Page 1

1#2013

medicor

2016 #2

medicor medicinska föreningen’s

student magazine

FINDING REFUGE IN ACADEMIA A young man’s journey from war to the lab bench and beyond

20 The gender gap in academia

12 Sexual and reproductive health rights in crises 22 Stockholm: A city of borders 1


1#2013

Overture

Prelude

KI CAMPUS Dear readers, I am delighted to introduce you to the second issue of Medicor 2016! The current Medicor team started working together in September 2015, right after the Kick-off event that was organized to capture new talented students. Piece by piece we started forging a new editorial team, to ensure that Medicor would continue to deliver articles of high interest to our readers, highlighting current issues happening not only at the university, but also in the Stockholm area and worldwide. As June approaches, the current study semester ends. For many of us, this also signifies the completion of our study program here at KI. Some of us may continue onto higher degree education, many may start working in their new job position and others may be leaving Stockholm for exciting, new opportunities. Several of our great editors and contributors will leave the Medicor team to start new chapters in their lives. It is for this very reason that this second issue of Medicor 2016 is so special - it offers us a chance to celebrate their fantastic contribution one last time.

38 12

9 12

MF´S ACTIVITY PLAN 2016

14

studeNT SOCIETY FOR SURGERY AND ANAESTHESIOLOGY

17

DOCTORAL STUDENTS’ ASSOCIATION

Science a giant leap for humankind

Medicor Magasin Grundad 2006. Tionde årgången. Utges av Medincinska Föreningen i Stockholm ISSN: 1653-9796 Ansvarig utgivare: Teresa Fernández Zafra Tryck och reproduktion: Åtta45, Solna Adress: Medicinska Föreningen i Stockholm Nobels Väg 10, Box 250, 171 77, Stockholm Utgivningsplan 2016: nr 1: mars, nr 2: maj, nr 3: oktober, nr 4: december. Kontakta Medicor: chefredaktor@medicor.nu www.medicinskaforeningen.se http://medicor.nu

I would like to end this editorial by wishing the best of luck to all those Medicor contributors that will no longer be part of our team. I will definitely miss you from the bottom of my heart and I hope that you always remember that without you Medicor would have not been possible. Thank you for your contribution and for Telling your Story.

Frilansmaterial: Medicor förbehåller sig rätten att redigera inkommet material och ansvarar inte för icke beställda texter eller bilder, samt tryckfel. Upphovsman svarar för, genom Medicor publicerat, signerat frilansmaterial; denna(e)s åsikter representerar nödvändigtvis inte Medicors eller Medicinska Föreningens.

GENDER GAP in ACADEMIA SLEEP AND THE BRAIN

23 24

Photo by Jingcheng Zhao for Medicor

For our central theme, we dive into the challenges of refugee integration. To this effect, we present two featured stories. First, we dissect the increase in segregation that Stockholm has been experiencing over the past decade and how it affects immigrants. We then turn our attention to the story of Aram Ghalali, a young refugee who, through steadfast determination, overcame numerous obstacles to reach his dream of becoming a successful researcher at KI.

26

SCIENCE SNIPPETS

20 22

Along with other interesting articles, we discuss the possible exit of Britain from the EU (i.e.“Brexit”), we take a closer look at the gender gap in academia and we also provide useful advice on how to beat procrastination – a subject that many students might find useful as exams or project deadlines are approaching.

22

SEXUAL aND REPRODUCTIVE health rights

18 19

In this issue of Medicor 2016, we set the scene with an exclusive interview with Dr Babatunde Osotimehin, the Executive Director of the United Nations Population Fund (UNFPA), in which we find out more about the sexual and reproductive health rights of women in a crisis-prone world.

Sincerely, Teresa Fernández Zafra Editor-in-Chief

medicor

science and the public can your birth date predict your health?

26

FINDING REFUGE IN ACADEMIA

Aram Ghalali tells us about how he went from being a refugee to a sucessful researcher.

18

Global Focus

19 24

32 33 34

brexit health outcomes measurement

Culture 37 38 40

Freelance material: Medicor retains the right to edit incoming material and does not take responsibility for unsolicited texts or pictures, and printing mistakes. The contributor agrees that, through published and signed Medicor material, their opinions do not necessarily represent those of Medicor or Medicinska Föreningen.

animal testing

GRADUATION TRAditions AVOID PROCRASTINATING SEGREGATION in sthlm

33 37

42 COMICS

32

medicor

Teresa Fernández Zafra • Editor-in-Chief | Radek J. Góra • Associate Editor | Saket Milind Nigam • Executive Editor & Director of Photography | Jessica De Loma Olson, Joanna Kritikou, Alex Browne • Web Managers | James Salisi • Editor of Global Focus | Sibel Ilter • Editor of Campus | Emily Clark • Editor of Science | Martha Nicholson • Editor of Culture

Cover photo by Simon Guérard for Medicor 2

James Salisi, Vaso Basinou, Nira Nirmalathas, Teresa Fernández Zafra • Layout Design | Jingcheng Zhao, Katarina Stojanovic, Oliver Ljong, Simon Guérard, Néstor Vázquez Bernat, Gustaf Drevin, Eric Wellme, Maria Belikova • Photographers | Jessica de Loma Olson, Joanna Kritikou, Radek J. Góra, Emily Clark, Benedek Bozoky, Maria López Quiroga, Frida Hellström, Iris Peña Arriarán, Jakub Olczak, Gustaf Drevin, Se whee Park, Markus Karlsson, Diana Cekatauskaite, Halima Hassan, Iskra Pollak Dorocic, Parvin Kumar, Mateusz Krawiec, Amy Jackson, Victoria Satchwell, Sarolta Gabulya • Writers | Mina Saleem, Anny Truong , Olivia Miossec, Daniela Kas Hanna• Proofreaders | Mikael Plymoth • Senior Comics Coordinator | Anny Truong, Eveline Shevin, Emily Clark, Pedro Veliça • Comic Illustrators | Jakub Lewicki, Freepik.com, flaticon.com • Infographics


Aperture Explore the Outdoor By Lauro Meneghel Taken at Tyresta National Park, Sweden

4

5


1#2013

medicor

8

02-03

NOBEL CONFERENCE “CELL CYCLE AND CELL DEATH IN DISEASE” @ NOBEL FORUM

EXAMINATION CEREMONIES medicinskaforeningen.se

ki.se/en/news/ki-calendar

15 SEMINAR - BEHAVIOUR OF SICK AND HEALTHY HUMANS Mats Lekander ki.se/en/cns/calendar

04 GRADUATION DINNER & PARTY medicinskaforeningen.se

07-10 SOLVIK FIXING WEEKEND medicinskaforeningen.se

30 KI CAMPUS

EVENTS

SEMINAR ON TISSUE IMMUNITY Georg Gasteiger - Mainz Medical Centre CMM, Karolinska University Hospital

ki.se/en/news/ki-calendar

JUNE.16 6

7

Photo by Oliver Ljong for medicor


1#2013

SmĂśrgĂĽsbord

Reconstructing new esophagus tissue A critically ill patient had his esophagus replaced with a stent. He refused, however, to remove the stent for three and a half years due to the fear of potential complications. Seven years after the reconstruction and four years after the stents were removed, the patient maintains a stable weight on a normal diet, with no swallowing problems whatsoever.

medicor

Markus Karlsson & Radek J. GĂłra

New blood test to detect liver cirrhosis Detecting the liver scarring level in patients suffering from liver diseases most often requires a biopsy, a procedure hardly safe from complications. Researchers at Newcastle University proposed a promising way to simplify the process: When liver cells are damaged, they release small amounts of cell-free DNA into the blood. By measuring DNA methylation levels on genes, it may be possible to determine the stage of liver cirrhosis in patients with non-alcoholic fatty liver disease. This could alleviate the patients and save costly health-care resources.

Fighting malaria in Bhutan Tropical diseases are still a burden to many countries in South Asia. The incidence of malaria in Bhutan has been falling in the past two decades, yet the government plans to completely eradicate the disease by 2016. With help of scientists from Australian National University, trends and burden of malaria were estimated. Researchers predict that the major challenges the small Kingdom must face in the future include malaria importation from India, continued protection of the population in endemic districts, and indoor residual spraying.

Digital information stored inside DNA?!? A team of computer scientists and electrical engineers from University of Washington has proposed one of the first complete systems to encode, store and retrieve digital data using DNA molecules. The digital data is chopped into pieces and stored by synthesizing a massive number of tiny DNA molecules, which can be dehydrated or otherwise preserved for longterm storage. The novel method of managing the information can prospectively allow companies to keep their data that today would fill a big box store supercenter in a space the size of a sugar cube.

Advances in heart transplants Cross-species transplantation presents a promising method to bypass the human heart supply problem that patients face on the waiting list. Porcine hearts transplanted into baboons have survived for over two years so far, report researchers from the School of Medicine, University of Maryland. This is the longest period noted, which could be achieved through the new immune-suppressing therapy.

8

9


1#2013

medicor

KI CAMPUS

How Medicinska Föreningen’s Board is handling the challenges of 2016 By Frida Hellström and Iris Peña Arriarán Photos by Katarina Stojanovic

Photo: Jingcheng Zhao

In the last issue the readers were introduced to the new board of Medicinska Föreningen (MF), but what do they really do? The activity plan for 2016 is very ambitious and the work has already started.

Hi there! Do you want to develop science and health care? At Innovation Office we help students with ideas within medicine and health. A mobile application, a care program or a medical device – we have the competence to take your idea to innovation. All of our services are available free of charge. Visit us in Aula Medica, Campus Solna or at ki.se/innovationoffice.

Campus Huddinge The southern KI campus, Campus Huddinge, has so far had a pretty inactive student life and the board seeks to change this, with the help of the sections and Odontologiska Föreningen (the student union for odontology students). With pubs, social events, meetings and a grand opening of the union facilities in Huddinge the group is planning a great improvement in local student life. MF is also a part of Flemingsbergs Förenade Studentkårer (FFS, a student union collaboration) who currently work with questions of a common union house and the general social life in Flemingsberg. In charge of the Huddinge-group is board member Pontus Dannberg.

Recruiting more members and improving our communication A constant challenge for the union is to recruit and keep its members, therefore the board has two of its representatives, Anna Petterson and Iris Peña Arriaran, that devote most of their time towards coming up with ideas to attract more members and spreading information about what the student union does and how one can get involved and reap the great benefits of the MF community. Right now they are in the process of trying to find out what we need as students and how MF can help us get it, this can be everything from student

students are also to be involved in recruiting a new vice-chancellor, and thus have appointed the representatives for the Consultative College (Hörandeförsamling) regarding the recruitment profile. Most, if not all, of these students will also be part of the Consultative College where the members vote on the candidates for the vice-chancellor position in October. The MF Vision As of two years MF has had a vision; “Medicinska Föreningen is an open meeting place characterized by interprofessionality and friendship, where all students can contribute, grow and prosper through joy, creativity and passion” and three central catchwords which we want

“Medicinska Föreningen is an open meeting place characterized by interprofessionality and

friendship, where all students can contribute, grow and prosper through joy, creativity and passion” Recruiting a General for Nobel Night Cap 2017 Every fourth year MF has organized Nobel Night Cap, which is a huge and exclusive after party to the Nobel Banquet. Originally a tradition started by the students of Stockholm it has now grown to a prestigious event with a theme that is top secret until the very last minute and it involves the commitment of hundreds of students every year. The party rotates between the four big universities in Stockholm and the board of MF hopes to produce another great party when it is our turn again next year. But for a Night Cap to happen, it needs a General, and the planning of the event needs to begin a year in advance. Therefore the recruitment of the General is currently underway with a board selected planning group who are in this

discounts and privileges to more student influence and general information. KomU are also involved in this work and their job is to make sure all students at KI know what’s going on at MF.

