Category: health

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Swimming Pool

Summer time is the time to enjoy outdoors. Hiking, biking, climbing as well as swimming are high on the agenda. With the Olympic games 2024 around the corner we rise to the challenge and get started again with more sports activities. Swimming has many health advantages. Most people think of cardiovascular training and relieve of back pain. Exercise without carrying your body weight is great for your joints and ligaments. The benefits for psychological wellbeing have long been underestimated. Diving into silence under water even if it is only for some seconds or a minute calms your spirit. The water pressure holds you tight without restricting your movements. Breath control is an almost meditative experience. Everyone can do it, again and again. Childhood memories, good and bad, are associated with swimming. Choose your style, costume and pool. The summer break is an ideal occasion to test the marvelous experience again of cold or warm water. The cold water bucket challenge of everyday life takes a break. Time to find your pool again. (Image extract from Susanne Hay, Swimming Pool II, 1996 in private collection, exhibition in Yerres, summer 2023)

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Live longer

It is an old dream of mankind to live longer and longer. The Covid-19 pandemic has taught us many lessons that there are powerfully viruses and their continued mutations which threaten this. Life expectancy declined slightly during the pandemic and we learned that long Covid is yet another threat to our life expectancy. Scientists have found other sources that are crucial for survival. Like sepsis, it is the constant inflammation processes in our bodies. Long working times, stressful commute to work and interrupted or shortened vacations all contribute to keep inflammation at higher levels than is healthy from a longevity perspective. The research note published in Nature on the inflammation enhancing protein IL-11 highlights the chain reaction process of inflammation causing cancer and autoimmune disorders and diseases. Hence, it is essential to watch the biomarkers of inflammation and probably adjust our lifestyles accordingly. The sources of inflammation are manifold, but the potential rewards to address the issue are huge as well. Among the easy to address sources is nutrition, exercise and working life. Changing just a little bit here and there can make already a change. Monitoring how you feel about such changes puts you on a learning curve for your own inflammation levels. Vacation times are also perfect for adaptive behavioral changes. We just need to keep trying.

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Greening Brussels

We tend to believe that inner cities have lost the fight against traffic jams and climate change. However, the number of projects that stem the tide is growing and some have gained visibility beyond their immediate neighborhood. This is the case of an urban planning project in Brussels that has taken back space from urban traffic to the citizens living there. Planting new trees and a gardening space reserved for flowers changed the street into a pleasant environment where people meet and greet again rather than hold their breath and disappear as quickly as possible. Parking of cars has been reduced on the street and instead bicycle parking has become a hint towards more sustainable mobility in inner cities. Walking the city, staying and shopping nearby will allow behavioral change for healthier lifestyles. It needs a lot of persuasion to accomplish this impact and years of reaching majorities for such projects and the ability to raise sufficient resources to implement them. The additional challenge is the need to take care of the green spaces that only works with the support of neighborhoods assisting in the care and protection of the urban lungs. As the awareness to act against inner city heat and pollution increases the number of persons willing to act and devote resources as well as time for such projects increases as well. It is a long way to improve inner city health again, but these signs of exemplary projects will convince many other people that urban renewal can work to the benefit of people.

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Back pain

Most people know some form of back pain. This is understandable as an ever increasing share of people work in seated positions and spend additional leisure time in a similar position (gaming). Recurrent back pain is a frequent diagnosis. An Australien study has found a rather simple remedy for the widespread pain. The WalkBack experiment succeeded to significantly reduce recurrent lower back pain in study participants. Individualized and progressive walking accompanied by an education program did the trick. Keep on walking and try to extend the range of the exercise. It’s amazing to witness how the human body adapts to being challenged. Learning about the mechanics at work like the release of own personal “pain killers” hormones helps to trust in your body’s positive response to each dose of the challenge to pain. Do not walk too quickly too far. Stretching is a must and not an option. Go for it. Modern technology (in any smartphone) supports your efforts with counting your steps and measuring distances. Keeping track of a “pain diary” might give you guidance not to overdo the exercise and pause activities. Join a group of friends or people who are like-minded and get adequate shoes and clothes to feel comfortable while walking and afterwards as well.

