When award winning actor and advocate for clear science communication, Alan Alda, talks to young scientists about ways to effectively describe their work to a nonscientist, Alda advises them to make their research personal: How does it relate to their lives and the lives of others? Why should the listener care? For Gerardo Moreno, M.D., M.S.H.S., answering these questions is easy. In fact, personal experience may be the most important driving force for his research.
Growing up in California’s Central Valley, Moreno witnessed the health challenges facing migrant farm workers, including his own parents. In college at San Jose State University, he was struck by the disparities between the largely poor, medically underserved people living in the agricultural valley and the wealth of the people in Silicon Valley. It was around that time that Moreno started thinking maybe there was something he could do to support the medical needs of his community.
“Becoming a doctor seemed almost out of the realm of possibility. My brother and I were the first of our family to ever attend college. But during a summer enrichment program, I had an opportunity to shadow a Latino doctor in my home town. It made me realize that with hard work I could achieve anything,” Moreno recalls.
Moreno received his medical degree from the University of California-Los Angeles (UCLA), did his residency at the University of California-San Francisco, and returned to UCLA for a Robert Wood Johnson Clinical Scholars postdoctoral research fellowship. Today, Moreno is an assistant professor of family medicine at UCLA and a research scientist with the UCLA/Charles R. Drew University Resource Center for Minority Aging Research, funded by the National Institute on Aging (NIA).
In a recent publication in the Journal of General Internal Medicine, Moreno and colleague, Leo Morales, M.D., Ph.D., present their findings about how Spanish-language interpreters affect patient satisfaction with their care. “In this study we focused on a national demonstration project to improve doctor-patient communication by increasing access to and quality of interpreter services called Hablamos Juntos – Together We Speak,” explains Moreno. “We surveyed Latinos at clinical sites in eight states to determine if people who used interpreters reported better experience with care than those for whom an interpreter was unavailable.”
As Moreno and Morales suspected, Spanish-speaking Latinos who needed and used an interpreter expressed higher satisfaction with doctor communication than those who did not have an interpreter. They also regarded the office staff as more helpful. People who needed an interpreter but did not have access to one had a much more negative perspective of their health care. The researchers evaluated doctor-patient communication in four areas: listening carefully to patients, explaining things in ways patients understand, showing respect for what patients say, and spending enough time with patients. Office staff communication was analyzed in two areas: (1) being courteous/respectful and (2) being helpful.
The researchers note that their study provides further incentives to comply with laws that require healthcare providers who receive federal funds to offer language interpreting services when needed. “Latinos represent one-half of the population growth in the U.S.,” says Morales, associate investigator at Seattle-based Group Health Research Institute. “In light of this trend, hospitals and clinics should strongly consider investing in a professional interpreter service. It will better position them to provide high quality care to linguistically diverse audiences and may result in happier, healthier patients.”
Moreno’s personal experiences continue to inform his research directions and clinical choices. Research that supports better health care for traditionally medically underserved populations remains at the heart of his professional interests, “My hope is that we can identify ways of removing barriers to positive health outcomes and minimize -- or, even better, eliminate -- the health disparities facing our rapidly growing Latino communities.”
Moreno, G. & Morales, L.S. Hablamos Juntos (Together We Speak): Interpreters, provider communication, and satisfaction with care. J Gen Intern Med. 2010. 25(12):1282-8.
You are on the seemingly paved road to a tenure track research position at a university. You excelled in your science courses and earned your Ph.D. You even landed a postdoc research fellowship. Fast forward 3 years and now what? Update your curriculum vitae and send out applications to every research position you can find? Try to extend your fellowship?
Each year a group of research fellows at the NIA Intramural Research Program (IRP) must ask themselves these questions. NIA’s annual FARE (Fellows Award for Research Excellence) Day & Career Symposium is a program developed by the Office of the Scientific Director to help fellows better understand their options.
