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I’m RWJF’s Newest Entrepreneur in Residence

Sep 23, 2014, 1:54 PM, Posted by Susannah Fox

Susannah Fox offers office hours at RWJF. Susannah Fox offers office hours at RWJF.

I am thrilled to begin my job as the entrepreneur in residence (EIR) at the Robert Wood Johnson Foundation.

You might think that the EIR role is traditionally associated with venture capital firms, not foundations. But scratch the surface and you’ll find commonalities between the two industries. Both VCs and philanthropists have daring ambitions, place lots of bets, and hope for a big pay-off every once in a while. The difference is that a philanthropy like the Robert Wood Johnson Foundation places a priority on societal dividends, such as greater access to health care or a reduction in childhood obesity.

I also like this definition of entrepreneurship: “The pursuit of opportunity without regard to resources currently controlled.” That fits the Foundation to a T as we pursue the audacious goal of building a Culture of Health in the United States.

But how will we measure success? How will we know if our bets ever pay off, especially when we are talking about culture change? I have a story to tell that I think illustrates how a small grant can make a big difference in the world.

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Recent Research About Nursing, September 2014

Sep 11, 2014, 5:33 PM

This is part of the September 2014 issue of Sharing Nursing’s Knowledge.

Lower Hospitalization Rates Linked to Broader NP Scope of Practice

New research correlating state-by-state hospitalization rates with state policies on nurse practitioner (NP) scope of practice offers a revealing conclusion: Medicare and Medicaid patients are less likely to require hospitalization in states that allow NPs a broader scope of practice.

A team of researchers from the University of Missouri Sinclair School of Nursing examined hospitalization data from a range of sources that sorted data by state, and then compared it with American Association of Nurse Practitioners data on state laws and regulations governing NP scope of practice. They found “a significant relationship between full practice of NPs and decreased hospitalization rates of Medicare and Medicaid beneficiaries in the United States and improved health outcomes of states.”

The researchers caution that the data do not prove a causal relationship between scope of practice and hospitalization rates, but write, “Our findings support the increasing call of facilitating Advanced Practice Registered Nurses [APRNs] to fulfill their full scope of practice in providing access and care to patients without direct or indirect supervision from physicians. The outcomes support the Institute of Medicine recommendation that APRNs practice to their full scope of practice including functioning as primary care providers.”

The study was published online by Nursing Outlook on August 4, 2014.

Read an abstract of the study or a news article on it in McKnight’s.

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Total Worker Health: Getting and Staying Healthy in the Workplace

Aug 4, 2014, 12:17 PM

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For the last several years, the U.S. Centers for Disease Control and Prevention (CDC) has been promoting a concept called “Total Worker Health,” which combines safety programs to prevent accidents on the job with health promotion programs such as smoking cessation. The idea is that emerging evidence recognizes that both work-related factors and health factors that are often beyond the workplace together contribute to many health and safety problems for employees and their families.

A new report in the CDC’s latest Morbidity and Mortality Weekly Report (MMWR) shows why the combination can be critical, finding that the risk for coronary heart disease (CHD) and stroke is higher for blue-collar and service workers than it is for white-collar workers. Studies have suggested that before, but the new MMWR recommends strategies that companies can implement to reduce that risk.

In the new report, CDC researcher Sarah Luckhaupt, MD, analyzed National Health Interview Survey data for 2008-2012. She found that the prevalence of a history of CHD or stroke among people ages 18 to 55 was 1.9 percent for employed adults, but among the employed the risk was 40 percent higher in blue-collar workers (e.g. construction workers and truck drivers) and 53 percent higher in service workers (e.g. hairdressers and restaurant servers). Luckhaupt says that job stress, shift work, exposure to particulate matter, noise and secondhand smoke are all likely contributing factors to the higher rates of CHD and stroke.

