Lucia is here too: Siblings of someone with PWS

The semester is almost over. My last blog assignment was due today! I can't stop blogging with out mentioning my niece Lucia Daniela. She probably wouldn't recognize me if she saw me in the street, because I've been living in the USA since she was born.  Just wanted to let her know that even though most of the blog has been about PWS and Luis Emilio, I wouldn't have any problem recognizing her anywhere.

Lucia Daniela picking fruits

I miss the fresh fruits from Nicaragua!! Save some for me Lucia Daniela

Luicia Daniela

Lucia Daniela

Growth hormone: is it a personal choice medication or medical necessity in patients with PWS?

Luis Emilio 5th birthday party!

Luis Emilio's Father (Hjalmar) I hope he gave the toy back!

The good news:  Luis Emilio’s growth hormone (GH) will no longer be paid out of pocket!! This has the whole family very happy.

To be fair:  I want to clarify that by no means did I mean to single out  Aetna health insurance, they just happen to be the first on a list of health insurances that were in alphabetical order. Another important point is that by no means is this a complete and thorough review of the evidence available.

My concern:
GH is the only drug approved by the U.S. Food & Drug Administration (FDA) for the treatment of Prader-Willi syndrome. I thought that if Luis Emilio can now get his medication for free in Nicaragua, patients in the USA are probably having their GH covered by their insurance as well. I looked at the Aetna 2011 Preferred drug pocket guide for Emory members and found that GH is a Tier 4  (personal choice) medication.  This insurance company technically covers the mediation. The patient will have to pay $100 co-pay though.

The same guide also states “Emory’s plan goal is to help keep the cost of prescription drugs affordable and provide you with access to the medications you need to stay healthy.” This brings up a lot of questions. Is $100 dollars affordable for most families? What makes a medication a personal choice? The most important question is:  Does the evidence show that growth hormone treatment (GHT) is needed in patients with PWS to stay healthy?

Lets look at some of the evidence:

We know the best evidence will be from randomized controlled trials (RCT).  One randomized study of twenty-five children with PWS, ages 4-37 months; found that the group that received GHT had: ¹

1. Increased Height
2. Improved language skills
3. Improved cognitive skills
4. Decrease body fat
5. Improved motor ability
6. One PWS subject experienced scoliosis progression.

If you are wondering about scoliosis and GHT, a RCT  found that GH treated children had similar onset of scoliosis and curve progression as randomized controls. ²

Another benefit of GHT found in a randomized, controlled GH trial in infants and prepubertal children (n=85) was:  ³

1. Improved HDLc/LDLc ratio. (Cholesterol)

GHT has also been studied in adults with PWS.  Forty-six adults with PWS were randomized to GHT or placebo treatment for 12 months in a double-blind trial and found that the group that received the GHT had:⁴

1. Decrease in visceral fat mass
2. Decreased abdominal fat mass
3. Decreased thigh fat mass
4. Increase muscle mass
5. Lean body mass improved
6. Total fat mass decreased
7. No major side effects were seen.

Not all studies that have been done on GHT in individuals with PWS are RCT. The results of these other studies add to the body of evidence in different ways:

1. They show consistency in the results. “Study findings that are replicated in different populations and by different investigators carry more weight than those that are not.” ⁵

Researchers compared 21 children (6-9 years old) treated with hGH for 6 years with 27 children of similar ages (5-9 years old) prior to treatment with hGH.  They found that PWS children treated with hGH demonstrated:⁶

1. Decreased body fat
2. Increased height
3. Greater motor strength
4. Increased high-density lipoprotein (good cholesterol)
5. Decreased low-density lipoprotein (bad cholesterol)

2. A study that followed 20 patient with PWS that received GHT proved a dose response: “The cumulative dose of rhGH over 10 years correlated inversely with the total body fat percentage” ⁷

Other concerns:

There have been concerns about Sleep disorders in patients treated with GH. One case report showed Obstructive sleep Apnea (OSA) developed after 6 months of treatment and resolved after stopping GH.⁸ Like I’ve mentioned in other post though, case reports are at the bottom of the list when it comes to quality of evidence.