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Nutrition Competence

Nutrition is a good example of how a long lasting disregard in education and learning systems has led to huge medical costs for individuals and societies nowadays. The obesity pandemic calls for urgent action and policy changes in the field of nutrition policies and learning goals for children and adults. Medical doctors have mostly discarded that it is also their responsibility to provide medical guidance on nutrition, as this is highly controversial at times and asks for behavioural changes of the patient. School teachers see little scope to act on the issue due to increasing demands in fields of literacy, numeracy, problem-solving, digital and communication skills. Hence, the hope is to fill the instruction and learning gaps with a hybrid approach of nurses taking on both roles and communicate with children as well as adults alike. This is a tough challenge for these persons, but hopes a high that they can make a significant improvement to the nutrition competences of individuals, pupils, their parents and specific target groups.
The starting point is to recognize that there is an issue with nutrition. The next to establish the best evidence and based on this to develop a curriculum for the nurses to be well-prepared for the challenge in the field. Even with the differentiation of different levels of competences, the learning has to be rather encompassing several related fields as well. Individual, behavioural as well as society-level factors like biology, technology, religious beliefs, economic and social factors determine nutritional choices and consumption. Just because there are so many factors to consider  does not justify to keep nutrition out of school curricula for example. Nutrition is a fine example of a topic which links disciplines across a broad range. It is a tasty, at times spicy mixture of issues to learn and apply. The former is the beginning, the latter the real challenge which needs ample and repeated guidance or coaching. (Image: Extrait of Abraham Mignon, 1640-1679, Undergrowth with flowers, animals and insects, MRBA Brussels)

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Nutrition Policy

The evidence on nutrition policies has accumulated a series of policy recommendations based on the best available evidence. The German Institute of Human Nutrition has presented these results repeatedly not only to the scientific community, but also to the interested public at the Science Week or the Long Night of Science. Their leaflet on the tools to improve our human nutrition in market economies highlights “nutrition competence” as a key component of a broad strategy to improve our food and subsequently health. Nutrition goes beyond the biological ingredients of food to include basic understandings of human metabolism including the times and timing of meals. This competence has to be transmitted to preschoolers, pupils as well as adults to stem the waves of obesity (ARTE Docu). Learning how to manage your own nutrition is a crucial competence to strive and survive. In schools it can have substantial impacts on performance and inequality of opportunities as well.

The science-based policy recommendations propose to alter the structure of costs, for example via tax reductions, in favor of healthy food. Plain water should be substantially cheaper than sweet beverages or alcoholic drinks. Nuts and proteins from vegetables fall in the same category as plain water. It is in the longer term interest of all of us that schools, canteens at work places or homes for the elderly offer also healthy nutrition at least as a daily option. More sustainability in food production is last, but not least part of nutrition policies. A lot to chew on to improve nutrition.

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Food Future

What do we have for dinner today, tomorrow or in 10 years from today? Research Institutes presented some of their insights based on solid evidence in the open door event in Berlin. The 5 years of the project “food4future” are over and my glance through some of the results suggests that we shall have many more proteins, most from vegetable sources, on our plates. The arguments for improved sustainability are rather compelling. The taste of these products that currently have higher amounts of bitter taste might be solved. Similarly sea food beyond fish like halophyte will enter our diet. The salty taste can be incorporated in meals in which we add salt or other spices anyway. These elements might make it possible to feed the 8 billion people on our planet. We probably also need to include protein rich insects in the meal plans of the still growing human species. It appears like a rather long shot into the future of nutrition, but if we do not think ahead and start the change in our mindsets we shall be badly prepared for the future and more people will decide to seek food in other places of the earth rather than stay hungry. It also helps us to refocus our priorities in nutrition and aim for a better balance of the pleasures of eating and sustainability. The issue of food for future generations starts with food for thought in the abundantly nourished Northern parts of the planet. (Image: AI Copilot, Prompt: 2 couples enjoy eating a meal of halophytes and insects, 2024-6-25)

