May 22, 2008
Thursday Photovoice - Photo 3
This is the third in a series of entries that will highlight photographs taken as part of the photovoice component of Project HYPE.
You can read more about Project HYPE and see other photographs at our photovoice page.
Check back next Thursday when we will highlight another photograph.
EXTRA: Stanley Feld M.D. takes John McCain's health plan to task:
Mr. McCain seems to have no idea of the problems in the healthcare system. The government should create new rules to change the incentives of the stakeholders. The rules must create incentives for the consumers and physicians and not be punitive. One hundred and fifty million people presently have some form of healthcare insurance provided by their employers. Nonetheless, those insured employees can not afford the deductible they are required to pay while receiving less coverage at higher costs.
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Posted by David Porter at 08:00 AM
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Category: Healthcare; Photo Voice; mccain; mural; neighborhood; photovoice
Voices to Action
Project REECH invites all interested researchers to attend:
Voices to Action. A report back on conversations held with community residents of the Hough neighborhood. This presentation will include Playback Theater.
Date: Thursday May 29th from 6:30 p.m. - 8:30 p.m.
Location: Imani Temple Church. 1855 Ansel Rd. Cleveland.
Attend and hear about the types of research community residents would like to see conducted in their neighborhoods.
RSVP to Karen Tabb by phone at 216-778-7332 or ktabb@metrohealth.org
Community Partners:
Fellowship Missionary Human Development Center
Famicos Foundation
NEON
Faith Temple Imani Church
Footprints for Girls
Lexington Bell Community Center
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Posted by David Porter at 08:00 AM
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Category: Research; cbpr; community development; playback theater; project reech
May 21, 2008
Community Based Participatory Research - Are the scales balanced?
Maghboeba Mosavel PhD and her team discuss their community based participatory research projects. The challenges, lessons learned, and what's next.
This presentation was part of our Works in Progress series.
See this page for information on downloading and subscribing to our podcast.
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Posted by David Porter at 03:09 PM
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Category: Audio / Video; cbpr; community based participatory research
Voices of Action - The Big Day
Project REECH (Research Engagement and Education for Community Health) is hosting a community meeting on health and health issues.
Date: Thursday May 22nd at 5:30 p.m.
Location: WSEM - 5209 Detroit. Doors open at 5:00 p.m.
For more information call 778-7332.
All participants will receive a gift for attending the session.
Sponsored by:
The Detroit Shoreway Community Development Organization
The Center for Reducing Health Disparities
Nueva Luz Urban Resource Center
El Barrio
West Side Ecumenical Ministry
Spanish American Committee
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Posted by David Porter at 08:31 AM
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Category: community health; project reech
Cool Whip #2
MSNBC.com - Doctor's text nagging prods teens to take meds.
You can find other comics from the series here.
EXTRA: Daniel Carlat, M.D asks, "Why does the company believe it needs to give pens and pizzas to doctors in order to get them to prescribe their drugs?"
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Posted by David Porter at 08:00 AM
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Category: Cool Whip; rx; teenagers; text messaging
May 20, 2008
Health Disparities Podcasts
Community Based Participatory Research - Are the scales balanced?
Presented by Maghboeba Mosavel, PhD, Karen Tabb, MSW, Catherine Oakar, BA, Ayella Shams, BS.
Dr. Mosavel and her team discuss the challenges, rewards, lessons learned, and 'what's next' for their CBPR projects.
Download link (audio and slides)
Download link (audio only)
"Addressing the Mental Health Disparities Evident in the African American and Latino Communities - A Grassroots Approach." Presented by Marsha Mitchell Blanks, M.S.W., L.S.W.
Download Link (Video Podcast)
"Elder Abuse: Framing the Issue." Presented by Georgia Anetzberger, PhD, ACSW, LISW.
Download Link (Video Podcast)
"Using the Primary Socialization Theory to Predict Adolescent Substance Use and Sexual Risk Taking Behaviors." Shelley A. Francis, MPH, DrPH, CHES.
Download Link (Video Podcast)
To download simply right click and select 'save as.' (Quicktime may be required to view.)
If you use iTunes you can subscribe to our podcasts by clicking this link. This will launch iTunes. You can then click "subscribe" to automatically receive new podcasts when available.
