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Big data, Cardiovascular Medicine, Patient Care, Public Health, Research, Stanford News

Widely prescribed heartburn drugs may heighten heart-attack risk

Widely prescribed heartburn drugs may heighten heart-attack risk

PrilosecHeartburn – that burning sensation in the chest that occurs when stomach acid rises up into your esophagus – has absolutely nothing whatsoever to do with the heart. People with heartburn (that’s a lot of us) are at no increased risk of developing heart disease. At least, not unless they’re taking the most commonly used class of drugs for treating heartburn.

That drug class would be proton-pump inhibitors, or PPIs, and it includes omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium) and a few more. All three are available over the counter. Although the labels direct users not to take these drugs for longer than a couple of weeks without consulting their physicians, people often pop them on a daily basis for months or years on end.

But a new PLOS ONE study, led by Stanford biomedical-informatics expert Nigam Shah, PhD, MBBS, and cardiovascular surgeon Nick Leeper, MD, shows a clear association between prior use of PPIs for heartburn and elevated risk of serious cardiovascular events including heart attacks. In a news release covering that “big data” study, which combed through nearly 3 million electronic health records to ferret out the PPI/cardiovascular-risk connection, I wrote:

… PPIs are among the world’s most widely prescribed drugs, with $14 billion in annual sales… In any given year, more than 20 million Americans – about one in every 14 – use PPIs… More than 100 million prescriptions are filled every year in the United States for PPIs, a class of drugs long considered benign except for people concurrently taking the blood thinner clopidogrel (Plavix). However, the new study upends this view: It indicates that PPI use was associated with a roughly 20 percent increase in the rate of subsequent heart-attack risk among all adult PPI users, even when excluding those also taking clopidogrel.

That increased risk was seen among younger adults (under age 45), too.

The study, in other words, found that everybody’s cardiovascular risk goes up if they use PPIs. Now, a 20 percent increase in risk may not amount to much if your baseline risk is very low to begin with (say, that of a 20-year-old woman in top physical condition with no genetic predisposition to high blood pressure or elevated cholesterol). But for many of us, especially if we’re middle-aged, a little pudgy, or struggling with hypertension or hypercholesterolemia, that 20 percent looms larger.

Importantly, people who take the second-most-widely prescribed class of drugs prescribed for heartburn, so-called H2 blockers, appear to suffer no ill effects from them in the cardiovascular-risk department, according to the study’s findings. H2 blockers, which have been around longer than PPIs, are reasonably effective.

So, why do PPIs, but not H2 blockers, cause trouble? As I noted in my release:

The study’s findings lend support to an explanation for an untoward effect of PPIs on heart-disease risk proposed by Stanford scientists a few years ago. Research done then showed that PPIs impede the production of an important substance, nitric oxide, in the endothelial cells that line all of the nearly 100,000 miles of blood vessels in an averag adult’s body.

Nitric oxide relaxes blood vessels. So it figures that chronic use of a drug that shuts down that chemical’s generation could cause chronic blood-vessel constriction and follow-on cardiovascular problems.

Read those labels, people.

Previously: How efforts to mine electronic health records are beginnning to influence critical care, New research scrutinizes off-label drug use and Damage to dead-cell disposal system may increase heart disease
Photo by John

 

Global Health, Pediatrics, Public Health, Research, Sexual Health, Stanford News

Male attitudes about sexual violence challenged by educational program in Kenya

Male attitudes about sexual violence challenged by educational program in Kenya

Your-MomentIn the slums of Nairobi, Kenya, where sexual assault is rampant, an NGO called No Means No Worldwide has made important inroads in reducing rape of girls and women. As I’ve reported previously, their empowerment program for high-school girls teaches young women that they are entitled to stop unwanted sexual advances and gives them skills to do so.

But, in a culture with persistent denigration of women, girls’ lack of empowerment is only part of the problem. Fortunately, the people at No Means No Worldwide have also been asking how to improve male attitudes and behaviors toward women.

The curriculum for these young men is centered on getting them to think about what kind of people they want to be

Today, they’re reporting success in the first study of their curriculum for adolescent boys. The set of six two-hour classes for young men in impoverished Nairobi high schools focused on getting participants to challenge prevailing ideas about of women, as a Stanford expert who worked on the study explains in our press release:

“The curriculum for these young men is centered on getting them to think about what kind of people they want to be,” said lead author Jennifer Keller, PhD, clinical associate professor of psychiatry and behavioral sciences. “It’s about really getting them invested in why they need to step up and care about violence toward women: It affects their mothers, sisters and girlfriends.”

