TAG: "Population health"

Study promoting sale of healthy foods by catering trucks wins national award


Simple signage, unique packaging, promotional apparel increased sale of healthy entrees.

Desiree Backman, UC Davis

Desiree Backman, chief prevention officer with the Institute for Population Health Improvement at UC Davis Health System, received a 2012 Best Great Educational Material (GEM) award for a study that showed signs, labeling and promotional apparel can increase the sale of healthful entrees offered at catering trucks serving workers in low-income communities. She received the award at the Society for Nutrition Education and Behavior’s annual conference in Washington, D.C., earlier this summer.

The award recognizes authors who produced the best educational materials published in the Journal of Nutrition Education and Behavior, the society’s peer-reviewed journal for disseminating original research, emerging issues and practices relevant to nutrition education and behavior worldwide.

Backman conducted the research while working on the Network for a Healthy California project, a collaboration with colleagues at the California Department of Public Health and the Sacramento-based Public Health Institute. Backman and her co-authors were recognized for their innovative study, “Catering Trucks in California Promote Healthful Eating in Low-Wage Worksites,” which was published in the journal’s July/August 2011 supplement.

For the study, the researchers engaged eight catering truck vendors in San Diego to include two healthful entrees as part of their “grab and go” lunch offerings. The items were a turkey, avocado and sprouts sandwich with sliced fresh fruit on the side, and a chicken wrap with sliced fresh fruit on the side. The entrée containers had a clear plastic top with an English- and Spanish-language sticker that stated “Eat Fruits & Vegetables and Be Active!” The same messaging also was posted on a colorful 11-by-17-inch sign in the truck and on employees’ T-shirts, hats and aprons.

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UC Davis institute launches California Health eQuality


Program will promote health care quality through exchange of health information.

UC Davis Health System has established the California Health eQuality (CHeQ) program, leaders at the Institute for Population Health Improvement announced today (Sept. 25). CHeQ seeks to improve health care quality and the coordination of care by using health information exchange (HIE) technology to facilitate the rapid flow of information among physician offices, hospitals and other health care providers.

Through a 16-month, $17.5 million interagency agreement with the California Health and Human Services Agency (CHHS), CHeQ will develop and implement HIE programs according to the state’s Cooperative Grant Agreement with the federal Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services. From March 2010 to August 2012, CHHS had utilized Cal eConnect, a nonprofit corporation, as California’s state-designated governance entity.

CHeQ’s programs intend to promote health care quality and the coordination of care by expanding underserved communities’ capacities to exchange health information or access to Direct, a simple, standards-based way for senders to push secure encrypted health information directly to trusted recipients over the Internet. CHeQ also will improve sharing of immunization, laboratory and care information and provide tools to assist providers in identifying private, secure, standardized and trusted systems.

Kenneth W. Kizer, director of the Institute for Population Health Improvement, will lead CHeQ. Kizer has a long history of public- and private-sector experience in health information technology, health care quality improvement and population health. He has served as chair, president and chief executive officer of Medsphere Systems Corp., the nation’s leading commercial provider of open-source health care information technology.

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Epidemiologist receives Goldsmith Award


UC Berkeley’s Brenda Eskenazi honored for innovative work in environmental epidemiology.

Brenda Eskenazi, UC Berkeley

On Wednesday (Aug. 29), UC Berkeley School of Public Health professor Brenda Eskenazi received the John Goldsmith Award for Outstanding Contributions to Environmental Epidemiology from the International Society of Environmental Epidemiology (ISEE), a society of more than 1,000 scientists worldwide. The premiere award of the ISEE honors environmental epidemiologists who serve as models of excellence in research, unwavering promotion of environmental health, and integrity.

Eskenzi, Jennifer and Brian Maxwell Professor of Maternal and Child Health and Epidemiology, received the award in part for her contributions to the field of environmental epidemiology through her work founding and directing the Center for Environmental Research and Children’s Health. She has conducted numerous studies worldwide on environmental exposures to children.

Since 1999, she has directed a longitudinal birth cohort study examining chemicals and other factors in the environment and children’s health as part of the CHAMACOS project. Among other findings, the landmark study has linked flame retardants to lower birth weights, associated PBDE exposure to reduced fertility and altered thyroid function in women, and linked mothers’ exposure to organophosphate pesticides during pregnancy to shorter gestation and lower IQs in children.

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Children of U.S.-born Latinas more likely to get retina cancer


UCLA researchers say mothers born in Mexico have healthier pregnancy behaviors, which may account for the reduced risk.

