Daily text messages may be an effective option to help children with asthma manage their symptoms and reduce doctor visits, according to recent research from the Georgia Institute of Technology.

In the study (.pdf), pediatric patients with asthma were randomly assigned to three programs: one group received text messages on alternate days, another received text messages daily and a third served as the control and did not receive any text messages. Participants ranged in age from 10 to 17 years old, owned a mobile phone and could read at the fifth grade level. The text messages asked patients questions about their symptoms and provided health information about asthma. Futurity reports:

Over four months, the intervention groups received and responded to SMS messages 87 percent of the time, and the average response time was within 22 minutes. After the study, the research team analyzed patients who had follow-up visits with their physician and found that sending at least one text message a day, whether it was a question about symptoms or about asthma in general, improved clinical outcomes.

“The results indicate that both awareness and knowledge are crucial to individuals engaging in proactive behavior to improve their condition,” [said Rosa Arriaga, PhD, who led the study].

The findings are noteworthy in light of past data showing texting is teenagers’ preferred method of communication, they get an average of 3,339 texts a month, and previous research showing they are amenable to receiving health information via text message.

Previously: CDC explores potential of using smartphones to collect public health data, Promoting healthy decisions among teens via text and Craving a cigarette but trying to quit? A supportive text message might help
Photo by Summer Skyes 11

A growing body of scientific evidence shows that mindful-based therapies, such as meditation, can lower psychological stress and boost both mental and physical health. Now findings recently published in PLoS One suggest that such practices may also change gene activity.

In the small study, researchers recruited individuals who had no prior meditation experience and examined participants’ genetic profile prior to their adoption of a basic daily relaxation practice. The 10- to 20-minute routine included reciting words, breathing exercises and attempts to exclude everyday thought. The New Scientist reports:

After eight weeks of performing the technique daily, the volunteers gene profile was analysed again. Clusters of important beneficial genes had become more active and harmful ones less so.

The boosted genes had three main beneficial effects: improving the efficiency of mitochondria, the powerhouse of cells; boosting insulin production, which improves control of blood sugar; and preventing the depletion of telomeres, caps on chromosomes that help to keep DNA stable and so prevent cells wearing out and ageing.

Clusters of genes that became less active were those governed by a master gene called NF-kappaB, which triggers chronic inflammation leading to diseases including high blood pressure, heart disease, inflammatory bowel disease and some cancers.

Even more interesting was that researchers found evidence to suggest that such changes can occur quickly and that regularly meditating can have lasting health effects:

By taking blood immediately after before and after performing the technique on a single day, researchers also showed that the gene changes happened within minutes.

For comparison, the researchers also took samples from 26 volunteers who had practised relaxation techniques for at least three years. They had beneficial gene profiles even before performing their routines in the lab, suggesting that the techniques had resulted in long term changes to their genes.

Previously: How mindfulness-based therapies can improve attention and health, Study offers insights into how yoga eases stress, Stanford scientists examine meditation and compassion in the brain and Study shows meditation may alter areas of the brain associated with psychiatric disorders
Photo by Georgie Sharp

Past research suggests that poor sleep during adolescence can have “lasting consequences” on the brain. Now a new study offers additional insights into the negative health effects of sleep deprivation on teens’ health.

In the study, researchers analyzed data collected from more than 10,000 adolescents as part of the National Comorbidity Survey Adolescent Supplement. As MedPage Today reports, their findings show that prolonged fatigue is associated with mood and anxiety disorders among teens:

In a nationally representative sample of adolescents ages 13 to 18, 3% reported having extreme fatigue lasting at least 3 months and about half of those who did also had mood or anxiety disorders, according to Kathleen Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues.

Having both prolonged fatigue and a mood or anxiety disorder was associated with poorer physical and mental health and greater use of healthcare services compared with having only one of the disorders, the researchers reported online in the American Journal of Psychiatry.

“This suggests that the presence of fatigue may be used in clinical practice as an indicator of a more severe depressive or anxiety disorder,” Merikangas and colleagues wrote.

