Transitions in Care: a medical student perspective

by Eva Catenaccio

“Have you had a bowel movement?” Ms. L smiled, shrugged, and pointed to her colostomy bag as if to say, “You tell me.” So began the first day of my internal medicine rotation as a third year medical student. My first patient was 83 years old and stuck in the hospital after a colon cancer surgery complicated by renal failure and pneumonia. I ended up following her for the next five weeks, spoon-feeding her lunch and bribing her for blood draws with ice chips I smuggled past the nurses.  Muted by a tracheostomy tube in her throat, she still had an emotional and expressive face. She smiled in delight at the ice chips, but winced and looked away when I struggled to find a vein.

Taking care of her, I learned how to harvest a sputum culture from her throat, how to apply the sequential compression devices to her calves, how to check the ventilator settings every morning and trace the tides of each breath in little green lines on the glowing monitor. I sat for many minutes holding her hand and trying to read her lips. She had worked years ago on that very wing of the hospital.  She had never learned to read or write. She had no family. One day she started to cry and could only mouth helplessly, “I’m afraid.”

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Health Disparities and Environmental Justice in the Bronx

by Danielle Pasquel

source: http://kids.niehs.nih.gov/explore/ehs/justice.htm

The direct link between socioeconomic status and human health has been well established in the field of public health. Poor communities face an array of distinct economic and social challenges that have quantifiably adverse effects on overall health and health outcomes. Many interrelated factors dictate the relationship between income and health, including sociopolitical status, access to and quality of healthcare, health literacy, nutritional awareness, stress management, and exposure to environmental hazards.

Health disparities in New York City (NYC) provide a perfect example. The Bronx, particularly the South Bronx, is the poorest congressional district in the country, and has some of the worse health outcomes in the nation—it isn’t difficult to see the connection. There is an overrepresentation of racial minorities in poorer communities—African Americans and Hispanics account for 43% and 54% of the South Bronx population, respectively (U.S. Census 2013). The community suffers from a host of health issues, including disproportionately high incidences of obesity, diabetes, asthma, cardiovascular disease, mental illness, and other chronic health conditions. Moreover, individuals from the Bronx are more likely to experience higher morbidity and mortality compared to white counterparts from middle-income or wealthier neighborhoods afflicted with the same disease, which is also the case nationwide.

The Impact of Bad Science

by Arthur Ruiz

Source: http://www.scienceblogs.com

A little bit of bad science can go a long way

Historians of science have always appreciated the collaborative efforts of communities of researchers, whose individual efforts can result in huge aggregate advances. For every revolutionary scientist like Isaac Newton or Nikola Tesla, who almost single-handedly changed the direction of their fields, there are numerous unsung scientists who have pushed a given discipline forward by their joint efforts. Newton and a few other Titans have planted entire mountains into the scientific landscape, while many others have resolutely contributed their pebbles. But pebbles can accumulate, and Newton himself was humble enough to observe: “If I have seen further, it is by standing on the shoulders of giants.” Scientists rely on the results and the insights of both predecessors and peers to drive their own studies forward. As contributors, however minute, to the collective edifice known as Science, we should therefore feel a special affront when we hear of an instance of scientific fraud or malfeasance.

From Gin to Citizen Science

by Leah Guthrie

What we do in our free time often reflects our preoccupations. For a newly growing city like London in the eighteenth century, binge drinking gin served as a favored pastime; especially, among the developing working class who were adjusting from rural life to a crowded industrial society with poor working conditions. Gin was a very cheap antidote to the harsh realities of life with visibly numbing effects. At the height of the Gin Crisis in the 1720s, alcohol-related death rates were steadily climbing while birth rates were dropping to concerning levels. Laws restricting gin access did little to mitigate the damage until economic improvement generated a higher standard of living and new social pastimes, like coffee houses and restaurants that took advantage of the crowded and compact nature of city life (1).

Porn Stars as Safe Sex Role Models? Measure B’s Educational Opportunity

Author’s name withheld by request

source: http://lgbtpov.frontiersla.com/

Many of us grow up emulating our favorite movie stars. But what if those movie stars were porn stars, and by acting like them we were preventing the spread of sexually transmitted diseases, such as gonorrhea and chlamydia? LA County lawmakers behind Measure B, or the “Safer Sex in the Adult Film Industry Act” perhaps had that idea.

In a recent study by Rodriguez-Hart et al., 28% of adult film actors in a 168-participant study were found to have chlamydia and/or gonorrhea ¹.This statistic is more appalling when compared to the negligible percentage of legal prostitutes in Nevada with the aforementioned STDs ². The study continued by describing how these diseases are transmitted, blaming unprotected oral and anal sex in addition to vaginal intercourse. Of the 47 (28%) participants with the STD, only 11 (23%) of them had STDs detectable through urogenital testing alone. In addition, over 90% of the oropharyngeal and rectal cases were asymptomatic. The study concluded that undiagnosed asymptomatic STDs were common and easily transmissible to sexual partners. The authors strongly believed that every performer should be tested for STDs at all anatomical sites and should have to use condoms for sex scenes. Measure B, which thoroughly addresses both of these concerns, was passed with 56% approval during the most recent election.

