DiversityNursing Blog

BY JULIANNE PEPITONE

Google mapped the world's streets and developed self-driving cars to roam them. Now, the company wants to map something much larger: perfect human health.

Google Baseline, announced last week, will collect molecular and genetic information from an initial 175 volunteers and later thousands more. The philosophy is to focus on the genetics of health itself, rather than focus on disease.

"We want to understand what it means to be healthy, down to the molecular and cellular level," Google said in a press release. Google repeated the phrase "what it means to be healthy" a few times -- and that's what worries one expert.

"My immediate question is, what does Google mean by that? Healthy for a six-year-old boy, or a 75-year-old woman? You're injecting values about the range of humanity, right off the bat," said Arthur Caplan, the director of the division of medical ethics at the NYU Langone Medical Center and an NBC News contributor.

Google isn't purporting to develop a model of the singular perfect human. The goal is to analyze participants' data from to uncover "biomarkers," or patterns, that can be used to detect disease earlier.

"It's a perfectly reasonable approach, but I wouldn't do it under the 'what it means to be healthy' mission statement," Caplan said. "Those are fighting words. The mother of a child with Down's syndrome may consider her child perfectly healthy."

What's more, genetics alone doesn't provide a full picture of health or of disease, pointed out Kedar Mate, M.D., the vice president of the Institute for Healthcare Improvement, a Massachusetts-based not-for-profit.

"Genes are about 15 to 40 percent, behavioral patterns 30 to 40, socioeconomic factors 20 to 30, etc.," Mate told NBC News. "So even a wonderful genetic model is not a total picture of health."

What makes Baseline different, Google argues, is that it will "try to connect traditional clinical observations of health" like diet and other habits with genetic information.

But while Google (nor anyone) can't create the full model of perfect health, the company still brings two major advantages to the field: technological power and an outsider perspective.

"Anyone can collect 175 DNA samples," Caplan said. "But Google is a very, very powerful computational company. That's what makes it exciting."

Google's trove of technology resources and know-how could create a faster, smarter process for analyzing the links between genes and disease.

But not everyone in the field considers Google's computational power a major boost. Some genomics experts scoffed online at Google's assertion that Baseline is a "clinical research study that has never been done before."

"Frankly, anything Google does gets attention," Mate said.

"What would make it really different is Google's knowledge of so much of our behavior," he added. "If Google could take all of that and combine it with genetic information -- no other organization can offer us that."

But given what little we know about Baseline, it doesn't sound like Google is planning to do that -- at least not now. It's not clear they could, even if they wanted to.

Whether Google would -- or even could -- move to combine health data with the rest of the information it knows about our behavior, Mate insisted the nature of Google's business adds a unique element to the pursuit of health.

"You wonder if they’ll bring a fresh and different perspective, because this isn’t a stodgy academic project," Mate said. "The entry of a player like Google has the ability to stimulate the space -- and break it out of the way things have always been done."

Source: www.nbcnews.com

By GILLIAN MOHNEY

For all the impressive advancements in medical technology, researchers and scientists still face a daunting challenge when they study the habits of the adorable but uncommunicative subjects called human infants.

In order to study infants without overwhelming them, scientists often try to mask the massive machines needed to view brain activity either by having the child sleep through it or by covering it in kid-friendly decorations. Other researchers have devised decidedly low-tech ways of reading an infant’s interest in a subject, even when they can’t say a single word.

In a study released Monday in the Proceedings of National Academy of Sciences, doctors used a special machine to examine infant brain activity as they start to learn language skills.

Patricia Kuhl, a professor of speech and hearing sciences at University of Washington and the lead author of the study, said the research indicated the area of the infants’ brain that controlled motor skills lit up when they heard certain words. The activity indicated that the infants are trying to mimic adults and speak much earlier before they say their first word.

However, Kuhl said, the study was important because of both the surprising findings and the way researchers were able to get them. To “read” the infant’s brain activity, they used the cutting-edge device called a magnetoencephalograph, that was quiet and nimble enough to read the chaotic world of infants’ brain activity.

Kuhl said unlike an MRI machine, which is extremely loud and requires a patient to be totally still, the magnetoencephalograph is nearly silent. However the infants still had to be strapped into a chair, so to keep them entertained the researchers were tasked with making silly faces and holding up toys all in the name of science.

“You want them to like the lab,” said Kuhl. “It’s decorated with fish and it’s got little stickies [on it.] It’s ... very baby friendly. We wave toys and we’re very aware and of their curiosity and of their desire to play. We do everything to make them comfortable.”

