Dr. Blascke's lectures and readings

Hello all:

I trust you enjoyed Dr. Blascke's lecture on Qualitative Research. Just a reminder that he has assigned two articles to be read by next week's lecture: Pediatric Residents' and Continuity Clinic Preceptors' Perceptions of the effects of Restricted Work Hours and Their Learning Relationship and Why do Parents bring Children to the Emergency Department for Nonurgent Conditions: A Qualitative Study. Also, don't forget to complete the discussion questions for each article.

If you are missing any articles or did not receive an email with Dr. Blaschke's PowerPoint presentation slides attached, please email me at sdelmar@ucsd.edu, and I will email them out to you as soon as possible. Otherwise, enjoy the reading and we will see you all in class next week.

PRIME HEq class starts tomorrow

Hello everyone:

My name is Stacey and I am Dr. Broyles new assistant for both the CRCHD program and for the PRIME HEq class. Just wanted to send out a reminder that PRIME HEq will begin tomorrow, Thursday, April 2 and will run from 3:00 to 5:00 pm. Class will be held in building #301, room #136. Please remember to bring your add cards.

Dr. Broyles is looking forward to seeing you all tomorrow in class, and we are both looking forward to working with you this quarter.

Stacey Delmar
Program Assistant
Comprehensive Research Center in Health Disparities (CRCHD)

Socio-economic Background Affects Brain Function

Hey all.

Here's an interesting article from BBC, talking about a study performed at Berkeley that tested the brain function of kids from both low and high socio-economic backgrounds. Turns out that kids from low SE families did not process information in their brains as well as those from higher SE backgrounds.


"This is a wake-up call - it's not just that these kids are poor and more likely to have health problems, but they might actually not be getting full brain development from the stressful and relatively impoverished environment associated with low socioeconomic status."

http://news.bbc.co.uk/2/hi/health/7762492.stm

Researchers think this lower performance may be because these children were not spoken to as much by adults as they developed.

NY Time Article

Yes, this is a bit late....

I came across this article in the Times: Finding a Voice to Match the Pressing Medical Needs of Hispanics.

It is an interesting story about a Latino community that rallied together and compelled their governor to give fully fund a program which institutes interpreters in medical facilities.

Certainly a step in the right direction--Yay :)

Impoverished HIV Patients in California

Hey Everyone,

This just came out today in the LA Times about California's health care system for poor patients with HIV:

http://www.latimes.com/features/health/la-me-hiv5-2008dec05,0,6358115.story

In 2002, Governor Gray Davis signed a bill into law that would make Medi-cal more accessible to low-income HIV patients.

Unfortunately, California's Department of Health Care Services failed to take the mandated steps to put the law into action.

Now, a LA County Superior Judge has decreed that Governor Schwarzenegger's administration has not fulfilled it's obligation to enact the law.

The intent of the law was to cut the costs of AIDS care by switching patients from expensive fee-for-service systems into managed care. The savings would then be used to extend Medi-cal coverage to more poor HIV patients.

A spokesperson for the Department claims that the increased cost of care could not be resolved by the proposed changes. However, instead of looking at other strategies for making the changes successful, it seems that the program was just abandoned.

It is disappointing to see our Department of Health Care Services giving up so easily on a project that could pave the way for more universal coverage. It's hard to say how much analysis or effort they put into the situation from reading just one article, but it would be nice to see some inspiring dedication and creative efforts put into something that is this important. If anyone has any insight on what went on behind the scenes, I'd love to know!

Nicole

Quick update: Obama & changes to U.S. healthcare!

Quick summary of Obama's recently announced plan here: I can't get the URL to work, so just go to news.google.com and type in "FACTBOX: Obama's ambitious healthcare plan"

My favorite points of the plan are:

-- Stop insurers from denying coverage based on pre-existing conditions.

-- Obama says he can reduce healthcare spending by 8 percent and save each taxpayer $2,500.

-- The Lewin Group, a consulting firm, forecasts the Obama proposal would raise federal spending by $1.17 trillion from 2010 through 2019. (From wikipedia: "In 2007 the U.S. spent $2.26 trillion on health care")

(Quick side note: The Lewin Group conducted a study on the single payer CA Bill SB840 showing that a single payer system would SAVE (versus increasing spending) $8 billion in the first year. Savings are because you decrease the insurance companies' 25% administrative overhead to the 4% Medicare admin overhead. Check it out here: http://www.healthcareforall.org/studies.html)

-- A National Health Insurance Exchange to help people buy private insurance, act as a watchdog and create standards

-- Tax employers who do not provide coverage.

