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Archive for the ‘interventions’ Category

Translational research

Less than two weeks and then I’ll be back in Finland. Wasn’t it just a blink of an eye ago when it was still summer? Time flies like an arrow. Aikakärpäset pitävät nuolesta.

Translation from English to Finnish doesn’t always work very well, as any Finn who’s used Google Translate might know. Similarly, translation from research to real world is challenging. Findings of laboratory experiments or pilot studies with a friendly crowd may not be applicable in real life situations, unless researchers also understand how communities, organizations, and policies work.

At Cornell, there is Bronfenbrenner Center for Translational Research that helps researchers and communities connect. (Incidentally, Urie Bronfenbrenner was the creator of the social ecological model, which categorizes the multiple levels of influence on behaviour.) People working at the center offer training, connections and small grants to investigators who wish to foray into real world and make a difference. They also synthesize research findings and translate them into understandable and usable format to communities. That means not using language like “There is a large body of experimental evidence which clearly indicates that members of the genus Mus tend to engage in recreational activity while the feline is remote from the locale”.

Social Ecological Model

Image from Boston University School of Public Health

Another related program is the Cooperative Extension, although it’s even more of a hands-on program that aims to engage the public and transfer research-based knowledge to them. As far as I’ve understood, all land-grant universities provide Cooperative Extension programs.

In Finland, we have the Centre for Health and Technology in Oulu, which seems to have a somewhat similar goal – connect universities with other organizations and companies, bring together providers and users of technologies. Should we have something similar in Tampere and other cities/regions (or do we already have and I just don’t know about it)?

I’ve become a firm believer in translational research – now I have a name for what I want to do. I’m also nowadays constantly reminding myself to always, always think about public health improvement as the ultimate outcome. In dissemination, M-PACE is a potentially useful method to tailor evidence-based interventions to new audiences.

Despite all this, I didn’t really do any translational research during this year. That’s going to be one of my new year’s resolutions: always strive to make a difference.

Be the change you wish to see in the world.


Healthy mind in healthy body

I’ve been going to this improvisation class every Saturday for the last four weeks. It’s been a fun and liberating experience, and I’d recommend it to anyone who sometimes struggles with being too much inside their heads and not being present in this moment. Blurting out the first thing that comes to my mind isn’t something that I usually do, but it’s something that I should do more. Heck, if I reveal my stupidity that way, at least I’m being honest about it.

Another great thing with improv is its physicality – moving around, expressing yourself with your body, interacting with imaginary objects, being a puppet for a puppeteer. I chatted with this white-haired, wise, sarcastic man who’s a social worker in his other life and feels that improv is everything he needs in his work: listening, accepting, being there, having energy. He gave me a great piece of advice: “Any time you feel you’re not present in this moment, do something physical.”

One of the big problems with the work that most people do nowadays is that it is very far from physical. And the problem with exercising after work is that for many people it’s a chore instead of fun. (I sometimes feel that way too, but right now I’d give a whole lot to be able to just run outside and go as far as my body can carry me. Bloody stress fracture.)

So, the last thing I want to do is to develop applications that would encourage people to spend yet more time with their computers or mobile phones. I’d love to encourage people to take a moment to relax, go to spend time with other people, go out and enjoy nature, be aware of their surroundings, and do something good for the sake of doing good. And try not to destroy this beautiful planet.

The planet is really beautiful.

We often talk about saving time. We eat fast food and ready-made meals, drive cars instead of waiting for a bus, shorten words in emails, fly instead of taking a train, make up excuses to end conversations. But what are we saving that time for? Everyone’s still busier than ever – trying to make more money to keep up with the Joneses. Fargo, the excellent (albeit gory) film by Coen brothers is an extreme example of the horrid things people can end up doing just to get more money. Shallow Grave is another one, on a smaller scale.

But I digress. It’s becoming a bad habit. I was going to talk about mental well-being, which in a nutshell is composed of three things: feeling that you’re doing what you want to do (and knowing what that is), being supported by other people, and feeling confident and satisfied with yourself. (Some may recognize the similarities to the three basic needs in Self-Determination Theory – it’s not a coincidence.) I think that if people feel good about themselves, then it doesn’t matter if their physical health isn’t super-fantastic.

