H420 BLOG #5

Diabetes Linked to Depression
During and After Pregnancy

Low-income women who have diabetes and are pregnant or recently just gave birth have twice the risk of depression compared to women who do not have diabetes. No matter if women develop diabetes before or during pregnancy the risk for depression was still much stronger for women with diabetes. Even women who have never been depressed are at risk. One study froudn that 1 in 10 women received diagnosis of depression within a year following delivery. Post-partum depression can also affect new mothers. About 10% of women between 2 to 6 months after birth are affected. One risk factor for post-partum depression is difficulty during pregnancy or delivery. A study of 11,000 women who had given birth between 2004 and 2006 and who were also enrolled in Medicaid found that: "15.2% of women with diabetes developed depression during or after their pregnancy. In women without diabetes, that number was 8.5%. In women who'd never been depressed before, 9.6% of those with diabetes developed depression, compared to 5.9% of those without diabetes."

I was unaware that diabetes was linked to depression during and after pregnancy. I think that it is interesting that this happens but it also makes a lot of sense. Low-income pregnant women could be dealing with a lot of stress issues which could lead to depression. Issues such as troubled relationships, domestic violence, stressful life events, financial problems, lack of social or emotional support, having a difficult pregnancy or delivery, and even health problems with the baby. These risk factors mentioned can lead to post-partum depression which in turn can affect new mothers. This article definitely presented us with compelling evidence that this topic is important. The statistics mentioned above prove that low-income women who have diabetes and are pregnant or recently just gave birth have twice the risk of depression compared to women who do not have diabetes! I definitely feel that this topic is important to address. This problem affects the public’s health significantly, especially low-income women. Some of the strategies for addressing this problem were to provide women who are on Medicaid with better access to education about diabetes control and monitoring. In understanding how to deal with diabetes these women would be less stressed which would lead to a healthier pregnancy, thus resulting in less of a chance in developing depression during or after pregnancy. Another strategy mentioned was to provide lower-income women with support systems before the baby arrives. Setting up extra help for these women will also be important in decreasing their stress levels. Health-care facilities should also pay more attention for depression in women with diabetes during the post-partum period. This way both diabetes and post-partum depression can be cured during this time frame. Some questions that I might ask after reading this article are: How many of these women during the study had planned pregnancies? How many women with diabetes were newly diagnosed? Also, it would be interesting to do a study on higher-income women to see what stressors would trigger depression during or after pregnancy. Overall I think it is important for people to understand that health care disparities such as this are more frequent than we would like to think. It is important for us to realize that we need to address these issues so we can start proceeding in helping solve them by providing more support.

H420 BLOG #4

Gender Differences related to Stroke

Studies have found that gender makes a difference when it comes to having a stroke. Men have been found to be treated better than women for treatment for a stroke. One study found that women admitted to hospitals with symptoms of stroke were less likely to be given tissue plasminogen activator (tPA), which treats stroke, than compared to men. Women were 30% less likely to have tPA compared to men. Another study looked at people who arrived at the hospital within 3 hours of the start of their stroke symptoms (the critical time when tPA must be given) and found that men were still more likely to be given the clot buster than women. Women were found to be 19% less likely than men to receive tPA. Researchers believe that more research needs to be conducted in order to figure out what triggers this gender gap however, some experts do believe that one reason for this gap is that women put off getting medical attention when a stroke is suspected longer than men. Other experts believe that mental confusion among women is more common during stroke then men which may change the way emergency medical service personnel perceive the situation.

I was unaware of the gender differences related to stroke treatment before reading this article. I always figured that women and men received fair treatment regarding strokes. I found it interesting that there was a 30% difference among men and women when receiving tPA during stroke treatment. This difference to me seems like a fairly large gap which in return makes me very concerned. This article provides us with compelling evidence that this topic is important. With women receiving tPA 19% less than men within the first 3 hours of stroke treatment. The article reminds us that more research needs to be conducted in order to figure out exactly what triggers this gender gap. There were two reasons that the article talked about that could take part in this gap among women and men. The first one mentioned was that women put off getting medical attention longer during stroke then men. The other reason was the idea that women and mental confusion during stroke is more present during stroke then men. I definitely feel that this gender difference significantly impacts the publics health, especially women. By not providing women with the proper stroke treatment they are more prone to death due to stroke or other major complications than men are. I think it is important to address this issue so that physicians, emergency care personnel, and stroke victims are aware of this gender gap. Education is one strategy to address in order to decrease this gap. Educating health care professionals on women and men and how they react during strokes and which drugs to administer are all important factors. By doing this we can help eliminate this gender gap regarding strokes. After reading the article I felt like researchers only focused on the tPA gap between men and women. It would have been interesting to see if there were any other gender gaps relating to stroke between men and women. I would also like to look into whether or not more research has been done related to tPA and reasons why women are not receiving it during the right time or why they are not receiving it at all. Overall I found this article very interesting and informative.

