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>>MY NAME IS MARRAH SCROGGINS,

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PROGRAM DIRECTOR IN DIVISION OF

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LUNG DISEASES AT THE NATIONAL

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HEART LUNG AND BLOOD INSTITUTE.

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I'M SERVING AS CO-CHAIR OF THE

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INSTITUTE WOMEN'S HEALTH WORKING

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GROUP.

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AND ON BEHALF OF AN NIH

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TRANS-NIH ORGANIZING COMMITTEE

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FOR THIS WORKSHOP, I WOULD LIKE

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TO EXTEND A WELCOME TO THE

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NEARLY 800 ATTENDEES WHO WILL BE

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JOINING US TODAY AND TOMORROW

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FOR THE BUILDING UNIFYING

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SYSTEMS OF CARE ADDRESSING

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CO-MORBIDITIES IN WOMEN AND

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GIRLS WORKSHOP WHICH IS

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SPONSORED BY THE NATIONAL HEART

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LUNG AND BLOOD INSTITUTE.

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NEXT SLIDE.

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I WOULD LIKE TO KICK OFF WITH A

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FEW SLIDES HIGHLIGHTING THE THE

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WORKSHOP CHARGE AND PURPOSE.

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THE PURPOSE OF THE WORKSHOP IS

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TO ADDRESS A NEED TO DEVELOP

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SUPPORT CONTINUUMS OF CARE WHICH

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WILL ADVANCE THE HEALTH OF

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RACIALETH IN THIS CASE DIVERSE

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WOMEN OF REPRODUCTIVE AGE WITH

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COMPLEX HEALTH CONDITIONS.

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TO ACHIEVE THIS GOAL THIS

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WORKSHOP WILL ADDRESS CURRENT

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GAPS AND OPPORTUNITIES TO

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IMPLEMENTING COMMUNITY ENGAGE

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RESEARCH, DESIGNED TO INCREASE

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THE ADOPTION OF INTEGRATED SET

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OF EVIDENCE BASED PRACTICES THAT

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ARE DELIVERED ACROSS HEALTHCARE

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SYSTEMS INCLUDING PRIMARY

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SPECIALTY BEHAVIORAL HEALTH AND

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COMMUNITY BASED HEALTHCARE

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SETTINGS.

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SEVERAL GOALS OF THIS WORKSHOP

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INCLUDE PROMOTING EDUCATION AND

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TRAINING ON INTEGRATIVE

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HEALTHCARE SUPPORTING

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INTEGRATION AND COORDINATION OF

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HEALTHCARE SERVICES, TO MEET THE

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NEEDS OF HEALTH AND SOCIAL

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DEVELOPMENT OF RACIAL ETHNIC

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UNDERSERVED WOMEN OF

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REPRODUCTIVE AGE ALL THE WHILE

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LEVERAGING EXISTING FEDERAL

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STATE AND LOCAL RESOURCES AS

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WELL AS COLLABORATIONS FOR

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ALIGNING COMMUNITY AND CLINICAL

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SERVICES ALL WITH THE GOAL OF

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ADDRESSING MULTI-MORBIDITY FOR

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WOMEN ACROSS LIFESPANS.

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RISING RATES IN ANXIETY AND

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DEPRESSION AMONG U.S. WOMEN ARE

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ACTING AS IMPORTANT DRIVERS FOR

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THE SHARP INCREASE OF HARMFUL

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ALCOHOL AND SUBSTANCE USE.

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IT MAYBE ALSO RELATED TO

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INCREASES IN OVERDOSE RELATED

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DEATH, PARTICULARLY IN WOMEN OF

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REPRODUCTIVE AGE.

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OVER THE PAST TWO DECADES

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OVERDOSES IN WOMEN HAS INCREASE

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BY 400% AND OPIOID CRISIS

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DISPROPORTIONATELY AFFECTS

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RACIAL ETHNIC WOMEN.

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ADDITIONALLY MENTAL ILLNESS

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INCLUDING MAJOR DEPRESSIVE

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DISORDERS AS WELL AS ABUSE OF

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SUBSTANCES OBESITY AND

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UNDERLYING METABOLIC DISORDERS

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SUCH AS DIABETES INCREASES THE

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RISK FOR CARDIOVASCULAR AND

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OTHER CARDIO PULMONARY DISEASE

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IN WOMEN.

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THE INTERSECTION OF THESE

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PROCESSES MAYBE PARTICULARLY

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IMPORTANT AND IMPACT MATERNAL

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HEALTH ACROSS PREGNANCY

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CHILDBIRTH SUCH AS INCREASING

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THE RISK OF PREECLAMPSIA, AND

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MAY ALSO RELATE TO CONDITIONS

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BEYOND PREGNANCY INCLUDING

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POSTPARTUM DEPRESSION.

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RESEARCH HAS FOUND THAT THERE

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ARE MULTIPLE FACTORS THAT

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CONTRIBUTE TO THESE DISPARITIES

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SUCH AS ACCESS TO QUALITY

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HEALTHCARE MULTIPLE CHRONIC

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UNDERLYING CONDITIONS,

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STRUCTURAL RACISM AND IMPLICIT

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BIAS.

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TO ADDRESS THESE COMMON

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CO-OCCURRING CONDITIONS WE HAVE

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BROUGHT TOGETHER VARIOUS EXPERTS

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AND STAKEHOLDERS TO HELP US FIND

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A PATH TOWARDS CONTINUUM OF CARE

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APPROACH THAT INTEGRATE PRIMARY

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CARE REPRODUCTIVE HEALTH

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BEHAVIORAL HEALTH AND CARDIO

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PULMONARY SPECIALTIES THAT

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ADDRESS HEALTH IN EACH DOMAIN

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AND HAVE GREATEST IMPACT TO

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HEALTH OF RACIAL ETHNIC WOMEN

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WHO ARE AT HIGHER RISK FOR LIFE

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LONG CHRONIC HEALTH CONDITIONS.

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BEFORE I INTRODUCE YOU TO

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REMAINDER OF THE WORKSHOP

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ORGANIZING TEAM I WANT TO TAKE A

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MOMENT TO RECOGNIZE ONE OUR

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COLLEAGUES DR. REBECCA WIG GINS.

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WE HEARD OF HER PASSING AND I

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WANTED TO GIVE HER A MOMENT OF

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REMEMBRANCE AT THIS WORKSHOP AS

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SHE WAS A TIRELESS ADVOCATED FOR

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WOMEN'S HEALTH RESEARCH.

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MANY ATTENDEES AT THIS WORKSHOP

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MAY HAVE WORKED WITH HER OVER

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DURING THE 30 YEARS FEDERAL

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SERVICE AND HER TIME AT THE NIH

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AND REISN'TLY WORKING IN OFFICE

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OF RESEARCH WOMEN'S HEALTH

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SUPPORTING SPECIALIZED ON SEX

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DIFFERENCES PROGRAMS VARIOUS

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INTERSECTION OF SEX AND GENDER

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RESEARCH PROGRAMS AS WELL AS

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BEING A CORE TEAM MEMBER OF THE

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SEX AS BIOLOGICAL VARIABLE

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RESEARCH PROGRAM.

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REBECCA WILL BE MISSED AND IF

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YOU WISH YOU MAY LEAVE MEMORIES

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FOR HER FRIENDS AND FAMILY AT

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THE LINK PROVIDED IN THIS SLIDE.

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NEXT SLIDE PLEASE.

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AT THIS TIME I WANT TO RECOGNIZE

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OUR TWO WORKSHOP CO-CHAIRS DR.

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JOHNSON AND GENDER, BOTH

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INSTRUMENTAL HELPING IDENTIFY

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SUBJECT MATTER EXPERTS TO

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PRESENT AT THIS WORKSHOP.

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THEY WILL HELP FACILITATE

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CONVERSATION BETWEEN YOU AS

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ATTENDEES AS PANELIST, AS A

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WORKSHOP PARTICIPANT YOU CAN

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SUBMIT QUESTIONS IN THE Q&A

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MODULE DURING THE WORKSHOP TO

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ENGAGE ANY PRESENTERS.

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THE CO-CHAIRS WILL LEAD THE

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WORKSHOP CLOSE OUT SESSION ON

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DAY TWO WHERE GROUP OF PANELISTS

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WILL DISCUSS MANY GAPS IN THE

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HEALTHCARE DELIVERY SYSTEM AND

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HOW WE CAN BE LEVERAGING VARIOUS

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OPPORTUNITIES DURING THE THE

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TRANSITION PERIODS TO IMPLEMENT

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EVIDENCE BASED PRACTICES THAT

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FACILITATE THE DELIVERY OF

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INTEGRATIVE INTERVENTIONS TO

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ADDRESS THE INTERSEXUALITY OF

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COMMON CO-OCCURRING CONDITIONS

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AND ADDRESS RACIAL ETHNIC

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DISPARITIES AND ENGAGEMENT

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RECEIPT AND RETENTION IN THE

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HEALTHCARE TREATMENT AMONG

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HISTORICALLY MARGINALIZED WOMEN

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WITH CO-MORBIDITIES.

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NEXT SLIDE.

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IT IS MY PLEASURE TO INTRODUCE

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YOU TO REMAINDER OF THE

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TRANS-NIH ORGANIZING COMMITTEE

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WHO ARE MEMBERS OF THE TRANS-NIH

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WORKING GROUP ON ADDRESSING

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COMMON CO-MORBIDITIES IN WOMEN

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AN GIRLS.

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DR. LAURIE DONZE FROM NHLBI DR.

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TAMARA JOHNSON NIMH, DR. DIEDRA

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ROACH FROM NIAAA AND DR. SMITH

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AND HOLLY MOORE FROM NIDA.

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EACH OF THESE MEMBERS WILL BE

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FACILITATING CONVERSATIONS

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THROUGHOUT THE WORKSHOP AND MANY

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OF THEM WILL ALSO BE MODERATING

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OUR WORKSHOP SESSIONS.

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NEXT SLIDE.

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TO HELP US KICK OFF THIS MEETING

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WE WILL HAVE SOME WELCOMING

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REMARKS FROM DR. KOOB, DIRECTOR

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OF NATIONAL INSTITUTE ON ALCOHOL

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ABUSE AND ALCOHOLISM AND HAS

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BEEN A STRONG CHAMPION FOR THE

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WORK OF THE TRANS-NIH WORKING

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GROUP ON ADDRESSING COMMON

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CO-MORBIDITIES IN WOMEN AND

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GIRLS, SINCE INCEPTION TWO YEARS

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AGO.

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SINCE THEN HE'S CONSISTENTLY

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OFFERED SUPPORT AND GUIDANCE TO

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OUR WORKING GROUP AND HAS

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SIGNIFICANTLY EXPANDED THE

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CONVERSATION ON BUILDING

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UNIFYING SYSTEMS OF CARE TO

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ADDRESS MULTI-MORBIDITY IN WOMEN

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AND GIRLS AMONG THE RANKS OF NIH

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SENIOR LEADERSHIP.

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AFTER DR. KOOB WE WILL HAVE AN

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INTRODUCTION FROM DR.IA JEAN

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CLAYTON ASSOCIATE DIRECTOR FOR

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RESEARCH ON WOMEN'S HEALTH AND

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DIRECTOR OF THE OFFICE OF

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RESEARCH ON WOMEN'S HEALTH WHO

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WILL BRIEFLY HIGHLIGHT HOW THIS

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WORKSHOP FITS WITHIN THE 2019,

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2023 TRANS-NIH STRATEGIC PLAN

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FOR WOMEN'S HEALTH RESEARCH.

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FOLLOWING THE TWO DIRECTORS

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REMARKS WE WILL HAVE DR. TEMKIN

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WHO SERVES AS ASSOCIATE DIRECTOR

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FOR CLINICAL RESEARCH AT OFFICE

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OF WOMEN'S HEALTH AND SHE WILL

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STRESS THE IMPORTANCE OF

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ADDRESSING CHRONIC DEBILITATING

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CONDITIONS IN WOMEN AS A

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FRAMEWORK FOR WHY WE NEED TO

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CREATE HEALTHCARE CONTINUUMS

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THAT ADDRESS MULTI-MORBIDITY

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ACROSS THE LIFE SPAN.

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WITH THAT, I WOULD LIKE TO THANK

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YOU ONCE AGAIN FOR JOINING OUR

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WORKSHOP AND I WILL TURN THIS

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MEETING OVER TO DR. KOOB.

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>> GOOD MORNING.

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GOOD DAY, EVERYONE.

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SO I WOULD LIKE TO EXTEND A WARM

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WELCOME TO THE SPEAKERS AND

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AUDIENCE MEMBERS TO WHAT

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PROMISES TO BE A VERY THOUGHT

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PROVOKING WORKSHOP.

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I AM DIRECTOR OF THE NATIONAL

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INSTITUTE ON ALCOHOL ABUSE AND

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ALCOHOLISM AND OF COURSE ALCOHOL

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IS A TERRIFIC BURDEN ON THE

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TARGETS THAT Y'ALL ARE

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INTERESTED IN IN TODAY'S

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WORKSHOP.

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FROM MY PERSPECTIVE THE

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CONVERSATION WE ARE ABOUT TO

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BEGIN COULD NOT BE MORE TIMELY

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OR MORE CRITICALLY IMPORTANT.

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THE PROPORTION OF U.S. ADULTS

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WITH CHRONIC CONDITIONS MULTIPLE

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CHRONIC CONDITIONS ESTIMATED TO

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BE 42% OR HIGHER PARTICULARLY

260
00:08:18,160 --> 00:08:22,320
AMONG ADULTS 65 AND OLDER AND

261
00:08:22,320 --> 00:08:24,040
THIS ME RICK SEEMS TO BE

262
00:08:24,040 --> 00:08:26,360
STEADILY INCREASING.

263
00:08:26,360 --> 00:08:27,640
THE PREVALENCE OF MULTIPLE

264
00:08:27,640 --> 00:08:29,320
CHRONIC CONDITIONS MAYBE TWICE

265
00:08:29,320 --> 00:08:31,000
AS HIGH AMONG PEOPLE LIVING IN

266
00:08:31,000 --> 00:08:33,880
POVERTY COMPARED TO THOSE LIVING

267
00:08:33,880 --> 00:08:38,640
AT 400% OR MORE POVERTY LEVEL,

268
00:08:38,640 --> 00:08:40,560
COVID PANDEMIC HAS ADDED FUEL TO

269
00:08:40,560 --> 00:08:42,800
THIS ALREADY RAGING FIRE CAUSING

270
00:08:42,800 --> 00:08:44,880
BY FAR THE GREATEST NUMBER OF

271
00:08:44,880 --> 00:08:46,040
HOSPITALIZATIONS AND DEATH AMONG

272
00:08:46,040 --> 00:08:48,160
THOSE WITH MULTIPLE CHRONIC

273
00:08:48,160 --> 00:08:50,040
CONDITIONS.

274
00:08:50,040 --> 00:08:51,160
PARTICULARLY AGAIN AMONG

275
00:08:51,160 --> 00:08:55,840
UNDERSERVED POPULATIONS.

276
00:08:55,840 --> 00:08:57,640
LESS WELL KNOWN MOUNTING

277
00:08:57,640 --> 00:08:58,840
EVIDENCE THE PHENOMENON OF

278
00:08:58,840 --> 00:09:01,280
MULTIPLE CHRONIC CONDITIONS IS

279
00:09:01,280 --> 00:09:03,960
HAVING A SIGNIFICANTLY GREATER

280
00:09:03,960 --> 00:09:06,720
AMONG WOMEN AND GIRLS THAN MEN

281
00:09:06,720 --> 00:09:10,240
AND AMONG SOME OTHER GROUPS IS

282
00:09:10,240 --> 00:09:11,960
VERY IMPORTANT.

283
00:09:11,960 --> 00:09:14,400
AND BECOMING MORE AND MORE

284
00:09:14,400 --> 00:09:15,080
EVIDENT.

285
00:09:15,080 --> 00:09:17,200
EVEN BEFORE COVID THE DATA WERE

286
00:09:17,200 --> 00:09:18,000
ALREADY TELLING US THAT WITH

287
00:09:18,000 --> 00:09:19,440
REGARD TO MENTAL HEALTH AND

288
00:09:19,440 --> 00:09:21,640
SUBSTANCE USE DISORDERS U.S. --

289
00:09:21,640 --> 00:09:23,200
IN THE U.S. WOMEN ARE IN STATE

290
00:09:23,200 --> 00:09:24,560
OF CRISIS.

291
00:09:24,560 --> 00:09:26,120
IS EVIDENCE BY SOME OF THE

292
00:09:26,120 --> 00:09:26,840
FOLLOWING.

293
00:09:26,840 --> 00:09:28,200
THERE'S SIGNIFICANT INCREASE IN

294
00:09:28,200 --> 00:09:31,640
THE NUMBER OF ADOLESCENTS WITH

295
00:09:31,640 --> 00:09:34,600
PAST YEAR MAJOR DEPRESSSIVE

296
00:09:34,600 --> 00:09:35,840
EPISODES DRIVEN BY INCREASE IN

297
00:09:35,840 --> 00:09:37,640
MAJOR DEPRESSION AMONG GIRLS.

298
00:09:37,640 --> 00:09:38,720
INCREASE RATES ATTEMPTED

299
00:09:38,720 --> 00:09:40,480
COMPLETED SUICIDE AMONG

300
00:09:40,480 --> 00:09:41,840
ADOLESCENT GIRLS AND YOUNG

301
00:09:41,840 --> 00:09:44,400
WOMEN, RAPIDLY ESCALATING RATES

302
00:09:44,400 --> 00:09:46,040
OF ALCOHOL RELATED EMERGENCY

303
00:09:46,040 --> 00:09:48,520
DEPARTMENT VISITS.

304
00:09:48,520 --> 00:09:51,240
WITH THE RATE AMONG WOMEN

305
00:09:51,240 --> 00:09:53,160
OUTPACING RATE AMONG MEN IN

306
00:09:53,160 --> 00:09:55,720
EVERY AGE GROUP BETWEEN 2000 AND

307
00:09:55,720 --> 00:09:57,840
2015, INCREASE IN AGE ADJUSTED

308
00:09:57,840 --> 00:09:59,640
DEATH RATE FROM ALCOHOL RELATED

309
00:09:59,640 --> 00:10:03,160
LIVER CIRRHOSIS IN WOMEN.

310
00:10:03,160 --> 00:10:06,880
IN A RECENT INTERACTION WITH THE

311
00:10:06,880 --> 00:10:09,360
AMERICAN SOCIETY OF LIVER

312
00:10:09,360 --> 00:10:10,360
DISEASE THEY BASICALLY ARE

313
00:10:10,360 --> 00:10:13,440
TALKING ABOUT A PANDEMIC OF

314
00:10:13,440 --> 00:10:16,760
ALCOHOL ASSOCIATED LIVER DISEASE

315
00:10:16,760 --> 00:10:20,920
THAT HAS BEEN EXACERBATED BY THE

316
00:10:20,920 --> 00:10:21,400
PANDEMIC.

317
00:10:21,400 --> 00:10:24,000
THE COVID PANDEMIC.

318
00:10:24,000 --> 00:10:25,240
SO THERE ARE SPECIFIC TIMES IN

319
00:10:25,240 --> 00:10:27,040
LIFE CYCLE OF WOMEN WHEN THEY

320
00:10:27,040 --> 00:10:29,120
ARE UNIQUELY VULNERABLE TO HEART

321
00:10:29,120 --> 00:10:32,440
AND MENTAL HEALTH CO-MORBIDITIES

322
00:10:32,440 --> 00:10:34,440
INCLUDING THE PERIPARTUM AND THE

323
00:10:34,440 --> 00:10:36,040
MENOPAUSE TRANSITION.

324
00:10:36,040 --> 00:10:37,800
BEFORE NOW THE BIOMEDICAL

325
00:10:37,800 --> 00:10:39,040
RESEARCH ENTERPRISE APPROACH

326
00:10:39,040 --> 00:10:40,640
COMMONLY OCCURRING

327
00:10:40,640 --> 00:10:41,760
CO-MORBIDITIES FOR THE MOST PART

328
00:10:41,760 --> 00:10:44,320
AND FRAGMENTED WAY MA MIRRORS

329
00:10:44,320 --> 00:10:48,160
THE FRAGMENTED WAY THAT ARE

330
00:10:48,160 --> 00:10:49,520
ADDRESSED IN MEDICAL PRACTICE IN

331
00:10:49,520 --> 00:10:51,560
GENERAL MULTIPLE ISOLATED

332
00:10:51,560 --> 00:10:52,680
CONDITIONS EXISTING SIDE BY SIDE

333
00:10:52,680 --> 00:10:53,440
IN THE SAME PERSON.

334
00:10:53,440 --> 00:10:54,960
THIS WORKSHOP IS PARTS OF

335
00:10:54,960 --> 00:10:56,960
GROWING EFFORT TO SHIFT THE

336
00:10:56,960 --> 00:10:57,840
CONVERSATION AWAY FROM THE

337
00:10:57,840 --> 00:11:01,160
NARRATIVE THAT FRAMES THE

338
00:11:01,160 --> 00:11:02,920
PHENOMENON MULTI-MORBIDITY AMONG

339
00:11:02,920 --> 00:11:04,360
WOMEN AS MULTIPLE ISOLATED

340
00:11:04,360 --> 00:11:06,120
CONDITIONS OCCURRING IN A SINGLE

341
00:11:06,120 --> 00:11:07,440
WOMAN OR GIRL.

342
00:11:07,440 --> 00:11:10,520
A BROKEN AND FRAGMENTED FRAME TO

343
00:11:10,520 --> 00:11:12,600
WHICH IS ENDEMIC FRAME THAT

344
00:11:12,600 --> 00:11:15,040
RECOGNIZES THAT THESE CONDITIONS

345
00:11:15,040 --> 00:11:17,240
OFTEN HAVE COMMON SOCIAL MENTAL

346
00:11:17,240 --> 00:11:21,080
HEALTH DETERMINANTS OVERLAPPING

347
00:11:21,080 --> 00:11:22,520
PATHOPHYSIOLOGY COMPLEX CLINICAL

348
00:11:22,520 --> 00:11:24,640
COURSE MORE SEVERE THAN

349
00:11:24,640 --> 00:11:26,080
CONDITION IN ISOLATION AN

350
00:11:26,080 --> 00:11:27,520
COMPLEX TREATMENT AND CLINICAL

351
00:11:27,520 --> 00:11:29,240
SUPPORT EXTENDING FAR BEYOND THE

352
00:11:29,240 --> 00:11:32,200
NEED FOR APPROPRIATE TREATMENT

353
00:11:32,200 --> 00:11:33,520
OF ACUTE DISEASE AND

354
00:11:33,520 --> 00:11:36,280
EXACERBATION OF CHRONIC DISEASE.

355
00:11:36,280 --> 00:11:37,440
I THINK EVERYBODY WHO IS

356
00:11:37,440 --> 00:11:39,680
PARTICIPATED IN OUR MEDICAL

357
00:11:39,680 --> 00:11:40,600
SYSTEM HAS PROBABLY EXPERIENCED

358
00:11:40,600 --> 00:11:44,880
WHAT I JUST OUTLINED AND WE

359
00:11:44,880 --> 00:11:45,960
REALLY NEED WHAT Y'ALL ARE GOING

360
00:11:45,960 --> 00:11:47,360
TO BE COVERING TODAY IN THIS

361
00:11:47,360 --> 00:11:49,680
WORKSHOP.

362
00:11:49,680 --> 00:11:51,600
THE WORKSHOP BRINGS TOGETHER

363
00:11:51,600 --> 00:11:53,040
SOME OF THE BEST LINES IN THE

364
00:11:53,040 --> 00:11:53,880
FIELD WITH SHARED UNDERSTANDING

365
00:11:53,880 --> 00:11:56,360
THAT MEETING THESE UNPRECEDENTED

366
00:11:56,360 --> 00:11:57,760
CHALLENGES WILL REQUIRE

367
00:11:57,760 --> 00:11:59,440
UNPRECEDENTED CREATIVITY AND

368
00:11:59,440 --> 00:12:00,640
INNOVATION HELPING THE BEST OF

369
00:12:00,640 --> 00:12:02,720
EXISTING RESOURCES AND

370
00:12:02,720 --> 00:12:04,840
GENERATING NEW RESOURCES THAT

371
00:12:04,840 --> 00:12:07,040
WILL ENABLE EFFECTIVE

372
00:12:07,040 --> 00:12:09,040
INTEGRATIVE APPROACHES TO THE

373
00:12:09,040 --> 00:12:10,160
PREVENTION SCREENING DIAGNOSIS

374
00:12:10,160 --> 00:12:11,640
AND TREATMENT OF MULTIPLE

375
00:12:11,640 --> 00:12:13,000
CHRONIC CONDITIONS.

376
00:12:13,000 --> 00:12:15,000
IN WOMEN AND GIRLS.

377
00:12:15,000 --> 00:12:16,680
EQUALLY IMPORTANT, THIS WORKSHOP

378
00:12:16,680 --> 00:12:18,920
WILL HIGHLIGHT KEY

379
00:12:18,920 --> 00:12:20,040
INFRASTRUCTURE NECESSARY TO

380
00:12:20,040 --> 00:12:22,040
DELIVER STATE OF THE ART

381
00:12:22,040 --> 00:12:23,360
INTEGRATIVE TREATMENT WITHIN

382
00:12:23,360 --> 00:12:26,440
UNIFIED DATA DRIVEN SYSTEMS OF

383
00:12:26,440 --> 00:12:26,920
CARE.

384
00:12:26,920 --> 00:12:29,720
SO AGAIN I WOULD LIKE TO EXTEND

385
00:12:29,720 --> 00:12:33,440
A WARM WELCOME TO EVERYONE AND

386
00:12:33,440 --> 00:12:34,920
TO SOME OF THE MOST BRILLIANT

387
00:12:34,920 --> 00:12:36,400
MINDS IN THE FIELD WHO WILL BE

388
00:12:36,400 --> 00:12:37,400
PARTICIPATING FROM OUR SPEAKERS

389
00:12:37,400 --> 00:12:40,640
AND AUDIENCE MEMBERS AND AGAIN I

390
00:12:40,640 --> 00:12:42,240
THINK THIS WILL BE A REALLY

391
00:12:42,240 --> 00:12:43,480
EXCELLENT WORKSHOP AND WE ARE

392
00:12:43,480 --> 00:12:45,360
REALLY EXCITED AND GRATEFUL FOR

393
00:12:45,360 --> 00:12:46,040
THIS OPPORTUNITY TO LEARN FROM

394
00:12:46,040 --> 00:12:49,720
YOU.

395
00:12:49,720 --> 00:12:51,280
CARRY ON.

396
00:12:51,280 --> 00:12:54,040
>> THANK YOU, DR. KOOB FOR THOSE

397
00:12:54,040 --> 00:12:55,320
GREAT WORDS, I APPRECIATE THE

398
00:12:55,320 --> 00:12:56,880
STATISTICS YOU PROVIDED, IT

399
00:12:56,880 --> 00:12:59,000
DRIVES POINT HOME THAT THIS

400
00:12:59,000 --> 00:13:00,880
IMPORTANT TIMELY WORKSHOP IS

401
00:13:00,880 --> 00:13:01,800
HAPPENING NOW AND I WOULD LIKE

402
00:13:01,800 --> 00:13:03,320
TO TURN IT OVER TO DR. CLAYTON.

403
00:13:03,320 --> 00:13:09,640
THANK YOU.

404
00:13:09,640 --> 00:13:10,760
GOOD MORNING, EVERYONE.

405
00:13:10,760 --> 00:13:14,440
I'M GOING TO GET THIS SET UP

406
00:13:14,440 --> 00:13:15,600
JUST RIGHT FOR YOU.

407
00:13:15,600 --> 00:13:17,040
I'M EXCITED TO BE HERE AND I

408
00:13:17,040 --> 00:13:21,240
WANT TO THANK DR. MARRAH

409
00:13:21,240 --> 00:13:22,800
LACHOWICZ SCROGGINS FOR INVITING

410
00:13:22,800 --> 00:13:24,160
ME AND THE NATIONAL HEART LUNG

411
00:13:24,160 --> 00:13:25,040
AND BLOOD INSTITUTE FOR

412
00:13:25,040 --> 00:13:26,320
LEADERSHIP AND VISION IN

413
00:13:26,320 --> 00:13:27,800
CREATING THIS WORKSHOP.

414
00:13:27,800 --> 00:13:29,640
I HOPE THAT THIS AND OTHER

415
00:13:29,640 --> 00:13:32,760
EFFORTS WILL LEAD TO NIH WIDE

416
00:13:32,760 --> 00:13:34,440
COLLABORATION IN THIS SPACE.

417
00:13:34,440 --> 00:13:36,240
THIS WORKSHOP IS SO IMPORTANT,

418
00:13:36,240 --> 00:13:37,840
YOU HEARD FROM DR. KOOB

419
00:13:37,840 --> 00:13:39,440
STAGGERING STATISTICS AROUND

420
00:13:39,440 --> 00:13:41,560
ALCOHOL USE AND THERE ARE OTHER

421
00:13:41,560 --> 00:13:42,920
STATISTICS AROUND THE WORLD OF

422
00:13:42,920 --> 00:13:44,640
TRAUMA AND VIOLENCE THAT ARE

423
00:13:44,640 --> 00:13:48,080
VERY DISTURBING INDEED.

424
00:13:48,080 --> 00:13:51,320
IN ORDER TO SHARE REMARKS I

425
00:13:51,320 --> 00:13:52,640
REALLY DELIGHTED THAT I WAS

426
00:13:52,640 --> 00:13:55,280
ASKED TO CHAIR A LITTLE ABOUT

427
00:13:55,280 --> 00:13:56,800
OFFICE OF RESEARCH WOMEN'S

428
00:13:56,800 --> 00:13:59,480
HEALTH, THE OFFICE WIDE AND

429
00:13:59,480 --> 00:14:01,000
CONTEXTUALIZE OUR REMARKS TODAY.

430
00:14:01,000 --> 00:14:02,360
THE U.S. CONGRESS IS

431
00:14:02,360 --> 00:14:03,360
PARTICULARLY INTERESTED IN

432
00:14:03,360 --> 00:14:04,960
WOMEN'S HEALTH AND RECENTLY

433
00:14:04,960 --> 00:14:07,080
ASKED NIH TO CONSIDER OUR

434
00:14:07,080 --> 00:14:09,840
RESEARCH PORTFOLIO IN THIS SPACE

435
00:14:09,840 --> 00:14:13,040
WITH ATTENTION TO MATERNAL

436
00:14:13,040 --> 00:14:14,040
MORBIDITY MORTALITY CERVICAL

437
00:14:14,040 --> 00:14:16,840
CANCER AND CHRONIC DEBILITATING

438
00:14:16,840 --> 00:14:17,840
CONDITIONS IN WOMEN.

439
00:14:17,840 --> 00:14:19,200
AS A RESULT OF THAT REQUEST WE

440
00:14:19,200 --> 00:14:21,640
RECENTLY HOST AD WOMEN'S HEALTH

441
00:14:21,640 --> 00:14:23,280
CONFERENCE AND THE CONFERENCE

442
00:14:23,280 --> 00:14:25,120
REPORT FROM THAT CONFERENCE WILL

443
00:14:25,120 --> 00:14:26,160
BE AVAILABLE SOON.

444
00:14:26,160 --> 00:14:28,240
THE CHRONIC DEBILITATING

445
00:14:28,240 --> 00:14:31,360
CONDITIONS ARENA WAS ONE OF

446
00:14:31,360 --> 00:14:32,040
INTENSE CONVERSATIONS.

447
00:14:32,040 --> 00:14:35,400
IN ADDITION THE RECENTLY

448
00:14:35,400 --> 00:14:37,040
RELEASED NIH WIDE STRATEGIC PLAN

449
00:14:37,040 --> 00:14:38,480
COVERING ALL DISEASES AND

450
00:14:38,480 --> 00:14:39,720
CONDITIONS AND ALL INSTITUTES

451
00:14:39,720 --> 00:14:42,000
AND CENTERS WAS ALSO RECENTLY

452
00:14:42,000 --> 00:14:43,640
RELEASED.

453
00:14:43,640 --> 00:14:45,440
THAT NEW PLAN CONTINUES TO

454
00:14:45,440 --> 00:14:48,400
ADVANCE VISION FOR BIOMEDICAL

455
00:14:48,400 --> 00:14:49,440
RESEARCH CAPACITY DIRECTION

456
00:14:49,440 --> 00:14:51,040
CAPACITY AND STEWARDSHIP AND

457
00:14:51,040 --> 00:14:52,200
INCLUDES FIVE CROSS CUTTING

458
00:14:52,200 --> 00:14:54,480
THEMES WHICH ENHANCING WOMEN'S

459
00:14:54,480 --> 00:14:55,840
HEALTH IS ONE.

460
00:14:55,840 --> 00:14:57,520
ONE OF THE THEME ALSO ADDRESSING

461
00:14:57,520 --> 00:14:58,960
PUBLIC HELP CHALLENGES ACROSS

462
00:14:58,960 --> 00:15:01,840
THE LIFE SPAN AND PROMOTING

463
00:15:01,840 --> 00:15:02,520
COLLABORATIVE SCIENCE.

464
00:15:02,520 --> 00:15:04,320
ALL RELEVANT TO DISCUSSION YOU

465
00:15:04,320 --> 00:15:06,240
ARE GOING TO HAVE TODAY.

466
00:15:06,240 --> 00:15:07,880
I WAS PARTICULARLY EXCITED TO

467
00:15:07,880 --> 00:15:09,440
HEAR ABOUT THE VARIETY OF AREAS

468
00:15:09,440 --> 00:15:11,640
THIS WORKSHOP WILL BE ADDRESSING

469
00:15:11,640 --> 00:15:13,240
BUILDING UNIFYING SYSTEMS OF

470
00:15:13,240 --> 00:15:16,000
CARE ADDRESSING CO-MORBIDITIES

471
00:15:16,000 --> 00:15:17,600
IN WOMEN AND GIRLS.

472
00:15:17,600 --> 00:15:19,720
TOPICS RELATED TO DEPRESSION

473
00:15:19,720 --> 00:15:20,840
CARDIO PULMONARY DISORDER

474
00:15:20,840 --> 00:15:23,200
SUBSTANCE USE DISORDERS, OBESITY

475
00:15:23,200 --> 00:15:25,000
DIABETES AND HIV AIDS WILL BE

476
00:15:25,000 --> 00:15:26,080
DISCUSSED.

477
00:15:26,080 --> 00:15:27,120
AND THERE WILL BE SPECIFIC

478
00:15:27,120 --> 00:15:28,840
ATTENTION TO CRITICAL LIFE

479
00:15:28,840 --> 00:15:31,040
PERIODS INCLUDING PREGNANT AND

480
00:15:31,040 --> 00:15:32,480
POST PAR THEM WOMEN I WOULD BE

481
00:15:32,480 --> 00:15:35,360
REMISS IF I DIDN'T INCLUDE JUST

482
00:15:35,360 --> 00:15:37,400
ONE SLIDE ON THE NIH SEX AS

483
00:15:37,400 --> 00:15:40,480
BIOLOGICAL VARIABLE AS YOU KNOW

484
00:15:40,480 --> 00:15:45,440
IN 2016 THIS POLICY WENT INTO

485
00:15:45,440 --> 00:15:46,560
EFFECT IN A NUTSHELL STATES NIH

486
00:15:46,560 --> 00:15:47,920
SEX BIOLOGICAL VARIABLE BE

487
00:15:47,920 --> 00:15:52,040
FACTORED TO RESEARCH DESIGNS

488
00:15:52,040 --> 00:15:53,800
ANALYSES AND REPORTING FOR

489
00:15:53,800 --> 00:15:54,840
VERTEBRAL ANIMAL HUMAN STUDIES

490
00:15:54,840 --> 00:15:56,520
AN JUSTIFICATION FOR LITERATURE

491
00:15:56,520 --> 00:15:57,640
OR OTHER RELEVANT CONSIDERINGS

492
00:15:57,640 --> 00:15:59,120
MUST BE PROVIDED FOR

493
00:15:59,120 --> 00:16:00,680
APPLICATIONS PROPOSING TO STUDY

494
00:16:00,680 --> 00:16:03,480
ONLY ONE SEX.

495
00:16:03,480 --> 00:16:05,480
IF WE CAN INTEGRATE SABB INTO

496
00:16:05,480 --> 00:16:06,640
THE PRE-CLINICAL RESEARCH THAT

497
00:16:06,640 --> 00:16:08,000
INFORMS THAT CLINICAL RESEARCH

498
00:16:08,000 --> 00:16:10,040
WE CAN GENERATE NEW KNOWLEDGE

499
00:16:10,040 --> 00:16:14,120
ABOUT FEMALE BIOLOGY AND FEMALE

500
00:16:14,120 --> 00:16:14,480
PATHOPHYSIOLOGY.

501
00:16:14,480 --> 00:16:16,280
OUR SCHEMATIC FOR THINKING ABOUT

502
00:16:16,280 --> 00:16:18,480
THIS IN TERMS OF THE ENTIRE

503
00:16:18,480 --> 00:16:19,840
RESEARCH CONTINUUM IS

504
00:16:19,840 --> 00:16:21,480
INCORPORATING SEX AND GENDER

505
00:16:21,480 --> 00:16:23,040
ACROSS THIS RESEARCH CONTINUUM

506
00:16:23,040 --> 00:16:24,640
FROM THOSE PRE-CLINICAL STUDIES

507
00:16:24,640 --> 00:16:27,240
TO TRANSLATION AND CLINICAL

508
00:16:27,240 --> 00:16:29,160
TRIALS CAN ADVANCE RIGOR

509
00:16:29,160 --> 00:16:32,480
DISCOVERY INNOVATION AND EQUITY.

510
00:16:32,480 --> 00:16:34,600
WITH SEX SPECIFIC RESULTS

511
00:16:34,600 --> 00:16:35,440
REPORTING, WE CAN UNDERSTAND

512
00:16:35,440 --> 00:16:36,640
BETTER TREATMENT EFFECTS IN MEN

513
00:16:36,640 --> 00:16:38,200
AND WOMEN AND SIDE EFFECTS IN

514
00:16:38,200 --> 00:16:39,120
MEN AND WOMEN.

515
00:16:39,120 --> 00:16:42,040
WE INTEGRATE PERSPECTIVES INTO

516
00:16:42,040 --> 00:16:42,840
INTERPROFESSIONAL EDUCATION,

517
00:16:42,840 --> 00:16:46,160
MEDICAL STUDENTS, TRAINEES AND

518
00:16:46,160 --> 00:16:47,840
POST DOCS LEARN ABOUT SEX AND

519
00:16:47,840 --> 00:16:49,200
GENDER HAVE ON HEALTH AND

520
00:16:49,200 --> 00:16:49,440
DISEASE.

521
00:16:49,440 --> 00:16:52,960
OF COURSE ALL THAT CAN INFORM

522
00:16:52,960 --> 00:16:54,040
POLICY AND SHOULD LEAD TO

523
00:16:54,040 --> 00:16:56,080
DELIVERY OF SEX AND GENDER WHERE

524
00:16:56,080 --> 00:16:58,880
CLINICAL CARE TO EACH AND EVERY

525
00:16:58,880 --> 00:16:59,600
PERSON.

526
00:16:59,600 --> 00:17:01,240
NIH WIDE STRATEGIC PLAN FOR

527
00:17:01,240 --> 00:17:03,680
WOMEN'S HEALTH RESEARCH WE PUT

528
00:17:03,680 --> 00:17:05,680
FORWARD THIS MULTI-DIMENSIONAL

529
00:17:05,680 --> 00:17:07,160
FRAMEWORK REPRESENTING AN

530
00:17:07,160 --> 00:17:08,280
INTERSECTION OF FACTORS

531
00:17:08,280 --> 00:17:10,640
AFFECTING THE HEALTH OF WOMEN.

532
00:17:10,640 --> 00:17:11,800
IT ALSO PUTS FORWARD RIGHT IN

533
00:17:11,800 --> 00:17:13,240
THE CENTER THERE THE LIFE COURSE

534
00:17:13,240 --> 00:17:14,760
PERSPECTIVE THAT IS SO IMPORTANT

535
00:17:14,760 --> 00:17:16,640
FOR UNDERSTANDING THE HEALTH OF

536
00:17:16,640 --> 00:17:17,040
WOMEN.

537
00:17:17,040 --> 00:17:19,640
WE HAVE BIOLOGICAL FACTORS SUCH

538
00:17:19,640 --> 00:17:22,400
AS SEX BUT OTHER MOLECULAR

539
00:17:22,400 --> 00:17:24,000
SECTOR PHYSIOLOGICAL FACTORS AS

540
00:17:24,000 --> 00:17:26,480
WELL THAT OPERATE AND WE HAVE

541
00:17:26,480 --> 00:17:29,160
EXTERNAL FACTORS THAT AFFECT

542
00:17:29,160 --> 00:17:30,560
HEALTH SUCH AS SOCIAL

543
00:17:30,560 --> 00:17:31,720
DETERMINANTS OF HEALTH INCLUDING

544
00:17:31,720 --> 00:17:33,040
GENDER ENVIRONMENTAL EXPOSURES

545
00:17:33,040 --> 00:17:36,280
OR POLICIES, THEN INTERACT WITH

546
00:17:36,280 --> 00:17:37,440
EACH OTHER ACROSS THE LIFE

547
00:17:37,440 --> 00:17:40,960
COURSE TO AFFECT THE HEALTH OF

548
00:17:40,960 --> 00:17:41,560
WOMEN.

549
00:17:41,560 --> 00:17:45,160
THIS INTEGRATED LIFE COURSE

550
00:17:45,160 --> 00:17:46,640
PERSPECTIVE IS CRITICAL TO

551
00:17:46,640 --> 00:17:48,280
UNDERSTANDING THE HEALTH OF

552
00:17:48,280 --> 00:17:48,760
WOMEN.

553
00:17:48,760 --> 00:17:50,640
IF YOU THINK ABOUT THIS LIFE

554
00:17:50,640 --> 00:17:52,640
COURSE FROM CHILDHOOD THROUGH

555
00:17:52,640 --> 00:17:54,880
PUBERTY AND PREGNANCY MENOPAUSE

556
00:17:54,880 --> 00:17:57,440
AND OLD AGE YOU CAN SEE

557
00:17:57,440 --> 00:17:58,840
GRAPHICALLY REPRESENTED HERE ON

558
00:17:58,840 --> 00:18:00,640
THIS EKG TRACING HOW IMPORTANT

559
00:18:00,640 --> 00:18:03,280
IT IS TO UNDERSTAND THAT FOR

560
00:18:03,280 --> 00:18:05,160
EXAMPLE DEPRESSION AND PUBERTY

561
00:18:05,160 --> 00:18:06,920
CAN PREDICT DEPRESSIVE EPISODES

562
00:18:06,920 --> 00:18:08,200
IN MENOPAUSE.

563
00:18:08,200 --> 00:18:09,760
OBESITY AND GESTATIONAL DIABETES

564
00:18:09,760 --> 00:18:12,520
AND PREECLAMPSIA WITH CONTRIBUTE

565
00:18:12,520 --> 00:18:14,520
TO CARDIOVASCULAR DISEASE LATER

566
00:18:14,520 --> 00:18:17,160
IN LIFE AND NHLBI STUDIES SHOWN

567
00:18:17,160 --> 00:18:18,720
US THAT PRE-ECLAMPSIA CAN

568
00:18:18,720 --> 00:18:20,640
ACTUALLY BE ASSOCIATED WITH

569
00:18:20,640 --> 00:18:22,400
DIAGNOSIS OF HYPERTENSION WITHIN

570
00:18:22,400 --> 00:18:24,520
THREE YEARS OF PREGNANCY.

571
00:18:24,520 --> 00:18:26,280
THIS PARTICULAR PERSPECTIVE

572
00:18:26,280 --> 00:18:27,960
WHERE WE HAVE REALIZED THAT

573
00:18:27,960 --> 00:18:29,640
EVERYTHING THAT CAME BEFORE IN

574
00:18:29,640 --> 00:18:31,840
WOMEN'S LIFE IS AFFECTING HER

575
00:18:31,840 --> 00:18:34,120
HEART STATE OF HEALTH IS SO

576
00:18:34,120 --> 00:18:37,080
IMPORTANT TO UNDERSTANDING THE

577
00:18:37,080 --> 00:18:38,240
HEALTH OF WOMEN.

578
00:18:38,240 --> 00:18:40,640
SO I CONCLUDE MY REMARKS IT IS

579
00:18:40,640 --> 00:18:43,840
REALLY IMPORTANT FOR US TO THINK

580
00:18:43,840 --> 00:18:46,760
ABOUT PRIORITIZING CHRONIC

581
00:18:46,760 --> 00:18:49,040
DISEASE HOW WE DEFINE CHRONIC

582
00:18:49,040 --> 00:18:51,120
DISEASE IN WOMEN, THINK ABOUT

583
00:18:51,120 --> 00:18:52,240
THE HEALTH SPAN VERSUS LIFE SPAN

584
00:18:52,240 --> 00:18:53,960
SO THE HEALTHY YEARS IS THE

585
00:18:53,960 --> 00:18:54,320
HEALTH SPAN.

586
00:18:54,320 --> 00:18:56,240
WE KNOW WOMEN LIVE LONGER THAN

587
00:18:56,240 --> 00:18:57,840
MEN BUT MORE YEARS WITH

588
00:18:57,840 --> 00:19:00,360
DISABILITY SO THEIR HEALTH SPAN

589
00:19:00,360 --> 00:19:01,840
IS CERTAINLY SHORTER THAN LIFE

590
00:19:01,840 --> 00:19:02,440
SPAN.

591
00:19:02,440 --> 00:19:03,760
THINKING MULTI-SYSTEM

592
00:19:03,760 --> 00:19:04,800
MANIFESTATIONS OF DISEASE THAT

593
00:19:04,800 --> 00:19:07,040
ARE COMMON IN WOMEN, THESE

594
00:19:07,040 --> 00:19:09,640
DISEASES DON'T EXIST IN SILOS.

595
00:19:09,640 --> 00:19:13,520
AND ARE STRUCTURES AT NIH ARE A

596
00:19:13,520 --> 00:19:15,880
BIT SILOED AT TIMES HOW CAN WE

597
00:19:15,880 --> 00:19:18,200
BRIDGE THAT DIVIDE THINKING

598
00:19:18,200 --> 00:19:20,240
CO-MORBIDITIES HOW THESE

599
00:19:20,240 --> 00:19:21,000
CONDITIONS AND CONDITIONS

600
00:19:21,000 --> 00:19:21,920
TOGETHER TO LEAD TO BETTER

601
00:19:21,920 --> 00:19:23,840
UNDERSTANDING OF THAT

602
00:19:23,840 --> 00:19:24,880
PATHOPHYSIOLOGY.

603
00:19:24,880 --> 00:19:26,560
MENTAL HEALTH AND I MENTION A AT

604
00:19:26,560 --> 00:19:28,600
THE BEGINNING VIOLENCE AND

605
00:19:28,600 --> 00:19:30,680
TRAUMA LINKAGE BETWEEN CARDIO

606
00:19:30,680 --> 00:19:32,360
PULMONARY DISEASE AND ANXIETY

607
00:19:32,360 --> 00:19:34,240
DEPRESSION OBESITY AND

608
00:19:34,240 --> 00:19:35,920
DEPRESSION AND WHOLE PERSON

609
00:19:35,920 --> 00:19:37,720
PERSPECTIVE IS SORELY NEEDED.

610
00:19:37,720 --> 00:19:39,840
SOME INSTITUTES AND CENTERS ARE

611
00:19:39,840 --> 00:19:41,360
TAKING THIS ON IN A VIGOROUS

612
00:19:41,360 --> 00:19:44,760
WAY.

613
00:19:44,760 --> 00:19:45,800
SO I WOULD END WITH FOUR

614
00:19:45,800 --> 00:19:46,320
QUESTIONS.

615
00:19:46,320 --> 00:19:48,440
HOW DO WE MOVE BEYOND POLICY

616
00:19:48,440 --> 00:19:50,280
PROGRAM TO DRIVE FUNDAMENTAL

617
00:19:50,280 --> 00:19:50,680
CHANGE.

618
00:19:50,680 --> 00:19:51,960
WHAT CHECKS AND BALANCES DO WE

619
00:19:51,960 --> 00:19:52,960
NEED TO HAVE IN THE SYSTEM TO

620
00:19:52,960 --> 00:19:54,400
MAKE SURE THAT WE ARE ADDRESSING

621
00:19:54,400 --> 00:19:56,240
QUESTIONS LIKE THIS TODAY.

622
00:19:56,240 --> 00:19:58,040
HOW CAN WE INCENTIVIZE CROSS

623
00:19:58,040 --> 00:19:59,840
SECTOR INNOVATION TO DRIVE

624
00:19:59,840 --> 00:20:01,720
DISCOVERY IN THE AREA OF CHRONIC

625
00:20:01,720 --> 00:20:03,600
DISEASE AND WOMEN'S HEALTH AND

626
00:20:03,600 --> 00:20:04,920
MOST IMPORTANTLY WHAT PART ARE

627
00:20:04,920 --> 00:20:08,040
YOU GOING TO PLAY.

628
00:20:08,040 --> 00:20:09,160
THANK YOU VERY MUCH FOR INVITING

629
00:20:09,160 --> 00:20:11,160
ME TO PARTICIPATE IN THIS

630
00:20:11,160 --> 00:20:12,720
WORKSHOP AND PROVIDE SOME

631
00:20:12,720 --> 00:20:13,240
OPENING REMARKS.

632
00:20:13,240 --> 00:20:21,720
BACK TO YOU, DR. LAW RA

633
00:20:21,720 --> 00:20:22,320
LACHOWICZ SCROGGINS.

634
00:20:22,320 --> 00:20:23,680
>> I APPRECIATE THE PARTNERSHIP

635
00:20:23,680 --> 00:20:26,240
AND THE DRIVE TO MOTIVATE US AND

636
00:20:26,240 --> 00:20:27,680
THE NIH TO WORK ON THIS

637
00:20:27,680 --> 00:20:27,960
TOGETHER.

638
00:20:27,960 --> 00:20:30,080
SO I WOULD LIKE TO INTRODUCE

639
00:20:30,080 --> 00:20:32,880
AGAIN DR. TEMKIN FROM ORWH WHO

640
00:20:32,880 --> 00:20:34,560
WILL DIVE DEEPER INTO THE

641
00:20:34,560 --> 00:20:35,560
IMPORTANCE OF CHRONIC

642
00:20:35,560 --> 00:20:37,200
DEBILITATING CONDITIONS.

643
00:20:37,200 --> 00:20:40,320
I'M SO HAPPY TO BE HERE TODAY

644
00:20:40,320 --> 00:20:42,080
AND THANK YOU FOR INVITING ME TO

645
00:20:42,080 --> 00:20:43,360
DISCUSS RECENT OFFICE OF

646
00:20:43,360 --> 00:20:44,600
RESEARCH WOMEN'S HEALTH

647
00:20:44,600 --> 00:20:45,920
ACTIVITIES RELATED TO CHRONIC

648
00:20:45,920 --> 00:20:47,320
DEBILITATING DISEASES IN WOMEN

649
00:20:47,320 --> 00:20:50,720
AND MULTI-MORBIDITY.

650
00:20:50,720 --> 00:20:53,280
AS DR. CLAYTON MENTIONED IN FY

651
00:20:53,280 --> 00:20:55,160
21 APPROPRIATIONS BILLS THE

652
00:20:55,160 --> 00:20:56,840
HOUSE AND SENATE PROBATIONS

653
00:20:56,840 --> 00:21:00,600
COMMITTEE REQUESTED THE NIH

654
00:21:00,600 --> 00:21:01,920
REVIEW ACTIVITIES RELATED TO

655
00:21:01,920 --> 00:21:03,400
WOMEN'S HEALTH AND CONVENE A

656
00:21:03,400 --> 00:21:05,360
CONFERENCE TO ADDRESS THE FUTURE

657
00:21:05,360 --> 00:21:06,840
OF RESEARCH OF WOMEN'S HEALTH.

658
00:21:06,840 --> 00:21:10,600
THE THREE TOPICS AS PUBLIC

659
00:21:10,600 --> 00:21:12,520
HEALTH CONCERNS FOR RISING RATES

660
00:21:12,520 --> 00:21:14,960
OF MATERNAL MORBIDITY AND

661
00:21:14,960 --> 00:21:16,640
MORTALITY, RISING RATES OF

662
00:21:16,640 --> 00:21:18,160
DEBILITATING CONDITIONS IN WOMEN

663
00:21:18,160 --> 00:21:20,280
AND CERVICAL CANCER SURVIVAL

664
00:21:20,280 --> 00:21:21,120
RATES THAT ARE SECOND.

665
00:21:21,120 --> 00:21:24,600
SO I'M GOING TO -- I'M GOING TO

666
00:21:24,600 --> 00:21:26,200
CONCENTRATE MY REMARKS ON THE

667
00:21:26,200 --> 00:21:28,320
ACTIVITIES RELATED TO CHRONIC

668
00:21:28,320 --> 00:21:28,880
DEBILITATING CONDITIONS IN

669
00:21:28,880 --> 00:21:30,520
WOMEN.

670
00:21:30,520 --> 00:21:31,960
DR. CLAYTON SHOWED THIS SLIDE AS

671
00:21:31,960 --> 00:21:33,200
WELL BUT IT DEMONSTRATES THE

672
00:21:33,200 --> 00:21:36,320
RESPONSE TO THE CONGRESSIONAL

673
00:21:36,320 --> 00:21:38,920
REQUEST ORWH BROUGHT INPUT FROM

674
00:21:38,920 --> 00:21:40,080
VARIOUS STAKEHOLDERS INCLUDING

675
00:21:40,080 --> 00:21:42,440
THE COORDINATING COMMITTEE ON

676
00:21:42,440 --> 00:21:43,440
RESEARCH ON WOMEN'S HEALTH,

677
00:21:43,440 --> 00:21:44,320
ADVISORY COMMITTEE ON RESEARCH

678
00:21:44,320 --> 00:21:47,440
FOR WOMEN'S HEALTH, AND PUBLIC.

679
00:21:47,440 --> 00:21:48,920
FEDERAL SUBJECT MATTER EXPERTS

680
00:21:48,920 --> 00:21:50,480
FORMED CLUSTERS TO REVIEW THE

681
00:21:50,480 --> 00:21:53,320
NIH PORTFOLIOS AND THE THREE

682
00:21:53,320 --> 00:21:54,760
FOCUS FOPICS THAT WERE TAR --

683
00:21:54,760 --> 00:21:55,800
TOPICS MENTIONED IN THE

684
00:21:55,800 --> 00:21:57,520
CONGRESSIONAL SIGNIFICANT ITEM

685
00:21:57,520 --> 00:21:59,640
INFORMATION WAS PRESENTED TO OUR

686
00:21:59,640 --> 00:22:00,920
ADVISORY COMMITTEE ON RESEARCH

687
00:22:00,920 --> 00:22:03,000
FOR WOMEN'S HEALTH IN ORDER TO

688
00:22:03,000 --> 00:22:05,000
FACILITATE PLANNING OF WOMEN'S

689
00:22:05,000 --> 00:22:05,400
HEALTH CONFERENCE.

690
00:22:05,400 --> 00:22:07,280
I WILL FOCUS REALLY ON THE

691
00:22:07,280 --> 00:22:09,080
REVIEW THAT WAS PERFORMED BY

692
00:22:09,080 --> 00:22:10,200
SUBJECT MATTER EXPERTS ACROSS

693
00:22:10,200 --> 00:22:12,320
THE FEDERAL SYSTEM ON THE

694
00:22:12,320 --> 00:22:13,680
CURRENT NIH ACTIVITIES OF

695
00:22:13,680 --> 00:22:15,760
CHRONIC DEBILITATING CONDITIONS

696
00:22:15,760 --> 00:22:17,200
AMONG WOMEN.

697
00:22:17,200 --> 00:22:19,040
THE FIRST CHALLENGE FACING THIS

698
00:22:19,040 --> 00:22:21,720
GROUP OF EXPERTS WAS TO DEFINE

699
00:22:21,720 --> 00:22:23,720
CHRONIC DEBILITATING CONDITIONS

700
00:22:23,720 --> 00:22:24,880
IN WOMEN AS NO AVAILABLE

701
00:22:24,880 --> 00:22:27,120
DEFINITION OF CHRONIC DISEASE

702
00:22:27,120 --> 00:22:29,520
WAS SPECIFIC TO WOMEN.

703
00:22:29,520 --> 00:22:31,200
OR WOMEN'S HEALTH.

704
00:22:31,200 --> 00:22:32,640
IN 2010 HHS DEFINED CHRONIC

705
00:22:32,640 --> 00:22:33,960
DISEASE AS CONDITIONS THAT LAST

706
00:22:33,960 --> 00:22:36,400
A YEAR OR MORE, AND REQUIRE

707
00:22:36,400 --> 00:22:38,760
ONGOING MEDICAL ATTENTION AND/OR

708
00:22:38,760 --> 00:22:39,720
LIMIT ACTIVITIES OF DAILY

709
00:22:39,720 --> 00:22:41,400
LIVING.

710
00:22:41,400 --> 00:22:44,040
WE ENDED UP USING THIS ACTIVITY

711
00:22:44,040 --> 00:22:46,480
-- THIS DEFINITION PRIMARILY BUT

712
00:22:46,480 --> 00:22:49,560
ALSO USED AT CMS DEFINITION THAT

713
00:22:49,560 --> 00:22:52,200
DEFIANCE CHRONIC DISEASES AS A

714
00:22:52,200 --> 00:22:53,600
LIST OF CONDITIONS THAT ARE

715
00:22:53,600 --> 00:22:55,520
PERIODICALLY UPDATED.

716
00:22:55,520 --> 00:22:58,840
OF THE 21 CONDITIONS INCLUDED BY

717
00:22:58,840 --> 00:23:00,520
CMS CHRONIC CONDITIONS

718
00:23:00,520 --> 00:23:01,960
PREVALENCE DATA IS AVAILABLE

719
00:23:01,960 --> 00:23:05,520
THAT IS DISAGGREGATED BY SEX.

720
00:23:05,520 --> 00:23:06,520
THIS DEMONSTRATES CERTAIN

721
00:23:06,520 --> 00:23:07,880
CONDITIONS ARE MORE COMMON IN

722
00:23:07,880 --> 00:23:09,200
WOMEN COMPARED TO MEN.

723
00:23:09,200 --> 00:23:12,520
THESE INCLUDE HYPERTENSION

724
00:23:12,520 --> 00:23:15,080
ARTHRITIS DEPRESSION DEMENTIA,

725
00:23:15,080 --> 00:23:15,720
OSTEOPOROSIS AND ASTHMA.

726
00:23:15,720 --> 00:23:17,960
YOU CAN SEE THE FEMALE

727
00:23:17,960 --> 00:23:21,600
PREVALENCE IN ORANGE AND BLUE --

728
00:23:21,600 --> 00:23:23,200
MALE PREVALENCE IN BLUE, THERE

729
00:23:23,200 --> 00:23:24,240
ARE OTHER CONDITIONS THAT ARE

730
00:23:24,240 --> 00:23:27,680
MORE COMMON IN MEN THAN WOMEN.

731
00:23:27,680 --> 00:23:28,840
MULTI-MORBIDITY ARE

732
00:23:28,840 --> 00:23:30,760
CO-OCCURRENCE OF TWO OR MORE

733
00:23:30,760 --> 00:23:32,240
CHRONIC DISEASE IN ONE

734
00:23:32,240 --> 00:23:33,720
INDIVIDUAL ALSO MORE COMMON IN

735
00:23:33,720 --> 00:23:33,960
BEAM.

736
00:23:33,960 --> 00:23:35,880
THIS MAY BE PARTLY BECAUSE WOMEN

737
00:23:35,880 --> 00:23:39,120
TYPICALLY LIVE LONGER THAN MEN

738
00:23:39,120 --> 00:23:40,800
BUT ALSO WOMEN HAVE ATYPICAL

739
00:23:40,800 --> 00:23:42,480
SYMPTOMS THAT RESULT IN DELAYS

740
00:23:42,480 --> 00:23:44,400
IN DIAGNOSIS AND POTENTIALLY

741
00:23:44,400 --> 00:23:46,520
POOR RESPONSE TO FIRST LINE

742
00:23:46,520 --> 00:23:48,200
THERAPIES.  INTERACTIONS BETWEEN

743
00:23:48,200 --> 00:23:49,360
CONDITIONS IN WOMEN AND

744
00:23:49,360 --> 00:23:50,600
DEVELOPMENT OF MULTI-MORBIDITY

745
00:23:50,600 --> 00:23:53,440
IS POORLY UNDERSTOOD IN WOMEN.

746
00:23:53,440 --> 00:23:55,120
WE DEVELOPED A FRAMEWORK

747
00:23:55,120 --> 00:23:57,240
SPECIFIC TO CHRONIC DEBILITATING

748
00:23:57,240 --> 00:23:58,280
CONDITIONS IN WOMEN.

749
00:23:58,280 --> 00:24:00,520
WE USE DISABILITY ADJUSTED LIFE

750
00:24:00,520 --> 00:24:01,960
YEARS OR DAILIES THE NUMBER OF

751
00:24:01,960 --> 00:24:05,000
YEARS LOST DUE TO I WILL HEALTH

752
00:24:05,000 --> 00:24:05,640
DISABILITY OR EARLY DEATH AS

753
00:24:05,640 --> 00:24:07,440
METRIC TO MEASURE BURDEN OF

754
00:24:07,440 --> 00:24:09,040
DISEASE ACROSS WOMEN IN THE

755
00:24:09,040 --> 00:24:10,120
UNITED STATES.

756
00:24:10,120 --> 00:24:12,000
CHRONIC DISEASE IN WOMEN WERE

757
00:24:12,000 --> 00:24:14,120
SEPARATED IN TO FEMALE SPECIFIC

758
00:24:14,120 --> 00:24:16,320
MORE COMMON IN WOMEN OR HIGHER

759
00:24:16,320 --> 00:24:18,440
MORBIDITY IN WOMEN POTENTIALLY

760
00:24:18,440 --> 00:24:19,920
UNDERSTUDIED IN WOMEN AND LASTLY

761
00:24:19,920 --> 00:24:21,280
HIGH MORBIDITY IN WOMEN

762
00:24:21,280 --> 00:24:21,680
CONDITIONS.

763
00:24:21,680 --> 00:24:23,120
THE CONDITIONS WITH THE HIGHEST

764
00:24:23,120 --> 00:24:25,840
BURDEN OF DISEASE MEASURED BY

765
00:24:25,840 --> 00:24:28,440
DAILIES ARE THE LEFT SIDE OF THE

766
00:24:28,440 --> 00:24:30,000
CHART AND DECLINE AS WE MOVE

767
00:24:30,000 --> 00:24:30,360
RIGHT.

768
00:24:30,360 --> 00:24:32,120
BECAUSE WE WERE LIMITED IN OUR

769
00:24:32,120 --> 00:24:34,800
ABILITY TO DO QUANTITATIVE

770
00:24:34,800 --> 00:24:36,120
REVIEW OF NIH ACTIVITIES IN

771
00:24:36,120 --> 00:24:37,520
CHRONIC DEBILITATING CONDITIONS

772
00:24:37,520 --> 00:24:41,240
IN WOMEN BECAUSE OF OUR LACK OF

773
00:24:41,240 --> 00:24:42,280
DEFINITION, AND BECAUSE THERE'S

774
00:24:42,280 --> 00:24:44,360
NO UNIFYING CODE OR METRIC WE

775
00:24:44,360 --> 00:24:47,000
PERFORMED WHAT WE CALL LIMITED

776
00:24:47,000 --> 00:24:49,320
SNAP SHOT, A BRIEF QUALITATIVE

777
00:24:49,320 --> 00:24:51,760
OVERVIEW OF IC ACTIVITIES IN

778
00:24:51,760 --> 00:24:52,400
THIS SPACE.