-- Small business tax credit to help pay for employee health insurance

-- Require healthcare for all children, expanding Medicaid & SCHIP to cover poor children

If the U.S. really can get insurance companies to take everyone, regardless of pre-existing conditions, that would make a big difference and would make us more like Germany, which you can watch a 10 minute Frontline video about here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Health Care Reform Reveals Doctor Shortage

Hi everyone,

It seems that every time time I read the news I encounter a new article about the need for universal health care. Just today, I was reading about former Senator Tom Daschle, Obama's nominee for Secretary of Health and Human Services, who has plans to hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.

One subtle aspect that is not being openly discussed is the fact that health insurance does not necessarily guarantee health care access. To prove this point, I just saw an article in the New York Times that relates a new crisis facing Massachusetts universal health care reform: the lack of primary care physicians to provide care for all the newly insured. The article stresses that what has happened in Massachusetts has put " a spotlight on the workforce shortages that don't get meaningfully talked about in just about any other other state." The main point is that Massachusetts is the first to encounter a problem that will confront other states as more people are able to afford/receive health insurance. People will have insurance, but who will accept them as patients? Unfortunately, this is a problem that promises to particularly affect poor and underserved communities.

Why the decreased interest in primary care? Why are so many existing primary care physicians disenchanted? Among the issues highlighted in the articles are high student-loan debt and poor compensation/reimbursements by insurance companies, Medicaid and Medicare for primary care visits--no one pays for the time it takes to fill out enormous amounts of paperwork, take on the insurance companies on behalf of patients or to write sick notes to employers.

What to do to change this situation? As one article states, "the solution is ultimately political, since it requires making sure that our enormous public investment in medical care goes where it will do the most good."

You can take a look at the following articles I just referenced at:
http://www.nytimes.com/2008/04/05/us/05doctors.html?pagewanted=1&sq=primary%20care%20physician%20shortage

http://seattletimes.nwsource.com/html/opinion/2002895859_rosenblatt29.html

http://www.npr.org/templates/story/story.php?storyId=97620520

All the best,
Rosa

Interesting article on health care access by undocumented immigrants

Hey everyone,

As I was preparing for our presentation a couple of weeks ago, I came across this comprehensive yet concise article on health care access/use by undocumented immigrants. In the heated immigration debates in California, it's often stated that undocumented immigrants use a disproportionate amount of public services, especially health care. The data presented in the article demonstrates that this population has low rates of health care utilization and that immigrant authorization status remains a significant barrier to health care access.
You can take a look at the article at: http://archinte.ama-assn.org/cgi/content/full/167/21/2354

Many regards,
Rosa

Homless Hospital Release Solutions

Here's an article that I found from National Coaltion for the Homeless that describes some of the changes that have to occur with physicians when homeless patients are released from hospital, in order to imporove patient outcomes.

http://www.nhchc.org/Network/HealingHands/2008/Oct2008HealingHands.pdf

I found most interesting the program at OHSU with their hospital, which seemed to mirror/alleviate many of the same problems that we have with patients at the Hillcrest hospital. I was also aghast at the crazy practices going on in LA.

A breathtaking aspiration for AIDS

An interesting opinion piece in the IHT about a Lancet research paper that suggests testing and treating everyone who tests positive in Africa. The idea is quite simple: test everyone, suppress viral loads in everyone who is positive, and transmission rates with be dramatically reduced. Whatta ya think?

Today is World AIDS Day, Please Take Action

Hey Everyone,

Today is World AIDS Day and it would be great if you could take a minute to help increase the availability of antiretrovirals and other life saving medicines in the developing world. I started a chapter of Universities Allied for Essential Medicines here at UCSD - it is a national advocacy organization that works to ensure Global Access Licencsing for university-based biotechnologies and drugs. You can ask me more about it if you are interested. Anyways, we are stepping up our campaign to encourage the President of the University of California system (Mark Yudof) to adopt global access licensing for all UC-developed health technologies. Please go to http://www.essentialmedicine.org/uc and sign the letter that will then be emailed to Yudof, and please send it to other friends and professors. Over 100 physical letters were already collected at UCSD alone, and nearly 1,000 at all the UC schools combined, and have been hand delivered to the UC President's office. We need to continue to remind him how important it is that the fruits of university research should be available to all, not just those who are fortunate enough to afford it.

