Public Health and Racial Justice Program Encourages Girls of Color to See Themselves As Agents of Change

Updated on Oct 4, 2023 | Community, Diversity and Inclusion, Featured

The Mount Sinai Department of Health Education, with support from The Blavatnik Family Women’s Health Research Institute, hosted its first in-person cohort of the Public Health and Racial Justice Program. Over the course of six weeks in July and August, 15 youth participants, all identifying as girls of color, met daily at The Mount Sinai Hospital to explore a variety of public health issues through a racial justice lens.

The Public Health and Racial Justice Program emphasizes the power and importance of civic engagement, community organizing, and youth activism in addressing the inequities that drive health disparities. The program aims to build skills, foster pride, and nurture community connection so that participants understand themselves as lifelong stakeholders invested in shaping the policies, institutions, and structures that affect the health and well-being of their families and their communities.

“Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

The Public Health and Racial Justice Program was designed and launched in the spring of 2020 as a direct response to the COVID-19 pandemic and the Black Lives Matter movement. Due to pandemic restrictions, the previous four cohorts participated in a part-time version of this program over video conferencing.

With generous support from the Helen Gurley Brown Foundation, and in partnership with The Blavatnik Family Women’s Health Institute, the Department of Health Education was able to significantly expand this summer programming, offering a full-time opportunity with a stipend for participating youth.

More than 80 guest speakers—primarily women of color—from across the Mount Sinai Health System, and from local and national organizations, spoke on a variety of issues, broadening participants’ understanding of the many different pathways one can follow into health equity and social justice work. The program featured union labor organizers, doulas, scientists, clinicians, sexuality educators, grassroots activists, researchers, and leaders from city agencies, including the Bureau of Health Equity Capacity Building at the New York City Department of Health and Mental Hygiene, and the New York City Public Advocate Office.

“My favorite part was hearing from the different activists and non-profit workers,” said one participant. “Hearing from both younger people and people who were actively involved in their communities and making a difference was inspiring and presented tangible ways for me to get involved in the community.”

Another participant added, “I loved meeting all the guest speakers and organizations. The most meaningful part was the new relationships I made and learning more about how to help my community.”

Participants completed a culminating project reflective of their summer experience. Each participant selected a public health issue affecting their community, which they documented using a unique photography application. They were then led through a series of semi-structured, dialogue-based activities with staff and peers to support their development of a complementary narrative. This narrative included suggested action steps for those inspired to get involved.

Participants presented their projects at a celebratory symposium on the final day of programming, attended by Mount Sinai staff, community partners, and their family and friends. Their work was featured in a gallery at The Mount Sinai Hospital, and guests were invited to explore.

For many of the participants, spending the summer in a safe space with other girls of color was a profound experience.

When asked about the most meaningful part of the program, responses included:

“Having that space to be myself and being able to express what I am thinking at the moment. Being vulnerable and having that respect that most of the time adults don’t give to teenagers. I loved the relationships that were built in such a short amount of time.”

“Feeling comfortable and welcomed into this space and meeting all these wonderful and intelligent people who inspire me to embrace who I am.”

“Getting to know other people of color that are around my age and listening to everyone’s different opinions and perspectives.”

 

For some participants, learning about the relationship between racism and health was new and eye-opening.

“All the things we talked about and learned about in the program were all new information to me so everything surprised me,” said one. “It surprised me that we aren’t taught these things in school but if we want to gain more knowledge on these topics, we have to learn it on our own or from a program like this. I learned a lot about Black maternal health, homelessness, workers’ rights.”

Many of the participants also appreciated learning more about the various career paths that can contribute to health equity.

“At first I thought I knew what career I wanted to be, to become a nurse practitioner. But I met really nice people in the program who talked about their careers and that gave me more options to be open to my opportunities,” said one. “I also thought that many professionals had one path and that they knew they were going to be where they are now but I learned that there is nothing wrong with switching to a different field and it’s all about being happy that you’re doing that job.”

When asked to share their final thoughts on the program, one participant said, “I truly appreciated having the opportunity to be a part of such a wonderful program. I learned so much from the positive and caring program leaders/educators, the speakers, and the other girls in the program.”

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To learn more about the summer 2023 session, read the full report

Mount Sinai Researchers Publish First Genome-Wide Analysis of Binge Eating Disorder

Sep 22, 2023 | Featured, Psychiatry, Research

Binge eating disorder is the most common eating disorder in the United States, thought to affect as many as 3 percent of people during their lifetimes. Yet it remains poorly understood.

