Tag: wellness

Designing buildings to improve health

Are the buildings that we live and work in stressing us out?

The answer is probably yes, according to Stanford engineer Sarah Billington, PhD, and her colleagues. They also believe this stress is taking a significant toll on our mental and physical health because Americans typically spend almost 90% of their lives indoors.

During a recent talk at a Stanford Reunion Homecoming alumni celebration, Billington described a typical noisy office cut off from nature and filled with artificial light and artificial materials. This built environment makes workers feel stress, anxiety and distraction, which reduces their productivity and their ability to collaborate with others, she explained.

Now, Billington’s multidisciplinary research team is working to design buildings that instead reduce stress and increase a sense of belonging, physical activity and creativity.

Their first step is to measure how building features — such as airflow, lighting and views of nature — affect human well-being. They are quantifying well-being by measuring levels of stress, belonging, creativity, physical activity and environmental behavior.

In a preliminary online study, the team showed about 300 participants pictures of different office environments and asked them to envision working there at a new job. Across the board, the fictitious work environment was viewed as important to well-being.

“In eight out of the nine things that we were looking at, there were statistically significant increases in their sense of belonging, their self-efficacy and their environmental efficacy when they believed they were going to be working in an environment that had natural materials, natural light or diverse representations,” said Billington.

The researchers are now expanding this work by performing larger lab studies and designing future field studies. They plan to collect data from “smart buildings,” which use high-tech sensors to control the heating, air conditioning, ventilation, lighting, security and other systems. The team also plans to collect data from personal devices such as smartwatches, smartphones and laptops.

By analyzing all of this data, they plan to infer the participants’ behaviors, emotions and physiological states. For example, the researchers will use the building’s occupancy sensors to detect if a worker is interacting with other people who are nearby. Or they will figure out someone’s stress level based on how he or she uses a laptop trackpad and mouse, Billington said.

Stanford computer scientist Pablo Paredes, PhD, who collaborates on the project, explained in a paper how their simple model of arm-hand dynamics can detect stress from mouse motion. Basically, your muscles get tense and stiff when you’re stressed, which changes how you move a computer mouse.

Next, the team plans to use statistical modeling and machine learning to connect these human states to specific building features. They believe this will allow them to design better buildings that improve the occupants’ health.

The researchers said they intend to bring nature indoors by engineering living walls with adaptable acoustic and thermal properties.

They also plan to incorporate dynamic digital displays — such as a large art display on the wall or a small one on an individual’s personal devices — that reflect occupant activity and well-being. For example, a digital image of a flower might represent the energy level of a working group based on how open the petals are, and this could nudge their behavior, Billington said in the talk.

“Our idea is, what if we could make our buildings shape us in a positive way and keep improving over time?” Billington said.

Photo by Nastuh Abootalebi

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Eponym debate: The case for biologically-descriptive names

Naming a disease after the scientist who discovered it, like Hashimoto’s thyroiditis or Diamond-Blackfan anemia, just doesn’t work anymore, some physicians say.

A main argument against eponyms is that plain-language names — which describe the disease symptoms or underlying biological mechanisms —  are more helpful for patients and medical trainees. For example, you can probably out a bit about acquired immunodeficiency syndrome (AIDS), whooping cough or pink eye just from their names.

“The more obscure and opaque the name — whether due to our profession’s Greek and Latin fetish or our predecessors’ narcissism — the more we separate ourselves from our patients,” says Caitlin Contag, MD, a resident physician at Stanford.

Stanford endocrinologist Danit Ariel, MD, agrees that patients are often confused by eponyms.

“I see this weekly in the clinic with autoimmune thyroid disease. Patients are often confusing Graves’ disease with Hashimoto’s thyroiditis because the names mean nothing to them,” says Ariel. “So when I’m educating them about their diagnosis, I try to use the simplest of terms so they understand what is going on with their body.”

Ariel says she explains to her patients that the thyroid is overactive in Graves’ disease and underactive in Hashimoto’s.

