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PBS NewsHour

Study finds trauma effects may linger in body chemistry of next generation

holocaust

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STEPHEN FEE: Fifty-nine-year-old Karen Sonneberg grew up on the North Shore of Long Island, just an hour’s drive from New York City. Her parents survived the Holocaust but rarely mentioned it.

KAREN SONNEBERG: “All I knew was that we were different, that I was different. I didn’t exactly know why.”

STEPHEN FEE: Her parents were Jewish, born in Germany – but after Hitler came to power, their families fled. Sonneberg’s parents were just children but carried the traumas of Nazi oppression throughout their lives.

KAREN SONNEBERG: My mother from the time she was three on, For my father, from the time he was five or six-years-old, he was subjected to the painful existence in Germany.”

STEPHEN FEE: Despite her own comfortable upbringing here in the US, Sonneberg privately struggled for years with anxiety and stress. While she couldn’t prove it, she believed it was somehow linked to her parents’ traumatic childhoods.

KAREN SONNEBERG: “Having discussed this with many of my friends who come from similar backgrounds, it seems to be consistent in most of us, or we’ve had the same challenges. There were definitely challenges that quote unquote ‘American’ kids didn’t seem to have experienced.”

STEPHEN FEE: “Even though you weren’t there.”

KAREN SONNEBERG: “Exactly. That’s the amazing part of it.”

STEPHEN FEE: Now, a new study published this month in the scientific journal Biological Psychiatry, bolsters Sonneberg’s belief that she experienced the after effects of her parents’ trauma.

Dr. Rachel Yehuda, director of Mount Sinai’s Traumatic Stress Studies Division led the study. Her team interviewed and drew blood from 32 sets of survivors and their children, focusing on a gene called FKBP5

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “We already know that this is a gene that contributes to risk for depression and Post-Traumatic Stress Disorder.”

STEPHEN FEE: Yehuda noticed a pattern among the Holocaust survivors called an “epigenetic change” — not a change in the gene itself, but rather a change in a chemical marker attached to it.

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “When we looked at their own children, their children also had an epigenetic change in the same spot on a stress-related gene.”

STEPHEN FEE: “What does that suggest?”

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “Well, in the first generation, in the Holocaust survivor, it suggests that there has been an adaptation or a response to a horrendous environmental event, and in the second generation it suggests that there has also been a response of the offspring to this parental trauma.”

STEPHEN FEE: Which means children of Holocaust survivors like Sonneberg could be more likely to develop stress or anxiety disorders.

Though their study was small, Yehuda and her team controlled for any early trauma the survivors’ children may have experienced themselves.

STEPHEN FEE: “How is it that a parent who was subjected to the trauma of the Holocaust is able to somehow transmit that to a child who wasn’t there?”

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “That’s a really good question, and this study that we did doesn’t address ‘the how.’
The study that we did just provides a proof of concept that we might be able to identify the how if we do more research.”

STEPHEN FEE: DNA is passed from parents to children. But research like Yehuda’s suggests parental life experiences can modify their body chemistry — and those modifications can be transmitted to children as well.

Scientists have examined this idea before. After a famine in Holland during 1944 and 1945, children were born with the effects of malnutrition two generations after the food shortage ended.

Previously, Yehuda herself studied stress hormone levels in children born to women who survived the September 11th terrorist attacks.
She’s been examining the link between trauma experienced by Holocaust survivors and their children for more than 20 years.

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “A trauma is an event that changes you. It doesn’t have to change you for the negative. Trauma changes you in lots of different ways, but most people who experience extreme trauma learn a great deal from that experience, and some of those lessons may be lessons that are transmitted to the child, and that’s not a bad thing.”

STEPHEN FEE: Yehuda says the implications aren’t limited to Holocaust survivors. But this dwindling population provides insight into how clinicians understand and treat stress disorders.

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “If you’re at risk for heart disease, a lot of times the doctor can separate out well this is your weight, that’s not good, this is your diet, these are you genetic risks, and things like that. And it would be very nice if we could develop a similar risk profile in the mental health arena where we would be able to understand where the risk factors come from for depression and anxiety.”

