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Women’s Health

Cancer, Health and Fitness, Pediatrics, Public Health, Research, Women's Health

Examining the long-term health benefits for women of exercise in adolescence

Examining the long-term health benefits for women of exercise in adolescence

soccer_8.4.15Sometime around the age of five, I distinctly remember my mother telling me, “You have to play a sport. You can pick any sport you want, but you have to play a sport.” I recall this encounter vividly because I really, really didn’t want to play sports. At the time, I was the “everything-has-to-be-pink, Barbie-doll-playing, glitter-loving” type. But I picked a sport, soccer, and surprisingly stuck with it through college.

Fast forward to today, when I came across new research touting the health benefits of exercise during adolescence and was compelled to send a “Thanks, mom” text for her fitness mandate. The findings, which were recently published in the journal Cancer Epidemiology, Biomarkers & Prevention, show that women who regularly exercised as teenagers had a decreased risk of dying from cancer, cardiovascular disease and other causes during middle-age and later in life.

The study was conducted by Vanderbilt University Medical Center and the Shanghai Cancer Institute and involved the analysis of data from the Shanghai Women’s Health Study, a large ongoing prospective cohort study of 74,941 Chinese women ages 40 to 70.

Researchers defined regular exercise as occurring a minimum of once a week for three consecutive months. Lead author Sarah Nechuta, PhD, said in a release, “In women, adolescent exercise participation, regardless of adult exercise, was associated with reduced risk of cancer and all-cause mortality.”

More details about the study results:

Investigators found that participation in exercise both during adolescence and recently as an adult was significantly associated with a 20 percent reduced risk of death from all causes, 17 percent for cardiovascular disease and 13 percent for cancer.

While there have been several studies of the role of weight gain and obesity on overall mortality later in life, the authors believe this is the first cohort study of the impact of exercise during adolescence on later cause-specific and all-cause mortality among women.

The authors note that an important next step is to evaluate the role of adolescent exercise in the incidence of major chronic diseases, such as cardiovascular disease and major cancers, which will also help provide more insight into the mechanisms of disease.

Previously: Study finds teens who play two sports show notably lower obesity rates, Exercise may lower women’s risk of dementia later in life, How physical activity influences health and Stanford pediatrician discusses developing effective programs to curtail childhood obesity
Photo by Ole Olson

Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Ask Stanford Med, Cancer, Genetics, Women's Health

Genetic testing and its role in women’s health and cancer screening

Genetic testing and its role in women's health and cancer screening

14342954637_3f8c3fde77_zYears ago, when I first learned that genetic testing could help screen for some cancers, such as breast, ovarian and bone, it seemed like a no-brainer to get this testing done. Now I know better; genetic testing is a helpful tool that can help you assess your risk for certain kinds of cancer, but it’s not recommended for everyone. Senior genetic counselor Kerry Kingham, a clinical assistant professor affiliated with the Cancer Genetics Clinic at Stanford, explains why this is the case in a recent Q&A with BeWell@Stanford.

Cancer can be “hereditary” or “sporadic” in nature, Kingham says. Hereditary cancers, such as the forms of breast cancer related to a mutation in the BRCA1 or BRCA2 genes, are associated with an inherited genetic mutation. In contrast, sporadic cancers arise independent of family history or other risk factors. Since genetics testing detects gene mutations, it can only be used to help screen for the mutations that may lead to forms of hereditary cancer.

Kingham elaborates on this point, when it makes sense to get genetic testing, and what the results may mean in the Q&A:

Twelve percent of women in the U.S. develop breast cancer; it is a common disease. Yet, only five to ten percent of these women will develop breast cancer because of a hereditary gene mutation.

The best step to take prior to deciding whether or not to proceed with genetic testing is to meet with a genetic counselor. Your doctor can provide a referral. The genetic counselor will take a three generation family history, discuss the testing that might be indicated for you or a family member, and explain the risks and benefits of the testing. They also discuss the potential outcomes of the testing: whether a mutation is found, a mutation is not found, or there are uncertain results. Even when a genetic test is negative, this may not mean that the individual or their family is not at risk for cancer.

At this point you may be wondering: Why bother with genetic testing if it’s only useful for hereditary cancers and a negative test result is no guarantee you’re risk-free? Kingham’s closing comment addresses this question nicely: “I would say that your genes don’t change – they are what they are, and knowing what is in our genes can often help us learn how to take better care of our health.”

