#Complications (Atul Gawande). Life is complicated. Medicine too.

What do we expect from a surgeon? To be precise and trustworthy is not enough, we mostly want him to save lives and spare people from death. Surgeons’ job is a tough one. “That’s why they are so well-paid”, we say. They have to save lives. Isn’t this supposed to be a God’s task?

Atul Gawande gives us an unexpected vision of doctors, particularly surgeons, which enhances a very simple fact, though very difficult to accept too: medicine is not a science and it is much more related to uncontrolled facts than what people might think (and would like it to be). Though the persistent attempts of the last two centuries to emphasize the technological and logical aspects of medicine while sacrificing the relational and humanistic sides of this scientific art, doctors are still human beings and they’re still fallible and subdued to human mistakes. Certainly, technology and scientific progress have much increased patients’ possibilities to survive. Nowadays few people die during an anesthesia and many risks, like inserting a breathing tube in the wrong throat channel or forgetting instruments inside patients’ bellies, have been drastically reduced thanks to the introduction of better monitoring systems and higher standards to control doctors’ work. Reduced doesn’t mean eliminated, though. The more scientists and doctors know, the more they would need to know. Moreover, our society and our world are getting more and more complex, some diseases have been almost definitely defeated, some new others have and will come out. Medicine needs to learn how to cope with this evolving environment, but, like all evolutionary processes, this needs time to proceed through a slow progressive adaptation.

Indeed, as it is human and deeply involved with the contradictions that mark the human soul, medicine is full of paradoxes. Medical education is as necessary as dangerous. Patients would like their doctors to be the most professional and prepared on the market. To become so, doctors need to practice a lot. At the same time, almost nobody would accept to be operated by an assistant, who still has to practice his techniques and is certainly more exposed to mistakes than the veterans. Medical education and continuous practice are the only ways to improve doctors’ professional skills. Nevertheless, they have a cost.

It’s also impossible to trace a definite paradeigma. Some people want to be conscious of their health situations, some others don’t. Doctors mainly have to follow precise protocols but they also need to adapt them to the single individuals they’re dealing with. Patients’ situations are pretty unique. If a doctor has to consider the amputation of a young girl’s leg diagnosed with necrotizing fasciitis (the so-called flesh-eating disease), he will think about cutting off the leg twice the times he would consider the same operation for an old man.

Medicine is deeply human because it doesn’t simply deals with bodies and their pathologies, but with the personal perception that accompanies those same bodies. The operation to stop pathologic blushing may cause irreversible damages to the patients’ face, expressions and sometimes it also leads to death. Still, some people prefer to risk and to try to improve their quality of life. A TV reporter that keeps on blushing every time she’s in front of the camera will never have a career with such a disability. She has to do something to achieve her life-goals. Risk is part of challenges. Improving the quality of a life, saving it is a huge challenge, don’t you think so?

Doctors are not machines and they have to deal with human conditionings like everybody else. To go further and make things better is the purpose, to do some steps backwards is part of life, something that has to be accepted. Beside the fragility of our medical knowledge and the misunderstood status of medicine, this book makes us remember that those ‘steps backwards’ may happen, sometimes for a reason, sometimes without.

That’s the first message Gawande seems to give. Our life is extremely fragile, which makes it even more precious.

Credits image: commons.wikimedia.org

NEW STEP IN BIOMEDICAL RESEARCH WITH 3D STEM CELLS

I find it particularly moving when I read that a research was done in a place where I actually lived for quite a while. That’s what happened when I read a Scottish study that was led thanks to the collaboration of the Heriot-Watt University and the Roslin Cellab. If you remember the story of Dolly the Sheep, she was actually created in the Roslin Institute, just outside Edinburgh. That city stole my heart. Especially due to its green surroundings, which include Roslin, also well-known for its chapel, which comes up in the Da Vinci Code.

