Category Archives: Health disparities

Nov 18 2014
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APHA 2014: A ReFreshing Collaboration is Building Better Health in New Orleans

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If we as a nation are to succeed in building a Culture of Health that benefits every individual, it will require collaboration across sectors, open communication among diverse organizations and a willingness to step out of traditional practices to find effective interventions.

On Monday, Robert Wood Johnson Foundation Vice President Michelle Larkin showcased one example of this innovative collaboration that is occurring on the edge of a low-income neighborhood in New Orleans, just a few miles away from this year’s American Public Health Association (APHA) annual meeting.

At the corner of North Broad Street and Bienville Avenue sits The ReFresh Project—an innovative fresh food hub located in a former warehouse that had been vacant since Hurricane Katrina struck the city nine years ago. Today the site is home to a Whole Foods Market, Liberty’s Kitchen, The Goldring Center for Culinary Medicine and an onsite farm.

The goal of the hub, according to project founder Jeffrey Schwartz, is to create new eating, working, exercise and community living cultures.

Each aspect of the Refresh Project is designed to realize these goals. 

WholeFoods The ReFresh Project in New Orleans, La.
  • At the Whole Foods market, which anchors the Refresh project development, products are specifically chosen to be both high quailty and affordable. Specifically, the store carries more store-line products and often has more sale items than other stores in the Whole Foods chain. Two healthy eating educators are also located on-site to answer questions, craft recipes, and host tours.
  • At Liberty’s Kitchen, a culinary work readiness and leadership program for at-risk youth, New Orleans youth ages 16-24 who are out of work and out of school are given an intensive and hands-on food service training, case management, job placement services and follow-up support. Ninety percent of Liberty’s Kitchen Youth Development Program participants are employed on graduation out of the program and 80 percent are still employed at the six-month benchmark, according to the organization.

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Nov 5 2014
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Public Health News Roundup: November 5

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Massachusetts Now Has the Nation’s Strongest Paid Sick Leave Requirements
Massachusetts now has the nation’s strongest requirement for providing paid sick leave. Under a ballot question passed yesterday, people who work for businesses with 11 or more employees are now entitled to up to 40 hours of paid sick time each year. Workers at smaller companies will receive 40 hours of annual unpaid sick time. NewPublicHealth has previously written on the benefits of paid sick leave, including about an American Journal of Public Health study which found that a lack of paid sick leave can be a significant factor in the spread of disease. Read more on business.

Study: Fast Food Marketing to Children Disproportionately Affects Certain Communities
Fast food marketing directed toward children disproportionately affects black, middle-income and rural communities, according to a new study out of Arizona State University (ASU). Researchers studied the marketing practices of 6,716 fast food restaurants, determining that “while most fast food restaurants sampled were located in non-Hispanic and majority white neighborhoods, those situated in middle-income neighborhoods, rural communities and majority black neighborhoods had higher odds of using child-directed marketing tactics.” “Marketing food to children is of great concern not only because it affects their current consumption patterns, but also because it may affect their taste and preferences,” said ASU researcher Punam Ohri-Vachaspati, an associate professor of nutrition in the School of Nutrition and Health Promotion. “We know that consumption of fast food in children may lead to obesity or poorer health, and that low income and minority children eat fast food more often.” Read more on nutrition.

Study: No Link Between Media Violence and Real-Life Violence
Despite the popular notion that media violence is a factor in real-life crime, homicide rates have actually fallen over the past several decades as media violence—in movies, on television and in video games—has increased, according to two new studies in the Journal of Communication. One of the studies examined the level of violence in 90 movies from 1920 to 2005, while the other looked for links between violence in video games and real-life violence among American young people from 1996 to 2011. "The idea that media has big effects on us or shapes our society is probably untenable," said author Christopher Ferguson, chair of the psychology department at Stetson University in Florida. "This doesn't mean media has no effect at all, of course, only that we need to try to move media research out of these culture wars if we're going to make any progress." Read more on technology.