Previously: Stanford researchers suss out cancer mutations in genome’s dark spotsAngelina Jolie Pitt’s New York Times essay praised by Stanford cancer expertNIH Director highlights Stanford research on breast cancer surgery choices and Researchers take a step towards understanding the genetics behind breast cancer
Photo by Paolo

Behavioral Science, Medicine and Society, Men's Health, Mental Health, Research, Women's Health

Living with a partner boosts your health

lonely-273629_1280Partners help. They help with daily activities like dishwashing and dog-walking, but they also provide the all-valuable emotional support needed to cope with everything from a rough commute to the death of a family member.

And those without a partner, perhaps due to divorce, are more likely to suffer from depression or anxiety, according to a new study (in Spanish) in the Spanish Journal of Sociological Research. Women have it the hardest, says lead author Carlos Simó-Noguera from the University of Valencia, who is quoted in a recent Medical News Today article.

Women who have lost their partner “show poorer health than men with the same marital and cohabiting status, and are more likely to suffer from chronic anxiety and chronic depression,” Simó-Noguera said.

Men are also affected, however. Separated or divorced men “have higher risk for chronic depression than the rest of men,” he said.

The team gathered data from the European Health Survey on people between ages 25 and 64.

“The key is not marital status per se, but is found in the interaction between marital status and cohabitation status. Therefore, living with a new partner after the dissolution of marriage preserves the health of the people involved,”Simó-Noguera said.

Previously: Practicing forgiveness to sustain healthy relationships, “Love hormone” may mediate wider range of relationships than previously thought and Study offers clue as to why parents of daughters are more likely to divorce
Photo by cocoparisienne

Global Health, HIV/AIDS, Immunology, Research, Stanford News, Women's Health

HIV study in Kenyan women: Diversity in a single immune-cell type flags likelihood of getting infected

HIV study in Kenyan women: Diversity in a single immune-cell type flags likelihood of getting infected

virally infected cellsWhen it comes to immune cells, “it takes all kinds” isn’t too bad a description of what makes for the best composition of our fighting force for warding off viruses, bacteria and incipient tumors. But in a study just published in Science Translational Medicine, Stanford infectious-disease immunologist Catherine Blish, MD, PhD, and her colleagues have found, unexpectedly, that high diversity in the overall population of one particular type of immune cells strongly correlates with an increased likelihood of subsequent infection by HIV.

The investigators had figured that diversity in so-called natural killer cells, or NK cells, would be a strength, not a detriment. “Our hypothesis was wrong,” Blish (much of whose research focuses on NK cells) told me. In this study,  it was higher, rather than lower, diversity in this immune-cell population that turned out to be associated with increased HIV susceptibility.

NK cells, fierce white blood cells that help fight viruses and tumors, harbor various combinations of receptors on their surface. Some receptors recognize signs of our other cells’ normalcy, while others recognize signs that a cell is stressed — due, say, to viral infection or cancerous mutation. On recognizing their targeted features on other cells’ surfaces, an NK cell’s “normalcy” receptors tend to inhibit it, while its stress-recognizing receptors activate it.

All told, NK cells can have many thousands of different combinations of these receptors on their surfaces, with each combination yielding a slightly different overall activation threshold. At birth, our NK cells are pretty similar to one another. But as they acquire life experience – largely from viral exposure, Blish thinks – they increasingly diverge in the specific combinations of receptors they carry on their surfaces.

From my news release on the study:

In order to assess the impact of NK-cell diversity on adult humans’ viral susceptibility, Blish and her associates turned to blood samples that had been drawn during the Mama Salama Study, a longitudinal study of just over 1,300 healthy … Kenyan women. [T]he researchers carried out a precise analysis of NK cells in the women’s blood and observed a strong positive correlation between the diversity of a woman’s NK cell population and her likelihood of becoming infected with HIV.

This correlation held up despite the women’s being statistically indistinguishable with respect to age, marital status, knowledge of sexual partners’ HIV status, history of trading sex for money or goods, sexually transmitted disease status or reported frequency of recent unprotected sex.

