Sunday, November 25, 2012

A Tool to Understand Stress: Better Golf, Better Parenting?

The Week End Wall Street Journal reports on new technology to measure stress in golfers.

Using a wristband loaded with sensors and a Bluetooth connection, an iPhone and some inferential physiology, cognitive neuroscientist Robert Goldberg developed a tool that seems able to conveniently measure stress in real time.

There are some interesting parallels to be drawn between the performance anxiety of golfers and the anxiety of new parents, and more that could be explored.

For example, when the device was tested on a couple of MIT golfers, the less experienced golfer was learning a new putting stroke; while his body indicated he had a high stress response, he said he  wasn't aware of it.  Yet, once it was identified, his coach emphasized a different technique and his stress level declined.

If the device proves to be a reliable and effective tool, there are lots of interesting questions relevant to prevention that could be explored:

- are there differences between men and women in the stress levels experienced by new parent (a question that certainly applies to golfers too...)?  [a pair of interesting studies from Sweden looked into m/f differences in reported stress levels - link1 - link2 - (interesting, fathers report less anxiety about incompetence than mothers.  Does that reflect society's lower expectations? ]
- how does learning and experience affect individual responses to stress?
- how does the learning curve of parenting correlate with stress levels?  Behavior changes is fairly rapid during early childhood.  Do parents who learn how to learn about developmental behavior fare better than those who don't?
- how do learned stress responses change during early childhood developmental stages?  In the article, one experienced golfer shows diminished stress when he follows his routine to set up a put.  That works well for the routine of golf, but what happens when parents learn a routine that comforts the needs of their three month old, then continue their behavior when it no longer is relevant to the growing child's needs?  Toddler conflict may prove to have roots in stress cycles...
- what individual factors affect the stress response?  Are there markers for adverse responses?
- do parents experience and acknowledge their actual stress levels?  What factors make it easier to acknowledge their experience?  Knowing that it's a common response?   Just knowing what is happening to them?  Given reports of people who give birth without knowing they were pregnant, perhaps prevention education needs to focus on how to normalize the experience.

Given that one common prevention, just put the baby down and walk away, is premised on the caregiver being able to recognize that their stress level is increasing, it would seem worthwhile to validate that assumption on some inexperienced caregivers.

If not, the primary caregivers may need to learn some coaching techniques.

The article mentions that the developer is exploring the possibility of marketing the device to pregnant women.  Wouldn't it be great if this start up expanded that vision to pair up with a parenting education program on a prevention research initiative?

Could lead to a marketing edge:

"We'll help you get comfortable with your new child, and your golf game."

Might just pique the interest of a few guys...

November 23, 2012
Using Science to Ward Off the 'Yips' 
Brain Scientist Designs App to Measure Stress While Golfing
The golf course is a treacherous, unforgiving place, where even the world's best players are vulnerable to stress-induced fits of madness.
For years, PGA Tour player Kevin Na has agonized over his swing as he waggles his club in the tee box six, seven, eight times—and then waggles it some more. Robert Karlsson abruptly withdrew from the British Open in July after finding that he simply couldn't swing, so tortured was his mental state. Just this month, Charlie Beljan was hospitalized after an early-round panic attack at a PGA Tour event in Lake Buena Vista, Fla., before he somehow summoned the wherewithal to return for the final 36 holes and win the tournament.
Lest we forget, golf is as much about the mind as it is the body—ask anyone who has had the "yips." The game can be so debilitating that the help of a neuroscientist sometimes seems required. Enter Robert Goldberg, a Ph.D. in cognitive neuroscience who has spent the last two years chipping away at one of the sports world's greatest challenges: How do you prevent golfers from blowing a gasket?

