Category Archives: Research & Analysis

Aug 28 2014
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RWJF Scholars in the News: Medical marijuana’s unanticipated benefits, infant sleep pods, 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:

States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.

An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.

Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.

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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 12 2014
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With IOM Report and More, Medical Education Is a Hot Topic

A new report from the Institute of Medicine (IOM) criticizes an absence of transparency and accountability in the nation’s graduate medical education (GME) financing system, which was created in conjunction with the Medicare and Medicaid programs nearly five decades ago. The 21-member IOM committee behind the report says there is “an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME,” and it recommends “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”

Because the majority of public financing for GME comes from Medicare and is rooted in statutes and regulations from 1965 that don’t reflect the state of health care today, the committee’s recommendations include a modernization of payment methods to “reward performance, ensure accountability, and incentivize innovation in the content and financing of GME,” with a gradual phase-out of the current Medicare GME payment system.

Read the report, Graduate Medical Education That Meets the Nation’s Health Needs.

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Aug 11 2014
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Physician Characteristics Can Affect Prostate Cancer Treatment

Management of low-risk prostate cancer varies widely among urologists and radiation oncologists, with characteristics of the physicians who provide treatment playing a significant role in decisions about care, according to a study published online by JAMA Internal Medicine.

Researchers found that urologists who did not graduate from medical school recently, and who care for patients with higher-risk prostate cancer, are more likely to pursue up-front treatment for patients with low-risk prostate cancer than other urologists, who choose to observe and monitor the disease. In many cases, low-risk prostate cancer does not cause symptoms or affect survival if left untreated.

The prevailing approach in the United States, the study says, for men with low-risk prostate cancer is treatment with prostatectomy or radiotherapy, which can cause complications such as urinary dysfunction, rectal bleeding, and impotence. 

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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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Jul 17 2014
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RWJF Scholars in the News: Gun violence, suicide, ‘structural’ versus ‘cultural’ competency, 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 NPR story quotes RWJF Health & Society Scholars program alumnus Andrew Papachristos, PhD, citing his extensive research on gun violence. Papachristos criticizes the lack of context in media coverage of violence, noting that incidents such as the series of shootings over the Fourth of July weekend in Chicago tend to be treated simply as a long stretch of violent incidents. “Treating Chicagoland violence as merely a tally necessarily dehumanizes its victims, but it also obscures so much of the larger story about that violence. It's data without context.” Not only is the murder rate steadily declining in Chicago, but there is a massive disparity in victims of these crimes: “Eighty-five percent of violence—any shootings—happens among 5 percent of people,” Papachristos says.

In an article about libertarianism and state laws related to guns and other topics, the Economist cites a study about the social costs of gun ownership by RWJF Investigator Award in Health Policy Research recipients Philip Cook, PhD, and Jens Ludwig, PhD. It finds that “more guns empirically lead to more gun-related violence, largely because legally purchased guns somehow end up in the hands of criminals via theft,” gun shows, and online sales, which are largely unregulated. To address these issues, Cook and Ludwig suggest making it costlier to buy guns in high-crime areas, and improving the records used to screen gun buyers by including more information on possible mental-health problems, among other proposals. (Free registration required to view article.)

A study co-authored by RWJF Health & Society Scholars program alumnus Alexander Tsai, PhD, MD, finds that men who are more socially connected are half as likely to commit suicide as men considered loners, NBC News reports. The study looks at data on nearly 35,000 men, ages 40 to 75, and finds that those who are more isolated are at greater risk, even if they are not mentally ill. “Public health practitioners think about things like cardiovascular disease as warranting public health attention,” says Tsai, suggesting that suicide may also need attention.

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Jul 14 2014
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Study Highlights Role for Non-Physicians in Preventing Childhood Blindness

A leading cause of preventable blindness in premature babies can be successfully identified by trained non-physician evaluators working remotely, according to a study published online by JAMA Ophthalmology. The number of ophthalmologists who conduct screenings for the condition, retinopathy of prematurity (ROP), has declined in the United States, while countries in parts of Latin America, Asia, and Eastern Europe have long-standing ophthalmologist shortages that contribute to high rates of childhood blindness caused by ROP.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind,” lead investigator Graham E. Quinn, MD, MSCE, said in a news release from the Children’s Hospital of Philadelphia, where he is a pediatric ophthalmologist.

The study involved retinal images taken by neonatal intensive care unit nurses and transmitted to trained image readers at a central location. Ophthalmologists had also examined the infants, and the image readers identified 90 percent of the infants the ophthalmologists had flagged as needing further evaluation.

“Telemedicine potentially gives every hospital access to excellent ROP screening,” said Quinn. 

Read the study in JAMA Ophthalmology

Jul 11 2014
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How Stress Makes Us Sick

Keely Muscatell, PhD, is a social neuroscientist and psychoneuroimmunologist. She is a post-doctoral scholar in the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), San Francisco and UC, Berkeley.

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Results from the recent NPR/RWJF/Harvard School of Public Health poll suggesting that Americans are living under high levels of stress probably don’t surprise anyone. In a way, I’ve been taking an informal version of this poll for the last six years, since when I tell people I meet on airplanes or at local bars that I study stress and health, I am unfailingly met with knowing glances and stories about stressors people are facing in their lives. Given that stress is pervasive (and problematic) in modern life, lots of current research in psychology and neuroscience is focused on understanding exactly how stress can get “into our brains” and “under our skin” to make us sick.

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When we think of illness, one of the first things that comes to mind is the immune system, with its lymph nodes, white blood cells, and antibodies hanging around to help us fight off infections and heal our injuries. An especially important component of the immune system involves inflammation. If you’ve ever gotten a paper cut, you’ve probably noticed that the area of skin around the cut tends to turn red and warm up shortly after the injury. This happens because proteins called “pro-inflammatory cytokines” swim through your blood stream to the site of the wound, where they call out to other immune cells to come to the area and help heal the cut. In the short term, this is a good thing; those little cytokines are a key part of healing. But if inflammation becomes widespread throughout the body, cytokines can lead to depression and even physical diseases, like arthritis and heart disease.

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Jul 11 2014
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Recent Research About Nursing, July 2014

This is part of the July 2014 issue of Sharing Nursing’s Knowledge.

Short Rest Between Nurses’ Shifts Linked with Fatigue

New research from Norway suggests that nurses with less than 11 hours between shifts could develop sleep problems and suffer fatigue on the job, with long-term implications for nurses’ health.

Psychologist Elisabeth Flo, PhD, of the University of Bergen in Norway, led a team of researchers that analyzed survey data from more than 1,200 Norwegian nurses, focusing on questions about how much time nurses had between shifts, their level of fatigue at work and elsewhere, and whether they experienced anxiety or depression.

Analyzing the data, they found that nurses, on average, had 33 instances of “quick returns” in the previous year—that is, shifts that began 11 hours or less after another shift ended. Nurses with more quick returns were more likely to have pathological fatigue or suffer from difficulty sleeping and excessive sleepiness while awake—both common problems for night workers.

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