H420 BLOG #3

Utah Blacks Face Significant Health Disparities

In Utah, Black residents have higher rates of:

1. Smoking



2. Uninsurance



3. Infant mortality

In Utah, the Black population is approximately 400,000 people. This is about 1.5% of Utah's overall population. Blacks smoke and lack health insurance at twice the rate of the entire state population as well as there being nearly 50% of Black women that do not receive adequate medical care. Black infants also have twice the risk of death as infants than do other races in this state.

I was aware of this problem before reading this article. In H420 we have talked about the various disparities that Blacks in the United States face on a day to day basis. The top three disparities among Blacks in Utah were listed above and are often ignored in today's society. There is sufficient evidence that shows that Blacks in Utah do have higher rates of smoking, uninsurance, and infant mortality rates. I believe that the reason for this is because of the way our society views the Black population. Blacks are also often living in poorer communities which in return leads to the three disparities that I have mentioned above.

The article did present us with some compelling evidence that this topic is important to address however, I don't feel like it presented ENOUGH information. The article talked about how Blacks smoke and lack health insurance at twice the rate of the entire state population in Utah. These are compelling numbers! The article also stated that nearly 50% of Black women in Utah do not receive adequate medical care. The question is WHY? This is most likely due to lack of medical coverage or inadequate services. Another piece of evidence that this article talked about was that Black infants have twice the risk of death as infants than do other races in this state. Could this be because of the inadequate care that Black women are receiving? The lack of health insurance?

I definitely believe that this problem is significantly impacting our nations health, especially those in the Black community. By not providing adequate care to those in need we as a country are slowly running ourselves into the ground. We should be able to provide care to all individuals no matter their race or socioeconomic status. By not providing adequate care to Black women we are seeing higher rates of infant mortality. I believe that this is a topic that should be addressed because it is important for people to understand and be aware of the disparities that go on in many of our lives.

The article discussed one strategy for addressing this problem which was focusing on how Utah was going to decrease infant mortality rates. The article talked about how state officials plan on targeting low-income and minority women with a program that promotes wellness before pregnancy. Utah's health department received a $1 million federal grant to fund the program. By taking action and doing this program Utah state hopes to decrease infant mortality rates as well as teach minority and lower income women the importance of wellness and nutrition. In return they are hoping it will reduce the number of infant mortality rates.

After reading this article I was a little disappointed. I felt that this article did not have enough information about the disparities that Blacks face in today's society. I believe that the article could have gone into a little more depth about the topic and that the article could have provided us with more statistics. However, I do think that it is important to acknowledge that this article was written in hopes that someone would read it and become more aware about this issue. That is great and I hope that after reading this blog you will go out and read more about health care disparities among the Black population.

H420 Blog #2

Access to Healthy Foods Worse in Poor Areas

An analysis of 54 studies has confirmed that people who live in poorer neighborhoods in the United States are less likely to have easy access to supermarkets carrying a wide variety of fresh produce and other healthy foods. Studies were conducted between the year 1985 into 2008 and focused on food access according to neighborhoods in the United States. Income, race, and ethnicity plays a mojor role in accessibility to healthier foods. Studies found that minority and low-income individuals living near supermarkets have healthier diets than those who don't. One study found that fruit and vegetable consumption of African-Americans rose by a whopping 32% with every additional supermarket within the perimeter of where individuals lived while another study found reduced risk of obesity. Food store availability in neighborhoods also plays a major role in access to healthier foods. Studies have found that in predominately white neighborhoods there are twice as many chain supermarkets as compared to mostly black neighborhoods. In these predominately white neighborhoods supermarkets were found to have healthier foods like low fat dairy foods, fresh produce, high fiber breads, and lean meats.

Before reading this article I was partially aware of this issue. I knew that income, race, and ethnicity played a major role in access to healthy foods however, I was unaware of the studies that were presented in this article. I found many of the studies listed about to be very interesting. I was unaware that the placement of supermarkets could affect communities so drastically. I think it is interesting that healthy and better quality foods have been found in predominately white communites almost twice as often as supermarkets located in mostly black neighborhoods. This is just crazy. It seems like no matter which supermarket you have available in your area that the food quality should be offered at equal prices across the board. This however is definitly not the case here in the United States.

The article presented compelling evidence that this topic is important. Giving us studies that show accurate and reliable results leads us to believe that this issue needs to be addressed. One of the studies mentioned in the article found evidence that if supermarkets were located within the census tract of individuals that their fruit and vegetable consumption rose to over 30%! Imagine if we could do this for every American just buy building a supermarket within reach. There is however one issue related to this and that is people living in rural communities which tend to have worse access to supermarkets.

I believe that this issue of not having access to healthy foods impacts the public's health drastically. By not having access to supermarkets that sell fresh produce, low fat dairy foods, high fiber breads, and lean meats leads to an increase of eating unhealthy foods. Many of these communities have plenty of unhealthy fast food restaurants to pick from however they are lacking supermarkets that are filled with healthy nutritious foods. The main issue here is an increase in obesity rates and other chronic diseases among the United States population. These inequalities to access healthy foods affects us all in the long run. Just for some statistics check out the Center for Disease Control and Prevention on preventing obesity and chronic diseases through good nutrition and physical activity. http://www.cdc.gov/nccdphp/publications/factsheets/prevention/obesity.htm

By increasing access to healthy foods among populations that are lacking we can help reduce obesity and other chronic diseases in the United States.

