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Teen Take Heart

Nov 5, 2014, 11:00 AM, Posted by Steven Palazzo

Steven J. Palazzo, PhD, MN, RN, CNE, is an assistant professor in the College of Nursing at Seattle University, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013 – 2016. ) His research focuses on evaluating the effectiveness of the Teen Take Heart program in mitigating cardiovascular risk factors in at-risk high school students.

Steven Palazzo

Difficult problems demand innovative solutions. Teen Take Heart (TTH) is a program I’ve worked to develop, in partnership with The Hope Heart Institute and with support from the RWJF Nurse Faulty Scholars Program, to address locally a problem we face nationally: an alarming increase in obesity and other modifiable cardiovascular risk factors among teenagers. The problem is substantial and costly in both economic and human terms. We developed TTH as a solution that could, if it proves effective in trials that begin this fall in my native Washington state, be translated to communities across the country.

The State of Obesity: Better Policies for a Healthier America, released recently by the Trust for America’s Health and RWJF, makes it clear that as a nation we are not winning the battle on obesity. The report reveals that a staggering 31.8 percent of children in the United States are overweight or obese and only 25 percent get the recommended 60 minutes of daily physical activity. The report also finds that only 5 percent of school districts nationwide have a wellness program that meets the physical education time requirement.

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In New Book, RWJF Scholar Explores Effects of Genetics on Environmental Science

Nov 4, 2014, 9:00 AM

Sara Shostak, PhD, MPH, is an associate professor of sociology at Brandeis University and author of Exposed Science: Genes, the Environment, and the Politics of Population Health. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). 

Sara Shostak Sara Shostak, PhD, MPH

Human Capital Blog: Your book, Exposed Science, won two awards from the American Sociological Association: the Eliot Freidson Outstanding Publication Award from the Medical Sociology Section and the Robert K. Merton Book Award from the section on Science, Knowledge, and Technology (SKAT). Congratulations! What do these awards mean for you and your work?

Sara Shostak: Thank you! I am deeply honored that Exposed Science won those awards. This kind of recognition from one’s colleagues is tremendously meaningful on a personal level, especially as there are many scholars in these sections whose work has inspired me for years.  

More broadly, the dual awards signal something important about the connection between these two domains of inquiry—medical sociology and the sociology of science. That is, science and the politics of science are important foci of analysis for sociologists concerned with population health. The conditions under which scientists do their research—the political economy of knowledge production—is a critical context for what we do and do not know about human health and illness.  

Population health researchers often observe that in the United States, health disparities research tends to focus on differences between racial and ethnic groups, while in the United Kingdom the focus tends to be on variations by social class (or what U.S. researchers more often call socioeconomic status). Scholars of science, knowledge, and technology can help us understand how and why these differences emerged, and with what consequences. My book raises questions also about how any of these determinants get operationalized in laboratory-based research. All of these aspects of how science is done have direct implications for public policy, as well.

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Health Care Workers Primed to Lead Global Response to Ebola

Oct 28, 2014, 10:00 AM

Timothy Landers, PhD, CNP, and Jason Farley, PhD, MPH, CRNP, are Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars. In his work, Landers focuses on the epidemiology and prevention of antibiotic-resistant infections, including the use of hand hygiene as a means of prevention. Farley evaluates treatment outcomes in multi-drug resistant infections including tuberculosis (TB) and Methicillin-Resistant Staphylococcus aureus (MRSA) in patients with HIV, with a focus on sub-Saharan Africa.

Timothy Landers Timothy Landers

The recent outbreak of Ebola virus in West Africa is a stark reminder that we live in a globally connected world and that outbreaks can occur without warning. As infection prevention specialists, we are acutely aware of the risks health care workers face in caring for the public, both now and in times of relatively less chaos.

The good news is that despite media reports, nurses, physicians, infection prevention specialists and other health care workers are in an ideal position to lead the global response to this disease.

Our experience with measures to address hospital-acquired infections—isolation precautions, hand hygiene, contact tracing and public health measures—are also the same methods necessary to contain the spread of Ebola.  

Jason Farley (smaller) Jason Farley

Building on experience addressing these infections, along with recognition of the differences in Ebola virus transmission, the Centers for Disease Control & Prevention (CDC) regularly updates the guidelines and is currently recommending enhanced versions of isolation precautions, including enhanced standard precautions, contact precautions, and droplet precautions. 

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Crusader Against Cancer

Oct 14, 2014, 9:00 AM

For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Jacqueline Barrientos, MD, a member of the 1994 class.

Jacqueline Barrientos Jacqueline Barrientos, MD

As far back as Ancient Egypt, cancer has frustrated medical practice. Papyri written around 1600 BC describe various cases, with one concluding that “there is no treatment.”

But there’s hope for patients diagnosed with chronic lymphocytic leukemia (CLL)—a cancer that attacks the blood and bone marrow—thanks to Jacqueline Barrientos, MD, who isn’t intimidated by the history surrounding the disease.

She’s busy helping to rewrite it.

Barrientos is part of a team researching new CLL therapies at the North Shore-LIJ Cancer Institute’s CLL Research and Treatment Center on Long Island. In clinical trials, the pioneering drug treatments produced unprecedented results—considerably better than those achieved with chemotherapy, and minus the brutal side effects.

“We’ve never seen response rates like this before,” says Barrientos. “It’s astonishing.” When the FDA approved the use of the new treatments earlier this year, she and her team were elated. “We’re giving life to patients who once had no hope of surviving because the cancer was so aggressive.”

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Let’s Talk About Stress

Oct 2, 2014, 9:52 AM, Posted by Michael Painter

Mike Painter Mike Painter speaking at Health 2.0.

