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Infectious Disease, Public Health, Research

Could self-administered flu vaccine patches replace injections?

Could self-administered flu vaccine patches replace injections?

vaccine_patchLike many of us, I loathe getting shots. But after a serious case of the flu while on vacation led to an emergency room visit, I began to overlook my fear of needles and now get an annual flu shot. Still, I was interested to read about new research showing that self-administration of flu vaccines with microneedle patches, which can be painlessly pressed into outer layers of the skin, may one day be feasible.

In the study, researchers tested if individuals could successfully apply a prototype vaccine patch to themselves. Participants, none of whom had any previous experience with microneedle patches, were given instructions on how to apply them. Those involved in the study applied three patches to themselves and had a member of the research team apply a fourth. Individuals also received an injection of saline with a conventional hypodermic needle.

A release describes the study results and speculates on the significance of the findings for boosting vaccine rates:

The researchers evaluated how well the volunteers were able to self-administer the microneedle patches. After the subjects pressed the patches into their skin, the researchers applied a dye to highlight the tiny holes made by the microneedles. By photographing the administration sites and counting the number of holes, they were able to assess the accuracy of the application.

“We found that everyone was capable of administering a microneedle patch appropriately, though not everyone did on the first try,” [said Mark Prausnitz, PhD, a professor in the School of Chemical and Biomolecular Engineering at the Georgia Institute of Technology].

Some of the subjects used an applicator that made a clicking sound when sufficient force was applied to the patch. Use of that feedback device improved the ability of subjects to correctly apply patches and virtually eliminated administration mistakes.

During the study, the volunteers were asked if they planned to receive a flu vaccination in the next year and if their intent to be vaccinated would change if it could be done with the patch. The percentage saying they’d be vaccinated jumped from 46 to 65 percent when the patch was an option.

“If this holds for the population as a whole, that would have a tremendous impact on preventing disease and the cost associated with both influenza and the vaccination process,” said Paula Frew, an assistant professor in the Emory University School of Medicine and a co-author of the study.

Previously: Scientists develop technique to deliver dried vaccines to the skin without a needle, Laser-powered needle holds potential for delivering pain-free injections and Taking the sting out of injections
Photo by Gary Meek

Mental Health, Parenting, Pediatrics, Public Health

Doctors advised to screen for depression and test cholesterol during well-child visits

Doctors advised to screen for depression and test cholesterol during well-child visits

Child_depressionHow old should children be before their doctors start annual depression screenings? According to revised guidelines from the American Academy of Pediatrics, the suggested age is 11. The national physician group also suggests pediatricians check middle school-age children’s cholesterol levels, test 16 to 18-year-olds for HIV, and not perform pap smears in girls younger than 21.

As reported in a Health Day story:

The changes attempt to address several pressing health issues affecting U.S. families today. The nation’s obesity epidemic means that children are developing high cholesterol levels — a risk factor for heart disease — at earlier ages. And depression is linked to higher risk for teen suicides and murder.

“One in five kids will, at some point in time, meet the criteria for depression,” said [Joseph Hagan, MD, co-editor of the guidelines and] a professor in pediatrics at the University of Vermont College of Medicine.

The article continues with explanations for specific changes. A full version of the updated guidelines was published yesterday in the journal Pediatrics.

Previously: Lucile Packard Children’s Hospital partners with high schools on student mental health programs and The link between teen depression and suicide
Photo by D. Sharon Pruitt

Addiction, Public Health, Research

Study shows legal drinking age of 21 saves lives and reduces health risks for young adults

beer_022414New research shows that a minimum drinking age of 21 is associated with a lower rate of drunk driving collisions among young adults, as well as a reduction in risk of health problems related to heavy drinking, including dating violence, unsafe sex and suicide.

A piece published today in the Huffington post takes a closer look at the findings in light of arguments made by some that the age limit doesn’t deter binge drinking and other health hazards. From the article:

…the new review found that since the legal drinking age was set at 21, young people have been drinking less, and are less likely to get into traffic accidents.

In fact, the age 21 laws have saved up to 900 lives yearly on the road, according to estimates from the National Highway Transportation Safety Administration.