STEPHEN FEE: “We’re on the tenth anniversary of Hurricane Katrina.
There were children who were born after that trauma. There are children born in the trauma of a war in Syria and other crises around the world. If you’re the child of a parent who experienced trauma, are you doomed to be depressed or stressed for the rest of your life?”

RACHEL YEHUDA, ICAHN SCHOOL OF MEDICINE AT MT. SINAI: “I don’t think you’re doomed. But I think that many children of traumatized parents have struggled with depression and anxiety. And I can tell you that many of them have felt relieved that there might be a contributing factor that has been based on how they’re responding to their parental trauma. I think that it’s helped people work through a lot of that depression and anxiety.”

STEPHEN FEE: Relief is exactly what Karen Sonneberg, the child of Holocaust survivors, felt after she participated in one of Dr. Yehuda’s trauma survivor studies. She lost her mother 30 years ago but looks forward to her father’s 90th birthday next year.

KAREN SONNEBERG: “I learned to cope in my life. I’ve learned to move on and get over all of this. Had I known at the time how my reactions could impact future children, my children’s reactions, I might’ve dealt with things differently or gotten them some sort of treatment that maybe would help them in the future.”

The post Study finds trauma effects may linger in body chemistry of next generation appeared first on PBS NewsHour.

Surgeons’ late-night work doesn’t cause patients harm, study says

Photo by Morsa Images via Getty

Photo by Morsa Images via Getty

Patients receiving common operations in the daytime fared no worse in the short-term if their attending physician worked a hospital graveyard shift the night before than patients whose doctor did not, according to a new study examining the effects of sleep deprivation on surgeons.

Patients whose physicians worked from midnight to 7 a.m. the night before a daytime operation were as likely to die, be readmitted to the hospital or suffer complications within 30 days of their procedure as other patients who had the same operations in the daytime from physicians who had not worked after midnight, researchers said. Short-term outcomes were compared for patients receiving 12 elective procedures such as knee and hip replacements, hysterectomies and spinal surgeries. The study, conducted in Ontario, Canada by researchers in Toronto, was published Wednesday in the New England Journal of Medicine. It included 38,978 patients and 1,448 physicians.

Its conclusions are at odds with previous research linking sleep deprivation in physicians to reduced performance.

In the New England Journal article, researchers said most earlier studies have focused on medical trainees, otherwise known as residents, but not on attending physicians. For example, working surgeons have more experience than trainees, which could compensate for reduced performance, they said. Nancy Baxter, one of the co-authors, said working surgeons have more control over their schedules than residents have and can schedule daytime surgeries with longer breaks between nighttime shifts.

Medical school residents once were expected to work 24- to 36-hour long shifts without scheduled breaks for sleep. New rules implemented in 2003 by the Accreditation Council for Graduate Medical Education, which set standards for medical residencies, capped all residents’ schedules at a maximum 80 hours per week or 24 consecutive hours on duty. They should not be on call more than every third night. Under rules set in 2011, first-year residents are limited to 16-hour shifts and require eight hours off between shifts.

But questions about attending surgeons’ rest persist.

A small survey study published in 2009 found that only 40 percent of surgeons — or 55 of 136 — limited their working time to no more than 30 continuous hours.

David Bates, who has previously researched the relationship between physician medical errors and their lack of sleep, said the new study should be reassuring to patients who get surgery after their doctor has worked overnight. But he cautioned the results do not address the effects of long shifts that last days without rest on patient outcomes.

Such a study would be difficult to conduct in the U.S. because data on attending surgeon hours isn’t routinely collected, he said. Canada also has a single-payer system, meaning researchers could cull massive amounts of information from one source. Doing a similar study in the U.S. would be nearly impossible because of the number of insurance companies involved in health care, Bates said.

The study reported in the New England Journal dealt only with short-term outcomes on patients, but a physician’s performance could have long-term effects on patient health too.

