Dr. Howard Smith Oncall

Vidcast:  ttps://youtu.be/r6alvHymzwg   Simply rubbing your hands with Purell™ or  knock-offs will not kill the influenza virus.  A Japanese study just published by the American Society of Microbiology shows that the mucus that contains the virus protects it from alcohol-based hand sanitizers.   The typical 15-30 second sanitizer rub won’t kill the flu virus, or probably any virus, unless the secretions are dried.  The good news is that first washing your hands with an antiseptic soap for 30 seconds will kill virus.     You don’t have antibacterial soap but do have Purell?  I suggest quickly washing your hands with any soap to eliminate mucus and then use the hand sanitizer.    Ryohei Hirose, Takaaki Nakaya, Yuji Naito, Tomo Daidoji, Risa Bandou, Ken Inoue, Osamu Dohi, Naohisa Yoshida, Hideyuki Konishi, Yoshito Itoh. Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients. mSphere, 2019; 4 (5) DOI: 10.1128/mSphere.00474-19   #Influenz

Vidcast:  https://youtu.be/GIM0xl8Rs10   Babies delivered by C-section rather than by a normal vaginal route develop a gastrointestinal bacterial population contaminated by bad bugs found around the hospital.  Their gut bacteria include antibiotic-resistant ones rather than the more benign species found in their mothers.   British researchers studied 600 healthy babies to identify their gut bacteria using DNA fingerprinting techniques.  The C-section babies had more than 800 potentially-dangerous bacteria, of the type that cause life-threatening, blood-borne infections in hospitalized patients.   These observations mandate that C-sections be avoided except for life-threatening situations.  Elective c-sections for convenience are foolish and unnecessarily risky.   Yan Shao et al. Stunted gut microbiota and increased pathogen colonisation associated with caesarean birth. Nature #2019 DOI: 10.1038/s41586-019-1560-1   #Caesariansection #microbiome #antibioticresistantbacteria

Vidcast:  https://youtu.be/bTWGLdnm90w   If you prefer more conservative medical therapy but must visit a surgeon for a consultation, pick an appointment at the end of day or just before lunch.  You’ll be half as likely to hear a recommendation for surgery.   A Swedish study of some 848 orthopedic appointments confirms that, when doctors are relatively fatigued, they avoid difficult or risky decisions.  Patients visited the orthopods during a total of 133 office sessions including morning, afternoon, or all-day.  The surgeons recommended operations more than 40% of the time earlier in the sessions but only 22% of the time at the end of any given session.   In general, if you can, see clinicians at the beginning of any given office session.  Their minds will be fresh and they will most likely be on time.   Emil Persson, Kinga Barrafrem, Andreas Meunier, Gustav Tinghög. The effect of decision fatigue on surgeons' clinical decision making. Health Economics, 2019; DOI: 10.1002/hec.3933   #Surgery #officevisits #c

Vidcast:  https://youtu.be/-81VImw-zEo   The prevalence of heart infections, bacterial infestations of the valves and cardiac linings known as endocarditis, have nearly doubled in drug abusers.  Cardiologists at the Cleveland Clinic studied nearly 1 million hospitalized patients with this disorder to understand the causes.   The drug users who developed bacterial endocarditis were predominately young, white men with incomes among the lowest 25%.  They had higher rates of concurrent hepatitis C, alcohol abuse, and HIV infection compared with non-drug abusing cardiac patients.  They were more likely to require heart surgery and had longer hospital stays and higher health care expenses.   Bacterial heart infections occur when germs enter the bloodstream, usually from reused and contaminated drug paraphernalia.  If you must use drugs, hopefully to withdraw from them, consume them by mouth.  If not, enlist help from clinicians to obtain sterile equipment.   Amer N. Kadri, Bryan Wilner, Adrian V. Hernandez, Georges

Vidcast:  https://youtu.be/BV1PEQG6hzk   WikiHow’s 3 step program to become extroverted.  It is excellent, and I will paraphrase it.   ONE: Have the mindset. TWO: Do the work. THREE: Engage with others.   Have the mindset:  Value Extroversion: make friends easily, comfortable in crowds, keep a party going. Envision yourself as a good extrovert: not phony or hurtful. Select a spot on the extrovert spectrum. Look forward to feeling better about yourself. Know transition is difficult.   Do the work:  Observe. Perform. Start small. Be around people. Know yourself Walk on the wild side.   Practice: Find the right group. Play your strengths Talk Assert yourself Interrupt politely Attract attention Make people laugh Keep the party going.     https://www.wikihow.com/Be-an-Extrovert   #Extroversion #introversion #acting