For other podcast managers you can add the following link to your podcast feeds:
http://blog.case.edu/ccrhd/podcasts/rsscrhdpodcast.xml
Be sure to check out some of our other multimedia presentations by clicking on the Audio / Video link in sidemenu on the left.
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Posted by David Porter at 12:00 PM
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Category: Podcasts
Huge gap in mortality rates among those with CKD
Using data from a population based survey of community dwelling individuals, Dr. Rajnish Mehrotra and his team found that those with chronic kidney disease (CKD) had an all-cause mortality rate twice that of those with normal kidney function. Also, among those with CKD, blacks who were under 65 years old were 78% more likely to die than their white counterparts.
From EurekaAlert.org:
Dr. Mehrotra and his team conclude that their findings may explain the lower mortality rates observed among blacks with advanced kidney disease. As a result of the higher risk for death in the early stage of chronic kidney disease, only healthier blacks are surviving and developing later stages of chronic kidney disease.
The study will appear in an upcoming issue of the Journal of the American Society of Nephrology.
EXTRA: Ohio Health Policy Review talks about how expensive open enrollment is for a high risk uninsured person. A single 40 year old can expect to pay $20,000 for a year of insurance.
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Posted by David Porter at 07:45 AM
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Category: Health Disparities; ckd; insurance; kidney disease; racial differences
May 19, 2008
What's wrong with what we eat
NYTimes food writer Mark Bittman takes on fast food, meat, carbs, salisbury steak, convenience foods, farm subsidies, the decline of a quality dinner, yogurt, granola bars, organic foods, and the U.S.D.A. in this insightful talk.
EXTRA: Be careful when parking your car. The Scalpel reports on a recent valet scam at a local hospital.
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Posted by David Porter at 08:00 AM
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Category: Healthcare; Nutrition; fast food; fast food; organic food; slow food; usda
May 16, 2008
Disparities in blood sugar control
From Reuters:
In general, the study found that black patients had a higher average blood sugar level than white patients did one year after starting drug therapy. They were also somewhat less likely to comply with their medication regimen, which was gauged by how often the patients refilled their prescriptions.
This did not, however, fully explain black patients' poorer blood sugar control, the researchers report in the journal Diabetes Care.
Exactly what does explain the racial gap remains an open question, according to the researchers, led by Dr. Alyce S. Adams.
One possibility, they suggest, is that African Americans tend to have more severe diabetes by the time they are diagnosed and treated. So they may need more intensive treatment off the bat, including higher medication doses.
The full study can be found at the journal Diabetes Care.
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Posted by David Porter at 09:34 AM
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Category: Health Disparities; blood sugar
May 15, 2008
Thursday Photovoice - Photo 2
This is the second in a series of entries that will highlight photographs taken as part of the photovoice component of Project HYPE.
You can read more about Project HYPE and see other photographs at our photovoice page.
Check back next Thursday when we will highlight another photograph.
EXTRA: Ohio Health Policy Review is reporting on the disparity in death rates between different levels of education.
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Posted by David Porter at 08:00 AM
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Category: Photo Voice; Research; cbpr; foreclosure; hypertension; photovoice; stress
May 14, 2008
Cool Whip #1
NYTimes.com - The Lost Supermarket
You can find other comics from the series here.
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Posted by David Porter at 08:00 AM
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Category: Cool Whip; Nutrition; fast food; grocery stores; supermarkets
May 13, 2008
Vet commits suicide outside veterans' clinic
On Saturday the Health Disparites Blog celebrated its 2nd birthday. I had planned on posting today the first in a new series of comics focused on the topics of health and healthcare.
Then last night I stumbled upon a terribly sad story at curethis.org that was originally posted at greenvilleonline.com:
Harriett Chapman's eyes filled with tears Sunday as she recalled one of the last conversations she had with her 89-year-old father before he fatally shot himself outside a Greenville veterans' clinic last month.
Grover Cleveland Chapman told his family, "No matter what I apply for at the VA, they turn me down," she recalled.
The next day, the World War II veteran took his own life outside the Veterans Outpatient Clinic at 3510 Augusta Road, said Greenville County Deputy Coroner Mike Ellis.
Somehow posting a comic today just didn't feel right.
EXTRA: GoozNews.com posted an interesting article about the FDA and the Helsinki Declaration.
