Cuba opens door to its health care system for visiting nursing students

Students and faculty from the UCLA School of Nursing visit Casa de Maternidad, where women with high-risk pregnancies can live to receive special care. Credit: UCLA

The timing couldn't have been better for 18 UCLA School of Nursing graduate students and two faculty members headed for Cuba on an educational mission. As they were boarding a flight to Havana from Miami on Dec. 17, big news was breaking: The U.S. was re-establishing diplomatic relations with Cuba, mending a break that has lasted more than 50 years. 

One hour later, the UCLA group arrived in Havana, where they were greeted with exuberant hugs, kisses and tears of joy by an excited group of Cuban health leaders over the historic turn of events.

That was the auspicious beginning of a five-day, action-packed visit for the UCLA group. To learn about Cuba’s health care system, they met with physician-nurse teams, engaged in Pan American Health Organization-based discussions on major causes of illness and death, among other topics; and visited community-based consultorios, polyclinics and sex education centers as well as nursing and medical schools.

Eager to see different health care settings, they spent time at a home for seniors and a residence where women with high-risk pregnancies went to live to receive special care.

Ties between Westwood and Havana

This was not the first time that UCLA nurses have connected with their counterparts in Cuba. In 2011, Maria Elena Ruiz, assistant adjunct professor at the school, attended an International Health Conference in Cuba as a member of the American Public Health Association. Through those meetings, she saw firsthand how a first-world, prevention-focused primary health care system functions with third-world economics.

When she returned to UCLA, Ruiz, together with Adey Nyamathi, associate dean for international research and scholarly activities, developed a program that would provide similar experiences for nursing students, who would receive partial credit for a public health course, complete required readings, participate in pre- and post- conferences, and write daily reflective papers.

How do they do it?

Cuba, the UCLA nurses learned during their visit last December, is a third-world country with some impressive health outcomes, including an overall life expectancy that rivals that in the U.S. (78.4 years for Cubans versus 78.6 years for Americans), immunization rates that are nearly 100% and low infant mortality. Yet their health care costs per capita are nearly 15 times lower than that of the United States.

Primary care and an emphasis on prevention are key to the success of the Cuban health care system.  

“Their system shows how primary care really does work,” said student Vladimir Camarce.  “And when implemented correctly, you can see great outcomes. Historically, the U.S. system has been focused on acute and tertiary care, but we are now starting to see a shift with the Affordable Care Act.”

In Cuba, public service announcements about health are shown daily on television. “They don’t have traditional television commercials like we do here, so the government uses the opportunity to deliver messages about hygiene or reminders on vaccines,” observed student Stephanie Phan.

Another reason for Cuba’s success is its focus on personalized, community-based care. Doctors and nurses work as a team and live in the communities they serve.  They might see patients in a clinic in the morning, said graduate student John Scholtz, and then visit patients who can’t get to the clinic at home “to ensure that they are receiving their checkups and following through with the recommendations.”

The students also noted the personal nature of health care in Cuba. “Patients are referred to by name,” said Phan, “not by 'the patient in room 11' …  They told us, ‘They’re not patients, they’re people.”

There is also a strong integration of traditional, herbal and western medicine. It’s all considered good health care. “I believe we should find a way to incorporate that integration into our practices because we do get a lot of patients who use complementary therapies,” said Camarce.

What amazed the students was that the Cubans achieve all this with a scarcity of equipment and health resources. “They don’t have the equipment we have, the technology we have or the pharmaceutical industry,” noted student Jacqueline Marroquin. “They make do with so little, but they are able to accomplish so much.”

“What medical equipment is available resembles a scene from the old MASH television series,” said Ruiz. “And yet we were overwhelmed with the kindness and eagerness of our hosts to share their health experiences with us.”

Also surprising: On average, nurses and doctors make only $20-$30 a month.  But their education and housing are free or subsidized, and they don’t have student loans to pay off.

“In the U.S., you wouldn’t have a lot of people pursuing these professions for that kind of pay,” said Scholtz. “But in Cuba, you have a lot of people interested in being doctors or nurses. They go into it because they want to make a difference in their community.”

Part of the reason why the Cuban system works is the collectivist-based culture and the population perspective, the students said. Many things that have been adapted in Cuba, however, wouldn’t work in the U.S.  “We might be able to integrate some of the ideas in a micro-community,” suggested Marroquin.