779
00:24:52,400 --> 00:24:54,520
ICs PARTICIPATING IN THE

780
00:24:54,520 --> 00:24:55,720
CONFERENCE PLANNING WERE ASKED

781
00:24:55,720 --> 00:24:57,120
TO SUBMIT HIGHEST FUNDED

782
00:24:57,120 --> 00:24:59,480
PROJECTS AND CHRONIC DISEASE IN

783
00:24:59,480 --> 00:25:00,080
WOMEN.

784
00:25:00,080 --> 00:25:02,320
184 PROJECTS FROM 11 ICS WERE

785
00:25:02,320 --> 00:25:03,760
RECEIVED IN CATEGORIZED INTO THE

786
00:25:03,760 --> 00:25:05,160
FRAMEWORK THAT I PRESENTED ON

787
00:25:05,160 --> 00:25:07,880
THE LAST SLIDE.

788
00:25:07,880 --> 00:25:10,080
THIS LIMITED SNAP SHOT

789
00:25:10,080 --> 00:25:11,520
DEMONSTRATED NIH ACTIVITY ACROSS

790
00:25:11,520 --> 00:25:13,520
ALL THE DOMAINS OF THE FRAMEWORK

791
00:25:13,520 --> 00:25:17,920
MOST ICO DESIGNATED CHRONIC

792
00:25:17,920 --> 00:25:19,520
CONDITIONS IN WOMEN WAS IN

793
00:25:19,520 --> 00:25:20,520
CONDITIONS CONSIDERED MORE

794
00:25:20,520 --> 00:25:22,080
COMMON IN WOMEN FOLLOWED BY

795
00:25:22,080 --> 00:25:24,720
POTENTIALLY NEGLECTED IN WOMEN

796
00:25:24,720 --> 00:25:25,640
THAN HIGH MORBIDITY IN WOMEN

797
00:25:25,640 --> 00:25:27,480
WITH LOWEST NUMBER OF SUBMITTED

798
00:25:27,480 --> 00:25:28,800
PROJECTS ON FEMALE SPECIFIC

799
00:25:28,800 --> 00:25:29,440
CONDITIONS.

800
00:25:29,440 --> 00:25:30,760
THERE WERE SO MANY LIMITATIONS

801
00:25:30,760 --> 00:25:32,720
TO THIS SNAP SHOT BUT WE USED IT

802
00:25:32,720 --> 00:25:35,200
TO PROVIDE A ROUGH ESTIMATE OF

803
00:25:35,200 --> 00:25:36,560
THE NIH ACTIVITIES AND

804
00:25:36,560 --> 00:25:39,000
PRIORITIES RELATED TO CHRONIC

805
00:25:39,000 --> 00:25:39,560
DEBILITATING CONDITIONS IN

806
00:25:39,560 --> 00:25:41,080
WOMEN.

807
00:25:41,080 --> 00:25:42,560
THE CLUSTER ENDED WITH THIS

808
00:25:42,560 --> 00:25:42,920
SUMMARY.

809
00:25:42,920 --> 00:25:45,520
THERE IS A NEED FOR A STANDARD

810
00:25:45,520 --> 00:25:48,040
DEFINITION OF CHRONIC DISEASES

811
00:25:48,040 --> 00:25:48,640
THAT NIH WIDE.

812
00:25:48,640 --> 00:25:50,520
WOMEN HAVE HIGHER CHRONIC

813
00:25:50,520 --> 00:25:52,480
DISEASE -- HIGHER RATES OF

814
00:25:52,480 --> 00:25:54,320
CHRONIC DISEASE AND

815
00:25:54,320 --> 00:25:55,560
MULTI-MORBIDITY COMPARED TO MEN

816
00:25:55,560 --> 00:25:56,920
BUT FEW STUDIES FOCUS

817
00:25:56,920 --> 00:26:00,800
SPECIFICALLY ON THIS TOPIC.

818
00:26:00,800 --> 00:26:02,360
NIH WIDE ACTIVITY ENOUGH WOMEN

819
00:26:02,360 --> 00:26:04,640
CROSSES PURVIEW OF MANY ICs

820
00:26:04,640 --> 00:26:06,520
THAT THERE ARE FEW CURRENT NIH

821
00:26:06,520 --> 00:26:08,440
WIDE EFFORTS IN THIS REALM.

822
00:26:08,440 --> 00:26:10,120
THE RECOMMENDATION WAS TO ALIGN

823
00:26:10,120 --> 00:26:11,640
RESEARCH ACTIVITIES WITH THE

824
00:26:11,640 --> 00:26:13,120
SPECIFIC NEEDS OF WOMEN THROUGH

825
00:26:13,120 --> 00:26:15,400
A MORE GRANULAR IDENTIFICATION

826
00:26:15,400 --> 00:26:17,000
AND DEFINITION OF CHRONIC

827
00:26:17,000 --> 00:26:19,120
DEBILITATING DISEASES IN WOMEN.

828
00:26:19,120 --> 00:26:21,160
WE ALSO RECEIVED INPUT FROM THE

829
00:26:21,160 --> 00:26:23,280
PUBLIC RELATED TO THIS TOPIC

830
00:26:23,280 --> 00:26:24,720
FOLLOWING REQUEST FOR

831
00:26:24,720 --> 00:26:28,720
INFORMATION PUBLISHED IN JULY.

832
00:26:28,720 --> 00:26:30,880
OF 247 COMMENTS RECEIVED 182

833
00:26:30,880 --> 00:26:33,120
MENTIONED CHRONIC DEBILITATING

834
00:26:33,120 --> 00:26:34,240
DISEASES IN WOMEN.

835
00:26:34,240 --> 00:26:36,280
THE MAJORITY MENTIONED FEMALE

836
00:26:36,280 --> 00:26:37,280
SPECIFIC DISEASES FOLLOWED BY

837
00:26:37,280 --> 00:26:39,360
THOSE POTENTIALLY UNDER STUDY

838
00:26:39,360 --> 00:26:41,120
AND THOSE COMMON IN WOMEN WITH

839
00:26:41,120 --> 00:26:42,480
THE FEWEST COMMENTS ON

840
00:26:42,480 --> 00:26:43,560
CONDITIONS WITH HIGH MORBIDITY

841
00:26:43,560 --> 00:26:43,960
IN WOMEN.

842
00:26:43,960 --> 00:26:46,000
THESE PROPORTIONS ARE NOTABLY

843
00:26:46,000 --> 00:26:47,440
DISSIMILAR TO THOSE IDENTIFIED

844
00:26:47,440 --> 00:26:50,720
IN THE NIH SNAP SHOT.

845
00:26:50,720 --> 00:26:55,200
ON OCTOBER 20 THE ADVANCING

846
00:26:55,200 --> 00:26:57,920
ADVANCE WOMEN HEALTH THIS SLIDE

847
00:26:57,920 --> 00:26:58,760
SHOWS AGENDA ITEMS SPECIFIC TO

848
00:26:58,760 --> 00:27:00,960
CHRONIC DISEASE IN WOMEN,

849
00:27:00,960 --> 00:27:03,040
INCLUDED AN OVERVIEW OF THE

850
00:27:03,040 --> 00:27:05,040
TOPIC FOLLOWED BY TALKS AND

851
00:27:05,040 --> 00:27:07,280
BREAK OUT SESSIONS ON PREVENTION

852
00:27:07,280 --> 00:27:08,720
FEMALE SPECIFIC CONDITIONS,

853
00:27:08,720 --> 00:27:10,040
CONDITIONS THAT CAUSE HIGH

854
00:27:10,040 --> 00:27:11,160
MORBIDITY IN WOMEN AND

855
00:27:11,160 --> 00:27:14,360
DISPARITIES.

856
00:27:14,360 --> 00:27:16,320
OVER 1100 ATTENDEES JOINED IN A

857
00:27:16,320 --> 00:27:17,760
CONFERENCE WITH HIGH ATTENDANCE

858
00:27:17,760 --> 00:27:20,000
IN BOTH MATERNAL MORBIDITY AND

859
00:27:20,000 --> 00:27:22,000
MORTALITY AND CHRONIC

860
00:27:22,000 --> 00:27:22,840
DEBILITATING CONDITIONS BREAK

861
00:27:22,840 --> 00:27:23,400
OUT SESSIONS.

862
00:27:23,400 --> 00:27:26,080
ON THE FOLLOWING DAY OCTOBER

863
00:27:26,080 --> 00:27:27,520
21ST ADVISORY COMMITTEE ON

864
00:27:27,520 --> 00:27:29,200
RESEARCH FOR WOMEN'S HEALTH MET

865
00:27:29,200 --> 00:27:30,560
SUMMARIZE MEETING AND DEVELOPED

866
00:27:30,560 --> 00:27:32,200
THIS SET OF OPPORTUNITIES FOR

867
00:27:32,200 --> 00:27:35,200
NIH RESEARCH ON CHRONIC

868
00:27:35,200 --> 00:27:35,960
DEBILITATING CONDITIONS IN

869
00:27:35,960 --> 00:27:36,400
WOMEN.

870
00:27:36,400 --> 00:27:37,600
THEIR RECOMMENDATIONS WERE TO

871
00:27:37,600 --> 00:27:38,640
DEVELOP DEFINITIONS IN A

872
00:27:38,640 --> 00:27:39,880
FRAMEWORK SPECIFIC TO CHRONIC

873
00:27:39,880 --> 00:27:41,480
DISEASES IN WOMEN.

874
00:27:41,480 --> 00:27:43,640
TO ALIGN CLINICAL RESEARCH WITH

875
00:27:43,640 --> 00:27:45,440
THE NEEDS OF WOMEN INCLUDING

876
00:27:45,440 --> 00:27:47,000
STUDY OBJECTIVES AND END POINTS

877
00:27:47,000 --> 00:27:49,200
TO INCREASE RESEARCH ACTIVITIES

878
00:27:49,200 --> 00:27:51,320
AND FEMALE SPECIFIC DISEASES.

879
00:27:51,320 --> 00:27:53,200
MENOPAUSE AND AGING TO CREATE

880
00:27:53,200 --> 00:27:54,680
CLINICAL RESEARCH NETWORKS THAT

881
00:27:54,680 --> 00:27:56,000
ARE SPECIFIC TO RESEARCH ON

882
00:27:56,000 --> 00:27:58,520
CHRONIC DISEASES IN WOMEN AND TO

883
00:27:58,520 --> 00:27:59,840
ENCOURAGE RESEARCH THROUGH THE

884
00:27:59,840 --> 00:28:01,400
DEVELOPMENT OF FUNDING

885
00:28:01,400 --> 00:28:01,880
OPPORTUNITIES AROUND

886
00:28:01,880 --> 00:28:05,120
MULTI-MORBIDITY.

887
00:28:05,120 --> 00:28:06,320
SO THANK YOU SO MUCH FOR HAVING

888
00:28:06,320 --> 00:28:08,960
ME HERE, HAPPY TO ANSWER ANY

889
00:28:08,960 --> 00:28:10,720
QUESTIONS AND PLEASE CHECK IN

890
00:28:10,720 --> 00:28:12,640
WITH OUR WEBSITE WITH VIDEOS AND

891
00:28:12,640 --> 00:28:14,960
SUMMARY OF THIS ACTIVITY ARE

892
00:28:14,960 --> 00:28:17,480
FORTHCOMING.

893
00:28:17,480 --> 00:28:19,520
>> THANK YOU, DR. TEMKIN.

894
00:28:19,520 --> 00:28:21,320
I APPRECIATE IN YOUR SLIDES HOW

895
00:28:21,320 --> 00:28:24,400
YOU HIGHLIGHTED SOME OF THE

896
00:28:24,400 --> 00:28:25,440
REMAINING GAPS AND OPPORTUNITIES

897
00:28:25,440 --> 00:28:27,640
FOR OUR ONGOING COLLABORATIVE

898
00:28:27,640 --> 00:28:28,040
EFFORTS.

899
00:28:28,040 --> 00:28:29,880
I THINK IT IS IMPORTANT TO THINK

900
00:28:29,880 --> 00:28:31,440
ABOUT THOSE TODAY AND TOMORROW

901
00:28:31,440 --> 00:28:33,520
AS WE GO OUT THROUGHOUT THE

902
00:28:33,520 --> 00:28:33,920
WORKSHOP.

903
00:28:33,920 --> 00:28:36,160
RIGHT NOW WE ARE GOING TO MOVE

904
00:28:36,160 --> 00:28:39,000
ON TO SESSION ONE WHICH IS

905
00:28:39,000 --> 00:28:41,000
MAKING THE CASE FOR INTEGRATIVE

906
00:28:41,000 --> 00:28:44,520
HEALTHCARE SYSTEMS FOR WOMEN AND

907
00:28:44,520 --> 00:28:47,320
GIRLS DR. JOHNSON IS GOING TO BE

908
00:28:47,320 --> 00:28:48,640
MODERATING THIS SESSION AND SHE

909
00:28:48,640 --> 00:28:50,520
WILL INTRODUCE TO EACH SPEAKER

910
00:28:50,520 --> 00:28:51,360
AS WELL.

911
00:28:51,360 --> 00:28:53,920
IF YOU HAVE QUESTIONS FOR DR.

912
00:28:53,920 --> 00:28:55,880
KOOB, DR. CLAYTON OR DR. TEMKIN

913
00:28:55,880 --> 00:28:58,320
YOU CAN PACE THEM INTO THE Q&A

914
00:28:58,320 --> 00:29:00,760
BOX AND THEY WILL HAVE AN

915
00:29:00,760 --> 00:29:02,880
OPPORTUNITY TO JOIN THE

916
00:29:02,880 --> 00:29:04,320
MODERATED PANELISTS AT THE END

917
00:29:04,320 --> 00:29:04,840
OF SESSION ONE.

918
00:29:04,840 --> 00:29:06,560
THANK YOU.

919
00:29:06,560 --> 00:29:11,440
>> THANK YOU, DR. LACHOWICZ

920
00:29:11,440 --> 00:29:12,120
SCROGGINS.

921
00:29:12,120 --> 00:29:14,480
I'M TAMARA LEWIS JOHNSON, CHIEF

922
00:29:14,480 --> 00:29:15,840
OF WOMEN'S MENTAL HEALTH

923
00:29:15,840 --> 00:29:17,160
RESEARCH PROGRAM AT THE NATIONAL

924
00:29:17,160 --> 00:29:19,920
INSTITUTE OF MENTAL HEALTH.

925
00:29:19,920 --> 00:29:22,560
I AM HONORED TO BE THE MODERATOR

926
00:29:22,560 --> 00:29:26,840
FOR SESSION ONE TODAY I WILL

927
00:29:26,840 --> 00:29:27,920
INTRODUCE EACH OF THE SPEAKERS

928
00:29:27,920 --> 00:29:28,920
AND THEY WILL DO THEIR

929
00:29:28,920 --> 00:29:32,120
PRESENTATIONS AND WE WILL HAVE A

930
00:29:32,120 --> 00:29:32,720
QUESTION-AND-ANSWER PERIOD AT

931
00:29:32,720 --> 00:29:34,040
THE END OF THE SESSION.

932
00:29:34,040 --> 00:29:35,800
WITH NO FURTHER ADIEU ALLOW ME

933
00:29:35,800 --> 00:29:38,240
TO INTRODUCE OUR KEYNOTE

934
00:29:38,240 --> 00:29:38,840
SPEAKER.

935
00:29:38,840 --> 00:29:41,920
DR. MELISSA SIMON.

936
00:29:41,920 --> 00:29:44,720
SHE IS THE GEORGE GARDENER

937
00:29:44,720 --> 00:29:46,280
PROFESSOR OF CLINICAL GYNECOLOGY

938
00:29:46,280 --> 00:29:47,800
AND VICE CHAIR OF RESEARCH

939
00:29:47,800 --> 00:29:49,800
DEPARTMENT OF OBSTETRICS AND

940
00:29:49,800 --> 00:29:51,920
GYNECOLOGY AT NORTHWESTERN

941
00:29:51,920 --> 00:29:54,480
UNIVERSITY FINE BROOK SCHOOL OF

942
00:29:54,480 --> 00:29:55,320
MEDICINE.

943
00:29:55,320 --> 00:29:56,920
FOUNDER AND DIRECTOR FOR CENTER

944
00:29:56,920 --> 00:29:58,600
FOR HEALTH EQUITY TRANSFORMATION

945
00:29:58,600 --> 00:30:00,880
AND CHICAGO CANCER HEALTH EQUITY

946
00:30:00,880 --> 00:30:02,320
COLLABORATIVE AND SHE'S

947
00:30:02,320 --> 00:30:04,520
RECOGNIZED WITH NUMEROUS AWARDS

948
00:30:04,520 --> 00:30:06,120
FOR SUBSTANTIAL CONTRIBUTION TO

949
00:30:06,120 --> 00:30:08,120
EXCELLENT AND HEALTH EQUITY

950
00:30:08,120 --> 00:30:09,280
SCHOLARSHIP, WOMEN HEALTH AND

951
00:30:09,280 --> 00:30:10,600
MENTOR SHIP EXEMPLIFIED BY

952
00:30:10,600 --> 00:30:13,280
RECENT ELECTION TO NATIONAL

953
00:30:13,280 --> 00:30:14,040
ACADEMY OF MEDICINE.

954
00:30:14,040 --> 00:30:16,600
WITH NO FURTHER ADIEU, ALLOW ME

955
00:30:16,600 --> 00:30:18,600
TO INTRODUCE DR. MELISSA SIMON

956
00:30:18,600 --> 00:30:20,640
WHO WILL GIVE THE TALK AND HOW

957
00:30:20,640 --> 00:30:22,320
CAN EVIDENCE BASED PRACTICES

958
00:30:22,320 --> 00:30:24,440
ADDRESS CO-OCCURRING CONDITIONS

959
00:30:24,440 --> 00:30:26,520
OF MULTI-MORBIDITY AND AT RISK

960
00:30:26,520 --> 00:30:27,400
WOMEN AND GIRLS.

961
00:30:27,400 --> 00:30:29,920
DR. SIMON.

962
00:30:29,920 --> 00:30:32,560
>> THANK YOU, VERY MUCH FOR

963
00:30:32,560 --> 00:30:35,120
THOSE VERY KIND WORDS DR. LEWIS

964
00:30:35,120 --> 00:30:36,760
JOHNSON, THANK YOU FOR THE

965
00:30:36,760 --> 00:30:38,120
INVITATION, I'M HONORED TO BE

966
00:30:38,120 --> 00:30:39,080
HERE TODAY.

967
00:30:39,080 --> 00:30:41,280
I HAVE TO SAY THAT MATERIALS

968
00:30:41,280 --> 00:30:42,600
PROVIDED IN THIS PRESENTATION

969
00:30:42,600 --> 00:30:43,640
REFLECT MY INDIVIDUAL VIEWS AND

970
00:30:43,640 --> 00:30:45,320
DO NOT REPRESENT THE VIEWS OR

971
00:30:45,320 --> 00:30:46,120
RECOMMENDATIONS OF THE UNITED

972
00:30:46,120 --> 00:30:49,480
STATES PREVENTIVE SERVICES TASK

973
00:30:49,480 --> 00:30:51,120
FORCE I'M CONSULTANT FOR AND

974
00:30:51,120 --> 00:30:52,040
IMMEDIATE PAST MEMBER OR THE

975
00:30:52,040 --> 00:30:55,480
OFFICE OF RESEARCH WOMEN HEALTH

976
00:30:55,480 --> 00:30:56,880
ADVISORY COMMITTEE FOR RESEARCH

977
00:30:56,880 --> 00:30:57,400
WOMEN HEALTH WHICH I AM A

978
00:30:57,400 --> 00:30:58,360
MEMBER.

979
00:30:58,360 --> 00:31:00,240
SO THE OVERALL PRESENTATION

980
00:31:00,240 --> 00:31:01,520
SHOULD BE BE A-- SHOULDN'T BE

981
00:31:01,520 --> 00:31:02,920
ATTRIBUTED TO EITHER OF THEM.

982
00:31:02,920 --> 00:31:05,360
MY GOAL FOR THE TALK IS TO SET

983
00:31:05,360 --> 00:31:06,720
INTENTION IN FRAMING TO

984
00:31:06,720 --> 00:31:08,920
HIGHLIGHT SOME KEY TOPICS INTO

985
00:31:08,920 --> 00:31:11,080
REALLY INTEGRATE SOME OF THE

986
00:31:11,080 --> 00:31:13,320
THINGS THAT DR. CLAYTON AND DR.

987
00:31:13,320 --> 00:31:16,080
KOOB AND DR. TEMKIN HAVE JUST

988
00:31:16,080 --> 00:31:17,600
HIGHLIGHTED APPROPRIATELY SO.

989
00:31:17,600 --> 00:31:20,080
TO REALLY START TO GET THE

990
00:31:20,080 --> 00:31:21,560
JUICES FLOWING AND GET SOME OF

991
00:31:21,560 --> 00:31:23,440
YOU FIRED UP MOPEFULLY ALL OF US

992
00:31:23,440 --> 00:31:24,520
TO MOVE THIS FORWARD.

993
00:31:24,520 --> 00:31:26,160
SO LET'S START WITH DEFINITIONS

994
00:31:26,160 --> 00:31:28,520
AND FRAMING.

995
00:31:28,520 --> 00:31:30,720
EVERYONE SEEN THIS, WE KNOW THAT

996
00:31:30,720 --> 00:31:32,280
ARCHITECTURE AND DESIGN ARE

997
00:31:32,280 --> 00:31:34,840
SUPER CRITICAL TO A WELL

998
00:31:34,840 --> 00:31:36,080
FUNCTIONING CELL IN OUR BODY.

999
00:31:36,080 --> 00:31:38,120
THE HARMONY AND ORCHESTRA

1000
00:31:38,120 --> 00:31:41,520
ORCHESTRATION OF ALL THOSE CELLS

1001
00:31:41,520 --> 00:31:43,240
TOGETHER HELP IMPACT HEALTH IN

1002
00:31:43,240 --> 00:31:45,440
MANY WAYS SO ARCHITECTURE AND

1003
00:31:45,440 --> 00:31:46,160
DESIGN MATTER MORE THAN THAT.

1004
00:31:46,160 --> 00:31:48,360
THEY MATTER IN EVERYTHING WE DO

1005
00:31:48,360 --> 00:31:49,320
EVERY STRUCTURE EVERY POLICY.

1006
00:31:49,320 --> 00:31:51,520
SO REALLY YOU HAVE TO ASK THE

1007
00:31:51,520 --> 00:31:53,440
RIGHT QUESTIONS INVOLVE THE

1008
00:31:53,440 --> 00:31:55,520
RIGHT PEOPLE TO GET OUTPUT MOST

1009
00:31:55,520 --> 00:31:59,720
REPRESENTATIVE OF THE ISSUE WE

1010
00:31:59,720 --> 00:32:00,800
ARE TRYING TO IMPROVE CRITICAL

1011
00:32:00,800 --> 00:32:04,920
FOR RESEARCH THAT TRANSLATES TO

1012
00:32:04,920 --> 00:32:06,120
IMPACT IMPROVEMENT IN THIS CASE

1013
00:32:06,120 --> 00:32:07,000
WOMEN AND GIRLS HEALTH SO WE

1014
00:32:07,000 --> 00:32:10,200
HAVE TO ASK THE RIGHT QUESTIONS,

1015
00:32:10,200 --> 00:32:13,080
WE DON'T WANT GARBAGE IN AND GET

1016
00:32:13,080 --> 00:32:14,320
GARBAGE OUT WE HAVE TO LOOK

1017
00:32:14,320 --> 00:32:17,920
UNDER THE HOOD OF THE CAR.

1018
00:32:17,920 --> 00:32:20,000
TO EMBED EQUITY ORIENTATION INTO

1019
00:32:20,000 --> 00:32:22,160
THE RESEARCH PROCESS, THAT SEEKS

1020
00:32:22,160 --> 00:32:23,840
TO IMPROVE HEALTH FOR EARN

1021
00:32:23,840 --> 00:32:25,160
PERSON IN THIS CASE WOMEN AND

1022
00:32:25,160 --> 00:32:25,360
GIRLS.

1023
00:32:25,360 --> 00:32:26,480
WE HAVE TO SCRUTINIZE ALL

1024
00:32:26,480 --> 00:32:28,880
RELATED PROCESSES AND STRUCTURE.

1025
00:32:28,880 --> 00:32:31,120
SO TO LEVEL SET NEVER ASSUME

1026
00:32:31,120 --> 00:32:32,960
ANYBODY KNOWS THE TERMINOLOGY

1027
00:32:32,960 --> 00:32:36,160
REGARDLESS OF THE AUDIENCE.

1028
00:32:36,160 --> 00:32:37,760
INEQUALITY AND AGAIN THIS IS A

1029
00:32:37,760 --> 00:32:40,760
TREE AND IT IS ORGANIC BUT THESE

1030
00:32:40,760 --> 00:32:43,560
STRUCTURE POLICY PRACTICES,

1031
00:32:43,560 --> 00:32:46,120
RESEARCH ET CETERA IS NOT

1032
00:32:46,120 --> 00:32:47,120
ORGANIC.

1033
00:32:47,120 --> 00:32:49,920
IT TENDS TO BE HUMAN MADE, HUMAN

1034
00:32:49,920 --> 00:32:50,920
IMPOSED, CREATED.

1035
00:32:50,920 --> 00:32:53,320
I'M JUST USING THIS AS AN

1036
00:32:53,320 --> 00:32:54,160
EXAMPLE.

1037
00:32:54,160 --> 00:32:56,040
INEQUALITY MEANS IN THE UP PER

1038
00:32:56,040 --> 00:32:57,840
LEFT HAND CORNER THAT THE TREE

1039
00:32:57,840 --> 00:32:59,000
OR THE STRUCTURE, THE POLICY,

1040
00:32:59,000 --> 00:33:00,640
THE PRACTICE, THE RESEARCH

1041
00:33:00,640 --> 00:33:02,560
QUESTION, THE RESEARCH APPROACH,

1042
00:33:02,560 --> 00:33:05,360
ET CETERA IS FUNDAMENTALLY BENT.

1043
00:33:05,360 --> 00:33:06,800
AND ACTIVELY FAVORING ONE PERSON

1044
00:33:06,800 --> 00:33:09,240
OR PEOPLE AND ACTIVELY

1045
00:33:09,240 --> 00:33:10,360
DISADVANTAGING ANOTHER GROUP OF

1046
00:33:10,360 --> 00:33:11,600
PERSONS OR PEOPLE.

1047
00:33:11,600 --> 00:33:13,680
AND IN THE UPPER RIGHT HAND

1048
00:33:13,680 --> 00:33:16,120
CORNER EQUALITY MEANS THAT WE

1049
00:33:16,120 --> 00:33:17,800
SAY OH WELL WE ARE ALL EQUAL,

1050
00:33:17,800 --> 00:33:20,680
THIS IS AN EQUAL COUNTRY, WE ARE

1051
00:33:20,680 --> 00:33:25,120
EQUAL UNDER THE CONSTITUTION AND

1052
00:33:25,120 --> 00:33:27,440
PRACTICES AND POLICY,

1053
00:33:27,440 --> 00:33:28,760
FUNDAMENTAL PRACTICE POLICY

1054
00:33:28,760 --> 00:33:30,520
RESEARCH PROJECT EXCLUSION OR

1055
00:33:30,520 --> 00:33:32,840
INCLUSION CRITERIA ET CETERA ARE

1056
00:33:32,840 --> 00:33:36,360
BENT, WE ARE STILL NOT GOING TO

1057
00:33:36,360 --> 00:33:38,600
HELP EVERYBODY GET TO THAT GOAL

1058
00:33:38,600 --> 00:33:41,280
WHICH IN THIS CASE IS GETTING AN

1059
00:33:41,280 --> 00:33:41,680
APPLE.

1060
00:33:41,680 --> 00:33:42,800
OR ACHIEVING HEALTH.

1061
00:33:42,800 --> 00:33:44,880
THE LOWER LEFT HAND CORNER

1062
00:33:44,880 --> 00:33:46,280
EQUITY FRAMEWORK WHY WE USE

1063
00:33:46,280 --> 00:33:48,040
EQUITY IS WE ACKNOWLEDGE

1064
00:33:48,040 --> 00:33:50,920
EVERYBODY NEEDS A DIFFERENT LIFT

1065
00:33:50,920 --> 00:33:53,360
DIFFERENT SUPPORT DIFFERENT TYPE

1066
00:33:53,360 --> 00:33:56,000
OF APPROACH TO GET TO THAT APPLE

1067
00:33:56,000 --> 00:33:57,360
OR INTENDED OUTCOME.

1068
00:33:57,360 --> 00:33:59,040
FINALLY THE CRITICAL QUESTIONS

1069
00:33:59,040 --> 00:34:02,000
TO ASK AND THAT IS WHAT

1070
00:34:02,000 --> 00:34:04,440
MULTI-LEVEL SYSTEMS APPROACHES

1071
00:34:04,440 --> 00:34:07,080
ARE REALLY IMPORTANT

1072
00:34:07,080 --> 00:34:08,160
TRANSDISCIPLINARY TO THINK ABOUT

1073
00:34:08,160 --> 00:34:11,040
AND IMPROVE THE HEALTH ACROSS

1074
00:34:11,040 --> 00:34:12,920
THE HEALTH SPAN AND LIFE SPAN, I

1075
00:34:12,920 --> 00:34:16,160
APPRECIATE THAT, DR. CLAYTON.

1076
00:34:16,160 --> 00:34:18,080
WE ASK FUNDAMENTAL QUESTIONS IS

1077
00:34:18,080 --> 00:34:19,920
WHY IS THE DARN TREE BENT IN THE

1078
00:34:19,920 --> 00:34:20,440
FIRST PLACE.

1079
00:34:20,440 --> 00:34:22,200
HOW DO WE UNBEND THE TREE.

1080
00:34:22,200 --> 00:34:23,320
I SAY UNDERSTOOD BEND AND NOT

1081
00:34:23,320 --> 00:34:26,160
STRAIGHTEN ON PURPOSE BECAUSE WE

1082
00:34:26,160 --> 00:34:28,280
ARE TRYING BECAUSE INITIALLY IT

1083
00:34:28,280 --> 00:34:30,120
MADE NOT BE FULLY STRAIGHTEN AND

1084
00:34:30,120 --> 00:34:31,360
YOU MAY HAVE TO BEND THE OTHER

1085
00:34:31,360 --> 00:34:33,320
WAY OR DO SOMETHING DIFFERENT OR

1086
00:34:33,320 --> 00:34:35,520
PLAN A NEW TREE, CREATE THE

1087
00:34:35,520 --> 00:34:38,280
WHOLE -- BLOW UP THE ORIGINAL

1088
00:34:38,280 --> 00:34:40,640
PRACTICE AND START NEW.

1089
00:34:40,640 --> 00:34:42,400
SO NOW THAT WE HAVE REVIEWED

1090
00:34:42,400 --> 00:34:43,640
DEFINITIONS, LET'S CONSIDER

1091
00:34:43,640 --> 00:34:44,320
ENVIRONMENT.

1092
00:34:44,320 --> 00:34:45,920
WE TALK A LOT ABOUTSOME

1093
00:34:45,920 --> 00:34:47,280
DETERMINANTS OF HEALTH AND HOW

1094
00:34:47,280 --> 00:34:48,640
THOSE ARE SO IMPORTANT.

1095
00:34:48,640 --> 00:34:50,680
SOCIAL ECONOMIC POLITICAL

1096
00:34:50,680 --> 00:34:51,080
FACTORS.

1097
00:34:51,080 --> 00:34:52,920
SO ALL OF THESE THINGS SOCIAL

1098
00:34:52,920 --> 00:34:53,880
ENVIRONMENT, TRANSPORTATION

1099
00:34:53,880 --> 00:34:56,920
EDUCATION EMPLOYMENT, HEALTH

1100
00:34:56,920 --> 00:34:59,400
SYSTEMS AND HEALTHCARE DELIVERY

1101
00:34:59,400 --> 00:35:01,200
HOUSING INCOME, JOB

1102
00:35:01,200 --> 00:35:03,320
OPPORTUNITIES AND NOT JUST JOBS

1103
00:35:03,320 --> 00:35:07,160
BUT CAREER PATH OPPORTUNITIES

1104
00:35:07,160 --> 00:35:08,280
AND PHYSICAL BUILT ENVIRONMENT

1105
00:35:08,280 --> 00:35:09,280
AND WORKPLACE ENVIRONMENTS ARE

1106
00:35:09,280 --> 00:35:10,920
CRITICAL AND THEY ACTIVELY ARE

1107
00:35:10,920 --> 00:35:11,400
BENT.

1108
00:35:11,400 --> 00:35:13,320
THEY ACTIVELY ARE FAVORING SOME

1109
00:35:13,320 --> 00:35:15,120
POPULATIONS AND ACTIVELY

1110
00:35:15,120 --> 00:35:15,800
DISADVANTAGING OTHERS.

1111
00:35:15,800 --> 00:35:22,040
THE UNDERLYING THAT BENTNESS IS

1112
00:35:22,040 --> 00:35:23,720
SYSTEMATIC RACISM THAT IS

1113
00:35:23,720 --> 00:35:25,400
DRIVING PROMULGATION OF SOCIAL

1114
00:35:25,400 --> 00:35:28,920
ECONOMIC POLITICAL FACTORS THAT

1115
00:35:28,920 --> 00:35:29,960
ARE DICES ADVANTAGING GIRLS AND

1116
00:35:29,960 --> 00:35:31,840
WOMEN ESPECIALLY GIRLS AND WOMEN

1117
00:35:31,840 --> 00:35:32,960
OF COLOR.

1118
00:35:32,960 --> 00:35:35,120
ANOTHER WAY WAY TO LOOK AT THIS

1119
00:35:35,120 --> 00:35:36,600
IS TWO SEPARATE CLIFFS AND WHY

1120
00:35:36,600 --> 00:35:38,160
ARE GREEN PERSONS IN THAT

1121
00:35:38,160 --> 00:35:40,720
DRAWING CLOSE STARTING CLOSER TO

1122
00:35:40,720 --> 00:35:42,320
END OF THE CLIFF WE CALL THEM AT

1123
00:35:42,320 --> 00:35:43,680
RISK, I DON'T LIKE CALLING THEM

1124
00:35:43,680 --> 00:35:44,440
AT RISK.

1125
00:35:44,440 --> 00:35:45,840
THEY ARE SYSTEMATICALLY

1126
00:35:45,840 --> 00:35:48,360
EXCLUDED.

1127
00:35:48,360 --> 00:35:49,280
SYSTEMATICALLY ON PRESSED

1128
00:35:49,280 --> 00:35:51,160
BECAUSE OF THOSE BENT TRIES AND

1129
00:35:51,160 --> 00:35:54,200
THAT SYSTEMIC RACISM.

1130
00:35:54,200 --> 00:35:55,760
ANOTHER TYPE OF ENVIRONMENT IS

1131
00:35:55,760 --> 00:35:56,720
THE RESEARCH PIPELINE.

1132
00:35:56,720 --> 00:35:57,720
WE GOT TO THINK ABOUT THIS

1133
00:35:57,720 --> 00:36:00,280
BECAUSE THIS IS AN NIH TALK.

1134
00:36:00,280 --> 00:36:03,160
I WOULD BE REMISS IF DIDN'T TALK

1135
00:36:03,160 --> 00:36:05,080
ABOUT ALL THE POSSIBLE

1136
00:36:05,080 --> 00:36:07,760
STRUCTURAL INEQUITIES AND RACISM

1137
00:36:07,760 --> 00:36:10,120
AND BIAS ALONG THE ENTIRE

1138
00:36:10,120 --> 00:36:11,840
PROCESS.

1139
00:36:11,840 --> 00:36:13,280
THAT STARTS WITH AND WHAT IS

1140
00:36:13,280 --> 00:36:14,520
REALLY IMPORTANT WE HAVE AN

1141
00:36:14,520 --> 00:36:16,760
EVOLVING DEMOGRAPHY AND ABOUT 20

1142
00:36:16,760 --> 00:36:18,640
YEARS FROM NOW WHICH IS NOT THAT

1143
00:36:18,640 --> 00:36:20,520
MUCH TIME, OUR POPULATION OF OUR

1144
00:36:20,520 --> 00:36:23,120
COUNTRY IS GOING TO BE TOTALLY

1145
00:36:23,120 --> 00:36:23,600
DIFFERENT.

1146
00:36:23,600 --> 00:36:25,680
WE WILL HAVE MORE DIVERSE

1147
00:36:25,680 --> 00:36:27,760
PERSONS OF MULTIPLE DIVERSE

1148
00:36:27,760 --> 00:36:29,840
BACKGROUNDS, THAT IS SO CRITICAL

1149
00:36:29,840 --> 00:36:31,080
BECAUSE IF THEY INPUT OF OUR

1150
00:36:31,080 --> 00:36:32,960
RESEARCH AND THE OUTPUT OF OUR

1151
00:36:32,960 --> 00:36:35,320
RESEARCH RIGHT NOW IS NOT REALLY

1152
00:36:35,320 --> 00:36:38,080
MEETING THE NEEDS OF DIVERSE

1153
00:36:38,080 --> 00:36:39,400
POPULATION TO DECADES FROM NOW,

1154
00:36:39,400 --> 00:36:40,560
WE ARE IN TROUBLE.

1155
00:36:40,560 --> 00:36:42,120
THIS IS FEDERAL MONEY SO WE NEED

1156
00:36:42,120 --> 00:36:43,560
TO THINK ABOUT THIS PROCESS AND

1157
00:36:43,560 --> 00:36:45,760
HOW WE ARE INVESTING IN OUR

1158
00:36:45,760 --> 00:36:47,280
APPROACH TO RESEARCH.

1159
00:36:47,280 --> 00:36:48,720
THE FUNDING ANNOUNCEMENT IN

1160
00:36:48,720 --> 00:36:50,720
UPPER LEFT HAND CORNER MAKES A

1161
00:36:50,720 --> 00:36:52,400
DIFFERENCE, HOW IT IS DESIGNED

1162
00:36:52,400 --> 00:36:54,040
AND HOW THAT IS DESIGNED IS

1163
00:36:54,040 --> 00:36:56,440
IMPACTED BY THE FEDERATED

1164
00:36:56,440 --> 00:36:58,440
STRUCTURE OF NIH FOR EXAMPLE

1165
00:36:58,440 --> 00:36:59,360
THINK ABOUT NIH FUNDING.

1166
00:36:59,360 --> 00:37:02,880
THIS CAN BE APPLIED TO MULTIPLE

1167
00:37:02,880 --> 00:37:04,800
FUNDERS NOT JUST NIH.

1168
00:37:04,800 --> 00:37:06,640
SO WE NEED TO THINK ABOUT HOW IS

1169
00:37:06,640 --> 00:37:09,000
THE FEDERATED SYSTEM DESIGNED

1170
00:37:09,000 --> 00:37:11,200
AND IS THERE AN INSTITUTE THAT

1171
00:37:11,200 --> 00:37:13,840
CAN ACTUALLY DO A STANDING PA

1172
00:37:13,840 --> 00:37:15,960
PROGRAM ANNOUNCEMENT OR FUNDING

1173
00:37:15,960 --> 00:37:17,320
OPPORTUNITY ANNOUNCEMENT OR

1174
00:37:17,320 --> 00:37:19,600
STANDING ONE WHICH ARGUABLY

1175
00:37:19,600 --> 00:37:21,520
OPENS THE DOORS FOR THE MOST

1176
00:37:21,520 --> 00:37:23,200
INNOVATIVE RESEARCH IMPACTFUL

1177
00:37:23,200 --> 00:37:24,520
RESEARCH BECAUSE IT GIVES YOU

1178
00:37:24,520 --> 00:37:27,080
THE MOST TIME TO DEVELOP THE

1179
00:37:27,080 --> 00:37:27,840
TRANSDISCIPLINARY TEAM REQUIRED

1180
00:37:27,840 --> 00:37:29,840
FOR THIS TYPE OF WORK.

1181
00:37:29,840 --> 00:37:32,160
THAT IS NOT AVAILABLE NOW

1182
00:37:32,160 --> 00:37:33,720
BECAUSE THE OFFICE OF RESEARCH

1183
00:37:33,720 --> 00:37:36,080
WOMEN HEALTH FOR EXAMPLE IS A

1184
00:37:36,080 --> 00:37:39,520
OFFICE AND NOT A IC.

1185
00:37:39,520 --> 00:37:41,200
IT CAN'T HAVE A PA.

1186
00:37:41,200 --> 00:37:42,560
IT IS JUST ONE EXAMPLE.

1187
00:37:42,560 --> 00:37:45,320
THE SCIENTISTS WHO CREATES THAT

1188
00:37:45,320 --> 00:37:46,520
SCIENTIST, WHO GETS TO BE A

1189
00:37:46,520 --> 00:37:48,480
SCIENTIST, WHO GETS TO BE A PI

1190
00:37:48,480 --> 00:37:50,720
OF AN NIH GRANT.

1191
00:37:50,720 --> 00:37:54,280
WE KNOW PIPELINE IS WROUGHT WITH

1192
00:37:54,280 --> 00:37:56,320
WEEKS AND PATHWAYS THAT ARE NOT

1193
00:37:56,320 --> 00:37:58,400
NECESSARILY AMENABLE FOR DIVERSE

1194
00:37:58,400 --> 00:37:59,240
PERSONS IN THE RESEARCH

1195
00:37:59,240 --> 00:38:00,600
PIPELINE.

1196
00:38:00,600 --> 00:38:02,680
FOR THAT DEVELOPMENT THINKING

1197
00:38:02,680 --> 00:38:03,400
THROUGH THAT.

1198
00:38:03,400 --> 00:38:05,520
STUDY PROTOCOL DESIGN INCLUSION

1199
00:38:05,520 --> 00:38:07,640
EXCLUSION CRITERIA, CRITICAL FOR

1200
00:38:07,640 --> 00:38:09,720
INVOLVING DIVERSE PERSONS OR

1201
00:38:09,720 --> 00:38:12,720
ACTUALLY ACTIVELY EXCLUDING

1202
00:38:12,720 --> 00:38:13,960
DIVERSE PERSONS, THINKING ABOUT

1203
00:38:13,960 --> 00:38:16,520
WHO PARTNERS ALONG THE WAY WITH

1204
00:38:16,520 --> 00:38:18,800
THIS TEAM THE HISTORY OF

1205
00:38:18,800 --> 00:38:20,240
DISTRUST AND DISCRIMINATION IN

1206
00:38:20,240 --> 00:38:21,720
BIAS RESEARCH PARTICIPATION, HOW

1207
00:38:21,720 --> 00:38:22,600
THOSE RESEARCH FINDINGS ARE

1208
00:38:22,600 --> 00:38:24,280
SHARED WITH THE COMMUNITY AND

1209
00:38:24,280 --> 00:38:25,480
THE PARTICIPANTS WHO PARTICIPATE

1210
00:38:25,480 --> 00:38:26,920
IN THE RESEARCH DISSEMINATION

1211
00:38:26,920 --> 00:38:29,080
AND IMPACT.

1212
00:38:29,080 --> 00:38:30,960
LET'S LOOK.

1213
00:38:30,960 --> 00:38:32,360
THIS IS NIH.

1214
00:38:32,360 --> 00:38:35,560
ALL THE DIFFERENT 27 ICs THEY

1215
00:38:35,560 --> 00:38:37,120
ARE EACH INDIVIDUAL AND WHERE IS

1216
00:38:37,120 --> 00:38:38,400
THE WOMAN AND GIRL MANY THE

1217
00:38:38,400 --> 00:38:40,320
WOMEN AND GIRLS HEALTH RESEARCH

1218
00:38:40,320 --> 00:38:42,280
AND ANY OF THESE?

1219
00:38:42,280 --> 00:38:43,360
THEY ARE ACROSS EVERYTHING.

1220
00:38:43,360 --> 00:38:46,640
THE FEMALE LOOKING WILD ON THE

1221
00:38:46,640 --> 00:38:47,840
RIGHT HAND CORNER IS KIND OF AT

1222
00:38:47,840 --> 00:38:48,720
THE CORNER AND AFTER THOUGHT OF

1223
00:38:48,720 --> 00:38:50,480
THAT.

1224
00:38:50,480 --> 00:38:52,920
WHAT WE REALLY NEED TO DO IF WE

1225
00:38:52,920 --> 00:38:55,560
ARE GOING TO ADDRESS NIH AS A

1226
00:38:55,560 --> 00:38:58,320
MISSION TO NOT ONLY GENERATE

1227
00:38:58,320 --> 00:39:00,240
KNOWLEDGE BUT TO ALSO APPLY THAT

1228
00:39:00,240 --> 00:39:02,360
KNOWLEDGE TO ENHANCE HEALTH

1229
00:39:02,360 --> 00:39:03,840
LENGTH AND LIFE AND REDUCE

1230
00:39:03,840 --> 00:39:05,200
ILLNESS AND DISABILITY.

1231
00:39:05,200 --> 00:39:07,120
WE CAN DO SYSTEMS THINKING

1232
00:39:07,120 --> 00:39:10,680
ACROSS THE LIFE SPAN AND HEALTH

1233
00:39:10,680 --> 00:39:12,640
SPAN TO ADVANCE INTEGRATIVE CARE

1234
00:39:12,640 --> 00:39:15,160
AND REDUCE MORBIDITY AND

1235
00:39:15,160 --> 00:39:17,280
OPTIMIZE HEALTH ALONG THAT

1236
00:39:17,280 --> 00:39:21,040
COURSE FOR WOMEN AN GIRLS.

1237
00:39:21,040 --> 00:39:23,640
THIS SIDE ROAD APPROACH OF ICs

1238
00:39:23,640 --> 00:39:25,120
DICTATES HOW FUNDING

1239
00:39:25,120 --> 00:39:27,120
ANNOUNCEMENTS ARE DESIGNED AND

1240
00:39:27,120 --> 00:39:28,360
HOW RESEARCH PROPOSALS ARE

1241
00:39:28,360 --> 00:39:28,920
CREATED.

1242
00:39:28,920 --> 00:39:30,360
THAT POSES A CHALLENGE WHEN

1243
00:39:30,360 --> 00:39:31,360
TRYING TO DO THIS WORK.

1244
00:39:31,360 --> 00:39:33,360
LET'S CONSIDER EXAMPLES OF

1245
00:39:33,360 --> 00:39:33,960
DISPARITIES.

1246
00:39:33,960 --> 00:39:36,920
YOU HEARD FROM DR. TEMKIN,

1247
00:39:36,920 --> 00:39:38,720
MENTAL HEALTH NOT ONLY DO WOMEN

1248
00:39:38,720 --> 00:39:40,160
BEAR THE BRUNT OF MENTAL HEALTH

1249
00:39:40,160 --> 00:39:41,720
DISPARITIES IN THE U.S. BUT WHEN

1250
00:39:41,720 --> 00:39:44,400
DATA EXAMINED BY RACE AND

1251
00:39:44,400 --> 00:39:46,120
ETHNICITY CLEAR MINOR ADVERTISED

1252
00:39:46,120 --> 00:39:49,040
GROUPS ARE MORE -- MINORITIZED

1253
00:39:49,040 --> 00:39:50,720
GROUPS EXPERIENCE RISK FACTORS

1254
00:39:50,720 --> 00:39:52,360
AND MORE LIKELY TO PERSIST.

1255
00:39:52,360 --> 00:39:53,600
THERE ARE WIDE ACCESS GAPS TO

1256
00:39:53,600 --> 00:39:54,080
CARE.

1257
00:39:54,080 --> 00:39:56,000
ESPECIALLY IN OTHER LANGUAGES

1258
00:39:56,000 --> 00:39:56,400
BESIDES ENGLISH.

1259
00:39:56,400 --> 00:39:58,640
THE BURDEN OF CART OWE VASCULAR

1260
00:39:58,640 --> 00:40:00,600
DISEASE OBESITY OSTEOARTHRITIS

1261
00:40:00,600 --> 00:40:02,960
AND OTHER CHRONIC DEBILITATING

1262
00:40:02,960 --> 00:40:04,760
CONDITIONS ARE SHOULDERED BY

1263
00:40:04,760 --> 00:40:07,600
BLACK AND LATINA OR LATINA

1264
00:40:07,600 --> 00:40:08,800
WOMEN, IT IS ALMOST EVERY STUDY

1265
00:40:08,800 --> 00:40:10,000
OF WOMEN OF COLOR ARE

1266
00:40:10,000 --> 00:40:12,000
UNDER-REPRESENTED.

1267
00:40:12,000 --> 00:40:13,480
MENOPAUSE FOR EXAMPLE BLACK

1268
00:40:13,480 --> 00:40:15,720
WOMEN EXPERIENCE MORE SYMPTOMS

1269
00:40:15,720 --> 00:40:16,720
YET SUBSTANTIALLY

1270
00:40:16,720 --> 00:40:17,360
UNDER-REPRESENTED IN THE

1271
00:40:17,360 --> 00:40:19,520
RESEARCH ESPECIALLY CLINICAL

1272
00:40:19,520 --> 00:40:19,760
TRIALS.

1273
00:40:19,760 --> 00:40:21,440
BLACK AND LATINO WOMEN HAVE

1274
00:40:21,440 --> 00:40:23,920
HIGHER RISK OF DEMENTIA AND

1275
00:40:23,920 --> 00:40:25,320
ALZHEIMER'S RELATED ASSOCIATED

1276
00:40:25,320 --> 00:40:26,920
DISEASE AND PREVENTIVE SERVICES

1277
00:40:26,920 --> 00:40:28,800
THAT CAN PREVENT CHRONIC

1278
00:40:28,800 --> 00:40:30,440
DEBILITATING CONDITIONS THERE'S

1279
00:40:30,440 --> 00:40:31,720
SUBSTANTIAL RESEARCH GAPS THAT

1280
00:40:31,720 --> 00:40:33,520
LIMIT APPLICABILITY GUIDELINES

1281
00:40:33,520 --> 00:40:35,240
AND RECOMMENDATIONS CONCORDANT

1282
00:40:35,240 --> 00:40:36,040
CARE.

1283
00:40:36,040 --> 00:40:37,720
HAVE SUBSTANTIAL IMPLEMENTATION

1284
00:40:37,720 --> 00:40:40,480
AND UPTAKE GAPS ACROSS THE

1285
00:40:40,480 --> 00:40:40,880
COUNTRY.

1286
00:40:40,880 --> 00:40:42,120
RECOMMENDATIONS ARE NOT

1287
00:40:42,120 --> 00:40:46,520
IMPLEMENTED IN THE SAME WAY BY

1288
00:40:46,520 --> 00:40:47,520
THAT SOMETIMES DETERMINED BY ZIP

1289
00:40:47,520 --> 00:40:51,080
CODE OR CLINIC THAT YOU GO TO.

1290
00:40:51,080 --> 00:40:52,120
FOR EXAMPLE LUNG CANCER

1291
00:40:52,120 --> 00:40:54,920
SCREENING IS A GREAT EXAMPLE OF

1292
00:40:54,920 --> 00:40:57,240
LOW IMPLEMENTATION UPTAKE AND

1293
00:40:57,240 --> 00:40:58,680
PRACTICE.

1294
00:40:58,680 --> 00:41:01,560
SO THESE CONDITIONS CHRONIC

1295
00:41:01,560 --> 00:41:02,520
DEBILITATING CONDITIONS START

1296
00:41:02,520 --> 00:41:05,040
DURING CHILDHOOD OR EARLY HAD

1297
00:41:05,040 --> 00:41:08,040
LESS SENSE OR WOMEN HOOD WITH

1298
00:41:08,040 --> 00:41:09,800
CUMULATIVE BUILD UP

1299
00:41:09,800 --> 00:41:11,120
OPPORTUNITIES FOR PREVENTION

1300
00:41:11,120 --> 00:41:12,920
TREATMENT TO MITIGATE IMPACT.

1301
00:41:12,920 --> 00:41:14,720
THAT IMPACTS THE HEALTH SPAN

1302
00:41:14,720 --> 00:41:16,120
WHICH IS IMPORTANT AND NOT JUST

1303
00:41:16,120 --> 00:41:18,240
MORE SYMPTOMS BUT ATYPICAL

1304
00:41:18,240 --> 00:41:20,840
SYMPTOMS THAT WOMEN GET.

1305
00:41:20,840 --> 00:41:23,400
CORE RESPONSES TO FIRST LINE

1306
00:41:23,400 --> 00:41:23,880
TREATMENT.

1307
00:41:23,880 --> 00:41:26,080
CO-MORBIDITY IS A PROXY FOR

1308
00:41:26,080 --> 00:41:28,840
POORLY UNDERINADEQUATELY COMPLEX

1309
00:41:28,840 --> 00:41:29,160
MORBIDITY.

1310
00:41:29,160 --> 00:41:30,840
SO LET'S CONSIDER INTEGRATIVE

1311
00:41:30,840 --> 00:41:32,320
MULTI-LEVEL APPROACHES.

1312
00:41:32,320 --> 00:41:33,200
IMPLEMENTATION SCIENCE SYSTEMS

1313
00:41:33,200 --> 00:41:34,360
THINKING.  IMPLEMENTATION

1314
00:41:34,360 --> 00:41:36,120
SCIENCE IS SUPPOSED TO REALLY

1315
00:41:36,120 --> 00:41:38,120
CLOSE THAT SCIENCE PRACTICE GAP.

1316
00:41:38,120 --> 00:41:40,080
THIS IS ONE OF MANY

1317
00:41:40,080 --> 00:41:40,880
IMPLEMENTATION SCIENCE FRAME

1318
00:41:40,880 --> 00:41:42,200
WORKS, THIS IS CONSOLIDATED

1319
00:41:42,200 --> 00:41:44,960
FRAMEWORK FOR IMPLEMENTATION

1320
00:41:44,960 --> 00:41:46,360
RESEARCH.

1321
00:41:46,360 --> 00:41:49,480
REALLY THIS IS WHAT IT LOOKS

1322
00:41:49,480 --> 00:41:49,920
LIKE.

1323
00:41:49,920 --> 00:41:51,920
SO YOU ARE REALLY LOOKING AT

1324
00:41:51,920 --> 00:41:52,960
DIFFERENT ENVIRONMENTS AND

1325
00:41:52,960 --> 00:41:55,400
PLACES THAT IMPACT ULTIMATELY

1326
00:41:55,400 --> 00:41:57,440
THE CARE WORK FLOW, ET CETERA SO

1327
00:41:57,440 --> 00:41:59,400
THERE IS OUTER SETTING AND INNER

1328
00:41:59,400 --> 00:42:00,520
SETTING AND INDIVIDUALS INVOLVED

1329
00:42:00,520 --> 00:42:02,840
THERE IS AN ITERATIVE PROCESS OF

1330
00:42:02,840 --> 00:42:04,920
EXAMINING THIS SO RAPID

1331
00:42:04,920 --> 00:42:05,720
ASSESSMENT IS IMPORTANT IN THIS

1332
00:42:05,720 --> 00:42:07,120
TYPE OF WORK.

1333
00:42:07,120 --> 00:42:08,440
RAPID CYCLE PROCESS IMPROVEMENT

1334
00:42:08,440 --> 00:42:09,040
AND OTHER THINGS.

1335
00:42:09,040 --> 00:42:11,560
IF WE LOOK AT THIS, IF WE LOOK

1336
00:42:11,560 --> 00:42:13,320
UNDER THE HOOD OF THE CAR THERE

1337
00:42:13,320 --> 00:42:19,280
IS OPPORTUNITY WE HAVE TO ALSO

1338
00:42:19,280 --> 00:42:20,920
MARRY HEALTH EQUITY AND

1339
00:42:20,920 --> 00:42:23,720
ANTI-RACISM APPROACHES AND

1340
00:42:23,720 --> 00:42:25,200
IMPLEMENTATION SCIENCE SYSTEM

1341
00:42:25,200 --> 00:42:25,800
THINKING IN ORDER TO DO THESE

1342
00:42:25,800 --> 00:42:27,080
TYPES OF PROJECTS AND IN ORDER

1343
00:42:27,080 --> 00:42:29,320
TO BEST GET THE END RESULT WE

1344
00:42:29,320 --> 00:42:30,640
WANT TO APPLY TO ALL

1345
00:42:30,640 --> 00:42:31,240
POPULATIONS.

1346
00:42:31,240 --> 00:42:34,320
SO WE NEED TO THINK ABOUT BIAS

1347
00:42:34,320 --> 00:42:35,160
THROUGHOUT SOCIETY SOCIO

1348
00:42:35,160 --> 00:42:37,040
POLITICAL STRUCTURE, POLICY

1349
00:42:37,040 --> 00:42:39,040
PRACTICES ORGANIZATIONAL CULTURE

1350
00:42:39,040 --> 00:42:40,240
EXPECTATIONS AND NORMS WHO IS ON

1351
00:42:40,240 --> 00:42:42,360
THE RESEARCH TEAM IS ALSO REALLY

1352
00:42:42,360 --> 00:42:43,640
IMPORTANT, WHO IS FUNDING THE

1353
00:42:43,640 --> 00:42:46,160
RESEARCH, HOW IS THAT FUNDING

1354
00:42:46,160 --> 00:42:47,440
OPPORTUNITY DESIGNED BECAUSE HOW

1355
00:42:47,440 --> 00:42:50,160
IT IS DESIGNED IS HOW RESEARCHER

1356
00:42:50,160 --> 00:42:51,840
LIKE ME IS GOING TO WRITE IT

1357
00:42:51,840 --> 00:42:53,160
BECAUSE THAT IS WHAT YOU TOLD ME

1358
00:42:53,160 --> 00:42:55,720
YOU HAVE TO DO TO ADDRESS IN MY

1359
00:42:55,720 --> 00:42:56,760
RESEARCH PROPOSAL IN ORDER THE

1360
00:42:56,760 --> 00:42:58,560
GET A GOOD REVIEW POTENTIALLY IN

1361
00:42:58,560 --> 00:43:01,040
ORDER TO GET FUNDED.

1362
00:43:01,040 --> 00:43:02,320
WHAT ARE THE JOURNALS THAT ARE

1363
00:43:02,320 --> 00:43:03,560
PUBLISHED IN THE RESEARCH.

1364
00:43:03,560 --> 00:43:05,920
THERE IS A LOT OF ISSUES WITH

1365
00:43:05,920 --> 00:43:07,200
PUBLICATION AND BIAS, WHO GETS

1366
00:43:07,200 --> 00:43:10,000
TO BE PUBLISHED IN CERTAIN

1367
00:43:10,000 --> 00:43:10,600
JOURNALS.

1368
00:43:10,600 --> 00:43:12,080
AGAIN, THIS IS A SYSTEMS

1369
00:43:12,080 --> 00:43:12,480
APPROACH.

1370
00:43:12,480 --> 00:43:13,560
SO THAT WAS IMPLEMENTATION

1371
00:43:13,560 --> 00:43:14,800
SCIENCE, THIS IS A SYSTEMS

1372
00:43:14,800 --> 00:43:16,920
APPROACH AND WHEN YOU ARE

1373
00:43:16,920 --> 00:43:17,800
LOOKING AT SYSTEMS YOU HAVE

1374
00:43:17,800 --> 00:43:20,440
EVIDENCE BASED INTERVENTIONS

1375
00:43:20,440 --> 00:43:22,440
THAT WORDS ON THE TOP, YOU GOT

1376
00:43:22,440 --> 00:43:24,680
ACROSS THE HEALTH SPAN AND LIFE

1377
00:43:24,680 --> 00:43:27,160
SPAN OF INDIVIDUAL GIRL OR

1378
00:43:27,160 --> 00:43:27,680
WOMEN.

1379
00:43:27,680 --> 00:43:29,200
YOU HAVE IMPLEMENTATION RESEARCH

1380
00:43:29,200 --> 00:43:31,720
GOING SICKICALLILY ITERATIVELY

1381
00:43:31,720 --> 00:43:34,520
RAPID CYCLE PROCESSES, RAPID

1382
00:43:34,520 --> 00:43:35,320
APPROACHES, YOU GOT IN THE

1383
00:43:35,320 --> 00:43:36,480
MIDDLE THE CORE LENS THAT YOU

1384
00:43:36,480 --> 00:43:38,200
WANT TO DO.

1385
00:43:38,200 --> 00:43:39,360
THAT YOU WANT TO LOOK THROUGH,

1386
00:43:39,360 --> 00:43:41,920
MAKE SURE THAT HEALTH EQUITY

1387
00:43:41,920 --> 00:43:45,280
STRUCTURAL RACISM THOSE ARE ALL

1388
00:43:45,280 --> 00:43:47,960
ADDRESS, BIAS MODELS AND SOCIAL

1389
00:43:47,960 --> 00:43:49,520
NORMS EXIST AND YOU HAVE TO

1390
00:43:49,520 --> 00:43:50,880
UNDERSTAND THAT AND YOU WANT TO

1391
00:43:50,880 --> 00:43:52,600
ALSO COMBAT THAT DISINFORMATION

1392
00:43:52,600 --> 00:43:55,280
HAPPENING AT THE SAME TIME.

1393
00:43:55,280 --> 00:43:58,360
LIVING IN THIS PANDEMIC THAT

1394
00:43:58,360 --> 00:43:59,080
INCLUDES DISINFORMATION.

1395
00:43:59,080 --> 00:44:01,360
L THESE ARE SOME EXAMPLES OF

1396
00:44:01,360 --> 00:44:05,480
CROSS CUTTING PRIORITY AREAS IN

1397
00:44:05,480 --> 00:44:08,800
THE BLUE H. ACCESS TO FOODS

1398
00:44:08,800 --> 00:44:11,320
ACTIVITIES, THE BUILT WORK

1399
00:44:11,320 --> 00:44:12,040
ENVIRONMENT SCHOOLS MENTAL

1400
00:44:12,040 --> 00:44:13,640
HEALTH ISSUES HEALTHCARE

1401
00:44:13,640 --> 00:44:16,160
DELIVERY, THE CRITICAL COMMUNITY

1402
00:44:16,160 --> 00:44:17,920
PARTNERSHIPS AND PRIVATE

1403
00:44:17,920 --> 00:44:19,120
PARTNERSHIPS FEDERAL ASSISTANCE

1404
00:44:19,120 --> 00:44:19,600
PROGRAMS.

1405
00:44:19,600 --> 00:44:21,920
THIS IS AN EXAMPLE AND IT IS NOT

1406
00:44:21,920 --> 00:44:23,680
MEANT FOR YOU TO READ IT.

1407
00:44:23,680 --> 00:44:27,520
WHAT IT IS MEANT FOR YOU TO DO

1408
00:44:27,520 --> 00:44:28,400
IS PIQUE YOUR CURIOSITY, I HAVE

1409
00:44:28,400 --> 00:44:30,560
THE WEBSITE, FROM NATIONAL

1410
00:44:30,560 --> 00:44:32,680
ACADEMY OF SCIENCE ENGINEERING

1411
00:44:32,680 --> 00:44:34,000
AND MEDICINE ROUND TABLE ON

1412
00:44:34,000 --> 00:44:34,400
OBESITY.

1413
00:44:34,400 --> 00:44:38,120
WHAT THIS IS, IS A SYSTEMS

1414
00:44:38,120 --> 00:44:40,120
APPROACH, I WAS PART OF THIS,

1415
00:44:40,120 --> 00:44:42,360
SYSTEMS MAP COMBINING SYSTEMS

1416
00:44:42,360 --> 00:44:44,560
AND SOLUTIONS FOR OBESITY, THIS

1417
00:44:44,560 --> 00:44:45,520
IS JUST OBESITY.