The classes helped boys recognize the cultural normalization of violence against women, and gain skills and courage to stop it. Topics of discussion included myths about women, negative gender stereotypes, when and how to safely intervene if you see someone else acting violently toward a woman, and what constitutes consent to sexual activity:

“If you think that when you take a woman out to dinner, she owes you something, you may believe that consent is different than it actually is,” Keller said. “The instructors and young men talked about understanding what true consent is and how to get that consent.”

At the end of the classes and at follow-up nine months later, the boys and young men who participated had significantly better attitudes and beliefs about women than a control group who participated in a life-skills class. Members of the intervention group also were more likely to step in to try to stop violent behavior they saw toward women. In the future, the research team plans to test whether the program also improves young men’s behavior in their own relationships with girlfriends.

Previously: Rape prevention program in Kenya attracting media attention, funding, Working to prevent sexual assaults in Kenya and Empowerment training prevents rape of Kenyan girls
Photo of participants in the “Your Moment of Truth” program by Duthie Photography, courtesy of No Means No Worldwide

Big data, Events, Medicine and Society, Precision health, Public Health, Stanford News

How Stanford Medicine will “develop, define and lead the field of precision health”

How Stanford Medicine will "develop, define and lead the field of precision health"

15313-a-healthy-young-woman-stretching-outdoors-pvPrecision health was the theme of the day here on Friday, with Dean Lloyd Minor, MD, describing to a standing-room-only crowd at a Town Hall event how Stanford Medicine will continue to lead and excel in this area.

Minor, along with colleagues Amir Dan Rubin, president and CEO of Stanford Health Care, and Christopher Dawes, president and CEO of Stanford Children’s Health, offered faculty, staff and students a glimpse of the future of precision health here.

The vision has seven primary tenets, Minor explained:

  • Stanford Medicine will lead a transition from diagnosis and treatment toward prediction and prevention
  • It will develop new scientific advances and paradigms
  • It will bridge the gap between basic scientific research and clinical care
  • It will transform clinical care to emphasize compassion and quality
  • It will deliver quality health care at excellent value
  • It will train the biomedical leaders of today and tomorrow
  • It will develop and share its advances globally

Stanford Medicine’s focus in this area came about as part of a strategic planning process and taps Stanford’s strengths in data science, fundamental bioscience research and specialized care in areas such as cancer, Minor said. It also capitalizes on the nationwide focus on precision medicine, which took center stage in January when President Barack Obama introduced a Precision Medicine Initiative to establish a national system capable of delivering treatments tailored to individual patients.

Precision health includes precision medicine but boldly expands its focus. Precision medicine provides personalized treatments once illness occurs; in contrast, precision health aims to prevent and predict illness, maintaining health and quality of life for as long as possible. Precision health draws on data science tools to translate volumes of research and clinical data into information patients and doctors can use.

A recent Inside Stanford Medicine article described the benefits of such widespread access to data:

Physicians and researchers can better predict individual risks for specific diseases, develop approaches to early detection and prevention, and arm clinicians with information to help them make real-time decisions about the best way to care for patients.

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Health and Fitness, Mental Health, Public Health

Not just for kids: A discussion of play and why we all need to do it

Not just for kids: A discussion of play and why we all need to do it

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All work and no play makes everyone a dull boy. Recognizing this, the California-based National Institute for Play focuses on shining light on the importance of the practice of play in everyday life. BeWell@Stanford recently spoke with its founder and president, Stuart Brown, MD, who here talks about play’s role in human function:

Play is a survival drive that is necessary for adaptation, flexibility and social learning. Play helps us belong in the community, develop the ability to suppress unwanted urges, and regulate our emotions.

He goes on to talk about play’s importance for adults in particular:

Most people tend to think that play is confined primarily to childhood, and my sense of the paleo-anthropological design of being human is that we are neotenist creatures.  We are designed to be juveniles until we die and that is part of our primate design as Homo sapiens. When we honor that design, we tend to be less violent, more communal and healthier.

Taking time off to play does not mean you shirk your responsibilities, or that you aren’t a good parent or a good productive citizen. In fact, it’s just the opposite: your level of agitation drops when you get playful, which tends to increase perseverance and mastery. Play has a real payoff.

Brown also speaks about the importance of play in childhood development, and how we can learn about play’s impact on behavioral patterns from other animals such as social rats. Lastly, he provides advice as to how to reconnect with the childlike fun of play and incorporate it into adult life.