Teen drinking and driving rates have dropped by 54 percent over the last two decades, and the biggest declines were seen between 1982 and 1995, a period which included changes in the Federal law that pushed all states to increase their drinking age to 21.

During that period, the number of fatally-injured drunk drivers decreased by 57 percent among those ages 16 to 20, compared with 39 percent for those ages 21 to 24, and 9 percent for those older than 25.

Looking at whether setting the age at 21 has driven teenagers to drink more, researchers found that psychological and social studies on drinking motivations have not supported this idea.

Previously: The costs of college binge drinking, Study estimates hospitalizations for underage drinking cost $755 million per year, CDC binge-drinking study demonstrates cell phones’ value in research, Using Facebook to assess alcohol-related problems among college students and Fighting binge drinking on campus
Photo by DeusXFlorida

Pediatrics, Public Health, Stanford News

Stanford physician leading efforts to track emerging polio-like illness in California children

Stanford physician leading efforts to track emerging polio-like illness in California children

Sofia JarvisJessica Tomei remembers the exact moment her daughter’s arm stopped functioning.

It had been a rough week. Sofia Jarvis, Tomei’s then-two-year-old, had been sick with a respiratory illness. Tomei and Sofia were leaving the pediatrician’s office with a pneumonia diagnosis and a prescription for antibiotics when, on the way out, Sofia reached for a toy.

“Her left arm, in mid grasp, stopped working,” Tomei said.

The next day, when Sofia was still not using her arm, Tomei and husband Jeff Jarvis took her back to the doctor. An MRI showed a lesion in Sofia’s spinal cord. At first, she was diagnosed with transverse myelitis, a form of paralysis from which some patients recover. But when the family eventually found their way to pediatric neurologist Keith Van Haren, MD, at Lucile Packard Children’s Hospital Stanford, he had bad news.

“Dr. Van Haren immediately said, ‘She probably will not get back the function of her arm,’” Tomei recalled.

Sofia’s case fit into a pattern that Van Haren and other neurologists around California had begun to observe: Since late 2012, about 20 children in the state have developed sudden-onset, permanent paralysis that looks similar to polio. Van Haren is the primary author of an abstract that describes five of the cases, which will be presented at the annual meeting of the American Academy of Neurology, April 26 to May 3 in Philadelphia.

From an AAN press release about the abstract:

“Although poliovirus has been eradicated from most of the globe, other viruses can also injure the spine, leading to a polio-like syndrome,” said case report author Keith Van Haren, MD, with Stanford University in Palo Alto, Calif. and a member of the American Academy of Neurology. “In the past decade, newly identified strains of enterovirus have been linked to polio-like outbreaks among children in Asia and Australia. These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California.”

All five of the children in the report, including Sofia, had been immunized against polio. Two others in addition to Sofia had respiratory symptoms before the paralysis began. In two of the children, the physicians found evidence of infection with enterovirus-68, which is from the same family as polio virus. Although the team suspects this form of paralysis is infectious, they have not completely excluded other causes such as autoimmune disease. They are asking other physicians to report similar cases to the California Department of Public Health so that the cause of the disease can be pinpointed.

One concern, Van Haren added, is that physicians who have not heard of the new disease may make the same misdiagnosis of transverse myelitis that Sofia received, giving affected children and their families unrealistic expectations about the likelihood of recovery.

“The MRI can look similar but the clinical exam is very distinct,” he said. “There’s a knee-jerk reaction to just call it transverse myelitis. This is something else, and it’s quite bad.”

The good news is that the disease is very rare and likely to remain so. “There have been similar reports in Southeast Asia for many years, and the disease has rarely reached epidemic proportions there,” Van Haren said. “We want to temper the concern about this. It is not a massive epidemic.”

Meanwhile, families like Sofia’s will be watching closely to see what is uncovered by the upcoming research.

“We really want to know what caused this,” Tomei said, adding that the disease and a string of attempted treatments have been difficult for Sofia to go through. Now four, Sofia is generally healthy, but her arm is still paralyzed and the muscles have begun to atrophy.

Still, the family is keeping a positive outlook. Said Tomei, “We’re lucky it was just her left arm.”