 One study that looked at sleep disorders before starting GHT and 6 weeks after starting GHT found no significant changes in sleep-related disorders before and after starting GHT.  It would have been nice if this study would have been longer. In the case report it took 6 months before she developed OSA! 12 infants did have an increase in the frequency of obstructive events associated with either upper respiratory infections or a diagnosis of gastroesophageal reflux after starting GHT. After the upper respiratory infection or GERD resolved so did the increase in frequency of obstructive events. ⁹ 

Current available information argues against a cause and effect relationship between rhGH treatment and increase mortality. Dr. Phillip D.K. Lee reviews the evidence in regards to this relationship in detail and can be found at the web site:  http://www.gghjournal.com/volume22/2/featureArticle.cfm

My thoughts:

I don't know how health insurance companies determine if a medication is a "personal choice" and classify it as a higher tier. With out an alternative treatment available, I don't think this policy is helping their goal of keeping prescription drugs affordable for their clients. Based on the evidence available I think GHT is a medical necessity for patients with PWS. The benefits go beyond increased height.  Hjamar (Luis Emilio's father) can confirm how I pushed for GHT to be started for Luis Emilio.   It wasn't an easy task. I had to convince my family that the health benefits were greater then the risk; and that the benefits were worth the $300- $400 a week they had to pay out of pocket when he started therapy. 

I understand the insurance companies have to make these same decisions on a larger scale. They may feel that even though GHT  increases height, reduces body fat, improves language, motor and cognitive skills; patient's with out GHT are not at risk of becoming acutely ill or having a life threatening condition if they don't start treatment. Since lack of treatment does not put patients at risk of harm, it may be a personal choice to start treatment. 

If they can't afford it, it is not a personal choice all patients with PWS can make. Luis Emilio did have periods where GHT was discontinued because the medication was too expensive.

Bibliography: 
1. Myers SE, Whitman BY, Carrel AL, Moerchen V, Bekx MT, Allen DB. Two years of growth hormone therapy in young children with Prader-Willi syndrome: physical and neurodevelopmental benefits. Am J Med Genet A. 2007 Mar 1;143(5):443-8. PubMed PMID: 17103437.
2. de Lind van Wijngaarden RF, de Klerk LW, Festen DA, Duivenvoorden HJ, Otten BJ, Hokken-Koelega AC. Randomized controlled trial to investigate the effects of  growth hormone treatment on scoliosis in children with Prader-Willi syndrome. J Clin Endocrinol Metab. 2009 Apr;94(4):1274-80. Epub 2009 Jan 21. PubMed PMID: 19158197.
3. de Lind van Wijngaarden RF, Cianflone K, Gao Y, Leunissen RW, Hokken-Koelega AC. Cardiovascular and metabolic risk profile and acylation-stimulating protein levels in children with Prader-Willi syndrome and effects of growth hormone treatment. J Clin Endocrinol Metab. 2010 Apr;95(4):1758-66. Epub 2010 Feb 19. PubMed PMID: 20173020.
4. Sode-Carlsen R, Farholt S, Rabben KF, Bollerslev J, Schreiner T, Jurik AG, Christiansen JS, Höybye C. One year of growth hormone treatment in adults with Prader-Willi syndrome improves body composition: results from a randomized, placebo-controlled study. J Clin Endocrinol Metab. 2010 Nov;95(11):4943-50. Epub  2010 Aug 11. PubMed PMID: 20702523.
5. Gordis, Leon. (2009). Epidemiology, fourth edition. Philadelphia, PA: Saunders Elsevier.
6. Carrel AL, Myers SE, Whitman BY, Eickhoff J, Allen DB. Long-term growth hormone therapy changes the natural history of body composition and motor function in children with prader-willi syndrome. J Clin Endocrinol Metab. 2010 Mar;95(3):1131-6. Epub 2010 Jan 8. PubMed PMID: 20061431; PubMed Central PMCID: PMC2841537.
7. Sipilä I, Sintonen H, Hietanen H, Apajasalo M, Alanne S, Viita AM, Leinonen E. Long-term effects of growth hormone therapy on patients with Prader-Willi syndrome. Acta Paediatr. 2010 Nov;99(11):1712-8. doi: 10.1111/j.1651-2227.2010.01904.x. Epub 2010 Jul 5. PubMed PMID: 20545932.
8. Nixon GM, Rodda CP, Davey MJ. Longitudinal association between growth hormone  therapy and obstructive sleep apnea in a child with Prader-Willi syndrome. J Clin Endocrinol Metab. 2011 Jan;96(1):29-33. Epub 2010 Oct 13. PubMed PMID: 20943780.
9. Miller JL, Shuster J, Theriaque D, Driscoll DJ, Wagner M. Sleep disordered breathing in infants with Prader-Willi syndrome during the first 6 weeks of growth hormone therapy: a pilot study. J Clin Sleep Med. 2009 Oct 15;5(5):448-53. PubMed PMID: 19961030; PubMed Central PMCID: PMC2762717.