Beate Ritz, UCLA

In a large epidemiologic study, researchers at UCLA’s Jonsson Cancer Center found that babies of U.S.-born Latinas are at higher risk for retinoblastoma — a malignant tumor of the retina which typically occurs before the age of 6 — than children of Mexico-born mothers.

The study, which focused on infants born in California, also found that children of older fathers and those born to women with sexually transmitted diseases were at greater risk for the disease, as were children from multiple-birth pregnancies, which may indicate an increased risk from in vitro fertilization. Those findings confirmed the results of several smaller studies.

The research team used data from the California Cancer Registry and examined all retinoblastoma cases reported from 1988 to 2007, said Julia Heck, first author of the study and an assistant researcher at the UCLA Fielding School of Public Health. Using California data allowed the researchers to cull information from a large and diverse population that included many Latinas.

The study appears in the early online edition of the journal Cancer Causes and Control.

“One of the most interesting things we found in this study that hasn’t been reported is the differences among Latina mothers and the risk being lower among mothers born in Mexico,” Heck said. “We believe this is because women born in Mexico who come to the United States and have children have very healthy behaviors in the perinatal period, immediately before and after giving birth.”

The study’s senior author, Dr. Beate Ritz, a Jonsson Cancer Center researcher and a professor of epidemiology and environmental health sciences at the Fielding School, said Latinas born in the U.S. are less likely to exhibit the healthy pregnancy behaviors found in foreign-born Latinas. For example, they generally have poorer diets and are more likely to smoke and drink during pregnancy, which could contribute to the risk of retinoblastoma.

“Compared to U.S.-born Latinas, immigrant women born in rural Mexico often have even less education and lower socioeconomic status, but they retain healthier diets and perinatal habits, which may be correlated to lower risk of disease in their children,” said Ritz, who chairs the Fielding School’s epidemiology department.

The team chose to study retinoblastoma because its causes remain poorly understood. The researchers sought to examine associations between perinatal factors and cancer risk in California children. They identified 609 retinoblastoma cases, 420 that occurred in one eye, 187 that occurred in both eyes and two for which it was unknown whether one or both eyes were involved. They randomly selected more than 200,000 control children without cancer from the California birth rolls. The source of most of the risk-factor data in this study was information from birth certificates, Ritz said.

Retinoblastoma is the result of the loss or mutation of both alleles of the RB1 tumor-suppressor gene. About 40 percent of cases are considered hereditary, and most of these present as bilateral disease — that is, in both eyes.

“In conclusion, we observed risk of retinoblastoma to be related to several risk factors,” the study states. “Bilateral disease risk was higher among children of older fathers, and among children of multiple-birth pregnancies. We observed a higher risk of unilateral disease among children of U.S.-born Latina women. Further research should be done to confirm this finding and to examine the unique risks experienced in this population.”

The study was funded by the National Institutes of Health’s National Institute of Environmental Health Sciences (R21 ES018960 and R21 ES019986).

UCLA’s Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation’s largest comprehensive cancer centers, the Jonsson Center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2012, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 12 of the last 13 years.

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Warren Winkelstein Jr. dies at 90


UC Berkeley epidemiologist led seminal AIDS, air pollution studies.

Warren Winkelstein Jr.

Dr. Warren Winkelstein Jr., professor emeritus of epidemiology and a former dean at the University of California, Berkeley, who is credited with leading definitive studies on AIDS transmission, air pollution and other health issues, died Sunday, July 22. He was 90.

Winkelstein died at his home in Point Richmond of complications from an infection.

Winkelstein’s distinguished career spanned six decades and was marked by numerous accomplishments, such as leading the landmark San Francisco Men’s Health Study that began in the early 1980s, a time when little was known about a mysterious new disease called AIDS.

“That study was the first to provide us information about how HIV was transmitted, the length of the virus’s incubation period, and what behaviors put people at greater risk,” said S. Leonard Syme, UC Berkeley professor emeritus of epidemiology, who first met Winkelstein in 1960. “There were only four AIDS research grants awarded at that time, and Winkelstein’s was the only one that started with a population of healthy people, rather than people who already had AIDS, and observed them over time. It was amazing work, and that research became the definitive study of how AIDS was spread.”

To this day, the San Francisco Men’s Health Study stands as one of the largest and best described cohorts of people at risk for HIV/AIDS, Syme said.

