Dr. Howard Smith Oncall

Vidcast:  https://youtu.be/mr_Zu297u7g   Forty-one weeks of gestation appears to be the safe upper limit for pregnancies.  This the conclusion of a Swedish multisite study of more than 2700 women with post-mature babies.   Half the group were randomized to be induced at 41 weeks,  The remainder were followed for up to another 7 days with mandatory induction at 42 weeks.  The study was abruptly ended when six babies in the watch and wait group died versus none in the 41 week-induced group.   A pregnancy is conventionally considered safe up to 42 weeks.  If you or a loved one is pregnant, insist on delivery by 41 weeks if the baby is large enough by ultrasound.   A.M. Jukic, D.D. Baird, C.R. Weinberg, D.R. McConnaughey, A.J. Wilcox. Length of human pregnancy and contributors to its natural variation. Human Reproduction, 2013 DOI: 10.1093/humrep/det297   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991404/   #Pregnancy #postterm #induction #csection

Vidcast:  ttps://youtu.be/r3cfXswib-I   Yoga instruction or individual physical therapy, PT, over a 12 week period leads to better sleep for those plagued by low back pain.  Boston University investigators report this conclusion following their study of  320 adults with back pain.   Those using yoga enjoyed a 12% improvement in sleep while those having physical therapy noted  9% better sleep.  The best news is that this sleep improvement is sustained for at least a year.   Previous work credits both yoga and PT with improving low back pain.  Now we know that yoga and PT can also help the nearly 60% of those with low back pain that also have sleep problems.     Eric J. Roseen, Hanna Gerlovin, Alexandra Femia, Jae Cho, Suzanne Bertisch, Susan Redline, Karen J. Sherman, Robert Saper. Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial. Journal of General Internal Medicine, 2019; D

Vidcast:  https://youtu.be/lSGFWPkOSJY   American men in a hetero relationship experience the lowest level of stress and anxiety when their female partners contribute 40% to the couple’s combined income.  British psychologists report this finding from their study of just over 6,000 US households.   Male stress peaks when he is the sole income earner, it dips as his partner contributes up to 40%, and then increases again as the woman’s contribution becomes predominant.  In comparison, women experience the least stress when she earns the same as her partner.  The male stress pattern disappeared if the woman clearly earned more before the marriage.   Men can reduce their stress level by welcoming, not fearing, financial contributions from their wives.    Joanna Syrda. Spousal Relative Income and Male Psychological Distress. Personality and Social Psychology Bulletin, 2019; 014616721988361 DOI: 10.1177/0146167219883611   #marriage #gender, #stress #income

Vidcast:  https://youtu.be/kwJ05jen3Wc   Eating fruits and veggies and foregoing fatty, sugary foods will reduce chances of hearing loss by up to 30%.  Harvard investigators managing the Nurses’ Health Study looked more than 3100 womens’ hearing as a function of diet over a 20 year period.   Women closely following healthy diets including the DASH, the Mediterranean, and the Alternate Healthy Eating Index eating plans had a 29% lower risk of mid-frequency hearing loss.  Their high frequency loss risk also dropped by 25%.   Our world is louder, and our hearing abilities will crash even sooner than in the past.  Vegetables, fruit, lean meat, and fish can help maintain your hearing fidelity.  Noise cancelling earplugs and earphones also help.   Sharon G Curhan, Christopher Halpin, Molin Wang, Roland D Eavey, Gary C Curhan. Prospective Study of Dietary Patterns and Hearing Threshold Decline. American Journal of Epidemiology, 2019; DOI: 10.1093/aje/kwz223   #diet #hearing #noise

Vidcast:  https://youtu.be/YH4G3xa8_sM   Patients receiving chemotherapy, radiation, immunotherapy, and surgery face stresses similar to astronauts blasted into deep space.  Exercise physiologists at New York’s Memorial Sloan-Kettering Center now propose NASA-like physical counter measure programs (CMPs).   Cancer patients and astronauts both suffer decreases in muscle mass, cardiac functional changes, cognitive shifts, and bone demineralization during their respective journeys.  Many of the training programs used prior to space flights are now being adapted for patient use.   Exercise improves brain, cardiac, and bowel function, enhances the immune response, and strengthens bones.  Expect to see the lessons of space medicine applied as CMPs to help all of us through medical and surgical therapy for cancer and more.   Jessica M. Scott, Lianne B. Dolan, Larry Norton, John B. Charles, Lee W. Jones. Multisystem Toxicity in Cancer: Lessons from NASA’s Countermeasures Program. Cell, 2019; 179 (5): 1003 DOI: 10.101