If you are interested in any of the activities please contact us at:

Studiebevakning One of the jobs MF has is to make sure students are represented everywhere (see other article), and the board helps the different sections with this if necessary. The

styrelsen@medicinskaforeningen.se

10

moment outlining the foundation and the plans and for this great endeavor.

The Union House renovation MF’s union house is located at Campus Solna, just opposite Aula Medica and next to the soon-to-be Biomedicum. With the surroundings developing so quickly, MF wants to improve with it to suit the atmosphere. Kårhus 2018 is a renovation project lead by board member and former vice president Andrea Montano Montes. The project is now in its planning and fundraising – a renovation is estimated to cost 20-25 million Swedish kronor – stages with workshops and events. The plan is to start the renovation on the 14th of December 2017, but there is a lot to do until then!

to live and work by: Diversity, Dedication, Development. The board is now working on implementing the vision in the organization and marketing it so that all members are aware of what MF strives to be: an open place for everyone to develop. Every year we arrange a workshop day for all the students at MF and KI to contribute to the Vision, learn what it means and also to see how they themselves can incorporate it into their work at the student union and become a part of the MF community. The Vision day will be held this fall at MF (more information to come). Student Health Being the student union of a medical institute such as KI requires a health focus among our members. The board is working together with Studenthälsan to improve students’ physical and psychological health. This includes all health questions such as stress, alcohol use, smoking, exercise and healthy, affordable food options. •

9


1#2013

medicor

KI CAMPUS

Sexual and reproductive health rights in crises By Emily Clark Interview by Radek J. Gora and Emily Clark Photos by Katarina Stojanovic To celebrate World Health Day, Karolinska Institutet hosted an afternoon seminar to discuss the protection of sexual and reproductive health rights (SRHR) of women and girls in a crisis-prone world. With an impressive panel of speakers, the afternoon was kicked off by Dr Babatunde Osotimehin, who, following a career as a medical doctor and Minister of Health in Nigeria, became the Executive Director of the United Nations Population Fund (UNFPA) in 2011. We then heard from Professor Anna Mia Ekström, head of the Global Health, HIV and SRHR research group at Karolinska Institutet; Per Örneus, current Ambassador for Humanitarian Affairs; and Hampus Holmer, PhD and medical student at Lund University. The scene was set by Osotimehin: conflict and crisis are not new phenomena. In fact, we are seeing increasing numbers of disasters. So long as the underlying volatile issues such as climate change, religious tensions, poverty and widening inequality exist, we can expect to see conflict. Camps that were initially built for temporary respite have sadly become all that many children know as home.

women want, for example by constructing toilets that are within the safe space, obviating the need for a dangerous journey at night time, outside, alone. They have es-

Ekström discussed the topical issue of migration. Migration is a time of great vulnerability for all, with difficulties in access to knowledge - including sex education, geographical or financial access to health care, language barriers, different cultural and sexual norms, stigma, and arduous journeys representing just some of these difficulties. Upon arriving in Sweden ongoing inequities exist as migrants have higher mortality rates, and later diagnoses of HIV. A basic health screen involving tests for syphilis, HIV, hepatitis B and TB is available to all refugees in Sweden, however, uptake of this initiative is about 50%. Why? How can we improve this?

Holmer brought up the question, “What is health?”. So much of health and ill-health can be associated with how and where we live, most of which is outside of what we would consider the health system. We should not consider SRHR in isolation; instead we need a holistic approach. Örneus emphasized the need for a longer-term health systems view, as well as looking at the bigger picture. Osotimehin reflected on these ideas later, asking, “Who owns our health?”. Evidence suggests that more exercise and a better diet will improve our health, yet arguably industry drives many of our choices that will impact on our health. The UNFPA has many ways in which it aims to improve SRHR for women and young children. It has established maternity units, which has recently delivered their 5000th baby. So far, their maternal and neonatal mortality rates are zero, highlighting what is possible with good quality care despite ongoing trouble. They have created safe spaces: physical spaces just for women. They have listened to what 12

war or conflict.” The UNFPA strengthens existing health systems, working closely with local services providers to improve sustainability.

“Pregnancy does not know war or conflict.” tablished centres for women to learn new skills, to obtain assistance – whether it be legal, psychological, or medical, including contraception. “Pregnancy does not know

Firstly, we must learn. We can learn from the experience of those in other settings. In these tough financial times with increasing demands, it is imperative to implement the best and most cost-effective evidence-based interventi-ons. Countries in conflict or in crisis can little afford – in money, in trust, in opportunity cost – to try what doesn’t work. And, of course, it needs to be contextualized. Underpinning any intervention are the concepts of accountability, quality assurance, strong leadership and policies, as well as education and capacity building. Communication is key – to bridge the gap between research and

Dr Babatunde Osotimehin with, on the left, seminar moderators Caroline Olsson and Daniel Helldén. On the right in the back row: the panel members Hampus Holmér, Professor Anna Mia Ekström and Per Örnéus. On the right in the front row, seminar organisers Karin Båge, Sanni Kujala and Giulia Gaudenzi.

the people, research and policy-makers. Mobile phone based technology has the potential to reach many people very simply, and this should be embraced. Lastly, the big issues need to be addressed. Prevention of economic collapse, of conflict, prioritising women’s and children’s welfare, building robust health systems and infrastructure. As Osotimehin put it, “Health belongs to the people.” Medicor exclusive interview with Dr Babatubde Osotimehin

Dr Babatunde was kind enough to speak with us after the seminar so we could pick his brains some more. Sexuality is fundamental to our existence. Yet, SRHR is often overlooked, overshadowed, ignored. “People don’t want to talk about sexuality” – cultural norms bear the responsibility here of sweeping SRHR under the carpet, out of sight, out of mind. Despite insufficient resources, the UNFPA has been “able to bring visibility” to SRHR. Through connecting with civil society and integrating and

engaging with students, the UNFPA has helped shine the spotlight onto SRHR. As the UNFPA looks ahead, challenges loom. Their aspiration? Aiming to “reach everybody and [leave] nobody behind”. They think that concentrating on young people, who number 1.8 billion, is a good place to start. And certainly the impact of supporting, caring for, and protecting just this demographic group will be a significant one. Girls in particular suffer during war situations: one such example is the use of rape as a weapon of war. It is imperative to be very clear on this: “…we do not condone it and that the ones who are caught, are penalised for it”. It is vital that cases are reported, documented and that offenders are prosecuted. As we all know, prevention is better than cure. How does the UNFPA employ this adage in their work? Resilience building is a concept which aims to “develop people to learn to cope with crisis”. It is not limited to conflict situations but is employed also for disasters such as flooding, where, in the acute setting, the population needs aid and food and shelter. But building resilience involves prioritising a long-term outlook and the “building [of] systems to prevent flooding”, which will avoid or reduce the need for such acute interventions in the future. Interventions should be contextualised to improve success, engagement, and acceptability. Does the UNFPA ever struggle with local customs? “We do, but we overcome them”. The key is, as ever, down to interpersonal relationships and communication: “you sit down on the floor, you talk to people, you tell them what value you are bringing”. It’s a process, requiring time and ongoing discussion. Under-

pinning this dialogue is evidence for the proposed intervention, and inspiring the other party to realise the importance and benefits to be had. Avoiding judgement is imperative. What about deeply engrained beliefs? The UNFPA identify and engage gatekeepers, people who need to be on board in order to reach the rest of the community. Gatekeepers fulfil a vital role of motivating the proposal, “champions of the program”. Without this, there cannot be sustainability.

“Health belongs to the people.” What can we do, as students? “Reach out to other students in the world” – students of any kind. We should realise we are in a very privileged position. We are able to discuss ideas, challenge ideas, generate new ideas, educate and empower people all over the globe. We have access to all sorts of research, evidence and statistics. We can highlight issues so that they become more prominent, we can “raise awareness…raise resources…find solutions”. Networking, and again, communication, is key. And the beauty is all of this can be done from home. There is no requirement to travel anywhere. Contact people affected by the crisis, ask them what they need, what they want us to do to help. Ask them how we can best work together. How can we put this issue in the spotlight? What resources do they need, and how can we obtain them? Do not underestimate the opportunities we have here, now. These global friendships are “incredible and powerful”. •

13


1#2013

Studentsällskapet för Kirurgi och Anestesi (KirA)

KI CAMPUS

KirA is a surgically and anaesthetic society for medical students. Through KirA, you will enjoy journal clubs, anatomy knowledge, and practical workshops related to surgery or anaesthesiology, sometimes with a global health touch. KirA cooperates with IFMSA Stockholm and Läkarsektionen. Founders are fourth-year medical students Gustaf Drevin and Jakub Olczak. Contact: ordforande@sallskapetkira.se

Do you want to be a surgeon?

KirA - a student society for surgery and anaesthesiology By Jakub Olczak and Gustaf Drevin Photo by Eric Wellme and Gustaf Drevin

The interest for Studentsällskapet för Kirurgi och Anestesi’s first suture workshop was immense - 150 people registered but the organisers could only select 15. Therefore, the spots were slumped using an online generator!

Founders Gustaf Drevin (standing left) and Jakub Olczak (standing right) instructing students in basic minor surgery theory. The workshop participants seemed to really enjoy getting a sneak peek on surgery, in the form of suturing.

Tuesday April 19th, 20 medical students in scrubs took over the clinical practice centrum at Karolinska Hospital Solna, as the newly created Student Society for Surgery and Anaesthesiology (Studentsällskapet för Kirurgi och Anestesi, KirA) held its first ever workshop - a suturing tutorial. We have created KirA to fill a void concerning opportunities for medical students to pursue specific interests already in medical school. From war to robotic surgery The Karolinska Institute was formed for a single purpose: training war surgeons for the 19th century Carolean wars stretching into Prussia, the Ukraine, and far into Russia. They were barbers and craftsmen and their methods urgently crude. Today, surgery and anaesthesiology have developed into complex sciences spanning from advanced practical techniques to modern technology, requiring operators to be skilled, flexible, and updated. No wonder so many medical students are intrigued by surgery and anaesthesiology. Premiere workshop There are hundreds of vibrant surgical student societies. Recently this trend has come to Sweden and now Stockholm, as Lund and Örebro have similar societies. Also known as KirA, our organisation provides medical students opportunities to involve themselves in surgery and anaesthesiology. The suturing workshop on April 19th was the premiere event, where 150 people were interested and ten participants randomly selected. Six older students were present to tutor groups of 2-3 14

medicor

beginners. A short lecture was also given to ensure participants has basic theory in minor surgery. Students were taught wound physiology, local anaesthetics, and suture techniques before teaching three sutures. Students seemed very happy. Julia Ekman, a second-year student, says it was “the excitement of learning basic but useful techniques early in my education and to get a foundation for future terms of

medical school” that made her interested. She adds that “the workshop truly whetted my appetite, and I am totally adding ‘suture kit’ to my birthday wish list!” KirA hopes to provide at least five workshops per term to cover the interest for such practice. Student interest The authors have always felt that the interest for different surgical specialties and anaesthesiology and critical or emergency care rank extremely high in the mind-set of medical students, already from an early stage in our education. It made sense for us to then perform a survey of this interest and investigate if the numbers did support our intuition. A whooping 551 medical students at Karolinska Institutet answered, and more than 80% want to engage in some kind of extra-curricular surgical or anaesthetic activity and three-fourths consider surgery or anaesthesiology as future careers. We are happy to cooperate with IFMSA Stockholm and Läkarsektionen in initiating KirA.