Ariel says she believes using biological names also helps medical students better understand the underlying mechanisms of diseases, whereas using eponyms relies on rote memorization that can hinder learning. “When using biologically-descriptive terms, it makes inherent sense and students are able to build on the concepts and embed the information more effectively,” Ariel says.

Medical eponyms are particularly confusing when more than one disease is named after the same person, Contag argues. For example, neurosurgeon Harvey Williams Cushing, MD, has 12 listings in the medical eponym dictionary. 

Stanford resident physician Angela Primbas, MD, agrees that having multiple syndromes named after the same person is confusing. She says it’s also confusing to have diseases named differently in different countries. In fact, the World Health Organization has tried to address this, along with other issues, by providing best-practice guidelines for naming infectious diseases. (Genetic disorders, however, lack a standard convention for naming.)

In addition, Primbas said she thinks naming a disease after a single person is an oversimplification of a complex story. “Often many people contribute to the discovery of a disease process or clinical finding, and naming it after one person is unfair to the other people who contributed,” she says. “Plus, it’s often disputed who first discovered a disease.”

Also, few disease names recognize the contributions (or suffering) of women and non-Europeans. And some eponyms are decidedly problematic, like those named after Nazi doctors. A famous example is Reiter’s syndrome named for Hans Reiter, MD, who was convicted of war crimes for his medical experiments performed at a concentration camp.

“Reiter’s syndrome is now called reactive arthritis for the simple reason that Reiter committed atrocities on other human beings to conduct his ‘science.’ Such people should not have their name tied to a profession that espouses the principles of beneficence and nonmaleficence,” says Vishesh Khanna, MD, a resident physician at Stanford. He says medicine is swinging away from using these controversial eponyms to describe them on the basis of their biology instead.

Personally, Khanna also admits that naming a disease after himself wouldn’t sit well.

“Receiving credit for discovering something can certainly be a wonderful feather in a physician’s career cap, but the thought of actually naming a disease after myself makes me cringe,” says Khanna. “Patients and doctors would utter my name every time they had to bring up a disease.”

Such sentiments may be why Contag’s example of a good disease name — cyclic vomiting syndrome — is in plain English. Was no one eager to lend his or her name to it?

While the debate over medical eponyms continues, Khanna suggests a potential solution. “Perhaps a reasonable approach to naming going forward is to allow the use of already established eponyms without dubious histories, while only naming newly discovered diseases based on pathophysiology,” he says.

Everyone I spoke with agrees that changing the medical eponyms will only happen slowly, if at all, since it is difficult to change language. However, it can be done, according to Dina Wang-Kraus, MD, a Stanford resident in psychiatry and behavioral sciences.

“I looked through our diagnostic manual and we do not have diseases named after people in psychiatry. This shift happened quite some time ago so as to avoid confusion and to allow clinicians from all over the world to have a unified language,” says Wang-Kraus. “In psych, we often say that we wish other specialties would adopt a universal nomenclature too.”

This is the conclusion of a series on naming diseases. The first part is available here.

Photo by 4772818

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Busting myths about milk

Photo by artemtation

Milk used to be simple. Your local dairy, say Berkeley Farms, delivered it to your doorstep.

But now we are faced with an unfathomable array: nonfat, low-fat or whole milk? Almond, soy, rice, hemp or oat milk? From goats or cows? With or without lactase? Raw or pasteurized? Plain or flavored? There’s even an ongoing controversy over which of these drinks can be called milk.

To sort through the confusion, I spoke with Stanford nutrition scientist Christopher Gardner, PhD. He is working to clear up some of the biggest misconceptions we have about milk.

Most of us grew up believing that milk is important for children to build strong bones and for the elderly to prevent osteoporosis. But milk, a good source of calcium, isn’t necessarily the most critical factor for bone health, Gardner said.

“There are countries like Japan and India where the population is predominantly lactose intolerant, where milk intake is low and hip fracture rates are also low. But many of those cultures do more weight-bearing activities than Americans,” he said. “It’s better to be physically active than drink milk as a way to strengthen your bones.”

Studies have shown that drinking milk can improve your bone density, but whether it helps prevent bone fractures is debatable, he added.

