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Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Behavioral Science, In the News, Research, Science

“Benign masochism” motivates common strange behaviors

"Benign masochism" motivates common strange behaviors

14674431439_be72558bd3_zI can recall many times I’ve offered something to a friend saying, “Smell this, it’s disgusting!” And more than once, the friend obliged. According to a National Geographic blog piece, the psychological motivation behind the appeal of stinky things is the same as the appeal of roller coasters, painfully spicy foods, and deep tissue massage. Likewise with reading sad novels or watching scary movies (though this last one is not something I personally enjoy). So what’s the common thread?

“Benign masochism,” a term coined by Paul Rozin, PhD, professor emeritus of psychology at the University of Pennsylvania, describes how humans enjoy negative sensations and emotions when they’re reassured that no harm will come to them. A “safe threat,” in other words.

The blog post is centered on our enjoyment of disgust, inspired by the massive audience at a recent blooming of a corpse flower at UC Berkeley’s Botanical Gardens. Valerie Curtis, PhD, a research director at the London School of Hygiene and Tropical Medicine and Psychology Today’sDisgustologist“, is quoted as saying the phenomenon is not dissimilar from kids playing war games in which they can “practice” their reactions to unpleasant situations.

“The ‘play’ motive leads humans (and most mammals, especially young ones) to try out experiences in relative safety, so as to be better equipped to deal with them when they meet them for real,” she says. “We are motivated to find out what a corpse smells like and see how we’d react if we met one.” Gross!

Previously: Looks of fear and disgust help us see threats, study shows
Photo by Dave Pape

Health Policy, Pediatrics, Research, Sleep

Rethinking middle and high-school success: strategies for creating healthier students

Rethinking middle and high-school success: strategies for creating healthier students

512px-Sleeping_while_studyingMy daughters are still years away from college or even high school, but I’m not looking forward to the high-pressure arena that they look to be from afar. The stress and lack of sleep has to take a toll on students’ health. I was curious, then, to hear about a program developed by researchers from Stanford’s Graduate School of Education called Challenge Success. The program helps parents and schools develop a more even-keeled approach to the high-pressure world that many college-bound middle- and high-schoolers find themselves in.

Last week, the program released Overloaded and Underprepared: Strategies for Stronger Schools and Healthy, Successful Kids, a book that gathers what researchers at Challenge Success have learned in the dozen years the program has been in place. The GSE’s website features a Q&A with two of the book’s authors: Denise Pope, PhD, EdM, a Stanford GSE lecturer and co-founder of Challenge Success, and Maureen Brown, Challenge Success Executive Director.

Below are some highlights of the interview, which is worth reading all the way through:

How are students overloaded today?

Pope: People assume with the new standards and requirements for college admission, that teachers need to cover more topics in class and that kids need to take more courses and do more activities in school and after school to meet expectations for success. This is a confusion between rigor and load. Rigor is real depth of understanding, mastery of the subject matter. That’s what we want. Load is how much work is assigned. Many educators and many parents assume that the more work you assign and the more work students do, the better they will understand it. That is not necessarily the case. For example, we have teachers who teach AP classes and cut their homework load in half, and the kids end up doing as well on the exam. You don’t have to do four hours of homework in order to learn something in depth or to retain it. But four hours of homework can be incredibly damaging physically and emotionally.

. . .

Who should read this book?

Pope: We started writing it for educators, to give a guide to those schools that couldn’t physically partner with us at Challenge Success. The goal was to compile our best practices. But after a little bit of writing, I handed it to my husband (who isn’t an educator) just to see if it made sense. He came back and said, ‘You know, I was really interested as a parent as to why a school would use a block schedule or why so many kids are cheating or what is the purpose of taking an Advanced Placement course.’ So we realized it was actually a book for a much broader audience of people who were interested in the research on some of these practices.

Brown: For example, if parents don’t understand the ‘why’ for certain policies or practices, they can’t help advocate for real systemic change. The book gives parents the ability to ask the right questions at their schools to understand why their school is going down a certain path.