Oct 20 2014
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Public Health News Roundup: October 20

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EBOLA UPDATE: 43 People Cleared from Ebola Watch Lists in Texas
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Dozens of people in the United States came off of Ebola watch lists this morning after showing no symptoms for 21 days. A total of forty-three people who came into contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, were cleared by Texas’ state health department. Another 120 people are still being monitored. The news comes as lawmakers continue to debate the feasibility and prudence of enacting a travel ban from West Africa. Read more on Ebola.

 

Healthy Lifestyle Habits Could Reduce Gestational Diabetes Cases by Half

Healthy lifestyle habits such as maintaining a normal weight, not smoking and staying physically active may help prevent as many as half of all gestational diabetes cases, according to a new study in the journal BMJ. Researchers analyzed data on more than 14,000 U.S. women, finding that women who were overweight or obese during pregnancy were at four times the risk of developing gestational diabetes. Women with all three of the identified healthy lifestyle behaviors were 83 percent less likely to develop gestational diabetes than were women who lacked all three. Read more on maternal and infant health.

 

Study: Men with IBS Report Greater Interpersonal Difficulties
Men with irritable bowel syndrome (IBS) experience more interpersonal difficulties than do women with the condition, according to a surprising new study presented at the American College of Gastroenterology annual meeting in Philadelphia. IBS symptoms include abdominal pain, diarrhea and/or constipation; it affects an estimate 25 million to 50 million Americans, but is twice as common among women, meaning less is known about how men experience the disorder. The study determined that men report feeling cold and detached, which leads to difficulties in interpersonal relationships. "Our findings underscore the significance of studying gender-based differences in how people experience the same disease or condition," says Jeffrey Lackner, PsyD, professor of medicine in the UB School of Medicine and Biomedical Sciences, in a release. "That discrepancy underscores our need to move beyond clinical intuition and anecdote, and systematically study the different ways that each gender experiences disease in general. Patients who have a domineering and distant interpersonal style may need to work more closely with the physicians.” Read more on health disparities.

 

Oct 15 2014
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Public Health News Roundup: October 15

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EBOLA UPDATE: Second Dallas Health Care Work Tests Positive for Ebola
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The Texas hospital that treated a man who has since died from Ebola has reported that a second health care worker has tested positive for the disease. The patient has been isolated at Texas Presbyterian Hospital in Dallas; the health care worker is being monitored for fever and symptoms while confirmation testing is performed at the Texas Department of State Health Services’ laboratory. The U.S. Centers for Disease Control and Prevention has interviewed the patient about any contacts or potential exposures. Read more on Ebola.

CDC is Utilizing New, Faster Lab Test for Enterovirus D68
The U.S. Centers for Disease Control and Prevention (CDC) has developed and is now using a new laboratory test that will enable it to more quickly test remaining specimens for the presence of enterovirus D68 (EV-D68). EV-D68 has been identified as the most common type of enterovirus this year; enteroviruses and rhinoviruses lead to millions of respiratory illnesses in children annually, and can be especially harmful to kids with asthma. “CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations,” said Anne Schuchat, MD, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases. “When rare or uncommon viruses suddenly begin causing severe illness, CDC works quickly to develop diagnostic tests to enhance our response and investigations. This new lab test will reduce what would normally take several weeks to get results to a few days.” Read more on pediatrics.

Study: Health Disparities at the Root of Post-Cancer Surgery Deaths
Approximately 5 percent of more than 1 million cancer patients who had surgery died within one month of their operation, according to a new study by Harvard researchers. Study lead author Brandon Mahal, a research fellow at the Dana-Farber Cancer Institute in Boston, cited disparities such as access to quality care, biological or genetic factors, social support and treatment differences as the most likely reasons for the death rate. The study determined that married patients had a 20 percent lower risk of dying within the month after surgery; insured patients had a 12 percent lower risk; wealthier patients had a 5 percent lower risk; and more-educated patients had a 2 percent lower risk. "Efforts to reduce deaths and eliminate disparities have the potential to significantly improve survival among patients with cancer," Mahal said. Read more on health disparities.