In a 2013 study published in Psychological Science, researchers used MRI machines to examine baby’s brain activity in response to different stimuli. However, to get the infants into a machine where they could not move, the researchers had the babies go in after they fell asleep naturally. They also used ear coverings so the loud MRI machine didn’t wake the infants.

MRI machines can be so distressing for patients because of claustrophobia or other fears about being in the hospital that a New York Hospital installed a pirate-themed scanner to put children (and some parents) more at ease.

“The genius is in this machine. ... There’s no noise and the baby can listen and can move,” said Kuhl of the magnetoencephalograph. “The ability for the first time to do this kind of recording in this kind of technical advanced machine ... [it’s like] we’re putting [on] a stethoscope.”

Aside from technological advancements, researchers rely on some decidedly low-tech approaches when studying infants.

Fei Xue, a professor of psychology at the University of California Berkeley, has done numerous studies examining how infants learn and react to new toys or information. She said researchers have plenty of tricks to keep babies focused on the tasks at hand.

Xue said most studies only last between 5-10 minutes because the infants will get bored if they're longer. If they want a baby to focus on an object, they darken the room and light up the object to draw the baby's attention.

“In a way, it’s easy to work with infants,” said Xue. “They’re very curious and they’re interested in the world.”

To measure if babies are interested in an object or scene without getting verbal confirmation, Xue and her fellow researchers simply follow the infant’s eye movement. While there are special computer programs, Xue said often it just comes down to a researcher holding a stopwatch and watching the infant through a monitor.

In spite of the infants’ inability to speak, Xue said, understanding their thought process can reveal how they learn, which could eventually help shape education programs.

“When they go to preschool and elementary school ... they will help us to know how to structure the school system,” said Xue of her young subjects. “Understanding these really young humans is important.”

Source: http://abcnews.go.com

By Cornell University

In a forthcoming Cornell study published in the journal Health Environments Research and Design, Rana Zadeh, assistant professor of design and environmental analysis, discovered nurses who had access to natural light enjoyed significantly lower blood pressure, communicated more often with their colleagues, laughed more and served their patients in better moods than nurses who settled for large doses of artificial light.

Letting natural light into the nurses’ workstations offered improved alertness and mood restoration effects. “The increase in positive sociability, as measured by the occurrence of frequent laughter, was … significant,” noted Zadeh in the paper.

Nurses work long shifts, during non-standardized hours. They work on demanding and sensitive tasks and their alertness is connected to both staff and patient safety. Past evidence indicates natural light and views have restorative effects on people both physiologically and psychologically. Maximizing access to natural daylight and providing quality lighting design in nursing areas may be an opportunity to improve safety though environmental design and enable staff to manage sleepiness, work in a better mood and stay alert, according to Zadeh.

“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession,” Zadeh said. “As a nurse, it’s an art to keep your smile – which helps ensure an excellent connection to patients. A smart and affordable way to bring positive mood – and laughter – into the workplace, is designing the right workspace for it.”

Access to natural daylight, and a nice view to outside, should be provided for clinical workspace design, said Zadeh. In situations where natural light is not possible, she suggests optimizing electric lighting in terms of spectrum, intensity and variability to support circadian rhythms and work performance.

“The physical environment in which the caregivers work on critical tasks should be designed to support a high-performing and healthy clinical staff,” she said “ improving the physiological and psychological wellbeing of healthcare staff, by designing the right workspace, can directly benefit the organization’s outcomes”.

In addition to Zadeh, this study, “The Impact of Windows and Daylight on Acute-Care Nurses’ Physiological, Psychological, and Behavioral Health,” was authored by Mardelle Shepley, Texas A&M University; Cornell doctoral candidate Susan Sung Eun Chung; and Gary Williams, MSN, RN. The research was supported by the Center for Health Design Research Coalition’s New Investigator Award.

Source: www.sciencedaily.com

By Jen Christensen

Cancer is plaguing a growing number of first responders and rescuers who worked at ground zero after the terrorist attack on the World Trade Center on September 11, 2001. These are cancers the federal government says are thought to be directly related to that effort -- cancers like leukemia, myeloma, thyroid and prostate cancers.

There are at least 1,646 certified cancer cases that have been documented by Mount Sinai Selikoff Centers for Occupational Health. There are some additional 863 cancer cases among both fire and EMS personnel, according to FDNY, which keeps a separate database for its members.

That's a total of 2,509 cases. The center has screened more than 37,000 World Trade Center rescue and recovery workers since 2002. It will continue to monitor those workers and volunteers for any new cases.

