TAG: "Health disparities"

UC students bring attention to impact of racial disparities in health care


Students stage “white coat die-ins” nationwide, including at UCSF, other UC medical schools.

UC San Francisco professional students led a national movement via social media that examined how racial disparities impact health care. (Photo by Leland Kim, UC San Francisco)

By Leland Kim, UC San Francisco

A group of UCSF School of Medicine students started a nationwide movement to bring attention to the impact of racial disparities in health care. They led more than 2,000 students in 80 medical schools across the country in a “white coat die-in” where they lay down in their white coats to protest recent grand jury decisions not to indict white police officers who killed Michael Brown and Eric Garner, unarmed African American men in Ferguson, Missouri, and New York City, respectively.

At UCSF, more than 150 students and some faculty and staff members gathered in front of the UCSF Parnassus Library at noon on Dec. 10. Making sure not to block the sidewalk or entrance to the library, they lay down for 45 minutes in silence. Many closed their eyes. Some held hands.

“As health professional students, we really want to emphasize the fact that what happens in the community bears relation to what happens in our work,” said event organizer Nicolás Barceló, a fourth-year student in UCSF School of Medicine. “The context in which our patients live contextualizes the type of care we need to provide.”

This movement started at UCSF several weeks before the “die-in” when a core group of students of color in the UCSF Underrepresented In Medicine (UIM) program, and their white allies within the School of Medicine, worked with established networks of the Student National Medical Association (SNMA), the Latino Medical Students Association (LMSA), and the PRIME Program of UC medical schools to raise awareness. Soon after the hashtag #whitecoat4blacklives was born.

“Using social media as the primary driver, and with the help of incredible individuals, many of whom we had never met, our idea became a shared cause,” said Barceló. “Students at UPenn were responsible for creating the national Facebook group. The national press release disseminated through Physicians for a National Health Program (PNHP), which was a product of the collaboration between students from UCSF, UPenn, Brown and Mt Sinai. The artwork of white coats becoming flying doves – perhaps most symbolic of the movement –was created by a student at UCSF.”

The School of Medicine-led event also included participation by students in the School of Dentistry, School of Nursing and School of Pharmacy. Students from other UC medical schools also participated at their locations. The hashtag #WhiteCoats4BlackLives generated close to 2,000 posts or mentions on Twitter, Facebook and Instagram on the day of the event, reaching more than one million people. It was covered by local and national media, including MSNBC, the Huffington Post and the San Francisco Chronicle.

“This movement is particularly important because in the end we’re here to advocate for our patients, to be the voice for those who are not heard,” said Daniela Brissett, a second-year School of Medicine student who helped organize the event. “Health care disparities for people of color are ever growing and we need to change that. It’s the responsibility of us, as well as our faculty and our deans. And it starts here, and it starts with the resources we need to provide for our patients.”

Some faculty members and members of the leadership team, including Renee Navarro, Pharm.D., M.D., vice chancellor of diversity and outreach, came out to support the students.

“It’s been an incredible catalyst to bring together students,” said Barceló . “We couldn’t be more grateful for the support we’ve received from our administration, from our Vice Chancellor Dr. Renee Navarro.”

“I am inspired by our students,” Navarro said. “I’m inspired by our collaboration, the solidarity across our schools, across our faculty, our students and our staff coming together on such a critically important issue, and recognizing as deliverers of health care, this is such an important component of what we do and we should have a voice in this.”

As a follow up, the student organizers of the “die-in” scheduled a town hall meeting on Dec. 12 at Cole Hall to share reflections on violence and racial bias in the community as well as in the health care system. They also brainstormed ideas for organized student response with several deans and some faculty members.

“We look forward to having productive conversations with leadership here at UCSF and other UC campuses to amend our curriculum, to increase diversity both in the students and in the faculty,” Barceló said. “Ultimately we want to improve relations between our institutions and the communities we serve.”

In the days following the “die-in,” several other college campuses in other parts of the country hosted town halls and open meetings to discuss and develop a plan for institutional change.