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Betting vice

Betting is considered a vice. The industry has moved from the local bookmakers to the internet and is spread across countries and continents. Some legal advisers have classified betting as the fastest growing vice industry and it is about time to launch a wake up call for more oversight of what is going on in the sector. As betting like gambling seems to be working in conjunction with other addictions the potential of cumulative risks is quite high. Our brains tend to wire things together which frequently occur jointly. It is difficult to disentangle these co-occurrences later again. The major angle of attack is prevention.
Health journals start warnings of the detrimental effects persons and observe that the industry follows similar strategies as the tobacco industry to address as many people as possible. And this is very successful and profitable for them. Hence, prevention strategies should also follow what has been applied to smoking like the ban from restaurants and bars as well as the restrictions on advertising. We will have to accept that betting and gambling should not be as easily accessible as it is currently. Age restrictions have to be applied stringently. I bet this will take quite a long time until Europe and elsewhere the regulations will change. Some of the young get interested in even more stimulating activities like exploring arts (image below class at Neue Nationalgalerie Berlin 2024-6) rather than betting on who is going to win the Euro 2024 football matches.

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Smoke Gamble

Smoking is like a gamble. Your input is your health and money. This is not including those who might rely on you or family relationships that might suffer one way or another. The other link has gambling at its source and smoking goes along with the continuous risk taking or the belief to be able to master the risks involved with both forms of potential addictions. Research has accumulated evidence that in fact both smoking and gambling occur frequently in combination with each other. Taking risks against the odds of suffering losses, maybe only in the medium or longer run perspectives like for health seems acceptable for those people. Society has put rather high taxes on both activities to discourage people and invests in prevention of addictions. However, it does not have substantial effects on people as smoking remains around the same level and gambling (poker online) or betting on sports (Euro 2024) are rising rapidly. Vaping and internet gaming have broadened the spectrum of addictive behaviors mostly for younger persons and young adults. The risks are manifold and increasing in their addictive potential since the smartphone is always in some pocket just like the smoking device. The behavioral turn in the social sciences has been well understood by the industries as well. The stakes for human development are high in this endeavor to offer young people equal opportunities at entry into adulthood.

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Cannabis Alcohol

The use of cannabis and/or alcohol is yet another question where we are used to ask questions in the form of: either the or the other? Over generations we have gotten used to no longer ask for each do you or don’t you. With the controlled liberalization or legalization of cannabis in some Western European states the framing of the question is more like you do the one or the other, particularly for many younger persons.
Decriminalization of both drugs in small quantities is apparently reducing crimes link to drug use and drug dealing. On the other hand, the thresholds for doing drugs are lower than they used to be. In inner cities it is therefore no longer a surprise to find both kinds of drugs with addictive potential next to each other (see image below). We know that it is a slippery road from regular drug use to uncontrolled dependency and personal disaster. For cannabis a study published in the Lancet (Petrilli et al. 2022) added the importance of the potency of tetrahydrocannabinol to the estimate of risks. This is similar to the studies that differentiate the level of alcohol in drinks consumed. The higher the concentration, the higher the risks. A simple proportional relationship prevails in both drugs. The cumulative effects of consuming both together might have quite surprising non-linear effects.
The big issue is the risks of mental health related to these drugs. However, the causal direction is not easy to detect. Drugs induce mental health problems, but also mental health issues lead to drug abuse. This remains quite a puzzle for scientists to disentangle.
Additionally, the link to smoking and addiction to nicotine is a frequently observed corollary. Studying just one single source of health problems and addiction might be too restrictive to learn about the whole set of causal effects and casualties. For the time being we seem to jump from one field of attention to the next one ignoring the multiple interrelated factors at hand.

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Smoking Vaping

Both smoking and vaping are big business. Nicotine is well known for its addictive capacity. Once started, it is very hard to give it up again. For many decades we devote considerable efforts and costs to encourage people to give up on smoking or, better, not to start smoking in the first place. The young are particularly vulnerable as damages persist for a longer time. Progress has been made to reduce passive smoking of children and people in restaurants, at work and public spaces. The relatively recent trend of vaping instead of smoking is considered less harmful, but scientific long-term evaluations, whether these effects are lasting for several years, are still missing.
A repeated cross-section study in England (Tattan-Birch et al. 2024) has revealed that the declining trend of nicotine use has already been reversed among youth due to the rise in vaping. Vaping seems to move from the fashionable niche product to the popular mainstream among youth. The addicts are only cost-sensitive on the margin. The relative prices of smoking and vaping might play a role to put people on different health trajectories. The question is not between either smoking or vaping, but for some it is both, although it should be none of both. The question of smoking yes/no is likely to be framed as either vaping/or smoking.  The re-framing of the question shows the harmful potential in the longer run. We shall have a hard time to convince people and particularly youth not to be tempted by either/or but to focus on their long-term health trajectory and potential. (Image: Extrait from Arnold Böcklin, Self-portrait with death playing the violine 1872, Alte Nationalgalerie Berlin)