1418
00:44:45,520 --> 00:44:47,200
THIS IS WHAT NEEDS TO BE DONE

1419
00:44:47,200 --> 00:44:49,400
AND ADDRESSED AND SOMEHOW

1420
00:44:49,400 --> 00:44:51,160
APPROACHED IN ORDER TO GET TO

1421
00:44:51,160 --> 00:44:53,080
THE OUTCOME OF REDUCING OBESITY

1422
00:44:53,080 --> 00:44:54,120
IN THIS COUNTRY.

1423
00:44:54,120 --> 00:44:55,360
THAT IS HOW COMPLEX IT IS.

1424
00:44:55,360 --> 00:44:57,200
THAT IS WHAT I'M CHALLENGING

1425
00:44:57,200 --> 00:44:59,200
Y'ALL TO THINK ABOUT OF HOW WE

1426
00:44:59,200 --> 00:45:01,880
WOULD APPLY THIS AND FOR THE

1427
00:45:01,880 --> 00:45:02,760
OTHER -- ALL THE OTHER

1428
00:45:02,760 --> 00:45:04,560
CONDITIONS WE ARE TALKING ABOUT

1429
00:45:04,560 --> 00:45:05,600
TODAY AND THE OTHER CONDITIONS

1430
00:45:05,600 --> 00:45:08,280
IN GENERAL.

1431
00:45:08,280 --> 00:45:10,080
ONE VERY SPECIFIC EXAMPLE, WE

1432
00:45:10,080 --> 00:45:11,520
ARE NOT TALKING CERVICAL CANCER

1433
00:45:11,520 --> 00:45:13,280
IN THE TWO DAY AGENDA, BUT THIS

1434
00:45:13,280 --> 00:45:15,240
IS A LITTLE MORE SPECIFIC AND

1435
00:45:15,240 --> 00:45:15,680
PRACTICAL.

1436
00:45:15,680 --> 00:45:17,880
THE WHO WORLD HEALTH

1437
00:45:17,880 --> 00:45:18,920
ORGANIZATION SAY THERE'S THREE

1438
00:45:18,920 --> 00:45:20,840
COLORS OF CERVICAL CANCER

1439
00:45:20,840 --> 00:45:21,200
ELIMINATION.

1440
00:45:21,200 --> 00:45:22,720
YOU HAVE TO DO ALL THREE IN

1441
00:45:22,720 --> 00:45:25,000
ORDER TO GET TO INCIDENCE LESS

1442
00:45:25,000 --> 00:45:26,040
THAN FOUR FOR HUNDRED THOUSAND

1443
00:45:26,040 --> 00:45:27,280
CASES PER YEAR AND THIS IS

1444
00:45:27,280 --> 00:45:29,320
POSSIBLE IN OUR COUNTRY.

1445
00:45:29,320 --> 00:45:32,560
BUT OUR RATES OF CERVICAL CANCER

1446
00:45:32,560 --> 00:45:34,600
HAVING STAGNANT FOR A DECADE

1447
00:45:34,600 --> 00:45:35,760
BECAUSE WE CAN'T DO THIS WELL.

1448
00:45:35,760 --> 00:45:37,720
WE HAVEN'T DONE ALL THREE.

1449
00:45:37,720 --> 00:45:40,640
THE HPV VACCINATION, SCREENING

1450
00:45:40,640 --> 00:45:41,920
AND FOLLOW UP AND TREATMENT YOU

1451
00:45:41,920 --> 00:45:43,520
NEED ALL THREE AND IN ORDER TO

1452
00:45:43,520 --> 00:45:46,560
DO THIS, THERE IS ALREADY A

1453
00:45:46,560 --> 00:45:48,920
MYRIAD OF WONDERFULLY FUNDED NCI

1454
00:45:48,920 --> 00:45:52,280
AND NIH STUDIES FOR EXAMPLE THAT

1455
00:45:52,280 --> 00:45:53,680
ACTUALLY HAVE PROVEN EVIDENCE

1456
00:45:53,680 --> 00:45:54,920
BASE INTERVENTIONS.

1457
00:45:54,920 --> 00:45:59,880
YOU NEED TO BE ABLE TO IMPLEMENT

1458
00:45:59,880 --> 00:46:01,400
ALL THREE EVIDENCE BASED

1459
00:46:01,400 --> 00:46:02,680
INTERVENTIONS ADDRESSING ALL

1460
00:46:02,680 --> 00:46:04,280
THREE PILLARS.

1461
00:46:04,280 --> 00:46:05,840
SO YOU NEED TO BE ABLE TO TAILOR

1462
00:46:05,840 --> 00:46:08,600
TO THE INDIVIDUAL CLINIC IN

1463
00:46:08,600 --> 00:46:10,520
TERMS OF WHAT ON THE MENU OF

1464
00:46:10,520 --> 00:46:13,360
EACH OF THESE PILLARS THAT ARE

1465
00:46:13,360 --> 00:46:14,520
EVIDENCE BASED INTERVENTIONS

1466
00:46:14,520 --> 00:46:16,360
BECAUSE THERE IS MORE THAN ONE

1467
00:46:16,360 --> 00:46:18,680
FOR EACH THREE PILLARS WHICH

1468
00:46:18,680 --> 00:46:19,720
ONES WORK FOR THE PARTICULAR

1469
00:46:19,720 --> 00:46:20,720
CLINIC.

1470
00:46:20,720 --> 00:46:21,840
THAT'S HOW DETAILED YOU HAVE TO

1471
00:46:21,840 --> 00:46:23,480
GET.

1472
00:46:23,480 --> 00:46:25,680
SO THAT IS REALLY IMPORTANT TO

1473
00:46:25,680 --> 00:46:27,440
THINK ABOUT WHAT THE COMPLEXITY

1474
00:46:27,440 --> 00:46:30,280
AND THE VOLUME AND SCALE THAT

1475
00:46:30,280 --> 00:46:32,160
NEEDS TO BE DONE IN ORDER TO

1476
00:46:32,160 --> 00:46:33,920
ACHIEVE WHAT Y'ALL WANT TO

1477
00:46:33,920 --> 00:46:34,240
ACHIEVE.

1478
00:46:34,240 --> 00:46:35,440
HERE IS THE EXAMPLE FROM

1479
00:46:35,440 --> 00:46:35,920
CHICAGO.

1480
00:46:35,920 --> 00:46:37,280
I WILL TAKE BREAST CANCER THIS

1481
00:46:37,280 --> 00:46:39,520
IS WHAT I HAVE DONE A LOT OF.

1482
00:46:39,520 --> 00:46:41,480
OUR BREAST CANCER DISPARITIES IN

1483
00:46:41,480 --> 00:46:43,320
CHICAGO BETWEEN BLACK AND WHITE

1484
00:46:43,320 --> 00:46:45,120
WOMEN WERE EGREGIOUS.

1485
00:46:45,120 --> 00:46:47,960
THE MAGENTA LINE IS BLACK

1486
00:46:47,960 --> 00:46:49,520
MORTALITY TO BREAST CANCER AND

1487
00:46:49,520 --> 00:46:52,280
THE GRAY LINE ON THIS GRAPH IS

1488
00:46:52,280 --> 00:46:53,960
WHITE MORTALITY.

1489
00:46:53,960 --> 00:46:56,160
SOMEWHERE THEY START AROUND THE

1490
00:46:56,160 --> 00:46:57,640
SAME MORTALITY RATES IN EARLY

1491
00:46:57,640 --> 00:46:59,320
'80s AND SOMEWHERE ALONG THE

1492
00:46:59,320 --> 00:47:01,520
WAY IN THE MID 90s THOSE

1493
00:47:01,520 --> 00:47:05,320
MORTALITY LINES DIVERGE.

1494
00:47:05,320 --> 00:47:06,840
BY 2007 BLACK WOMEN IN CHICAGO

1495
00:47:06,840 --> 00:47:09,240
ALL THE WAY AT THE RIGHT OF THE

1496
00:47:09,240 --> 00:47:10,720
YOUR GRAPH BLACK WOMEN IN

1497
00:47:10,720 --> 00:47:14,880
CHICAGO WERE DYING AT A RACE 62%

1498
00:47:14,880 --> 00:47:16,040
GREATER THAN WHITE WOMEN.

1499
00:47:16,040 --> 00:47:16,960
WHY IS THIS HAPPENING?

1500
00:47:16,960 --> 00:47:19,320
WE KNEW THAT IN NEW YORK THE

1501
00:47:19,320 --> 00:47:21,040
RATE WAS 27%, UNITED STATES IT

1502
00:47:21,040 --> 00:47:23,560
WAS IN THE 40s, WHAT WAS GOING

1503
00:47:23,560 --> 00:47:25,040
ON IN CHICAGO?

1504
00:47:25,040 --> 00:47:26,280
TREES WERE BENT.

1505
00:47:26,280 --> 00:47:27,520
AND THEY WERE BENT ACROSS

1506
00:47:27,520 --> 00:47:29,800
MULTIPLE POLICIES MULTIPLE

1507
00:47:29,800 --> 00:47:33,200
PRACTICES, RED LINING,

1508
00:47:33,200 --> 00:47:34,520
DISINVESTMENT IN COMMUNITIES ON

1509
00:47:34,520 --> 00:47:36,280
THE WEST AND SOUTH SIDE BLACK

1510
00:47:36,280 --> 00:47:40,240
WOMEN WERE CONCENTRATED, OVER

1511
00:47:40,240 --> 00:47:41,840
DECADES.

1512
00:47:41,840 --> 00:47:44,880
ACCESS ISSUES, ISSUES AROUND THE

1513
00:47:44,880 --> 00:47:46,240
MAMMOGRAPHY SCREENING FOLLOW-UP,

1514
00:47:46,240 --> 00:47:47,280
ALL THESE THINGS.

1515
00:47:47,280 --> 00:47:50,080
WHEN YOU TAKE A SYSTEMS APPROACH

1516
00:47:50,080 --> 00:47:51,640
AND STRUCTURAL ELEMENTS OF

1517
00:47:51,640 --> 00:47:54,320
ECOLOGY TO THINK ABOUT SOCIAL

1518
00:47:54,320 --> 00:47:56,160
ECOLOGICAL MODEL WHAT YOU NEED

1519
00:47:56,160 --> 00:47:58,720
TO DO INTERPERSONAL BARRIERS

1520
00:47:58,720 --> 00:48:00,520
COMMUNITY BARRIERS NEEDED

1521
00:48:00,520 --> 00:48:03,640
PATIENT NAVIGATION APPROACH.

1522
00:48:03,640 --> 00:48:05,640
THE HEALTH SYSTEM BARRIERS AND

1523
00:48:05,640 --> 00:48:07,400
COMMUNITY BARRIERS NEEDED

1524
00:48:07,400 --> 00:48:09,400
IMPLEMENTATION SCIENCE AND

1525
00:48:09,400 --> 00:48:11,440
QUALITY IMPROVEMENT APPROACHES,

1526
00:48:11,440 --> 00:48:14,240
RAPID CYCLE APPROACHES.

1527
00:48:14,240 --> 00:48:16,560
THEN THERE NEEDED TO BE ADVOCACY

1528
00:48:16,560 --> 00:48:18,520
POLICY AND CERTAINLY GOOD

1529
00:48:18,520 --> 00:48:19,520
COMMUNICATION.

1530
00:48:19,520 --> 00:48:21,920
SO PATIENT NAVIGATION IS AN

1531
00:48:21,920 --> 00:48:23,440
EVIDENCE BASED INTERVENTION, IT

1532
00:48:23,440 --> 00:48:26,240
IS A COMPLETE EDI WE KNOW THIS.

1533
00:48:26,240 --> 00:48:27,840
IT IS NOT ONE SIZE FITS ALL, IT

1534
00:48:27,840 --> 00:48:30,200
IS MORE THAN JUST INDIVIDUAL

1535
00:48:30,200 --> 00:48:31,680
NAVIGATORS, THE CORE PRINCIPLES

1536
00:48:31,680 --> 00:48:32,680
ARE PATIENT CENTERED AND

1537
00:48:32,680 --> 00:48:35,720
COMMUNITY CENTERED.

1538
00:48:35,720 --> 00:48:36,960
CAN ADJUST DIFFERENT HEALTHCARE

1539
00:48:36,960 --> 00:48:38,440
SETTINGS.

1540
00:48:38,440 --> 00:48:40,480
AND IT IS TO ELIMINATE BARRIERS

1541
00:48:40,480 --> 00:48:42,800
TO TIMELY CARE ACROSS ALL PHASES

1542
00:48:42,800 --> 00:48:44,160
OF THE HEALTHCARE CONTINUUM AND

1543
00:48:44,160 --> 00:48:47,520
DOES A SYSTEMS APPROACH.

1544
00:48:47,520 --> 00:48:49,720
IT IS VITAL TO SCALE UP PATIENT

1545
00:48:49,720 --> 00:48:52,120
NAVIGATION APPROACHES THAT EMBED

1546
00:48:52,120 --> 00:48:53,520
EQUITY AND ANTI-RACISM

1547
00:48:53,520 --> 00:48:55,640
PRINCIPLES.

1548
00:48:55,640 --> 00:48:57,360
THAT IS HOW, IT IS CRITICAL.

1549
00:48:57,360 --> 00:48:58,400
THAT IS NOT THE ONLY THING WE

1550
00:48:58,400 --> 00:48:58,760
DID.

1551
00:48:58,760 --> 00:49:00,440
WE HAD TO THINK ABOUT OTHER

1552
00:49:00,440 --> 00:49:01,680
PATIENT NAVIGATION APPROACHES

1553
00:49:01,680 --> 00:49:03,120
AND ONE IS THIS CHECKLIST.

1554
00:49:03,120 --> 00:49:07,040
THIS IS AN EXAMPLE OF WHAT OUR

1555
00:49:07,040 --> 00:49:08,120
TEAM HAS DEVELOPED FOR OUR

1556
00:49:08,120 --> 00:49:08,520
SEQUENCE.

1557
00:49:08,520 --> 00:49:10,960
THIS IS JUST ONE EXAMPLE FOR

1558
00:49:10,960 --> 00:49:13,880
BREAST CANCER, WHAT WE DID IS WE

1559
00:49:13,880 --> 00:49:15,360
TOOK A GANT CHART WE WORKED WITH

1560
00:49:15,360 --> 00:49:18,640
SYSTEMS ENGINEERS, WE TOOK A

1561
00:49:18,640 --> 00:49:19,680
GANT CHART AND PUT ALL THE

1562
00:49:19,680 --> 00:49:21,480
POSSIBLE THINGS A PATIENT NEEDED

1563
00:49:21,480 --> 00:49:23,040
TO GO THROUGH WHEN THEY STARTED

1564
00:49:23,040 --> 00:49:24,840
BREAST CANCER SURGERY, ALL THE

1565
00:49:24,840 --> 00:49:25,240
LIST.

1566
00:49:25,240 --> 00:49:27,360
THE REASON WHY THE LIST AND

1567
00:49:27,360 --> 00:49:30,760
BEING A PAPER FORM IS SO

1568
00:49:30,760 --> 00:49:33,080
CRITICAL, ONE CHECK BOX IS NOT

1569
00:49:33,080 --> 00:49:35,720
CHECKED, IT GIVES PATIENT AND

1570
00:49:35,720 --> 00:49:37,960
CAREGIVER AGENCY TO SAY HEY DOC

1571
00:49:37,960 --> 00:49:40,160
OR TEAM OR NURSE, HEY WHATEVER,

1572
00:49:40,160 --> 00:49:43,200
WHY IS THIS BOX NOT CHECKED?

1573
00:49:43,200 --> 00:49:44,720
WHEN YOU HAVE LOW LITERACY AND

1574
00:49:44,720 --> 00:49:46,960
ALL THE OTHER ISSUES, EXPERIENCE

1575
00:49:46,960 --> 00:49:48,600
DISTRUST IN THE HEALTHCARE

1576
00:49:48,600 --> 00:49:49,760
SYSTEM, HAVING IT SIMPLE LIKE

1577
00:49:49,760 --> 00:49:52,320
THIS, BEING ABLE TO SAY THAT BOX

1578
00:49:52,320 --> 00:49:54,880
ISN'T CHECKED AND WHEN IS IT

1579
00:49:54,880 --> 00:49:56,440
GOING TO GET CHECKED HELPS

1580
00:49:56,440 --> 00:49:57,040
TREMENDOUSLY.

1581
00:49:57,040 --> 00:50:00,000
THAT IS THE BACK OF THAT PAPER

1582
00:50:00,000 --> 00:50:02,440
THE DIFFERENT CONTACTS FOR EACH

1583
00:50:02,440 --> 00:50:04,040
OF THOSE DIFFERENT THINGS.

1584
00:50:04,040 --> 00:50:05,480
THE OTHER THING SYSTEMS

1585
00:50:05,480 --> 00:50:08,040
APPROACHES IMPLEMENTATION

1586
00:50:08,040 --> 00:50:09,160
SCIENCE DOES IS BRING PEOPLE

1587
00:50:09,160 --> 00:50:09,440
TOGETHER.

1588
00:50:09,440 --> 00:50:10,760
WE HAVE STUDIED THAT IT BRINGS

1589
00:50:10,760 --> 00:50:13,080
-- BUILDS MORE RELATIONSHIPS

1590
00:50:13,080 --> 00:50:14,320
BETWEEN THE WRAP AROUND SERVICE

1591
00:50:14,320 --> 00:50:16,200
AGENCIES THAT ARE SO CRITICAL IN

1592
00:50:16,200 --> 00:50:18,520
A COMMUNITY TO ADDRESSING THE

1593
00:50:18,520 --> 00:50:19,920
SOCIAL ECONOMIC DETERMINANTS OF

1594
00:50:19,920 --> 00:50:21,560
HEALTH.

1595
00:50:21,560 --> 00:50:23,520
SO WHEN YOU HAVE RELATIONSHIPS

1596
00:50:23,520 --> 00:50:25,760
AND AGENCIES COMING TOGETHER TO

1597
00:50:25,760 --> 00:50:27,480
WRAP AROUND CARE BECAUSE THE

1598
00:50:27,480 --> 00:50:30,440
HEALTH SYSTEMS CANNOT ADDRESS

1599
00:50:30,440 --> 00:50:31,160
ALLSOME DETERMINANTS OF HEALTH.

1600
00:50:31,160 --> 00:50:33,160
THAT IS WHAT IMPROVES CARE

1601
00:50:33,160 --> 00:50:35,760
DELIVERY IN A SYSTEMS WAY.

1602
00:50:35,760 --> 00:50:39,720
VERY COLLABORATIVE AND ITERATIVE

1603
00:50:39,720 --> 00:50:41,520
EFFORT WE WERE ABLE TO CLOSE THE

1604
00:50:41,520 --> 00:50:41,720
GAP.

1605
00:50:41,720 --> 00:50:44,720
THIS WAS 2017, WE CLOSE AROUND

1606
00:50:44,720 --> 00:50:45,880
36% MORTALITY SO LOOK AT THE FAR

1607
00:50:45,880 --> 00:50:46,320
RIGHT.

1608
00:50:46,320 --> 00:50:48,240
THAT IS A CONTINUUM OF THE GRAPH

1609
00:50:48,240 --> 00:50:50,840
THAT I ALREADY SHOWED EARLIER.

1610
00:50:50,840 --> 00:50:52,920
THAT TOOK A LOT OF SYSTEMS

1611
00:50:52,920 --> 00:50:54,320
APPROACH IMPLEMENTATION SCIENCE

1612
00:50:54,320 --> 00:50:56,640
AND A LOT OF ITERATION.

1613
00:50:56,640 --> 00:50:59,720
IT WAS PREDICATED ON THINGS LIKE

1614
00:50:59,720 --> 00:51:00,960
COLLABORATIVE LIKE CHICAGO

1615
00:51:00,960 --> 00:51:02,520
CANCER HEALTH EQUITY

1616
00:51:02,520 --> 00:51:04,120
COLLABORATIVE ACROSS THE CITY,

1617
00:51:04,120 --> 00:51:07,720
THANKS TO FUNDING FROM NCI, IT

1618
00:51:07,720 --> 00:51:10,600
TOOK COMMUNITY PARTNERSHIPS,

1619
00:51:10,600 --> 00:51:13,280
AGAIN FUNDED BY SEVERAL FUNDERS

1620
00:51:13,280 --> 00:51:14,520
INCLUDING NIH, IT TOOK

1621
00:51:14,520 --> 00:51:16,720
PARTNERSHIPS WITH THE LIBRARIES

1622
00:51:16,720 --> 00:51:19,920
AND WE ARE STILL DOING THIS,

1623
00:51:19,920 --> 00:51:20,440
NLM.

1624
00:51:20,440 --> 00:51:21,920
AGAIN COMMUNITY SCIENTISTS AND

1625
00:51:21,920 --> 00:51:23,160
BRINGING THEM INTO OUR BENCH

1626
00:51:23,160 --> 00:51:28,040
INTO OUR RESEARCH TEAMS TO

1627
00:51:28,040 --> 00:51:29,160
IMPROVE THIS APPROACH.

1628
00:51:29,160 --> 00:51:32,360
BUT IT REQUIRED MULTIPLE

1629
00:51:32,360 --> 00:51:33,720
INSTITUTES AND MULTIPLE

1630
00:51:33,720 --> 00:51:36,440
PROPOSALS MULTIPLE FAILURE AND

1631
00:51:36,440 --> 00:51:37,480
MANY YEARS.

1632
00:51:37,480 --> 00:51:39,560
THE OTHER THINGS TO CONSIDER AS

1633
00:51:39,560 --> 00:51:43,440
I CLOSE TODAY IS OPTIMIZING

1634
00:51:43,440 --> 00:51:44,720
TRAINING CAREER MENTORSHIP

1635
00:51:44,720 --> 00:51:46,720
PATHWAYS TO DO THIS WORK, NOT

1636
00:51:46,720 --> 00:51:48,600
ALL PEOPLE KNOW HOW TO DO THIS

1637
00:51:48,600 --> 00:51:49,720
WORK AND HOW TO MENTOR IT.

1638
00:51:49,720 --> 00:51:52,040
THAT'S CRITICAL.

1639
00:51:52,040 --> 00:51:53,280
ENHANCING DIVERSION COMMUNITY

1640
00:51:53,280 --> 00:51:54,560
OPTIMIZING COMMUNITY ENGAGEMENT

1641
00:51:54,560 --> 00:51:55,360
INVOLVEMENT SUPPORT AND NOT

1642
00:51:55,360 --> 00:51:56,720
EVERYBODY KNOWS HOW TO DO THAT

1643
00:51:56,720 --> 00:51:57,760
EITHER.

1644
00:51:57,760 --> 00:51:59,520
I APPRECIATE SOME GREAT CURRENT

1645
00:51:59,520 --> 00:52:01,760
NIH EXAMPLES OF THE UNITE

1646
00:52:01,760 --> 00:52:03,840
INITIATIVE, THE FIRST GRANT, THE

1647
00:52:03,840 --> 00:52:05,880
CL INITIATIVE, OFFICE OF

1648
00:52:05,880 --> 00:52:08,840
RESEARCH WOMEN'S HEALTH HAVE A

1649
00:52:08,840 --> 00:52:10,520
VARIETY OF INITIATIVES BESIDES

1650
00:52:10,520 --> 00:52:12,720
SCORE GRANT, THIS CURRENT NOTICE

1651
00:52:12,720 --> 00:52:14,880
OF SPECIAL INTEREST TO U 3

1652
00:52:14,880 --> 00:52:17,080
MECHANISM NHLBI IS MATERNITY

1653
00:52:17,080 --> 00:52:18,240
HEALTH COMMUNITY IMPLEMENTATION

1654
00:52:18,240 --> 00:52:20,800
PROJECT THAT I'M PART OF NIMH

1655
00:52:20,800 --> 00:52:23,120
HAS A GREAT MENOPAUSE TRANSITION

1656
00:52:23,120 --> 00:52:26,480
RFA THAT I APPRECIATE.

1657
00:52:26,480 --> 00:52:28,120
IN CONCLUSION CURRENT RESEARCH

1658
00:52:28,120 --> 00:52:29,440
FUNDING DESIGN NIH STRUCTURE

1659
00:52:29,440 --> 00:52:32,680
CREATES DOESN'T ALIGN WITH THIS

1660
00:52:32,680 --> 00:52:33,920
NIH MISSION TO TURN THIS INTO

1661
00:52:33,920 --> 00:52:35,280
HEALTH AND WE ARE TALKING WOMEN

1662
00:52:35,280 --> 00:52:36,840
AND GIRLS CHRONIC CONDITIONS,

1663
00:52:36,840 --> 00:52:39,520
AND TRYING TO PREEMPT THEM.

1664
00:52:39,520 --> 00:52:41,880
IT DOESN'T READILY ALLOW

1665
00:52:41,880 --> 00:52:44,200
RESEARCH TEAMS TO

1666
00:52:44,200 --> 00:52:46,320
COMPREHENSIVELY AND ADEQUATELY

1667
00:52:46,320 --> 00:52:48,840
ADDRESS THE NUANCE SEX SPECIFIC

1668
00:52:48,840 --> 00:52:50,640
GENDER AND VERGE WITH HEALTH

1669
00:52:50,640 --> 00:52:52,520
SPAN AND LIFE SPAN MULTI-SYSTEMS

1670
00:52:52,520 --> 00:52:53,520
IMPLEMENTATION APPROACHES NEEDED

1671
00:52:53,520 --> 00:52:55,880
TO ADDRESS THE WHOLE WOMAN AND

1672
00:52:55,880 --> 00:52:56,920
ESPECIALLY WOMEN OF COLOR.

1673
00:52:56,920 --> 00:52:59,720
IT DOESN'T MEET TRUE WOMEN'S

1674
00:52:59,720 --> 00:53:03,240
CRITICAL CARE NEEDS AND WOMEN

1675
00:53:03,240 --> 00:53:04,720
ARE 50.6% U.S. POPULATION.

1676
00:53:04,720 --> 00:53:07,680
SO INSTEAD OF THIS, THESE

1677
00:53:07,680 --> 00:53:08,760
INDIVIDUAL ROADS THAT HAVE

1678
00:53:08,760 --> 00:53:10,120
CRACKS AND GAPS IN TREES THAT

1679
00:53:10,120 --> 00:53:10,720
ARE BENT.

1680
00:53:10,720 --> 00:53:11,360
WE WANT THIS.

1681
00:53:11,360 --> 00:53:14,200
THIS IS A WAY WE WANT TO GO.

1682
00:53:14,200 --> 00:53:16,880
THANK YOU SO MUCH, I APPRECIATE

1683
00:53:16,880 --> 00:53:18,360
YOU INVITING ME HERE.

1684
00:53:18,360 --> 00:53:19,720
HERE IS MY CONTACT INFORMATION

1685
00:53:19,720 --> 00:53:20,840
IF YOU HAVE ANY QUESTIONS I LOOK

1686
00:53:20,840 --> 00:53:21,560
FORWARD TO OUR QUESTION AND

1687
00:53:21,560 --> 00:53:24,680
ANSWER.

1688
00:53:24,680 --> 00:53:26,840
>> THANK YOU SO MUCH, DR. SIMON,

1689
00:53:26,840 --> 00:53:29,720
FOR THAT OUTSTANDING KEYNOTE

1690
00:53:29,720 --> 00:53:30,240
ADDRESS.

1691
00:53:30,240 --> 00:53:33,280
NOW WE WILL GO INTO OUR

1692
00:53:33,280 --> 00:53:37,120
PANELIST, THE FIRST OF WHOM IS

1693
00:53:37,120 --> 00:53:40,320
DR. KIM TEMPLETON, PROFESSOR OF

1694
00:53:40,320 --> 00:53:41,680
ORTHOPEDIC SURGERY UNIVERSITY OF

1695
00:53:41,680 --> 00:53:44,120
KANSAS MEDICAL CENTER IN KANSAS

1696
00:53:44,120 --> 00:53:44,720
CITY.

1697
00:53:44,720 --> 00:53:46,440
AND DEPARTMENT VICE CHAIR FOR

1698
00:53:46,440 --> 00:53:48,840
DIVERSITY EQUITY AND INCLUSION.

1699
00:53:48,840 --> 00:53:52,600
SHE WAS THE FIRST MCCAN

1700
00:53:52,600 --> 00:53:53,360
PROFESSOR OF WOMEN AND SCIENCE

1701
00:53:53,360 --> 00:53:54,000
IN THE UNITED STATES.

1702
00:53:54,000 --> 00:53:55,880
SHE RECEIVED NUMEROUS AWARDS

1703
00:53:55,880 --> 00:53:57,560
FROM THE UNIVERSITY AS WELL AS

1704
00:53:57,560 --> 00:53:58,800
NATIONAL ORGANIZATIONS TO

1705
00:53:58,800 --> 00:54:00,520
RECOGNIZE LEADERSHIP IN HER WORK

1706
00:54:00,520 --> 00:54:02,440
ADVANCING THE CAUSE OF WOMEN IN

1707
00:54:02,440 --> 00:54:02,920
MEDICINE.

1708
00:54:02,920 --> 00:54:05,360
DR. TEMPLETON IS A PAST

1709
00:54:05,360 --> 00:54:06,720
PRESIDENT OF THE U.S. PHONE AND

1710
00:54:06,720 --> 00:54:08,160
JOINT INITIATIVE AND THE

1711
00:54:08,160 --> 00:54:09,480
AMERICAN MEDICAL WOMEN'S

1712
00:54:09,480 --> 00:54:09,920
ASSOCIATION.

1713
00:54:09,920 --> 00:54:12,160
SHE IS THE PAST VICE CHAIR OF

1714
00:54:12,160 --> 00:54:14,520
THE AMA WOMEN PHYSICIAN SECTION

1715
00:54:14,520 --> 00:54:17,920
AND PAST CHAIR OF THE AMA

1716
00:54:17,920 --> 00:54:19,280
ORTHOPEDIC SECTION SHE INITIATED

1717
00:54:19,280 --> 00:54:20,720
AND WORKED WITH THE AMA

1718
00:54:20,720 --> 00:54:22,760
DEVELOPING NEW POLICY TO

1719
00:54:22,760 --> 00:54:23,840
RECOGNIZE AND EXPAND DEFINITION

1720
00:54:23,840 --> 00:54:24,560
OF WOMEN'S HEALTH.

1721
00:54:24,560 --> 00:54:26,720
SHE IS A MEMBER OF THE BONE AND

1722
00:54:26,720 --> 00:54:28,240
JOINT EXPERT REVIEW COMMITTEE OF

1723
00:54:28,240 --> 00:54:30,680
THE NCQA AND ADVISORY COMMITTEE

1724
00:54:30,680 --> 00:54:33,720
TO THE OFFICE OF RESERGE SEARCH

1725
00:54:33,720 --> 00:54:34,960
ON WOMEN'S HEALTH.

1726
00:54:34,960 --> 00:54:37,600
SHE WILL TALK THIS AFTERNOON

1727
00:54:37,600 --> 00:54:39,480
ABOUT THE IMPACT OF CHRONIC

1728
00:54:39,480 --> 00:54:40,040
DEBILITATING CONDITIONS ON

1729
00:54:40,040 --> 00:54:40,880
WOMEN.

1730
00:54:40,880 --> 00:54:42,360
WITH NO FURTHER ADIEU, DR.

1731
00:54:42,360 --> 00:54:44,960
TEMPLETON.

1732
00:54:44,960 --> 00:54:46,880
>> THANK YOU SO MUCH FOR THE

1733
00:54:46,880 --> 00:54:47,560
KIND INTRODUCTION AND

1734
00:54:47,560 --> 00:54:49,160
OPPORTUNITY TO SPEAK TODAY.

1735
00:54:49,160 --> 00:54:51,720
SO I WILL TALK CHRONIC

1736
00:54:51,720 --> 00:54:52,640
DEBILITATING CONDITIONS FOCUSING

1737
00:54:52,640 --> 00:54:56,400
ON ONE, THAT IS OSTEOARTHRITIS.

1738
00:54:56,400 --> 00:55:00,360
THE REASON I AM FOCUSING ON

1739
00:55:00,360 --> 00:55:02,800
THAT, IS OSTEOARTHRITIS IS

1740
00:55:02,800 --> 00:55:04,040
LEADING CAUSE OF DISABILITY

1741
00:55:04,040 --> 00:55:06,280
ACROSS THE GLOBE AS WELL AS

1742
00:55:06,280 --> 00:55:06,960
WITHIN THE UNITED STATES.

1743
00:55:06,960 --> 00:55:09,000
THERE IS ALSO HIGHER PREVALENCE

1744
00:55:09,000 --> 00:55:09,920
AMONG WOMEN.

1745
00:55:09,920 --> 00:55:11,360
WHETHER YOU DEFINE THIS AS

1746
00:55:11,360 --> 00:55:13,520
PATIENT REPORTED PHYSICIAN

1747
00:55:13,520 --> 00:55:16,360
REPORTED, RADIOGRAPHIC

1748
00:55:16,360 --> 00:55:17,640
OSTEOARTHRITIS, ANY DEFINITION

1749
00:55:17,640 --> 00:55:20,920
YOU USE, WOMEN ARE MORE COMMONLY

1750
00:55:20,920 --> 00:55:21,320
AFFECTED.

1751
00:55:21,320 --> 00:55:23,120
YOU CAN SEE THE GRAPH ON THE

1752
00:55:23,120 --> 00:55:27,120
LEFT SHOWING PROPORTION OF WOMEN

1753
00:55:27,120 --> 00:55:27,520
TO MEN.

1754
00:55:27,520 --> 00:55:29,680
THIS IS ACROSS LIFE SPAN

1755
00:55:29,680 --> 00:55:31,120
STARTING AGE 40 YOU SEE

1756
00:55:31,120 --> 00:55:32,800
DISPARITIES BETWEEN WOMEN AND

1757
00:55:32,800 --> 00:55:33,160
MEN.

1758
00:55:33,160 --> 00:55:35,920
THE PREVALENCE LIFETIME RISK FOR

1759
00:55:35,920 --> 00:55:37,360
DEVELOPING OSTEOARTHRITIS IS

1760
00:55:37,360 --> 00:55:40,240
25%, ABOUT 30% WOMEN AND 20% FOR

1761
00:55:40,240 --> 00:55:40,680
MEN.

1762
00:55:40,680 --> 00:55:42,720
EVEN THOUGH WE KNOW

1763
00:55:42,720 --> 00:55:43,840
OSTEOARTHRITIS IS MORE COMMON

1764
00:55:43,840 --> 00:55:45,080
AMONG WOMEN WHAT WE DON'T

1765
00:55:45,080 --> 00:55:47,640
UNDERSTAND IS WHY IT IS MORE

1766
00:55:47,640 --> 00:55:49,320
COMMON, ONCE WE UNDERSTAND THAT

1767
00:55:49,320 --> 00:55:50,880
ARE THERE WAYS WE CAN PREVENT

1768
00:55:50,880 --> 00:55:53,080
THIS BECAUSE OSTEOARTHRITIS IS A

1769
00:55:53,080 --> 00:55:54,120
DEBILITATING CONDITION AND IT IS

1770
00:55:54,120 --> 00:55:55,600
EXPENSIVE TO TREAT.

1771
00:55:55,600 --> 00:55:59,040
IF YOU LOOK ANT GRAPH ON THE

1772
00:55:59,040 --> 00:56:01,040
RIGHT MOST JOINTS OTHER THAN

1773
00:56:01,040 --> 00:56:02,840
SHOULDER OSTEOARTHRITIS IS MORE

1774
00:56:02,840 --> 00:56:04,280
COMMON IN WOMEN THAN MEN THOUGH

1775
00:56:04,280 --> 00:56:05,520
DATA FOR SHOULDER IS POOR SO

1776
00:56:05,520 --> 00:56:07,560
THERE MAYBE A DIFFERENCE THERE.

1777
00:56:07,560 --> 00:56:09,720
WHERE YOU SEE GREATEST GAP IS IN

1778
00:56:09,720 --> 00:56:12,600
THE PREVALENCE OF

1779
00:56:12,600 --> 00:56:14,080
NEOOSTEOARTHRITIS, REPRESENTING

1780
00:56:14,080 --> 00:56:15,200
ABOUT 80 PERCENT OF THE BURDEN

1781
00:56:15,200 --> 00:56:16,880
OF DISEASE FROM OA SO I WILL

1782
00:56:16,880 --> 00:56:18,280
FURTHER FOCUS ON THAT AND SHOW

1783
00:56:18,280 --> 00:56:19,640
SOME OF THE ISSUES THAT WE SEE

1784
00:56:19,640 --> 00:56:20,560
AMONG WOMEN.

1785
00:56:20,560 --> 00:56:22,680
SO IF YOU LOOK AT SEX AND GENDER

1786
00:56:22,680 --> 00:56:24,280
SPECIFIC RISK FACTORS THERE ARE

1787
00:56:24,280 --> 00:56:25,600
A VARIETY OF THEM THAT HAVE BEEN

1788
00:56:25,600 --> 00:56:28,000
DISCUSSED IN THE LITERATURE

1789
00:56:28,000 --> 00:56:30,080
WHETHER ACQUIRED DUE TO INJURY,

1790
00:56:30,080 --> 00:56:32,640
INHERENT DUE TO VARIOUS ANATOMIC

1791
00:56:32,640 --> 00:56:34,400
DIFFERENCE GATE PATTERNS IMPACT

1792
00:56:34,400 --> 00:56:36,520
OF SEX HORMONE LEVELS MUSCLE

1793
00:56:36,520 --> 00:56:37,880
STRENGTH, FOR A LOT OF THIS WHAT

1794
00:56:37,880 --> 00:56:39,640
YOU GET TO IS A CORE DIFFERENCE

1795
00:56:39,640 --> 00:56:40,920
IN INFLAMMATORY RESPONSE.

1796
00:56:40,920 --> 00:56:42,720
WHETHER INFLAMMATORY RESPONSE TO

1797
00:56:42,720 --> 00:56:45,520
INJURIES, OBESITY, OR JUST OA

1798
00:56:45,520 --> 00:56:47,080
DEVELOPS THERE IS INFLAMMATORY

1799
00:56:47,080 --> 00:56:49,320
REACTION WHICH MAY BE

1800
00:56:49,320 --> 00:56:50,720
SELF-PERPETUATING LEADING TO

1801
00:56:50,720 --> 00:56:53,160
FURTHER CARTILAGE INJURY SO

1802
00:56:53,160 --> 00:56:55,600
LOOKING FIRST AT JOINT INJURIES,

1803
00:56:55,600 --> 00:56:59,520
JOINT INJURIES SPECIALLY KNEE

1804
00:56:59,520 --> 00:57:01,400
INJURIES LIGAMENT INJURY

1805
00:57:01,400 --> 00:57:03,120
SIGNIFICANTLY HIGHER AMONG WOMEN

1806
00:57:03,120 --> 00:57:05,200
THAN MEN, THERE IS A VARIETY OF

1807
00:57:05,200 --> 00:57:07,120
REASONS FOR THAT, MOST RESEARCH

1808
00:57:07,120 --> 00:57:09,160
WENT TO DIFFERENCES IN

1809
00:57:09,160 --> 00:57:09,720
NEUROMOOSE SKYLAR CONTROL.

1810
00:57:09,720 --> 00:57:12,680
WHEN YOU LOOK AT -- NEUROMS.

1811
00:57:12,680 --> 00:57:13,120
SKEWS LAR CONTROL.

1812
00:57:13,120 --> 00:57:15,520
WHEN YOU LOOK AT ATHLETES.

1813
00:57:15,520 --> 00:57:17,080
THE RISK OF DEVELOPING

1814
00:57:17,080 --> 00:57:18,440
OSTEOARTHRITIS IS HIGHER IN

1815
00:57:18,440 --> 00:57:21,360
WOMEN THAN MEN AND RISK HAPPENS

1816
00:57:21,360 --> 00:57:23,560
ABOUT -- STARTS INCREASING ABOUT

1817
00:57:23,560 --> 00:57:23,960
15 YEARS EARLIER.

1818
00:57:23,960 --> 00:57:25,400
WHEN YOU LOOK AT EVEN MORE

1819
00:57:25,400 --> 00:57:27,360
RECENT DATA THAT'S FOLLOWING FOR

1820
00:57:27,360 --> 00:57:30,040
LONGER PERIOD OF TIME THE STATE

1821
00:57:30,040 --> 00:57:31,840
IS STILL HOLDS UP.

1822
00:57:31,840 --> 00:57:32,960
BUT WHY?

1823
00:57:32,960 --> 00:57:34,520
WHY WITH THE SAME INJURY, THE

1824
00:57:34,520 --> 00:57:35,720
SAME LEVEL OF DAMAGE ARE WOMEN

1825
00:57:35,720 --> 00:57:40,600
MORE LIKELY TO DEVELOP

1826
00:57:40,600 --> 00:57:42,120
OSTEOARTHRITIS, THERE'S SOME

1827
00:57:42,120 --> 00:57:43,600
INFLAMMATORY RESPONSE TO INJURY

1828
00:57:43,600 --> 00:57:46,240
PERHAPS THAT LEADS TO FURTHER

1829
00:57:46,240 --> 00:57:47,600
CARTILAGE LOSS BUT WE DON'T KNOW

1830
00:57:47,600 --> 00:57:49,200
THAT'S WHERE WE HAVE A LARGE GAP

1831
00:57:49,200 --> 00:57:51,120
IN THE DATA.

1832
00:57:51,120 --> 00:57:52,240
EVEN AFTER KNEE RECONSTRUCTION

1833
00:57:52,240 --> 00:57:54,680
OR ACL RECONSTRUCTION THIS GAP

1834
00:57:54,680 --> 00:57:57,000
STILL EXISTS, STILL RISK OF

1835
00:57:57,000 --> 00:57:57,720
OSTEOARTHRITIS.

1836
00:57:57,720 --> 00:57:58,520
WHEN YOU LOOK AT THE DATA PART

1837
00:57:58,520 --> 00:57:59,800
OF THE PROBLEM LIKE MANY

1838
00:57:59,800 --> 00:58:00,800
CONDITIONS IS LACK OF

1839
00:58:00,800 --> 00:58:02,080
DISAGGREGATION OF RESULTS BASED

1840
00:58:02,080 --> 00:58:04,520
ON SEX OR GENDER.

1841
00:58:04,520 --> 00:58:06,680
WE DID A SYSTEMATIC REVIEW

1842
00:58:06,680 --> 00:58:07,840
IMPRESSED AT THIS POINT WHAT ARE

1843
00:58:07,840 --> 00:58:09,520
THE RESULTS FROM THE ONLY A

1844
00:58:09,520 --> 00:58:10,840
THIRD OF STUDIES REPORTED

1845
00:58:10,840 --> 00:58:13,560
RESULTS AT ACL RECONSTRUCTION

1846
00:58:13,560 --> 00:58:15,800
BASED ON SEX OR GENDER, WITHOUT

1847
00:58:15,800 --> 00:58:16,720
THE DATA HARD TO KNOW WHAT THE

1848
00:58:16,720 --> 00:58:19,360
DIFFERENCES ARE, AND WHY AND

1849
00:58:19,360 --> 00:58:21,280
THEN WHAT CAN WE DO IN TERMS OF

1850
00:58:21,280 --> 00:58:21,880
INTERVENTION.

1851
00:58:21,880 --> 00:58:24,320
ONE INTERVENTION WE KNOW WORKS

1852
00:58:24,320 --> 00:58:26,240
SEX BASED DIFFERENCES, AND

1853
00:58:26,240 --> 00:58:27,560
PREVENTION MEASURES FOR KNEE

1854
00:58:27,560 --> 00:58:29,640
INJURY, UNFORTUNATELY THESE ARE

1855
00:58:29,640 --> 00:58:31,440
NOT CONSISTENTLY IMPLEMENTED.

1856
00:58:31,440 --> 00:58:33,560
OTHER RISK FACTORS FOR

1857
00:58:33,560 --> 00:58:34,600
OSTEOARTHRITIS OF THE KNEE, A

1858
00:58:34,600 --> 00:58:36,320
VARIETY OF THINGS DISCUSSED, A

1859
00:58:36,320 --> 00:58:41,000
LOT OF IT INHERENT ANATOMIC

1860
00:58:41,000 --> 00:58:42,720
DIFFERENCES, OTHER THINGS

1861
00:58:42,720 --> 00:58:44,040
DIFFERENT INTEND TO ARE HAVE

1862
00:58:44,040 --> 00:58:45,360
GREATER VOLUME ON KNEE CARTILAGE

1863
00:58:45,360 --> 00:58:49,800
BASED ON BODY AND SIZE.

1864
00:58:49,800 --> 00:58:51,280
THE DIFFERENT FOR WOMEN, WOMEN

1865
00:58:51,280 --> 00:58:55,480
HAVE LARGER PROMINENT ANTERIOR

1866
00:58:55,480 --> 00:58:57,200
CHON DIAL ALONG THE FEMUR.

1867
00:58:57,200 --> 00:58:59,160
WHEN YOU LOOK AT THESE THINGS

1868
00:58:59,160 --> 00:59:01,160
INCLUDING THE Q ANGLE, IN TERMS

1869
00:59:01,160 --> 00:59:03,520
OF CAUSING ISSUES WITH THE KNEE,

1870
00:59:03,520 --> 00:59:04,640
THESE RAISE CONCERNS ABOUT

1871
00:59:04,640 --> 00:59:06,520
INCREASE RISK OF OSTEOARTHRITIS,

1872
00:59:06,520 --> 00:59:08,480
BUT NONE OF THESE ARE THINGS

1873
00:59:08,480 --> 00:59:09,360
THAT YOU CAN ADDRESS.

1874
00:59:09,360 --> 00:59:10,760
NONE OF THESE ARE THINGS THAT

1875
00:59:10,760 --> 00:59:12,720
YOU CAN IN WHICH YOU CAN

1876
00:59:12,720 --> 00:59:14,640
INTERVENE TO PREVENT

1877
00:59:14,640 --> 00:59:15,320
OSTEOARTHRITIS.

1878
00:59:15,320 --> 00:59:16,720
THOUGH INTERESTING, THERE IS NOT

1879
00:59:16,720 --> 00:59:18,520
A LOT WE CAN DO ABOUT IT.

1880
00:59:18,520 --> 00:59:19,960
I THINK PROBABLY BETTER THINGS

1881
00:59:19,960 --> 00:59:23,320
TO LOOK AT ARE MORE DYNAMIC

1882
00:59:23,320 --> 00:59:25,240
MEASURES, THERE ARE VARIOUS SEX

1883
00:59:25,240 --> 00:59:26,240
BASE DIFFERENCES THAT ARE

1884
00:59:26,240 --> 00:59:27,680
IDENTIFIED IN TERMS OF FORCES

1885
00:59:27,680 --> 00:59:29,440
AND MOMENTS AROUND THE KNEE AND

1886
00:59:29,440 --> 00:59:31,680
THOSE WITHOUT OSTEOARTHRITIS.

1887
00:59:31,680 --> 00:59:33,560
THOSE DIFFERENCES LEAD TO SEX

1888
00:59:33,560 --> 00:59:35,800
BASED DIFFERENCE IN LOADING

1889
00:59:35,800 --> 00:59:36,960
ARTICULATE CARTILAGE BUT WHAT WE

1890
00:59:36,960 --> 00:59:38,040
DON'T KNOW IS DOES THAT IMPACT

1891
00:59:38,040 --> 00:59:40,160
THE RISK OF DEVELOPING

1892
00:59:40,160 --> 00:59:41,960
OSTEOARTHRITIS.

1893
00:59:41,960 --> 00:59:44,320
IF SO THEN ARE THESE PLACES IN

1894
00:59:44,320 --> 00:59:45,880
WHICH WE CAN INTERVENE AND

1895
00:59:45,880 --> 00:59:47,640
ADDRESS ISSUES WITH WOMEN

1896
00:59:47,640 --> 00:59:50,080
DEVELOPING OSTEOARTHRITIS.

1897
00:59:50,080 --> 00:59:52,520
WE KNOW THERE ARE EFFECTS OF

1898
00:59:52,520 --> 00:59:54,320
ESTROGEN ON ARTICULAR CARTILAGE,

1899
00:59:54,320 --> 00:59:57,120
THIS IS A STUDY LOOKING AT MICE

1900
00:59:57,120 --> 01:00:00,720
WITH A MODEL INDUCED

1901
01:00:00,720 --> 01:00:02,160
OSTEOARTHRITIS, O VARYECTOMY LED

1902
01:00:02,160 --> 01:00:04,760
TO INCREASE CARTILAGE INJURY.

1903
01:00:04,760 --> 01:00:06,640
UNKNOWN IF THAT WAS DIRECT

1904
01:00:06,640 --> 01:00:08,200
IMPACT ON CARTILAGE, THOUGH

1905
01:00:08,200 --> 01:00:11,200
CARTILAGE CONTAINS ESTROGEN

1906
01:00:11,200 --> 01:00:12,560
RECEPTORS, MAYBE WAS INDIRECT

1907
01:00:12,560 --> 01:00:15,640
EFFECT BECAUSE OF LOSS OF SUB

1908
01:00:15,640 --> 01:00:17,520
BONE BUT WHAT WE DO WITH THIS AS

1909
01:00:17,520 --> 01:00:19,360
MAN AL STUDY DOES THIS TRANSLATE

1910
01:00:19,360 --> 01:00:22,560
TO INCREASE RISK OF

1911
01:00:22,560 --> 01:00:23,800
OSTEOARTHRITIS OF THE KNEE WE

1912
01:00:23,800 --> 01:00:25,040
SEE IN WOMEN AFTER MENOPAUSE.

1913
01:00:25,040 --> 01:00:27,400
THERE'S RECENT STUDIES THAT SHOW

1914
01:00:27,400 --> 01:00:29,640
LEVELS OF SEX HORMONE HAVE NO

1915
01:00:29,640 --> 01:00:32,000
IMPACT ON CARTILAGE VOLUME AMONG

1916
01:00:32,000 --> 01:00:34,520
MEN HOWEVER AMONG WOMEN THERE

1917
01:00:34,520 --> 01:00:36,640
WAS INCREASE LEVEL OF CARTILAGE

1918
01:00:36,640 --> 01:00:38,520
FOR THOSE HIGHER LEVELS OF

1919
01:00:38,520 --> 01:00:41,240
PROGESTERONE AND LOWER ESTRADIOL

1920
01:00:41,240 --> 01:00:42,800
LEVELS CORRELATED WITH BONE

1921
01:00:42,800 --> 01:00:45,600
MARROW LESIONS SUGGESTED TO

1922
01:00:45,600 --> 01:00:46,320
INTERCARTILAGE.

1923
01:00:46,320 --> 01:00:47,480
INTERESTING BUT IS THERE A

1924
01:00:47,480 --> 01:00:48,880
CAUSATIVE FACTOR, THIS WHERE WE

1925
01:00:48,880 --> 01:00:52,440
NEED MORE RESEARCH.

1926
01:00:52,440 --> 01:00:53,920
MUSCLE STRENGTH BOTH INHERENT AS

1927
01:00:53,920 --> 01:00:58,000
WELL AS ACQUIRED, IN THIS STUDY

1928
01:00:58,000 --> 01:01:01,000
WE LOOK AT WOMEN THAT HAD

1929
01:01:01,000 --> 01:01:04,320
OSTEOARTHRITIS PLUS OR MINUS

1930
01:01:04,320 --> 01:01:05,120
HAVING X-RAY CHANGES.

1931
01:01:05,120 --> 01:01:07,160
THE GRAPH AT THE RIGHT THE SCALE

1932
01:01:07,160 --> 01:01:11,160
IS A MEASURE OF DEGREE OF

1933
01:01:11,160 --> 01:01:12,640
OSTEOARTHRITIS 0 TO 1 MILD 3 TO

1934
01:01:12,640 --> 01:01:13,680
4 IS SEVERE.

1935
01:01:13,680 --> 01:01:15,000
AMONG THOSE AS YOU CAN SEE FROM

1936
01:01:15,000 --> 01:01:18,760
THIS THE HIGHER THE SCORE OR THE

1937
01:01:18,760 --> 01:01:21,320
GREATER DEGREE OF OSTEOARTHRITIS

1938
01:01:21,320 --> 01:01:23,320
THE WEAKER THE QUADRICEP

1939
01:01:23,320 --> 01:01:23,800
STRENGTH.

1940
01:01:23,800 --> 01:01:25,720
INTERESTING ANY IN THE STUDY

1941
01:01:25,720 --> 01:01:27,720
HALF PARTICIPANTS HAD PAIN SO

1942
01:01:27,720 --> 01:01:30,360
YOU CAN'T ENTIRELY ATTRIBUTE THE

1943
01:01:30,360 --> 01:01:32,800
LOSS OF STRENGTH TO PAIN IN THIS

1944
01:01:32,800 --> 01:01:33,720
STUDY.

1945
01:01:33,720 --> 01:01:35,640
SO DID THE LOSS OF STRENGTH LEAD

1946
01:01:35,640 --> 01:01:37,440
TO OSTEOARTHRITIS, IS THAT

1947
01:01:37,440 --> 01:01:38,720
ANOTHER ADDITIONAL CONTRIBUTING

1948
01:01:38,720 --> 01:01:40,400
FACTOR, ESPECIALLY RADIOGRAPHIC

1949
01:01:40,400 --> 01:01:42,520
CHANGES BUT NOT SYMPTOMS FROM

1950
01:01:42,520 --> 01:01:44,400
THIS, IS THIS AN AREA WHERE WE

1951
01:01:44,400 --> 01:01:46,600
CAN POTENTIALLY HAVE IMPACT IF

1952
01:01:46,600 --> 01:01:49,720
THERE IS A RELATIONSHIP BETWEEN

1953
01:01:49,720 --> 01:01:50,880
QUADRICEP OR OTHER STRENGTH

1954
01:01:50,880 --> 01:01:51,680
WEAKNESS AND ABILITY TO

1955
01:01:51,680 --> 01:01:53,360
STABILIZE THE JOINT AND RISK OF

1956
01:01:53,360 --> 01:01:55,080
DEVELOPING OSTEOARTHRITIS

1957
01:01:55,080 --> 01:01:55,720
ESPECIALLY A WOMEN BECAUSE YOU

1958
01:01:55,720 --> 01:01:57,840
DON'T SEE THE SAME RELATIONSHIP

1959
01:01:57,840 --> 01:01:59,720
IN MEN, THIS GIVES AN AREA WHERE

1960
01:01:59,720 --> 01:02:02,960
WE CAN POTENTIALLY HAVE IMPACT

1961
01:02:02,960 --> 01:02:04,640
IN TERMS OF PREVENTION IF NOT

1962
01:02:04,640 --> 01:02:09,360
TRYING TO RELIEVE SYMPTOMS.

1963
01:02:09,360 --> 01:02:11,600
WE KNOW HIGHER LEVELS OF BMI

1964
01:02:11,600 --> 01:02:14,760
PLACE ADDITIONAL STRESSORS ON

1965
01:02:14,760 --> 01:02:16,120
CARTILAGE, THIS RELATIONSHIP OF

1966
01:02:16,120 --> 01:02:17,720
RISK OF CARTILAGE DAMAGE WITH

1967
01:02:17,720 --> 01:02:20,520
INCREASING BMI IS GREATER AMONG

1968
01:02:20,520 --> 01:02:22,640
WOMEN THAN MEN.

1969
01:02:22,640 --> 01:02:24,320
THIS IS A POPULATION BASED CASE

1970
01:02:24,320 --> 01:02:26,320
CONTROL STUDY, LOOKING AT THOSE

1971
01:02:26,320 --> 01:02:30,120
PATIENTS THAT WERE WAITING FOR

1972
01:02:30,120 --> 01:02:31,880
ARTHROPLASTY COMPARED TO SEX AGE

1973
01:02:31,880 --> 01:02:33,080
MATCH CONTROLS.

1974
01:02:33,080 --> 01:02:34,520
ON THE RIGHT BMI INCREASE THERE

1975
01:02:34,520 --> 01:02:37,080
WAS INCREASING ODDS RATIO OF

1976
01:02:37,080 --> 01:02:40,280
HAVING SYMPTOMATIC

1977
01:02:40,280 --> 01:02:41,080
OSTEOARTHRITIS.

1978
01:02:41,080 --> 01:02:42,680
THERE WAS INTERACTION BETWEEN

1979
01:02:42,680 --> 01:02:44,920
BMI AND OTHER ISSUES SUCH AS

1980
01:02:44,920 --> 01:02:47,160
PREVIOUS INJURY BUT ESPECIALLY

1981
01:02:47,160 --> 01:02:49,600
IN WOMEN, THAT RELATIONSHIP WAS

1982
01:02:49,600 --> 01:02:51,120
MORE THAN ADDITIVE.

1983
01:02:51,120 --> 01:02:53,120
THE RISK ASSOCIATED WITH PIECETY

1984
01:02:53,120 --> 01:02:55,120
TENDED TO BE HIGHER WOMEN THAN

1985
01:02:55,120 --> 01:02:57,800
MEN THOUGH DEGREE OF RISK WAS

1986
01:02:57,800 --> 01:02:59,520
NOT DESCRIBED IN THE STUDY.

1987
01:02:59,520 --> 01:03:01,080
SO FOR BOTH MEN AND WOMEN THERE

1988
01:03:01,080 --> 01:03:03,040
IS AN IMPACT OF BMI PUTTING

1989
01:03:03,040 --> 01:03:04,600
STRESS ON CARTILAGE ON THE RISK

1990
01:03:04,600 --> 01:03:06,360
OF OA BUT THAT RELATIONSHIP IN

1991
01:03:06,360 --> 01:03:07,760
WOMEN IS HIGHER.

1992
01:03:07,760 --> 01:03:12,160
WHY IS IT HIGHER?

1993
01:03:12,160 --> 01:03:13,320
IS IT RELATED TO OTHER THINGS

1994
01:03:13,320 --> 01:03:14,400
PRIOR INJURY?

1995
01:03:14,400 --> 01:03:15,520
INFLAMMATION THERE IS HIGHER

1996
01:03:15,520 --> 01:03:16,640
INFLAMMATORY RESPONSE AMONG

1997
01:03:16,640 --> 01:03:20,520
THOSE THAT ARE OBESE SO IS THIS

1998
01:03:20,520 --> 01:03:21,920
WITH GREATER INFLAMMATORY

1999
01:03:21,920 --> 01:03:23,600
RESPONSE WOMEN, IS IT AN

2000
01:03:23,600 --> 01:03:28,240
INFLAMMATION RELATED RESPONSE?

2001
01:03:28,240 --> 01:03:31,920
THE WOMEN ALSO TEND TO HAVE

2002
01:03:31,920 --> 01:03:33,400
HIGHER ASSOCIATION BETWEEN

2003
01:03:33,400 --> 01:03:35,080
METABOLIC SYNDROME

2004
01:03:35,080 --> 01:03:36,240
OSTEOARTHRITIS.

2005
01:03:36,240 --> 01:03:39,200
THE STUDY EFFECT OF OBESITY

2006
01:03:39,200 --> 01:03:41,280
GREATER FOR WOMEN THAN MEN.

2007
01:03:41,280 --> 01:03:42,880
THE HIGHER THE LAWRENCE SCALE

2008
01:03:42,880 --> 01:03:46,400
LOOKING AT HIGHER DEGREE OF

2009
01:03:46,400 --> 01:03:48,840
OSTEOARTHRITIS ON THE RIGHT MORE

2010
01:03:48,840 --> 01:03:50,640
SIGNIFICANT AMONG WOMEN THAN MEN

2011
01:03:50,640 --> 01:03:52,400
WHEN YOU GET HIGHER LEVELS OR

2012
01:03:52,400 --> 01:03:53,920
DEGREE OF OSTEOARTHRITIS.

2013
01:03:53,920 --> 01:03:56,000
COULD THIS BE MEDIATED BY

2014
01:03:56,000 --> 01:03:57,040
INFLAMMATION, POTENTIALLY

2015
01:03:57,040 --> 01:03:58,720
THROUGH LEPTON WAITING TO LOW

2016
01:03:58,720 --> 01:04:01,800
GRADE CHRONIC INFLAMMATION.

2017
01:04:01,800 --> 01:04:03,280
BUT ARE THERE OTHER DIFFERENCES

2018
01:04:03,280 --> 01:04:04,080
IN INFLAMMATORY RESPONSE?

2019
01:04:04,080 --> 01:04:07,720
WE KNOW THERE IS THE FIBER

2020
01:04:07,720 --> 01:04:09,200
CARTILAGE IN KNEES IN WOMEN

2021
01:04:09,200 --> 01:04:10,680
TENDS TO RELEASE INTEND TO HAVE

2022
01:04:10,680 --> 01:04:12,240
HIGHER LEVEL OF INFLAMMATION OR

2023
01:04:12,240 --> 01:04:14,520
HIGHER INFLAMMATORY BIOMARKER.

2024
01:04:14,520 --> 01:04:16,920
SO ONCE THERE'S CARTILAGE DAMAGE

2025
01:04:16,920 --> 01:04:18,920
THE RELEASE OF INFLAMMATORY

2026
01:04:18,920 --> 01:04:21,240
BIOMARKERS IS GREATER IN WOMEN

2027
01:04:21,240 --> 01:04:24,320
THAN MEN SO COULD THIS BE

2028
01:04:24,320 --> 01:04:24,720
SELF-PERPETUATING.

2029
01:04:24,720 --> 01:04:26,520
WHEN DOES THIS START?

2030
01:04:26,520 --> 01:04:27,760
UNFORTUNATELY WE KNOW OBESITY

2031
01:04:27,760 --> 01:04:30,520
CAN OCCUR EARLY, THIS IS A STUDY

2032
01:04:30,520 --> 01:04:33,520
LOOKING AT ADOLESCENCE WHO ARE

2033
01:04:33,520 --> 01:04:36,160
OBESE AND LOOK AT THEIR

2034
01:04:36,160 --> 01:04:38,120
DIFFERENCES IN KNEE PAIN AND

2035
01:04:38,120 --> 01:04:39,640
DIFFERENCES IN ARTICULAR

2036
01:04:39,640 --> 01:04:41,400
CARTILAGE BASED ON MRI.

2037
01:04:41,400 --> 01:04:43,720
AND WHAT THEY FOUND IS THAT THE

2038
01:04:43,720 --> 01:04:45,920
GREAT, THE HIGHER THE BMI THE

2039
01:04:45,920 --> 01:04:47,720
MORE CARTILAGE DAMAGE YOU SAW ON

2040
01:04:47,720 --> 01:04:50,280
THE MRI AND THE MORE LIKELY THEY

2041
01:04:50,280 --> 01:04:56,120
WERE TO HAVE SYMPTOMS SYMPTOMS
ESPECIALLY

2042
01:04:56,120 --> 01:04:57,640
PAIN AND IMPACT ON DAILY

2043
01:04:57,640 --> 01:04:59,720
ACTIVITY WITH GREATER BMI.

2044
01:04:59,720 --> 01:05:01,600
THIS STUDY LIKE MANY STUDIES WAS

2045
01:05:01,600 --> 01:05:04,240
NOT DISAGGREGATED BY SEX.

2046
01:05:04,240 --> 01:05:06,320
BUT IS OSTEOARTHRITIS YET

2047
01:05:06,320 --> 01:05:07,680
ANOTHER PEDIATRIC OR ADOLESCENT

2048
01:05:07,680 --> 01:05:09,440
CONDITION THAT DOESN'T MANIFEST

2049
01:05:09,440 --> 01:05:12,920
UNTIL ADULTHOOD.

2050
01:05:12,920 --> 01:05:17,000
LOOKING AT OSTEOARTHRITIS A MAY

2051
01:05:17,000 --> 01:05:19,000
JR. PRESENTING SYMPTOM IS PAIN

2052
01:05:19,000 --> 01:05:20,320
BUT THERE'S SEX AND GENDER

2053
01:05:20,320 --> 01:05:20,760
DIFFERENCES IN PAIN.

