Dietary choices are linked to higher rates of preeclampsia among Latinas

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Vanessa G. Sánchez | KFF Health News (TNS)

For pregnant Latinas, food choices could reduce the risk of preeclampsia, a dangerous type of high blood pressure, and a diet based on cultural food preferences, rather than on U.S. government benchmarks, is more likely to help ward off the illness, a new study shows.

Researchers at the USC Keck School of Medicine found that a combination of solid fats, refined grains, and cheese was linked to higher rates of preeclampsia among a group of low-income Latinas in Los Angeles. By contrast, women who ate vegetables, fruits, and meals made with healthy oils were less likely to develop the illness.

The combination of vegetables, fruits, and healthy oils, such as olive oil, showed a stronger correlation with lower rates of preeclampsia than did the Healthy Eating Index-2015, a list of dietary recommendations designed by the U.S. Department of Agriculture and the Department of Health and Human Services.

The study, published in February by the Journal of the American Heart Association, yielded important information on which food combinations affect pregnant Latinas, said Luis Maldonado, the lead investigator and a postdoctoral scholar at the Department of Population and Public Health Sciences at USC Keck. It suggests that dietary recommendations for pregnant Latinas should incorporate more foods from their culture, he said.

“A lot of studies that have been done among pregnant women in general have been predominantly white, and diet is very much tied to culture,” Maldonado said. “Your culture can facilitate how you eat because you know what your favorite food is.”

(Dreamstime/TNS)

Preeclampsia is estimated to occur in about 5% of pregnancies in the U.S. and is among the leading causes of maternal morbidity, according to the Centers for Disease Control and Prevention. It typically occurs during the third trimester of pregnancy and is associated with obesity, hypertension, and chronic kidney disease, among other conditions.

There isn’t a way to cure or predict preeclampsia. The disease can damage the heart and liver and lead to other complications for both the mother and the baby, including preterm birth and even death.

Rates of preeclampsia have increased in the past two decades nationally. In California, rates of preeclampsia increased by 83% and hypertension by 78% from 2016 to 2022, according to the most recent data available, and the conditions are highest among Black residents and Pacific Islanders.

Maldonado said 12% of the 451 Latina women who participated in the study developed preeclampsia, a number almost twice the national average. More than half of the participants, who averaged 28 years old, had pre-pregnancy risks, such as diabetes and high body mass index.

Maldonado and his team used data from the Maternal and Developmental Risks from Environmental and Social Stressors Center, a USC research group that studies the effects of environmental exposures and social stressors on the health of mothers and their children.

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The subjects, who were predominantly low-income Latinas in Los Angeles, completed two questionnaires about their diet during the third trimester of their pregnancy. The researchers identified two significant patterns of eating: one in which the most consumed foods were vegetables, oils, fruits, whole grains, and yogurt; and a second in which the women’s diet consisted primarily of solid fats, refined grains, cheese, added sugar, and processed meat.

Women who followed the first eating pattern had a lower rate of preeclampsia than those who followed the second.

When Maldonado and his team tested for a correlation between lower rates of preeclampsia and the Healthy Eating Index-2015, they found it was not statistically significant except for women who were overweight before pregnancy.

The Healthy Eating Index includes combinations of nutrients and foods, like dairy and fatty acids. Maldonado said more research is needed to determine the exact profile of fruits, vegetables, and oils that could benefit Latina women.

When it comes to diet, the right messaging and recommendations are vital to helping pregnant Latinas make informed decisions, said A. Susana Ramírez, an associate professor of public health communication at the University of California-Merced.

Ramírez has conducted studies on why healthy-eating messages, while well intended, have not been successful in Hispanic communities. She found that the messaging has led some Latinos to believe that Mexican food is unhealthier than American food.