Winkelstein was born on July 1, 1922, in Syracuse, N.Y. He was in the inaugural class of students at the Putney School in Vermont, a progressive preparatory high school that emphasizes experiential education. He served in the Army in World War II before continuing his education at the University of North Carolina, where he received his bachelor’s degree in sociology in 1943. He went on to earn his medical degree from Syracuse University in 1947, and his master’s degree in public health from Columbia University in 1950.

After graduation, Winkelstein served a year with the U.S. Public Health Service, where he was assigned to work on a Special Technical and Economic Mission to North Vietnam. This work was a forerunner to the creation of the U.S. Agency for International Development.

In 1951, Winkelstein joined the Erie County Health Department in Buffalo, New York, as a district health officer. Two years later, he became director of the department’s Division of Communicable Disease Control, a position he held until 1956. During his tenure there, he headed one of the largest trials ever conducted of the Salk polio vaccine.

Winkelstein also established the Epidemiology Research Program at the State University of New York, Buffalo, and while there he led one of the first studies to successfully isolate air pollution as the cause of health problems in low-income neighborhoods. That work helped influence the development of U.S. air quality standards.

“I was an executive secretary at the NIH (National Institutes of Health) at that time, and we had never seen a grant proposal like his before,” Syme recalled. “He proposed a way to study the health effects of air pollution that could separate out the confounding variables associated with poverty. That had never been done before. He kept picking topics that no one else had looked at, and his research has really changed our lives.”

In 1968, Syme, by then a faculty member at UC Berkeley, helped recruit Winkelstein to a growing division of epidemiology at the School of Public Health. Winkelstein joined as a professor of epidemiology and served as the school’s dean from 1972 to 1981. He was considered a valued and trusted colleague and thoughtful mentor to scores of graduate students in public health. 

“Warren Winkelstein was one of America’s greatest epidemiologists,” said Dr. Arthur Reingold, UC Berkeley professor of epidemiology and associate dean for research at the School of Public Health. “He was world-renowned for his pioneering studies in the history of epidemiology, and for his superb teaching skills. He was an important mentor to dozens of epidemiologists, and beloved by several generations of students. He will be sorely missed.”

Among other achievements credited to Winkelstein is the first case-control study of risk factors of coronary heart disease in women, and his pioneering research on the link between tobacco smoke and cervical cancer.

Winkelstein remained active after his retirement in 1991. He continued to teach graduate courses on ethics in epidemiology and the history of the field. He also wrote biographical sketches of prominent figures in the field of epidemiology, including John Snow; Edward Jenner; his mentor, Abraham Lilienfeld; and Janet Elizabeth Lane-Claypon, who conducted a classic study of breast cancer epidemiology in the 1920s.

Winkelstein was preceded in death in 2004 by his third wife, Veva Winkelstein. He is survived by his three children, Rebecca Yamin of Philadelphia.; Joshua Winkelstein of Holt, Mich.; and Shoshana Winkelstein of Oakland; as well as by three grandchildren and three great-grandchildren.

A campus memorial service will be held from 4 to 7 p.m. on Monday, Sept. 10, at the Great Hall of The Faculty Club. Click here for a map.

Gifts may be made in Winkelstein’s memory to The Warren Winkelstein Epidemiology Graduate Student Support FundChecks should be made payable to the UC Berkeley Foundation and sent to the School of Public Health, 417H University Hall, University of California, Berkeley, CA 94720-7360. The name of the fund should be noted on the check.

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UC Davis partners with state on cancer registry


Will run key resource for population-based data on cancer.

Kenneth W. Kizer, UC Davis

The UC Davis Health System announced today (June 26) that it will partner with the California Department of Public Health to run the day-to-day operations of the California Cancer Registry, one of the world’s leading resources for population-based data on cancer.

Kenneth W. Kizer, director of the Institute for Population Health Improvement (IPHI) at UC Davis Health System will lead the partnership. As a past director (from 1984 to 1991) of the former California Department of Health Services, he led efforts to obtain the legislation authorizing statewide cancer reporting in 1986 and then oversaw the implementation of the statewide California Cancer Registry.

California’s statewide population-based cancer surveillance system is a data gold mine containing information on more than 4 million cancer cases diagnosed since 1988 including patient demographics, cancer type, extent of disease at diagnosis, treatment and survival information. The database is a powerful tool that enables researchers and health care professionals to assess geographic, ethnic, racial and other risk factors for cancer. Data about trends, disparities in cancer occurrence and treatment, and other information derived from the registry, help shape policy, refine guidelines on patient care, and reveal where early detection, education or other cancer-related programs should be directed. The CCR also has been a critical tool in analyzing cancer “clusters” and the relationship of these unusual occurrences of cancer to environmental factors.