What is the Real Worth of a University?

by Arthur Ruiz

Amidst the negotiations between Yeshiva University and Montefiore over the fate of Albert Einstein College of Medicine, the Einstein Community demands some answers.

Einstein Price Center

What is a University? The word “university” comes from the Latin universitas, “the whole; aggregate”, and it is a telling definition. A university is the summation of the proficiencies and resources of its academic and scientific communities. It is more than the buildings, the labs, the physical infrastructure, the financial assets – it is the people, their expertise and their relationships that produce the real value in a place like the Albert Einstein College of Medicine.

However, this University is under threat. The status of Einstein has been up in the air for the past year, during which Einstein’s owner, Yeshiva University (YU), has been in negotiations with Montefiore Medical Group (MMG) to sell Einstein. Financial turmoil, court settlements and bad investments have cost YU $1.3 billion over the past decade, and Yeshiva finds itself unable or unwilling to continue to support Einstein. Partnering Einstein with MMG offers a way forward for Einstein, but negotiations have been stalled out in the past couple of months. Now YU, after spending an undisclosed amount of money on the efficiency consulting firm Alvarez and Marsal, has determined that eliminating the Sue Golding Graduate Program and its associated basic research program would reduce their budget deficit and ease their financial plight – but at what cost?

Ecology for biomedical scientists and bankers: A recap of the World Science Festival (WSF) salon on “Predicting the Collapse of Complex Systems”

by Leah Guthrie

 Simon A. Levin, a Professor of Biology at Princeton University, opened up the World Science Fair (WSF) salon on Predicting the Collapse of Complex Systems by relating a story of how ecologists predicted the 2008 financial collapse. He starts at a meeting hosted by the New York Federal Reserve on systemic or undiversifiable risk that involves the collapse of an entire market, as opposed to a specific industry (1). Levin was one of three ecologists in attendance, and they all were all struck by the evident parallels between ecological and financial systems. Their collective thoughts were published in February of 2008 in a Nature paper entitled Ecology for Bankers (Nature 451, 893-895).

Is Fat Shaming the Wrong Battle in the War Against Obesity?

by Kirsten Hartil

Cindy Baker, Personal Appearance, 2008-2012. Part of the image used in the flyer promoting Fat Studies: Bodies, Culture, Health. It depicts Cindy Baker in a custom-built professional mascot costume. Her Personal Appearance engages the notion of ‘fat geography addressing the lived reality of taboo bodies in spaces make for the ‘socio-normative’ body.

Phrases such as: “the obesity epidemic” and “the war on obesity” have become part of the daily lexicon of biomedical and public health researchers engaged in obesity research. The consequences of framing the discussion this way was the topic of Fat Studies: Bodies, Culture, Health, a panel discussion held at the New School on Monday June 16, 2014.

The four-member panel consisting of professors of clinical psychology, public health, art history, and history was moderated by Dr. Fabio Parasecoli, associate professor and coordinator of the Food Studies Program, the New School for Public Engagement.

Help to Find the Health in Healthcare: A Discussion of Cost, Competing Factors, and Consequences

by Ramon A. Robertson

source: http://www.exactdata.net/industry-solutions/healthcare/

In Population Health: Transforming Health Care to Improve Our Health, Dr. Sederer’s central thesis, is that we must expand our collective consciousness (as medical doctors, public health specialist, and private individuals) of the tenants (or determinants) which are ultimately driving our health status outside of provisional healthcare services. Further, we must realize the modicum of worth (10%) that “healthcare” provides to our human experience, and instead, consider more closely, the truly impressive determinants that modulate the crux of our health as a population. ¹

He points out that what is actually making us sick, are our poorly self-regulated behaviors and practices — “excessive and poor eating, more than moderate drinking, smoking, [lack of] physical activity, high salt and processed food intake” — that are most responsible for the steady decline in health and growth in illness. ¹ Though many fall back on the genetics controlling their fate argument, Sederer points out the reality that though genetic effects are indeed hardwired, they can be modulated by environmental exposures to either remain quiescent or manifest destructively. ¹ Sederer also reminds us that this discussion is not merely an academic one, as the gravity of a structurally unsound healthcare system is reflected in our country’s financial statement — in that we spend on average almost a fifth (18%) of our nation’s GDP ($2.7 trillion annually) on healthcare costs — far above any other comparably developed nation in the world. ¹

Can racism explain the increased rates of maternal and infant mortality among African Americans?

by Kirsten Hartil

This post is a modified version of a paper submitted for the Multiculture and Diversity Issues course of Einstein’s MPH Program. 

Rates of perinatal and maternal mortality are higher in the U.S. than 16 other high-income countries including the United Kingdom, Canada, Japan, Sweden and Denmark.

The Centers for Disease Control and Prevention estimates that in the U.S. every year 25,000 infants die before their first birthday. These rates are lower than most low- and middle-income countries. Sierra Leone, for example had an infant mortality rate of 117 deaths per 1,000 in 2012. Still, according to Save the Children’s 14th annual State of the World’s Mothers report, 50 percent more newborns die within their first 24 hours in the U.S. compared to all other industrialized countries combined.

Congenital malformations, pre-term birth or low birth weight, sudden infant death syndrome (SIDS), and maternal complications and injuries (e.g., suffocation) are the major causes of infant mortality in the U.S., accounting for 57% of all infant deaths in the United States in 2010.