Jeffrey Rothschild, a hospitalist physician at Newton-Wellesley Hospital in Massachusetts, published a study in 2009 finding that post-surgical complications rose when physicians at a single hospital had less than six hours of opportunity for sleep.

More studies should be done looking at long-term effects of sleep deprivation on physicians and at the quantities of sleep to patient outcomes, he said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report on its website.

The post Surgeons’ late-night work doesn’t cause patients harm, study says appeared first on PBS NewsHour.

Will reimagined New Orleans hospital meet the needs of its most vulnerable?

20150826_nola1

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GWEN IFILL: Now we turn to our weeklong series on how New Orleans is faring after Katrina 10 years later.

The floodwaters that rose after the storm trapped hundreds of patients in the city’s hospitals. More than 140 of them died in a slow-motion evacuation that took days. Things went from bad to worse when officials declared the much-loved state-run Charity Hospital unfit to reopen.

A major new hospital was dedicated in New Orleans today, a crucial part of a reimagined health care system. But worries remain that some will still be left behind.

Special correspondent Jackie Judd has our report.

JACKIE JUDD:
Hurricane Katrina and all that the winds, the rain, the flooding destroyed or disabled allowed for a reimagining of what a modern health care system in New Orleans would look like. This is the centerpiece of that reimaging.

NARRATOR: University Medical Center New Orleans is a place to heal, teach and discover for generations to come. UNC New Orleans, the future of health care is here.

JACKIE JUDD: University Medical Center was a decade in the making, at a cost exceeding $1 billion, most of that from the federal government. The doors recently opened to a high-tech trauma center, expensive artwork and what’s promised to be hurricane-proof windows and internal systems. Some early reviews are in.

GLYNN JAMES, New Orleans: Much, much better place, inside, clean.

MAN: It’s what New Orleans needs. They need a good hospital here. Charity was a good hospital now. Back in the day, when I was growing up, it was a good hospital, but this is way better.

DR. PETER DEBLIEUX,
University Medical Center New Orleans: It’s actually built out for redundancy for one patient in case something…

JACKIE JUDD: In case of a storm?

DR. PETER DEBLIEUX:
In case of a storm, if you will.

JACKIE JUDD: Dr. Peter Deblieux, who worked at Charity Hospital, then in makeshift tents, a converted department store and finally the interim hospital, is proud of what the city has built. This hospital’s aim, he says, is twofold, serve the poor, as Charity did, and those who pay full freight.

DR. PETER DEBLIEUX: The vision of this hospital is not to be solely an indigent care or solely a safety net hospital. That’s a vital portion of what we do, but sustainability of this hospital will be directly linked in our ability to attract all payers. What’s new and what is exciting is building destination services, so services that allow us to compete with a Houston or a Birmingham to keep regional patients here at home.

JACKIE JUDD: From the windows of the new hospital, what came before is in clear sight. Charity Hospital holds a storied place in the city’s history, because it’s where generations of residents came for care regardless of their ability to pay, and, for many, the measure of success at the new hospital is whether that tradition will continue.

SILVINA HENRY,
New Orleans: And we took that together long before the order changed.

JACKIE JUDD:
This was in Charity?

SILVINA HENRY: This was in Charity, yes.

JACKIE JUDD:
Silvina Henry worked there as a nurse’s assistant and healed there as a patient.

SILVINA HENRY: Every time I pass there, I look at Charity, because it’s the only thing — and people in New Orleans know it’s about Charity.

JACKIE JUDD: The new hospital is run by a nonprofit private company, adding to concerns that Charity’s mission to serve the public no matter the cost will be lost.

University is required to have at least 20 percent of the uninsured in its patient mix, considerably less than what Charity saw. But officials promise to give care to those who need it.

Community activist Jacques Morial organized a lawsuit to get Charity back up and running.

JACQUES MORIAL,
Community Activist: Working poor people trusted Charity to take good care of them. And reassembling all of that intellectual capital, that understanding of patients, with teamwork and the know-how, is not like assembling LEGOs. It takes lots of time, lots of work and lots of money.

