Research Roundup

    • February 27, 2012

Clinical Scholars
In a study published by Academic Pediatrics (December 1, 2011), Lenard Lesser, MD, MSHS, (’09) and colleagues assessed food options and environments at California’s 14 children’s hospitals and found “considerable room for improvement.” Hospitals that serve healthier food have the potential to change diets and improve health for patients, visitors and staff, Lesser said. The study, conducted in collaboration with RAND, received significant media attention, including Kaiser Health News, the Wall Street Journal, the Sacramento Bee, the San Francisco Chronicle, United Press International, National Public Radio and the PBS News Hour.

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Clinical Scholars
In a study published by the Archives of Internal Medicine (January 2012), Clinical Scholar Justin Fox, MD, (’10) and program alumnus/Yale program co-director Cary Gross, MD, found that among women 75 years or older who discussed screening mammography with their health care providers, few of them discussed reasons to forgo screening, nearly all women received a recommendation to undergo screening mammography, and less than half believed their health care providers sought their preferences about screening mammography. The authors suggest that taken together, these issues may contribute to high screening rates among women who are unlikely to benefit.

Preliminary results of a study by Clinical Scholars alumna Kelly Kyanko, MD, (’09) and her faculty mentor, Susan Busch, PhD, associate professor of health policy in the Yale School of Public Health, suggest that a possible factor in higher health care costs may be a higher use of out-of-network services by women than men. The study, which is pending publication in Health Services Research, received media coverage in HealthCanal.com.

In a study examining the effect of the August 2007 closure of the Martin Luther King Hospital in South Los Angeles, program alumna Kara Odom Walker, MD, MPH, MSHS, (’07) and colleagues found that the closure had a ripple effect for the primary care physician network in the area. Odom Walker, who interviewed 42 primary care physicians who were affected, identified a variety of disruptions to the care network, including reduced access to specialty care, overcrowding at nearby hospitals and emergency departments, delayed and poorer quality of care for patients, reduced communication and disrupted patient connections, and a loss of colleagues and opportunities to teach residents and medical students. The study, published in Annals of Family Medicine (November/December 2011), received media coverage in HealthLeadersMedia.com.

Contributing to his work on the health and health care of American Muslims, Aasim I. Padela MD, MS (’08) assistant professor of medicine and director of the Initiative on Islam and Medicine at the University of Chicago, published “Brain Death in Islamic Ethico-Legal Deliberation: Challenges for Applied Islamic Bioethics,” in Bioethics on December 13, 2011. Padela and colleagues analyzed the definition of brain death from the perspective of applied Islamic bioethics by some juridical councils, such as the Organization of Islamic Conferences’ Islamic Fiqh Academy (OIC-IFA), that equate brain death with cardiopulmonary death, and others such as the Islamic Organization of Medical Sciences (IOMS) that analogize brain death to an intermediate state between life and death. The authors identify gaps in these definitions and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists.

Padela’s latest paper continues the publication of his community-based participatory research work on health care accommodations to improve the quality of care received by American Muslims. His latest paper, “Religious Values and Healthcare Accommodations: Voices from the American Muslim Community,” published in the Journal of General Internal Medicine on January 5, 2012, provides specific, data-driven recommendations for structural modifications of the health care environment and health care delivery. In particular, Padela and colleagues found that the most important accommodations requested by the American Muslim community in Detroit are the provision of gender-concordant care, halal food, and a neutral prayer space. They argue that health care systems improve cultural sensitivity, engender trust, and improve the health care experiences of American Muslims by understanding and then attempting to accommodate these values as much as possible.

The American Journal of Public Health published “Promoting Transparency in Pharmaceutical Industry-Sponsored Research,” (November 17, 2011) a study by Clinical Scholars alumni Joseph S. Ross, MD, MHS, (’04) and Cary P. Gross, MD, (’97). Gross is also associate director of the Yale Clinical Scholars program. Harlan M. Krumholz, MD, director of the Yale program, is also a co-author. The authors argue that although policies to promote transparency can improve accountability, “minimizing marketing’s impact on clinical trial research and strengthening the science will protect medical literature’s integrity and the public’s health.”

Executive Nurse Fellows
Johns Hopkins nurse researcher Deborah Gross, DNSc, MS, BSN, (’06) was awarded a $3.2 million grant from the National Institute of Nursing Research to compare and measure the impact of two programs—Parent-Child Interaction Therapy (PCIT) and Gross’ Chicago Parent Program—on Baltimore families. In 2002 Gross and colleagues developed the Chicago Parent Program, which focuses on a population overlooked in prior data-driven parenting programs: Latino and African-American families raising children in urban neighborhoods. Gross’ work is the first study showing the comparison between the Chicago Parent Program and PCIT.

Loretta Heuer, PhD, RN, FAAN, (’02) associate dean of Nursing and Allied Sciences at North Dakota State University’s Department of Nursing, is principal investigator in a recently awarded four-year, $1.9 million research and evaluation grant to help Native Americans become health care professionals, and to help North Dakota’s health care workforce become more culturally diverse.

Harold Amos Medical Faculty Development Program
Jose Pineda, MD, (’09) assistant professor at Washington University School of Medicine in St. Louis, is leading research examining trauma to the mitochondria in children, according to a university press release. Pineda is exploring a way to stimulate the mitochondria in kids with traumatic brain injury. “We would administer a medication that will travel to the injured brain, go directly to the mitochondria, and help it heal,” explained Pineda.