Surgical survey A pre-launch survey engaging 551 medical students at the Karolinska Institute showed that despite a huge interest in these specialities, there is a lack of channels for expressing one’s interest or curiosity in surgery or anaesthesiology.

The tutor Lottie Phillips, fourth-year, says she “would have loved to have been given a chance early on to learn some basic surgical techniques from and older student who could say ‘hey, I know it seems far off, but you will be there before you know it.’ Being a tutor for KirA is a way to be that student for somebody else.” The three founding pillars Our main vision is that medical students can pursue their interests in different capacities, in order to establish a full-width and realistic perspective of otherwise indeed over-romanticised specialties. We

have envisaged three founding pillars to guide the society. Firstly, KirA wants to showcase the benefits or doing research by arranging student-adapted journal clubs with some of Sweden’s most prominent researchers in surgery and anaesthesiology. Students of any level can participate and no previous experience or knowledge will be required. Participants can expect to learn how to read scientific articles, get inspiration, and meet researchers. The second pillar is anatomy, which is often forgotten between the anatomical and surgical semesters. This, of course, is a more or less personal experience of the authors... One aim is to create anatomy booklets to complement atlases and lectures. The third and perhaps most attractive feature is our practical approach, where suturing can be complemented with workshops on keeping free airways, robotic surgery, or advanced suturing techniques. This concrete and hands-on approach is what most students want, according to our survey. We are happy to provide this rewarding break in your studies! Anaesthesia and global health Apart from the founding pillars, two additional important elements make up KirA. There has been an unfortunate divide between anaesthesiology and surgery, the

severity of which can depend on country, culture, clinic, and level of care. Many students are palpably positively surprised by the thrill of anaesthesiology. KirA wants students to tap into that underrated potential and be introduced to this enabling feature of modern surgery. The second element is a global focus. Approximately 5 billion people lack access to “safe, affordable, and accessible surgical and anaesthetic care” (WHO, 2015) and global surgery is the “neglected stepchild of global health”. KirA hopes to bridge this divide and emphasise that the international nature of medicine applies also here. The future KirA has been in contact with and received verbal support from the four surgery course directors at the Karolinska Institute. It has been encouraging and given KirA a sense of academic anchorage. We, the authors of this article and founders of KirA, intend to make KirA a standing committee and society for many more medical students to come. One day, we hope to meet younger future colleagues in the corridor, saying they want to become surgeons because they once joined a surgical student society at their university. We hope you want to join us in this vision and promote surgery and anaesthesiology at the Karolinska Institute with us. • 15


1#2013

medicor

KI CAMPUS

The science behind the Doctoral Students’ Association By Benedek Bozoky Photo by Néstor Vázquez Bernat

From left to right: Luliia Savchuk (BM), Eva Hesselmark (BM), Cheng Xu (BM), Frida Kalm, Paula Cermakova, Fei Yang (BM), Chenhong Lin, Matilda Liljedahl (BM), Débora Masini (BM), Benedek Bozoky (Chair), Manideep Gupta Vemula (BM), Simone Setterberg (BM) Not present: Javad Jafari (Treasurer), Susanne Neumann (Secretary). BM: Board Member

The reason many of us PhD students chose to do science is because we enjoy reading and learning. We like thinking about complex problems, analyzing and discussing them in our research groups. But don’t think it’s only in the lab that you can do these things. When I first joined the student union I found that what they do is maybe not so different from research and science. In a quick read I introduce how we function and what the purpose of the Doctoral Students’ Association is. But be aware! If you are a true scientist you might end up joining us (to your supervisor’s regret)! The Doctoral Students’ Association

The Doctoral Students’ Association represents around 2100 PhD candidates, constituting the biggest section of the main student union at KI, Medicinska Föreningen. Our main objective is to make sure that the voices of students are heard and are part of the decisions made at KI. We therefore nominate or elect representatives to the major boards, committees, even to the highest body at KI, the senate (konsistoriet). We have four representatives sitting in the Board of Doctoral Education, three in the Board of Research and two in the senate, just to mention a few. There is probably no other organ at KI that has such a good representation in the decision making as we do. Luckily for us, Swedish universities in general and KI in particular have a good tradition of involving students. This has helped us to continue to improve and stay ahead. Those of us who have studied 16

abroad know this is not always self-evident. We are fortunate for having the opportunity to be partners with the faculty improving the institute. The Board Meetings Every month we have a board meeting, usually around 15 of us gather discussing student issues over a slice of pizza and some soft drinks. Every meeting a few new students find us. The reasons they join vary, but many who come share the belief that as students we also have a responsibility to create a modern and forward looking University. Some do this simply by letting us know about problems or issues they notice. Others go a step further and will give suggestions on how to solve them. Those who are especially enthusiastic will join us and take part in the discussions to find the best solutions. What’s on the Agenda now? In addition to the student representation we have different workgroups with particular focal points. One workgroup is for Clinical PhDs and another one aims to organize social events, like pubs and parties during the upcoming year. Finally, we have the KID workgroup that will start to reach out to students to discuss how to improve it for its planned reintroduction in 2018. We are also lucky to have a board with a lot of different interests so each can focus on different issues. Some are passionate about international relations, some are particularly keen on equality issues while others are experts in KI’s organization. This diverse board, with

different backgrounds and different interests, creates a dynamic and enjoyable atmosphere for discussions. You might even learn something! Student union work isn’t just fun but can be rewarding too. Participating helps to develop your soft skills, the way to interact and discuss. You find out how the university is structured, how decisions are made and how you can influence them. You learn to discuss and debate, and how to present your arguments. You practice how to communicate and to work in a team to solve difficult and complex problems. Sounding like science yet? What we do is not so different from research - we identify problems, read up on them, discuss them and finally try to come up with ways to solve them. Our “research group” (the Board) is enthusiastic and engaged, and is often willing to stay late into the evenings to discuss and debate about the decisions we make. Finally, as many research groups do, at the end of a year of hard work we go for a Christmas dinner as a reward for our efforts. I hope that the next time will be full of new faces! •

You are always welcome to join us for one of the board meetings! Contact us at: dsa@medicinskaforeningen.se For more info: www.medicinskaforeningen.se/phd 17


1#2013

Science

Science

Science Snippets By Joanna Kritikou

Did a comet start life on Earth? Were the building blocks of life on Earth created here or were they brought by comets or meteorites? Most of the organic compounds have been found in meteorites, comets, and interstellar dust. But the sugar ribose, which forms the backbone of RNA, has never been detected. A recent experiment that mimics the conditions of a comet hitting a planet resulted in the formation of a large variety of organic compounds, including ribose and other sugar molecules. This finding strengthens the idea of comets being the kick-starters of life on Earth. (Science, April 2016) Photo credit: Chris Jupin (Flickr)

Fighting big bugs with small particles Antibiotic resistance is an increasing issue as superbugs (antibiotic resistant microbes) are emerging. One recent player in the fight against superbugs is nanoparticles, which are a million times smaller than a millimeter. More specifically, nanoscale quantum dots were used to kill multidrug resistant superbugs. These can be activated by light once in the body. Toxicity in the nearby tissue can be controlled because the quantum dots upset the balance of chemical processes in the bacteria without harming human cells. (Nature Materials, January 2016) Photo credit: Kanijoman (Flickr)

The evolutionary history of Malaria The parasite Plasmodium falciparum is thought to have killed 438,000 people in 2015. There are several other members of the Plasmodium family. So why is this one so deadly? By comparing its genetics to species of malaria found in wild chimpanzees, a recent study aimed to uncover the reason for the increased infectiousness of human Plasmodium falciparum. It was found that it uses a much higher number of genes to infect red blood cells and that two invasion sites in particular had an extremely high diversity compared to the chimp parasites. (Nature Communications, March 2016) Photo credit: Jim Gathany (CDC #5814)

18

medicor

Ancient retrovirus lurking in human DNA Retroviruses insert their genome into the cells they infect, which can sometimes be germline cells. These cells pass on their DNA to the next generation…and the next…and the next. Usually, these retroviral sequences or “genomic fossils” are no longer capable of producing any sort of infectious particles. Intriguingly, however, one such retroviral fossil (called HERV-K) was recently found “alive” in humans and is therefore potentially capable of replication despite being millions of years old. Studying this might give clues as to how to deal with the not-yet-fossilized retroviruses, like HIV. (PNAS, March 2016)

HIV you’re (edited) out! The CRISPR/Cas9 technique of genomic editing has now been used to excise HIV DNA that has been incorporated into cellular DNA of CD4+ T cells. Current antiretroviral drugs can stop the virus from entering the cells, but once the virus has placed its DNA they are of little help. Researchers used a modified CRISPR/ Cas9 system to allow recognition of specific DNA sequences positioned within the HIV-1 promoter. They were able to show that removal of these sequences completely eliminated viral production, without any genotoxicity to host cell DNA, and reduced viral replication. (Scientific Reports, March 2016)

One step closer to understanding men’s emotions Researchers have discovered that testosterone reduces connectivity in brain regions responsible for feeling empathy. Women’s brains were imaged by fMRI while they were asked to associate an emotion with certain images. The inferior frontal gyrus region became specifically activated, suggesting that it plays a role in empathy. After this, the same women performed the experiment after an administration of testosterone. They took significantly longer to identify the emotions being expressed in the picture, indicating that the hormone did impair their capacity for empathy. (Psychoneuroendocrinology, March 2016)

Preparing for the next giant leap for humankind A twin study in space By Halima Hassan After several successful space conquests, the next big venture for space agencies around the world is to figure out how humans can conquer Mars. This mission, called Mars One, has a launch date set for the year 2024 and preparations are already well under way. The possibility of human settlements on Mars is all the more exciting and very plausible now after the discovery of water on the surface of the red planet. A major question is what biological changes occur as a result of extended human space flight. It

ing genetically the same, they have both had very similar trajectories in life. Having one of the twins spend time in space while the other remained on earth gives scientists an ideal experimental set up: Mark Kelly, the retired astronaut acts as a biological control, to which data acquired from Scott Kelly will be compared to upon his return from space. As well as all the physical and physiological changes, the advantage of any twin study is that changes at the genomic level can also be tracked and analyzed.

their genetic similarity provides an excellent opportunity for science

The proposal from the Kelly twins offers a particularly exciting advantage as they are identical twins. As well as be-

However, some of the results from this twin study may never see the light of day. The Kelly twins are having their entire genomes sequenced, and if they discover sensitive medical information they do not want shared, such as susceptibility to certain diseases, those results may not be published.

some of the results from this twin study may never see the light of day

is estimated that a Mars mission will take around two and a half years in total, with approximately one year spent flying in zero gravity for the trip to and from Earth. After all, there is little point in making such a trip if we couldn’t survive it, or if we were affected so detrimentally on a physical level by the journey alone. This is where the astronaut Scott Kelly and his twin, retired astronaut Mark Kelly, come into play. They suggested organizing and taking part in a study to help answer this particular question, and their genetic similarity provides an excellent opportunity for science. NASA and the Russian space agency, Roscosmos, have some understanding of how human bodies adapt to spaceflight: this comes from the many tests and analysis performed on all returning astronauts. One of the most interesting observations from earlier space excursions relates to vision. A survey of the returning astronauts revealed that 29 percent of shuttle astronauts and 60 percent of station astronauts reported worse vision while in flight. “Many became farsighted or experienced blurriness, possibly because the shape of the eye flattens with pressure changes in the skull,” NASA reports.

be weeks, even months, of data collection continuing post-flight, and samples that are still on the ISS will need to be returned to Earth. So far, the main findings are that Scott Kelly looks great; year-long missions are not the limit; and this mission was successful largely because of the close coordination between the Russians, the US and all the partners.

