Minggu, 19 Mei 2019

Possible Health Benefits of Lower Bedroom Temperatures

You may want to think twice before turning down your air conditioner! An interesting study was released recently investigating the possible health benefits of sleeping in cooler temperatures at night. It is something we usually do not think about, but some are starting to think it can really make a difference. Specifically, researchers set out to see if it had an effect on stores of brown (good) fat which has the potential to improve metabolism.  Sponsored by the American Diabetes Association, researchers took 5 healthy young men and had them sleep in a controlled environment. During the course of the experiment, they had them all sleep in different room temperatures. It was found that when the temperature was cooler, significantly higher amounts of brown fat were found. This implies that there is possibility of metabolic benefit to sleeping in colder temperatures.
However, is the same true for women? We do not know. Since the study only included 5 men, it is impossible to know if the same results would have been found in a group of 5 women. With the possible metabolic benefits this study eludes to, it is hopeful that it will be repeated not only with women, but with a larger and more diverse group.
Resources:
Article abstract and link in PubMed
Article: Let's Cool it in the Bedroom  New York Times

Sabtu, 18 Mei 2019

Fruit Juice is Very Important


Juice For Health

Should I be juicing?One of the new and interesting things I have been getting a lot of questions about recently are juice cleanses. These juice cleanses are 1-4 week journeys where people seek to drink nothing but fruits and vegetables in juice form or even only water with different additions like cayenne pepper and honey. As a long time food lover this seemed almost tortuous to me and I wanted to figure out what was behind peoples motivation to try these things. It seemed that in a desperation before the summer to obtain that perfect “beach bod” people were turning to anything they could find including these cleanses. Some people justified it by saying that they felt overloaded with toxins after overeating all winter and others simply saw this as a quick and efficient way to lose some weight. Wondering about some of the pros and cons into juicing and whether or not this could be hurting us I did a little bit of research.

In general when we do not put food into our body our body senses distress and goes into starvation mode. First it begins breaking down any sugar that we had stored in our body as glycogen—we only have about 24 hours of stored glycogen so after that we start breaking down the fats. After the fats start breaking down that’s when we start to get into a bit of trouble and break down our muscles (don’t forget the heart is a muscle too) and this can end up doing significant damage. The other thing is that our livers and kidneys are REMARKABLE organs and in our everyday life are capable of filtering out toxins meaning that as long as we are not poisoning our bodies our livers and kidneys can keep up and do a good job.

Usually when a person starts a juice cleanse they might notice a sudden drop in weight which is mostly all water weight, but as the body goes more and more into starvation mode and will eventually store almost anything you feed the body when the diet is over. This means that whatever water weight you lose at the beginning you can end up rebounding and gaining it all back and more when you stop. Another problem is that when you juice the fruits and vegetables you lose a lot of the nutrients that you would normally get just by eating an apple or cucumber.

One final thing that I thought about when looking through all these products that they try to sell you to get you to buy into the whole juice cleanse thing is WOW are these products expensive! Is it worth it to get all of these powders or supplements just to lose a few pounds and gain it back? Really we are better off at picking a few things that we can change in our lives—they don’t have to be big changes but they can make a difference. Pack an apple in your lunch instead of potato chips, or even just try cutting out all other drinks besides water—you would be surprised at not only how much weight you might lose but how much better you feel!

So skip the juice diets and the water cleanses because you could be permanently lowering your metabolism and setting yourself up for failure in the future once you re-enter the real world of food. Try small things every day—you don’t have to change your entire diet in one day—and make that a permanent change in your life because it will be way more worthwhile and effective in the long term.


-Sarah Hall, MS4

Senin, 13 Mei 2019

Sex/gender disparities in atrial fibrillation-related stroke risk


  

At a recent European cardiology meeting, a retrospective cohort study1 was presented which looked at differences in hospitalization rates for acute ischemic stroke among male and female patients with atrial fibrillation over a 15 year period (1998 – 2012).  The study, which included 1.1 million patients admitted to 1000 hospitals in 46 states, revealed that women had a 23% higher risk of being hospitalized for stroke than men after adjusting for such risk factors as age, diabetes, hypertension, previous stroke and heart failure.  In addition, women had a higher risk of stroke compared to men regardless of race, socioeconomic status, or geographic location.  According to the study authors, “women have second-rate outcomes across the board due to inadequate stroke prevention care rather than biological differences”.   Why should this be so?