Vidcast:  https://youtu.be/eFtj42jop5Q   If you’re quiet and withdrawn by nature, you’ll be happier if you push yourself to be outgoing.  UC-Riverside psychologists studied 123 subjects classifying them as introverts or extroverts.   Investigators coached each participant to act, for one week, as quiet, reserved introverts or as talkative, outgoing, “life of the party” extroverts.   The participants reported greater feelings of well-being during their week spent as extroverts.   Those who were naturally quiet and had to work the hardest to be talkative and spontaneous showed no ill effects as the result of the charade.   We are all actors of sorts, and this study shows that it is healthy to get outside yourself.  Humans are naturally social animals, and the qualities associated with extroversion facilitate that tendency.   Seth Margolis, Sonja Lyubomirsky. Experimental manipulation of extraverted and introverted behavior and its effects on well-being.. Journal of Experimental Psychology: General, 2019; DOI: 1

Vidcast:  https://youtu.be/4V_LSBkMV5s   Four months on a plant-based, low fat diet can cleanse your gut and leave you with a healthier microbiome that helps you control your weight, improve your body composition, and avoid diabetes.  The Physician Committee for Responsible Medicine demonstrated this result after studying 147 subject half of whom followed the vegan program.   Those foregoing meat and fish showed significantly reduced body weights, a significantly lower fat mass, an increase in their insulin sensitivity, and a healthier gastrointestinal bacterial composition.  The investigators conclude that the fiber from the plant-based diet is the magic sauce that refines the gut microbiome.   If you’re looking for a healthy way to lose some weight and improve your metabolism, take a break and become a vegan for 12 weeks.   Diabetologia. "Short-term study suggests vegan diet can boost gut microbes related to body weight, body composition and blood sugar control." ScienceDaily. ScienceDaily, 16 September 201

Vidcast:  ttps://youtu.be/0PQgrkKSGSw   You’ll make poor choices and turn in awful intellectual performances on an empty stomach.  Psychologists at Scotland’s University of Dundee put 50 participants to the test either 2 hours after eating or following a 10 hour fast.   Test results revealed that hunger triggers impatience, impulsivity, and a need for immediate gratification .  The well-fed were willing to wait over a month for a substantial reward while the hungry could only manage 3 days.   If you want and need consistent mental performance, start with a good breakfast and eat regularly.  The researchers add, of course, that you shouldn’t food shop when you’re hungry.   Jordan Skrynka, Benjamin T. Vincent. Hunger increases delay discounting of food and non-food rewards. Psychonomic Bulletin & Review, 2019; DOI: 10.3758/s13423-019-01655-0     #Hunger #impulsivity #impatience

Vidcast:  https://youtu.be/OSjfU5mXNbI   Studies prove that oral exposure to peanut protein can tame deadly peanut allergies.   The FDA just approved a drug therapy program, Palforzia, to do just that.     A Stanford University study now shows that peanut reactivity will return unless therapeutic peanut exposures continue.   The researchers studied 120 peanut-allergic participants.    After nearly 3.5 months of ever increasing peanut protein, all were successfully desensitized and could safely consume the equivalent of 200 peanuts.  Stopping the 200 peanut treatments completely or continuing with daily exposures of only 15 peanuts a day failed to maintain peanut non-reactivity.   This result suggests that any desensitization program, including Palforzia, will require continuation of therapy for an extended period.  It would be dangerous to stop.    R Sharon Chinthrajah, MD ,Natasha Purington, MS, Sandra Andorf, PhD, etal.  Sustained outcomes in oral immunotherapy for peanut allergy (POISED study): a large, ra

Vidcast:  https://youtu.be/UUTcZc0Izxs   The harder you think, the more sleep you require.  Neuroscientists at University College London report this finding after studying sleeping patterns in zebrafish.  These marine animals are a good model since, like humans, require a daily sleep session to rejuvenate their brains.   Experimental animals were driven to continuous brain activity by drugs such as caffeine or by forced, non-stop, swimming.  When an opportunity for them to rest occurred, they demonstrated a greater need for sleep.   Now that school and work are back in full swing, we all must be certain to permit our brains sufficient time for a recharge.  That necessary rejuvenation only comes from restful, deep, and uninterrupted sleep.   Sabine Reichert, Oriol Pavón Arocas, Jason Rihel. The Neuropeptide Galanin Is Required for Homeostatic Rebound Sleep following Increased Neuronal Activity. Neuron, 2019; DOI: 10.1016/j.neuron.2019.08.010   #Thought #sleep  