And the NK-diversity-dependent difference in these women’s likelihood of HIV infection was huge. From my release:

Those with the most NK-cell diversity were 10 times as likely as those with the least diversity to become infected. A 10-fold risk increase based solely on NK-cell diversity is far from negligible, said Blish. “By way of comparison, having syphilis increases the risk of contracting HIV two- to four-fold, while circumcised men’s HIV risk is reduced by a factor of 2.5 or 3,” she said.

These surprising findings  could spur the development of blood tests capable of predicting individuals’ susceptibility to viral infection.

Previously: Study: Pregnancy causes surprising changes in how the immune system responds to the flu, Revealed: Epic evolutionary struggle between reproduction and immunity to infectious disease and Our aging immune systems are still in business, but increasingly thrown out of balance
Photo by NIAID

Patient Care, Pregnancy, Women's Health

“The Mama Sherpas”: Exploring the work of nurse-midwives and their collaborations with doctors

"The Mama Sherpas": Exploring the work of nurse-midwives and their collaborations with doctors

baby feetAs a doula, I’m pretty tapped into the birth community, and I’ve definitely noticed a trend toward midwifery care and low-intervention births. Indeed, a 2012 study showed that more babies than ever before are being delivered by midwives.

Now, a new film is documenting how midwives and obstetricians are increasingly teaming up to offer great maternity care. “The Mama Sherpas,” directed by Brigid Maher and produced by Ricki Lake and Abby Epstein (the same people behind the well-known “The Business of Being Born“), showcases the growing popularity of Certified Nurse Midwives (CNMs) in hospital births.

CNMs are registered nurses who have a master’s degree in midwifery and who adhere to the “woman-centered” Midwives Model of Care. According to the film, collaborative care between CNMs and obstetricians can lead to decreased C-section rates, increased VBAC rates (vaginal birth after cesarean), far lower health-care costs, and mothers who are more satisfied with their birth experience.

I had the chance to attend an advance screening, sponsored by the Nurse-Midwives of Monterey Bay, last week, and I was particularly impressed by the footage of the births of the women chronicled. While highly graphic, it provided beautiful portraits of calm and powerful vaginal births, a life-saving caesarian, and even a vaginal breech birth – which I and many in the audience of birth workers had never seen before! Afterwards, the panel of CNMs and obstetricians from hospitals in Santa Cruz and Davis called for more obstetricians to be trained in vaginal delivery of breech births, and in turning breech babies by performing external versions, so that those options can be offered to women.

Previously: In poorest countries, increase in midwives could save lives of mothers and their babiesA reminder that prenatal care is key to a healthy pregnancyUnneeded cesareans are risky and expensive and Tensions high in debate over safety of home births
Photo by Bridget Colla

Behavioral Science, Nutrition, Research, Women's Health

Adventurous eaters more likely to be healthy, new study shows

Adventurous eaters more likely to be healthy, new study shows

9044506418_142bb67dcc_zAre you willing to sample chocolate-covered silkworm pupae? What about blood sausage or, for the vegetarians among us, some shoo-fly pie (one of my personal favorites)?

If any or all of those sound tasty, or at least worth trying, then you’re probably a food neophile, aka an adventurous eater. And for you, I’m the bearer of good news: Adventurous eaters have lower body-mass indexes and are generally more conscious about healthy eating than their less adventurous diners, according to a study published recently in Obesity.

Researchers from Cornell University and the University of Vermont recruited about 500 women and had them complete a survey on their eating habits and willingness to try new things and foods. The answers shed insight into the connections between healthy habits and adventurousness:

…Adventurous eaters were less concerned that a food was easy to prepare and about its price, but more interested in cooking as a way to connect with their heritage and more likely to have friends over for dinner. Given that cooking at home is associated with lower BMI and increased consumption of healthy foods, if adventurous eaters are comfortable with foods that were harder to prepare, and often have friends over for dinner, it may be that they prepare their own food more often than non-adventurous eaters. Furthermore, eating with others versus eating alone has been associated with decreased intake in some studies. The lower concern about price of foods exhibited by more adventurous eaters is in line with characteristics of foodies, who are much more concerned with food quality than food price. Because healthy foods are often more expensive than junk foods and require preparation, adventurous eaters may be more likely to procure and prepare these types of foods than non-adventurous eaters.