The piece is an intriguing conversation that might make readers slow down, think about their life, and remember that fun isn’t just for kids.

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: Workaholics vs work engagement: The difference is playExercise and relaxation techniques may help ease social anxiety, study finds and Exercise may boost heart failure patients’ mental and physical health
Photo by kilgarron

FDA, In the News, Nutrition, Public Health

FDA changes regulation for antibiotic use in animals

FDA changes regulation for antibiotic use in animals

8756885685_0ebc1c75ce_zLivestock can no longer be fed antibiotics “preventatively” or to help them grow bigger. The FDA has ruled to change their regulations of how drugs can be administered to food animals, including those used to make animal feed.

After this ruling, livestock producers can only use antibiotics to treat animals that actually have an infection, and only under the supervision of a veterinarian. These new rules are aimed at decreasing the risk of developing drug-resistant bacteria, sometimes called “super bugs.” According to the Centers for Disease Control and Prevention, drug-resistant bacteria cause 2 million illnesses and about 23,000 deaths in the United States each year.

According to an article from The Hill, the Department of Health and Human Services is moving forward with new regulations for hospitals, and President Obama has called on government cafeterias to prioritize meat that has been raised with responsible antibiotic practices.

Previously: Paradox: Antibiotics may increase contagion among salmonella-infected animals, and Healthy gut bacteria help chicken producers avoid antibiotics
Photo by Chiot’s Run

In the News, Public Health, Research, Sleep

New recommendation: Adults need at least 7 hours of sleep each night

New recommendation: Adults need at least 7 hours of sleep each night

17376155493_6588ac3dcc_zHow much sleep is enough, and is it possible to sleep too much? Until recently, there wasn’t much consensus on sleep guidelines for adults. Now, a new set of recommendations agreed upon by a team of sleep experts helps put these questions to rest: Adults need a minimum of seven hours of sleep each night, preferably more.

These new recommendations, published yesterday in the journal SLEEP (subscription required), were developed by 15 sleep experts in a consensus panel assembled by the American Academy of Sleep Medicine and the Sleep Research Society. One of the panelists was Clete Kushida, MD, PhD, medical director of the Stanford Sleep Medicine Center, and I reached out to him to learn more about their work.

The goal of the panel was to take stock of existing studies on sleep and use the information to come to a consensus on a recommended sleep amount, he told me. To do so, “the panel reviewed and evaluated 5,314 scientific articles on sleep over a 12-month period.”

After examining the literature, the panel concluded that “sleeping six or fewer hours per night is inadequate to sustain health and safety in adults, and [they] agreed that seven or more hours of sleep per night is recommended for all healthy adults.”

Perhaps the most interesting aspect of the recommendations is that they don’t place an upper limit on the amount of sleep. Nine hours is often cited as the maximum amount of time an adult should sleep, yet these new guidelines state that it’s okay for adults to sleep more if needed.

I asked Kushida why the new recommendations do away with the nine-hour sleep limit. Simply put, he said: “Sleeping more than nine hours per night on a regular basis may be appropriate for young adults, individuals recovering from sleep debt, and individuals with illnesses.”

The take-home message is that adults can be healthy on seven hours of sleep each night, but this amount of rest is not ideal. It’s better for adults to sleep more if possible, especially when they’re young, sleep deprived or ill.

Previously: Exploring the history and study of sleep with Stanford’s William DementStanford docs discuss all things sleepBBC study: Oh, what a difference an hour of sleep makes, Study shows seniors sleep better than younger adultsExploring the effect of sleep loss on health and What are the consequences of sleep deprivation?
Photo by Craig Sunter

Cancer, Dermatology, FDA, Health Policy, In the News, Public Health

Experts call on FDA for a “tanning prevention policy”

Experts call on FDA for a "tanning prevention policy"

6635416457_a62bfeb09d_zIndoor UV tanning beds are known carcinogens that are responsible for many cases of skin cancer, which is the most commonly diagnosed form of cancer in the U.S. A recently issued Call to Action to Prevent Skin Cancer from the U.S. Surgeon General states that “more than 400,000 cases of skin cancer [8% of the total], about 6,000 of which are melanomas, are estimated to be related to indoor tanning in the U.S. each year” while “nearly 1 out of every 3 young white women engages in indoor tanning each year,” making indoor tanning a serious public health issue.