In a conversation with NewPublicHealth, Luckhaupt said that employers can help improve the health profiles of employees by using the Total Worker Health program, launched by CDC and the National Institute for Occupational Safety and Health three years ago as a guideline for workplace wellness programs. CDC now publishes quarterly reports on effective Total Worker Health programs established by employers across the United States. Recent examples include:

  • Live Well/Work Well at the Dartmouth-Hitchcock Medical Center in N.H., which aims to improve worker safety and health at the medical center.
  • Hearing loss prevention at the Domtar Paper Company in Kingsport, Tenn., and the 3M manufacturing plant in Hutchinson, Minn., which address both noise reduction exposure on the job and in the community.
  • A “Culture of Health” at Lincoln Industries, a manufacturing factory in Lincoln, Neb., which includes companywide stretching for 15 minutes every day to help prepare the muscles that will be used on the job; massage therapists who assess and treat people who may be at risk for injury; an on-site clinic for health maintenance, wellness coaching and acute care; counseling and support programs; and social and fitness events.

This commentary originally appeared on the RWJF New Public Health blog.

Loneliness: A Significant Stressor that Requires Intervention

Aug 4, 2014, 10:00 AM

Laurie A. Theeke, PhD, FNP-BC, is an alumna of the Robert Wood Johnson Foundation Nurse Faculty Scholars program and an associate professor of nursing at West Virginia University School of Nursing.

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The Burden of Stress in America, a new report commissioned by NPR, RWJF, and the Harvard School of Public Health, makes it clear that Americans are experiencing extremely stressful life events that are contributing to poor health outcomes. As a researcher who studies loneliness and how it contributes to poor health, I found the report somewhat alarming. Many of the life events identified by survey respondents are already associated with loneliness in the health and social science literature. Stressful events like new illness and disease, losing a spouse or loved one, or major life transitions can all lead to a personal experience of loneliness. This is very concerning because loneliness is a unique psychological stressor that can be hard to recognize or remedy without professional help.

Loneliness is a significant biopsychosocial stressor that contributes to multiple chronic conditions. We have known since the 1950s that there is an association between loneliness and cardiovascular problems like hypertension (Hawkey, Masi, Berry, & Cacioppo, 2006). More recent studies have identified loneliness as a major predictor of stroke as well.

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Child ‘Vehicular Heatstroke’: Good Samaritan Laws and Other Public Health Solutions

Jul 21, 2014, 2:36 PM

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Earlier this month, following the heatstroke death of a Georgia toddler who was left in a sweltering car for hours, Tennessee became the first state in the nation to pass a law that specifically protects people from liability for forcibly breaking into cars and rescuing kids they think are at risk of heatstroke. The law requires those individuals to call 911 first and follow instructions.

Many states have Good Samaritan laws that may protect people in such instances, but the specifics vary from state to state, according to Cristina M. Meneses, JD, MS, a staff attorney with the Network for Public Health Law’s Eastern Region. A recent Today show poll found that 88 percent of the 44,000 people asked would break into a car to rescue a child they thought was in danger, but specific laws can increase the response—and potentially remove penalties—while raising awareness of the issue. More such laws could soon follow. Janette Fennell, founder and head of KidsAndCars, a nonprofit based in Kansas City, Mo., which advocates for laws that will protect kids from heat in vehicles, said she’s received inquiries from two states about those laws since Tennessee’s law was passed. Another set of laws that KidsAndCars tracks are those that penalize adults for leaving kids in cars. Nineteen states currently have such laws on the books.

“It’s a good deterrent for anyone who might think, ‘Oh, I’ll just leave them in the car for a minute,’” said Fennell, “because it’s often that minute that turns into much longer and results in injury or death.”

According to the National Highway Traffic Safety Administration (NHTSA), more than 40 kids—often under age 2—die each year of “vehicular heatstroke.” Seventeen U.S. kids have died after being left or trapped in car since the beginning of 2014. Fennell and other experts say many people just don’t realize how quickly temperatures can climb in a car, even if the window is cracked open a bit—when outside temperatures are in the low 80's, the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Children's bodies, in particular, overheat easily; and infants and children under four years old are at the greatest risk for heat-related illness.