Thanks,
Chris

Hey all! So, I'm finally sharing some thoughts on the blog. About time . . . Below is a link to a relevant article that was buried deep in the NYTimes over the weekend. It discusses a new report from the European Union which accuses Big Pharma in Europe of intentionally delaying generic production of certain medications, which cost the EU almost $4billion over the last seven years. Drug policy is an interest of mine and I would encourage us all to ask questions about not only access to care but also the cost of helathcare. Lets all encourage the Obama administration to ensure access to low cost medications!

http://www.nytimes.com/2008/11/29/business/worldbusiness/29drugs.html?_r=1&pagewanted=print

Along the same lines, I recently became aware that many corporate pharmacies have a $4 generic drug list. Any drug on the list only cotst $4 to fill a prescription, with or without insurance. So, let's try to make sure our attendings are writing Rx for generics whenever possible, particularly if we know our patient doesn't have insurance!

Broken Promises

Hi all!

Congratulations on completing our first round of courses in med school =)

When I had originally signed up for the ethnic minorities presentation group, the particular group of interest I had in mind was Native Americans. I know there are many reservations in this area and I do not feel that I have a good grasp on the disparities they face. Before our group decided to focus on the Latino population, I began research on Native Americans and wanted to share with you one of the most informative resources I came across. It is extremely long, but I felt it would be a good resource for all of us because this is a population of patients we WILL be treating in San Diego. (Plus it has a handy table of contents).

The document also provides a history of health policies and decisions involving the Native Americans--attempts at solutions which have ultimately not been accomplished yet. It is incredible what a role the federal government has played in the health care of Native Americans and ultimately how their relationship has lead to health disparities experienced by this population.

I hope you all find this educational and interesting.

And have a wonderful Thanksgiving!

Cassidy

http://www.usccr.gov/pubs/nahealth/nabroken.pdf

Hepatitis B Virus-Induced Liver Cancer in Asian Americans: A Preventable Disease

Hello!



I recently attended a Hepatitis B conference sponsored by APAMSA and was surprised to learn that about 1 out of 10 Asian Americans have chronic hepatitis B infections, compared to only 1 out of 1,000 white Americans! I think the statistic speaks for itself. Hepatitis B is a serious liver disease that disproportionately affects Asian Americans today.


Why so common among Asian Americans? First of all, 90% of Hepatitis B infections were acquired from other countries, and not in the U.S. Thus, Asian immigrants and their descent often carry the disease. Sadly most are unaware of it. People with chronic HBV often show no symptoms. Blood test is the only way of detecting the infection. Chronic Hepatitis B infection can lead to liver cancer.


Because Hepatitis B is a sexually transmitted disease, talking about Hepatitis B is a social taboo in Asian culture. However, sex is not the only method of transmission. People living in developing countries often acquire the disease from their mother at birth.


One of the main speakers at the conference has Hepatitis B. She acquired Hepatitis B from her mother at birth. She was in her mid-40s when she found out. Consequently, she unknowingly passed Hepatitis B to her husband and her three children - all of whom are now at risk of liver cancer....However there is hope!


Treatment for Hepatitis B is now available! Although it is not a complete cure, studies have shown that the new treatment can reduce a patient's risk of developing liver cancer significantly. Unfortunately, most old Asian healthcare providers are unaware of the new treatment and still follow the old rule: “If your liver looks fine, you are fine.” People who have Hepatitis B need to be tested and treated.


I encourage you to check the following article that was published this year! A lot of Hepatitis B awareness (Jade Ribbon Campaign) in the U.S. just started a couple of years ago and is happening now! http://liver.stanford.edu/



Please join the movement by staying informed!



Hepatitis B Virus-Induced Liver Cancer in Asian Americans: A Preventable Disease

JNCI Journal of the National Cancer Institute 2008 100(8):528-529

http://jnci.oxfordjournals.org/cgi/content/full/100/8/528

UCSD SOM Kiva Loan Community

I have created a community on Kiva.org for the UCSD SOM. Its an open community and anybody can join. It would be awesome if some of you would like to join it and loan as little as $25! To join the community you simply go to kiva.org Then click on Communities. If you search for UCSD it should come up with the UCSD SOM community. Just click to join. You'll first have to create an account on Kiva and then you can join the community. As a member of the team you still actually do the loans individually. So that means you can choose anyone on kiva to loan to yourself. However if you don't want to take the time just let me know and I'll make a couple of suggestions.

