eMindful

By LINDSEY TANNER,  AP Medical Writer – Mon Apr 26, 6:26 PM PDT

Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests. The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

“You don’t need to be extreme” to be in the healthy category, Kvaavik said. “These behaviors add up, so together it’s quite good. It should be possible for most people to manage to do it.”

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations. June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity. The findings don’t mean that everyone who maintains a healthy lifestyle will live longer than those who don’t, but it will increase the odds, Stevens said.

Too much body fat linked to wide range of the disease, researchers say

One night during my training, long after all the other doctors had fled the hospital, I found a senior surgeon still on the wards working on a patient note. He was a surgeon with extraordinary skill, a doctor of few words whose folksy quips had become the stuff of department legend. “I’m sorry you’re still stuck here,” I said, walking up to him.

He looked up from the chart. “I’m not working tomorrow, so I’m just fine.”

I had just reviewed the next day’s operating room schedule and knew he had a full day of cases. I began to contradict him, but he held his hand up to stop me.

“Time in the O.R.,” he said with a broad grin, “is not work; it’s play.”

For several years my peers and I relished anecdotes like this one because we believed we knew exactly what our mentor had meant. All of us had had the experience of “disappearing” into the meditative world of a procedure and re-emerging not exhausted, but refreshed. The ritual ablutions by the scrub sink washed away the bacteria clinging to our skin and the endless paperwork threatening to choke our enthusiasm. A single rhythmic cardiac monitor replaced the relentless calls of our beepers; and nothing would matter during the long operations except the patient under our knife.

We had entered “the zone.” We were focused on nothing else but our patients and that moment.

But my more recent conversations with surgical colleagues and physicians from other specialties have had a distinctly different timbre. While we continue to deal with many of the same pressures that my mentor dealt with — decreasing autonomy, increasing administrative requirements, less control over our practice environment — the demands on our attention have gone, well, viral.

Extreme multitasking has invaded the patient-doctor relationship.

Now, along with the piles of forms to fill and blinking lights of phone calls on hold, are threads of text messages, columns of e-mails and lists of electronic medical record alerts to attend to. In this ever-widening sea of distractions, all that once gave meaning to our work and allowed us to enter the zone — the operations, the diagnostic saves, the lifetime relationships — have turned quaintly insufficient.

As one surgical colleague confided, “I still like operating, but it’s not enough. There are so many hassles it’s hardly worth practicing.”

Or as another doctor said to me recently while simultaneously typing an electronic medical record note, checking e-mail and holding a phone to his ear, “It used to never bother me to put in extra time at work. But I cannot do that anymore.”

The time pressures and demands that drive this endless multitasking and loss of focus on patients have contributed to high rates of burnout among physicians. Depending on the study, anywhere from one out of every three to more than half of all doctors is suffering from burnout, with potentially devastating clinical implications. Doctors who are burned out are more likely to depersonalize their patients and treat them as objects rather than as individuals suffering from disease. They are less professional, exhibit less empathy and are more prone to making errors. And these physicians are also more likely to become depressed, commit suicide and leave a profession that is already facing severe shortages in specialties like primary care.

As with most other occupations and aspects of our lives, it is probably impossible to hold back the rising tide of demands on our attention. But within the clinics, the wards and the operating rooms, is there a way for physicians to do all their work and maintain their focus on the patient in front of them, without accelerating the rate of burnout?

It turns out that working and living in the zone, not just getting into it on occasion, may be one solution.

Last month, The Journal of the American Medical Association published the results of a study examining the effects of a year-long course for primary care physicians on mindfulness, that ability to be in the zone and present in the moment purposefully and without judgment. Seventy physicians enrolled and participated in the four components of the course — mindfulness meditation; writing sessions; discussions; and lectures on topics like managing conflict, setting boundaries and self-care.

The effects of the sessions were dramatic. The participating doctors became more mindful, less burned out and less emotionally exhausted. But two additional findings surprised the investigators. Several of the improvements persisted even after the yearlong course ended. And, those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.

