nurse practitionering

Lately I've been concentrating a lot on the "public health" aspect of this blog, and less on the grad school aspect. Since the blog really should be about both, this'd be a good time for me to talk more about studying to be a nurse practitioner.

Not everyone is totally clear what a nurse practitioner is. The basic idea is that a nurse practitioner is a registered nurse who has completed master's level coursework, and has been licensed by the state to diagnose and treat illness. An NP's privileges vary by the state: most states require that the NP work with a "supervising physician" and limit an NP's prescribing privileges. New York policy is very liberal: NPs here have full prescriptive power, and work with a "collaborating physician". Many NPs see the future of the profession in the provision of primary care; as US physicians become more and more specialized, and as we move (fingers crossed) towards more comprehensive health coverage, a "primary care gap" like the one that has emerged in Massachusetts since the insurance reforms of 2007 is expected to become more and more prevalent. This is, to the minds of many, where NPs come in.

In order to be an NP candidate, one must already be an RN, usually with a BSN, although there are some associate-to-master's programs. (Columbia used to have one, but it was discontinued.) My program is four semesters worth of coursework. The first semester was: Pharmacology, Physical Assessment, Health Policy, and Introduction to Primary Care. That semester had no clinical component. This past semester (Spring 2009) was Diagnosis and Management I, Seminar in Primary Care (basically case presentations), and Genetics. We also had a clinical requirement, which I have blogged about in the past.

I also work part time at a NYC facility for formerly homeless adults, but that's for another post. :)

exciting development

A new vaginal ring, which provides a combination of ART and contraception, has been shown in laboratory tests to prevent pregnancy and HIV transmission. The study, headed by Drs. Brij Saxena and Jeffrey Laurence, both of New York-Presbyterian Hospital, will be published in AIDS later this year.

The ring uses three ART drugs, released by the ring over a 28 day period, to prevent the transmission of HIV. The drugs are: AZT, the lesser known PMPA, and a new compound called Boc-lysinated betulonic acid, or dapivirine. "The combination of these antiviral drugs has proven to be potent agents that may block infection by the HIV virus," Dr. Saxena told the the Times of India. The contraception the ring provides, which is non-hormonal, prevents conception by raising the acidity of the vagina, thickening vaginal mucus, and diminishing sperm motility.

This is a huge step forward: a method to both prevent conception and the transmission of AIDS that depends only on female compliance has been a goal of researchers for a long time.

new health initiatives

This Saturday two public health groups, The Perinatal Network of Monroe County and the Finger Lakes Health Systems Agency, announced 13 initiatives to improve public health in northern New York.

The initiatives, which are aimed at reducing racial disparities in health, were developed by an interdisciplinary team of over 100 clergy, doctors, nurses, social workers, and insurers who which met from October to January. The initiatives include: studying the effect of maternity leave on fetal health, arranging community wide viewings of a documentary on racial health disparities, and trainings for clergy and social workers so they can teach clients how to manage chronic illnesses.

The Perinatal Network of Monroe County works to reduce racial and ethnic disparities in maternal fetal health. The Finger Lakes Health Systems Agency promotes public health by "providing a 'community table' where all stakeholders meet, conducting outreach to community groups, [and] retaining extensive data on the region's health and health care."

all i have to say about swine flu

This blog, which is about public health in New York City, has thus far said nothing about the most covered public health crisis in NYC this year: swine (H1N1) flu. This teriffic video in part explains why. The video is a quick exploration of the "death to news" ratio of swine flu and TB over the course of thirteen days. In sum: they're very different. The video's less than three minutes; click! If nothing else, the narrator makes it interesting.

in support of testing

A recent editorial appeared in Long Island's Newsday, supporting the bill before the state legislature to make HIV testing in New York more accessible. The editorial appears in its entirety here:

Bill would reduce stigma surrounding HIV testing

There's no harm in offering to test every adult for HIV when they're treated at a hospital or clinic. The harm is in not making the attempt. A quarter of the people who are HIV positive don't know they have the virus, and they're the source of the majority of new infections.

To slow the spread of this deadly virus, the State Legislature should make it mandatory for health care workers to offer testing. And it should lower barriers that discourage patients from giving their consent. Under current law, the offer isn't required. When it is made, rigid, pretest counseling is mandated and patients must sign a written consent form before they're tested. The goal should be to reduce the stigma of HIV testing by making it routine.

A bill by Assemb. Annette Robinson (D-Brooklyn) would do that by requiring doctors to offer the test, explain its purpose, how it's done and answer any questions, but then simply note in a patient's chart whether the offer was accepted or rejected. That would advance the critical public health objective here, which is to get people tested.

NYC Health Commissioner to head CDC

President Obama announced his intention to appoint NYC's Health Commissioner the head of the CDC. Dr. Thomas R. Frieden, an infectious disease specialist, is expected to begin work in a month. This is the second time the Obama administration has pulled an official from NYC; former city health commissioner Dr. Margaret A. Hamburg is expected to be confirmed as commissioner of the Food and Drug Administration.

Dr. Frieden's efforts as commissioner are well known to most New Yorkers: no smoking in bars and restaurants, free condoms, and more accessible HIV testing. The appointment was met with enthusiasm by public health advocates in New York City: Dennis deLeon, president of the Latino Commission on AIDS in New York City, told the NY Times of Dr. Frieden: “I found he’s willing to challenge the status quo in an effort to make a difference."

whoops!

I missed International Nurses' Day! It's celebrated every year on May 12 and honors nurses throughout the world. (This also means I missed my free CinnaBun, but oh, well.)

In honor of the day, Gary Cohen, a member of US Fund for UNICEF's board and an executive vice president at a medical technology firm, wrote this interesting column about health clinics for health care providers in the developing world, established and operated by the International Council of Nurses.