Ramírez said we need to think about promoting diets that are relevant for a particular population. “We understand now that diet is enormously important for health, and so to the extent that any nutrition counseling is culturally consonant, that will improve health overall,” Ramírez said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Doctors take on dental duties to reach low-income and uninsured patients

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Kate Ruder | (TNS) KFF Health News

DENVER — Pediatrician Patricia Braun and her team saw roughly 100 children at a community health clinic on a recent Monday. They gave flu shots and treatments for illnesses like ear infections. But Braun also did something most primary care doctors don’t. She peered inside mouths searching for cavities or she brushed fluoride varnish on their teeth.

“We’re seeing more oral disease than the general population. There is a bigger need,” Braun said of the patients she treats at Bernard F. Gipson Eastside Family Health Center, which is part of Denver Health, the largest safety-net hospital in Colorado, serving low-income, uninsured, and underinsured residents.

Braun is part of a trend across the United States to integrate oral health into medical checkups for children, pregnant women, and others who cannot afford or do not have easy access to dentists. With federal and private funding, these programs have expanded in the past 10 years, but they face socioeconomic barriers, workforce shortages, and the challenge of dealing with the needs of new immigrants.

With a five-year, $6 million federal grant, Braun and her colleagues have helped train 250 primary care providers in oral health in Colorado, Montana, Wyoming, and Arizona. Similar projects are wrapping up in Illinois, Michigan, Virginia, and New York, funded by the federal Health Resources and Services Administration’s Maternal and Child Health Bureau. Beyond assessment, education, and preventive care, primary care providers refer patients to on- or off-site dentists, or work with embedded dental hygienists as part of their practice.

“Federally qualified health centers have a long history of co-locating dental services within their systems,” Braun said. “We’re taking that next step where care is not just co-located, meaning, say, we’re upstairs and dental is downstairs, but we’re integrated so that it becomes part of the same visit for the patient.”

Pediatrician Patricia Braun (left) and registered dental hygienist Valerie Cuzella, who works with Braun and other Denver Health pediatricians, sit in Cuzella’s office. (Kate Ruder/KFF Health News/TNS

Having doctors, nurses, and physician assistants who assess oral health, make referrals, and apply fluoride at community health centers is critical for the many children who lack access to dental care, said Tara Callaghan, director of operations for the Montana Primary Care Association, which represents 14 federally qualified health centers and five Urban Indian organizations.

“Providing these services during medical visits increases the frequency of fluoride application,” Callaghan said, and “improves parents’ knowledge of caring for their child’s teeth.” But obstacles remain.

Because of Montana’s large geographic area and small population, recruiting dental professionals is difficult, Callaghan said. Fifty of the state’s 56 counties are designated dental shortage areas and some counties don’t have a single dentist who takes Medicaid, she added. Montana ranks near the bottom for residents having access to fluoridated water, which can prevent cavities and strengthen teeth.

Pediatric dental specialists, in particular, are scarce in rural areas, with families sometimes driving hours to neighboring counties for care, she said.

Embedding dental hygienists with medical doctors is one way to reach patients in a single medical visit.

Valerie Cuzella, a registered dental hygienist, works closely with Braun and others at Denver Health, which serves nearly half of the city’s children and has embedded hygienists in five of its clinics that see children.

State regulations vary on which services hygienists can provide without supervision from a dentist. In Colorado, Cuzella can, among other things, independently perform X-rays and apply silver diamine fluoride, a tool to harden teeth and slow decay. She does all this in a cozy corner office.

Braun and Cuzella work so closely that they often finish each other’s sentences. Throughout the day they text each other, taking advantage of brief lulls when Cuzella can pop into an exam room to check for gum disease or demonstrate good brushing habits. Braun herself takes similar opportunities to assess oral health during her exams, and both focus on educating parents.

Medical and dental care have traditionally been siloed. “Schools are getting better at interprofessional collaboration and education, but by and large we train separately, we practice separately,” said Katy Battani, a registered dental hygienist and assistant professor at Georgetown University.

Battani is trying to bridge the divide by helping community health centers in nine states — including California, Texas, and Maryland — integrate dental care into prenatal visits for pregnant women. Pregnancy creates opportunities to improve oral health because some women gain dental coverage with Medicaid and see providers at least once a month, Battani said.