But don’t young kids need milk? According to Gardner, it depends on what kind of milk. Breast milk is incredibly important, but cow’s milk isn’t, he said.

“This myth goes way back to before the food pyramid when the National Dairy Council offered to provide nutrition material to schools for free. And in all those materials, they said that you need multiple servings of dairy every day for a healthy diet,” Gardner said. “That was never agreed on. A lot of people are lactose intolerant, and you don’t need it.”

Milk can be healthier than other options like soda. He recommended checking the nutrition panel to make sure the milk isn’t just as sugary as soda though, particularly with plant-based milks. “The popular vanilla and chocolate versions of the plant-based milks are often loaded with added sugar. Even the plain is typically sweetened, but you can get unsweetened. The lactose in milk isn’t so bad so there is no need to water it down, just avoid milks with added sugars.”

The nutrition label also allows you to compare the amount of fats, protein, carbs and vitamins in each type of milk. “For example, the plant-based milks generally don’t have saturated fat like cow’s milk so they don’t raise LDL-cholesterol as much as dairy milk, but they do have about the same amount of calcium,” he said. “And soy milk has the same amount of protein as dairy milk, but almond milk has much less protein.”

Another common misunderstanding is that 2 percent milk means that two percent of the calories are from fat — it’s really 2 percent of the weight (which is mostly water) and 35 percent of the calories, he said. “Whole milk has close to 50 percent of its calories as fat, and 1 percent milk has about 20 percent.”

However, your milk’s fat content may not affect your weight. The old belief was that drinking whole fat milk will make you fat and skim milk will help you lose weight. But this was refuted by Harvard’s Nurses’ Health Study that followed the diets of over 100,000 nurses for over 30 years, including how their diets changed.

“The Harvard study found that switching back and forth from whole fat to 2 percent to 1 percent was not associated with changes in weight,” explained Gardner.

But does drinking more milk help? Some small, short-term studies showed that people lost weight if they drank more milk. According to Gardner, this raises the always present nutrition research challenge: Was it drinking more milk or was it consuming less of something else that caused the weight loss?

And what about raw milk? Raw milk proponents argue that pasteurization kills off important healthy bacteria along with the bad listeria bacteria, but Gardner says that it’s difficult to prove any health benefits from these bacteria. Some raw milk producers also claim that it is easier to digest. However, Gardner’s study found that lactose intolerant participants had the same symptoms with raw and pasteurized milk.

And what does Gardner himself drink? He said he gave up cow’s milk for ethical reasons.

“Now, I drink unsweetened soy milk,” he admitted. ‘In our household, my wife doesn’t digest dairy milk very well, so we don’t even have it around. My four boys all drink unsweetened soy milk.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford researcher explores use of meditation app to reduce physician burnout

Photo courtesy of Louise Wen

Slammed by long and unpredictable hours, heavy clinical workloads, fatigue and limited professional control, many medical residents experience stress and even burnout. And surveys indicate this burnout can seriously impact physician well-being and patient care outcomes.

How do you combat burnout? Studies show that meditation can improve well-being, but jamming one more thing into a resident’s hectic day is tough, as Louise Wen, MD, a clinical instructor at Stanford’s Department of Anesthesiology, Perioperative and Pain Medicine, points out. So Wen joined a team of Stanford researchers to test the effectiveness of a mindfulness app, and there work was published this summer in Academic Psychiatry.

I recently spoke with her about the pilot study.

What inspired your study?

“I experienced burnout as a resident, and meditation was a key aspect to my recovery. Growing up, I had been introduced to meditation by my family. In college, I trained to become a yoga teacher and therapist. However, once residency started, my mediation practice essentially stopped.

My low point in residency was precipitated by a HIV needle-stick injury. The month-long antiretroviral prophylactic therapy was effective, but I struggled with the medication’s side effects. My mother advised me to meditate, and afterwards, I felt like my brain had been rebooted. Surprised by the effect of such a brief intervention, I wanted to explore ways to introduce this technique to other time-strapped and stressed residents.”

Why did you use a mindfulness app?