Leaving hehind impressions — and hand sanitizers

While the students were there to learn, they also taught Cubans something about Americans.  “Our interactions showed them that we were open to ideas and willing to learn from them,” said Scholtz. On a more tangible note, the group left behind hand sanitizers.  And pens. Lots of them.  “There is a real need for basic hygienic supplies, everything we take for granted,” added Ruiz.

But more importantly, the UCLA visitors came away with a new resolve. “As nursing students, as nurses, we really need to understand what is going on across our borders,” said Marroquin.

Nyamathi added:  “These students are now motivated to make a difference, to learn more about other countries and to question our health system, health care costs, disparities, and what we can learn from others to improve health and health care in the U.S.” 

It’s also a hope that, with the dawning of warmer relationships with Cuba, the U. S. health care community may be able to learn a lot more from their neighbor, they said.

Source: UCLA

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New technology allows medical professionals to step into their patients' shoes

Transports is a piece of technology that uses a low cost Raspberry Pi computer system, and allows users to recreate symptoms including dizziness and speech problems, along with wearable technology which creates a 6Hz tremor in the participant’s right hand. Credit: Image courtesy of University of Royal Holloway London

A pioneering piece of technology will allow users to experience the world through the eyes of a person with Young-Onset Parkinson's disease -- which could revolutionise the way carers and medical staff treat people with the degenerative condition.

Analogue, a theatre company set up by alumni of Royal Holloway, University of London has designed Transports -- a piece of technology which uses a low cost Raspberry Pi computer system, and allows users to recreate symptoms including dizziness and speech problems, along with wearable technology which creates a 6Hz tremor in the participant's right hand.
Young-Onset Parkinson's is a form of the neurological condition which affects people aged under 50. Symptoms of the disease include tremors, slowed movement and falls, and with no cure currently available, how care and treatment are managed can make a significant difference to a patient's quality of life.

The revolutionary project has been designed in collaboration with neuroscience specialist, Professor Narender Ramnani from the Department of Psychology at Royal Holloway, along with carers, researchers and people with the disease, at Parkinson's UK to ensure it is as effective and realistic as possible.

Liam Jarvis, Co-director of Analogue and Drama PhD Student at Royal Holloway, said: "Our principal interest is to work out how we can improve and facilitate communication and empathy by using simple technologies to immerse participants in the remote embodied experiences of others. Using inexpensive Raspberry Pi technology, we hope to expand the project to place participants inside different virtual subjects as an aid to better understand the experience of others."

The technology will now be tested with BSc psychology students at Royal Holloway and carers at Parkinson's UK to see how it can help medical practitioners better understand their patients and in the long term improve the treatment of the disease.

Anna Farrer, User Involvement Advisor at Parkinson's UK, said:"We know that people with Parkinson's feel that better public awareness about the condition would mean that they face less discrimination and have a better quality of life. Projects such as Transports have an important role educating the public, raising awareness -- and we hope, changing attitudes."

Source: University of Royal Holloway London

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Mother's diet affects the 'silencing' of her child's genes

An infant from the Gambia. Credit: Felicia Webb

A mother's diet before conception can permanently affect how her child's genes function, according to a study published in Nature Communications.

The first such evidence of the effect in humans opens up the possibility that a mother's diet before pregnancy could permanently affect many aspects of her children's lifelong health.

Researchers from the MRC International Nutrition Group, based at the London School of Hygiene & Tropical Medicine and MRC Unit, The Gambia, utilized a unique 'experiment of nature' in rural Gambia, where the population's dependence on own grown foods and a markedly seasonal climate impose a large difference in people's dietary patterns between rainy and dry seasons.

Through a selection process involving over 2,000 women, the researchers enrolled pregnant women who conceived at the peak of the rainy season (84 women) and the peak of the dry season (83 women). By measuring the concentrations of nutrients in their blood, and later analysing blood and hair follicle samples from their 2-8 month old infants, they found that a mother's diet before conception had a significant effect on the properties of her child's DNA.

While a child's genes are inherited directly from their parents, how these genes are expressed is controlled through 'epigenetic' modifications to the DNA. One such modification involves tagging gene regions with chemical compounds called methyl groups and results in silencing the genes. The addition of these compounds requires key nutrients including folate, vitamins B2, B6 and B12, choline and methionine.