In Denver, housing instability, language barriers, lack of transportation, and the “astronomical cost” of dentistry without insurance make dental care inaccessible for many children, the migrant community, and seniors, said Sung Cho, a dentist who oversees the dental program at STRIDE Community Health Center, serving the Denver metro area.

Dentist Sung Cho oversees the dental program at STRIDE Community Health Center. (Kate Ruder/KFF Health News/TNS)

STRIDE tries to overcome these barriers by offering interpretation services and a sliding pay scale for those without insurance. That includes people like Celinda Ochoa, 35, of Wheat Ridge, who waited at STRIDE Community Health Center while her 15-year-old son, Alexander, had his teeth cleaned. He was flagged for dental care during a past medical checkup and now he and his three siblings regularly see a dentist and hygienist at STRIDE.

One of Ochoa’s children has Medicaid dental coverage, but her three others are uninsured, and they couldn’t otherwise afford dental care, said Ochoa. STRIDE offers an exam, X-rays, and cleaning for $60 for the uninsured.

In the past year, Cho has seen an influx of migrants and refugees who have never seen a dentist before and need extensive care. Medical exams for refugees at STRIDE increased to 1,700 in 2023 from 1,300 in 2022, said Ryn Moravec, STRIDE’s director of development. She estimates the program has seen 800 to 1,000 new immigrants in 2024.

Even with growing needs, Cho said the Medicaid “unwinding” — the process underway to reexamine post-pandemic eligibility for the government program that provides health coverage for people with low incomes and disabilities — has created financial uncertainty. He said he worries about meeting the upfront costs of new staff and of replacing aging dental equipment.

At STRIDE’s Wheat Ridge clinic, two hygienists float between dental and pediatrics as part of the medical-dental integration. Yet Cho said he needs more hygienists at other locations to keep up with demand. The pandemic created bottlenecks of need that are only now being slowly cleared, particularly because few dentists take Medicaid. If they do accept it, they often limit the number of Medicaid patients they’ll take, said Moravec. Ideally, STRIDE could hire two hygienists and three dental assistants, Moravec said.

In 2022, Colorado enacted a law to alleviate workforce shortages by allowing dental therapists— midlevel providers who do preventive and restorative care — to practice. But Colorado does not have any schools to train or accredit them.

Before age 3, children are scheduled to see a pediatrician for 12 well visits, a metric that medical and dental integration capitalizes on, particularly for at-risk children. As part of Braun’s program in the Rocky Mountain region, providers have applied more than 17,000 fluoride varnishes and increased the percentage of children 3 and younger who received preventive oral health care to 78% from 33% in its first 2½ years.

Callaghan, at the Montana Primary Care Association, witnesses that on the ground at community health centers in Montana. “It’s about leveraging the fact that kids see their medical provider for a well-child visit much more often and before they see their dental provider — if they have one.”

___

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Emily Blomberg named president of Regions Hospital and the Regions Hospital Foundation

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Emily Blomberg. (Courtesy of HealthPartners)

Emily Blomberg has been named president of Regions Hospital and the Regions Hospital Foundation.

Blomberg, a Rochester, Minn., native, brings local and national health care leadership to HealthPartners, according to the announcement of her appointment. She recently served as chief operating officer for University of Iowa Hospitals & Clinics.

“Throughout Emily’s leadership career, she has shown a deep commitment to quality improvement, health equity and colleague engagement,” said Andrea Walsh, HealthPartners president and CEO, in a statement. “We’re looking forward to what she will bring to our team as we care for patients in St. Paul and the broader community.”

In 2019, Blomberg received 40 Under 40 honors from the Minneapolis/St. Paul Business Journal when she was Hennepin Healthcare’s chief operating officer, a position she had from 2017 to 2022. Also, she had several roles at the University of Texas Medical Branch in Galveston from 2010 to 2017, including health system operations vice president, associate vice president and director.