Vidcast:  ttps://youtu.be/YZQ4NNpfZ1Y   After my years as a camp counselor, raising 4 kids, and caring for children and their parents as a pediatric otolaryngologist for 40 years, here are my go-to principles for effective parenting.   ONE. Consistency.  Establish reasonable boundaries that create security.  Offer praise and rewards for remaining within them.  Use a carrot versus a stick.  Announce consequences for violations.  Say what you’ll do and do what you say.   TWO: TWO: Responsibility.  Allow progressive decision-making within limited choice boundaries even for infants and toddlers.  Child refuses food.  You say, “Do you want apples or peaches?” Have a balky, uncooperative teen?  “Do you want garbage or yard duty?”   THREE: Distraction.   When the inevitable poor behaviors and disagreements arise, distract using redirection to a different activity or location and…..   FOUR: Humor.  Laughter and smiles are powerful parenting tools.  Don’t be afraid to clown around and show love in a offbeat ways.   #p

Vidcast:  https://youtu.be/X36J-0nZ-rk   The common child discipline, the good old time out, is safe and effective.  University of Michigan pediatric psychologists report this conclusion after studying a large group of children in Early Had State Research study at 3 points in their early development: around 3, 4 and 10 years of age.   Despite the statements found on 30% of parental advice websites, time outs are recommended by the Academy of Pediatrics and not associated with anxiety, depression, aggressive behavior, or loss of self-control.     Time outs are part of my 4 commandments of good parenting that I’ll review in another report.   Rachel M. Knight, Jeremy Albright, Lindsay Deling, Dawn Dore-Stites, Amy K. Drayton. Longitudinal Relationship Between Time-Out and Child Emotional and Behavioral Functioning. Journal of Developmental & Behavioral Pediatrics, 2019; 1 DOI: 10.1097/DBP.0000000000000725   #Timeouts #parenting #discipline

Vidcast:  https://youtu.be/ia2-rZBk8yo   Sleep quality impaired by breathing disruptions accelerates the aging process.  So said sleep scientists from Harvard’s Brigham and Women’s Hospital earlier this summer at the Associated Professional Sleep Societies annual meeting.    A group of 622 adults underwent sleep analysis via polysomnography and quantitative aging determination by epigenetic DNA methylation.  Each standard deviation increase in apnea ages you 215 days. Each standard deviation increase in sleep disruption ages you 321 days.  Women were more susceptible than men.   Poor sleep quality negatively impacts every body organ leading to a shortened life.  This study puts it on a disease severity on par with diabetes.   https://www.medscape.com/viewarticle/914374   #Apnea #aging #sleepdisorderedbreathing  

Vidcast:  ttps://youtu.be/4O6kaDUCs-4   Children born even as little as 3 weeks prematurely during the summer months may be inappropriately placed a grade ahead.   Then they go through their elementary education at a profound disadvantage and are twice as likely to underperform.     The researchers at Britain’s University of Leeds do not recommend arbitrarily holding back a premie. Instead they suggest special educational services for such kids when they stumble and require them.     I suggest that, for educational placement purposes, the child’s date of birth be considered to be their expected due date, the date on which they should have been born.  Then, again, if the child needs help, it may be provided.     University of Leeds. "Early education setback for summer premature births." ScienceDaily. ScienceDaily, 13 August 2019. to be published in the Archives of Disease in Childhood.   #Premies #schoolplacement #duedate

Vidcast:  https://youtu.be/LXahZTaYegs   Your child is more likely to suffer a head injury biking or skate boarding than playing team sports like soccer, rugby, or basketball.  So says a Australian-New Zealand study of  20,000 plus kids presenting to emergency departments with head injuries.   Bike riding, skateboarding, and golf are 20 times more likely than rugby to produce a head injury.  Of the team sports, surprisingly only baseball and softball were the most dangerous accounting for 8% of the total head injuries.   Only you can instill your children with a 6th sense of impending danger.  Encourage them to play safely and use headgear.   Nitaa Eapen, Gavin A Davis, Meredith L Borland, Natalie Phillips, Ed Oakley, Stephen Hearps, Amit Kochar, Sarah Dalton, John Cheek, Jeremy Furyk, Mark D Lyttle, Silvia Bressan, Louise Crowe, Stuart Dalziel, Emma Tavender, Franz E Babl. Clinically important sport‐related traumatic brain injuries in children. Medical Journal of Australia, 2019; DOI: 10.5694/mja2.50311   #h