Is stealing always a crime?

I talked to my family in Nicaragua this weekend and the topic of how they were punishing Luis Emilio when he takes food he was not suppose to eat came up. Because he is still a toddler we haven’t had to face the legal problems young people with PWS can have when they steal food. It is heartbreaking to read stories like: “An eleven-year-old girl is arrested for stealing food from her neighbor’s freezer”.  We know that people with PWS always feel hungry. Anyone who felt like they were starving to death would also have a hard time controlling the urge to steal something to eat. Is punishing Luis Emilio going to make any difference in his behavior?

In a quick Google search today I found a few case studies on the effects of behavior therapy in food stealing in patients with PWS.  One study “ found that verbal reprimands, delivered contingent upon eating prohibited foods, were sufficient to decrease the food stealing of a girl with Prader-Willi syndrome.”¹ This was in a supervised environment in a hospital. We really can’t say this will make any difference in the real world, or that it will help other people with PWS.

If we look at how scientific evidence is categorize based on the quality of its source, case reports are at the bottom of the list. They are still important. Based on this report, a larger study can be proposed. If behavior therapy really works we can replicate the findings in different studies and in different populations.

In the mean time, should the laws be different for people with PWS? Is stealing always a crime?

Reference:

1. Maglieri KA, DeLeon IG, Rodriguez-Catter V, Sevin BM. Treatment of covert food stealing in an individual with Prader-Willi syndrome. J Appl Behav Anal. 2000 Winter;33(4):615-8. PubMed PMID: 11214035; PubMed Central PMCID: PMC1284283.

Getting back to the research question!

PWS is found in people of both sexes and all races worldwide. Luis Emilio was born and is currently living Nicaragua.

I have been blogging about PWS in hopes to contribute to the Prader-Willi Syndrome on the Move awareness initiative. Can blogging really increase awareness though? Life can get pretty busy. Especially if you have a family member with PWS that requires physical therapy, office visit to multiple specialists, in addition to the usual things most of us have to do on a regular day. We want to make sure that family members and friends interested in increasing awareness are investing their time in things that are really making a difference. One of the benefits of using the Internet to increase awareness is the number of potential people that will be exposed to the blog. The down side is, it makes it very difficult to measure the effect of our efforts. 

Study design: I propose doing a cross sectional study to explore the relationship between blogging about PWS and awareness about the signs and symptoms seen in patients with PWS. Participants in the study will fill out a short survey that will evaluate their level of knowledge about PWS and the level of exposure to this blog. This will allow us not only to determine if there is any relationship between blogging and awareness, but it will also allow us to determine the proportion of the population that is exposed to the blog.

Study population: Students enrolled in the principals of epidemiology class at MU during the spring semester of 2011. This blog is part of an epidemiology project. Part of our assignment is to read other students blog. Students are not required to read everyone’s blog. This makes it a convenient population to study because we can expect to have students that have read the blog and students that have not read the blog.

Exposure variable: Number of post about PWS the student read from the blog:  sonia-lookingforhappiness.

Outcome Variable: Percent of questions answered correctly about the signs and symptoms in patients with PWS.

Sample size: Because the study population is relatively small we can afford to survey the entire class. The proportion of students exposed to the blog and the effect size, if any, found in this study can be used for calculation of sample size in future studies on this subject that may have a larger study population.

Limitations of the study:

1. We are measuring the exposure and the outcome at the same time and therefore we cannot determine a temporal relationship. It may be that students with increased awareness about PWS were interested in reading the blog.