Vidcast:  https://youtu.be/yIqurbhKfAw   That’s the bottom line of the ISCHEMIA study, an international effort coordinated by cardiologists at Stanford and New York Universities.  Presented last week at the American Heart Association’s meetings, the study had nearly 5200 participants in 37 countries.   Patients with stable coronary blockages do no better with invasive surgery, either angiographic stent placement or open chest arterial bypass grafts, than those treated conservatively using medications.  The one exception: patients with chest pain, angina, achieved more relief from surgery.   There are rare cases when surgery is absolutely necessary.  When an operation is recommended to you, ask if there is an alternative.  If you are told, “No,” get a second opinion.   https://med.stanford.edu/news/all-news/2019/11/invasive-heart-treatments-not-always-needed.html   #Coronaryarterydisease #stents #CABG #angina

Vidcast:   https://youtu.be/sKbA3LbiCVg   Parents tightly managing their kids’ academic and social paths produce offspring with faulty academic and social skills, poor self-control, and emotional problems.  Family studies researchers at West Virginia University draw these conclusions from surveys of 302 young adults.   The investigators add that the parents who herd their children into the right preschools, elite grade schools, the most selective colleges, and 6 and 7 figure jobs do so for bragging rights.  The study terms these manipulated kids “hothouse children” comparing them to orchids bred under carefully controlled conditions.   Parents who truly love their kids give them guidance and the skills to focus on their life targets.  Then, they step back and applaud their self-directed accomplishments.   Kristin L. Moilanen, Mary Lynn Manuel. Helicopter Parenting and Adjustment Outcomes in Young Adulthood: A Consideration of the Mediating Roles of Mastery and Self-Regulation. Journal of Child and Family Stud

Vidcast:  https://youtu.be/h0lSb9JaTLA   Cleaning products and disinfectants can increase your risk of developing handicapping chronic obstructive lung disease, COPD, by up to 38%.  Harvard and NIH researchers followed more than 73,000 US nurses occupationally exposed to such toxic chemicals over a 6 year period.   The nurses were using chemicals including bleach, hydrogen peroxide, alcohol, ammonia, and glutaraldehyde to clean both surfaces and medical instruments.  A history of smoking or asthma did not impact the recorded risks.   COPD is the 3td leading cause of death worldwide, and up to 20% of cases are linked to occupational toxins.  You probably use many products that crippled these nurses at home.  When you do, limit your exposure and ventilate well.   Orianne Dumas, PhD1,2; Raphaëlle Varraso, PhD1,2; Krislyn M. Boggs, MPH3,4; et al.  Association of Occupational Exposure to Disinfectants With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses.  JAMA Netw Open. 2019;2(10):e19

Vidcast:  https://youtu.be/aaIi2jdCaVU   The high fat, low carb diet that is keto triggers activation of special lung T lymphocytes that make mucus webs which sideline  influenza viruses.  This finding is now reported by Yale immunobiologists using a mouse model.   The keto diet facilitates influenza virus death and better experimental animal survival compared with a high carb diet.  A line of mice incapable to producing the mucus-generating T cells saw no benefit from the keto diet.   With the flu season upon us, do get the vaccine.  Add to its protection by going keto and increasing your intake of fatty fish, beef, full-fat milk and cheese, avocado, peanut and almond butters, and healthy fatty oils.   Emily L. Goldberg, Ryan D. Molony, Eriko Kudo, Sviatoslav Sidorov, Yong Kong, Vishwa Deep Dixit, Akiko Iwasaki. Ketogenic diet activates protective γδ T cell responses against influenza virus infection. Science Immunology, 2019; 4 (41): eaav2026 DOI: 10.1126/sciimmunol.aav2026   https://www.healthline.com/nutr

  Vidcast:  https://youtu.be/jTrtQsWO7y4   Next week’s bingeing on that pie with ice cream and whipped cream piled high could trigger inflammatory bowel disease or worsen the disease you already have.  A mouse study from Canada’s University of Alberta reports that sugar in the gut feeds renegade bacteria like E. coli that trigger inflammation and destructive immune responses.   It only took two days of the sugary diet to give the experimental animals a bellyache.  Patients with inflammatory bowel disorders like Crohn’s and ulcerative colitis report similar experiences.   The good news is that your holiday sugar gorge may be neutralized by downing high fiber fruits, veggies, whole grains, beans and nuts that produce short-chain fatty acids.   Michael Laffin, Robert Fedorak, Aiden Zalasky, Heekuk Park, Amanpreet Gill, Ambika Agrawal, Ammar Keshteli, Naomi Hotte, Karen L. Madsen. A high-sugar diet rapidly enhances susceptibility to colitis via depletion of luminal short-chain fatty acids in mice. Scientific Repo

