Category Archives: Poor and economically disadvantaged

Aug 19 2014
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Nurse Practitioners Make a Difference with Mobile Clinic

Nurse practitioners enjoyed prime time TV coverage when Sunday’s 60 Minutes program ran a segment about the Health Wagon, a mobile clinic serving six counties in an impoverished Appalachian coal-mining region in southwestern Virginia.

The segment, originally broadcast in April, highlighted the work of Teresa Gardner and Paula Hill-Meade, both doctors of nursing practice, who currently see approximately 20 patients a day in a converted RV, while also keeping up with up fundraising responsibilities related to the federal grants and corporate and private donations that keep the organization going.

Their patients “are people that are in desperate need,” Meade told 60 Minutes correspondent Scott Pelley. “They have no insurance and they usually wait, we say, until they are train wrecks. Their blood pressures come in at emergency levels. We have blood sugars come in at 500, 600, because they can’t afford their insulin. ...They have nowhere else to go.”

However, Gardner said, as demanding as the work is, “we get more out of it than we ever give.”

Watch the 60 Minutes segment on CBS News online.

Apr 18 2014
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Subsidized Health Insurance May Lower Poverty, But We Don’t Measure It

Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics.

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In these early days of the Affordable Care Act, the uninsured rate has begun to sharply decrease. One recent estimate suggests 5.4 million adults gained insurance coverage in the first quarter of 2014. The Congressional Budget Office projects that enrollment in Medicaid and the health insurance Marketplaces will increase even more rapidly over the next two years.

The importance of increased health insurance coverage for improved access to health care justifiably receive much of the public’s attention, but the impact of coverage on the financial health of families may be equally important. Subsidized health insurance can increase the disposable income of families by freeing up money that was previously used to pay out-of-pocket for doctor’s visits and prescription drugs. Newly insured individuals also benefit from the risk-protection of health insurance since even people who use little or no health care are at risk of unexpected accidents or newly diagnosed diseases.

A recent study in Oregon that compared adults who received free health insurance through a lottery to those who applied but did not receive the free care found that the “winners” were much less likely to say that they needed to cut back on necessities to pay for health care. They also had much less medical debt and a lower likelihood of receiving a notice from a collection agency.

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Feb 6 2014
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Human Capital News Roundup: Avoiding aneurysms, healthy food, gun safety, 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:

In a Huffington Post Latino Voices blog, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, discusses obesity among Hispanic Americans and how parents can influence children’s behavior, particularly regarding physical activity. She also flags influences that impede efforts to improve health for Hispanic youth: “In the U.S., food advertising on Spanish-language television is more likely to promote nutritionally-poor food than English-language advertising, hindering Hispanic children.”

During months when low-income individuals have access to Earned Income Tax Credit benefits, they spend more on healthy food, according to a study by RWJF Scholars in Health Policy Research alumna Diane Whitmore Schanzenbach, PhD. The study suggests that people with low incomes also buy more healthy food when their income increases, reports the Wall Street Journal Real Time Economics blog.

Health care professionals could make a vital contribution to educating children about the dangers of gun-related injuries, according to a study by RWFJ Clinical Scholar John Leventhal, PhD. He told Fox News: “Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.”

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Jan 13 2014
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Feds Set Aside $45 Million to Strengthen Nursing

The federal government announced late last year it would deliver $55.5 million in fiscal 2013 to programs designed to strengthen, diversify, and grow the health care workforce.

The bulk of the funds—82 percent, or $45.4 million—are targeted at nurses, the largest segment of the health care workforce.

The announcement came as welcome news to supporters of a national campaign backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform the nursing profession to improve health and health care.

Many of the grants support the Future of Nursing: Campaign for Action’s call for a more highly educated and more diverse nursing workforce and for more interprofessional collaboration among nurses and other health care professionals, according to Winifred Quinn, PhD, co-director of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF.