At the national level, student leaders of the movement are deciding how to proceed in effecting change. They hope to systematically reform the policies and practice of medicine to more adequately address racism and violence as major determinants to health.

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Cloudy water, even if it is safe, affects rural immigrants’ health


UC Davis researchers examine connection between water quality, childhood obesity.

Cloudy tap water may have a greater effect for California’s rural immigrants than merely leaving behind a bad taste, according to a new policy brief released by the Center for Poverty Research at the University of California, Davis.

Researchers looked at the connection between water quality and childhood obesity in two poor immigrant communities in California’s Central Valley — San Joaquin and Firebaugh. Poor-quality tap water, or even a perception that the water is bad, combined with environmental factors such as lack of access to healthy foods and nutrition education, likely contribute to health disparities in these communities, the study finds.

“If the tap water that comes out looks dirty or has a poor taste, they’re not going to have a lot more confidence in the drinking system here,” said Lucia Kaiser, a UC Cooperative Extension specialist in the Department of Nutrition at UC Davis and the study’s co-principal investigator. “The immigrant populations in these communities come from Mexico, where they may have experienced unsafe drinking water in rural areas,” she said.

Kaiser interviewed 27 mothers from these communities after giving a class on the health effects of sugar-sweetened beverages. Most of the women reported relying on purchased and, to a lesser extent, home-filtered water for drinking and cooking. Kaiser said that the additional cost represents an extra burden on these low-income families.

“In these communities, more than a third can’t afford to put enough food on their table, and now they have to buy drinking water, too. Every expense really matters,” said Kaiser.

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2 UCSF-led programs receive funding to tackle S.F. health issues


Hellman Foundation supports fruit and vegetable voucher program, kids’ oral health program.

A woman shops for fresh produce at UCSF Parnassus' farmers market.

By Leland Kim, UC San Francisco

Two UC San Francisco-sponsored programs beat out more than 80 others to win major funding to help advance meaningful solutions to local health issues in San Francisco.

The Hellman Foundation announced the award of the first Hellman Collaborative Change Initiative grants to the EatSF Fruit and Vegetable Voucher Program and the Children’s Oral Health Collaborative. Each program will receive $400,000 — coupled with strategic support from the Hellman Foundation — to strengthen their partnerships and support their efforts to improve lives in San Francisco.

The EatSF Fruit and Vegetable Voucher Program is creating a San Francisco where underserved communities can enjoy fresh fruits and vegetables from their local market.

Diets low in fresh fruits and vegetables are associated with obesity, diabetes, cardiovascular diseases and some cancers.  But many low-income families simply do not have access to these vitally important foods. By creating a citywide network where vouchers are redeemable at local vendors for fresh fruits and vegetables, EatSF is improving nutrition for San Franciscans most in need.

“In 2012, it is estimated that San Francisco’s underserved population had to scramble to afford 67.8 million meals. That is appalling in a city that is as wealthy as ours,” said Hilary Seligman, M.D., an associate professor in the UCSF School of Medicine, who is leading the EatSF Fruit and Vegetable Voucher Program. “We are committed to finding strategies that allow all members of our community to eat the healthy foods that prevent the development of chronic disease.”

The Children’s Oral Health Collaborative is committed to eradicating health disparities in childhood tooth decay, with the aim of making San Francisco cavity-free. The program is co-led by UCSF’s Lisa Chung, D.D.S., M.P.H., and San Francisco Department of Public Health’s Margaret Fisher, R.D.H.A.P.

Tooth decay is the most common chronic childhood disease. In San Francisco, emergency department visits for preventable dental problems are higher than that for asthma and diabetes combined, and untreated tooth decay is two to three times more common for children of color.

“Our success is due to many dedicated partners, some individuals who have spent much of their careers to combat tooth decay, a pervasive health problem that all too often goes unacknowledged and untreated in children,” said Chung, an associate professor in the UCSF School of Dentistry’s Department of Preventive and Restorative Dental Sciences.