I recently returned from the Health 2.0 conference in California, which drew 2,000 health care innovators. One of the most popular Health 2.0 sessions was called “The Unmentionables”—where speakers discussed those important things that affect our health but we are often afraid to address. I participated in this year’s session where we talked stress—what it is and how it’s making us sick.

I’m an avid cyclist. That means I train a lot. Training on a bike means purposefully and intensely stressing your body—sometimes ridiculously hard—in order to make your body stronger, fitter and faster. In that sense stress can be really good. You can’t get stronger without it.

But here’s the key: as you ratchet up that stress—the miles, the hours on the bike, the intensity—you must work just as hard on the flipside, the buffering. The more you train, the more you have to focus on the rest, the sleep, your social supports, the yoga, the nutrition—whatever it takes.

If you don’t buffer you will burn out, get injured or sick, or all of the above. Without buffers, the stress will crush you.

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Helping ‘Care Partners’ Help Patients with Diabetes

Sep 24, 2014, 9:00 AM

Ann-Marie Rosland, MD, MS, is a research scientist at the VA Ann Arbor Center for Clinical Management Research, an assistant professor at the University of Michigan Medical School, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2006-2009). She recently received a U.S. Department of Veterans Affairs Merit Award to test a family engagement intervention for patients with diabetes.

Ann Marie Rosland

Human Capital Blog: Congratulations on your Veterans Health Administration (VA) Merit Award! The award recognizes your research into a family engagement intervention in the context of the VA’s patient-centered medical home program. How did your study work, and what did you find?

Ann-Marie Rosland: This study is unique in that we work with family member/patient pairs in managing diabetes. We call these family members “care partners.” This study asks the question:  “How we can best recognize and support the vital roles that patients’ family members often take in the care of chronic illnesses, so these care partners can have the largest positive impact on patients’ health and medical care?”

Our prior work has shown that the majority of people with diabetes, heart disease and other chronic conditions have a family member who is regularly involved with the care of these conditions. Some help to keep track of medications and refill them, some help to track and manage symptoms or sugar readings, many come to medical appointments and help patients communicate with their medical teams, and some help patients navigate the health care system. In general, patients who have support from family members tend to be more successful at managing chronic illness, particularly with eating healthier and exercising more. Yet patients and family tell us that care partners face barriers in helping with the medical side of care; for example, they can’t easily find out what medications or tests the patient’s medical team is recommending, or what health system programs are available to the patient.

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Stress: Withstanding the Waves

Sep 23, 2014, 11:42 AM, Posted by Ari Kramer

Infographic: stress_section
Infographic: stress_section

Infographic: How Do We Move From a Culture of Stress to a Culture of Health?

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As a kid, when you went to the beach, did you ever play that game where you’d wade into the ocean and test your strength against the waves? You'd stand your ground or get knocked over, and after a few minutes, you'd head back to shore.

We didn’t realize it at the time, but as we felt those waves roll by, we were getting an early glimpse of the stresses of everyday life. The difference is, as adults we can't choose to stand up to just the small ones. And for the most part, going back to shore is not an option.

In a survey RWJF conducted with the Harvard School of Public Health and NPR, about half of the public reported experiencing a major stressful event in the past year. In more than four in 10 instances, people reported events related specifically to health. Many also reported feeling a lot of stress connected with jobs and finances, family situations, and responsibility in general.

Over time, those waves can take their toll. And when they become overwhelming, they can truly wear us down, seriously affecting our both our physical and emotional health.

So how can we deal with these waves of stress? Certainly, there are proactive things we can all do help manage its effect on our lives—exercise, for example. At the same time, we’ve probably all experienced instances when we’d love nothing more than to get up early for a run or brisk walk—but don’t have the energy because stress kept us up at night. Or we may just be too tapped out from long hours, relationship struggles, caring for loved ones, etc., to spare the energy or the time.

If this sounds familiar, consider yourself human. Right next to you, whether at work, on the train, in your grocery store, is probably someone whose waves are similar to or bigger than your own. So at the same time as you try to manage your stress, ask yourself: What could be done to help others achieve a solid footing? In this ocean of ours, there’s never a shortage of opportunity to lend a helping hand.

Have an idea to help move from a culture of stress to a Culture of Health in the home, workplace or community? Please share below—we’d love to hear from you.

Changing the Culture of Health to Prevent Suicide

Sep 12, 2014, 9:00 AM, Posted by Alexander Tsai

Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.

Alexander Tsai

When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.

But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?

It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.

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Obesity in America: Are We Turning the Corner?

Sep 4, 2014, 9:18 AM, Posted by John R. Lumpkin

Childhood Obesity West Virginia

What word describes the current state of obesity in the United States?

How about the unexpected: Optimistic.

You might think that would be the least likely descriptor. After all, the annual report The State of Obesity: Better Policies for a Healthier America, released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), says adult obesity rates went up in six states over last year.

The obesity rate is now at or above 30 percent in 20 states (as high as 35 percent in Mississippi and West Virginia), and not below 21 percent in any. Colorado has the lowest rate at 21.3 percent, which still puts it higher than today’s highest state—Mississippi—was 20 years ago.  The childhood obesity headlines are difficult to swallow as well. As of 2011-2012, nearly one out of three children and teens ages 2 to 19 is overweight or obese. Similar to adults, racial and ethnic disparities persist. And rates are higher still among Black and Latino communities.

But if we look a little deeper, we see a hint of promise on the horizon.

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Pediatricians Need to Take Community-Based Approach to Addressing Chronic Conditions in Children

Aug 29, 2014, 9:00 AM, Posted by James Perrin

James Perrin

Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?

James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.

First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.

Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.

Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.

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