Last week, the FDA formally declared that it will no longer require that clinical trials submitted to the agency to get regulatory approval for a new drug adhere to the Helsinki Declaration. The new rule, which goes into effect next October, was supported by the drug industry but opposed by numerous public interest, patient advocacy, and consumer groups.
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Posted by David Porter at 08:00 AM
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Category: Health Care
May 12, 2008
How the cost of medical school can affect health care quality
Andrew Herstein writing at theNation.com explains how the cost of medical school affects both patient care and health care access.
According to the article, in 2006 graduates of public medical schools owed a median amount of $120,000 in student debt. Their private school counterparts owed $160,000.
Citing 2004 U.S. Census Bureau statistics Mr. Herstein shows that while minorities make up 30% of the U.S. population only 14% of applicants to schools that grant an M.D are minorities. From theNation.com:
According to the Association of American Medical Colleges (AAMC), the primary reason for this discrepancy is that minority students are much more likely to see financing a medical education as an insurmountable problem.
The article continues by showing how race matters with regards to health care providers.
Patients report higher measures of satisfaction and trust when their doctor is of the same race and ethnicity. One study found that race-concordant visits were longer on average and were characterized by more positive physician affect. In addition, minority physicians are more likely than white physicians to practice in geographic areas whose populations face multiple challenges to maintaining good health.
In addition, minority doctors report providing more care for under-served populations.
So what should be done about the low number of minority applicants to medical school? Mr. Herstein offers two possible solutions.
First the U.S. government could work towards reducing the cost of medical school for qualified college graduates. This could be accomplished by increased funding for scholarship programs that reward those who work in under-served areas.
The second possible solution is to provide more money to health professions schools which should increase the number of need based scholarships.
With the rising cost of tuition the article ends with a warning that things could get worse:
If such rapid tuition growth continues, larger and larger numbers of minority students will consider a medical education to be unaffordable. The result would be a workforce that is even less diverse than it is now. Considering the many benefits that a diverse workforce provides, this outcome should be avoided. The federal government has the ability to shape the composition of the physician workforce and ought to do so.
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Posted by David Porter at 08:30 AM
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Category: Health Care; Healthcare; health care access; medical school; medical school debt
May 09, 2008
Cultural and Linguistic Competency - Implications for Reseach
On May 19th there will be a half-day symposium looking at techniques for designing research projects sensitive to cultural dynamics of patient population.
The guest speaker and facilitator will be Tawara D. Goode, M.A. Ms. Goode is an Assistant Professor and Director of the National Center for Cultural Competence at the Georgetown University Center for Child and Human Development.
Date: May 19th, 2008
Time 8:00 - 1:00 p.m.
Location: Wolstein Research Building, Room 1413, Case Western Reserve
You can download a pdf version of the flyer for the event here.
Please RSVP to Michele Abraham at 216-778-3858 or mabraham@metrohealth.org no later than May 12, 2008.
This symposium is sponsored in part by Case Western Reserve University, the Francis Payne Bolton School of Nursing, and the Clinical & Translational Science Collaborative.
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Posted by David Porter at 08:00 AM
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Category: Cultural competency; Cultural competency; Linguistic Competency; Research
May 08, 2008
Thursday Photovoice - Photo 1
This is the first in a series of entries that will highlight photographs taken as part of the photovoice component of Project HYPE.
Project HYPE is a community-based research project aimed at identifying the social context of hypertension management. The photovoice aspect of the project is designed to have community members photograph those things which positively and negatively affect their hypertension. Participants told the story behind each photo which stimulated dialogue about the issues related to hypertension management.
Check back next Thursday when we will highlight another photograph.
BONUS: I will be attending Case's Collaboration Technology and Engaging the Campus today. I'm looking forward to meeting many of the best and brightest of the Case digital community.
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Posted by David Porter at 08:00 AM
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Category: Photo Voice; Research; cbpr; community; hypertension; photovoice
May 07, 2008
Racial disparities in diabetes control
DIABETES CONTROL may be more challenging for Hispanics than for non-Hispanic whites, a meta-analysis suggests.
Researchers found that hemoglobin A1c (HbA1c) levels are higher in Hispanics than non-Hispanic whites, with an overall mean HbA1c difference of 0.5%. The reasons for the disparity in HbA1c levels are not known, but plausible explanations include differences in biology, access to care, insurance status, and diabetes treatment adherence
BONUS: New York City started issuing citations to restaurants that did not have calories posted on their menus. See NYTimes.com for more info.