“Our collaboration recently formed thanks to the coordination and strong support from UCSF SF HIP (San Francisco Health Improvement Partnership) and SF DPH (San Francisco Department of Public Health), and funding from the Metta Fund. We hope this support from Hellman will bring greater awareness to the problem, our work to address it, and more partners to join us in our efforts.”

In choosing from an impressive array of active collaborations, the Hellman Foundation focused on cross-sector partnerships that had strong leadership, targeted a significant San Francisco challenge, and had the potential to make a real difference.

To learn more about the EatSF Fruit and Vegetable Voucher, please email eatsfvoucher@gmail.com. To get more information about the Children’s Oral Health Collaborative, please read its strategic plan.

Established in 2011, the Hellman Foundation finds and supports the creative change-makers improving the lives and livelihoods for all who call the San Francisco Bay Area home. For more information, visit its website.

Editor’s note: Content from the Hellman Foundation was used in this story.

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Is life in America hazardous to immigrants’ health?


Over time, the health status of immigrant groups tends to decline.

By Dan Gordon, UCLA

America is a nation of immigrants drawn from all parts of the world by the promise of freedom and a good life. But a substantial body of evidence suggests that for the newly arrived, life in the United States can be hazardous to their well-being.

When they get here, immigrants are on average healthier than their native-born American counterparts. But the longer they stay, the worse they fare on measures such as heart disease, hypertension, diabetes and mental health.

Faculty at the UCLA Fielding School of Public Health are working on identifying factors contributing to the declining health status of immigrant groups that’s occurring over time and through the generations.

Part of it has to do with an unfamiliarity with U.S. society and its complicated health care system. Many immigrants lack health insurance. But Marjorie Kagawa-Singer, a professor at the Fielding School who focuses on the delivery of care that appropriately considers a patient’s culture, notes that it’s more than just cost.

“If someone is new to this country, doesn’t speak the language and has to learn to navigate our system, it’s like plopping us in the middle of Siberia and expecting us to figure out what we need,” she said.

For example, many immigrants across the educational and cultural spectrum hold beliefs about disease and how the body works that diverge from the biomedical model practiced in the U.S., Kagawa-Singer added, and many health care practitioners are uneducated on those differences.

“When you have problems in both health literacy among patients and cultural competence among practitioners, you get this ‘perfect storm’ of people who will not be able to utilize the health care system even when it’s offered,” said Kagawa-Singer.

Since 2000, Kagawa-Singer has headed the Los Angeles site of the Asian American Network for Cancer Awareness, Research and Training, the first federally funded cancer prevention and control research initiative focusing on Asian Americans. In lectures and short courses on cultural competence, Kagawa-Singer advises health professionals to demonstrate their trustworthiness and compassion.

“It’s not the health problem you’re treating, it’s the person,” she said. “When patients recognize you’re making the effort and respecting their dignity, they’re going to be much more forgiving and willing to teach and learn.” The challenge, she noted, is that the U.S. health care system is designed for short encounters, despite the fact that it may take longer to get to know and understand patients from different backgrounds.

Adopting the American diet

Public health experts have postulated that immigrants decline in health as they assimilate and adopt the health habits of their new communities — including high-fat diets and processed foods, along with reduced physical activity. To some extent, though, that equation has changed with globalization of the food supply, said May C. Wang, a Fielding School professor who focuses on early childhood obesity.

“Most low-income countries now have access to the processed foods we’ve been eating for the past few decades,” Wang noted. But even when immigrants’ tastes are similar to those of non-immigrants, immigrants with minimal financial means face considerable challenges to eating well. “Education alone doesn’t work in a community that doesn’t have the ability to access healthy food,” Wang said. “And in the very poorest communities, trying to change the environment by placing healthier foods where people live, work and go to school is challenging.”

The problem is compounded for immigrant groups, she explained, because they tend to have fewer social ties, are constricted by language barriers and often lack the know-how to pursue resources that could help them.