The CCR is a highly collaborative effort among the California Department of Public Health and its Cancer Surveillance and Research Branch (CSRB), the state’s eight regional cancer registries, health-care providers and cancer researchers throughout the state and nationally. Until now, the registry has been operated by the Public Health Institute since 1986.

“They created and maintain a great resource for cancer research for Californians,” said Ron Chapman, director of the California Department of Public Health and state health officer. “CDPH is looking forward to continuing this great public health resource and is excited to partner with UC Davis IPHI.”

Through the new partnership with UC Davis, IPHI will take the lead in collecting, analyzing, interpreting and disseminating information on cancer incidence and mortality for the state. Working with the state public health department and cancer surveillance branch, IPHI and UC Davis Health System staff will monitor the incidence and mortality of specific cancers over time and analyze differential cancer risks, cancer by geographic region, age, race/ethnicity, sex and other social characteristics of the population. They also will gather cancer data through the registry and work with researchers on special projects related to the etiology, treatment, risk factors and prevention of specific cancers.

“The California Cancer Registry provides an unparalleled opportunity to understand the relationship of cancer to genetic, environmental, lifestyle and other factors, and to use that knowledge to advance cancer care and inform public policy,” said Kizer. “Nesting the Registry at UC Davis provides an unrivaled opportunity to leverage the expertise of the UC Davis Comprehensive Cancer Center, departments of information technology and public health aciences, and many other departments and programs throughout the university to translate the registry data into actionable intelligence to lessen the devastating effects of cancer.”

UC Davis plans to enhance the registry’s information management technologies to facilitate rapid collection of accurate cancer-case data and expand easy access to users located throughout the state. In addition, as researchers further develop genetic and molecular medicine and other new technologies to better diagnose and treat cancer, those advancements will inform operation of the registry.

“As a National Cancer Institute-designated comprehensive cancer center, we are committed to further developing the California Cancer Registry to improve health and transform health care,” said Ralph de Vere White, director of the UC Davis Comprehensive Cancer Center. “Our Population Sciences and Health Disparities Program conducts comprehensive research on cancer prevention, initiation, progression and survival. Our emphasis is on reducing disparities in the incidence of particular cancers, as well as improving cancer outcomes in all populations.”

UC Davis Health System has a long history of partnering with the state to improve lives and the delivery of health care. UC Davis clinical informatics specialists developed and currently operate the California’s Electronic Death Registration System, the largest and most successfully adopted death registration system in the United States.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute care teaching hospital, a 1,000-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

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Supporting efforts to transform health care in China


UC Davis’ Kenneth Kizer discusses health reform strategies in Beijing.

UC Davis' Kenneth Kizer (center) and representatives of the Chinese Academy of Social Sciences (left) and the leadership of Beijing Chao-Yang Hospital (right).

China is increasingly becoming an urbanized and mobile society, and with that tremendous growth has come a number of health care challenges. The county has a rapidly rising elderly population and increased rates of cancer and other chronic diseases. The expanding upper and middle classes are changing their expectations on the delivery of health care services, and more than 800 million low-income individuals in rural and remote settings need better access to health care.

To meet these emerging needs, Chinese officials have begun a massive strategic planning process to update the health care delivery system. Last month, they invited Kenneth W. Kizer, director of the Institute for Population Health Improvement at UC Davis Health System, to deliver the keynote address and discuss reform strategies in Beijing at the first international conference on restructuring China’s public hospital system.

The conference was organized by and held at the Chinese Academy of Social Sciences (CASS), the primary “think tank” for the People’s Republic of China. CASS includes 31 research institutes and more than 50 research centers and is China’s highest academic research organization.

“China’s health care delivery system is at a pivotal point,” said Kizer. “The county is poised for major change although the challenges are enormous. Health care is perhaps at a comparable stage today as their manufacturing industries were in the mid-to-late 1990s, and a central question they are wrestling with is to what degree the health care transformation should be driven by initiatives in the public or private sectors, or both.”

Public hospitals and other publicly funded programs provide nearly all of the health care for China’s 1.3 billion people. About 4.5 percent of China’s gross domestic product is spent on health care, compared to 17.3 percent in the U.S. and 8 to 9 percent in most other western countries.

Private health insurance and private hospitals are largely not available in China, although there is growing interest in establishing private sector health care options.