2054
01:05:20,760 --> 01:05:22,320
SO PART OF THE INCREASE

2055
01:05:22,320 --> 01:05:24,520
INCIDENCE OF SIMILAR TO MATTIC

2056
01:05:24,520 --> 01:05:28,000
OSTEOARTHRITIS IN WOMEN BASED ON

2057
01:05:28,000 --> 01:05:30,200
ONLY ON WHAT IS GOING ON IN

2058
01:05:30,200 --> 01:05:31,800
JOINT BUT PAIN EXPERIENCE HEALTH

2059
01:05:31,800 --> 01:05:33,560
AND HOW PATIENT GOES THROUGH THE

2060
01:05:33,560 --> 01:05:33,880
EXPERIENCE.

2061
01:05:33,880 --> 01:05:37,320
THERE'S SEX BASED DIFFERENCES IN

2062
01:05:37,320 --> 01:05:41,160
TEEMS OF HOW NEUROCHEMICAL

2063
01:05:41,160 --> 01:05:44,520
IMPACT OF SEX STEROIDS

2064
01:05:44,520 --> 01:05:45,560
INFLAMMATORY IMPACT ON LOGIC

2065
01:05:45,560 --> 01:05:47,560
PAIN IS EXPERIENCE AND GENDER IN

2066
01:05:47,560 --> 01:05:49,560
TERMS OF PSYCHOSOCIAL, SOCIAL

2067
01:05:49,560 --> 01:05:51,120
CULTURAL EXPERIENTIAL IMPACT ON

2068
01:05:51,120 --> 01:05:52,600
EXPERIENCE OF PAIN.

2069
01:05:52,600 --> 01:05:57,200
SO HOW DOES THAT FIT INTO HIGHER

2070
01:05:57,200 --> 01:05:59,360
RISK SYMPTOMATIC OSTEOARTHRITIS

2071
01:05:59,360 --> 01:06:01,080
AMONG WOMEN.

2072
01:06:01,080 --> 01:06:03,720
HOW ARE SEX AND GENDER

2073
01:06:03,720 --> 01:06:08,400
DIFFERENCES IN OSTEOARTHRITIS

2074
01:06:08,400 --> 01:06:10,960
MANIFESTED.

2075
01:06:10,960 --> 01:06:12,880
WAITING FOR ARTHROPLASTY, IN THE

2076
01:06:12,880 --> 01:06:15,160
12 MONTHS PRIOR TO SURGERY,

2077
01:06:15,160 --> 01:06:17,840
WOMEN ARE MORE LIKELY TO SEEK

2078
01:06:17,840 --> 01:06:20,320
AND RECEIVE OPIOID, NON-OPIOID,

2079
01:06:20,320 --> 01:06:24,720
OBJECTIONS PHYSICAL THERAPY, IF

2080
01:06:24,720 --> 01:06:25,840
THEY ARE WAITING FOR SURGERY,

2081
01:06:25,840 --> 01:06:28,520
YOU HAVE TO ASSUME RADIOGRAPHIC

2082
01:06:28,520 --> 01:06:31,320
LIKELY SYMPTOMATIC EQUIVALENCE

2083
01:06:31,320 --> 01:06:32,800
BETWEEN MEME AN MEN BUT IF SO

2084
01:06:32,800 --> 01:06:37,600
WHY ARE WOMEN RECEIVING MORE

2085
01:06:37,600 --> 01:06:38,000
INTERVENTION?

2086
01:06:38,000 --> 01:06:39,480
A VARIETY OF EXPLANATIONS HAVE

2087
01:06:39,480 --> 01:06:42,120
BEEN SUGGESTED, PERHAPS WOMEN

2088
01:06:42,120 --> 01:06:43,120
HAVE RAPID PROGRESSION OF

2089
01:06:43,120 --> 01:06:44,160
DISEASE.

2090
01:06:44,160 --> 01:06:45,320
THERE'S SOME SUGGESTION

2091
01:06:45,320 --> 01:06:46,400
OSTEOARTHRITIS IN WOMEN IS A

2092
01:06:46,400 --> 01:06:47,240
DIFFERENT CONDITION THAN IT IS

2093
01:06:47,240 --> 01:06:49,040
IN MEN.

2094
01:06:49,040 --> 01:06:52,720
BUT ONCE IT STARTS IT IS RAPIDLY

2095
01:06:52,720 --> 01:06:53,800
PROGRESSIVE WHY WOMEN NEED

2096
01:06:53,800 --> 01:06:54,840
INTERVENTION BEFORE THEY UNDERGO

2097
01:06:54,840 --> 01:06:57,720
SURGERY.

2098
01:06:57,720 --> 01:06:59,160
RELATED TO HOW THEY EXPERIENCE

2099
01:06:59,160 --> 01:07:00,440
PAIN?

2100
01:07:00,440 --> 01:07:01,240
RADIOGRAPHICALLY NO DIFFERENCE

2101
01:07:01,240 --> 01:07:02,800
BETWEEN THE SEX BUS THE PAIN

2102
01:07:02,800 --> 01:07:07,960
EXPERIENCE IS DIFFERENT.

2103
01:07:07,960 --> 01:07:08,880
SO WOMEN SEEN MORE INTERVENTION

2104
01:07:08,880 --> 01:07:09,760
BECAUSE THEY ARE EXPERIENCING

2105
01:07:09,760 --> 01:07:11,800
MORE PAIN.

2106
01:07:11,800 --> 01:07:13,320
IS IT BECAUSE WOMEN ARE LIKELY

2107
01:07:13,320 --> 01:07:16,760
TO BE REFERRED FOR SURGICAL

2108
01:07:16,760 --> 01:07:18,120
REPLACEMENT IN JOIN REPLACEMENT.

2109
01:07:18,120 --> 01:07:20,560
WE KNOW WOMEN ARE REFERRED LATER

2110
01:07:20,560 --> 01:07:22,800
THAN MEN FOR ARTHROPLASTY

2111
01:07:22,800 --> 01:07:24,160
ESPECIALLY UNDERREPPED MINORITY

2112
01:07:24,160 --> 01:07:25,880
WOMEN SO MAYBE IN THIS 12 MONTHS

2113
01:07:25,880 --> 01:07:27,160
PRIOR TO SURGERY MAYBE THEY

2114
01:07:27,160 --> 01:07:28,040
SHOULD HAVE BEEN REFERRED

2115
01:07:28,040 --> 01:07:29,960
EARLIER FOR SURGERY SO THEY ARE

2116
01:07:29,960 --> 01:07:31,320
IN WORSE CONDITION, THEY HAVE

2117
01:07:31,320 --> 01:07:33,080
MORE PAIN, WORSE FUNCTION AND

2118
01:07:33,080 --> 01:07:34,600
THEREFORE NEED MORE

2119
01:07:34,600 --> 01:07:35,520
INTERVENTIONS WHILE WAITING FOR

2120
01:07:35,520 --> 01:07:37,520
THEIR SURGERY.

2121
01:07:37,520 --> 01:07:39,320
OTHER SEX BASED DIFFERENCES YOU

2122
01:07:39,320 --> 01:07:40,680
SEE SEX BASED DIFFERENCES IN

2123
01:07:40,680 --> 01:07:43,800
SURGICAL OUTCOMES.

2124
01:07:43,800 --> 01:07:45,760
MEN AND WOMEN IMPROVE PAIN AND

2125
01:07:45,760 --> 01:07:48,040
FUNCTION AFTER JOINTS REPLACE,

2126
01:07:48,040 --> 01:07:49,040
HOWEVER IN ALMOST EVERY STUDY

2127
01:07:49,040 --> 01:07:50,600
WOMEN ARE FOUND WITH LOWER

2128
01:07:50,600 --> 01:07:52,080
SCORES IN PAIN AND FUNCTION AT

2129
01:07:52,080 --> 01:07:54,000
ALL TIME POINTS.

2130
01:07:54,000 --> 01:07:56,320
BUT WE NEED TO UNDERSTAND WHY

2131
01:07:56,320 --> 01:07:58,320
BUT WE TRY TO FIGURE OUT HOW TO

2132
01:07:58,320 --> 01:07:58,840
FIX THIS.

2133
01:07:58,840 --> 01:08:01,920
THIS IS RELATED TO PAIN

2134
01:08:01,920 --> 01:08:03,480
EXPERIENCE, RELATED TO PAIN AND

2135
01:08:03,480 --> 01:08:05,560
FUNCTION AT THE TIME OF SURGERY.

2136
01:08:05,560 --> 01:08:08,200
THIS STUDY THIS IS AGAIN LOOKING

2137
01:08:08,200 --> 01:08:09,760
AT PATIENTS BOTH MEN AND WOMEN

2138
01:08:09,760 --> 01:08:11,720
WHO ARE WAITING -- WITH

2139
01:08:11,720 --> 01:08:13,200
OSTEOARTHRITIS WHO ARE WAITK FOR

2140
01:08:13,200 --> 01:08:15,880
HIP REPLACEMENT OR KNEE

2141
01:08:15,880 --> 01:08:17,200
REPLACEMENT, WOMEN HAVE

2142
01:08:17,200 --> 01:08:17,880
SIGNIFICANTLY POOR HEALTH

2143
01:08:17,880 --> 01:08:22,080
RELATED QUALITY OF LIFE SCORSES

2144
01:08:22,080 --> 01:08:22,880
SELF-EFFICACY CONFIDENCE AND

2145
01:08:22,880 --> 01:08:26,840
MANAGEMENT OF PAIN FATIGUE AND

2146
01:08:26,840 --> 01:08:27,240
FUNCTION.

2147
01:08:27,240 --> 01:08:28,680
IF WOMEN COME TO SURGERY WITH

2148
01:08:28,680 --> 01:08:30,520
WORSE PAIN AND WORSE FUNCTION,

2149
01:08:30,520 --> 01:08:31,880
THEN IF THEY ARE GOING TO GET

2150
01:08:31,880 --> 01:08:33,440
BETTER AFTER SURGERY THEY HAVE

2151
01:08:33,440 --> 01:08:35,720
MORE GROUNDS TO MAKE UP.

2152
01:08:35,720 --> 01:08:37,600
SO BUT AGAIN IT GETS BACK TO IS

2153
01:08:37,600 --> 01:08:38,520
THIS A DIFFERENCE IN THEIR

2154
01:08:38,520 --> 01:08:41,120
DISEASE PROCESS, OR A GENDER

2155
01:08:41,120 --> 01:08:43,520
SOCIETAL BASED ISSUE U IN WOMEN

2156
01:08:43,520 --> 01:08:44,600
ESPECIALLY UNDER-REPRESENTED

2157
01:08:44,600 --> 01:08:45,960
MINORITY WOMEN BEING REFERRED AT

2158
01:08:45,960 --> 01:08:50,520
LATER STAGE FROM SURGERY.

2159
01:08:50,520 --> 01:08:51,520
HOWEVER, OTHER SUGGESTIONS HAVE

2160
01:08:51,520 --> 01:08:52,880
BEEN MADE IN TERMS OF WHY WOMEN

2161
01:08:52,880 --> 01:08:54,600
DON'T DO AS WELL AFTER JOINT

2162
01:08:54,600 --> 01:08:55,960
REPLACEMENT SURGERY.

2163
01:08:55,960 --> 01:08:57,640
IN THIS STUDY PATIENTS WITH MEN

2164
01:08:57,640 --> 01:08:58,760
AND WOMEN WERE REFERRED BECAUSE

2165
01:08:58,760 --> 01:09:00,040
THEY HAD PAINFUL JOINT

2166
01:09:00,040 --> 01:09:01,800
REPLACEMENTS.

2167
01:09:01,800 --> 01:09:04,240
WOMEN ACROSS THE BOARD HIGHER

2168
01:09:04,240 --> 01:09:06,000
LEVELS OF PAIN THAN DID MEN BUT

2169
01:09:06,000 --> 01:09:08,120
WOMEN HIGHER RATES OF SEVERITY

2170
01:09:08,120 --> 01:09:09,040
MENTAL SENSITIZATION.

2171
01:09:09,040 --> 01:09:11,080
IS THIS AN ISSUE MORE WITH THEIR

2172
01:09:11,080 --> 01:09:13,400
REACTION TO THE METAL OR THE

2173
01:09:13,400 --> 01:09:16,200
ARTHROPLASTY AS OPPOSED TO PAIN

2174
01:09:16,200 --> 01:09:17,200
AND FUNCTION PRIOR TO SURGERY,

2175
01:09:17,200 --> 01:09:18,320
THAT'S SOMETHING WE STILL DON'T

2176
01:09:18,320 --> 01:09:20,800
KNOW.

2177
01:09:20,800 --> 01:09:21,920
HOWEVER PAIN FUNCTION AFTER

2178
01:09:21,920 --> 01:09:26,000
JOINT REPLACEMENT SURGERY SEX

2179
01:09:26,000 --> 01:09:27,680
AND GENDER BASED DIFFERENCES IS

2180
01:09:27,680 --> 01:09:29,280
MORE COMPLEX THAN METAL AND WHAT

2181
01:09:29,280 --> 01:09:31,360
TYPE OF KNEE REPLACEMENT WAS

2182
01:09:31,360 --> 01:09:34,880
USED IN THIS STUDY WOMEN AND MEN

2183
01:09:34,880 --> 01:09:36,240
AFTER ARTHROPLASTY FOR WOMEN,

2184
01:09:36,240 --> 01:09:38,720
MOST STUDIES SIGNIFICANTLY WORSE

2185
01:09:38,720 --> 01:09:40,040
IN TERMS OF PAIN AND FUNCTION

2186
01:09:40,040 --> 01:09:43,120
AFTER WORDS BUT IF YOU LOOK

2187
01:09:43,120 --> 01:09:43,680
PREOP OPERATIVELY THEY HAVE

2188
01:09:43,680 --> 01:09:44,440
WORSE PAIN FUNCTION HIGHER

2189
01:09:44,440 --> 01:09:46,720
LEVELS OF DEPRESSION OBESITY AND

2190
01:09:46,720 --> 01:09:50,440
HAD MORE JOINTS INVOLVED.

2191
01:09:50,440 --> 01:09:52,560
IF YOU INCLUDE FACTORS TO LOOK

2192
01:09:52,560 --> 01:09:54,120
AT THEIR POST-OPERATIVE OUTCOME

2193
01:09:54,120 --> 01:09:56,240
THE EFFECTS OF SEX IS LESS

2194
01:09:56,240 --> 01:09:58,480
ESPECIALLY IF YOU FACTOR IN

2195
01:09:58,480 --> 01:10:01,000
PRE-OPERATIVE PAIN AND FUNCTION

2196
01:10:01,000 --> 01:10:02,800
PRE-SURGE ARE I PAIN LOW BACK

2197
01:10:02,800 --> 01:10:04,480
PAIN HIGHER LEVEL DEPRESSION

2198
01:10:04,480 --> 01:10:06,040
SIGNIFICANTLY ASSOCIATED WITH

2199
01:10:06,040 --> 01:10:07,600
WORSE PAIN SCORES, SIX MONTHS

2200
01:10:07,600 --> 01:10:09,160
BOTH WOMEN AND MEN BUT ALL

2201
01:10:09,160 --> 01:10:10,920
GREATER AMONG WOMEN SO IS THAT

2202
01:10:10,920 --> 01:10:13,520
CAUSING THE WORSE OUTCOMES AMONG

2203
01:10:13,520 --> 01:10:13,720
WOMEN?

2204
01:10:13,720 --> 01:10:15,120
IF YOU INCLUDED ALL THESE

2205
01:10:15,120 --> 01:10:16,280
VARIABLES, AND ESPECIALLY

2206
01:10:16,280 --> 01:10:19,080
LOOKING AT THE PRESENCE OF

2207
01:10:19,080 --> 01:10:20,120
CO-MORBIDITIES SEX THEN NO

2208
01:10:20,120 --> 01:10:21,680
LONGER FACTORED IN AS AN

2209
01:10:21,680 --> 01:10:23,280
INDEPENDENT VARIABLE.

2210
01:10:23,280 --> 01:10:27,120
SO AGAIN I THINK IT IS MORE

2211
01:10:27,120 --> 01:10:28,360
COMPLEX THAN WOMEN DO WORSE

2212
01:10:28,360 --> 01:10:29,800
AFTER KNEE REPLACEMENT THEREFORE

2213
01:10:29,800 --> 01:10:31,480
WE NEED TO DESIGN A KNEE

2214
01:10:31,480 --> 01:10:33,800
REPLACEMENT FOR THEM,THAT'S BEEN

2215
01:10:33,800 --> 01:10:35,280
TRIED IN THE PAST DIDN'T MAKE

2216
01:10:35,280 --> 01:10:35,880
OUTCOMES BETTER.

2217
01:10:35,880 --> 01:10:37,640
LOOKING MORE IN DEPTH IN TERMS

2218
01:10:37,640 --> 01:10:39,880
OF PAIN, AND FUNCTION AND

2219
01:10:39,880 --> 01:10:41,120
DEPRESSION AND OTHER

2220
01:10:41,120 --> 01:10:42,240
CO-MORBIDITIES BECAUSE WE KNOW

2221
01:10:42,240 --> 01:10:44,280
THIS IMPACTS WOMEN'S FUNCTION

2222
01:10:44,280 --> 01:10:46,080
AND PAIN AFTER THEY HAVE HAD THE

2223
01:10:46,080 --> 01:10:52,120
DEFINITIVE TREATMENT OF SURGERY.

2224
01:10:52,120 --> 01:10:53,360
WHY DO WE CARE?

2225
01:10:53,360 --> 01:10:54,200
TWO THINGS.

2226
01:10:54,200 --> 01:10:56,440
ONE LIFE DISABILITY BUT FACTORS

2227
01:10:56,440 --> 01:10:58,560
IN MOW CO-MORBIDITIES.

2228
01:10:58,560 --> 01:11:00,800
SO OSTEOARTHRITIS LEADS TO

2229
01:11:00,800 --> 01:11:01,920
CHRONIC PAIN, DIFFICULTY WITH

2230
01:11:01,920 --> 01:11:03,520
ACTIVITIES OF DAILY LIVING.

2231
01:11:03,520 --> 01:11:04,960
LOOK AT THIS GRAPH ON THE LEFT

2232
01:11:04,960 --> 01:11:08,960
IF YOU LOOK SPECIFICALLY UNDER

2233
01:11:08,960 --> 01:11:10,960
ARTHRITIS, THIS IS AMONG PEOPLE

2234
01:11:10,960 --> 01:11:12,680
WITH SELF-REPORTED LIMITATION

2235
01:11:12,680 --> 01:11:13,800
AND ACTIVITIES OF DAILY LIVING

2236
01:11:13,800 --> 01:11:17,200
FOR ARTHRITIS MUCH MORE COMMON

2237
01:11:17,200 --> 01:11:19,120
TO BE WHEN THAN MEN, LOOK AT THE

2238
01:11:19,120 --> 01:11:21,360
GRAPH ON THE RIGHT.

2239
01:11:21,360 --> 01:11:24,920
THESE PATIENTS HAD SELF-REPORTED

2240
01:11:24,920 --> 01:11:25,920
OSTEOARTHRITIS, YOU CAN SEE

2241
01:11:25,920 --> 01:11:27,520
WOMEN CONSTITUTE MAJORITY BUT

2242
01:11:27,520 --> 01:11:29,800
LOOK AT THE LAST SECTION ON THE

2243
01:11:29,800 --> 01:11:32,120
FAR RIGHT LOOK AT TOTAL LOST

2244
01:11:32,120 --> 01:11:35,160
DAYS FROM WORK, MORE LIKELY TO

2245
01:11:35,160 --> 01:11:37,800
BE AMONG WOMEN THAN MEN.

2246
01:11:37,800 --> 01:11:39,240
WE KNOW WOMEN LOSE MORE DAYS

2247
01:11:39,240 --> 01:11:42,520
FROM WORK THAN DO MEN, THE ODDS

2248
01:11:42,520 --> 01:11:44,320
RATIO FOR WOMEN IS TWO TIMES FOR

2249
01:11:44,320 --> 01:11:45,800
THOSE COMPARED TO THOSE THAT

2250
01:11:45,800 --> 01:11:48,840
DON'T HAVE OA, A LITTLE OVER 1.5

2251
01:11:48,840 --> 01:11:49,200
FOR MEN.

2252
01:11:49,200 --> 01:11:50,920
LOOK AT THOSE WHO LOST TIME OFF

2253
01:11:50,920 --> 01:11:52,720
OF WORK, WOMEN HAVE MORE DAYS

2254
01:11:52,720 --> 01:11:54,280
LOST OFF OF WORK ONCE THEY TAKE

2255
01:11:54,280 --> 01:11:55,720
TIME OFF WORK BECAUSE OF PAIN

2256
01:11:55,720 --> 01:11:57,480
THAN DO MEN SO THIS HAS THE

2257
01:11:57,480 --> 01:11:59,160
SIGNIFICANT IMPACT ON QUALITY OF

2258
01:11:59,160 --> 01:11:59,720
LIFE.

2259
01:11:59,720 --> 01:12:01,160
AND THEIR ABILITY TO EARN A

2260
01:12:01,160 --> 01:12:04,120
LIVING.

2261
01:12:04,120 --> 01:12:06,520
ALSO AS IMPACT OF OSTEOARTHRITIS

2262
01:12:06,520 --> 01:12:07,960
ON OR BY OTHER CHRONIC HEALTH

2263
01:12:07,960 --> 01:12:08,520
CONDITIONS.

2264
01:12:08,520 --> 01:12:10,800
LOOK AT GRAPH ON THE RIGHT THIS

2265
01:12:10,800 --> 01:12:13,120
IS DATA FROM CDC LOOK AT COMMON

2266
01:12:13,120 --> 01:12:14,920
CONDITIONS OBESITY DIABETES

2267
01:12:14,920 --> 01:12:17,920
HEART DISEASE, MUCH MORE LIKELY

2268
01:12:17,920 --> 01:12:19,320
TO PATIENTS IN -- WITH EACH OF

2269
01:12:19,320 --> 01:12:20,240
THESE DISEASE PROCESSES MUCH

2270
01:12:20,240 --> 01:12:21,920
MORE LIKELY TO HAVE ARTHRITIS

2271
01:12:21,920 --> 01:12:25,720
AND NOT TO HAVE ARTHRITIS.

2272
01:12:25,720 --> 01:12:27,200
NOT DISAGGREGATED ON SEX BUT

2273
01:12:27,200 --> 01:12:28,920
SOMETHING TO KEEP IN MIND.

2274
01:12:28,920 --> 01:12:31,000
IN THIS STUDY LOOKING AT BOTH

2275
01:12:31,000 --> 01:12:33,960
MEN AND WOMEN AND AT

2276
01:12:33,960 --> 01:12:34,760
CO-MORBIDITIES, HYPERTENSION

2277
01:12:34,760 --> 01:12:37,240
DEPRESSION COPD COMMON

2278
01:12:37,240 --> 01:12:39,880
CONDITIONS AMONG WOMEN MEN WITH

2279
01:12:39,880 --> 01:12:40,280
OA.

2280
01:12:40,280 --> 01:12:41,520
WITH PREVALENCE OF CONDITIONS

2281
01:12:41,520 --> 01:12:44,400
MORE COMMON AMONG WOMEN THAN

2282
01:12:44,400 --> 01:12:46,840
MEN, AND WOMEN HAD HIGHER NUMBER

2283
01:12:46,840 --> 01:12:47,520
OF CO-MORBIDITIES.

2284
01:12:47,520 --> 01:12:49,360
SO LOOKING AT OSTEOARTHRITIS IT

2285
01:12:49,360 --> 01:12:51,120
IS NOT JUST OSTEOARTHRITIS, WHAT

2286
01:12:51,120 --> 01:12:54,160
ELSE DOES IT IMPACT AND WHAT

2287
01:12:54,160 --> 01:12:56,040
ELSE IMPACTS ARTHRITIS.

2288
01:12:56,040 --> 01:12:56,720
DOES THIS REFLECTS COMMON

2289
01:12:56,720 --> 01:12:57,960
PATHWAYS SUCH AS INFLAMMATION,

2290
01:12:57,960 --> 01:13:01,280
DOES THAT LEAD TO INCREASE

2291
01:13:01,280 --> 01:13:02,920
CARDIOVASCULAR DISEASE WHICH

2292
01:13:02,920 --> 01:13:05,080
IMPACTS OSTEOARTHRITIS.

2293
01:13:05,080 --> 01:13:07,040
IS IT THE PAINFUL JOINT THAT

2294
01:13:07,040 --> 01:13:08,520
LIMITS ABILITY TO ADDRESS OTHER

2295
01:13:08,520 --> 01:13:09,640
HEALTH CONDITIONS.

2296
01:13:09,640 --> 01:13:11,280
SO IF YOU HAVE PAIN AND DECREASE

2297
01:13:11,280 --> 01:13:12,360
FUNCTION YOU CAN'T EXERCISE.

2298
01:13:12,360 --> 01:13:15,320
IF YOU USE EXERCISE TOY ADDRESS

2299
01:13:15,320 --> 01:13:16,200
OBESITY DIABETES OR HEART

2300
01:13:16,200 --> 01:13:16,880
DISEASE IT IS HARD TO IF YOU

2301
01:13:16,880 --> 01:13:19,120
HAVE A PAINFUL JOINT.

2302
01:13:19,120 --> 01:13:21,400
SOS IS IT FUNCTION,

2303
01:13:21,400 --> 01:13:22,120
INFLAMMATION, SOME OTHER

2304
01:13:22,120 --> 01:13:24,520
UNDERLYING PATHWAY.

2305
01:13:24,520 --> 01:13:25,400
>> A MINUTE.

2306
01:13:25,400 --> 01:13:27,960
>> SO LOOK AT JUST

2307
01:13:27,960 --> 01:13:31,160
CARDIOVASCULAR DISEASE, LOOK AT

2308
01:13:31,160 --> 01:13:32,760
WOMEN MORTALITY, INCREASE ALL

2309
01:13:32,760 --> 01:13:34,760
CAUSE MORTALITY FOR WOMEN WITH

2310
01:13:34,760 --> 01:13:35,920
OSTEOARTHRITIS BUT ONLY PAINFUL

2311
01:13:35,920 --> 01:13:37,440
NOT JUST RAIDS OWE GRAPHIC.

2312
01:13:37,440 --> 01:13:39,840
SO -- RADIOGRAPHIC SO IF YOU

2313
01:13:39,840 --> 01:13:41,960
HAVE KNEE PAIN AND RADIOGRAPHIC

2314
01:13:41,960 --> 01:13:43,680
97% INCREASE IN MORTALITY RISK.

2315
01:13:43,680 --> 01:13:47,960
BUT THIS IS SEEN ONLY THOSE WITH

2316
01:13:47,960 --> 01:13:50,680
KNEE OA, NOT HAND, OA SO GETS

2317
01:13:50,680 --> 01:13:52,120
BACK TO FUNCTIONAL ISSUE NOT

2318
01:13:52,120 --> 01:13:53,840
INFLAMMATORY IF OA OF THE HAND

2319
01:13:53,840 --> 01:13:56,160
DOESN'T LEAD TO INCREASE

2320
01:13:56,160 --> 01:13:57,320
MORTALITY BUT OF THE KNEE WHICH

2321
01:13:57,320 --> 01:13:58,720
MORE SIGNIFICANTLY IMPACT

2322
01:13:58,720 --> 01:14:00,600
FUNCTION DOES.

2323
01:14:00,600 --> 01:14:02,720
PART ISSUE WITH ALL OF THIS IS

2324
01:14:02,720 --> 01:14:04,800
LACK OF RESULTS REPORTED BASED

2325
01:14:04,800 --> 01:14:06,560
ON SEX, THIS IS ARTICLE FROM

2326
01:14:06,560 --> 01:14:09,680
LAST YEAR AT OA AS WELL AS

2327
01:14:09,680 --> 01:14:11,040
INJURIES ABOUT A THIRD STUDIES

2328
01:14:11,040 --> 01:14:13,600
REPORTED RESULTS BASED ON SEX SO

2329
01:14:13,600 --> 01:14:15,720
THAT IS PART OF THE PROBLEM WE

2330
01:14:15,720 --> 01:14:17,400
NEED BETTER DATA BETTER

2331
01:14:17,400 --> 01:14:18,680
DISAGGREGATION OF DATABASED ON

2332
01:14:18,680 --> 01:14:18,840
SEX.

2333
01:14:18,840 --> 01:14:20,640
SO WHAT IS THE TROUBLE WITH

2334
01:14:20,640 --> 01:14:21,680
SILOS WITH WOMEN'S HEALTH

2335
01:14:21,680 --> 01:14:24,680
ESPECIALLY IF YOU ARE TREATK

2336
01:14:24,680 --> 01:14:25,400
OSTEOARTHRITIS?

2337
01:14:25,400 --> 01:14:26,400
IT IS UNDERSTANDING FROM

2338
01:14:26,400 --> 01:14:27,760
EVERYONE'S PERSPECTIVE

2339
01:14:27,760 --> 01:14:29,160
ADDRESSING OA IS NOT JUST ABOUT

2340
01:14:29,160 --> 01:14:30,520
TREATING PAINFUL JOINTS.

2341
01:14:30,520 --> 01:14:32,920
BECAUSE IF YOU DO THAT YOU MISS

2342
01:14:32,920 --> 01:14:34,640
THE INTERCONNECTIONS EARLIER AND

2343
01:14:34,640 --> 01:14:36,520
LATER AND THAT MISSING

2344
01:14:36,520 --> 01:14:37,320
ENTERCONNECTS FROM PATIENT

2345
01:14:37,320 --> 01:14:39,520
PERSPECTIVE AS WELL AS

2346
01:14:39,520 --> 01:14:40,600
HEALTHCARE PERSPECTIVE AS WELL

2347
01:14:40,600 --> 01:14:42,320
AS RESEARCHER PERSPECTIVE.

2348
01:14:42,320 --> 01:14:44,440
IF IN SILOS WITH RELESS ABLE TO

2349
01:14:44,440 --> 01:14:46,120
RECOGNIZE IMPACT OF OTHER

2350
01:14:46,120 --> 01:14:48,240
CONDITIONS ON AND BY

2351
01:14:48,240 --> 01:14:49,720
OSTEOARTHRITIS AND HOW DOES

2352
01:14:49,720 --> 01:14:50,920
TREATING PAIN ESPECIALLY

2353
01:14:50,920 --> 01:14:52,040
FUNCTION IMPACT THESE OTHER

2354
01:14:52,040 --> 01:14:52,640
CONDITIONS.

2355
01:14:52,640 --> 01:14:53,760
AND THEIR TREATMENT, HOW DOES IT

2356
01:14:53,760 --> 01:14:57,000
IMPACT QUALITY OF LIFE.

2357
01:14:57,000 --> 01:14:57,880
MORBIDITY MORTALITY.

2358
01:14:57,880 --> 01:14:59,320
IN TERMS OF FUTURE DIRECTION WE

2359
01:14:59,320 --> 01:15:00,560
NEED CONTINUED EXPLORATION OF

2360
01:15:00,560 --> 01:15:03,520
IMPACT OF SEX AND GENDER ON

2361
01:15:03,520 --> 01:15:05,320
OSTEOARTHRITIS NOT JUST RESEARCH

2362
01:15:05,320 --> 01:15:06,720
OSTEOARTHRITIS IN GENERAL IN

2363
01:15:06,720 --> 01:15:09,120
TERMS OF ONSET RISK FACTORS,

2364
01:15:09,120 --> 01:15:10,120
RESPONSE TO TREATMENT,

2365
01:15:10,120 --> 01:15:11,160
INTERACTION WITH OTHER HEALTH

2366
01:15:11,160 --> 01:15:11,760
CONDITIONS.

2367
01:15:11,760 --> 01:15:13,320
ALL THESE NEEDS TO BE DICES

2368
01:15:13,320 --> 01:15:15,320
AGGREGATESSED BASED ON SEX.

2369
01:15:15,320 --> 01:15:17,000
THAT REQUIRES DISAGGREGATION OF

2370
01:15:17,000 --> 01:15:18,840
DATA ALL STUDY BASED ON SEX AND

2371
01:15:18,840 --> 01:15:21,280
TARGETED RESEARCH FUNDING OA

2372
01:15:21,280 --> 01:15:22,720
AMONG WOMEN GIVEN DIFFERENT

2373
01:15:22,720 --> 01:15:24,640
RISKS CONTRIBUTING FACTORS, AS

2374
01:15:24,640 --> 01:15:27,280
WELL AS IMPACT ON OTHER HEALTH

2375
01:15:27,280 --> 01:15:28,400
CONDITIONS ENHANCED HEALTH

2376
01:15:28,400 --> 01:15:30,360
EDUCATION SEX GENDER TO TRAIN

2377
01:15:30,360 --> 01:15:32,480
THE NEXT GENERATION OF

2378
01:15:32,480 --> 01:15:33,840
CLINICIANS AND RESEARCHERS ON

2379
01:15:33,840 --> 01:15:34,840
ALL HEALTH CONDITIONS AND

2380
01:15:34,840 --> 01:15:37,280
REMOVING SILOS THAT WE DISCUSS

2381
01:15:37,280 --> 01:15:39,480
RESEARCH TREAT OA ACROSS AGE

2382
01:15:39,480 --> 01:15:41,040
SPECTRUM AND ACROSS DISCIPLINES

2383
01:15:41,040 --> 01:15:43,120
AND PROFESSIONS.

2384
01:15:43,120 --> 01:15:46,280
THANK YOU VERY MUCH.

2385
01:15:46,280 --> 01:15:47,960
>> THANK YOU SO MUCH DR.

2386
01:15:47,960 --> 01:15:50,240
TEMPLETON FOR YOUR PRESENTATION.

2387
01:15:50,240 --> 01:15:53,960
IT WAS VERY THOUGHT PROVOKING.

2388
01:15:53,960 --> 01:15:56,120
WE ARE NOW GOING TO GO TO OUR

2389
01:15:56,120 --> 01:15:58,800
NEXT PANELIST, WHO IS DR.

2390
01:15:58,800 --> 01:16:03,120
CAMILLE CLARE.

2391
01:16:03,120 --> 01:16:05,120
CHAIR DEPARTMENT OF OBSTETRICS

2392
01:16:05,120 --> 01:16:06,760
GYNECOLOGY AND PROFESSOR AT

2393
01:16:06,760 --> 01:16:08,320
COLLEGE OF MEDICINE AND SCHOOL

2394
01:16:08,320 --> 01:16:11,880
OF PUBLIC HEALTH AT THE SUNY

2395
01:16:11,880 --> 01:16:12,640
DOWN STATE HEALTH SCIENCES

2396
01:16:12,640 --> 01:16:14,280
UNIVERSITY.

2397
01:16:14,280 --> 01:16:16,200
SHE RECEIVED HER MEDICAL DEGREE

2398
01:16:16,200 --> 01:16:17,720
FROM ALBERT EINSTEIN COLLEGE OF

2399
01:16:17,720 --> 01:16:19,920
MEDICINE IN THE BRONX NEW YORK

2400
01:16:19,920 --> 01:16:22,720
AND COMPLETED HER OBSTETRICS

2401
01:16:22,720 --> 01:16:23,840
GYNECOLOGY RESIDENCY AT THE

2402
01:16:23,840 --> 01:16:25,520
STATE UNIVERSITY OF NEW YORK AT

2403
01:16:25,520 --> 01:16:25,960
BUFFALO.

2404
01:16:25,960 --> 01:16:27,880
SHE OBTAINED A MASTERS PUBLIC

2405
01:16:27,880 --> 01:16:29,400
HEALTH AND HEALTH POLICY

2406
01:16:29,400 --> 01:16:31,800
MANAGEMENT AT NEW YORK MEDICAL

2407
01:16:31,800 --> 01:16:34,360
COLLEGE AND MAY 2018 DR. CLARE

2408
01:16:34,360 --> 01:16:37,400
WAS INDUCKED TO THE ALPHA OMEGA

2409
01:16:37,400 --> 01:16:39,120
ALPHA HONOR SOCIETY CHAPTER IN

2410
01:16:39,120 --> 01:16:42,200
NEW YORK AND IS NEW YORK MEDICAL

2411
01:16:42,200 --> 01:16:43,840
COLLEGE AS A FACULTY MEMBER.

2412
01:16:43,840 --> 01:16:45,840
WITH NO FURTHER ADIEU, SHE IS

2413
01:16:45,840 --> 01:16:49,120
GOING TO BE PRESENTING ON

2414
01:16:49,120 --> 01:16:50,280
POLICIES AND INFRASTRUCTURE THAT

2415
01:16:50,280 --> 01:16:51,760
SUPPORT QUALITY INTEGRATED CARE

2416
01:16:51,760 --> 01:16:54,880
FOR MEDICALLY UNDERSERVED AND

2417
01:16:54,880 --> 01:16:56,000
ATTENTION TO DIVERSITY INCLUSION

2418
01:16:56,000 --> 01:16:59,400
AND SYSTEMS OF CARE.

2419
01:16:59,400 --> 01:17:00,000
DR. CLARE.

2420
01:17:00,000 --> 01:17:01,720
>> THANK YOU SO MUCH FOR MY

2421
01:17:01,720 --> 01:17:04,600
COLLEAGUES AND THANK YOU TO DR.

2422
01:17:04,600 --> 01:17:05,960
JOHNSON FOR THE INVITATION AND

2423
01:17:05,960 --> 01:17:08,320
DR. MOSES SIMON PEER MENTOR AS

2424
01:17:08,320 --> 01:17:10,760
WELL AS DR. JANINE CLAYTON AND

2425
01:17:10,760 --> 01:17:11,960
COLLEAGUES FOR GIVING INSIGHT.

2426
01:17:11,960 --> 01:17:14,720
SO I'M NOT GOING TO SPEAK ABOUT

2427
01:17:14,720 --> 01:17:16,000
OBSTETRICS AND GYNECOLOGY THOUGH

2428
01:17:16,000 --> 01:17:17,640
MY FAVORITE THING TO SPEAK

2429
01:17:17,640 --> 01:17:18,400
ABOUT.

2430
01:17:18,400 --> 01:17:19,600
HOPEFULLY SLIDES WILL ADVANCE.

2431
01:17:19,600 --> 01:17:21,800
I HAVE NO FINANCIAL DISCLOSURES

2432
01:17:21,800 --> 01:17:23,280
H HOWEVER I SIT ON THE BOARD OF

2433
01:17:23,280 --> 01:17:24,160
DIRECTORS FOR AMERICAN COLLEGE

2434
01:17:24,160 --> 01:17:25,920
OF OBSTETRICIAN AND

2435
01:17:25,920 --> 01:17:26,720
GYNECOLOGISTS AND ON THE BOARD

2436
01:17:26,720 --> 01:17:28,640
OF TRUSTEES, THE NATIONAL

2437
01:17:28,640 --> 01:17:31,600
MEDICAL ASSOCIATION.

2438
01:17:31,600 --> 01:17:33,400
SO WE ARE TALK ABOUT STATE OF

2439
01:17:33,400 --> 01:17:35,520
WOMEN ACADEMIC MEDICINE FROM

2440
01:17:35,520 --> 01:17:37,160
WORK FORCE PERSPECTIVE, MAKE A

2441
01:17:37,160 --> 01:17:38,640
CASE WHY MORE WOMEN LEADERS ARE

2442
01:17:38,640 --> 01:17:42,240
NEEDED IN HEALTHCARE DELIVERY

2443
01:17:42,240 --> 01:17:43,720
SYSTEMS, AND TALK SOME

2444
01:17:43,720 --> 01:17:45,360
SOLUTIONS.

2445
01:17:45,360 --> 01:17:47,720
AS WE CAN SEE, FROM THIS SLIDE,

2446
01:17:47,720 --> 01:17:49,120
THE WOMEN AND ACADEMIC MEDICINE

2447
01:17:49,120 --> 01:17:51,160
WHO ARE MEDICAL SCHOOL

2448
01:17:51,160 --> 01:17:53,560
APPLICANTS HAS BEEN ABOUT 51%,

2449
01:17:53,560 --> 01:17:57,480
THOSE WHO HAVE GRADUATED IS

2450
01:17:57,480 --> 01:17:59,800
ABOUT 48%.

2451
01:17:59,800 --> 01:18:02,560
THOSE WHO OBTAINED RESIDENCY 46%

2452
01:18:02,560 --> 01:18:05,040
DECLINED BY THE TIME YOU GET TO

2453
01:18:05,040 --> 01:18:07,200
FACULTY LEVEL OF 41%.

2454
01:18:07,200 --> 01:18:10,160
SIMILARLY LEADERSHIP THERE IS

2455
01:18:10,160 --> 01:18:13,360
ONLY 29% WHO ARE DIVISION

2456
01:18:13,360 --> 01:18:15,280
CHIEFS, ONLY QUARTER OF FULL

2457
01:18:15,280 --> 01:18:17,720
PROFESSORS, ABOUT THIRD SENIOR

2458
01:18:17,720 --> 01:18:19,040
ASSOCIATE DEANS MEDICAL SCHOOL

2459
01:18:19,040 --> 01:18:20,720
LEVEL AND 18% ARE DEPARTMENT

2460
01:18:20,720 --> 01:18:25,360
CHAIRS AS WELL AS DEANS, THIS IS

2461
01:18:25,360 --> 01:18:28,080
DATA FROM AAMC.

2462
01:18:28,080 --> 01:18:30,520
IN THE SCIENCES AND DOCTORAL

2463
01:18:30,520 --> 01:18:32,680
PROGRAM, WOMEN ARE 58% GRADUATE

2464
01:18:32,680 --> 01:18:33,680
STUDENTS ENROLLED IN THESE TYPE

2465
01:18:33,680 --> 01:18:35,080
OF PROGRAMS.

2466
01:18:35,080 --> 01:18:36,280
AMEND THESE NUMBERS HAVE BEEN

2467
01:18:36,280 --> 01:18:39,000
DECLINING OF WOMEN IN THE

2468
01:18:39,000 --> 01:18:41,120
SCIENCES SINCE 2008.

2469
01:18:41,120 --> 01:18:44,520
OF THE SIX ACADEMIC DEPARTMENTS

2470
01:18:44,520 --> 01:18:47,080
CLINICAL DEPARTMENTS WITH 50% OR

2471
01:18:47,080 --> 01:18:48,720
MORE FULL TIME WOMEN FACULTY

2472
01:18:48,720 --> 01:18:55,040
INCLUDING MY OWN 64% OBSTETRICS

2473
01:18:55,040 --> 01:18:57,880
GYNECOLOGY, 51% IN DERMATOLOGY.

2474
01:18:57,880 --> 01:18:59,440
DEPARTMENTS WITH LESS THAN 50%

2475
01:18:59,440 --> 01:19:02,680
OF WOMEN ARE SMALLEST PROPORTION

2476
01:19:02,680 --> 01:19:04,320
OF WOMEN FULL TIME FACULTY

2477
01:19:04,320 --> 01:19:07,520
INCLUDING SUCH THINGS AS

2478
01:19:07,520 --> 01:19:08,880
ORTHOPEDIC SURGERY, OF MY

2479
01:19:08,880 --> 01:19:10,320
COLLEAGUE DR. TEMPLETON WHO

2480
01:19:10,320 --> 01:19:12,120
SPOKE BEFORE SURGERY AS WELL AS

2481
01:19:12,120 --> 01:19:14,120
SOME OF THE BASIC SCIENCE

2482
01:19:14,120 --> 01:19:17,480
DISCIPLINES SHOWN HERE.

2483
01:19:17,480 --> 01:19:20,480
AGAIN WOMEN WHO ACHIEVED SECTION

2484
01:19:20,480 --> 01:19:22,120
CHIEF DIVISION CHIEF HAS NEARLY

2485
01:19:22,120 --> 01:19:25,040
DOUBLED SINCE 2004.

2486
01:19:25,040 --> 01:19:27,360
ONLY LESS THAN A THIRD OF WOMEN

2487
01:19:27,360 --> 01:19:31,240
WHO ARE CHIEF OF THE DEPARTMENT

2488
01:19:31,240 --> 01:19:32,120
IN 2018.

2489
01:19:32,120 --> 01:19:33,560
SIMILARLY AT THE CENTER

2490
01:19:33,560 --> 01:19:37,320
INSTITUTE DIRECTOR LEVEL BY

2491
01:19:37,320 --> 01:19:39,040
GENDER, WOMEN ARE LESS THAN A

2492
01:19:39,040 --> 01:19:39,800
THIRD CENTER INSTITUTE

2493
01:19:39,800 --> 01:19:42,800
DIRECTORS.

2494
01:19:42,800 --> 01:19:44,800
IN TERMS OF ROLES WOMEN FACULTY

2495
01:19:44,800 --> 01:19:47,240
HAVE IN ACADEMIC MEDICAL

2496
01:19:47,240 --> 01:19:49,440
CENTERS, LESS THAN HALF HAVE

2497
01:19:49,440 --> 01:19:51,000
FORMAL ADMINISTRATIVE ROLE

2498
01:19:51,000 --> 01:19:52,560
SOLELY DEDICATED TO WOMEN AND

2499
01:19:52,560 --> 01:19:56,240
GENDER ISSUES, THIS AMOUNTS TO

2500
01:19:56,240 --> 01:19:58,120
.38 FTE.

2501
01:19:58,120 --> 01:20:01,960
THIS IS BEYOND TITLE NINE

2502
01:20:01,960 --> 01:20:03,120
COMPLIANCE ROLES.

2503
01:20:03,120 --> 01:20:04,760
ABOUT 20% SCHOOLS DID NOT HAVE

2504
01:20:04,760 --> 01:20:08,960
ANY LOCAL WOMEN IN MEDICINE OR

2505
01:20:08,960 --> 01:20:10,680
SCIENCE ORGANIZATIONS 10%

2506
01:20:10,680 --> 01:20:12,440
WITHOUT ORGANIZATIONS STILL HAVE

2507
01:20:12,440 --> 01:20:15,280
TARGETED PROGRAMMING AND 10%

2508
01:20:15,280 --> 01:20:20,000
HAVE BOTH NO PROGRAMMING AS WELL

2509
01:20:20,000 --> 01:20:22,680
AS NO WOMEN AND IN MEDICINE AND

2510
01:20:22,680 --> 01:20:23,320
SCIENCE ORGANIZATION.

2511
01:20:23,320 --> 01:20:24,280
WHAT DO I MEAN?

2512
01:20:24,280 --> 01:20:26,880
ACCORDING TO THE AAMC WOMEN

2513
01:20:26,880 --> 01:20:29,160
GROUP MEDICINE SCIENCE IS A

2514
01:20:29,160 --> 01:20:30,640
GROUP THAT ADVANCES SUCCESSFUL

2515
01:20:30,640 --> 01:20:33,600
AND FULL PARTICIPATION AND

2516
01:20:33,600 --> 01:20:35,120
INCLUSION OF WOMEN WITH ACADEMIC

2517
01:20:35,120 --> 01:20:37,240
MEDICINE BY ADDRESSING SUCH

2518
01:20:37,240 --> 01:20:39,120
ISSUE AS GENDER EQUITY

2519
01:20:39,120 --> 01:20:40,240
RECRUITMENT AND RETENTION AWARDS

2520
01:20:40,240 --> 01:20:42,120
AND RECOGNITION AN CAREER

2521
01:20:42,120 --> 01:20:44,040
ADVANCEMENT ALL WHICH ARE

2522
01:20:44,040 --> 01:20:45,680
EXTREMELY IMPORTANT TO ADVANCE

2523
01:20:45,680 --> 01:20:47,360
THE MISSION AS MENTIONED IN THIS

2524
01:20:47,360 --> 01:20:51,760
PRESENTATION TODAY.

2525
01:20:51,760 --> 01:20:56,240
LOOK AT OUTCOMES FOR PHYSICIAN,

2526
01:20:56,240 --> 01:21:00,480
THIS IS ESTABLISHED IN 2017 BY

2527
01:21:00,480 --> 01:21:03,000
-- LOOKING AT MATERNAL MORTALITY

2528
01:21:03,000 --> 01:21:05,600
AND READMISSION RATES BASED ON

2529
01:21:05,600 --> 01:21:07,240
PHYSICIANS TREATED BY MALE OR

2530
01:21:07,240 --> 01:21:08,840
FEMALE PHYSICIANS.

2531
01:21:08,840 --> 01:21:10,960
THEY LOOK AT RANDOM SAMPLE OF

2532
01:21:10,960 --> 01:21:13,600
20% MEDICARE FEE FOR SERVICE

2533
01:21:13,600 --> 01:21:15,160
BENEFICIARIES OVER 65 YEARS OF

2534
01:21:15,160 --> 01:21:16,600
AGE AND OLDER WHO ARE

2535
01:21:16,600 --> 01:21:18,200
HOSPITALIZED WITH A GENERAL

2536
01:21:18,200 --> 01:21:18,720
MEDICAL CONDITION.

2537
01:21:18,720 --> 01:21:20,360
THAT WERE TREATED BY INTERNISTS

2538
01:21:20,360 --> 01:21:25,680
IN PERIOD OF TIME FROM 2011 TO

2539
01:21:25,680 --> 01:21:27,160
2014.

2540
01:21:27,160 --> 01:21:30,320
THEY ASSOCIATED BASED ON SEX

2541
01:21:30,320 --> 01:21:31,400
IDENTITY OF THE PHYSICIAN.

2542
01:21:31,400 --> 01:21:33,280
THEY FOUND ELDERLY PATIENTS WHO

2543
01:21:33,280 --> 01:21:34,720
RECEIVED INPATIENT CARE FROM

2544
01:21:34,720 --> 01:21:38,560
FEMALE INTERNISTS HAD A LOWER 30

2545
01:21:38,560 --> 01:21:40,480
DAY MORTALITY AND READMISSION

2546
01:21:40,480 --> 01:21:41,680
RATED COMPARED TO PATIENTS CARED

2547
01:21:41,680 --> 01:21:42,800
FOR BY MALE INTERNISTS.

2548
01:21:42,800 --> 01:21:45,680
THIS WAS ACROSS MULTIPLE

2549
01:21:45,680 --> 01:21:47,680
CONDITIONS ACROSS MULTIPLE

2550
01:21:47,680 --> 01:21:49,000
SEVERITY TESTIFY ILLNESS,

2551
01:21:49,000 --> 01:21:50,520
INTERNISTS HAVE BETTER OUTCOMES

2552
01:21:50,520 --> 01:21:52,280
FOR IN PATIENT CARE COMPARED TO

2553
01:21:52,280 --> 01:21:55,280
MALE COLLEAGUES.

2554
01:21:55,280 --> 01:21:57,040
THIS RELATED TO MULTIPLE

2555
01:21:57,040 --> 01:21:58,720
MEASURES OF QUALITY SEEN IN

2556
01:21:58,720 --> 01:22:00,280
PREVIOUS STUDIES, FEMALE

2557
01:22:00,280 --> 01:22:02,360
PHYSICIAN MORE LIKELY TO

2558
01:22:02,360 --> 01:22:02,960
PRACTICE EVIDENCE BASED

2559
01:22:02,960 --> 01:22:04,920
MEDICINE, THEY PERFORMED AS WELL

2560
01:22:04,920 --> 01:22:06,400
OR BETTER THAN STANDARDIZED

2561
01:22:06,400 --> 01:22:08,280
EXAMINATION AND PERFORMED

2562
01:22:08,280 --> 01:22:10,800
PATIENT CENTERED CARE.

2563
01:22:10,800 --> 01:22:14,240
THE PATIENTS ALSO HAD FEWER

2564
01:22:14,240 --> 01:22:15,280
MERGE DEPARTMENT VISITS AS

2565
01:22:15,280 --> 01:22:16,720
WELCOME PAIRED TO MALE COUNTER

2566
01:22:16,720 --> 01:22:19,600
PARTS.

2567
01:22:19,600 --> 01:22:22,560
SO I WAS ASKED TO TALK HOW WOMEN

2568
01:22:22,560 --> 01:22:25,880
PHYSICIAN PLAY A ROLE IMPROVING

2569
01:22:25,880 --> 01:22:28,720
SEX SPECIFIC CONDITIONS.

2570
01:22:28,720 --> 01:22:30,560
MENT I WANTED TO DEFINE WHAT

2571
01:22:30,560 --> 01:22:31,320
THIS MEANS FOR THE GROUP.

2572
01:22:31,320 --> 01:22:32,640
SEX SPECIFIC CARE IS CARE

2573
01:22:32,640 --> 01:22:34,280
RELATED TO THE HEALTH NEEDS

2574
01:22:34,280 --> 01:22:35,800
UNIQUE TO WOMEN SUCH AS

2575
01:22:35,800 --> 01:22:37,520
PREGNANCY, AND MENOPAUSE.

2576
01:22:37,520 --> 01:22:39,600
SEX AWARE -- CARE IS CARE FOR

2577
01:22:39,600 --> 01:22:40,520
CONDITIONS THAT AGAIN ARE

2578
01:22:40,520 --> 01:22:42,640
DIAGNOSED OR TREATED DIFFERENTLY

2579
01:22:42,640 --> 01:22:44,720
IN WOMEN COMPARED TO MEN SUCH AS

2580
01:22:44,720 --> 01:22:47,080
HEART DISEASE NEURODEGENERATIVE

2581
01:22:47,080 --> 01:22:49,280
DISEASE AS MENTION AND GENDER

2582
01:22:49,280 --> 01:22:53,240
SENSITIVE CARE PROVIDING WAYS

2583
01:22:53,240 --> 01:22:54,440
INCLUSIVE OF GENDER SPECIFIC

2584
01:22:54,440 --> 01:22:57,760
PREFERENCES INCLUDING LGBTQIA

2585
01:22:57,760 --> 01:23:00,520
HEALTH NEEDS, SPECIFICALLY.

2586
01:23:00,520 --> 01:23:04,800
IF WE THINK ABOUT HOW WOMEN

2587
01:23:04,800 --> 01:23:08,120
PHYSICIANS IMPROVE THE CARE FOR

2588
01:23:08,120 --> 01:23:09,600
SEX SPECIFIC CONDITIONS

2589
01:23:09,600 --> 01:23:11,400
ESPECIALLY WOMEN WITH

2590
01:23:11,400 --> 01:23:12,680
CO-MORBIDITIES, SOME OF THE

2591
01:23:12,680 --> 01:23:13,280
STRATEGIES THAT HAVE BEEN

2592
01:23:13,280 --> 01:23:16,160
OFFERED INCLUDING ENDING

2593
01:23:16,160 --> 01:23:18,120
POLITICAL OMITTYIZATION OF

2594
01:23:18,120 --> 01:23:19,280
WOMEN'S HEALTHCARE ACROSS THE

2595
01:23:19,280 --> 01:23:22,560
LIFE COURSE AND I ALSO INCLUDE

2596
01:23:22,560 --> 01:23:25,000
TRANSMEN AS WELL IN THIS

2597
01:23:25,000 --> 01:23:28,400
CONVERSATION MOSTLY SPEAKING

2598
01:23:28,400 --> 01:23:30,200
ABOUT MULTIPLE GENDER IDENTITIES

2599
01:23:30,200 --> 01:23:33,520
CREATING A FRAMEWORK THAT REALLY

2600
01:23:33,520 --> 01:23:34,360
TRANSFORMS PRIMARY HEALTHCARE TO

2601
01:23:34,360 --> 01:23:38,680
THINK OF AGAIN WOMEN ACROSS ALL

2602
01:23:38,680 --> 01:23:39,720
RANKS ALL STAGE OF LIFE WHICH IS

2603
01:23:39,720 --> 01:23:42,240
WELL OUTLINED BY DR. CLAYTON IN

2604
01:23:42,240 --> 01:23:44,240
HER INTRODUCTORY COMMENTS AND

2605
01:23:44,240 --> 01:23:46,120
DELIVERS CARE THAT SEX SPECIFIC

2606
01:23:46,120 --> 01:23:48,280
SEX AWARE, GENDER SENSITIVE AND

2607
01:23:48,280 --> 01:23:52,560
REALLY ADAPTS TO AND COORDINATES

2608
01:23:52,560 --> 01:23:53,760
CARE ACROSS VARIETY OF

2609
01:23:53,760 --> 01:23:54,880
HEALTHCARE EXPERIENCES.

2610
01:23:54,880 --> 01:23:57,000
PRIMARY HEALTHCARE MODELS REALLY

2611
01:23:57,000 --> 01:23:59,360
NEED TO BE FUNDED AND NEED TO BE

2612
01:23:59,360 --> 01:24:00,000
SUPPORTED.

2613
01:24:00,000 --> 01:24:01,640
INVESTMENTS REALLY NEED TO BE

2614
01:24:01,640 --> 01:24:03,080
MADE, COMPANIES THAT ARE WOMEN

2615
01:24:03,080 --> 01:24:04,520
HEALTH FOCUSED AND REALLY

2616
01:24:04,520 --> 01:24:07,400
WORKING TO PROMOTE GENDER

2617
01:24:07,400 --> 01:24:09,960
DIVERSITY FROM A FINANCIAL

2618
01:24:09,960 --> 01:24:10,600
PERSPECTIVE.

2619
01:24:10,600 --> 01:24:12,720
IF WE THINK THE ROLE OF WOMEN

2620
01:24:12,720 --> 01:24:14,600
WHO ARE LEADERS IN HEALTHCARE

2621
01:24:14,600 --> 01:24:16,120
DELIVERY SYSTEMS IN A STUDY BY

2622
01:24:16,120 --> 01:24:18,120
THE BUREAU OF ECONOMIC

2623
01:24:18,120 --> 01:24:20,560
STATISTICS WE KNOW THAT ALMOST

2624
01:24:20,560 --> 01:24:22,200
80% HEALTH SERVICES WORK FORCE

2625
01:24:22,200 --> 01:24:23,400
ARE WOMEN.

2626
01:24:23,400 --> 01:24:25,040
AND ABOUT THREE OUT OF FOUR

2627
01:24:25,040 --> 01:24:26,920
EMPLOYEES IN HOSPITALS ARE

2628
01:24:26,920 --> 01:24:28,360
WOMEN.

2629
01:24:28,360 --> 01:24:32,920
ALL DIFFERENT VARIETY OF JOBS.

2630
01:24:32,920 --> 01:24:34,640
SO EQUAL EMPLOYMENT OPPORTUNITY

2631
01:24:34,640 --> 01:24:36,840
COMMISSION SHOWS IN THE

2632
01:24:36,840 --> 01:24:37,560
MANAGERIAL LEVEL FOR POSITIONS

2633
01:24:37,560 --> 01:24:39,520
THAT ARE EXECUTIVE OR SENIOR

2634
01:24:39,520 --> 01:24:40,720
ADMINISTRATIVE LEVEL WOMEN ARE

2635
01:24:40,720 --> 01:24:45,760
ALSO ACCOUNTED FOR ALMOST 72%.

2636
01:24:45,760 --> 01:24:47,080
THIS MEANS 3 MILLION

2637
01:24:47,080 --> 01:24:50,320
PROFESSIONAL WHOSE ARE IN

2638
01:24:50,320 --> 01:24:51,320
HEALTHCARE OR SOCIAL ASSISTANT

2639
01:24:51,320 --> 01:24:53,520
PRIVATE SECTORS, 80% WHOM ARE

2640
01:24:53,520 --> 01:24:53,920
WOMEN.

2641
01:24:53,920 --> 01:24:56,400
IF WE THINK ABOUT THE C SUITE OF

2642
01:24:56,400 --> 01:24:58,400
HIGHEST LEVEL CHIEF OFFICE OF

2643
01:24:58,400 --> 01:24:59,960
POSITIONS IN THE HOSPITAL, OR IN

2644
01:24:59,960 --> 01:25:03,400
THE HEALTHCARE SYSTEM, THERE ARE

2645
01:25:03,400 --> 01:25:05,920
HUGE STILL GENDER DISPARITIES.

2646
01:25:05,920 --> 01:25:08,040
WE DID A SURVEY IN 2012 LOOKING

2647
01:25:08,040 --> 01:25:09,680
AT EXPERIENCE OF WOMEN IN

2648
01:25:09,680 --> 01:25:11,640
HEALTHCARE SECTORS COMPARING IT

2649
01:25:11,640 --> 01:25:13,280
TO MEN WITH SAME AMOUNT OF

2650
01:25:13,280 --> 01:25:13,760
EXPERIENCE.

2651
01:25:13,760 --> 01:25:17,480
AND ONLY 11% WOMEN ACHIEVE LEVEL

2652
01:25:17,480 --> 01:25:19,120
CHIEF EXECUTIVE OFFICER COMPARED

2653
01:25:19,120 --> 01:25:21,920
TO 22% OF WOMEN.

2654
01:25:21,920 --> 01:25:22,720
AGAIN AMERICAN COLLEGE OF

2655
01:25:22,720 --> 01:25:23,920
HEALTHCARE EXECUTIVES LOOK AT

2656
01:25:23,920 --> 01:25:27,440
THIS DATA.

2657
01:25:27,440 --> 01:25:29,840
NOT MUCH CHANGED SINCE EARLY

2658
01:25:29,840 --> 01:25:31,400
1990s.

2659
01:25:31,400 --> 01:25:33,120
11% OF WOMEN ROSE TO CEO

2660
01:25:33,120 --> 01:25:35,120
POSITIONS, DECREASED A LITTLE

2661
01:25:35,120 --> 01:25:39,040
BIT 1995, TO 8%, 12% IN 2006,

2662
01:25:39,040 --> 01:25:42,040
MORE RECENT DATA I SAW IN JAMA

2663
01:25:42,040 --> 01:25:44,920
IT IS ONLY ABOUT 50% OF WOMEN

2664
01:25:44,920 --> 01:25:48,960
CURRENTLY IN THESE CEO ROLES.

2665
01:25:48,960 --> 01:25:50,520
WE KNOW THERE IS EXTREME BENEFIT

2666
01:25:50,520 --> 01:25:53,920
TO LEADERSHIP DIVERSITY ACROSS

2667
01:25:53,920 --> 01:25:57,280
VARIETY OF INDUSTRIES.

2668
01:25:57,280 --> 01:25:57,920
INCLUDING HEALTHCARE IN THE

2669
01:25:57,920 --> 01:25:59,280
UNITED STATES AND ACROSS OTHER

2670
01:25:59,280 --> 01:26:03,280
ECONOMIES THAT ARE SIMILAR THIS

2671
01:26:03,280 --> 01:26:04,080
WILL CANADA AND GREAT BRITAIN.

2672
01:26:04,080 --> 01:26:06,360
WE KNOW BENEFITS ARE SOCIALLY

2673
01:26:06,360 --> 01:26:07,720
DIVERSE TEAMS ARE INNOVATIVE,

2674
01:26:07,720 --> 01:26:09,240
MORE LIKELY THE BREAK DOWN

2675
01:26:09,240 --> 01:26:10,280
BARRIERS TO CARE.

2676
01:26:10,280 --> 01:26:15,280
TEAMS ARE MORE LIKELY TO BE MORE

2677
01:26:15,280 --> 01:26:17,360
EFFECTIVE AS WE HAVE SEEN IN THE

2678
01:26:17,360 --> 01:26:18,720
COVID-19 PANDEMIC ARE ABLE TO

2679
01:26:18,720 --> 01:26:20,600
ACTIVATE RESILIENCE DURING TIMES

2680
01:26:20,600 --> 01:26:22,360
OF CRISIS AS WE HAVE SEEN IN

2681
01:26:22,360 --> 01:26:24,360
MULTIPLE TIME POINTS IN

2682
01:26:24,360 --> 01:26:25,840
HEALTHCARE DELIVERY.

