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Tag: Health Disparities

  • Finnish study shows those at risk were less likely to get vaccinated.

    Finnish study shows those at risk were less likely to get vaccinated.

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    Newswise — A large-scale registry study in Finland has identified several factors associated with uptake of the first dose of COVID-19 vaccination. In particular, persons with low or no labor income and persons with mental health or substance abuse issues were less likely to vaccinate.

    The study, carried out in collaboration between the University of Helsinki and the Finnish Institute of Health and Welfare, tested the association of nearly 3000 health, demographic and socio-economic variables with the uptake of the first COVID-19 vaccination dose across the entire Finnish population. 

    This work, just published in the Nature Human Behavior, is the largest study to date on this topic. 

    The single most significant factors that associated with reduced likelihood of being vaccinated were lack of labor income in the year preceding the pandemic, mother tongue other than Finnish or Swedish and having unvaccinated close relatives, especially the mother. Among health-related variables, factors related to mental health and substance abuse problems associated with reduced vaccination.

    “Lack of labor income can be due to unemployment, sickness or retirement. Furthermore, among individuals with labor income, we saw that low-income earners where the least likely to vaccinate”, explains Tuomo Hartonen, Postdoctoral Researcher at the Institute for Molecular Medicine Finland FIMM, University of Helsinki.

    The study was based on the FinRegistry data. Researchers analysed population-wide national health and population register data from the pre-pandemic period and compared these with the vaccination status data. The analyses were limited to people aged 30-80 years.

    “A particular strength of our study is that it is based on registers covering the entire Finnish population. This way we can avoid all selection bias, which is a major challenge of survey studies”, Postdoctoral Researcher Bradley Jermy from FIMM says.

    The researchers stress that their results describe the association between the studied variables and vaccination uptake at the population level, but do not allow conclusions to be drawn about causal relationships. Furthermore, the generalizability of the findings outside Finland requires further studies. However, it is clear from the results that in Finland, vaccination uptake was lowest among those who are already in a vulnerable position.

    Researchers created a machine learning-based model to predict vaccination uptake

    In addition to studying single predictors, the research team constructed a machine learning-based model to predict vaccination uptake. This prediction model allowed the researchers to group individuals according to their likelihood of receiving the COVID-19 vaccine.

    Approximately 90% of the total study population received at least one dose of COVID-19 vaccination. In contrast, the group with the lowest probability of being vaccinated based on the model had a vaccination rate of less than 19%.

    “Our research has created a framework for using machine learning and statistical approaches to identify those groups that are at higher risk of not vaccinating”, says the corresponding author of the study, Associate Professor Andrea Ganna from FIMM.

     “These results and the predictive model could be used in the future, for example in designing vaccination campaigns”, says the Principal Investigator of the FinRegistry study, Research Professor Markus Perola from THL.

    “This study is a great example of the possibilities that the FinRegistry study creates for investigating highly topical issues in a short timeframe. The collaboration between THL’s genetic and registry researchers and FIMM scientists will help to understand the many pathways that lead to susceptibility to different diseases,” Perola continues.

    The study is part of the FinRegistry project, a joint research project between the Finnish Institute for Health and Welfare (THL) and the Institute for Molecular Medicine Finland (FIMM) at the University of Helsinki.

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    University of Helsinki

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  • New Study at Johns Hopkins Kimmel Cancer Center Shows Patient/Clinician Identity Differences Are Factor in Cancer Care

    New Study at Johns Hopkins Kimmel Cancer Center Shows Patient/Clinician Identity Differences Are Factor in Cancer Care

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    Newswise — A new study by researchers at the Johns Hopkins Kimmel Cancer Center in collaboration with Dell Medical School, University of Minnesota, and the Vanderbilt University Medical Center, using a national data sample from the National Institutes of Health All of Us Research Program, revealed that a small but statistically significant proportion of patients with cancer, especially younger and lower-income minorities, disproportionately reported delaying care because of patient/clinician racial, gender and cultural differences.

    The study, led by student doctor and first author Vishal Patel from Dell Medical School at the University of Texas at Austin and senior author S. M. Qasim Hussaini, M.D., Chief Medical Oncology Fellow at the Johns Hopkins Kimmel Cancer Center, was published March 30 in the journal JAMA Oncology.

    The All of Us Research Program data is housed at the Vanderbilt University Medical Center.

    Hussaini, along with program leadership, led recent efforts focused on Diversity, Equity, and Inclusion within the hematology-oncology fellowship program at Johns Hopkins with a dedicated program focused on curricular development, recruitment and retention, minority engagement, and health systems research.

    The current work addresses the American Society of Clinical Oncology’s recently announced strategic action plans to improve workforce diversity and clinician preparedness, says Hussaini. The findings, he notes, directly inform policies to increase uptake of educational priorities and workforce diversification within oncology.

    “Our article provides important evidence that a lack of physician diversity may be contributing to disparities in care delivery for patients with cancer and can be harmful to patients,” says Patel.

    “This represents the kind of important research that needs to be done if we are to get optimal care to all Americans.  The greatest reason for racial health disparities in cancer outcomes is racial disparities in receipt of quality care,” says Otis W. Brawley, M.D., Bloomberg Distinguished Professor of Oncology and Epidemiology.

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    Johns Hopkins Medicine

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  • Bringing Cancer Education to American Indian Communities

    Bringing Cancer Education to American Indian Communities

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    Newswise — Phyllis Nassi, MSW, associate director of research and science, special populations, directs the American Indian program at Huntsman Cancer Institute and recently received the 2023 American Association for Cancer Research (AACR) Distinguished Public Service Award for Exceptional Leadership in Cancer Advocacy. ­

    “My favorite part of what I do is being boots on the ground in the community,” says Nassi. “I’ve spent a lot of time helping to change the course of what research means in the area we serve and beyond at Huntsman Cancer Institute. We’ve been able to build a reputation of trust and I have permission from Tribal Leaders to bring education about clinical trials to the reservation.”

    Nassi, an enrolled member of the Otoe-Missouria Tribe and member of the Cherokee Nation, focuses on bringing cancer education to the frontier and rural locations across the Mountain West. She started at Huntsman Cancer Institute in 2001 as a manager of special populations and has served on many committees and advisory boards.

    “Nassi has shown relentless commitment and cultural humility to serve as an advocate for American Indian communities across Utah and 17 other states, including Idaho, New Mexico, Montana, Arizona, and Alaska,” says Neli Ulrich, PhD, MS, executive director of the Comprehensive Cancer Center at Huntsman Cancer Institute. “She improves cancer awareness and survival through promotion of early detection practices, communication about the benefits of cancer research, and clinical trial enrollment. Her passion and efforts to reduce disparities and bring health equity to underserved populations makes her highly deserving of the prestigious AACR Public Service award.”

    Huntsman Cancer Institute founder Jon M. Huntsman, Sr., former National Cancer Institute Director Andrew C. von Eschenbach, MD, and former U.S. Speaker of the House Nancy Pelosi, are just some of the previous honorees.

    “It’s amazing and humbling to be part of this group, I could not have done what I do and what I love without the support of my son, Enrico, his partner, and my late husband Walter.”

     

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    About Huntsman Cancer Institute at the University of Utah

    Huntsman Cancer Institute at the University of Utah is the official cancer center of Utah and the only National Cancer Institute-designated Comprehensive Cancer Center in the Mountain West. The campus includes a state-of-the-art cancer specialty hospital and two buildings dedicated to cancer research. Huntsman Cancer Institute provides patient care, cancer screening, and education at community clinics and affiliate hospitals throughout the Mountain West. It is consistently recognized among the best cancer hospitals in the country by U.S. News and World Report. The region’s first proton therapy center opened in 2021 and a major hospital expansion is underway. Huntsman Cancer Institute is committed to creating a diverse and inclusive environment for staff, students, patients, and communities. Advancing cancer research discoveries and treatments to meet the needs of patients who live far away from a major medical center is a unique focus. More genes for inherited cancers have been discovered at Huntsman Cancer Institute than at any other cancer center, including genes responsible for breast, ovarian, colon, head and neck cancers, and melanoma. Huntsman Cancer Institute was founded by Jon M. and Karen Huntsman.

