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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

Cardiovascular Medicine, Research, Stanford News, Stem Cells

Tension helps heart cells develop normally, Stanford study shows

Tension helps heart cells develop normally, Stanford study shows

heart_newsTension might not be fun for us, but it looks like it’s critical for our hearts. So much so that without a little tension heart cells in the lab fail to develop normally.

This is a finding that took a mechanical engineer looking at a biological problem to solve. For many years now scientists have been able to mature stem cells into beating clumps of cells in the lab. But although those cells could beat, they didn’t do it very well. They don’t produce much force, can’t maintain a steady rhythm and would be a failure at pumping actual blood.

Beth Pruitt, PhD, a Stanford mechanical engineer, realized that in our bodies heart cells are under considerable tension, and thought that might be critical to how the cells develop.

She and postdoctoral scholar Alexandre Ribeiro started investigating how heart cells matured in different shapes and under different amounts of tension. They found a combination that produces normal looking cells with strong contractions.
The work could be useful for scientists hoping to replace animal heart cells as the gold standard for identifying heart-related side effects of drugs. Those cells are quite different from our own and often fail to detect side effects that could damage hearts in people taking the drug.

In my story about the work, I quote Ribeiro saying, “We hope this can be a drop-in replacement for animal cells, and potentially instead of having to do individual recordings from each cell we could use video analysis.”

Previously: A new era for stem cells in cardiac medicine? A simple, effective way to generate patient-specific heart muscle cells and “Clinical trial in a dish” may make common medicines safer, say Stanford scientists
Photo by Alexandre Ribeiro

Research, Stanford News, Women's Health

Measuring how military service affects women’s longevity and overall health

Measuring how military service affects women's longevity and overall health

16044566446_77b89745de_zDespite the large numbers of women who serve in the military, there is a dearth of information about their postmenopausal health risks and how military service might impact their longevity. Now comes a study of more than 3,700 female veterans, led by a Stanford-affiliated psychologist, which is the first to examine the postmenopausal health of women veterans who participated in the Women’s Health Initiative (WHI) and who, given their ages, likely served in World War II or the Korean War.

The study, which appears online in the journal Women’s Health Issues, shows these women have higher all-cause mortality rates than non-veterans, even though their risks for heart disease, cancer, diabetes and hip fractures were found to be the same.

“The findings underscore the salience of previous military service as a critical factor in understanding women’s postmenopausal health and mortality risk, and the value of comparing women veterans to appropriately selected groups of non-veteran women, rather than benchmarking their health against that of the general public. It also reminds us of the importance of including women veterans in research,” said Julie Weitlauf, PhD, the study’s lead author and a clinical associate professor (affiliated) of psychiatry and behavioral sciences at the School of Medicine.

The Women’s Health Initiative is one of the most comprehensive research initiatives undertaken on the post-menopausal health of women, involving more than 160,000 women, including nearly 4,000 veterans.

Women can only serve in the military if they are deemed to be in good health, and military service stresses physical activity and many other elements of a healthy lifestyle, thus contributing to the concept of a “healthy soldier effect,” Weitlauf said. That explains why research typically shows that veterans, including women, have better health and lower mortality risk than non-veterans from the general public, she said. While the women in the study, most of whom who were likely military nurses, were probably very fit and healthy during their time of service, this effect may not be sustained throughout their lifetimes.

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Medical Education, Medicine and Society, Stanford Medicine Unplugged

Learning how to learn medicine

Learning how to learn medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

A few weekends ago, I saw a patient with bloated shins at our school’s free clinic, and I marked in my notes that she exhibited “peripheral edema,” an esoteric phrase that means little to those outside of the medical community. That experience only highlighted the tendency in medicine to inflate common bodily functions into opaque medical jargon. Its use can be frustrating for patients who are trying to understand their illness — and at times even for the uninformed medical student who is trying to learn about his patient.