Photo: NASA Johnson Spacewalk (Flickr)

“It would be nice to learn that there are no genetic effects of long-term space flight, but I somewhat doubt that to be the case.” — Scott Kelly On March 1st 2016 Scott Kelly, along with astronaut Mikhail Kornienko, returned after 340 days on the International Space Station (ISS). This is the longest period of time that a US scientist has spent in space. This mission is not over just because the flight landed. There will

It is safe to say that though the results of this mission will contribute significantly to the preparations for the Mars One mission in 2024, there will have to be more long duration missions before the final takeoff. This twin study will provide invaluable information about the differences between the human body in space compared to Earth and many of the results may even aid scientists in understanding more about disease susceptibility and treatment on this planet. In this regard, the outcome of this mission will not only help humankind take that step towards exploring another planet but the results may help us achieve a better life here on Earth, our first home. •

For more information and updates on this study check:

www.nasa.gov/twins-study/ research

19


1#2013

Science

The gender gap in academia By Iskra Pollak Dorocic Infographic by Jakub Lewicki Not long after winning the Nobel Prize in 2014, neuroscientist May-Britt Moser took part in the BBC program Nobel Minds. As the lone woman at a roundtable discussion she, along with the other prize winners, discussed her scientific discoveries and their implications for the world. However, it was only Dr. Moser who was singled out and questioned about how she managed to balance her career and having children, not her male counterparts. Why is it that in this day and age, when gender equality should be the norm, that women are greeted by surprise at having successful careers and being parents? And why are women still underrepresented at top levels of academia? It’s tempting to think that gender discrimination is a thing of the past, especially in a progressive country like Sweden. While it’s true that the fight for equality has made great strides over the last decades, current statistics and experimental studies on the issue show that the playing field is still not even. Let’s first look at the situation at Karolinska Institutet. There is a peculiar gender gap at both the student and professor level – albeit an opposite one. Women make up the majority at KI, both as students (a whopping 70% of KI students are female), as well as staff (62%). But looking at the highest-level professor positions, women make up only 28% of the full professors at KI. In the United States, the numbers look similar, with 21% of science professors being female despite equal numbers of PhDs between the genders. Several explanations for this gender gap are commonly offered – women simply aren’t as interested in working their way up the career ladder as men are, perhaps due to still sharing a disproportionate burden of family obligations. Or is there a glass ceiling that makes it difficult to break through due to both overt discrimination and unconscious gender bias? There’s no simple answer to that question. Shirley Tilghman, president of Princeton University, aptly explained to Nature, “I don’t think there’s a single obstacle, I think there’s a whole series of phenomena that add up.” Interestingly, research has shown that women are just as ambitious as men when 20

they begin their careers. Michelle Ryan, a professor of social and organizational psychology told the Guardian, “We’ve done the surveys for numerous professions, and whether it’s police officers, surgical trainees, or women in science, men and women have absolutely equal levels of ambition and want to make it to top in equal numbers. But while men’s ambition increases over time, women’s decreases.” Gender bias, based on stereotype assumptions, starts early. Males are presumed to be better at math and science, even if test scores suggest otherwise. At the University of Washington, 1,700 biology undergraduates were asked to rate their fellow students based on competence. The male students rated their female peers lower, even if they were equally competent based on their grades. They judged other men higher than women who had better grades and equal amounts of class participation, and the study showed that a woman would need to get a grade of A to acquire the same prestige as a man getting a B. This attitude continues in higher academia. One of the first studies to shine light on the uneven playing field of academia was performed right here in Sweden, and published in 1997 in Nature. The study tried to figure out why, despite graduating in even numbers, male PhD holders ended up in professorships at a much higher rate than their female counterparts. It turned out that postdoctoral funding grant decision by the Swedish Medical Research Council gave women significantly lower competence scores, despite the female applicants having the same scientific productivity as the males (as measured by publications and citations). A female applicant had to be 2.5 times more productive than the average male applicant, at time of applying for postdoc funding, to receive the equivalent competence score – this would amount to 3 extra papers in Nature or Science! A more recent investigation into academic funding in the United States, based on 2015 NIH funding outcomes, shows slightly more encouraging numbers. Even though men apply for more grants than women, the number of grants awarded is proportional in most cases. One interesting exception is the NIH Early Independence Award, which requires institutions

to nominate applicants. In this case men are overrepresented, showing that men are more likely to be supported and promoted by their institutions at the crucial early stage. It’s difficult to study gender bias in the real world – there are many factors to be controlled for and no two candidates are identical when applying for a position or grant. In a clever experiment published in 2012 in PNAS, researchers sent out identical CVs for a lab manager position to scientists at 6 different US universities – the only difference was one CV had a male name on top, while the other a female name. The result was striking - professors were more likely to mentor “John” and were willing to offer him US$3,730 more in pay per year than “Jennifer”. Both male and female professors showed this discrimination against female applicants, underlining that both men and women exhibit an unconscious gender bias. In addition to gender bias, there seem to be psychological factors at play. Women consistently underestimate their abilities, perhaps due to internalizing the gender stereotypes, and display a confidence gap compared to their male peers. In one of the most replicable psychology experiments, men both overestimate their abilities and subsequent performance on a variety of tests by up to 30%, while women underestimate both. The actual test scores do not statistically differ. Women also more frequently feel the “impostor syndrome”, where a highachieving individual believes she or he is not smart enough to deserve the success they have attained, and will eventually be exposed as a fraud. When a person holds back due to a lack of confidence, they do not pursue opportunities. “Success, it turns out, correlates just as closely with confidence as it does with competence”, write Katty Kay and Claire Shipman, authors of a book on this topic. When it comes to salaries, most fields report lower pay for women doing the same job as men. Linda Babcock, a professor of economics at Carnegie Mellon University and the author of Women Don’t Ask explains, “men initiate salary negotiations four times as often as women do, and when women do negotiate, they ask for 30% less money than men do”. The

pay gap of female to male American scientists is 18%. Additionally, it has been shown that when women enter a male-dominated work field in large numbers, the pay for the whole job sector drops.

medicor

Science

Clearly women are negatively impacted by their lack of confidence and negotiation skills in the workplace. But what happens when women do behave assertively? They may suffer a whole other set of consequences, ones that men don’t typically experience. Iris Bohnet, author of What Works: Gender Equality by Design, writes, “what is celebrated as entrepreneurship, self-confidence, and vision in a man is perceived as arrogance and self-promotion in a woman”. Using data from 14 million student reviews on the Rate My Professors site, researchers found that people tend to think more favorably of men than women in the work place. Men are praised for the same things women are criticized for, and reviews are more likely to focus on a woman’s appearance or personality and on a man’s skills and intelligence. Given that most of us, male and female, display cognitive and often unconscious gender biases, how do we make the academic workplace fairer and more equal? One way is to become more aware of the issues and consciously question why we judge individuals the way we do. But more realistically, a solution is to de-bias institutions and organizations instead of just the individuals. Iris Bohnet, author of a book on the subject, proposes we “create policies and institutions that work for real human beings with their limitations, for example, cognitive biases, including prejudice”. For instance, making the review process for publications, grants, and job applications blind - by removing the names during the evaluation process - could eliminate the variable of judging the applicant by their gender, as well as other irrelevant factors. Things do seem to be changing. The gender gap has been decreasing over the decades due to increasing number of women pursuing PhDs, though at a slower pace than expected. In 2012, the Swedish government stipulated that at least 47% of newly hired professors at KI should be women. A 2015 study in PNAS showed faculty members prefer female candidates for tenuretrack jobs in science and engineering over males, at least on paper (the results were based on surveys, not actual hiring). Making academia fairer and more accessible to the most competent people, regardless their gender, race, sexual orientation and otherwise, will ultimately benefit us all. After all, science has no lack of problems to solve, and adding different perspectives to the process can only be an advantage. • 21


1#2013

Science

medicor

Science feat. the Public or Science vs. the Public?

Science

Two unrelated stories epitomise the growing divide between what is proven and what is not. By Diana Čekatauskaitė

Sleep is to the brain what flushing is to the toilet By Maria López Quiroga We dedicate roughly a third of our lives to sleep, a universal characteristic highly conserved through many species - from flies to humans. Despite its undeniable restorative and reinvigorating powers, its evolutionary costs are high: during sleep we are vulnerable and subjected to “predators”; we don’t eat, drink, socialize or reproduce. However, we know little to nothing of what really happens in the brain once we fall asleep, but do not fret! Recent research led by Lulu Xie, from University of Rochester Medical Center in New York, suggests that sleep drives toxic waste out of the adult brain. Their work, published in the journal Science, studied volume fluctuations in the brain’s cerebrospinal fluids (CSF) during wake and sleep cycles. The brain, as opposed to the rest of the body, lacks a working lymphatic system to dispose of metabolic waste. In turn, it has a “glymphatic system” which allows for CSF to recirculate around the brain flushing away the toxic waste produced as the re22

sult of brain’s activity, and accumulated in-between cells throughout the day. The scientists measured mice brainwave activity to confirm the sleep or wake condition. They then marked mice CSF using fluorescent traces injected into the brain and observed, in real time, the “glymphatic” CSF volume variations. It was found that mice CSF volume fraction changed from 14% during wake state to 23% during sleep. These results suggest that the higher volumes of CSF during sleep permit the brain to effectively remove neurotoxic waste. Dr Lisa Genzel, of the University of Edinburgh’s Centre for Cognitive and Neural Systems, whose focus is human sleep and memory research, said: “It’s fascinating! It seems that sleep is like the metabolic regulating machine of the brain. This study opens a promising research field”. Many diseases, such as stroke or dementia, are associated with sleeping problems. Future therapies could target brain’s metabolic role by helping to dispose of its neurotoxic waste products. Furthermore, most neurodegenerative diseases, such as

Alzheimer’s and Parkinson’s, are associated with “misaccumulation” of protein aggregates and metabolic waste products that harm brain cells. Researchers investigated how efficient the glymphatic flushing system was at disposing of these noxious substances. They radiolabelled amyloid beta, a protein linked to Alzheimer’s progression which builds up in the brain when we are awake, and observed its clearance rate. Results showed that clearance rate of amyloid beta during sleep was twice as fast as during waking. Dr Genzel also said: “We previously knew that sleep is important for memory consolidation, but now this new research also shows that sleep plays a role in basic metabolic processes, which may also be linked to Alzheimer’s disease”. These findings offer an explanation for sleep’s remarkable restorative functions, which may be due to the 60% CSF volume increase during sleep, facilitating the clearance of neurotoxic metabolic waste accumulated during the day and keeping neurodegenerative diseases at bay. So remember, don’t forget to flush! •