2683
01:26:25,840 --> 01:26:27,080
WHEN WOMEN ARE REPRESENTED IN

2684
01:26:27,080 --> 01:26:28,880
SUCH THINGS AS LEGISLATIVE

2685
01:26:28,880 --> 01:26:31,920
BODIES, ABLE TO DISCUSS AND

2686
01:26:31,920 --> 01:26:33,600
IMPLEMENT THESE WOMEN POLICY

2687
01:26:33,600 --> 01:26:35,280
PRIORITIES, THAT ARE IMPORTANT

2688
01:26:35,280 --> 01:26:37,360
TO WOMEN, THESE PRIORITIES AGAIN

2689
01:26:37,360 --> 01:26:39,480
TEND TO INCREASE.

2690
01:26:39,480 --> 01:26:42,520
SO IF HOSPITAL LEADERSHIP CAN

2691
01:26:42,520 --> 01:26:43,960
REFLECT GENDER DIVERSE WORK

2692
01:26:43,960 --> 01:26:48,560
FORCE IN THE COMMUNITIES THEY

2693
01:26:48,560 --> 01:26:49,760
SERVE, MORE BENEFITS ARE

2694
01:26:49,760 --> 01:26:50,120
ACHIEVED.

2695
01:26:50,120 --> 01:26:52,000
THIS IS IMPORTANT IN THE

2696
01:26:52,000 --> 01:26:55,440
HEALTHCARE SERVICE DELIVERY

2697
01:26:55,440 --> 01:26:56,720
SYSTEM, WHICH IS COMPLEX AND

2698
01:26:56,720 --> 01:27:00,720
FOCUSES ON ACUTE CARE DELIVERY.

2699
01:27:00,720 --> 01:27:03,200
IN A MORE RECENT STUDY BY JASON

2700
01:27:03,200 --> 01:27:05,200
MOST LOOKING AT A AGAIN WOMEN

2701
01:27:05,200 --> 01:27:08,440
MANY TOP EXECUTIVE POSITIONS IN

2702
01:27:08,440 --> 01:27:09,400
MEDICAL SURGICAL HOSPITALSES,

2703
01:27:09,400 --> 01:27:10,880
THIS WAS A STUDY LOOKING AT

2704
01:27:10,880 --> 01:27:12,440
PROPORTION OF WOMEN IN THESE

2705
01:27:12,440 --> 01:27:14,440
LEADERSHIP POSITIONS, TO

2706
01:27:14,440 --> 01:27:15,440
DETERMINE IF THERE ARE ANY

2707
01:27:15,440 --> 01:27:20,480
FACTORS AT THE HOSPITAL LEVEL

2708
01:27:20,480 --> 01:27:22,160
AND COMMUNITY LEVEL IMPACT OF

2709
01:27:22,160 --> 01:27:24,120
WOMEN BEING EXECUTIVE

2710
01:27:24,120 --> 01:27:26,240
CONDITIONS.  THESE DATA FROM

2711
01:27:26,240 --> 01:27:28,400
4300 HOSPITALS FROM THE AMERICAN

2712
01:27:28,400 --> 01:27:30,320
HOSPITAL ASSOCIATION, TO

2713
01:27:30,320 --> 01:27:33,560
CALCULATE PROPORTION OF WOMEN

2714
01:27:33,560 --> 01:27:34,560
WHO ARE IN THESE ROLES.

2715
01:27:34,560 --> 01:27:36,920
THEY FOUND WOMEN EXECUTIVES WERE

2716
01:27:36,920 --> 01:27:38,920
UNDER-REPRESENTED IN ALL

2717
01:27:38,920 --> 01:27:40,760
POSITIONS, WITH EXCEPTION OF

2718
01:27:40,760 --> 01:27:42,400
CHIEF HUMAN RESOURCES POSITION.

2719
01:27:42,400 --> 01:27:44,680
AS WELL AS CHIEF NURSING OFFICE

2720
01:27:44,680 --> 01:27:45,360
POSITION.

2721
01:27:45,360 --> 01:27:47,920
SO HUMAN RESOURCES IT WAS ABOUT

2722
01:27:47,920 --> 01:27:50,920
73% AND CHIEF NURSING OFFICE --

2723
01:27:50,920 --> 01:27:52,720
OFFICER POSITIONS WAS 91%.

2724
01:27:52,720 --> 01:27:54,520
SO AS MENTIONED WOMEN IN THIS

2725
01:27:54,520 --> 01:27:58,880
MOST RECENT STUDY, ACCOUNTED FOR

2726
01:27:58,880 --> 01:28:01,520
ABOUT 13% CEO AT SYSTEM LEVEL

2727
01:28:01,520 --> 01:28:05,440
AND THIRD CEO AT HOSPITAL LEVEL.

2728
01:28:05,440 --> 01:28:07,440
THIS WAS LOOKING AT NUMBER OF

2729
01:28:07,440 --> 01:28:08,800
HOSPITALS EVALUATED IN STUDY AND

2730
01:28:08,800 --> 01:28:10,200
SIZE OF HOSPITAL.

2731
01:28:10,200 --> 01:28:13,680
SO WOMEN WHO WERE AT LARGE

2732
01:28:13,680 --> 01:28:16,280
HOSPITALS TALKING ABOUT 400 BEDS

2733
01:28:16,280 --> 01:28:17,600
OAR MORE, LESS LIKELY TO HOLD

2734
01:28:17,600 --> 01:28:20,920
CHIEF POSITIONS COMPARED TO

2735
01:28:20,920 --> 01:28:21,800
THOSE WORKING IN SMALLER

2736
01:28:21,800 --> 01:28:25,440
HOSPITAL SETTINGS.  SO TWO

2737
01:28:25,440 --> 01:28:26,520
CRITICAL COMPONENTS HOSPITALS

2738
01:28:26,520 --> 01:28:29,800
NEED TO ENCOURAGE LEADERSHIP

2739
01:28:29,800 --> 01:28:31,600
DIVERSITY INCLUDING GENDER

2740
01:28:31,600 --> 01:28:32,440
DIVERSITY IN ORDER TO BE

2741
01:28:32,440 --> 01:28:35,800
SUCCESSFUL IN THEIR ROLE.

2742
01:28:35,800 --> 01:28:37,320
ACCORDING TO NATIONAL GLASS

2743
01:28:37,320 --> 01:28:39,320
CEILING COMMISSION IN 1995, THEY

2744
01:28:39,320 --> 01:28:40,680
IDENTIFIED MULTIPLE BARRIERS,

2745
01:28:40,680 --> 01:28:42,520
THREE CATEGORIES TO WOMEN

2746
01:28:42,520 --> 01:28:43,560
ASCENDING TO THOSE ROLES.

2747
01:28:43,560 --> 01:28:46,440
SO THERE ARE BARRIERS AT LEVEL

2748
01:28:46,440 --> 01:28:48,120
OF SOCIETY, INTERNAL BARRIERS OR

2749
01:28:48,120 --> 01:28:50,640
GOVERNMENT BARRIERS, LACK OF

2750
01:28:50,640 --> 01:28:51,920
EDUCATIONAL OPPORTUNITIES,

2751
01:28:51,920 --> 01:28:52,880
PREJUDICE DISCRIMINATION AND

2752
01:28:52,880 --> 01:28:55,320
BIAS RELATED TO THE

2753
01:28:55,320 --> 01:28:56,440
INTERSECTIONALITY AND GENDER,

2754
01:28:56,440 --> 01:28:57,800
GENDER IDENTITY, RACE AND

2755
01:28:57,800 --> 01:28:59,160
ETHNICITY AS WELL AS RECRUITMENT

2756
01:28:59,160 --> 01:29:02,520
PRACTICES, WE TALKED ABOUT

2757
01:29:02,520 --> 01:29:04,080
FORMALLY KNOWN AS PIPELINES OR

2758
01:29:04,080 --> 01:29:07,720
PATHWAY BARRIERS THAT REALLY

2759
01:29:07,720 --> 01:29:09,520
PREVENT ADVANCEMENT OF WOMEN,

2760
01:29:09,520 --> 01:29:11,320
LACK OF APPROPRIATE MENTORING,

2761
01:29:11,320 --> 01:29:13,520
LACK OF GOVERNMENT MONITORING

2762
01:29:13,520 --> 01:29:18,040
ENFORCEMENT THAT RESTRAINS WOMEN

2763
01:29:18,040 --> 01:29:19,160
ADVANCING TO TOP ROLES.

2764
01:29:19,160 --> 01:29:22,000
IN OTHER DATA WE LOOK AT THE

2765
01:29:22,000 --> 01:29:23,480
HEALTHCARE MANAGER, AND

2766
01:29:23,480 --> 01:29:24,360
ADMINISTRATIVE RANKS, THIS IS

2767
01:29:24,360 --> 01:29:26,280
BASED ON WOMEN WHO GRADUATED IN

2768
01:29:26,280 --> 01:29:29,800
THE EARLY 1990s, OF ABOUT 6300

2769
01:29:29,800 --> 01:29:33,000
WOMEN WITH HIGHER LEVEL DEGREES,

2770
01:29:33,000 --> 01:29:34,760
69% WERE AWARDED TO WOMEN, WE

2771
01:29:34,760 --> 01:29:36,720
ARE TALKING ABOUT MBA,

2772
01:29:36,720 --> 01:29:38,120
HEALTHCARE ADMINISTRATION,

2773
01:29:38,120 --> 01:29:43,600
MANAGEMENT DEGREES, 46% IN

2774
01:29:43,600 --> 01:29:44,760
PARTICULAR HAD MBAs.

2775
01:29:44,760 --> 01:29:49,080
OTHER CATEGORIES ACCOUNTING AND

2776
01:29:49,080 --> 01:29:50,600
FINANCE, A LITTLE OVER 60% WERE

2777
01:29:50,600 --> 01:29:54,720
AWARDED TO WOMEN, SO PATHWAY

2778
01:29:54,720 --> 01:29:56,280
COMPONENTS ARE NOT THE ONLY

2779
01:29:56,280 --> 01:29:58,280
EXPLANATION TO WHY WOMEN ARE NOT

2780
01:29:58,280 --> 01:30:00,440
ACHIEVING THESE TOP LEADERSHIP

2781
01:30:00,440 --> 01:30:02,200
POSITIONS.

2782
01:30:02,200 --> 01:30:03,400
ACCORDING TO WALT DISNEY, THE

2783
01:30:03,400 --> 01:30:05,120
BEST WAY THE GET STARTED IS TO

2784
01:30:05,120 --> 01:30:06,760
QUIT TALKING, WE ARE DOING A LOT

2785
01:30:06,760 --> 01:30:08,120
OF TALKING TODAY BUT HOPEFULLY

2786
01:30:08,120 --> 01:30:10,760
WE ARE ABLE TO MOVE OUR

2787
01:30:10,760 --> 01:30:11,920
CONVERSATIONS TO SOLUTIONS AND

2788
01:30:11,920 --> 01:30:16,960
TO BEGIN IMPLEMENTING SUCH

2789
01:30:16,960 --> 01:30:19,560
SOLUTIONS THEY INCLUDE HOW WE

2790
01:30:19,560 --> 01:30:21,480
CAN INVESTIGATE IDENTIFY LOOK AT

2791
01:30:21,480 --> 01:30:22,840
OUR RETENTION PRACTICES

2792
01:30:22,840 --> 01:30:27,680
PROMOTION PRACTICES, CULTURE OF

2793
01:30:27,680 --> 01:30:29,280
ORGANIZATIONS WHICH WE ARE WORK

2794
01:30:29,280 --> 01:30:31,200
AND ANY OTHER FACTORS THAT MIGHT

2795
01:30:31,200 --> 01:30:33,200
BE FOUND TO SHUT OUT QUALIFIED

2796
01:30:33,200 --> 01:30:38,360
WOMEN ESPECIALLY IN LARGER

2797
01:30:38,360 --> 01:30:40,200
HOSPITAL SYSTEMS WE WORK.

2798
01:30:40,200 --> 01:30:42,120
HOSPITAL INVEST INTERVENTIONS TO

2799
01:30:42,120 --> 01:30:43,480
IMPROVE THEIR ATTENTION

2800
01:30:43,480 --> 01:30:44,840
RECRUITMENT AND PROMOTION OF

2801
01:30:44,840 --> 01:30:46,880
WOMEN MANY THESE ROLES.

2802
01:30:46,880 --> 01:30:50,520
SO THIS REQUIRES NEW

2803
01:30:50,520 --> 01:30:51,520
INTERVENTIONS NEW APPROACH SUCH

2804
01:30:51,520 --> 01:30:53,320
AS SPONSORSHIP AND IN ADDITION

2805
01:30:53,320 --> 01:30:58,120
TO MENTORSHIP.

2806
01:30:58,120 --> 01:30:58,840
CULTURALLY SUPPORTIVE

2807
01:30:58,840 --> 01:30:59,960
ENVIRONMENT FOR WOMEN,

2808
01:30:59,960 --> 01:31:01,280
INTERSEXUALITY OF MANY.

2809
01:31:01,280 --> 01:31:02,560
I'M BLACK WOMAN IN MEDICINE I

2810
01:31:02,560 --> 01:31:05,200
CANNOT REALLY SEPARATE THOSE TWO

2811
01:31:05,200 --> 01:31:06,440
CATEGORIES OR SELF-IDENTITIES

2812
01:31:06,440 --> 01:31:08,800
WHICH I FALL INTO.

2813
01:31:08,800 --> 01:31:11,280
THIS REQUIRES A MULTI-PRONG

2814
01:31:11,280 --> 01:31:14,400
APPROACH CONCERTED, TOP HOSPITAL

2815
01:31:14,400 --> 01:31:17,200
LEADERSHIP HAS TO WORK ON THIS,

2816
01:31:17,200 --> 01:31:19,120
BECAUSE WE KNOW GENDER DIVERSITY

2817
01:31:19,120 --> 01:31:21,120
REFLECTED IN THE HOSPITAL WORK

2818
01:31:21,120 --> 01:31:22,600
FORCE AS MENTIONED.

2819
01:31:22,600 --> 01:31:24,280
SO I KNOW MY COMMENTS WERE MUCH

2820
01:31:24,280 --> 01:31:26,400
BRIEFER THAN ANTICIPATED.

2821
01:31:26,400 --> 01:31:28,120
I AM ON SOCIAL MEDIA AND I CAN

2822
01:31:28,120 --> 01:31:31,120
BE FOUND THERE AS WELL AS LINKED

2823
01:31:31,120 --> 01:31:32,600
IN, HAPPY TO ADDRESS QUESTIONS

2824
01:31:32,600 --> 01:31:36,560
THAT MAY COME UP DURING THE Q&A

2825
01:31:36,560 --> 01:31:37,240
SESSION.

2826
01:31:37,240 --> 01:31:37,920
THANKS AGAIN FOR THE OPPORTUNITY

2827
01:31:37,920 --> 01:31:39,480
TO SPEAK.

2828
01:31:39,480 --> 01:31:43,200
>> THANK YOU SO MUCH, DR. CLARE,

2829
01:31:43,200 --> 01:31:46,400
FOR YOUR PRESENTATION, VERY

2830
01:31:46,400 --> 01:31:47,920
INFORMATIVE AND ALSO VERY

2831
01:31:47,920 --> 01:31:49,800
THOUGHT PROVOKING.

2832
01:31:49,800 --> 01:31:53,400
OUR FINAL TALK FOR SESSION 1 IS

2833
01:31:53,400 --> 01:31:56,800
WILL BE GIVEN BY DR. ADAM WILK.

2834
01:31:56,800 --> 01:31:58,800
HE IS A HEALTH ECONOMIST AND

2835
01:31:58,800 --> 01:32:00,680
HEALTH SERVICES RESEARCHER IN

2836
01:32:00,680 --> 01:32:01,920
THE DEPARTMENT OF HEALTH POLICY

2837
01:32:01,920 --> 01:32:05,240
AND MANAGEMENT AT EMORY

2838
01:32:05,240 --> 01:32:05,880
UNIVERSITY ROLAND SCHOOL OF

2839
01:32:05,880 --> 01:32:06,520
PUBLIC HEALTH.

2840
01:32:06,520 --> 01:32:08,400
HIS RESEARCH EXAMINES THE

2841
01:32:08,400 --> 01:32:10,600
RELATIONSHIPS AMONG POLICY,

2842
01:32:10,600 --> 01:32:12,520
HEALTH STRUCTURE, AND THE

2843
01:32:12,520 --> 01:32:14,280
CLINICAL OPERATIONAL DECISION OF

2844
01:32:14,280 --> 01:32:16,680
INDIVIDUAL PROVIDERS THAT SERVE

2845
01:32:16,680 --> 01:32:18,240
UNDERSERVE LOW INCOME AND RACIAL

2846
01:32:18,240 --> 01:32:19,840
ETHNIC MINORITY POPULATIONS WITH

2847
01:32:19,840 --> 01:32:20,960
CHRONIC ILLNESS.

2848
01:32:20,960 --> 01:32:24,600
DR. WILK'S WORK IS PARTICULARLY

2849
01:32:24,600 --> 01:32:26,720
FOCUSED ON RACE -- RACIAL ETHNIC

2850
01:32:26,720 --> 01:32:28,200
AND SOCIAL ECONOMIC DISPARITIES

2851
01:32:28,200 --> 01:32:29,720
AND ACCESS TO KIDNEY

2852
01:32:29,720 --> 01:32:32,160
TRANSPLANTATION.

2853
01:32:32,160 --> 01:32:34,280
AND HOME DIALYSIS AMONG

2854
01:32:34,280 --> 01:32:35,520
INDIVIDUALS WITH KIDNEY FAILURE

2855
01:32:35,520 --> 01:32:37,760
AS PROVIDER ORGANIZATIONAL AND

2856
01:32:37,760 --> 01:32:39,040
SYSTEM LEVEL FACTORS THAT

2857
01:32:39,040 --> 01:32:39,440
INFLUENCE THEM.

2858
01:32:39,440 --> 01:32:41,760
HE WILL BE PRESENTING ON A MODEL

2859
01:32:41,760 --> 01:32:43,920
FOR DELIVERING POPULATION HEALTH

2860
01:32:43,920 --> 01:32:47,280
ACROSS THE CARE CONTINUES WOMB.

2861
01:32:47,280 --> 01:32:54,440
DR. WILKCONTINUUM.

2862
01:32:54,440 --> 01:32:55,840
>> THANK YOU TO BE HERE TODAY

2863
01:32:55,840 --> 01:32:56,920
AND PRIVILEGE TO BE HERE WITH

2864
01:32:56,920 --> 01:32:57,520
Y'ALL.

2865
01:32:57,520 --> 01:32:59,320
HAS DR. LEWIS JOHNSON SUGGESTED

2866
01:32:59,320 --> 01:33:00,480
I WILL TALK A MODEL FOR

2867
01:33:00,480 --> 01:33:01,280
DELIVERING POPULATION HEALTH

2868
01:33:01,280 --> 01:33:02,520
ACROSS THE CARE CONTINUUM AND

2869
01:33:02,520 --> 01:33:05,560
USE IT TO INFORM MY COMMENTS

2870
01:33:05,560 --> 01:33:07,040
ABOUT OPPORTUNITIES AND BARRIERS

2871
01:33:07,040 --> 01:33:08,960
DELIVERING WHOLE PERSON CARE

2872
01:33:08,960 --> 01:33:10,440
SYSTEMS LEVEL.

2873
01:33:10,440 --> 01:33:11,920
START WITH BIG PICTURE WE ARE

2874
01:33:11,920 --> 01:33:13,600
ALL SUPPORTIVE OF INCREASING

2875
01:33:13,600 --> 01:33:17,280
WHOLE PERSON CARE DELIVERY

2876
01:33:17,280 --> 01:33:21,240
VERSUS CONVENTIONAL CARE FOR

2877
01:33:21,240 --> 01:33:21,920
WOMEN AN GIRLS.

2878
01:33:21,920 --> 01:33:23,280
WHAT I MEAN BY THESE TERMS AND

2879
01:33:23,280 --> 01:33:24,960
WHAT IT LOOKS LIKE TO BOOST

2880
01:33:24,960 --> 01:33:28,040
WHOLE PERSON CARE.

2881
01:33:28,040 --> 01:33:30,520
WHAT WE ARE AIMING FOR SHOULD

2882
01:33:30,520 --> 01:33:33,360
LOOK LIKE THIS.

2883
01:33:33,360 --> 01:33:35,920
FIGURE COMES FROM A STUDY BY

2884
01:33:35,920 --> 01:33:38,240
JANE AND MYSELF AND COLLEAGUES

2885
01:33:38,240 --> 01:33:39,120
AND CARE TEAM BALANCE OF

2886
01:33:39,120 --> 01:33:41,320
PREVENTION AND WELL CARE VERSUS

2887
01:33:41,320 --> 01:33:43,320
DISEASE MANAGEMENT FORGIVEN

2888
01:33:43,320 --> 01:33:44,360
INDIVIDUAL AT DIFFERENT POINTS

2889
01:33:44,360 --> 01:33:45,600
IN TIME RELATIVE TO PROGRESSION

2890
01:33:45,600 --> 01:33:47,920
OF ONE OR MORE CHRONIC

2891
01:33:47,920 --> 01:33:48,280
ILLNESSES.

2892
01:33:48,280 --> 01:33:49,800
LEFT IDENTIFY GUSH PRIOR TO

2893
01:33:49,800 --> 01:33:52,720
DIAGNOSIS OF CHRONIC ILLNESS,

2894
01:33:52,720 --> 01:33:54,000
IDEAL CARRIES IN PHASE 1

2895
01:33:54,000 --> 01:33:55,240
PREVENTION AND WELL CARE.

2896
01:33:55,240 --> 01:33:56,480
THE PRIORITY SHOULD BE PLACED ON

2897
01:33:56,480 --> 01:33:59,040
RISK REDUCTION HEALTHY BEHAVIOR

2898
01:33:59,040 --> 01:34:00,800
APPROPRIATE SCREENING AND

2899
01:34:00,800 --> 01:34:01,800
AVOIDING WORSENING IN ACUTE

2900
01:34:01,800 --> 01:34:04,280
ILLNESS.

2901
01:34:04,280 --> 01:34:07,560
THAT IS PRIMARY SECONDARY AND

2902
01:34:07,560 --> 01:34:09,040
TERTIARY INTERVENTIONMENT IF YOU

2903
01:34:09,040 --> 01:34:12,120
LOOK AT BROAD VIEW OF ACTIVITIES

2904
01:34:12,120 --> 01:34:13,880
ENCOMPASSING ALL PATIENT NEEDS

2905
01:34:13,880 --> 01:34:16,520
THIS REPRESENTS WHOLE PERSON

2906
01:34:16,520 --> 01:34:17,880
CARE PRIOR TO ANY PERSON

2907
01:34:17,880 --> 01:34:19,280
DIAGNOSED WITH CHRONIC ILLNESS.

2908
01:34:19,280 --> 01:34:21,360
AFTER DIAGNOSIS, IN PHASE 2 TO

2909
01:34:21,360 --> 01:34:24,240
SEIZE MANAGEMENT RAMPS UP WITH

2910
01:34:24,240 --> 01:34:25,520
INITIAL TREATMENT BY CYCLES OF

2911
01:34:25,520 --> 01:34:27,640
ONGOING ADDITIONAL CONTROL AND

2912
01:34:27,640 --> 01:34:29,120
FOLLOW-UP CARE AFTER

2913
01:34:29,120 --> 01:34:29,760
EXACERBATION.

2914
01:34:29,760 --> 01:34:31,320
WHEN CONDITION IS LESS SEVERE OR

2915
01:34:31,320 --> 01:34:35,520
IS WELL CONTROLLED, SOME

2916
01:34:35,520 --> 01:34:37,080
PRIORITY GIVEN SO SECONDARY AND

2917
01:34:37,080 --> 01:34:37,960
TERTIARY PREVENTION.

2918
01:34:37,960 --> 01:34:38,880
TAS CONDITION BECOMES MORE

2919
01:34:38,880 --> 01:34:42,680
SEVERE OR LESS WELL CONTROLLED,

2920
01:34:42,680 --> 01:34:45,160
GREATER PRIORITY GIVEN TO

2921
01:34:45,160 --> 01:34:46,760
DISEASE MANAGEMENTS.

2922
01:34:46,760 --> 01:34:48,320
OVERALL IN POPULATIONS WITH

2923
01:34:48,320 --> 01:34:49,320
GREATER CONDITION HEIGHTENED

2924
01:34:49,320 --> 01:34:50,600
FOCUS ON DISEASE MANAGEMENT THE

2925
01:34:50,600 --> 01:34:52,600
CARE MANAGEMENT TEAM SHOULD BY

2926
01:34:52,600 --> 01:34:54,560
NO MEANS IGNORE OTHER SERVICES

2927
01:34:54,560 --> 01:34:56,280
THAT COULD HELP MEET INDIVIDUAL

2928
01:34:56,280 --> 01:34:58,040
BROADER NEEDS ALONGSIDE CHRONIC

2929
01:34:58,040 --> 01:35:02,400
DISEASE MANAGEMENT.

2930
01:35:02,400 --> 01:35:04,600
SO THIS IS WHAT IT LOOK LIKE FOR

2931
01:35:04,600 --> 01:35:06,360
WOMAN OR GIRL WITH CHRONIC

2932
01:35:06,360 --> 01:35:07,520
CONDITIONS IN GENERAL THOUGH

2933
01:35:07,520 --> 01:35:09,040
DETAILS VARY FROM PERSON TO

2934
01:35:09,040 --> 01:35:10,120
PERSON.

2935
01:35:10,120 --> 01:35:11,320
WE ARE CONCERNED ALL TOO OFTEN

2936
01:35:11,320 --> 01:35:12,600
THIS IS WHAT CONVENTIONAL CARE

2937
01:35:12,600 --> 01:35:14,800
MIGHT LOOK LIKE FOR WOMAN OR

2938
01:35:14,800 --> 01:35:16,280
GIRL WITH ONE OR MORE CHRONIC

2939
01:35:16,280 --> 01:35:16,640
CONDITIONS.

2940
01:35:16,640 --> 01:35:18,280
A HEAVY EMPHASIS ON DISEASE

2941
01:35:18,280 --> 01:35:20,200
MANAGEMENT BASICALLY TO

2942
01:35:20,200 --> 01:35:23,000
EXCLUSION OF CARE OR PREVENTION,

2943
01:35:23,000 --> 01:35:24,160
THE OPPOSITE OF WHOLE PERSON

2944
01:35:24,160 --> 01:35:26,520
CARE.

2945
01:35:26,520 --> 01:35:28,320
SO HOW DO WE ACHIEVE WELL

2946
01:35:28,320 --> 01:35:30,280
COORDINATED INTEGRATED CARE THAT

2947
01:35:30,280 --> 01:35:35,120
LOOKS MORE LIKE THIS FOR WOMEN

2948
01:35:35,120 --> 01:35:36,480
OR GIRLS WITH CHRONIC

2949
01:35:36,480 --> 01:35:37,000
CONDITIONS.

2950
01:35:37,000 --> 01:35:40,360
MIGHT BE HELPFUL TO ASK WHO IS

2951
01:35:40,360 --> 01:35:42,920
RESPONSIBLE HERE?

2952
01:35:42,920 --> 01:35:44,760
FOUR MAIN ACTORS IN DETERMINING

2953
01:35:44,760 --> 01:35:45,480
STRUCTURE OF COUNTRY'S

2954
01:35:45,480 --> 01:35:46,720
HEALTHCARE DELIVERY MODELS ARE

2955
01:35:46,720 --> 01:35:48,280
THE PATIENT PAYER AND POLICY

2956
01:35:48,280 --> 01:35:49,600
MAKER THE HEALTH SYSTEM AND

2957
01:35:49,600 --> 01:35:53,600
FRONT LINE CLINICIAN.

2958
01:35:53,600 --> 01:35:56,720
THE CLINICIAN THAT SEES PATIENTS

2959
01:35:56,720 --> 01:35:58,520
AND MAKES CARE PLANS.

2960
01:35:58,520 --> 01:35:59,880
ALL BARE RESPONSIBILITY WHETHER

2961
01:35:59,880 --> 01:36:02,440
PAYERS POLICY MAKERS SETTING

2962
01:36:02,440 --> 01:36:03,560
REGULATORY BOUNDARIES AND

2963
01:36:03,560 --> 01:36:05,320
INCENTIVE SYSTEMS, HEALTH

2964
01:36:05,320 --> 01:36:06,280
SYSTEMS ORGANIZING CLINICIANS OF

2965
01:36:06,280 --> 01:36:08,720
CARE NETWORKS.

2966
01:36:08,720 --> 01:36:09,720
CLINICIANS WORKING WITH HEALTH

2967
01:36:09,720 --> 01:36:11,160
SYSTEM LEADER SHIPBUILDING CARE

2968
01:36:11,160 --> 01:36:13,280
PLANS PROVIDING TREATMENT AND

2969
01:36:13,280 --> 01:36:14,520
PATIENTS BY GUIDING CARE PLANS

2970
01:36:14,520 --> 01:36:16,200
AND PROVIDING FEEDBACK TO PAYERS

2971
01:36:16,200 --> 01:36:20,840
AND POLICY MAKERS.

2972
01:36:20,840 --> 01:36:21,960
THOUGH PATIENT PROBABLY BEARS

2973
01:36:21,960 --> 01:36:22,960
LEAST RESPONSIBILITY AMONG

2974
01:36:22,960 --> 01:36:23,360
ENTITIES.

2975
01:36:23,360 --> 01:36:26,240
IN OUR PAPER MY CO-AUTHORS AND I

2976
01:36:26,240 --> 01:36:27,760
FOCUS ON FRONT LINE CLINICIAN

2977
01:36:27,760 --> 01:36:29,520
AND HEALTH SYSTEMS LEADERSHIP

2978
01:36:29,520 --> 01:36:31,640
AND CONFLICTING INCENTIVES WHEN

2979
01:36:31,640 --> 01:36:36,920
ORGANIZING CARE MODELS.

2980
01:36:36,920 --> 01:36:40,040
I WOULD ARGUE IT WOULD BE EASY

2981
01:36:40,040 --> 01:36:41,720
TO OVERLOOK CONFLICT BETWEEN

2982
01:36:41,720 --> 01:36:43,720
FRONT LINE CLINICIAN AND HEALTH

2983
01:36:43,720 --> 01:36:45,600
SYSTEMS LEADERS ESPECIALLY IF

2984
01:36:45,600 --> 01:36:47,280
YOU ARE NOT ADMINISTRATOR.

2985
01:36:47,280 --> 01:36:48,880
THESE ARE AMONG MOST IMPORTANT

2986
01:36:48,880 --> 01:36:50,320
BARRIERS TO SEEING WHOLE PERSON

2987
01:36:50,320 --> 01:36:55,680
CARE ROUTINELY IN THE U.S..

2988
01:36:55,680 --> 01:36:56,560
WHAT DO I MOO EN?

2989
01:36:56,560 --> 01:36:58,400
LOTS OF POTENTIAL SOURCES OF

2990
01:36:58,400 --> 01:36:59,520
TENSION BETWEEN HEALTH SYSTEMS

2991
01:36:59,520 --> 01:37:00,880
AND FRONT LINE CLINICIANS.

2992
01:37:00,880 --> 01:37:02,720
WORKING DOWN THE LIST, HEALTH

2993
01:37:02,720 --> 01:37:03,400
SYSTEMS ARE RESPONSIBLE FOR

2994
01:37:03,400 --> 01:37:05,200
TAKING A POPULATION OF

2995
01:37:05,200 --> 01:37:06,640
PERSPECTIVE ON HEALTH.

2996
01:37:06,640 --> 01:37:08,720
AND FOR EXAMPLE, USING

2997
01:37:08,720 --> 01:37:10,720
POPULATION LEVEL DATA TO INFORM

2998
01:37:10,720 --> 01:37:12,520
WHAT GUIDANCE THEY GET FRONT

2999
01:37:12,520 --> 01:37:14,920
LINE CLINICIAN OR IDENTIFYING

3000
01:37:14,920 --> 01:37:17,920
PRIORITY FROM CO-MORBID SYSTEMS

3001
01:37:17,920 --> 01:37:19,720
AND IMPLEMENTING CARE SYSTEMS TO

3002
01:37:19,720 --> 01:37:20,920
FILL IN GAPS.

3003
01:37:20,920 --> 01:37:22,400
FRONT LINE CLINICIAN DON'T SEE

3004
01:37:22,400 --> 01:37:24,080
EYE THE EYE WITH SYSTEM LEADER

3005
01:37:24,080 --> 01:37:25,560
SHIP AND IN PART BECAUSE THEY

3006
01:37:25,560 --> 01:37:26,720
TRAINING AND EXPERIENCE

3007
01:37:26,720 --> 01:37:29,880
SIGNIFICANTLY EMPHASIZED DISEASE

3008
01:37:29,880 --> 01:37:31,120
MANAGEMENT AND MEETING THE NEEDS

3009
01:37:31,120 --> 01:37:32,000
OF PATIENT AND EXAM.

3010
01:37:32,000 --> 01:37:36,280
ONE AT A TIME.

3011
01:37:36,280 --> 01:37:37,720
THIS IS TRUE OF SPECIALISTS.

3012
01:37:37,720 --> 01:37:41,280
PAYMENT SYSTEMS FEED INTO THIS

3013
01:37:41,280 --> 01:37:42,640
CONFLICT IN A BIG WAY.

3014
01:37:42,640 --> 01:37:44,320
THEY TRAIN DURING ERA WHEN FEE

3015
01:37:44,320 --> 01:37:49,120
FOR SERVICES CAME AND CARE

3016
01:37:49,120 --> 01:37:50,640
MODELS SET UP ACCORDINGLY.

3017
01:37:50,640 --> 01:37:51,720
VALUE BASED PAYMENTS AND

3018
01:37:51,720 --> 01:37:52,960
FINANCIAL RISK SHARING ARE

3019
01:37:52,960 --> 01:37:54,200
COMING IF THEY HAVEN'T TAKEN

3020
01:37:54,200 --> 01:37:57,720
HOLD ALREADY.

3021
01:37:57,720 --> 01:37:58,520
AS FRONT LINE CLINICIAN LEARN

3022
01:37:58,520 --> 01:38:00,520
WHAT VALUE PACE BASED PAYMENT

3023
01:38:00,520 --> 01:38:01,880
AND RISK SHARING AND WHAT IT

3024
01:38:01,880 --> 01:38:03,680
MEANS FOR PRACTICE, HEALTH

3025
01:38:03,680 --> 01:38:05,760
SYSTEM FACILITATE ANNOTATION AND

3026
01:38:05,760 --> 01:38:06,520
HEALTH SYSTEMS AREN'T HAVING TO

3027
01:38:06,520 --> 01:38:11,080
SUCCEED IN DOING THAT WELL.

3028
01:38:11,080 --> 01:38:12,720
ONE PART IS INVOLVING INTERNAL

3029
01:38:12,720 --> 01:38:14,200
COMPENSATION MODELS FOR

3030
01:38:14,200 --> 01:38:15,240
CLINICIANS, WHO ARE HEALTH

3031
01:38:15,240 --> 01:38:18,760
SYSTEM EMPLOYEES.

3032
01:38:18,760 --> 01:38:20,600
THE DATA ARE NOT DETAILED BUT

3033
01:38:20,600 --> 01:38:22,400
CLINICIANS ACCEPT A SALARY WITH

3034
01:38:22,400 --> 01:38:25,360
SOME ADJUSTMENT OR BONUS FOR

3035
01:38:25,360 --> 01:38:26,840
PATIENT CARE VOLUME OR SELECT

3036
01:38:26,840 --> 01:38:27,760
QUALITY METRICS.

3037
01:38:27,760 --> 01:38:30,240
IT IS GENERALLY UNCLEAR WHETHER

3038
01:38:30,240 --> 01:38:31,560
QUALITY METRICS IN THESE

3039
01:38:31,560 --> 01:38:32,760
COMPENSATION MODELS ARE WELL

3040
01:38:32,760 --> 01:38:35,760
ALIGNED WITH THOSE IN HEALTH

3041
01:38:35,760 --> 01:38:37,760
SYSTEMS CONTRACTS WITH PAYERS OR

3042
01:38:37,760 --> 01:38:39,520
WHETHER THERE'S MISCONNECTION

3043
01:38:39,520 --> 01:38:39,920
THERE.

3044
01:38:39,920 --> 01:38:41,560
THEY PROMOTE WHOLE PERSON CARE

3045
01:38:41,560 --> 01:38:43,560
OR JUST NARROW FOCUS ON MEASURED

3046
01:38:43,560 --> 01:38:45,640
CARE LIKE BREAST CANCER SCREENS

3047
01:38:45,640 --> 01:38:49,240
TO BE EXCLUSION OF METRIC CARE.

3048
01:38:49,240 --> 01:38:51,400
I WANT TO BE CLEAR ABOUT PICKER

3049
01:38:51,400 --> 01:38:51,760
PICTURE.

3050
01:38:51,760 --> 01:38:53,560
A WHOLLY POPULATION HEALTH

3051
01:38:53,560 --> 01:38:56,520
PERSPECTIVE DOESN'T REPRESENT

3052
01:38:56,520 --> 01:38:58,000
WHOLE PERSON CARE.

3053
01:38:58,000 --> 01:38:59,280
DISEASE MANAGEMENT DOESN'T

3054
01:38:59,280 --> 01:39:00,640
REPRESENT WHOLE PERSON CARE.

3055
01:39:00,640 --> 01:39:01,640
THE ANSWER LIES IN THE BALANCE

3056
01:39:01,640 --> 01:39:03,720
OF THE TWO.

3057
01:39:03,720 --> 01:39:04,640
STRIKING THAT BALANCE IS

3058
01:39:04,640 --> 01:39:06,680
DIFFICULT FOR MANY REASONS.

3059
01:39:06,680 --> 01:39:08,680
HOWEVER, AND I'LL BE GETTING TO

3060
01:39:08,680 --> 01:39:10,360
SOME OF THOSE AND I WALK THROUGH

3061
01:39:10,360 --> 01:39:13,360
REAL WORLD EXAMPLES.

3062
01:39:13,360 --> 01:39:14,560
EFFORTS TO BETTER INTEGRATE

3063
01:39:14,560 --> 01:39:15,800
MENTAL HEALTH OR BEHAVIORAL

3064
01:39:15,800 --> 01:39:17,360
HEALTHCARE IN PRIMARY CARE

3065
01:39:17,360 --> 01:39:18,840
CLINICS HAVE BEEN GOING ON FOR

3066
01:39:18,840 --> 01:39:21,160
YEARS NOW.

3067
01:39:21,160 --> 01:39:23,400
AND THE EVIDENCE HAS GROWN.

3068
01:39:23,400 --> 01:39:24,280
THERE'S EVIDENCE THAT

3069
01:39:24,280 --> 01:39:25,720
COLLABORATIVE CARE MODEL AND

3070
01:39:25,720 --> 01:39:27,120
OTHER LIKE MODELS ASSOCIATED

3071
01:39:27,120 --> 01:39:28,520
WITH BETTER ACCESS TO TREATMENT

3072
01:39:28,520 --> 01:39:29,760
AND OUTCOMES.

3073
01:39:29,760 --> 01:39:31,280
WITH MY NOD TO MY FELLOW

3074
01:39:31,280 --> 01:39:34,120
PANELIST THERE IS IS ALSO

3075
01:39:34,120 --> 01:39:35,480
EVIDENCE THAT SUPPORTS PERINATAL

3076
01:39:35,480 --> 01:39:36,920
DEPRESSION.

3077
01:39:36,920 --> 01:39:38,360
THERE IS SOME MANY THIS

3078
01:39:38,360 --> 01:39:41,320
LITERATURE AND INCLUDING

3079
01:39:41,320 --> 01:39:42,120
BEHAVIORAL HEALTH CONDITIONS

3080
01:39:42,120 --> 01:39:44,040
OTHER THAN DEPRESSION, AND

3081
01:39:44,040 --> 01:39:45,360
IDENTIFYING THE MOST ESSENTIAL

3082
01:39:45,360 --> 01:39:47,880
PIECES OF INTEGRATED BEHAVIORAL

3083
01:39:47,880 --> 01:39:49,520
HEALTH MODELS WHEN THEY NEED TO

3084
01:39:49,520 --> 01:39:52,640
BE ADAPTED AND IN MEASURING

3085
01:39:52,640 --> 01:39:53,320
EQUITY.

3086
01:39:53,320 --> 01:39:57,640
AND IMPACT BY GENDER RACE

3087
01:39:57,640 --> 01:39:59,120
ETHNICITY, SOCIOECONOMIC STATUS

3088
01:39:59,120 --> 01:39:59,640
AND OTHER IDENTITIES.

3089
01:39:59,640 --> 01:40:01,640
TWO BARRIERS TO INTEGRATED

3090
01:40:01,640 --> 01:40:02,240
BEHAVIORAL HEALTH.

3091
01:40:02,240 --> 01:40:03,800
FIRST THESE PRACTICE LEVEL

3092
01:40:03,800 --> 01:40:08,440
SERVICE TRANSFORMATIONS ARE

3093
01:40:08,440 --> 01:40:09,040
COMPLEX.

3094
01:40:09,040 --> 01:40:11,240
OUTSIDE EXPERTS HIRED BY HEALTH

3095
01:40:11,240 --> 01:40:12,280
SYSTEM MIGHT BE NEEDED TO

3096
01:40:12,280 --> 01:40:13,480
IMPLEMENT AND THIS CAN RAISE

3097
01:40:13,480 --> 01:40:14,800
TENSIONS BETWEEN CLINICIAN AND

3098
01:40:14,800 --> 01:40:19,240
HEALTH SYSTEM LEADER SHIM.

3099
01:40:19,240 --> 01:40:22,440
SETTING UP FINANCIAL MODELS TO

3100
01:40:22,440 --> 01:40:23,320
SUSTAIN STRUCTURE CAN BE

3101
01:40:23,320 --> 01:40:24,560
CRITICAL, HEALTH SYSTEM MAY TAKE

3102
01:40:24,560 --> 01:40:29,160
THE LEAD THERE.

3103
01:40:29,160 --> 01:40:30,880
SOME CONTEXT FOR THE TWO

3104
01:40:30,880 --> 01:40:32,160
EXAMPLES CARE AND SUPPORT

3105
01:40:32,160 --> 01:40:33,680
SETTINGS HEALTHCARE AND

3106
01:40:33,680 --> 01:40:35,240
NON-HEALTHCARE PROVIDERS IN

3107
01:40:35,240 --> 01:40:37,760
CONVENTIONAL TERMS ARE NOT

3108
01:40:37,760 --> 01:40:39,680
INCLUDED IN DIALOGUE BETWEEN

3109
01:40:39,680 --> 01:40:40,760
HEALTH SYSTEM LEADERS AND FRONT

3110
01:40:40,760 --> 01:40:42,920
LINE CLINICIANS.

3111
01:40:42,920 --> 01:40:45,480
A KEY REASON IS HEALTH COMES

3112
01:40:45,480 --> 01:40:47,360
HAVE CONFLICTING INCENTIVES

3113
01:40:47,360 --> 01:40:50,480
SPECIFICALLY SETTINGS MEET CARE

3114
01:40:50,480 --> 01:40:52,360
NEEDS AND SUPPORT NEEDS FOR

3115
01:40:52,360 --> 01:40:53,280
DISPROPORTIONATELY LOW INCOME

3116
01:40:53,280 --> 01:40:55,760
AND UNDERINSURED POPULATIONS.

3117
01:40:55,760 --> 01:40:57,120
SO AS HEALTH SYSTEMS TAKE MORE

3118
01:40:57,120 --> 01:40:59,320
RISK IN THEIR PAYER CONTRACTS

3119
01:40:59,320 --> 01:41:04,320
THESE POPULATIONS LOOK RISKIER.

3120
01:41:04,320 --> 01:41:05,960
THESE CAN BE EFFECTIVE IN

3121
01:41:05,960 --> 01:41:07,400
ENGAGING WOMEN AND GIRLS IN

3122
01:41:07,400 --> 01:41:08,920
PREVENTION ESPECIALLY CONCERNING

3123
01:41:08,920 --> 01:41:10,400
SOCIAL RISK FACTORS.

3124
01:41:10,400 --> 01:41:13,240
ALSO RELEVANT TRAIN TRAINING AND

3125
01:41:13,240 --> 01:41:17,280
CONTINUITY OF CARE IS HELPFUL IN

3126
01:41:17,280 --> 01:41:18,880
BUILDING STRONG RELATIONSHIPS

3127
01:41:18,880 --> 01:41:20,120
WITH INDIVIDUALS IDENTIFYING

3128
01:41:20,120 --> 01:41:21,040
NEEDS EXPECTATIONS AND

3129
01:41:21,040 --> 01:41:21,720
PREFERENCES WELL.

3130
01:41:21,720 --> 01:41:23,480
MY NEXT TWO EXAMPLES ILLUSTRATE

3131
01:41:23,480 --> 01:41:25,600
THIS IN CONTEXT OF SCHOOLS, AND

3132
01:41:25,600 --> 01:41:28,800
DIALYSIS FACILITIES.

3133
01:41:28,800 --> 01:41:30,240
SCHOOL MENTAL HEALTH FIRST.

3134
01:41:30,240 --> 01:41:31,400
IN GENERAL SCHOOL MENTAL HEALTH

3135
01:41:31,400 --> 01:41:33,240
IS ASSOCIATED WITH BETTER ACCESS

3136
01:41:33,240 --> 01:41:34,760
ENGAGEMENT AND TREATMENT THAT

3137
01:41:34,760 --> 01:41:38,080
CONVECTIONAL COMMUNITY BASED OUT

3138
01:41:38,080 --> 01:41:39,560
OUTPATIENT MEN DATA TREATMENT,

3139
01:41:39,560 --> 01:41:40,840
WHERE YOU HAVE REGULATE SCHOOL

3140
01:41:40,840 --> 01:41:41,720
AND TRAVEL OFF SITE TO RECEIVE

3141
01:41:41,720 --> 01:41:43,760
CARE.

3142
01:41:43,760 --> 01:41:45,040
SOME ADMINISTRATIVE BURDEN THE

3143
01:41:45,040 --> 01:41:46,280
MAKING SCHOOL MENTAL HEALTH

3144
01:41:46,280 --> 01:41:50,360
MODELS WORK.

3145
01:41:50,360 --> 01:41:52,720
REDUCING GEOGRAPHIC LOGISTICAL

3146
01:41:52,720 --> 01:41:54,280
BARRIERS MAKE A DIFFERENCE.

3147
01:41:54,280 --> 01:41:56,840
AT CONTROLLING FOR OTHER FACTORS

3148
01:41:56,840 --> 01:41:58,200
ADOLESCENT GIRLS TEND TO USE

3149
01:41:58,200 --> 01:42:01,480
SCHOOL MENTAL HEALTH SERVICE

3150
01:42:01,480 --> 01:42:03,400
MORRIS THAN ADOLESCENT BOYS.

3151
01:42:03,400 --> 01:42:04,640
SCHOOL MENTAL HEALTH IS

3152
01:42:04,640 --> 01:42:05,800
ASSOCIATED WITH REDUCED

3153
01:42:05,800 --> 01:42:06,840
DISPARITIES IN TREATMENT,

3154
01:42:06,840 --> 01:42:08,800
IMPROVE QUALITY OF LIFE AND A

3155
01:42:08,800 --> 01:42:09,720
ACADEMIC PERFORMANCE AND LOWER

3156
01:42:09,720 --> 01:42:10,400
COST OF CARE.

3157
01:42:10,400 --> 01:42:12,400
KEY POINT HERE THE WHOLE PERSON

3158
01:42:12,400 --> 01:42:14,480
CARE EXTENDS BEI DON'T

3159
01:42:14,480 --> 01:42:15,320
UNDERSTAND THE FOCAL CHRONIC

3160
01:42:15,320 --> 01:42:17,160
CONDITION LIKE MENTAL HEALTH AND

3161
01:42:17,160 --> 01:42:18,480
INCLUDES OTHER THINGS THAT

3162
01:42:18,480 --> 01:42:19,400
FAMILIES CARE ABOUT AND

3163
01:42:19,400 --> 01:42:20,800
INDIVIDUALS CARE ABOUT.

3164
01:42:20,800 --> 01:42:23,520
LIKE ACADEMIC, BEHAVIOR,

3165
01:42:23,520 --> 01:42:26,360
DISCIPLINARY OUTCOMES AND OTHER

3166
01:42:26,360 --> 01:42:27,880
SOCIAL OUTCOMES MEETING YOUTH

3167
01:42:27,880 --> 01:42:30,120
WHERE THEY ARE OUTSIDE OF YOUTH

3168
01:42:30,120 --> 01:42:33,000
SETTINGS BRING IN PERSPECTIVES

3169
01:42:33,000 --> 01:42:36,520
TO PRIORITIZE OTHER OUTCOMES WE

3170
01:42:36,520 --> 01:42:38,280
CARE ABOUT.

3171
01:42:38,280 --> 01:42:39,880
SWITCHING TO KIDNEY DISEASE FOR

3172
01:42:39,880 --> 01:42:44,280
CONTEXT MORE WOMEN THAN MEN HAVE

3173
01:42:44,280 --> 01:42:46,080
KKED DUE TO LONGER LIFE

3174
01:42:46,080 --> 01:42:46,560
EXPECTANCY.

3175
01:42:46,560 --> 01:42:48,360
THAT IS MORE COMMON IN OLDER

3176
01:42:48,360 --> 01:42:48,920
ADULTS.

3177
01:42:48,920 --> 01:42:53,840
THE AGE GRADIANT EXPLAIN WISE

3178
01:42:53,840 --> 01:42:56,640
THEY ARE UNLIKELY TO UNDERGO

3179
01:42:56,640 --> 01:42:57,680
CONSERVATIVE MANAGEMENT VERSUS

3180
01:42:57,680 --> 01:42:58,760
WHEN KIDNEYS FAIL.

3181
01:42:58,760 --> 01:43:00,480
WHEN ON DIALYSIS, WOMEN'S

3182
01:43:00,480 --> 01:43:03,360
QUALITY OF LIFE IS POORER THAN

3183
01:43:03,360 --> 01:43:06,040
MEN AND REPORT HIGHER SYMPTOM

3184
01:43:06,040 --> 01:43:07,640
BURDEN AND GREATER SYMPTOM

3185
01:43:07,640 --> 01:43:09,120
SEVERITY THAN MEN.

3186
01:43:09,120 --> 01:43:11,320
TIED TO WOMEN OLDER AGE ON

3187
01:43:11,320 --> 01:43:13,640
AVERAGE IN THIS POPULATION MORE

3188
01:43:13,640 --> 01:43:17,920
GERIATRIC NON-DISEASE SPECIFIC

3189
01:43:17,920 --> 01:43:19,320
SYNDROMES WHICH ARE NOT WELL

3190
01:43:19,320 --> 01:43:20,640
MANAGED IN CONVECTIONAL CARE

3191
01:43:20,640 --> 01:43:21,280
MODELS.

3192
01:43:21,280 --> 01:43:22,720
SO WHOLE PERSON CARE IS NEEDED

3193
01:43:22,720 --> 01:43:25,840
FOR WOMEN IN THIS CONTEXT.

3194
01:43:25,840 --> 01:43:27,000
KEY POINT FOR PATIENTS

3195
01:43:27,000 --> 01:43:28,520
UNDERGOING DIALYSIS IS TIME AND

3196
01:43:28,520 --> 01:43:32,920
ENERGY IS SEVERELY CONSTRAINED,

3197
01:43:32,920 --> 01:43:33,640
DIALYSIS TREATMENT.

3198
01:43:33,640 --> 01:43:36,960
THEY TEND TO RELY ON NEFFOLOGIST

3199
01:43:36,960 --> 01:43:39,240
FOR CARE NEEDS.

3200
01:43:39,240 --> 01:43:41,440
EVIDENCE SUGGESTS CARE MODELS

3201
01:43:41,440 --> 01:43:43,560
YIELD SUBOPTIMAL PRIMARY CARE

3202
01:43:43,560 --> 01:43:45,640
RELATED OUTCOMES.

3203
01:43:45,640 --> 01:43:47,200
COLLEAGUES HIGHLIGHTED KEY

3204
01:43:47,200 --> 01:43:48,720
BARRIERS EFFECTIVELY DELIVERING

3205
01:43:48,720 --> 01:43:50,520
PRIMARY CARE MANY THESE

3206
01:43:50,520 --> 01:43:51,680
SETTINGS, TALK ABOUT LACK OF

3207
01:43:51,680 --> 01:43:53,760
PRIVATE SPACE FOR PATIENT

3208
01:43:53,760 --> 01:43:55,040
CONSULTATION WHICH OFTEN HAPPEN

3209
01:43:55,040 --> 01:43:58,240
IN MIDDLE OF DIALYSIS UNITS.

3210
01:43:58,240 --> 01:44:00,000
PROVIDERS HAVE LIMITED KNOWLEDGE

3211
01:44:00,000 --> 01:44:02,600
OF SKILLS OR TIME MAYBE LITTLE

3212
01:44:02,600 --> 01:44:04,760
INTERNS IN ADDRESSING GENERAL

3213
01:44:04,760 --> 01:44:06,080
MEDICINE NEEDS AND NEFFOLOGISTS

3214
01:44:06,080 --> 01:44:08,040
AND PRIMARY CARE PHYSICIANINGS

3215
01:44:08,040 --> 01:44:09,680
CAN BE UNCLEAR ABOUT WHO IS

3216
01:44:09,680 --> 01:44:11,400
RESPONSIBLE FOR WHICH GENERAL

3217
01:44:11,400 --> 01:44:14,400
MEDICINE CARE NEEDS.

3218
01:44:14,400 --> 01:44:15,760
THEN LOWER REIMBURSEMENT FOR

3219
01:44:15,760 --> 01:44:17,600
MANAGEMENT OF NON-KIDNEY ISSUES

3220
01:44:17,600 --> 01:44:21,000
SO SPECIALISTS LIKE NEFFOLOGIST,

3221
01:44:21,000 --> 01:44:24,320
FEE FOR SERVICE PAYMENT

3222
01:44:24,320 --> 01:44:25,680
ENINCENTIVIZES HIGHER FEE FOR

3223
01:44:25,680 --> 01:44:27,560
CARE SERVICES OVER LOWER FEE FOR

3224
01:44:27,560 --> 01:44:29,600
GENERAL MEDICINE SERVICES.

3225
01:44:29,600 --> 01:44:30,800
HEALTH SYSTEMS LED PAYMENT

3226
01:44:30,800 --> 01:44:32,240
REFORMS THAT FOSTER GREATER

3227
01:44:32,240 --> 01:44:34,560
PAYMENT EQUITY, OR SET NEW

3228
01:44:34,560 --> 01:44:36,120
INCENTIVES FOR SPECIALIST LIKE

3229
01:44:36,120 --> 01:44:38,920
UNDER GLOBAL PAYMENT OR SHARED

3230
01:44:38,920 --> 01:44:39,800
SAVINGS PAYMENT MODELS WOULD

3231
01:44:39,800 --> 01:44:42,520
LEAD TO MAJOR CHANGES IN

3232
01:44:42,520 --> 01:44:43,640
INFRASTRUCTURE TRAINED STAFFING,

3233
01:44:43,640 --> 01:44:46,240
TASK ALLOCATION, AND DIEIAL

3234
01:44:46,240 --> 01:44:47,800
SISES FACILITIES ALL THE ABOVE.

3235
01:44:47,800 --> 01:44:51,400
SO A KEY LESSON HERE IN MY

3236
01:44:51,400 --> 01:44:54,640
OPINION IS FIXING THE PAYMENT

3237
01:44:54,640 --> 01:44:55,880
ISSUE LEAD TO THE OTHERS IN A

3238
01:44:55,880 --> 01:44:56,280
BIG WAY.

3239
01:44:56,280 --> 01:44:58,040
THE LAST POINT ON PAYMENT, BRING

3240
01:44:58,040 --> 01:44:59,240
US BACK TO THE QUESTION OF WHO

3241
01:44:59,240 --> 01:45:00,560
IS PRIMARILY RESPONSIBLE FOR

3242
01:45:00,560 --> 01:45:01,800
BRINGING ABOUT WHOLE PERSON

3243
01:45:01,800 --> 01:45:04,040
CARE.

3244
01:45:04,040 --> 01:45:06,040
NOW, I MENTIONED FINANCING

3245
01:45:06,040 --> 01:45:08,440
MULTIPLE TIMES, MAYBE PAYERS AND

3246
01:45:08,440 --> 01:45:10,120
POLICY MAKERS HAVE POWERFUL

3247
01:45:10,120 --> 01:45:11,360
TOOLS.

3248
01:45:11,360 --> 01:45:12,600
PUSHING HEALTH SYSTEMS

3249
01:45:12,600 --> 01:45:14,160
CLINICIANS TO ADOPT WHOLE PERSON

3250
01:45:14,160 --> 01:45:16,720
CARE MODELS.

3251
01:45:16,720 --> 01:45:20,280
A CAVEAT REFORMS LIKE USUALLY

3252
01:45:20,280 --> 01:45:23,040
MOST EFFECTIVE WHEN IMPLEMENTED

3253
01:45:23,040 --> 01:45:24,280
COLLABORATIVELY IN THE WIDER

3254
01:45:24,280 --> 01:45:27,720
COMMUNITY -- PROVIDER COMMUNITY.

3255
01:45:27,720 --> 01:45:29,760
SO BACK TO HEALTH SYSTEMS AND

3256
01:45:29,760 --> 01:45:31,640
FRONT LINE CLINICIANS AND THEIR

3257
01:45:31,640 --> 01:45:33,440
ROLES IN WHOLE PERSON CARE. 

3258
01:45:33,440 --> 01:45:35,440
FINANCING HEALTH SYSTEM LEADER

3259
01:45:35,440 --> 01:45:36,600
NEGOTIATE CONTRACTS WITH PAYERS

3260
01:45:36,600 --> 01:45:39,800
SO INCENTIVES ARE ALIGNED BETTER

3261
01:45:39,800 --> 01:45:40,840
WITH THIS GOAL.

3262
01:45:40,840 --> 01:45:44,120
CLINICIAN CAN DO LIKEWISE

3263
01:45:44,120 --> 01:45:45,160
NEGOTIATING CLINICAL TRIALS TO

3264
01:45:45,160 --> 01:45:47,560
HEALTH SYSTEMS.

3265
01:45:47,560 --> 01:45:48,480
CLINICIANS TOGETHER TO ESTABLISH

3266
01:45:48,480 --> 01:45:50,240
MANAGE PREVENTION CARE TEAMS AND

3267
01:45:50,240 --> 01:45:51,480
NETWORKS AND IMPLEMENTING

3268
01:45:51,480 --> 01:45:54,400
POPULATION HEALTH DATA TOOLS.

3269
01:45:54,400 --> 01:45:55,400
CLINICIANS PROVIDE REGULAR

3270
01:45:55,400 --> 01:45:56,760
FEEDBACK TO HEALTH SYSTEM ABOUT

3271
01:45:56,760 --> 01:45:57,840
HOW WELL THEY ARE DOING.

3272
01:45:57,840 --> 01:45:59,360
AND WHETHER THEY SEE ANY REAL

3273
01:45:59,360 --> 01:46:00,720
BARRIERS TO DELIVERING WHOLE

3274
01:46:00,720 --> 01:46:01,480
PERSON CARE AT THE POINT OF

3275
01:46:01,480 --> 01:46:03,120
CARE.

3276
01:46:03,120 --> 01:46:05,000
BOTTOM LINE HERE IS THAT WHILE

3277
01:46:05,000 --> 01:46:06,440
LOT OF THIS FALLS ON HEALTH

3278
01:46:06,440 --> 01:46:08,000
SYSTEM LEADERSHIP INCLUDING

3279
01:46:08,000 --> 01:46:08,800
COORDINATING WITH NON-HEALTHCARE

3280
01:46:08,800 --> 01:46:10,920
SETTINGS I MENTIONED, WHOLE

3281
01:46:10,920 --> 01:46:12,880
PERSON CARE HAPPENS WHEN HEALTH

3282
01:46:12,880 --> 01:46:13,880
SYSTEMS AND FRONT LINE

3283
01:46:13,880 --> 01:46:15,800
CLINICIANS ARE ALIGNED IN THEIR

3284
01:46:15,800 --> 01:46:16,440
INCENTIVES AND SUPPORT ONE

3285
01:46:16,440 --> 01:46:19,640
ANOTHER.

3286
01:46:19,640 --> 01:46:21,080
HEALTH ECONOMIST I WAS ASKED TO

3287
01:46:21,080 --> 01:46:22,520
COMMENT ON COST EFFECTIVENESS IN

3288
01:46:22,520 --> 01:46:24,000
THE CONTEXT OF INTEGRATED CARE

3289
01:46:24,000 --> 01:46:25,240
MODELS, THERE IS A WORKING

3290
01:46:25,240 --> 01:46:26,440
DEFINITION OF COST EFFECTIVENESS

3291
01:46:26,440 --> 01:46:27,560
ON THIS SLIDE HERE BUT I WOULD

3292
01:46:27,560 --> 01:46:30,480
LIKE TO SKIP DOWN TO WAYS TO

3293
01:46:30,480 --> 01:46:34,120
LOOKING FOR COST EFFECTIVE WAYS

3294
01:46:34,120 --> 01:46:35,720
ONE WAY LOOKS FOR ECONOMIES OF

3295
01:46:35,720 --> 01:46:39,320
SCALE AT THE POPULATION SO WE

3296
01:46:39,320 --> 01:46:41,960
INVEST IN RELATIVELY IF U BUT

3297
01:46:41,960 --> 01:46:44,120
LARGER SCALE INITIATIVES.

3298
01:46:44,120 --> 01:46:46,560
THE -- OTHER WAY IS LEADING

3299
01:46:46,560 --> 01:46:47,640
INDIVIDUAL PATIENT NEEDS AND

3300
01:46:47,640 --> 01:46:49,760
NEED TO INVEST IN DIFFERENT

3301
01:46:49,760 --> 01:46:52,880
INITIATIVES TARGETED.

3302
01:46:52,880 --> 01:46:54,960
BOTH EASIER SAID THAN DONE AND

3303
01:46:54,960 --> 01:46:57,520
BOTH WORK YET PROBABLY THE BEST

3304
01:46:57,520 --> 01:47:01,320
BALANCE IS BETWEEN THE TWO.

3305
01:47:01,320 --> 01:47:04,280
HERE IS MY RECIPE FOR COST

3306
01:47:04,280 --> 01:47:06,120
EFFECTIVE INTEGRATED CARE

3307
01:47:06,120 --> 01:47:06,800
INITIATIVES.

3308
01:47:06,800 --> 01:47:12,720
FIRST FIND LOW COST SCREENING

3309
01:47:12,720 --> 01:47:17,440
FOR RISK FACTORS.

3310
01:47:17,440 --> 01:47:18,240
PARSIMONIOUS DEATH AND

3311
01:47:18,240 --> 01:47:19,760
SUFFICIENT ALGORITHMS TO BUILD

3312
01:47:19,760 --> 01:47:20,680
RISK PROFILES.

3313
01:47:20,680 --> 01:47:22,960
SECOND REDUCE COST OF TARGETING

3314
01:47:22,960 --> 01:47:23,680
THE INITIATIVE.

3315
01:47:23,680 --> 01:47:25,480
YOU ARE LOOKING TO MAXIMIZE

3316
01:47:25,480 --> 01:47:27,920
POPULATION COVERAGE AND MINIMIZE

3317
01:47:27,920 --> 01:47:29,720
UNNEEDED INTERVENTION USE, HIGH

3318
01:47:29,720 --> 01:47:30,920
SENSITIVITY AND HIGH

3319
01:47:30,920 --> 01:47:31,800
SPECIFICITY.

3320
01:47:31,800 --> 01:47:34,160
BUT AS PROTIP, YOU CAN OFTEN

3321
01:47:34,160 --> 01:47:36,720
IMPROVE EFFICIENCY HERE BY

3322
01:47:36,720 --> 01:47:38,640
COMPROMISING SOME ON PRECISION.