As medical students, we feel as if we’re training to become glorified breathing-and-walking medical dictionaries

It doesn’t help that the list of jargon is endless. Itchiness becomes pruritus. Listening to the body’s internal noises condenses into auscultation. When you urinate, you’re really micturating, and if you have trouble doing so, you also have dysuria. Having a rash turns into having erythema. An abnormally large liver translates to hepatomegaly. An unhealthy level of cholesterol is labeled as hyperlipidemia. Chest pain is referred to as angina. Even the simple act of sweating is termed hidrosis. For vast majority of the first two years of medical school, we spend our time learning this vast and complex language that seems to have a word or phrase for every single bodily event — health and unhealthy, normal and abnormal.

But that is what medical training and much of medicine are — making observations of the human body and noting them with memorized jargon. And once we have acknowledged all the relevant observations, we connect the dots to form a story. If we’re astute and lucky enough, that story will end with the name of the disease along with its possible treatments and cures.

One would think that in order to provide adequate treatment to our patients, our education would possess more depth into the mechanisms behind drugs and diseases. But we only graze their physiological and molecular basis. It isn’t a reflection on our lack of curiosity. Rather, unfortunately, medicine is still limited by our dearth of knowledge. Despite the trillions of dollars poured into research, our advances in human genomics, and the fancy gadgetry, the human body remains a stubborn black box. Most of the time, all we can do is look at the inputs and outputs. Take aspirin, for example. Cardiologists recommend patients with a history of cardiovascular disease to take a baby aspirin every day to reduce their chances of a heart attack. But how this drug — first discovered by the ancient Egyptians — leads to decreased risk of death still remains a mystery.

These days, patients can sequence their entire genomes at a speed and price that was unimaginable a decade ago. They can scan their entire bodies to produce images with unprecedented detail. But in a unexpected twist, in order to confirm a diagnosis, physicians may still resort to the primitive practice of taking a gross piece of tissue from the patient and viewing it under a compound microscope, a contraption invented nearly half a century ago. Our expensive technology has been only able to expand our ability to observe and has done little peel back the veil covering the underlying mechanisms of human diseases.

But that is not to say that we should lose faith in medicine and underestimate the importance of labeling our observations. For the patient, putting a name on an abnormality, even if there may be no treatment available, can be comforting and give hope for recovery. For the caretaker, being able to identify an important physical finding can point to a set of suspect diseases. For my patient, leg swelling strongly suggested that he might be suffering from congestive heart failure.

As medical students, we must feel as if we’re training to become glorified breathing-and-walking medical dictionaries. Make no mistake — we are. We’re learning to make observations, note them down, and make sense of them down the road. And we shouldn’t underestimate the power of this process. It is at the core of the scientific process, and it’ll be how we ultimately serve our patients.

Steven Zhang is a second-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail.

Photo in featured entry box by Patrick

Health Policy, NIH, Research, Science Policy, Stanford News

NIH tries to reduce the gray in the grant pool

NIH tries to reduce the gray in the grant pool

This 45-second animation vividly illustrates the funding crisis that young scientists face as they work to launch their research careers: For the last three decades, large NIH grants have increasingly been awarded to older investigators.

“The average age of first-time, R01-funded investigators who have PhDs remains 42, even after seven years of policies at NIH to increase the numbers of new and early-stage investigators,” said Robin Barr, director of the NIH’s Division of Extramural Activities, in a recent editorial on the NIH website.

But there is hope on the horizon, as the NIH rolls out a series of funding mechanisms that aim to give new investigators a leg up. I recently wrote about one such program, the KL2 mentored career development award, and an inspirational Stanford physician-researcher, Rita Hamad, MD, MPH, who is taking full advantage of it.

Hamad is interested in studying the cause-and-effect relationships between poverty and health. The KL2 program helps Hamad’s research through salary support, mentoring, pilot grants and tuition subsidies. In just two years, she has produced actionable data that can be used by policymakers and by health-care providers to improve the overall health of populations, including a study exploring the impact of the earned-income tax credit on child health in the United States. It will be published this fall in the American Journal of Epidemiology.

Previously:NIH funding mechanism “totally broken,” says Stanford researcher, NIH director on scaring young scientists with budget cuts: “If they go away, they won’t come back” and Sequestration hits the NIH – fewer new grants, smaller budgets
Animation by the NIH

Infectious Disease, Microbiology, Research, Stanford News

Why C. difficile-defanging mouse cure may work in people, too

Why C. difficile-defanging mouse cure may work in people, too

CdiffI wrote a news release last week about a study just published in Science Translational Medicine. The study, despite it having been conducted in mice, not humans, received a fair amount of coverage – by The Washington Post, Yahoo!, Fox News, NBC, CBS and Reuters, among other places – and deserved the attention it got. It demonstrated the efficacy of a small-molecule drug that can disable the nasty intestinal pathogen C. difficile without killing it – and, importantly, without decimating the “good” bacteria that populate our gut by the trillions.