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Posted by David Porter at 08:00 AM
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Category: Health Disparities
May 06, 2008
Engaging community members for research purposes: Who benefits?
The Case Center for Reducing Health Disparities and Cleveland State's Center for Health Equity are hosting the next presentation in the Works in Progress Lecture Series.
“Engaging community members for research purposes: Who benefits?”
Date
Friday, May 9, 2008.
Time
3-4 p.m.
Location
Case Western Reserver University School of Medicine
2109 Adelbert Avenue.
T503
(the School of Medicine is #50 on this map.)
Please RSVP your attendance to Cydney Johnson at cjohnson3@metrohealth.org or by phone at (216) 778-8484.
We look forward to seeing you there.
BONUS: a NYTimes.com story reports that high blood pressure is a greater risk in poor and middle income countries.
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Posted by David Porter at 08:00 AM
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Category: Works in Progress
May 05, 2008
Health care delivery problems in Canada
Often when the issue of health care access is discussed someone will point north and advocate for a Canada-styled heath care system for the U.S.
But there are problems in the Canadian health care system too. From theglobalandmail.com:
Canada, once able to boast about its high rank in the world for low infant-mortality rate – sixth place in 1990 – saw its rank plummet to 25th place in 2005, according to figures published this year by the Organization for Economic Co-operation and Development.
Specifically, Canada's infant mortality rate of 5.4 deaths per 1,000 live births is tied with Estonia's and more than double Sweden's rate of 2.4.
According to the OECD the infant mortality rate for the U.S. was not listed for 2005 but it was 6.8 (deaths per 1000 live births) for 2004.
In addition, the waiting times for many procedures in Canada seems long. In a report titled The Wait Time Strategy (available as a pdf at the health.gov.on.ca website) the number of days between decision to treat and treatment is listed. These are the average number of days waiting for December 2006 and January 2007.
Cancer Surgery 68 days
Angiography 28 days
Angioplasty 17 days
Bypass Surgery 48 days
Cataract Surgery 183 days
Hip Replacement 257 days
Knee Replacement 307 days
MRI 105 days
CT 62 days
If interested, you can navigate the Canadian health care website and check the average waiting times for various hospitals and geographic areas in Ontario.
Bonus: The next lecture in our Works in Progress series will be titled, "“Engaging community members for research purposes: Who benefits?" Check back tomorrow for full details.
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Posted by David Porter at 06:46 AM
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Category: Health Care
May 02, 2008
Disparities in nutrition among poor women
From Reuters:
Researchers found that among 603 mothers of children in Head Start programs in Alabama and Texas, diets tended to be too low in important nutrients. But Hispanic mothers did generally get more fruits and vegetables than white and African-American mothers did, and a lower percentage of their daily calories came from fat.
On average, the study found, Hispanic women consumed what health experts consider an adequate amount of fruits and vegetables -- 4.6 cups per day, based on detailed dietary questionnaires.
In contrast, white and black women averaged between 2 and 3 cups per day, the researchers report in the Journal of the American Dietetic Association.
The study can be found in the Journal of the American Dietetic Association.
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Posted by David Porter at 08:30 AM
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Category: Health Disparities
House introduces Health Equity and Accountability Act
Representative Joe Baca writing at the Huffington Post:
Latino children are less likely to receive adequate medical care, such as routine examinations and vaccinations. Latinos and African-Americans comprise 60% of all HIV/AIDS cases in the country. It is evident that priority must be given to diminishing these health disparities. If we have any chance of fixing health care for our community as a whole, action must be taken now.
To help address this issue the House has introduced the Health Equity and Accountability Act, H.R. 3014.
Bonus: The journal, Archives of Surgery, is soliciting papers for a year long theme on the topic of disparities in health care.
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Posted by David Porter at 08:00 AM
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Category:
May 01, 2008
Access barriers and disparities in the disabled
Posting as part of Blogging Against Disablism Day.
In a 2007 commentary that appeared in JAMA the authors list previous research that demonstrates how disabilities affect treatment.
- Women with major mobility problems were less like to have received a PAP test in the prior three years than women without major mobility issues.
- 45% of women with major mobility issues reported have a mammogram in the previous 2 years vs. 64% of women without mobility issues.