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Forecasting floods

As floods as becoming more frequent and more severe forecasting of such events is crucial. The recent example in Bavaria (Germany) of the Danube river (2nd longest in Europe) has demonstrated the role of forecasting to spur adequate behavior of people living in areas at risk of flooding. With the weather forecast announcing lots of rain for a large area the forecasting of floods needs to follow closely these trends. It is not only a question of expectations, but an issue of adaptive expectations for people to adopt appropriate precautions. In retrospect the early forecasts turned out to be fairly accurate in terms of the peak of flooding to be expected in June 2024. The Bavarian “Hochwassernachrichtendienst” (no joke, one word) forecasted on the 2nd of June about 7.50 as the peak to be reached in 2 days in the city of Kelheim. This was beyond the usual 4 warning levels based on an escalation scale. The forecast was beyond the frequent flooding levels established in the last decades. People and emergency services would have to adapt their expectations accordingly. Renewing forecasts is essential to guide people and services in their efforts to deal with emergencies and repair damages as flood levels recede. Management of crises critically depends on forecasting even if they are obviously prone to error margins which should usually be reported as well just like in weather forecasts. Adaptive expectations are key in combination with forecasts to ensure survival.

Hochwassernachrichtendienst Bayern 2024-6
Kelheim on Danube
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Marketing bicycles

The marketing of bicycles has changed considerably over the course of history. Today’s narrative is more about the eco friendly impact of it. Historically the freedom aspect of free movement and emancipation of women was at the forefront. The collection of images in poster formats presented at the DTM in Berlin is impressive. The focus on women on bicycles is quite surprising for this early time around 1900. Few of the companies from the early days have survived until today. Bicycles are still fascinating children and adults today. The experience of a fragile equilibrium, your own strength and weakness in muscle power, cardiac or pulmonary strength is always challenging. It is you who is in control of speed and direction. This should be easy to sell to the masses, and it was and still is. “Bikenomics” is here to stay. Artists had the same impression and created a whole universe of promises for riders of bicycles. The long run health benefits were not even known at the time, but it was unthinkable that humans would spend most hours sitting in offices, cars and on their couches. The biking story needs to be retold to encourage people to take up the emancipating storyline again. Get on your bike again!

DTM Berlin 2024-6
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Bikenomics

There is a whole cluster of enterprises associated with bicycles. Selling a bike is only the first we might think of. Repair works are the most tricky part of bikenomics, a bit like bidenomics. In many cities during spring and summer it is even more difficult to get an appointment for bicycle repairs than for a doctor’s appointment, and that can be hard at times. Shortages of skilled technicians are pervasive in this sector. DIY for do it yourself is the best alternative. With the arrival of e-bikes and the digital connectivity the skill set has been enhanced recently as well. Insurance for bikes, lockers, helmets, airbag system or clothing including spectacles are part of the standard safety and security set of bicycle riders nowadays. Many, many job opportunities there and the willingness to pay for bicycles has steadily increased over the last years.

Berlin has just seen its 48th bicycle demonstration in 2024-6 on roads including 2 motorways with several ten thousands of participants. In a star like fashion multiple tracks met at the city center. The final meeting with stands and information was at the Deutsche Technik Museum with refreshments and repairs. The exhibition of cargo bikes and taxi bikes or “rickshaws” was another highlight. We need to rethink our mobility concepts and try to get the sharing to work more comfortably. For different purposes and activities you need a different bike. Ownership of each is no longer adequate as for example with aging alone your preferences for mobility with bikes also changes. Sharing is caring and this is also part of bikenomics.