I asked Dr. Michael S. Krasner, lead author of the study and an associate professor of clinical medicine at the University of Rochester, about mindfulness and its effects on physician burnout and the patient-doctor relationship.

“We all use mindfulness at some point,” Dr. Krasner said. “It’s not something that you go out and get, but it’s something you can cultivate.” Some examples of mindfulness in everyday life include nursing a baby, attending to a young child in distress or, for surgeons, being engrossed in an operation. “Mindfulness allows us to be in a whole host of situations with a sense of equanimity. We don’t get sucked into how charged an experience is but are simply having that experience.”

While many physicians try to be present for their patients, “there are so many other distractions and traps that pull us away,” Dr. Krasner observed. Those distractions can make practicing mindfulness particularly difficult. “It’s one thing to sit and be comfortable with oneself. But trying to be mindful in a busy clinical practice can be really challenging.”

Over time, the persistent distractions of such a practice can lead to burnout. For many of the study participants, “they barely recognized certain experiences as either powerful or challenging before they moved to the next experience,” Dr. Krasner noted. The word “silo” came up again and again during the course, and the physicians recounted how they “kept their nose to the grindstone” and rarely reflected on their work. “It becomes easy to look at our patients as objects,” Dr. Krasner said, “rather than appreciating the meaning and joy of an experience, even if that experience is difficult. But lack of meaning goes hand in hand with ineffectiveness and a lack of well-being as a physician.”

Acquiring the ability to be mindful in the most challenging circumstances can do more than improve a physician’s well-being; it can also sharpen clinical skills. “If something goes wrong and you fail to notice,” said Dr. Krasner, “you end up going down one path in your care. But if you fully accept these challenges — not resign yourself to them but fully accept them — you can see more clearly and proceed down a path where you have a better chance of success.”

Dr. Krasner acknowledges that courses like his may not be helpful for every doctor. “There are people who aren’t going to be interested because it may seem different, even a little frightening, to get together with colleagues and be silent for a while, then talk about these things with one another.” Instead, he proposes offering physicians in the future a “menu of options” to choose from to help prevent burnout. “But I think mindfulness should be among the menu of educational interventions that are evidence-based.”

“Patients know when their doctors are or are not present,” Dr. Krasner said. “As a practitioner, I know when I’m really there for my patients and when other things are pulling me away and I’m not.” It seems fitting then that physicians, who are constantly asking their patients to be mindful — asking them to talk about how they feel — should also be able to do so themselves.

“One of the most wonderful things about practicing medicine,” Dr. Krasner said, “is that you have the opportunity to be in the middle of challenging events. Reflecting on those events while also holding them in your thoughts has to do with not only physician well-being but also patient healing.”

“If we can be mindful in the midst of those challenging circumstances,” Dr. Krasner reflected, “we can derive a greater sense of meaning from even the most demanding situations.”

Jacksonville Business Journal
by Kimberly Morrison

Ken Jacobs wasn’t looking for a ticket to nirvana when he embarked on a journey into the ancient spiritual tradition of yoga.

As a partner at Gray Robinson PA, long hours and high stress had begun to take a toll on his body. He took to running for relief from tension in his neck, shoulders and back, but instead ended up with knee pain and shin splints.

Like a good attorney, he switched strategies and headed for a yoga class at his gym. Three years later, he and a dozen other attorneys at his firm were practicing yoga together on a hotel lawn to get focused before an intense year-end law firm meeting.

Among the 16 million Americans practicing yoga, they represent a new class of yogis. They are neither the obnoxious yoga yuppie breed sporting $98 Lululemon yogawear, nor the incense-burning, Maharishi-loving hippie in search of enlightenment. These overworked corporate types are finding a practical application for yoga in their work life: balance.

Stress at Work and at Home Takes a Toll on Your Physical Health

Every year, millions of workers suffer disabling injuries and thousands lose their lives to work-related stress.

In the movie “Network,” a stressed out news anchor loses it on live television, “I’m as mad as hell, and I’m not going to take this anymore,” he screams as he storms off set.

