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Behavioral Science, Men's Health, Patient Care, Public Health, Stanford News

How can we get men to take better care of themselves?

How can we get men to take better care of themselves?

7206160814_dca6203a04_zFirst, I tried asking. Sprinkling little reminders, jokingly throughout the day. Then I started lecturing. Now, more than a month into my get-my-husband-to-the-dentist campaign, I’ve moved on to heckling, grilling, guilt-tripping and bargaining. I’m not too proud to beg.

I’ll bet my efforts sound familiar to men’s health expert Donnovan Somera Yisrael, MA. He’s a wellness educator at Stanford’s Vaden Health Center and he manages sexual and emotional health programs, often focusing on preventing or curbing risky behavior. And not going to the dentist, when you have an obvious tooth problem, counts as risky in my book.

Yisrael recently sat down for a Q&A with BeWell@Stanford to discuss his work with men. And his first sentence solidly supports my case: “I believe that the phenomenon of men neglecting their health generally as compared with women has been solidly established.” Uh, huh! And he has a few ideas about why that is:

Over the years, as I’ve dug deeper into “why people do risky things,” it has become evident that culture (broadly defined) is a huge factor in these risky behaviors, and in turn gender roles/stereotypes play powerful roles in the culture that influences our behavior.  Whether we are talking about wearing sunscreen, body image/eating disorders, alcohol/drug abuse or sexual/relationship violence, gender “rules” play a major role.

I’m up against a tough foe and eager for tips. The BeWell interviewer read my mind by asking how we can encourage the men in our lives to take better care of themselves. Yisrael’s response:

Men need to be persuaded and educated that in order to best maintain health, they must find a healthy way of asking for help. They must pursue health maintenance and self-care without concern that doing so means they are weak or not “real men.”

We must work to challenge what it means to be a guy, boy, man, father, etc. in 2015 and beyond. This issue is dealt with so brilliantly in the film The Mask You Live In by Jennifer Siebel Newsom. I recommend it to everyone.

And, in the case of the dentist, I’ll keep cajoling and perhaps add a bit of gender messaging to my arsenal: Manly men visit the dentist regularly.

Previously: To live longer, men need to embrace their femininity, new research suggests, Sex matters: Why we shouldn’t conduct basic research without taking it into account and Examining how fathers’ postpartum depression affects toddlers 
Image by Christoph Weigel via Marcel Douwe Dekker

 

Pediatrics, Public Health, Public Safety, Sleep, Stanford News

Rolling through campus and talking sleep with famed researcher William Dement

Rolling through campus and talking sleep with famed researcher William Dement

Dement in shuttle2 (RS) - croppedRenowned sleep researcher William Dement, MD, PhD, is maneuvering his way in his “Sleep and Dreams Mobile” through the Stanford University campus, en route to the Jerry House, site of some of the early, landmark studies in sleep. The house, a sprawling Mediterranean-style dormitory, housed Stanford’s Summer Sleep Camp in the 70s and 80s, where Dement and his colleagues planted the seed for some of the most important findings in the field of sleep among adults and teens.

Three years ago, the house was immortalized with a plaque and a party in which Jeff Chimenti of Grateful Dead fame performed for a crowd of 60 celebrants (the building is named after the Grateful Dead’s Jerry Garcia). Dement, now 85, says he often passed the house on his way to his ever-popular Sleep and Dreams class and thought it was important to mark the spot.

“I’d go by this house and think, ‘What happened here is the biggest thing in sleep disorders.’ So I thought something should be done to create a memorial,” he says, leaning on the banister in the living room of the house.

I’ve asked him to give me a tour of the house as background for a story on teen sleep that I’m writing for the next issue of Stanford Medicine magazine. He points to the backyard of the house, now a barren Lake Lagunita, where young volunteers played volleyball, all the while carrying a nest of wires on their heads to monitor their brain waves. Inside, researchers would monitor the youngsters’ brain activity 24 hours a day to better understand their patterns of sleep.

“The electrodes would stay on their heads because it was too difficult to take them off,” Dement explains. When the volunteers would trudge off to Tresidder Union to go bowling or do other activities, he says, “People would say, ‘Here come the trodes.’”

Dement and his colleagues followed the youngsters for ten successive summers, observing patterns in how their sleep changed as they matured.

A major goal of the study was to confirm the popular belief that as teens get older, they need less sleep. To the researchers’ surprise, they found that as the youngsters aged, the number of hours they slept stayed the same – roughly 9 hours.

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Chronic Disease, Global Health, Health Policy, Public Health, Research, Stanford News

Finding the sweet spot in public health law to regulate sugary drinks

Finding the sweet spot in public health law to regulate sugary drinks

lemonade-155663_1280Two Stanford public health law experts say one of the biggest culprits of the obesity epidemic – on top of fast foods and sedentary lifestyles – is sugary drinks. And they believe the sweet spot for public health law in curbing the adverse effects of sugar-sweetened beverages (SSBs) lies in the strategic use of measures such as higher SSB taxes, limits on advertisements targeting kids, and restrictions on soft drinks and sugar-sweetened teas and sports drinks in government institutions, such as public schools.

“Enough is already known about the promise of some legal interventions to curb SSB consumption – significant tax hikes and advertising restrictions are two good examples – to be fairly confident that they would make a difference,” says David Studdert, MD, a professor in the medical and law schools and a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research.

Studdert is the lead author of a review paper, “Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages,” which was published today in PLoS Medicine.

Studdert and senior author Michelle Mello, MD, also a professor in the medical and law schools, and co-author Jordan Flanders, a former Stanford Law School student, argue that sugary drinks are a substantial, yet preventable contributor to the global burden of obesity and associated health conditions.

A recent study in the journal Circulation linked the consumption of sugary drinks to an estimated 184,000 adult deaths each year, with more than 25,000 of those Americans. While Americans’ consumption of sugary drinks has plateaued, according to the research, about three-fourths of the deaths due to SSBs are now in developing countries. Mexico leads with 24,000 total deaths. The United States still ranks fourth, however, just behind South Africa and Morocco.

The Stanford researchers say the evidence shows that sugary drinks are contributors to the global obesity epidemic, but the appropriate reach of regulation to curtail SSB consumptions remains highly contested.

“Finding public health law’s sweet spot requires regulatory approaches that are capable both of achieving measurable improvements to public health and of winning victories in courts of law and public opinion,” they wrote.

That’s often difficult.

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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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