Vidcast:  https://youtu.be/pTL7gMnka1s   Feeding your infant to excess triggers undesirable genetic changes that could condemn the child to diabetes, heart disease, and cancer.  Pediatricians and molecular geneticists at Texas’ Baylor College of Medicine now report that overfed mouse neonates develop lifelong DNA methylation abnormalities.   These genetic changes led to premature aging patterns of the pancreas.  That, in turn, produces less robust insulin production with diabetes and all its dire consequences.   Parental responsibility for good child nutrition begins at birth.  This study adds to other than emphasize that the effects of an unbalanced diet are difficult if not impossible to correct.   Ge Li, Tihomira D Petkova, Eleonora Laritsky, Noah Kessler, Maria S Baker, Shaoyu Zhu, Robert A Waterland. Early postnatal overnutrition accelerates aging-associated epigenetic drift in pancreatic islets. Environmental Epigenetics, 2019; 5 (3) DOI: 10.1093/eep/dvz015   #Overfeeding #diabetes #DNAmethylation

Vidcast:  https://youtu.be/nt8CnzUfzIE   Protect your brains guys if you value your virility and sex lives.  The Harvard Football Players Study reports that repeated head trauma is associated with testosterone reductions and a risk of erectile problems or ED.   Included in the study were 3400 former football players.  Those with the highest concussion scores were 2.4 times more likely to have low testosterone and 1.7 times more likely to report ED.   If you played high school, college, or pro ball, don’t be shy about getting testosterone testing.   If you are counseling your sons about football, hockey, rugby, or soccer heading, have them pick a safer sport.   Grashow R, Weisskopf MG, Miller KK, et al. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol. Published online August 26, 2019. doi:10.1001/jamaneurol.2019.2664   #Concussion #headtrauma #testosterone #erectivedysfunction

Vidcast:  https://youtu.be/LVHpX2FdrEA   Ladies with post-traumatic stress should so inform their ob-gyns and seek close surveillance for ovarian cancer. The Harvard School of Public Health just reported that young women with past traumatic experiences and PTSD symptoms have up to a 3 fold higher risk of this deadly disease.   The study of nearly 55,000 nurses showed that women with the most PTSD symptoms including flashbacks, social isolation, nightmares, insomnia, anxiety, and anger issues had a average 2 fold greater cancer risk. The subset of young, pre-menopausal women suffered the highest 3 fold risk.   Stress and its hormones stymie your immune system and its fight against cancer.  If you have PTSD, neutralize its symptoms and maintain a watchful eye for its dire consequences.   Andrea L. Roberts, Tianyi Huang, Karestan C. Koenen, Yongjoo Kim, Laura D. Kubzansky, Shelley S. Tworoger. Posttraumatic stress disorder (PTSD) is associated with increased risk of ovarian cancer: a prospective and retrospectiv

Vidcast:  https://youtu.be/4waXXk7vFG4   Growing up with an older brother slows a young child’s language emergence.  French developmental linguists observed this phenomenon after observing more than 1100 children from birth to 5 and a half years.   Children of either gender with older brothers had a 2 month language delay compared with those having a sister.   The investigators suggest that this gap may be the result of more language stimulation from the sister as girls tend to develop verbal language faster than boys.   Young parents whose growing families have an oldest male child should give special time and provide more language stimulation for that younger sib.   Naomi Havron, Franck Ramus, Barbara Heude, etal. The Effect of Older Siblings on Language Development as a Function of Age Difference and Sex. Psychological Science, 2019; 095679761986143 DOI: 10.1177/0956797619861436   #Languagedevelopment #siblings

Vidcast:  https://youtu.be/kR-yJ1SX370   Positive thinking fuels a longer, happier life.  A collaborative study from Boston University, the Boston VA Medical Center, and Harvard’s School of Public Health now shows that optimistic men and women live 11 to 15% longer and have a 50-70% greater chance of living to 85 years.   The study looked at more than 70,000 participants.  Surveys quantitated their optimism, and medical records provided their health status.   Researchers speculate that optimism neutralizes stress and its nasty associated hormones.  A smile on your face and a positive half-full philosophy will not only brighten but also lengthen your life.   Lewina O. Lee, Peter James, Emily S. Zevon, Eric S. Kim, Claudia Trudel-Fitzgerald, Avron Spiro III, Francine Grodstein, and Laura D. Kubzansky. Optimism is associated with exceptional longevity in 2 epidemiologic cohorts of men and women. PNAS, 2019 DOI: 10.1073/pnas.1900712116   #Optimism #longevity #stress