Kizer’s lecture focused on lessons learned in transforming publicly funded health care delivery systems in the U.S. His talk was followed by a question-and-answer session with administrators, clinicians and researchers who were most interested in health care financing strategies, the role of competition in health care, and the advantages and limitations of public versus private-sector financing strategies.

“Governments can provide high-quality and efficient patient-centered care, and rapid and dramatic change is possible even in large, politically sensitive and financially stressed publicly administered health care systems,” said Kizer. “Having a clear vision of and explicit goals for the new system, and measuring and publicly reporting performance data, are essential to ensuring the success of health care change efforts.”

Kizer also emphasized the importance of continuously involving frontline clinicians in the planning and implementation of changes, incorporating automated information-management tools such as electronic health records, communicating frequently about goals and milestones, and educating and training the workforce in essential new skills.

Kizer is a distinguished professor at UC Davis and former under secretary for health at the U.S. Department of Veteran Affairs (VA). In the latter capacity, he engineered what is widely regarded as the largest and most successful health care “turnaround” in U.S. history. He transformed the VA system from a fragmented hospital-centered system to a system of integrated regional networks of care that routinely provides some of the highest quality health care in the U.S.

Kizer currently leads the Medi-Cal Quality Improvement Program, a partnership between UC Davis Health System’s Institute for Population Health Improvement and the California Department of Health Care Services aimed at improving care delivery in the state’s $46 billion a year Medicaid program (Medi-Cal).

During the past few years, UC Davis has established new partnerships and collaborations with China to advance medical education, medical research, patient care, hospital management and health care policy. These include the agreements with BGI, the world’s largest genomics organization, and memoranda of understanding with Tongji University School of Medicine, Soochow University and Nanjing Medical University, as well as leaders of the Shanghai Medical Tourism Products & Promotion Platform.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

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$50M gift for UCLA public health school


School will be renamed after donors Jonathan and Karin Fielding.

The UCLA School of Public Health has received an extraordinary gift from faculty member and public health leader Dr. Jonathan Fielding and his wife, Karin Fielding. The gift, valued at $50 million, is the largest in the school’s 50-year history. In recognition, the school will be renamed the UCLA Jonathan and Karin Fielding School of Public Health.

“I am humbled by the exceptional generosity of Jonathan and Karin Fielding,” UCLA Chancellor Gene Block said. “This investment from longtime champions of public health reflects our shared confidence in the UCLA School of Public Health as a resource not only for greater Los Angeles but the entire world and will extend the school’s reach as a global leader in teaching and service.”

An innovator, leader and public health visionary, Dr. Jonathan Fielding, founding director of the Los Angeles County Department of Public Health, is a distinguished professor of health services and pediatrics, having joined the UCLA faculty in 1979. With a shared passion for improving public health, Karin Fielding serves as an officer of the charitable organization The Everychild Foundation, whose mission is to ease the suffering of children in the greater Los Angeles area, whether due to disease, disability, abuse, neglect or poverty. She is also a court-appointed special advocate, working with children in foster care, both in court and in the community.

The Fieldings have two sons, Andrew and Preston, who join them in making this family gift and who look forward to seeing the fruits of this investment in the continued development of the school and its impact on the public’s health.

“Improving quality of life and promoting health for all is something Jonathan and Karin have spent their lives working to advance,” said Dr. Linda Rosenstock, dean of the School of Public Health. “This gift will play a tangible role in improving health for people in the United States and beyond. It is especially gratifying that this gift comes from one of our own who is an icon in public health.”

“The UCLA School of Public Health hosts a world-class faculty and one of the nation’s brightest and most diverse student bodies. Their talents are improving the public’s health locally, nationally and globally,” said Dr. Fielding. “UCLA’s commitment to civic engagement, community service and social justice is something our family is thrilled to support.”

The Fieldings’ gift will equally support faculty, students and educational infrastructure. It will endow a chair in population health to encourage work to improve health through non-health sectors, such as transportation, housing and education. In addition, the fund will enable UCLA to regularly assess programs to ensure that UCLA School of Public Health students graduate with the tools and skills they need to be leaders in the field of public health as it evolves.

The gift, independently valued at $50 million, is a commitment of assets associated with holdings in Dimensional Fund Advisors. The school will receive an income stream from the assets and additional earnings upon redemption or sale.