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    Huntsman Cancer Institute at the University of Utah

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  • More Research, Advocacy Can Improve PAH Disparities

    More Research, Advocacy Can Improve PAH Disparities

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    Photo Credit: omgimages / Getty Images

    SOURCES:

    Chest: “Delay in Recognition of Pulmonary Arterial Hypertension,” “Race and Sex Differences in Response to Endothelin Receptor Antagonists for Pulmonary Arterial Hypertension.”

    CDC: “Health Disparities.”

    American Lung Association: “Learn About Pulmonary Arterial Hypertension.”

    Journal of the American Heart Association: “Mortality in Pulmonary Arterial Hypertension in the Modern Era: Early Insights From the Pulmonary Hypertension Association Registry.”

    Kingman, M., et al. Increasing Awareness about Pulmonary Arterial Hypertension Treatment for Nurses. StatPearls Publishing, 2022.

    Mayo Clinic: “Pulmonary Hypertension.”

    Charles Vega, MD, clinical professor of family medicine, University of California, Irvine.

    Stephen C. Mathai, MD, associate professor, The Johns Hopkins Pulmonary Hypertension Program.

    Frontiers in Aging: “Sex Differences in Pulmonary Hypertension.”

    Advances in Pulmonary Hypertension: “Health Disparities in Pulmonary Arterial Hypertension and the Impact of the COVID-19 Pandemic.”

    European Respiratory Review: “Sex and Gender in Pulmonary Arterial Hypertension.”

    Pulmonary Circulation: “Racial and Ethnic Differences in Pulmonary Arterial Hypertension,” “Time to Diagnosis of Pulmonary Hypertension and Diagnostic Burden: A Retrospective Analysis of Nationwide U.S. Healthcare Data.”

    Current Problems in Cardiology: “Urban-Rural Disparities in Pulmonary Hypertension-Related Mortality Between 2004 and 2019: A Call to Improve Access to Specialty Care Centers for Rural Residents in the United States.”

    Mei-Sing Ong, PhD, assistant professor, Harvard Pilgrim Health Care.

    European Respiratory Journal: “Traffic Exposures, Air Pollution and Outcomes in Pulmonary Arterial Hypertension: A UK Cohort Study Analysis.”

    Elizabeth Joseloff, PhD, vice president of quality care and research, Pulmonary Hypertension Association. 

    Annals of the American Thoracic Society: “Secular and Regional Trends among Pulmonary Arterial Hypertension Clinical Trial Participants.”

    Proceedings of the American Thoracic Society: “Patients with Pulmonary Arterial Hypertension in Clinical Trials: Who Are They?”

    American Journal of Respiratory and Critical Care Medicine: “Health Disparities in Patients with Pulmonary Arterial Hypertension: A Blueprint for Action. An Official American Thoracic Society Statement.”

    Frontiers in Drug Discovery: “Novel and Emerging Therapies in Pulmonary Arterial Hypertension.”

    For Long-Term Treatment of Pulmonary Arterial Hypertension, Canadian Agency for Drugs and Technologies in Health, 2015.

    BMC Health Services Research: “The Economic Burden of Pulmonary Arterial Hypertension (PAH) in the U.S. on Payers and Patients.”

    Pulmonary Hypertension Association: “Advocacy Action Center.”

    The American Journal of Managed Care: “Health Insurance and Racial Disparities in Pulmonary Hypertension Outcomes.”

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  • Use of racially concordant educational video did not affect acceptance of heart implant devices among Black patients

    Use of racially concordant educational video did not affect acceptance of heart implant devices among Black patients

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    Newswise — DALLAS – April 03, 2023 – Multiple studies have demonstrated that Black patients are significantly less likely than white patients to undergo invasive cardiovascular procedures. Prior research also has demonstrated substantial racial disparities in the use of implantable cardioverter-defibrillators (ICDs) that can be lifesaving for those at high risk for sudden cardiac death.

    Agreeing to have an ICD, though, relies on patients having a clear understanding of the potential benefits of the procedure as well as trust in their care team. Cardiologists at Duke University, including Eric Peterson, M.D., M.P.H., who served at Duke before joining UT Southwestern Medical Center in 2020, investigated whether an educational video that used both white and Black physicians and patients might increase patients’ willingness to consider an ICD.

    “Racial health disparities are often complex and multifactorial. Yet empowering patients to better understand their disease and potential treatment options is one way to help overcome this,” said Dr. Peterson, Vice Provost and Senior Associate Dean for Clinical Research at UTSW and the study’s lead author.

    The findings, published in Annals of Internal Medicine, examined two separate facets. First, it looked to see whether the video would affect patients’ decision-making process. The study found that rates of ICD implantation were not different among those randomized to the video versus not, about 60% in each. However, the researchers did find that patients seeing the video felt they understood their options better and had to spend less time with their physicians to reach a decision. 

    Second, the researchers examined whether the video’s impact was altered by whether the race of the characters in the video matched that of the patient. Interestingly, racial concordance or discordance had no impact on the video’s effectiveness.

    The researchers concluded that better educational tools could engage more patients and give them confidence in their treatment decisions. However, education alone will not fully rectify complex differences in procedural use by race. Since a high percentage of Black patients in both arms were willing to undergo the procedure, Dr. Peterson concluded that the major underlying causes for ICD disparities may lie more with who is offered the costly device rather than on who agrees to the procedure.    

    Dr. Peterson holds the Adelyn and Edmund M. Hoffman Distinguished Chair in Medical Science.

    The study was supported by a Patient-Centered Outcomes Research Institute Program Award (AD-1503-29746).

    About UT Southwestern Medical Center

    UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.

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    UT Southwestern Medical Center

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  • Mental distress among female individuals of reproductive age after overturning of Roe v Wade

    Mental distress among female individuals of reproductive age after overturning of Roe v Wade

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    About The Study: This case control study found that for female individuals, the loss of abortion rights was associated with a 10% increase in prevalence of mental distress relative to the mean over the three months after the Supreme Court of the U.S. decision. Restricting legal abortion access may be associated with disproportionate outcomes among individuals of lower socioeconomic status and in medically underserved areas, who may experience greater economic and mental health burdens of having unwanted pregnancies due to increased travel costs of obtaining abortions. 

    Authors: Muzhe Yang, Ph.D., of Lehigh University in Bethlehem, Pennsylvania, is the corresponding author. 

     

    Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

    #  #  #

     

    About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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    JAMA – Journal of the American Medical Association

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  • Study Finds Relationship Between Discrimination and Frailty in Black Cancer Survivors

    Study Finds Relationship Between Discrimination and Frailty in Black Cancer Survivors

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    Newswise — WASHINGTON — Discrimination experienced by Black people can affect their health and increase their frailty, which can be particularly impactful for cancer survivors, according to a new study by researchers at Georgetown University’s Lombardi Comprehensive Cancer Center and colleagues at the Barbara Ann Karmanos Cancer Institute in Detroit. The researchers assessed frailty by a number of factors, including whether a participant had several chronic diseases, poor muscle strength and difficulty performing activities of daily living.

    The findings appeared March 20, 2023, in Cancer.

    “Discrimination can act as a chronic stressor which can throw the body off balance, resulting in increases in blood pressure, heart rate, metabolism, inflammation, and numerous other factors. These stressors can also increase rates of aging, leading to greater risk of frailty,” says the study’s lead investigator, Jeanne Mandelblatt, MD, MPH, director of the Georgetown Lombardi Institute for Cancer and Aging Research. “We hypothesize that discrimination can lead to an older biological age than a person’s actual chronological age. This is important to understand as there have been virtually no studies of the relationships between discrimination and aging in the setting of cancer survivorship.”

    The investigators looked at associations between discrimination and frailty among 2,232 Black breast, lung, prostate and colorectal cancer survivors who were within five years of their diagnoses and were no longer actively being treated for their cancers. Survivors were 62 years of age on average (with ages ranging from 23 to 84) at the time of the study, but they may have experienced discrimination over many decades of their lives. All participants were part of the Detroit Research on Cancer Survivors (ROCS), which is the largest U.S. study of Black cancer survivors.

