist suggests you see a psychiatrist about depression. The rash is back, too. And you are tired all the time.

For some people this frustrating and scary lack of diagnosis and care can go on for years. Sometimes, doctors have overlooked a common disease that just manifests oddly. But often, the patient has a rare disease their doctors have never heard of, let alone seen.

Yesterday, NIH launched a new Undiagnosed Diseases Network, consisting of seven major medical centers where select patients with no diagnosis can go — at no cost — for the best diagnostic facilities available. Together, the seven centers, one of which is at Stanford Medicine, magnify that network of expertise to consider patients’ cases.

Euan Ashley, MRCP, DPhil, associate professor of cardiovascular medicine and of genetics at Stanford Medicine, is co-chair of the UDN steering committee. Recently, he spoke to me for a Q&A about the new network, which is open for business. And more information on the Stanford Center for Undiagnosed Diseases can be found here.

Previously: NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases and Using crowdsourcing to diagnose medical mysteries
Photo by Christian Krohg, 1881, from Wikimedia Commons

Patient Care, Public Health, Stanford News

Stanford physician provides insight on use of aspirin to help keep heart attacks and cancer away

Stanford physician provides insight on use of aspirin to help keep heart attacks and cancer away


Douglas Owens, MD, is on the panel of medical experts that just recommended a daily dose of aspiring to ward off heart attacks and cancer. But he doesn’t want people running off to the drugstore just yet.

“It is nuanced,” said Owens, director of the Center for Health Policy/Center for Primary Care and Outcomes Research, in an online story. “Our recommendation applies to people who are at increased risk of heart disease and who do not have increased risk of bleeding complications.”

The U.S. Preventive Services Task Force, an independent panel of medical experts from around the nation, said yesterday that taking aspirin can help 50- to 59-year-olds who are at increased risk of cardiovascular disease prevent heart attacks and strokes.

The panel also said that taking aspirin for at least five to 10 years could help prevent colorectal cancer. Individuals 60 to 69 may also benefit from aspirin, but the benefit is smaller than in people 50 to 59.

But Owens cautioned the new recommendations come with a caveat: A daily dose of aspirin can cause stomach and brain bleeds. People with stomach and liver problems, bleeding disorders or who are taking blood thinners, are at greater risk of experiencing the side effects of aspirin.

And, he emphasized, the new recommendations are for older adults and those with substantially elevated risk of cardiovascular disease.

“Each person has only one decision to make — whether or not to take aspirin for prevention,” said Owens. “To help individuals and their clinicians make this decision, the task force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin.”

But the task force also concluded that it doesn’t have enough to current evidence to assess the balance of benefits and harms of aspirin use in adults younger than age 50 and those older than 70.

The draft guidelines, which are open for public comment at the task force website, have provoked criticism by some cardiologists and physicians who are concerned that healthy Americans who start taking aspirin on a daily basis could expose themselves to the drug’s negative side effects, such as stomach bleeding and hemorrhagic strokes.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research.

Previously: Study shows daily aspirin could lower women’s risk of ovarian cancerCan repackaging aspirin get more people to take it daily for prevention? and New research shows aspirin may cut melanoma risk
Photo courtesy of CHP/PCOR

Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

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

Thinking about “culture” as part of global well-being

Thinking about "culture" as part of global well-being

5294003888_300b57c958_zEffective and ethical global-health initiatives involve some acknowledgement of culture – that is, they take into account local practices, beliefs, and circumstances, and they recognize that medicine is not “one size fits all.” A recent post on the blog Anthropological Observations takes this one step further, asserting that “culture” should be seen as something that is always changing, rather than a static fact to be accounted for. As a medical and cultural anthropologist pursuing a PhD, I couldn’t agree more.

Culture is often seen as a barrier to health by global-health professionals, as in “it’s not part of the local culture to visit clinics” or “cultural beliefs about how medication works make patients non-adherent to drug regimens: they take pills when they experience symptoms instead of at regular intervals.” Such observations are useful and can help adapt health initiatives to specific locales. However, this attitude can also be paternalistic and limiting because it doesn’t give people credit for being able to adapt to new information or situations.

The post’s author, Ted Fischer, PhD, a professor of anthropology at Vanderbilt University who has been advising the WHO’s project on the cultural contexts of health, writes:

A human-centered approach to health and wellbeing should adopt contemporary understandings of culture as dynamicfuture oriented, and driven by agency. We in anthropology now see culture as much more of a fluid process, a process rather than a thing. Cultural actors are always improvising, actively creating meaning out of the resources at hand.

He concludes that it is more accurate is to see culture as an opportunity for health, instead of an obstacle to it.

Previously: Exploring the benefits of pursuing anthropology and medicine, What other cultures can teach us about managing postpartum sleep deprivation, Exhibit on health and medicine among indigenous cultures opens at US National Library of Medicine and It’s a small world after all: Global health field takes off in the US
Photo by Onasil Bill Badzo

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