NHTSA research shows that heatstroke deaths and injuries often occur after a child gets into an unlocked vehicle to play without a parent or caregiver's knowledge. Other incidents can occur when a parent or caregiver who is not used to transporting a child as part of their daily routine inadvertently forgets a child sleeping in the back.

Last week, KidsAndCars launched a petition drive to encourage NHTSA to require technology in all cars that would remind a driver that there is a child in the back. There are devices parents can install, but a 2012 study by NHTSA found that none that the agency studied were consistently effective.

“You get a warning if you don't buckle your seatbelt, leave a car door open, your gas is low or you leave your headlights on,” said Fennell. “If a child is left behind then you absolutely need a warning.”

Guidelines from NHTSA and other safety experts aimed at never leaving a child unattended in a car include:

  • Make a habit of looking in the vehicle—front and back—before locking the door and walking away
  • Ask childcare providers to call if a child doesn't show up for care as expected
  • Put items in the back seat you’ll have to retrieve such as a purse or briefcase, or put a stuffed animal in sight of the driver to indicate there’s a child in the car.

>>Bonus Links:

This commentary originally appeared on the RWJF New Public Health blog.

What’s Keeping the Cardiac Polypill off the Market?

Jul 3, 2014, 10:05 AM, Posted by Sheree Crute

Lisa Ranson Lisa Ranson

No matter how busy Lisa Ranson’s morning gets, somewhere between preparing breakfast and suiting up for work or play, she takes the first cluster of eight pills that protect her from a family legacy of heart disease so powerful she had bypass surgery at 34.

Even at that young age, she was no stranger to daily prescription regimens. Growing up, she watched her dad struggle. These days they compare notes. “He’s survived two heart attacks, had bypass surgery, and he has a pacemaker,” Ranson says.

An avid walker who treks three and a half miles most days near her home in the small town of Dunbar, W.Va., Ranson is now 51 and in great shape. But her healthy lifestyle is no match for her genetic inheritance—she is one of 34 million people living with hypercholesterolemia.

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Reengineering Medical Product Innovation

Jul 3, 2014, 9:00 AM, Posted by Arthur Kellermann

Arthur Kellermann, MD, MPH, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is professor and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. He is co-author of the new RAND report, “Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.” Here, he shares recommendations for a brave new world of medical technology.

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Americans take justifiable pride in our capacity for innovation. From putting the first men on the moon to developing the Internet, we lead the world in developing innovative technologies. Health care is no exception. The United States holds more Nobel prizes in medicine than any other nation.

Novel drugs, biologics, diagnostics, and medical devices have transformed American health care, but not always for the better.

Some innovations have made a big difference. Combination antiretroviral therapy changed HIV infection from a death sentence to a treatable, chronic disease. Before an effective vaccine was developed, Hemophilus Influenze type b, a bacterial disease, was a major cause of death and mental disability in young children. Today, it is virtually eradicated here and in Western Europe.

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New NIH Pain Research Database Could Be a Key Tool in the Fight Against Prescription Drug Abuse

May 28, 2014, 2:04 PM

A new database on pain research established by the National Institutes of Health (NIH) and several other federal agencies might help practitioners choose more effective and safer options for their patients dealing with pain. It could also potentially reduce reliance on opioid drugs, which often turns patients into addicts and creates an easy source of the drugs for potential abusers.

The database, launched last week, is called the Interagency Pain Research Portfolio (IPRP) and offers information on federal pain research projects. According to the NIH, pain is a symptom of many disorders and can be a disease itself; the economic cost of pain is estimated to be hundreds of billions of dollars annually in lost wages and productivity.

“This database [allows] the public and the research community...to learn more about the breadth and details of pain research supported across the federal government. They can search for individual research projects or sets of projects grouped by themes uniquely relevant to pain,” said Linda Porter, PhD, Policy Advisor for Pain at the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH.

