Jan 29, 2015, 7:00 PM, Posted by
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A man asking for money on the subway this week told me how Hurricane Sandy led to a series of events that left him stressed out by the challenges of putting food on the table for his children.
Recessions, hurricanes, violence—how many ways can we count that add stress to our lives? Whether dealing with economic stress, the stress of caring for an aging parent, or even the stress of keeping up with email, research shows that all of it affects our health. As Alexandra Drane, a guest in the latest episode of RWJF’s Pioneering Ideas podcast, puts it: “When life goes wrong, health goes wrong.”
This episode of the Pioneering Ideas podcast explores unconventional approaches to tackling stress—and other health problems—with energizing possibilities that could also transform health and health care. From monitoring electricity use as a way of helping the elderly stay in their homes, to measuring the indirect health effects of social services (what if heating assistance led to greater medication adherence?), these conversations offer cutting-edge ideas for building a Culture of Health.
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Jan 29, 2015, 9:54 AM, Posted by
Maryjoan Ladden, Susan Mende
Ever since President Obama announced the restoration of diplomatic ties between the United States and Cuba, there’s been growing excitement over the potential for new opportunities for tourism, as well as technology and business exchanges. Most people assume that the flow will be one-sided, with the United States providing expertise and investment to help Cuba’s struggling economy and decaying infrastructure.
That assumption would be wrong. America can—and already has—learned a lot from Cuba. At RWJF, we support MEDICC, an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States—South Los Angeles; Oakland, Calif.; Albuquerque, N.M.; and the Bronx, N.Y. Even with very limited resources, Cuba has universal medical and dental care and provides preventive strategies and primary care at the neighborhood level, resulting in enviable health outcomes. Cuba has a low infant mortality rate and the lowest HIV rate in the Americas, for example—with a fraction of the budget spent in the United States.
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Jan 29, 2015, 7:31 AM, Posted by
Jacquelyn Taylor, PhD, PNP-BC, RN, FAAN, is an associate professor of nursing at Yale University and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program (2008-2012). She recently received a $3.4 million grant from the National Institute of Nursing Research, a department of the National Institutes of Health, to conduct a large-scale study on the influence of genetic and psychological factors on high blood pressure in African-American women and children.
Human Capital Blog: Congratulations on your new grant from the National Institutes of Health to study blood pressure in African-Americans. What will be your focus?
Jacquelyn Taylor: African-Americans have the highest incidence of hypertension of any racial or ethnic group in our country. Studies show that some medications don’t work very well in reducing blood pressure in this population, and we are convinced that some other underlying mechanisms are at play. My co-principal investigator, Cindy Crusto, PhD, an associate professor in the department of psychology at Yale School of Medicine, and our research team and I will be studying two of those—genetic markers and psychological factors, such as perceived feelings of racism, mental health, and parenting behaviors—in our study. We want to know what effects these variables have on increases in blood pressure among African-American women and children over time.
HCB: Does this study build on your earlier work?
Taylor: In a previous study in Detroit, I looked at gene-environment interactions for high blood pressure in three generations of African-American women and identified hypertension risk alleles in grandmothers and in their daughters and granddaughters. Then I replicated the study in West Africa, where people live the same way as they did in the 1400s—in clay huts, with no running water, no sanitation, and no fast food as in the developed areas such as Detroit. The West African Dogon sample were mostly underweight, participated in large amount of physical activity, and had a limited but healthy diet. But they still had the same genetic markers for hypertension that I had identified in the sample in Detroit.
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Jan 28, 2015, 3:00 PM, Posted by
Every few weeks, Dana Todd, MD, does something rare for an American physician: She makes a house call. The visits are her way of making life easier for a bedridden stroke survivor and her caregiver daughter.
“One afternoon, I looked out into the clinic waiting room and there they were,” Todd recalls. “My patient was laying on a stretcher. Her daughter was by her side. Her family was adamantly against putting her in a nursing home because she is only in her 50s, so coming in was the only way she could get care. I just hated seeing her that way so I said, ‘Next time, I’ll come to you.’”
Todd is one of four primary care physicians who, along with a small group of nurse practitioners, provide care for residents of Greensboro, Ala., population 2,440, in rural Hale County. The little town, though, is a lot more to Todd than a place to work.
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Jan 28, 2015, 8:00 AM, Posted by
Aara Amidi-Nouri, PhD, RN, is associate professor of nursing and director of diversity at Samuel Merritt University in Oakland, Calif. She is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2014-2017) and has served as a project director for the RWJF New Careers in Nursing scholarship program at Samuel Merritt University since 2009.
Trust. Our health depends on it, and so do our lives.
Our very first stage of personality development as infants starts with trust, according to renowned developmental psychologist Erik Erikson. A newborn’s basic needs—food, shelter, and clothing—are entirely entrusted to a caregiver, one who hopefully recognizes that he or she does not yet have an ability to shiver, sweat, or shed tears.
When caregivers are attuned to babies’ environments and hunger cues, they are able to meet their needs and build their trust in other human beings. When caregivers hold newborns close, they meet their need for love and affection, building trust with every heartbeat and with every breath. We are social beings, dependent on one another. We must trust one another in order to survive. It’s no coincidence that our pennies—our most basic form of currency—are engraved with that very word.
What happens when, instead of building trust, we createmistrust? What happens when we can’t trust our health care system or our health care providers—our own caregivers, the very people who hold our fate and our lives in their hands?
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Jan 27, 2015, 4:38 PM, Posted by
“If you’ve been waiting more than 15 minutes, please see the receptionist.”
