Category Archives: Women and girls
Health Care Providers Shouldn’t Hit the Snooze Button When It Comes to Asking Their Patients About Sleep
Aric A. Prather, PhD, is an assistant professor of psychiatry at the University of California, San Francisco and an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program.
Heart disease accounts for one in every four deaths in the United States—600,000 deaths per year. Prevention and treatment regimens for heart disease include important changes in lifestyle, centering primarily on alterations to diet and physical activity. Interestingly, sleep is rarely part of this discussion.
This is alarming given the growing evidence from large-scale population studies and laboratory-based experiments that demonstrate that sleep plays a larger role in heart health than originally appreciated by the medical community. For example, in a 2003 study, women with established coronary heart disease who reported poor sleep quality were more than 2.5 times more likely to go on to experience a cardiac event than good quality sleepers. Nevertheless, when it comes to asking patients about their sleep, health care providers routinely hit the snooze button.
In an effort to raise the profile of sleep as a risk factor for cardiovascular disease (CVD), my work has focused on investigating the links between sleep and the biological pathways implicated in CVD development and progression. Said another way, much of my research focuses on how sleep disturbance gets under the skin.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:
RWJF/U.S. Department of Veterans Affairs Clinical Scholar Anita Vashi, MD, is the lead author of a study that finds many patients visit emergency departments after being discharged from the hospital. With Medicare now structuring financial incentives and penalties around hospital readmission rates, Vashi and her colleagues suggest the focus on hospital readmissions as a measure of quality of care misses the large number of patients who return to the hospital's emergency room after discharge, but are not readmitted. Among the outlets to report on the findings: the Los Angeles Times, Nurse.com, and MedPage Today. Read more about Vashi’s research.
Product Design and Development featured RWJF Nurse Faculty Scholar Jennifer Doering, PhD, RN, and her interdisciplinary team, which designed and tested a research-based sleeping pod for infants. Many parents sleep with their infants, despite the dangers, so Doering’s team has created a portable, protective sleeping pod, equipped with wireless sensors to alert sleeping adults if they start to roll over onto it or if blankets or pillows fall on a sleeping baby. Read more about Doering’s research on the sleep habits of new mothers and infants.
Allison E. Aiello, PhD, MS, an alumna of the RWJF Health & Society Scholars program, spoke to NBC News and the AnnArbor.com about norovirus (the stomach flu). The virus is hard to get rid of, Aiello says, and can be spread to others before an infected person even feels sick. Proper hand-washing is important, at home and in public places like restaurants.
By Elizabeth A. Kostas-Polston, PhD, ARNP, WHNP-BC, Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and assistant professor, University of South Florida; and Versie Johnson-Mallard, PhD, MSMS, ARNP, WHNP-BC, RWJF Nurse Faculty Scholar alumna and assistant professor, University of South Florida.
On November 14, 2012, we met a princess. No, we were not at Disneyworld or Disneyland. The princess was beautiful, talented and focused on making a difference in her country for girls and women. The princess’s name is Princess Bajrakitiyabha Mahidol, her Royal Highness of Thailand. We met her when we were invited to Thailand to present at the International Council on Women’s Health Issues (ICOWHI) 19th International Congress on Women’s Health 2012: Partnering for a Brighter Global Future.
During the conference we unveiled our national/international initiative, The Blue Bra Campaign: Leading Global Change in Women’s Health. The Blue Bra Campaign is housed at the University of South Florida College of Nursing, under our leadership. The name for the campaign was inspired from an international event that occurred in 2011, when a young Egyptian woman was beaten, stomped on and nearly stripped while participating in a political demonstration. Aside from the sheer brutality inflicted upon her by Egyptian police, what stood out to millions viewing the nightmare as it unfolded on international television was the young woman’s abaya falling open to reveal a lacey, bright-blue bra. That moment was so unexpected, so shocking—so transforming! The young woman, covered from head to toe in traditional dress, refused to remain invisible demonstrating her femininity through her choice of undergarment—a blue bra!
While they make up 73 percent of medical and health services managers, women account for only a small portion of CEOs at hospital and health care organizations, according to a report by RockHealth. The analysis of data from the U.S. Bureau of Labor Statistics and other surveys finds that just 4 percent of health care organization CEOs and 18 percent of hospital CEOs are women.
RockHealth’s report highlights a range of barriers to women’s advancement, including persistent gender roles in the workplace, a lack of mentors and role models for women, and more. To understand what women in the health care workforce thought, RockHealth conducted interviews with 100 women in the field. Nearly half the survey respondents reported that insufficient self-confidence was one of the biggest barriers to their career advancement. Among other reported obstacles: time constraints (45 percent) and the ability to connect with senior leadership (43 percent).