Wang works closely with the Public Health Foundation Enterprises Women, Infants, and Children (WIC) Program, the largest local WIC agency in the country. It serves 300,000-plus families a year, the vast majority of them non-English-speaking immigrants. The overall childhood obesity rate has plateaued or declined in the U.S. in recent years, Wang noted, but the obesity rate among the mostly immigrant Latino children remains substantially higher than for other groups. Among the low-income, preschool-aged Latino children enrolled in L.A. County’s WIC program in 2011, nearly 22 percent were obese.

To better understand the impact of various strategies to improve diet and reduce early childhood obesity, said Wang, “We are examining the social and physical environments in which immigrants live and how these affect their ability to put into practice nutrition knowledge they acquire from participation in the WIC program.”

The work aligns with the University of California Global Food Initiative, which seeks to harness the resources of all 10 UC campuses to address a critical issue of our time: How to sustainably and nutritiously feed a world population expected to reach eight billion by 2025.

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Perceptions, referrals by providers affect mental health treatment disparities


Asian-American patients least likely to be assessed or counseled for mental health problems.

Oanh Meyer, UC Davis

By Phyllis Brown, UC Davis

Disparities in mental health treatment are known to be associated with patients’ racial and ethnic backgrounds. Now, a large study by researchers with UC Davis has found one possible reason for those disparities: Some racial and ethnic minorities are less likely to be assessed and referred for treatment by their medical providers.

The study of more than 9,000 diverse individuals, including Latinos, African Americans, Asian Americans and non-Hispanic whites, found that patients of different racial and ethnic backgrounds reported experiencing differing treatment approaches from medical providers, such as primary care physicians and specialists, including referrals to mental health care and medications, and that these differences were associated with race.

The research, “Disparities in Assessment, Treatment, and Recommendations for Specialty Mental-Health Care: Patient Reports of Medical Provider Behavior,” is published online today (Dec. 1) in Health Services Research, a journal of the Health Research and Educational Trust of the American Hospital Association.

It found that when compared with non-Hispanic white patients, Asian-American patients were the least likely to be assessed or counseled for mental health or substance abuse problems, and also were less likely to receive recommendations for treatment with medication. These differences were resolved after factors such as education, income and clinical diagnosis were taken into account, said Oanh Meyer, a postdoctoral scholar in the UC Davis Department of Neurology.

“These findings are especially important for medical providers treating racial and ethnic minorities,” Meyer said. “Minorities are far more likely to seek treatment for their mental health problems from their primary care physicians. Since these providers are the source of referrals to mental health professionals, they serve as the gatekeepers.”

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Online tool provides health information by ZIP code, city, legislative district


UCLA site advances Center for Health Policy Research mission of democratizing data.

For the first time, anyone can easily access comprehensive California health statistics by ZIP code, city and legislative district thanks to a new web tool created by the UCLA Center for Health Policy Research. The easy-to-use AskCHIS Neighborhood Edition, or AskCHIS NE, enables users to customize searches, compare and “pool” small geographic areas, and map and chart their results.

AskCHIS NE covers a wide range of health topics, including rates of health insurance, chronic conditions like asthma and diabetes, and behaviors like smoking and physical activity; quality of children’s health; and access to health care and mental health care; and much more.

AskCHIS Neighborhood Edition is a service of the center’s renowned California Health Interview Survey, the nation’s largest state health survey. An existing companion web tool, AskCHIS, allows users to find health data at the county, region and state levels.

AskCHIS NE drills down even deeper than AskCHIS, allowing users to quickly find health disparities within specific cities or legislative districts. Using the system’s pooling feature, hospitals can build health profiles of their service areas, combining ZIP codes or cities. Community groups can decide which programs to offer at parks based on a neighborhood’s specific health needs. Journalists can compare obesity rates in neighborhoods they cover.

“This is the first time that Californians will be able to access neighborhood health information in just a few, simple steps,” said Ninez Ponce, the California Health Interview Survey’s principal investigator. “This information will help Californians make health decisions that are specifically targeted to the unique needs of their communities.”