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Dec 16 2013
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Explaining the Link between Income, Race, and Susceptibility to Kidney Disease

Deidra Crews, MD, ScM, an alumna of the Harold Amos Medical Faculty Development Program (2009-2013), was named the 2013-2015 Gilbert S. Omenn Anniversary Fellow at the prestigious Institute of Medicine. Among her current research is a study examining the association between unhealthy diet and kidney disease among low-income individuals.

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Human Capital Blog: Congratulations on your fellowship! What are your priorities for the coming year?

Deidra Crews: Over the next two years, I'll be participating in different activities of the Institute of Medicine (IOM). I'll be working with IOM committees and participating in roundtables and workshops. That's the main function of the fellowship. The great thing about it is I'll get to experience firsthand the activities of IOM and hopefully contribute to one or more of the reports that will come out of the IOM over the next couple of years. Because of my interest in disparities in chronic kidney disease, I will be working with the committee on social and behavioral domains for electronic health records, which falls under the IOM board of population health and public health practice. We will be making recommendations on which social and behavioral factors should be tracked in patients' electronic health records.

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Aug 29 2013
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Human Capital News Roundup: Depression and poverty, substance use among SNAP recipients, accountable care organizations, 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:

The U.S. News & World Report Economic Intelligence blog cites a study co-authored by RWJF Scholars in Health Policy Research alumna M. Marit Rehavi, PhD, that finds mothers who are physicians are 9 percent less likely to have unscheduled C-sections than their non-physician counterparts. The researchers used this and other data to examine the interaction between patient information and financial incentives for physicians, as C-sections are typically more profitable than traditional deliveries.

A low-cost, home-based program called “Beat the Blues” lowers depressive symptoms among older African Americans who are having trouble paying for basic needs, according to a study co-authored by RWJF Nurse Faculty Scholar Sarah Szanton, PhD, CRNP. Szanton’s findings coupled with those in another study that showed meaningful reductions in depressive symptoms from the program “suggest that depression can be 'decoupled’ from financial strain," Nurse.com reports.

Harold Pollack, PhD, MPP, co-authored a post for the Washington Post Wonk blog about research he led that finds adults whose households receive support from the Supplemental Nutrition Assistance Program (SNAP) are only slightly more likely than non-recipients to display substance use disorders. “Proposals to drug-test SNAP recipients don’t address the genuine challenges posed by drug and alcohol misuse in American society,” he writes. “Instead, poor families who seek a little help with the food money are being used as stage extras in a different, nasty ideological fight.” Pollack is an alumnus of the Scholars in Health Policy Research program and recipient of an RWJF Investigator Award in Health Policy Research.

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Oct 25 2012
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When Crossing the Street is the Difference Between Life and Death

Comilla Sasson, MD, MS, FACEP is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado.  Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010. Her latest study is published in the October 25th, 2012 issue of the New England Journal of Medicine.

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Dead. How do you make someone “undead?” How, with just your two hands, can you prolong the time that paramedics have to restart a person’s heart? How can a normal, ordinary person make a difference and literally save a life?

We know that a person’s chances of surviving an out-of-hospital sudden heart arrest decreases by 10 percent for every one minute he/she does not get CPR (cardiopulmonary resuscitation).  I had learned about hands-only CPR in my medical training.  Hands-only CPR is where all you have to do is push hard and fast (to the tune of “Staying Alive”) at a 100 times a minute until helps arrives.

But time and time again, I cared for African-American patients in Atlanta who had laid in their families’ homes for critical minutes as their brains slowly died from a lack of blood supply from the heart.  Their hearts had stopped and no one called 911. No one placed their hands on the chest and started doing hands-only CPR.

Maybe this is just Atlanta? Is it the color of a person’s skin or is the place where he or she collapses that makes the difference?

In my Robert Wood Johnson Foundation Clinical Scholars Program (RWJCSP) at the University of Michigan (2007-2010), I learned about the importance of neighborhoods in determining a person’s health.  After wading through the literature, my a priori hypothesis was that having someone stop to provide CPR is completely dependent upon others; therefore, the neighborhood plays a large role in whether or not someone does CPR.