The more people that join the bigger impact we can make so please join up! Its only $25 and like 98% you'll get your money back! I'll keep people updated with emails on how its going after you join as well. Some of the people receiving money send out little updates and things. Thanks!!

Culture and Health Literacy

Hey guys,

     I came across this interesting article while doing research for my project. It discusses the role of culture in health literacy and provides some guidance into breaking the cultural divides. I know we have talked a lot about this, but it never hurts to see what is actually being published about the subject. Enjoy!

http://springerlink.metapress.com/content/x03720m20857mm86/fulltext.pdf

-Daniel

DENTAL DISPARITY in Minority Children

Hey everyone - Today we will talking about a few child disparities but there was ONE that was very shocking to our group that we don't have time to talk about today.

The article is linked below but the main point is that minority children have extremely high cavity rates compared to white children. Apparently cavities can be almost completely eliminated if water is fluoridated:
"Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children."

It was shocking to our group that 62% of water supplies are NOT fluoridated - that is a simple and relatively cheap solution to the problem. This is a solution that even us as medical students could help initiate and could save millions of dollars of dental care later.

Full Article:
http://jama.ama-assn.org/cgi/content/full/284/20/2625

Brush your teeth!!

The Current State of Primary Care

This is an extremely relevant video that is a must watch for us PRIME kids, especially because we're all "going to be in Primary Care, right?" (David Ding)

Anyway, the video is a roundtable discussion of a bunch of doctors and one M.D.,M.P.H. Their collective intellect is nice to be around.


They first spend some time citing the problems and their roots,
Then they go into new ways of viewing Primary Care and delivering it,
After which they discuss the importance of using different sectors of medicine in building a "Primary Care Team",
And finally, the group tries to tackle the age-old dragon: Payment Reform.


Enjoy with a ice-cold beverage and bare feet. It's a fun one.


http://www.nejm.org/perspective/primary-care-video/

articles related to "greening" our cities

Hey guys,

    I was just browsing through bbc news and came across an article that relates to Dr. Sidelinger's talk on how urban planning and green spaces affect health. 

    This first article talks about a study done by a couple of scottish scientists on how greener neighborhoods relate to reducing the "health gap" between rich and poor.  They studied the relation between the death of 36600 people between 2001 and 2005 and how "green" their local neighborhoods were.  I don't believe all of the evidence but its interesting. 

http://news.bbc.co.uk/2/hi/health/7714950.stm

   The next one done by researchers at Colombia University is an older one discussing the links between green neighborhoods and a reduction in asthma. They even go so far as to say that "asthma rates among children aged four and five fell by 25% for every extra 343 trees per square kilometre." It also discusses some of the stuff we learned about during the asthma clinical correlate about how exposure to more microbes as a child reduces the risk of asthma. They, however, link greener neighborhoods with playing outside more often. This therefore leads to more exposure to microbes thus lowers asthma risk. I'd like to see some more convincing evidence, but its a start.

http://news.bbc.co.uk/2/hi/health/7374078.stm

-Daniel

Hey everybody,

This is an article that I've always thought was interesting. The reported findings are alarming, yet very relevant to what we're trying to train ourselves to do. I've written a quick snippet just to whet your appetites, so that you may go on to the link to read it for yourself: http://jama.ama-assn.org/cgi/content/full/294/9/1058?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=residents%27+preparedness&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Without a question, current residents are required to face difficulties arising from cross-cultural differences. JAMA reports in a survey taken of residents that 96% do acknowledge that it was very important to address cultural components when giving care, while only 8% answered that they were not prepared to care for diverse cultures. Interestingly, when asked about addressing specific aspects of cross-cultural care, the following results arose: 25% reported that they were not ready to care for someone who firmly believed in something other than Western Medicine, 25% reported that they were not ready to care for new immigrants, and 20% were not ready to care for patients with strong religious beliefs. The discrepancy between these two sets of numbers (8% and 25%) points towards the simple fact that some residents are not even able to pinpoint exactly what entails “cross-cultural care”. This gap in the type of knowledge required in these specific settings may arise from a plethora of situations, ranging from a lack of focused cultural component in the medical school curriculum, to a lack of a mentor who possesses a strong understanding of such issues, to even the failure of the school or hospital administration to believe in the importance of said issues.

Chao!

hubert