Photo courtesy of Jessica Tomei and Jeff Jarvis

Patient Care, Public Health, Stanford News

New research scrutinizes off-label drug use

New research scrutinizes off-label drug use

row of pills - smallIn the U.S., more than one in five drug prescriptions are for off-label indications. Better tracking of these unapproved uses could help medical researchers identify potentially dangerous uses and prioritize promising ones for further study and eventual approval.

Prescription records don’t usually indicate the condition a drug is intended to treat, but physicians’ clinical notes are likely to include this information. Researchers at Stanford developed a new method to extract off-label uses from 9.5 million de-identified clinical records collected at Stanford since 1994. Their study was published online today in PLOS ONE.

In a news release, Nigam Shah, MBBS, PhD, assistant professor of medicine and senior author of the study, describes his team’s approach to sorting the 400 off-label uses they discovered:

To prioritize these uses for further study, the researchers took into account the cost of each drug and its risk of causing adverse reactions. They used these two parameters to rank each drug use. “Then we placed them into good and bad buckets,” Shah said. The “bad bucket” of high-cost, high-risk uses should raise red flags that prompt re-evaluation by physicians and regulators.

Lead author Kenneth Jung, a graduate student in biomedical informatics, was surprised by how many of the novel uses were predictable based on prior knowledge.

“A lot of it actually made sense,” he said. “We should have known about some of these uses already. This gives us confidence that the method we developed works.”

Among the low-risk prescriptions, folic acid was used to treat a wide range of conditions, while several immunosuppressants and anti-tumor agents were classified as especially high-risk. To test the robustness of their findings, the researchers plan to apply the same method to electronic medical records from other hospitals and compare their results.

Previously: Clinical informatics gains recognition as new medical sub-specialty, Stanford researchers use data mining to show safety of peripheral artery disease treatment and Studies document risky use of powerful clotting drug
Photo by Erin DeMay

Public Health, Research, Rural Health, Stanford News

Stanford study finds Lyme disease among ticks in California parks

Stanford study finds Lyme disease among ticks in California parks

hikingHikers, beware: Ticks infected with the bacterium at the root of Lyme disease have been found roaming California parks, as described in a study to be published in Emerging Infectious Disease. The same paper by Stanford researchers, including ones associated with the university’s Woods Institute for the Environment, also identified a human pathogen, Borrelia miyamotoi, in black-legged ticks, which are carried by western gray squirrels in California and white-footed mice back east.

From a Stanford Report article:

The findings raise the question of whether B. miyamotoi has gone undetected in California residents. The research results are “an important step toward dispelling the perception that you cannot acquire Lyme disease in California,” said Ana Thompson, the executive director of the Bay Area Lyme Foundation.

B. miyamotoi has been known for some time to infect ticks; the first known human case of B. miyamotoi infection in the U.S. was discovered in 2013. Beyond Lyme-like symptoms such as fever and headache, little is known about its potential health impacts. In the Bay Area, low awareness of tick-borne diseases such as Lyme could heighten the risk of infection with B. miyamotoi for users of the region’s extensive natural areas and trails.

The piece notes that the School of Medicine’s interdisciplinary Lyme Disease Working Group “is exploring ways to improve diagnostic tests and medical understanding, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness.”

Previously: Add a tick check to your vacation checklistAsk Stanford Med: Answers to your questions about wilderness medicine and Piecing together the clues: Diagnosing and treating autonomic disorders
Photo by Ray Bouknight

Behavioral Science, Nutrition, Parenting, Pediatrics, Public Health, Research

Fruit-filled Manga comics may increase kids’ consumption of healthy food

Fruit-filled Manga comics may increase kids' consumption of healthy food

kidsfruitMore than a decade into adulthood, I’m still drawn in to the worlds created by sugar-cereal commercials. Hypnotized by the swirling pattern of Cinnamon Toast Crunch and captivated by the magic of Lucky Charms, I can see how actual kids’ eating behavior could be influenced by cartoon messaging.

So I was interested to read about a pilot study in New York City public school children that examined how reading comics featuring healthy food could have an effect on snack choice.

