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Nov 17 2014
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Is Louisville, Kentucky, the New Face of Asthma Healthography?

Meredith Barrett, PhD, is vice president of science and research at Propeller Health, a health technology company working to reduce the burden of asthma and chronic obstructive pulmonary disease (COPD). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), Berkeley and UC, San Francisco. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.

Meredith Barrett

Leaders in Louisville, Kentucky, know first-hand that where you live and work affects your health and well-being. During a special session at the American Public Health Association’s meeting this week in New Orleans, we explore how the air quality in Louisville neighborhoods impacts the health, economy and overall vibrancy of the community. And we’ll highlight how Louisville is the poster child for tackling tough issues like asthma head-on, top-down and bottom-up, through data and collaboration among individual residents, corporate execs, community organizers and public leaders. 

American Public Health Association Meeting & Expo

Asthma attacks are sneaky, expensive and debilitating, yet almost entirely preventable.

Asthma is one of the most common and costly chronic diseases in the United States, affecting more than 8 percent of the U.S. population. Despite decades of research and the development of effective treatments, rates of morbidity have not declined and health care costs reach more than $50 billion a year. Asthma also leads to more than 13 million missed days of school and 10 million missed days of work, negatively affecting educational achievement, employee productivity and regional business growth. But the most frustrating part is that a large proportion of these hefty impacts could be avoided with improvements in self-management, community policy and advances in digital health care.

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Nov 17 2014
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What Determines Your Health?

Minoo Sarkarati, BA, is a third-year medical student and Robert Wood Johnson Foundation (RWJF) Health Policy Scholar at Meharry Medical College. She completed her undergraduate degrees of psychology and integrative biology at the University of California, Berkeley. Learn about the RWJF Briefings @ the Booth at the APHA Annual Meeting on Monday, November 17 and Tuesday, November 18.

Minoo Sarkarati

What determines your health?  Is it your zip code? Is it the clinic or hospital you go to? Is it the physician you see? Or is it you?

American Public Health Association Meeting & Expo

I could not say that the answer to this critical question is solely any one of these. However, understanding how each component plays a role in one’s health, as well as exploring further determinants, is vital to building healthier communities.

This year’s American Public Health Association (APHA) Meeting theme is Healthography. It is an opportunity to explore how our environment—whether it is access to clean air, safe housing, transportation, healthy foods, safe places to exercise, jobs, or quality health care—plays a role in our health. 

As a medical student training in a safety-net hospital, I have seen how each of these elements plays a role in one’s health. Without addressing these factors, a large part of medical care is lost. Encouraging regular exercise is not so simple when you do not have sidewalks or green spaces, or you do not feel safe being outside in your neighborhood. Writing a prescription to treat diabetes becomes meaningless if your patient cannot fill it because he/she does not make enough income to purchase the medication.

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Nov 14 2014
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Are You Going to the American Public Health Association Meeting Next Week?

During this year’s American Public Health Association (APHA) Annual Meeting & Exposition, 10 Robert Wood Johnson Foundation (RWJF) grantees will give short talks at the first-ever RWJF Briefings @ the Booth on Monday, November 17 and Tuesday, November 18. Grantees from a variety of programs, representing numerous health and health care sectors, will share their insights on topics ranging from health literacy to obesity interventions to green building certification.

American Public Health Association Meeting & Expo

The briefings will take place at the RWJF exhibit space in the Ernest N. Morial Convention Center.

Grab a cup of coffee at the RWJF café and join a briefing! The schedule follows.

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Nov 14 2014
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Misfortune at Birth

Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.

Eileen Lake (Smaller photo) Eileen Lake

Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity.  It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery.  It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.

A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior?  A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals.  Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives. 

Jeannette Rogowski Jeannette Rogowski

A Brighter Future

What can be done to make these hospitals better?  A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.

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Nov 13 2014
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Addressing the Needs of Female Veterans Who Have Experienced Violence and Harassment

Jacquelyn Campbell, PhD, RN, FAAN, is director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing.  Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an alumna of the RWJF Nurse Faculty Scholars program.

