from the world's big
The Medical Life
Dr. Robert Rubino, founder of the Rubino OB/GYN Group, earned a BA in biology from Rutgers University and an MD from UMDNJ’s New Jersey Medical School in Newark, NJ. He completed a residency in obstetrics and gynecology at the UMDNJ University Hospital and now serves as Clinical Assistant Professor at that school’s Department of Obstetrics and Gynecology.
Dr. Rubino’s interest in highly skilled, office-based procedures that improve the lives of women has been a driving force for the practice. Under his direction, the Rubino OB/GYN Group has become known as the premier OB/GYN practice in North Central New Jersey for advanced out-patient procedures such as the Essure® sterilization procedure, Her Option® in-office cryoablation therapy, and the PapSure test.
Question: What drew you to gynecology?
Robert Rubino: You know, essentially, it’s kind of the nexus of medicine. It’s where all the disciplines kind of meet. There’s some internal medicine, there’s surgery, endocrinology, a little bit of pediatrics and some psychiatry, you know, so it’s kind of the area where if you like everything in medicine, it’s a natural discipline for a lot of folks then.
Question: What advice would you offer to medical students?
Robert Rubino: Well, it’s probably similar to what everybody told you along the way; you really have to have almost like a magnetism for the specialty or, you know, for medicine. So if you don’t feel like an undertow bringing you there, then you probably shouldn’t pursue it. But if you do feel that undertow, you eventually have to give into it so you might as well do it sooner rather than later. After, you know, five years in business, the undertow is still there.
Question: What are the challenges and rewards of private medical practice?
Robert Rubino: Well, I think balance and perspective is a daily challenge so you have to kind of remember why you did it and make sure you’re still happy doing the actual work, which for me, that’s easy, But you also, you know, you have to pay attention to the things that nobody wants to tell you about when you’re in training which is, you know, the business of medicine. It’s kind of our duty to really learn that, not only for our patients but for ourselves and our families that we support and I think always looking to keep it interesting. And for me, I’ve gone through all the clinical disciplines that interest me and I, you know, kind of grow into the next one. Electronic medical records was something that was a big part of my life for the last five years, converting my practice from the old paper chart to the digital records and now we’re all paperless. And that’s still an ongoing challenge, but I like that a lot. And then, you know, the new technologies that arrive, to investigate them, find out if they’re a flash in the pan or if they’re really something legitimate for the future and that’s always interesting.
Question: How does the current insurance environment affect your practice?
Robert Rubino: Well, I think after you come to grips with it, you shrug it off and say well, I’ll succeed and whatever I have to do to succeed, you know, I’ll adapt. And I think that philosophy serves anybody well. In our particular private practice, we do work out of a teaching hospital so we do teach residents and that keeps it interesting, but always adjusting to whatever, whether it’s insurance companies or new developments, you just have to kind of adapt and always pay attention to your core discipline of taking care of the patient and at the end of the day, paying attention to what you need to do to survive, which as long as you’re willing to work, you can do it.
Question: Do you welcome the concept of universal health care?
Robert Rubino: It depends on what somebody’s intent is, universal healthcare. I think government taking over healthcare, I just imagine going into Motor Vehicle and my experience there, and that’s kind of a simple task; medicine is too complex I think for one person to take care of it. I think our system here is not as bad as everybody says and, you know, I’m a member of it. And while it’s not perfect, I still think it breeds the best innovation in medicine. And still I think around the world, people look to this country for the innovation in medicine. And I think a universal system, while it sounds great ‘cause no matter what it is, we’ll have like one fix for everything, it just doesn’t work in medicine. So I think we can’t fix it, we have to just adapt to it and let it almost naturally run its course and see what we come with. But right now, the system is not as terrible as everybody thinks, but I think it could be continually improved.
Question: What improvements could be made?
Robert Rubino: Well, I think letting the consumer really drive the marketplace. So some people will choose now not to have healthcare because they’re banking on their health somewhat the same way maybe a twenty-one-year old won’t buy life insurance because they’re banking on the fact that they’ll be around for ten or twenty years. I think over time, letting the consumer spend their healthcare dollar I think would be in the long run cheaper than paying up front for insurance because to a certain extent, they’re just paying forward for their healthcare, it’s not insurance because they know the event of going to the doctor’s gonna happen. A lot of times insurance is paying for something that might not happen. Well, going to the doctor is going to happen for preventative care. So I think giving folks the option of paying as they go to the doctor and then maybe to put some money aside in a tax-free account to grow over time where they’ll be rewarded for staying healthy and maybe having some kind of safety net for
getting admitted to the hospital where your costs really take off. I think at the level of the office, we keep things inexpensive because it’s preventative care a lot of the times where the interventions don’t call into play all the services of other professionals.