The result of Goldberg's research is a wristband that measures stress in real time by shooting small electrical charges into sweat glands. That data is then relayed via Bluetooth to an iPhone app, which displays stress as a line graph, with peaks and valleys, depending on how rattled the player feels. Goldberg hopes that golfers—and their coaches—can use that information to understand what triggers stress on the course and then go about unearthing solutions.
Goldberg, who recently left his post as a visiting scientist at the Massachusetts Institute of Technology, said he first considered the intersection of sports and stress when he was 12 years old and working as a standard-bearer at the Greater Hartford Open. The playing group that he accompanied one afternoon included Ken Green, a PGA Tour professional and notorious hothead who "lost his s—," as Goldberg put it. By the end of his round, Green was so disgusted with his play that he gave young Goldberg his Ping putter. Even then, Goldberg was fascinated by the mental aspect of the game.
"It got me wondering: How do things like that hold people back from peak performance?" Goldberg said. "There are guys who have all the physical skills but don't have the right mind-set."
Goldberg said his work focuses on the adrenal system—glands near the kidneys that release hormones in response to stress. When that happens, the body attempts to cool itself by perspiring. The small electrical charges in his device essentially measure how much sweat accumulates in the skin. "We can see a response in under a half a second," Goldberg said. To isolate these fluctuations in stress, the device has a built-in "accelerometer" that accounts for the effect of motion, as well as a temperature gauge.
Goldberg recently tested his work on two MIT golfers—one of the team's top players and one of its most inexperienced. There were patterns, he said. With the top player, a sophomore named Jon Warneke, Goldberg found that Warneke's stress level remained static during his swing—an indication that Warneke felt comfortable with his mechanics. And his stress level actually decreased during the act of replacing his ball on the green before putting. "There must be something about that routine that I find very calming," said Warneke, a double major in theoretical math and physics.
Putting was a different story: His stress level skyrocketed. Though putting is a self-described weakness, Warneke said he had no idea that his body was enduring physiological changes as a result of stress. He was too focused on the task at hand to notice. But even small amounts of stress can cause shortness of breath, an increased heart rate and/or butterflies in the stomach, any of which are kryptonite for a golfer who's trying to keep his hands steady as he lines up an 8-foot par putt.
Once the problem areas are identified, however, there are solutions, Goldberg said—breathing techniques, for example, or a revamped pre-shot routine. The graph won't lie: It will show whether the new approach is effective.
"MIT kids in general don't really show stress," MIT golf coach Jesse Struebing said. "So it's neat for me to see what's going on inside their heads. You don't know exactly what they're thinking about, but you can see from the graph that there's stuff going on up there."
As for the relatively inexperienced MIT player, his stress level always spiked at the exact moment of impact—just as his club face struck the ball. Struebing said he'd been working with the player on his swing, and it was a sign to him that the player wasn't confident in what he was doing. "It told me that maybe I needed to take a new approach," Struebing said. Once he did, he found that the player's stress level at impact decreased over the course of the round and his play improved.
Golf is one subset of a larger project for Goldberg, who has formed a company called Neumitra with two colleagues, Anand Yadav and Safiyy Momen. The idea, Goldberg said, is that anyone can use the device to monitor and manage stress. Of particular interest to the group are those who have post-traumatic stress disorder, though Goldberg said the company plans to target a broad mix of consumers—students, pregnant women, tech geeks. He said he expects the device, known as "Bandu," to hit the market in 2014.

Saturday, November 24, 2012

Prevention Education in Vacaville, California: Simulator Doll

The Vacaville Reporter brings news of a prevention effort in California.

Recognize the motivation, but have to wonder about how likely this prevention technique would have been in preventing the case that gave rise to the initiative (although, since the article doesn't say how the person charged and the baby are related, or if they are...).

Would the target audiences have included him?  Can't tell, but one wonders how many 42 year old men would opt to be in the audience at the places they intend to offer the demonstration.

Nor can one tell whether this is The Strategy, or merely one part of a comprehensive strategy that uses hospital based education for new parents, school based parenting education for students and baby-sitters and mandatory education for child care providers to teach parents and caregivers how they can help keep children in their care safe from inflicted injuries.

Let's hope the latter.

A broad, comprehensive, non-selective, inclusive campaign that educates all parents and all caregivers about what they can do to keep children safe, using a message that minimizes pushback, is more likely to be shared, and more likely to be self-sustaining.

It would be useful to others looking for evidence-based programs if the reporter checks back in a year to see what's actually been accomplished.

Sometime between Thanksgiving and Christmas, a fairly large amount of new exercise equipment is purchased.  Sometime the following spring, spring cleaning moves a large amount of unused exercise equipment from garages and basements to yard sales and the like.

Prevention resources being scarce, no one wants to see them recycled that way...

