Author Archives: Susan Promislo

Trumping ACEs: Building Resilience and Better Health in Kids and Families Experiencing Trauma

Jun 19, 2013, 4:18 PM, Posted by Susan Promislo

A woman holds her baby.

Fifteen years ago the Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACEs) study found that children exposed to traumatic events were more likely to develop mental and behavioral health problems like depression and addiction. They were also more likely to have physical illnesses like heart disease and diabetes.

Today, based on that evidence, we are witnessing a health revolution.

An op-ed published today in The Philadelphia Inquirer highlights a recent summit and ongoing efforts in Philadelphia to raise awareness about the negative impact of ACEs on health, education, and other outcomes. The piece states:

Neuroscientists have found that traumatic childhood events like abuse and neglect can create dangerous levels of stress and derail healthy brain development, putting young brains in permanent "fight or flight" mode. What scientists often refer to as "toxic stress" has damaging long-term effects on learning, behavior, and health. Very young children are especially vulnerable.

The same message was echoed in testimony today at the RWJF Commission to Build a Healthier America convening in Washington, D.C., where panelists like Jack Shonkoff of the Harvard Center for the Developing Child emphasized the need for early childhood interventions that focus on building the capabilities of parents to protect their children from high levels of violence and stress, and model resilience. 

Continuing to develop our understanding of the connection between ACEs and poor health and other social outcomes, and supporting interventions like Child First, Nurse-Family Partnership, and other efforts that work to stabilize fragile families and put children on the path to healthy development  will help shape RWJF’s ongoing efforts to foster a vibrant culture of health in communities nationwide.

Are questionable dosing practices fueling antibiotic resistance?

Oct 11, 2009, 11:34 AM, Posted by Susan Promislo

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

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Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

Antibiotic guidelines have historically been developed to maximize treatment efficacy and minimize toxicity – without the consideration of resistance development. This has led to the creation of duration guidelines that are unnecessarily long. One example is the treatment of otitis media, which results from a middle ear infection caused by Streptococcus pneumoniae (by volume, the leading cause of antibiotic resistance). For this specific case, three days with antibiotic treatment has been shown to be no less effective than ten days. Despite this fact, we continue to recommend that patients complete the full ten day course of antibiotic treatment, thereby accelerating the rate with which resistance evolves and spreads.

Regardless of the fact that antibiotic drugs have been used for some 70 years to cure bacterial infections, knowledge on how to use these drugs is still incomplete. And with lack of knowledge, we tend to fit the same approach for treating all infections among all patients. With resistance growing, it is time to ask ourselves: how long can we wait before we change the way we use antibiotic drugs, and are we willing to risk the consequences?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

2nd-Round Project HealthDesign CFP Targets "Observations of Daily Living"

Apr 8, 2009, 5:20 AM, Posted by Susan Promislo

RWJF launched Project HealthDesign in 2006 to stimulate innovation in the development of personal health record (PHR) systems by transforming the concept of PHRs as data collection tools to PHRs as a foundation for action and improved health decision-making.

 

The first round of funding resulted in a range of applications that addressed self-management tasks ranging from a cell phone-enabled medication-management system to a personal digital assistant that collects and supports self-reported pain and activity data and provides a fuller picture of patients’ everyday chronic pain experiences.

 

In the second round, RWJF will award up to $2.4 million in grants to as many as five grantee teams for 24-month demonstration projects that will assess and test how “observations of daily living” — data on experiences such as meals, sleep, exercise, pain episodes and even moods — can be collected and interpreted such that patients can take action to better manage their health and clinicians can integrate new insights into clinical-care processes. 

 

Brief proposals are due on June 3.

 

Lygeia Ricciardi provides more details over on the Project HealthDesign blog.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Project HealthDesign Webcast now available

Sep 23, 2008, 8:48 AM, Posted by Susan Promislo

Click here for a complete Webcast from last week's Project HealthDesign forum on the future of personal health records.  The Webcast is broken down by sessions so you can check out as much or as little of the day as you like.  I also encourage you to check out a set of short videos that drive home what it might be like for patients to use next-gen PHR tools and applications in the future -- you can access them by clicking on the links to each grantee's summary. 