Previously: Excessive homework for high-performing high schoolers could be harmful, study findsWith school bells ringing, parents should ensure their children are doing enough sleeping, Stanford expert: Students shouldn’t sacrifice sleep and Stanford researchers to study effectiveness of yoga-based wellness program at local schools
Photo by Psy3330 W10

Health Disparities, Medical Education, Medicine and Society, Public Health, Science

Stanford Medical Youth Science Program for underrepresented students expands and deepens

Stanford Medical Youth Science Program for underrepresented students expands and deepens

unnamedThe Stanford Medical Youth Science Program (SMYSP) is a 5-week summer residential program for rising high school juniors and seniors interested in science and medicine. The students, who come from underrepresented and low-income backgrounds, have an opportunity to experience the medical profession from the inside out. This year’s program concluded late last month with a graduation ceremony in which the students presented their scientific research projects on health disparities and advocacy to an audience of their parents and supporters.

A few weeks ago, I had the chance to speak with the program’s longtime director, Judith T. Ned, EdD, who told me SMYSP has come a long way since it was co-founded 28 years ago by Stanford epidemiologist Marilyn Winkleby, PhD, MPH. This is Ned’s 14th year running the show. She has made lot of beneficial changes and expansions, many of which happened since we last featured SMYSP in 2010, without losing sight of the program’s purpose: to expose these kids to the fields of science and medicine while increasing workforce diversity in the health professions.

Each year, 12 boys and 12 girls are selected for the program, all of whom come from 20 counties surrounding Stanford. “The goal is to really provide services and opportunities to students who are in our backyard, if you will,” Ned told me. The students have a well-rounded curriculum – not only do they attend lectures by leading academics and industry professionals, anatomy lectures and labs (with cadavers!), and twice-weekly clinical internships, but they have non-clinical days where they investigate departments like hospital food service, security, and art therapy. “We want to show them that it takes multiple people in multiple areas to really make the hospital function. Most of the time, many of my students serve as translators for their parents when they go into the hospital. This is the flip side: the provider’s perspective, not the patient’s. It’s been an interesting experience to see them switch mindsets.”

Programming includes SAT prep, “game shows” to improve knowledge retention, and evening workshops that include leadership development and performing arts. Ned wants the students to know that “you can take a well-rounded liberal arts education, get into medical school, and still practice your craft, embracing both sides of your identity.” Community service is also a key feature of the program, such as the beautification project they did at the East Palo Alto YMCA the Saturday before our interview.

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Aging, Health Costs, Health Policy, Patient Care

A look back at Medicare’s 50 years

Hand in HandOn Friday, KQED’s Forum offered a look at Medicare and Medicaid to mark the programs’ 50-year anniversary. Stanford health policy researcher Laurence Baker, PhD, participated in the discussion, which covered issues such as how the programs drive the way prices for care are negotiated with medical providers, how the large population of Baby Boomers will affect the system, and how reimbursement rates affect the kind of care Medicare and Medicaid patients receive.

The panel also discussed the gaps in coverage — services like dental care are not covered by Medicare — and the challenges they create. Medicare coverage has grown from the narrow set of conditions it first covered, and Baker thinks the conditions are right to begin a new national conversation about expanding coverage:

One of the things that’s really ripe for discussion is how this country is going to handle the long-term care issues. Medicare’s got to be at the center of that. And it almost feels like the time is coming that we’re going to have to think about that much more seriously.

And when host Mina Kim asked Baker the question that’s on a lot of people’s mind — Is Medicare sustainable for the long term? — Baker noted:

The program is pretty important; it’s clearly something the country values across the political spectrum. Lots of people want to see it sustained. It may not be a pretty process. It might not be fun to watch the politics of how we work all this out, but there are lots of ways to keep the program solvent, so I’m optimistic.

Previously: Competition keeps health-care costs low, Stanford study findsWhat’s the going rate? Examining variations in private payments to physiciansCheck the map – medical procedure rates vary widely across CaliforniaMedicare payment reform shown to cut costs and improve patient care and KQED health program focuses on baby boomers and the future of Medicare
Photo by Garry Knight

Bioengineering, Research, Stanford News, Technology

New Stanford-developed technology bypasses “virtual reality sickness”

New Stanford-developed technology bypasses "virtual reality sickness"

headset_newsResearchers in the Stanford Computational Imaging Group have developed a new virtual reality headset that takes into account how the human eye focuses and processes depth.

Current display technologies are essentially two-dimensional and don’t present images the way our eyes were designed to see them, which can cause “virtual reality sickness,” or VR sickness for short, after only a few minutes.

The new system involves two transparent LCD displays with a spacer in between, which is called “light field technology.” A Stanford News article describes a light field as creating “multiple, slightly different perspectives over different parts of the same pupil. The result: you can freely move your focus and experience depth in the virtual scene, just as in real life.”