JACKIE JUDD: Dr. Deblieux, who once argued for the old hospital to reopen, now says that the quality of care at Charity has been romanticized and that concerns about the new hospital are unfounded.

If you are so convinced of the success of this model, why did you fight hard to try to keep Charity open?

DR. PETER DEBLIEUX: So, what I tried hard to do was to keep open a facility that would meet on the safety care needs of our population. And I would continue that fight today if we walked away from that mission. We’re not. That’s as strong as it’s ever been.

JACKIE JUDD:
The other half of the reimagining is an extensive network of community health centers. The clinics dot poor and working neighborhoods throughout the city and provide primary care.

Dr. Karen DeSalvo worked at a pop-up clinic here near the French Quarter. Later, as the city’s health commissioner, she drove the effort to build permanent clinics where people live.

DR. KAREN DESALVO, Former New Orleans Health Commissioner: Because the health care infrastructure went down, it caused many of us to literally stand on the street and look and say, we can do better, we can come up off our knees and build a system that’s going to meet the needs of this community.

Looking at the evidence and listening to people that what they wanted was the front-line access to preventive care, primary care in neighborhoods.

JACKIE JUDD: Charity’s emergency room had been a principal source of primary care, but habits and services are slowly changing.

Silvina Henry’s primary care doctor, Keith Winfrey, is the chief medical officer at a clinic in New Orleans East, a community of African-American and Vietnamese residents.

DR. KEITH WINFREY,
Chief Medical Officer, New Orleans East Community Health Center: Prior to Katrina, it was more the traditional physician-patient interaction and the population wasn’t different. But it was more the physician-patient interaction. Since Katrina, there has been a total transformation in primary care, where it’s more of a team-based model of primary care, the patient-centered medical home.

JACKIE JUDD:
Henry, whose home on the banks of Lake Pontchartrain was badly damaged by Katrina, fled the city. She was cut off from her doctors, her medication, her medical records, charting chronic ailments, including high blood pressure and diabetes. She later returned to an entirely different experience, including electronic medical records that will survive a storm.

SILVINA HENRY: Every time I go, they get on the computer, and they can tell me everything that is going on. And when I go to see the doctor in the room, the doctor has a record that they can open, paper record that they can tell me what is going on.

MAN: Now, it’s my understanding that you have been sent to see me by your primary care doctor.

JACKIE JUDD: Mental health services are woven into the clinic services, and throughout the city, mobile vans offer on-the-spot support, but it is widely acknowledged here that far more is needed.

The police department’s Cecile Tebo has long worked with the mentally ill who have had run-ins with the law. She is incensed that the new hospital currently has just about a third of the psychiatric beds that Charity once held.

CECILE TEBO, New Orleans Police Department: We’re standing in front of Orleans Parish Prison. This is our largest mental health hospital in our community, which is so sad, because this is not where treatment is going to happen.

JACKIE JUDD: The great uncertainty in sustaining the new hospital and the clinics is money. Governor Bobby Jindal didn’t expand Medicaid under the Affordable Care Act, and so many uninsured patients still need free care. As part of the law, the federal government is reducing the dollars it sends states for that care.

CECILE TEBO: I think we still mostly have questions in the area of how we’re going to finance this system long-term that is going to be affordable for everyone.

JACQUES MORIAL: I think it’s going to take a lot of vigilance, a lot of advocacy and a lot of demand for accountability for all of this to work.

SILVINA HENRY: And she can get my medicines for me.

JACKIE JUDD:
Still, for people like Silvina Henry, the progress here is real. A far more robust health care system is in place to care for people than the very fragile system that Katrina washed away.

For the PBS NewsHour, this is Jackie Judd in New Orleans.

The post Will reimagined New Orleans hospital meet the needs of its most vulnerable? appeared first on PBS NewsHour.