Photo: Science News Cycle; “Piled Higher and Deeper” by Jorge Cham

Photo: Sleeping is needed to facilitate the clearance of neurotoxic metabolic waste. Henri Rousseau, “The Sleeping Gypsy” (1897)

Fake Correlation Real Consequences 1998: The Lancet publishes a study by Wakefield et al. that argues for the presence of a link between the MMR vaccine and development of autism. Regardless of the fact that it was a correlational study consisting of merely 12 patients, its findings were presented and understood by a large part of the society as a causal relationship. This led to mass hysteria, fuelled by sensationalism in media, and feeding into people’s lack of comprehensive understanding of the research. The paper was retracted (although only in 2010) after Brian Deer’s investigation for The Sunday Times revealed that Wakefield was apparently paid an exorbitant amount of money to conduct the study to dissuade people from using the MMR vaccine, and vaccination in general. All attempts to replicate the study - the largest had a sample size of more than 1.2 million children - argued exactly the opposite. But after 18 years of arduous work to discredit the fraudulent researcher, vaccination rates are still in decline in developed countries. Why? Not-So-Golden Rice 2000: Science publishes a paper on genetically engineered rice that produces betacarotene (vitamin A precursor), designed to overcome the shortage of dietary vitamin A. Vitamin A deficiency results in blindness and other illnesses, which are said to be responsible for ~2.5 million preventable deaths per year. In 2013, protesters, allegedly encouraged by Greenpeace, vandalized the Golden Rice field trial in Philippines because the rice was genetically modified (GM). As of 2016, not a single country has grown Golden Rice commercially. In addition, the public outcry after one death of a patient after attempted treatment of a rare metabolic disorder with GM adenovirus resulted in halting all human-gene-therapy experiments for several years. It is staggering to see the difference between the scientists’ expectations of the benefits of the genome-editing techniques, and the connotations and fear

the GM acronym has in the general public. Even researching transgenic organisms has somewhat become a taboo with strict regulations. But why? Science and the Public: it’s complicated While looking for answers to these “whys”, the most striking thing to realize is the “gulf of mutual incomprehension… but most of all lack of understanding” between the two camps of ‘sciences’ and ‘humanities’ the society has been divided into, as warned by C. P. Snow in his famous Rede Lecture. While scientists are not always the best communicators of ideas, science cannot exist for its own sake, without the public. Therefore, it is alarming that it was so easy to spark such panic and shake the trust in one of the most important scientific inventions of all time, leaving an unpleasant impression that the

trust between the camps was not exactly there in the first place. Why is that? The fear the general public has comes from miscommunication and a lack of tools to assess scientific claims critically. This creates a fertile ground to profit from claims with no scientific basis, while disproving them is expensive and inefficient. Even though there have already been attempts to implement interdisciplinary education to close the gap, yet the faster science progresses, the bigger role the gap has. It is now time to try the public with CRISPR – an extremely precise gene-editing tool that can possibly change the genetic lineage of mankind. Here come the benefits, the risks, the moral issues, and everyone, not only scientists, have to get involved. The question we all need to ask ourselves now is how to ensure that CRISPR avoids the GM fate. • 23


1#2013

Science

Can your birth sign predict your health destiny?

By Vaso Basinou

I have thoroughly investigated the matter and frankly I wish I had not. As it turns out, people born in winter time are more susceptible to mood disorders. And as a Scorpio, I had to admit: There is some science behind our bad reputation as the darkest sign in the zodiac!

The anatomical-astrological human by Limbourg brothers

24

Do you believe in astrology? If your answer is YES you belong to the 30% of Swedes that swear on the predictive power of horoscopes. If you belong to the remaining 70%, do not read this article: it may challenge your thinking. There may be compelling scientific evidence supporting the notion that the month we are born plays an important role for diseases we are likely to develop. Scientists at the Columbia University investigated whether a person’s birth month has anything to do with risk of getting a particular disease. ‘’Every time we go to the doctor data is being recorded about us by the Hospital and we can use these medical records for research’’ says Nicholas Tatonetti, the lead researcher. ‘’We had a very large clinical data set, approximately 1.7 million patients, and we examined 1600 diseases for birth month dependencies’’1. What they found is pretty staggering: 55 diseases, including asthma, cardiomyopathy and attention deficit hyperactivity disorder (ADHD), were strongly linked to the patients’ birth month. For example, people born in early spring (March/April) seemed to have higher risk for developing a heart condition, while people born in early autumn (September/ October)were more prone

to respiratory problems. Those born in early winter appear to be at higher risk for neurological and reproductive diseases. October and November are the months with the highest overall disease risk, while on the other hand May appears as the ‘’safest’’ month to be born. Finally something positive about being a Gemini! But before you get overly excited that your zodiac sign guarantees protection, or worried that your November-born child will develop ADHD, it is important to realize that although there is a strong association, the birth month is not the only risk factor and definitely not the most crucial one. “The risk related to birth month is relatively minor when compared to more influential variables like diet and exercise. The point of the research wasn’t to scare people off giving birth in certain months, but ra-ther to use the mass of data available to uncover new disease risk factors, ” Tatonetti explains1. If your birth month plays a significant role in the diseases you are likely to develop during your lifetime does that mean that astrology holds the key to human health? And when a new moon occurs in Aries will it have physiological effects on Capricorns? The answer is that our health has nothing to do with the

medicor

October and November are the months with the highest overall disease risk, while May appears as the ‘’safest’’ birth month D and exposure to seasonal pathogens. But perhaps the most compelling explanation came from a research group at Vanderbilt University. “Our biological clocks measure the day length and change our behaviour according to the seasons. We were curious to see if light signals could shape the development of the biological clock,” said Douglas McMahon, the principal investigator3. We all possess internal time-measuring devices that are called biological clocks. What they do is to provide a representation of the external time and fine-tune our physiology to the demands of daily light/dark cycle. This is what regulates our sleep/wake cyThe effects of seasonal cle, body temperature, feedchanges on health are so proing/fasting cycle, hormone found that people in ancient production and metabolism. times seem to have been fully The way our biological clocks were aware of it. ‘’To investitell the time is by receiving gate medicine properly, this is light information through what one should do’’ Hippothe retina which can directly crates states. ‘’First, to careful‘’tune’’ our master clock ly consider the seasons of Our found in the hypothalathe year and what they mus. If our internal health yield ... for knowhas nothing to clock is well-tuned ing the changes to the external of the seasons, do with the moon time, then we the risings and can be sure that or the position of the settings of the our physiologistars, [the physi- planets. It has to do cal functions cian] will be able with the season will also run on to tell beforehand time. However, if we were what sort of a year is there is a mismatch going to ensue’’. At that born in between internal and extime astrology and astronternal timing, problems will omy served the same purpose: appear. That’s where the birth to provide a measure of time. season comes into play. Later, astronomy employed scientific methods to predict The McMahon team found cosmic phenomenon and the that perinatal exposure to diftwo disciplines diverged. We ferent light periods of a day know, after all, that planets are (called photoperiods) has not made of magical stuff, and strong effects on the stability the moon has hardly any influ- of our biological clock in latence on small volumes of wa- er life. In brief, they exposed ter, like lakes, let alone on the newborn mice in three differ56 litters of water contained in ent photoperiods: a 12 hour an average human body. light/12 hour dark schedule (corresponding to spring/ So, what it is about seafall), a 18 hour light/6 hour sons that influence our health? dark schedule (correspondSeveral assumptions point to ing to summer), or a 6 hour the levels of maternal vitamin moon or the position of the planets. It is associated with changes in light, humidity and temperature occurring during the different seasons of the year. It is not about which month you are born in, but more accurately it is about the season you were born in. Seasonality affects many aspects of our biology even in industrialized societies, where we have control over light, temperature and food availability. It is really remarkable that even in isolation of these environmental influences, humans still have seasonal rhythms of births and susceptibility to illnesses, which are related to the month of conception2.

If our internal clock is well-tuned to the external time, then we can be sure that our physiological functions will also run on time light/18 hour dark schedule (corresponding to winter). Mice were then switched into a different photoperiod environment and almost all of them were able to adjust their clocks accordingly. All but one group: mice raised in the winter schedule had an unstable biological clock that could not adapt to the different photoperiods (summer or spring/ autumn). “This exaggerated response to a change in season is strikingly similar to that of human patients suffering from seasonal affective disorder,” McMahon commented. “We know that the biological clock regulates mood in humans. If an imprinting mechanism similar to the one that we found in mice operates in humans, then it could not only have an effect on a number of behavioural disorders but also have a more general effect on personality,” 3 In a follow up study, they demonstrated that the perinatal winter photoperiod induces changes in the function of serotonin neurons that lead

to increased depression and anxiety-like behaviours. In a nutshell: Someone born in dark winter is at a higher risk for developing psychological disorders compared to someone born in a sunnier month. Building on that, people born in spring and summer are shown to have higher levels of hyperthymic temperament—a tendency to be excessively positive4. And a hyperthymic temperament can sometimes be assisted by the fun of reading how magic your day is going to be when the Venus is occurring on the second house of Leo. Despite the fact that there is no scientific reason for believing in horoscope prognosis, we can still enjoy the power of selective perception when it comes to things that matter to us. ‘‘Faith is to believe what you do not yet see’’ wrote Saint Augustine and pointed that ’’reward of this faith is to see what you believe’’. •

Sources 1

Press release: Data Scientists Find Connections Between Birth Month and Health: http://newsroom.cumc.columbia.edu/blog/2015/06/08/data-scientistsfind-connections-between-birth-month-and-health

3

Forster and Roenneberg (2008) Human Responses to the Geophysical Daily, Annual and Lunar Cycles:http://dx.doi.org/10.1016/j.cub.2008.07.003

4

2

Press release: Babies’ biological clocks dramatically affected by birth light cycle: http://news.vanderbilt.edu/2010/12/babies-biological-clocks-dramaticallyaffected-by-birth-light-cycle/

Press release: Astrology and celebrity: Seasons really do influence personality: http://www.eurekalert.org/pub_releases/2015-05/uoc-aac051315.php

25


1#2013

medicor

Finding Refuge in Academia: A young man’s journey from war to the lab bench and beyond Story by Iskra Pollak Dorocic and Parvin Kumar Photography by Simon GuÊrard

