Updated on Jun 30, 2022 | Community, Featured, Research
Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health, right, with, from left: Hilda Mejias, a Health Coach in Harlem, and Anna Stapleton, Program Manager for Policy at The Arnhold Institute for Global Health.
The United States spends more money on health care than any other country, yet has poorer outcomes with shorter average life expectancies (78.8 years, per capita) than peer nations, such as Japan and Spain, with 83.4 years and 83.2 years, respectively. Furthermore, a child born in poverty in Detroit has a life expectancy that is six years shorter than a child born in similar circumstances in New York City. And someone born on the Upper East Side of Manhattan has a life expectancy that is nine years longer than a person born ten blocks away in East Harlem.
Mending this uneven patchwork of U.S. health outcomes will require a new model of care that embraces the use of community health workers (CHWs), non-clinical workers who provide underserved patients with the continuum of care they need, according to a new report from The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and the Office of the UN Secretary General’s Special Envoy for Health in Agenda 2030 and for Malaria. The report recommends creating a pilot program in Newark, New Jersey, a city with many non-English speaking residents that lags behind the rest of the state in health outcomes.
CHWs come from the same communities as their patients and serve as the primary mechanism that enables patients to live healthier lives. They can serve as educators, for example, explaining the relationship between diabetes, blood sugar, high-sugar foods, and insulin in a way patients understand, or link patients to neighborhood exercise groups or food pantries that provide health-conscious meals. Such programs have been successful in South America, sub-Saharan Africa, and Southeast Asia.
“A growing body of evidence tells us that social, economic, genomic, and cultural factors can impact an individual’s ability to build and maintain health, and community health workers have the ability to help bridge that gap between medical advice and a patient’s ability to comply,” says Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health, and the report’s senior author. Dr. Singh co-founded the One Million Community Health Worker Campaign with Jeffrey Sachs, an author and well-regarded sustainable development leader, whom The Arnhold Institute for Global Health is hosting as a visiting fellow through 2018.
Claire Qureshi, MBA, Vice President of Frontline Delivery, Office of the UN Special Envoy for Health in Agenda 2030 and for Malaria, co-wrote the report with Dr. Singh. “We’ve seen the health impact and economic value of CHWs in countries around the world and fundamentally believe that working with them as part of integrated primary care is a better way to practice medicine,” says Ms. Qureshi. “With careful construction of the right care models, including the organizational and financial infrastructure needed to support them, CHWs can contribute enormously to patients, communities, and health systems alike.”
While CHWs have existed in the United States for decades, they have struggled to gain widespread acceptance. The services they provide have not been reimbursed by public or private health insurance plans, which are based on traditional fee-for-service payments made to hospitals and clinics. In this old model of health care, there has been little incentive to pay for the preventive and maintenance support provided by CHWs, and little consideration given to the support patients need to comply with the medical advice they receive.
But that is changing. The country’s new emphasis on keeping populations healthy and out of the hospital is creating fertile ground for robust, sustainable CHW programs to emerge, according to the report.
Updated on Jun 30, 2022 | Featured, Patient Stories
Anna Balint and Mark S. Courey, MD, after her successful surgery
In August 2015, Anna Balint fell in her New Jersey home and sustained a neck fracture. Then, during reparative surgery at a local hospital, the anesthesiologist damaged Mrs. Balint’s voice box, which left her near death.
“I turned blue from lack of oxygen,” she says, reflecting on her ordeal. Fortunately, another physician in the room was able to perform an emergency tracheostomy and saved her life. In rescuing Mrs. Balint, however, the physician damaged her larynx and left her unable to speak.
An ear, nose and throat specialist, whom she later consulted in New Jersey, told Mrs. Balint that he would not be able to restore her voice—confirming her worst fears. But he did provide a silver lining: he recommended that she see Mark S. Courey, MD, Division Chief of Laryngology and Director of the Grabscheid Voice and Swallowing Center of Mount Sinai. That set her on the path to healing.
Dr. Courey scoped Mrs. Balint’s throat and found complicated damage to the airway. He said he could bring her voice back with additional surgery to her larynx and trachea, although he could not guarantee that she would regain her pre-injury tone. To Mrs. Balint, who had once prided herself on having a lovely singing voice and enjoyed singing in church, that was a small price to pay, because at this point, the only way she could communicate was by writing her thoughts down on paper.
A six-hour operation to repair her voice box soon followed. During the surgery, Dr. Courey fixed a complex airway narrowing, performed a resection of Mrs. Balint’s trachea, and created a new tracheotomy. Although she remained in the hospital for five days following the surgery and was connected to a ventilator, Mrs. Balint noticed immediate results.
“As soon as I was out of surgery, I started to speak,” she says. “I did not have to write down everything. I was so happy! Can you imagine how many months I had to go through writing everything down before my operation with Dr. Courey?”
At first, Mrs. Balint saw Dr. Courey every two to three weeks so he could check on the progression of her healing. The ventilator made sleeping at night particularly uncomfortable. But, approximately one year after her ordeal began, Dr. Courey removed her from the machine and Mrs. Balint says she finally felt “free. Dr. Courey held my hand and said, ‘Everything is going to be all right.’ ”
Mrs. Balint says, “I still have a small hole in my neck. If I talk too much I have to assist my voice with my stomach, but I have no machine. Every day I think about Dr. Courey. Nobody else knew how to correct my voice, only he did. I would recommend him to everybody. In fact, I have already recommended two friends to see him. I am alive and can speak to my husband and grandchildren, I am very happy.”
Updated on Jun 30, 2022 | Featured, Research
The Icahn School of Medicine at Mount Sinai will receive $4.7 million from the National Institutes of Health (NIH) to participate in a landmark study with 20 other research centers that will examine how childhood experiences and habits affect brain development and, ultimately, social, behavioral, academic, and health outcomes.