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Cars electrified

It is not only cars, but the whole automotive industry that got somehow electrified. The U.S. have imposed a 100% tax on electric cars produced in China recently. Europe is feeling the heat as well (compare Fressoz in Le Monde 31.5.2024). Production of cars is not a for fun activity. It is firmly embedded in our economic system which believes in profit maximization even at high environmental costs. Therefore, the production of cars follows the logic to build cars that generate the highest profits. Bigger cars yield bigger profits and this has been known for decades. Why should we expect our car producers to deviate from this logic. Investors push hard in this direction as well. Small e-cars generate small profits. This can only be economically valid if large numbers are produced. China’s home market has the market size and air pollution levels that make this a viable strategy also for the lower income people. If not sold in the US or Europe, the home market is able to absorb huge amounts of electrified cars. Downsizing of cars needs to happen particularly in inner cities. The implementation of this is not going to be easy and without resistance.

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Competence Gardening

Primary Schools in Berlin have the possibility to participate in the “Gartenarbeitsschule”, the school with learning goal of gardening. It is an interesting option to go out into the real world and deal with nature, sustainability, consumption, climate and many other topics. Voltaire could complement the curriculum in philosophy with his biographical links to gardening. The access to the fields is easy next to one of the central train stations and a larger urban reforestation project as just one example of the 15 overall in Berlin in 2024. (Südkreuz, Südgelände). Hands-on experience of gardening can address multiple forms of problem-solving competencies. Beyond the use of AI, a major advantage is the possibility to train collaborative problem-solving. Beyond the multifactorial approach in determining what to plant, the organization of the implementation and individual contributions towards the realization, all these elements are learning goals. The scope of learning qualifies gardening for learning well beyond primary school as well. It is a nice example of lifelong and lifewide learning even a hundred years after their wider applications in Berlin.

Gardening School, Berlin 2024
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Patient Empowerment

The empowerment of patients is a well-established practice in the treatment of diabetes. Measuring your own blood sugar and adjusting your medication to the self-monitored data is common practice. For patients with high blood pressure this patient empowerment is less prevalent. A medical study carried out in Valencia (Spain) by Martínez-Ibáñez et al. (2024) has tested the effects of such a self-monitoring and self-medication experiment.
The results publishes in (JAMA) gave rise to considerable attention in the profession as the empowerment of patients is one way out of the likely increasing shortage of medical professionals in aging societies. Whereas other studies found that total costs to the medical system might increase, the study in Spain provides evidence of the cost-reduction effect of such an empowerment. 24 months after the beginning of the trial. After the establishment of a “medication based on an individualized prearranged plan used in primary care” the self-administering participants achieved a significant decrease in their blood pressure that lasted until the end of the study after 2 years. The drop-outs of the study seem to follow a random pattern.
The conclusion gives support to the potential of patient empowerment in the widespread treatment of higher blood pressure beyond the regular visits of medical doctors. The monitoring of changes in lifestyle add to this to keep the costs of health care under control in aging societies.

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Camparing Covid-19

In the middle of May 2024 we tend to believe the Covid-19 pandemic is over. However, towards the beginning of the year 2024 in the U.S. we observed at the peak about 2500 deaths per week. In Germany deaths/week amounted to 250. Compared to the overall population size killing is more pervasive in the U.S. than in Germany. The map of the specialized agency “Centers for Disease Control and Prevention” (CDC) in the U.S. shows the coastal regions to be more affected than the center. Population density seems to be still a driver of the spread of infections, illness and deaths. The timeline of deaths due to Covid-19 infections for Germany follows a broadly similar pattern, albeit on a lower level even if roughly accounting for population size (RKI-data). As we tend to forget what the pandemic caused as social and economic disaster in societies, we have to stay alert as the major prevention of Covid-19. Learn to live with the virus around us. This means to keep up our preventive levels of hygiene as well as monitoring of trends.
Many thanks to all those who do the sometimes boring number crunching for us. This includes the medical doctors who bother to do the timely reporting of new infectious diseases on a regular basis.

