Published by
Stanford Medicine

Author

Health Costs, In the News, Mental Health, Research, Stanford News

Exploring the costs and deaths associated with workplace stress

Exploring the costs and deaths associated with workplace stress

6273248505_43d0b56424_oMany of us know that a stressful job or work environment can be hard on our physical and mental health. But what is less known – and less studied – is how work-related stress translates into deaths and dollars spent on health care. According to new research, work-related stress may be linked to more than 120,000 deaths per year and about $190 billion in health-care costs in the United States alone.

In a study submitted to Management Science, former Stanford doctoral student Joel Goh, PhD, and Stanford professors Jeffrey Pfeffer, PhD, and Stefanos A. Zenios, PhD, reviewed 228 studies to explore the relationships between ten common sources of workplace stress, mortality and healthcare expenses in the U.S.

The researchers found that a lack of health insurance and job insecurity were among the top stressors linked to poor physical and emotional health. From a recent Stanford Business story:

Job insecurity increased the odds of reporting poor health by 50%, while long work hours increased mortality by almost 20%. Additionally, highly demanding jobs raised the odds of a physician-diagnosed illness by 35%.

“The deaths are comparable to the fourth- and fifth-largest causes of death in the country — heart disease and accidents,” says Zenios, a professor of operations, information, and technology. “It’s more than deaths from diabetes, Alzheimer’s, or influenza.”

Perhaps the most surprising result, the researchers explain, was the strong effect of psychological stressors on overall health:

Employees who reported that their work demands prevented them from meeting their family obligations or vice versa were 90% more likely to self-report poor physical health, the researchers note. And employees who perceive their workplaces as being unfair are about 50% more likely to develop a physician-diagnosed condition.

The researchers acknowledge that the study has some limitations. For example, they were unable to make strong causal links between work-related stress, mortality and health-care expenses; and they only examined 10 sources of stress. The importance of the study, Pfeffer explains, is that it draws attention to the need to create positive work environments where people feel good about themselves and their work.

Previously: How the stress of our “always on” culture can impact performance, health and happinessStudy finds happy employees are 12 percent more productiveWorkplace stress and how it influences health and How work stress affects wellness, health-care costs
Photo by Bernard Goldbach

Imaging, Neuroscience, Research, Videos

Exploring the science of decision making

Exploring the science of decision making

Every day we make decisions that affect our work, personal relationships and health. With stakes this high, it’s no wonder many of us dread decision-making and wish we knew how to make better choices.

The first step towards making better decisions is to understand how the process works. This animation from Worldview Stanford’s upcoming course, The Science of Decision Making, shows the regions of the brain that are activated as we evaluate information.

Enrollment is now open for this interdisciplinary course, which explores and applies the nitty-gritty science of making a choice. If you’re unable to participate in the class, but you’d like to learn more about how to make better decisions, you can visit the Worldview Stanford blog for a sample of animations, videos and content from this course and their other offerings (.pdf).

Previously: Exploring the intelligence-gathering and decision-making processes of infantsIs there a connection between consuming mass media and making healthy choices?Genetics may influence financial risk-takingStanford neurobiologist Bill Newsome: Seeking gains for the brain and How does the brain plan movement? Stanford grad students explain in a video

Cardiovascular Medicine, Pediatrics, Pregnancy, Surgery

Baby with rare heart defect saved by innovative surgery

Baby with rare heart defect saved by innovative surgery

jackson-lane-stanford-childrens560

Elyse Lane was 20-weeks pregnant when she learned that her unborn son had a rare and severe heart defect. Her baby was missing his pulmonary valve and his pulmonary artery was 10 times the normal size.

The outlook was bleak. The baby’s enlarged artery hampered his blood and oxygen flow, a condition called tetralogy of Fallot, and his missing pulmonary valve made the defect worse.

Fortunately, Lane and her husband, Andy Lane, a former Major League Baseball coach with the Chicago Cubs, were referred to Frank Hanley, MD, a cardiothoracic surgeon at Stanford Children’s Health. Hanley had experience with this kind of heart defect and knew how to perform the delicate surgery needed to repair their baby’s heart.