Stanford physician Michelle Primeau, MD, recently explored the topic of how teen sleep habits affect mood in a recent Stanford Center for Sleep Sciences and Medicine blog entry on the Huffington Post. In her post, she explains why teens in particular are at risk of chronic partial sleep deprivation:

Teenagers need to sleep about nine hours, and as they get older, they tend to sleep less. This is not because they need less, but because they are busier with school, jobs, extracurricular activities, and friends. Their biology also will often shift so that they tend to fall asleep later and want to sleep in later, an occurrence that may represent delayed sleep phase syndrome. This may explains why your teenager is so hard to wake up on Saturdays. But this shift to a later bedtime, both of social and biologic causes, in combination with fixed early school times, means that many teenagers are walking around sleep deprived.

Previously: Can sleep help prevent sports injuries in teens?, Study shows link between lack of sleep and obesity in teen boys, Study shows lack of sleep during adolescence may have “lasting consequences” on the brain, Teens and sleep: A Q&A, Sleep deprivation may increase young adults’ risk of mental distress, obesity, Districts pushing back bells for the sake of teens’ sleep and Lack of sleep may be harmful to a teen’s well-being
Photo by lunchtimemama

As a reminder, today is the final day of our Ask Stanford Med installment focused on breast cancer. Questions related to breast cancer screening, dense breast notification legislation and advances in diagnostics and therapies can be submitted to Stanford surgeon Fredrick Dirbas, MD, by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section of our previous entry. We’ll accept questions until 5 p.m. Pacific time.

We provided details about Dirbas’ clinical work and research in our earlier post:

As head of the Breast Disease Management Group at the Stanford Women’s Cancer Center, Dirbas works with an interdisciplinary team of radiologists, oncologists, pathologists, researchers and support programs to provide patients with a comprehensive treatment approach. His research focuses on improving breast cancer therapy by refining existing diagnostic and treatment options and introducing new methods that reduce side effects and improve patients’ quality of life.

A 2011 Stanford Hospital Health Notes article describes how Dirbas and colleagues are at the forefront of exploring new ideas for delivering radiation in a more targeted and accelerated fashion, including methods such as intraoperative radiotherapy and another approach using external radiation therapy after surgery.

Previously: Ask Stanford Med: Surgeon taking questions on breast cancer diagnostics and therapies, California’s new law on dense breast notification: What it means for women and Five days instead of five weeks: A less-invasive breast cancer therapy
Photo by Wellcome Images

Society is increasingly becoming more data-driven. Noting the power of vast reservoirs of public information, the federal government launched the Big Data Research and Development Initiative — a $200 million commitment to “greatly improve the tools and techniques needed to access, organize and glean discoveries from huge volumes of digital data.” And the National Institutes of Health expanded its stake in the federal initiative in hopes of speeding up the translation of biomedical discoveries into bedside applications.

In an effort to bring together innovative thinkers from information-technology corporations, startups, venture-capital firms and academia to capitalize on the wealth of opportunities using data-mining in biomedicine, Stanford Medicine and Oxford University are sponsoring a three-day conference from May 22-24. Curious to know more about the event and promise of big data, I reached out to Atul Butte, MD, PhD, Stanford systems-medicine chief and the conference’s scientific program committee chair. Below he shares why he’s passionate about how data-mining can transform scientific research and health care and discusses the conference program.

A recent Stanford Medicine article called data-mining the “fastest, least costly, most effective path to improving people’s health” that you know. Can you explain why you believe this to be the case?

Data-driven science, or data-mining, works faster and effectively because we are already sitting on billions of measurements made across the health system! Every time a physician orders a medication, every time a nurse or pharmacist dispenses a drug, every time a blood test is performed, every x-ray or CT scan that’s performed… all of this information ends up in a database today. So the part of science or innovation that involves collecting the measurements is actually the easiest part now, because the measurements are already there, just waiting for the right question to be asked.

In the same article, you said “hiding within [existing] mounds of data is knowledge that could change the life of a patient, or change the world” - and that if you didn’t analyze those data or show others how to, you feared no one will. How did you grow so passionate about this area?

I think we in the biomedical field make these measurements, but we often don’t realize how these measurements can interrelate or be used together. Our example from one of our recent articles was on our use of two big sets of public data. One set covered the molecular changes seen in tissues affected by diseases, and another set covered the molecular changes seen in cells treated by drugs. We realized that we could partner just these two public data sets together, to get new ideas of what other diseases might be treatable by these drugs. And, we could do this in a purely computational approach – an approach that is nearly infinitely scalable to more diseases, more investigators and more ideas. When I see hard working investigators working tirelessly to make highly accurate and significant measurements, but so few people taking advantage of that data, I can’t help but be passionate!