The NIH initiative, known as the Adolescent Brain Cognitive Development (ABCD) study, will follow approximately 10,000 children for 10 years, beginning at ages 9 and 10, through adolescence, and into early adulthood. Researchers will use advanced brain imaging, interviews, and behavioral testing to determine how video games, school sports, sleep habits, social media, smoking, alcohol, and drug use interact with each other and with a child’s changing biology to alter the development of the brain over the short and long terms.
Rita Goldstein, PhD, Professor of Psychiatry, and Neuroscience, and Chief of the Neuropsychoimaging of Addiction and Related Conditions research group and the Brain Imaging Core at the Icahn School of Medicine, is Mount Sinai’s principal investigator on the study. Dr. Goldstein and her team will collaborate with Yale University to recruit more than 1,000 children, an effort that will unfold over the next two years through partnerships with public and private schools.
The ABCD study is “a paradigm shift for the brain development study,” says Dr. Goldstein. “Multimodal neuroimaging studies to uncover brain mechanisms that could change over time with development and shed light on health, resilience, and vulnerability factors have not been conducted at this scale before, making this project both exciting and crucially important.”
An additional partnership with BJ Casey, PhD, the study’s principal investigator at Yale, will enable Dr. Goldstein’s team to study the cortical-subcortical pathways that underlie select behaviors crucial during the adolescent years.
“Such early identification of the dynamics of brain states, pathways, and mechanisms is crucial for enhancing the understanding of factors that may contribute to certain behaviors,” says Dr. Goldstein. “We will also be able to identify the brain circuits and pathways that may predispose to or protect against certain risks. The identification of mechanisms underlying resilience has always been an important focus at Mount Sinai.”
Ultimately, the study is expected to provide parents, school principals and teachers, medical professionals, and public policymakers with useful data to promote the health, well-being, and success of children.
“We know the brain is still developing well into the mid-20s, making it vulnerable to a host of influences,” said NIH Director Francis S. Collins, MD, PhD, in announcing the initiative. “With several NIH institutes and centers working together on this important study, we will be able to learn how a variety of biological events and environmental exposures affect brain development, giving us greater insight into what helps adolescents traverse that potentially tumultuous time to become healthy and productive adults.”
For additional information, please call 844-422-2301, email: abcd@mssm.edu, or visit our web sign-up page: http://tinyurl.com/mssm-ABCD.
Updated on Jun 30, 2022 | Featured, Research
Aaron E. Miller, MD, left, and Fred D. Lublin, MD, helped lead groundbreaking multiple sclerosis research.
Three multicenter Phase III trials in which Mount Sinai researchers played key roles have reported highly encouraging results for the investigational drug ocrelizumab in treating both primary progressive multiple sclerosis (MS), the most disabling form of the disease, as well as relapsing MS, the most prevalent form. Two of the three trials, known as OPERA I and OPERA II, were focused on relapsing MS. The third trial, ORATORIO, was aimed at primary progressive MS. The findings were published online Wednesday, December 21, 2016, in The New England Journal of Medicine (NEJM). “The results for ORATORIO were truly groundbreaking because we never before had a treatment that was proven to work with primary progressive MS,” says Aaron E. Miller, MD, Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Medical Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai. “In the case of relapsing MS, we have had many options in the past, but this new treatment has extremely good efficacy and will probably be widely used for patients with the disease.”
MS is a complicated, often disabling, disease of the central nervous system that can produce a wide variety of neurological symptoms as it disrupts the flow of information within the brain and spinal cord, and between the brain and body. It afflicts an estimated 2.3 million people worldwide and 400,000 in the United States. Approximately 10 to 15 percent of this population is diagnosed with primary progressive MS, in which patients, instead of relapsing and recovering partly or fully, experience gradual deterioration from disease onset.
According to Dr. Miller, who served as principal investigator at Mount Sinai for ORATORIO, ocrelizumab significantly reduced the progression of clinical disability of primary progressive MS at both 12 and 24 weeks—a finding that prompted the NEJM to hail the trial in an editorial as a “landmark study in the field.”
Fred D. Lublin, MD, Saunders Family Professor of Neurology at the Icahn School of Medicine at Mount Sinai and Director of the Corinne Goldsmith Dickinson Center, was a member of the steering committee that designed and monitored ORATORIO. Dr. Lublin was also an author for OPERA I and OPERA II, which found that ocrelizumab resulted in 46 to 47 percent lower relapse rates than interferon beta-1a, a current leading treatment for relapsing MS. Ocrelizumab, from Genentech, a member of the Roche Group, was created to treat both forms of the disease. A humanized monoclonal antibody, ocrelizumab binds to CD-20 proteins on the surface of certain B cells, causing their depletion. B cells are believed to be a key contributor to attacks on the insulation and support around nerve fibers in the brain, spinal cord, and optic nerves that can lead to disability. Ocrelizumab is administered by intravenous infusion every six months.
“Every study brings us closer to a cure, and now we have opened the door to a whole new group: patients with primary progressive MS, whom we can more successfully treat,” Dr. Lublin says. “The next challenge is to see if we can select patients most likely to respond to this therapy.”
Updated on Jun 30, 2022 | Community, Featured, Patient Stories
After treatment for ovarian cancer, Valerie Goldfein created Woman to Woman, a program at The Mount Sinai Hospital to support other gynecologic cancer patients that has expanded nationwide.
Updated on Jun 30, 2022 | Community, Featured
More than 40 middle school students from several East Harlem schools were exposed to science, medicine and healthcare at The Mount Sinai Hospital during an event called “Day-With-A-Scientist: The Brain.”
https://www.youtube.com/watch?v=2N9lOdvZ4Q0