The goal: No more Shaken Baby Syndrome cases in Solano County 
By Catherine Bowen/ CBowen@TheReporter.comPosted:   11/24/2012 01:08:26 AM PST 
A shake and the crying stopped.
On Sept. 16, a 5-month-old Fairfield baby was hospitalized with brain bleeding, said Fairfield police Sgt. Kevin Carella. The baby's head had started swelling, before arriving at the hospital and medical staff immediately recognized the symptoms.
A short time later, 42-year-old Kenneth Burroughs was arrested by Fairfield police on suspicion of child abuse causing great bodily injury, Carella said. The baby remains in the hospital.
An estimated 1,200 to 1,400 babies are treated for Shaken Baby Syndrome (SBS), a term used to describe child abuse caused by the vigorous shaking of an infant -- often in anger -- to get the child to stop crying or fussing, each year, according to the California Department of Social Services. Of that number, 25 to 30 percent die as a result of their injuries, and many others suffer lifelong complications.
Authorities suspect many more children also fall victim to SBS but do not receive treatment.
The severity of September's case rocked Fairfield authorities, and launched them into an outreach mission to educate others on just how devastating the effects of SBS can be, according to Carella, who works with both the department's Major Crimes and Family Violence units. 
To bring their demonstration home, the department purchased a RealCare shaken baby doll simulator, while a second doll was donated by the Twilight Rotary Service Club.
Each of the life-sized dolls is fitted with a see-through plastic head, Carella explained. The RealCare Shaken Baby cries inconsolably, like some real infants do and, when the doll is shaken a device inside its head measures the force on the brain area. The simulator's cries stop abruptly and red LED lights show the specific parts of the brain that suffer damage.
Carella said it is the department's hope to provide training at Solano Community College, local high schools, service clubs and other law enforcement agencies for future parents, babysitters and child care providers.
"Our hope is to demonstrate to people how little force it takes to injure a child," Carella said.
"It is our goal to reduce the number of SBS incidents in Fairfield and our surrounding communities with this valuable instruction," Carella stated. 
The training is comprised of specific instruction on topics including:
* The many reasons babies cry and helpful ways to soothe them,
* Signs and symptoms of SBS,
* Physical results of SBS-related brain injuries, and
* A pledge to never shake a baby.
For more information, or to schedule a demonstration contact Carella at 428-7354 or Debra Shibuya with the Fairfield Family Violence Unit at 428-7770.
Follow Staff Writer Catherine Bowen at

Sunday, November 18, 2012

Abusive Head Trauma (SBS) - Costs, Benefits and Prevention: New Zealand Does the Maths!

The abstract below is from the November 2012 edition of the Journal of Child Abuse and Neglect.  

The full article is behind a paywall, but the abstract indicates this study from the folks at Starship Children’s in NZ will be a solid step forward in making the economic case for prevention.  Click on this link for the abstract

More good work from the Starship!

PS. This seems to provide a good template for replicating the analysis on our side of the Equator, no?
Primary prevention of pediatric abusive head trauma: A cost audit and cost-utility analysis.J Friedman, P Reed, P Sharplin, and P KellyChild Abuse Negl, November 8, 2012
Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Private Bag 92024,Auckland 1142, New Zealand. OBJECTIVES: To obtain comprehensive, reliable data on the direct cost of pediatric abusive head trauma in New Zealand, and to use this data to evaluate the possible cost-benefit of a national primary prevention program.
 METHODS: A 5 year cohort of infants with abusive head trauma admitted to hospital inAucklandNew Zealand was reviewed. We determined the direct costs of hospital care (from hospital and Ministry of Health financial records), community rehabilitation (from the Accident Compensation Corporation), special education (from the Ministry of Education), investigation and child protection (from the Police and Child Protective Services), criminal trials (from the Police, prosecution and defence), punishment of offenders (from the Department of Corrections) and life-time care for moderate or severe disability (from the Accident Compensation Corporation). Analysis of the possible cost-utility of a national primary prevention program was undertaken, using the costs established in our cohort, recent New Zealand national data on the incidence of pediatric abusive head trauma, international data on quality of life after head trauma, and published international literature on prevention programs.
 RESULTS: There were 52 cases of abusive head trauma in the sample.
 Hospital costs totaled: $NZ 2,433,340,child protection: $NZ 1,560,123,police investigation: $NZ 1,842,237,criminal trials: $NZ 3,214,020,punishment of offenders: $NZ 4,411,852 andcommunity rehabilitation: $NZ 2,895,848. Projected education costs for disabled survivors: $NZ 2,452,148, and the cost of projected lifetime care:$NZ 33,624,297.  Total costs were $NZ 52,433,864, averaging $NZ 1,008,344 per child.[NB. current exchange rate 1.00 NZ = .81 US] Cost-utility analysis resulted in a strongly positive economic argument for primary prevention, with expected case scenarios showing lowered net costs with improved health outcomes. CONCLUSIONS: Pediatric abusive head trauma is very expensive, and on a conservative estimate the costs of acute hospitalization represent no more than 4% of lifetime direct costs.If shaken baby prevention programs are effective, there is likely to be a strong economic argument for their implementation. This study also provides robust data for future cost-benefit analysis in the field of abusive head trauma prevention.

