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Time for Schools to Act: Sleeping and Adolescents

This is a follow up to my two columns in CommonHealth offering a brief list of resources related to sleep and adolescents. A subject that has not been addressed by the school systems in Greater Boston.  The evidence on the case of sleeping is overwhelming but few schools are responding accordingly. The article by the New York Times is a good tool for parents to bring the attention of superintendents and principals. Time for a change.

New York TimesThe sputtering, nearly 20-year movement to start high schools later has recently gained momentum in communities like this one, as hundreds of schools in dozens of districts across the country have bowed to the accumulating research on the adolescent body clock.

Research Evidence Selected Resources

Great suggestion by one of my twitter friends on sleep and adolescents in GoPubMed

Filed under: Emergency, Media, Policy, psychology trauma, public health, Research

Las Comunidades Virtuales de Pacientes: ¿Cuál es la evidencia?



Comunidades Virtuales de PacientesComunidades Virtuales de Pacientes: ¿Cuál es la evidencia?


Filed under: eHealth

La Conferencia Salud 2.0 : Notas Día Cero

por Gonzalo @Bacigalupe

La conferencia Salud 2.0 organizada por Oberri está por comenzar en Bilbao este Lunes 8 de Julio. Es la tercera versión de una reunión en la cual de modo sistemático hemos intentado dar a conocer y reflexionar acerca de la fluida y continuamente cambiante aplicación de las tecnologías de la información en la salud.

Salud 2.0 reúne a un grupo heterogéneo de personas e intereses. Están los que hacen investigación, otras que vienen de la clínica, del mundo empresarial, activistas desde el frente de pacientes, gente de gobierno y de las instituciones públicas, y muchos otros y otras. Como en versiones anteriores, vienen algunos invitados internacionales, en esta versión están presentando la antropóloga Susannah Fox del Pew Internet Research, y el investigador salubrista de Oxford John Powell.

El primer día después de la conferencia de apertura (aquí un enlace en preparación para esa conferencia). Con Susannah además entrenaremos en Euskadi el arte de Regina Holiday. Después de la apertura estaré en una mesa con el investigador Francisco Lupianez y el médico de familia Rafa Rotaeche. Hablaremos de evidencia, evaluación, y las comunidades de pacientes. Mi presentación mañana acerca de la investigación en el caso de las comunidades de pacientes estará disponible para vosotros en un enlace a Prezi. En la tarde, el investigador de Tromso Luis Luque, de Andalucía la bibliotecaria Angela Escobar y la periodista Marta Vásquez, y de Valencia el medico familiar Bernardo Valdivieso. Para finalizar el día, varios talleres prácticos están diseñados para aplicar los conceptos de la Salud 2.0 a las practicas clínicas, de activación de los pacientes, de comunicación y las “apps”. Con el comité científico y los organizadores esperamos que disfruten la conversación y participen tanto desde dentro del auditorio en la Universidad de Deusto como a través de los medios virtuales.

El programa completo de las jornadas en Bilbao se encuentra en la página del a conferencia Para seguir el diálogo de los asistentes y conferencistas, les recomiendo está #Salud2EUS en twitter o a través de uno de los twitter chats como Estoy seguro además que el algún modo de videostream estará disponible ese día como en otras ocasiones.


La Municipalidad de Bilbao

Filed under: eHealth

Redes Sociales de Pacientes Charla Virtual 15 de Mayo 2013

Screen Shot 2013-05-06 at 3.41.59 PM 

Filed under: global health

Who should pay for our safety?

Who Should Pay for Our Safety?

Invited column by Matthew Katz

The National Rifle Association’s statements suggested that we increase school security by bringing more guns to our schools. Instead of making taxpayers to foot the bill for police to ‘secure’ our schools, maybe gun owners should be required to pay for the right to own lethal weapons.

When I was sixteen, I had to get a driver’s permit. I couldn’t drive without an adult and had to pay for driver’s school and testing to obtain a license. I had to demonstrate that I was competent enough to keep my vehicle from being a lethal weapon. I have driver’s insurance and have to pay for annual car inspections to prove my vehicle is safe to drive.

As a doctor, I have to pass multiple exams to prove competence for board certification. State licenses and hospital credentialing are essential to practice medicine. I practice in two states, so I maintain two DEA certificates for each state. I maintain malpractice insurance. Because even though I intend to heal and help cancer patients, the medications and radiation therapy I prescribe can potentially harm or kill them.

The National Rifle Association can argue that it represents the interests of hunters, business owners and defenders of the constitution. I support the rights of many good people who value their right to bear arms. But if cars and medicine require education, regulation, insurance and licenses then so should lethal weapons.

If you want to own a gun, then accept the costs and responsibilities that accompany that right. If you can’t prove you’re competent and safe, then turn in your weapons. If you can’t afford to pay for the registration and insurance, then turn in your weapons. If you can’t prove you store lethal weapons safely, then turn in your weapons.