To get to the point of the study itself, some Scottish researchers have discovered a new 3D printing technique to produce embryonic stem cells (hESCs) that stay alive and maintain their capacity to differentiate into different types of cells.These 3D structures from hESCs will lead to the creation of accurate human tissue models that are fundamental for in vitro drug development and toxicity-testing. Furthermore, in the longer term they might be used to create viable 3D organs for medical implantation. The research has been published on 4^th February 2013 in the journal Biofabrication.

Dr. Shu, co-author of the study, said: “This is the first time that hESCs have been printed”. While most of the laboratory grown cells grew in 2D, there have been previous researches that printed certain cell types in 3D. In any case, due to their high sensitivity, it hasn’t been possible to manipulate human stem cell cultures in this way before. These researchers used a valve-based printing technique that  managed to preserve the delicate properties of hESCs, which were driven by pneumatic pressure and accurately controlled by the opening and closing of a microvalve. Shu explained: “The valve‐based printing is gentle enough to maintain high stem cell viability, accurate enough to produce spheroids of uniform size, and, most importantly, the printed hESCsmaintained their ability to be differentiated into any other cell type.”

This is a real breakthrough because so far animal cells have been used in the majority of the studies to test the different printing methods for the fabrication of 3D tissues and organs. But most of drug discoveries target human diseases, so it is more reasonable to use human tissues for the experiments, which would make the process of drug testing both faster and more effective. In the longer term the development of this technique might also lead to the creation of organs for transplant. Donations would be unnecessary and the problems of immune suppression and transplant rejection would be avoided because 3D organs would be created from a patient’s own cells.

Biomaterials and regenerative medicine are rapidly developing studies: in the future, they might succeed where medicine has not found solutions yet. The Chinese have already recognized their potential value and are largely investing in tissue engineering and biomaterials:this new Scottish achievement leads scientific research in these fields one step further.

Credits image: Flickr, Bikerock

No food baby, thanks

You are what you eat, said Feuerbach once. But it seems that ‘you are what your mum eats’ suits children better. We (almost) all know that sugary drinks, chips, sweets are bad for our health and relate to higher possibilities of becoming obese. Add bad nutritional habits to lack of exercise and you’ll likely be in trouble with your weight.

But what about children? Aren’t they supposed (‘they’ stand for general scientific and pseudo-scientific publications about children and nutrition) to easily control their appetite? A child knows how to say ‘no’. Children don’t get stressed and don’t have to quarrel with annoying partners, why shouldn’t they be safe from binge-eating disorders?

A research from WSU alumna Halley Morrison (this is her undegraduate honor thesis XD) shows that mums’ eating habits and their behaviour at the dinner table can strongly influence their children’s obesity risk. Almost 17% of American children between 2 and 19 are obese. Changing families’ habits wouldn’t cost: the problem is over-abundance of food and cutting it would just result in saving familiar money. The research analysed surveys of 222 preschoolers and caregivers, choosing them among African-American and Latino populations, who are the highest ones for obesity rates (21% and 22%).

What about the results? Morrison found that if a mum keeps on eating when she’s full and shows high level of control when feeding her kids (for example, if she pushes her children to finish everything or forces them not to eat until the following meal), then children tend to become picky eaters.

On the other hand, if a mum tends to eat in response to her emotions or is easily tempted by the visual aspect and taste of food, children grow up with a huge appetite. The research also revealed that these mums tend to keep unhealthy desired foods out of cupboard.

Mindfulness comes back, here. Morrison suggests it’s important that parents get conscious of their eating behaviour, in order to create a good environment at mealtime. Smaller portions have to be preferred because they’re more visually satisfying and there’s no need to overfeed children giving them double portions when they do not ask that (that’s what I call ‘post-war mentality’. Italian grannies are very keen on that: ‘Eat, eat, eat, my little boy/girl’. If you don’t eat, they get disappointed. Nevertheless, they soon stop and don’t avoid remarkable acid comments when you’re too chubby to find a decent partner).