Using AskCHIS NE is simple:

  • Log onto http://askchisne.ucla.edu. People who have previously used AskCHIS can use an existing logon ID and password; new users can create a free account before logging in for the first time.
  • Select a topic from the panel on the left.
  • Search for geographic areas of interest and click the “Create a table” button.
  • The search results are quickly displayed in a table, bar chart and interactive map.

The interactive map makes it easy to for users to see health disparities across the landscape. Data for one ZIP code can be loaded and displayed, but the user also can zoom out to view adjacent ZIP codes or the entire state for comparison.

As in AskCHIS, results can be easily exported into Excel spreadsheets. But AskCHIS NE also makes it easy for users to download the charts and maps for use in reports and presentations. The site also makes HTML coding available for use in online media.

“AskCHIS NE truly moves forward the center’s mission of democratizing data,” said Bogdan Rau, the project manager for AskCHIS NE. “It’s provided as a public service so that everyone who needs access to quality, authoritative health information can benefit.”

AskCHIS Neighborhood Edition is sponsored by grants from Kaiser Permanente and the California Wellness Foundation.

Heavy website traffic is expected when AskCHIS NE launches. If the site is busy, please try again later.

Visit the UCLA Center for Health Policy Research — and see a demo of AskCHIS NE — at Booth 1043 at the American Public Health Association annual meeting in New Orleans, Nov. 16 – 19. View the schedule for the meeting.

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UC Riverside hosting Inland Empire Black Health Expo


Free event to be held Nov. 22 and is open to the entire community.

Members of region’s African American community are invited to attend the Inland Empire Black Health Expo on the campus of UC Riverside on Saturday, Nov. 22, from 8 a.m. to 4:30 p.m. at the Highlander Union Building.

There is no cost to attend the expo, but those who plan to attend are asked to RSVP online at http://go.ucr.edu/bhe. Free parking is available in Parking Lot 1. The full event flier is available for download.

“The purpose of the expo is to create an environment specifically dedicated to improving health care disparities in the African American community,” said fourth-year neuroscience major Maryam Bello, the president of African Americans United in Science (AAUS) at UCR. “I hope it serves as a catalyst that drives African Americans and health care professionals to become more involved in improving minority health disparities.”

The expo will include workshops and speakers, community resources, information on Ebola, health screenings including blood pressure, health-related vendors, presentations on fitness, heart health, mental health, infectious diseases and more.

“A lot of people don’t realize the simple changes they can make to better their lives,” fourth-year biological sciences in anthropology major and vice president of AAUS Dijon Gatewood said. “I hope that through this expo, we can help the black community become more aware of the importance of health.”

The expo is sponsored by AAUS, in conjunction with Healthy Heritage Movement, UCR African Student Programs, J. W. Vines Medical Foundation, UCR School of Medicine, Riverside Community Health Foundation, the Black Voice News, Western University – College of Allied Health Professionals, PhRMA, PepsiCo, Colgate, Schools First Credit Union, African American Health Initiative, Inland Empire Black Nurses Association, and African-American Family Wellness Advisory Group (AAFWAG).

Organizers said they hope the expo will become an annual event.

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Social status can impact health and happiness


Impacts seen among egalitarian forager-farmers.

A Tsimane leader mediates a dispute between villagers. (Photo by Chris von Reuden, UC Santa Barbara)

In western society, where keeping up with the Joneses — or, better yet, surpassing them — is expected and even encouraged, status matters. So important is it that for many people, physical and emotional wellbeing are directly connected to their place in the social hierarchy.

That’s hardly news to anthropologists at UC Santa Barbara, but they were taken by surprise when research findings indicated that the same relationship exists among the Tsimane, an egalitarian society of forager-farmers in the Bolivian Amazon. Their work, “Political Influence Associates With Cortisol and Health Among Egalitarian Forager-Farmers,” is published online in the journal Evolution, Medicine, and Public Health.