In a JAMA opinion piece published yesterday, Darren Mays, PhD, MPH, from the Georgetown University Medical Center‘s Department of Oncology, and John Kraemer, JD, MPH, from Georgetown’s School of Nursing and Health Studies, argued that the FDA needs to step up its regulatory approach and restrict access to this technology – due to its limited therapeutic benefits and known damaging effects.

In 2011, California was the first state to ban access to indoor UV tanning beds to minors. The authors assert that “state-level policies restricting a minor’s access to indoor tanning devices are effectively reducing the prevalence of this cancer risk behavior among youth,” but argue that regulation at the federal level is in order:

Like tobacco products, a national regulatory framework designed to prevent and reduce indoor tanning could reduce public health burden and financial costs of skin cancer. …from a public health perspective the indoor tanning device regulations are not commensurate to those of other regulated products that are known carcinogens with very little or no therapeutic benefit.

However, the likelihood of this regulation taking place is questionable:

FDA did not leverage its authority last year to put a broader regulatory framework in place, which could have included a national minimum age requirement and stronger indoor tanning device warning labels… Critical factors seem to be aligning for such policy change to take place, but additional momentum is needed to promote change at a national scale. The US national political environment makes more expansive regulation by either FDA or Congress seem unlikely in the near future.

The authors concluded with a call for organizations other than governments to help build momentum on toward a “national indoor tanning prevention policy.” For example, they said, universities could implement “tan-free” campus policies similar to the “tobacco-free” campaign.

Previously: More evidence on the link between indoor tanning and cancers, Medical experts question the safety of spray-on tanning productsTime for teens to stop tanning?, Senator Ted Lieu weighs in on tanning bed legislation and A push to keep minors away from tanning beds
Photo by leyla.a

Behavioral Science, Health and Fitness, Obesity, Public Health, Sleep

How insufficient sleep can lead to weight gain

How insufficient sleep can lead to weight gain

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I don’t think I’ve ever met a person who hates sleep and can’t wait to get less of it. Yet, even though most people want more sleep and know it’s important for their health, few people get as much shut-eye as they need. If you’re one of the many who needs a bit more motivation to get to bed earlier, a recent BeWell@Stanford article on how sleep can affect your weight may do the trick.

In the Q&A, sleep expert Emmanuel Mignot, MD, PhD, director of the Stanford Center for Sleep Sciences and Medicine, explains why and how insufficient sleep can increase your risk of weight gain:

It is very clear that if you’re not sleeping enough, you’re putting yourself at risk for increasing your weight.  If you sleep less than six hours a night, you’re likely to have a higher BMI (body mass index). Longitudinal data — and the evidence is quite strong — shows that if you sleep more over time, you’ll lower your BMI, which correlates with weight reduction.

In the first centuries of human life on earth, if humans weren’t sleeping they were probably looking for food or fleeing a predator. Not sleeping enough was a sign that we were in danger or that we were under stress. When we are sleep deprived, we feel hungry. Data indicates that if you sleep less, you eat more, and it disrupts your hormones. This problem is magnified in today’s world because food is too available!

Mignot also discusses the top reasons why people sleep so little, the importance of naps, and how being sleep-deprived skews our perception of doing and performing well. “[W]e have to make sure we don’t burn the candle at both ends, Mignot said. “Sleeping brings creativity, productivity and the ability to perform at a higher level.”

The piece is a quick, and informative, read.

Previously: Exploring the history and study of sleep with Stanford’s William Dement“Father of Sleep Medicine” talks with CNN about what happens when we don’t sleep wellStanford doc gives teens a crash course on the dangers of sleep deprivation, Narcoleptic Chihuahua joins Stanford sleep researcher’s family and More evidence linking sleep deprivation and obesity
Photo by Goodiez

Behavioral Science, In the News, Mental Health, Public Health, Research

Green roofs are not just good for the environment, they boost productivity, study shows

Green roofs are not just good for the environment, they boost productivity, study shows

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Boosting productivity can be as simple as looking at a grassy roof for just forty seconds, conclude researchers at the University of Melbourne. It’s been shown that contact with nature can relieve stress and improve concentration and mood, but this is one of the first studies to see if novel urban manifestations of greenery can have the same effect.

The study, published in the Journal of Environmental Psychology and led by Kate Lee of Melbourne’s Green Infrastructure Research Group, involved giving students a mindless computer task to do in a city office building with a brief break spent looking at a picture of either a lush green roof or bare concrete roof. Those who looked at the green one made significantly fewer mistakes and showed better concentration in the second half of the task. The study was based on the idea of “attention restoration” through microbreaks lasting under a minute, which happen spontaneously throughout the work day.