As for the correct attitude towards forbidden food, like sweets, it’s important to limit the availability of high-calorie low-nutrient foods. But without banishing them completely, because grown-up children tend to crave forbidden food, just for the sake of transgression. That’s what happened to me and a bunch of people I know with Nutella. They should write on the label ‘it causes addiction’, same as cigarettes.

There are plenty of Tv programmes, scientific articles, diet experts that promote the necessity of changing eating habits, especially in the richest countries. Still, percentages of obese people are far from decreasing. You might remember Jamie Oliver  and the food revolution he started promoting some years ago from the very fattest city in America, Hungtington (West Virginia).

To be continued, necessarily.

 

 

 

 

 

 

 

 

Time Warp Education

Learning is better when we do it together. Nice way to be welcomed in a course. encouraging, at least. to be welcomed is a good way to start a new project. mine, today, is starting to verify by myself the possibilities of online education. I decided to join a course on Coursera.

I got enrolled in the course called Introductory Human Physiology.

Quite interesting, isn’t it? They say only a basic level of biology is required. Two smiling appealing teachers appear in the presentation. I’m quite sure I’ll be very happy to follow them.

So, this is my plan. I want to try all these online educational resources. There’s edX. There’s Udacity. And many others I still have to discover.

Credits: http://www.educationonline.com/

I could choose a course on bioengineering and one in business plans. They’re both so far from the type of subjects I’m used to study that I assume they could be a good parameter to compare they efficacy. Clearly, I’m such a mild judge I might not be able to be a good critic. I need to ask for some peer review as well. And start using my pupils, my siblings and friends (not enough, though, I know) to make my experiment, to get the most inspiring things from each one of these websites.

Today, I was lucky. I’ve been enlighted by a Skype interview. That sounds appropriate for a digital journalist. So far, so good.

The topic might  not have seemed so appealing for the others, but it was for me. ‘School’ sounds a boring word for most people that left it saying ‘hurray’. It was the same for me, I’m not that paranormal. But I’ve changed a lot. Now I do admit I can’t help myself from feeling enthusiastic after an almost-two-hours chat with an educational editor. (in one of my possible futures in 50 years I’ll be one of the ladies drinking teas at the charity reunion while discussing for the best strategy to save children from illiteracy)

The big personality I happened to meet today is called Marika De Acetis and she works for the editor Pearson, a widespread multinational in the educational field.

She told us about the trends in education, suggesting that the percentage of children with learning problems is around 10% nowadays. Children get distracted more easily, tend to read more, to visualise things and to be more noisy. School might be a conservative word, but nobody can stop progress. A famous Italian singer, Lucio Battisti, once said ‘Can a cliff stop the sea?’. That’s the same with education. Since children have to learn, teachers have to learn new ways of learning. A linear correspondance, apparently.

There are problems, though (there always are some, otherwise it would be too simple). For example, Italian teachers are usually old. Few schools have got an interactive luminous blackboard and even if surveys say 82% of public schools have got one, it’s usually not enough for the number of students. Materials are not enough. A lot of books still have old design and lose appeal. et cetera et cetera.

To turn all of that into a positive statement (and to take this long post to an end)

THERE’S MUCH TO DO

requests for education will never decrease, reasonably. There’s still much to create, despite any crisis.

consider pressure

Stress has always been a central topic to me. I can’t stand it myself. Moreover, as I give private lessons (try to, at least) of Latin and Greek, my main goal is defeating my pupils’ sense of being-constantly-under-pressure. Apart from filling their brains with notions of grammar rules, I do believe it is important that they relax and feel at ease before starting their translations. I mean, it is normal to feel a bit under pressure if you don’t pass exams or if you really don’t understand a whole subject. It shows that you’re willing to learn. Problems arise when the human limit is overtaken. As long as I meet more and more students, I’ve started collecting their stories and found that stress has become a common problem among teens (and teens already have a lot of unsolved questions). Since my pupils are around 15-16-17 years old, you might wonder how this can be possible. That’s what I ask myself. It’s too early, I think, to develop this kind of disorder. They have all their lives to get crazy with business and family lives.