The day includes a:
For many people, a career is a journey rather than a destination. If you ask your colleagues, teachers, and friends how they arrived at their current position, you may be surprised by what they say. Whether by choice or necessity, many people who planned on life as a university researcher have often found it necessary to pursue another path. So, to encourage its research fellows to start thinking more broadly about career options, NIA, in partnership with the National Institute on Drug Abuse (NIDA), invited former NIH fellows to participate in a panel discussion sharing how their career goals evolved during and after their fellowship.
Each panelist provided advice on how to make the most of the NIH fellowship and how to cultivate the skills necessary to succeed as a research scientist. There were a few common recommendations: get a well-rounded experience -- the fellowship is a time to do research and to learn how to manage a laboratory. Also, network in and out of the laboratory -- look for role models working outside the traditional tenure-track university position; they might have a unique perspective that can help you broaden your job search.
Panelists also had advice about when fellows should start their job search and tips for finding a position. The takeaway message: start looking early and keep an open mind. Finally, panelists warned fellows to be aware of application cycles and be patient, as it can take 2 years to land a job.
Luigi Ferrucci, M.D., Ph.D., an internationally known geriatrician and gerontologist, has been named NIA’s Scientific Director, effective May 8, 2011. Ferrucci has served in NIA’s Intramural Research Program as chief of the Longitudinal Studies Section in the Clinical Research Branch since 2002, where he also has directed the Baltimore Longitudinal Study of Aging (BLSA).
Under his leadership, the BLSA has been reconceptualized and revitalized, based on new paradigms about how we age. Findings from this research could one day be used to develop ways to reduce the burden of disease and disability on older people.
“I look forward to Dr. Ferrucci bringing the same compassion, dedication, and innovation that has characterized his career to this new position of leadership in aging research,” stated NIA Director Richard J. Hodes, M.D. in an announcement to NIA staff.
As a physician-researcher with a doctorate in the biology and pathophysiology of aging, Ferrucci has mentored dozens of scientists and been a resource to gerontologists across the Institute and beyond. His teaching extends to adjunct professorships at both University of Maryland School of Medicine and The Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology. Ferrucci has served as Editor of the Journal of Gerontology: Medical Sciences since 2005 and is Associate Editor of the Journal of Cachexia, Sarcopenia and Muscle, on the editorial board of Geriatría y Gerontología (Barcelona, Spain), and a reviewer for The Wellcome Trust (London, England). He is a member of American Geriatrics Society and the Gerontological Society of America.
Before joining NIA, Ferrucci was Assistant Director and Coordinator of the Laboratory of Clinical Epidemiology at the National Institute for Research and Care on Aging in Italy.
Effective health communications is not just about clearly expressing your health message. You must deliver the message using language that literally and figuratively speaks to your audience. To improve communications about Alzheimer’s disease and research, NIA- supported scientists asked participants – 60 Latino Puerto Rican and 60 non-Latino White – living in the Philadelphia area how they would characterize Alzheimer’s disease and Alzheimer’s-related clinical trials using their own words.
Participants, depending on their ethnicity, met individually with a Latina or non-Latina research assistant, in a location of their choice. Along with a brief interview, research assistants collected data through a series of free-listing exercises – the research assistant introduced a concept and the participant wrote down all the words he/she associated with that concept.
“For example, the interviewer would ask about ‘the words that come to mind with you think of Alzheimer’s disease’ and participants would make a list,” explains Jason Karlawish, M.D., 1997 Summer Institute on Aging Research attendee and lead author on the paper in Alzheimer’s & Dementia.
Additional interviewing exercises were about symptoms of Alzheimer’s and causes of the disease. Participants listened to a vignette about a wife who cares for her husband with Alzheimer’s disease and then were asked to describe the wife. Participants who were caregivers were also asked to list words about Alzheimer’s clinical trials, including risks/benefits of research and reasons to participate or not in research studies. Responses were grouped according to the participants’ ethnicity and caregiver status.
The Puerto Rican Latino participants were mostly female. Non-Latinos were typically male with more years of education than the Latino cohort.
“We found certain words to describe Alzheimer’s were common among all the participants suggesting they are pervasive in messages about the disease,” says Karlawish. “For instance ‘memory loss’ was a universal expression to describe Alzheimer’s disease as well as symptoms of Alzheimer’s disease. ‘Sadness’ was also a common word used to describe Alzheimer’s among all groups except Latinos who weren’t caregivers.”