Myriad studies have shown that low social status can have negative effects on health, both in humans and in our non-human primate relatives. This status-health relationship adds moral weight to current debates about the increasing inequality in industrialized societies. What is surprising about the relationship between status and health, the researchers argue, is that the improved access to health care, food, housing and other benefits that money and influence can buy do not fully explain it. Instead, the growing consensus is that the health risks of low status are due in part to the chronic psychosocial stress of the rat race itself, and of perceived social subordination, whether by other individuals or by institutions.

“Status has its obvious rewards in a modern, stratified society — if you were on the sinking Titanic in 1912 and you were high status, then it was more likely there was a place for you on one of the lifeboats,” said Michael Gurven, professor of anthropology at UCSB and senior author of the paper. “Or status is key if it brings you preferential access to arable land and livestock in a land-limited society with rigid rules of inheritance.”

But with the Tsimane, he continued, none of that is relevant. Everyone has access to farmland, and everyone can freely fish, hunt and gather. Villages do have leaders, but no one holds sway over anyone else. If people don’t like the leadership in one village, they simply move to another.

“We’re able to show that there are measurable differences in recognized social status even within the egalitarian context, and that these differences matter,” Gurven continued.

“They’re all equal, and yet social status is important. It impacts their perceptions, their level of stress and their health.”

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Sesame Street helps teach physicians a lesson


Incarceration plays major role in health disparities in U.S., says UC Riverside professor.

UC Riverside’s Scott Allen (left) is seen here with Sesame Street’s Alex, a blue-haired, green-nosed Muppet who has a father in jail, and Brown University’s Josiah Rich (right). (Photo courtesy of Pam Hacker, Sesame Street)

More than two million people are incarcerated in the United States, the highest incarceration rate in the world. So perhaps it comes as no surprise that last year the popular children’s television series Sesame Street introduced a character that has an incarcerated father.

With incarceration having found a home even on Sesame Street, public health practitioners, policymakers and health care providers ought to pay closer attention to incarceration’s impact on health inequality in the country, argue a team of two physicians and a medical researcher in an article published today (Oct. 6) in Annals of Internal Medicine.

Scott A. Allen, M.D., a professor of medicine in the School of Medicine at the University of California, Riverside, and his colleagues report that while many people need to be in prison for the safety of society, a majority are incarcerated due to behaviors linked to treatable diseases such as mental illness and addiction.

“In such cases, incarceration will improve neither the imprisoned person nor the social problem without medical intervention,” Allen writes, along with co-authors Dora M. Dumont, Ph.D., M.P.H., at the Rhode Island Department of Health and Josiah D. Rich, M.D., M.P.H., at Brown University.

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UC Davis names Future of Nursing Scholars recipient


New scholarship program will increase the number of doctorally prepared nurses.

Sarah Brown Blake, UC Davis

Betty Irene Moore School of Nursing graduate student Sarah Brown Blake is among the 16 nurses who are the first recipients of the Future of Nursing Scholars program awards. This new multifunder scholarship program, spearheaded by the Robert Wood Johnson Foundation (RWJF), is aimed at increasing the number of doctorally prepared nurses. Brown Blake’s scholarship is funded by RWJF and was awarded by UC Davis.

Brown Blake intends to focus her doctoral research on exploring environmental health disparities. She is particularly concerned about issues related to clean, accessible and affordable drinking water and the impact of water contamination on the health of rural and agricultural communities in California’s San Joaquin Valley. Brown Blake completed the interprofessional and innovative Master of Science — Leadership in Nursing Science and Health-Care Leadership Graduate Degree Program at the Betty Irene Moore School of Nursing at UC Davis in spring 2014. Prior to that, Brown Blake was a public health nurse with the Arlington County Health Department in Arlington, Virginia, where she specialized in maternal, child and adolescent health.

“I am tremendously grateful to receive this scholarship and other support from the RWJF. I have no doubt that this opportunity will significantly impact my career as a future researcher, educator and nurse leader,” Brown Blake said.