    The researchers surveyed the participants, via phone, in writing, or online about any aging-related diseases they had, their ability to maintain a healthy lifestyle, and most importantly, about major discrimination events they may have experienced over their lifetimes, specifically targeting seven areas:

    • being unfairly fired or denied a promotion in their job;
    • not being hired for a job;
    • being unfairly stopped, searched, questioned, physically threatened or abused by police officers;
    • being unfairly discouraged by a teacher or advisor from continuing their education;
    • unfairly receiving worse medical care than other people;
    • being prevented from moving into a neighborhood because a landlord or realtor refused to sell or rent them a house or an apartment; and/or
    • moved into a neighborhood where neighbors made life difficult.

    Based on the survey results, the majority of cancer survivors were classified as either prefrail (42.7%), meaning they had some health difficulties, or frail (32.9%). Only 24.4% of those surveyed had few or no signs of frailty. When queried about the seven discrimination areas, 63.2% of the participants reported experiencing major discrimination, with an average respondent reporting 2.4 types of discrimination.

    “For those cancer survivors who reported four to seven types of discrimination events, we observed a large, clinically meaningful increase in frailty scores compared to survivors with fewer discrimination events,” explains Mandelblatt, also a professor of oncology and medicine at the Georgetown University School of Medicine. “Significantly, this pattern of discrimination affecting frailty was consistent across the four types of cancer surveyed, indicating that discrimination is an important factor to study and understand in Black cancer survivors in order to improve their quality and length of life.”

    “Our results indicate that after considering the effects of traditional factors on poor health, such as income, education and types of cancer treatment, discrimination was a significant factor explaining frailty and it acted independently of the other variables,” says  Ann Schwartz, PhD, MPH, co-lead author on the paper and co-principal investigator of the Detroit ROCS. “Regardless of whether you were rich or poor, if you experienced more discrimination then you had greater frailty.” Schwartz is also professor and associate chair of oncology at Wayne State University School of Medicine, and deputy center director and executive vice president for research and academic affairs at Karmanos.

    For their next steps, the researchers are hoping to study the relationships between major discrimination, other chronic life stressors and markers of biological aging and test how cancer and its treatment further contributes to biological aging among racial and ethnic minorities. 

    “We have long since recognized the impact of discrimination on health and well-being in Black communities,” says study co-author Lucile Adams-Campbell, PhD, a professor of oncology and associate director for Minority Health and Health Disparities Research at Georgetown Lombardi. “We hope that this study leads to more discussions between providers and their patients about the types of discrimination they have experienced and gives providers a greater understanding of how discrimination impacts frailty.”

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    Additional authors include Xingtao Zhou and Traci Bethea at Georgetown Lombardi; Julie Ruterbusch, Hayley Thompson and Kristen Purrington at Wayne State University School of Medicine and Karmanos Cancer Institute.

    The authors report having no personal financial interests related to the study.

    This research was supported by National Cancer Institute grants U01 CA199240, R01CA129769,  R35CA197289 and K01CA212056 and a National Institute on Aging grant R21AG07500. This work was supported by the Epidemiology Research Core and the National Cancer Institute Center Grant (P30CA022453) awarded to the Karmanos Cancer Institute at Wayne State University.

    About Georgetown University’s Lombardi Comprehensive Cancer Center
    Georgetown’s Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute (NCI) as a comprehensive cancer center. A part of Georgetown University Medical Center, Georgetown Lombardi is the only comprehensive cancer center in the Washington D.C. area. It serves as the research engine for MedStar Health, Georgetown University’s clinical partner. Georgetown Lombardi is also an NCI recognized consortium with John Theurer Cancer Center/Hackensack Meridian Health in Bergen County, New Jersey. The consortium reflects an integrated cancer research enterprise with scientists and physician-researchers from both locations. Georgetown Lombardi seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic, translational and clinical research, patient care, community education and outreach to service communities throughout the Washington region, while its consortium member John Theurer Cancer Center/Hackensack Meridian Health serves communities in northern New Jersey. Georgetown Lombardi is a member of the NCI Community Oncology Research Program (UG1CA239758). Georgetown Lombardi is supported in part by a National Cancer Institute Cancer Center Support Grant (P30CA051008). Connect with Georgetown Lombardi on Facebook (Facebook.com/GeorgetownLombardi) and Twitter (@LombardiCancer).

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    Lombardi Comprehensive Cancer Center at Georgetown University

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  • A Young Neurologist Mentors Black Women, Fights Disparities

    A Young Neurologist Mentors Black Women, Fights Disparities

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    Eseosa Ighodaro, MD, PhD, is a neurologist busy tackling health disparities now. But she kept her first experiments on ice at home.

    “I used to hide experiments in the freezer so my mom couldn’t see them,” she says. “I’d mix orange juice, pepper, and salt to see if I could create a chemical reaction. Afterwards, my mom would go into the kitchen and say, ‘Where are my ingredients?’ She was calling me ‘Doctor’ even before I knew I wanted to be a physician-scientist.”

    In the family dining room, Ighodaro’s father set up a whiteboard with erasers and markers to teach his daughters math and science. He’d come to the U.S. from Nigeria in his 20s with $20 in his pocket. Having worked part-time jobs while getting his computer science degree, he had no patience for excuses.

    “On the weekend, when other kids were playing outside, he’d say, ‘Where’s your science book? Where’s your math book?’” Ighodaro says. “I went to college thinking I could take over the world!”

    The achievements kept coming. Ighodaro became the first Black woman to graduate from the University of Kentucky College of Medicine with a combined MD/PhD degree in 2019. A medical school neuroscience class made her fall in love with the brain. So after graduating, she headed to the Mayo Clinic in Minnesota for her residency in neurology and neuroscience research. Next comes a fellowship in vascular neurology at Emory University, where she plans to become a stroke specialist.

    But her goals go way beyond her degrees. 

    Combating Health Disparities in Neurology

    Ighodaro plans to take on the health disparities around stroke in the Black community. That includes studying how chronic racism may raise stroke risk – and helping to prevent Black people who’ve already had one stroke to not have another.

    She’s already gained national prominence as an advocate and teacher. The COVID-19 death of another doctor – Susan Moore, MD, an internal medicine doctor in Indiana – was a turning point.

    Ighodaro had seen Moore’s videos posted on Facebook while hospitalized and severely ill. Moore described how she had begged for a CT scan and to get the antiviral drug remdesivir, and how she was refused pain medication. “If I was white, I wouldn’t have to go through that,” Moore said in one video. “This is how Black people get killed, when you send them home, and they don’t know how to fight for themselves.” Moore was discharged from one hospital on Dec. 7, 2020, and was readmitted to another hospital just 12 hours later. She died on Dec. 20, 2020. 

    “Watching this video, I was irate,” Ighodaro says. “It was unacceptable! A Black female physician begging to be seen, to be treated as human, only to be dismissed. She died of COVID-19 complications because a system in which she worked to take care of patients treated her like a drug-seeker.”

    Ighodaro put together a panel of eight Black women doctors and medical students. They released a video, “Tragedy: The Story of Dr. Susan Moore and Black Medical Disparities,” about what Moore’s death meant to them. Its success inspired Ighodaro to produce two more panel discussion videos: one on racial health disparities in fertility, labor, and delivery and another on racism in medical publishing. 

    The response to her videos prompted Ighodaro to create  Ziengbe (“zee-en-bay”), a nonprofit health advocacy organization. The word means “perseverance” in the Edo language of Nigeria, her father’s people. Ziengbe’s mission is to eliminate neurological and other health disparities facing the Black community through advocacy, education, and empowerment. 

    “I want us to treat this issue like a medical emergency,” like how a stroke is treated, Ighodaro says. “If we don’t, Black people will continue to die.” 

    Nurturing the Next Generation

    Ighodaro also has her eye on the doctors and scientists who’re coming after her. 

    One of her first projects with Ziengbe was to harness social media to support, educate, and mentor young people from communities of color and other underrepresented groups who are interested in pursuing neurology careers. 