That’s a big deal. If you want to see a lot of ugly weeds pop up, there’s no better way to go about it than letting your lawn go to hell.

C. difficile – responsible for more than 250,000 hospitalizations and 15,000 deaths per year in the United States and a $4 billion annual health-care tab in the U.S. alone – is typically treated by antibiotics, which have the unfortunate side effect of wiping out much of our intestinal microbe population. That loss of carpeting, ironically, lays the groundwork for a dangerous and all-too-common comeback of C. difficile infection.

A question worth asking about this study, conducted by what-makes-pathogens-tick expert Matt Bogyo, PhD, and a team of Stanford associates: Why should we think that what works in mice is going to work in people?

The only sure answer isn’t a torrent of language but a clinical trial of the drug, ebselen, in real, live people with C. difficile infections or at risk for them. (Bogyo has already started accumulating funding to initiate a trial along those lines.)

But there’s also reassurance to be drawn from the fact that ebselen isn’t an entirely exotic newcomer to the world of medical research. As I noted in my release:

Bogyo and his associates focused on … ebselen because, in addition to having a strong inhibitory effect, ebselen also has been tested in clinical trials for chemotherapy-related hearing loss and for stroke. Preclinical testing provided evidence that ebselen is safe and tolerable, and it has shown no significant adverse effects in ensuing clinical trials.

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Events, Medicine X

Stanford Medicine X, in pictures

Stanford Medicine X, in pictures

We’ve written extensively over the last six days about Stanford Medicine X and its sister conference, Stanford Medicine X | ED; you can see all the coverage in this category. And now, one last look at what transpired here.

More photos of Stanford Medicine events, people and places can be found on Instagram

Photos courtesy of Stanford Medicine X

Research, Science, Stanford News

#NextGreatDiscovery: Exploring the important work of basic scientists

#NextGreatDiscovery: Exploring the important work of basic scientists

Today, Stanford is launching a digital series, called #NextGreatDiscovery, to share the stories of some of the scientists doing groundbreaking basic research here. Through photographs and short videos, followers will get a taste of the work of these grad students, postdocs and professors – in fields ranging from computational structural biology to genetics to immunology – and hear about how important it is that this work continues. After all, basic science not only advances knowledge but has the potential to lead to great biomedical innovations.

Our series comes at a time where national funding for research is critically low, and some investigators are opting to leave academia in favor of industry positions that may not support fundamental research. What would we lose if more of these great minds chose different paths? What would go undiscovered? It’s something to keep in mind as you read this feature story, view our photos on Instagram, and follow #NextGreatDiscovery on Twitter.

Previously: The value of exploring jellyfish eyes: Scientist-penned book supports “curiosity-driven” research, Basic research underlies effort to thwart “greatest threat to face humanity” and Funding basic science leads to clinical discoveries, eventually
Photo by Peter van Agtmael/Magnum Photos

Chronic Disease, Events, Medicine X, Sexual Health

A discussion of intimacy and illness at Medicine X: “Embrace yourself and embrace your normal”

A discussion of intimacy and illness at Medicine X: "Embrace yourself and embrace your normal"

21735972186_ef347da42d_zMedicine X is well known for shining a light on dark feelings and difficult-to-talk about topics, as well as being a safe place to hold such conversations within the health-care community. Last year, a key theme of the conference was addressing the relationship of mental and physical health. The discussion of treating the whole person, not just their disease or symptoms, was expanded this year to include sexual health.

In a Sunday session exploring intimacy and illness, Medicine X executive board member and well-known patient advocate Sarah Kucharski bravely spoke about her own relationship experiences as she led the discussion. “Illness completely changes one’s relationship with one’s body. It’s the idea of feeling broken. Of feeling you’re a burden. Of feeling not sexy,” she said.