The UCLA School of Public Health is consistently rated among the top 10 schools of public health in the nation by U.S. News & World Report. Its faculty and students are actively participating in important work in partnership with underserved communities in the greater Los Angeles area and are engaged in research in more than 70 countries.

“My experiences in UCLA classrooms and working with other faculty members, students and alumni in public health practice made the UCLA School of Public Health an easy choice for our family’s support,” Dr. Fielding said. “UCLA School of Public Health students enter the field with a passion and commitment to public health. As someone who has dedicated my career to service, I am inspired by the talent and enthusiasm of UCLA students, and I am delighted that our family can help them achieve their educational goals and make a palpable difference in the wider world.”

A tireless advocate for public health, Dr. Fielding, in addition to medical and public health degrees, has advanced training in business (M.B.A.) and the history of science (M.A.). He has worked for more than 40 years in the public health field and is a national and international leader in effective prevention and evidence-based public health practice. For the last 14 years, he has served as director of public health for the Los Angeles County Department of Health Services.

Under Fielding’s leadership, the Los Angeles County Department of Public Health has launched many innovative activities, including the highly touted ABC restaurant grading program; one of the nation’s largest chronic disease–prevention programs, featuring nutrition and physical activity; and a state-of-the-art emergency preparedness and readiness program.

Among his numerous honors, Dr. Fielding is an elected member of the Institute of Medicine of the National Academy of Sciences and has received the Sedgwick Memorial Medal for Distinguished Public Health and the Roemer Award for creative public health practice, both from the American Public Health Association. In 2009, he was awarded The UCLA Medal, the highest honor conferred by the university.

Dr. Fielding is a founding member of the U.S. Preventive Services Task Force and chair of the U.S. Community Preventive Services Task Force. He is the immediate past chair of the Partnership for Prevention and the U.S. Health and Human Services Secretary’s Advisory Committee on the 2020 Health Objectives for the Nation. In 2010, President Barack Obama appointed Dr. Fielding to the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

Video
Video for news media is available at http://video-archive.ph.ucla.edu/downloads. (Contents include 1:45 tracked and untracked package; 12 selected sound bites with Jonathan Fielding, Karin Fielding and Linda Rosenstock; and b-roll of the UCLA School of Public Health.)The UCLA School of Public Health is dedicated to enhancing the public’s health by conducting innovative research; training future leaders and health professionals; translating research into policy and practice; and serving local, national and international communities.

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Statewide Medi-Cal quality improvement program established


UC Davis partnership aims to provide strategic advice and mentoring services to facilitate better care.

Kenneth Kizer, UC Davis

The California Department of Health Care Services (DHCS) announced today (Feb. 9) that it has established a partnership with the Institute for Population Health Improvement (IPHI) at UC Davis Health System to improve the quality of care provided by the state’s $46 billion per year Medi-Cal program.

“This partnership will provide strategic advice and mentoring services to guide our capacity for quality improvement, population health management and organizational change,” said Neal Kohatsu, DHCS’ medical director. “It will help strengthen our relationships with partner hospitals by emphasizing bi-directional communication, education and interventions that drive improvement in population health.”

The five-year, $4.25 million agreement calls for, among other things, the IPHI to design and support a statewide Medi-Cal quality improvement plan, develop a systems-level strategy for DHCS to assess hospitals’ success in achieving the goals set forth by the Medicaid Section 1115 waiver’s Delivery System Reform Incentive Pool (DSRIP) program, convene a Medi-Cal Performance Advisory Committee of experts in clinical sciences, system thinking, quality improvement and organizational change, and provide quality improvement training and mentoring for DHCS managers.

“The department is focused on improving and enhancing quality care and reducing health care-related costs,” said DHCS Director Toby Douglas. “Our agreement with IPHI will help us achieve these interconnected goals.”

Medi-Cal is a joint state-federal health insurance program that serves more than 7.6 million low-income and medically high-risk Californians. The DSRIP program is a new component of Medi-Cal that provides federal funds to public hospitals that have demonstrated success in expanding capacity and making services more coordinated, efficient and patient-centered. DSRIP is part of California’s five-year, $10 billion “Bridge to Reform” Medicaid Section 1115 waiver, which aims to strengthen the Medi-Cal program and prepare safety net providers for nearly one million newly eligible Medi-Cal beneficiaries in 2014. The 1115 waiver is an agreement between the state of California and the federal Centers for Medicare & Medicaid Services (CMS) that “waives” certain Medicaid requirements in order to test new strategies for improving care and service delivery.