Some reports suggest the number of cancer cases in this group has doubled since last year. While that may be mathematically true, cancer experts caution that we can't draw any significant conclusions from the increase.

"For every decade of life, if you look at a population ... cancer rates go up the older you are," said Dr. Otis Brawley, the chief medical and scientific officer and executive vice president of the American Cancer Society. "Looking at an increase from one year to the next is a nonscientific way of making an assessment that is incredibly biased to find a link between the activity and the cancer."

To be scientifically accurate, Brawley said someone would have to look at all the cancer records for the people in the 9/11 group and compare them to a group that had the same age makeup, same gender, and other demographic data. There would also have to be a significant portion of firefighters in that sample, because as a profession they tend to have higher cancer rates than the general population, Brawley said.

A deep scientific analysis of available medical data through 2010 showed a 20% increase in the rate of cancer cases for 9/11 rescue and recovery workers when compared to the general population, according to Mount Sinai.

Government reports suggest workers at the World Trade Center were exposed to a number of chemicals that were known to be carcinogens, or agents that may cause cancer.

Many people who worked at the site are struggling with devastating cancers they may not otherwise have had, had they not responded to the tragedy. That much is clear, according to the U.S. government, which set up a special World Trade Center Health Program.

The program provides medical monitoring and treatment services for 9/11 responders and survivors. Nearly 65,000 people are enrolled. Enrollees are qualified to get health care treatment through several reputable medical centers that keep experts on staff who are qualified to treat and identify illnesses related to the terrorist attacks. The program plans to continue to monitor those workers.

"I think all of us are open to the possibility that these brave folks were exposed to things that caused further illness," Brawley said. "What's most important is that someone has cancer and needs help and we should continue to provide them with the good care they truly deserve."

Source: www.cnn.com

By Caitlin Schmidt

When you're sick, sometimes it feels impossible to get out of bed, let alone get to the doctor. And the last thing anyone wants to do is spend hours at the emergency room.

So Silicon Valley is retooling a service that was common almost a century ago: the house call. Several companies have developed smartphone apps that bring doctors to patients, often in less time than it would take to seek treatment elsewhere. With apps like Pager and Medicast, a patient can request a doctor with the push of a button.

In the 1930s, physician house calls accounted for 40% of medical visits, according to a 2011 article in the journal American Academy of Family Physicians. By the 1980s, that number had dropped to 1%, due in part to a lack of funding by insurance carriers.

Elizabeth Krusic, a mother of two young children from Seal Beach, California, knows how difficult it can be to take a sick child to see a doctor. When her daughter developed an eye infection, she took a friend's advice and tried Medicast, calling a doctor into her home and saving the stress of getting her small children ready and out of the house.

The doctor arrived in 30 minutes and had the necessary prescription medication on hand.

"My son was able to sleep during the entire visit, because the doctor came to the house," Krusic said. "The doctor came into my daughter's room and conducted the visit there, where she was comfortable."

The house call also removed the risk that her children would be exposed to illnesses in a waiting room.

Inspired by Uber

In early 2014, Uber co-founder Oscar Salazar saw room for improvement in the health care system and seized the opportunity.

The app he developed, Pager, offers house call services for customers in Manhattan and, starting next week, Brooklyn. Pager's doctors are available from 8 a.m. to 10 p.m., 365 days a year, with an additional after-hour fee for nights and weekends.

Toby Hervey, Pager's head of marketing and business development, said that several aspects of Uber informed Pager's approach. Like Uber, the app is structured as a mobile, location-based service.

"Convenient access to quality health care when you need it is a real problem," he said. "We're using technology to make the house call -- one of the best ways to get personal care -- viable again."

Hervey said customers range from parents not wanting to take a sick child to an emergency room to businesspeople with no time to see a doctor during the day.

A similar company, Medicast, started in South Florida in late 2013, with services now also available in San Diego, Orange County and Los Angeles.

"Long wait times are frustrating for everyone," Sam Zebarjadi, co-founder and CEO of Medicast, said. "With the proliferation of technology and increasing levels of education, we knew there were alternate ways to get amazing health care."

Dr. Kimberly Henderson is a Pager physician and works in the emergency room at New York's Beth Israel Medical Center. For her, the idea of being a part of a new practice of medicine was appealing.

"I believe we will see a shift away from medical practice exclusively in the brick and mortar model," Henderson said. "Medicine will become, or return to being, more mobile."