Earlier this year, you published a study, which involved combing through large amounts of data, to find that beta carotene may protect people with a common genetic risk factor for type-2 diabetes. Can you describe other recent findings that have stemmed from researchers’ use of this “big data” approach?

Stanford professor Russ Altman, MD, PhD, and his team recently showed how search engine logs can be mined to discover side effect of release drugs that might not have shown up during the initial clinical trials on those drugs. Similarly, Nigam Shah, MBBS, PhD, assistant professor of medicine, showed how similar side effects for drugs are sitting in physician clinical notes. Both text-based clinical notes and search engine logs are massive sources of big data that to date have barely been tapped for medical research.

What was the catalyst for launching the Big Data in Biomedicine conference?

The Li Ka Shing Foundation has played the leading role in bringing us together with Oxford University in planning events on big data. Our first, smaller conference was held in Oxford last November. Based on the success of that event, we realized we could host a larger conference at Stanford and open it up to the public. We couldn’t have done this without the support of the Li Ka Shing Foundation.

Continue Reading »

Researchers at the National Institutes of Health and University of California-San Francisco have found that stimulating a key part of the brain reduces compulsive cocaine-seeking and suggests the possibility of changing addictive behavior generally. NIH Director Francis Collins, MD, PhD, discussed the study, and the significance of the findings in a blog post earlier this month:

The researchers studied rats that were chronically addicted to cocaine. Their need for the drug was so strong that they would ignore electric shocks in order to get a hit. But when those same rats received the laser light pulses, the light activated the [prelimbic area of the prefrontal cortex], causing electrical activity in that brain region to surge. Remarkably, the rat’s fear of the foot shock reappeared, and assisted in deterring cocaine seeking. On the other hand, when the team used a different optogenetics technique to reduce activity in this same brain region, rats that were previously deterred by the foot shocks became chronic cocaine junkies.

Clearly this same approach wouldn’t be used in humans. But it does suggest that boosting activity in the prefrontal cortex using methods like transcranial magnetic stimulation (TMS), which is already used to treat depression, might help.

This image shows optogenetic stimulation using laser pulses illuminating the prelimbic cortex. The channelrhodopsins used to create the photo were provided to researchers by Stanford bioengineer Karl Deisseroth, MD, PhD.

Previously: Better than the real thing: How drugs hot wire our brains’ reward circuitry, The brain’s control tower for pleasure and Addiction: All in the mind?
Photo by Billy Chen and Antonello Bonci

The five most-read stories on Scope this week were:

The secret life of hair follicles, revealed by Stanford researchers: Stanford researchers delve into the cells surrounding our hair follicles to better understand what makes them grow and maintain hair. In the process, research associate Yiqin Xiong, PhD, and associate professor of medicine Ching-Pin Chang, MD, PhD, have identified a signaling circuit that controls the activity of stem cells, called “bulge cells,” within the follicle.

When you say nothing at all: Living with an invisible illness: Inspire contributor Dawn Nellor explores the communication gap between chronically ill patients and physicians, discusses steps she’s taken to be more proactive in her own care and explains how she has strengthened her voice as a patient. Overall, she urges physicians and patients to respect each other in an effort to achieve greater results.

Stanford and Oxford team up for conference on “big data’s” role in biomedicine: The “big data” deluge promises to accelerate the process of understanding disease while driving down the costs of developing new therapies. To underscore the wealth of opportunities for scientists who can mine these continuously growing databases in innovative ways, Stanford Medicine and Oxford University are sponsoring a three-day conference May 22-14 on the Stanford campus exploring big data’s role in biomedicine.

To meet weight loss goals, start exercise and healthy eating programs at the same time: New research from Stanford shows that to successfully slim down, a dual approach – addressing both improving eating habits and increasing physical activity – is most effective.

Quitting smoking for the baby you plan to have together: Keith Humphreys, PhD, a professor of psychiatry and behavioral sciences at Stanford, provides an overview of the research and clinical evidence about smoking cessation for parents-to-be who have questions about kicking the nicotine habit.