But numbers say nowadays 75% of the general population experiences ‘some stress’ every two weeks and 7%-8% of the population in the U.S. develops Post Traumatic Stress Disorder (PTSD) in their lifetime. Even in the ancient world some people (especially soldiers on the frontiers) might have suffered of PTSD, of course. It is hard to generalise and argue with numbers, since there weren’t all the instruments for measuring that we do have now. But it’s a matter of fact that the modern world has multiplied stimulos, offers, choices. And new kinds of obsessions. From certain points of view, things have fallen apart since the Greeks.

Chronic stress makes human beings sick. The economic crisis has just increased the number of people suffering from this disorder. We should learn how to deal with it from snowshoe hares. Recent biological researchs state that wild animals are much better than us in coping with pressure. It doesn’t affect their health and lifestyle. Lucky rabbits.

Going back to human, I keep on wondering…

So what? What can be done?

What should I tell my students to deal with stress?

• take the BBC test to check out if you can compete with stress

https://ssl.bbc.co.uk/labuk

• follow the thousands -.- of miraculous -.- tips you can get from the net to deal with stress (double -.-)

http://stress.about.com/od/lowstresslifestyle/tp/self_care.htm

Have some green tea, avoid coffee, alcohol, pills, binge eating, sugary things, take your time, breathe, be surrounded by green things, have broccoli and cauliflower, drink milk before going to sleep, pet a cat, pet a dog, have sex, have a walk, have a trip if you can. I’m just listing SOME of the prescriptions/suggestions/tips you can read on the net to cope with stress. so much bullshit has been said on this topic, I don’t need to add anything. Anyhow, I do feel a sort of moral duty to tell my students to slow down and think about reaching some kind of mindfulness, instead of limitating themselves to look for results and marks.

Yet, I always remark I don’t have solutions (another wicked problem to add to the list), obviously. I’m still looking for a way to deal with my own stress. hoping that I’ll never end up having the same eyeholes of the stressed man in Fantasia- Rhapsody in Blue. fingers crossed.

http://youtu.be/8rR367GrFhk

Mind-blowing media

Long time ago, in 1968, psychologist Robert Zajonc led an experiment to explain the ‘effect of exposition’. He showed to 5 groups of volunteers several papers where unknown Turkish words were written. While the 1^st group of volunteers was shown the unknown word just once, the 2^nd group was shown it twice, the 3^rd group three times and so on and so on…

As a result, people who had seen the word 4 or 5 times were led to think that the unknown word was a major concept, an object, a positive situation or something interesting. On the contrary, the volunteers who saw the world just once or twice didn’t consider it particularly interesting. Zajonc got the same results with Chinese words.

What’s this effect? We all get used to the objects that we often see. We feel at ease whenever we meet familiar objects (at home, in our intimacy). In the same way, we find acceptable (or even enjoyable) new elements that become familiar after a prolonged exposition.

It is a powerful effect, definitely. The media (especially TV, web, cinema) can project symbols, images, names and faces in the intimacy of people by invading their familiar spaces.

I was reading this article by chance on a psychological magazine (Psicologia Contemporanea) today at the library, when I heard about what happened in Connecticut. ‘Once more’ was my first thought. Once more violence. Too many victims. I know it is too simplistic to accuse the media for the overabundance of violence everybody can find in them. I don’t mean that. The murderer’s profile shows that he had an anti-social behaviour and he might have been suffering from a kind of acute autism.

But, still, I cannot prevent myself from wondering how we are getting more and more familiar with all this dark side of the mind.

come on closer. how attachment can change our brain

Which emotions does this picture inspire you?