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Killing me softly

The problem with pollution is, it is killing you softly from inside. It is almost impossible to escape air pollution as it is pervasive in cities, but also in the countryside where you do not expect it that much. This is the result of the study by Kuzma et al. (2024) published in “The Lancet Regional Health Europe”. Based on a data set of 8 million persons from Eastern Poland the effects of air pollution on myocardial infarction incidence was analysed. The use of the “European Union’s Earth Observation Programme” contributed data on air pollutants like PMs, BaP (benzo(a)pyrene), SO2 and NO2 concentrations. The multi-level data of 5 voivodeships, 101 counties, and 709 communities in Poland allows to differentiate the effects of damage to the heart tissue on cardiovascular disease. The other well-known factors are arterial hypertension, diabetes, obesity, chronic kidney disease, hyperlipidaemia, and smoking as most of us know already. The effects of  BaP (benzo(a)pyrene) is shown for rural areas despite the lower observed traffic density in these areas. The killing occurs softly from within our bodies by just breathing in and out, and in and out continuously. The disease burden in these regions is observed with “recorded 63,154 hospitalizations and 5921 in-hospital deaths (9.4%) due to STEMI; and 76,543 hospitalizations and 4079 (5%) in-hospital deaths due to NSTEMI”. In short, the need to reduce air pollution further is an urgent demand that saves lives eventually.
(Image from public domain wikipedia or “do-it-yourself” here).

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Silent Pandemic

There is a pandemic that is silently spreading across countries and continents. It only indirectly related to the Covid-19 pandemic. The medical journal “The Lancet Respiratory Health” (2024) has an editorial about the inequities of asthma as they develop over the life course. The development of asthma has pre-natal, genetic, environmental, life-style and socio-economic co-determinants. The study of respiratory disease, therefore, is a multi-factorial issue, which needs to disentangle the specific influences. Smoking as well as obesity have an impact on asthma, instantaneously or with delayed time effects of sometimes many years. Hence, it is important to take the whole life course into account, if we want to address the rising disease burden of asthma. Air pollution and heating-up of the planet are important drivers of the silent asthma pandemic across the globe. The social distribution of people working in “asthma- prone” work environments and/or living in highly polluted urban, suburban or rural areas near high frequency traffic is another latent factor causing huge costs to persons and society as a whole. Health inequity is growing over the life course. This is not easy to tackle as policy target as the onset of the disease has no single trigger, but rather a combination of influences that contribute in varying amounts to the evolution of respiratory diseases. (Image air pollution https://aqicn.org/map/germany/de/)

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Weight Stigma

The fashion industry has for a long time produced images of mostly women and men that did not correspond to the normal weight distribution of people. Skinny models were present across all media. The so-called social media of today amplify this trend further. The “Barbie hype” has reinforced the idea of low weight as a socially desirable norm. In scientific research the term coined for this phenomenon is “internalized weight stigma” (IWS). A study shows (Highes et al. 2024) it affects more women than men and more people who are described as socioeconomically disadvantaged adults. Pressure to lose weight originates from multiple sources and social media platforms have given rise to bullying. A major outcome of IWS is eating disorders as eating is often wrongly associated to be the only cause of higher weight. It is not. Many other factors contribute to the actual weight of a person. Even the overuse of the body mass index (BMI) as short hand version to define overweight or obesity is misleading for persons with strong muscles. Just fixing on one parameter of body shape or weight tends to reinforce weight stigma. “Keep walking” and a regular healthy diet, this avoids to internalize a weight stigma. Exercise is fun, the more you do it in a group, the easier it is to get going regularly. We ought to keep trying and eventually it will become a routine.

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Screening Paradoxon

In the field of public health the screening paradoxon is a well-known feature of large scale programs to check for and contain the large increases in cancer among populations. A recent medical study underscores the necessity to curtail the screening paradox in Europe. The screening paradoxon is defined as “the underuse of screening by those with unhealthy lifestyles and high risks”. The opposite cases, “the overuse of screening by those with healthy lifestyles and low risks” only cause a problem for the costs of the health system as those unlikely of attaining a form of cancer make extensive use of screening. In terms of social inequality we have to be concerned about both ends of these distributions. The publicly available screening programs are skewed towards the higher educated with risk awareness as well as healthy life styles. More of them participate in screening. The other distribution of actual risks and detection of cancer is skewed towards the other end of the risk distribution. The 2 probability distributions overlap to an extent that is most likely co-determined by cultural factors like general attitudes towards prevention.
With the increase in cancer rates generally and due to demographic aging of societies, we shall need to target our resources devoted to health more precisely rather than spending too much on screening of people with very low risks. Increasing the duration between screenings might not impede detection rates of those with healthy lifestyles, but could allow to devote more resources to those people who are hard to reach by screening programs so far. Evaluations of such programs are necessary to judge the need for more targeted programs.(Image own representation inspired by Ola et al. 2024)