“The gold standard for mindfulness studies is a Mindfulness Based Stress Reduction course developed by Jon Kabat-Zinn, PhD. This eight-week course entails a two-hour group class weekly and 45 minutes of individual home practice daily, plus one full-day silent retreat. This excellent and evidence-based intervention is unfortunately not a feasible format for residents. Instead, the Headspace app on a smart phone delivers guided meditations in an efficient and accessible format.

For the study, we recruited 43 residents from general surgery, anesthesia and obstetrics and gynecology. They were asked to use the app at least two times per week for a month. The app provided 10-minute guided audio meditations, animated videos and longer focused meditations.”

How did you measure whether the app improved wellness?

“Our participating residents were asked to complete surveys measuring their stress, mindfulness and app usage — at enrollment, week 2 and week 4. We found that residents benefitted from using the app and this benefit correlated with increasing app usage.”

Are you doing any follow-up studies?

“A significant challenge of our app study was motivating people to practice the intervention. We’re now working on a study based on the concept of the popular opinion leader. We have developed a four-week, video-based curriculum for anesthesia residents. These videos feature interviews with attendings from our department, where they share their personal meditation and gratitude practices. We showed the videos to the intervention group of residents, whereas the control group watched a boring video of me saying that they should meditate. We are now analyzing the data.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford researcher travels to Qatar to discuss how behavior changes can improve global health

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Photo courtesy of Jodi Prochaska

About 1400 health-care experts and government officials from over a 100 countries recently attended the World Innovation Summit for Health (WISH) in Doha, Qatar. WISH aims to create a global community to tackle health-care challenges, such as the global burden of autism spectrum disorder and the rise in cardiovascular disease mortality.

The summit included a Behavioral Insights Forum to investigate how new findings on behavior change can lead to better health outcomes at a lower cost. Jodi Prochaska, PhD, an associate professor of medicine with the Stanford Prevention Research Center, was a member of the behavioral insights team. We recently discussed the WISH summit and her involvement.

What was accomplished at the WISH Summit?

“The WISH meeting — in an intensely focused 2-day period — engaged and fostered collaborations among academic researchers, health professionals, public policy officials and entrepreneurs. The meeting showcased innovations that can make a difference for health-care communities globally.

The program content included nine panel forums on: accountable care, autism, cardiovascular disease, population health, health economics, precision medicine, health profession education, genomics and behavioral insights. Each collaborative panel generated a white paper centered on its particular area of expertise. In addition, there were several inspiring keynote speakers.”

Why did you get involved with the behavioral insights panel? How did you participate?

“The behavioral insights team sounded novel, and I was able to help shape the white paper and participate at the WISH meeting. Oftentimes in academic research, behavior change is siloed — you have your tobacco control experts, your nutrition experts and your physical activity experts. The WISH panel focused on bridging across behaviors to identify key principles of change at the individual, social, organizational and policy levels for supporting wellness and wellbeing. We identified case studies from around the globe and covered a range of health behaviors: exercise, diet, tobacco, cancer screening, suicide and accident prevention, medication adherence and patient safety.

For instance, the panel showcased research I am doing with the University of California, Irvine using Twitter to facilitate peer-to-peer support groups for quitting smoking, which has doubled quit rates relative to usual care. The meeting also showcased a trial to paint reference lines on the rail track in Mumbai to improve pedestrians’ ability to judge speed, which led to a 75 percent decline in trespassing deaths at the test location. Also, we discussed the success of a project to send letters to the highest antibiotic prescribers in the U.K., which resulted in 75,000 fewer doses being prescribed across 800 practices.”

What was Qatar like?

“Doha, Qatar was striking. It was modern and pristine, as well as easy and safe to navigate. The people of Qatar were hospitable and kind. During my stay, I had a chance to go in the Persian Gulf and to visit a local market with traditional food, spices and live animals.

I was thrilled to represent Stanford in Doha, Qatar and to bring back the knowledge gained and connections made for future collaborations.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Project aims to improve well-being in rural Mexican communities

san-miguel-peras_jshTo improve the health and well-being of people around the world, researchers must first understand what it means to be well and whether this has the same meaning for everyone.