Monday, February 27, 2012

Georgia: As the House Looks at Comprehensive Education for New Parents, a Few Suggestions

Anyone from Georgia? Pending legislation in Georgia calls for the creation of a Joint Study Commission on Education for Parents with Newborn Children. It suggests that the state that's home to CDC may be taking a comprehensive look at education for parents of newborns.
[um, just noticed the bill actually says "mothers" should have an oppportunity to see a video in the hospital - while there apparently isn't need to educate the bill drafters that infants usually have two parents, they may need to know that mothers aren't the only ones who benefit from the information, and there are a number of reasons why the hospital should try for both parents**]..
Hopefully, CDC staff in Atlanta who are already involved with SBS prevention education and social media, and/or who are new parents themselves, will work with the bill drafters and the state health department to ensure the proposed initiative is as effective as possible.

CDC's already got a good guide to SBS prevention for health departments.

Thinking about social media would be a good place to start.

For example, why limit "video" to a DVD hand out to watch at home when this generation of parents have grown up with YouTube, iPad and iPhones, and are probably posting video on Facebook from the hospital?
- Lo and behold, Sutter Hospital's Facebook page for announcing births.
- And while he probably had his people do it, Sweden's Crown Prince posted his daughter's birth announcement on Facebook
Imagine if the nurse or parenting educator comes in, introduces both parents to the video highlights on an iPad, then downloads an app to both parents' mobile devices that allows them to download and watch a video course from the health department, the hospital and the AAP.  

A course keyed to the developmental stages of their child (especially important with the rate of premature births).   In their choice of language.

Think new parents might need motivation? Offer coupons from local stores - Starbucks and newborn diapers if they finished the course - and links for new baby products.

Think that parents might appreciate the thoughtfulness and effort by their hospital, pediatrican and health department? That it might influence their recommendations to friends and relatives who are expecting about hospitals?  Think they might tell their Ob-Gyn it was a good experience?

Think Disney or Target might be looking for an opt-in marketing opportunity?

And who better to share the knowledge among other new parents, child care providers, etc. than a new parent?

Why not a Facebook page and YouTube Channel for the state prevention programs?


If you're in Georgia and want to thank your legislator, the bill info and a list of sponsors follow...

2011 Bill Text GA H.B. 1159, GEORGIA 151ST GENERAL ASSEMBLY -- 2011-12 REGULAR SESSION, Introduced: February 23, 2012, A BILL TO BE ENTITLED: AN ACT To amend Article 1 of
Chapter 1 of Title 31 of the Official Code of Georgia Annotated, relating to general provisions relating to health, so as to provide for the creation of the Joint Study Commission on Education for Parents with Newborn Children; to provide for its composition and duties; to provide for the distribution of informational videos on health related topics by hospitals and other health care facilities to mothers of newborn infants; to provide for a definition; to provide that such requirement is contingent on available funding; to provide for related matters; to repeal conflicting laws; and for other purposes. ..................................

Sponsored By (1) Pruett, Jimmy 144th (2) Dobbs, Elly 53rd (3) Lindsey, Edward 54th (4) Gardner, Pat 57th (5) Harden, Buddy 147th (6) Ashe, Kathy 56th
**Well, the bill says hospitals should offer "mothers" opportunity to view in hospital, but that the "parents" will get a copy to take home and watch. Most states encourage the hospitals to encourage both parents to participate. Perhaps even more important if the the male in the household is not related to the child...

(b)(1) ... the department shall distribute informational videos in an appropriate format to each health 52 facility in order to provide the information described in Code Section 31-1-14 and in this Code section to each mother of an infant born in such health facility. To the extent feasible, each health facility shall provide an opportunity for each mother of a newborn infant to view the video while in the health facility. Each health facility shall also provide a copy of such video, as furnished by the department, to the parent or parents of a newborn at the time of discharge from the health facility.