Oct 9 2014
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‘Virtual’ Dental Exams Help the Underserved: Q&A with Jenny Kattlove, The Children’s Partnership

Recent data out of California has shown that close to 90,000 children go to the emergency room for dental care each year. Although the cost of those visits is tens of millions of dollars, often little more is done than prescribing antibiotics to control infections. While that is important, after such a visit a child’s teeth remain decayed, posing significant risks for adult dental health problems, which can lead to illnesses, deaths, huge out of pocket costs and reduced job opportunities if teeth are noticeably missing.

But California is now also the first state in the nation to permit dentists to take care of underserved kids and adults virtually. A law passed at the end of September vastly expands the Virtual Dental Home, a demonstration project that uses telehealth technology to bring dental services directly to patients in community settings, such as preschools, elementary schools and nursing homes.

Under the program, dental hygienists and assistants perform preventive care and provide patient information electronically for review by an off-site dentist. Under the direction of the dentist, the providers can also place temporary fillings—no drilling required—which can last for years, according to Jenny Kattlove, an oral health policy analyst for The Children’s Partnership, a children’s advocacy group. Patients who need more advanced care are referred to a dentist, and often they’re the dentist who worked with their technician.

A recent Pew study examined how the Virtual Dental Home worked at an elementary school in Sacramento, where the program provided cost-effective services to low-income children who did not have a regular source of dental care. Care under the Virtual Dental Home is paid for under California’s Medicaid program.

According to research by the University of the Pacific Arthur A. Dugoni School of Dentistry, which operates the Virtual Dental Home pilot program, more than 30 percent of Californians are unable to meet their oral health needs through the traditional dental care system. More than half of California’s Medicaid-enrolled children received no dental care in 2012 and even fewer received preventive care services.

NewPublicHealth recently spoke with Kattlove about the new law and its potential as a model for dental care for low income individuals across the country.

NewPublicHealth: What is the most significant advantage of the Virtual Dental Home?

Jenny Kattlove: The Virtual Dental Home is a way to diversify or disperse the workforce so that all the professionals are working at the top of their skills and expertise. By putting dental hygienists in a community setting and having them take care of the majority of the care that the child needs, the dentist can be in the clinic or in their dental office taking care of the more complex needs and supervising the hygienist. 

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Oct 7 2014
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Public Health News Roundup: October 7

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EBOLA UPDATE: Spain Sees Ebola’s First Transmission Outside of Africa
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Four people have been hospitalized and twenty-two are being monitored in Spain after the first confirmed transmission of Ebola outside of West Africa. The nurse, who tested positive yesterday, had treated two Spanish missionaries who contracted the disease in Africa. And while the World Health Organization believes the further spread of Ebola in Europe is “unavoidable,” the global health agency also says that the content is prepared to handle the disease. Read more on Ebola.

CDC Launches Social Media Campaign on the Importance of Tobacco Cessation
More than 20 million Americans have died from tobacco-related causes since the first U.S. Surgeon General’s Report on Smoking and Health more than 50 years ago. As a reminder of the ongoing need for tobacco cessation efforts—and in honor of those lost—the U.S. Centers for Disease Control and Prevention (CDC) has launched the “#20Million Memorial” social media campaign. The CDC will collect social media posts of people sharing messages or photos dedicated to someone they lost across Facebook, Google+, Instagram, Twitter or Vine using the hashtag "#20Million. Smokers looking for free help with quitting and go here; go here for more information on the #20Million Memorial. Read more on tobacco.

HUD: $60 Million to Improving Housing, Stimulate Growth in 90 Tribal Communities
The U.S. Department of Housing and Urban Development (HUD) has announced approximately $60 million in funding to help improve housing conditions and stimulate community development in more than 90 tribal communities across the country. The funds are provided through HUD’s Indian Community Development Block Grant (ICDBG) Program. “ICDBG funds are an important investment in the remote and low-income tribal communities that need it most,” said HUD Secretary Julián Castro, in a release. “Through this work, we’re proud to help our tribal partners expand opportunity in their community by determining on their own, not from Washington, which local projects meet their needs and strengthen their future.” Read more on health disparities.