- In a study of Los Angeles County residents with disabilities those who were black, had lower incomes, and were more severely disabled were more likely to report difficulties in accessing clinicians offices.
- In women with breast cancer those who were disabled were less likely to receive radiotherapy following breast-conserving surgery.
The authors close with a call to reduce structural barriers and emphasize form and function:
As health care facilities managers renovate structures, construct new buildings, and purchase equipment and furnishings, they should remember legal requirements as well as health care’s therapeutic mission. Environments with barriers will not foster healing and could endanger the safety and experiences of patients and employees. Form follows function. Healing, not handicapping, should guide design of environments to ensure health care access for all persons.
BONUS: The Medical Humanities Blog has the latest Health Wonk Review up. There are even a few Seinfeld references in the mix.
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Posted by David Porter at 08:00 AM
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Category: Health Disparities
April 30, 2008
Blogging Against Disablism Day
On May 1st the Health Disparities Blog will join a host of other medical bloggers with an entry focused on the topic of health disparities and disabilities.
More information can be found here.
Make sure you check back tomorrow.
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Posted by David Porter at 12:22 PM
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Category: About Us
Cancer, stroke, and health disparities in China
China Daily is reporting on a new study by the Chinese Ministry of Health.
The study looked at the health of about 210 million Chinese across the nation. The primary finding was that cancer and stroke are the countries top killers.
In addition, the report found increasing disparities between the rural and urban areas of China.
The differences were reflective of the yawning gap between the country's rural and urban areas in terms of health awareness and living standards, [MOH spokesman Deng Haihua] said.
Disparities in economic development between rural and urban regions, which lead to an imbalance in medical care and health awareness, can influence the death rate in different areas, he said.
The number of deaths in the countryside was 19 percent higher than in urban areas. Within urban areas, the death rate in less developed western cities was 25 percent higher than in the more developed east.
Part of the problem is China's tremendous cigarette consumption. MSN reported that China consumes 2.3 trillion (2,300,000,000,000) cigarettes or two-fifths the world's total.
The China Daily article also mentions the infamous cucumber, "people in the rural regions of Hebei province like to eat homemade pickles that have high nitrite content, which can lead to cancer...."
You can read our other entries related to China at this link.
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Posted by David Porter at 08:00 AM
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Category: China
April 29, 2008
Hospital says payment before treatment
From the Health Blog at WSJ.com:
As a front-page article in today’s WSJ reports, hospitals are seeking cash upfront to reduce bad debt they’re experiencing amid a surge in patients who don’t pay their bills. Some are uninsured and other carry coverage that requires high co-payments.
Let us not forget a topic we blogged about earlier - medical credit scores and how they might influence treatment.
BONUS: A new study out reports that blacks have a 5x higher rate of amputations in the Chicago area.
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Posted by David Porter at 08:00 AM
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Category: Health Care
April 27, 2008
Low Medicaid reimbursement may lead to disparities
From Health Affairs:
PCPs in high-minority practices rely more heavily on lower-paying Medicaid reimbursements, devote more time to uncompensated charity care, and earn lower incomes. Magnifying these resource disparities, geographic areas with more high-minority practices tend to have lower Medicaid and private insurance reimbursements than those with fewer high-minority practices.
Our results indicate that the minority makeup of physicians' patient panels is associated with greater reports from physicians of difficulties providing high-quality care. At least some of this relationship appears to be explained by the lower resources flowing to high-minority practices. Two of the quality indicators most affected by Medicaid payment levels in our simulations, time spent per patient seen and difficulties getting timely reports from other providers, suggest the possibility that physicians may compensate for the lower revenue flows by increasing the volume of patients they see, reducing the time spent per patient seen, and perhaps devoting less time to coordinating and documenting care. This is despite the more complex psychosocial contexts and the language and cultural barriers that often complicate the treatment of lower-income and minority patients.
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Posted by David Porter at 08:00 AM
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Category: Health Care
April 25, 2008
Sold her house to open a clinic
CNN.com has a story posted about a doctor who left private practice, sold her house, and opened a clinic focused on providing health care for the poor.
In 2002, these efforts resulted in "The Clinic: Medical Center for the Uninsured," a charitable, sun-filled clinic that has since received more than 40,000 patient visits.