    “I had such wonderful mentors who played a major role in my becoming a neurologist,” she says. But she sees “so many students” who don’t.

     

    Ighodaro has virtual neurology study groups. She uses email, WhatsApp, and social media platforms such as Instagram, Twitter, and Facebook and has grown it into a community of nearly 500 students and mentors. In more than a dozen online study sessions over the past year, she’s hosted sessions on topics including stroke management, seizures, and traumatic brain injury as well as preparing first-year interns for their first time practicing medicine on a hospital ward. The videos are archived online via the Ziengbe website. 

    She’s helped students publish their work, strengthening them as neurology residency candidates. “Some of them have never written a paper like this for a medical journal before,” Ighodaro says. She also speaks to medical professional societies, such as the American Academy of Neurology, about using social media to recruit the next generation of doctors, empower underserved populations, and combat racial disparities in health and health care.

    “One of my primary goals is to recruit more people of color to the field of neurology and neuroscience, especially Black women,” Ighodaro says. “I’m trying to be the mentor that I wanted when I was younger. During my education, it was rare for me to be taught by a Black female neurologist or neuroscientist, or even come across one.”

    Those too young to know their possibilities are some of her favorites. 

    “I want to show little Black girls that we are here,” Ighodaro says. “The road is difficult and can be lonely at times, but we can do it. We just have to dream big.”

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  • Black patients wait longer for uterine cancer testing, diagnosis

    Black patients wait longer for uterine cancer testing, diagnosis

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    Newswise — Early diagnosis of uterine cancer is known to improve a patient’s chances for survival, but previous research has found that Black patients are less likely to receive early diagnoses than people of other racial and ethnic groups. A new analysis by Yale researchers provides insights into why that is: They found that Black patients were more likely than their white counterparts to experience testing delays or to not receive recommended tests at all.

    The findings were published Feb. 15 in the Journal of the National Cancer Institute.

    At what stage a patient is diagnosed with uterine cancer has a major impact on how well that patient will fare. When diagnosed while the cancer is still confined to the uterus, nearly 95% of patients will survive the next five years. But that rate drops to less than 70% once the cancer has spread to areas or lymph nodes nearby and plummets to around 18% once the cancer has spread to other parts of the body.

    “Early diagnosis is important,” said Xiao Xu, an associate professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, member of Yale Cancer Center, and lead author of the study. “We don’t know why there’s a racial disparity in early diagnosis and until we do, it’s hard to address it.”

    To determine whether differences in the diagnosis process contribute to this disparity, Xu and her colleagues used the MarketScan Multi-State Medicaid Database, which has deidentified data from more than 44 million Medicaid patients across the United States.

    For their analysis, they included adult patients who had reported abnormal uterine bleeding to their health care providers and later received a diagnosis of uterine cancer. Abnormal uterine bleeding is the most common symptom of uterine cancer, Xu said, and can present as light spotting or heavier bleeding at unexpected times.

    The American College of Obstetricians and Gynecologists recommends several procedures to evaluate the cause of abnormal uterine bleeding, such as endometrial biopsy, transvaginal/pelvic ultrasound, and hysteroscopy, in which a physician examines the inside of the cervix and uterus with a small, telescope-like device. In the new study, researchers found that more than twice as many Black patients than white patients did not receive any of these procedures (10.1% of Black patients versus 5% of white patients).

    Further, of the patients who did receive procedures, Black patients were more likely than white patients to experience a delay of more than two months in receiving their first diagnostic procedure following their report of abnormal uterine bleeding.

    Ultimately, Black patients were more likely than white patients to experience a delay in receiving their cancer diagnosis. The researchers found that 11.3% of Black patients who’d reported abnormal uterine bleeding waited more than a year to receive a uterine cancer diagnosis, compared with 8.3% of white patients.

    “Overall, we found a pretty consistent difference in the quality of care received by Black and white patients,” said Xu.

    To better understand the driving factors behind this difference in care and how best to address them, Xu and her colleagues are evaluating additional sets of data to determine whether Black patients might experience barriers to accessing specialist care, if more education about the symptoms of uterine cancer may be beneficial for patients, and whether delays in diagnoses result in patients being diagnosed at later stages of cancer. They are also studying whether these findings among Medicaid patients are similarly seen in other patient populations.

    “The goal,” said Xu, “is for every patient to receive high-quality care.”

    Other authors include Marcella Nunez-Smith and Mitchell Clark from Yale School of Medicine and Ling Chen and Jason Wright from Columbia University.

    The research was supported by the National Institute on Minority Health and Health Disparities.

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    Yale Cancer Center

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  • Training Individuals to Work in their Communities to Reduce Health Disparities

    Training Individuals to Work in their Communities to Reduce Health Disparities

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    Newswise — Community health workers were trusted messengers, disseminating health information in underserved communities during the COVID-19 pandemic, and playing a vital role in reducing health disparities. 

    This form of outreach is the basis of a newly launched academic-community partnership, led by the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego and is funded by a $3-million Health Resources and Services Administration grant, that aims to train 200 individuals from refugee, immigrant, and Native American populations living in San Diego County to become community health workers on key health topics disproportionately affecting their communities.

    “COVID-19 highlighted the need for individuals with culturally and linguistically competent skills to be engaged as community health workers within their own neighborhoods. At the urging of our community collaborators to design a certified training program, I felt responsibility to take that role and address health disparity that is negatively impacting these communities,” said Wael Al-Delaimy, M.D., Ph.D., professor at the Herbert Wertheim School of Public Health and Human Longevity Science, who is bilingual and an immigrant from the Middle East.

    Nationally, San Diego is the second largest hub for immigrants from the Middle East and Somalia, two populations targeted by this program.

    Al-Deliamy is the director of the newly funded initiative titled Community Health Workers for Advancing Public Health within Immigrant/Refugee and Native American Communities Program (CHWAP), which is a collaboration with the UC San Diego Division of Extended Studies, UC San Diego Altman Clinical and Translational Research Institute (ACTRI) Center for Community Health, Somali Family Service of San Diego, and more than 14 community organization partners.

    The program will provide all-expenses paid training that will be held in combination of community settings, at the UC San Diego campus, and online.

    Somali Family Service will recruit trainees from underserved communities and will provide additional services including transportation, childcare, mentorship and career services such as resume writing and cover letter development workshops. It will also assist participants to find living wage jobs.

    “It is important for community members to access trusted messengers equipped with the capacity to holistically relate and respond to their needs and concerns while providing valuable and impactful services and solutions,” said Ahmed Sahid, president and CEO of Somali Family Service of San Diego.

    “The Community Health Workers for Advancing Public Health within Immigrant/Refugee and Native American Communities Program significantly bolsters our community health workers’ efforts by ensuring they receive the training, tools and support necessary to uplift underserved and vulnerable communities.”

    Community health workers are not medical or public health professionals. They are individuals who bridge culture, language and life experiences with public health, health care and the needs of the community in which they live.

    The Herbert Wertheim School of Public Health competed and was selected to become part of a national network to develop capacity in training 13,000 community health workers through a $225 million HRSA program under the directive of the White House.

    UC San Diego Division of Extended Studies will oversee the academic components of CHWAP, providing access to world-class training in health support, soft skills development, and leadership and self-care.  

    “We hope to train as many as 200 new community health workers over the next three years and are honored to work with the Herbert Wertheim School of Public Health and Human Longevity Science and our community partners to ensure a talented and diverse public health workforce and reduce healthcare disparities in our region,” said Laura B. Fandino, J.D., Ph.D., assistant dean of academic affairs, Division of Extended Studies. 

    Among the community organizations helping to recruit community health workers is the San Diego Refugee Communities Coalition, a collective of ethnic-community based organizations in San Diego County with a history of serving thousands of underserved refugee families and residents. The ACTRI Center for Community Health Refugee Health Unit serves as the backbone organization for the coalition.

    CHWAP will provide an opportunity for expanded workforce development within refugee and underserved communities to improve access to health resources in a way that was unavailable prior to the COVID-19 pandemic, said Blanca Meléndrez, executive director of the ACTRI Center for Community Health and co-director of CHWAP.

