Category Archives: Health & Society Scholars

Sep 18 2014
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RWJF Scholars in the News: Antibiotic overuse, sexual assault nurse examiners, diaper banks, and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

RWJF Investigator Award in Health Policy Research recipient Anthony So, MD, MPA, co-authors a piece in the News & Observer (Raleigh, North Carolina) about the need to reduce the overuse of antibiotics, in both humans and animals. Overuse accelerates the development of antibiotic-resistant bacteria. The Centers for Disease Control and Prevention estimates that half of human antibiotic use and much animal antibiotic use is unnecessary, the article says. So calls for public policies that create incentives for farmers to decrease use of antibiotics and that limit antibiotic use in animals to disease treatment, rather than growth-promotion or as a substitute for hygiene and infection-control.

In Chicago, most children with asthma or food allergies do not have a health management form on file at school, leaving their schools without information they might need in emergencies, according to a study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH that was covered by Reuters Health. Researchers analyzed 2012-13 school year data on more than 400,000 Chicago schoolchildren, including 18,287 with asthma and 4,250 with a food allergy. Only a quarter of the asthmatic students and half of those with a food allergy had a health management plan on file. The study was also covered by The Chicago Tribune, Fox News, The Baltimore Sun, and Red Orbit, among other outlets.

RWJF Nurse Faculty Scholars alumna Angela Frederick Amar, PhD, RN, FAAN, publishes an op-ed on Talking Points Memo about the report from the White House Task Force to Protect Students from Sexual Assault, Not Alone. Amar notes that effective response to campus sexual assault should include medical care for survivors, and that Sexual Assault Nurse Examiners (SANEs) are trained to tend to the medical and emotional needs of survivors and collect forensic evidence. In other institutions with high rates of sexual violence, such as the military, SANEs are considered an essential part of treatment for victims of sexual violence, Amar writes.

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Sep 12 2014
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Changing the Culture of Health to Prevent Suicide

Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.

Alexander Tsai

When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.

But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?

It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.

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Sep 11 2014
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RWJF Scholars in the News: Mental health and returning service members, children of incarcerated parents, nurse turnover, more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

When reserve service members return to civilian life, such stresses as marriage and health care problems are more likely to trigger drinking problems than traumatic events that occurred during deployment, according to a study reported by Fox News. When it comes to the “long-term mental health for National Guard members, what matters is what happens after they come home,” said lead author Magdalena Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna. “Financial difficulties, re-integrating, difficulties accessing quality health care, all of those seem to matter.” But deployment stress also has an impact. “[T]he more traumatic events they are exposed to during or after combat, the more problems they have in daily life when they come home,” she said. RWJF Investigator Award in Health Policy Research recipient Sandro Galea, MD, MPH, DrPH, co-authored the study. Health Canal also reported on it.

An estimated 17.5 percent of newly licensed RNs leave their first nursing job within the first year, and one in three leave within two years, according to research conducted by RWJF’s RN Work Project. Advance for Nurses quotes co-directors Christine T. Kovner, PhD, RN, FAAN, and Carol Brewer, PhD, RN, FAAN. “One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “A high rate of turnover at a hospital, if it's voluntary, could be problematic,” Brewer added, “but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” Nurse.com also covered the study.

Having incarcerated parents is associated with significant health problems and behavioral issues, and may be more harmful to children’s health than divorce or the death of a parent, USA Today reports. “These kids are saddled with disadvantages,” said Kristin Turney, PhD, author of the study that reached those conclusions. She is an RWJF Health & Society Scholars program alumna. “They’re not only dealing with parental incarceration, but also mental health issues.” The study found that having a parent in prison was associated with such conditions as attention deficit hyperactivity disorder, learning disabilities, speech or language problems, and developmental delays. Turney’s study was also covered by US News and World Report, Salon, Psych Central, Healthline and Mother Jones, among other outlets. 

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Sep 4 2014
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RWJF Scholars in the News: The nursing shortage, ADHD, meaningful online communications and more.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:

NBC 2 (Buffalo, New York) interviewed Carol S. Brewer, PhD, RN, FAAN, co-director of RWJF’s RN Work Project, for a story about the nursing shortage and job prospects for nurses early in their careers. “We are not seeing as much demand for brand new graduates,” Brewer said. However, the anticipated retirement of many older nurses and the increasing demand for health care as a result of the Affordable Care Act could combine to create a 19-percent increase in demand for nurses in the near future, Brewer said. In the meantime, she suggests that new nurses be willing to relocate and look for nursing jobs in rural communities, where demand is greater.