3323
01:47:38,640 --> 01:47:40,400
100% IS NEVER THE MOST COST

3324
01:47:40,400 --> 01:47:42,680
EFFECTIVE APPROACH.

3325
01:47:42,680 --> 01:47:43,720
FINALLY, MAKES SURE YOUR

3326
01:47:43,720 --> 01:47:44,720
INTERVENTION IS EFFECTIVE FOR

3327
01:47:44,720 --> 01:47:46,360
THE TARGETED POPULATION.

3328
01:47:46,360 --> 01:47:47,720
EVEN IF INTERVENTION ITSELF IS

3329
01:47:47,720 --> 01:47:49,160
ON EXPENSIVE SIDE IF YOU ARE

3330
01:47:49,160 --> 01:47:50,880
SCREENING AND TARGETING

3331
01:47:50,880 --> 01:47:52,120
APPROACHES ARE EFFICIENT YOU CAN

3332
01:47:52,120 --> 01:47:53,920
STILL HAVE A COST EFFECTIVE

3333
01:47:53,920 --> 01:47:54,520
INITIATIVE OVER ALL IF

3334
01:47:54,520 --> 01:47:56,120
EFFECTIVE.

3335
01:47:56,120 --> 01:47:58,440
I WILL WRAP UP BY POINTING OUT

3336
01:47:58,440 --> 01:48:00,560
THAT COST EFFECTIVE IS NOT

3337
01:48:00,560 --> 01:48:01,920
MEANING COST SAVING.

3338
01:48:01,920 --> 01:48:03,600
IF YOU ARE HOLDING OUT COST

3339
01:48:03,600 --> 01:48:05,160
SAVINGS WHEN CHOOSING A MODEL TO

3340
01:48:05,160 --> 01:48:06,280
IMPLEMENT, YOU MIGHT BE WAITING

3341
01:48:06,280 --> 01:48:06,760
A WHILE.

3342
01:48:06,760 --> 01:48:08,720
THIS IS A CALL BACK TO DR.

3343
01:48:08,720 --> 01:48:10,960
CLARE'S QUOTE FROM WALT DISNEY,

3344
01:48:10,960 --> 01:48:12,040
GET DOING.

3345
01:48:12,040 --> 01:48:14,360
SO WITH THAT, I'LL THANK YOU,

3346
01:48:14,360 --> 01:48:16,160
VERY MUCH FOR THE OPPORTUNITY TO

3347
01:48:16,160 --> 01:48:17,160
JOIN Y'ALL TODAY, LOOK FORWARD

3348
01:48:17,160 --> 01:48:19,480
TO THE PANEL DISCUSSION.

3349
01:48:19,480 --> 01:48:22,000
>> THANK YOU, DR. WILK FOR THAT

3350
01:48:22,000 --> 01:48:24,120
VERY INFORMATIVE PRESENTATION.

3351
01:48:24,120 --> 01:48:27,240
NOW WE ARE OFFICIALLY IN TO THE

3352
01:48:27,240 --> 01:48:29,760
Q&A SESSION.

3353
01:48:29,760 --> 01:48:32,680
SO THERE IS STILL TIME TO -- IF

3354
01:48:32,680 --> 01:48:34,920
YOU ARE PARTICIPATING IN THE

3355
01:48:34,920 --> 01:48:35,920
WORKSHOP THIS AFTERNOON, AND

3356
01:48:35,920 --> 01:48:38,480
WOULD LIKE TO PUT SOME QUESTIONS

3357
01:48:38,480 --> 01:48:40,040
IN, FEEL FREE.

3358
01:48:40,040 --> 01:48:42,800
IF YOU HAVE QUESTIONS TO DR.

3359
01:48:42,800 --> 01:48:44,680
KOOB, DR. CLAYTON, DR. TEMKIN,

3360
01:48:44,680 --> 01:48:47,840
YOU CAN ALSO PUT QUESTIONS IN

3361
01:48:47,840 --> 01:48:51,080
THAT Q&A AREA.

3362
01:48:51,080 --> 01:48:52,640
I CAN MAKE SURE THEY HAVE AN

3363
01:48:52,640 --> 01:48:53,920
OPPORTUNITY TO RESPOND TO THOSE

3364
01:48:53,920 --> 01:48:54,600
QUESTIONS.

3365
01:48:54,600 --> 01:48:59,840
SO LET'S REALLY GET TO THE

3366
01:48:59,840 --> 01:49:04,040
QUESTIONS THAT ARE AVAILABLE.

3367
01:49:04,040 --> 01:49:06,120
SO THE FIRST QUESTION IS, HOW

3368
01:49:06,120 --> 01:49:10,120
CAN WE EFFECTIVELY ADDRESS

3369
01:49:10,120 --> 01:49:10,920
PROBLEMS, THESE PROBLEMS WHEN

3370
01:49:10,920 --> 01:49:13,680
THE MEDICAL SYSTEM AND

3371
01:49:13,680 --> 01:49:14,560
PHARMACEUTICAL INDUSTRY ARE

3372
01:49:14,560 --> 01:49:17,120
BASED ON GENERATING PROFITS NOT

3373
01:49:17,120 --> 01:49:20,680
PREVENTING ILLNESS AND DISEASE

3374
01:49:20,680 --> 01:49:22,560
GREATER FOR THOSE WITH CHRONIC

3375
01:49:22,560 --> 01:49:23,400
CONDITIONS?

3376
01:49:23,400 --> 01:49:25,200
WITHOUT A SYSTEM THAT

3377
01:49:25,200 --> 01:49:26,640
PRIORITIZES PUBLIC HEALTH AND

3378
01:49:26,640 --> 01:49:27,520
PREVENTION FOR ALL AMERICANS

3379
01:49:27,520 --> 01:49:29,960
EVEN THE BEST SCIENCE WHICH WE

3380
01:49:29,960 --> 01:49:33,400
NEED MAY NOT STILL SUCCEED

3381
01:49:33,400 --> 01:49:35,080
WITHOUT CHARGING LARGER SYSTEMS,

3382
01:49:35,080 --> 01:49:37,640
THE PANDEMIC HAS SHOWN THIS SO

3383
01:49:37,640 --> 01:49:38,560
STARKLY.

3384
01:49:38,560 --> 01:49:40,040
INCLUDING DISPARATE IMPACT ON

3385
01:49:40,040 --> 01:49:41,720
WOMEN ESPECIALLY WOMEN OF COLOR

3386
01:49:41,720 --> 01:49:42,520
AND THE POOR.

3387
01:49:42,520 --> 01:49:45,000
I THINK THIS QUESTION IS

3388
01:49:45,000 --> 01:49:46,000
DIRECTED TO DR. SIMON.

3389
01:49:46,000 --> 01:49:59,720
CAN YOU RESPOND?

3390
01:49:59,720 --> 01:50:01,040
WHAT DO WE VALUE AS SOCIETY?

3391
01:50:01,040 --> 01:50:01,920
DO WE VALUE HUMAN?

3392
01:50:01,920 --> 01:50:03,720
LAST I CHECKED REGARDLESS OF

3393
01:50:03,720 --> 01:50:05,600
SKIN COLOR, REGARDLESS GENDER

3394
01:50:05,600 --> 01:50:09,040
SEXUAL ORIENTATION, RURAL URBAN,

3395
01:50:09,040 --> 01:50:10,920
WHATEVER COUNTRY OR COME FROM,

3396
01:50:10,920 --> 01:50:12,120
REGARDLESS OF LANGUAGE, ET

3397
01:50:12,120 --> 01:50:15,120
CETERA, ET CETERA, ET CETERA,

3398
01:50:15,120 --> 01:50:16,840
WHO WE WORSHIP INCLUDED WE ARE

3399
01:50:16,840 --> 01:50:19,120
ALL HUMAN AND IF WE VALUE HUMAN

3400
01:50:19,120 --> 01:50:24,120
AND HUMANITY, THERE IS A MORAL

3401
01:50:24,120 --> 01:50:24,880
IMPERATIVE.

3402
01:50:24,880 --> 01:50:28,840
WHAT THIS STARTS WITH IS HIGHEST

3403
01:50:28,840 --> 01:50:31,920
ELECTED LEADERS.

3404
01:50:31,920 --> 01:50:33,280
COUNTRIES, REPRESENTATIVES ON

3405
01:50:33,280 --> 01:50:35,600
THE HILL, TAKE THE UNITED

3406
01:50:35,600 --> 01:50:36,880
STATES, LEADER IN INSTITUTIONS,

3407
01:50:36,880 --> 01:50:38,720
IN OUR HEALTHCARE SYSTEMS, WHO

3408
01:50:38,720 --> 01:50:41,920
ARE POLICY MAKERS, WHO ARE THE

3409
01:50:41,920 --> 01:50:44,040
GATE KEEPERS.

3410
01:50:44,040 --> 01:50:45,000
THEY ARE CRUCIAL AT EVERY STEP

3411
01:50:45,000 --> 01:50:47,120
OF THE PROCESS.

3412
01:50:47,120 --> 01:50:52,080
IF THEY DON'T VALUE HUMANITY AND

3413
01:50:52,080 --> 01:50:53,560
THIS MORAL IMPERATIVE TO DO

3414
01:50:53,560 --> 01:50:57,400
BETTER, BECAUSE WE CAN DO

3415
01:50:57,400 --> 01:50:59,000
BETTER, TO TRY TO GET TOWARDS

3416
01:50:59,000 --> 01:51:00,280
GETTING IT RIGHT, WE ARE NOT

3417
01:51:00,280 --> 01:51:01,080
GOING TO GET THERE.

3418
01:51:01,080 --> 01:51:03,960
SO I REALLY -- SO COMES DOWN TO

3419
01:51:03,960 --> 01:51:06,520
THINGS LIKE CIVIC ENGAGEMENT AND

3420
01:51:06,520 --> 01:51:09,320
VOTING AND MAKING SURE IN SEARCH

3421
01:51:09,320 --> 01:51:10,720
COMMITTEES AND INSTITUTIONS THAT

3422
01:51:10,720 --> 01:51:14,280
THERE IS DIVERSITY CHAMPIONS

3423
01:51:14,280 --> 01:51:19,160
THAT WE PUSH THE NEEDLE IN ALL

3424
01:51:19,160 --> 01:51:21,040
LEVELS WHEN IT COMES TO ELECTING

3425
01:51:21,040 --> 01:51:22,840
GATE KEEPERS WHETHER NATIONAL

3426
01:51:22,840 --> 01:51:24,320
LEVEL OR INSTITUTION LEVEL OR

3427
01:51:24,320 --> 01:51:25,280
DIVISION OR DEPARTMENT OR CENTER

3428
01:51:25,280 --> 01:51:27,400
LEVEL.

3429
01:51:27,400 --> 01:51:28,560
ALL CRITICAL IN EVERYTHING WE

3430
01:51:28,560 --> 01:51:36,200
DO.

3431
01:51:36,200 --> 01:51:37,320
THANK YOU VERY MUCH.

3432
01:51:37,320 --> 01:51:39,120
ANOTHER QUESTIONS QUESTION FROM

3433
01:51:39,120 --> 01:51:39,360
ODD YEN.

3434
01:51:39,360 --> 01:51:41,120
DO YOU THINK LACK OF TRANSITION

3435
01:51:41,120 --> 01:51:43,880
IS DUE TO OUR SEX IN GENERAL,

3436
01:51:43,880 --> 01:51:44,360
FEMALE SEX?

3437
01:51:44,360 --> 01:51:49,520
THE FACT THAT WE MAY NEED DAYS

3438
01:51:49,520 --> 01:51:52,320
OFF FOR REPRODUCTIVE CYCLES SUCH

3439
01:51:52,320 --> 01:51:53,000
AS MENSTRUATION OR HAVING

3440
01:51:53,000 --> 01:51:53,840
CHILDREN, THE POSSIBILITY THAT

3441
01:51:53,840 --> 01:51:56,040
WE MAY NEED TO HAVE OPERATIONS

3442
01:51:56,040 --> 01:51:58,400
TO REMOVE THESE ORGANS BECAUSE

3443
01:51:58,400 --> 01:52:09,520
OF HEALTH RISKS?

3444
01:52:09,520 --> 01:52:13,480
WHAT SORT OF NATIONAL POLICIES

3445
01:52:13,480 --> 01:52:15,440
WILL BOOST THE OPPORTUNITY FOR

3446
01:52:15,440 --> 01:52:16,520
WOMEN AND GIRLS OF CO-MORBID

3447
01:52:16,520 --> 01:52:17,960
CONDITIONS TO BE ABLE TO TAKE

3448
01:52:17,960 --> 01:52:20,720
BETTER CARE OF THEMSELVES, AND

3449
01:52:20,720 --> 01:52:22,920
GET THE LEAVE TIME THEY NEED TO

3450
01:52:22,920 --> 01:52:29,920
CARE FOR THEIR -- THEMSELVES.

3451
01:52:29,920 --> 01:52:32,920
>> AGREE, IT COMES DOWN TO

3452
01:52:32,920 --> 01:52:35,360
STRUCTURE AND POLICIES WHETHER

3453
01:52:35,360 --> 01:52:36,200
THE TREES BEND, WHERE ARE

3454
01:52:36,200 --> 01:52:37,400
POLICIES AND PRACTICES USING FOR

3455
01:52:37,400 --> 01:52:39,840
A LONG TIME, WHERE ARE THEY BENT

3456
01:52:39,840 --> 01:52:55,400
TOWARDS NOT FAVORING WOMEN'S

3457
01:52:55,400 --> 01:52:56,440
HEALTH SURGERIES OR HEALTH

3458
01:52:56,440 --> 01:52:59,720
RELATED PROCEDURES, IN THE

3459
01:52:59,720 --> 01:53:00,880
HEALTHCARE SYSTEM VERSUS MALE

3460
01:53:00,880 --> 01:53:03,520
RELATED PROCEDURES.

3461
01:53:03,520 --> 01:53:06,840
THERE ARE INEQUITIES AT EVERY

3462
01:53:06,840 --> 01:53:08,440
SINGLE SPOT AND SO WE REALLY

3463
01:53:08,440 --> 01:53:10,880
NEED MORE PEOPLE TO BE AWARE OF

3464
01:53:10,880 --> 01:53:12,960
THESE INEQUITIES AND TO ACTUALLY

3465
01:53:12,960 --> 01:53:17,680
START ASKING THOSE QUESTIONS.

3466
01:53:17,680 --> 01:53:19,240
WHY ARE WE NOT REIMBURSING THE

3467
01:53:19,240 --> 01:53:26,520
SAME, WHY IS ONE MEDICATION FOR

3468
01:53:26,520 --> 01:53:28,600
SUPPORTING SEXUAL PROWESS AND

3469
01:53:28,600 --> 01:53:32,120
SEXUALITY, FOR ONE SEX AND NOT

3470
01:53:32,120 --> 01:53:33,440
FOR ANOTHER?

3471
01:53:33,440 --> 01:53:34,920
WHY ARE THESE HAPPENING?

3472
01:53:34,920 --> 01:53:37,520
WHEN MORE PEOPLE ASK WHY, THEN

3473
01:53:37,520 --> 01:53:40,440
WE START TO MOVE THINGS FORWARD

3474
01:53:40,440 --> 01:53:41,720
WITH MAYBE WE SHOULD RETHINK

3475
01:53:41,720 --> 01:53:46,080
THAT POLICY OR PRACTICE.

3476
01:53:46,080 --> 01:53:48,200
>> LIKE ANYTHING WE IMMEDIATE

3477
01:53:48,200 --> 01:53:49,360
NOR DATA.

3478
01:53:49,360 --> 01:53:50,080
-- NEED MORE DATA.

3479
01:53:50,080 --> 01:53:51,840
SO THERE'S ASSUMPTIONS BUT NOT A

3480
01:53:51,840 --> 01:53:53,520
LOT OF DATA TO BACK UP SO LOOK

3481
01:53:53,520 --> 01:53:56,120
AT PROGRESS IN WOMEN'S MEDICINE

3482
01:53:56,120 --> 01:53:59,200
THAT IS GOOD EXCUSE, BUT NOT A

3483
01:53:59,200 --> 01:53:59,720
GOOD REASON.

3484
01:53:59,720 --> 01:54:01,040
THAT IS PART OF THE ISSUE WHEN

3485
01:54:01,040 --> 01:54:02,600
YOU SEE ISSUES WITH BURN OUT IN

3486
01:54:02,600 --> 01:54:05,840
WOMEN LEAVING THE HEALTHCARE

3487
01:54:05,840 --> 01:54:07,080
PROFESSION, IN MY OPINION BASIS

3488
01:54:07,080 --> 01:54:09,080
OF IT IS THAT WE ARE NOT SEEN OR

3489
01:54:09,080 --> 01:54:12,520
NOT HEARD AND NOT VALUED.

3490
01:54:12,520 --> 01:54:14,560
PEOPLE DON'T ASK US WHAT IT IS

3491
01:54:14,560 --> 01:54:16,320
THAT WE NEED TO SUCCEED AND HOW

3492
01:54:16,320 --> 01:54:18,040
THE SYSTEM IN GENERAL CAN HELP

3493
01:54:18,040 --> 01:54:20,120
IF A LOT OF ASSUMPTIONS WHAT MAY

3494
01:54:20,120 --> 01:54:22,920
OR MAY NOT HAPPEN AND UNTIL OR

3495
01:54:22,920 --> 01:54:24,480
UNLESS WE INTERVENE AND ENGAGE

3496
01:54:24,480 --> 01:54:28,320
WOMEN IN THAT DISCUSSION, IN

3497
01:54:28,320 --> 01:54:29,920
TERMS OF CAREER PROGRESSION, YES

3498
01:54:29,920 --> 01:54:35,800
NOT GOING TO GET FAR.

3499
01:54:35,800 --> 01:54:37,920
>> THANK YOU, DR. TEMPLETON, HOW

3500
01:54:37,920 --> 01:54:39,920
DO WE ADDRESS SILOS RELATED TO

3501
01:54:39,920 --> 01:54:41,400
WOMEN WITH OSTEOARTHRITIS OR

3502
01:54:41,400 --> 01:54:43,040
OTHER CHRONIC HEALTH CONDITIONS?

3503
01:54:43,040 --> 01:54:44,200
>> GREAT QUESTION.

3504
01:54:44,200 --> 01:54:45,280
I THINK PART GETS BACK TO

3505
01:54:45,280 --> 01:54:47,920
EDUCATION.

3506
01:54:47,920 --> 01:54:50,280
AND IMPROVING SEX AND GENDER

3507
01:54:50,280 --> 01:54:53,720
BASED EDUCATION IN HEALTH

3508
01:54:53,720 --> 01:54:56,720
PROFESSIONS.

3509
01:54:56,720 --> 01:54:57,320
INCREASING UNDERSTAND THING THAT

3510
01:54:57,320 --> 01:54:59,000
SEX AND GENDER IMPACTS EVERY

3511
01:54:59,000 --> 01:55:00,240
HEALTH CONDITION BUT THOSE

3512
01:55:00,240 --> 01:55:00,920
AREN'T SILOED.

3513
01:55:00,920 --> 01:55:02,720
SO WHEN YOU ARE SEEING A PATIENT

3514
01:55:02,720 --> 01:55:03,840
WITH OSTEOARTHRITIS, ONE

3515
01:55:03,840 --> 01:55:05,160
QUESTION THAT CAME UP IS WHY ARE

3516
01:55:05,160 --> 01:55:07,280
WOMEN REFERRED LATER, IN

3517
01:55:07,280 --> 01:55:09,240
ADDITION TO THE ANSWER I REPLIED

3518
01:55:09,240 --> 01:55:11,440
ONE ISSUE IS PEOPLE THINK IT IS

3519
01:55:11,440 --> 01:55:14,040
JUST JOINT PAIN.

3520
01:55:14,040 --> 01:55:16,320
THAT IS TRUE EVERY OTHER CHRONIC

3521
01:55:16,320 --> 01:55:19,120
CONDITION AMONG WOMEN, ASSUMED

3522
01:55:19,120 --> 01:55:21,560
JUST CONDITION X OR Y, YOU ARE

3523
01:55:21,560 --> 01:55:22,920
MISSING THE INNER CONNECTIONS,

3524
01:55:22,920 --> 01:55:24,680
UNTIL YOU SEE A WOMAN AS A WHOLE

3525
01:55:24,680 --> 01:55:26,280
AND SEE EVERY HEALTH CONDITION

3526
01:55:26,280 --> 01:55:28,480
THEY HAVE IS LIKELY GOING TO

3527
01:55:28,480 --> 01:55:29,520
IMPACT OTHER HEALTH CONDITIONS

3528
01:55:29,520 --> 01:55:31,600
THEN YOU ARE GOING TO NOT

3529
01:55:31,600 --> 01:55:32,040
IMPROVE THEIR CARE.

3530
01:55:32,040 --> 01:55:34,640
SO ADDRESSING SILOS, IT IS

3531
01:55:34,640 --> 01:55:37,880
IMPROVING EDUCATION SYSTEM FROM

3532
01:55:37,880 --> 01:55:38,680
UNDERGRADUATE TO CONTINUING

3533
01:55:38,680 --> 01:55:42,520
MEDICAL EDUCATION, TO BETTER --

3534
01:55:42,520 --> 01:55:44,280
HAVE BROADER MORE EXPANSIVE

3535
01:55:44,280 --> 01:55:49,320
DISCUSSION ON WHAT IS WOMEN'S

3536
01:55:49,320 --> 01:55:51,640
HEALTH, AND HOW ISSUES

3537
01:55:51,640 --> 01:55:52,320
INTERCONNECT SO WHEN TEACHING WE

3538
01:55:52,320 --> 01:55:54,840
HAVE TO TALK ABOUT INNER

3539
01:55:54,840 --> 01:55:55,440
CONNECTIONS.

3540
01:55:55,440 --> 01:55:56,520
>> THANK YOU SO MUCH DR.

3541
01:55:56,520 --> 01:55:56,880
TEMPLETON.

3542
01:55:56,880 --> 01:55:59,480
FOR RESPONDING TO THAT QUESTION.

3543
01:55:59,480 --> 01:56:01,800
DR. CLARE, THERE IS A QUESTION

3544
01:56:01,800 --> 01:56:03,160
FOR YOU.

3545
01:56:03,160 --> 01:56:04,520
FROM THE AUDIENCE THERE SAYING

3546
01:56:04,520 --> 01:56:05,680
THANK YOU FOR YOUR TALK, HAVE

3547
01:56:05,680 --> 01:56:07,920
YOU ENCOUNTERED OR DO YOU HAVE

3548
01:56:07,920 --> 01:56:13,920
ANY INSIGHT ON HOW TO DETER

3549
01:56:13,920 --> 01:56:15,320
HAZING MENTALITY SENIOR WOMEN

3550
01:56:15,320 --> 01:56:17,040
MADE IT HAVE TOWARDS WOMEN MORE

3551
01:56:17,040 --> 01:56:21,320
JUNIOR THAN THAT?

3552
01:56:21,320 --> 01:56:23,320
>> THIS QUESTION SPOKE TO ME, I

3553
01:56:23,320 --> 01:56:25,040
WORKED FOR WOMEN MAJORITY OF MY

3554
01:56:25,040 --> 01:56:26,160
CAREER BEFORE MY CURRENT ROLE

3555
01:56:26,160 --> 01:56:27,840
AND WAS CHALLENGED THROUGHOUT MY

3556
01:56:27,840 --> 01:56:30,360
WHOLE CAREER, ABOUT THIS

3557
01:56:30,360 --> 01:56:36,200
SPECIFIC ISSUE.

3558
01:56:36,200 --> 01:56:37,480
SO FOR THOSE ROLES WE ARE, WE

3559
01:56:37,480 --> 01:56:38,760
HAVE A RESPONSIBILITY TO MENTOR

3560
01:56:38,760 --> 01:56:40,520
AND SPONSOR AND OPEN THE DOOR

3561
01:56:40,520 --> 01:56:43,520
AND KICK DOWN THE DOOR AS DR.

3562
01:56:43,520 --> 01:56:46,040
SIMON MENTIONED, PERHAPS

3563
01:56:46,040 --> 01:56:48,480
DEMOLISH THE TREE FOR OUR

3564
01:56:48,480 --> 01:56:50,800
COLLEAGUES WE HAVE A RESPONSIBLE

3565
01:56:50,800 --> 01:56:52,200
RESPONSIBILITY TO DO SO.

3566
01:56:52,200 --> 01:56:53,320
THERE ARE INDIVIDUALS THAT DO

3567
01:56:53,320 --> 01:56:57,240
BELIEVE I DID IT ON MY OWN YOU

3568
01:56:57,240 --> 01:56:59,080
SHOULD BE ABLE TO DO IT, YOU

3569
01:56:59,080 --> 01:57:00,120
SHOULD WALK THE PATH ON YOUR

3570
01:57:00,120 --> 01:57:02,200
OWN.

3571
01:57:02,200 --> 01:57:03,920
THAT IS NOT RESPONSIBLE FOR OUR

3572
01:57:03,920 --> 01:57:04,280
COLLEAGUES.

3573
01:57:04,280 --> 01:57:05,720
WE HAVE ALREADY MENTIONED

3574
01:57:05,720 --> 01:57:07,840
THROUGH THE WORK FORCE DATA I

3575
01:57:07,840 --> 01:57:09,840
SHARED WITH YOU, THERE ARE MORE

3576
01:57:09,840 --> 01:57:10,760
WOMEN IN MEDS SIN.

3577
01:57:10,760 --> 01:57:12,760
THIS WAS 40% IN MY MEDICAL

3578
01:57:12,760 --> 01:57:17,320
SCHOOL CLASS NOW OVER 50%.

3579
01:57:17,320 --> 01:57:19,840
I WAS WORRIED DOING CERTAIN

3580
01:57:19,840 --> 01:57:20,600
ROTATIONS HOW I WOULD BE

3581
01:57:20,600 --> 01:57:21,000
TREATED.

3582
01:57:21,000 --> 01:57:24,120
SO WE HAVE A RESPONSIBILITY TO

3583
01:57:24,120 --> 01:57:26,160
REALLY LEAD TEAGUES BY THE HAND,

3584
01:57:26,160 --> 01:57:28,560
GIVE SPECIFIC TOOLS, MENTORS AND

3585
01:57:28,560 --> 01:57:30,120
SPONSORS FOR THEM AND DEMOLISH

3586
01:57:30,120 --> 01:57:30,720
BOTH SYSTEMS.

3587
01:57:30,720 --> 01:57:33,800
THAT DATA IS OUT THERE,

3588
01:57:33,800 --> 01:57:36,280
REGARDING GENDER DISPARITIES AND

3589
01:57:36,280 --> 01:57:38,320
OBGYN THAT DATA IS OUT THERE,

3590
01:57:38,320 --> 01:57:40,920
MORE OF US WENT TO OBSTETRICS

3591
01:57:40,920 --> 01:57:43,720
GYNECOLOGY THAT REIMBURSEMENT IS

3592
01:57:43,720 --> 01:57:44,760
THERE SO WE HAVE TO BELIEVE THE

3593
01:57:44,760 --> 01:57:45,800
DATA AND WE HAVE TO DO SOMETHING

3594
01:57:45,800 --> 01:57:47,080
ABOUT IT SO HOPE THAT ANSWERS MY

3595
01:57:47,080 --> 01:57:49,440
COLLEAGUE'S QUESTION.

3596
01:57:49,440 --> 01:57:51,240
>> HERE IS ANOTHER QUESTION I

3597
01:57:51,240 --> 01:57:52,720
THINK FOR YOU, DR. CLARE, FROM

3598
01:57:52,720 --> 01:57:54,640
THE AUDIENCE.

3599
01:57:54,640 --> 01:57:56,840
SHOULD MEDICAL EDUCATION INVOLVE

3600
01:57:56,840 --> 01:57:59,480
FROM A DISEASE MANAGEMENT MODEL

3601
01:57:59,480 --> 01:58:00,800
TO A POPULATION HEALTH MODEL

3602
01:58:00,800 --> 01:58:03,440
GIVEN ANTICIPATED POLICY CHANGES

3603
01:58:03,440 --> 01:58:04,880
TOWARDS WHOLE PERSON -- WHOLE

3604
01:58:04,880 --> 01:58:05,640
PATIENT CARE AND INTEGRATED

3605
01:58:05,640 --> 01:58:05,840
CARE?

3606
01:58:05,840 --> 01:58:06,960
THE

3607
01:58:06,960 --> 01:58:09,840
>> I THINK WHEN I GOT MY MASTERS

3608
01:58:09,840 --> 01:58:12,200
OF PUBLIC HEALTH I DEFINITELY

3609
01:58:12,200 --> 01:58:13,760
CHANGED MY PERSPECTIVE IN TERMS

3610
01:58:13,760 --> 01:58:15,320
OF TAKING CARE OF ONE INDIVIDUAL

3611
01:58:15,320 --> 01:58:17,720
OPPOSED TO I CAN TAKING CARE

3612
01:58:17,720 --> 01:58:21,800
POPULATIONS AND COMMUNITIES SO

3613
01:58:21,800 --> 01:58:23,400
OUR PERSPECTIVE IN TERMS OF

3614
01:58:23,400 --> 01:58:24,960
PREVENTIVE MEDICINE NOT JUST

3615
01:58:24,960 --> 01:58:26,880
ILLNESS BASED MED MEDICINE AND

3616
01:58:26,880 --> 01:58:28,200
THE GREAT SLIDE DR. CLAYTON

3617
01:58:28,200 --> 01:58:30,280
MENTIONED REGARDING LIFE COURSE

3618
01:58:30,280 --> 01:58:31,760
IS REALLY CRITICAL.

3619
01:58:31,760 --> 01:58:33,960
WE HAVE SEEN THAT FOR THOSE OF

3620
01:58:33,960 --> 01:58:36,640
US IN OBSTETRICS GYNECOLOGY

3621
01:58:36,640 --> 01:58:38,880
WOMEN HAD POOR HEALTH OUTCOMES

3622
01:58:38,880 --> 01:58:40,680
DURING PREGNANCY THAT MIRRORS

3623
01:58:40,680 --> 01:58:46,320
WHAT WILL HAPPEN LATER.

3624
01:58:46,320 --> 01:58:48,960
THOSE WILL DEVELOP

3625
01:58:48,960 --> 01:58:51,120
CARDIOVASCULAR DISEASE, WHO HAS

3626
01:58:51,120 --> 01:58:53,960
PREECLAMPSIA DURING PREGNANCY OR

3627
01:58:53,960 --> 01:58:54,480
GESTATIONAL DIABETES SO

3628
01:58:54,480 --> 01:58:56,200
IMPORTANT TO THINK ABOUT THE

3629
01:58:56,200 --> 01:58:57,520
WHOLE PERSON POPULATION ANSWER

3630
01:58:57,520 --> 01:58:59,600
COMMUNITY WHICH SOMEONE LIVES

3631
01:58:59,600 --> 01:59:01,040
ALL THOSE SOCIAL DETERMINANTS,

3632
01:59:01,040 --> 01:59:02,360
WHERE THEY CAME FROM AS

3633
01:59:02,360 --> 01:59:03,040
ILLUSTRATED IS VERY, VERY

3634
01:59:03,040 --> 01:59:04,400
IMPORTANT.

3635
01:59:04,400 --> 01:59:07,360
COMES FROM POLICIES AN PRACTICES

3636
01:59:07,360 --> 01:59:09,400
RACISM THAT WE HAVE TO ADDRESS.

3637
01:59:09,400 --> 01:59:11,480
WE HAVE TO BELIEVE ABLE TO LOOK

3638
01:59:11,480 --> 01:59:12,800
IN THE MIRROR AND REALLY

3639
01:59:12,800 --> 01:59:14,320
ADDRESS.

3640
01:59:14,320 --> 01:59:15,040
>> THANK YOU.

3641
01:59:15,040 --> 01:59:17,360
I THINK THIS IS A QUESTION FOR

3642
01:59:17,360 --> 01:59:20,480
-- THAT I WILL HAVE DR. WILK

3643
01:59:20,480 --> 01:59:22,520
RESPOND TO.

3644
01:59:22,520 --> 01:59:24,320
WE -- COMMENT FROM THE AUDIENCE

3645
01:59:24,320 --> 01:59:28,240
IS THAT WE ARE SAYING TOO MUCH

3646
01:59:28,240 --> 01:59:30,040
IN THE INDIVIDUAL LEVEL SOCIO

3647
01:59:30,040 --> 01:59:31,240
ECOLOGICAL MODEL AND NOT HOW WE

3648
01:59:31,240 --> 01:59:33,320
CAN CHANGE THE SYSTEM.

3649
01:59:33,320 --> 01:59:36,680
HOW MUCH DATA DO WE NEED, WE

3650
01:59:36,680 --> 01:59:37,560
HAVE BEEN COLLECTING DATA ON

3651
01:59:37,560 --> 01:59:39,720
WOMEN AND GIRLS.

3652
01:59:39,720 --> 01:59:42,600
SEEING A WOMAN AS A WHOLE PERSON

3653
01:59:42,600 --> 01:59:43,760
IS STILL ON AN INDIVIDUAL LEVEL

3654
01:59:43,760 --> 01:59:45,440
AND HOW WE MOVE FROM THE

3655
01:59:45,440 --> 01:59:48,720
INDIVIDUAL TO SYSTEMS.

3656
01:59:48,720 --> 01:59:50,760
>> DR. TEMPLETON MADE AN

3657
01:59:50,760 --> 01:59:52,240
EXCELLENT POINT ON THIS WHICH IS

3658
01:59:52,240 --> 01:59:55,320
IN SO MUCH OF OUR RESEARCH,

3659
01:59:55,320 --> 01:59:58,000
RESULTS ARE NOT REPORTED IN A

3660
01:59:58,000 --> 01:59:59,440
DISAGGREGATED WAY FOR EACH

3661
01:59:59,440 --> 02:00:00,800
DIFFERENT SUBPOPULATION WHOM

3662
02:00:00,800 --> 02:00:02,720
THESE INTERVENTIONS NEED TO WORK

3663
02:00:02,720 --> 02:00:03,120
BEST.

3664
02:00:03,120 --> 02:00:05,040
SO IF THEY WORK WELL ON AVERAGE

3665
02:00:05,040 --> 02:00:07,280
WHICH IS WHAT A LOT OF OUR DATA

3666
02:00:07,280 --> 02:00:09,400
SHOWS, THEY MAY STILL NOT WORK

3667
02:00:09,400 --> 02:00:11,080
WELL FOR INDIVIDUALS WITH

3668
02:00:11,080 --> 02:00:11,840
PARTICULAR INTERSECTIONAL

3669
02:00:11,840 --> 02:00:13,880
IDENTITIES.

3670
02:00:13,880 --> 02:00:15,400
SO THAT IS REALLY IMPORTANT TO

3671
02:00:15,400 --> 02:00:18,160
KEEP THE DATA FLOWING SO THAT

3672
02:00:18,160 --> 02:00:19,080
EVERY INTERVENTION AND

3673
02:00:19,080 --> 02:00:20,680
INITIATIVE CAN BE MORE AND MORE

3674
02:00:20,680 --> 02:00:23,880
PRECISELY TARGETED.

3675
02:00:23,880 --> 02:00:25,440
AND PLEA AGREEMENTED IN WAY THAT

3676
02:00:25,440 --> 02:00:28,080
MAXIMIZES BENEFIT IF WE ARE

3677
02:00:28,080 --> 02:00:30,280
LUCKY REDUCES SPENDING TO L A

3678
02:00:30,280 --> 02:00:34,880
ATTORNEYTIVE INTERVENTIONS.

3679
02:00:34,880 --> 02:00:36,840
SO -- ALTERNATIVE INTERVENTIONS

3680
02:00:36,840 --> 02:00:38,120
SO WE HAVE A LOT OF DATA THAT

3681
02:00:38,120 --> 02:00:38,920
SUPPORT OBJECTIVES OF THIS

3682
02:00:38,920 --> 02:00:41,000
CONFERENCE IN WAYS BUT DOING THE

3683
02:00:41,000 --> 02:00:43,000
DIRTY WORK OF FINDING THE RIGHT

3684
02:00:43,000 --> 02:00:44,880
INTERVENTION AND PUTTING IT INTO

3685
02:00:44,880 --> 02:00:47,040
PLACE EFFECTIVELY, IS SOMETHING

3686
02:00:47,040 --> 02:00:48,240
THAT WE DON'T HAVE NEARLY ENOUGH

3687
02:00:48,240 --> 02:00:50,720
DATA ABOUT IN MY OPINION.

3688
02:00:50,720 --> 02:00:51,920
>> THANK YOU.

3689
02:00:51,920 --> 02:00:56,760
THIS IS A RELATED QUESTION.

3690
02:00:56,760 --> 02:01:00,960
FOR DR. WILK.

3691
02:01:00,960 --> 02:01:02,880
THE PERSON SAYS ENJOYING YOUR

3692
02:01:02,880 --> 02:01:05,280
TALK AND KEY INTERPLAY BETWEEN

3693
02:01:05,280 --> 02:01:06,800
FRONT LINE CLINICIANS HEALTH

3694
02:01:06,800 --> 02:01:18,080
SYSTEMS PAYER/POLICY MAKERS.

3695
02:01:18,080 --> 02:01:19,680
THE GOAL TO ADVANCE FOCUS ON

3696
02:01:19,680 --> 02:01:20,680
POPULATION HEALTH AND

3697
02:01:20,680 --> 02:01:23,320
PARTNERSHIP WITH CLINICIANS AND

3698
02:01:23,320 --> 02:01:24,120
RESEARCHERS, SOUNDS CONSISTENT

3699
02:01:24,120 --> 02:01:27,000
WITH THE EMERGING LEARNING

3700
02:01:27,000 --> 02:01:27,720
HEALTH SYSTEMS LITERATURE.

3701
02:01:27,720 --> 02:01:30,120
WHAT ARE YOUR THOUGHTS ON HOW

3702
02:01:30,120 --> 02:01:31,120
LEARNING HEALTH SYSTEMS ARE

3703
02:01:31,120 --> 02:01:33,120
RELATED TO YOUR GOALS FOR

3704
02:01:33,120 --> 02:01:36,480
IMPROVING POPULATION HEALTH.

3705
02:01:36,480 --> 02:01:37,520
>> CLOSELY RELATED, AND RELATED

3706
02:01:37,520 --> 02:01:39,880
TO THE POINT THAT I WAS MAKING

3707
02:01:39,880 --> 02:01:43,520
ABOUT THE IMPORTANCE OF GETTING

3708
02:01:43,520 --> 02:01:47,160
INTERVENTIONS RIGHT FOR TARGET

3709
02:01:47,160 --> 02:01:48,080
POPULATIONS THAT ANY

3710
02:01:48,080 --> 02:01:49,000
INTERVENTION IS TARGETING.

3711
02:01:49,000 --> 02:01:52,440
SO LEARNING HEALTH SYSTEMS ARE

3712
02:01:52,440 --> 02:01:54,520
-- WHEN IMPLEMENTED WELL, CAN BE

3713
02:01:54,520 --> 02:01:56,520
QUITE GOOD AT COLLECTING THE

3714
02:01:56,520 --> 02:01:57,880
RIGHT DATA ON THE POPULATIONS

3715
02:01:57,880 --> 02:02:00,400
THAT YOU WANT TO TARGET, AND

3716
02:02:00,400 --> 02:02:02,840
USING THAT DATA TO CONTINUOUSLY

3717
02:02:02,840 --> 02:02:04,840
REFINE AND IMPROVE THE

3718
02:02:04,840 --> 02:02:07,760
INTERVENTIONS AND SYSTEMS IN

3719
02:02:07,760 --> 02:02:08,560
PLACE.

3720
02:02:08,560 --> 02:02:10,600
THIS GOES BACK TO MY POINT ABOUT

3721
02:02:10,600 --> 02:02:12,360
IMPORTANCE OF PROVIDERS

3722
02:02:12,360 --> 02:02:14,920
THEMSELVES WHOSE ARE AT THE

3723
02:02:14,920 --> 02:02:19,720
LEADING EDGE OF CARE.

3724
02:02:19,720 --> 02:02:21,600
PROVIDING FEEDBACK TO HEALTH

3725
02:02:21,600 --> 02:02:23,320
SYSTEMS AND ADMINISTRATORS WHO

3726
02:02:23,320 --> 02:02:24,200
ARE EMPLOYING OR COLLABORATING

3727
02:02:24,200 --> 02:02:26,520
WITH THEM SO THEY CAN REPORT

3728
02:02:26,520 --> 02:02:27,960
WHAT THEY SEE AS WORKING WELL OR

3729
02:02:27,960 --> 02:02:29,400
NOT WORKING WELL AND THEN

3730
02:02:29,400 --> 02:02:30,920
LOOKING WITH THE SYSTEMS

3731
02:02:30,920 --> 02:02:32,800
LEADERSHIP TO REFORM THESE

3732
02:02:32,800 --> 02:02:34,520
INTERVENTIONS AND INITIATIVES TO

3733
02:02:34,520 --> 02:02:35,680
MAKE SURE WOMEN HEALTH IS

3734
02:02:35,680 --> 02:02:39,120
MAXIMIZED.

3735
02:02:39,120 --> 02:02:40,120
LEARNING HEALTH SYSTEMS IS NOT

3736
02:02:40,120 --> 02:02:42,120
THE ONLY FRAMEWORK FOR THAT.

3737
02:02:42,120 --> 02:02:44,000
I MENTIONED IN RESPONSE TO

3738
02:02:44,000 --> 02:02:45,800
ANOTHER QUESTION IN THE Q&A THE

3739
02:02:45,800 --> 02:02:48,320
IDEA OF ACCOUNTABLE CARE

3740
02:02:48,320 --> 02:02:49,520
COMMUNITIES.

3741
02:02:49,520 --> 02:02:51,040
THIS IS AN EXPANSION OF

3742
02:02:51,040 --> 02:02:52,440
ACCOUNTABLE CARE ORGANIZATIONS

3743
02:02:52,440 --> 02:02:55,520
WHICH YOU HEARD ABOUT A DECADE

3744
02:02:55,520 --> 02:02:55,920
AGO.

3745
02:02:55,920 --> 02:02:58,560
THEY INVOLVE MORE ROUTINELY

3746
02:02:58,560 --> 02:03:01,400
GETTING USEFUL INPUT FROM LOT OF

3747
02:03:01,400 --> 02:03:04,160
COMMUNITY ORGANIZATIONS AND

3748
02:03:04,160 --> 02:03:06,600
STAKEHOLDERS SO AGAIN THINGS ARE

3749
02:03:06,600 --> 02:03:12,480
MEASURE AND DATA IS USED TO

3750
02:03:12,480 --> 02:03:13,720
REDIRECT THE EFFORTS BUILDING

3751
02:03:13,720 --> 02:03:14,840
TOWARDS WHOLE PERSON CARE.

3752
02:03:14,840 --> 02:03:16,840
DR. SIMON MAYBE I SAID SOMETHING

3753
02:03:16,840 --> 02:03:17,640
THAT OFFENDED YOU AND YOU WOULD

3754
02:03:17,640 --> 02:03:20,720
LIKE TO RESPOND?

3755
02:03:20,720 --> 02:03:23,320
>> NO OFFENSE WHATSOEVER.

3756
02:03:23,320 --> 02:03:26,040
YOU ARE SPOT ON BUT RAISED MY

3757
02:03:26,040 --> 02:03:27,640
HAND BECAUSE I TOO SUPPORT THAT,

3758
02:03:27,640 --> 02:03:28,640
THE LEARNING HEALTH SYSTEM

3759
02:03:28,640 --> 02:03:30,280
APPROACH IS NOT SOMETHING OR THE

3760
02:03:30,280 --> 02:03:31,640
SYSTEMS APPROACH IN GENERAL IS

3761
02:03:31,640 --> 02:03:34,120
NOT SOMETHING WE DO ENOUGH OF

3762
02:03:34,120 --> 02:03:36,800
AND AGAIN PATIENT NAVIGATION FOR

3763
02:03:36,800 --> 02:03:38,160
EXAMPLE ARE COMMUNITY HEALTH

3764
02:03:38,160 --> 02:03:41,840
WORKER MODELS, THINGS THAT ARE

3765
02:03:41,840 --> 02:03:44,080
DEPLOYED ACROSS MANY DIFFERENT

3766
02:03:44,080 --> 02:03:46,600
SPACES, ACROSS THE WORLD, HAVE

3767
02:03:46,600 --> 02:03:48,720
NOT BEEN ACTUALLY EXAMINED IN

3768
02:03:48,720 --> 02:03:51,880
THE LEARNING HEALTH SYSTEMS

3769
02:03:51,880 --> 02:03:52,600
APPROACH.

3770
02:03:52,600 --> 02:03:55,600
COMMUNITY HEALTH WORKERS FROM --

3771
02:03:55,600 --> 02:03:57,480
PATIENT NAVIGATORS, WHATEVER YOU

3772
02:03:57,480 --> 02:04:00,400
WANT TO CALL THOSE INDIVIDUALS

3773
02:04:00,400 --> 02:04:09,920
HELP US LEARN WHERE GAPS ARE.

3774
02:04:09,920 --> 02:04:11,160
IF WE CAN REFER TO ACTIVITIES IN

3775
02:04:11,160 --> 02:04:12,320
A VARIETY OF PATIENTS AND PEOPLE

3776
02:04:12,320 --> 02:04:14,000
IN A VARIETY OF SETTINGS WE CAN

3777
02:04:14,000 --> 02:04:15,800
ACTUALLY LEARN AND IMPROVE OUR

3778
02:04:15,800 --> 02:04:17,520
HEALTHCARE DELIVERY SYSTEMS.

3779
02:04:17,520 --> 02:04:20,280
THAT'S CRITICAL WHEN TALKING

3780
02:04:20,280 --> 02:04:22,080
ABOUT THIS PARTICULAR TOPIC OF

3781
02:04:22,080 --> 02:04:23,400
CHRONIC CO-MORBID CONDITIONS,

3782
02:04:23,400 --> 02:04:29,120
AND WOMEN AND GIRLS AND HOW TO

3783
02:04:29,120 --> 02:04:34,480
REALLY ACROSS THE ENTIRE LIFE

3784
02:04:34,480 --> 02:04:35,520
SPAN.

3785
02:04:35,520 --> 02:04:36,880
USING DR. TEMPLETON EXAMPLE IS

3786
02:04:36,880 --> 02:04:37,080
GREAT.

3787
02:04:37,080 --> 02:04:38,840
IF YOU DON'T HAVE ACCESS TO

3788
02:04:38,840 --> 02:04:39,920
HEALTHY FOODS WHEN PREGNANT AND

3789
02:04:39,920 --> 02:04:42,160
WHEN YOU ARE A CHILD, WHAT DOES

3790
02:04:42,160 --> 02:04:43,960
THAT SAY?

3791
02:04:43,960 --> 02:04:45,640
YOU WENT FOR OBESITY, RIGHT AND

3792
02:04:45,640 --> 02:04:47,320
THE SYSTEMS OF OPPRESSION AND

3793
02:04:47,320 --> 02:04:49,400
ALL THOSE OTHER THINGS THAT

3794
02:04:49,400 --> 02:04:51,680
IMPACT YOU AS AN INDIVIDUAL

3795
02:04:51,680 --> 02:04:53,400
ACROSS THAT LIFE AND HEALTH SPAN

3796
02:04:53,400 --> 02:04:55,520
IS GOING TO IMPACT YOUR

3797
02:04:55,520 --> 02:04:58,840
DEVELOPMENT OF OSTEOARTHRITIS

3798
02:04:58,840 --> 02:05:00,280
LATER ON.

3799
02:05:00,280 --> 02:05:01,640
OBESE, YOU HAVE WEIGHT BARING

3800
02:05:01,640 --> 02:05:01,880
ISSUES.

3801
02:05:01,880 --> 02:05:03,840
THERE WAS A QUESTION IN THE CHAT

3802
02:05:03,840 --> 02:05:05,200
-- IN THE Q&A BUT THOSE ALL

3803
02:05:05,200 --> 02:05:05,600
MATTER.

3804
02:05:05,600 --> 02:05:08,120
SO THIS LEARNING HEALTH SYSTEM

3805
02:05:08,120 --> 02:05:18,760
APPROACHES IS CRITICAL.

3806
02:05:18,760 --> 02:05:32,000
IN YOUR RECIPE WHERE SHOULD

3807
02:05:32,000 --> 02:05:36,720
INTERVENTIONS OCCUR IN PRIMARY

3808
02:05:36,720 --> 02:05:44,640
CARE I WILL GIVE A COP OUT

3809
02:05:44,640 --> 02:05:46,920
ANSWER, IT DOES DEPEND, I THINK

3810
02:05:46,920 --> 02:05:49,960
THERE ARE SOME INTERVENTIONS.

3811
02:05:49,960 --> 02:05:51,360
AND IT DEPENDS IMPORTANTLY ON

3812
02:05:51,360 --> 02:05:56,720
EXPERTISE OF THE AVAILABLE

3813
02:05:56,720 --> 02:05:58,880
INDIVIDUALS INTERVENTIONS

3814
02:05:58,880 --> 02:05:59,880
SCREEN, ET CETERA, SO I MENTION

3815
02:05:59,880 --> 02:06:00,720
THE CASE OF SCHOOL MENTAL

3816
02:06:00,720 --> 02:06:15,520
HEALTH.

3817
02:06:15,520 --> 02:06:17,320
CAN BE LOCATED AT SCHOOLS OR IN

3818
02:06:17,320 --> 02:06:18,640
COMMUNITY OUTPATIENT MENTAL

3819
02:06:18,640 --> 02:06:20,000
HEALTH TREATMENT CENTERS OR IN

3820
02:06:20,000 --> 02:06:21,120
MANY OTHER DIFFERENT PLACES,

3821
02:06:21,120 --> 02:06:23,240
COMMUNITY HEALTH CENTERS, WOMEN

3822
02:06:23,240 --> 02:06:45,400
HEALTH CLINIC, SO ON.

3823
02:06:45,400 --> 02:06:47,160
DO THAT WHEN YOU CAN BECAUSE OF

3824
02:06:47,160 --> 02:06:48,640
ADVANTAGES WITH RESPECT TO

3825
02:06:48,640 --> 02:06:49,720
OVERCOMING LIST SOMEWHERICAL AND

3826
02:06:49,720 --> 02:06:51,920
GEOGRAPHIC BARRIERS.

3827
02:06:51,920 --> 02:06:52,560
BUT FOR HOSPITALS OF OTHER

3828
02:06:52,560 --> 02:06:57,680
INTERVENTIONS AND SCREENINGS. 

3829
02:06:57,680 --> 02:06:59,240
IT MAYBE HARD TORE LOCATE

3830
02:06:59,240 --> 02:07:00,560
INDIVIDUALS AT SCHOOLS AND OTHER

3831
02:07:00,560 --> 02:07:18,720
CLINIC SETTINGS, SEPARATE FROM

3832
02:07:18,720 --> 02:07:19,880
AND EXMOTHER THE DIFFERENCE IN

3833
02:07:19,880 --> 02:07:21,520
TERMS OF OUTCOMES, ACCESS

3834
02:07:21,520 --> 02:07:22,200
ENGAGEMENT IN DIFFERENT

3835
02:07:22,200 --> 02:07:22,560
SETTINGS.

3836
02:07:22,560 --> 02:07:25,760
BECAUSE IF THERE IS A BIG

3837
02:07:25,760 --> 02:07:28,520
DIFFERENCE, IN THE OUTCOMES THAT

3838
02:07:28,520 --> 02:07:32,440
SHOULD TIP YOU OFF TO WHERE

3839
02:07:32,440 --> 02:07:33,720
POTENTIAL EFFICIENCIES OR

3840
02:07:33,720 --> 02:07:35,560
IMPROVED EFFECTIVENESS CAN BE

3841
02:07:35,560 --> 02:07:37,080
GARNERED DEPENDING HOW YOU

3842
02:07:37,080 --> 02:07:54,720
IMPLEMENT THESE.

3843
02:07:54,720 --> 02:07:56,640
ON THIS HEALTH STRATEGY.

3844
02:07:56,640 --> 02:08:00,560
SO THE PERSON FROM AUDIENCE IS

3845
02:08:00,560 --> 02:08:06,320
SHARINGs PERNSES ABOUT --

3846
02:08:06,320 --> 02:08:08,000
EXPERIENCES IN HER LIFE AND

3847
02:08:08,000 --> 02:08:10,760
HAVING HYPERTENSION AND ORGAN

3848
02:08:10,760 --> 02:08:13,200
FAILURE AND HOW WOULD ONE BEGIN

3849
02:08:13,200 --> 02:08:14,720
TO ADDRESS COMPLEXITY OF WOMEN'S

3850
02:08:14,720 --> 02:08:16,720
LIVES?

3851
02:08:16,720 --> 02:08:18,280
DR. TEMPERATURE TON CAN YOU

3852
02:08:18,280 --> 02:08:19,520
RESPOND TO THAT?

3853
02:08:19,520 --> 02:08:22,040
>> I WAS GIVING A BRIEF

3854
02:08:22,040 --> 02:08:24,080
RESPONSE, GET BACK TO ISSUE WITH

3855
02:08:24,080 --> 02:08:25,200
OSTEOARTHRITIS AND JOINT PAIN

3856
02:08:25,200 --> 02:08:26,520
STUDIES LOOK AT PATIENTS WHO

3857
02:08:26,520 --> 02:08:28,720
PRESENT WITH CHRONIC

3858
02:08:28,720 --> 02:08:29,920
MUSCULOSKELETAL PAIN, A THIRD

3859
02:08:29,920 --> 02:08:31,840
HAVE PREVIOUSLY UNDIAGNOSED

3860
02:08:31,840 --> 02:08:35,160
UNTREATED DEPRESSION AND ANXIETY

3861
02:08:35,160 --> 02:08:36,040
ANXIETY.

3862
02:08:36,040 --> 02:08:37,520
SIGNIFICANT PORTION OF THOSE

3863
02:08:37,520 --> 02:08:39,440
HAVE DOMESTIC VIOLENCE AN PTSD

3864
02:08:39,440 --> 02:08:43,120
SO GETS BACK TO THE EARLIER

3865
02:08:43,120 --> 02:08:44,680
QUESTION IF YOU DO SCREENING IT

3866
02:08:44,680 --> 02:08:45,600
NEEDS TO BE BIDIRECTIONAL, IF

3867
02:08:45,600 --> 02:08:47,520
YOU ARE PRIMARY -- IF YOUR

3868
02:08:47,520 --> 02:08:49,320
PRIMARY CARE PROVIDER YOU HAVE

3869
02:08:49,320 --> 02:08:51,520
GOT TO BE ASKING ABOUT SPECIALTY

3870
02:08:51,520 --> 02:08:53,360
THINGS LIKE JOINT PAIN OR ANY

3871
02:08:53,360 --> 02:08:54,160
OTHER MORE SPECIFIC HEALTH

3872
02:08:54,160 --> 02:08:56,080
CONDITION.

3873
02:08:56,080 --> 02:08:57,480
IF YOU ARE SPECIALIST YOU NEED

3874
02:08:57,480 --> 02:09:00,120
TO ASK ABOUT THESE OTHER THINGS

3875
02:09:00,120 --> 02:09:01,920
SO IF YOU HAVE PATIENTS COMING

3876
02:09:01,920 --> 02:09:03,880
IN DUE TO CHRONIC JOIN PAINT

3877
02:09:03,880 --> 02:09:04,880
UNLESS YOU ASK ABOUT OR

3878
02:09:04,880 --> 02:09:06,240
INVESTIGATING HISTORY OF MENTAL

3879
02:09:06,240 --> 02:09:07,760
HEALTH ISSUES AND WHETHER THEY

3880
02:09:07,760 --> 02:09:09,800
ARE VICTIMS OF DOMESTIC

3881
02:09:09,800 --> 02:09:11,880
VIOLENCE, NO MATTER HOW AWESOME

3882
02:09:11,880 --> 02:09:13,480
THE MENTAL IS YOU CAN PUT IN --

3883
02:09:13,480 --> 02:09:15,080
METAL IS TO PUT IN, THEY ARE NOT

3884
02:09:15,080 --> 02:09:16,080
GOING TO GET BETTER AS I

3885
02:09:16,080 --> 02:09:18,120
MENTIONED IN ONE STUDY, SEVERAL

3886
02:09:18,120 --> 02:09:19,480
STUDIES, PRE-EXISTING DEPRESSION

3887
02:09:19,480 --> 02:09:21,360
AND OTHER MENTAL HEALTH ISSUES

3888
02:09:21,360 --> 02:09:24,000
LEADS TO PEOPLE EVEN AFTER WHAT

3889
02:09:24,000 --> 02:09:25,440
WOULD SEEM SUCCESSFUL SURGERY

3890
02:09:25,440 --> 02:09:27,560
NOT GETTING BETTER.

3891
02:09:27,560 --> 02:09:29,320
SO THIS -- DOMESTIC VIOLENCE

3892
02:09:29,320 --> 02:09:30,640
ISSUE DOES DESCRIBE THE

3893
02:09:30,640 --> 02:09:33,640
COMPLEXITY OF WOMEN'S HEALTH, IT

3894
02:09:33,640 --> 02:09:34,920
HAS TO BE EVERYONE LOOKING AT

3895
02:09:34,920 --> 02:09:36,760
EVERYTHING, IF YOU COME IN

3896
02:09:36,760 --> 02:09:38,480
BECAUSE YOUR KNEE HURTS I NEED

3897
02:09:38,480 --> 02:09:40,040
TO FIND OUT WHAT ELSE IS GOING

3898
02:09:40,040 --> 02:09:40,840
ON IN YOUR LIFE.

3899
02:09:40,840 --> 02:09:41,920
MAYBE YOU ARE HURTING BECAUSE

3900
02:09:41,920 --> 02:09:44,440
YOU ARE A VICTIM OF DOMESTIC

3901
02:09:44,440 --> 02:09:45,520
VIOLENCE OR YOU HAVE PTSD.

3902
02:09:45,520 --> 02:09:50,040
WE NEED TO BE ASKING ABOUT THAT,

3903
02:09:50,040 --> 02:09:54,960
SO IT GETS TO MY EARLIER ANSWER,

3904
02:09:54,960 --> 02:09:57,200
THIS BACK TO EDUCATION, TEACHING

3905
02:09:57,200 --> 02:09:58,120
COMPLEXITIES AN DIVERSITY OF SEX

3906
02:09:58,120 --> 02:09:59,920
AND GENDER BASED DIFFERENCES

3907
02:09:59,920 --> 02:10:02,040
ALONG ALL HEALTH CONDITIONS AT

3908
02:10:02,040 --> 02:10:03,480
EVERY LEVEL OF EDUCATION AND HOW

3909
02:10:03,480 --> 02:10:05,320
THESE CONDITIONS INTERACT AND

3910
02:10:05,320 --> 02:10:06,320
INTERPLACE.

3911
02:10:06,320 --> 02:10:07,040
-- INTERPLAY.

3912
02:10:07,040 --> 02:10:10,080
>> THANK YOU SO MUC MUCH NOR
THAT

3913
02:10:10,080 --> 02:10:10,760
DR. TEMPLETON.

3914
02:10:10,760 --> 02:10:12,360
HERE IS ANOTHER QUESTION FROM

3915
02:10:12,360 --> 02:10:20,320
THE AUDIENCE.

3916
02:10:20,320 --> 02:10:21,880
BY PARTICIPANT/GROUP

3917
02:10:21,880 --> 02:10:23,120
CHARACTERISTICS SEEM LACK OF

3918
02:10:23,120 --> 02:10:25,000
INTEREST FROM FUNDING AGENCIES.

3919
02:10:25,000 --> 02:10:27,240
AND JOURNAL EDITORS.

3920
02:10:27,240 --> 02:10:29,320
/REVIEWS AND INCREASING

3921
02:10:29,320 --> 02:10:30,600
ACCEPTABILITY AS OUTCOME.

3922
02:10:30,600 --> 02:10:37,520
RATHER THAN ASKING ACCEPTABLE WE

3923
02:10:37,520 --> 02:10:40,520
NEED TO ASK FOR WHOM AND WHEN

3924
02:10:40,520 --> 02:10:41,920
INTERVENTION ACCEPTABLE BUT

3925
02:10:41,920 --> 02:10:42,600
FEELS LIKE THE FIELD IS ONLY

3926
02:10:42,600 --> 02:10:43,720
INTERESTED IN SEEING

3927
02:10:43,720 --> 02:10:45,840
EFFECTIVENESS IN -- ON AVERAGE,

3928
02:10:45,840 --> 02:10:48,400
IF THE VULNERABLE PARTICIPANTS

3929
02:10:48,400 --> 02:10:49,280
DON'T ACCEPT INTERVENTION IT

3930
02:10:49,280 --> 02:10:50,600
WILL NEVER BE EFFECTIVE FOR

3931
02:10:50,600 --> 02:10:51,000
THEM.

3932
02:10:51,000 --> 02:10:55,000
HOW DO WE EXPRESS THE IMPORTANCE

3933
02:10:55,000 --> 02:10:57,920
OF ACCEPTABILITY AS VARIABLE ON

3934
02:10:57,920 --> 02:10:59,880
ITS OWN SEPARATE FROM EFFICACY?

3935
02:10:59,880 --> 02:11:01,560
DR. SIMON CAN YOU RESPOND TO

3936
02:11:01,560 --> 02:11:03,200
THAT AND PERHAPS ALL THE

3937
02:11:03,200 --> 02:11:04,840
PANELISTS MAY WANT TO TAKE

3938
02:11:04,840 --> 02:11:06,240
RESPONSE TO THAT.

3939
02:11:06,240 --> 02:11:09,560
>> DEFINITELY APPRECIATE THAT.

3940
02:11:09,560 --> 02:11:14,160
AND I ENCOURAGE IF YOU HEARD MY

3941
02:11:14,160 --> 02:11:16,400
TALK A LITTLE BIT, THERE'S TALKS

3942
02:11:16,400 --> 02:11:25,920
REPORTED SO I DID TOUCH ON THIS.

3943
02:11:25,920 --> 02:11:28,320
THERE IS BIAS ALONG THE ENTIRE

3944
02:11:28,320 --> 02:11:29,400
PIPELINE TO IMPACT THE PERSON

3945
02:11:29,400 --> 02:11:32,720
LEVEL OR COMMUNITY LEVEL.

3946
02:11:32,720 --> 02:11:36,280
SO WHEN WE THOUGH BIASES IN EACH

3947
02:11:36,280 --> 02:11:38,080
PART OF THE RESEARCH AND

3948
02:11:38,080 --> 02:11:39,200
PUBLICATION, WE CAN SEE WHAT IS

3949
02:11:39,200 --> 02:11:40,680
GOING ON BUT WE NEED TO ASK

3950
02:11:40,680 --> 02:11:43,920
THOSE CRITICAL QUESTIONS AT

3951
02:11:43,920 --> 02:11:45,480
EVERY STATE -- EVERY STEP IN

3952
02:11:45,480 --> 02:11:48,240
THAT GATE KEEPING PROCESS.

3953
02:11:48,240 --> 02:11:52,040
SO ACCEPTABILITY PATIENT CENTER

3954
02:11:52,040 --> 02:11:54,280
CENTERED WHAT DOES THAT MEAN TO

3955
02:11:54,280 --> 02:11:55,440
DELIVER PATIENT TRULY PATIENT

3956
02:11:55,440 --> 02:11:58,120
CENTERED CARE UNDERSTANDING

3957
02:11:58,120 --> 02:12:00,520
COMPLEXITY AND CONTEXT OF WOMEN

3958
02:12:00,520 --> 02:12:01,480
WITHIN GIRLS LIVES AND PEOPLE'S

3959
02:12:01,480 --> 02:12:05,480
LIVES IN GENERAL.