Other movies feature employees crashing computers and bashing fax machines.

But are these examples of art imitating life?

Three-quarters of Americans in a new study say they experience nerve-racking moments at work — though few people are aware that those hostile job conditions can be deadly.

“Repeated exposure to workplace stress can definitely increase the risk of a heart attack, death or stroke,” said Dr. Pk Shah, director of cardiology at the Cedar Sinai Medical Center.

The Journal of American Medical Association study, whose results were published on Oct. 10, found people who return to a stressful job after recovering from a heart attack are twice as likely than those without stress to experience another one.

“This should be a wake up call not only for patients,” Shah said, “but also for employers, because employers should recognize that chronic exposure can have a very adverse effect on their employees’ health.”

Inner city high school teachers, police officers, miners and air traffic controllers are among those with the most stressful jobs in America, according to Health magazine.

“Four controllers that I have known over the years I’ve have been at O’Hare have died of a heart attack,” former air traffic controller Bob Richards said. “And you say, ‘Well, people die; that happens. Let me give you the ages — 29, 30, 38, 39. Now if that’s normal, then I must be missing something.”

And if someone thinks they can escape the stresses of work by going home, they should think again. A second study of 4,000 men and women published in the journal Psychosomatic Medicine said how someone argues with a spouse could also affect their heart.

Women who don’t speak their minds are four times more likely to die than those who do.

“One of the biggest coping mechanisms is not keeping your feelings bottled up,” ABC News workplace contributor Tory Johnson said. “By not venting by not making their feelings known whether it’s at home or work they are at greater risk for stress and all kinds of physical and mental illness.

ABC’s Andrea Canning contributed to this report.

COLUMBUS, Ohio – A new study here shows that even slight stress and anxiety can substantially worsen a person’s allergic reaction to some routine allergens.

Moreover, the added impact of stress and anxiety seem to linger, causing the second day of a stressed person’s allergy attack to be much worse.

Janice Kiecolt-Glaser

Ronald Glaser

The finding, the latest in more than three decades of study on stress and immunity, is important since allergic reactions are the fifth-most-common chronic disease in America, and medical costs to treat them can reach $3.4 billion each year.

In a report presented today (8/14) at the annual meeting of the American Psychological Association in Boston, Ohio State University researchers described recent experiments meant to gauge how psychological stress might affect allergy sufferers.

“Allergies are not minor problems,” explained Jan Kiecolt-Glaser, a professor of psychology and psychiatry at Ohio State.  “A huge number of people suffer from allergies and, while hay fever, for example, is generally not life-threatening, allergy sufferers often also have asthma which can be deadly.”

Some data suggest that 38 percent of the people who suffer from allergic rhinitis also have asthma, and that 78 percent of asthma sufferers have allergic rhinitis.

Kiecolt-Glaser and Ronald Glaser, professor of molecular virology, immunology and medical genetics at Ohio State, recruited 28 men and women.  All of the volunteers had a history of hay fever and seasonal allergies.

The volunteers spent two half-days in a research unit at the Ohio State University Medical Center.  Each time, they were given the standard skin prick test several times to determine their reactions to various allergens, and blood, saliva and serum samples were taken before, after and at several times during the research project.

All of the participants were given a battery of psychological questionnaires to determine their levels of stress, anxiety, self-confidence and feelings of control over situations.

On the day that individuals were assigned to the low-stress control condition, they were given the skin prick test and then asked to read from a magazine.  Then they were asked to tape themselves reading the same material aloud.

During the day that people were assigned to the experimental condition, however, they had a much tougher time.

“We used a ‘speech stressor test’ used in a lot of psychology research,” Kiecolt-Glaser said.

“Basically the participants each appeared before a panel of several ‘evaluators’ who supposedly were behavioral experts.  Participants had to give a 10-minute speech, which was videotaped, and then are asked a series of math questions they had to solve without paper or pen.”

Afterwards, they had to watch their videotaped performance.