The Lanes recount the story of their son’s lifesaving surgery on the Lucile Packard Children’s Hospital blog:

When he was just five days old, Jackson underwent a 13-hour operation that would save his life. Hanley and his team did a complex overhaul of Jackson’s heart: they inserted a pulmonary valve, reduced the size of Jackson’s right pulmonary artery, and enlarged his small, disconnected, left pulmonary artery. Hanley also used an innovative and intricate procedure known as the LeCompte maneuver, which altered the pathway of Jackson’s right and left pulmonary arteries from the back of the heart and aorta to the front. This gave his severely compromised bronchial tubes room to grow and remodel after surgery was over.

As the story explains, Jackson’s heart will need some maintenance in the future, but he should live a normal and long life.

“He can now do anything he wants in life,” said Elyse Lane in in the blog piece. “He’s already made it through the biggest challenge.”

Previously: Patient is “living to live instead of living to survive,” thanks to heart repair surgery, A very special small package: Three-pound baby receives pacemaker, Advancing heart surgery for the most fragile babies, and Little hearts, big tools
Photo courtesy of Lucile Packard Children’s Hospital

Cardiovascular Medicine, In the News, Public Health, Research, Women's Health

A look at why young women who have heart attacks delay seeking care

A look at why young women who have heart attacks delay seeking care

317916781_c8bb9b352e_zHeart attacks kill more than 15,000 women in the U.S. each year and are disproportionately deadly for females under the age of 55. Although several studies, including those by Stanford cardiologist Jennifer Tremmel, MD, have investigated the signs and consequences of heart attacks in men and women, relatively little is known about heart disease in women or why it’s so lethal for young females. And according to new research, misconceptions about the risk factors and signs of coronary heart disease may be why young females are less likely to recognize and seek emergency care for a heart attack.

In the study, published yesterday in Circulation: Cardiovascular Quality and Outcomes, a research team led by Judith Lichtman, PhD, MPH, of the Yale School of Public Health, interviewed 30 women between the ages of 30 to 55  who had been hospitalized for a heart attack. The researchers identified five common themes among the symptoms and treatments of the women they interviewed, and one potentially important finding was that women were unsure they’d had a heart attack so they were hesitant to seek medical treatment.

From an NPR story:

A heart attack doesn’t necessarily feel like a sudden painful episode that ends in collapse, [Lichtman] notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.

“Women may experience a combination of things they don’t always associate with a heart attack,” Lichtman says. “Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like.”

Tremmel also provided comment on the study, saying it indicates a need to encourage women to seek help for medical concerns. “This is an ongoing issue in the medical field,” she said. “…We all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they’re afraid there’s something wrong.”

Previously: New test could lead to increase of women diagnosed with heart attack, Heart attacks and chest pain: Understanding the signs in young womenAsk Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart healthPaper highlights major differences in disease between men and women and Gap exists in women’s knowledge of heart disease
Photo by Simon Mason

Autoimmune Disease, Chronic Disease, Health and Fitness, Nutrition, Obesity, Research

Study clarifies link between dieting, exercise and reduced inflammation

Study clarifies link between dieting, exercise and reduced inflammation

4503404991_13da58b6e6_bIf you’ve ever wondered how dieting and exercise reduce inflammation, read on. According to new research, a compound that our bodies crank out when energy supplies are low could be the link between diet and exercise, and reduced swelling in the body.

When diet, fasting and exercise starve the body for calories, the body increases production of a compound called beta hydroxybutyrate (BHB). This compound has long been known as an alternate source of energy; the new research suggests that BHB can also block the inflammatory response.

In their study, published this week in Nature Medicine online (subscription required), a team of scientists co-led by Yun-Hee Youm and Kim Yen Nguyen at the Yale School of Medicine, discovered that the compound BHB reduces swelling in the body by inactivating a group of proteins, called the inflammasome, that drive the inflammatory response.

The research team used human immune cells and mice to explore the effects of BHB in the body. They found that mice given BHB directly, and mice fed a low-carbohydrate diet (that prompted their bodies to synthesize their own BHB), both benefited from reduced inflammation.

These results are noteworthy because a better understanding of the mechanism that links diet, exercise and inflammation could help scientists develop more effective treatments for inflammatory disorders such as Type 2 diabetes, atherosclerosis and Alzheimer’s disease.