    “Community health workers can provide culturally competent, locally relevant services to individuals in their primary language which makes community members more comfortable and open to discussing sensitive topics,” said Amina Sheik-Mohamed, M.P.H., ACTRI Center for Community Health Refugee Health Unit director.

    Chag Lowry, who is of Yurok, Maidu, and Achumawi Native ancestry from California, will be coordinating the program’s outreach and recruitment effort to Native Americans. 

    “Our Native American community suffered health inequity for decades and was hit hard by the COVID-19 pandemic. This is a welcome effort to build capacity in an effort to address the health equity gap,” said Lowry, administrative director of the California American Indian Tobacco Initiative Evaluation based at the Herbert Wertheim School of Public Health.

    CHWAP will coordinate job placements and development of an apprenticeship program with hospitals, clinics and regional partners including the San Diego Workforce Partnership, said Eric Hekler, Ph.D., CHWAP co-director and associate dean for community partnerships at the Herbert Wertheim School of Public Health.

    In addition, CHWAP is collaborating with the California Consortium for Urban Indian Health, the County of San Diego, Health Center Partners of Southern California, the Hospital Association of San Diego and Imperial Counties, and Family Health Centers of San Diego.

    “Part of the mission of the Herbert Wertheim School of Public Health and Human Longevity Science is to collaborate with diverse partners to develop community-led health solutions,” said Hekler.  

    “The Community Health Workers for Advancing Public Health within Immigrant/Refugee and Native American Communities Program helps us cultivate our capacity to serve our local communities by training and supporting job placement of people within their neighborhoods as well as influence health inequities.”

    Information about the program and how to enroll is available on the CHWAP website. 

    This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $3 million with no other non-governmental sources. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the United States government. For more information, please visit HRSA.gov

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    University of California San Diego

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  • Language of Care: University of Utah Health Researchers Co-Design Health Care With the Deaf Community

    Language of Care: University of Utah Health Researchers Co-Design Health Care With the Deaf Community

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    Newswise — Navigating health care is hard enough when English is your first language—imagine the difficulty when American Sign is your first language. How can we bridge the linguistic and cultural gaps needed to better care for patients? University of Utah Health is proud to present Language of Care, an incredible story of how a community of Deaf patients are breaking barriers by co-designing their own care with University of Utah Health researchers.

    Made possible by generous support from the Kahlert Foundation, Language of Care premiered at Sundance Film Festival 2023. The film showcases an innovative approach to health care being co-created by Michelle Litchman, PhD, her research team, and members of the Deaf community from across the country. Together, they lead a program called Deaf Diabetes Can Together. Litchman is a nurse practitioner, diabetes researcher, and Medical Director of the Intensive Diabetes Education and Support (IDEAS) Program at the University of Utah.

    Nearly 40 million people in the U.S. live with diabetes, but the majority of Deaf people with diabetes do not have equal access to health care. The film tells the story of how Deaf Diabetes Can Together is creating solutions for health equity in the Deaf community. By understanding the community’s unique needs, the team is tailoring educational and other types of resources to increase access to accurate information and care. This model is being replicated for rural, Pacific Islander and other under-resourced communities.

    “Together, with our patients, we’re changing the way heath care works,” Litchman explains in Language of Care.

    Academy Award®-winning filmmaker Ross Kauffman came to Utah to document the Language of Care story. Kauffman has directed a number of award-winning films, including Born into Brothels, Of Medicine and Miracles, and Tigerland. Language of Care was produced by Robin Honan with executive producers Joe Borgenicht of U of U Health, award-winning documentarian Geralyn Dreyfous, and Heather Kahlert of the Kahlert Foundation.

    Language of Care is the third film in the U of U Health-produced series New Narratives in Health, which brings together scientists and artists to more broadly communicate advances in knowledge. The first film in the series, One in a Million, tells the story of how advanced genomic technologies combined with expert clinical insights vastly improved the quality of life for Tyler, a boy with a rare, debilitating disease. The second, Meet Me Where I Am, follows Adolphus Nickleberry through his journey at U of U Health’s Intensive Outpatient Clinic as he rewrites his story, which had been shaped by health disparities.

    Learn more at languageofcareutah.org.

    # # #

    About University of Utah Health

    University of Utah Health  provides leading-edge and compassionate care for a referral area that encompasses Idaho, Wyoming, Montana, and much of Nevada. A hub for health sciences research and education in the region, U of U Health has a $458 million research enterprise and trains scientists and the majority of Utah’s physicians and health care providers at its Colleges of Health, Nursing, and Pharmacy and Schools of Dentistry and Medicine. With more than 20,000 employees, the system includes 12 community clinics and five hospitals. U of U Health is recognized nationally as a transformative health care system and provider of world-class care.

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    University of Utah Health

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  • Across the US, white neighborhoods have more greenery, fewer dilapidated buildings, fewer multi-family homes

    Across the US, white neighborhoods have more greenery, fewer dilapidated buildings, fewer multi-family homes

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    Newswise — Historic redlining and other racist policies have led to present-day racial and economic segregation and disinvestment in many cities across the United States. Research has shown how neighborhood characteristics and resources are associated with health disparities such as preterm birth and asthma, but most of these studies are limited in scale and overlook many aspects in a neighborhood that are difficult to measure, including dilapidated buildings and crosswalks.

    Now, a new study led by Boston University School of Public Health (BUSPH) and the Center for Antiracist Research (CAR) at Boston University (BU) has utilized panorama digital technology through Google Street View (GSV) to identify these neighborhood characteristics on a national scale and shed light on how they contribute to racial and ethnic disparities in local resources and health outcomes across the US.

    Published in the journal JAMA Network Open, the study found that predominantly White neighborhoods had better neighborhood conditions generally associated with good health, such as fewer neglected buildings and multi-family homes, and more greenery than neighborhoods with residents who were primarily Black, of other minority races, or of a variety of races and ethnicities. 

    The findings underscore the need for comprehensive and accessible data platforms that researchers can utilize to better understand the role of the built environment on racial and health inequities, and inform policies that aim to create equitable neighborhood resources in all communities.

    “Large datasets on determinants of health can help us better understand the associations between past and present policies—including racist and antiracist policies—and neighborhood health outcomes,” says study corresponding author Dr. Elaine Nsoesie, associate professor of global health at BUSPH. “Neighborhood images are one dataset that have the potential to enable us to track how neighborhoods are changing, how policies are impacting these changes and the inequities that exist between neighborhoods.”

    For the study, Dr. Nsoesie and colleagues analyzed national data on race, ethnicity, socioeconomics, and health outcomes, and 164 million GSV images across nearly 60,000 US census tracts. The team examined five neighborhood characteristics: dilapidated buildings, green spaces, crosswalks, multi-family homes, and single-lane roads.

    The largest disparities in neighborhood environments were reflected in green space and non-single family homes. Compared to predominantly White neighborhoods, predominantly Black neighborhoods had 2 percent less green space, and neighborhoods with racial minorities other than Black had 11 percent less green space. Compared to White neighborhoods, neighborhoods with racial minorities other than Black had 17 percent more multi-family homes, while neighborhoods with Black residents and neighborhoods with residents representing a variety of races and ethnicities had 6 percent and 4 percent more multi-family homes, respectively.

    The researchers also conducted modeling to measure how the built environment may influence the association between health outcomes and the racial makeup of neighborhoods, and found the strongest connections between sleeping problems among residents in neighborhoods with racial minorities other than Black or White, and asthma among neighborhoods with residents representing a variety of races and ethnicities.

    “An interesting finding from our paper is how a considerable portion of the racial/ethnic differences of the built environment conditions was shown at the state level,” says study co-lead author Yukun Yang, a data scientist at CAR. “This prompts us to think practically about how state and local government and policymakers could and should address the inequitable distribution of built environment resources which could further address the health disparities we observed today.” 

    “Our findings really demonstrate the path-dependent nature of inequality and racial disparities,” says study co-lead author Ahyoung Cho, a racial data/policy tracker at CAR and a political science PhD student at BU. “It is critical to develop appropriate policies to address structural racism.”