Jimmy Carter: ‘I’ll be prepared for anything that comes’

Former U.S. President Jimmy Carter  (C) takes questions from the media during a news conference about
         his recent cancer diagnosis and treatment plans, as his grandson Jason Carter (R) listens on, at the Carter Center in Atlanta,
         Georgia August 20, 2015. Carter said on Thursday he will start radiation treatment for cancer on his brain later in the day.
         Carter, 90, said he will cut back dramatically on his schedule to receive treatment every three weeks after doctors detected
         four spots of melanoma on his brain following recent liver cancer surgery. REUTERS/John Amis - RTX1OYC8

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GWEN IFILL: But, first, we turn to former President Jimmy Carter’s cancer diagnosis. The 90-year-old revealed today he has spots of melanoma on his brain. He talked about life, faith and the course of the disease with reporters at the Carter Center today, just before beginning radiation treatment at Atlanta’s Emory Hospital this afternoon.

JIMMY CARTER, Former President of the United States: In May, I went down to Guyana to help monitor an election, and I had a very bad cold.

And I left down there and came back to Emory, so they could check me over. And in the process, they did a complete physical examination, and the MRI showed that there was a cancer, or a growth, a tumor on my liver.

And they did a biopsy and found that it was, indeed, cancer and it was melanoma. And they had a very high suspicion then and now that the melanoma started somewhere else on my body and spread to the — to the liver.

At first, I felt that it was confined to my liver, and that they had — the operation had completely removed it, so I — quite relieved.

And then, that same afternoon, we had an MRI of my head and neck, and it showed up that it was already in four places in my brain. So, I would say that night and the next day, until I came back up to Emory, I just thought I had a few weeks left.

But I was surprisingly at ease. Now I feel, you know, it’s in the hands of God, whom I worship. And I will be prepared for anything that comes.

I feel good. I haven’t felt any weakness or debility. The pain has been very slight.

Both of the — former President Bush, he called me at one time, and then George H.W. Bush, Bush Sr., called me yesterday afternoon again. I think I appreciated that very much, and their wives were there on the telephone with them.

President Obama called. The vice president called. Bill Clinton called. Hillary Clinton called. The secretary of state called, the first time they’ve called me in a long time.

(LAUGHTER)

JIMMY CARTER: For a number of years, Rosalynn and I have planned on dramatically reducing our work at Carter Center. We have not done it yet.

(LAUGHTER)

JIMMY CARTER: We talked about this when I was 80. We talked about it again when I was 85. We talked about it again I was 90.

So, this is a propitious time, I think, for us finally to carry out our long-delayed plans. So I’m going to cut back fairly dramatically on my obligations.

I think I have been as blessed as any human being in the world, becoming president of the United States of America, and governor of Georgia, and worked at the Carter Center, and a big and growing family, and thousands of friends.

So I don’t think — and living to be 91 years old 1st of October. So, I have had — everything has been a blessing for me.

QUESTION: Is there anything you wish that you had not done or that you had done differently?

JIMMY CARTER: I wish I had sent one more helicopter to get the hostages, and we would have rescued them and I would have been reelected. But that may have…

(LAUGHTER)

JIMMY CARTER: And that may have interfered with the foundation of the Carter Center. And if I had to choose between four more years and the Carter Center, I think I would choose the Carter Center.

QUESTION: In the time that you have left, what would give you the most satisfaction to see something happen?

JIMMY CARTER: Well, in international affairs, I would say peace for Israel and its neighbors. That’s been a top priority for my foreign policy projects for the last 30 years.

Right now, I think the prospects are more dismal than any time I remember in the last 50 years. It’s practically — the whole process is practically dormant.

As far as the Carter Center’s concerned, I would like to see guinea worm completely eradicated before — before I die. I would like the last guinea worm to die before I do.

(LAUGHTER)

JUDY WOODRUFF: President Carter, we will all pulling for you.

And you can watch my conversation with President Jimmy Carter from last month, before his diagnosis, where we discussed his latest book, “A Full Life.” That’s at PBS.org/NewsHour.

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