Sep 26 2014
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Public Health News Roundup: September 26

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EBOLA UPDATE: American Physician Declared Ebola-Free, Released From Hospital
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Rick Sacra, MD, an American physician who was working in an obstetrics clinic in Liberia when he became infected with the Ebola virus, has been cleared as disease-free by the U.S. Centers for Disease Control and Prevention and released from The Nebraska Medical Center. He entered the facility, which includes one of the United States’ few biocontainment units, three weeks ago. Kenty Brantly, MD, who was previously and successfully treated for Ebola at Emory Hospital in Atlanta, had donated two pints of his blood for Sacra’s treatment. Read more on Ebola.

UTHealth to Use $1.3M Grant to Study Asthma Risk for Health Care Workers
As asthma prevalence continues to rise across the country, the University of Texas Health Science Center at Houston (UTHealth) School of Public Health will utilize a four-year, $1.3 million grant from the U.S. Centers for Disease Control and Prevention (CDC) to study how the risk of asthma has changed for Texas health care workers over the past decade. The health care field is one of the population groups that see a higher risk for the breathing disorder. For the study, researchers will repeat a 2003 survey which found that, after entering the field, 7.3 percent of nurses and 4.2 to 5.6 percent of doctors, respiratory therapists and occupational therapists developed asthma. “Practices in hospitals have changed in 10 years. There are new cleaning chemicals, including many environmentally friendly ones, but are those products without risk? We want to find out,” said George Delclos, MD, PhD, co-principal investigator and professor in the Division of Epidemiology, Human Genetics & Environmental Sciences at the UTHealth School of Public Health. Read more on health disparities.

HHS: $212M to Strengthen State, Local Programs Designed to Prevent Chronic Diseases
The U.S. Department of Health and Human Services (HHS) announced yesterday that it will award nearly $212 million in grants to help all 50 states and the District of Columbia strengthen efforts to prevent chronic diseases. A total of 193 awards will go to state and local programs, and are funded in part through the Affordable Care Act. “Tobacco use, high blood pressure, and obesity are leading preventable causes of death in the United States,” said U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, in a release. “These grants will enable state and local health departments, national and community organizations, and other partners from all sectors of society to help us prevent heart disease, cancer, stroke, and other leading chronic diseases, and help Americans to live longer, healthier, and more productive lives.” Read more on prevention.

Sep 22 2014
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Public Health News Roundup: September 22

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UPDATE: Sierra Leone Ends Three-Day Lockdown, Reports 130 New Cases
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Officials in Sierra Leone have ended a three-day curfew designed to help contain the continuing spread of the Ebola virus, calling the effort a success. Authorities reported 130 new cases during the lockdown and are waiting for tests on 39 more people. The West African country has been one of the hardest hit by the outbreak—more than 550 of the nearly 2,800 total deaths have been in Sierra Leone. In addition more than 100 tons of health-related supplies are being flown to Sierra Leone and Liberia. They include gloves, masks, gowns, goggles, saline, antibiotics, oral rehydration solution and painkillers. "We must do all we can to reduce further the human tragedy caused by this deadly outbreak and help communities avoid an even deeper setback than has occurred already," said Chief Executive Thomas Tighe of Direct Relief, according to USA Today. Read more on Ebola.

Study: Medicare Patients Less Likely to Receive Post-Stroke Surgery
Despite the fact that it can significantly help recovery and reduce the risk of long-term disability or even death, a common post-stroke surgical treatment is far less likely to be referred by physicians of patients with Medicare, according to a new study in the journal PLOS One. Researchers at the University of Florida (UF) analyzed data on more than 21,000 adult patients discharged from 2003 to 2008 with a diagnosis of subarachnoid hemorrhage, finding that—when compared to patients with private insurance—Medicare patients were almost 45 percent less likely to receive surgery and were more than twice as likely to die in the hospital. Azra Bihorac, MD, the study’s senior author and an associate professor of anesthesiology, medicine and surgery at the UF College of Medicine, said the results could indicate a conscious or unconscious bias. “Not every hospital has skilled neurosurgeons who specialize in subarachnoid hemorrhage,” he said in a release. “If these hospitals don’t have the necessary expertise, then they may actually overestimate the risk of a bad prognosis. They may assume that the patient won’t do well anyway, so they won’t proceed with surgery.” Read more on access to care.