Blomberg starts at Regions on June 13. She will report to Megan Remark, who was Regions president since 2015 before being named chief operating officer of the HealthPartners care group in March. Regions Hospital has been part of HealthPartners since 1993.

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Loons’ Robin Lod in company of MLS stars, but will still pass on spotlight

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Robin Lod’s hot start this season has the Loons midfielder in danger of finally shedding his long-held status as one of the most underrated players in MLS.

The Finnish international has three goals and five assists through seven games in 2024, and those eight total goal contributions are on par or just off the pace of some of MLS brightest stars. Lod is tied with 2023 MLS MVP Lucho Acosta in Cincinnati and two behind Inter Miami superstars Leo Messi and Luis Suarez.

“It’s something I’ve been working on, especially coming from the injury,” Lod said Tuesday in reference to his season-ending meniscus injury suffered 11 months ago. “I feel like I have a lot of energy and (hunger) to show up. It’s something I’ve been focusing on to just have those goal contributions to help the team.”

Lod doesn’t pay too much attention to the company he now keeps and is content in continuing to shirk the spotlight.

“I don’t need that extra” attention, Lod said. “I know when I’m playing good. It’s enough that the coach is here (and) likes what I do. That’s all that matters for me.”

New MNUFC head coach Eric Ramsay now highly rates Lod.

“He is one of those players that you can’t appreciate quite how good of a player he is until you’ve seen him up close and you can appreciate how he can execute various ways of playing,” Ramsay said. “He can play within different systems. Obviously, he’s relatively both footed, athletic.”

Ramsay said Lod has built himself up to 100 percent in the last few weeks, an elite level on display late in games when he has set up Tani Oluwaseyi and Franco Fragapane’s goals against Real Salt Lake and Houston Dynamo at Allianz Field earlier this month.

Lod then assisted on Oluwaseyi and Hassani Dotson’s goals and Lod scored one of his own in the 3-0 win at Charlotte FC on Sunday.

“He’s also getting back to his best as well; he would say that himself,” Ramsay said. “… You’ve seen him in the last two or three games that he’s finishing the games really strong. As the game starts to open up, he comes into his own. He’s a really good player for the MLS for this level and he’s brilliant to work with.”

Window shutting quietly

MNUFC was not expected to make any significant roster moves with the MLS primary transfer window set to close Tuesday.

That has been by design.

Loons Chief Soccer Officer Khaled El-Ahmad, who has only slightly tinkered with the roster he inherited this year, is keeping the salary flexibility and open roster spots available for what is expected to be a more active summer transfer window.

MLS is expected, according to The Athletic, to implement two roster paths for clubs: No. 1: Clubs can have up to two Designated Players and four Under-22 Initiative spots, plus $2 million in General Allocation Money (GAM). Or No. 2: Clubs can carry three DPs and three U-22 players.

The Loons are expected to pursue the two DP/four U22 route, which would further help them achieve one of their goals of creating a younger team for the future.

The summer transfer window runs from July 18 to Aug. 14, and it might include offloading absentee DP Emanuel Reynoso to another club via intra-league trade or transfer outside of MLS.

Briefly

Winger Sang Bin Jeong suffered a muscle cramp when he was stretchered off the field in South Korea’s Asian Cup Under-23 win over Japan on Monday, Ramsay said. Jeong will remain with his national team in its Olympic qualifying tournament, which continues in the knockout stage versus. Indonesia on Thursday. He will miss Loons-Sporting Kansas City match in St. Paul on Saturday. … Coming off a hat trick in MNUFC2’s 4-3 win Sunday, mdifeidler Carlos Harvey might see an opportunity with the first team in the near future. “He’s had a really good couple of week,” Ramsay said. “He’s notably improving on his level of fitness and readiness and obviously he’s had a couple of really good impacts on the second team. Every time he has been with (the first team), he has trained really well recently. I think his chance (in MLS) is just around the corner.”