After consulting with my two RWJCSP alumni mentors, David Magid, MD, MPH, and Arthur Kellermann, MD, MPH, FACEP, the question became clear: What role does the racial and socioeconomic composition of a neighborhood have on an individual’s likelihood of receiving life-saving bystander CPR?

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Jun 21 2012
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Human Capital News Roundup: Income-based discrimination, nursing education, bans on sugary drinks, 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 and grantees. Some recent examples:

“As a physician, I have seen the tremendous capabilities of nurses – capabilities that are essential to meeting patient needs,” RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, writes in a June 14, 2012 post on MedScape Today [free subscription]. “But to ensure that they maximize their contributions to health and health care, nurses will need advanced skills and expertise in care management, interdisciplinary teamwork, problem solving, and more. This makes higher levels of education imperative. In addition, having a larger pool of highly educated nurses will be necessary to expand the ranks of nurse faculty, addressing the shortfall that now causes nursing schools to turn away thousands of qualified applicants each year. These advanced degree nurses are also needed to help ameliorate the worsening primary care shortage.” The piece was reprinted from Pediatric Nursing.

RWJF Health & Society Scholar Amy Non, PhD, MPH, is the lead author of a study that finds a significant association between low education levels and hypertension in African Americans. The findings debunk the theory that African ancestry plays a role in the disproportionately high rates of hypertension. U.S. News & World Report, Health magazine, and MSN Health are among the outlets to report on the findings. Read more about the study.

United Press International (UPI) and the Journal Sentinel (Milwaukee, Wis.) report on a study led by Thomas Fuller-Rowell, PhD, also a Health & Society Scholar, that finds social-class- and income-based discrimination harms child health. Read more about the study.

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Jun 11 2012
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Mindfulness and Yoga for Disadvantaged Urban Youth

Tamar Mendelson, PhD, is an assistant professor at the Johns Hopkins Bloomberg School of Public Health, and an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006). Her research interests include the development of prevention and intervention strategies for reducing mental health problems, with a focus on underserved urban populations. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health. Mendelson is a member of the program’s 2nd cohort.

Tamar Mendelson
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Anyone who's ever spread a yoga mat across a floor will tell you that it's about more than flexibility. One of many benefits of yoga is that it helps those who practice it deal with stress in their lives. An emerging body of research points to the conclusion that yoga can have a stress-relieving effect.

One problem with the research base is that it's mostly focused on adults. But grown-ups aren’t the only ones who deal with stress in their lives. Children face it as well, and they often do it without the same resources—emotional, financial and otherwise—that adults have.

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Feb 22 2012
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Sharing Nursing's Knowledge: What's in the January Issue

Are you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the latest nursing news, research and trends. Here’s a review of what’s in the January issue:

Nurse Educator Helps Lift Native Hawaiians Out of Poverty

Read about the remarkable journey of RWJF Community Health Leader Jamie Kamailani Boyd, who made a long and arduous climb out of poverty and is now helping others do the same. She has created an academic program called Pathway Out of Poverty, which helps disadvantaged Hawaiians become nurse’s aides and registered nurses.

RWJF Executive Nurse Fellows are Using Their Leadership Skills to Improve Health and Health Care

Several alumni of the RWJF Executive Nurse Fellows program are using the leadership and risk-taking skills they gained in the program to support Partners Investing in Nursing's Future projects in their home states.

Four Decades of Championing Nursing

This piece examines some of the early work that laid the foundation for even more innovative and ambitious RWJF programs to build nursing leadership, improve nurse education, strengthen the nursing workforce and, ultimately, improve health and health care. Read about former RWJF staff member Terrance Keenan, who influenced the Foundation’s early investments in nursing programs and initiatives.

Nurses Reach Out to Help Those Who Are Hungry

As the economic downturn made hunger and food insecurity more common last year, RWJF Scholars and alumni stepped up to help in their communities. Read about their work, individually and through their nursing schools.

See the entire January issue here. Sign up to receive Sharing Nursing’s Knowledge here.