It is important to keep media and public focus on the Affordable Care Act, Jake Haselswerdt, PhD, an RWJF Scholar in Health Policy Research, tells the Independent Voters Network website, because some states are still blocking full implementation of the law. “In order for the more stubborn states to move forward with implementation and expanding care, there may need to be some continued pressure,” he said. “That’s going to require the media to pay attention to the big disparities that are emerging between states that tried to implement the law and those that resisted.”

Tina Bloom, PhD, RN, an RWJF Nurse Faculty Scholar, led training for nurses in Columbia, Missouri, aimed at helping them identify the risk factors and symptoms of domestic violence, and then to support victims, ABC17 News reports. The training is consistent with preventive care provisions in the Affordable Care Act, the article says. Among other things, Bloom teaches nurses to look for certain types of injuries and for issues in patients’ medical histories that do not make sense.

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Aug 25 2014
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RWJF Milestones, August 2014

The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni:

James S. Jackson, PhD, a 2009 recipient of an RWJF Investigator Award in Health Policy Research, has been appointed by President Obama to serve on the National Science Foundation’s National Science Board. Jackson is a professor at the University of Michigan School of Public Health, and director of its Institute for Social Research.

Geraldine “Polly” Bednash, PhD, RN, FAAN, will receive the National League for Nursing’s (NLN) highest honor, the President’s Award, at the 2014 NLN Education Summit in mid-September. Bednash is the recently retired chief executive officer of the American Association of Colleges of Nursing (AACN) and director of New Careers in Nursing, a joint initiative of RWJF and AACN focused on increasing diversity in the nursing workforce.

Sally Cohen, PhD, RN, FAAN, has been selected as the 2014-2015 Distinguished Nurse Scholar-in-Residence at the Institute of Medicine of the National Academies. The program provides a yearlong leadership opportunity to participate in shaping health policy. Cohen was also named editor-in-chief of the journal, Policy, Politics & Nursing Practice.  She is director of the Nursing and Health Policy Collaborative at the University of New Mexico.

Lainie Ross, MD, PhD, a 2013 recipient of an RWJF Investigator Award in Health Policy Research, has been named a 2014 Guggenheim Fellow. Ross will use her fellowship year to research the relationship between ethics and genetics for a book, currently titled, From Peapods to Whole Genomes: Incidental Findings and Unintended Consequences in a Post-Mendelian World. The fellowship is awarded by the John Simon Guggenheim Memorial Foundation to recipients with “demonstrated exceptional capacity for productive scholarship or exceptional creative ability in the arts.”

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Aug 18 2014
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Combating Suicide in the Population Most At Risk: Older, White Men

Briana Mezuk, PhD, is an assistant professor at Virginia Commonwealth University Medical Center and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently earned the Best Early Investigator Award for the top research study from the American Association for Geriatric Psychiatry. 

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Human Capital Blog: Congratulations on your award! What led to your interest in suicide risk in long-term care facilities?

Briana Mezuk: Older adults, particularly non-Hispanic white men, have the highest risk of suicide. This risk increases exponentially after age 75, and recent data suggest that men in the Baby Boomer generation have a higher suicide risk than previous cohorts. There are many risk factors for this group, including social isolation, feelings of disconnection to society, and lack of social supports and close confidantes. Older men are often unwilling to talk about mental health problems with their physicians; they think they are supposed to ‘grin and bear it.’

HCB: What was the goal of your study?

Mezuk: We were trying to understand the epidemiology of suicide in long-term care facilities, and in nursing homes and assisted-living facilities in particular. Suicide risk in these settings may be higher, or lower, than in the general community. For example, suicide risk may be lower in supervised settings because residents would have less access to a means to self-harm. But suicide risk might be higher because residents often have health problems and, frequently, depressive symptoms that are risk factors for suicide. We used data from the Virginia Violent Death Reporting System to identify suicides that occurred among residents of, and among individuals anticipating moving into, these types of facilities.

HCB: What did you find?

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Aug 14 2014
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RWJF Scholars in the News: Ebola fears, ER closures and mortality, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Bringing two American medical volunteers infected with the Ebola virus back to the United States for treatment triggered some criticism, particularly on social media. But Susan Mitchell Grant, MS, RN, CNAA-BC, who is treating the two patients at Emory Healthcare in Atlanta, writes that the criticism is “unfounded and reflect[s] a lack of knowledge about Ebola and our ability to safely manage and contain it.... We are caring for these patients because it is the right thing to do,” she says in a Washington Post op-ed. “Ebola won’t become a threat to the general public from their presence in our facility.” Grant, an RWJF Executive Nurse Fellows alumna, goes on to explain that “the insight we gain by caring for them will prepare us to better treat emergent diseases that may confront the United States in the future.”