The Future of Nursing Scholars program provides grants to schools of nursing so that they can provide scholarships to doctoral students who commit to completing the program in three years. Brown Blake will receive an award of $75,000, as well as mentoring and leadership development over the course of the Doctor of Philosophy program.

“We are honored to be included as one of the first nursing schools to receive the Future of Nursing Scholars grants, especially as a new school that this year graduated our first Doctors of Philosophy,” said Heather M. Young, associate vice chancellor for nursing and dean of the Betty Irene Moore School of Nursing at UC Davis. “Being a part of the Future for Nursing: Campaign for Action has brought home to me the importance of increasing the number of doctorally prepared nurses in the nation. This effort goes a long way toward promoting that goal. It’s a wonderful way to create community among doctoral scholars who will be our future leaders.”

In addition to RWJF, Independence Blue Cross Foundation, United Health Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting the Future of Nursing Scholars grants to schools of nursing this year.

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Three UC schools receive grants to prepare doctoral nurses

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Implantable heart devices provide similar survival benefits to diverse groups


Study is among the largest to compare survival benefits of these devices by race, ethnicity.

Gregg Fonarow, UCLA

Racial and ethnic minorities who receive implantable devices to treat heart failure derive the same substantial survival benefit from these therapies as white patients, new UCLA-led research shows.

While the American College of Cardiology and American Heart Association jointly recommend the use of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices for all eligible patients, minorities have not been well represented in clinical trials of the devices, and previous studies had shown that African American and Hispanic patients are less likely to receive these recommended therapies.

The current study — among the largest to compare the survival benefits of these devices by race and ethnicity — involved more than 15,000 patients at 167 cardiology and multi-specialty practices across the U.S. The research was coordinated by 10 academic medical centers, including UCLA

The findings are published in the current issue of the Journal of the American College of Cardiology.

Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), the researchers monitored 15,177 heart failure patients over two years to measure the benefits of implantable device therapy on survival in community practice settings.

They found that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. They also found a 45 percent reduction in mortality with CRT therapy, again without any significant differences in device benefit by race or ethnicity.

“This is among the largest studies to address the question of race- and ethnicity-specific benefits with ICD or CRT therapies in real-world practice,” said senior author Dr. Gregg C. Fonarow, who holds the Eliot Corday Chair in Cardiovascular Medicine and Science and directs the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA. “Our results are a reminder to physicians and patients that this proven life-extending therapy should be offered to all eligible heart failure patients without regard for race or ethnicity.”

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Low-income diabetics up to 10 times likelier to lose a limb than wealthier patients


Most amputations preventable with earlier medical care, UCLA researchers say.

Carl Stevens, UCLA

It’s no secret that poverty is bad for your health. Now a new UCLA study demonstrates that California diabetics who live in low-income neighborhoods are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas of the state. Earlier diagnosis and proper treatment could prevent many of these amputations, the researchers say.

The study authors hope their findings, published in the August issue of Health Affairs, will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire policymakers to adopt legislation to reduce barriers to care.

“I’ve stood at the bedsides of diabetic patients and listened to the surgical residents say, ‘We have to cut your foot off to save your life,’” said lead author Dr. Carl Stevens, a clinical professor of medicine at the David Geffen School of Medicine at UCLA. “These patients are often the family breadwinners and parents of young children — people with many productive years ahead of them.

“When you have diabetes, where you live directly relates to whether you’ll lose a limb to the disease,” added Stevens, an emergency physician for 30 years at Harbor–UCLA Medical Center. ”Millions of Californians have undergone preventable amputations due to poorly managed diabetes. We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014.”

Dylan Roby, UCLA

The authors used data from the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by ZIP code. They blended these statistics with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetes-related amputations by ZIP code.

The result was a detailed set of maps showing diabetic amputation rates by neighborhood for patients 45 and older — the age range at greatest risk for amputation from disease complications.

“Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level,” said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. “Amputation rates in California were 10 times higher in the poorest neighborhoods, like Compton and East Los Angeles, than in the richest neighborhoods, such as Malibu and Beverly Hills.”

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