2. The exposure variable is subject to recall bias.  Students may not remember how many post they read or if they read the blog at all. This may also lead to misclassification. For example, a student may not remember that he skimmed through a couple of post at the beginning of the month and be classified in our study analysis as a non-exposed student.

3. Although our goal would be to survey the entire class. Students may decide not to participate in the study. This can lead to selection bias. Students that have increased awareness about PWS would be more likely to complete the survey weather or not they read the blog.

4. Participants in the study would be graduate students, many with a health background; hence generalizability of the results to the general population is limited.

5. There are multiple known confounders that we would need to control for.  For example: the different levels of medical knowledge in students in the class. If only the students with a health background read the blog, a higher percent of correct answers on the survey may not be related to the blog at all!

6. The study doesn’t measure the effect it has on other readers that are not in the class!

Do you think that blogging increases awareness?

Fact six: A disability or different abilities?

Luis Emilio

According to the WHO a disability includes having activity limitations. "An activity limitation is a difficulty encountered by an individual in executing a task or action". ¹ We all have a hard time with certain activities. I definitely encounter difficulties playing sports, singing, ...well the list could get very long.  So are we all disabled or do we have different abilities?

Children with Prader-Willi Syndrome (PWS) have a special talent and interest for jigsaw puzzles. Elisabeth M. Dykens compared the ability to solve jigsaw puzzles in individuals with PWS with age matched typically developing individuals. She found that individuals with PWS on average placed 28.10 pieces correctly, while typically developing individuals placed 10.71. As expected the participants with PWS had a significantly lower IQ. On average their IQ was 63.48 (SD: 14.75) compared to 103.53 (SD10.3) ² in the typically developing individuals. Yet they placed more than twice as many pieces correctly!

Because this is after all an epidemiology blog, we should talk about the limitations of the study. Anecdotally children with PWS like to play with jigsaw puzzles more then most children. The study didn’t control for exposure or practice with jigsaw puzzles. It could be that children with PWS have more practice. Practice makes perfect right? But like the author of the article mentions; this still leaves the question of why children with Prader-Willi syndrome are attracted to jigsaw puzzles to begin with? Don’t we all enjoy doing things we are good at? 

Fact six: Individuals with PWS, like all of us, have different abilities. Many of them are really good at solving jigsaw puzzles!

Luis Emilio

Bibliography:

1. World Health Organization. (2011). Disabilities. Retrieved 04 2, 2011, from WHO: http://www.who.int/topics/disabilities/en/

2. Dykens, E. M. (2002), Are jigsaw puzzle skills `spared' in persons with Prader-Willi syndrome?. Journal of Child Psychology and Psychiatry, 43: 343–352. doi: 10.1111/1469-7610.00025

Fact five: Hunger=Overeating=Obesity= Chronic Disease in PWS

The increased appetite in children with PWS leads them to overeat and become obese. Like in all of us, obesity increases our risk of chronic diseases like hypertension and diabetes.

To make the problem worse,   they have reduced muscle tone as mentioned in earlier posts. This leads to low muscle mass, which means they need less calories then most of us do.

It's important to control their diet. Even if this means locking up food in the house.  Like all of us, they should be very active to maintain a healthy weight!

Luis Emilio started suffering from central obesity from a very young age.

Fact four: Hunger

He is hungry in that picture and he is still smiling! What's your excuse?

The free on line dictionary defines hunger as "the discomfort, weakness, or pain caused by a prolonged lack of food". Children with PWS feel this all day, everyday. The part of our brain that tells us we are full does not work.

The hunger is physiological and uncontrollable. So when Anonymous commented on one of my post: "you all ready have everything to be happy, you have that power to control and know when you are full and you know and you can stop eating, tell me is not that enough to be happy." Click on the link to read the complete comment.  I think he or she is right.

I'm going to bed tonight with out the feeling of hunger.  I am one of the lucky people that had the means to buy food today. The part of my brain that controls hunger was able to register that I ate and made that "discomfort" I had when I came home from work go away. Millions of children and adults are not that lucky. They will spend all day feeling hungry, either because they live in poverty or have PWS.  Click on the link for PWSA-USA below and learn how you can get involved and help us in finding a cure.

Fact Three: Hypotonia, why does it matter?

