Tuesday, November 26, 2013

Medical Literary Messenger: Inaugural Issue Now Available

Congratulations to my friend and colleague Dr. Gonzalo Bearman, whose brainchild The Medical Literary Messenger has published its first issue! Special congratulations also go out to Brie Dubinsky and Rachel Van Hart, as well, whose phenomenal editing has produced a terrific product.

The Medical Literary Messenger is an online literary journal focused on the "healing arts," publishing works in a variety of formats. The first issue can be found here.

Monday, November 25, 2013

CDC Releases Health Disparities and Inequalities Report

The CDC released their second report on Health Disparities and Inequalities last week in the Morbidity and Mortality Weekly Report (MMWR).

This report is a detailed, comprehensive examination of the health status of people living in the United States broken down by race and socioeconomic status. The 187 page report contains numerous individual studies investigating a host of things (morbidity, mortality, unemployment, education, health behaviors, rates of HIV infection, obesity, tuberculosis, access to healthy food, cancer screening, homicide rates, et cetera).

Not surprisingly, substantial differences in health were identified across all health parameters by race as well as socioeconomic status.

A few of the key findings are highlighted below (this is far from a comprehensive list):

1) Black adults are > 50% more likely than white adults to die from heart disease
2) Diabetes is more prevalent in hispanic and black Americans than in whites
3) Infant mortality is > 2 times higher for blacks (than whites)
4) Poverty was associated with a higher risk for diabetes, HIV and hypertension, as well as a decreased likelihood of being screened for colorectal cancer or receiving influenza vaccination

The report does highlight a few successes in addressing health disparities in the US, including the Vaccines for Children program (helping provide economically disadvantaged children access to vaccines) as well as healthcare access expansion via the Affordable Care Act.

There is an enormous amount of work to be done to address healthcare inequity in the US. The CDC is making strides in the right direction by producing comprehensive, actionable data to help identify at risk populations and target interventions. Hopefully we will continue to see these data monitored and reported on at regular intervals.

Friday, November 15, 2013

GH2DP Participants Present at ASTMH Conference in Washington, DC

Dr. Wang, Kate Pearson, Dr. Donovan, at the ASTMH
conference in Washington, DC
Congratulations to Dr. Jeff Wang, Dr. Summer Donovan and to Kate Pearson (a 4th year medical student at VCU) who presented their research at the annual conference of the American Society of Tropical Medicine and Hygiene in Washington, DC, yesterday. Jeff, Kate and Summer all worked on GH2DP-related projects in Honduras this past June.

Kate and Jeff looked at satisfaction with brigade care on our last medical outreach trip to Yoro, Honduras.

Town of La Hicaca; this is one of the sites where we see
patients in Honduras; Chagas disease is a major problem in the area
Our group provides medical and public health services to approximately 2,000 people living in 17 villages in the Yoro area of northern Honduras. Because of logistical issues (lack of road access) our primary clinical site is in the village of La Hicaca; people from the surrounding villages come see us there. Unfortunately, distance to the clinic is a significant barrier for many people, with some people having to walk upwards of 6 hours to come and see us.

Kate and Jeff found that satisfaction with brigade care differed on whether survey respondents were
Data from Jeff and Kate's survey
from La Hicaca or one of the surrounding villages (with the former group more satisfied with the services we provide, on the whole). Also, their work identified differences in the services requested, with mental health services being the second most commonly requested service in the surrounding villages (this was the 4th most requested service in La Hicaca).

Their work will significantly impact our future efforts to reach more individuals at remote village sites. It will also help us to tailor and expand the services we provide moving forward.

Dr. Donovan's work focused on knowledge and perceptions of Chagas disease in the communities we serve; we were asked to undertake this project by our local contacts in the health ministry.

Chagas disease is one of the neglected tropical diseases, and is an insect-borne parasitic infection that affects people in the Americas, especially parts of rural Latin America.

The insect vectors for the disease are known as "kissing bugs." They live in the walls and roofs of houses made of adobe, mud, straw and thatch, and emerge at night to feed on people's faces (I am not making this up). The insects thereafter defecate and the parasite (Trypanosoma cruzi), which is in the stool, gets inoculated through the skin when a person scratches.

It is estimated that 11 million people are currently living with this infection, and untreated these diseases persist for life. Chagas disease is associated with major morbidity: over time the infection can lead to heart failure and death from arrhythmias, as well as dilatation of the esophagus and colon with attendant gastrointestinal issues.

Dr. Donovan found that many people reported the presence of the vector in their homes (65% for people in La Hicaca, 76% for people in the surrounding villages) and that although general awareness about the disease was good (around 90% of survey respondents) understanding how the disease is transmitted was low (0%). This has implications for future control and educational efforts in the region. 

Chagas disease survey findings (LH: La Hicaca, SV:
surrounding villages) 
Again, congratulations to Jeff, Kate and Summer! They are phenomenal young researchers whose work will significantly impact the people we serve in Honduras. We look forward to more great things from them moving forward.