Previously: Newly identified type-2 diabetes gene’s odds of being a false finding equal one in 1 followed by 19 zeroesImproving your health using herbs and spices, Exercise may alleviate symptoms of arthritis regardless of weight loss, Study points to inflammation as cause of plaque buildup in heart vessels and Examining the role of exercise in managing and preventing diabetes
Via ScienceDaily
Photo by Dave Nakayama

Applied Biotechnology, Stanford News, Technology

Stanford team produces free Braille notetaker app

Stanford team produces free Braille notetaker app

brailleIn 2011, we showed you a video demonstration of an app that enables visually impaired people to type on a touchscreen tablet. Over the past few years, Sohan Dharmaraja, PhD, and Adrian Lew, PhD, completely redesigned the prototype they first developed with New Mexico State University student Adam Duran at Stanford’s Army High-Performance Computing Research Center. Now, their app, called iBrailler Notes, is ready for prime time.

This finished product, as Dharmajara and Lew explain in a recent story in Stanford Report, looks nothing like the original prototype that caught the media’s eye over three years ago. “Creating a prototype is relatively easy when your audience is a handful of fellow classmates. We did it almost as a whim to see if we could do it,” Dharmaraja said. “But creating a real app, that potentially millions might rely upon every day, is a whole other ballgame.”

Redesigning the app was no small feat because the final design had to be intuitive for users that may have little to no experience with touchscreen technology. As Dharmaraja explains, several of their test subjects had never used a tablet before:

Our testers did not know what a tablet computer or a touchscreen was, much less how to use them. We had to teach them how to use a touchscreen before they could tell us how to improve our products.

Dharmajara and Lew patterned their iBrailler Notes app after the traditional eight-keyed Perkins Brailler. What makes iBrailler Notes unique is the app enables the user to type regardless of where they position their fingers on the touchscreen—the user simply places eight to ten fingers on the touchscreen and the app automatically encircles each fingertip with a key. More from the article:

“We constantly pushed ourselves to innovate because being born with a disability shouldn’t mean you get left out of today’s technology revolution,” Dharmaraja said. “When you see the smile of someone doing something that you and I take for granted, it’s motivating.”

Lew added, “We think the time was well-spent to get it right.”

Previously: Developing a touchscreen Braille writerTennis, anyone? New York Times examines tennis for the blindMap of the Carina Nebula for the visually impairedRubik’s Cube for the visually impairedThe blind can see, and The mind maps the visual world with minimal means.
Photo courtesy of Sohan Dharmaraja

Health Disparities, NIH, Research, Stanford News, Women's Health

Stanford professor encourages researchers to take gender into account

Stanford professor encourages researchers to take gender into account

SchiebingerAs a scientist, I’m trained to look for biases that can cause unreliable results. This is why I feel so disheartened every time I read about scientific studies that fail to take sex and gender differences into account.

These differences, and the work of Londa Schiebinger, PhD, a Stanford professor of the history of science, were the focus of a recent Stanford Report article. In the piece, Schiebinger, who directs the Gendered Innovations in Science, Health & Medicine, Engineering, and Environment, explains that ignoring the biological differences between males and females is a form of gender bias that can have catastrophic results:

…Experiments done in women may not have been tested first in female mice or rats — “a potentially dangerous situation,” Schiebinger said.

Recent studies have shown that 80 percent of rodent drug studies are conducted using male models. This means that not only are females left out, but that research sees nothing unique to females in the initial stages of research.

“We’re missing the opportunity to build our foundation of knowledge of just about every biological system more accurately at the outset, which should be a fundamental goal of science,” said Marcia Stefanick, research professor of medicine in the Stanford Prevention Research Center and of obstetrics and gynecology and co-director of the Gendered Innovations project.

Incorporating gender and sex differences in the design of a scientific study is not only good science, it can make the end product more effective. Shiebinger’s latest endeavor is to help scientists understand when and how to address gender biases in their research. This goal is the focus of a new initiative she’s leading with support from the U.S. National Science Foundation and the European Commission.

Shiebinger admits that there’s much work to do, but her efforts, and those of others in the field, are paying off. As mentioned in the piece, the EU Research and Innovation program last winter identified 137 fields of science and technology that could be improved by gender analysis. “…Eyes have been opened – and we will not return to a world that ignores gender,” Shiebinger said.

Previously: A look at NIH’s new rules for gender balance in biomedical studies, Why it’s critical to study the impact of gender differences on diseases and treatments, Stanford Gendered Innovations program offers tools for improving scientific research, Study shows many heart devices receive FDA approval without adequate testing on women and Women underrepresented in heart studies
Photo by Daniel Pozo

Image of the Week, Neuroscience

Image of the Week: One of 2013's "coolest" microscopic images

Image of the Week: One of 2013's "coolest" microscopic images

Salehi image

Recently, Olympus announced the winners of its BioScapes International Digital Imaging Competition. A photo by Ahmad Salehi, MD, PhD, an associate professor in Stanford’s Department of Psychiatry and Behavioral Sciences received honorable mention in this competition; it was also selected by Gizmodo India as one of the year’s top ten “coolest” microscopic images.