    **

    About Boston University School of Public Health

    Founded in 1976, Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master’s- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally

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    Boston University School of Public Health

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  • Introduction of Diagnostic and Supplemental Imaging Legislation Could Benefit Thousands of Missourians

    Introduction of Diagnostic and Supplemental Imaging Legislation Could Benefit Thousands of Missourians

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    Newswise — ST. LOUIS, MISSOURI – JANUARY 10, 2023 – Susan G. Komen®, the world’s leading breast cancer organization, applauds Representative Brenda Shields (R-St. Joseph) for working with Komen to introduce legislation that would remove financial barriers to imaging that can rule out breast cancer or confirm the need for a biopsy. Last year alone, more than 5,560 individuals were diagnosed with breast cancer and more than 820 died of the disease in Missouri.

    “This legislation can make an immediate impact for thousands of people who require diagnostic or supplemental breast imaging yet are unable to afford it and often forego the tests,” said Molly Guthrie, Vice President of Policy and Advocacy at Susan G. Komen. “Everyone should be able to access the care they need and afford it, especially when it could mean the difference between a person’s life and death.”

    HB 575, introduced by Rep. Shields, would eliminate out-of-pocket costs for diagnostic and supplemental breast imaging (such as an MRI, ultrasound, diagnostic mammogram) when medically necessary. These exams can be extremely expensive and require people to pay high out-of-pocket costs – all before more expensive treatment even begins.

    A Komen-commissioned study found the costs to patients range from $234 for a diagnostic mammogram to more than $1,021 for a breast MRI. The cost of the test prevents individuals in Missouri from getting the imaging they require, making it difficult to detect their breast cancer as early as possible. 

    An estimated 16 percent of people who receive annual screening mammograms nationwide get called back for diagnostic imaging. Additionally, these tests are often recommended for those who have previously been diagnosed with breast cancer and for some individuals who are considered at high-risk for breast cancer, making their out-of-pocket costs particularly burdensome to those individuals.

    “When the threat of breast cancer rears its head, women and their doctors need every tool available to for an accurate diagnosis,” said Rep. Shields. “Early detection is vital to protecting the women of Missouri – and insurance coverage of diagnostic mammograms should not stand in the way of Missourians’ access to this life-saving technology. This bill will save lives by ensuring treatment can begin as early as possible.”

    The use of breast cancer screening and follow-up diagnostics have led to significant increases in the early detection of breast cancer in the past 30 years. However, this is not true across all demographics. Evidence shows that Black and Hispanic breast cancer patients tend to be diagnosed at a later stage, perhaps due to delays in follow-up imaging after abnormal findings on an annual mammogram.

    More diagnostic and supplemental breast imaging is likely going to be needed due to “missed” breast cancers during the COVID-19 pandemic. Experts warn that missed mammograms could lead to more later-stage breast cancer diagnoses, once detected, so it is critically important that we increase access to affordable tests to those who medically require it.  

    About Susan G. Komen®

    Susan G. Komen® is the world’s leading nonprofit breast cancer organization, working to save lives and end breast cancer forever. Komen has an unmatched, comprehensive 360-degree approach to fighting this disease across all fronts and supporting millions of people in the U.S. and in countries worldwide. We advocate for patients, drive research breakthroughs, improve access to high-quality care, offer direct patient support and empower people with trustworthy information. Founded by Nancy G. Brinker, who promised her sister, Susan G. Komen, that she would end the disease that claimed Suzy’s life, Komen remains committed to supporting those affected by breast cancer today, while tirelessly searching for tomorrow’s cures. Visit komen.org or call 1-877 GO KOMEN. Connect with us on social at www.komen.org/contact-us/follow-us/.

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    Susan G. Komen

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  • Keck Medicine of USC launches Gender-Affirming Care Program

    Keck Medicine of USC launches Gender-Affirming Care Program

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    Newswise — LOS ANGELES — When Bridget, 57, moved from the East Coast to Los Angeles, she sought health care to maintain and monitor her hormone therapy. 

    She was quickly disappointed. One provider admitted they knew nothing about transgender health, and another labeled her transgender status as a “medical problem.” 

    She then discovered the Keck Medicine of USC Gender-Affirming Care Program and met with Laura Taylor, MD, a Keck Medicine family medicine specialist and medical director of the program. Taylor has been Bridget’s primary care doctor ever since.

    As Bridget experienced, transgender people often face barriers to equitable health care. According to a 2021 study from the Center for American Progress, one in three transgender adults said they had to teach their doctors about transgender health to receive appropriate care. Nearly one-half reported having negative or discriminatory experiences with a health care provider. 

    To address the many health care disparities faced by transgender individuals, Keck Medicine has launched the Gender-Affirming Care Program to meet the comprehensive needs of the transgender, nonbinary and gender-diverse community. Services include everything from routine health care, such as preventive cancer screenings, yearly checkups and flu shots, to gender-affirming hormone therapy and surgery.  

    The program is comprised of physicians from several disciplines including family medicine, plastic surgery, gynecology, urology and otolaryngology. Specialists in voice, occupational and physical therapy are also available to patients.

    A nurse navigator coordinates care with the providers to ensure patients receive seamless specialized treatment. The physicians and program staff have collectively received more than 600 hours of gender-affirming sensitivity and inclusivity training.

    “Our program brings together a multidisciplinary group of physicians across specialties to address the specialized needs of this underserved population,” said Taylor. “We’re proud to offer a full range of health care services in a safe and supportive environment.”

    Another key aspect of the Gender-Affirming Care Program is that it was designed with input from the local transgender community.

    “Due to historic marginalization of the transgender population, some within the community view medical providers with distrust,” said Roberto Travieso, MD, surgical director of the program. “It was important to make our local community part of the process as we built the program.”

    As part of its outreach, Keck Medicine partnered with The [email protected] Coalition, the largest trans-led nonprofit organization in Los Angeles that advocates for the needs of transgender, gender non-conforming and intersex immigrants across the country.

    This collaboration helps Keck Medicine establish a strong foundation within the transgender community and provides ongoing feedback on how the program can best serve patients.

    The Gender-Affirming Care Program was in development for several years, but came to full fruition with the arrival of Taylor and Travieso to Keck Medicine, respectively in 2020 and 2021. Taylor is trained in LGBTQ+ health care and Travieso is fellowship-trained in gender-affirming surgery.

    The program leaders hope to hire and train more gender-affirming practitioners, build more mental health services into care and foster additional community partnerships.

    Meanwhile, for patients like Bridget, the Gender-Affirming Care Program is a gift.

    “I am doing really well under Dr. Taylor’s care, and feeling happy and healthy,” she said.

    ###

    For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

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    Keck Medicine of USC

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  • Black patients more likely to get emergency colorectal cancer surgery

    Black patients more likely to get emergency colorectal cancer surgery

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    Newswise — In an analysis of data from hospitals across the state of Michigan, University of Michigan researchers found that Black, non-Hispanic patients were more likely to undergo emergency surgery for colorectal cancer than other races and ethnicities.

    Undergoing emergency surgery was associated with a higher rate of complications, including death. Out of close to 5,000 patients who underwent any type of surgery for colorectal cancer, 23% had emergency surgery — but those patients made up 63% of the deaths.

    Patients who underwent emergency surgery also received less complete evaluations and testing as part of their workup by surgeons and their medical teams.

    “Overall, these results suggest that racial and ethnic differences persist in presentation and management of colorectal cancer and that these differences likely contribute to disparities in postoperative outcomes among these groups,” said Ryan Howard, M.D., M.S., a general surgery resident at University of Michigan Health and the first author of the study.

    Howard and his research team used data from the Michigan Surgical Quality Collaborative, a statewide initiative funded by Blue Cross Blue Shield of Michigan that aims to improve the quality and cost of surgical care across the state. 

    Their goal was to identify opportunities to improve patient care earlier in the process of cancer diagnosis and treatment.