We hope you'll continue to give us your reactions to the day's discussions, whether you saw them live or on the Web. 

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Game Drives Open-Source Biochemical Discoveries

May 9, 2008, 11:38 AM, Posted by Susan Promislo

On Day 1 of the Games for Health conference, Zoran Popovic of the University of Washington gave a demo of his Fold It! game project.  This unique effort, produced in partnership with Electronic Arts and others, is a massive multiplayer game that challenges thousands of players to work in competition and collaboratively to answer unknowns about the stucture and design of proteins.  I don't know a whole lot about proteins, beyond the fact that they play a big part in many diseases and also can contribute to cures, which is intriguing scientists like Zoran.  Ultimately, the answers uncovered through the game play contribute to the search for vaccines and cures related to HIV/AIDS, cancer, Alzheimers, etc.

file Here's a screen shot of Fold It!

What was especially interesting was the model Zoran and his team had developed --  in figuring out answers to individual challenges presented by the game, players share many partial solutions to bigger biochemical questions.  In this open-source game space, individual players each add their complements to solve the problem.  Some have strong biochemist backgrounds, while others just seem to have the skill to figure out the challenge and keep moving to new levels.  In designing the game, Zoran's team tried to pay as much attention to making it fun as to ensuring that it was scientifically valid and useful.

The top-scoring player, as measured by the best-possible folded protein, gets his or her approach tested in real-world labs.  Zoran's team is working on future games involving nanotech design and DNA computing.  As he noted, the next Nobel Prize winner might just be a gamer.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

The "Second Life" of NY Times Magazine Cover Feature, CeaseFire

May 3, 2008, 4:27 AM, Posted by Susan Promislo

On 9/13/2012 CeaseFire changed its name to Cure Violence

This weekend's New York Times Magazine cover story profiles CeaseFire, a violence prevention program built on a public health model that attacks the spread of violence much like epidemiologists attack the spread of infectious diseases.  The charge it issues in its ads and print materials is clear-cut:  Stop. Shooting. People.  CeaseFire is supported by RWJF's Vulnerable Populations portfolio, and its innovative "violence interruption" strategies are making a real difference on the streets of Chicago and increasingly, as the article notes, in other urban centers plagued by gun crimes and deaths.  Among RWJF programs, CeaseFire also has been out in front in testing virtual world tools and techniques to enhance its real world impact.  In 2006, CeaseFire Deputy Director Candice Kane and her partners at the University of Illinois at Chicago's Center for the Advancement of Distance Education (CADE) attended a Games for Health West Coast meet-up in LA.  Since then, they have developed two islands in Second Life as part of their training protocol for violence interrupters and community outreach staff, helping them learn how to diffuse situations that otherwise might escalate in to violent attacks or acts of retribution. 

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CeaseFire Island avatars and streetscapes are closely modeled on real-life Chicago staff and neighborhoods...right down to the graffiti and cigarette ads plastered on the buildings.  A slide deck from CADE provides some great screenshots -- if you read the Times story, you'll recognize Janell, Tio, and others and see what their avatars look like. Coming up, we'll get the chance to talk to Candice about CeaseFire's experience in using Second Life to complement its offline training efforts, though we might have to wait for their phones to stop ringing off the hook, given the interest the Times article might spark.  Stay tuned... P.S.  The slide presentation also highlights other ways in which CADE is using virtual worlds to improve pandemic flu and bioterror-related disaster preparedness.  

This commentary originally appeared on the RWJF Pioneering Ideas blog.

RWJF's Wii Workout

Mar 31, 2008, 12:21 PM, Posted by Susan Promislo

Following on Theresa's post...

Though we might not be as edgy as the Game Developers Conference (yet), RWJF is making strides (and swings, punches, serves, strikes and spares).  We thought you might like to check out a few photos from the recent "getting to know Wii" sessions that the Foundation held for staff.  Thanks to all who graciously gave us the OK to share these (and who pull it off with such style in their business-gamer attire).

file Jasmine and James have the crowd on their feet.
file Linda and Lois duke it out in the boxing ring.
file And Wilson shows off his left hook as Jasmine plans her next move.