Please do not tell me that to protect my wife and children I have to pay for police to guard them. It is the responsibility of gun owners, not the taxpayers, to bear that burden.


Filed under: global health,

Beyond False Promises of Safety: Ideas for Psychologists, Educators, and Parents of Children in an Unsafe World

Invited Column by Jodie Kliman, Ph.D., Massachusetts School of Professional Psychology

 As someone with many years of experience with helping children cope with both personal and large-scale catastrophic events, I have been struck by a few things largely missing in the interviews and talking points of many psychologists interviewed by the press since Friday.  I think it would be useful to lay them out, especially for the many of us students and faculty who are directly working with children and adolescents and/or with people who have themselves previously experienced the sudden (especially violent) death of someone close to them:

  1. A collective trauma like the tragedy in Newtown is likely to trigger personal experiences of grief for one’s own loved ones, especially loved ones who died suddenly and/or violently — in individual acts of violence, or in war.  This is the case for people of all ages, but is especially important to address for children and adolescents who may have already lost family members in untimely and terrible ways, and for any youth living in areas with wide-spread urban violence, as well as for child refugees.
  2. Related to this point is the common wisdom among many psychologists that parents, teachers, and other caring adults need to reassure children that they will be kept safe.  This safety cannot be guaranteed in inner cities, including Boston, where the walk home from the school bus or the 7-11 can be fatal.  Let’s be more realistic in how we reassure children in such settings – helping children think about how to be safer, rather than absolutely safe.  We can and should give youth a sense of efficacy in self-protection and a sense of an adult protective presence, but false reassurances based on comfortable suburban experience will not be helpful – or believed.  My own work in inner cities and with children who have grown up in war zones tells me that children know from very early on that it is not wise to assume that they are safe or that all adults will protect them.  This is a terrible fact, and they must be helped to process it and be strengthened to navigate their world as safely as possible.
  3. Even some younger children, and many older children in such chronically unsafe conditions recognize that violent and tragic gun deaths in their communities, which happen one by one, rather than 26 at a time as in suburban schools, get less media attention and less compassionate and outraged outcry from the general public.  This is an issue of both race and class.  In the 1960’s, when African Americans were being murdered routinely in the South for trying to register to vote or for otherwise standing up for their rights, there was no outcry, and it didn’t hit the news.  Civil rights workers determined that the only way to get media attention and therefore social change was for many young white people, college students, to join local African American civil rights worker, and risk their own deaths.  Those deaths happened — and the media noticed, for the first time, and that led very quickly to the Voting Rights Act of 1964, signed weeks after the deaths of two white civil rights workers and one African American civil rights worker, Andrew Goodman, Michael Schwerner, and James Chaney. I raise this point because those of us working with children of color and children of any race in poor and violent communities can help youth who may grieve with all of America for the beautiful lives lost in Newtown — but who at the same time are very understandably angry that the 63 gun deaths in Boston alone last year, most of young people of color, don’t evoke the same grief and outrage across the country.  How can we help children (and ourselves) hold the complexity of that simultaneous grief and righteous anger at their own community’s invisible daily tragedy? We can’t avoid this question.
  4. We can’t realistically promise safety to children — but we can offer them tools to be proactive, compassionate, voices for the safety of all people.  Active mastery is key.  Even the youngest children can be asked if they want to draw pictures to send to the children of Newtown – or to the family of the latest murder victim in their own city.  Children feel better if they can do something to help others.  Children as young as 9 or 10 can be encouraged to write letters – to newspapers, congressmen and women, senators, mayors, governors, and the president, demanding real gun control — not just for the safety of children in schools, but for their safety on the streets and in their own homes.  This can make a big difference psychologically – and it makes a good electioneering story for elected officials who go for re-election.
  5. And finally, as health professionals, educators, and parents, we need to lobby for change on one of the worst public health crises in our nation, with 30,000 people a year killed and many more injured by guns.  We are well-placed to lobby for true gun-control and to ask: why are assault weapons so much easier to access than community-based mental health services, especially for children?

Filed under: Disaster, Emergency, Policy, psychology trauma, trauma

What If We Treated Gun Violence Like Cancer?

Invited Column by Matthew Katz, MD

In oncology, we get excited when we can improve survival modestly, 5% or more.  The stark difference in gun violence mortality and injury in the United States compared to other developed other nations with strict gun laws makes me wonder: why not eliminate violence with the same commitment we have for cancer care?

Violence is not a biologic cancer, but a societal one.  Unlike malignancies, it’s purely from human interaction.  This disease is more in our control than cancer; if we choose to act upon it.