    “We can spend all day working on, say, reducing complications right after surgery,” Howard said. “But if we’re still not getting the right treatment to the right patient at the right time, then we’re not doing a good enough job.”

    “Colorectal cancer is universally screened for and develops fairly slowly. So if someone is plugged into the health care system, the chances are very high that we will detect it and they will get the appropriate evaluation and work-up,” he added. “The fact that we found patients who are not getting that suggests that there is an opportunity to improve the care we deliver to patients, even before they get to the surgical episode.”

    Howard points to patient navigators and targeted community outreach as proven strategies to help reduce disparities in cancer care and believes the state of Michigan, with its network of collaborative quality initiatives, is well positioned to incorporate these solutions into future projects.

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    Michigan Medicine – University of Michigan

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  • Internal medicine physicians call for improved access and quality in health care for incarcerated patients

    Internal medicine physicians call for improved access and quality in health care for incarcerated patients

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    Abstract: https://www.acpjournals.org/doi/10.7326/M22-2370

    URL goes live when the embargo lifts

    Note: Sound bites from ACP President Ryan Mire, MD, MACP available for download at https://www.dssimon.com/MM/ACP-Incarceration

    Adequately funded policies and procedures are needed to reduce health care disparities in access to, and quality of, health care for the U.S. jail and prison population says the American College of Physicians (ACP). Health Care During Incarceration: A Policy Position Paper of the American College of Physicians details recommendations to improve the health and wellbeing of individuals incarcerated in adult correctional facilities. The paper is published in Annals of Internal Medicine.

    ACP’s recommendations include adequate funding for, and timely access to, necessary health care services that are evidence-based and meet community standards. They also recommend measures to ensure adequate nutrition; opportunity for physical activity; smoke-free policies and smoking cessation interventions; and access to recommended preventive health services. ACP further calls for policies to adequately treat both chronic noncommunicable diseases and infectious diseases. This should include infectious disease prevention and control programs developed with public health authorities. In addition, all persons entering correctional facilities should be screened for substance use disorders and behavioral health conditions and provided with treatment if necessary.  ACP also supports policies that promote the treatment of patients with substance use disorders as an alternative incarceration.

    The paper also details recommendations for population segments within correctional facilities. This includes recommendations for how to better meet the needs of incarcerated women; LGBTQ+ patients; aging patients and those living with disabilities or life-limiting illnesses; and immigrant populations.

    Lastly, the paper details how health care needs must be included in community re-entry planning for individuals who are released from jail or prison, so that they are able to continue to access health care and social services once they return to their communities. ACP specifically makes recommends for policies that would help to facilitate or reinstate state Medicaid enrollment.

     

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    American College of Physicians (ACP)

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  • Study: COVID-19 policies harmed minority women’s perinatal experiences, magnified inequities

    Study: COVID-19 policies harmed minority women’s perinatal experiences, magnified inequities

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    Newswise — CHAMPAIGN, Ill. — Black, Indigenous and other women of color who were pregnant or gave birth during the pandemic said these experiences were overshadowed by isolation, confusion and fear, much of it caused by unclear or frequently changing institutional policies, according to a new study.

    Women from across the U.S. who participated in online focus groups said medical providers’ COVID-19 safety protocols and the lack of clarity from federal public health officials magnified existing health care disparities, compromised the quality of care they received and increased the trauma of giving birth, said first author Tuyet-Mai (Mai) Ha Hoang, a professor of social work at the University of Illinois Urbana-Champaign.

    The 41 women who participated in the study believed that these policies deeply affected their experiences and “made (their) pregnancies less about the celebration of birth and more about the management of trauma and loss,” Hoang and her co-authors wrote.

    Hoang and co-author Karen Tabb Dina, a professor in the same department, experienced some of these difficulties firsthand, as both gave birth during the pandemic. Hoang, who is Vietnamese American, delivered two babies – the first in December 2019 and the second in March 2022 – and Tabb Dina, who is African American, gave birth in May 2021. 

    “My child’s birth in March was really hard due to hospital policies that restricted visitors and the support people allowed in the room,” Hoang said. “Giving birth is a traumatic experience in itself and not having a support person there made it more difficult.”

    Tabb Dina, who birthed her third child during the pandemic, said her husband was deeply disappointed that he was not allowed to attend the ultrasound appointment with her because of the health care provider’s policies at the time, and she felt a profound sense of isolation after the baby’s birth due to the hospital’s visitor restrictions.

    “We found very consistent themes across the U.S., regardless of whether women were in big cities or rural areas,” Hoang said about the study, which included women who ranged from 19-45 years old.

    About half the study participants were African American, one-fourth were Latina, and 20% were Asian or Pacific Islanders. Two participants identified themselves as multiracial and one person as Indigenous.

    Published in the International Journal of Environmental Research and Public Health, the findings may shed light on some of the structural factors behind what the U.S. Centers for Disease Control and Prevention called “alarming” increases in maternal death rates for women of color from 2019-20.

    During that time, maternal death rates increased from 44.8% to 55.3% among Black women, and from 17.9% to 18.2% among Hispanic women, according to a report from the CDC published on the U.S. Government Accountability Office website.

    “We’re in a maternal and infant mortality crisis,” Hoang said. “People need to recognize that the way the health care system is set up right now is not treating pregnant patients correctly. It exacerbates risks rather than protections, especially with minoritized and marginalized communities.”

    Study participants said medical providers’ erratic COVID-19 policies increased their difficulty navigating the health care system and obtaining care. Appointments for regular perinatal care or treatment for sudden complications were nonexistent or handled very quickly, and patients struggled to coordinate tests and procedures with multiple providers.

    An Indigenous woman identified in the study as “M” told the researchers that in the early stages of pregnancy, she was losing 15 pounds per week, but emergency room providers kept telling her that what she was going through was normal. She said she was frustrated that she had to go to the ER “maybe six times before they would get me in to schedule an appointment.”

    Some of the women felt that providers were unsympathetic or indifferent to their physical pain, dignity or bodily autonomy – mirroring racial disparities that were well documented in prior research, Hoang said. These patients believed that COVID-19 testing “trumped everything, including their pain, and they had to wait for relief,” the researchers wrote.

    A mother of two children called “R” in the study told the team: “I was getting an IV in my left arm and the COVID test at the same time. I was having contractions, and everyone was working. I was still a human, and I was like ‘I’m in pain, can you stop?’ and they didn’t listen.”

    Women in the study said medical providers’ communication lacked empathy, and these patients felt shamed or discriminated against for refusing COVID-19 vaccines when they were pregnant or breastfeeding because they were concerned about the side effects on their babies.

    Those who were forced to attend appointments such as sonograms and genetic counseling alone said they felt providers bombarded them with too much information while leaving important questions unanswered – causing them to feel overwhelmed and confused.

    Conversely, many informational workshops and childbirth classes were suspended during lockdowns, leaving some expectant mothers without access to vital information and disrupting their birthing plans, the researchers found.

    The “trickle-down effect” of these COVID-19 mitigation policies was that they exacerbated patients’ stress, and those in the study said it was evident that perinatal patients were not involved in the decision-making processes.  

    U. of I. scholars Kaylee M. Lukacena, a research development manager with the Center for Social and Behavioral Science; then-doctoral student Wen-Jung (Wendy) Hsieh; and doctoral candidate B. Andi Lee also co-wrote the study.

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    University of Illinois at Urbana-Champaign

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  • Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved

    Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved

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    Newswise — To improve the health of a community, the first step is to identify its most pressing needs. To that end, in 2022 Hospital for Special Surgery (HSS) implemented a community-based participatory research (CBPR) approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs.

    Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations.

    The study, “Assessing Musculoskeletal Health Needs of Underserved Patients & Community Members Using a Community Based Participatory Research Approach,” was presented virtually at ACR Convergence 2022, the annual meeting of the American College of Rheumatology in Philadelphia.

    “Musculoskeletal disorders are the most prevalent health conditions in the United States, resulting in financial and social burdens, especially in underserved communities,” explained Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute. “Studies show that musculoskeletal health disparities disproportionately affect women, older adults and racial/ethnic minorities.”

