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Thursday, October 28, 2010

Loyola fellowship

Community and Global Stewards Fellowship (CSF)

Announcement

The Graduate School announces the 2010-2011 Community and Global Stewards Fellowship competition. Community Stewards are encouraged to engage social issues and challenges generously and to embrace a scholarship of engagement that connects our intellectual resources to the pressing social, civic, and ethical problems in our communities and the world. As community stewards, LUC graduate students will be provided with opportunities to demonstrate how their graduate study and research connects with a larger public by partnering with community groups, grassroots organizations, local businesses, and industries to help address societal needs.


Fellowships of $2000-$3000 each will be awarded on a competitive basis to outstanding students who have a demonstrated record of academic excellence and community service. The awards can be used for a variety of purposes, including internship and community-based research support. Criteria for eligibility for a CSF include:



1. Students enrolled in a program housed in the Graduate School.

2. Master’s students who have completed one semester of coursework or doctoral students who have completed one semester of coursework are eligible.

3. Applicants must not be funded from other university sources or previously held a CSF award.

4. A minimum GPA of 3.3.

5. A letter of application in which applicants must demonstrate that their internship, field experience, practicum, or research represents an integral part of their degree requirement.

6. A one-page statement that demonstrates how their internship, field experience, practicum, or research reflects community or global stewardship.

7. A letter of support from the applicant’s Graduate Program Director, sent directly to the Graduate School by the application deadline.

eApplication Deadline: Applicants: please submit all application materials (parts 5 and 6) electronically to Dr. Patricia Mooney-Melvin (pmooney@luc.edu), Associate Dean of the Graduate School, by November 15, 2010. Graduate Program Directors: please submit your letter of support (part 7) electronically to Dr. Patricia Mooney-Melvin by November 15, 2010 as well.

Tuesday, October 26, 2010

Congratulations Dr. Hiroki Ito

Dr. Ito, a recent graduate of the Master's Program in Clinical Research Methods and Epidemiology has been invited to present the finidngs from his master's thesis research project at the American Heart Association Meeting held in Chicago this November. His thesis is on the addition of serum creatinine or cystatin C to the Framingham risk score and prediction of cardiovascular events. We know you will give a great talk Dr. Ito!

Grand Rounds

October 28 11 AM Maguire Bldg room 3340
Professor Dru Bhattacharya will present "Update on Health Care Legislation: 6 Months Later"

November 4 11 AM Maguire Bldg Room 3340 (note room change)
Dr. Amy Luke will present "Preliminary Data from METS Study"

Friday, October 22, 2010

Congratulations Professor Dru!

Congratulations to Professor Dru Bhattacharya on publication of his extensive manuscript entitled "The Perils of Simultaneous Adjudication and Consultation: Using the Optional Protocol to CEDAW to Secure Women's Health." It was recently published in the Women's Rights Law Reporter - Rugers School of Law. Hear Professor Bhattacharya discuss the updates on the new health care legislation Thursday October 28 at 11 AM in the Maguire Bldg room 3347.

Tuesday, October 19, 2010

MPH Grand Rounds: Department of Preventive Medicine Conference Series

Thursday, October 21 11 AM Maguire Bldg Room 3347
Dr. Amy Luke will present "Environmental exposure to bisphenol A in countries at different levels of economic development: effects on human health and aquatic life." Learn how the widespread use of plastic may influence health outcomes and her ongoing research with Dr. Nancy Tuchman on the health and environmental effects of bisphenol A.

Thursday, October 28 11 AM Maguire bldg Room 3347
If you missed Professor Bhattacharya's medicine grand rounds presentation on the health care legislation, you have another chance. Dru Bhattacharya will present "The Health Care Legislation: A 6 Month Update October 28 for the Department of Preventive Medicine." His talk will include discussion of the ongoing lawsuit in Florida and the potential consequences in addition to other ongoing debates.

Thursday, October 7, 2010

Follow-up on Severability, and the Primary Care Workforce

Note to readers: Many thanks to everyone who attended the session, and special thanks to my colleagues who asked me to probe a little deeper on issues related to severability, primary care, electronic health records, and Medicaid. Below, I revisit the issues of severability with an eye towards December’s oral argument in Florida, and why I continue to emphasize the act’s impact on nurses, rather than physicians, with respect to the workforce shortages, notwithstanding the media hype surrounding general education/training grants for PCPs. In the interests of space, I’ll upload my thoughts on Medicaid and Electronic Health Records in a future post, and welcome any additional issues you would like me to raise or explore as we figure out what healthcare reform is all about.

Severability’s Catch-22

This may be more complicated than I assumed, so I will ask the natural follow-up to the easy question. Is there an explicit severability provision in the act? No. But does it matter? That’s where it gets very tricky. Let’s assume the mandate is declared unconstitutional and the issue appears before the Supreme Court, along with a severability issue that threatens the validity of the entire act. A few years ago, in the Supreme Court case of U.S. v. Booker, Justice Thomas noted that the Court had a “longstanding presumption of the severability of unconstitutional applications of statutory provisions.” But “normally,” he stated that a court would first declare a provision (e.g., individual mandate) as unconstitutional, and then determine whether the remainder of the act could be left standing. So here, presuming the individual mandate is declared unconstitutional, proponents will have to argue that the otherwise regulated tax-payer (who escaped the individual mandate) be regulated to ensure that the provisions that are constitutional remain effective. That’s the argument proponents will have to make to ensure the act isn’t invalidated owing to the absence of a severability clause. Opponents, ironically, will have to claim that the individual mandate isn’t necessary to ensure implementation of those other provisions—but wouldn’t that defeat the severability argument to begin with? It seems like a catch-22, and I don’t envy the Court’s position in sorting this out. The easy approach would be to have an about face on the notion of presumptive severability at the outset; but this may be more influenced by political forces than legal doctrine.