“The whole exercise is a nice stress experiment in the laboratory,” she said.

The researchers measured the raised “wheals” that formed on the arms of the participants before and after they were stressed, as well as the next day.

“The wheals on a person who was moderately anxious because of the experiment were 75 percent larger after the experiment, compared to that same person’s response on the day when they were not stressed,” Kiecolt-Glaser said, signifying a stronger reaction.

“But people who were highly anxious had wheals that were twice as big after they were stressed compared to their response when they were not stressed.  Moreover, these same people were four times more likely to have a stronger reaction to the skin test one day later after the stress,” she said.

This next-day change – labeled a “late-phase reaction” – is important because it signals an ongoing and strengthening response to the allergens, and even suggests that sufferers may react strongly to other stimuli that previously hadn’t caused them to develop an allergic reaction.

Gailen Marshall, a co-investigator on the project and professor of medicine and pediatrics at the University of Mississippi, said that late phase, or delayed, reactions are typically unresponsive to the most common forms of allergy treatment, such as antihistimines.

“Late phase reactions also occur in allergic asthma and can, in the proper settings, be potentially life-threatening.

“The results of this study should alert practitioners and patients alike to the adverse effects of stress on allergic reactions in the nose, chest, skin and other organs that may seemingly resolve within a few minutes to hours after starting, but may reappear the nest day when least expected,” he said.

Partner Ronald Glaser, director of the University’s Institute for Behavioral Medicine Research, said that they stimulated cells taken from study participants and then measured the levels of cytokines like interleukin-6 (IL-6) that the cells produced.

Lymphocytes taken from participants during the study showed increased levels of cytokines like IL-6.  High levels of IL-6 are part of the allergic response to an allergen, Glaser said.  The researchers also measured levels of stress hormones called catecholamines and they were elevated as well.

He suggests that the raised levels of these compounds are to blame for the residual effects seen in the late-phase reaction.

“What’s interesting about this is that it shows that being stressed can cause a person’s allergies to worsen the next day,” she explained.

“This is clinically important for patients since most of what we do to treat allergies is to take antihistimines to control the symptoms – runny nose, watery, itchy eyes, and congestion.

“Antihistimines don’t deal with those symptoms on the next day.
People may be setting themselves up to have more persistent problems by being stressed and anxious when allergy attacks begin,” Kiecolt-Glaser said.

The researchers estimate that Americans pay $2.3 billion for allergy medications each year and $1.1 billion for doctor visits to treat allergy attacks.  Those amounts don’t include approximately 3.5 million workdays lost as well.

Working along with Kiecolt-Glaser, Glaser and Marshall on the project were William Malarkey, professor of internal medicine; Stanley Lemeshow, professor and dean of public health; Kathi Heffner from Ohio University; Kyle Porter, Cathie Atkinson and Byron Laskowski, all from Ohio State.

The research was supported in part by the National Institutes of Health.

By Belle Waring
Photos by Ernie Branson

The idea that the mind affects health and illness is thousands of years old, but only in recent decades have scientists tracked down the data. Now Ohio State University’s Dr. Janice Kiecolt-Glaser is adding to the growing evidence on the health consequences of stress. In her talk “How Stress Kills: New Perspectives on Stress and Inflammation,” she offered recent findings to a packed house in Lipsett Amphitheater.“She has done seminal work in a field with a long name,” said NIDCR’s Dr. Nadya Lumelsky in her introduction. That field is psychoneuroimmunology, the interdisciplinary study of brain, mind and immune system. “There was lots of anecdotal evidence, but Dr. Kiecolt-Glaser has shown a causal relationship between stress and other diseases.”

	Dr. Janice Kiecolt-Glaser

A clinical psychologist, Kiecolt-Glaser collaborates with her husband, virologist Dr. Ronald Glaser, at OSU’s Mind/Body Center, and has received support for 3 clinical trials from NCI, NCCAM and NIA. She was invited to speak by NIDCR as part of its translational seminar series.