Study: Weekly Text Reminders about Calories Help People Make Healthier Choices
Something as simple as a weekly text reminder may help U.S. adults develop a better understanding of basic nutrition and make healthier food choices, according to a new study in Health Promotion Practice. Researchers from the Johns Hopkins Bloomberg School of Public Health sent either a weekly text message reminder, a weekly email reminder, or no weekly reminder about the U.S. Food and Drug Administration’s recommendation of a reasonable daily caloric intake—2,000 calories—to 246 participants dining in the Johns Hopkins Hospital cafeteria. They found that at the beginning of the study approximately 58 percent knew the recommended benchmark, but after four weeks the participants who received texts were twice as likely to know the benchmark. “While daily energy needs vary, the 2,000-calorie value provides a general frame of reference that can make menu and product nutrition labels more meaningful,” said study leader Lawrence J. Cheskin, MD, director of the Johns Hopkins Weight Management Center, in a release. “When people know their calorie ‘budget’ for the day, they have context for making healthier meal and snack choices.” Read more on nutrition.

Sep 11 2014
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For the Homeless, a Place to Call Home After a Hospital Stay

A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.

Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).

Medical Respite Centers Location of medical respite centers in the United States

Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.

Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.

The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.

The goals of the guidelines for the respite care centers are to:

  • Align with other health industry standards related to patient care
  • Represent the needs of the patients being served in the medical respite centers.
  • Promote quality care and improved health
  • Create standards for a range of respite center types with varying degrees of resources

NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.

There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.

“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.

Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.

>>Bonus Links:

Sep 4 2014
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Public Health News Roundup: September 4

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EBOLA UPDATE: WHO Says More than $600M Needed to Combat the Ebola Outbreak
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Approximately $600 million in supplies is needed to combat the ongoing Ebola outbreak in West Africa, according to the World Health Organization (WHO), while Canadian health officials continue to work on a way to transport an experimental treatment to the affected area. "We are now working with the WHO to address complex regulatory, logistical and ethical issues so that the vaccine can be safely and ethically deployed as rapidly as possible," said Health Canada spokesman Sean Upton, in a statement. "For example, the logistics surrounding the safe delivery of the vaccine are complicated." More than 1,900 people have died in the outbreak. Read more on Ebola.

RWJF, TFAH Report Finds State Obesity Rates Continue to Remain High
Adult obesity rates continue to be high across the country, with rates increasing in six states and decreasing in none over the past year, according to a new report from the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The report, The State of Obesity: Better Policies for a Healthier America, found that rates climbed in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming. Mississippi and West Virginia have the highest rates, at 35.1 percent, and no state has a rate below 21 percent. “Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” said Jeffrey Levi, PhD, executive director of TFAH, in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities—so every American has the greatest opportunity to have a healthy weight and live a healthy life.” Read more on obesity.

Study: Women Are Underrepresented in Surgical Research
A review of more than 600 studies in five major surgical journals found that males are vastly overrepresented, calling into question how the findings will translate for female patients.  The journals— Annals of SurgeryAmerican Journal of Surgery, JAMA SurgeryJournal of Surgical Research and Surgery—responded by announcing they will now require study authors to report the sex of animals and cells in their research, or to explain why only one sex was analyzed. "Women make up half the population, but in surgical literature, 80 percent of the studies only use males," study senior author Melina Kibbe, MD, professor of surgical research at Northwestern University Feinberg School of Medicine, said in a release. "We need to do better and provide basic research on both sexes to ultimately improve treatments for male and female patients.” The study appeared in the journal Surgery. Read more on health disparities.