Hypotonia in children with Prader-Willi Syndrome (PWS) will begin to improve between the ages of 8 and 11 months. Their motor-skills will be one-two years behind compared to other children.

If hypotonia improves over time, why is it such a big problem? During infancy they have significant problems feedings.  It takes muscle strength to be able to breast feed or suck on a bottle.  Many children will need to have a feeding tube placed to get enough calories. Like I mentioned yesterday, they have a weak cry if they are able to cry at all. Crying is how babies communicate they are hungry, in pain, uncomfortable, and/ or need their diaper changed for example. Their lack of muscle tone will also cause them to have delayed speech.

It's important for these children to start physical therapy as early as possible.  Luis Emilio was the youngest child to receive physical therapy in Nicaragua at the time.  Although it took several years for us to find out his diagnosis.  He started therapy as soon as the motor skill deficit was noted. 

 

 

Luis Emilio in physical therapy/swimming lessons

Luis Emilio with his Mother, Perla, at physical therapy.

Fact two: Hypotonia in PWS

Luis Emilio with significant hypotonia.

 
Fact Two:   When babies with Prader-Willi Syndrome (PWS) are born,  88% of them have neonatal hypotonia.  Hypotonia means they have decreased muscle tone. In one word they are floppy babies.  Luis Emilio wasn't able to cry for most of his first year of life.  It takes a lot of muscles to cry and he just didn't have the muscle strength.

Luis Emilio (My Nephew) at 7 months of age.

First Fact about PWS

I have already not followed the study protocol! The plan was to start posting facts 3 days ago.  If this was a real study, we would need to report that Exposure to facts about PWS was not started as established by the study protocol.  These things happen in real research though.  Life happens.  We just have to do our best to follow our protocol and report any variations that occur in the process. That way the reader is aware of the possible circumstances that could effect our results.

I wish I had a great story to tell you of why I didn't blog.....Something exciting or at least relevant to my blog.  But I don't. It's just been a busy week and remember my first couple post? My main goal in life is happiness.  I kinda feel like the guy in this article published in the onion: Grown Adult actually expects to be happy.  So the last three days when I came home exhausted: sleep won!! I'm sorry.  Better late then never.

Fact number one:

Prader Willi Syndrome is a genetic disorder. We won't get too technical about it. Bottom line: part of chromosome 15 from the father of patients with PWS isn't expressed.

Portrait of Doña Eugenia Martínez Vallejo at age 6.   Painted by a Spanish baroque court painter: Juan Carreno de Miranda.  This painting done in 1680 displays classic characteristics of PWS

Prader- Willi Syndrome Association awareness month in May!!

Luis Emilio and me! Look at that smile. Doesn't he make you happy just looking at him? :)

So far I’ve been blogging about finding happiness and treatments for depression.  My assignment this week is to blog about a study design.  The topic I chose will be a little different then what you are use to.  Never the less, it’s a topic very important to me: Prader -Willi Syndrome (PWS).  Infants and young children with PWS are typically happy and loving human beings, so I can sort of link the topics together.  Children and adults with PWS can definitely teach us to be grateful about simple things in life that many of us take for granted.  In my experience they have helped me recognize that it is the small, everyday miracles that make life worthwhile.

My nephew, Luis Emilio, was born with PWS.  He has brought a lot of happiness to our family.  Blogging about how he has brought our family together and filled our home with happiness is another way to spread the happiness to my readers and give hope to other families that struggle with family members with PWS themselves.

“Prader-Willis Syndrome on the Move is the new PWSA (USA) national awareness initiative, targeted to take place annually beginning this May, during PWS awareness month."  In honor of this event and in effort to increase awareness about PWS, I will dedicate my study design assignment to PWS.

The Study will try to answer the following question: 

Will blogging about PWS, increase awareness about the signs and symptoms of patients with PWS?

Can blogging make me happy?

I just read an article published on the ABC news website that says yes! But the studies they site as their source of information don't say that at all!!  

The only published study they site was a cross-sectional study which gives us a snap shot of New Myspace.com users intention to blog or not to blog and several psychological variables. "Intending bloggers scored higher on psychological distress, self-blame, and venting and scored lower on social integration and satisfaction with number of online and face-to-face friends."¹ The participants hadn't actually blogged though!! They just had the intention to blog.  So the exposure I'm interested in: "Blogging" and its effect on happiness weren’t really studied.