A Stanford team at the Wellness Living Laboratory (WELL) is working to define and measure wellness by identifying the factors that help people maintain it and by testing new interventions. As announced earlier this week, they’re engaging thousands of participants from around the world, including the U.S., China and Taiwan, with the ultimate goal of optimizing everyone’s health and well-being.

Nicole Rodriguez, a research assistant with the Wellness Living Laboratory at the Stanford Prevention Research Center, recently extended this work to Mexico in conjunction with Stanford’s Community Health in Oaxaca program. This summer Rodriguez carried out a new research study with a team of Stanford undergraduates to explore the well-being of two impoverished, rural communities in Oaxaca, Mexico; I recently spoke with Rodriquez about her work.

How do you define “well-being”? Why is it important to study this worldwide?

“Well-being is about considering the whole person, where health extends beyond physical health to encompass emotional health, social connectedness, lifestyle behaviors and even factors like sense of purpose and creativity.

It’s important to consider what factors contribute to universal well-being — across cultures and socioeconomic gradients. Studying well-being helps us understand what people in diverse parts of the world care about the most and how they prioritize aspects of their lives and health. Understanding what motivates and drives people then allows for more targeted and efficient public health efforts.”

What inspired you to work in Oaxaca?

“I’ve been working with underserved Hispanic populations throughout Santa Clara County doing WELL research, and I was curious to learn more about the cross-cultural well-being in Latin American populations.

Seven years ago, I participated as an undergraduate in Stanford’s community health overseas program in Oaxaca with Gabriel Garcia, MD and Ann Banchoff. The class launched me on a career working to address health disparities among marginalized populations. This year, I returned as a program assistant to help build the research portion of the course. It was an honor to give back to the program and revisit the place and people that shaped my aspirations in medicine.”

What did the research group do in Oaxaca?

“We worked with a partnering non-profit organization, Niño a Niño, to carry out a project that would help the non-profit and community leaders better understand the community’s needs and priorities. Our group carried out a well-being study with 38 participants in San Miguel Peras and Pensamiento, two rural communities living in extreme poverty.

The first part of the study was an open-ended interview aimed at understanding individual perspectives and priorities surrounding well-being, which was modeled after the WELL measures process developed by Cathy Heaney, PhD. The second portion of the study incorporated the citizen science process developed by Abby King, PhD, which empowers community residents to capture the barriers and facilitators to their health and well-being — by carrying out a tablet-based environmental assessment, taking photos and recording audio narratives — and then engage in community advocacy. Lastly, we conducted WELL’s core well-being questionnaire that is being used on an international scale.

I think looking at well-being is especially important in low-resource settings because communities have to think carefully about how to allot and prioritize limited resources, people and time. Niño a Niño is going to use the data about community priorities to plan out its community-based efforts for the upcoming year.”

What was it like in these remote rural communities?

“Political protests and unrest across Oaxaca complicated the decision to bring the students to Mexico this summer. The city was generally calm while we were there, but we did face some shutdowns of public transportation, clinics and hospitals. I think it provided good exposure to how governmental issues can impact critical public services like healthcare.

The students also learned about community health fieldwork in marginalized and remote villages. After a rocky two-hour bus ride through muddy unpaved cliffs, we arrived in the village center. A group of children greeted our team to lead us to the family homes where we would carry out the interviews. Assuring us that the homes were close by, the children led us on an uphill scramble for about an hour to reach the families. We crossed rivers, slipped on fresh clay and mud, and held on to rocks and branches for balance as we worked our way up to the homes — while our young guides hopped gracefully through the paths.

In these rural impoverished settings, well-being was about meeting the basic necessities of daily life — having enough water in the rainwater catchment tank and enough food to put on the table. Whereas a lot of our Santa Clara County interviewees discussed issues like balancing work, personal life and health, the conversations in Oaxaca revolved around meeting fundamental necessities. Exploring issues of well-being in these communities helps us think about what is truly essential for health and well-being.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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