26

27


1#2013

medicor

Cover Story

- Izzeldin Abuelaish

T

he migrant crisis is a geopolitical event unlike any other in two generations. Hundreds of thousands of refugees mostly from Iraq and Syria have arrived on the shores of Europe and much can be done to help them - both indirectly through diplomacy and aid or directly through welcoming and integrating refugees. Whilst the ongoing crisis has garnered a spotlight on the collective plight of refugees, less is known about the personal narratives of those who made the demanding journey over land and sea. Perhaps if we got to know them a little better we would understand what this crisis means to our own humanity. Amidst the tragedies, could there be a glimmer of hope for a resolution? We think there is a story set so deep in all of this that it could perhaps be an inspiration for our times. As a teenager, Aram fled his homeland and took an arduous journey spanning a whole continent – across Iran, Turkey, then Greece, Albania, onwards to Italy, France, Germany, Denmark, and finally Sweden. The journey took several years and multiple stops, traveling solely by foot and sometimes train. Sound familiar? These days it’s a recognizable story heard in the news – hundreds of thousands of refugees from Syria and other war-torn regions are desperately trying to make it to Europe to find a peaceful life. But the story of Aram Ghalali is not one you’ll find in the newspapers today. Though he took the same path, Aram arrived in Sweden in 1998 when he was 15 years old. His family fled their home in Kurdistan, Iraq after their father and a 28

number of other relatives were killed and their house confiscated. Was it easier to arrive as a refugee in Europe then? “No, I think it is easier now. There were clear borders between the countries then. So it was difficult”, explains Aram as we chat at Jöns Jakob on a cloudy February afternoon. Today he is 33 years old and holds a PhD degree from Karolinska Institutet, where he now works as a cancer researcher at the Institute of Environmental Medicine. Although we often hear the beginning of these kind of narratives, we rarely hear the outcomes and stories of successful adaptation. Aram’s story is one of overcoming great difficulties and setbacks, but per-

Although we often hear the beginning of these kind of narratives, we rarely hear the outcomes and stories of successful adaptation. severing despite them. A major life goal was to study science and become a medical doctor, and since arriving in Sweden Aram tirelessly worked towards that goal. It was not without obstacles. At first, he did not speak Swedish nor have proof of previous studies and grades. “When I wanted to study science, the teachers told me this is impossible, because only absolutely the top students in Sweden go into science”, explains Aram. The other immigrant students around him were sent to

Tragedy cannot be the end of our lives. We cannot allow it to control and defeat us.

trade schools, to become mechanics and electricians. But Aram was stubborn and managed to convince his high school’s guidance counselor to give him a chance to go into the science track. He was given one month to listen in on math and physics classes and take a qualifying exam. Aram passed with flying colors. This crucial moment started his path to a career in science. Once again, the road was not easy, but Aram’s hard work and determination led him toward his goals. “I wanted to be a doctor. At this time I did not have any papers, no citizenship from any country. In my Swedish residence permit it said my identity could not be confirmed because I came with no papers.” Aram got accepted to King’s College in the UK but due to lack of papers he was not able to get a UK visa. Instead, he went to Mälardalen University College in Eskilstuna and obtained an impressive total of 5 different degrees in science and engineering. All the while, Aram’s goal was to study at Karolinska Institutet. He describes visiting KI for medical school interviews, “I saw the roads on campus, called Nobel road and Berzelius road... It was sort of a holy land. I got the feeling of some sort of spirit of KI and I thought one day I need to study here, I mean I HAVE to study here.” Finally, he found himself at KI for a Master thesis research project, which eventually led to a PhD position in cell biology. These days Aram’s research focuses on environmental factors influencing different types of cancer, asthma and inflammation.

29


1#2013

Cover Story

I think the knowledge I learned here at KI is something I should somehow give back to society and humanity. – Aram Ghalali

“For me, science is not something that you own”, explains Aram . He draws inspiration from issues facing his community, such as the high incidence of certain types of cancer in Aram’s hometown in Iraq, due to the use of chemical weapons. “I think the knowledge I learned here at KI is something I should somehow give back to society and humanity.”

“I saw the roads on campus, called Nobel road and Berzelius road... It was sort of a holy land” Between 1987-1988, vast areas of Iraq were subjected to repeated attacks of chemical weapons. The town of Halabja, close to Aram’s hometown, was attacked with a mixture of both blistering sulphur mustard and organophosphorus nerve gases which killed and injured thousands of civilians. Aram explains, “Most farmers have now returned to their previously poisoned farms and villages. Physicians and oncologists in this region are alarmed that the cancer risks in this population are very high. They observe that very young individuals die of large, aggressive, rapidly metastasizing tumors.” Clearly there is a need to scientifically determine the danger to the population living in the affected region. “I plan to analyze soil samples from exposed areas for chemi30

cal weapons and to identify toxicological effects of compounds remaining in the soil. I hope that the results can be used for cleaning up, and for deterring political leaders from using these gases.” Aram’s passion for human rights does not end with science. He also founded a non-profit organization called War in my playground, which has members in several countries. The organization’s goal is to provide children affected by the current conflicts in Iraq and Syria with necessities to increase their educational opportunities. The organization delivers teaching materials such as books, pencils and notebooks, as well as toys to bring some joy to kids living in refugee camps. “We believe that a happy childhood is a universal right”, explains Aram. An overarching theme emerges out of our conversation with Aram – his awareness of a specific type of mindset to overcome obstacles: “I think it’s all about your mentality, your way of thinking.” Aram argues against determinism, the perception that our intelligence or attitude are something we are born with and are unchangeable. “There are some who have a welcoming attitude towards challenges, persevering when they encounter setbacks and see criticism as a chance to learn more. They do not have the same view of intelligence, but consider it something that is developed by hard work and new skills.” His philosophy about life reflects the psychological quality of resil-

ience, the ability to adapt in the face of adversity, as well as personal responsibility. However, Aram is also quick to point out that circumstances are important as well. He credits his success to people along the way who have helped him out, such as his high school guidance counselor as well as his PhD advisor at KI, both of whom gave him a chance to continue his scientific quest. When asked what he hopes for other immigrants coming to Sweden today, Aram answers: “The welcome that I got. I could flourish in this system, and I hope they get it as well.”

Aram’s passion for human rights does not end with science. How difficult is it for a newly arrived immigrant or perhaps a refugee, in a similar situation as Aram, to continue on to higher education? On the one hand, universities want to attract international students and staff, as this bolsters their reputation. Maria Olsson, Senior Officer and Program Manager at the KI International Relations Office told us, “every year several hundred exchange students study at Karolinska Institutet and one-third of the students come from other countries. These students bring fresh perspectives and help to create an internationally oriented workplace and study. By attracting internationally competitive employees, students and partners strengthen and im-

prove the exchange of knowledge, which in turn further increases the quality of the operations.” One issue is the problem of accreditation that newly arriving students face. We asked Maria Olsson whether any programs exist to help immigrants, including refugees, who may be highly qualified but do not have the proper papers or accreditation when they apply. “No, unfortunately not,” she replied. However, “KI is the national coordinator for a fast track to get immigrants into our professions. That is, for those who already have a medical degree (from another country)”. Unfortunately, the situation still stands that many highly educated immigrants who arrive in Sweden will spend a lot of time and effort requalifying for higher education and relicensing their degrees - if they ever manage to do so. According to a report by the UN Refugee Agency (UNHCR), 86% of Syrian refugees reaching EU shores in 2015 had completed secondary school, and half of those were University educated.

“I think it’s all about your mentality, your way of thinking.” In light of this situation, Swedish regulators are stepping up efforts to recognize the academic merit of refugees and expedite their return to work. Migrationsverket, for example, has reallocated resources to the burgeoning asylum appli-

cations. Regular applications have been halted or delayed and effort is being made to match incoming refugees to vocations that are best suited for their interests and educational level. The European Union, since the beginning of 2015, has launched the EU Science4Refugees initiative. The initiative is aimed at “helping refugee scientists and researchers find suitable jobs that both improve their own situation and put their skills and experience to good use in Europe’s research system.” Such initiatives would be welcomed by refugee scientists and academics who would benefit from getting work and being recognized by society. History is dotted with luminary examples of refugees who have gone on to excel in their chosen vocations and become world leaders. The former American secretary of state Madeleine Albright and her family were refugees that fled the war in Czechoslovakia to the United States. Enrico Fermi the “architect of the nuclear age” was an Italian theoretical and experimental physicist who fled fascist Italy to join the American War effort against the Nazis. Now we have heard the trials and tribulations of one Iraqi academic war refugee who has come through to realise his dream of pursuing scientific research. Through pure grit and determination every obstacle Aram faced became a stepping stone toward his dream of higher education and research. But he couldn’t have done it alone, a welcoming and sup-

medicor

portive society was just as important for his successful integration. If we were to take a leaf from Aram’s story it should be the one that pertains to his mindset. The mindset to adapt to change and overcome challenges.

How we act as students, researchers and doctors will set an example for the society at large We live in times marked by cultural, economic and technological shifts. Many challenges we face as a society stem from these shifts and upheavals. One way to adapt is to discard the belief that our personality is immutable and adapt to meet the challenges that we are posed. How we act as students, researchers and doctors will set an example for the society at large and how society responds to the migrant crisis will be judged by historians for decades to come. By refining our attitudes to the migrant crisis we could redefine the outcome for Europe and the hundreds of thousands of refugees. How do we strengthen Europe - so that it continues to be a sanctuary of peace for the hundreds of millions who reside here? The answer probably lies in the courage at the heart of the individual citizen. Perhaps if we find the courage to give them a home they will, • as did Aram, gift us a dream. 31


1#2013

medicor

Global Focus

About the “Alternative” Diet Animal Well-Being and Animal Experimentation By Mateusz Krawiec

I

t has been nearly half a year since I began my transition to being a person with more respect towards the lives of other beings – a vegan. After having been influenced by many anti-animal cruelty messages from social media, I decided it was the time to cut the suffering of fellow living creatures. According to the Vegan Society, a vegan is a person seeking exclusion of all forms of exploitation and cruelty to animals for food, clothing, or any another purposes. However due to my current stand on animal testing I find it difficult to ascribe myself, by the strictest definition, the title of vegan. Throughout the times the food repertoire has changed, and populations have adapted to varying cuisines, e.g. from hunting, to growing one’s own food and later shopping at local markets or grocery stores. Despite recent reports that vegetable products may have higher greenhouse gas emission per calorie compared to meats, the animal industry taken as a whole remains on the top of the ladder of the food production carbon footprint. This reason combined with the contemporary advancement in agricultural methods, and additional knowledge such as the suffering of animals or the carcinogenic effects of red meats, are now leading people to turn to new dietary alternatives. There are as well individuals taking progressive steps to eliminate animal products from usage in everyday items such as jackets or pillows, but also in the world of animal testing.

However, one has to realize that the current research methods are not as advanced (yet) as one would like them to be. For a direct example, 94 of the total 104 Nobel Prize winners in the category for Physiology or Medicine had their work depend directly on animal tests. Without it, they, and we as humans, would have not been able to achieve the highly regarded advancements benefiting a modern-day world. If you think that other animals’ lives are as worthy as human ones, I do respect that, but I doubt that everyone is going to agree. Imagine that you yourself, or somebody close to you falls to the hands of a severe condition. The only way to improve your or their state, and possibly find a revolutionary treatment for this condition, would involve animal testing. Would you still say no to it? Take for example the Swedish Animal Alliance group (sv. Djurrättsalliansen) launching a petition against malaria vac-

cine testing on primates at KI. Had malaria been a common problem in this country, would there be such high support for this movement? Jeff Djevdet (Flickr)

As a student pursuing a program in medical sciences, I myself have had previous experience with animal testing. And trust me, holding the life of another being in your hands as it helplessly takes its last breath is not a pleasant feeling at all. On the other hand, one comes to appreciate the sacrifice that has to be made in order to generate new knowledge. What should be really taken into consideration is that ongoing animal testing can actually be beneficial in creating a future, cruelty-free research. By allowing research to progress, one has the chance to create a greater basis for computeraided models of animal testing. One of such models is being developed by the EU’s NOTOX project, which focuses on designing algorithms that mimic the processes taking place in living organisms. When it comes to taking sides and parting oneself to a specific label, we have to take into consideration that the world is not always black and white. Being aware of the serious issue of animal manipulation should not be taken lightly. However, not everything can be resolved at once. By slow progress we could adapt to non-animal diets and move to a phase of animal cruelty free research, each at their individual steps. •

From: www.livescience.com/32860-why-do-medical-researchers-use-mice.html

32

UK votes on EU Membership Referendum on possible Brexit to take place in June By Amy Jackson

O

n Thursday 23rd June, Britain will hold a nationwide referendum on its membership of the European Union. Individuals over the age of eighteen will be asked to vote for or against remaining in the EU in the first time since 1975 that membership has been put to a common vote.