That’s the sign that was posted on a bulletin board in the radiology clinic where I was waiting for an MRI earlier this month. The funny thing? It was so lost amid the other postings around it screaming for attention that I only saw it on my way out, as I waited for a copy of the disk with my MRI on it. It struck me as odd, and a little concerning; did that mean I should be worried the clinic staff might have forgotten about me if I’d been waiting more than 15 minutes?
Don’t get me wrong: I understand that unpreventable delays happen. For me, the most frustrating aspect of signs like this is that they take the power away from the patient.
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Jan 27, 2015, 10:54 AM, Posted by
It's a brand new year and like many Americans, I'm thinking about New Year’s resolutions—specifically, fitness and exercise resolutions. People who know me well know how I feel about working out (Hint: I don't like it. Or do it). But I have lots of good reasons for wanting to start. I turned 30 this year, so I’m starting to age out of that Young Invincible demographic (#GetCovered), and realizing that I am, in fact, “vincible.” As I get older, and watch my parents age, it's starting to hit home that getting to a particular shape or size really isn't the point. The point is getting my heart and body in the best shape I possibly can.
So this year, New Year’s resolution time feels a little different. And as I start thinking about making some changes, I’m reflecting back over the last two Data for Health listening sessions I attended in Charleston and San Francisco. As a result, I’ve decided that it’s time to think about setting my New Year’s resolutions in an entirely different way--by using data.
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Jan 27, 2015, 9:00 AM, Posted by
At Virginia Commonwealth University School of Medicine, Briana Mezuk, PhD, is an assistant professor in the Department of Family Medicine and Population Health, Division of Epidemiology; and Tiffany L. Green, PhD, is an assistant professor in the Department of Healthcare Policy and Research. Both are alumnae of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program.
Approximately 30 million U.S. adults currently have diabetes, and an additional 86 million have pre-diabetes. The incidence of diabetes has increased substantially over the past 30 years, including among children. Estimates place the direct and indirect costs of diabetes at a staggering $218 billion annually.1 Like many other diseases, disparities on the basis of race and income are apparent with diabetes. Non-Hispanic blacks, Hispanics, Native Americans, and socioeconomically disadvantaged groups are more likely to develop diabetes than non-Hispanic whites and socioeconomically advantaged groups.
Despite the enormous economic and social costs associated with diabetes, it remains a struggle to apply what we know about diabetes prevention to communities at the highest risk. We have robust evidence from randomized controlled trials that changing health behaviors, including adopting a healthy diet and regular exercise routine and subsequent weight loss, will significantly lower the risk of diabetes. Unfortunately, these promising findings only appear to apply to the short-term. Even worse, results from community-based translation efforts have been much more modest than expected, and show only limited promise of reducing long-term diabetes risk. In response, leaders at the National Institutes of Health have noted that many efforts at translating clinical findings into community settings are “limited in scope and applicability, underemphasizing the value of context.”2
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Jan 26, 2015, 9:00 AM, Posted by
Laren Riesche, MSN, RN, is a nursing PhD student at the University of Illinois at Chicago. With clinical experience in neonatal nursing, her research focuses on the role of the placenta in fetal programming and its effect on health and disease throughout the life span. She is a Robert Wood Johnson Foundation (RWJF) New Careers in Nursing alumna and an RWJF Future of Nursing Scholar.
I have been extremely fortunate to have had great leadership development opportunities throughout my nursing education, thanks in part to the Robert Wood Johnson Foundation (RWJF). I have been privileged to be selected for two RWJF nursing education scholarship programs which are not only helping build my leadership skills, but also shaping my perspective on the importance of nurse leaders.
I am one of 16 nurses in the inaugural cohort of the Future of Nursing Scholars program, which supports nurses earning their PhDs. This August, we all participated in a leadership development workshop that was part of the very first scholars’ Boot Camp. The event was intended to help us prepare to complete our nursing PhDs in three years.
One of the activities involved choosing and then discussing a picture that represented our fears; we chose from more than 200 picture-cards that bore a wide range of images, from nature scenes to cityscapes, family events to individual athletes, and everything in between. I chose a picture of a koala bear hanging out in a tree. What I saw was a koala, all alone with nothing to hold onto but a single tree branch. It tapped into my fear that I was throwing everything I had into my PhD program, pushing my family and friends away, and losing myself in order to stay focused on finishing in three years—and maybe, in the end, the only thing I would have to hang onto was my degree.
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Jan 23, 2015, 9:00 AM, Posted by
Erin D. Maughan, PhD, MS, RN, APHN-BC, is director of research at the National Association of School Nurses and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2013 Cohort).
If we want to create a Culture of Health in America, a 2015 priority must be to focus on ways to break down the barriers that separate us and keep us from being as effective and efficient as possible. Currently, health care systems, education, housing, and public health work in siloes; they are funded in siloes, and workers are trained in siloes. Yet, people’s concerns and lives are not siloed and a community health culture/system cannot be either. One of the places to begin coordinated cultural change is in schools.
Schools are a smart choice to target because nearly 98 percent of school-age children, in their formative years, attend school and schools provide access to families and neighborhood communities. The Department of Education’s Full-Service Community Schools Program and Whole School, Whole Child, Whole Community Initiative reminds us that, in order for children to be educated, they need to be healthy and there must be a connection between school and community.
There are many school health initiatives in place, such as healthy food choices, physical fitness, healthy policies, school health services, community support, and after-school programs. The potential is there—but so are the siloes. But when schools are appropriately staffed with school nurses, the nurses help break down the siloes; that is because school nurses are extensions of health care, education, and public health and thus can provide or coordinate efforts to ensure a holistic, resource efficient, healthy school community.
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