How do scientists prove the effects of stress on health? One path is to follow the cytokines, among the most crucial proteins in the body. Cytokines, including the interleukins, carry messages vital to immune response. Part of that response is inflammation. As one of the body’s normal defenses against infection, injury, irritation or surgery, inflammation is not the same as infection. And acute inflammation is not the same as chronic.

“We need good inflammation,” said Kiecolt-Glaser, “because cytokines attract immune cells. With acute inflammation, good things happen. With chronic inflammation, you have troubles, because of its association with tumor cell survival” and other harms.

It’s an intricate process. Imagine tumbling down a ladder in a cascade of negative effects:

• Chronic stress can cause immune dysregulation.
• This dysregulation causes increased risk of disease.
• And that risk in turn increases the proinflammatory cytokines, including interleukin-6 (IL-6).

Kiecolt-Glaser’s studies show that “you can skip all the steps and go directly from stress to cytokines.”

Some highlights on how chronic stress affects health:

• Chronic stress substantially accelerates age-related changes in IL-6, a cytokine linked to some cancers, cardiovascular disease, type II diabetes, osteoporosis, arthritis, frailty and function decline. “It’s a new paradigm,” Kiecolt-Glaser said. “Cholesterol and the immune system work together to cause heart disease and stroke.”
• At 71 or older, age interacts with stress, and “the older you are, the more stress really matters.” It impairs vaccine responses in older adults.
• Turning to the young: When dental students on vacation were compared to those taking “a particularly dreaded exam—immunology,” no student healed as rapidly during exams. Oral wound-healing took them 40 percent longer.
• Personal relationships influence immune/endocrine function and health. Hostile couples’ wounds healed more slowly after conflict.
• Women show larger response to interpersonal stress.
• In caregivers (for example, spouses caring for their aging/ailing mates) the average rate of increase for IL-6 was about 4 times larger than that of non-caregivers.

Chronic stress increases proinflammatory cytokines, says OSU’s Kiecolt-Glaser.

“What happens when caregiving ends?” an audience member queried.

“Normal bereavement decreases after 2 years,” said Kiecolt-Glaser. “It doesn’t create a change in mood, long term.”

But for those exhausted by extended caregiving, “they lose part of their social networks, becoming increasingly depressed. You lose part of your life.”

A vicious cycle takes hold. “Patients with major depression will have even more depressive symptoms. The stressed get more stressed, serving as substrate for more inflammation. They are primed to respond more strongly to subsequent challenges.”

And although we know we’re supposed to take care of ourselves, “what we tend to do is to turn to high-fat diet, less exercise, poor sleep and smoking,” she said. “Stress promotes poor health behaviors…and sleep is one of the first things to go. If you didn’t sleep well last night, your IL-6 is higher today.”

Meanwhile, “Adipose belly fat secretes as much as three times the level of IL-6. Those fat cells act like little IL-6 factories.”

Moderate physical activity can help attenuate inflammation, she said. “Of course, when you’re stressed, that’s the last thing you want to do.”

Kiecolt-Glaser is also investigating the ability of omega-3 fatty acid supplementation to alter mood and inflammation.

There is, of course, good fat and bad fat. The history of dietary changes, along with epidemiological evidence, shows that “countries that eat more fish are better off,” she said. Also healthful are fish oil, walnuts, wheat germ and flax seed.

There is also the correct ratio of different types of fatty acids—in this case, omega-3 and omega- 6. That ratio is implicated in depression, cardiovascular disease and inflammation.

“This is nutritional neuroscience and psychoimmunology: interdisciplinary science at the crossroads,” she said. Depressive symptoms interact with diet to enhance inflammation. During Q&A, an audience member asked: When it comes to the stress of caregiving, does the individual have any control?

A big theme is the lack of control, she said. Changes in a spouse’s health status can be unpredictable and are some of the worst stressors, since treatments can be “hard to implement in real life.”

Her ongoing work includes how mind-body interventions such as yoga may modulate endocrine and immune responses.