Prior to announcing the referendum, the UK Prime Minister, David Cameron renegotiated Britain’s position within the European Union. The new deal focussed on four key areas: in-work benefits; child benefits; the Eurozone and exemption from the treaty motto of “ever closer union among the peoples of Europe”. Whilst Cameron was not able to achieve all of his aims, protracted negotiations have culminated in a deal that Cameron has heralded as giving the country “special status” in the 28-country bloc. The announcement of the referendum has led to the creation of multiple campaign groups, highlighting the level of division within, as well as between, political parties. In theory, the Labour party, SNP, Plaid Cymru and the Lib Dems have stated they favour staying in the Union, the UK Independence Party to leave, whilst the Conservatives have chosen to remain neutral. However, in reality the decision has transcended party lines, with politicians on both sides of the debate. Cameron has seen close allies, such as Boris Johnson and Michael Gove, join the campaign to leave the EU highlighting the divide at the top of Government.

Whilst the support received by the ‘Brexit’ campaign has shocked many, there is no definition of what a Brexit would look like. Leaving the EU would remove the UK from the common market, which means that goods, services and people would no longer be able to move across the bloc freely. Additionally, the UK would no longer have to adhere to legislation created in Brussels after a two year cooling off period. The UK would be required to negotiate a new bilateral agreement with the EU, which would leave the country dependent on the wishes of the Union. Those in favour of leaving the Union argue that membership has eroded the UK’s sovereignty and ability to make its own decisions. It has been argued that as one of the richest countries in the bloc, the UK has borne significant costs of membership. The current migrant crisis has exacerbated the concerns of those wishing to leave the EU, fearing that the UK will be at the whim of decisions made in Brussels regarding the admittance of migrants. The campaign to remain in the EU has focused on the economic benefits of being

part of the common market, and the need to be part of a larger bloc in order for the small island to have a place on the world stage. If the UK votes to remain in the EU, the new deal negotiated by Cameron will still need to be put to vote in the European Parliament. The increased popularity of the UK Independence Party in the 2015 General Elections gave the first glimpse of the attitudes towards Europe. According to the journal The Week, opinion polls show both sides are receiving an even split of the vote- demonstrating just how close the decision could be. The rejection of an EU- Ukraine partnership in the Netherlands this week has been touted as a sign of events to come in the UK referendum. The opinion polls were famously wrong in the days preceding the 2015 General Election, with shock across the country as results were released. The resulting apprehension is pushing both campaigns to do all they can to convince citizens of their arguments. However, with the referendum still two months away, anything could happen and it remains extremely uncertain just how the UK will vote. •

33


1#2013

Global Focus

Global Focus

Working towards common-sense outcomes measurement By Victoria Satchwell

T

he BMJ Health Outcomes Summit brought together a small but committed group of participants from research and industry to consider the way forward for the burgeoning discipline of health outcomes measurement. It offered a snapshot of current challenges facing this important field and coincided with the International Forum on Quality and Safety in Healthcare held in Gothenburg from 12-15 April. Health outcomes measurement aims to capture the effects of healthcare interventions on patient and population health. Its focus is empirically verifiable information about the relationship between what is done in the healthcare setting and the results of those actions. Unlike other medical research, where the effects of drugs or surgical procedures are examined, outcomes research understands ‘intervention’ more broadly to include not only treatments and services but also the structures and processes of care, and the way that care is organized.

Outcomes studied include clinical parameters such as blood pressure, survival or hospitalization days but increasingly focus is being directed towards broader questions about the ultimate impact of care and the value that patients experience as a result of that care. Good outcomes measures are more likely to approximate what we understand as the fundamental purpose of healthcare - health. One such measure, Quality Adjusted life Years (QALYs), aims to reflect a patient survival and health related quality of life. Other measures are based on patient responses and may reflect a patient’s experience of an illness, what worries them most about their condition, its affect on their life and functionality or their satisfaction with care. Health outcomes measurement informs several important health system process-

drowning in measures that describe individual aspects of care but know very little about the quality of care experienced at the level of the patient. Marc describes how the separation of healthcare into various departments and specializations, and an eagerness within each unit to demonstrate its own value results in fractured health outcomes measurement that fails to reflect the journey of the patient through the care cycle. Within healthcare management, the metaphor of silos is commonly used to illustrate the division of healthcare activities into distinct jurisdictions and to consider the effect of these divisions on care. Because quality of care is a product of the interaction between the activities of these silos, and often occurs at the intersections or where providers collaborate, health outcomes measurement must work to transcend ‘silo-ization’.

By Silhouette_Mr_Pipo.svg: Nevit Dilmen (talk) via Wikimedia Commons

es. It forms the cornerstone of healthcare quality improvement and can be used to hold providers accountable both to patients and regulators. Perhaps most importantly, outcomes measurement contributes to evidence-based medicine, and the establishment of guidelines for care. In the case of standardized outcome measures, the common language that these measures provide to healthcare practitioners facilitates transnational conversations and learning opportunities. Within the paradigm of Michael Porter and Elizabeth Teisberg’s ‘value-based healthcare’, outcomes measurement is seen as tool to re-orientate care towards improving value for patients and redefine the nature of competition in healthcare.

a recommitment to the common sense understanding at the heart of healthcare - that what matters is the outcomes that patients experience. As such, this area of research is a response both to the call for evidence-based practice and comparative effectiveness assessments, and the concern that mounting healthcare expenditures have not delivered increased value for patients.

Within a value-based purchasing system, outcomes measurement informs an individual’s choice between practitioners, facilities or procedures, and provides health-insurers and public-payers information to aid in healthcare purchasing decisions.

Keynote speaker, Marc Berg, an advisor at KPMG, introduced the challenge of measuring value as a problem that really hasn’t been solved. He aimed to orientate the group’s thinking within the somewhat messy waters of patient-centered outcomes measurement and to ground this thinking in what might be described as a common-sense approach.

Growth in the field of health outcomes research represents the awakening of healthcare providers to the need to evaluate the results of their activities, and

The BMJ Health Outcomes summit centered on questions related to the scalability of outcome measures, the transferability and adaptation of measures to fit local circumstances, what makes a good measure, and whether measures capture what they should.

By Chris Sampson via Wikimedia Commons

value for patients than a gauge of ward hygiene or whether a physician attended the delivery. Performance within silos may very well contribute to quality of care but is in no way an obvious determinant of whether a patient experiences value. The argument is for outcomes that reflect the ultimate objectives of a function that may For example, for the function ‘chronic span silos rather than an outcome that care’, patients are more interested in tells us how a silo is performing. This arwhether a provider successfully prevents gument highlights the point that asking deterioration than their waiting time when the right question is key to meaningful they come for a visit. For the function ‘pre- outcome measures. natal and maternity care’, a healthy baby and healthy mother is a better measure of In order to understand value experienced by patients, Marc suggests a shift in focus away from silos and towards care functions. He points out that from the patient’s perspective there are a limited number of care functions that a health system delivers and that the outcomes associated with each of these functions are distinctive.

A shift in thinking towards outcomes that span the cycle of care draws focus to the question of which data sources are key and where money and the time of healthcare professionals is being underinvested. Marc points out that you often don’t need very much data to construct measures that both matter to patients and that feel relevant to the work of the healthcare professionals that will be capturing this data and using these measures to improve care. •

A shift in thinking towards outcomes that span the cycle of care draws focus to the question of which data sources are key and where money and the time of healthcare professionals is being underinvested

It is a paradox of outcomes measurement that healthcare providers are often

The BMJ Health Outcomes summit centered on questions related to the scalability of outcome measures, the transferability and adaptation of measures to fit local circumstances, what makes a good measure, and whether measures capture what they should. 34

medicor

By DALY_disability_affected_life_year_infographic.png: Planemad derivative work: Radio89 via Wikimedia Commons

35


1#2013

medicor

CULTURE

Photo: Stefan Wermuth/Reuters (Financial Times)

Graduation Traditions Around the Globe From raw eggs and flour to tailor-made hats and rings By Se whee Park You’ve done it, you’ve survived. After the copious amounts of caffeine-fuelled confusion, late night stress and maybe even exam hall terror, you have endured and you have now finally reached the bliss of graduation. The future looks bright and you are ready and enthusiastic to embark on the next adventure of your life. However, before you graduate there is just one more task to do. That is to hop naked in the five major fountains across the campus of course! Well, that is if you are a graduating student from Butler University. Though unfortunately most of us are not, and while we might be bummed out (pun intended) that we will not be able to participate in that tradition, here are a few other graduation traditions from all over the globe that just might tickle your fancy in preparation for KI’s own graduation ceremonies this summer from mid-May to early June.

like months of cultivated old milk. This tradition, although probably not the most pleasant, has good intentions and is meant to bring good luck for the future.

At Edinburgh University friends shower each other in raw eggs and flour the moment they come out of their last exam to celebrate the end of student life.

In the Philippines it is common to hold a baccalaureate mass a day before the graduation ceremony. This is especially true if the university has Catholic backgrounds. The service is believed to have originated from Oxford University when it was required that each student was to deliver a sermon in Latin. However as universities became less associated with religion this tradition served more as a purpose to honor those graduating. Today the baccalaureate mass is an interfaith festivity of songs and prayers to celebrate learning and wisdom.

Similarly at Oxford University, the longheld tradition called “trashing” is a celebration of the end of the final exam and involves a messy horde of students covered in egg, flour, confetti and shaving foam. Meanwhile in Argentina this theme of “trashing” is taken up a notch. On the day of the last exam family and friends gather to throw a whole range of messy and foul-smelling products at the students. This could range from something milder like ketchup to something more extreme 36

At the University of Witwatersrand of South Africa, once the formal graduation ceremony is over the song “I Got You (I Feel Good)” by James Brown is blasted across the hallways. This is usually followed by enthusiastic sing-a-longs and dancing. In Zimbabwe the graduation ceremony is usually hosted by a guest of honor. Usually this person is the Chancellor of the University. However in state universities the President of Zimbabwe is both the chancellor and guest of honor. Therefore by receiving the diplomas each graduate gets to say that they have also shaken the hand of the President.