A previously published, related study2 that evaluated over 500,000 Medicare patients (87% white, 41% male) after newly diagnosed atrial fibrillation found statistically significant differences in the receipt of appropriate medical services (e.g. evaluation by a cardiologist, catheter ablation, anticoagulation, use of beta blockers and antiarrhythmic drugs) - especially catheter ablation (female vs male: AHR 0.65; 95% CI 0.63-0.68; P < .001) and receipt of oral anticoagulants (female vs male: AHR 0.93; 95% CI 0.93-0.94; P < .001). 

http://www.womenheart.org/resource/resmgr/Afib_images/SocialMedia_AFib_v1.jpgIt is all too obvious that women with atrial fibrillation receive less state-of-the-art therapy for atrial fibrillation and stroke prevention compared to men.  Although the reasons behind this disparity remain uncertain, they likely include differences in presenting symptoms (see illustration) including the absence of symptoms in ~30% of women, delays in seeking medical attention (women are notorious for putting everyone else’s needs above their own), and provider bias (attributing symptoms to panic attacks or stress).  As medical professionals we need to be aware of and eliminate disparities so that we deliver appropriate, personalized care to all of our patients.

                                                                                                    

             Judith Wolf, MD             Associate Director, WHEP


  1. Ghanshyam Palamaner Subash Shantha; Hardik Doshi; Anita Kumar; Gopi Dandamudi; Prashant Bhave; Alexander Mazur; Denice Hodgson-Zingman; Michael Giudici ‘Gender differences in the rates of hospitalizations for acute ischemic stroke among patients with atrial fibrillation in the United States: A 15 year experience involving 1.1 million patients’ CARDIOSTIM – EHRA EUROPACE 2016.  June 8-11. Nice, France  http://www.cardiostim.com/
  2. Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015;12(7):1406–1412.

Minggu, 12 Mei 2019

Balancing career and family

Image result for work-life balance

Work-Life Balance: Is it possible to have it all?

As I begin the dreaded process of applying for residency, I have been deeply thinking about what my priorities are in life. In addition to applications, I am also in the midst of planning my wedding for the spring. Of course I want to have a great learning experience in residency and a successful medical career, but I would also like to be able to start a family. Is it possible for female physicians to have an amazing career and family – can we have it all?

This is a common problem faced by many women in the healthcare field. As the number of female physicians continues to rise, the challenges that women physicians face in trying to maintain this balance has come to light. The work-life balance is a significant factor in which specialty a woman chooses. There are many specialties where women are underrepresented, especially in the surgical fields and in the academic setting, likely related to difficulty to find balance in these demanding careers.1 The timing of pregnancy is also a major decision for women. Many factors contribute to this decision, including the program’s policies on maternity leave, the availability of childcare, and even whether the new mom would have a private place to pump breast milk at work in order to continue breastfeeding. One issue with pregnancy during residency is that there is a potential for resentment among co-residents, as physician-mothers may be seen as having special treatment. However, this also needs to be balanced against the a physician-mother’s guilt of leaving her infant at home or daycare as she returns to work. Unfortunately, female physicians who desire starting a family continue to face these (and many other) challenges when entering residency in the medical field.

In order to make this balance more feasible for women, it would be beneficial for more programs to establish accommodating practices that allow female physicians to tackle the aforementioned challenges. Flexible hours and part-time work are good options to allow women to have more time to manage childcare. Also, there needs to be a decrease in stigmatization of women who decide to take time off for parenting reasons, especially in the surgical fields. It would also be helpful to many mothers if more hospitals provided childcare during working hours. This would allow physicians (and all other healthcare workers) to continue to work and still be nearby to their young children.

As for me, I hope to find a happy balance between my roles as a physician, wife, and mother in the future. I know it will take a lot of sacrifice to juggle a clinical and academic career with motherhood, but with some flexibility, a lot of hard work, and establishing priorities, you can accomplish everything that is important to you. Reference:1. Verlander, G. 2004. “Female physicians: Balancing career and family.” Acad Psychiatry 28(4):331-6.https://www.med.upenn.edu/gastro/documents/BalancingCareerandFamily.pdfShelby McLaughlin, MS4WHEP Pathway Student


Kamis, 09 Mei 2019

Is Gluten Allergy Even Real?!

Have you ever seen labels at grocery stores claiming to be gluten free on items ranging from certain crackers to ketchup and wondered what gluten really is-- a made up word from marketing experts to start yet another diet fad or a legitimate condition?