    HSS researchers used a mixed-method approach to develop a Community Health Needs Assessment (CHNA). “For quantitative data, we distributed a community survey in four languages—English, Spanish, Chinese and Russian—to assess the socio-demographic characteristics of the populations we serve; health status and quality of life; health behavior and lifestyle; use of and access to care; and health education needs,” explained Adeniran. “For qualitative data, we conducted interviews with 22 community partners, including community-based organizations, city and state agencies and universities.”

    The survey was distributed in various ways, including online, via email, using Alchemer panels, in person, and through the mail over a four-week period from January 15 to February 15, 2022. A total of 18,248 patients and community members completed the surveys, with 57% representing a diverse and underserved population.

    In addition to the surveys, interviews with community partners provided valuable insights into unmet health needs, Adeniran noted. Community organizations represented all five boroughs of New York City, as well as surrounding areas serving racially/ethnically diverse populations. They represented all age, gender, and socioeconomic groups.

    Key findings:

    • Chronic pain, osteoarthritis or another form of arthritis were the most common musculoskeletal conditions reported in the survey.
    • Among respondents with a musculoskeletal condition, a lack of confidence in managing symptoms emerged as a health need, particularly among medically underserved community members.
    • Almost one-third of all respondents reported falling in the past year.
    • Those with chronic pain, fibromyalgia or lupus were more likely to report two or more weeks of poor physical and mental health.
    • Medically underserved respondents diagnosed with lupus, chronic pain or rheumatoid arthritis were more likely to have used a prescription opioid to manage pain.
    • Health education emerged as a major need, with 70% of respondents reporting no participation in health education in the past 12 months. The top reasons were fear of COVID-19 and not knowing about educational programs.
    • The top issues impacting respondents’ health and well-being were COVID-19 related issues, social isolation/loneliness, limited places to exercise, and limited access to healthy foods.
    • The survey identified a need to address access to healthcare, with 42% of respondents reporting they could not access healthcare in the past 12 months, compared to 8% in a previous survey conducted in 2019. The top barriers were difficulty getting an appointment, lack of affordability or a service not covered by insurance. The need for transportation was also cited among the medically underserved.
    • The most common type of discrimination reported in medical settings was that a doctor or nurse was not listening to the respondent. More than half of those taking the survey cited this issue.

    “Broad community engagement is crucial to the success of any CBPR approach when assessing the health needs of the community and identifying health disparities,” said Sandra Goldsmith, MA, MS, RD, assistant vice president at the HSS Education Institute. “The results of our study will enable us to raise awareness about disparities that continue to affect our diverse and underserved populations and help us develop community-based initiatives to promote health equity.”

     

    Titilayo Adeniran, Bertilia Trieu, Sandra Goldsmith and Laura Robbins, Hospital for Special Surgery, New York, NY

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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    Hospital for Special Surgery

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  • Decades-Long Push to Lower Stillbirth Rate in the U.S. Has Stalled

    Decades-Long Push to Lower Stillbirth Rate in the U.S. Has Stalled

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    Newswise — A decades-long effort to lower the stillbirth rate in the United States has stalled, as has progress in closing a persistent gap in excess stillbirths experienced by Black women compared with White women, according to a Rutgers-led study.

    “Over the last 40 years, we have reduced certain risk factors for stillbirth, such as smoking and alcohol use before and during pregnancy, but these gains have been countered by substantial increases in other risk factors, like obesity and structural racism,” said Cande Ananth, chief of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Rutgers Robert Wood Johnson Medical School and lead author of the study published in The Lancet Regional Health – Americas.

    “Our findings illustrate that past progress has now been offset by these newly identified risks,” Ananth said.

    To determine how cultural and environmental factors impact stillbirths among Black and White women in the U.S., Ananth and a team of Rutgers obstetricians examined changes in stillbirth rates between 1980 and 2020.

    Using data compiled by the National Center for Health Statistics of the Centers for Disease Control and Prevention and covering all 50 states and the District of Columbia, the researchers measured how maternal age, year of death (indicative of changes in prenatal and intrapartum care and other factors) and maternal birth cohorts (indicative of social and environmental elements,  such as socioeconomic status, education, nutrition and substance use at the time of the women’s birth) shaped stillbirth trends.

    More than 157 million live births and nearly 711,000 stillbirths delivered at 24 or more weeks over the last four decades in the U.S. were included in the study.

    Consistent with previous studies, the researchers found that total stillbirth rates in the U.S. declined steadily between 1980 and 2005, backed by advances in prenatal care and maternal health. For every 1,000 women who delivered in 1980, 10 of those pregnancies ended in stillbirth. By 2005, the figure had declined to about 5 per 1,000.

    But since then, the researchers found, improvements have flatlined and the rate today is about the same as it was more than a decade ago.

    Additionally, despite efforts to reduce structural racism and increase health-care access to women of color, the disparity in stillbirth rates for Black women compared with White women remained unchanged during the 40-year period. The rate for Black women was about twice the rate of White women in 1980 (17.4 versus 9.2 per 1,000 births) and remained twofold in 2020 (10.1 versus 5.0 per 1,000 births).

    Unlike most previous work, which has focused primarily on risks such as age at delivery and social and environmental conditions, Ananth’s study added a third element: the birth cohort – the year the mother herself was born.

    Ananth said that the data demonstrates a strong link between birth cohort and stillbirth risk.

    “The cohort is a new dimension to understanding these adverse outcomes,” said Ananth. “To understand the paper’s significance, you need to view it in a three-dimensional perspective. We have age of the mother, year of delivery and the birth cohort. All three factors are time-related and intertwined.”

    Several factors might explain the stalled decline in reducing stillbirth rates. One possible cause, the researchers wrote, is a national effort in 2009 to reduce elective deliveries before 39 weeks. There also may have been a slowdown in medical advances and obstetrical intervention to predict or prevent stillbirth.

    The persistent gap in stillbirth disparities is more complicated and includes structural racism and biases, social inequality and a greater burden of chronic diseases and illness, Ananth said.

    Taken together, Ananth said these data paint a dire health care picture that needs urgent attention at local, state and national levels.

    “I am a firm believer that even one death is one too many,” he said. “Delivering a stillbirth carries so much social and emotional trauma – for the parents, and for the entire society.”

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    Rutgers University-New Brunswick

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  • NIH’s Climate and Health Initiative tackles global health effects associated with a changing climate

    NIH’s Climate and Health Initiative tackles global health effects associated with a changing climate

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    Newswise — Media Availability

    What: Leaders from the National Institutes of Health discuss the agency’s plan to address the risk to human health posed by a changing climate in a commentary published in The Lancet. As floods, hurricanes, tornados, wildfires, and heat waves become more extreme, the risk to human health grows, exacerbating existing health threats and creating new public health challenges around the world.

    The authors, a coalition of leaders at NIH, outline how the NIH Climate Change and Health Initiative is uniquely poised to lead and engage with communities and agencies globally to address the health effects associated with climate change.

    Article: The NIH Climate Change and Health Initiative and Strategic Framework: addressing the threat of climate change to health. The Lancet, November 2022. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02163-8/fulltext

    Who:  The following NIH leaders are available for interviews:

    Richard P. Woychik, Ph.D., director of the National Institute of Environmental Health Sciences. He is the lead author on The Lancet commentary, and the chair of the Executive Committee leading the NIH Climate Change and Health Initiative.

    Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute.

    Roger I. Glass, M.D., Ph.D., director of the Fogarty International Center.

    Joshua A. Gordon, M.D., Ph.D., director of the National Institute of Mental Health

    Eliseo J. Pérez-Stable, M.D., director of the National Institute of Minority Health and Health Disparities.

     

    NOTE FOR REPORTERS: This commentary is under embargo until 7:30 p.m. EDT on Friday, Nov. 4, 2022.

    Comment pieces are written by experts in the field, and represent their own views, rather than necessarily the views of The Lancet or any Lancet specialty journal. Unlike Articles containing original research, not all Comments are externally peer reviewed.

     

    About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical and translational medical research, and is investigating the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov.

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    National Institute of Environmental Health Sciences (NIEHS)

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