At Yale University during graduation students smoke tobacco out of a clay pipe. Once the ceremony is over they then throw the pipes to the floor and crush it

with their foot. This is meant to be a sign of relief and joy now that the university days are over. In Finland, unlike the common graduation dress code that consists of the gown and mortarboard, the doctors to be conferred are required to wear a traditional doctoral hat and doctoral sword. This tailor-made hat is a representation of degree and status and the emblem attached to the front of it differs between universities and faculties. Likewise in Sweden, along with the doctoral hat the doctorate is also given a doctoral ring “doktorsringar”. Although not mandatory these 18K gold rings are designed specifically for each faculty. However unlike the hat the ring is not mandatory during the conferment, but if in possession it is to be worn daily, on the left hand index finger. At Karolinska Institutet the conferment ceremony for doctoral students are held twice a year in the Blue Hall of the Stockholm City Hall. The ceremony is followed by a banquet in the Golden Hall and the dress code is strictly formal, entailing long evening gowns and white tie and tailcoats. Some exceptions to the dress code are national costumes or military mess wears. No matter the traditions, as bizarre they might be, the graduation ceremony is a precious moment shared with those we keep near. With that, on behalf of Medicor, I would like to wish everyone graduating this year big congratulations. •

37


1#2013

CULTURE

Should you be working right now instead of reading this? Dear Procrastinator. This is for you. By Jessica de Loma Olson Photo by Maria Belikova Tick tock. Tick tock. Yes, your clock is ticking and once again you have lost 30 minutes of your precious final hours to a series of pointless cat videos. Your deadline is fast approaching and you are blaming yourself for starting so extremely late. You stress, you suffer, you hate your past you for letting you be so irresponsible. You promised yourself –once again- that you would never do this. But then it happens over and over. Sounds familiar? It has to. Welcome to the exciting life of a procrastinator! This term does not refer to not doing anything at all. It is about avoid-

ing your main useful responsibilities and switching them up for other random activities, whatever they may be. While growing up, did your mom ever tell you to clean your room? Such a drama; you were never in the mood for that. But oh how things changed when you had a presentation deadline due the next day. That’s right, then your room was spontaneously spotless. If you think this behavior is characteristic of our lazy media-obsessed generation, think twice. The art of procrastinating is not new. It is not a consequence of social media or computers. Just as a fun

quote, back in 1949 Robert Benchley, an American humorist said “…anyone can do any amount of work, provided it isn’t the work he is supposed to be doing at the moment.” However, considering the time of the year it is, our essential work has to be done. So here are some top 11 tips and ideas on how to stop procrastinating and start doing. Have a calendar, a to-do list and a done list: Making a schedule and keeping track of your duties with a to-do list is quite a classic. But remember to actually

do it and keep it updated. A nice idea is also to keep a done list. Put simple things in your lists and cross them out as you finish them. It will boost your ego and make you feel productive.

get you motivated and make it seem like a challenge, a personal race against time. Also, this method will help you avoid wasting your time if the task was not that crucial.

Does size matter? The smaller the better: Divide your major tasks in smaller challenges. Simpler activities are more manageable and it will feel so much better as you go accomplishing them. It will also help you organize your time in a more efficient way.

Think about your task in the most random place: The reason behind your procrastination might be that you do not feel inspired and lack motivation. To make things more interesting, try and think about your project while you are walking around town or commuting. You might get unexpected and fresh ideas, that even if they are too crazy they might get you excited and want to dig into them. Having our phones with us all day also helps here, so you can take notes on the go.

Meet up with your friends: This is a dangerous suggestion, I know. It can be very helpful or end up being an eternal fika. If you find your right study buddy, meeting up with that person can force you to get going. Also, it allows you to look forward to a nice break every now and then. Just be careful the pause does not end up being the whole day! Structured procrastination: This is actually a thing. Procrastinating is about doing something else to avoid what you have to do. So let that something else be useful. John Perry, a professor at Stanford suggests creating a list of goals. At the top of the list, put the most demanding but not necessarily urgent tasks. At the bottom, everything else. Just to avoid the first thing, you should start doing all the other ones. Limit the time you invest in a specific activity: Before you start, decide how much time you think you need to perform a specific task and stick to it. This should

38

Bribe yourself: Keep the rewards coming! If you fulfill an activity, give yourself a treat. It can be a funny cat clip on YouTube –but just one!- or that chocolate ice cream you have been craving for hours. Remember though, to stick to your goals. Write outlines or ideas on Post-it notes: If you are suffering from writer’s block, this could be a good start. Write a basic outline or just independent ideas on the page. Anything is better than leaving a blank space. You can also try using Postit notes to start with the creative process. Walk around and scribble a couple of ideas!

medicor

beware, getting too comfy might lull you into a peaceful sleep. A typical Swedish thing is to work standing up, keeping the blood flowing; give it a try! Start with something randomly: Sometimes you have so many things to get done, it’s hard to know where to even start. You waste more time thinking what to do first than actually working. So get over this by taking your to-do list and selecting something with a random criterion. Prioritize by alphabetical order or just roll a dice. Get yourself in a good mood before starting: If you love funny cat videos, go and enjoy them. Watch something fun during a specific amount of time. But do not jump from one YouTube video to the next! Put a timer on, enjoy and then get to work! With all this said, dear lazy you, 1328573995. Sure you did not even bother to read the whole number. But, if you got this far to read through all these tips, there is a high probability that you should be doing something else more productive. So go ahead, put my wise advice into practice and get to work! •

Get the right posture: Make sure you have a nice environment and a comfortable chair. Not having an ergonomic posture will prevent you from focusing. But

39


1#2013

medicor

CULTURE

Stockholm: A city of borders By Sarolta Gabulya and Diana Čekatauskaitė Photos by Katarina Stojanovic

With a population set to increase by 1 million by 2020, will fears of segregation in housing, healthcare and education in Stockholm become a catastrophic reality? What is the situation now and what can be done to bring down the borders. Two sides to Stockholm

There are so many reasons why we enjoy living in Stockholm. It has everything: world class universities, classical Scandinavian architecture, beautiful landscapes, and a strong and supportive welfare system. Central Stockholm is a playground of tourist attractions and luxury boutiques. However, while the inhabitants of Östermalm indulge in the finer things in life, the reality of suburban minority groups is poor housing, failing schools and troubled health centres. For some of our city’s residents, their Stockholm is Rågsveda or Rinkeby, not the city that the tourists come to see. It is another Stockholm. This holds particularly true for recent immigrants, because living in a central location is simply not possible. With the fastest growing population in Europe (Stockholm Chamber of Commerce, 2015), the increasing segregation of ethnic groups is on track to worsen.

Housing. What are our choices?

Timothy Anderson is a research fellow at Nordregio, the Nordic Centre for Spatial Development, specializing on urban governance and social sustainability. Accord-

ing to him, the current housing market is the biggest reason why people get stuck in a vicious circle of being confined to Stockholm’s outskirts, especially those with a foreign background. Divided housing drives segregation in other aspects of people’s lives. The fact that neighbourhoods with high ethnic diversity can be well defined on a map puts Stockholm in the same league as Los Angeles or New York, notoriously known for their racial disparities. In addition to the spatial segregation, housing market segmentation closes borders within Stockholm in other ways. A strong correlation was found between different types of tenure and income levels of ethnic groups. For example, in Rinkeby, which is the poorest neighbourhood in Stockholm municipality, publicly owned rental housing comprises 99.7% of the total available housing, whereas in central areas of Stockholm the number drops to 6%. There is also very little development in central areas due to pressure from homeowners and tenant unions. For example, in Östermalm, which is considered to be the most affluent neighbour-

hood in Stockholm municipality, there have been no new rental homes built. These factors added to a strange mixture of tightly-controlled public apartments, loosening second-hand rent regulations and a desperate shortage of housing mean that most young people and immigrants are restricted to peripheral areas. Central Stockholm remains reserved for older generations and native white Swedes. There have been pledges from the state to municipalities to renew construction of rental housing, but the process is slow because of the systematic reliance on income tax. Instead, municipalities are encouraged to sell the rental housing to either investors or force tenants to buy their flats. This further decreases the availability of places to rent and reduces mobility. Finding a solution to the shortage of housing is important. However, even if governmental subsidies for rental housing construction are increased, they would not necessarily resolve the issue of segregation in Stockholm. Consumer choices always play a role despite being

“It’s really critical at the moment to alleviate the shortage of housing – whether it’s in or outside the centre – through rental housing construction.” hard to control. The moving patterns of native Swedes are related with those of low-income and minority groups. The tendency is that the more low-income minority groups live in an area, the less likely wealthy Swedes are to move there, and vice-versa. A pattern of gentrification in low-income areas has had a knock-on effect on a dwindling availability of affordable housing, pushing already marginalised groups into outlying areas. These areas have received a lot of media coverage. Public discussion about the housing problem and segregated society is crucial to alleviate problems. However, in Anderson’s view, the coverage does more harm than help; “People recognize Husby, Rinkeby, Skärholmen as being poor and having a high concentration of immigrants, but the effect of the discourse is often to stigmatize these areas. Their negative traits are being exaggerated.” In essence, the general population often perpetuate the stigma and do not see how their own actions are connected with it and how segregation can materialize in Stockholmers’ everyday lives.

Segregation in healthcare

Segregation is not just found in housing, but is also apparent in our healthcare system. Stockholm has a different situation to those found in other cities. For instance, although a strong correlation has been shown between life expectancy and neighbourhoods in other big cities such as London and New York, this is not the 40

case in Stockholm. Anderson explains that the spatial segregation in health care has mostly been prevented by our freedom to choose our health center and the well-connected public transport system, with regular buses and underground taking us almost anywhere. Despite a well set up system, overcrowded and understaffed health centers in low-income areas are still cause inequalities. An important example of healthcare segregation is the case of two children’s health centers in Stureby and Rågsveda. Although they are only three stops away from each other on the Tunnelbana, the difficulties experienced by the staff could not be more different. In Stureby, where 19% of the population has a foreign background, the daily challenges consist of the “worried well”: over-informed, anxious parents. Family issues are well disguised behind the well-groomed facades. A few minutes down the line in Rågsveda on the other hand, where 67% of the population are not Swedish, the story is quite different. Here, the district nurse has a tough time getting families to visit the health centre. Living conditions affect family health, particularly with those who are living four or five to a one-room apartment and will be regularly transitioning between homes, sometimes disappearing for months at a time.

Segregation in Education

Education is not resistant to segregation either. The free choice of compulsory

school was introduced a couple of years ago to improve school results. It meant that parents could freely decide which school their children should attend and only charter schools have the right to refuse students. However, Timothy Anderson explains that the rule has not only failed to achieve its goal, but has deepened the segregation as now wealthy and typically white families tend to send their children to schools with similar demographics. This schooling customer preference issue mirrors those found in the housing market.

What’s the solution?

Stockholm municipality has acknowledged the ever deepening divides and has formed a long-term plan. It’s called Vision 2040, for more socially, economically, ecologically sustainable and democratic Stockholm. The mottos of “a good school for everybody” and an “accessible city for everybody” is what we need. But are these ideals detached from reality? The current social mobility trends are not encouraging, given the ongoing population growth of the city and the health, education and housing differences that residents experience. Perhaps Stockholm needs to make a bigger cultural shift towards inclusion and embracing diversity, on top of institutionalising Vision 2040. Improvement is not something that happens overnight and it will take a lasting change in attitudes to solve the housing catastrophe and unequal access to public services. •

41


1#2013

Culture COMICS

42

medicor

cOMICS

43


Tell your story Everybody has a unique story. You can share it in many ways. Come tell yours.

medicinska föreningen’s student magazine

44

Become a member today!

medicor

don’t just think about it, join us today! contact: chefredaktor@medicor.nu

Profile for Medicor MF Magazine

Medicor 2016 #2  

Medicor 2016 #2  

Advertisement