Salehi’s close-up of a mouse hippocampus was created using the same basic technique and microscope that many school kids use to magnify objects in biology classes. The technique is called bright field microscopy because the microscope lights up the the field of view where an object, such as a brain, is magnified.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Photo courtesy of Ahmad Salehi

Cancer, Stanford News, Videos, Women's Health

Stanford Women's Cancer Center: Peace of mind and advanced care under one umbrella

Stanford Women's Cancer Center: Peace of mind and advanced care under one umbrella

Flamingo-pink carpet lined the path to the Sharon Heights Golf and Country Club in Palo Alto, Calif. – the location of the fifth annual Under One Umbrella benefit for the Stanford Women’s Cancer Center. As I walked into the reception hall, I thought of the phone call that was my introduction to the center several months before.

In March, I tested positive for the HPV virus that can cause cervical cancer and I was scared. Cervical cancer claimed the life of my best friend, and the memory of the day she mentioned that she needed “some testing” is etched in my mind. My phone call to the Stanford Women’s Cancer Center gave me the information and courage I needed to schedule additional testing. “We hope you never need our services,” the receptionist said, “but if you do, we’re here if you need us.”

I ultimately didn’t need the services of the center, but many of the nearly 340 guests in the fundraiser’s reception hall did. For these people, and for many others, the center is a source of medical treatment and hope.

Yet, the center is more than a cancer care facility, as Nicole Kidman, Academy Award-winning actress and honorary chair of the Under One Umbrella committee, explains in the short film above. The center unites medical treatment with cancer research and prevention.

The Under One Umbrella committee supports the cancer center’s efforts, and the annual benefit is a big part of that support. “It brings together an amazing group of people who are interested in furthering research of women’s cancer,” Lloyd Minor, MD, dean of the Stanford medical school told me. “It highlights the talents of Stanford researchers and the wonderful job that Jonathan Berek, MD, [the center’s director] has done with the center. It also gives us the opportunity to rededicate our commitment to the cause.”

A crucial step of this commitment and care begins when a patient first learns she has cancer. As social worker Jordan Chavez explains in the film, “When patients come in and have a diagnosis of cancer there’s pandemonium, either internal or external. I think a lot of what I do is to provide, hopefully, some stability and some calm amidst a lot of chaos and to normalize what is a very scary experience for patients and for families, and to help them understand that they will not be alone.”

This sense of camaraderie pervaded all aspects of the benefit. As the fundraiser came to a close, the guest of honor, country music star Keith Urban, gave an (outstanding) unplugged, solo concert. As he sang, the cancer survivors, their family members and friends, and the center’s medical experts forgot themselves. They were simply a crowd of fast friends.

As I left the event, I wondered how I could explain the importance of the women’s cancer center to someone who wasn’t a woman with cancer. The answer came to me in the form of an umbrella I carry with me rain or shine.

I know that I won’t need an umbrella most days, but it’s comforting to know that if I do, it will be there to shelter me from the storm.

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Garth Brooks and Trisha Yearwood help fundraising effort for Women’s Cancer Center at StanfordStanford expert weighs in on ovarian-cancer screening recommendationWhat’s 1,454 feet tall, glows pink and sounds like country music?Stanford Women’s Cancer Center opens Monday and Wellness after cancer: Stanford opens clinic to address survivors’ needs
Video, Embracing the Challenge, from Friday’s Films

Image of the Week

Image of the Week: Sigmoid volvulus

imageoftheweek_radiograph

This week’s image comes to us via Figure 1, a smartphone app that’s a virtual library where medical professionals can upload and share medical images. This particular image is an X-ray of a twist in the sigmoid colon that results in a condition called sigmoid volvulus. A hip replacement can also be seen on this X-ray.

Much like a garden hose, the kinked section of the intestine balloons in size as pressure increases. The puffy upside-down “U” shape that fills this patient’s abdomen is the section of the intestine that is cut off from the rest of the intestine by the twist.

This alarming and uncomfortable condition can be corrected with surgery.

Photo via Figure 1

Stanford Medicine Resources: