Place Matters

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May 16, 2013 | 11:38 AM | By

Alameda County Details How Transit Cuts Harm Health

By Rachel Dornhelm

(Getty Images)

(Getty Images)

At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation. Continue reading →

FILED UNDER: Place Matters, Policy, Public Transportation, SDOH, Social Determinants of Health
May 3, 2013 | 10:18 AM | By

How Nurses and Other ‘Mid-Level Providers’ Fill Growing Gap in Primary Care

By Jose Martinez, KPCC

(Keith Brofsky/Getty Images)

(Keith Brofsky/Getty Images)

Simmi Gandhi — a family nurse practitioner at South LA’s UMMA Community Clinic — is at work early. When she calls a patient, she apologizes for waking the woman up. But she knew the woman was waiting for test results.

In Urdu, she tells the patient her mammogram shows the mass in the woman’s breast isn’t cancer. After Gandhi hangs up, she doesn’t miss a beat: She starts debriefing for her next patient, who’s been missing appointment for months.

“Looks like he has diabetes,” she says. “I had asked for him to be able to get an appointment six weeks thereafter, so that was back in September. That was cancelled, and then he didn’t come for two appointments that were rescheduled. And now he’s finally back.”

Simmi Gandhi is what’s called a midlevel provider — which includes registered nurses, physician assistants and nurse practitioners. These are medical professionals who are in-between physicians and lower skilled medical technicians and nurses. At the UMMA clinic, she provides a wide range of primary care people in need.

“A community like this has less resources,” she says. “A lot of the folks that live here have less education as I’m sure everybody’s aware, our educational system is stressed so the basic education people get around their bodies … is low.” Continue reading →

FILED UNDER: KQED blogs, Place Matters, Midlevel Providers, Primary Care
May 1, 2013 | 3:49 PM | By

What Prisons and the Solar Industry Have in Common in California

It's all that land around the prison (Avenal State Prison seen here) that carries a health hazard, the same one that affects solar manufacturers. (Buzzbo/Flickr)

It’s all that land around the prison (Avenal State Prison seen here) that carries a health hazard, the same one that affects solar manufacturers. (Buzzbo/Flickr)

Normally, you wouldn’t put “prisons” and “solar” together when thinking about a significant health problem hitting California. But the two prisons in question are in the dry, dusty Central Valley. The solar manufacturing is on huge construction sites in the California desert. Anyone who lives in those areas of California might quickly add these two clues together and come up with an answer:

Valley Fever.

Valley Fever can cause something like a nasty flu, but some people, especially those with compromised immune systems, can die. It is not contagious. Instead the illness spreads when people inhale fungal spores carried in the dirt by the wind.

California’s prison system has been fighting a losing battle with Valley Fever since 2006. In particular, inmates in two prisons along the I-5 corridor are right in harms way. Continue reading →

FILED UNDER: Place Matters, Science, Valley Fever
April 29, 2013 | 9:27 AM | By

School-Based Health Centers Serve More Than Just Students

By Chris Richard

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew's great-grandmother, Yvonne Lee (right) says Andrew's entire family relies on the center for medical care.(Photo/Chris Richard)

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew’s great-grandmother, Yvonne Lee (right) says Andrew’s entire family relies on the center for medical care.(Photo/Chris Richard)

When Compton’s Dominguez High School celebrated the opening of a new campus wellness center last month, it was a timeless moment.

The marching band blared and thundered. Drill teams members pranced and whirled, just as they’ve been dancing and high-kicking on high school campuses for generations.

But the scene in the wellness center itself offered a glimpse of what the future could be for school medical services in California.

There was a student in for routine blood work. In the next cubicle, a mother had brought her young son, who had the flu. And neighborhood resident Jonetta Stewart, 76, had come seeking relief from frequent vertigo and headaches.

Physician’s assistant Rachel Damicali checked Stewart’s blood pressure. It was very high.

Some campus-based wellness centers offer free and low-cost services not just to students, but to entire neighborhoods, to people of any age.
Dimacali says she sees a lot of variety in her fast-paced days.

“My last patient was a 4-year-old kid, and now I’m seeing Jonetta for her blood pressure management,” she said. “So, we see a whole range: from chronic disease to urgent care visits to just physical exams.”

Just in time for the implementation of President Obama’s health care overhaul coming Jan. 1, a handful of California schools are starting to open campus-based wellness centers like the one at Dominguez, offering free and low-cost services not just to students, but to entire neighborhoods, to people of any age. Continue reading →

FILED UNDER: Place Matters, Policy, School Health Centers, Science
April 24, 2013 | 12:50 PM | By

Are Minority Kids Being Missed In ADHD Diagnosis?

(Getty Images)

(Getty Images)

For years, doctors, teachers and parents have fretted that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and that children are overprescribed the stimulants that treat the brain disorder too often.

But, as EdSource Today reports, that’s not the case in California. According to new data from the National Survey of Children’s Health, California ranks 5th lowest in the country in diagnosis. The national average of children with ADHD is 7.9 percent, but in California, the rate is 5.2 percent.

That 5.2 percent rate may be a low one nationally. But globally, rates vary between 3 and 9 percent, “with the average closer to 5,” Prof. Joshua Israel told EdSource Today.

Still, within ethnic groups in California, the diagnosis rates drop dramatically. Kaiser researchers published data earlier this year which showed white children had a 5.6 percent rate — well in line with global averages. But other groups had much lower ADHD diagnosis rates as follows:

  • Black children: 4.1 percent
  • Latino children:  2.5 percent
  • Asian American children: 1.9 percent Continue reading →
FILED UNDER: Place Matters, Policy, ADHD, Overdiagnosis, Science, Underdiagnosis
April 23, 2013 | 5:00 AM | By

‘Cal Enviroscreen’ Ranks Zip Codes Statewide By Pollution

New Screening Tool Provides Broad Snapshot of Total Environmental Burden

Factory in West Fresno. (Sasha Khokha/KQED)

A factory in West Fresno. (Sasha Khokha/KQED)

It’s the first environmental health screening tool of its kind in the country.

California’s Environmental Protection Agency is rolling out “Cal Enviroscreen” which helps pinpoint communities that may be particularly vulnerable to pollution. And it’s not just for wonks. You can look up your own community. Cal Enviroscreen measures a broad range of pollutants and health indicators in every zip code across the state.

The most vulnerable community in the state? West Fresno, one of Fresno’s poorest areas. Other zip codes in the top ten include Bakersfield, Stockton and the Los Angeles-area communities of Vernon, Baldwin Park, and Boyle Heights.

Look up your community’s score by zip code
Toxicologist Dr. George Alexeeff heads the state’s Office of Environmental Health Hazard Assessment. He says California regulators have done a pretty good job of targeting individual pollution problems, like reducing diesel exhaust, or eliminating particular chemicals in drinking water.

But that kind of regulation doesn’t give a broad snapshot of the total environmental burden some communities face. Continue reading →

FILED UNDER: Place Matters, Policy, Cal Enviroscreen, Pollution, Science
April 8, 2013 | 2:55 PM | By

Immigrant Doctors Help Ease California’s Primary Care Doctor Shortage

By Jenny Gold, Kaiser Health News

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).

It’s a familiar story in California.

When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get — stocking warehouses, construction, cleaning houses and working in a meat processing plant.

But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.

Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.
“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”

A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training ­­medical students to work in the U.S.  Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.

But a program at the University of California is seeking to change that, while at the same time helping to address the shortage of primary care doctors in the state. The UCLA International Medical Graduate Program offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years. Continue reading →

FILED UNDER: Place Matters, Policy, Doctor Shortage, Immigrant Health, Primary Care
April 8, 2013 | 11:34 AM | By

Sex Information, Teens and Technology: YTHLive in San Francisco

A powerful way to reach teens with credible health information say conference organizers. (okalkavan/Flickr)

A powerful way to reach underserved teens with credible health information say conference organizers. (okalkavan/Flickr)

In the olden days, teens and young adults who wanted accurate information about contraception or sexually transmitted diseases would perhaps find a trusted adult or sneak a book or perhaps rely on information (misinformation?) from peers.

Not so much any more. Mobile apps and websites provide a range of options, and YTH.org (that’s for youth, tech, health) is the focal point.

Its mission: To advance youth health and wellness through technology.

YTH Live kicked off Sunday in San Francisco and runs through tomorrow. The conference convenes everyone from public health professionals to youth advocates to social entrepreneurs. KQED’s Stephanie Martin talked with YTH.org executive director Deb Levine about the conference.

Here’s their conversation, lightly edited: Continue reading →

FILED UNDER: Place Matters, Science, Technology, Teen Health
April 5, 2013 | 5:00 AM | By

Study Finds Surprising Outcomes for Undocumented HIV Patients

By Mina Kim

(gernhaex/Flickr)

(gernhaex/Flickr)

While there hasn’t been much research into how well undocumented Hispanic immigrants do if they are infected with HIV,  a small study from researchers at Baylor adds to what’s known — and found some surprising results.

In the retrospective study researchers reviewed the cases of 1,620 HIV-positive adults at a clinic in Houston. Researchers looked at patients’ health one year after they started HIV treatment and compared between groups — African American, white, Hispanic — with undocumented Hispanics reviewed in a separate category.

“What we found was, though they entered care with more advanced HIV,” said lead researcher Thomas Giordano in reference to the undocumented Hispanics, “actually when we looked at their outcomes they did as well, if not better, than the other groups in the study.”

Giordano says the study did not look specifically at why this might be happening, but did recount what is known about undocumented immigrants and overall health status. From the study: Continue reading →

FILED UNDER: Place Matters, Policy, Health Disparities, HIV, Undocumented Immigrants
April 3, 2013 | 5:14 PM | By

Schools Struggle to Provide Dental Health Safety Net

Dental disease at the intersection of school performance and health for thousands of California children

By Jane Meredith Adams, EdSource Today

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back.

Hundreds of thousands of children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.

Increasingly, dental health advocates are looking to school districts to help solve the crisis. Innovative oral health care projects have been launched in school districts around the state that provide students with no-cost dental screening or treatment. Insurance companies are billed whenever possible.

Dental disease is at “epidemic” levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families.

Students with toothaches were almost four times as likely to have a lower grade point average than students with healthy teeth.
“The issue is huge,” said Gordon Jackson, director of the state Department of Education’s division which oversees health, counseling and other support programs provided at schools. “Tooth decay remains one of the most chronic diseases for children and adolescents. As we’re having the conversation about California’s future and student academic achievement, we have to have a conversation about oral health as well.”

But many districts lack the resources, or balk at being asked to provide dental care on top of a rigorous curriculum.

“It’s a great idea to bring universal prevention programs of all types, including dental, to schools,” said Kimberly Uyeda, director of student medical services for the Los Angeles Unified School District. “Whether there’s enough time in the day is another question.” Continue reading →

FILED UNDER: Money, Place Matters, Children's Health, Dental Health, School Health Centers