Now, researchers from the Icahn School of Medicine at Mount Sinai have made important progress with the first genome-wide analysis of binge eating disorder (BED). The study, published in Nature Genetics in August, identified genes that appear to be associated with BED risk. The study also found evidence that iron metabolism may play a role in the disease.

“By applying machine learning to the study of binge eating disorder, we’ve gained important insights into this poorly understood condition, and a new tool for exploring other underdiagnosed diseases,” says Panos Roussos, MD, PhD, Professor of Psychiatry, and Genetics and Genomic Sciences at Icahn Mount Sinai and Director of the Center for Disease Neurogenomics, who is a co-author of the study. “By combining Neuroscience with genomics and big data analysis, we can discover more about how the brain works and ultimately prevent psychiatric disease.”

A Fresh Look at Binge Eating Disorder

Binge eating disorder has significant impacts on a person’s health and well-being. “It can cause substantial distress and impairment in quality of life,” says Trevor Griffen, MD, PhD, a psychiatrist and neuroscientist who collaborated on the recent study while he was a fellow in child and adolescent psychiatry at Mount Sinai. “BED often co-occurs with other psychiatric disorders, such as depression, ADHD, and substance use, and seems to be a nexus of metabolic dysfunction, with associations to conditions like diabetes and high blood pressure.”

Trevor Griffen, MD, PhD

Yet it took a long time for the scientific community to recognize BED as a distinct disorder. It was first included as a new diagnosis when the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2014. As a result, the diagnosis is all but absent in the electronic health records and large biobanks that researchers tap into for large-scale genetic analyses. Luckily, the Mount Sinai team developed a workaround.

“A big part of this study was using machine learning to figure out the people most likely to have BED,” says lead author David Burstein, PhD, a data scientist at Mount Sinai who works in the labs of Dr. Roussos and study co-author Georgios Voloudakis, MD, PhD, Assistant Professor of Psychiatry, and Genetics and Genomic Sciences.

Using electronic health record data from more than 767,000 people through the Million Veterans Project, Dr. Burstein and his colleagues applied machine learning approaches to sift through medical diagnoses, prescription medicines, body mass index (BMI) data, and other factors, looking for patterns that would predict if a person had BED. Applying their model to smaller cohorts of people with diagnosed BED, they showed the approach could meaningfully predict the disorder, even in the absence of a formal diagnosis.

Genes Point to New Binge Eating Disorder Treatments

Applying the machine learning model to some 362,000 people for whom genetic information was available, the researchers zeroed in on several genetic loci that appear to be associated with BED risk. One of the genes implicated in the new study is MCHR2, which is associated with the regulation of appetite in the brain. Two others, LRP11 and APOE, have previously been shown to play a role in cholesterol metabolism.

David Burstein, PhD

Another gene identified in the study, HFE, is involved in iron metabolism. The identification of HFE aligns with recent research suggesting iron metabolism may have an important role in regulating overall metabolism, Dr. Griffen says. In particular, iron overload seems to be associated with binge eating, the team found. Interestingly, iron deficiency has been implicated in pica, a disorder that drives people to eat non-food items such as soil or hair.

“There have been hints that iron is a player in the eating disorder world,” Dr. Burstein says. “This new study is more evidence that the mineral deserves a closer look.”

The findings also point toward new directions for treating BED. So far, treatment has mostly focused on repurposing therapies used for other disorders, such as depression or ADHD.

“This study identifies genes and systems that could serve as potential targets for treatments that finally address the underlying biology of BED,” Dr. Griffen says. “It also continues to build evidence that there are biological and genetic drivers of binge eating behaviors. The more we get that message out there, the more we can decrease stigma associated with binge eating.”

A New Tool for Eating Disorder Research

Dr. Griffen is continuing to collaborate with Dr. Roussos and Dr. Voloudakis to expand on their findings, with plans to develop mouse models and dig deeper into the mechanisms. Ultimately, their goal is to develop new treatments that target the underlying biology of BED.

Meanwhile, the researchers are eager to apply their new computational approach to other diseases such as bulimia nervosa—another common eating disorder for which no genome-wide analysis has ever been done.

“Being able to infer a diagnosis from medical records is really significant, not only for BED but for other eating disorders, which are often extremely underdiagnosed” and therefore challenging to study using electronic health records, Dr. Burstein says.

The approach can also extend the science into populations that have been overlooked in past research. Most research on eating disorders has focused on white females. Using machine learning, researchers can more thoroughly study eating disorders in males and populations with other racial or ethnic backgrounds.