As the doctor shortage grows and patients struggle to balance their busy lives, telemedicine has become a fast-growing field. Health care professionals offer their services using two-way video, e-mail, smartphones and other forms of technology. Apps, such as Doctor on Demand and Ringadoc, allow patients to speak to a physician via phone or video chat.

Doctors enrolled with the service PINGMD can receive text, photo or video messages from their patients that can be forwarded to colleagues for referrals and are automatically saved to the patient's medical file. Another app, HealthTap, connects patients to 50,000 doctors across the country for verified answers to medical questions. Patients can search the database or ask their own questions and receive responses from multiple doctors, providing them with several opinions.

The American Medical Association says that telemedicine, including house call services, is useful for both patients and the health care industry as a whole, according to its June Report on the Council of Medical Service.

"Telemedicine, a key innovation in support of health care delivery reform, is being used in initiatives to improve access to care, care coordination and quality, as well as reduce the rate of growth in health care spending."

How house call apps work

After a brief video conference, a doctor will assess the patient's need for a home visit. If no visit is necessary or the physician recommends a trip to the emergency room, there's no charge.

"With this system, we're able to provide high quality care that goes beyond the issue at hand," Zebarjadi said. "With the doctor visiting patients in their own homes, it's easy to make observations and discuss other health concerns and lifestyle choices."

"I love the concept of bringing our services to people's homes," said Medicast's Dr. Elisa Malin. "It's a convenience factor, both for the patients and for us as physicians, in the sense that I can choose to be on call whenever I'm available."

Malin also works as a pediatric hospitalist for Kaiser Permanente. She said that a typical house call visit lasts about 45 minutes, as opposed to the average 10-minute visit at a clinic.

"The fact that I get the luxury of time with Medicast patients improves the quality of care they receive."

With both apps, physicians follow up with the patient via phone and are available to answer any questions that may have come up since the visit.

Although the apps are only currently available for iPhone, Pager and Medicast are actively working on an Android app. For non-iPhone users, their services are also available by phone and on their websites. They also have plans to move into other markets in the near future.

The house calls are comparable to an urgent care visit, and cost much less than the emergency room, where many people still go to seek treatment for minor ailments. Both companies offer flat rates, starting at $199 for a house call. Customers can also sign up for a monthly plan that allows them two or four visits a year.

The companies aren't able to accept insurance, but are in talks with various providers to make that option available in the future.

House calls have their advantages, such as privacy and convenience, according to Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons. They also can save on office overhead for physicians. But they do have limitations, she said.

"The doctor's black bag won't have all the equipment available in the office," she said.

Both companies' websites have long lists of conditions they treat, such as cold and flu, sprains, eye infections, pneumonia, abdominal pain and cuts that require stitches. But there are also conditions their doctors cannot handle. You should call 911 or go to the emergency room if you are experiencing chest pain, shortness of breath, or have had a head injury and lost consciousness.

Source: www.cnn.com

Source: www.rntobsnonlineprogram.com

By Michelle Healy

Nearly one-third of U.S. children and adolescents are obese or overweight, but many don't realize that they fall into that category.

According to new government statistics, approximately 30% of children and adolescents ages 8-15 years (32% of boys and 28% of girls) — an estimated 9.1 million young people — don't have an accurate read on their own weight.

About 33% of kids (ages 8–11) and 27% of teens (ages 12–15) misperceive their weight status, says the report from the National Center for Health Statistics.

Based on data collected between 2005 and 2012 from more than 6,100 kids and teens for the National Health and Nutrition Examination Survey (NHANES), the report also finds:

• 42% of those classified as obese (48% of boys; 36% of girls) considered themselves to be about the right weight.

• 76% of those classified as overweight (81% of boys; 71% of girls) believed they were about the right weight.

• 13% of those classified as being at a healthy weight considered themselves too thin (9%) or too fat (4%).

Studies have shown that recognizing obesity can be an important step in reversing what is a major health problem for U.S. children and adolescents, and it can be an important predictor of later weight-control behaviors, says Neda Sarafrazi, a nutritional epidemiologist at NCHS and lead author of the report.

"When overweight kids underestimate their weight, they are less likely to take steps to reduce their weight or do additional things to control their weight, like adopt healthier eating habits or exercise regularly," Sarafrazi says.

"On the other hand, when normal weight or underweight kids overestimate their weight, they might have unhealthy weight-control behaviors," she says.

Weight misperception varied by race and Hispanic origin, according to the report. Black and Mexican-American youths were more likely to misperceive their weight than white children. It also varied by income level and was significantly less common among higher-income families compared with lower-income families.