Emergency helicopter transport can be pricey and, as recent reports of aircraft crashes show, potentially dangerous. Such downsides have sparked some concerns that transporting trauma patients by air may not be worth the risk. So researchers at Stanford set out to investigate how often medical helicopters needed to help save critically injured patients’ lives in order to be considered cost-effective when compared with ambulances.

Researchers published their findings (subscription required) online this month in the Annals of Emergency Medicine. My colleague explains their results in a release:

The researchers found that if an additional 1.6 percent of seriously injured patients survive after being transported by helicopter from the scene of injury to a level-1 or level-2 trauma center, then such transport should be considered cost-effective. In other words, if 90 percent of seriously injured trauma victims survive with the help of ground transport, 91.6 need to survive with the help of helicopter transport for it to be considered cost-effective.

The study… does not address whether most helicopter transport actually meets the additional 1.6 percent survivorship threshold.

“What we aimed to do is reduce the uncertainty about the factors that drive the cost-effective use of this important critical care resource,” said the study’s lead author, M. Kit Delgado, MD, MS, an instructor in the Division of Emergency Medicine. “The goal is to continue to save the lives of those who need air transport, but spare flight personnel the additional risks of flying - and patients with minor injuries the additional cost - when helicopter transport is not likely to be cost-effective.” (Helicopter medical services generally bill patients’ insurance providers directly, but patients may have to pay some of the bill out of pocket, or, if they’re uninsured, possibly all of it.)

The findings only apply to situations and locations where patients could be taken by both ambulance and helicopter to a trauma center. Researchers said that in scenarios where ground transportation to a trauma center wasn’t feasible, then transport by helicopter was preferable.

Photo by Brett Neilson

Although Coca-Cola products are readily available for sale in remote African villages, many of the life saving medicines needed for easily treatable diseases can only be obtained at health clinics located a day-long walk, or further, away. So an innovative nonprofit called ColaLife developed packaging and a method for using the Coca-Cola distribution network to distribute medicines, specifically anti-diarrhea kits, in Zambia.

The nonprofit’s work is highlighted in a new documentary film titled “The Cola Road.” In the above film trailer, ColaLife founders Simon and Jane Berry discuss the project and Tim Llewellyn, designer of the Aidpod device used to deliver medicines in Coke crates, explains how the medicines are packaged and transported. Scientific American’s Talking back blog reports on the success of the project:

Tiny village shops, always stocked with Coke, have now started to receive oral rehydration Kit Yamoyos (kits of life)—and, no, Coke itself is not a particularly good rehydration fluid, despite the lore. Thousands of the kits have been sold already in Zambian rural districts and the Ministry of Health, the film points out, now has plans to use the same supplier network to distribute other types of medicine. The income for the shopkeepers provides an incentive to keep the kits on the shelves.

The research on how stress affects our body can be confusing. Previous studies have linked chronic stress to a variety of health conditions ranging from the common cold to Alzheimer’s disease. However, researchers at Stanford and Yale have found that short-term stress can aid in recovery from surgery and, as senior author of the paper Firdaus Dhabhar, PhD, explained in a past Q&A, a growing body of scientific evidence shows that acute stress may have protective or beneficial health properties.

But what about brief bursts of stress when individuals are already coping with something upsetting or feeling anxious? Is this helpful or harmful to the body? To find out, researchers at University of California-San Francisco asked a group of chronically stressed women to give a speech in front of a skeptical panel of judges. The New Scientist reports:

For the stressed women, the extra challenge indeed proved particularly harmful: the threat of the test caused more cellular damage than in the non-stressed controls. Perhaps more intriguing, though, was an unexpected effect [researchers] found within the control group.

Among these normally relaxed women, those who found the task moderately stressful had lower levels of cellular damage than those who did not find it stressful at all. In other words, while chronic stress can have knock-on effects that damage cellular structures, short bursts of stress can reduce such damage and protect our health in some circumstances.

The idea that being under pressure helps to focus attention and makes us better at cognitive tasks has been around for almost a century. But [the UCSF] study is a first step to showing how it can sometimes make us physically healthier as well – although exactly what is going on at the cellular level to explain the result is still unclear.

Previously: Sweating the small stuff may harm your mental health, How does your body respond to stress?, Using an app to get a better handle on what stresses you out, Study suggests anticipation of stress may accelerate cellular aging and Workplace stress and how it influences health
Photo by Sybren A. Stüvel