Mental health predicts physical health in teens, according to this study.

Depression and anxiety are starting to be as serious problems as obesity in terms of societal burden. Also, they are linked to obesity: depressed people are 60% more likely and anxious people 30% more likely to be obese than those without either of the disorders. Reasons? Common socioeconomic and perhaps hereditary risk factors, topped with physical inactivity and emotional eating triggered by loneliness and low mood.

Depression and anxiety are relatively easy to treat, I’ve heard. That’s why they should be screened out among obese people. Nutrition counselling and exercise programs won’t help if you don’t believe in your ability to achieve results, if you don’t see any reason to try, or if you don’t have anyone who cares.Online interventions for depression and anxiety could help enormously with this population, but I don’t know if they’re used in such a way yet. Anyway, some programs that are in real clinical use include:

  • FearFighter (anxiety, phobia, panic attacks). Used in UK since 2006, recently launched in Denmark and the Netherlands.
  • Beating the Blues (depression). UK since 2006.
  • CRUfADclinic (depression, anxiety). Australia.

And probably more, but can’t think of them right now. These require a clinician’s referral. In Australia (and in the whole world, actually) there’s also eCouch which is open for anyone. They have modules for depression, anxiety, social anxiety, relationship breakdown, and loss & grief. That’s a pretty good selection already.

So. I said I don’t want to encourage people to spend more time with their computers, but going through programs like these can be a great help and a good first step for people with depression or anxiety. Unwarping warped thinking requires some guidance and processing.

Now, why don’t we have programs like that in Finland yet?

Apps ad nauseam

This is some sort of a Sunday-evening rant. Be warned.

I’ve spent several hours browsing all sorts of apps and devices for health-related goals, and right now I don’t want to see or try out any of them. I guess I reached the saturation point. Who are the intended users of these thingamabobs? Surely not the ones whose need for intervention would be the highest.

Mothers who struggle with budget and time constraints, trying to do their best to keep themselves sane while preparing food for their families and working two jobs. Businessmen and -women whose days are filled with one meeting after another, sitting in cars and airplanes, grabbing food where it’s available and entertaining clients over one drink too many. And lonely, depressed teenagers and adults who try to fill their emotional voids with food and end up feeling even worse, triggering another binge to relieve their self-disgust.

It is difficult to understand the worlds that other people live in, let alone design fancy gadgets that could help them change their behaviors (if they could afford them or be bothered to try them out). Unhealthy diet and lack of exercise are often just symptoms of deeper-lying issues. Somehow, the simple idea of eating food has become incredibly complicated.

Let’s say that the (obese or at-risk) population can be split into three groups: first group lacks awareness of healthy habits, the second lacks the abilities, and the third one just isn’t motivated. All groups can to some extent be nudged with upstream interventions that make healthy options more available, appealing, and affordable than unhealthy ones. However, downstream interventions that target individuals need to be tailored to their personal needs. And those needs can be really complex. (For instance, the need for cognition. Mine is pretty high, which works against me sometimes – I usually want explanations, it’s not so easy for me to just go with the flow and intuitively follow suggestions or hunches.)

I’m looking for solutions that could work in the real world and actually reach people in need. I think that one channel really can be social media – probably not Facebook, but other online communities which provide a tight social group with similar goals, intimate understanding of problems, and emotional support. We are herd animals and like to flock together. Now, lot of people just lurk on online forums, taking information in but not posting anything themselves. If we would advertise suitable applications among these communities, perhaps we could reach a part of the lurker population. These suitable applications should obviously be effortless to use, somewhat entertaining, and emotionally engaging. Stories are powerful persuaders, and social support is something almost everyone craves.

Not saying that trackers and self-monitoring apps don’t have their place. Of course, a part of the population benefits from habit trackers that serve to increase their awareness of their nutritional intake, activity level, sleep quality and so on. However, most applications assume that people are rational and can change their behavior based on this new self-awareness. For some people, calorie counting and tracking may just feed their obsessions about their diet and weight, when they would in reality need to become more aware of what’s going on in their mind.

I’m not a mental health expert. I’m just someone who’s experienced her share of stress, loneliness and anxiety, and also struggled with sensible eating at some point. And I would like to understand why human beings make their lives so difficult sometimes.