  Vidcast:  https://youtu.be/zq8SI0miOgg   Manipulating your facial expression to show serious, focused determination, a game face, will actually improve your performance on intellectual challenges.  A University of Tennessee psychology study looked at 62 participants as they solved Mandala puzzles.   Putting on the game face that so many athletic coaches demand of their players did actually speed the subjects’ thought processes and puzzle solution by some 20%.  Skin conductance measurements showed that game face actually reduced the participants’ stress levels   Remember that game face depends on the game you’re playing.  When I walk in to treat my pediatric patients, it’s show time.  I adjust best crazy tie and put on a broad smile.   Matthew T. Richesin, Michael D. Oliver, Debora R. Baldwin, Lahai A.M. Wicks. Game Face Expressions and Performance on Competitive Tasks. Stress and Health, 2019; DOI: 10.1002/smi.2899   #Gameface #winning #puzzles #acting  

  Vidcast:  https://youtu.be/DSErGGTJmQI   Instrumental music insulates your body’s nervous system from pressures of traffic jams, nasty other drivers, and sudden stops.  This the result of a small Brazilian study just published in Complementary Therapies in Medicine.   The investigators measured the effects of driving an unfamiliar car during a nerve-racking urban rush hour on the hearts of young, relatively inexperienced drivers.  Driving with peaceful music eliminated stress on the drivers’ autonomic nervous system as measured by heart rate variability.   If driving, commuting on mass transit, school pressures, your boss, or virtually any noxious experiences are literally driving you crazy, try some jazz or classical music.  Those calming melodies will neutralize the toxins of life.   Myrela AleneAlvesaDavid M.GarnerabJoice A.T.do AmaralcFernando R.OliveiradVitor E.Valentia.  The effects of musical auditory stimulation on heart rate autonomic responses to driving: A prospective randomized case-control pilo

  Vidcast:  https://youtu.be/5JaCIuYeWaw   Taking extra testosterone can double a man’s risk of dangerous leg blood clots, and that risk is tripled if he is younger than 65.  A study just published in JAMA Internal Medicine studied use of the supplement in nearly 40,000 men over a 7 year period.   Leg blood clots can travel up into the lungs and trigger a pulmonary embolism.  This blockage of blood into the lungs that kills up to 100,000 Americans each year.   Men take testosterone to increase physical and sexual vitality despite good scientific proof.  On the other hand extra hormone can enlarge a man’s breasts, reduce his sperm production, enlarge his prostate, and trigger sleep apnea.   I wouldn’t recommend it guys!   Walker RF, Zakai NA, MacLehose RF, et al. Association of Testosterone Therapy With Risk of Venous Thromboembolism Among Men With and Without Hypogonadism. JAMA Intern Med. Published online November 11, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5135   https://www.mayoclinic.org/hea

Vidcast:  https://youtu.be/n287C8md9t0   It’s generally thought that background music stirs creativity.  Not so says a study from several universities in the UK and Sweden just published in the journal Applied Cognitive Psychology.   A total of 84 university students and staff were presented with tests of creative ability, so-called Compound Remote Associate Tasks or CRAT for short.  Subjects were exposed to instrumental music only, songs with completely unfamiliar foreign language lyrics, or hit songs with familiar lyrics.  The control sounds were library background buzz and absolute quiet.   The study results showed that the familiar songs with lyrics negatively impacted creativity the most followed by instrumentals and then foreign language songs.  Test performances were the same in absolute silence and in the low din of the library.   The researchers hypothesize that the changing state of sound is most responsible for reducing creativity as the music reduces the performance of verbal working memory.  I pe

Vidcast:  https://youtu.be/9_LxyguWH5U   Deep sleep, the slow wave, non-REM variety, is the best sleep for literally cleansing your brain according to a new study from the University of Rochester.  The scientists studied the effects of deep sleep in a mouse model inducing that state with the unique combination of general anesthetics ketamine and xylazine.   The combination of deep slow wave sleep and the low level cardiovascular activity that accompanies it triggers the so-called glymphatic system, the brain’s unique plumbing apparatus that flushes waste from our brain cells.  This essential purging fails to occur during sleep deprivation and is also less likely to occur as we age when it becomes more difficult to achieve deep sleep.      Other studies suggest that the onset of Alzheimer’s is associated with less deep sleep and this may be due to poor glymphatic system activity.   You can help yourself get deep sleep at any age with the following tips.  Before bedtime: no eating, caffeinated beverages, exerci