The Robert Wood Johnson Foundation has long championed leadership development, for women and men alike. Many of the Foundation’s programs offer leadership training for nurses, physicians and other health care professionals, to help advance their careers. Learn more about RWJF programs at RWJFLeaders.org.
What do you think? Are females underrepresented in health care leadership? What can we do to increase their representation? Register below to leave a comment.
Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston. She is a 2010 Robert Wood Johnson Foundation Community Health Leader.
The prolonged recession of the last four years has hit many people hard. My work is taking care of homeless women, which I have done for the past 20 years. I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters. We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.
I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers. Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.
Here is a glimpse of our work.
Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.
She is hungover. She drank to escape the horror of having been attacked. She has been on and off the wagon so many times we have all lost count. She’s also been raped and stabbed more times than any of us can remember. She doesn’t go to the police any more. She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork. I give her a hug and remind her that I love her no matter what. I know that she has a library of negative and self-loathing messages in her head. Mine is the one that can break through that chatter and give her a shred of self-respect.
How a Personal Experience Led to a Program of Research Focused on Eliminating Intimate Partner Violence Disparities Among Hispanic Women
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rosa M. Gonzalez-Guarda, PhD, MPH, RN, Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and Assistant Professor, University of Miami, School of Nursing & Health Studies.
As a young Cuban-American and Miami native who grew up in an Hispanic enclave, I was naturally drawn to Hispanic men—short, dark and handsome. Who would have expected that I would have found him during my last year of college at Georgetown University in Washington, DC? I fell in love with this other Cuban-American Miami native quickly. He was fun, smart, charming, had strong family values and, to top it all off, he could dance salsa and merengue.
It was not too long before I realized that my college sweetheart was jealous and controlling. However, this did not seem all that unusual since these are characteristics that are endorsed by many in the culture where I come from. In fact, when I questioned that he was “allowed” to go out with his friends to bars, but I was not, some family and friends agreed with him. Although I did not realize it at the time, the “allowed” language and his controlling behavior were a good indicator of what lay ahead in our relationship—a nightmare.
Moments of romance and bliss turned into moments of anger, aggression and torment. Times of peace grew shorter and shorter, as he grew increasingly emotionally abusive. He did some “man handling” too.
When I decided to go off to graduate school at Johns Hopkins University School of Nursing and the Bloomberg School of Public Health, things got worse. I was in another city and the co-chair of a social and cultural student committee. This made him feel like he was completely out of control and very jealous. He grew more aggressive and emotionally abusive. My family and friends became increasingly worried about me, as they saw my cheery personality slowly dwindle. My parents put a lot of pressure on me to break things off. I knew they were right, but for some reason I couldn’t bring myself to do it. I just needed time.
I thought that I could appease my family by getting help. I went to the school psychologist and when a faculty member at the School of Nursing looked for volunteers for a research study on teen dating violence, I quickly signed up. At that time, I had no idea that the Principal Investigator of the study was a world renowned violence researcher: who else but our very own Jacquelyn Campbell, PhD, RN, FAAN, who directs the RWJF Nurse Faculty Scholars program. Working on this study made me realize that I also wanted to conduct research on health disparities affecting my own community of Hispanic women at home. As I fell in love with the prospects of health disparities and violence research, I fell out of love with an abusive partner.
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Elisa L. Patterson, MS, CNM, a fellow with the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico.
I have been a certified nurse-midwife for almost 19 years. It is an ingrained part of who I am. I have served women of many different ethnic, socioeconomic, and cultural backgrounds. Being a nurse-midwife embraces my duality of being a nurse and a midwife. I am very proud of these credentials.
As I add to my education in a PhD program – through the RWJF Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing – I have found it a challenge to express in my “elevator speech” how these two credentials enhance my abilities to do policy work. I tried starting with what I am doing as a PhD student at the University of New Mexico. But when I say, “I’m also a nurse–midwife,” listeners seem to tag onto that singular piece of information and forget the rest of the conversation. Then, they might share their personal birth story or one that is a fond memory from a close friend. Or, they might ask me if I deliver babies at home.
I have not been able to figure out how to combine the important and, to me, impressive fact that while, yes, I am a nurse-midwife, I am also very capable of conversing about, researching and representing many other issues.
The American College of Nurse-Midwives (ACNM) has a way to help me and other nurse-midwives who face this dilemma. Next month at their annual gathering, a public relations campaign will be presented to the membership. It will include a vision, mission statement, and core values. The ultimate goal is to describe the value of nurse-midwives and, in general, support the provision of high-quality maternity care and women’s health services by Certified Nurse-Midwives.