“This is exciting work, with so many potential future directions,” Dr. Burstein says.

Read more stories about Psychiatry at Mount Sinai

Why it Is Important for Men to Get Tested for Prostate Cancer

Updated on Sep 9, 2024 | Featured, Your Health

Prostate cancer is the second most common cancer among men in the United States, after skin cancer, and the number of cases has been rising yearly. About one man in eight will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society.

Prostate cancer comes in many different forms, which is why Mount Sinai offers a wide variety of treatment options while conducting research to find new and innovative treatments and expanding care to those communities most at risk.

“The most important thing people can do is find this cancer early, when it is easier to cure. That starts with understanding your own risk, and talking with your doctor before there are any symptoms,” says Ash Tewari, MBBS, MCh, FRCS (Hon.), Professor and Chair, Milton and Carroll Petrie Department of Urology and Director of the Center of Excellence for Prostate Cancer at The Tisch Cancer Institute at Mount Sinai.

One key message remains unchanged: Prostate cancer screening is critical to detecting this cancer early, before you have any symptoms, when you have more treatment options.

Click here to watch a series of short videos on prostate cancer from the Department of Urology and learn more about the importance of your family history and how to minimize your risk for prostate cancer.

In this Q&A, Dr. Tewari, who is also Surgeon-in-Chief of the Tisch Cancer Hospital at The Mount Sinai Hospital, explains when men should be tested for prostate cancer and what options are available to those who may be diagnosed with prostate cancer.

What should patients and consumers know about the rise of prostate cancer?

Ash Tewari, MBBS, MCh, FRCS (Hon.)

It is likely that this perceived rise of prostate cancer is not a true rise in prostate cancer incidence but rather there has been increased awareness about testing and screening. This is a good thing because we can prioritize delivering care to those who need it and make sure they are managed appropriately.

 Who should be tested for prostate cancer, and when?

The decision of when to initiate screening should be an individual one that is based on shared decision making between physician and patient. There are several factors to consider including race, family history of cancer (not only prostate but also breast, ovarian, and pancreatic cancer), and age. According to the U.S. Preventative Services Task Force, all men over the age of 55 should have this conversation with their physician about the decision to begin screening with Prostate-Specific Antigen (PSA) testing. Patients who are at higher risk, such as those with family history, should start this conversation earlier, and some as early as age 40.

 Who is most at risk for prostate cancer?

 Those who are most at risk of prostate cancer include:

  • Black men
  • Men with a family history of prostate cancer and other cancers
  • Men over 55 years old
  • Men who have done genetic testing and were found to have mutations, such as BRCA2, that are known to be correlated with a higher risk of prostate cancer

How is prostate cancer diagnosed?

Prostate cancer is diagnosed when a PSA test rises above a certain threshold, and a biopsy becomes indicated. A biopsy can be done even if PSA is not above threshold—for example if a patient has other factors that might put him at risk or has a concerning magnetic resonance imaging (MRI) test. This biopsy can be performed transperineally or transrectally. Sometimes, this biopsy is guided by imaging tests such as an MRI and micro-ultrasound imaging to increase the sensitivity of the biopsy.

How do doctors use the PSA test?

The PSA test is a blood test that can be used for screening. It also is used as a marker to track treatment response and for surveillance to detect recurrences after treatment. A single PSA test is often insufficient to draw meaningful conclusions. A single elevated PSA during screening is followed up with another PSA test to corroborate that the rise was not due to other factors, such as the result of inflammation or infection in the prostate.

What treatments are available for prostate cancer?

If you are diagnosed with prostate cancer, what follows next would be a discussion with your doctor about next steps. The conversation depends largely on the type of prostate cancer diagnosed. There are a number of different types and grades of prostate cancer, and treatment must be appropriate for the individual patient. Some patients are diagnosed with a disease that is confined to the prostate. Options for these patients range from active surveillance for low-risk disease to radical treatments such as radiation or surgery for intermediate-risk and high-risk disease. There are also emerging experimental therapies, called focal therapies, that are being investigated for their appropriateness and safety for certain patients. For advanced and metastatic disease, sometimes hormones and other treatments that target the entire body, such as chemotherapy may be used. This is also a very active field of research. There is a tremendous effort to improve the outcomes and quality of life for patients.

What is active surveillance, and why is that important?

Active surveillance is an approach that is used for patients who have low-risk and very low-risk cancer confined to the prostate. Because these cancers are usually slow growing and do not involve complications or pain, we prefer not to implement radical treatments if they are not necessary, and so active surveillance can be a good option for them. This protocol often involves periodic imaging and biopsies to monitor the disease and intervene only if necessary.