Ethnicity played a role in the responses, as well. Latinos, especially those who were caregivers, used words related to behavioral and emotional problems to describe symptoms of Alzheimer’s more frequently than people who were not Latino. Also, only Latino participants identified psychological and psychosocial stressors (specifically “loneliness” and “stress”) as causes of Alzheimer’s. On the other hand, caregivers who were not Latino, listed biomedical causes of Alzheimer’s such as “build up of plaque” and “lack of brain activity,” indicating they might have a understanding of the disease pathology.
During data analysis, investigators determined that gender, age, and years of education were not as salient as ethnicity and caregiver status.
Overall, Latinos who were not caregivers had the least knowledge about Alzheimer’s disease. In fact, some could not come up with any words to describe Alzheimer’s. Researchers suggest that providing general information about Alzheimer’s disease could be an important health education message for the Latino community.
In the study, researchers defined a caregiver as someone who had a friend or family member with Alzheimer’s disease and who either assisted the patient with activities of daily living or decision-making or provided information to health care professionals. They found that the Puerto Rican Latino caregivers were mostly adult children and non-Latino caregivers were generally the spouse of the patient.
While Latino and non-Latino caregivers shared some common views of Alzheimer’s, the researchers also found ethnicity did shape the caregiving experience. For example, Latinos never used the term “caregiver” to describe the wife of the Alzheimer’s patient in the vignette.
“Interestingly, no participants used the word ‘burden’ to describe the caregiver’s role, so this word might be best avoided in materials targeted to caregivers,” says Karlawish.
Researchers identified differences between how Latino and non-Latino caregivers characterized the risks and benefits of clinical trials for the Alzheimer’s patient and caregiver. Most caregivers listed “time” or “side effects” as reasons to not participate in a clinical trial. But non-Latino participants also mentioned travel, concerns about receiving a placebo, and creating false hopes as deterrents, while some of the Latino caregivers did not list any downside.
In listing the benefits of participating in a clinical trial, both Latino and non-Latinos included patient improvement and improved memory. But, there were also differences. Some Latino caregivers said that learning more about the disease would be a benefit. Only non-Latinos identified helping others and helping research as benefits to participation.
Findings from this study support the notion that when it comes to Alzheimer’s messaging, one size does not fit all. “To be most effective, communications materials should account for differences in how Latinos and non-Latinos view the disease, the caregiver’s role, and clinical trials,” recommends Karlawish.
For example, the research suggests that the difference in how Latino and non-Latino respondents viewed clinical trials could be important to developing culturally appropriate
recruitment materials. Materials aimed at recruiting Latinos, for instance, might be more effective if they describe the clinical trial as an educational opportunity for the caregiver, and materials for non-Latinos could portray participation as an altruistic opportunity. The researchers encourage additional research to determine if their findings apply to other Latino and non-Latino groups and have a wider application to Alzheimer’s communications.
Karlawish, J., Barg, F.K., Augsburger, D., et al. What Latino Puerto Ricans and non-Latinos say when they talk about Alzheimer’s disease. Alzheimer’s & Dementia. 2011. 7(2):161-170.
NIA intramural research fellows represent the best and brightest students from across the United States and world-wide. The NIH Fellows Award for Research Excellence (FARE) is an annual competition that provides recognition for outstanding scientific research among these and other Institutes’ intramural fellows. The winners each receive a travel stipend to attend a scientific meeting where they present their abstract, either as a poster or a seminar. In addition, they present their work at one of the FARE poster sessions at NIH and judge the next year’s FARE competition.
2010 NIA FARE Winners
Suhasini Avvaru, Ph.D., Laboratory of Molecular Gerontology
One of the biggest decisions high school students in the U.S. make is where they might want to go to college. Growing up in India, Chandrika Canugovi, Ph.D., had to decide her future.
After the U.S. equivalent of 10th grade, students in India must select whether they want to go into science or commerce. Their education, career, and future are based on that decision.