There's even talk that they may break out the Wii for our trustees to play during their upcoming board meeting.  In a few weeks I'll check in with Kristine Nasto, who oversees our facilities including the fitness center, to see whether and how the games are influencing people's workout preferences.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Ruckus Nation Celebration!

Mar 18, 2008, 10:31 AM, Posted by Susan Promislo

Ruckus Nation announced its grand prize winner today -- congratulations to Stacy Cho, a Seattle middle school teacher, for rising to the top of 429 entries with her "Dancing Craze" game idea and landing the top prize of $50,000! 

“Dancing Craze” is an interactive game with wearable motion sensors that make your virtual character come alive as you show off your real-world dance moves. It lets you pick your music, record your moves and share your virtual dance video online. With “Dancing Craze,” you can also create group dances or test your skills by mimicking videos from other players, and log on to the “Dancing Craze” website to see whose moves are voted number one.

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Moments after finding out she won, Stacy said:  "I wake up every day and look for ways to motivate kids. I looked around at the games kids were playing and realized that the piece that was missing was physical activity. My idea is all about movement and music and fun to get kids moving." 

When she learned about Ruckus Nation, she encouraged her students at Island Middle School to enter, and then got inspired to enter herself.  The idea came to her in the middle of the night.  "You always think of the best things when you’re sleeping, right?  Kids are obsessed right now with games, with Dance Dance Revolution and Guitar Hero. We even have Rock Band at our house. I just started trying to think of what else I wish they had, and I thought, ‘Why can’t a game respond to my movements or actions?’"

HopeLab founder and board chair Pam Omidyar had this to say about the competition to find ingenious ideas to get kids more physically active -- "We learned from our experience with Re-Mission that if you lead with fun, health will follow...Ruckus Nation continues that tradition. HopeLab’s commitment to quality research and innovation will ensure that the creative thinking put forward in Ruckus Nation is put to great use to help kids.”  Indeed, the next step is for HopeLab to test the winning idea for its viability as a product that could be prototyped and brought to market.

The awards ceremony took place at the de Young Museum in Golden Gate Park, and our own Paul Tarini was on hand to help judge finalist entries and speak at the ceremony.  Congratulations to the winners and to HopeLab -- it was exciting to see the creativity from so many teams around the world.  Ruckus Nation always challenged people to believe that "Your idea could start a movement."  Hopefully, the ideas it generated will help sustain a movement to direct innovation toward helping kids lead healthier lives.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Wii are excited...

Mar 4, 2008, 1:47 AM, Posted by Susan Promislo

Every Tuesday morning, RWJF program staff gather for a meeting to review proposed grants, policies and other foundation matters.  There's usually a few minutes at the start when announcements, staff birthdays, etc. flash on the screen at the front of the room.  Today we found out that RWJF's fitness center is adding the Nintendo Wii to the array of fitness services that are available to staff and guests. 

I was surprised at first that they made the move, but think it's great that the facility is so forward-thinking in its approach to fitness.  It may be the trick to get me in there one more day a week, which I've been pledging to do for ages now, but with no real conviction. 

I'll try to follow up with our fitness center staff to see whether and how staff incorporate the Wii in to their workouts, and report back to the blog.  In the meantime, have you heard of other workplaces that are trying this out?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Blog and Press Accounts of Games for Health Day

Aug 24, 2007, 4:03 AM, Posted by Susan Promislo

There's a great recap of several Games for Health Day-Seattle presentations on Mark Danger Chen's blog...it's always good to get the perspectives of a self-confessed gamer in academia.  Thanks, Mark...from one who was writing about this event from her desk in Jersey, this was nearly as good as being there!  The Seattle Post-Intelligencer also ran a story on the event in today's paper.  Games for Health director Ben Sawyer had this to say:

"There's this caveman logic that it's all about kids and games, but there are so many other people we can reach....We can get the (health care and gaming) worlds to crash together and apply the different ideas in new and innovative ways."

This commentary originally appeared on the RWJF Pioneering Ideas blog.