3960
02:12:05,480 --> 02:12:07,720
SO THOSE ARE IMPORTANT WHETHER

3961
02:12:07,720 --> 02:12:09,800
ORTHO POD OR GYN OR OB OR

3962
02:12:09,800 --> 02:12:12,920
WHATEVER YOU ARE, EVEN HEALTH

3963
02:12:12,920 --> 02:12:17,440
ECONOMIST, DR. WILK, WE ALL NEED

3964
02:12:17,440 --> 02:12:20,200
TO RECOGNIZE THAT AND THAT'S HOW

3965
02:12:20,200 --> 02:12:22,320
WE DO A BETTER JOB ONCE WE

3966
02:12:22,320 --> 02:12:27,000
PAUSE, WE ACT FOLIAGE WHAT IT IS

3967
02:12:27,000 --> 02:12:28,480
OUR LIMITATIONS ARE ON OUR

3968
02:12:28,480 --> 02:12:32,360
KNOWLEDGE AND PERSONAL LIFE

3969
02:12:32,360 --> 02:12:33,720
EXPERIENCE, WE REFLECT ON THAT

3970
02:12:33,720 --> 02:12:34,960
BECAUSE THAT IS HOW WE ACTIVELY

3971
02:12:34,960 --> 02:12:39,440
MANAGE BIAS IN EVERY SINGLE

3972
02:12:39,440 --> 02:12:40,720
SITUATION, AND THEN DECIDE RYE

3973
02:12:40,720 --> 02:12:44,760
TO WORK WITH PARTICULAR PATIENT

3974
02:12:44,760 --> 02:12:46,880
OR PERSON AND LOVED ONES

3975
02:12:46,880 --> 02:12:48,680
CAREGIVERS DEPENDING ON SCENARIO

3976
02:12:48,680 --> 02:12:52,600
AND DEVELOP A CARE PLAN AND

3977
02:12:52,600 --> 02:12:54,760
APPROACH CENTERED ACKNOWLEDGING

3978
02:12:54,760 --> 02:12:56,600
CONTEXT AND COMPLEXITY OF EACH

3979
02:12:56,600 --> 02:12:58,320
INDIVIDUAL PERSON.

3980
02:12:58,320 --> 02:13:00,280
>> THANK YOU SO MUCH, DR. SIMON.

3981
02:13:00,280 --> 02:13:02,920
THERE WAS A QUESTION THAT I SAW

3982
02:13:02,920 --> 02:13:04,720
EARLIER THAT I WANT THAT I

3983
02:13:04,720 --> 02:13:05,840
DIDN'T HAVE AN OPPORTUNITY TO

3984
02:13:05,840 --> 02:13:07,400
ADDRESS THAT I WILL SAY NOW.

3985
02:13:07,400 --> 02:13:10,200
SOMEONE FROM THE AUDIENCE MADE

3986
02:13:10,200 --> 02:13:11,320
OBSERVATION THAT THE TALKS HAVE

3987
02:13:11,320 --> 02:13:14,320
BEEN REFLECTING CIS GENDER

3988
02:13:14,320 --> 02:13:15,520
WOMEN, WHEN WE TALK ABOUT

3989
02:13:15,520 --> 02:13:18,320
CO-MORBID CO-OCCURRING

3990
02:13:18,320 --> 02:13:20,760
CONDITIONS, AND TRANSGENDER

3991
02:13:20,760 --> 02:13:22,680
WOMEN AN GIRLS WHAT SYSTEMS OF

3992
02:13:22,680 --> 02:13:26,120
CARE DO WE NEED THE HAVE, HOW DO

3993
02:13:26,120 --> 02:13:29,160
WE INCLUSIVE THE RANGE OF WOMEN

3994
02:13:29,160 --> 02:13:30,680
AND INDIVIDUALS WHO IDENTIFY

3995
02:13:30,680 --> 02:13:32,920
BEING WOMEN?

3996
02:13:32,920 --> 02:13:35,040
DR. SIMON CAN YOU RESPOND TO

3997
02:13:35,040 --> 02:13:35,240
THAT?

3998
02:13:35,240 --> 02:13:38,120
>> I WOULD LIKE TO GIVE ONE

3999
02:13:38,120 --> 02:13:39,920
PANELIST A CHANCE, DR. CLARE AND

4000
02:13:39,920 --> 02:13:41,560
DR. TEMPLETON BOTH HAD THEIR

4001
02:13:41,560 --> 02:13:42,760
HANDS UP SO I WILL LET THEM --

4002
02:13:42,760 --> 02:13:43,720
>> OKAY.

4003
02:13:43,720 --> 02:13:44,280
GREAT.

4004
02:13:44,280 --> 02:13:46,320
>> I WOULD SAY FIRST THIS IS AN

4005
02:13:46,320 --> 02:13:49,880
INCREDIBLY IMPORTANT QUESTION.

4006
02:13:49,880 --> 02:13:51,600
UNDERSTANDING THE, ISSUES OF

4007
02:13:51,600 --> 02:13:52,720
TRANSGENDER WOMEN THE

4008
02:13:52,720 --> 02:13:53,680
TRANSPOPULATION IN GENERAL IS

4009
02:13:53,680 --> 02:13:54,480
IMPORTANT BUT I THINK PART OF

4010
02:13:54,480 --> 02:13:57,280
THE ISSUE THAT WE HAVE NOW IS WE

4011
02:13:57,280 --> 02:13:59,120
DON'T HAVE GOOD DATA OR GOOD

4012
02:13:59,120 --> 02:14:00,160
UNDERSTANDING OF WHAT HAPPENS ON

4013
02:14:00,160 --> 02:14:06,520
A SEX BASED LEVEL FOR WOMEN.

4014
02:14:06,520 --> 02:14:09,080
WHAT DOES IT MEAN TO BE XX OR XY

4015
02:14:09,080 --> 02:14:10,680
OR PERMUTATION THEREOF.

4016
02:14:10,680 --> 02:14:16,960
ANYWHERE FROM 25 TO 30% ARTICLES

4017
02:14:16,960 --> 02:14:18,040
DISAGGREGATE REPORT DATA ON SEX.

4018
02:14:18,040 --> 02:14:19,840
SO UNTIL WE UNDERSTAND THE BASIC

4019
02:14:19,840 --> 02:14:21,720
INFLUENCE OF GENETICS IN THE

4020
02:14:21,720 --> 02:14:25,720
PHYSIOLOGY OF BEING XX OR XY,

4021
02:14:25,720 --> 02:14:26,920
UMIAKS IT CHALLENGEOGRAPHY GUSH

4022
02:14:26,920 --> 02:14:28,680
OUT THEN WHAT HAPPENS IF WHEN

4023
02:14:28,680 --> 02:14:30,880
YOU ARE TRANSGENDER.

4024
02:14:30,880 --> 02:14:33,000
FROM BOTH THE PHYSIOLOGIC AND

4025
02:14:33,000 --> 02:14:36,200
HORMONAL LEVEL AND MEDICATIONS

4026
02:14:36,200 --> 02:14:38,240
AND THE STRUCTURAL LEVEL AND THE

4027
02:14:38,240 --> 02:14:39,640
SOCIETAL GENDER BASED COMPONENT

4028
02:14:39,640 --> 02:14:41,080
OF IT SO IT IS INCREDIBLY

4029
02:14:41,080 --> 02:14:44,720
IMPORTANT TO LOOK AT BUT I WORRY

4030
02:14:44,720 --> 02:14:48,040
UNTIL WE UNDERSTAND BETTER

4031
02:14:48,040 --> 02:14:49,640
REPORT BETTER PHYSIOLOGY, HOW DO

4032
02:14:49,640 --> 02:14:50,880
WE THEN UNDERSTAND THE

4033
02:14:50,880 --> 02:14:51,520
TRANSPOPULATION.

4034
02:14:51,520 --> 02:14:53,160
SO IT'S REALLY STARTING AT THE

4035
02:14:53,160 --> 02:14:53,520
BASICS.

4036
02:14:53,520 --> 02:14:54,440
WE DON'T HAVE THAT YET.

4037
02:14:54,440 --> 02:14:56,320
SO IT DOESN'T MEAN WE CAN'T WORK

4038
02:14:56,320 --> 02:14:58,080
WITH LOOKING AT CIS AND

4039
02:14:58,080 --> 02:14:59,120
TRANSGENDER POPULATIONS IN

4040
02:14:59,120 --> 02:14:59,640
PARALLEL.

4041
02:14:59,640 --> 02:15:01,160
BUT WE NEED TO DO A WHOLE LOT

4042
02:15:01,160 --> 02:15:03,480
BETTER IN REPORTING DATA JUST

4043
02:15:03,480 --> 02:15:04,520
BASED ON CHROMOSOMES AT THIS

4044
02:15:04,520 --> 02:15:06,560
POINT.

4045
02:15:06,560 --> 02:15:07,920
>> DR. CLARE DID YOU WANT TO

4046
02:15:07,920 --> 02:15:09,320
RESPOND TO THAT QUESTION?

4047
02:15:09,320 --> 02:15:10,080
>> YES.

4048
02:15:10,080 --> 02:15:12,840
I THIS I SOME OF THE STRATEGIES

4049
02:15:12,840 --> 02:15:14,600
IS ONE IN THE ELECTRONIC MEDICAL

4050
02:15:14,600 --> 02:15:19,920
REPORT CAPTURING THAT SOGI DATA,

4051
02:15:19,920 --> 02:15:21,240
SEXUAL ORIENTATION GENDER

4052
02:15:21,240 --> 02:15:22,200
IDENTITY IS CRITICAL.

4053
02:15:22,200 --> 02:15:23,760
NOT ALL SYSTEMS CAPTURE THAT, IT

4054
02:15:23,760 --> 02:15:26,320
IS PRETTY GOOD ONE EXAMPLE, THE

4055
02:15:26,320 --> 02:15:27,800
OTHER THING IS AT THE LEVEL OF

4056
02:15:27,800 --> 02:15:30,000
MEDICAL EDUCATION, AS I KNOW DR.

4057
02:15:30,000 --> 02:15:32,040
SIMON HAS DONE WORK IN THIS

4058
02:15:32,040 --> 02:15:35,560
AREA, AS WELL, LOOKING AT

4059
02:15:35,560 --> 02:15:39,640
CURRICULUM AND JUST EDUCATING

4060
02:15:39,640 --> 02:15:40,760
LEARNERS ON GETTING MORE

4061
02:15:40,760 --> 02:15:42,440
COMFORTABLE IN EVALUATING

4062
02:15:42,440 --> 02:15:44,960
PATIENTS THAT ARE NOT CIS GENDER

4063
02:15:44,960 --> 02:15:47,520
PATIENTS, FROM A CURRICULUM

4064
02:15:47,520 --> 02:15:48,200
PERSPECTIVE.

4065
02:15:48,200 --> 02:15:50,880
SO WORK NEEDS TO BE DONE, MANY

4066
02:15:50,880 --> 02:15:55,280
ORGANIZATIONS ARE MOVING GENDER

4067
02:15:55,280 --> 02:15:56,880
NEUTRAL LANGUAGE AS WELL SO

4068
02:15:56,880 --> 02:15:57,920
SPEAKING ABOUT GIRLS IN THIS

4069
02:15:57,920 --> 02:15:59,000
PARTICULAR PANEL BEING AWARE OF

4070
02:15:59,000 --> 02:16:00,720
GENDER IDENTITIES AND THAT WILL

4071
02:16:00,720 --> 02:16:04,120
SPECTRUM IS CRITICAL AS AUDIENCE

4072
02:16:04,120 --> 02:16:07,320
MEMBER MENTIONED SO REALLY

4073
02:16:07,320 --> 02:16:09,440
IMPORTANT POINT TO ELUCIDATE.

4074
02:16:09,440 --> 02:16:12,120
>> THANK YOU SO MUCH, DR. CLARE

4075
02:16:12,120 --> 02:16:17,440
FOR RESPONDING TO THAT.

4076
02:16:17,440 --> 02:16:20,720
>> CAN I JUST ADD TO THAT,

4077
02:16:20,720 --> 02:16:22,440
MEDICAL LITERATURE, SEX AND

4078
02:16:22,440 --> 02:16:27,560
GENDER ARE VERY, VERY OFTEN

4079
02:16:27,560 --> 02:16:29,440
CONFLATED OR CONFUSED SO THAT IS

4080
02:16:29,440 --> 02:16:32,440
SOMETHING THAT WE WOULD LIKE TO

4081
02:16:32,440 --> 02:16:34,720
SEE DONE BETTER ACROSS THE

4082
02:16:34,720 --> 02:16:35,200
BOARD.

4083
02:16:35,200 --> 02:16:38,640
THERE ARE CERTAIN GROUPS WORKING

4084
02:16:38,640 --> 02:16:42,880
ON REPRODUCIBLE DATA CAPTURE FOR

4085
02:16:42,880 --> 02:16:44,200
GENDER WHICH IS NECESSARY TO

4086
02:16:44,200 --> 02:16:46,640
EVEN BEGIN TO ADDRESS SOME OF

4087
02:16:46,640 --> 02:16:48,440
THE SEX AND GENDER DIFFERENCES

4088
02:16:48,440 --> 02:16:50,880
IN OUR POPULATION HEALTH.

4089
02:16:50,880 --> 02:16:53,720
THE LAST THING TO ADD IS THAT

4090
02:16:53,720 --> 02:16:57,160
THE OFFICE RESEARCH WOMEN'S

4091
02:16:57,160 --> 02:17:00,200
HEALTH HAS NOTICE OF SPECIAL

4092
02:17:00,200 --> 02:17:01,800
INTEREST SUPPLEMENT PROGRAM THAT

4093
02:17:01,800 --> 02:17:04,120
IS LOOKING AT UNDERSERVED

4094
02:17:04,120 --> 02:17:05,360
UNDER-REPRESENTED

4095
02:17:05,360 --> 02:17:06,320
UNDERRESEARCHED COMMUNITIES.

4096
02:17:06,320 --> 02:17:08,880
I JUST PUT THAT TO THE CHAT

4097
02:17:08,880 --> 02:17:11,760
BECAUSE WE ARE VERY INTERESTED

4098
02:17:11,760 --> 02:17:13,320
IN SEEING APPLICATIONS FOR

4099
02:17:13,320 --> 02:17:14,800
RESEARCH RELATED TO THESE

4100
02:17:14,800 --> 02:17:18,480
TOPICS.

4101
02:17:18,480 --> 02:17:22,120
>> THANK YOU SO MUCH DR. TEMKIN

4102
02:17:22,120 --> 02:17:22,720
FOR THAT RESPONSE.

4103
02:17:22,720 --> 02:17:27,000
I WANTED TO PUT THIS QUESTION TO

4104
02:17:27,000 --> 02:17:30,520
THE PANELISTS INCLUDING YOU, DR.

4105
02:17:30,520 --> 02:17:31,120
TEMKIN.

4106
02:17:31,120 --> 02:17:32,920
HOW WILL MORE PERSPECTIVE

4107
02:17:32,920 --> 02:17:34,480
RESEARCH ESPECIALLY OR

4108
02:17:34,480 --> 02:17:36,280
SPECIFICALLY LONGITUDINAL

4109
02:17:36,280 --> 02:17:38,240
COHORTS IN RANDOMIZED CLINICAL

4110
02:17:38,240 --> 02:17:43,160
TRIALS BE USEFUL TO PROVIDE

4111
02:17:43,160 --> 02:17:43,960
DEFINSIVE EVIDENCE

4112
02:17:43,960 --> 02:17:47,200
MULTI-MORBIDITY ON WOMEN AND

4113
02:17:47,200 --> 02:17:49,280
GIRLS?

4114
02:17:49,280 --> 02:17:51,040
DR. TEMKIN DO YOU WANT TO

4115
02:17:51,040 --> 02:17:51,280
RESPOND?

4116
02:17:51,280 --> 02:17:52,800
>> ONE THING WE DISCOVERED IN

4117
02:17:52,800 --> 02:17:54,600
PREPARING FOR THE WOMEN'S HEALTH

4118
02:17:54,600 --> 02:17:56,120
CONFERENCE THIS FALL WAS HOW

4119
02:17:56,120 --> 02:17:58,520
LITTLE DATA THERE IS THAT'S AS

4120
02:17:58,520 --> 02:18:00,120
WE HAVE BEEN TALKING ABOUT

4121
02:18:00,120 --> 02:18:02,120
DISAGGREGATED BY SEX AND GENDER

4122
02:18:02,120 --> 02:18:05,480
IN THE MEDICAL LITERATURE ON

4123
02:18:05,480 --> 02:18:07,720
CHRONIC CONDITIONS AND ON

4124
02:18:07,720 --> 02:18:08,720
MULTI-MORBIDITY.

4125
02:18:08,720 --> 02:18:10,760
WE KNOW THAT WOMEN HAVE MORE

4126
02:18:10,760 --> 02:18:12,080
CHRONIC CONDITIONS THAN MEN THAT

4127
02:18:12,080 --> 02:18:14,640
THEY HAVE MORE MULTI-MORBIDITY

4128
02:18:14,640 --> 02:18:16,280
THAN MEN.

4129
02:18:16,280 --> 02:18:19,440
WE DON'T EVEN -- I THINK ONE OF

4130
02:18:19,440 --> 02:18:22,800
THE OTHER THINGS DR. TEMPLETON

4131
02:18:22,800 --> 02:18:26,120
HAVE BEEN TALKING ABOUT IS

4132
02:18:26,120 --> 02:18:27,080
ACCUMULATION OF MORBIDITY IN

4133
02:18:27,080 --> 02:18:28,320
WOMEN, AND HOW IT'S DIFFERENT

4134
02:18:28,320 --> 02:18:31,000
FROM THE ACCUMULATION OF

4135
02:18:31,000 --> 02:18:32,280
MORBIDITY IN MEN.

4136
02:18:32,280 --> 02:18:36,560
WOMEN HAVE DELAYS IN DIAGNOSIS,

4137
02:18:36,560 --> 02:18:37,480
THEY HAVE DIFFERENT PROBLEMS

4138
02:18:37,480 --> 02:18:39,040
WITH ACCESS TO CARE AND ALL

4139
02:18:39,040 --> 02:18:40,920
THOSE THINGS ACCUMULATE.

4140
02:18:40,920 --> 02:18:44,560
I THINK PROSPECTIVELY STUDYING

4141
02:18:44,560 --> 02:18:46,920
THESE ISSUES IN WOMEN CAN GIVE

4142
02:18:46,920 --> 02:18:48,560
US DATA REGARDING HOW TO FIX

4143
02:18:48,560 --> 02:18:51,720
SOME OF THESE PROBLEMS.

4144
02:18:51,720 --> 02:18:53,760
>> THANK YOU, DR. TEMKIN, ANYONE

4145
02:18:53,760 --> 02:18:54,480
ELSE WANT TO RESPOND TO THAT

4146
02:18:54,480 --> 02:18:56,120
QUESTION?

4147
02:18:56,120 --> 02:18:58,440
>> DR. TEMKIN'S TOTALLY RIGHT.

4148
02:18:58,440 --> 02:19:01,520
THE DESIGN OF THE FUNDING

4149
02:19:01,520 --> 02:19:03,840
OPPORTUNITY YOU ALL FOR EXAMPLE

4150
02:19:03,840 --> 02:19:07,920
AT NIH DO, IS SO CRITICAL.

4151
02:19:07,920 --> 02:19:10,040
I UNDERLINE AND BOLD AND

4152
02:19:10,040 --> 02:19:11,320
CAPITALIZE SO CRITICAL.

4153
02:19:11,320 --> 02:19:14,520
TO HOW WE AS SCIENCE, SCIENTISTS

4154
02:19:14,520 --> 02:19:16,000
RESEARCH ASSEMBLE THE RESEARCH

4155
02:19:16,000 --> 02:19:18,440
TEAM, COMMUNITY PARTNER ASSEMBLE

4156
02:19:18,440 --> 02:19:20,120
COMMUNITY PARTNERS, CENTER ALL

4157
02:19:20,120 --> 02:19:22,720
THOSE VOICES.

4158
02:19:22,720 --> 02:19:24,360
THIS THAT IS SO CRITICAL.

4159
02:19:24,360 --> 02:19:26,120
HOW YOU DESIGN THE FUNDING

4160
02:19:26,120 --> 02:19:30,000
OPPORTUNITY ANNOUNCEMENT IS HOW

4161
02:19:30,000 --> 02:19:31,680
THE SCIENTIFIC TEAM WILL APPLY

4162
02:19:31,680 --> 02:19:32,720
FOR THE OPPORTUNITY.

4163
02:19:32,720 --> 02:19:34,280
AND WILL THEN DESIGN THAT

4164
02:19:34,280 --> 02:19:36,560
PROTOCOL OR THE RESEARCH METHODS

4165
02:19:36,560 --> 02:19:39,680
AND APPROACHES TO MEET THE

4166
02:19:39,680 --> 02:19:41,360
REQUIREMENTS OF THAT FUNDING

4167
02:19:41,360 --> 02:19:41,920
OPPORTUNITY.

4168
02:19:41,920 --> 02:19:44,160
GO BACK TO THAT PIPELINE

4169
02:19:44,160 --> 02:19:46,400
PICTURE, THAT I FLASHED UP ON MY

4170
02:19:46,400 --> 02:19:48,280
SCREEN DURING MY TALK, IT IS

4171
02:19:48,280 --> 02:19:49,840
CRITICAL AND IS REALLY -- I

4172
02:19:49,840 --> 02:19:51,520
CAN'T EMPHASIZE THAT MORE.

4173
02:19:51,520 --> 02:19:53,280
>> WE HEAR YOU, DR. SIMON.

4174
02:19:53,280 --> 02:19:55,360
WE DO HEAR YOU AND I WANT TO ADD

4175
02:19:55,360 --> 02:19:58,800
THAT IT'S REALLY IMPORTANT FOR

4176
02:19:58,800 --> 02:20:00,480
WHEN WE PUT OUT REQUEST FOR

4177
02:20:00,480 --> 02:20:02,120
INFORMATION, WHEN WE ARE

4178
02:20:02,120 --> 02:20:03,680
DEVELOPING NEW STRATEGIC PLANS

4179
02:20:03,680 --> 02:20:06,880
THAT WE HEAR FROM YOU FORMALLY,

4180
02:20:06,880 --> 02:20:10,360
AT NIH RESPOND TO THOSE RFIs,

4181
02:20:10,360 --> 02:20:11,400
RESPOND TO THOSE OPPORTUNITIES

4182
02:20:11,400 --> 02:20:13,320
TO HAVE YOUR VOICE HEARD AS AN

4183
02:20:13,320 --> 02:20:16,720
ASSOCIATION, AS A CITIZEN, AS A

4184
02:20:16,720 --> 02:20:18,200
PATIENT, THAT INFORMATION MAKES

4185
02:20:18,200 --> 02:20:18,600
A DIFFERENCE.

4186
02:20:18,600 --> 02:20:20,800
I WANT TO MAKE SURE FOLKS KNOW

4187
02:20:20,800 --> 02:20:22,800
ABOUT THOSE OPPORTUNITIES.

4188
02:20:22,800 --> 02:20:24,600
>> THANK YOU, DR. CLAYTON SO

4189
02:20:24,600 --> 02:20:26,720
MUCH FOR RESPONDING TO THAT

4190
02:20:26,720 --> 02:20:27,520
QUESTION.

4191
02:20:27,520 --> 02:20:28,520
HERE IS ANOTHER FROM THE

4192
02:20:28,520 --> 02:20:30,720
AUDIENCE, HOW DO WE WORK THROUGH

4193
02:20:30,720 --> 02:20:31,720
DISPARITIES OF TREATMENT OPTIONS

4194
02:20:31,720 --> 02:20:34,080
SUCH AS BREAST CANCER

4195
02:20:34,080 --> 02:20:35,440
MEDICATION, THAT ARE PRESENTED

4196
02:20:35,440 --> 02:20:38,040
ON TELEVISION COMMERCIALS.

4197
02:20:38,040 --> 02:20:39,520
THE PHYSICIAN SEES THE TREATMENT

4198
02:20:39,520 --> 02:20:41,360
AS VIABLE OPTIONS BUT INSURANCE

4199
02:20:41,360 --> 02:20:41,880
DENIES PAYMENT.

4200
02:20:41,880 --> 02:20:48,360
THIS IS MORE OF A FINANCING

4201
02:20:48,360 --> 02:20:53,080
MEDICATION QUESTION H. DOES

4202
02:20:53,080 --> 02:20:53,720
ANYONE WANT TO RESPOND TO THAT

4203
02:20:53,720 --> 02:20:54,240
LAST ONE?

4204
02:20:54,240 --> 02:20:56,800
>> COMES BACK TO CIVIC

4205
02:20:56,800 --> 02:20:58,800
ENGAGEMENT WHO WE ELECT AS

4206
02:20:58,800 --> 02:20:59,880
LEADERS, THE WHOLE SYSTEM NEEDS

4207
02:20:59,880 --> 02:21:00,720
TO BE INFLUENCED.

4208
02:21:00,720 --> 02:21:02,320
SO WHO IS CREATING THOSE

4209
02:21:02,320 --> 02:21:05,960
POLICIES AND PRACTICES, WHO IS

4210
02:21:05,960 --> 02:21:07,320
CREATING HEALTHCARE, SYSTEMS FOR

4211
02:21:07,320 --> 02:21:10,440
THE UNITED STATES, OF AMERICA,

4212
02:21:10,440 --> 02:21:13,320
THOSE ALL IMPACT THEN THE

4213
02:21:13,320 --> 02:21:14,680
DISPARITY IN TREATMENT

4214
02:21:14,680 --> 02:21:17,560
AVAILABLE, HOW ARE PHARMA

4215
02:21:17,560 --> 02:21:18,080
REGULATED.

4216
02:21:18,080 --> 02:21:21,080
IS THE SAME THING WITH RESPECT

4217
02:21:21,080 --> 02:21:22,520
TO COVID VACCINATION, HOW THAT

4218
02:21:22,520 --> 02:21:25,120
WAS DEVELOPED AND HOW THAT WAS

4219
02:21:25,120 --> 02:21:28,240
THEN DISTRIBUTED IN TERMS OF THE

4220
02:21:28,240 --> 02:21:29,560
PHASED SYSTEM SO ALL THESE

4221
02:21:29,560 --> 02:21:31,320
POLICIES PRACTICES AND THE

4222
02:21:31,320 --> 02:21:33,120
SYSTEMS LOOKING AT THE TREE AND

4223
02:21:33,120 --> 02:21:35,600
WHERE IT IS BENT IS CRITICAL.

4224
02:21:35,600 --> 02:21:37,920
BEING EMPOWERED TO ASK THE RIGHT

4225
02:21:37,920 --> 02:21:39,520
QUESTIONS ABOUT WHY IS TREE BENT

4226
02:21:39,520 --> 02:21:42,600
AND HOW CAN WE CHANGE THAT.

4227
02:21:42,600 --> 02:21:44,200
>> I LOVE THAT METAPHOR, DR.

4228
02:21:44,200 --> 02:21:44,680
SIMON.

4229
02:21:44,680 --> 02:21:45,920
ON THAT RESPONSE WE ARE GOING TO

4230
02:21:45,920 --> 02:21:46,360
CLOSE THIS SESSION.

4231
02:21:46,360 --> 02:21:48,160
WE ARE AT TIME.

4232
02:21:48,160 --> 02:21:50,840
THANK YOU TO ALL THE PANELIST,

4233
02:21:50,840 --> 02:21:52,800
THUS FAR, ALL THE SPEAKERS, THEY

4234
02:21:52,800 --> 02:21:54,520
HAVE BEEN VERY INVIGORATING.

4235
02:21:54,520 --> 02:21:55,760
AUDIENCE PLEASE STAY WITH US AS

4236
02:21:55,760 --> 02:21:59,600
WE MOVE INTO OUR NEXT SESSION.

4237
02:21:59,600 --> 02:22:00,680
THANK YOU.

4238
02:22:00,680 --> 02:22:04,080
>> THANK YOU VERY MUCH.

4239
02:22:04,080 --> 02:22:07,600
>> I WOULD LIKE TO ECHO TAMARA'S

4240
02:22:07,600 --> 02:22:10,280
SENTIMENTS THANKS TO SESSION 1

4241
02:22:10,280 --> 02:22:11,320
PANELISTS AND NIH LEADERS WHO

4242
02:22:11,320 --> 02:22:12,560
KICKED OFF WORKSHOP.

4243
02:22:12,560 --> 02:22:13,920
MANY INTRIGUING POINTS WERE

4244
02:22:13,920 --> 02:22:15,520
RAISED ABOUT BARRIERS TO CARE

4245
02:22:15,520 --> 02:22:16,880
FOR WOMEN AND GIRLS INCLUDING

4246
02:22:16,880 --> 02:22:19,000
SYSTEMIC ISSUES, HIGHLIGHTING

4247
02:22:19,000 --> 02:22:21,240
HOW INEQUITIES MEDICAL

4248
02:22:21,240 --> 02:22:22,560
LEADERSHIP FOR WOMEN PHYSICIANS

4249
02:22:22,560 --> 02:22:24,400
CONTRIBUTE TO LOWER ACCESS TO

4250
02:22:24,400 --> 02:22:25,440
QUALITY CARE.

4251
02:22:25,440 --> 02:22:27,440
AND HOW PAYER POLICIES CAN BE

4252
02:22:27,440 --> 02:22:29,080
BARRIER TO INTEGRATED HEALTH

4253
02:22:29,080 --> 02:22:30,840
SYSTEMS FOR ADDRESSING

4254
02:22:30,840 --> 02:22:31,760
CO-MORBIDITIES.

4255
02:22:31,760 --> 02:22:32,760
ADDITIONALLY WE HEARD SEVERAL

4256
02:22:32,760 --> 02:22:34,920
TALKS HIGHLIGHTING MANY

4257
02:22:34,920 --> 02:22:36,120
CONDITIONS WITH HIGHER

4258
02:22:36,120 --> 02:22:37,120
PREVALENCE AND HEALTHCARE

4259
02:22:37,120 --> 02:22:39,360
DISPARITIES FOR WOMEN AND GIRLS.

4260
02:22:39,360 --> 02:22:41,720
I WOULD ASK WE CONTINUE TO THINK

4261
02:22:41,720 --> 02:22:42,840
ABOUT ALL THESE AS WE GO THROUGH

4262
02:22:42,840 --> 02:22:46,560
THE REMAINING SESSIONS TO FIND

4263
02:22:46,560 --> 02:22:48,440
UNIFYING THEMES WHERE WE CAN

4264
02:22:48,440 --> 02:22:49,920
FIND OPPORTUNITIES FOR ACTION. 

4265
02:22:49,920 --> 02:22:51,360
AT THIS TIME ON OUR SCHEDULE WE

4266
02:22:51,360 --> 02:22:53,520
ARE SCHEDULED TO TAKE A SHORT

4267
02:22:53,520 --> 02:22:53,840
BREAK.

4268
02:22:53,840 --> 02:22:56,080
WE'LL HAVE A TIMER PUT UP ON THE

4269
02:22:56,080 --> 02:22:57,840
SCREEN AND WE ASK YOU TO COME

4270
02:22:57,840 --> 02:23:01,000
BACK FOR SESSION 2.

4271
02:23:01,000 --> 02:23:02,360
>> WELCOME BACK FOR THE SECOND

4272
02:23:02,360 --> 02:23:03,600
SESSION FOR THE WORKSHOP IN

4273
02:23:03,600 --> 02:23:04,680
BILLING UNIFYING SYSTEMS OF

4274
02:23:04,680 --> 02:23:07,720
CARE.

4275
02:23:07,720 --> 02:23:08,960
ADDRESSING CO-MORBIDITIES FOR

4276
02:23:08,960 --> 02:23:10,120
WOMEN AN GIRLS.

4277
02:23:10,120 --> 02:23:11,760
THIS SESSION AND COMPONENT OF

4278
02:23:11,760 --> 02:23:12,440
INTEGRATIVE HEALTHCARE SYSTEMS

4279
02:23:12,440 --> 02:23:13,960
FOR WOMEN AND GIRLS WILL BE

4280
02:23:13,960 --> 02:23:15,480
MODERATED BY ONE WORKSHOP

4281
02:23:15,480 --> 02:23:17,280
CO-CHAIRS, DR. JENNIFER JOHNSON.

4282
02:23:17,280 --> 02:23:19,680
WHO IS A CLINICAL PSYCHOLOGIST

4283
02:23:19,680 --> 02:23:21,960
AND ECS ENDOWED PROFESSOR OF

4284
02:23:21,960 --> 02:23:26,080
PUBLIC HEALTH, AND PROFESSOR OF

4285
02:23:26,080 --> 02:23:28,800
OBGYN, PROFESSOR PSYCHIATRY

4286
02:23:28,800 --> 02:23:29,880
BEHAVIORAL MEDICINE MICHIGAN

4287
02:23:29,880 --> 02:23:30,640
STATE UNIVERSITY.

4288
02:23:30,640 --> 02:23:33,640
HER EXPERTISE IS IMPLEMENTATION

4289
02:23:33,640 --> 02:23:34,960
AND EFFECTIVENESS TRIALS OF

4290
02:23:34,960 --> 02:23:36,800
MENTAL HEALTH SUBSTANCE USE

4291
02:23:36,800 --> 02:23:38,040
INTERVENTIONS FOR VULNERABLE

4292
02:23:38,040 --> 02:23:40,480
POPULATION INCLUDING PERINATAL

4293
02:23:40,480 --> 02:23:42,400
WOMEN AND INDIVIDUALS INVOLVED

4294
02:23:42,400 --> 02:23:43,880
IN THE CRIMINAL JUSTICE SYSTEM.

4295
02:23:43,880 --> 02:23:44,880
AT THIS TIME I WOULD LIKE TO

4296
02:23:44,880 --> 02:23:46,240
TURN OVER THE WORKSHOP TO DR.

4297
02:23:46,240 --> 02:23:48,800
JOHNSON.  

4298
02:23:48,800 --> 02:23:49,920
>> THANK YOU VERY MUCH.

4299
02:23:49,920 --> 02:23:52,560
LET ME INTRODUCE OUR OTHER TWO

4300
02:23:52,560 --> 02:23:53,880
SPEAKERS AT THE BEGINNING AND

4301
02:23:53,880 --> 02:23:56,320
THEN WE CAN MOVE THROUGH OUR

4302
02:23:56,320 --> 02:23:59,760
FIRST SPEAKER WILL BE DR. AMY

4303
02:23:59,760 --> 02:24:00,120
BOARD.

4304
02:24:00,120 --> 02:24:02,920
HEALTH SCIENTIST WITH PRE-NATAL

4305
02:24:02,920 --> 02:24:05,520
SUBSTANCE I EXPOSURE

4306
02:24:05,520 --> 02:24:06,480
SURVEILLANCE RESEARCH TEAM AT

4307
02:24:06,480 --> 02:24:10,280
THE CDC.

4308
02:24:10,280 --> 02:24:12,080
AND HER FOCUS IS ON SCREENING

4309
02:24:12,080 --> 02:24:13,720
AND INTERVENTION SERVICES ON

4310
02:24:13,720 --> 02:24:15,760
POLYSUBSTANCE USE IN PREGNANCY.

4311
02:24:15,760 --> 02:24:17,080
ONE INTERESTING FACT ABOUT HER

4312
02:24:17,080 --> 02:24:19,320
IS SHE HAS BACKGROUND IN SOCIAL

4313
02:24:19,320 --> 02:24:21,160
WORK WORK AS PROGRAM MANAGER FOR

4314
02:24:21,160 --> 02:24:23,440
REFUGEE RESETTLEMENT AGENCY.

4315
02:24:23,440 --> 02:24:26,080
OUR SECOND SPEAKER WILL BE DR.

4316
02:24:26,080 --> 02:24:28,800
STEVEN ONDERSMA PROFESSOR

4317
02:24:28,800 --> 02:24:30,360
DEPARTMENT OBGYN AN DIVISION

4318
02:24:30,360 --> 02:24:33,440
PUBLIC HEALTH MICHIGAN STATE

4319
02:24:33,440 --> 02:24:33,840
UNIVERSITY.

4320
02:24:33,840 --> 02:24:35,680
HE HIS PRIMARY INTEREST IS

4321
02:24:35,680 --> 02:24:37,640
POPULATION LEVEL INTERVENTION

4322
02:24:37,640 --> 02:24:39,200
PROMOTE MATERNAL CHILD HEALTH IN

4323
02:24:39,200 --> 02:24:40,680
UNDERSERVED COMMUNITIES

4324
02:24:40,680 --> 02:24:43,280
ESPECIALLY USING TECHNOLOGY,

4325
02:24:43,280 --> 02:24:46,080
INTERESTING FACT ABOUT HIM, HE

4326
02:24:46,080 --> 02:24:48,480
IS A SUPER NICE PERSON AND

4327
02:24:48,480 --> 02:24:51,680
FANTASTIC COLLEAGUE, GREAT TO BE

4328
02:24:51,680 --> 02:24:52,480
JOINED OUR DEPARTMENT ABOUT A

4329
02:24:52,480 --> 02:24:53,960
YEAR AGO AND HAS BEEN FANTASTIC

4330
02:24:53,960 --> 02:24:54,480
TO HAVE HIM.

4331
02:24:54,480 --> 02:24:56,320
SO WE'LL JUST GO RIGHT THROUGH

4332
02:24:56,320 --> 02:25:00,760
IN ORDER, DR. BOARD, ONDERSMA

4333
02:25:00,760 --> 02:25:01,920
AND THEN WE WILL SAVE ALL

4334
02:25:01,920 --> 02:25:03,400
QUESTIONS FOR THE 20 MINUTES AT

4335
02:25:03,400 --> 02:25:21,080
THE END.

4336
02:25:21,080 --> 02:25:24,200
>> THANK YOU SO MUCH.

4337
02:25:24,200 --> 02:25:25,320
GOOD AFTERNOON, EVERYONE.

4338
02:25:25,320 --> 02:25:27,480
THANK YOU SO MUCH FOR THE

4339
02:25:27,480 --> 02:25:29,160
OPPORTUNITY TO PRESENT TODAY.

4340
02:25:29,160 --> 02:25:31,080
I'M GOING TO TALK ABOUT THE WORK

4341
02:25:31,080 --> 02:25:33,600
THAT CDC IS GOING RELATED TO

4342
02:25:33,600 --> 02:25:35,280
SURVEILLANCE, PREVENTION, IN

4343
02:25:35,280 --> 02:25:36,400
SCREENING AND BRIEF INTERVENTION

4344
02:25:36,400 --> 02:25:38,800
TO REDUCE ALCOHOL AND OTHER

4345
02:25:38,800 --> 02:25:42,480
SUBSTANCE USE DURING PREGNANCY.

4346
02:25:42,480 --> 02:25:44,760
SO FIRST I WOULD LIKE TO PROVIDE

4347
02:25:44,760 --> 02:25:47,200
A BRIEF OVERVIEW OF SURVEILLANCE

4348
02:25:47,200 --> 02:25:50,280
DATA RELATED TO ADULT ALCOHOL

4349
02:25:50,280 --> 02:25:52,480
USE AND BING DRINKING INCLUDING

4350
02:25:52,480 --> 02:25:56,880
ALCOHOL AN AND OTHER SUBSTANCE
USE

4351
02:25:56,880 --> 02:25:57,760
DURING PREGNANCY.

4352
02:25:57,760 --> 02:25:59,280
SUBSTANCE USE IN PREGNANCY HAVE

4353
02:25:59,280 --> 02:26:00,480
NEGATIVE EFFECTS ON PREGNANT

4354
02:26:00,480 --> 02:26:03,520
PERSON AND THE DEVELOPING BABY.

4355
02:26:03,520 --> 02:26:05,000
ALCOHOL USE DURING PREGNANCY CAN

4356
02:26:05,000 --> 02:26:07,400
CAUSE A RANGE OF LIFE LONG BIRTH

4357
02:26:07,400 --> 02:26:08,840
DEFECTS AND DEVELOPMENTAL

4358
02:26:08,840 --> 02:26:10,200
DISABILITIES AND MIGHT INCREASE

4359
02:26:10,200 --> 02:26:12,480
RISK FOR MISCARRIAGE AND

4360
02:26:12,480 --> 02:26:13,080
STILLBIRTH.

4361
02:26:13,080 --> 02:26:15,040
THESE DISABILITIES ARE KNOWN AS

4362
02:26:15,040 --> 02:26:17,320
FETAL ALCOHOL SPECTRUM

4363
02:26:17,320 --> 02:26:18,080
DISORDERS.

4364
02:26:18,080 --> 02:26:19,320
SMOKING DURING PREGNANCY

4365
02:26:19,320 --> 02:26:21,560
INCREASES THE RISK OF PRE-TERM

4366
02:26:21,560 --> 02:26:24,080
BIRTH, LOW BIRTH WEIGHT, AND

4367
02:26:24,080 --> 02:26:25,360
ORAL FACIAL COLLAPSE.

4368
02:26:25,360 --> 02:26:26,840
SMOKING DURING AND AFTER

4369
02:26:26,840 --> 02:26:29,600
PREGNANCY ALSO INCREASES RISK OF

4370
02:26:29,600 --> 02:26:30,880
SUDDEN INFANT DEATH SYNDROME.

4371
02:26:30,880 --> 02:26:40,880
IN I A DIVISION eCIGARETTE
eCIGARETTES ARE
 NOT SAFE IN

4372
02:26:40,880 --> 02:26:41,800
PREGNANCY.

4373
02:26:41,800 --> 02:26:43,440
OPIOID USE DURING PREGNANCY IS

4374
02:26:43,440 --> 02:26:46,680
LINKED TO POOR FETAL GROWTH,

4375
02:26:46,680 --> 02:26:48,880
PRE-TERM BIRTH, STILLBIRTH

4376
02:26:48,880 --> 02:26:51,000
SELECTED BIRTH DETECTS AND

4377
02:26:51,000 --> 02:26:55,320
NEONATAL ABSTINENCE SYNDROME OR

4378
02:26:55,320 --> 02:26:56,480
NAS.

4379
02:26:56,480 --> 02:26:58,360
CDC PUBLISHED A REPORT THAT

4380
02:26:58,360 --> 02:27:00,600
EXAMINED BEHAVIORAL RISK FACTOR

4381
02:27:00,600 --> 02:27:01,880
SUR VASE LENS SYSTEM DATA FROM

4382
02:27:01,880 --> 02:27:03,680
2011 TO 2018.

4383
02:27:03,680 --> 02:27:06,080
WE FOUND THAT BOTH CURRENT

4384
02:27:06,080 --> 02:27:07,840
ALCOHOL USE AND BINGE DRINKING

4385
02:27:07,840 --> 02:27:09,480
THE LAST 30 DAYS INCREASED

4386
02:27:09,480 --> 02:27:11,280
SLIGHTLY AMONG PREGNANT WOMEN

4387
02:27:11,280 --> 02:27:12,600
AGE 18 TO 44 YEARS IN THE UNITED

4388
02:27:12,600 --> 02:27:14,680
STATES.

4389
02:27:14,680 --> 02:27:18,080
CURRENT DRINKING INCREASED FROM

4390
02:27:18,080 --> 02:27:22,360
9.2% TO 11.3%, BINGE DRINKING

4391
02:27:22,360 --> 02:27:26,760
FROM 2.5% TO 4.0%.

4392
02:27:26,760 --> 02:27:28,440
CDC ALSO ANALYZED NATIONAL

4393
02:27:28,440 --> 02:27:30,400
SURVEY ON DRUG USE AN HEALTH

4394
02:27:30,400 --> 02:27:32,480
DATA FROM PREGNANT RESPONDENTS

4395
02:27:32,480 --> 02:27:35,440
12 TO 44 YEARS OF AGE FROM 2015

4396
02:27:35,440 --> 02:27:37,800
TO 2018.

4397
02:27:37,800 --> 02:27:40,760
WE LOOKED AT PAST 30 DAY

4398
02:27:40,760 --> 02:27:42,040
CO-OCCURRING USE OF OTHER

4399
02:27:42,040 --> 02:27:43,360
SUBSTANCES AMONG RESPONSE DENS

4400
02:27:43,360 --> 02:27:45,400
WHO DRANK ALCOHOL.

4401
02:27:45,400 --> 02:27:47,520
NEARLY 10% REPORTED PAST 30 DAY

4402
02:27:47,520 --> 02:27:49,000
DRINKING.

4403
02:27:49,000 --> 02:27:50,000
AMONG THOSE WHO REPORTED

4404
02:27:50,000 --> 02:27:53,200
DRINKING MANY THE PAST 30 DAYS,

4405
02:27:53,200 --> 02:27:56,240
40% REPORTED ALSO USING ONE OR

4406
02:27:56,240 --> 02:27:57,320
MORE OTHER SUBSTANCE.

4407
02:27:57,320 --> 02:27:59,200
THE MOST FREQUENTLY USED

4408
02:27:59,200 --> 02:28:00,440
SUBSTANCES OF ALCOHOL WERE

4409
02:28:00,440 --> 02:28:03,760
TOBACCO AND MARIJUANA AT 28% AND

4410
02:28:03,760 --> 02:28:05,400
21% RESPECTIVELY.

4411
02:28:05,400 --> 02:28:08,680
IN THE NEXT TWO SLIDES, I WILL

4412
02:28:08,680 --> 02:28:09,880
DIVE DEEPER INTO THE FINDINGS

4413
02:28:09,880 --> 02:28:18,000
FROM THOSE STUDY.

4414
02:28:18,000 --> 02:28:21,960
THIS GRAPH PAST 30 DAY BINGE

4415
02:28:21,960 --> 02:28:24,800
DRINKING HAVING FOUR OR MORE

4416
02:28:24,800 --> 02:28:27,560
DRINKS ON ONE OCCASION BY

4417
02:28:27,560 --> 02:28:29,800
TRIMESTER IN PREGNANCY.

4418
02:28:29,800 --> 02:28:31,880
RESPOND DENS IN FIRST TRIMESTER

4419
02:28:31,880 --> 02:28:33,280
REPORTED HIGHER PAST 30 DAY

4420
02:28:33,280 --> 02:28:35,080
DRINKING THAN RESPONDENTS IN

4421
02:28:35,080 --> 02:28:37,720
SECOND OR THIRD.

4422
02:28:37,720 --> 02:28:39,640
19.6% IN THEIR FIRST TRIMESTER

4423
02:28:39,640 --> 02:28:41,520
OF PREGNANCY REPORTED PAST 30

4424
02:28:41,520 --> 02:28:44,480
DAY DRINKING WHILE 10.5%

4425
02:28:44,480 --> 02:28:46,760
REPORTED PAST 30 DAY BINGE

4426
02:28:46,760 --> 02:28:47,040
DRINKING.

4427
02:28:47,040 --> 02:28:50,080
IN CONTRAST, 4.7% RESPONDENTS IN

4428
02:28:50,080 --> 02:28:52,600
THEIR SECOND OR THIRD TRIMESTER

4429
02:28:52,600 --> 02:28:55,120
PREGNANCY REPORTED PAST 30 DAY

4430
02:28:55,120 --> 02:28:58,720
DRINKING AND 1.4% REPORTED PAST

4431
02:28:58,720 --> 02:28:59,640
30 DAY BINGE DRINKING.

4432
02:28:59,640 --> 02:29:02,160
SO THESE FINDINGS SUGGEST THAT

4433
02:29:02,160 --> 02:29:03,920
RESPONDENTS DECREASE THEIR

4434
02:29:03,920 --> 02:29:05,160
ALCOHOL USE ONCE THEY KNEW THEY

4435
02:29:05,160 --> 02:29:08,720
WERE PREGNANT.

4436
02:29:08,720 --> 02:29:11,480
THESE PIE GRAPH THE SAME REPORT

4437
02:29:11,480 --> 02:29:13,320
ILLUSTRATE DISTRIBUTION OF PAST

4438
02:29:13,320 --> 02:29:15,680
12 MONTH, PAST 30 DAY DRINKING

4439
02:29:15,680 --> 02:29:17,360
ALONEND IN COMBINATION WITH

4440
02:29:17,360 --> 02:29:19,200
OTHER SUBSTANCES IN PREGNANT

4441
02:29:19,200 --> 02:29:21,680
RESPONDENTS.

4442
02:29:21,680 --> 02:29:24,800
NEARLY 65% RESPONDENTS REPORTED

4443
02:29:24,800 --> 02:29:26,280
PAST 12 MONTH DRINKING.

4444
02:29:26,280 --> 02:29:28,320
38% REPORTED DRINKING WITHOUT

4445
02:29:28,320 --> 02:29:30,680
USING OTHER SUBSTANCES AND 27%

4446
02:29:30,680 --> 02:29:32,680
REPORTED DRINKING AND USING ONE

4447
02:29:32,680 --> 02:29:35,720
OR MORE OTHER SUBSTANCE.

4448
02:29:35,720 --> 02:29:39,160
NEARLY 10% REPORTED PAST 30 DAY

4449
02:29:39,160 --> 02:29:40,880
DRINKING, 6% REPORTED DRINKING

4450
02:29:40,880 --> 02:29:43,160
WITHOUTIOUSING OTHER SUBSTANCES

4451
02:29:43,160 --> 02:29:45,480
AND 4% REPORTED DRINKING AND

4452
02:29:45,480 --> 02:29:47,880
USING ONE OR MORE OTHER

4453
02:29:47,880 --> 02:29:48,880
SUBSTANCES.

4454
02:29:48,880 --> 02:29:52,160
FOR BOTH PAST 12 MONTH AND PAST

4455
02:29:52,160 --> 02:29:53,040
30 DAY YOU, THE SUBSTANCES MOST

4456
02:29:53,040 --> 02:29:54,480
COMMONLY REPORTED AMONG THOSE

4457
02:29:54,480 --> 02:29:56,480
WHO REPORTED ALCOHOL USE WERE

4458
02:29:56,480 --> 02:30:03,000
TOBACCO AND MARIJUANA.

4459
02:30:03,000 --> 02:30:04,440
CDC MONITORS ALCOHOL USE AMONG

4460
02:30:04,440 --> 02:30:06,080
PEOPLE IN WOMEN AND REPRODUCTIVE

4461
02:30:06,080 --> 02:30:07,320
AGE AND FREQUENCY OF ALCOHOL

4462
02:30:07,320 --> 02:30:09,280
SCREENING AND BRIEF INTERVENTION

4463
02:30:09,280 --> 02:30:10,520
USING BOTH PATIENT AND PROVIDERS

4464
02:30:10,520 --> 02:30:12,400
DATA.

4465
02:30:12,400 --> 02:30:13,880
THERE ARE SEVERAL POPULATION

4466
02:30:13,880 --> 02:30:15,440
BASED PUBLIC USE DATA SETS

4467
02:30:15,440 --> 02:30:18,880
AVAILABLE THAT WE USE AS WELL AS

4468
02:30:18,880 --> 02:30:21,080
CONVENIENCE PANEL SURVEY.

4469
02:30:21,080 --> 02:30:22,960
THE BEHAVIORAL RISK FACTOR

4470
02:30:22,960 --> 02:30:26,160
SURVEILLANCE SYSTEM IS A HEALTH

4471
02:30:26,160 --> 02:30:27,920
RELATED SYSTEM SURVEY THAT

4472
02:30:27,920 --> 02:30:28,920
COLLECTS STATE SPECIFIC DATA

4473
02:30:28,920 --> 02:30:30,680
ABOUT U.S. RESIDENTS REGARDING

4474
02:30:30,680 --> 02:30:32,280
THEIR HEALTH RELATED RISK

4475
02:30:32,280 --> 02:30:33,400
BEHAVIORS CHRONIC HEALTH

4476
02:30:33,400 --> 02:30:35,120
CONDITIONS AND USE OF PREVENTIVE

4477
02:30:35,120 --> 02:30:38,560
SERVICES.

4478
02:30:38,560 --> 02:30:41,200
-- WAS ESTABLISHED IN 1984 WITH

4479
02:30:41,200 --> 02:30:41,840
15 STATES.

4480
02:30:41,840 --> 02:30:43,920
NOW COLLECTS DATA IN ALL 50

4481
02:30:43,920 --> 02:30:46,080
STATES AS WELL AS DISTRICT OF

4482
02:30:46,080 --> 02:30:47,080
COLUMBIA, AND THREE U.S.

4483
02:30:47,080 --> 02:30:50,280
TERRITORIES.

4484
02:30:50,280 --> 02:30:52,160
COMPLETES MORE THAN 400,000

4485
02:30:52,160 --> 02:30:54,400
ADULT INTERVIEWS EACH YEAR

4486
02:30:54,400 --> 02:30:56,240
MAKING IT THE LARGEST

4487
02:30:56,240 --> 02:30:58,120
CONTINUOUSLY CONDUCTED HEALTH

4488
02:30:58,120 --> 02:31:00,440
SURVEY SYSTEM IN THE WORLD.

4489
02:31:00,440 --> 02:31:01,880
THERE ARE ALCOHOL CONSUMPTION

4490
02:31:01,880 --> 02:31:04,400
QUESTIONS THAT ARE ASKED WITH

4491
02:31:04,400 --> 02:31:06,040
EVERY SURVEY AND ALSO ADDED

4492
02:31:06,040 --> 02:31:07,680
OPTIONAL MODULE FOCUSED ON

4493
02:31:07,680 --> 02:31:08,920
ALCOHOL SCREENING AN BRIEF

4494
02:31:08,920 --> 02:31:10,520
INTERVENTION.

4495
02:31:10,520 --> 02:31:11,680
INDIVIDUAL WHOSE REPORTED HAVING

4496
02:31:11,680 --> 02:31:13,200
A CHECK UP IN THE LAST TWO YEARS

4497
02:31:13,200 --> 02:31:14,880
WERE ASKED QUESTIONS ABOUT

4498
02:31:14,880 --> 02:31:16,440
WHETHER THEY WERE SCREENED AND

4499
02:31:16,440 --> 02:31:18,680
ADVISED ABOUT ALCOHOL USE DURING

4500
02:31:18,680 --> 02:31:20,040
THAT CLINICAL ENCOUNTER.

4501
02:31:20,040 --> 02:31:21,600
WE ARE FIELDING THE ALCOHOL

4502
02:31:21,600 --> 02:31:23,120
SCREENING AND BRIEF INTERVENTION

4503
02:31:23,120 --> 02:31:28,400
MODULE AGAIN MANY 2022 WITH 16

4504
02:31:28,400 --> 02:31:28,880
STATES.

4505
02:31:28,880 --> 02:31:30,800
WE ALSO LIKE DATA FROM SAMHSA

4506
02:31:30,800 --> 02:31:33,240
NATIONAL SURVEY ON DRUG USE AN

4507
02:31:33,240 --> 02:31:34,680
HEALTH AND ANNUAL NATIONALLY

4508
02:31:34,680 --> 02:31:36,480
REPRESENTATIVE SURVEY THAT ASKS

4509
02:31:36,480 --> 02:31:38,280
ABOUT WIDE RANGE OF SUBSTANCES,

4510
02:31:38,280 --> 02:31:42,080
INCLUDING ALCOHOL USE.

4511
02:31:42,080 --> 02:31:45,400
UNLIKE BFFS IN THIS STEP WE LOOK

4512
02:31:45,400 --> 02:31:46,640
AT USE BY TRIMESTER AT

4513
02:31:46,640 --> 02:31:47,480
PREGNANCY.

4514
02:31:47,480 --> 02:31:51,880
WE ALSO ANALYZE DATA FROM

4515
02:31:51,880 --> 02:31:52,760
PREGNANCY MONITORING SYSTEM

4516
02:31:52,760 --> 02:31:54,640
WHICH CAPTURES DATA FROM WOMEN

4517
02:31:54,640 --> 02:31:56,000
WHO DELIVERED LIVE BIRTH.

4518
02:31:56,000 --> 02:31:57,680
THERE IS A FOLLOW BACK SURVEY

4519
02:31:57,680 --> 02:32:00,120
FOCUSED ON OPIOIDS, AND AS AN

4520
02:32:00,120 --> 02:32:02,560
ADD ON WE ADDED QUESTIONS AROUND

4521
02:32:02,560 --> 02:32:05,120
ALCOHOL SCREENING AND BRIEF

4522
02:32:05,120 --> 02:32:05,840
INTERVENTION.

4523
02:32:05,840 --> 02:32:07,280
THE FOLLOW BACK VARY INCLUDES

4524
02:32:07,280 --> 02:32:09,720
DATA FROM PARTICIPANTS IN SEVEN

4525
02:32:09,720 --> 02:32:10,560
STATES.

4526
02:32:10,560 --> 02:32:12,680
FINALLY WE ANALYZE DOC STYLES

4527
02:32:12,680 --> 02:32:14,480
DATA WHICH IS A PANEL SURVEY AS

4528
02:32:14,480 --> 02:32:16,560
A CONVENIENCE SAMPLE OF

4529
02:32:16,560 --> 02:32:16,920
PHYSICIANS.

4530
02:32:16,920 --> 02:32:19,320
THIS PROVIDER DATA IS AN

4531
02:32:19,320 --> 02:32:20,880
IMPORTANT COMPLIMENT TO DATA

4532
02:32:20,880 --> 02:32:24,320
FROM PATIENTS THAT WE GET FROM

4533
02:32:24,320 --> 02:32:27,680
PRAMS.

4534
02:32:27,680 --> 02:32:29,280
SO NOW SURVEILLANCE DATA I WOULD

4535
02:32:29,280 --> 02:32:32,280
LIKE TO SHIFT GEAR AND TALK CDC

4536
02:32:32,280 --> 02:32:33,720
PROJECT RELATED TO PREVENTION OF

4537
02:32:33,720 --> 02:32:35,520
ALCOHOL AND OTHER SUBSTANCE USE

4538
02:32:35,520 --> 02:32:39,400
DURING PREGNANCY.

4539
02:32:39,400 --> 02:32:41,160
U.S. PREVENTATIVE SERVICES TASK

4540
02:32:41,160 --> 02:32:42,680
FORCE RECOMMENDS SCREENING FOR

4541
02:32:42,680 --> 02:32:44,280
UNHEALTHY ALCOHOL USE IN PRIMARY

4542
02:32:44,280 --> 02:32:46,600
CARE SETTINGS, IN ADULTS 18

4543
02:32:46,600 --> 02:32:48,360
YEARS OR OLDER INCLUDING

4544
02:32:48,360 --> 02:32:50,600
PREGNANT PEOPLE, AND PROVIDING

4545
02:32:50,600 --> 02:32:52,480
PERSONS ENGAGED IN RISKY OR

4546
02:32:52,480 --> 02:32:54,800
HAZARDOUS DRINKING WITH BRIEF

4547
02:32:54,800 --> 02:32:55,800
BEHAVIORAL COUNSELING

4548
02:32:55,800 --> 02:32:57,040
INTERVENTIONS TO REDUCE

4549
02:32:57,040 --> 02:32:59,440
UNHEALTHY ALCOHOL USE.

4550
02:32:59,440 --> 02:33:01,680
THE U.S. PREVENTIVE SERVICES

4551
02:33:01,680 --> 02:33:03,680
TASK FORCE ALSO RECOMMENDS THAT

4552
02:33:03,680 --> 02:33:06,120
CLINICIANS ASK ALL PREGNANCY

4553
02:33:06,120 --> 02:33:08,680
PEOPLE ABOUT TOBACCO USE, ADVICE

4554
02:33:08,680 --> 02:33:11,120
THEM TO STOP USING TOBACCO AN

4555
02:33:11,120 --> 02:33:12,240
PROVIDE BEHAVIORAL INTERVENTIONS

4556
02:33:12,240 --> 02:33:16,720
FOR CESSATION TO PREGNANT PEOPLE

4557
02:33:16,720 --> 02:33:18,440
TO USE TOBACCO.

4558
02:33:18,440 --> 02:33:20,200
MEDICATION FOR OPIOID USE

4559
02:33:20,200 --> 02:33:22,600
DISORDER DURING PREGNANCY LEAD

4560
02:33:22,600 --> 02:33:23,840
TO FAVORABLE OUTCOMES.

4561
02:33:23,840 --> 02:33:25,440
SO WHAT DOES THIS LOOK LIKE.

4562
02:33:25,440 --> 02:33:27,680
IN PRACTICE?

4563
02:33:27,680 --> 02:33:32,680
RECENT CDC FOUND 81% U.S. ADULTS

4564
02:33:32,680 --> 02:33:33,880
IN 13 STATES DISTRICT OF

4565
02:33:33,880 --> 02:33:35,640
COLUMBIA REPORTED BEING ASKED BY

4566
02:33:35,640 --> 02:33:37,560
HEALTHCARE PROVIDER ABOUT

4567
02:33:37,560 --> 02:33:38,720
ALCOHOL USE DURING ROUTINE CHECK

4568
02:33:38,720 --> 02:33:42,200
UP IN THE LAST TWO YEARS.

4569
02:33:42,200 --> 02:33:45,080
HOWEVER, THIS REPORT ALSO FOUND

4570
02:33:45,080 --> 02:33:48,120
80% RESPONDENTS WHO REPORTED

4571
02:33:48,120 --> 02:33:49,440
CURRENTLY BINGE DRINKING AND WHO

4572
02:33:49,440 --> 02:33:51,880
ARE ASKED ALCOHOL USE AT LAST

4573
02:33:51,880 --> 02:33:53,880
CHECK UP WERE NOT ADVISED TO

4574
02:33:53,880 --> 02:33:57,760
RECUSE THEIR DRINKING.

4575
02:33:57,760 --> 02:33:59,560
SO GIVEN THESE FINDINGS, CDC

4576
02:33:59,560 --> 02:34:00,600
CURRENTLY HAS COOPERATIVE

4577
02:34:00,600 --> 02:34:03,120
AGREEMENTS IN PLACE WITH FOUR

4578
02:34:03,120 --> 02:34:04,280
HEALTH SYSTEMS OR UNIVERSITIES. 

4579
02:34:04,280 --> 02:34:06,040
THESE PROJECTS FOCUS ON ALCOHOL

4580
02:34:06,040 --> 02:34:09,000
SCREENING AND BRIEF INTERVENTION

4581
02:34:09,000 --> 02:34:09,680
IMPLEMENTATION WITHIN HEALTH

4582
02:34:09,680 --> 02:34:11,600
SYSTEMS PROVIDING WOMEN HEALTH

4583
02:34:11,600 --> 02:34:11,960
SERVICES.

4584
02:34:11,960 --> 02:34:14,480
WITH THE AIM OF REDUCING RISKY

4585
02:34:14,480 --> 02:34:17,080
ALCOHOL USE AMONG WOMEN

4586
02:34:17,080 --> 02:34:17,760
REPRODUCTIVE AGE.

4587
02:34:17,760 --> 02:34:18,880
GOALS OF THE COOPERATIVE

4588
02:34:18,880 --> 02:34:21,160
AGREEMENT INCLUDE INTEGRATING

4589
02:34:21,160 --> 02:34:22,640
EVIDENCE BASED SUSTAINABLE

4590
02:34:22,640 --> 02:34:23,920
ALCOHOL SCREENING AND BRIEF

4591
02:34:23,920 --> 02:34:25,600
INTERVENTION PROTOCOLS IN LARGE

4592
02:34:25,600 --> 02:34:28,640
HEALTH SYSTEMS.

4593
02:34:28,640 --> 02:34:29,520
EVALUATING FEASIBILITY AND

4594
02:34:29,520 --> 02:34:31,320
IMPACT OF IMPLEMENTATION

4595
02:34:31,320 --> 02:34:32,600
EFFORTS, DOCUMENTING LESSONS

4596
02:34:32,600 --> 02:34:34,280
LEARNED ON IMPLEMENTATION

4597
02:34:34,280 --> 02:34:35,680
APPROACHES FOR EXAMPLE

4598
02:34:35,680 --> 02:34:37,160
ELECTRONIC HEALTH RECORD

4599
02:34:37,160 --> 02:34:38,480
INTEGRATION, AND SHARING

4600
02:34:38,480 --> 02:34:41,480
PROMISING PRACTICES AND MODELS.