Both in public speeches and private briefings with reporters, U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, has called on physicians to find alternatives to narcotics for pain patients when medically advisable, such as guided imagery and other forms of relaxation. He’s also called for starting with less potent medications than narcotics, in order to reduce the chance of addiction and to introduce far fewer amounts of prescription drugs into the community where they are often taken from medicine cabinets by people—especially young adults—for whom they’re not prescribed. According to the Substance Abuse and Mental Health Administration, approximately 22 million people nationwide have taken narcotic pain relievers for non-medical reasons.

U.S. Food and Drug Administration head Margaret Hamburg, MD, also spoke on the subject during a town hall meeting last week on prescription drug abuse, hosted by the Johns Hopkins School of Public Health and the Clinton Foundation. Hamburg said that “we need to recognize that opiates are... probably most often not the treatment strategy of first choice...but it may be the option a provider knows best. We need to actively engage with the scientific research community and industry to try to develop new non-opiate, non-addictive pain strategies...”

This commentary originally appeared on the RWJF New Public Health blog.

Hypertension ‘Kills More People Around the World than Anything Else’

May 20, 2014, 11:55 AM

“Hypertension affects nearly one in three adults and kills more people around the world than anything else. It is both too common and too often poorly controlled.”

So said Tom Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), during a panel discussion at the annual meeting of the American Society of Hypertension (ASH) this past weekend. The panel was convened by ASH, the American Heart Association and the CDC to launch a project supporting improved control of hypertension worldwide. According to the panel an estimated 970 million people have hypertension worldwide, and the disease is responsible for more than nine million deaths, as hypertension can lead to heart disease and stroke.

Data from the groups finds that rates of hypertension have increased in both developed and developing nations, due in part to an aging population and lifestyles that include high salt diets and low physical activity.

For the developing world, the CDC; the Pan American Health Organization; and other regional and global stakeholders are identifying both cost effective medicines and inexpensive delivery strategies for the drugs to help patients afford and receive them.

In the United States, the Affordable Care Act is expected to increase the number of people on hypertension medications, but despite the availability of coverage for hypertension diagnosis and treatment there remains concern over disparities. A study of more than 16,000 members of the Hispanic community published in the American Journal of Hypertension earlier this year found that while the prevalence of hypertension among Hispanics is nearly equal to that of non-Hispanic whites, diagnosis of the disease is much lower, as is general awareness of its symptoms and treatment options.

"Given the relative ease of identifying hypertension and the availability of low-cost medications, enabling better access to diagnostic and treatment services should be prioritized to reduce the burden of cardiovascular disease on Hispanic populations,” said Paul Sorlie, MD, the lead author of the study and an epidemiologist with the National Heart, Lung and Blood Institute. “This study gives us the information needed to support the development of policies that can improve this access and, subsequently, the overall health of countless US citizens.”

>>Bonus Links:

  • A new infographic from the Measure Up/Pressure Down initiative of the American Medical Group Association provides some key patient information about hypertension, including normal and dangerous ranges of blood pressure—numbers patients should be familiar with.
  • A map from the Institute for Health Metrics and Evaluation at the University of Washington shows hypertension levels for 2001 to 2009 by race and gender.

This commentary originally appeared on the RWJF New Public Health blog.

Public Health Campaign of the Month: ‘Save a Minute’ Stroke PSA

May 13, 2014, 2:22 PM

May is stroke awareness month and a new infographic from the American Stroke Association wants everyone to know minutes count when a stroke hits. The campaign uses research published by the Association this year in the campaign infographic to let people know that for each minute shaved off stroke response in a hospital, patients get back days of healthy living.

The infographic includes the  FAST warning signs and symptoms for stroke:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

>>Bonus Content: The American Stroke Association has a site full of patient education resources on stroke awareness and prevention, including a very effective PSA on body language to help teach the FAST warning signs of stroke. The association also previously created another infographic on the FAST warning signs.

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This commentary originally appeared on the RWJF New Public Health blog.