Here are some possible ways to decrease the violence:


  • Don’t buy ‘Halo 4’ or ‘Assassin’s Creed’ for your kids for Christmas.  Get a nice chess board instead.
  • Consider banning violent video games, which may promote aggression.
  • Don’t go to movies with gratuitous violence to ‘entertain’ you.
  • Screen new TV shows before your kids start watching them.
  • Expand mental health services available to get people help who are at risk of becoming violent.
  • Ban firearm use without robust registration.   If I have to register to prescribe medication, then people who want to hunt should register lethal weapons.
  • The media should stop giving any attention to the perpetrator.  It glorifies and may encourage others.  Social media doesn’t help; so this applies to all of us.


  • Train teachers to identify potentially dangerous situations and provide them with methods to respond to crises like Sandy Hook, Virginia Tech, Columbine and others. This may minimize the deaths when events do occur.
  • Research, develop and implement validated screening tools to assist with picking up on potential perpetrators before they can begin.
  • Involved process for weapons registration may need to include psychological profiling.
  • Registered weapons owners may need to provide ongoing proof that weapons are stored securely.


  • No good analogy.  I do not see providing every teacher with a holstered gun as a solution.


  • Develop national resources for grief management, emergency medical care that are easily available to every fire department, police station and schools.

Cost of Care

There are also sound economic reasons to lessen violence:

I’m not an economist or health policy researcher, but you get the point.

If we reframe the United States’ culture of violence as a disease, maybe it will help get past some of the typical hyperbole.  May be not.  But until we act to ensure the safety of our children, expect more preventable tragedies like Sandy Hook to occur.


Any of these options, or others, can be evaluated and tested for effectiveness.  What are we waiting for?

Filed under: Disaster, Emergency, Policy

Clinicians are Citizens, Not Just Helpers: Let’s Work Upstream, Not Just Downstream

It is usual that reporters and media outlets contact mental health experts to address the questions of trauma after a massacre. The tragedy in Newtown is not different. What should we do as family therapists in response to those questions?

A lot of valuable documents (research, clinical, etc.), however, have been written about what to do, what to tell children and parents to assure them and normalize their grief responses. Most clinicians can speak competently about trauma after a tragedy like the ones we witness with so much frequency. Information for the public and the professionals is easily accessible via sites like the American Psychological Association, the American Academy of Pediatrics, the National Association of School Psychologists, the National Child Traumatic Stress Network, and SAMHSA, among many others. The evidence is there, no need for new statements about what needs to be done. Sadly, this is the new normal.

What we probably don’t do is to speak aloud about gun control, question the rights of citizens to kill others, of thinking really systemically about what our responsibilities are as citizens-clinicians and not as just helpers. We are to engage with our skills in changing the problem upstream not downstream. If we are really willing to struggle and collaborate in the transformation of this problem, we need to really not only be witness to the pain of the most recent victims.

the-number-of-landslides-and-other-natural-disasters-has-increased-by-70-percent-since-the-reservoir-filled-up-in-2010We invest too much in thinking about what can help traumatized families (we know that) and not changing the minds of those who continue to support policies that allow anyone to use guns to kill. Or, we think less about how to contribute our expertise to shape sound gun control policies. Let’s think progressively about this. It is tempting to jump on the need to resolve the pain or to ask for more mental health opportunities—we need them but it is not enough.

In all honesty, just being helpers is like pulling water with a cup out of sinking ship.

This is a public health problem and not a clinical one. We need the later, but we are to take more responsibility for entering the policy and political discussion to shift the upstream causes.

Gonzalo Bacigalupe, EdD, MPH

Filed under: Disaster, Emergency, Policy, psychology trauma

Health Equity Scholars Application

APPLY to the HESP!

The purpose of HESP is to train, support and mentor students interested in health disparities. Developing a diverse workforce committed to health disparities research is key in meeting the heath care needs of an increasingly diverse population. HESP is a project of UMass Center for Health Equity Intervention Research (CHEIR). It is supported by a collaborative partnership between UMass Medical School and UMass Boston. Funded by National Institutes of Health and National Center for Minority Health and Health Disparities.

Who is eligible?

– Students from underrepresented communities—African American, Native American, Latino
– Successfully completed at least 24 credits, 3.0 GPA
– Interest in exploring health research and health careers

What does it mean to be a HESP Scholar?

– Complete a 3 credit elective course (Introduction to Health Disparities). The course meets Wednesdays, 4pm – 7pm in Spring 2013.
– Opportunity to learn about health careers
– Opportunity to join a research project
– Present your course project at an Annual Research Meeting
– Provide support until graduation

How to apply: please download the application and the faculty recommendation form, and e-mail both to Yvonne Gomes-SantosThe deadline is Friday, December 7th. For more information contact Yvonne Gomes-Santos at 617.287.5885.

The Gastón Institute has partnered with the William Monroe Trotter Institute and the Institute for New England Native American Studies to develop this program.

Filed under: global health, , , , , , , , , ,

Pacientes, Web 2.0 y los Nuevos Modelos de Financiacion: Que Necesitan y que buscan los pacientes en las redes sociales?


Filed under: eHealth, global health, public health

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