In a cross sectional study we can't determine temporal sequence.  What came first the intention to blog or the distress?  When I started blogging I would have reported increase distress and venting because I didn't want to blog!! I would have still reported I had the intention to blog.  Blogging was causing my distress not helping it though.... 

The second study mentioned had not been published.  According to the article the authors sent out questionnaires to the same group of MySpace users.  In the first study there where 134 participants.   Of those only 59 responded to the second questionnaires.  That means that we don't know what happened to 56% of the participants.  That is high number that could have had a negative effect from blogging or internet social networking. 

Based on these articles, I can’t start recommending my patients start to blog to help with their depression.  Intention to blog may be a good screening tool though.  Maybe we need to do a study about that.  

 

There are studies that journaling helps depression.  Blogging is not the same though.  Journaling is private.  When you blog your letting the whole world know what your feeling and they can comment on it. This feedback may be good or bad for you though. 

If you are interested you can download the UW-Madison patient hand out I use on Using Journaling to aid health by clicking on the link.  The website also has more information on non-drug approaches to help you feel happier.

What do you think?  Has blogging helped you? 

Bibliography: 

1. Baker JR, Moore SM. Distress, coping, and blogging: comparing new myspace users by their intention to blog. Cyberpsychol Behav. 2008 Feb;11(1):81-5. PubMed PMID: 18275317.

Why Blog? Bupropion Vs SSRI, If you can't beat them, join them.

Guidelines based on evidence!

I wasn’t too excited with my assignment to blog about epidemiology.  It seemed like an assignment that would consume a lot of my time and I wouldn’t necessarily learn much more then I would with traditional methods of teaching. 

I saw a patient this week that definitely changed my mind though. She has been battling with depression for many years. She has been going to counseling for 2 years with little improvement of her symptoms.  Thanks to “reading tons of blogs” she came to the conclusion that it’s not “bad” to take medications for depression.  Through the blogs she learned that depression is a chemical imbalance in the brain and there is treatment for it. She also had a thorough knowledge of available medications for depression and their side effects.

Reading these blogs was obviously more effective in getting her the treatment she needed than her counselor or her primary care doctor!

I recommended we start a SSRI (selective serotonin reuptake inhibitor) a type of medication used for depression.  She also had some symptoms of anxiety and SSRIs are also used to treat anxiety.  I thought this would be the best option for her.  Many bloggers apparently had horrible things to say about SSRIs.  After reading personal experiences from other bloggers she wanted nothing to do with SSRIs and wanted to try Bupropion, another medication used for depression.  So that’s what we started her on.

Should patients be making medical decision based on personal experiences that people blog about though? How about the millions of people that responded well to SSRIs and just didn’t blog about it?  Maybe an SSRI would have been better for her. A pooled meta-analysis of 10 randomized studies from 1991 through 2006 found that in patients with high levels of anxiety “there appears to be a modest advantage for the SSRIs compared to Bupropion in the treatment of anxious depression (6% difference in response rates).”¹ This meta analysis looked at the experience of 1,275 patients with anxious depression to come to that conclusion. 

So why did I still prescribe Bupropion? Shared decision-making.  At one point she apologized for asking for a different medication then the one I recommended.  I let her know I would never prescribe something I did not feel comfortable with and Bupropion is a good choice! No need to apologize.  “The American College of Physicians recommends that when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants on the basis of adverse effect profiles, cost, and patient preferences (Grade: strong recommendation; moderate-quality evidence).” ² That’s exactly what we did.  Bupropion is a second-generation antidepressant.  Thanks to other bloggers she was very familiar with the side effect profile of all the available antidepressants.  That was her preference. 

Whether we like it or not, this is where our patient’s are getting their medical information.  If you can’t beat them, join them!

Bibliography:

1.  Papakostas GI, Stahl SM, Krishen A, Seifert CA, Tucker VL, Goodale EP, Fava M. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of major depressive disorder with high levels of anxiety (anxious depression): a pooled analysis of 10 studies. J Clin Psychiatry. 2008 Aug;69(8):1287-92. PubMed PMID: 18605812.