“Fortunately, my choice was not too difficult. I had a teacher who could make the most impractical science experiment interesting and showed us how the concepts behind the experiment could be useful in real life. I loved it. I knew that was the best path for me,” recalls Canugovi. Canugovi continued her studies in India, earning a Master’s degree in marine biotechnology. While in school, she met a student who had recently returned from a university in the U.S.
“I was intrigued by the opportunity to study abroad. In my program in India, we had state-of-the-art technology at our fingertips, but few people knew how to use it to its full potential. It was somewhat limiting. I thought studying in America might give me a boost,” explains Canugovi.
The only problem was that both Canugovi and her husband (then fiancé), also a scientist, needed to find a program of interest in the U.S. or neither could go. Fortunately, Canugovi got into a Master’s program at University of Texas in San Antonio, and her husband was accepted at Wayne State University in Detroit, Michigan. After a semester apart, Canugovi was accepted into a Biochemistry doctoral program at Wayne State. Her research was focused on the effect of transcription on AID mutagenesis, a protein that is essential for antibody development. Her thesis work described how genes can be modified to make the “evolutionary leap” necessary to counter infection.
After finishing their studies, Canugovi and her husband found themselves in a familiar predicament. They each needed to find a postdoc opportunity that met their interests and career goals and were in proximate locations. Baltimore, Maryland, lived up to its nickname -- the charm city. Canugovi’s husband found a position at Johns Hopkins University, and she got a placement at NIA.
“I was really drawn to NIA’s Laboratory of Molecular Gerontology. I didn’t have a background in gerontology, but I saw a natural connection between my study of DNA damage-repair with aging. Both are a consequence of oxidative damage. I could continue basic research on DNA repair and apply it to aging and aging-related syndromes,” says Canugovi.
Under the mentorship of NIA researcher Vilhelm Bohr, M.D., Ph.D., Canugovi studies DNA repair in mitochondria. She is specifically looking at a protein called mitochondrial transcription factor A (TFAM). She received a 2010 FARE for this work. During the FARE day poster session, Canugovi presented findings that indicate TFAM helps in modulating a mechanism to fix DNA damage called base excision repair (BER). TFAM protects the DNA from damage as well as unnecessary repairs by binding normal and damaged DNA, inhibiting BER.
Canugovi credits some of her success to good mentorship. “I’ve been lucky to be mentored by people like Dr. Deborah Croteau and Lab Chief Dr. Vilhelm Bohr. I’m learning new techniques as well as how to manage a lab. Dr. Bohr gives postdocs the freedom to come up with their own research ideas and asks thought provoking questions to help us decide if those projects are reasonable. Also, because it’s a pretty big lab, I have the chance to get a lot of helpful input from colleagues who have expertise in different areas. I always knew collaboration was the key to success, but here I’ve learned first-hand that it not only saves time but also helps you to think outside the box.”
It’s been about two-and-a-half years since Canugovi came to NIA. It’s time to once again think about the next step in her career. Meanwhile, she’s been practicing grant writing for NIH funding to continue her work.
“I’ve learned that being a scientist requires 110% effort and drive. I’m hoping that my passion pays off and in about 3 to 5 years from now I’m an independent researcher here or in India.”
When not at the bench, Canugovi enjoys watching movies and traveling around DC and beyond. “My favorite place is the Mayflower festival in Holland -- Michigan, that is. It’s the most beautiful thing I’ve ever seen, acres and acres of tulip flowers.”
Luca Caracciolo, Ph.D., received his doctoral degree in Molecular Genetics Applied to Medical Sciences from the University of Brescia in his home country Italy. But for Caracciolo, there was never a question of what would come next.
“I wanted to come to America for a postdoctoral fellowship. It is very hard for scientists in Italy. The Federal government supports much more research here. You can get more done and publish more papers. Also, here scientists are able to interact with leaders in the field and develop collaborations, whereas in Italy you have very limited access to senior scientists,” says Caracciolo.