Kenneth W. Kizer, one of the nation’s preeminent authorities on public health and health care quality improvement and founding director of IPHI, will lead the effort.

“This partnership will result in better health care for millions of Californians and better value for taxpayers who fund the program,” said Kizer, who also is a distinguished professor at the UC Davis School of Medicine and Betty Irene Moore School of Nursing. “We will be developing a clearly defined quality improvement plan for the Medi-Cal program that will include specific quantitative goals and performance measures to track improvement in health care processes and health outcomes, equitable access to care, the prudent use of resources and appropriate matching of resources with needs. In evaluating the DSRIP program and helping develop a systems-level strategy, we expect to make specific recommendations for DHCS and individual hospital systems that will help them achieve DSRIP program milestones and more.”

The plan’s goals and performance measures will reflect the shared values and best practices of the federal Department of Health and Human Services’ National Quality Strategy. DSRIP program evaluations will address interventions in each hospital system plan, including the implementation of electronic health records and use of other health information technology, implementation of patient-centered medical homes, use of evidence-based population health management methods and integration of clinical services to improve the coordination and continuity of care. Kohatsu believes that “Dr. Kizer’s extensive knowledge and history of transforming health care in California and across the nation make him an outstanding director of this statewide initiative.”

Kizer is a member of the Institute of Medicine of the National Academy of Sciences and a fellow of the National Academy of Public Administration. As director of the former California Department of Health Services for Gov. George Deukmejian from 1984 to 1991, he pioneered Medi-Cal managed care, led California’s response to the HIV/AIDS epidemic, launched California’s famed Tobacco Control Program and established a number of leading programs that have become national models of excellence. Some of these include the “5 a Day for Better Health” nutrition program, the California Cancer Registry and California’s birth defects monitoring program.

As undersecretary for health in the U.S. Department of Veterans Affairs (VA) for President Clinton from 1994 to 1999, Kizer engineered the internationally acclaimed transformation of the VA health care system, which included the most rapid and largest ever deployment of a system-wide electronic health record and a comprehensive quality improvement and performance management system that has been cited as a model by Harvard University and others. As founding president and chief executive officer of the National Quality Forum (NQF), Kizer led efforts to establish national standards for reporting of health care quality. Today, NQF-endorsed performance measures are widely used by the federal government and throughout American health care.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 631-bed acute-care teaching hospital, an 800-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

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How many lives could a soda tax save?


By curbing consumption, funding treatment, tens of thousands of lives could be saved.

Kirsten Bibbins-Domingo, UC San Francisco

Every year, Americans drink 13.8 billion gallons of soda, fruit punch, sweet tea, sports drinks, and other sweetened beverages — a mass consumption of sugar that is fueling soaring obesity and diabetes rates in the United States.

Now a group of scientists at the University of California, San Francisco, San Francisco General Hospital and Trauma Center (SFGH) and Columbia University have analyzed the effect of a nationwide tax on these sugary drinks.

They estimate slapping a penny-per-ounce tax on sweetened beverages would prevent nearly 100,000 cases of heart disease, 8,000 strokes, and 26,000 deaths over the next decade.

“You would also prevent 240,000 cases of diabetes per year,” said Kirsten Bibbins-Domingo, M.D., Ph.D., an associate professor of medicine and of epidemiology and biostatistics at UCSF and acting director of the Center for Vulnerable Populations at the UCSF-affiliated SFGH.

In addition to $13 billion per year in direct tax revenue, Bibbins-Domingo and her colleagues estimated that such a tax would save the public $17 billion over the next decade in health care-related expenses due to the decline of obesity-related diseases.

“Our hope is that these types of numbers are useful for policy makers to weigh decisions,” she said.

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Improving the safety of blood transfusions


UCSF part of major research initiative to improve safety, effectiveness of blood transfusions.

Edward Murphy, UC San Francisco

UC San Francisco and its affiliate Blood Systems Research Institute (BSRI) have been awarded nearly $33 million in research contracts for four projects as part of a major new research initiative designed to improve the safety and effectiveness of blood transfusions in the United States and abroad.

Suported by the National Institutes of Health (NIH) National Heart, Lung and Blood Institute, the multicenter collaboration project, titled “Recipient Epidemiology and Donor Evaluation Study III (REDS-III),’’ will span seven years.

“For decades, transfusion safety research has focused on blood donors and infectious disease testing — now for the first time, we will be looking at the patients who receive blood transfusions,’’ said Edward L. Murphy, M.D., M.P.H., professor in the UCSF Departments of Laboratory Medicine and Epidemiology/Biostatistics and senior investigator with the BSRI.