Jacquelyn Campbell Jacquelyn Campbell

As two scholars who have worked in research, practice and policy arenas around issues of gender-based violence for years, we honor our veterans this week by paying tribute to the Pentagon and the U.S. Department of Veterans Affairs (VA) for addressing intimate partner and sexual violence among active duty and returning military and their families, and urge continued system-wide involvement and innovative solutions.  

In our work, we’ve heard outrageous, painful stories. One female servicemember explained to Angela why she was ignoring the sexual harassment she experienced. She knew that hearing that she was inferior because she was a woman, being called “Kitty” instead of her name, and having the number 69 used in place of any relevant number was harassing. She knew it was wrong. But she had decided that she would not let it bother her. I can acknowledge that he is a jerk, but I can’t let that affect me.  

Angela Amar Angela Amar

I can’t let his behavior define me as a person. On some level this may seem like an accurate way of dealing with a problem person. However, sexual harassment isn’t just about one obnoxious person. Not telling the story doesn’t make the behavior go away. Rather, it sends the message that the behavior is acceptable and that sexist comments are a normal part of the lexicon of male/female interactions.

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Nov 13 2014
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RWJF Scholars in the News: EpiPens in schools, suicide prevention, financial incentives for wellness, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

A study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH, shows that keeping supplies of epinephrine, commonly known as EpiPens, in schools saves lives, Health Day reports. Epinephrine injections are given in response to life-threatening allergic reactions to food or to insect stings. Gupta’s study found that epinephrine was administered to 35 children and three adults in Chicago public schools during the 2012-13 school year. “We were surprised to see that of those who received the epinephrine, more than half of the reactions were first-time incidents,” Gupta said. “Many children are trying foods for the first time at school, and therefore it is critical that schools are prepared for a possible anaphylactic reaction.”  Forty-one states have laws recommending schools stock epinephrine, according to the article.

Matt Wray, PhD, MA, an RWJF Health & Society Scholars program alumnus, writes in Medical Xpress that when it comes to preventing suicides, it’s important to focus some attention on how a person seeks to end his or her life. According to the article, suicide-prevention research has shown that when people who have begun to act on suicidal impulses find that access to their chosen method is blocked, many do not seek out other means. “Most people don’t have a backup plan,” Wray writes. “So when their initial attempt is stalled, the destructive impulse often passes. Moreover, contrary to what many believe, people who attempt suicide more than once are rare. Less than 10 percent of those who survive an attempt ever end up dying by suicide.”

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Nov 12 2014
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Connected Health Approaches to Improve the Health of Veterans

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Mitesh Patel

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

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Nov 12 2014
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Improving Mental Health Care for Veterans is Vital

Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).

Ilse Wiechers

Health and disease are on a continuum.  We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.

These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.

I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.

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Nov 11 2014
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Stony Brook Helps Veterans Become Nurses

Lori Escallier, PhD, RN, CPNP, is a professor and associate dean for evaluation and outcomes at the State University of New York at Stony Brook School of Nursing. She is her university’s project director for a program that helps veterans earn baccalaureate degrees in nursing (VBSN) and for New Careers in Nursing, a program supported by the Robert Wood Johnson Foundation (RWJF) and the American Association of Colleges of Nursing (AACN) that supports second-career nurses in accelerated master’s and baccalaureate nursing programs.

Lori Escallier

Human Capital Blog: Please tell us about your university’s program for nursing students who are veterans.

Lori Escallier: The project is entitled Enhancing the Nursing Workforce: Career Ladder Opportunities for Veterans. The purpose is to increase the enrollment, retention and educational success of veterans in the baccalaureate nursing program at Stony Brook. Our program operationalizes the collaborative efforts of the Health Resources and Services Administration, the Department of Defense, and the Department of Veterans Affairs (VA) by providing opportunities for veterans to transition into nursing careers.

HCB: How is the VBSN program helping to build a Culture of Health that more effectively serves veterans?

Escallier: One of the project’s aims is to enhance the nursing workforce with veterans. Veterans certainly have a good understanding of the needs of other veterans and their families. Who better to promote a Culture of Health for veterans than those who have “walked the walk?”

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Nov 11 2014
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Let’s Put Veterans in Charge of Their Pain Care

Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.

Erin Krebs (Veterans Day)

How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.

Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.

Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.

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