Diagnosed at the age of 31 with intimal fibromuscular dysplasia, Kucharski has undergone multiple surgeries, resulting in permanent scarring of her body. She shared with the audience her anxiety over romantic partners seeing the scars for the first time during intimate moments and suddenly having to answer their questions. She said, “To expose that visual reminder of my health, maybe it’s too much. Maybe it’s forcing me to be who I really am instead of enjoying a certain escapism,” she said. “It takes away my opportunity to talk about my health.”

Many patients and caregivers can relate to Kucharski’s struggle with intimacy and illness. She conducted an informal online survey in preparation for the conversation. The biggest finding? There is no normal. But this reality often isn’t conveyed in doctor-patient conversations. For patients who undergo a medical procedure or women who give childbirth, physician advice is usually to wait for a certain period of time until they are physically healed and then resume sexual activity “when they feel ready.”

Matthew Dudley, MD, a hospitalist who works in Alaska, said one of the factors driving the lack of doctor-patient communication about sexual health is that “health care in this country is reactionary.” He added, “We end up dealing with this emergent actions, and so you don’t get time to sit down and talk about these issues.”

In addition, pointed out panelist Alexandra Drane, the medical education curriculum at many institutions doesn’t dedicate enough time to sexual health issues. Beyond expanding the training of future doctors, she advocated for “normalizing the conversation” about intimacy. “This is a topic that most people really, really want to talk about. There needs to be training [for doctors] on how to have these conversations and how to make someone feel safe and normal,” said Drane, co-founder of the Eliza Corporation.

But more training for medical students may not to be the silver bullet that resolves the problem, say some panelists. Dudely said he received a full two weeks of training on sexual health issues during medical school. “I thought at my school we did a good job,” he said, “But in the day to day it gets lost. We need patients to go to their doctors and say, ‘I want to know more about this.’ As our culture becomes more open about these issues, I think it will come to the forefront.”

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Medical Apps, Medical Education, Medicine X, Patient Care, Technology

A look at using smartphone apps for patient-centered research

A look at using smartphone apps for patient-centered research

The usefulness and power of mobile apps in research was one of the last topics at Medicine X yesterday. One of the panelists in the late-afternoon “Clinical research in the palm of your hand” session was Stephen Friend, MD, PhD, who told attendees how willing most patients are to share their health data for science. “If you give someone a choice and ask them, ‘Do you want your data to be looked at by qualified researchers around the world?'” people usually say yes, reported Friend, president of the nonprofit biomedical research organization Sage Bionetworks.

Panelist Michael McConnell, MD, professor of cardiovascular medicine at Stanford, can certainly attest to this: He’s principle investigator of a study, MyHeart Counts, that has seen tens of thousands of users offer up their heart-related data for study.

Stanley Shaw, MD, assistant professor of medicine at Harvard, shared thoughts on how having an ongoing data connection with patients can feel for a physician-researcher: “I had a surprising sense of immediacy when I started looking at… data. We had people upload information such as their blood glucose levels. You can see people cranking the level down day by day over weeks or months. It really does remind you of that pact between an individual and their physician and that it’s a privilege to take care of patients. It’s very exciting.”

Also exciting is when apps are shown to have a direct impact on a patient’s care or quality of life. Friend gave the example of a program that reduced emergency room visits and hospitalizations by allowing providers to keep track of patients via an app. “If someone has been holed up in their house for four days, we can send someone to find out why,” he said. And if a patient stops taking a daily walk, that provides the medical team with clues as well.

Of course, not every patient— especially one with a chronic illness — is going to bother logging onto an app to share data every day, said Yvonne Chan, MD, PhD, assistant professor of emergency medicine at Mount Sinai Hospital. “We talk about access and engagement,” she said, but different types of users are going to engage with an app differently. For example, asthma patients with severe, poorly-controlled baseline disease are easy to engage and keep — especially if they happen to own a smart phone. Such patients are highly motivated to better control their disease and stay out of the emergency room.

“But people with minor disease that’s well controlled, maybe they have better things to do,” she said. Apps could be designed to engage different patient populations; maybe that asthma app could have a mode that included more entertainment for patients who are less sick and less motivated.

More news about the conference is available in the Medicine X category

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