The U.S. Department of Health and Human Services, Office on Women’s Health has designated May 13 to May 19 as National Women’s Health Week. It is designed to bring together communities, businesses, government, health organizations and others to promote women’s health. The goal in 2012 is to empower women to make their health a top priority. The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is launching an occasional series on women’s health in conjunction with the week. This post is by Rebekah Gee, MD, MPH, RWJF Clinical Scholars alumna and an assistant professor of public health and obstetrics and gynecology at Louisiana State University (LSU). She is director of the Louisiana Birth Outcomes Initiative.
Louisiana is a fantastic place to live. It’s one of the most culturally rich and enchanting places in the United States. The state, however, also faces some of the greatest challenges in our nation.
Louisiana has a long history of poverty, poor education, and social problems that affect the health of too many of its citizens. And for women—particularly African American women—the challenges are even greater. We are 49th in the nation in terms of overall birth outcomes, like infant prematurity and mortality, and we get failing grades on report cards that measure those indicators of health.
In 2010, Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals (DHH), recognized the importance of poor birth outcomes as a crucial public health issue—and named it his top priority. We were the first state in the nation to offer birth outcomes this kind of backing from our government officials. In November, 2010, we launched the Birth Outcomes Initiative, which I direct. It engages partners across the state—physicians, hospitals, clinics, nurses—and provides them with the best evidence and guiding principles to achieve change. We have made significant progress already.
We are working with the state’s hospitals on maternity care quality improvements, including ending all medically unnecessary deliveries before 39 weeks gestation. We have partnered with 15 of the largest maternity hospitals to provide them with the support and resources to make this a reality. Now, every maternity hospital in the state (there are 58) has signed on to the 39-Week Initiative.
Soon, we will be publishing perinatal quality scores—available to the public—so hospitals and physicians are held accountable for outcomes. In our pioneer facilities, we have seen the rates of elective deliveries drop by half. Many facilities have had as much as a 30-percent drop in the number of babies who needed to go to the NICU. The efforts of the Birth Outcomes Initiative are improving lives day after day.
VA May Need to Do More to Help Women Veterans Who Are Homeless or At Risk for Homelessness, Study by RWJF/VA Scholar Finds
Oni Blackstock, MD, is a primary care physician and Robert Wood Johnson Foundation/U.S. Department of Veteran’s Affairs (VA) Clinical Scholar at the Yale University School of Medicine and the VA Connecticut Healthcare System. Her study, available online now and to be printed in the April issue of Medical Care, examines gender differences in the use of Veterans Health Administration specialized homeless services programs among Veterans of the conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).
Human Capital Blog: Tell us why you decided to look at this group of Veterans specifically. What makes them—and the time they are returning from service—unique from other Veteran cohorts?
Blackstock: I was interested in understanding use of VA homeless services programs among OEF/OIF Veterans for two primary reasons. The first reason is that many of these Veterans are returning to a country in the midst of an economic recession and housing crisis; therefore, characterizing use of VA homeless services programs among this group is particularly important. The second reason is that this group of Veterans has the largest proportion of women to serve and to be exposed to combat (about 12 percent of OEF/OIF Veterans are women). I wanted to know if women in this group of Veterans were using VA homeless services programs and how their use compared to their male counterparts.
As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nalo M. Hamilton, PhD, MSN, WHNP/ANP-BC, Assistant Professor at the University of California Los Angeles School of Nursing and an RWJF Nurse Faculty Scholar.
As 2012 approaches, I hope that the United States remains resolute in providing access to equitable health care for all, especially women.
We live in a time where women have made significant contributions in academic, social and political areas but their contributions to women’s health care are eroded with every passing year. Currently, as the working poor, a record number of women are living in poverty and are unable to access affordable health care.
Thus, their diaspora of medical conditions go without primary care management resulting in acute conditions that are stabilized in the emergency department. However, once the condition is stabilized, a woman is sent home without the ability to follow-up with her primary care provider, thus continuing the cycle of acute onset, ER admission and discharge.
In my current practice I primarily manage: hypertension, tobacco dependence, obesity, anxiety, depression, dyslipidemia, breast disorders, diabetes, hypothyroidism, infections, dysfunctional uterine bleeding and family planning. For me this list represents the many organs that exist between a woman’s eyeballs and toes. Additionally, these conditions highlight how critical it is for women to have access to health care, not only for chronic conditions but for preventative screening as well.
The Affordable Care Act is a critical first step but much remains to be done at local and national levels.
A new year brings with it new opportunities and hope, so raise your glass with me in a toast to 2012—the beginning of health care equity.