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Time Perception

There are many different angles from which to look at time. Of course, we all do it several times a day or during boring meetings. The study by Ma, Cameron and Wiener (2024) highlights the bi-directional link of perceived time and memorability. Visual stimuli alter our perception of time. Watching a video we all make the experience that the perceived length of the time spent watching varies according to content and maybe only the cutting technique applied to shorten the perceived length. Similarly it has been demonstrated that looking for longer at an image and grasp the meaning or implicit story we tend to remember the image for longer. In courts it is a usual procedure to question the memory capacity of persons and the sources of bias. The study by Ma et al. demonstrates the impact of the size of the scene, how cluttered it is and aspects of memorability in visual perception. Our memories are co-determined by these factors. The other direction of causality i.e. that memorability determines the time perception seems equally at work. This apparent undetermined element, so far, calls for additional care when analyzing recall from memory. Memory is not only selective in terms of content, it also is subject to the impact of all sorts of visual stimuli.
Time can be many things. For humans it is everything but exact. In science we measure time with ever more exactitude and try to standardize time on the moon now. In addition to exact time, humans have perceived time and subjective versions and even concepts of time. About time to take time more seriously.

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Hospital Bias

Asking people about differences between private and public hospitals, you are most likely getting answers that the private hospitals deliver superior patient outcomes. Whereas private hospitals seem to have a positive stigma attached to them, public hospitals commonly have a negative stigma. Scientific evaluations are helpful to set the record straight again. The study published in “The Lancet Regional Health” in 2024 shows that in the simple descriptive statistics on several patient outcome indicators, this is what the data showed between 2026 and 2019. However, a more precise statistical analysis reveals that there is also a selective admission to the private and public hospitals in England. Using so-called instrumental variables approaches that account for the selection process between admission to the 2 types of hospitals (private versus public) most of the differences between the hospital types disappear. The underlying mechanism is a sorting of different patients into the private or public hospitals. Put in easy words, for a routine intervention people tend to chose the private hospital, but the more rare and difficult operations were more likely admitted to public hospitals. The number of co-morbidities (heart disease) is also of importance as they might negatively affect patient outcomes. Jumping to conclusions and reinforcing stigma about public or private provision of services hinders progress and an equitable provision of services.
The analysis of a potential selection bias can reveal the “creaming” effect of private provision of (health) services. Just caring for the “easy” or routine cases and avoiding the more difficult and costly cases has economic advantages, but for society as a whole the costs overall remain the same. A good public service in health is a definite asset.

(Image: Exposition Isa Genzken 2023 in Neue Nationalgalerie Berlin)

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Digital Estonia

The progress of Estonia in going digital is quite advanced. The electronic identity card which allows data to be linked to health data and accounts or banking gives an impression of how far-reaching digitalization may go. Great steps have been taken to guide the population on the way to move towards the digital (only) world. Learning and coaching of a huge amount need to take place so that people do not abandon or get lost on the path towards “everything digital”. For the so-called digital natives, who have grown up with the sound of their smartphone at the bedside all the time, this move feels “natural”. Some experienced or silver workers got on track, if they were accompanied in suitable forms. The 65+ population might find it harder to adapt to the permanent use of digital devices for not only getting around in your city, but also to do your tax declaration, pay your dues and vote in elections.
Digitalization is not a goal in itself. It has advantages to reach communities in remote places or islands, but it might alienate older persons that have no other person around to assist them in the digital only world. An easy way to get some social science data to inform the debate is to refer to Eurostat and the surveys with information about the “overall life satisfaction” of people (EU-SILC). Checking for some major countries of the EU and neighbours of Estonia with less digitalization the differences are rather small. In terms of overall life satisfaction (16+ years old) Estonia has been catching up to the EU-average mainly between 2013 and 2021. Since then, stagnation at the EU-average is what the data tell. A quick testing of the hypothesis that the older persons (65+) might not see the past evolution as rosy is reflected in the EU-data as well. Good pensions seem to drive the “happiness” of older persons in the EU more than good digitalization. Eventually the two features of a society will have to go hand in hand to improve life satisfaction to higher levels. (Image: Data Eurostat EU-SILC Life satisfaction 65+, selected countries 2013-2023, retrieved on 2024-4-23, comparison with table all ages here, Data source)