I think it is important for us to understand that this is an issue that people are dealing with day to day in the United States. To some this may not seem like it is a problem at all, when in fact access to healthy foods is a HUGE problem in this country. If more Americans take the time to realize that this is affecting our society then I believe that there is a chance that this issue can be reduced. The article discussed that other countries such as Canada and Australia, to name a few, have made supermarket availibility greater in lower-income areas which in turn has increased access to healthy foods in these communities.

Strategies for addressing access to healthy foods was discussed in this article. Strategies suggested were to encourage supermarkets to build in lower income neighborhoods by including financial incentives. The financial incentives mentioned were to help "conduct market feasibility studies, assistance with parking/transportation plans, and assistance with cleanup/assembly". To me this seems like it could be a reasonable way to get supermarkets to set up shop. I believe that there is a huge need for new policies and local actions in these communities in order to address the problem of access to healthier foods in lower income, rural, and minority communities.

I would love to research a bit more on the topic of access to healthier foods. I think that this article just touched on the need for better access to supermarkets when in fact I feel like this is only a part of the issue. I think it would be interesting to look into income a little bit more. Obviously that does play a huge role in whether or not you can afford to buy healthier foods however, I don't feel that this article discussed this in very much detail. I will definitly be researching this topic a bit more to help me better understand just what is causing this huge issue with access to healthy foods in poorer neighborhoods in the United States.

Article: http://www.nlm.nih.gov/medlineplus/news/fullstory_74043.html

H420 BLOG #1

Older women have less access to
donor kidneys

Summary of article: A study by Johns Hopkins University in Baltimore found that younger women have equal access to kidney transplants compared to men their age. Women who are older however are less likely to receive kidney transplants compared to men their age. The study shows that women 75+ access to kidney transplants declines nearly 60 percent with age compared to men 75+. The study believes that doctors and patients perceive older women as being too sick or too frail to receive kidney transplants.
Before reading this article I was unaware that older women were less likely to receive kidney transplants compared to men equal in age because of the way that doctors and themselves perceive their health. This just shows one of the many health disparities that occur on a day to day basis in our society.
I do believe that this topic is important to discuss because it does affect older women significantly. Older women are being denied care based on the the way their doctors and themselves perceive their health. If these older/sicker women are not provided with the proper care they need because of the assumption that they are too frail to receive a kidney transplant then they will most likely die a lot sooner from their illness. This is not fair and should be determined rather by information/data not by perception about the patients health.

The article definitly presented us with some compelling evidence about this issue. The study at John Hopkins tells us that "gender disparity increased with increasing age, such that women ages 56 to 65 had 15 percent less access then men of the same age. Women between 66 to 75 years old had 29 percent less access, while those older than 75 years had 59 percent less access." These statistics are based on a study of more than 560,000 adults with kidney disease. The information provided shows us that access for women declines almost 60 percent with age! This is just unbelievable to me.

I believe that this decline in access to kidney transplants for older women is an issue that impacts the public's health and needs to be addressed. It affects the patients (older women) involved, families of the patients, and can affect the patients doctor. By not providing patients with the care they need, having families involved in these situations, and doctors who are making assumptions about whether or not their patient should receive treatment leads me to believe that people are not working together. The health care system does not always use a team-based approach for every health care situation. If we could provide care on a team-based approach level then these women, families, and doctors could determine whether or not the care should be provided or not. There should be no such thing as DENIED health care.

The main reason why I believe this topic is important is because this health disparity of older women not getting access to kidney transplants can turn into a huge issue among women of all ages. If we can stop these women at a young age from having kidney problems with more preventative care then we can decrease the number of women that need kidney transplants later in life. Also giving people the freedom to choose whether or not they want to receive transplants or not rather than denying them access.

There were not really any strategies for addressing the problem tied into the story but I do believe that preventative care is definitly one way of going about it. I also think that we should provide equal access for older adults to kidney transplants no matter what their gender is. Doctors should look at patient data rather than assuming they are too frail or ill to recieve treatment.

Overall after reading the article I found that I still had many unanswered questions. Questions such as: Why does gender play such a huge role in whether or not an older adult will receive a kidney transplant? How can you predict one's health status by assuming that they are too frail or ill to receive treatment? What were all the illnesses that were included in the assumption that these women were too frail or ill besides diabetes, heart disease, or blood vessel disease? And, why is there such a thing as denied access to care? All of these questions would help me better understand why these women are not receiving kidney transplants rather than saying it is all based on assumption of their illness or that their bodies are too frail for surgery.

CHOICE is the action that should take place.

Link to article: http://www.msnbc.msn.com/id/28563606/