Caracciolo started looking online for positions in the United States. As part of his search, he contacted several investigators at NIH, including Italian researcher Francesca Bosetti, Pharm.D., Ph.D., at the NIA. Bosetti and her laboratory in the Brain Physiology and Metabolism Section seemed to be a perfect match for Caracciolo. For one, they both did research related to his work on the glutamate receptor, a system that has been found to have a role in multiple neurological and psychiatric disease models, including schizophrenia and depression. And, two, working with an Italian investigator would help Caracciolo with the initial language barrier. The University of Brescia invited Bosetti to come to Italy to talk about her research. As Caracciolo hoped, Bosetti and he were a good match.
“During her visit, we initiated a research collaboration which began at the University of Brescia and finished at NIA in Maryland,” he recalls.
Caracciolo came to the NIA in November 2009. Building on his graduate work, Caracciolo continue to study the glutamate receptor. His FARE research focused on the glutamate receptor in a strain of genetically altered mice that lack the COX-2 gene. Cyclooxygenase, or COX, has been implicated in neurological function and neurodegenerative disease and now, based in part on Caracciolo’s studies, is thought to have a role in the glutamate receptor activity. He believes this research could have important future clinical implications for diseases with an inflammatory component, including Alzheimer’s disease.
Completing his work at NIA over the coming months allows Caracciolo to open a new door in his career. He is now interested in studying stroke and stroke recovery as a postdoctoral fellow at UCLA. This research has a personal meaning to him, “My father had a stroke, and this fellowship will be an opportunity to learn more about something that has touched my family’s life.”
While he looks forward to this new research opportunity, he will miss working with Bosetti, “She is a great teacher. She taught me new experimental techniques and would give me papers to study. She wants people in her laboratory to grow as researchers and have freedom to develop their own studies. She is always available to answer questions, and during meetings she can be counted on to ask critical questions that help direct our work.”
Caracciolo hopes that his new fellowship position at UCLA may lead into something more permanent at a university, “I’d love to teach and do research.”
He says that when he’s not running around in the lab, he enjoys running outside. And in his limited free time, he unwinds by socializing with friends, cooking, traveling, and learning about different people’s traditions.
For Annemarie Koster, Ph.D., the decision to come to NIA for a fellowship was as easy as “ABC.” NIA’s Health, Aging and Body Composition, or Health ABC Study, had been the foundation for Koster’s doctoral work.
Koster’s research career began in her native Netherlands. “My first research project was a master thesis focusing on the relationship between nutrition and Amyotrophic Lateral Sclerosis (ALS). I conducted the research while earning a Master of Science in Nutrition and Health at Wageningen University and a Master of Science in Epidemiology through the Netherlands Epidemiological Society. I really enjoyed epidemiological research and knew I needed a Ph.D. if I wanted to continue down that path,” says Koster.
The Ph.D. application process is particularly challenging in the Netherlands. Students apply to a 4-year research position rather than an academic program. Her Ph.D. project looked at the influences of socioeconomic status on health in old age and identified possible explanations for these differences. As part of her background research, Koster spent 6 months at Wake Forest University’s Sticht Center on Aging working with NIA’s Health ABC data. That’s when she first got in touch with Tamara Harris, M.D., M.S., from NIA’s Laboratory of Epidemiology, Demography, and Biometry. Harris later became Koster’s mentor.
“I had the chance to work with top researchers in the field and became even more interested in the epidemiology of aging. I also had a chance to attend the Gerontological Society of America conference where I learned about the breadth of the work in the field of aging. All these factors helped me realize my research calling,” explains Koster.
It has been 5 years since Koster received her Ph.D. in Health Sciences from the Maastricht University, Department of Health Care Studies, section of Medical Sociology, and came to NIA for a postdoc fellowship in Harris’s lab. During her time at NIA, Koster has published 25 papers and mentored many students. In 2010, she received a FARE for her work using the Health ABC data to identify what separates people who are obese and healthy (good cholesterol levels, healthy blood pressure, normal glucose levels, etc.) from those who are obese and unhealthy. She found that even though the healthy and unhealthy groups have approximately the same body mass index (BMI), the healthy group has lower visceral (belly) fat and more thigh fat compared to the unhealthy group. According to Koster, the work could have clinical relevance, “My findings provide evidence to suggest that doctors should also look at where fat is located, not just the BMI.”
