JUNE 2001 - UCLA School of Public Health

More documents

Recommendations

Info

6 The two critical elements of UPBEAT care were in-depth psychogeriatric assessment and proactive mental health care coordination by a multidisciplinary clinical team trained in psychogeriatrics, including nurses, psychiatrists, psychologists, and social workers. UPBEAT began once the patient was discharged from the hospital and was based on a comprehensive treatment plan that included regular telephone or face-to-face contact between the patient and an assigned clinician. This clinician acted as mental health care coordinator with patients, families, and primary care providers; facilitated and monitored ambulatory care; and provided continuity of care for both mental health and physical health. Kominski, Associate Professor of Health Services, found that because of UPBEAT’s emphasis on increased use of appropriate ambulatory care, veterans in the program had increased outpatient costs of $1,171 when compared with control-group patients. However, inpatient costs were significantly lower for the UPBEAT group, producing an overall savings of $1,856. Inpatient savings resulted from shorter lengths of stay rather than fewer admissions. Veterans with the most severe disease burden, defined as having one or more hospitalizations both before and after initial study enrollment, benefited the most from UPBEAT, with an overall savings of more than $6,000. “The care coordination that was an essential element of UPBEAT appears to accelerate the transition from inpatient to outpatient care for veterans with acute non-psychiatric admissions,” says Kominski, the lead author of the study (published in the journal Medical Care), who was joined in the effort by Drs. Ronald Andersen and Roshan Bastani. “The next step is to determine whether screening for, and treating, undiagnosed psychiatric conditions among veterans in ambulatory care settings proves to be more effective in reducing symptoms.” Diets High in Boron Lower Risk for Prostate Cancer UCLAPUBLIC HEALTH Boron can be found in nuts, avocados, red and white wine, grapes, peaches, nectarines, plums and apples. THE FIRST EPIDEMIOLOGICAL STUDY TO LOOK AT THE RELATIONSHIP between dietary boron intake and prostate cancer has found that individuals with the highest boron intake (the top 25%) had a 65% lower risk of developing prostate cancer than did individuals with the lowest boron intake (the bottom 25%). Epidemiologist Zuo-Feng Zhang and colleagues at the UCLA School of Public Health used data from the third National Health and Nutrition Examination Survey to compare a group of 76 prostate cancer patients with 7,651 men without cancer. Dietary boron intake was estimated based on dietary history, and the results were adjusted for the effects of age, race, education, cigarette smoking, body mass index, and total dietary intake of calories. Although the study involved a relatively small number of patients with prostate cancer, Zhang says there was a clear relationship between boron intake and the disease: The lower the amount of boron consumed in the diet, the higher the risk for prostate cancer. The relationship was also very specific to prostate cancer. Consuming higher or lower amounts of boron did not appear to affect the likelihood of cancers of the breast, cervix, uterus, colon and rectum. Boron is present in the diet because it is an essential nutrient for plants and a natural component of plant cells. Foods high in boron include those associated with the Mediterranean diet such as nuts, avocados, red and white wine, grapes, peaches, nectarines, plums and apples. Prostate cancer is the most common malignancy in men after skin cancer, and the second leading cause of cancer death in men in the United States after lung cancer. Zhang was joined on the study by Dr. Curtis Eckhert, Chair of the Department of Environmental Health Sciences at the School, who initiated the research. According to Eckhert, boron’s ability to lower the risk of prostate cancer may be related to its role in cell division and growth. His laboratory has shown that fertilized eggs require boron to develop into embryos; he is currently studying the role of boron in gene expression.
Disadvantaged Groups Less Likely to Get State-of-the-Art HIV Treatment HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART), the state of the art in HIV treatment, is less likely to be used by certain socioeconomically disadvantaged groups, according to the latest findings to come out of a large national research consortium based at UCLA and RAND. The recent study, headed by Dr. William Cunningham of the Schools of Public Health and Medicine, found that the major factor predicting lower use among populations was lack of insurance coverage. HAART, the drug cocktail that contains protease inhibitors, has been shown in other studies to improve health outcomes among people with HIV. Cunningham’s group found that by the end of 1996, the year protease inhibitors became widely available, 37% of patients reported that they had taken the medication. Interviews with the same patients in January 1998 found that 71% had ever been on the medication. But the proportion of patients still taking HAART at the time of the second interview was only 53%. Moreover, certain groups were least likely to be taking the drug combination: African Americans, drug users, women who contracted HIV through heterosexual contact, people with less education, the uninsured, and those covered by Medicaid. While insurance was the key determinant in this study, another study by the group identified other barriers to HAART use, including transportation and having competing subsistence needs. “Insofar as there are non-clinical explanations for these disparities, this fits a pattern we have observed both in HIV and in other diseases, in which the most socioeconomically disadvantaged groups are not getting the best treatment,” Cunningham says. His group is now studying the effect of these differences on outcomes, and examining interventions that could address the problem, including the use of case managers to ensure more coordinated and comprehensive care. The research is part of the HIV Cost and Services Utilization Study, in which a national consortium of investigators, funded by the federal Agency for Healthcare Quality and Research, has been examining HIV/AIDS health services. Cunningham has led the access section along with Dr. Ronald Andersen, Chair of the UCLA School of Public Health’s Department of Health Services. Strong Ethnic Identity Among African American Women Is Linked to Good Mental, Physical Health A UCLA SCHOOL OF PUBLIC HEALTH STUDY EXAMINING the relationship between obesity and depression in African American women links, for the first time, good mental and physical health with strong feelings of ethnic identity. The study, supported by a National Cancer Institute grant and published in Preventive Medicine, surveyed 429 Los Angeles women from a culturally tailored program promoting healthful eating and exercise. The research team, headed by Drs. Antronette K. Yancey and Judith M. Siegel, found an inverse relationship between depression and strong ties to the African American community, independent of other demographic and health factors. Their survey found the lowest levels of depression among women with strong ethnic identity and less excess weight. continued on next page PERCENTAGE OF AFRICAN AMERICANS AND WHITES WHO EVER RECEIVED HAART 20% DEC 1996 JAN 1998 African Americans 47% Whites 59% 78% 7 research UCLAPUBLIC HEALTH
Page 1 and 2: UCLA PUBLIC HEALTH JUNE 2001 UCLA S
Page 3 and 4: When the Best Medicine Is Public He
Page 5 and 6: DEAN’S ADVISORY BOARD 3 ANDREW AL
Page 7: Chiropractic Care Appears Slightly
Page 11 and 12: The Healthcare Collaborative at UCL
Page 13 and 14: 11 Why so much bickering over the r
Page 15 and 16: 13 There is a national shortage of
Page 17 and 18: measure it and find places to inter
Page 19 and 20: Left to right: Postdoctoral fellow
Page 21 and 22: Pillars of the Community FOUR YEARS
Page 23 and 24: alumni profile Heal the Bay’s Mar
Page 25 and 26: 2001 student awards 23 DAVID M. SOU
Page 27 and 28: honor roll 2000 THE SCHOOL THANKS A
Page 29 and 30: ALEXANDER CAPRON AND KATHLEEN WEST
Page 31 and 32: WILLIAM AND FLORA HEWLETT FOUNDATIO

JUNE 2001 - UCLA School of Public Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?