Vidcast:  https://youtu.be/md9yTWb2Jos   You and I have talked many times about the fact that exercise, almost any exercise other than reaching for a donut, will help you live longer.  Now a study from Denmark published in the Mayo Clinic Proceedings pinpoints just which forms of exercise will add extra years to your life.   The investigators reviewed data from more than 8500 participants in the Copenhagen City Heart Study.  Although 12% of that group were total couch potatoes, 75% of those remaining participated in at least one form of physical activity.   When the data was tallied, it turns out that playing tennis seems to add the most extra years to your life at nearly 10 years.  Following that we have badminton at 6 years, soccer at nearly 5 years, cycling at nearly 4 years, swimming, jogging, and calisthenics at 3 years.   Bringing up the rear was health club exercise at 1.5 years.  Remember that this study merely reports an association between longer life and different types of recreational activity.  

Vidcast:  https://youtu.be/Esf1lZ987dg   Microplastics from yoga outfits, sweat-wicking suits, and fleece vests are turning up in Pacific Ocean oysters and clams.  Marine biologists from Portland State University surveyed some 300 oysters and clams from 15 sites along the Oregon coast.   Plastic material was found in nearly all of the sampled marine organisms with an average of 11 microplastics per oyster and 9 per clam.  Almost all plastics were microfibers likely from clothing as more of them were found in oysters during the spring than in the summer.   Microplastics are invading our world as plastic bags and bottles as well as synthetic fabrics break down.  We are literally poisoning ourselves and our children.  You know the solutions!     Britta R. Baechler, Elise F. Granek, Matthew V. Hunter, Kathleen E. Conn. Microplastic concentrations in two Oregon bivalve species: Spatial, temporal, and species variability. Limnology and Oceanography Letters, 2019; DOI: 10.1002/lol2.10124   #Plastics #pollution #clot

Vidcast:  https://youtu.be/qw5OQrPXXHE   Sleep problems affect as many as 70 million Americans.  The problem is worsening over the past 4 years as 5 million more of us generally considered to be healthy sleepers have a problem falling asleep and nearly 8 million more of us cannot remain asleep.   Investigators at Iowa State University studied sleep pattern data from about 165,000 subjects.  Though the results failed to definitely pinpoint a cause, they speculate that technology is playing a key role.  That includes smartphone use before bedtime and electronic notifications interrupting sleep.    Sleep is critical for the daily rejuvenation of our bodies and their component cells.  Though technology interrupts it, newer wearables permit evaluation of sleep quality in order to effect improvement     Garrett C. Hisler, Diana Muranovic, Zlatan Krizan. Changes in sleep difficulties among the U.S. population from 2013 to 2017: results from the National Health Interview Survey. Sleep Health, 2019; DOI: 10.1016/j.sle

Vidcast:  https://youtu.be/B03-WxqRrVA   Competitive esport players face the same intense psychological pressure as professional athletes in other sports. Psychologists at Britain’s University of Chichester studied a group of elite gamers and uncovered some 51 stress factors that impact them.   The two most onerous are strategic communications with teammates and performances before a live audience.  In order to suppress fears about miscommunications, gamers either become aggressive with one another or avoid interchanges.  The eplayers mention no specific strategies for managing stage fright.   The investigators conclude that electronic gamers require not only psychological support when they falter due to the stress, but also the necessary mental and physical bulking up even before the play begins.   Matthew J. Smith, Phil D.J. Birch, Dave Bright. Identifying Stressors and Coping Strategies of Elite Esports Competitors. International Journal of Gaming and Computer-Mediated Simulations, 2019; 11 (2): 22 DOI: 10

Vidcast: https://youtu.be/ijN1YN_akxg   Your parents, siblings, and others hanging on your family tree may be more important to your health than your spouse or significant other.  With Thanksgiving just around the corner, think ahead!   UT Southwestern family medicine researchers studied some 2800 middle-aged adults over a 20 year period.  They tabulated the incidence of illness as a function of the participants’ various relationships.   Those experiencing more intra-family squabbles have significantly more illness.  Intimate partner relationships had no such effect.  On the other hand, supportive family relationships improve disease outcomes.   Holidays are the time to cement good family relationships or to initiate them.  Either way, your life may depend on it.  Think transplant.     Sarah B. Woods, Jacob B. Priest, and Patricia N. E. Roberson. Family Versus Intimate Partners: Estimating WhoMatters More for Health in a 20-Year Longitudinal Study. Journal of Family Psychology, 2019 DOI: 10.1037/fam0000600