2.  Qaseem A, Snow V, Denberg TD, Forciea MA, Owens DK; Clinical Efficacy Assessment Subcommittee of American College of Physicians. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008 Nov 18;149(10):725-33. Erratum in: Ann Intern Med. 2009 Jan 20;150(2):148. PubMed PMID: 19017591.

Now that the sun is out…should I forgive Erik?

“Back at the hotel in Columbia, MO. After laughing at dinner like I haven't laughed in a long time! De regreso en el hotel en Columbia, MO, Despues de reirme en la cena como no lo habia hecho en mucho tiempo!”

Top of Form

    June 10, 2010 at 11:45pm · Friends Only ·

Bottom of Form

That was my FB status after going out to dinner with Erik (my program director), his wife, and a couple friends during my interview process at MU.  After that dinner my decision was made:  I would do my fellowship at MU.  It seamed like a fun group of people to work with.  The scenery was beautiful and I clearly remember Erik saying the winters where mild, “Snow never sticks.”  You can imagine my surprise during the historic snowstorm this month.  I didn’t leave my apartment for 3 days!!  I felt deceived!  Could not seeing the sun for 3 days really reduce my chances of being happy?

In a personal view article in the BMJ it mentions “Research has shown that people are happier, more energetic, and less likely to be sick in the longer and brighter days of summer, whereas their mood tends to decline—and anxious and depressive states to intensify—during the shorter and duller days of winter.” ¹ They didn’t reference these studies though.

I found one study done in nurses working at Akdeniz University Hospital in Antalya, Turkey where “exposure to daylight at least 3 h a day was found to cause less stress and higher satisfaction at work.” ² Can these results apply to me?  Is a study done in Turkey useful for people that live in the sates?

To complicate things even more. A study in the Netherlands found NO association between mean daily temperature, duration of sunshine and duration of rainfall to major depression and sad mood in the general population. ³

Bottom line for now:  this epidemiology thing and using in to make decisions in our everyday life is kinda of complicated!  One of the biggest decisions I will have to make in the near future is deciding where I should live.  There are so many things to take in to consideration when making this decision.  Looking at studies that have researched what things effect quality of life and Job satisfaction will be on my list of things to do.  But may give no definite answer! 

In the meantime, now that the sun is out and the temperature today is in the 40s, should I forgive Erik?

Bibliography:

1.   Hillman, Mayer; More daylight, better health: why we shouldn’t be putting the clocks back this weekend. BMJ 2010; 341:c5964 

2.   Alimoglu, Mustafa Kemal; Levent Donmez, Levent; Daylight exposure and the other predictors of burnout among nurses in a University Hospital. International Journal of Nursing Studies, Volume 42, Issue 5, July 2005, Pages 549-555

3.   Huibers MJ, De Graaf LE, Peeters FP, Arnts A. Does the weather make us sad? Meteorological determinants of mood and depression in the general population;  Psychiatry Research, Volume 180, Issues 2-3 December 2010, Pages 143-146

Is epidemiology the answer to finding true happiness?

 My main goal in life is to be happy. Is that not everyone’s goal?  Even if your goal is to save the world, deep down it’s because you think this will make you happy! I’ve had ups and down in achieving this goal.  This trimester I will explore epidemiology as the possible answer to achieving a perpetual state of happiness. 

Now you’re thinking what does epidemiology have anything to do with happiness? Well here is my reasoning:

Epidemiology studies the distribution of disease in populations with the goal of finding everything that can influence or cause a disease to ultimately intervene and prevent disease all together.  Making everyone healthier.

The world health organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” That sounds like happiness to me!

According to the Epidemiology text by Leon Gordis fourth edition: “The premise underlying epidemiology is that disease, illness, and ill health are not randomly distributed in human populations.” So, if the lack of “a state of complete physical, mental and social well-being” is not random, neither is the presence of it. I just have to find what interventions I need to take to increase my chances of achieving this state.  Epidemiology I think will give me the best chances of succeeding at this.

I welcome comments and suggestion. Keep in mind though, for those that will argue that the answer to happiness is God, and may suggest I read the bible rather then Gordis…. this blog is part of my epidemiology assignment. I might take a theology class next semester if epidemiologically speaking this increases my chances of being happy....