Some hospice providers may not be serving patients in the way the end-of-life care should, according to research covered by the Washington Post. Joan Teno, MD, MS, recipient of an RWJF Investigator Award in Health Policy Research, is lead author of a study that analyzed more than 1 million records of Medicare patients across the country. Her research team found that some hospices, particularly those that are new and for-profit, have discharge rates of 30 percent or higher. That is double the standard discharge rate. Historically, some patients are discharged from hospice because their health unexpectedly improves. But Teno and colleagues say the higher discharge rates suggest two types of improper hospice practices: admitting patients who are not dying; and releasing patients when their care becomes expensive. She suggests that both practices may be driven more by “profit margins than compassionate care.”   

Chronic stress during adolescence can lead to adverse health outcomes later in life, says Keely Muscatell, PhD, an RWJF Health & Society Scholar, in an interview with NPR member station KALW (San Francisco). Based on her study, “How Stress Makes Us Sick,” Muscatell suggests that ongoing psychological stress during childhood triggers physiological inflammation throughout the body and could be a primary link to such conditions as major depression, cardiovascular disease, and rheumatoid arthritis. Muscatell explains that chronic stress can even change patterns of gene expression that lead to poor health later in life.

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Aug 13 2014
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Debt Takes Toll on Health, Study Finds

Elizabeth Sweet, PhD, is a biocultural anthropologist researching economic and racial disparities in health and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2008-2010). She was the lead author of a recent study exploring the impact of financial debt on health. 

Elizabeth Sweet

Human Capital Blog: You have published more than one study that looks at the impact of debt on health. What led to your interest in this topic?

Elizabeth Sweet: My interest is driven by both intellectual and personal reasons. As someone who studies the impact of social inequalities on health, I am interested in personal debt as a dimension of socioeconomic status, a site of racial and economic disparity, and a reflection of broader social, cultural, and political-economic forces. Also, as someone who completed education with a fair amount of debt, I am personally familiar with the profound stress that debt can cause.

HCB: College tuition is rising and more people are defaulting on student loan debt. How does student loan debt affect young people’s mental and physical health?

Sweet: This is such an important question. Our study suggests that financial debt indeed impacts the health and well-being of young people—leading to higher stress and depressive symptoms, worse general health, and higher blood pressure. The specific impact of student loan debt, vs. other kinds of debt, is an open question though; the Add Health data that we used did not have that level of detail regarding the types of debt that respondents had. 

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Aug 7 2014
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RWJF Scholars in the News: The ACA and mental health treatment, HIV training for nurses, the rise of superbugs, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

An Affordable Care Act (ACA) provision that allows parents to keep adult children on their health insurance plans under they reach age 26 has resulted in millions more young people with mental-health and substance-abuse problems getting treatment, according to a study led by Brendan Saloner, PhD. Time reports that over two years, young adults ages 18 to 25 who had screened positive for mental health or substance abuse disorders increased their use of mental-health treatment by 5.3 percent compared to a similar group who were not eligible for their parents’ coverage. Vox and HealthDay were among the outlets to report on the study. Saloner is an RWJF Health & Society Scholar.

Infection Control Today quotes Jason Farley, PhD, MPH, CRNP, on the growing need to train nurses to provide HIV care. An RWJF Nurse Faculty Scholar, Farley developed new HIV curriculum for the John Hopkins School of Nursing, where he is an associate professor. “For many years these specialty training programs in HIV have been available for physicians,” he says. “This is the first time we’re offering them to non-physician providers. It’s quite an important development. When you look at data comparing patient outcomes with physician care and with nurse practitioner care in HIV, whether in the United States or in sub-Saharan Africa, those outcomes are the same.”

Magda Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna, explores the stressors that lead to high numbers of returning National Guard soldiers abusing alcohol, reports Science Codex. Cerda is the lead investigator of the study, which examined 1,095 Ohio National Guard soldiers who served primarily in Iraq or Afghanistan in 2008 and 2009, and found that having just one civilian stressor such as job loss, or legal or financial problems, raised the odds of alcohol use disorders. Medical Daily and Medical Xpress also cover Cerda’s work.

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Jul 31 2014
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RWJF Scholars in the News: Cesarean sections, hospital readmissions, nurse practitioners, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system  during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.

In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.

A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.

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