Recorded on: 04/29/2008
Robert Rubino discusses his passion for gynecology, his advice to medical students, and his thoughts on the current state of health insurance in America.
Chronic irregular sleep in children was associated with psychotic experiences in adolescence, according to a recent study out of the University of Birmingham's School of Psychology.
A time for sleep<div class="rm-shortcode" data-media_id="Mt29uUqI" data-player_id="FvQKszTI" data-rm-shortcode-id="931343dee3c02121445e51e94ba22446"> <div id="botr_Mt29uUqI_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/Mt29uUqI-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/Mt29uUqI-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/Mt29uUqI-FvQKszTI.js"></script> </div> <p>Previous studies had already suggested a link between persistent nightmares in childhood and psychosis and borderline personality disorder (BPD) by adolescence, but researchers at the University of Birmingham's School of Psychology wanted to see if a similar connection existed between these mental disorders and other childhood behavioral sleep problems.</p><p>To do this, they scoured data from the Avon Longitudinal Study of Parents and Children, a longitudinal cohort study that followed approximately 14,000 children born in Avon, England, in the early 1990s. The study followed the children for more than 13 years. During that time, mothers filled out questionnaires asking about the children's lives. Factors looked at included housing, parenting, nutrition, physical health, mental wellbeing, environmental exposures, and so on. </p><p>The cohort study inquired about sleep routines, sleep duration, and awakening frequency when the children were 6, 18, and 30 months old, and then again at 3.5, 4.8, and 5.8 years. It also assessed mental health in adolescence using semi-structured interviews, such as the Psychosis-Like Symptom Interview.</p><p>"We know that adolescence is a key developmental period to study the onset of many mental disorders, including psychosis or BPD. This is because of particular brain and hormonal changes which occur at this stage," <a href="https://www.birmingham.ac.uk/staff/profiles/psychology/marwaha-steven.aspx" target="_blank">Steven Marwaha</a>, professor of psychiatry at Birmingham and senior author on the study, <a href="https://www.sciencedaily.com/releases/2020/07/200701125431.htm" target="_blank">said in a release</a>. "Sleep may be one of the most important underlying factors—and it's one that we can influence with effective, early interventions, so it's important that we understand these links."</p><p>After compiling the data, the researchers discovered an association between children with irregular sleeping patterns and teenagers with <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/about-psychosis/" target="_blank">psychotic experiences</a>—that is, episodes when the person perceives reality differently than those around them. Even when depression at 10 years old was considered as a mediating factor, their findings still suggested "a specific pathway between these childhood sleep problems and adolescent psychotic experiences." </p><p>Toddlers with shorter nighttime sleep duration and late bedtimes were likewise associated with a <a href="https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">borderline personality disorder</a>—a disorder marked by a pattern of varying moods, self-images, and behaviors—in their teenage years. Depression at age 10 did not mediate this particular association, suggesting a separate and more specific pathway. </p>
A more restful tomorrow<p>While the sample size was large and mental health was assessed with a validated interview, there nevertheless remain limitations to this data. For starters, sleep habits were based on mothers' reports. Because they came from memory, versus a more direct observation method such as actigraphy, these data may be prone to imperfect recollection and reporting error. There are also many confounders that could be secretly nudging the results, such as family conditions, prenatal medicines, and a host of environmental factors. Finally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024884/#:~:text=Sleep%20difficulties%20in%20youth%20with,fear%20of%20dark%20%5B13%5D." target="_blank">the relationship between sleep problems and mental disorders</a> is both complex and two-way.</p><p>As such, the study shows an association between poor childhood sleep later mental disorders but does not prove a causal link. Parents need not worry that a string of nightmares or the eternal struggle settle into bed will be the first ingredients in a witches' brew of debilitating mental disorders. The goal of the study, the researchers point out, is not to create undue worry but improve our ability to recognize the signs of at-risk children and deliver necessary interventions earlier.</p><p>"The results of this study could have important implications for helping practitioners identify children who might be at higher risk for psychotic experiences or BPD symptoms in adolescence, and potentially lead to the design of more effectively targeted sleep or psychological interventions to prevent the onset or attenuate these mental disorders," Isabel Morales-Muñoz, the study's lead researcher, <a href="https://www.healio.com/news/psychiatry/20200702/childhood-sleep-problems-linked-to-adolescent-psychosis-borderline-personality-disorder#:~:text=Sleep%20problems%20during%20early%20childhood,study%20published%20in%20JAMA%20Psychiatry." target="_blank">told Healio Psychiatry</a><u>.</u></p><p>If a parent reading this is worried that their child's sleep patterns are deleterious, the take away should not be despair over an unyielding fate. It should be to seek professional help as soon as possible to begin improving sleep duration and quality. Even if you aren't worried, it's worth remembering that childhood experiences lay the foundation for a lifetime of salubrious sleeping habits. It's so much more than beauty rest.</p>
Are we genetically inclined for superstition or just fearful of the truth?