The authors go on to write that the findings “have exciting practical implications” and suggest “several strategies [that] practitioners could use to help increase adventurousness.” But they acknowledge the research has several limitations, including its lack of men and definition of “adventurousness.”

Previously:  Where is the love? A discussion of nutrition, health and repairing our relationship with food, “They might be healthier, but they’ll still be junk foods”: Expert comments on trans-fat ban and Examining how food texture impacts perceived calorie content
Photo by Smabs Sputzer

Chronic Disease, Neuroscience, Pregnancy, Research, Women's Health

Women with epilepsy face elevated risk of death during pregnancy and childbirth – but why?

Women with epilepsy face elevated risk of death during pregnancy and childbirth - but why?

5987537049_ed5eff3b31_zWomen with epilepsy face a higher risk of death and a host of complications during their pregnancies than other women, according to a new study published today in the Journal of the American Medical Association Neurology.

The researchers found women with epilepsy had a risk of 80 deaths per 100,000 pregnancies, more than 10 times higher than the risk of 6 deaths per 100,000 pregnancies faced by other women.

That’s a big deal, neurologists Jacqueline French, MD, from NYU Langone Medical Center, and Stanford’s Kimford Meador, MD, write in an accompanying editorial.

“The study should sound a major alarm among physicians and researchers,” French and Meador write. But, it fails to answer an integral question, they say: Who exactly is at risk and why did the women die?

Women with epilepsy are more likely to have hypertension, diabetes and a variety of psychiatric conditions. Are those conditions responsible for the differences in death rates, the authors question.

The study also fails to distinguish between women with well-controlled epilepsy and those continuing to suffer seizures. “These are critical questions, and, without the answers, we are left in the unsatisfying position of having to advise all women with epilepsy that they may be at higher risk,” French and Meador write. The study “raises far more questions than it answers. Most women with epilepsy have uncomplicated pregnancies.”

The authors conclude: “Future studies need to confirm and build on the present findings to improve the care of women with epilepsy during pregnancy.”

Previously: Treating intractible epilepsy, Ask Stanford Med: Neurologist taking questions on drug-resistant epilepsy and How epilepsy patients are teaching Stanford scientists more about the brain
Photo by José Manuel Ríos Valiente

NIH, Pregnancy, Research, Technology, Women's Health

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

2798127284_487b56b9cf_zThese days it seems that just about anything can be recreated on a microchip. But still, I did a double-take when I read about the new way that scientists are using technology to study pregnancy: They’ve created a “placenta-on-a-chip.”

A functioning placenta is critical for a healthy pregnancy because it regulates the flow of nutrients, oxygen and waste products between the mother and fetus. It also controls the fetus’ exposure to bacteria, viruses and other harmful substances. Researchers would like to learn more about how the placenta acts as a “crossing guard” and how it can regulate the body’s traffic so well. Yet, studying the placenta is hard to do because it’s highly variable, and tinkering with the placenta is risky for the fetus.

To overcome these challenges, an interdisciplinary team led by a University of Pennsylvania researcher created a two-chambered microchip that mimics the structure and function of the human placenta. The study was published online in the Journal of Maternal-Fetal and Neonatal Medicine and is reported on in this National Institutes of Health press release:

The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

As Roberto Romero, MD, chief of the perinatology research branch at the NIH’s National Institute of Child Health and Human Development, explains in the press release, this new technology could help researchers explore how the placenta works, and what happens when it fails, in ways that couldn’t be safely done before. This, the researchers say, could lead to more successful pregnancies.

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organPlacenta: the video game, The placenta sacrifices itself to keep baby healthy in case of starvation, research showsThe placenta sacrifices itself to keep baby healthy in case of starvation, research shows and Program focuses on the treatment of placental disorders
Photo by Jack Fussell

Global Health, Nutrition, Pediatrics, Stanford News, Technology, Women's Health

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Nomfusi_counselingWhat if we could “leapfrog” over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve “mentor mothers” have been using the tablets since March. As you’ll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we’ve gotten was that a lot of the mothers being counseled said, “You know, you’ve been using phrases like ‘balanced diet’ for many years, and I didn’t quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains.” Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they’re very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention… It’s really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they’ll be used next in Guatemala… We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that’s why it’s so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal… We tried to show a variety of different fruits and vegetables without specifically showing that “this is a guava,” because a guava might not grow in other parts of the world.

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