Can I reduce my risk for prostate cancer?

There is no evidence that one lifestyle choice will either cause or prevent prostate cancer. Studies show that patients who eat more vegetables and less red meat, and patients who exercise regularly, are at lower risk for prostate cancer. Overall, leading a healthy lifestyle has many wide-reaching benefits.

What steps is Mount Sinai taking to bring prostate cancer screening to the community?

In 2022, we launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit, a state-of-the-art mobile facility equipped with advanced PSA tests and trained staff that visits predominantly Black neighborhoods across New York City. We are very excited about this initiative. We want to reach patients who cannot easily access a urologist, and we want to make it easier to screen for prostate cancer and treat them if necessary to save their lives. So far, we have screened more than 3,000 patients and of those, we have found several hundred with elevated PSAs that required further follow up. We detected cancer in 30 patients and conducted surgery to remove the cancer in half of these patients. In addition, we are following up with these patients to make sure they have the most appropriate testing and treatment.

Learn more about our services and make an appointment

Mount Sinai West Installs Dedicated Cardiovascular CT System

Sep 21, 2023 | Community, Featured

As part of a continued expansion of cardiology imaging, Mount Sinai West has opened  its first dedicated cardiovascular computerized tomography (CT) system, called Cardiographe.

This new CT system addresses the challenges of scanning patients with high or unstable heart rates, a common issue in urgent cardiac imaging, providing robust clinical detail needed for diagnosis and assessment.

“The launch of CardioGraphe at Mount Sinai West underscores our commitment to providing the best possible care for our patients, enhancing both accessibility and quality in the early diagnosis and treatment of heart disease,” said Jeffrey Bander, MD, FACC, Chief of Cardiology, Mount Sinai West. “Our aim is to improve access to high-quality imaging solutions, and the CardioGraphe is an affordable and accessible tool that allows physicians to diagnose and treat patients with cardiovascular diseases more efficiently.”

This system can create a 3D image of the coronaries, valves, chambers, and myocardium in a single heartbeat and can perform CT angiography studies beyond the heart, including the aorta and carotid arteries. It provides physicians with crucial information about heart function and the necessary anatomic detail to plan procedures like Percutaneous Coronary Intervention (PCI) and Transcatheter Aortic Valve Replacement (TAVR).

To schedule a patient, call 212-636-4107 or email MSWCT@mountsinai.org.

How Do I Know if I Could Have Celiac Disease?

Sep 20, 2023 | Featured, Your Health

Celiac disease, an autoimmune disorder affecting the small intestine, is normally a condition you inherit and runs in families. The condition affects approximately 1 percent of people in the United States and is triggered by consuming gluten, a protein found in wheat, barley, and rye.

The small intestine, which is responsible for absorbing nutrients from food, is damaged by this immune process, and this can lead to other health concerns. People with celiac disease are at increased risk for malnutrition, osteoporosis, small bowel cancers, depression, and infertility. Yet only about 30 percent of people with celiac disease are properly diagnosed, according to the Celiac Disease Foundation.

To schedule an appointment with Christopher Cao, MD, a celiac disease specialist, call 212-241-4299 or schedule online.

In this Q&A, Christopher Cao, MD, Assistant Professor, Gastroenterology, Icahn School of Medicine at Mount Sinai, who treats patients and conducts research on celiac disease, explains how to know if you have this condition and how to optimize your diet and improve your quality of life.

How do I know if should screen for celiac disease? What screenings are available? 

Celiac disease may produce various gastrointestinal and systemic symptoms. Common gastrointestinal symptoms include abdominal discomfort, bloating, diarrhea, constipation, and nausea or vomiting. You may also experience a skin rash, joint pains, fatigue, or weight loss. As celiac disease is hereditary, it is important that family members of individuals with celiac disease be screened. Individuals with known autoimmune disorders should also be screened for celiac disease. Screening for celiac disease uses a combination of blood work, genetic testing, and endoscopic evaluation. These services are offered through the Mount Sinai Celiac Disease Program.

What foods should I eat or avoid if I have celiac disease?

The only effective treatment for celiac disease is a strict gluten-free diet, as there are no medications approved by the Food and Drug Administration for the management of celiac disease. By eliminating gluten from their diet, individuals with celiac disease can prevent further damage to their small intestine and alleviate their symptoms. Dieticians specializing in celiac disease will work closely with patients to develop personalized gluten-free dietary plans to ensure optimal health and well-being.