Individuals receive free or low-cost primary medical care across eight specialties, regardless of income or locality.
"Since there's no need to spend a lot of time doing paperwork, we have time to talk to the patient and really hear what they're saying," says Stuart. "So the patients go away feeling they've been heard, that they've been helped."
An arsenal of more than 100 local volunteers, including 20 retired and practicing physicians, assist Stuart in providing expert medical services to more than 800 patients per month from across the southeastern Pennsylvania, New Jersey and Delaware area.
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Posted by David Porter at 08:00 AM
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Category: Health Care
April 24, 2008
Health care around the world
Healthcare-Economist.com has been reviewing many of the national health care systems around the world.
The reviews are based on an article by Michael Tanner that appeared at Cato.org.
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Posted by David Porter at 08:00 AM
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Category: Health Care
April 23, 2008
Racist Doctors?
Rahul K. Parikh, M.D. writing at Salon.com:
In 2002, the Institute of Medicine issued a sobering report about health disparities in America. In that report, the IOM challenged assumptions by asking one very hard question: Do doctors treat minority patients differently? Its answer, after reviewing more than 100 studies, was yes, "evidence suggests that bias, prejudice and stereotyping on the part of health care providers may contribute to differences in care."
Dr. Parikh furthers the discussion with a Harvard Medical School study that used computer images to test for implicit racial biases.
In that study researchers recruited internal medicine and emergency medicine residents in the Boston and Atlanta areas. Participants logged into a website and read a clinical vignette while viewing a picture of a black or white person.
The participants were then asked a series of questions regarding the source and treatment of the problem.
In their analysis the Harvard researchers reported no explicit biases by the participants with regards to black and white Americans. However, with regards to implicit biases negative attributes were assigned to blacks more often than whites.
From the Harvard study:
Not surprisingly, most physicians did not admit to any racial biases explicitly. However, on the implicit measures of bias (IATs), most nonblack physicians demonstrated some degree of bias favoring whites over blacks. Participants’ scores on the race preference IAT showed a range of implicit race bias similar to previous experiments on nonphysicians.
Back to Dr. Parikh.
Does this mean that doctors are racist? No. In fact, the discrepancy between explicit and implicit biases in the Harvard study suggests the opposite. But it's clear deeper biases exist, and for several reasons.
First, and most important, doctors are people. There's plenty of evidence that well-intentioned people, whatever their background, possess and demonstrate unconscious negative racial attitudes and stereotypes. Doctors are no different. We share many common conceptions about race in America. We bring those influences, right or wrong, with us to the office.
Dr. Parikh adds that the medical decision making process is often complex and the pressure of time forces the doctor to use shortcuts to arrive at a diagnosis. Stereotypes are just one of those shortcuts.
BONUS: If you are curious about implicit biases there is an online test by the University of Chicago. It looks at your response time in dealing with black and white males with and without a gun. Nicholas Kristof reports his results in this NYTimes.com article.
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Posted by David Porter at 08:30 AM
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Category: Health Disparities
April 22, 2008
Disparities in the Organ Allocation System
"Disparities in Perceptions of the Organ Allocation System and Willingness to Donate Organs."
Presented by L. Ebony Boulware, MD, MPH, FACP
Date: Friday, April 25th from 9:00-10:30 a.m.
Location: MetroHealth Medical Center. 2500 MetroHealth Ave. Rammelkamp R219.
All are welcome to attend.
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Posted by David Porter at 02:54 PM
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Category: Health Services Research Seminar
Life expectancy - It goes beyond race
From Reuters:
Smoking, obesity and high blood pressure are taking the lives of women in Appalachia, Mississippi River states and parts of Texas, a team at Harvard School of Public Health reported.
"There has been increasing disparity in health in the U.S. population for two decades," said Majid Ezzati of the school's department of population and international health, who led the study.
Overall U.S. life expectancy increased mostly because of fewer deaths from heart disease, the No. 1 cause of death, and stroke. But by the 1980s, death rates started to head back up in many counties.
"The majority of these counties were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas," Ezzati's team wrote.
While many of the worst-affected counties had a high black population, Ezzati found that white populations in poorer counties fared worse that whites elsewhere, too.
"It exists above and beyond race," he said.
The study can be found free and online at PLoS Medicine.
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Posted by David Porter at 08:30 AM
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Category: Health Disparities