(AP)

It’s no surprise that constant stress can make people sick, and now a team of researchers has figured out how.

A study focused on 119 men and women taking care of spouses with dementia. The health of the caregivers was compared with that of 106 people of similar ages not living under the stress of constant care giving.

Blood tests showed that a chemical called Interleukin-6 sharply increased in the blood of the stressed caregivers compared with blood of the others in the test. Previous studies have associated IL-6 with several diseases, including heart disease, arthritis, osteoporosis, type-2 diabetes and certain cancers.

The study also found the increase in IL-6 can linger in caregivers for as long as three years after a caregiver had ceased that role because of the spouse’s death. Of the test group, 78 spouses died during the survey.

“This really makes a link to why chronic stress can actually kill people,” said Janice Kiecolt-Glaser, professor of psychology and psychiatry at Ohio State University. “We haven’t had a good mechanism before.”

She explained that people under stress tend to respond by doing things that can increase their levels of IL-6.

For example, they may smoke or overeat; smoking raises IL-6 levels, and the chemical is secreted by fat cells. Stressed people also may not get enough exercise or sleep, she added. Exercise reduces IL-6, she said, and normal sleep helps regulate levels of the chemical.

It clearly points to the need to control stress better, she said.

The findings by the research group, headed by Kiecolt-Glaser and her husband, Ronald Glaser, a professor of molecular virology, immunology and medical genetics at Ohio State, appear in this week’s issue of Proceedings of the National Academy of Sciences.

Congressman Ryan discusses Mindfulness with Health and Human Services Secretary

Portland, Ore.

OHSU scientists are exploring alternative treatments for post-combat stress as part of five-year study

Oregon Health & Science University is beginning a research study to examine the different aspects of mindfulness meditation as part of an effort to find new ways to treat combat-related post-traumatic stress disorder (PTSD).

An estimated 15 percent to 50 percent of all veterans returning from deployment suffer from PTSD, although the exact number is unclear. In the case of veterans from Iraq and Afghanistan, 62,929 (21.8 percent) were diagnosed with post-traumatic stress disorder (PTSD) from 2002 to 2008 according to one University of California San Francisco study. Thousands of additional combat veterans from other wars also suffer from the disorder. PTSD causes veterans to experience increased anxiety, trouble sleeping, difficulty in relationships, and recurring unwanted thoughts and dreams about their past traumas that impair their normal functioning.

Mindfulness meditation has been shown to help people deal with anxiety, intrusive thoughts and sleep difficulties, issues similar to what people with PTSD face. OHSU scientists believe the therapy may help combat veterans as well. The university has begun a five-year study funded by the National Center for Complementary and Alternative Medicine, a component of the National Institutes of Health.

“People who suffer from PTSD have greater activation in the emotional processing part of their brain called the amygdala,” says Helané Wahbeh, N.D., a naturopathic physician-researcher at OHSU. “And they have less activation in their frontal lobe, which modulates their emotional response. Mindfulness meditation has been shown to help reorient the brain, so the frontal areas of the brain are better able to process over-reactive emotional responses that hinder people from leading normal lives.”

For example, a Vietnam veteran might be walking down the street when they hear a helicopter, and be overcome by intrusive thoughts related to their time in combat. If they suffer from PTSD, they may experience a flashback where they temporarily believe they are back in Vietnam. Mindfulness meditation should help them realize they are dealing with a memory or flashback, and not the actual combat situation, Wahbeh explained.

OHSU is seeking veterans between the ages of 25 and 65 to participate. Interested veterans can call 503-494-7399. The study is part of an ongoing series at OHSU’s Oregon Center for Complementary & Alternative Medicine in Neurological Disorders that seeks to identify complementary and alternative therapies that will effectively treat PTSD.

“The project described was supported by Award Number K01AT0004951 from the National Center for Complementary & Alternative Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Complementary & Alternative Medicine or National Institutes of Health.”

About OHSU

Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland’s largest employer and the fourth largest in Oregon (excluding government)… OHSU’s size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.