Science 2.0 reports:

It comprised 57 youth, approximately 11 years of age, nearly 90% of whom were either Black/African American or Hispanic and 54% were female. The school districts in the study had greater percentages of students eligible for free lunch (79 and 96%, respectively) compared to the citywide average of 66%.

After reading either a Manga comic, titled “Fight for Your Right to Fruit,” or a non-health-related newsletter, children were given the choice between a healthy snack (oranges, grapes, apples, strawberries) or an energy-dense snack (cookies, potato chips, nacho chips, and cheese-filled crackers). 61% of children in the comic group chose a healthy snack after reading, opposed to just 35% of the control group.

Regarding the choice of Manga, a Japanese comic form featuring detailed artwork and storytelling, the study notes:

The Transportation-Imagery Model (TIM) explains how Manga comics may contribute to changes in health-related beliefs and behaviors. According to the TIM, persuasion of a story’s messages occurs because an individual is “transported” or immersed into the narrative world.15 The TIM also suggests that images are most impactful when they are embedded in a story, rather than provided in isolation.15 Thus, visual images relevant to the story’s messages, such as those incorporated in Manga comics, may further influence attitudes and beliefs.

The authors write, “Results suggest Manga comics may be a useful format to promote healthy snack selection in urban minority youth.” (Side note: Writing about this pilot study made me want to eat mangoes.)

The research was published in the Journal of Nutrition Education and Behavior.

Previously: Depictions of obesity in children’s moviesNo bribery necessary: Children eat more vegetables when they understand how food affects their bodies, Talking to kids about junk food ads, Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids and Researchers find cartoons really do make food taste better (or so kids think)
Photo by North Charleston

Cardiovascular Medicine, In the News, Public Health

Survey shows Americans need a refresher course on heart health

heart_shapeIs there a specific gene that helps determine your risk for heart disease? What are the signs and symptoms of a heart problem? Does fish oil help prevent heart disease?

If you find yourself baffled by these questions, you’re not alone. A recent survey conducted by the Cleveland Clinic found that many Americans are misinformed when it comes to heart health and, as a result, aren’t taking the steps necessary to guard off future heart problems. Health Day reports on the survey results:

Although 64 percent of Americans have heart disease or know someone who does, 70 percent of Americans are unaware of all the symptoms of the condition, the researchers found. Less than a third were able to identify unusual fatigue, sleep disturbances and jaw pain as a few of the possible signs of heart disease.

Meanwhile, Americans also have their vitamin facts wrong. Although there are no vitamins that can promote heart health, the survey found that 44 percent of Americans think vitamins can lower cholesterol and 61 percent wrongly believe that vitamins or supplements can help prevent heart disease.

Even fish oil supplements do little to prevent heart disease, the researchers said. Still, 55 percent of Americans believe taking the recommended daily dose of fish oil can ward off the condition. The researchers also cautioned that seafood could be just as high in cholesterol as red meat. The survey showed, however, that only 45 percent of Americans are aware of this.

Americans are also not up to speed on sources of sodium. When it comes to salt, about 32 percent of people wrongly believe that cheese is the biggest culprit, the survey found. Just 24 percent of Americans were aware that bread products typically have a higher salt content.

The survey also showed that almost 60 percent of Americans think there is a heart disease gene that helps determine their risk for the condition. Scientists have not yet identified any such gene.

In recognition of February being American Heart Health Month, Stanford Hospital & Clinics is issuing weekly challenges to help you take the first steps toward a lifetime of better heart health. Visit the hospital’s website and Facebook page or follow @StanfordHosp on Twitter to learn more about heart disease and ways to keep your heart healthy.

Previously: The exercise pill: A better prescription than drugs for patients with heart problems?, Heart attacks and chest pain: Understanding the signs in young women, Childhood obesity a risk for imminent heart problems, research shows, Ask Stanford Med: Answers to your questions about heart health and cardiovascular research and Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health
Photo by samantha celera

Addiction, In the News, Public Health

A focus on addiction, the country’s leading cause of accidental death

A focus on addiction, the country's leading cause of accidental death

Over on Wonkblog, there’s a lengthy discussion between Stanford addiction expert Keith Humphreys, PhD, and Harold Pollack, PhD, on drug overdoses, the recent death of actor Philip Seymour Hoffman, and ways to prevent others from dying. The entire piece is worth a read, but a few parts jumped out at me:

HP: Many people don’t realize that overdose is the leading cause of accidental death in the U.S. I gave a talk about five years ago in Chicago, and I mentioned that we had more overdose deaths than traffic fatalities. My audience literally did not believe me. People were absolutely convinced that I had mis-transcribed the numbers. Every year, America loses a little over 32,000 people in auto crashes, and something like 38,000 from overdose deaths annually.