Experiments in animals have already shown that environmental influences before conception can lead to epigenetic changes that affect the offspring. A 2003 study found that a female mouse's diet can change her offspring's coat colour by permanently modifying DNA methylation.1 But until this latest research, funded by the Wellcome Trust and the MRC, it was unknown whether such effects also occur in humans.

Senior author Dr Branwen Hennig, Senior Investigator Scientist at the MRC Gambia Unit and the London School of Hygiene & Tropical Medicine, said: "Our results represent the first demonstration in humans that a mother's nutritional well-being at the time of conception can change how her child's genes will be interpreted, with a life-long impact."

The researchers found that infants from rainy season conceptions had consistently higher rates of methyl groups present in all six genes they studied, and that these were linked to various nutrient levels in the mother's blood. Strong associations were found with two compounds in particular (homocysteine and cysteine), and the mothers' body mass index (BMI) had an additional influence. However, although these epigenetic effects were observed, their functional consequences remain unknown.

Professor Andrew Prentice, Professor of International Nutrition at the London School of Hygiene & Tropical Medicine, and head of the Nutrition Theme at the MRC Unit, The Gambia, said: "Our on-going research is yielding strong indications that the methylation machinery can be disrupted by nutrient deficiencies and that this can lead to disease. Our ultimate goal is to define an optimal diet for mothers-to-be that would prevent defects in the methylation process. Pre-conceptional folic acid is already used to prevent defects in embryos. Now our research is pointing towards the need for a cocktail of nutrients, which could come from the diet or from supplements."

Dr Rob Waterland of Baylor College of Medicine in Houston, who conducted the epigenetic analyses said: "We selected these gene regions because our earlier studies in mice had shown that establishment of DNA methylation at metastable epialleles is particularly sensitive to maternal nutrition in early pregnancy."

The authors note that their study was limited by including only one blood sampling point during early pregnancy, but estimates of pre-conception nutrient concentrations were calculated using results from non-pregnant women sampled throughout a whole calendar year. The authors also plan to increase the sample size in further studies.

Source: London School of Hygiene & Tropical Medicine

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Fine particulate air pollution linked with increased autism risk

The greater the exposure a pregnant woman has to fine particulate matter, the greater the risk of their baby having autism, researchers found. Credit: © Oleg Shelomentsev / Fotolia

Women exposed to high levels of fine particulate matter specifically during pregnancy--particularly during the third trimester--may face up to twice the risk of having a child with autism than mothers living in areas with low particulate matter, according to a new study from Harvard School of Public Health (HSPH). The greater the exposure, the greater the risk, researchers found. It was the first U.S.-wide study exploring the link between airborne particulate matter and autism.

"Our data add additional important support to the hypothesis that maternal exposure to air pollution contributes to the risk of autism spectrum disorders," said Marc Weisskopf, associate professor of environmental and occupational epidemiology and senior author of the study. "The specificity of our findings for the pregnancy period, and third trimester in particular, rules out many other possible explanations for these findings."

The study appears online December 18, 2014 in Environmental Health Perspectives.

Prior studies have suggested that, in addition to genetics, exposure to airborne environmental contaminants, particularly during pregnancy and early life, may affect risk of autism. This study focused specifically on the pregnancy period.

The study population included offspring of participants living in all 50 states in Nurses' Health Study II, a cohort of more than 116,000 female U.S. nurses begun in 1989. The researchers collected data on where participants lived during their pregnancies as well as data from the U.S. Environmental Protection Agency and other sources on levels of fine particulate matter air pollution (PM2.5)--particles 2.5 microns in diameter or smaller--in locations across the U.S. The researchers identified 245 children who were diagnosed with autism spectrum disorder (ASD) and a control group of 1,522 children without ASD during the time period studied.

The researchers explored the association between autism and exposure to PM2.5 before, during, and after pregnancy. They also calculated exposure to PM2.5 during each pregnancy trimester.

Exposure to PM2.5 was significantly associated with autism during pregnancy, but not before or after, the study found. And during the pregnancy, the third trimester specifically was significantly associated with an increased risk. Little association was found between air pollution from larger-sized particles (PM10-2.5) and autism.

"The evidence base for a role for maternal exposure to air pollution increasing the risk of autism spectrum disorders is becoming quite strong," said Weisskopf. "This not only gives us important insight as we continue to pursue the origins of autism spectrum disorders, but as a modifiable exposure, opens the door to thinking about possible preventative measures."

Source: Harvard School of Public Health

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