- From secret societies to faked moon landings, one thing that humanity seems to have an endless supply of is conspiracy theories. In this compilation, physicist Michio Kaku, science communicator Bill Nye, psychologist Sarah Rose Cavanagh, skeptic Michael Shermer, and actor and playwright John Cameron Mitchell consider the nature of truth and why some groups believe the things they do.
- "I think there's a gene for superstition, a gene for hearsay, a gene for magic, a gene for magical thinking," argues Kaku. The theoretical physicist says that science goes against "natural thinking," and that the superstition gene persists because, one out of ten times, it actually worked and saved us.
- Other theories shared include the idea of cognitive dissonance, the dangerous power of fear to inhibit critical thinking, and Hollywood's romanticization of conspiracies. Because conspiracy theories are so diverse and multifaceted, combating them has not been an easy task for science.
Construction of the $500 billion dollar tech city-state of the future is moving ahead.
- The futuristic megacity Neom is being built in Saudi Arabia.
- The city will be fully automated, leading in health, education and quality of life.
- It will feature an artificial moon, cloud seeding, robotic gladiators and flying taxis.
The Red Sea area where Neom will be built:
Saudi Arabia Plans Futuristic City, "Neom" (Full Promotional Video)<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="c646d528d230c1bf66c75422bc4ccf6f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/N53DzL3_BHA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
A growing body of research suggests COVID-19 can cause serious neurological problems.
- The new study seeks to track the health of 50,000 people who have tested positive for COVID-19.
- The study aims to explore whether the disease causes cognitive impairment and other conditions.
- Recent research suggests that COVID-19 can, directly or indirectly, cause brain dysfunction, strokes, nerve damage and other neurological problems.
Brain images of a patient with acute demyelinating encephalomyelitis.
COVID-19 and the brain<p>A growing body of research reveals alarming neurological complications among COVID-19 patients. On Wednesday, for example, researchers from University College London published a <a href="https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408" target="_blank">study</a> in the journal Brain that describes how some patients have suffered temporary brain dysfunction, strokes, nerve damage, and other neurological problems concurrent with COVID-19.</p><p>Some patients suffered brain inflammation as a result of a rare disease called acute disseminated encephalomyelitis, which can cause numbness, seizures, and confusion. One patient in the study even hallucinated monkeys and lions in her home.</p>
Photo by Mario Tama/Getty Images<p>A separate study published in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198407/" target="_blank">Journal of Clinical Neuroscience</a> notes that some COVID-19 patients have also suffered neurological complications like impaired consciousness and acute cerebrovascular disease. The study notes that past viruses like MERS and SARS also seemed to cause neurological problems.</p><p>A troubling finding among this growing body of research is that some patients seem to suffer neurological damage even when respiratory symptoms aren't obvious. Additionally, scientists aren't sure whether damage from the disease will be permanent.</p><p style="margin-left: 20px;">"Given that the disease has only been around for a matter of months, we might not yet know what long-term damage COVID-19 can cause," Dr. Ross Paterson, joint first author of the University College London study, said in a <a href="https://www.eurekalert.org/pub_releases/2020-07/ucl-iid070620.php" target="_blank">press release</a>. "Doctors needs to be aware of possible neurological effects, as early diagnosis can improve patient outcomes."</p><p>If you've been diagnosed with COVID-19 and want to enroll in the study, visit <a href="https://www.cambridgebrainsciences.com/studies/covid-brain-study" target="_blank">cambridgebrainsciences.com/studies/covid-brain-study</a>.</p>