More than five million patients in the United States undergo transfusion therapy annually.

REDS-III will entail the creation of four “hubs,’’ each consisting of a regional blood center and affiliated hospitals. The San Francisco hub will involve the Blood Centers of the Pacific, UCSF Medical Center, San Francisco General Hospital & Trauma Center, and the San Francisco Veterans Administration Medical Center. Blood Centers of the Pacific supplies more than 90 percent of the blood used by the three hospitals.

One of the new projects will focus on improving the practice of blood transfusion and evaluating the positive and negative effects of blood transfusion in the hospital setting. As many as 200,000 patients annually at the assorted hubs who receive blood transfusions, and up to 500,000 blood donors a year will be studied to determine, among other things, pulmonary edema after transfusion, transfusion-related lung injury, alloimmunization and other immunological effects of transfusion, Murphy said.

Another project will look at use of plasma, currently thought to be overused for clotting disorders, Murphy said.

UCSF and BSRI also feature prominently in the international component of the initiative:  collaborative research will be conducted in Brazil and South Africa (Johns Hopkins will partner with China for the third site). International projects will focus on prevention of transfusion-transmitted infectious diseases such as HIV, dengue virus and Chagas disease. The researchers also will study obstetric hemorrhage and increased recruitment of black blood donors in South Africa as well as the treatment and genetics of sickle cell disease in Brazil.

BSRI was additionally awarded the contract for a central laboratory that will provide laboratory support and expertise to the seven clinical centers in the U.S. and overseas.

“One of the things that enabled these projects to occur is the partnership between UCSF and BSRI,’’ said Murphy. “The collaborative culture of UCSF has helped enormously.’’

The project will also use resources of the UCSF Clinical and Translational Sciences Institute.

The overall research initiative totaling $87.2 million is funded by the NIH’s National Heart, Lung, and Blood Institute (NHLBI). The research program will build upon and extend the findings of prior projects that began in 1989 in response to the emerging HIV/AIDS epidemic. As the risk of transfusion-transmitted HIV, Hepatitis B and C viruses and West Nile virus has diminished, REDS-III will shift focus toward several new research areas including health outcomes in transfused patients, health screening of blood donors and even genetic studies in the blood bank setting.

“This research effort will protect both blood donors and recipients from existing and future risks, benefitting both the United States and countries struggling to ensure blood safety and availability,’’ said Susan B. Shurin, MD, acting director of the NHLBI.

Murphy said that the nature of blood transfusions has changed dramatically in recent decades since the advent of HIV.

“Before then, physicians used to transfuse much more liberally,’’ he said. “But HIV and other diseases changed transfusion practice — blood should be given based upon evidence-based guidelines, not just because there is a drop in hemoglobin.’’

For more information, go here.

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Q&A: Brenda Eskenazi


UC Berkeley professor shines a light on human exposure to chemicals.

Brenda Eskenazi always had a thing for brains. By the age of 12, she was carving up cow and chicken brains to explore their anatomy. As a young woman at the 1969 Woodstock festival, surrounded by people on hallucinogens, she saw a man dive off a car headfirst into the concrete, thinking it was water. “Of course, at first, I was just horrified,” she recalls. “But then I remember walking back from Woodstock for miles in the rain, and wondering what happened to his brain? How had those chemicals distorted his brain?”

Eskenazi went on to study everything she could about the brain until she picked up the scent of a whole new field in the late 1970s – environmental health. At the time, many scientists thought “environmental factors” affecting human health involved things like social class and nutrition.

But Eskenazi put chemicals in the picture. In the 30 years of research that followed, she explored the impacts of everything from cigarette smoke, caffeine and chemotherapy to pesticides and flame retardants on brains, child development and reproductive health.

As a professor of public health at UC Berkeley, Eskenazi also spearheaded a study of 536 children born to farmworker families in the Salinas Valley between 2000 and 2001. Her research group began this long-term study during pregnancy and has been tracking development of the children ever since. In two recent papers, they found, for example, that children exposed to prenatal pesticides had lower IQs, and those exposed to flame retardants had lower birth weights.

Discussing her career trajectory, Eskenazi described some of the turning points and how she developed her passion for environmental health. Next year, this passion will take her to Africa to take part in one of the first studies of DDT exposure levels on the continent and its effects on human health.

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Match Day at UC San Diego School of Medicine

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UC Davis: Investigating liver cancer disparities

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