How do I prevent a flare up? 

The lifelong management of celiac disease with a gluten-free diet can be difficult and should not be understated, as even tiny traces of gluten may trigger a reaction. The Mount Sinai Celiac Disease Center is dedicated in providing comprehensive and compassionate care for those with celiac disease. Our team consists of experienced gastroenterologists, dietitians, and health care professionals who can help support individuals through their celiac journey—from obtaining an accurate diagnosis to optimizing a gluten-free diet and improving their quality of life.

Find out more about celiac disease and what foods to eat

After a Summer on Capitol Hill, a Mount Sinai Medical Student Draws Attention to the Need for Changes to Medicare and Medicaid to Help Vulnerable Populations

Updated on Sep 22, 2023 | Community, Featured, School

U.S. Senator Bill Cassidy, MD, (R-LA), left, and Mount Sinai medical student Sunjay Letchuman

With the annual Medicare open enrollment period approaching, Mount Sinai medical student Sunjay Letchuman (class of 2026) and U.S. Senator Bill Cassidy, MD, (R-LA) have come together to shine a light on a vulnerable population of Americans who are poor, elderly, and sometimes disabled. This group of more than 12 million Americans is so called “dually eligible” because they qualify for insurance through both Medicare and Medicaid.

Having two forms of insurance might seem to be better than one. But data reveal that dually eligible individuals experience worse health outcomes when compared to similar populations, even after controlling for confounding variables. These poor health outcomes result, in part, from the lack of payment coordination between Medicare and Medicaid.

“Medicare pays for most hospital services while Medicaid pays for long-term care services, such as nursing home care,” says Mr. Letchuman. “Without payment coordination between the two insurers, Medicaid does not know that a dually eligible patient is hospitalized unless subsequent long-term care is needed. As such, Medicaid has no financial incentive to prevent the hospitalization in the first place in light of Medicare’s responsibility to pay. This is just one illustration of how poor coordination is not serving these patients, who experience longer hospitalizations and higher costs.”

This summer, Mr. Letchuman, raised in Louisiana, had the unique opportunity to research this policy issue while serving as a Health Fellow for Dr. Cassidy. While working together, Dr. Cassidy suggested they co-author an article to draw attention to the problem. The result: a Viewpoint essay published in JAMA September 15 titled, “A Prescription for Americans Dually Eligible for Medicare and Medicaid.”

“It was a pleasure to co-author this piece with my health fellow, medical colleague, and Shreveport, Louisiana, native Sunjay Letchuman,” says Dr. Cassidy. “Dually eligible patients have poor outcomes, despite society devoting significant resources to pay for their care. Sunjay spent his time as a health fellow learning this issue and, as importantly, using this understanding to help develop solutions. He is a health scholar serving patients, profession, and country by other means. This editorial is a manifestation and furtherance of this service.”

Mount Sinai medical student Sunjay Letchuman with a patient

In their JAMA article, the pair conclude that the federal government should establish guidelines requiring care to be coordinated between Medicare and Medicaid at the state level. Dr. Cassidy is part of a bipartisan group of six senators working to get this done. The issue is of particular relevance to New York as the state is home to a high number of dually eligible Americans, as is the case in the two authors’ home state.

“Addressing the needs of dually eligible Americans is more than just a policy interest of mine; it’s a commitment to serve my home state of Louisiana where more than 250,000 dually eligible Americans live and deserve better coordinated care and improved health outcomes,” says Dr. Letchuman.

This was not Mr. Letchuman’s first deep dive into a health policy issue. Over the summer, he also co-authored an article in the New England Journal of Medicine about whether nonprofit hospitals deserve their tax exemptions—an issue he worked on as a health fellow for the U.S. House Committee on Ways and Means.

“In exchange for not paying taxes, nonprofit hospitals are required to provide substantial community benefit and charity care. Not all nonprofit hospitals fulfill this commitment, and local communities pay the price,” he says.

Mr. Letchuman studied the business of health care as an undergraduate, which has helped prepare him for a career in both medicine and health policy. This made him a perfect candidate for the Icahn School of Medicine at Mount Sinai’s FlexMed program, which encourages college sophomores in any major to apply and provides students with the flexibility to pursue their academic passions during college. Mount Sinai was the first medical school to create an admissions pathway that provides such early assurance.

“The FlexMed program allowed me to pursue my health policy dreams early in college,” he says. “I am confident that Mount Sinai’s education and support, then and now, are shaping me into a more effective physician and policymaker.”

Read more about the Donald and Vera Blinken FlexMed Program

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