I’d say affection, love, tenderness, calmness, peacefulness and, least but not last, a deep feeling of confidence and reliance.

But what’s beyond children’s faith in their parents?

There’s a special bond between an infant and his caregiver (usually a parent), which doesn’t simply correspond to the satisfaction of primary needs. According to neuroscientists, the emotional bond that links a parent to his child deeply stimulates brain growth and it affects personality development and lifelong ability to create stable relationships.

A good style of attachment has got many advantages for the child’s physical and emotional health. It also conditions his social and intellective skills in his adult age. New-born children are completely dependent on their parents. In fact, they cannot cope with their own needs and they would not survive without somebody that take care of them. To grow up well and to express their potential abilities, they mainly need a proper nest.

On the other hand, maternal deprivation and parents’ lack of care usually lead to psychological problems and an increase of emotional and social difficulties. This can be easily observed in orphans and has been widely studied by Spitz and Bowlby (http://youtu.be/Q80W-5zvyR0).

It is actually impossible to teach how to do the hardest job in the world. Unless you read the work of a narcissist, you will never get precise instructions on how to become the perfect dad/mum.

But it possible to recognize and analyzed the main features of a good style of attachment. What comes after depends on your ability to translate theories in practical behaviour.

As I pointed out at the beginning, safe and good attachment involves empathy and the capacity of recognizing children’s primary needs (if he’s hungry, thirsty, sleepy, dirty/ if he needs to be cradled or to be cured/ if he needs a calmer environment).

But it should also include a more complex interaction with the child, made by facial expressions, primitive sounds, childish plays and all the possible ways of communication that can be established between a baby and an adult.

The baby can be left alone, since he has to experience solitude as well: but he has to feel sure that his parent will come back. Try to do this and you might get unexpected satisfactions. My father confirms (just don’t expect to receive them during your child’s teenage years, obviously).

I’ll leave you with this interesting link, which explains developmental psychologist Mary Answorth‘s work on attachment. Pretty inspiring, I’d say.

http://www.childdevelopmentmedia.com/mary-ainsworth-and-attachment-theory.html

too much SAD

Let’s start from some relevant numbers. The number of prescriptions of antidepressant medications has increased of 400 percent over the past years. 13% percent of the general population of the Western countries suffers from Social Anxiety Disorder. This percentage arises to 30% within those that are seeking mental health treatment.

Almost everybody has been embarrassed or humiliated during their lives. Most people find it hard to approach an attractive stranger at a party. And many people don’t feel at ease if they’re asked to give a public speech. Mark Twain used to say that man is the only animal that can blush and that he should do it more often. But the edge between shyness and a social disease is not easy to define. Social Anxiety Disorder (SAD) can seriously harm the quality of life of suffering people.

Rhode Island Hospital researcher Kristy L. Dalrymple, Ph.D., of the department of psychiatry, has published a paper in the Expert Review of Neurotherapeutics, where she explores the variances between the two, and discusses the differing beliefs of over- and under-diagnosis of SAD and the possible therapies.

SAD has got a strong impact on the lives of people suffering of this disease. They usually avoid social circumstances they think they cannot cope with, which causes a high amount of distress. Moreover, this problem is usually linked with other disturbs, like mood, anxiety and substance abuse. SAD is also related to lower levels of education, single marital status and unemployment. It also is associated with fewer days worked and reduced work productivity, and as a result, with substantial economic costs.

Though it is such a invasive and compromising disease, it is difficult to diagnose it correctly, because most patients don’t dare to admit their emotions and, despite the high number of researchs, the cause of this disease has not been found yet. The therapies themselves are still debated: do doctors have just to medicate patients or do they have to help them in a more comprehensive way, by giving them also moral support?

Dalrymple points out that the public media don’t give much attention to this problem. Though it would deserve it. SAD affects a large and increasing part of the population. It is important to support researchers and clinicians to achieve more public consciousness and find a way to fight this disturb.