Gordon Wetzstein, PhD, assistant professor of electrical engineering, developed the technology along with researchers Fu-Chung Huang and Kevin Chen. In the news piece, Wetzstein listed the variety of applications this advance could have, robotic surgery top among them: “If you have a five-hour [robotic] surgery, you really want to try to minimize the eye strain that you put on the surgeon and create as natural and comfortable a viewing experience as possible.”

But the applications aren’t limited to what has already been imagined. Wetzstein explains, “Virtual reality gives us a new way of communicating among people, of telling stories, of experiencing all kinds of things remotely or closely. It’s going to change communication between people on a fundamental level.”

You can access a short video on the new development here.

Previously: Fear factor: Using virtual reality to overcome phobias, From “abstract” to “visceral”: Virtual reality systems could help address pain, Double vision: How the brain creates a single view of the world, Discover magazine looks at super human vision and Augmented reality iOS app for color vision deficiency
Photo by Vignesh Ramachandran

Medical Education, Research, Stanford News

Study examines high costs of maintaining medical certification

Study examines high costs of maintaining medical certification

stethoscope-448614_1280After you’ve got an MD and passed your board exams, you’re all set, right?

Well, not quite. Physicians must meet new requirements for maintaining medical board certifications – and doing so can be costly. A new study from a team at Stanford and University of California-San Francisco explored the costs of the American Board of Internal Medicine (ABIM) requirements, as described in a UCSF article:

The researchers developed a mathematical simulation model of the entire ABIM-certified workforce of internists, hospitalists and internal medicine subspecialists in the United States and estimated total societal costs over 10 years – including ABIM fees and the monetary value of physician time spent on fulfilling [maintenance-of-certification (MOC)] requirements. They calculated that costs to individual physicians would average $23,607 over 10 years, with costs in some subspecialties exceeding $40,000. Subspecialists face higher costs than general internists in the program, primarily because they take additional certification examinations that generate more fees and a greater time outlay.

“We found that 9 out of every 10 dollars in MOC costs were related to the program’s demands on physician time,” said Alexander Sandhu, MD, the lead author of the study and the Veterans Affairs Health Services Research and Development fellow at the Center for Health Policy/Center for Primary Care and Outcomes Research at Stanford University, and a clinical instructor for the Department of Medicine…

The study comes after the ABIM increased its requirements and fees in 2014. Following protest, the ABIM revised the requirements earlier this year but retained the fees and number of modules required. The February changes are “a step in the right direction,” the authors write, but further examination is needed:

Whether the costs of MOC ultimately will be borne by physicians or will be passed on to employers, payers, or patients is uncertain. Furthermore, unless balanced by improved efficiency downstream, the increased demand on physician time in a period of anticipated physician workforce shortfalls may have a deleterious effect on access to care, particularly elective care.

Dhruv Kazi, MD, an assistant professor of medicine at UCSF, was senior author of the study.

Previously: Clinical informatics gains recognition as new medical sub-speciality, A call for extended bedside-manner training and The next challenge for biodesign: constraining health-care costs 
Photo by HolgersFotografie

Global Health, Medical Education, Surgery

Bringing surgical training to female medical students in Zimbabwe

Bringing surgical training to female medical students in Zimbabwe

IMG_1468Earlier this summer, I shared the story of how two pioneering women are challenging the status quo in Zimbabwe by saying it’s okay for women take up careers in surgery. Now, this professor-student duo – Stanford surgeon Sherry Wren, MD, and surgeon-in-training Annete Bonigwe Moyo – have launched the first surgical skills training for female medical students at the University of Zimbabwe’s College of Health Sciences.

For a girl growing up in Zimbabwe like Moyo, expressing interest in surgery can be met with ridicule and doubt. But when Moyo met Wren two years ago, Moyo was inspired to change this perception.

She founded DREAM (Dedicated to Reach, Empower And Mentor women in surgery) to empower her female peers and increase participation in the profession. Wren has been a core advisor since the organization’s inception, helping to achieve their mission by providing mentorship and new educational opportunities for the women of DREAM.