Primary Care – on physician shortages, and paradigm shifts

I shrugged the supposed fix on the primary care physician shortage, and emphasized elements that focused on nursing, so let me put this in perspective. The physician incentives are anything but coherent, and any optimism may be offset by the mix of “fixes” and dis-incentives that currently plague the system. Let’s start off with the personnel problem, which we can agree is somewhere (on the low end) between 35,000-50,000 PCPs over the next 10-15 years. The act posits two solutions: a Medicare reimbursement hike of 10% for PCPs, and the education and training grants for future physicians, nurses, physician assistants, etc. On salaries: even assuming that medical students choose a specialty based on salaries, 110% of current earnings (~$190,000 average) are not going to be a driving factor compared to specialty salaries at 150-200+% of those earnings, especially given the exorbitant student debt (~$157,000 average) upon graduation. A related issue is Medicare reimbursement, since the SGR has become a perpetual gadfly on the wall. The act didn’t do anything to fix this. When the June 1, 2010 deadline was looming this past summer, Congress continued its long-standing tradition of punting the Medicare cuts, fearing the mad dash of physicians opting out of treating patients (Dec 1, 2010 is the next go around). The method for keeping spending in line with the growth of the GDP hasn’t been pretty. (Notably, the payments are not based on actual costs of practice.) The CBO further estimated the cuts to cost around $276 billion over the next decade. An AMA survey this past summer also cited around 68% of physicians indicating that they would (be forced to) limit the number of beneficiaries they care for. Against this backdrop, I don’t think that an additional 500 PCPs with 10% Medicare reimbursement pay is going to significantly alter student choice of specialties, offset attendant practice costs, or tempter the increased demand that will accompany (near) universal coverage, and particularly the growing population of Medicare and Medicaid patients. So does the act do something to fix the PCP shortage? I think the contribution is too small to be taken seriously, at best. My two cents: lessen the bureaucratic red tape, and restore more control to the physicians instead of arbitrarily manipulating reimbursement rates and setting elusive staffing goals.

So why emphasize the support for nursing? Consider the context. The act will provide support for 600 primary care nurse practitioners and midwives, and 900 advanced practice nurses, who will operate nurse manage health clinics (NMHC). Notably, it also provides demonstration grants for NMHCs so NPs can serve as primary care providers in FQHCs and NMHCs, and work under a model of primary care consistent with the IOM’s principles and the needs of vulnerable populations. Additionally, certified nurse midwives will now be reimbursed for 100% for services (i.e. on par with physicians performance), in contrast to the prior rate set at 65%. The 10% incentive mentioned above also applies to the NPs, and like their physician counterparts, will also enjoy the number of training and education related support. So based on these developments, I think it’s fair to say that we’re seeing a significant shift in how primary care is being delivered, and nurses are going to be a playing a central role in that.


-Dru

Friday, October 1, 2010

Loyola Doctor Talks about 2010-11 Flu Season

Work in Progress Series

On October 7, Dr.s Holly Kramer and Ramon Durazo will present their ongoing work on vitamin D and mortality among adults with kidney disease. They will discuss the pros/cons of analyzing a continuous variable as continuous vs. categories and how do associations differ when using hazard ratios vs. incidence rate ratios. Seminar will start at 11 AM and will be held in the Maguire Building room 3347.

Can Policy Abrogate Obesity Trends?

Requiring use of seatbelts, prohibition of smoking in public places and advocating helmet use in children are examples of policies which substantially improved measures of public health e.g. auto accidents, cancer rates, and head injuries. Numerous policies have been implemented to reverse trends in obesity among children and adolescents but the overwhelming majority of policies have shown little to no effect. In fact, trends in soft drink consumption have shown an increase among adolescents over the past decade. What interventions work to reduce obesity among children and adolescents and what are the theories behind these interventions? Dr. Dan Taber from the Univeristy of Illinois visited the Loyola Department of Preventive Medicine this week and discussed these issues with the Loyola online MPH Program faculty. During his talk he discussed policy changes implemented during years 2000-2006 and their estimated effects on soft drink consumption and adiposity among adolescents in 2007. Staes which implemented policy changes such as banning the sale of processed foods and the sale of soft drinks in vending machines in schools or similar policies did show an effect on both soda consumption and adiposity in 2007 albeit effects were small. Policy effects on soda consumption were actually strongest in African-American boys. His research was not able to track individual changes but rather looked at the population distribution within the year 2007. Soft drink consumption is a policy target area for addressing the obesity epidemic. Suggested policies have included the banning of soft drinks in schools, taxing soda and warning labels. However, there are few data which demonstrate that such policies would have a substantial public health effect, especially among adolescents. What is known is that one particular method to abrogate obesity will not suffice. The problem is so complex that multiple policies, interventions and societal attitudes all need to interact effectively to impact the most important public health problem the U.S. is facing.