Lee is quoted in a press release:

We know that green roofs are great for the environment, but now we can say that they boost attention too. Imagine the impact that has for thousands of employees working in nearby offices… It’s really important to have micro-breaks. It’s something that a lot of us do naturally when we’re stressed or mentally fatigued. There’s a reason you look out the window and seek nature, it can help you concentrate on your work and to maintain performance across the workday.

Certainly this study has implications for workplace well-being and adds extra impetus to continue greening our cities. City planners around the world are switching on to these benefits of green roofs and we hope the future of our cities will be a very green one.

She and her team next plan to see if city greening makes people more helpful and creative, as well as productive.

Previously: Nature is good for you, right? and Out of office auto-reply: Reaping the benefits of nature
Photo by Jeremy Reding

Global Health, LGBT, Public Health, Public Safety, Women's Health

Advocating for the rights of women and LGBT individuals in the developing world

Advocating for the rights of women and LGBT individuals in the developing world

Randy Barry - smallLast spring, I traveled to Washington, D.C. for my first experience as a citizen-activist, lobbying in Congress for the rights and well-being of women and LGBT individuals in the developing world. I recently returned there to see some of the impact of that work – crucial new appointees, new legislators in support of key issues and new words of encouragement from both sides of the political aisle.

I visited Washington as part of a 170-person delegation from the American Jewish World Service (AJWS), an international organization that promotes human rights and seeks to end poverty in developing countries. Our goal was to advance several initiatives, including passage of the International Violence Against Women Act, and changes to ensure that U.S. foreign contracts and foreign aid programs do not discriminate against LGBT individuals.

I was thrilled to hear a talk by Randy Berry, the State Department’s first-ever Special Envoy for the Human Rights of LGBT Persons, who assumed the new post in February. Just a year ago, AJWS had made the appointment of a special envoy one of its priority issues, and many of us, myself included, had met with our Congressional representatives to push for the position. I had been motivated by my experiences as an AJWS Global Justice Fellow in Uganda in 2014, when we met with LGBT activists who were living in a climate of terror because of the country’s impending anti-gay law. We heard stories of people who had been raped, beaten, harassed, evicted from homes and jobs and subjected to summary arrest.

I realized it was important to make LGBT rights a priority issue for U.S. foreign policy. Berry, the new U.S. envoy, said AJWS had been a “prime mover” in the creation of his new office – gratifying news indeed. He said he views LGBT rights as a “core human rights issue.”

“We are talking about equality, and it should go hand-in-hand with what we are doing in gender equality and in the disabled community,” he told us. “One of the most disturbing elements of discrimination is that it’s the first step to denying one’s humanity.”

He acknowledged that he has a daunting job ahead; while the U.S. is making swift progress on gay rights, these rights are just as swiftly being eroded in other parts of the world. Nearly 80 countries now criminalize same-sex behavior, with penalties that include death or life in prison. Yet the fact that the U.S. has made so much progress in recent decades suggests it’s possible to change the climate elsewhere as well, he said.

“Who would have dreamed 20 years ago that we would be where we are today in the United States,” he said. “I am sitting here today with the support of the State Department, the president and members on both sides of the aisle.”

We also saw progress on the International Violence Against Women Act, which would make ending violence against women worldwide a top U.S. diplomatic and development priority. Violence against women and girls is alarmingly pervasive, with as many as one in three being beaten, coerced into sex or subjected to other abuse in her lifetime.

The legislation was reintroduced in the House of Representatives in March with a record 18 co-sponsors, including many more Republicans than in the past. On the morning of our lobbying visits, we heard from seven Members of Congress, including Chris Gibson (R-NY), Richard Hanna (R-NY) and Lee Zeldin (R-NY), all of whom expressed strong support for the bill. David Cicilline (D-RI) described a trip to Liberia in which he met a group of young girls who had been subjected to “hideous, indescribable sexual violence.”

“It made me realize we need to do everything we can to change the lives of these young girls,” he told us.

I couldn’t agree more.

Previously: Stanford study shows many LGBT med students stay in the closetChanging the prevailing attitude about AIDS, gender and reproductive health in southern AfricaLobbying Congress on bill to stop violence against womenPreventing domestic violence and HIV in Uganda and Sex work in Uganda: Risky business
Photo of Randy Berry by Ruthann Richter

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