“Surgery is a core subject in our medical undergraduate curriculum requiring the acquisition of cognitive diagnostic demands, as well as procedural skills,” Moyo, a senior medical student at the University of Zimbabwe, told me. “However, in spite of the advent of skills laboratories and simulators, undergraduate trainees are barely exposed to the procedural aspect of training. For many graduating medical students in these circumstances, surgery is a far-off thought, and few have the confidence to carry out basic surgical procedures as they go through their internship.”

IMG_1473In an effort to help medical students translate the knowledge gained in the classroom to the operating table, Wren recently facilitated a basic surgical skills training session hosted by DREAM – a first for medical students in Zimbabwe. The training was attended by 21 third, fourth and fifth year MBChB students – all of them women.

Moyo reported to me:

[Wren] began the session by helping the women appreciate standard operating room etiquette and protocol, sterile procedures, sharps and fluid safety, scrubbing, gowning and gloving. For most of the students present, this was the first time they were being walked through these important basic principles of surgery.

Excitement grew as [Wren] began teaching the women some basic surgical sutures on sterile towels… Soon the ladies were ready to apply their newly learned skills on loops of bowel procured to give a more real feel to the exercise. It was amazing to see how quickly what was initially a barely discernible pattern of uneven sutures transformed into neat even sutures…

By the end of the 3-hour session, the timid girl who was clueless as to how to handle the most basic of surgical instruments, or let alone tie a surgical knot, had become a confident future surgeon raring to do whatever it took to realize her dream.

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Grand Roundup

Grand Roundup: Top posts of July

Grand Roundup: Top posts of July

It’s time to look back at this month’s five-most read stories on Scope. They were:

Eating for good blood: Tips for boosting iron levels and hemoglobin: This entry from the Stanford Blood Center discusses hemoglobin levels and offers ways to boost levels prior to blood donation.

Genetic study supports single migratory origin for aboriginal Americans: An international team of geneticists, evolutionary biologists, and statisticians have concluded that all Native Americans descended from a single immigration event out of Siberia.

“This is probably one of the last major diseases we know nothing about”: A look at CFS: A recent issue of Palo Alto Weekly focused on chronic fatigue syndrome (also known as systemic exertion intolerance disease) and the work of Ronald Davis, PhD, director of Stanford’s Chronic Fatigue Syndrome Research Center and others here.

The worst disease you’ve never heard of: Stanford researchers and patients battle EB: An article in Stanford Medicine magazine describes the toll of a devastating skin disease called epidermoloysis bullosa on two young men and their families, as well as the determined efforts of a dedicated team of doctors and scientists to find a treatment.

Physician-monk leads Stanford doctors in meditation: This post highlighted a recent campus talk by Barry Kerzin, MD, a Buddhist monk who provides medical care to His Holiness the Dalai Lama.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Autism, Behavioral Science, Medical Apps, Nutrition, Stanford News, Technology

Stanford grad students design new tools for learning about nutrition, feelings

Stanford grad students design new tools for learning about nutrition, feelings

2789442655_1f5c33ac51_zMushrooms and tomatoes, veggies that are often reviled by preschoolers, star in a new app designed by a Stanford graduate student that aims to involve children in preparing, and eating, healthy meals.

“Children are more likely to try food that they’ve helped cook,” explained Ashley Moulton, a graduate student in the School of Education’s Learning, Design and Technology Program, in a recent Stanford News story.

Moulton’s iPad app, Nomster Chef, is one of several student projects featured in the article and accompanying video:

Before cooking, children receive an educational video about a food they’ll be working with – for example, a video on how mushrooms grow. The app also incorporates food information in the recipe steps, like the fact that tomatoes are actually a fruit.

After user-testing the app prototype, “I heard from parents that they noticed differences in how their kids are eating,” Moulton said. The app also kept kids engaged throughout the cooking process.

For her project, fellow student Karen Wang developed an iPad app called FeelingTalk that helps children with autism interpret facial expressions:

…[I]n the first level of FeelingTalk, kids choose the one face that’s different (a sad face) from the three happy faces on the screen. The app will then label the different face “sad.”

“My app will be utilizing learning mechanics that directly work with the autistic brain to help them work on something that they’re having difficulty with,” Wang said. “By leveraging something they’re good at, we’re going to teach them to get comfortable looking at people’s faces, examining the key features, and eventually understanding emotions.”

Moulton, Wang and other students will present their work this afternoon at the LDT Expo at the Stanford Graduate School of Education.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health and No bribery necessary: Children eat more vegetables when they understand how food affects their bodies
Photo by Peter Weemeeuw

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