The report's findings are not a surprise, says Timothy Nelson, an assistant professor of psychology at the University of Nebraska-Lincoln. He was not involved in the study.

"In general, children and adolescents have a tendency to underestimate their health risks, and this certainly appears to be the case with obesity," says Nelson, who studies pediatric health behaviors. "We see a similar pattern of misperception when parents are asked about their children's weight. Parents are often unaware of the problem."

With obesity so prevalent today, it's understandable that many kids might have a skewed take on their weight, he says. "If they are surrounded by people who are overweight, they may be less likely to label their own weight as a problem."

The findings highlight the need for health professionals "to communicate with families about the child's weight," Nelson says. "This can be a tough conversation when the child is overweight, but it is critical that pediatricians help parents understand where their child stands and what steps need to be taken to get the child on a healthier track."

Source: http://www.usatoday.com

By: Healthday

Odds are small, but family, doctors should keep possibility in mind, researchers say.

Babies born prematurely appear to have a slightly increased risk of potentially fatal blood clots that they will carry into adulthood, Swedish researchers report.

Doctors have previously suspected that babies born earlier than 37 weeks' gestation have a raised risk of deep vein thrombosis and pulmonary embolism, two serious conditions caused by blood clotting in the veins, the researchers noted in background information.

This new study confirms that link, and takes it even further. Premature birth appears to be linked to an increased chance of blood clots in the veins in childhood and early adulthood, according to findings published online July 28 in the journal Pediatrics.

The researchers also reported that a baby's chances of blood clot-related illnesses are directly related to the degree of prematurity. "The more premature, the higher the risk," said Dr. Edward McCabe, chief medical officer of the March of Dimes. A full-term pregnancy lasts from 39 to 40 weeks.

While parents and doctors should keep this risk in mind, they should also be aware that the risk is not huge, said Dr. Kristi Watterberg, chair of the American Academy of Pediatrics' committee on the fetus and newborn. Watterberg and McCabe were not involved with the study.

The association between premature birth and clot risk seen in the study does not prove a cause-and-effect relationship.

The study involved 3.5 million babies born in Sweden between 1973 and 2008, including almost 207,000 born preterm. Out of all the births, only about 7,500 children -- 0.2 percent -- suffered either deep vein thrombosis or pulmonary embolism later in life.

"I think it's important scientifically to know, but it's such a low incidence phenomenon that there are a lot of things to think about before that," said Watterberg, a professor of pediatrics and neonatology at the University of New Mexico School of Medicine.

Deep vein thrombosis involves blood clots that form in a vein deep in the body. If these clots aren't treated and dissolved, they can break off and travel through the bloodstream to the lungs, causing a blockage called a pulmonary embolism. Such a blockage can be deadly.

For the study, Dr. Bengt Zoller, of the Center for Primary Health Care Research at Lund University in Malmo, Sweden, and colleagues used records from the Swedish Birth Registry to track the babies' health. The researchers found that premature babies had an increased risk of blood clots in their veins in infancy, but also from ages 1 to 5 and from 18 to 38.

Very preterm births -- before 34 weeks of gestation -- also had a risk of blood clot-related illness in adolescence, from age 13 to 17.

Boys had an increased risk of blood clots in infancy, while girls were more likely to carry the risk into adolescence and adulthood, the study authors reported.

No one knows why this increased risk exists, but it could be due to genetic factors that caused the mother to deliver prematurely in the first place, Watterberg and McCabe said.

Diseases such as diabetes, thyroid problems and obesity are genetic in nature and can cause preterm delivery, McCabe said.

Also, some mothers who suffer a genetic deficiency in a key protein that controls blood clotting may be predisposed to give birth prematurely, Watterberg said.

"It may be that maternal genetics are a setup for preterm delivery, and those problems are passed along to the infant," she said.

The mother's wellness and lifestyle also play a role in a baby's lifelong health, and could influence their risk of blood clots, McCabe said.

Finally, this link might arise because the babies are born prematurely, and are robbed of maternal hormones and nutrition in the womb that could have decreased their future risk of blood clots.

"We are not as good at getting nutrition into those babies as the mother and placenta are, and we do know that hormones have something to do with the predisposition to clotting," Watterberg said. "It makes sense to me you'd have changes in those long-term outcomes as well."

In any case, it is something for the family and doctor of a person born prematurely to keep in mind, McCabe said.

"If a patient has a history of preterm birth, and the more preterm, the more attention it needs to have," he said. "It helps us be better prepared. If a patient comes in with unusual findings, this provides us some clue."

Source: http://healthfinder.gov