Health & Society Scholars
The research of Sarah Burgard, PhD, MS, MA, (’03) was referenced in a Washington Post article on “midnight moms.” Burgard studied time patterns of women between 2003 and 2007 and found that even when both parents work the same hours during the day, moms pull the graveyard shift at home. These time patterns can take a toll on future earnings and career development for these women, according to the projections in Burgard’s study.

Alison M. Buttenheim, PhD, MBA, (’09) released a study, “Increasing SNAP/EBT sales at farmers markets with vendor-operated wireless point-of-sale terminals,” in the Journal of the Academy of Nutrition and Dietetics (February 8, 2012). The study finds that food-stamp purchases at farmers’ markets increased when wireless point-of-sale terminals (card-swipe machines) are made available to each vendor. This addition of multiple machines at a Philadelphia-area farmers’ market resulted in a 38-percent increase in monthly food stamp sales. Currently, the food-stamp program subsidizes the cost of card-swipe machines in supermarkets but not in farmers’ markets. The authors write, “Our study prompts several evaluation and policy questions. At the policy level, it highlights the need for an equitable approach to subsidizing EBT(electronic benefit technology) terminals and fees at farmers’ markets, given that EBT and processing are currently provided free of charge to supermarkets and other brick-and-mortar FNS (USDA Food and Nutrition Service) retailers.”

Mark Hatzenbuehler, PhD, (’10) authored a study, “Effect of Same-Sex Marriage Laws on Health Care Use and Expenditures in Sexual Minority Men: A Quasi-Natural Experiment,” in the December 15, 2011, issue of the American Journal of Public Health. The study was profiled in US News & World Report, USAToday, CBS News, and New York Daily News. It found that gay men who live in states where same-sex marriage is legal are healthier, have less stress, make fewer doctor visits and have lower health care costs. “These findings suggest that marriage equality may produce broad public health benefits by reducing the occurrence of stress-related health conditions in gay and bisexual men,” Hatzenbuehler said.

Investigator Awards in Health Policy Research
Using the case of gabapentin (Neurontin), a drug approved for epilepsy but prescribed for a variety of conditions, Investigator awardee Aaron Kesselheim, MD, JD, MPH, (’09) and colleagues evaluated whether the penalties for off-label promotion of drugs influenced off-label prescribing rates. The study, published in Health Affairs (December 2011), revealed that enforcement efforts targeting illegal off-label promotion did not significantly deter prescription rates until after legal settlement. Kesselheim and colleagues suggest that enforcement actions should be combined with other efforts, including additional resources for enforcement and a steep increase in penalties, because settlements to this point have been dwarfed by the financial gains to pharmaceutical companies from engaging in improper off-label marketing. Media coverage for the study included FiercePharma, BioPortfolio, FDA Week and the (Newark) Star-Ledger, among others.

Physician Faculty Scholars
Kristen Copeland, MD, FAAP, (’08) published “Societal Values and Policies May Curtail Preschool Children’s Physical Activity in Child Care Centers” in Pediatrics (January 2, 2012). Seventy-five percent of U.S. preschool-age children are in child care; daily physical activity is essential for motor and socio-emotional development and for the prevention of obesity, but little is known about physical-activity barriers in child care. Copeland and colleagues held nine focus groups with 49 child-care providers from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. The authors identified three main barriers to children’s physical activity in child care: injury concerns, financial, and a focus on “academics.” They concluded that societal priorities for young children—safety and school readiness—may be hindering children’s physical development. In designing environments that optimally promote children’s health and development, child advocates should think holistically about potential unintended consequences of policies. The study was covered by the Washington Post’s “On Parenting” blog and MedPage Today, among other outlets.

Renee Hsia, MD, MSc, (’09) published “System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients Are at Higher Risk of Losing Their Emergency Departments” in Annals of Emergency Medicine (online November 17, 2011). In a retrospective cohort study of California hospital emergency departments (EDs) between 1998 and 2008, Hsia and colleagues evaluated factors associated with ED closure in the state and sought to determine whether hospitals serving more vulnerable populations have a higher rate of ED closure. The study found that 7.2 percent of EDs (29 of 401) closed. In a model adjusted for total ED visits, hospital discharges, trauma center and teaching status, ownership, operating margin, and urbanicity, hospitals with more Black patients and Medi-Cal recipients had higher risk of ED closure, as did for-profit institutions. The authors noted that whether their findings are a manifestation of poorer reimbursement in at-risk EDs is unclear. The study was covered by Reuters Health (a story that was picked up by numerous outlets, including ChicagoTribune.com, MSNBC.com, and Baltimore Sun online, among others).

Scholars in Health Policy Research
Jeb Barnes, JD, PhD, (’03) released his book, Dust-Up: Asbestos Litigation and the Failure of Commonsense Policy Reform. Dust-Up explores the most recent congressional efforts to reform asbestos litigation—a case in which the politics of efficiency played a central role and seemed likely to prevail. Yet these efforts failed to produce a winning coalition, even though reform could have saved billions of dollars and provided quicker compensation to victims of asbestos-related diseases. Set at the intersection of law, politics, and public policy, Dust-Up provides the first in-depth analysis of the political obstacles to Congress in replacing a form of litigation that many agree is woefully inefficient and unfair to both victims and businesses.

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