KH: Yeah, it’s remarkable if you compare overdoses to AIDS, which at its peak was taking about the same number of lives. The difference in reaction is really startling. We appropriately became galvanized about HIV/AIDS, and implemented much better public policy to prevent HIV-related deaths. It’s much harder to get traction on the overdose issue, or even to get people to believe how prevalent the problem actually is.

HP: Just to note the numbers, in 1999 there were about 4,000 prescription opiate overdoses. In 2010, there were about 16,000. By comparison, there are about 10,000 gun homicides in the United States.

KH: It is pretty amazing. Many people are focusing on the return of heroin and saying, “It’s all the fault of criminals.” You’ve got to remember, 4 in 5 of people today who start using heroin began their opioid addiction on  prescription opioids. The responsibility doesn’t start today with the stereotypical criminal street dealer. We basically created this problem with legally manufactured drugs that were legally prescribed. This really flies in the face of the argument that  if we just had a flow of legal drugs, the harms would be minimal.

HP: Can I ask you an embarrassingly basic question? If someone like Philip Seymour Hoffman presumably had access to all sorts of prescription opioids, why does he end up injecting heroin?

KH: That’s actually a good question. Cost drives many people to heroin. It’s more expensive to buy oxycodone than it is to buy heroin. Presumably that was a less pressing concern for Mr. Hoffman. Perhaps the intensity of the rush of injected heroin was more reinforcing to him than opioid medications were. The prescription medications have a longer, slower cycle of action in the body. His heroin use could also be the result of habit. He had experienced a heroin problem before, many years ago. It could be that that was the drug that he knew best or was available in the networks of dealers he used. I’m speculating about somebody I don’t know, but those are some possible reasons.

For most people it’s cost. Add one other thing; when people lose their health insurance, they may need the opioids to manage their pain. People sometimes end up buying street drugs including heroin to manage their pain because they have lost the insurance that used to cover their pain medication.

Previously: A reminder that addiction is a chronic disease, Is it damaging to refer to addicts as drug “abusers?”, Breaking Good: How to wipe out meth labs, How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and How to combat prescription-drug abuse

Cancer, NIH, Public Health, Women's Health

Study shows daily aspirin could lower women’s risk of ovarian cancer

Study shows daily aspirin could lower women's risk of ovarian cancer

aspirinA team of researchers at the National Cancer Institute have conducted the largest study to date assessing the relationship between non-steroidal anti-inflammatory drugs and ovarian cancer risk. Their findings show that taking aspirin daily may lower women’s risk of ovarian cancer; however researchers caution that more studies are needed before clinical recommendations can be made.

In the study, researchers examined a dozen previous epidemiological studies that included roughly 8,000 women diagnosed with ovarian cancer and nearly 12,000 women who did not have the disease. According to an NCI release:

The researchers determined that participants who reported daily aspirin use had a 20 percent lower risk of ovarian cancer than those who used aspirin less than once per week. For non-aspirin NSAIDs (non-steroidal anti-inflammatory drugs), which include a wide variety of drugs, the picture was less clear: the scientists observed a 10 percent lower ovarian cancer risk among women who used NSAIDs at least once per week compared with those who used NSAIDs less frequently. However, this finding did not fall in a range that was significant statistically. In contrast to the findings for aspirin and NSAIDs, use of acetaminophen, which is not an anti-inflammatory agent, was not associated with reduced ovarian cancer risk.

This study comes on the heels of Stanford research showing that aspirin use appears to cut the risk of another type of cancer (melanoma) in women.

Previously: Can repackaging aspirin get more people to take it daily for prevention? and New research shows aspirin may cut melanoma risk
Photo by Chaval Brasil

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