Truth is, gluten is a protein found within wheat, barley, and rye (grains that are surprisingly found a wide variety of foods). Many of us do not have the enzymes to completely break down this protein, which often remains undigested in our gut. For those of us who are gluten tolerant, these peptides or pieces of proteins are eliminated. However, for those who are gluten intolerant, the peptides are dangerous to the body, because they may cross our intestinal barrier and cause the immune system to attack the villi of the intestine that are important for absorbing nutrients. Hence, this autoimmune disease may eventually lead to malabsorption which can be very serious.

The truest label of gluten intolerance is known as celiac disease, which affects 1 in 133 individuals though up to 85% have yet to be diagnosed.  Both genetic (1 in 10 people with affected close relatives are at risk) and environmental circumstances can play a role. The symptoms of celiac disease range from bloating, gas, diarrhea, weight loss, depression, abdominal pain, anemia, and with children, distended abdomen, dental defects, and failure to thrive. Sometimes, this disease may also cause dermatitis herpetiformis (DH) that can cause itchy blisters. The only known treatment is to have a gluten-free diet; taking probiotics is also encouraged. However, not all individuals who believe they are allergic to gluten may have celiac but are in fact allergic to other foods that may be associated with wheat or are victims of a "created disease" without an underlying biological condition. 

The problem today is that there is a significant rise in celiac disease. In the 1950s prevalence of the disease was approximately 0.2%. Today, however, this number has grown to 1% which may not seem large but statistically is 3 million people out of 300 million individuals. According to Dr. Guandalini in an interview with University of Chicago, this rise may be attributed to the extreme cleanliness many children born in the United States are accustomed to. This hygiene hypothesis suggests that babies are not exposed to the same level of antigens and bacteria as in the past. Consequently, our gut immune system  responds in a autoimmune or allergic fashion.
What is your opinion concerning combating this disease in our every day life?

Meghana Pisupati
IMS 2017

Sabtu, 04 Mei 2019

Will You be Able to Find an OB/GYN When You Need One?




By 2020, there will be a major US shortage of OB/GYNs.
Currently, women in Philadelphia wait up to an average of 51 days for a new patient appointment with an OB/GYN1. The Affordable Care Act has caused some additional increase in the wait times as more individuals are able to seek care; however, the shortage of primary care physicians has been evident for many years now. ACOG estimates that by 2020, there will be 8,000 less OB/GYNs than needed2. Having a shortage of OB/GYNs puts women, especially those in more rural areas, at a huge risk. This means less access to prenatal care and preventative health screenings, as well as, a larger dependence on nurse practitioners and midwives.


Two of the biggest causes of this problem are physician burn-out leading to early retirement and residency shortages3. So, what is burnout? Burnout is a combination of lack of enthusiasm for work, skepticism, distrust, and low sense of personal accomplishment. This can be due to long work hours, lower than desired pay, lack of control over work situations and lack of support within the work environment. OB/GYN is a field with long, unpredictable hours, many medical liability lawsuits, and high stakes decision making. This can quickly lead to burnout over a short period of time4.


There are 241 OB/GYN residency programs which translates into 1,288 resident spots5. There has been little change to the number of residency programs/spots since the 1997 Balanced Budgeting Act which capped federal funding of medical residency programs. The limited amount of residency spots for OB/GYN continues to worsen the shortage of OB/GYNs available to women, as well as, adds to the physician burnout by causing additional stress to the providers we do have. Approximately 47% of physicians remain in the area where they completed residency training6. The residency programs for OB/GYN are primarily in hospitals in more urban regions. The location of OB/GYN residency programs adds to the lack of OB/GYNs within rural areas, where half of the women must travel over 30 minutes to the nearest hospital with OB/GYN services in the region7.


As, a fourth-year medical student hoping to match into OB/GYN this Spring, I find this information disheartening. I hope we can find ways to rectify this problem soon to assure all women have access to female reproductive health care services.
Victoria Martino, MS4, Women’s Health Pathway


Resources
1https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/mha2017waittimesurveyPDF.pdf
2https://www.acog.org/Clinical-Guidance-and-Publications/The-Ob-Gyn-Workforce/The-Obstetrician-Gynecologist-
Workforce-in-the-United-States
3https://www.documentcloud.org/documents/3897592-Doximity-Report-OB-GYN-Workload-and-Potential.html
4http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/why-are-obgyns-burning-out?page=0,0
5http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf
6 https://members.aamc.org/eweb/upload/2015StateDataBook%20(revised).pdf
7 https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-
Underserved-Women/Health-Disparities-in-Rural-Women
https://medicalschoolhq.net/ss-27-a-deep-dive-into-obgyn-residency-match-data/