Even though Koster’s fellowship is coming to an end and she already has plans to start her academic career in the Netherlands, her work with NIA will continue. She is currently setting up a sub-study of NIA’s Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study in Iceland using an accelerometer to objectively measure intensity of physical activity. Most current measures of physical activity are subjective -- based on questionnaires that ask participants, for example, how active they were last week. In Koster’s protocol, researchers will examine 80-year olds to determine how specific activity levels and daily activity pattern relate to their health.
“I’ve been lucky with Dr. Harris as my supervisor. She gave me freedom to find my own research direction and let me lead the set up of an ancillary study within the AGES-Reykjavik Study. I’m leaving my fellowship not just knowing how to use data, but with experience setting up protocols and establishing working relationships with collaborators.”
When not working in the office, Koster enjoys working out. She goes to the gym several times a week and loves bicycling, she jokes, “I’m from the Netherlands, we’re born on a bike.”
Read more about NIA’s fellowship program, and learn more about other NIA fellows in the spring 2010 issue of Links, www.nia.nih.gov/about/features/links-minority-research-training-spring-2010. 
How can I keep my heart healthy as I get older? Is my mother’s pain normal? I’ve been smoking for 30 years—can I stop at my age?
These are just a few questions that people may ask themselves. NIA’s three new Vivir Mejor la Tercera Edad fact sheets (Spanish language AgePages) on heart health, pain, and smoking cessation have answers to these questions and more. Each fact sheet includes a basic overview of the subject and a list of organizations to contact for more information.
NIA also recently updated its Spanish-language AgePages on stroke, aging eyes, foot care, and hyperthermia. They’re part of 38 topics of interest to older adults, families, and caregivers.
Visit NIA’s website to read, download, or order:
On November 17-18, 2011, NIA will hold its two-day interactive forum, the Grants Technical Assistance Workshop for Minority and Emerging Scientists and Students. During the workshop, NIA staff and associated faculty members will present information and provide technical assistance on applying for NIA grants. Participants in the workshop, depending on career stage, will have an opportunity to make podium presentations of current or planned research projects and receive feedback from peers and NIA staff. The workshop will be held immediately before the 2011 Annual Scientific Meeting of the Gerontological Society of America, in Boston, MA. Participation is by competitive application. NIA encourages applications from members of groups underrepresented in aging research and investigators committed to research careers related to minority aging issues. Applicants should be pre- and post-doctoral students or recent recipients of Ph.D., M.D., or related doctoral degrees; new to the NIH application process and/or embarking on an independent program of research; investigators with less than 5 years of research experience; and U.S. citizens, non-citizen nationals, or permanent residents.
Applications are due by Friday, July 22. For information and application forms, please contact Andrea Griffin-Mann at 301-496-0765 or email@example.com .
We asked for updates and you responded. Former Summer Institute on Aging attendee Chih-Hung Chang, Ph.D. reports:
I have just accepted an invitation to serve as a member of the Nursing and Related Clinical Sciences Study Section for a four-year term. I feel privileged to have this opportunity after serving as an ad-hoc reviewer on many review panels since 2005. I value very much of what I learned from the 2003 Summer Institute on Aging Research and NIA’s advice and guidance when I began my career on aging research.
Chang is Associate Professor of Medicine and Director of the Methodology and Infometrics Section in the Buehler Center on Aging, Health & Society at Feinberg School of Medicine, Northwestern University. He is also an adjunct professor at the Graduate Institute of Biostatistics of China Medical University in Taiwan.
We are always interested in hearing from all our program faculty, alumni, and students. Please send us your update and let us know if it can be shared with our readers. We also welcome any feedback about the Links newsletter.
Work Group on Minority Aging and Health Disparities
Office of the Director, National Institute on Aging
Building 31, Room 5C35, Bethesda, MD 20892-2292