4601
02:34:41,480 --> 02:34:44,560
TO DATE THESE PROJECTS HAVE

4602
02:34:44,560 --> 02:34:45,680
IMPLEMENTED ALCOHOL SCREENING

4603
02:34:45,680 --> 02:34:48,600
AND BRIEF INTERVENTION IN 67

4604
02:34:48,600 --> 02:34:49,160
CLINICS.

4605
02:34:49,160 --> 02:34:52,200
JUST TO HIGHLIGHT A FEW SPECIFIC

4606
02:34:52,200 --> 02:34:56,080
PROJECTS OUR PANELISTS TODAY IS

4607
02:34:56,080 --> 02:34:58,400
CO-PI OF PROJECT HENRY FORD

4608
02:34:58,400 --> 02:35:00,080
HEALTH SYSTEM WHICH HAS LAUNCHED

4609
02:35:00,080 --> 02:35:01,280
ELECTRONIC SCREENING AN BRIEF

4610
02:35:01,280 --> 02:35:04,480
INTERVENTION PROGRAM.

4611
02:35:04,480 --> 02:35:06,280
BOSS SON MEDICAL HAS DEVELOP AD

4612
02:35:06,280 --> 02:35:08,560
THREE PART PODCAST CALLED

4613
02:35:08,560 --> 02:35:09,600
ALCOHOL AND PREGNANCY THE MORE

4614
02:35:09,600 --> 02:35:10,080
YOU KNOW.

4615
02:35:10,080 --> 02:35:12,080
THE SERIES FEATURES INTERVIEWS

4616
02:35:12,080 --> 02:35:14,480
WITH PEDIATRICIAN PATIENT

4617
02:35:14,480 --> 02:35:15,880
ADVOCATE, SOCIAL WORKER AND

4618
02:35:15,880 --> 02:35:17,480
MOTHER WHOSE CHILD IS EFFECTED

4619
02:35:17,480 --> 02:35:23,000
BY PRE-NATAL ALCOHOL EXPOSURE.

4620
02:35:23,000 --> 02:35:25,880
THE PODCAST IS DOWN LOWED 1,100

4621
02:35:25,880 --> 02:35:27,600
TIMES WITH 104 CLAIMING

4622
02:35:27,600 --> 02:35:32,040
CONTINUING EDUCATION CREDIT.

4623
02:35:32,040 --> 02:35:34,400
SINCE SEPTEMBER 2019 WE WORK

4624
02:35:34,400 --> 02:35:36,000
WITH A FEDERALLY FUNDED RESEARCH

4625
02:35:36,000 --> 02:35:39,040
DEVELOPMENT CENTER TO CREATE

4626
02:35:39,040 --> 02:35:41,680
STANDARD BASED VENDOR NEUTRAL

4627
02:35:41,680 --> 02:35:45,920
CLINICAL DECISION SUPPORT OR

4628
02:35:45,920 --> 02:35:47,160
CDS, BASED ON ESTABLISHED

4629
02:35:47,160 --> 02:35:48,280
GUIDELINES.

4630
02:35:48,280 --> 02:35:51,320
CREATION AND IMPLEMENTATION CAN

4631
02:35:51,320 --> 02:35:52,680
HELP FACILITATE CLINICAL

4632
02:35:52,680 --> 02:35:56,120
DECISIONS NEEDED TO DELIVER

4633
02:35:56,120 --> 02:35:57,160
SCREENING AND INTERVENTION IN

4634
02:35:57,160 --> 02:36:00,040
PRIMARY CARE STUDIES.

4635
02:36:00,040 --> 02:36:01,480
MINOR DEVELOPED SEMISTRUCTURED

4636
02:36:01,480 --> 02:36:03,360
LOGIC AND STRUCTURED CODE FOR

4637
02:36:03,360 --> 02:36:05,720
THREE SCREENING INSTRUMENTS, TWO

4638
02:36:05,720 --> 02:36:07,600
ALCOHOL ONLY AND ONE IS FOCUSED

4639
02:36:07,600 --> 02:36:08,880
ON SUBSTANCE USE SCREENING.

4640
02:36:08,880 --> 02:36:10,480
AS WELL AS TWO BRIEF

4641
02:36:10,480 --> 02:36:13,320
INTERVENTION TOOLS.

4642
02:36:13,320 --> 02:36:14,360
IMPLEMENTATION GUIDE COMPANY

4643
02:36:14,360 --> 02:36:17,080
EACH PRODUCT AND ARE ALSO

4644
02:36:17,080 --> 02:36:18,480
AVAILABLE THIS MEANS THAT

4645
02:36:18,480 --> 02:36:19,880
SYSTEMS CAN INTEGRATE THE TOOLS

4646
02:36:19,880 --> 02:36:22,200
INTO THEIR ELECTRONIC HEALTH

4647
02:36:22,200 --> 02:36:23,880
RECORDS AND DIGITAL FORMATS TO

4648
02:36:23,880 --> 02:36:26,240
IMPROVE DECISIONS, AND IMPROVE

4649
02:36:26,240 --> 02:36:29,480
HEALTHCARE DELIVERY.

4650
02:36:29,480 --> 02:36:32,360
THESE TOOLS ARE NOW AVAILABLE

4651
02:36:32,360 --> 02:36:35,760
VIA CDS CONNECT AND ONLINE

4652
02:36:35,760 --> 02:36:37,880
REPOSITORY DISSEMINATE CDS TOOLS

4653
02:36:37,880 --> 02:36:40,560
ON BIDE RANGE OF HEALTH TOPICS.

4654
02:36:40,560 --> 02:36:42,880
ALSO THE SOFTWARE DEVELOP CDS

4655
02:36:42,880 --> 02:36:45,080
AND TEST TO TOOLS PRIOR TO

4656
02:36:45,080 --> 02:36:45,760
ELECTRONIC HEALTH REPORT

4657
02:36:45,760 --> 02:36:48,280
INTEGRATION IS POSTED ON GITHUB

4658
02:36:48,280 --> 02:36:50,200
AND ONLINE PLATFORM DEVELOPERS

4659
02:36:50,200 --> 02:36:51,480
AND CODERS POST AND SHARE CODE

4660
02:36:51,480 --> 02:36:53,920
IN SOFTWARE.

4661
02:36:53,920 --> 02:36:56,600
PILOT PROJECT TO TEST SELECT

4662
02:36:56,600 --> 02:36:57,960
TOOLS IS UNDERWAY WHERE WE ARE

4663
02:36:57,960 --> 02:37:00,600
WORKING WITH MIDR AND ALLIANCE

4664
02:37:00,600 --> 02:37:01,800
CHICAGO TO INTEGRATE TOOL WITHIN

4665
02:37:01,800 --> 02:37:04,680
THE ELECTRONIC HEALTH RECORD

4666
02:37:04,680 --> 02:37:05,480
SYSTEM OF SEVERAL CLINICAL

4667
02:37:05,480 --> 02:37:09,080
LOCATIONS IN CHICAGO ILLINOIS

4668
02:37:09,080 --> 02:37:10,800
THE HEART LAND HEALTH CENTERS.

4669
02:37:10,800 --> 02:37:12,680
WE ALSO HAVE COOPERATIVE

4670
02:37:12,680 --> 02:37:14,040
AGREEMENTS WITH FIVE HEALTHCARE

4671
02:37:14,040 --> 02:37:15,080
PROFESSIONAL ORGANIZES AND

4672
02:37:15,080 --> 02:37:16,600
UNIVERSITIES TO PROMOTE THE

4673
02:37:16,600 --> 02:37:18,600
PREVENTION AND FASD THAT ARE

4674
02:37:18,600 --> 02:37:19,920
ACTIVE HEALTH PROFESSIONAL

4675
02:37:19,920 --> 02:37:22,360
MEMBERSHIPS RATHER THAN PREGNANT

4676
02:37:22,360 --> 02:37:24,040
WOMEN AND WOMEN OF REPRODUCTIVE

4677
02:37:24,040 --> 02:37:24,440
AGE.

4678
02:37:24,440 --> 02:37:25,680
THE GOALS OF THIS PROJECT

4679
02:37:25,680 --> 02:37:30,040
INCLUDE ASSESSING AND PROMOTING

4680
02:37:30,040 --> 02:37:31,600
AWARENESS OF ALCOHOL USE

4681
02:37:31,600 --> 02:37:33,280
INCLUDING USE DURING PREGNANCY,

4682
02:37:33,280 --> 02:37:35,800
BUILDING AND EXPANDING CHAMPIONS

4683
02:37:35,800 --> 02:37:38,280
NETWORKS TO SUPPORT AWARENESS

4684
02:37:38,280 --> 02:37:40,360
ACTIVITIES AND DISSEMINATION OF

4685
02:37:40,360 --> 02:37:41,600
RESOURCES DEVELOPING

4686
02:37:41,600 --> 02:37:43,680
IMPLEMENTING RECERTIFICATION

4687
02:37:43,680 --> 02:37:45,000
REQUIREMENTS, PROMOTING USE OF

4688
02:37:45,000 --> 02:37:46,360
SCIENCE BASED MESSAGES THROUGH

4689
02:37:46,360 --> 02:37:48,600
TESTING AND DISSEMINATION OF CDC

4690
02:37:48,600 --> 02:37:50,280
PRODUCTS, AND PROMOTING CLINICAL

4691
02:37:50,280 --> 02:37:52,040
GUIDELINES AND POLICIES THAT

4692
02:37:52,040 --> 02:37:53,080
SUPPORT IMPLEMENTATION OF

4693
02:37:53,080 --> 02:37:55,560
ALCOHOL SCREENING AND BRIEF

4694
02:37:55,560 --> 02:37:56,280
INTERVENTION.

4695
02:37:56,280 --> 02:37:58,520
SOME HIGHLIGHTS FROM THIS WORK

4696
02:37:58,520 --> 02:38:00,280
ARE AMERICAN ACADEMY OF FAMILY

4697
02:38:00,280 --> 02:38:02,640
PHYSICIANS AS RECORDED SOME

4698
02:38:02,640 --> 02:38:03,720
MICROLEARNINGS TO BRIEFLY

4699
02:38:03,720 --> 02:38:05,520
ADDRESS HOW TO BREAK DOWN

4700
02:38:05,520 --> 02:38:06,640
BARRIERS TO IMPLEMENTING ALCOHOL

4701
02:38:06,640 --> 02:38:08,280
SCREENING AND BRIEF INTERVENTION

4702
02:38:08,280 --> 02:38:08,960
AND PRACTICE.

4703
02:38:08,960 --> 02:38:10,800
FOR OUR PROJECT WITH THE

4704
02:38:10,800 --> 02:38:12,200
AMERICAN COLLEGE OF

4705
02:38:12,200 --> 02:38:13,560
OBSTETRICIANS AN GYNECOLOGISTS,

4706
02:38:13,560 --> 02:38:16,320
WE HAVE A SUCCESSFUL SPEAKERS

4707
02:38:16,320 --> 02:38:18,640
BUREAU MODEL OBGYN CHAMPIONS ARE

4708
02:38:18,640 --> 02:38:21,280
PAIRED WITH A BIRTH MOTHER FROM

4709
02:38:21,280 --> 02:38:23,720
FASD UNITED FORNALLY KNOWN AS

4710
02:38:23,720 --> 02:38:26,280
NOFAS TO SHARE LIVED EXPERIENCE.

4711
02:38:26,280 --> 02:38:27,320
ADDITIONALLY, OUR PROJECT WITH

4712
02:38:27,320 --> 02:38:29,480
THE UNIVERSITY OF NEVADA RENO

4713
02:38:29,480 --> 02:38:32,880
HAS CREATED HEALTHY PREGNANCIES

4714
02:38:32,880 --> 02:38:34,520
PRODUCTS INTENDED TO MAXIMIZE

4715
02:38:34,520 --> 02:38:35,960
THE LIMITED TIME MEDICAL

4716
02:38:35,960 --> 02:38:37,360
ASSISTANTS HAVE WITH PATIENTS

4717
02:38:37,360 --> 02:38:39,320
DURING APPOINTMENTS AND PROVIDE

4718
02:38:39,320 --> 02:38:40,480
IMPORTANT REMINDERS ABOUT

4719
02:38:40,480 --> 02:38:44,600
ALCOHOL USE.

4720
02:38:44,600 --> 02:38:46,480
CDC IS WORKING TO DEVELOP

4721
02:38:46,480 --> 02:38:47,680
MESSAGES FOR HEALTHCARE

4722
02:38:47,680 --> 02:38:48,680
PROVIDERS ON THE IMPORTANCE OF

4723
02:38:48,680 --> 02:38:50,040
PROVIDING ALCOHOL SCREENING AND

4724
02:38:50,040 --> 02:38:52,240
BRIEF INTERVENTION TO WOMEN OF

4725
02:38:52,240 --> 02:38:52,720
REPRODUCTIVE AGE.

4726
02:38:52,720 --> 02:38:55,080
AND TO ENHANCE PATIENT PROVIDER

4727
02:38:55,080 --> 02:38:56,480
COMMUNICATION ABOUT ALCOHOL USE

4728
02:38:56,480 --> 02:38:57,600
AND ITS RISKS DURING PREGNANT

4729
02:38:57,600 --> 02:39:04,080
SCHISM WE HAVE A TWO YEAR

4730
02:39:04,080 --> 02:39:05,360
CONTRACT TO FORMALLY TEST

4731
02:39:05,360 --> 02:39:08,000
PREVIOUSLY DEVELOPED CONCEPTS,

4732
02:39:08,000 --> 02:39:11,000
DEVELOP FINAL PRODUCT, DEVELOP

4733
02:39:11,000 --> 02:39:12,040
AND TEST MESSAGES FOR A GUIDES

4734
02:39:12,040 --> 02:39:16,520
FOR FASD RELATED MESSAGING.  

4735
02:39:16,520 --> 02:39:17,560
COMPLETED MESSAGE TESTING AND

4736
02:39:17,560 --> 02:39:18,840
DATA COLLECTION IN THE ANALYSIS

4737
02:39:18,840 --> 02:39:20,640
CURRENTLY UNDERWAY.

4738
02:39:20,640 --> 02:39:23,440
THE PROJECT COMPLETED ONLINE

4739
02:39:23,440 --> 02:39:24,680
DISCUSSION BOARDS WITH 47

4740
02:39:24,680 --> 02:39:28,080
HEALTHCARE PROFESSIONALS AND 44

4741
02:39:28,080 --> 02:39:30,000
WOMEN OF REPRODUCTIVE AGE AND IN

4742
02:39:30,000 --> 02:39:31,360
DEPTH INTERVIEWS WITH 21

4743
02:39:31,360 --> 02:39:32,320
HEALTHCARE PROFESSIONAL WHOSE

4744
02:39:32,320 --> 02:39:33,560
PARTICIPATED IN THE ONLINE

4745
02:39:33,560 --> 02:39:34,840
DISCUSSION BOARDS.

4746
02:39:34,840 --> 02:39:37,200
THEY ALSO COMPLETED 12 FOCUS

4747
02:39:37,200 --> 02:39:40,320
GROUPS IN CHICAGO IN MINNEAPOLIS

4748
02:39:40,320 --> 02:39:41,160
WITH 49 WOMEN.

4749
02:39:41,160 --> 02:39:42,400
FINDINGS FROM THIS COMMUNICATION

4750
02:39:42,400 --> 02:39:44,680
RESEARCH IS GOING TO INFORM

4751
02:39:44,680 --> 02:39:47,520
FUTURE MATERIALS.

4752
02:39:47,520 --> 02:39:49,840
SO FINALLY, I WANT TO MAKE YOU

4753
02:39:49,840 --> 02:39:51,640
AWARE OF ADDITIONAL RESOURCE

4754
02:39:51,640 --> 02:39:55,000
ADDRESSING POLYSUBSTANCE USE IN

4755
02:39:55,000 --> 02:39:55,840
PREGNANCY.

4756
02:39:55,840 --> 02:39:58,920
ON AUGUST 18, 2020 CDC HOSTED

4757
02:39:58,920 --> 02:40:00,640
PUBLIC HEALTH GRAND ROUNDS

4758
02:40:00,640 --> 02:40:02,080
REDUCING POLYSUBSTANCE USE IN

4759
02:40:02,080 --> 02:40:02,720
PREGNANCY.

4760
02:40:02,720 --> 02:40:05,240
THE SESSION DISCUSSED ADVERSE

4761
02:40:05,240 --> 02:40:07,000
MATERNAL CHILD HEALTH OUTCOMES

4762
02:40:07,000 --> 02:40:10,720
CAUSED BY POLYSUBSTANCE USE.

4763
02:40:10,720 --> 02:40:12,440
HOW DATA IMPROVE UNDERSTANDING

4764
02:40:12,440 --> 02:40:16,080
OF POLYSUBSTANCE USE, HOW

4765
02:40:16,080 --> 02:40:17,080
SCREENING BRIEF INTERVENTION

4766
02:40:17,080 --> 02:40:18,640
REDUCE PRE-NATAL SUBSTANCE

4767
02:40:18,640 --> 02:40:20,080
EXPOSURE AN IMPROVE HEALTH OF

4768
02:40:20,080 --> 02:40:21,920
PREGNANT PERSONS AND INFANTS.

4769
02:40:21,920 --> 02:40:24,040
IF YOU FOLLOW THE LINK ON THIS

4770
02:40:24,040 --> 02:40:25,600
SLIDE AND CLICK ON MATERNAL

4771
02:40:25,600 --> 02:40:27,120
HEALTH, YOU WILL FIND THE

4772
02:40:27,120 --> 02:40:28,160
SESSION AND CAN VIEW THE

4773
02:40:28,160 --> 02:40:29,960
REPORTING FROM THE GRAND ROUNDS

4774
02:40:29,960 --> 02:40:31,280
INCLUDING THE PRESENTATIONS AS

4775
02:40:31,280 --> 02:40:34,120
WELL AS THE LIVE Q&A SEGMENT.

4776
02:40:34,120 --> 02:40:36,240
PODCAST CALLED BEYOND THE DATA

4777
02:40:36,240 --> 02:40:38,440
IN THE CDC WEB PAGE ON

4778
02:40:38,440 --> 02:40:40,880
POLYSUBSTANCE USE IN PREGNANCY.

4779
02:40:40,880 --> 02:40:43,000
SO THANK YOU SO MUCH FOR GIVING

4780
02:40:43,000 --> 02:40:44,560
ME THE OPPORTUNITY TO PROVIDE

4781
02:40:44,560 --> 02:40:46,760
QUICK OVERVIEW OF CDC

4782
02:40:46,760 --> 02:40:47,800
SURVEILLANCE AND PREVENTION

4783
02:40:47,800 --> 02:40:48,880
ACTIVITIES RELATED TO ALCOHOL

4784
02:40:48,880 --> 02:40:50,280
AND OTHER SUBSTANCE USE DURING

4785
02:40:50,280 --> 02:40:52,080
PREGNANCY.

4786
02:40:52,080 --> 02:40:54,480
AS I WRAP UP I WANTED TO MENTION

4787
02:40:54,480 --> 02:40:56,280
WE HAVE DEVELOPED A NEW WORKING

4788
02:40:56,280 --> 02:40:58,640
GROUP WITHIN THE INTERAGENCY

4789
02:40:58,640 --> 02:41:00,960
COORDINATING COMMITTEE ON FETAL

4790
02:41:00,960 --> 02:41:03,200
ALCOHOL SPECTRUM DISORDERS

4791
02:41:03,200 --> 02:41:06,000
FOCUSED ON SCREENING AND BRIEF

4792
02:41:06,000 --> 02:41:07,560
INTERVENTION FOR PREGNANT AND

4793
02:41:07,560 --> 02:41:08,480
POSTPARTUM PEOPLE.

4794
02:41:08,480 --> 02:41:09,840
IT MEETS MONTHLY INCLUDING

4795
02:41:09,840 --> 02:41:11,200
REPRESENTATIVES FROM KEY FEDERAL

4796
02:41:11,200 --> 02:41:12,360
AGENCIES INVOLVED IN THIS WORK

4797
02:41:12,360 --> 02:41:13,640
WITH THE GOAL OF RESOURCE

4798
02:41:13,640 --> 02:41:16,920
SHARING AND ENHANCING

4799
02:41:16,920 --> 02:41:18,160
COMMUNICATION AND CORD NATION

4800
02:41:18,160 --> 02:41:21,240
AMONG FED -- COORDINATION AMONG

4801
02:41:21,240 --> 02:41:21,760
AGENCIES.

4802
02:41:21,760 --> 02:41:23,600
REACH OUT TO THE EMAIL ON THE

4803
02:41:23,600 --> 02:41:24,480
SLIDE IF YOU ARE INTERESTED IN

4804
02:41:24,480 --> 02:41:25,920
LEARNING MORE ABOUT THE EFFORTS

4805
02:41:25,920 --> 02:41:27,600
I MENTIONED IN THIS

4806
02:41:27,600 --> 02:41:28,240
PRESENTATION.

4807
02:41:28,240 --> 02:41:30,080
AND ALSO HAPPY TO TAKE ANY

4808
02:41:30,080 --> 02:41:31,480
QUESTIONS DURING THE Q&A

4809
02:41:31,480 --> 02:41:32,360
SESSION.

4810
02:41:32,360 --> 02:41:34,400
SO I WILL STOP SHARING MY SCREEN

4811
02:41:34,400 --> 02:41:38,520
NOW AND TURN IT OVER TO OUR NEXT

4812
02:41:38,520 --> 02:41:51,080
PRESENTER.

4813
02:41:51,080 --> 02:41:54,240
>> DR. BOHR IS A HARD ACT TO

4814
02:41:54,240 --> 02:41:55,240
FOLLOW BUT AT THE SAME TIME I

4815
02:41:55,240 --> 02:41:58,280
COULDN'T HAVE ASKED FOR A BETTER

4816
02:41:58,280 --> 02:42:00,880
BACKDROP TO TALKING HOW

4817
02:42:00,880 --> 02:42:03,920
TECHNOLOGY MIGHT BE AN IMPORTANT

4818
02:42:03,920 --> 02:42:05,120
TECHNIQUE FOR SCREENING AND

4819
02:42:05,120 --> 02:42:06,600
BRIEF INTERVENTION IN HEALTHCARE

4820
02:42:06,600 --> 02:42:08,960
SETTINGS AND IN UNIFYING AND

4821
02:42:08,960 --> 02:42:09,920
INTEGRATING SYSTEMS OF CARE

4822
02:42:09,920 --> 02:42:14,600
DURING THE PROCESS.

4823
02:42:14,600 --> 02:42:16,280
THANKFUL TO HAVE BEEN GIVEN THIS

4824
02:42:16,280 --> 02:42:17,400
OPPORTUNITY.

4825
02:42:17,400 --> 02:42:22,120
TALK ABOUT THREE SPECIFIC

4826
02:42:22,120 --> 02:42:23,920
ISSUES, I WILL GO OVER

4827
02:42:23,920 --> 02:42:25,120
IMPORTANCE OF REACH AND WHY I

4828
02:42:25,120 --> 02:42:26,360
THINK INTEGRATION AND HEALTHCARE

4829
02:42:26,360 --> 02:42:27,360
SYSTEM IS SUCH AN IMPORTANT

4830
02:42:27,360 --> 02:42:31,480
ANSWER TO THAT.

4831
02:42:31,480 --> 02:42:32,760
ATTEND TO NON-TREATMENT SEEKING

4832
02:42:32,760 --> 02:42:34,000
AS A CRITICAL BARRIER.

4833
02:42:34,000 --> 02:42:38,240
I WILL TALK ABOUT TECHNOLOGY CAN

4834
02:42:38,240 --> 02:42:41,240
PROMOTE REACH THROUGH

4835
02:42:41,240 --> 02:42:41,920
INTEGRATION HEALTHCARE SETTINGS

4836
02:42:41,920 --> 02:42:43,080
AND INTEGRATION OF OTHER SYSTEMS

4837
02:42:43,080 --> 02:42:45,680
OF CARE.

4838
02:42:45,680 --> 02:42:48,520
SO FIRST IN TERMS OF REACH, I

4839
02:42:48,520 --> 02:42:51,080
THINK ABOUT REACH IN TERMS OF

4840
02:42:51,080 --> 02:42:53,320
THAT CLASSIC PUBLIC HEALTH

4841
02:42:53,320 --> 02:42:56,440
FORMULA IN WHICH POPULATION PACT

4842
02:42:56,440 --> 02:42:57,880
IS FUNCTION OF EFFECTIVE

4843
02:42:57,880 --> 02:43:00,040
INTERVENTION AND THE PROPORTION

4844
02:43:00,040 --> 02:43:01,480
OF AFFECTEDVINGS WHO RECEIVE

4845
02:43:01,480 --> 02:43:05,360
THAT INTERVENTION.

4846
02:43:05,360 --> 02:43:07,240
WE HAVE DONE BETTER MANY TERMS

4847
02:43:07,240 --> 02:43:08,480
OF DEVELOPING EFFECTIVE

4848
02:43:08,480 --> 02:43:10,000
INTERVENTION THAN WE HAVE AT

4849
02:43:10,000 --> 02:43:12,360
REACHING EFFECTIVE INDIVIDUALS

4850
02:43:12,360 --> 02:43:14,480
AND THAT IS THUS A HUGE BARRIER

4851
02:43:14,480 --> 02:43:16,320
TO ACHIEVING POPULATION IMPACT

4852
02:43:16,320 --> 02:43:16,880
THAT WE WANT.

4853
02:43:16,880 --> 02:43:18,880
FOR EXAMPLE, THESE ARE DATA FROM

4854
02:43:18,880 --> 02:43:21,160
NATIONAL SURVEY ON DRUG USE AN

4855
02:43:21,160 --> 02:43:22,280
HEALTH SHOWING THAT VAST

4856
02:43:22,280 --> 02:43:24,200
MAJORITY OF PEOPLE CERTAINLY

4857
02:43:24,200 --> 02:43:25,760
WITH RESPECT TO SUBSTANCE USE

4858
02:43:25,760 --> 02:43:27,400
DISORDERS HAVE NOT RECEIVED ANY

4859
02:43:27,400 --> 02:43:29,320
TREATMENT IN THE PAST YEAR.

4860
02:43:29,320 --> 02:43:30,680
90% HAVE NOT RECEIVED ANY

4861
02:43:30,680 --> 02:43:31,880
TREATMENT IN THE PAST YEAR.

4862
02:43:31,880 --> 02:43:35,080
FOR OTHER MENTAL HEALTH

4863
02:43:35,080 --> 02:43:36,440
DISORDERS, 57% HAVE NOT RECEIVED

4864
02:43:36,440 --> 02:43:39,280
TREATMENT IN THE PAST YEAR AND

4865
02:43:39,280 --> 02:43:41,000
EVEN 36% THOSE WITH SERIOUS

4866
02:43:41,000 --> 02:43:43,120
MENTAL ILLNESS HAVE NOT RECEIVED

4867
02:43:43,120 --> 02:43:43,920
TREATMENT IN THE PAST YEAR.

4868
02:43:43,920 --> 02:43:46,880
SO WHAT WE GENERALLY LEAP TO

4869
02:43:46,880 --> 02:43:50,240
WHEN CONFRONTED WITH DATA LIKE

4870
02:43:50,240 --> 02:43:52,600
THIS, IS THE ANSWER THAT YEAH

4871
02:43:52,600 --> 02:43:54,280
STIGMA IS A BIG ISSUE AND ACCESS

4872
02:43:54,280 --> 02:43:56,160
TO CARE IS A ISSUE, AND WE HAVE

4873
02:43:56,160 --> 02:43:57,680
TO DO SOMETHING ABOUT THAT.

4874
02:43:57,680 --> 02:44:01,080
THEY ARE BIG ISSUES.

4875
02:44:01,080 --> 02:44:02,480
WE HAVE TO DO SOMETHING ABOUT

4876
02:44:02,480 --> 02:44:06,040
THEM BUT PRIMARY GOAL HERE IS TO

4877
02:44:06,040 --> 02:44:07,760
OR ORIENT THINKING ABOUT THE

4878
02:44:07,760 --> 02:44:09,320
GAPS THAT WE ARE LOOKING AT AND

4879
02:44:09,320 --> 02:44:15,280
WHERE THEY MIGHT BE COMING FROM.

4880
02:44:15,280 --> 02:44:16,960
NATIONAL SURVEY AND DRUG USE

4881
02:44:16,960 --> 02:44:18,160
HEALTH DATA OF THAT PROPORTION

4882
02:44:18,160 --> 02:44:18,960
THAT HAS NOT RECEIVED TREATMENT

4883
02:44:18,960 --> 02:44:23,680
IN THE PAST YEAR FOR SUBSTANCE

4884
02:44:23,680 --> 02:44:26,880
USE DISORDER 95% DIDN'T FEEL

4885
02:44:26,880 --> 02:44:28,440
TREATMENT WAS NECESSARY.

4886
02:44:28,440 --> 02:44:30,920
ONLY A VERY SMALL SLIVER AS WE

4887
02:44:30,920 --> 02:44:32,280
SEE HERE ACTUALLY SOUGHT

4888
02:44:32,280 --> 02:44:33,600
TREATMENT AND WAS UNABLE TO GET

4889
02:44:33,600 --> 02:44:38,280
I WANT.

4890
02:44:38,280 --> 02:44:39,360
WHEN YOU PUT TOGETHER NOT

4891
02:44:39,360 --> 02:44:42,040
GETTING TREATMENT AND LACK OF

4892
02:44:42,040 --> 02:44:49,000
FUELING THAT CARE NEEDED, 85%

4893
02:44:49,000 --> 02:44:50,280
NEITHER RECEIVED TREATMENT NOR

4894
02:44:50,280 --> 02:44:53,480
FEEL THEY NEEDED.

4895
02:44:53,480 --> 02:44:56,680
SO FEE FACT IN REORIENT HOW TO

4896
02:44:56,680 --> 02:44:57,920
ACHIEVE THE REACH WE WOULD LIKE

4897
02:44:57,920 --> 02:45:01,040
TO ACHIEVE.

4898
02:45:01,040 --> 02:45:03,240
FOR MENTAL ILLNESS WITHIN THE

4899
02:45:03,240 --> 02:45:05,920
HALF THAT DIDN'T RECEIVE

4900
02:45:05,920 --> 02:45:11,000
TREATMENT OF THOSE 27% FELT

4901
02:45:11,000 --> 02:45:12,360
UNMET NEED FOR SERVICES AND

4902
02:45:12,360 --> 02:45:17,720
RECENT VARY FROM SAFETY AND LAB,

4903
02:45:17,720 --> 02:45:18,840
45% DIDN'T RECEIVE TREATMENT

4904
02:45:18,840 --> 02:45:20,400
MOSTLY BECAUSE OF LACK OF

4905
02:45:20,400 --> 02:45:22,160
CONFIDENCE AN MENTAL HEALTH

4906
02:45:22,160 --> 02:45:23,400
TREATMENT LACK OF KNOWLEDGE TO

4907
02:45:23,400 --> 02:45:25,760
WHERE TO FIND IT, OR EVEN

4908
02:45:25,760 --> 02:45:26,880
PREFERRING SELF HELP TREATMENT

4909
02:45:26,880 --> 02:45:32,400
SO MORE PEOPLE PREFER SELF HELP

4910
02:45:32,400 --> 02:45:33,640
THAN SAID DIDN'T HAVE ACCESS

4911
02:45:33,640 --> 02:45:34,960
COULDN'T AFFORD CARE OR

4912
02:45:34,960 --> 02:45:40,680
CONCERNED ABOUT STIGMA.

4913
02:45:40,680 --> 02:45:42,400
SO WHAT MIGHT WE DO AND HOW

4914
02:45:42,400 --> 02:45:45,480
MIGHT TECHNOLOGY HELP WITH THIS

4915
02:45:45,480 --> 02:45:47,840
REACHING THE NON-SEEKING

4916
02:45:47,840 --> 02:45:48,400
MAJORITY?

4917
02:45:48,400 --> 02:45:51,400
I HAVE TO SAY AS WE JUST HEARD,

4918
02:45:51,400 --> 02:45:52,520
IN THAT EXCELLENT PRESENTATION

4919
02:45:52,520 --> 02:45:54,000
SCREENING AN BRIEF INTERVENTION

4920
02:45:54,000 --> 02:45:56,200
IS A WELL ESTABLISHED WELL KNOWN

4921
02:45:56,200 --> 02:45:57,960
APPROACH FOR NON-TREATMENT

4922
02:45:57,960 --> 02:45:59,640
SEEKING INDIVIDUALS, IT HAS TWO

4923
02:45:59,640 --> 02:46:00,560
KEY COMPONENTS THAT MAKE IT

4924
02:46:00,560 --> 02:46:02,760
PERFECT FOR THAT.

4925
02:46:02,760 --> 02:46:04,320
ONE INVOLVES UNIVERSAL AND

4926
02:46:04,320 --> 02:46:05,680
PROACTIVE SCREENING, NOT TO

4927
02:46:05,680 --> 02:46:08,160
PEOPLE WHO ARE IDENTIFIED

4928
02:46:08,160 --> 02:46:08,960
BECAUSE THEY HAVE A PARTICULAR

4929
02:46:08,960 --> 02:46:10,640
HIGH RISK AND NOT TO PEOPLE WHO

4930
02:46:10,640 --> 02:46:12,400
RAISE THEIR HAND AND SAY THEY

4931
02:46:12,400 --> 02:46:15,040
WANT HELP BUT SIMPLY EVERYBODY

4932
02:46:15,040 --> 02:46:15,920
IN HEALTHCARE SETTING GETS

4933
02:46:15,920 --> 02:46:17,080
SCREENED.

4934
02:46:17,080 --> 02:46:17,880
PROACTIVELY.

4935
02:46:17,880 --> 02:46:18,640
THAT'S ONE KEY PIECE.

4936
02:46:18,640 --> 02:46:20,960
THE SECOND KEY PIECE IS THAT

4937
02:46:20,960 --> 02:46:23,080
THEY ARE OFFERED AN INTERVENTION

4938
02:46:23,080 --> 02:46:25,760
THAT IS BRIEF ENOUGH ALMOST

4939
02:46:25,760 --> 02:46:27,320
EVERYBODY WILL SAY SURE WHY NOT

4940
02:46:27,320 --> 02:46:28,280
I WILL DO THAT.

4941
02:46:28,280 --> 02:46:31,080
SURE, I WILL HAVE A FIVE TO TEN

4942
02:46:31,080 --> 02:46:32,320
TO 15 MINUTE CONVERSATION WITH

4943
02:46:32,320 --> 02:46:33,600
MY HEALTHCARE PROVIDER.

4944
02:46:33,600 --> 02:46:34,320
WHY NOT.

4945
02:46:34,320 --> 02:46:36,440
IF WE ARE ASKING TO ATTEND

4946
02:46:36,440 --> 02:46:39,000
TREATMENT AT ANOTHER SETTING, 12

4947
02:46:39,000 --> 02:46:40,680
SESSIONS OVER FEW MONTHS WE GET

4948
02:46:40,680 --> 02:46:43,800
MUCH LOWER UPTAKE BUT IF WE SAY

4949
02:46:43,800 --> 02:46:45,480
CAN WE CHAT ABOUT THIS, AND

4950
02:46:45,480 --> 02:46:48,080
NOTICE THAT YOU SAID THAT YOU

4951
02:46:48,080 --> 02:46:50,520
HAVE BEEN DRINKING FAIRLY

4952
02:46:50,520 --> 02:46:51,120
FREQUENTLY AND THAT SOMETIMES

4953
02:46:51,120 --> 02:46:52,240
YOU HAVE TROUBLE IN THE MORNING.

4954
02:46:52,240 --> 02:46:56,880
IS THAT OKAY IF WE HAVE A TALK?

4955
02:46:56,880 --> 02:46:58,480
VERY DIFFERENT PROPOSITION MAKES

4956
02:46:58,480 --> 02:46:59,320
SCREENING AND INTERVENTION SO

4957
02:46:59,320 --> 02:47:02,280
IMPORTANT.

4958
02:47:02,280 --> 02:47:03,200
EVIDENCE SUGGESTS SMALL

4959
02:47:03,200 --> 02:47:05,680
REDUCTION IN SUBSTANCE USE FROM

4960
02:47:05,680 --> 02:47:06,280
FROM JEANING AN BRIEF

4961
02:47:06,280 --> 02:47:07,320
INTERVENTION, CERTAINLY ALCOHOL

4962
02:47:07,320 --> 02:47:09,520
AND TOBACCO, MUCH WEAKER

4963
02:47:09,520 --> 02:47:11,320
EVIDENCE FOR DRUG USE.

4964
02:47:11,320 --> 02:47:15,880
BUT ALSO THAT WE STRUGGLE WITH

4965
02:47:15,880 --> 02:47:16,520
IMPLEMENTATION, THUS FOUR

4966
02:47:16,520 --> 02:47:18,120
PROGRAMS THE CDC IS WORKING ON

4967
02:47:18,120 --> 02:47:21,880
TO GET THAT SCALABILITY AND

4968
02:47:21,880 --> 02:47:25,240
IMPLEMENTATION AND WE DON'T GET

4969
02:47:25,240 --> 02:47:26,280
PROMOTION OF CONNECTION TO OTHER

4970
02:47:26,280 --> 02:47:27,120
SERVICES THAT WE WOULD LIKE TO

4971
02:47:27,120 --> 02:47:29,360
GET.

4972
02:47:29,360 --> 02:47:30,600
TECHNOLOGY POTENTIALLY HELP BE

4973
02:47:30,600 --> 02:47:32,400
THESE THINGS.

4974
02:47:32,400 --> 02:47:35,280
TECHNOLOGY CAN HELP SCALE MORE

4975
02:47:35,280 --> 02:47:37,280
QUICKLY, CAN HELP CONNECT WITH

4976
02:47:37,280 --> 02:47:39,920
OTHER SERVICES MORE READILY.

4977
02:47:39,920 --> 02:47:41,880
AND CAN EXTEND BRIEF ENCOUNTERS

4978
02:47:41,880 --> 02:47:43,520
OVER TIME.

4979
02:47:43,520 --> 02:47:45,480
BRIEF INTERACTION WITH

4980
02:47:45,480 --> 02:47:47,680
TECHNOLOGY MIGHT MEET TO

4981
02:47:47,680 --> 02:47:48,920
SUBSEQUENT TEXT MESSAGES OR

4982
02:47:48,920 --> 02:47:50,320
OTHER TOUCHES.

4983
02:47:50,320 --> 02:47:53,760
SUCH THAT OVER TIME, THERE IS

4984
02:47:53,760 --> 02:47:54,520
INITIAL HEALTHCARE CONTACT IN

4985
02:47:54,520 --> 02:47:57,280
WHICH RISK IS IDENTIFIED,

4986
02:47:57,280 --> 02:47:58,680
BASELINE BRIEF INTERVENTION AND

4987
02:47:58,680 --> 02:48:00,080
PROMOTION OF CONNECTION TO

4988
02:48:00,080 --> 02:48:00,680
AVAILABLE CARE.

4989
02:48:00,680 --> 02:48:02,560
THAT CAN BE FOLLOWED BY TAYLOR

4990
02:48:02,560 --> 02:48:04,320
TEXT MESSAGING THAT INDIVIDUAL

4991
02:48:04,320 --> 02:48:05,520
TRYING TO FURTHER PROMOTE THOSE

4992
02:48:05,520 --> 02:48:07,800
CONNECTIONS.

4993
02:48:07,800 --> 02:48:09,480
THROUGH PATIENT PORTALS MADE

4994
02:48:09,480 --> 02:48:10,960
AVAILABLE AND THE USE OF THESE

4995
02:48:10,960 --> 02:48:14,400
PATIENT PORTALS LIKE MY CHART

4996
02:48:14,400 --> 02:48:16,600
FROM EPIC HAS GROWN

4997
02:48:16,600 --> 02:48:17,080
EXPONENTIALLY DURING THE

4998
02:48:17,080 --> 02:48:18,640
PANDEMIC, IT'S ONE SMALL SILVER

4999
02:48:18,640 --> 02:48:19,880
LINING OF THIS.

5000
02:48:19,880 --> 02:48:22,880
THAT'S ANOTHER GREAT WAY TO

5001
02:48:22,880 --> 02:48:24,120
PROMOTE AND ENHANCE CONNECTION

5002
02:48:24,120 --> 02:48:25,720
TO CARE.

5003
02:48:25,720 --> 02:48:27,280
WITH REPEATED HEALTHCARE VISITS

5004
02:48:27,280 --> 02:48:30,360
WE CAN DO IT ALL OVER AGAIN.

5005
02:48:30,360 --> 02:48:31,880
WE NEED THINK ABOUT WHAT WE

5006
02:48:31,880 --> 02:48:33,360
MIGHT LOSE WHEN WE TAKE AWAY A

5007
02:48:33,360 --> 02:48:34,680
PERSON DELIVERED INTERVENTION

5008
02:48:34,680 --> 02:48:36,000
BUT WE ALSO HAVE TO KEEP IN MIND

5009
02:48:36,000 --> 02:48:37,160
THE THINGS LIKE THIS THAT WE

5010
02:48:37,160 --> 02:48:38,720
MIGHT GAIN WITH THE TECHNOLOGY

5011
02:48:38,720 --> 02:48:40,680
APPROACH.

5012
02:48:40,680 --> 02:48:42,800
WHAT IS THE EVIDENCE?

5013
02:48:42,800 --> 02:48:44,680
I WILL TALK HERE ABOUT THE

5014
02:48:44,680 --> 02:48:46,040
EVIDENCE THAT WE HAVE SO FAR FOR

5015
02:48:46,040 --> 02:48:47,640
HOW WELL THIS IS WORKING.

5016
02:48:47,640 --> 02:48:48,880
THE STUDIES THAT I WILL BE

5017
02:48:48,880 --> 02:48:50,880
PRESENTING HAVE A FEW THINGS

5018
02:48:50,880 --> 02:48:52,280
THAT ARE IN COMMON, PRIMARILY

5019
02:48:52,280 --> 02:48:55,720
ABOUT A ROUGHLY 15 MINUTE

5020
02:48:55,720 --> 02:48:56,960
TECHNOLOGY DELIVERED BRIEF

5021
02:48:56,960 --> 02:48:59,960
INTERVENTION WITH NO THERAPIST

5022
02:48:59,960 --> 02:49:02,080
OR HEALTHCARE CONTACT, MOST

5023
02:49:02,080 --> 02:49:03,800
INVOLVE FOLLOW-UP TAILORED

5024
02:49:03,800 --> 02:49:09,280
MESSAGING OF SOME KIND INITIALLY

5025
02:49:09,280 --> 02:49:10,040
MAIL, FLAIRS AND SUCH AND

5026
02:49:10,040 --> 02:49:11,480
TAILORED TEXT MESSAGING AND THEY

5027
02:49:11,480 --> 02:49:15,120
ARE DELIVERED WITH PARTICIPANT

5028
02:49:15,120 --> 02:49:16,280
AND STAFF INPUT.

5029
02:49:16,280 --> 02:49:20,600
WE USE A TREATMENT AS USUAL

5030
02:49:20,600 --> 02:49:22,360
CONTROL IN THESE CONTROL TRIALS.

5031
02:49:22,360 --> 02:49:24,920
WE TAKE A PRAGMATIC APPROACH AND

5032
02:49:24,920 --> 02:49:29,240
EXPLANATORY APPROACH, WE USE

5033
02:49:29,240 --> 02:49:30,680
MINIMAL ELIGIBILITY CRITERIA,

5034
02:49:30,680 --> 02:49:32,040
MOST SAMPLES ARE

5035
02:49:32,040 --> 02:49:34,920
UNDER-REPRESENTED MINORITIES ALL

5036
02:49:34,920 --> 02:49:36,560
THE TRIALS PRE-REGISTER AND

5037
02:49:36,560 --> 02:49:38,000
BLINDED WITH BIOVERIFICATION AND

5038
02:49:38,000 --> 02:49:39,120
INTENT TO TREAT ANALYSIS

5039
02:49:39,120 --> 02:49:42,840
APPROACH.

5040
02:49:42,840 --> 02:49:51,280
PRIMARY OUTPUT BEING ABSTINENCE.

5041
02:49:51,280 --> 02:49:53,000
IN TERMS OF FEASIBILITY THIS WAS

5042
02:49:53,000 --> 02:49:54,680
A KEY ACCORDANCE, ARE THEY LIKE

5043
02:49:54,680 --> 02:49:56,920
IT, DOES IT WORK IS IT HELPFUL?

5044
02:49:56,920 --> 02:49:58,200
RATINGS ARE EXTREMELY GOOD IN

5045
02:49:58,200 --> 02:49:58,680
THIS REGARD.

5046
02:49:58,680 --> 02:50:00,680
TURNS OUT THAT IF YOU BUILD YOUR

5047
02:50:00,680 --> 02:50:04,880
TECHNOLOGY WITH USABILITY IN

5048
02:50:04,880 --> 02:50:06,680
MIND, AND INTERVENTION CONTENT

5049
02:50:06,680 --> 02:50:08,400
WITH PARTICIPANT AND STAFF INPUT

5050
02:50:08,400 --> 02:50:09,920
YOU CAN GENERALLY GET GOOD

5051
02:50:09,920 --> 02:50:11,640
RESPONSES SO VERY HIGH RATINGS

5052
02:50:11,640 --> 02:50:13,280
FOR EASE OF USE AND OVERALL

5053
02:50:13,280 --> 02:50:15,200
LIKING OF THE INTERVENTION AND

5054
02:50:15,200 --> 02:50:18,160
OVERALL RESPECTFULNESS OF THE

5055
02:50:18,160 --> 02:50:18,800
INTERVENTIONS.

5056
02:50:18,800 --> 02:50:20,640
FIND MOST SAY THAT IT MADE THEM

5057
02:50:20,640 --> 02:50:25,040
LIKELY TO CHANGE.

5058
02:50:25,040 --> 02:50:26,080
MAJORITY SAID THEY PREFERRED THE

5059
02:50:26,080 --> 02:50:29,680
SOFTWARE OVER A PERSON AND

5060
02:50:29,680 --> 02:50:31,160
MINORITY SAID RATHER TALK ABOUT

5061
02:50:31,160 --> 02:50:38,040
THESE WITH DOCTOR OR NURSE.

5062
02:50:38,040 --> 02:50:40,040
THIS IS A REPLICATION STUDY WE

5063
02:50:40,040 --> 02:50:41,640
PLEATED A WHILE AGO FOLLOWING UP

5064
02:50:41,640 --> 02:50:47,800
ON EARLIER STUDY THIS INVOLVED

5065
02:50:47,800 --> 02:50:49,920
POST PAR THEM WOMEN AFTER GIVING

5066
02:50:49,920 --> 02:50:52,440
BIT AFTER SLEEPING BEFORE BEING

5067
02:50:52,440 --> 02:50:53,480
DISCHARGED, RECEIVING THAT BRIEF

5068
02:50:53,480 --> 02:50:54,600
INTERVENTION AND FOLLOWED UP

5069
02:50:54,600 --> 02:50:58,160
THREE AN SIX MONTHS P WE FOUND

5070
02:50:58,160 --> 02:51:01,840
EFFECT ON OVERALL DRUG USE ON --

5071
02:51:01,840 --> 02:51:03,560
AT THREE MONTH FOLLOW-UP, NOT

5072
02:51:03,560 --> 02:51:06,920
SIGNIFICANT AT SIX MONTHS.

5073
02:51:06,920 --> 02:51:08,680
BUT OVERALL EFFECT SIZE OF

5074
02:51:08,680 --> 02:51:11,240
INTERVENTION WAS QUITE

5075
02:51:11,240 --> 02:51:17,520
ENCOURAGING IN THIS TOBACCO USE

5076
02:51:17,520 --> 02:51:19,880
IN PREGNANCY WE SAW SIGNIFICANT

5077
02:51:19,880 --> 02:51:21,880
EFFECTS ON ABSTINENCE AT BIRTH.

5078
02:51:21,880 --> 02:51:22,880
EVALUATED PRIOR TO LEAVING

5079
02:51:22,880 --> 02:51:25,880
HOSPITAL AND WE SAW THIS

5080
02:51:25,880 --> 02:51:28,160
PROMOTION OF TALKING TO THE

5081
02:51:28,160 --> 02:51:29,440
DOCTOR OR NURSE ABOUT SMOKING.

5082
02:51:29,440 --> 02:51:31,160
WE THOUGHT THAT WAS POSITIVE.

5083
02:51:31,160 --> 02:51:33,360
SO WE YOU HEARD EARLIER BRIEF

5084
02:51:33,360 --> 02:51:34,720
INTERVENTIONS THOUGH THEY HAVE

5085
02:51:34,720 --> 02:51:37,640
SOME IMPACT ON SUBSTANCE USE,

5086
02:51:37,640 --> 02:51:39,000
AREN'T AS GOOD CONNECTING PEOPLE

5087
02:51:39,000 --> 02:51:41,280
TO OTHER SERVICES TRADITIONALLY,

5088
02:51:41,280 --> 02:51:43,880
TURNS OUT THAT MAYBE IF YOU TRY

5089
02:51:43,880 --> 02:51:45,560
PROMOTE SOMETHING THAT IS LESS

5090
02:51:45,560 --> 02:51:48,080
DISTAL BUT MORE PROXIMAL,

5091
02:51:48,080 --> 02:51:49,600
SOMETHING CLOSE SIMPLY TALKING

5092
02:51:49,600 --> 02:51:51,080
TO DOCTOR OR NURSE, YOU MIGHT BE

5093
02:51:51,080 --> 02:51:52,680
ABLE TO HAVE BETTER LUCK AND WE

5094
02:51:52,680 --> 02:51:56,280
ARE INTERESTED IN FOLLOWING UP

5095
02:51:56,280 --> 02:52:00,000
ON THAT FINDING.

5096
02:52:00,000 --> 02:52:01,480
ALCOHOL USE THIS PREGNANCY ARE

5097
02:52:01,480 --> 02:52:03,120
CURRENT HI IN THE MIDST OF FULLY

5098
02:52:03,120 --> 02:52:09,240
POWERED RA RANDOMIZE TRIAL
FUNDED

5099
02:52:09,240 --> 02:52:10,280
BY NIAA.

5100
02:52:10,280 --> 02:52:11,720
THIS IS THE PILOT STUDY THAT LED

5101
02:52:11,720 --> 02:52:13,960
TO WORK, THOUGH NOT SIGNIFICANT

5102
02:52:13,960 --> 02:52:16,720
DIFFERENCE AS EXPECTED WITH

5103
02:52:16,720 --> 02:52:19,880
SAMPLE SIZE WE FOUND ENCOURAGING

5104
02:52:19,880 --> 02:52:22,960
EFFECT SIZES ON BIRTH OUTCOME AS

5105
02:52:22,960 --> 02:52:27,880
WELL AS ABSTINENCE AT CHILDBIRTH

5106
02:52:27,880 --> 02:52:28,200
CHILDBIRTH.

5107
02:52:28,200 --> 02:52:30,320
FINALLY A QUESTION WE GET IS HOW

5108
02:52:30,320 --> 02:52:32,080
THIS LOOKS COMPARED TO A PERSON

5109
02:52:32,080 --> 02:52:33,000
DELIVERED BRIEF INTERVENTION SO

5110
02:52:33,000 --> 02:52:37,680
I WILL TALK ABOUT A STUDY LED MY

5111
02:52:37,680 --> 02:52:41,640
COLLEAGUES KIM YONKERS AND STEVE

5112
02:52:41,640 --> 02:52:43,160
WITH NIDA FUNDING COMPARING

5113
02:52:43,160 --> 02:52:44,680
BRIEF PERSON DELIVERED SCREENING

5114
02:52:44,680 --> 02:52:46,000
BRIEF INTERVENTION TO TECHNOLOGY

5115
02:52:46,000 --> 02:52:49,200
DELIVERED SCREENING AND BRIEF

5116
02:52:49,200 --> 02:52:50,360
INTERVENTION, TO ENHANCE USUAL

5117
02:52:50,360 --> 02:52:53,480
CARE CONDITION AMONG 439 WOMEN

5118
02:52:53,480 --> 02:52:54,880
RECEIVING REPRODUCTIVE

5119
02:52:54,880 --> 02:52:57,160
HEALTHCARE AND HEALTHCARE

5120
02:52:57,160 --> 02:53:00,080
SETTING.

5121
02:53:00,080 --> 02:53:06,360
17% WHOM WERE PREGNANT.

5122
02:53:06,360 --> 02:53:08,280
THE SCREENING BRIEF INTERVENTION

5123
02:53:08,280 --> 02:53:10,640
BOTH OF THE SCREENING BRIEF

5124
02:53:10,640 --> 02:53:11,320
INTERVENTION CONDITIONS

5125
02:53:11,320 --> 02:53:12,880
OUTPERFORMED THE ENHANCED

5126
02:53:12,880 --> 02:53:14,840
TREATMENT AS USUAL CONDITION.

5127
02:53:14,840 --> 02:53:16,720
AND WHILE THIS WAS NOT A

5128
02:53:16,720 --> 02:53:18,840
SUPERIORITY TRIAL, THE EFFECT

5129
02:53:18,840 --> 02:53:21,280
SIZE FOR THE COMPUTER DELIVERED

5130
02:53:21,280 --> 02:53:22,320
BRIEF INTERVENTION COMPARED

5131
02:53:22,320 --> 02:53:24,560
QUITE WELL.

5132
02:53:24,560 --> 02:53:26,480
WE ALSO IMPORTANTLY HAD A

5133
02:53:26,480 --> 02:53:28,040
DETAILED COST ANALYSIS CONNECTED

5134
02:53:28,040 --> 02:53:34,280
TO THIS STUDY LED BY TODD

5135
02:53:34,280 --> 02:53:35,960
OLMSTED AND ELECTRONIC SCREENING

5136
02:53:35,960 --> 02:53:37,680
BRIEF INTERVENTION WAS MORE COST

5137
02:53:37,680 --> 02:53:38,760
EFFECTIVE FROM THE CLINIC AND

5138
02:53:38,760 --> 02:53:45,080
THE PATIENT PERSPECTIVE.

5139
02:53:45,080 --> 02:53:46,360
THAT IS INTEGRATION WITHIN

5140
02:53:46,360 --> 02:53:48,600
HEALTHCARE AND HOW THAT MIGHT

5141
02:53:48,600 --> 02:53:49,000
WORK.

5142
02:53:49,000 --> 02:53:50,200
WHAT ABOUT REAL WORK CONNECTIONS

5143
02:53:50,200 --> 02:53:53,080
WHEN WE GE GET AWAY FROM FUNDED

5144
02:53:53,080 --> 02:53:55,880
STUDY WITH RA DOING ALL THE WORK

5145
02:53:55,880 --> 02:53:59,400
CAN WE GET INTO ONGOING CARE IN

5146
02:53:59,400 --> 02:54:02,880
A COMMUNITY SETTING.

5147
02:54:02,880 --> 02:54:04,440
ON TOP OF THAT CAN WE USE THAT

5148
02:54:04,440 --> 02:54:05,200
TECHNOLOGY BIT TO LEVERAGE

5149
02:54:05,200 --> 02:54:09,320
CONNECTION TO OTHER SORTS OF

5150
02:54:09,320 --> 02:54:10,840
CARE, THAT MIGHT BE AVAILABLE

5151
02:54:10,840 --> 02:54:11,320
AROUND THAT PARTICULAR

5152
02:54:11,320 --> 02:54:11,640
COMMUNITY.

5153
02:54:11,640 --> 02:54:13,920
SO ONE STEP IN THIS HAS BEEN

5154
02:54:13,920 --> 02:54:15,400
HEALTHCARE INTEGRATION WITH THE

5155
02:54:15,400 --> 02:54:19,040
MOMS HEALTH CHECK UP APP WHICH

5156
02:54:19,040 --> 02:54:21,080
IS WHAT WE CALL HIGH TOUCH

5157
02:54:21,080 --> 02:54:22,120
HIGH-TECH PROGRAM BEING

5158
02:54:22,120 --> 02:54:24,040
DISSEMINATED THROUGHOUT MICHIGAN

5159
02:54:24,040 --> 02:54:25,360
MULTIPLE SITES, USED BY

5160
02:54:25,360 --> 02:54:27,800
THOUSANDS OF WOMEN SO FAR WITH

5161
02:54:27,800 --> 02:54:30,600
HIGH RATINGS FOR ACCEPTABILITY.

5162
02:54:30,600 --> 02:54:33,680
AND HIGH RATES OF TECH

5163
02:54:33,680 --> 02:54:35,480
INTRODUCTION BY FRONT DESK STAFF

5164
02:54:35,480 --> 02:54:37,240
SO PRE-PANDEMIC WE WERE GETTING

5165
02:54:37,240 --> 02:54:41,280
MORE THAN 90% NEW OB INTAKES

5166
02:54:41,280 --> 02:54:44,560
BEING GIVEN iPAD BY FRONT DESK

5167
02:54:44,560 --> 02:54:45,960
STAFF COMPLETING THE APP AND

5168
02:54:45,960 --> 02:54:48,360
HANDING IT BACK.

5169
02:54:48,360 --> 02:54:49,400
WE ARE EXCITED.

5170
02:54:49,400 --> 02:54:51,080
IT CAN BE DONE TWO WAYS.

5171
02:54:51,080 --> 02:54:53,960
YOU CAN HAND OUT THE TABLET AT

5172
02:54:53,960 --> 02:54:55,440
LIVE IN PERSON APPOINTMENT LIKE

5173
02:54:55,440 --> 02:54:57,800
I SAID, OR THEY CAN BE HANDED A

5174
02:54:57,800 --> 02:54:59,360
FLYER AND USE THEIR OWN DEVICE,

5175
02:54:59,360 --> 02:55:01,080
THAT IS AN EXAMPLE OF ONE OF

5176
02:55:01,080 --> 02:55:02,000
THOSE FLYERS.

5177
02:55:02,000 --> 02:55:04,760
SO THEY CAN SIMPLY FLASH THIS QR

5178
02:55:04,760 --> 02:55:06,680
CODE OR GO TO WEBSITE AND

5179
02:55:06,680 --> 02:55:08,320
COMPLETE THE SCREENING AND BRIEF

5180
02:55:08,320 --> 02:55:11,160
INTERVENTION THAT WAY.

5181
02:55:11,160 --> 02:55:14,120
ALL THE CONTENT IS DEVELOPED

5182
02:55:14,120 --> 02:55:16,480
BOTH WITH PREGNANT WOMEN AND

5183
02:55:16,480 --> 02:55:18,400
COMMUNITY PARTNERS IN TERMS OF

5184
02:55:18,400 --> 02:55:20,160
WORK FLOW THAT PROVIDES

5185
02:55:20,160 --> 02:55:23,880
ELECTRONIC SCREENING AND

5186
02:55:23,880 --> 02:55:25,880
BRIEFING INTERVENTIONS AND WE

5187
02:55:25,880 --> 02:55:27,560
HAVE ADD AD PROVIDER SUMMARY IN

5188
02:55:27,560 --> 02:55:29,960
THIS PARTICULAR PROJECT.

5189
02:55:29,960 --> 02:55:33,480
SO THAT HEALTHCARE PROVIDERS GET

5190
02:55:33,480 --> 02:55:35,600
OUTPUT AND MAKING

5191
02:55:35,600 --> 02:55:36,920
RECOMMENDATIONS FOR SERVICES,

5192
02:55:36,920 --> 02:55:38,080
PROGRAMS IN THE AREA, THEY MIGHT

5193
02:55:38,080 --> 02:55:40,080
REFER TO.

5194
02:55:40,080 --> 02:55:43,880
WE FURTHER TAYLOR TO EACH NEW

5195
02:55:43,880 --> 02:55:44,280
SITE.

5196
02:55:44,280 --> 02:55:45,840
NOT EXACTTY SAME APP FOR EACH

5197
02:55:45,840 --> 02:55:47,600
CLINIC.

5198
02:55:47,600 --> 02:55:48,840
A LITTLE DIFFERENT FOR EACH ONE

5199
02:55:48,840 --> 02:55:52,120
AND WE ARE ABLE TO DO THAT

5200
02:55:52,120 --> 02:55:53,840
BECAUSE WE USE A PARTICULAR

5201
02:55:53,840 --> 02:55:57,480
PLATFORM AN NIH SUPPORTED

5202
02:55:57,480 --> 02:55:58,640
ELECTRONIC INTERVENTION

5203
02:55:58,640 --> 02:56:00,520
AUTHORING TOOL TO LEARN MORE

5204
02:56:00,520 --> 02:56:03,440
ABOUT AT SIAS.APP,

5205
02:56:03,440 --> 02:56:04,760
NON-COMMERCIAL NIH SUPPORTED

5206
02:56:04,760 --> 02:56:06,040
OPEN SOURCE AND LETS ANYBODY

5207
02:56:06,040 --> 02:56:07,440
MAKE THEIR OWN CONTENT SHARE

5208
02:56:07,440 --> 02:56:10,200
THEIR CONSENT AND DEPLOY IT IN

5209
02:56:10,200 --> 02:56:14,960
STUDIES AT NO COST.

5210
02:56:14,960 --> 02:56:16,760
THERE IS ANOTHER LEVEL, WE WANT

5211
02:56:16,760 --> 02:56:19,040
TO ENHANCE CONNECTION TO OTHER

5212
02:56:19,040 --> 02:56:20,040
SERVICES OUTSIDE OF THAT

5213
02:56:20,040 --> 02:56:22,840
PARTICULAR CLINIC.

5214
02:56:22,840 --> 02:56:24,280
WE HAVE GOOD LUCK WITH THIS, ONE

5215
02:56:24,280 --> 02:56:26,920
WAY WE DO THAT IS USING

5216
02:56:26,920 --> 02:56:29,080
SOMETHING YOU CAN SEE IN THIS

5217
02:56:29,080 --> 02:56:30,600
FIRST SCREEN HERE WHERE WE TELL

5218
02:56:30,600 --> 02:56:32,160
THEM ABOUT THE IMPORTANCE OF

5219
02:56:32,160 --> 02:56:35,040
HOME VISITING HOW IT IS FREELY

5220
02:56:35,040 --> 02:56:36,280
AVAILABLE TO ANY WOMAN IN

5221
02:56:36,280 --> 02:56:38,960
MICHIGAN COVERED BY MEDICAID.

5222
02:56:38,960 --> 02:56:41,640
HOW IT IS AVAILABLE FOR FREE AND

5223
02:56:41,640 --> 02:56:43,160
BE SUPPORTED BOTH DURING

5224
02:56:43,160 --> 02:56:44,320
PREGNANCY AND AFTER.

5225
02:56:44,320 --> 02:56:45,640
WE ASK IF THEY ARE INTERESTED

5226
02:56:45,640 --> 02:56:47,880
AND IF THEY SAY THEY ARE, WE ASK

5227
02:56:47,880 --> 02:56:50,280
FOR PERMISSION TO SEND THEIR

5228
02:56:50,280 --> 02:56:51,760
INFORMATION TO THE LOCAL A HOME

5229
02:56:51,760 --> 02:56:53,320
VISITING PROGRAMS SO THAT THEY

5230
02:56:53,320 --> 02:56:55,240
CAN REACH OUT TO THEM.

5231
02:56:55,240 --> 02:56:56,600
GET HIGHER RATES ENDORSEMENT OF

5232
02:56:56,600 --> 02:56:58,760
THIS, WE GIVE THE INFORMATION TO

5233
02:56:58,760 --> 02:56:59,600
THE HEALTHCARE PROGRAM THEY

5234
02:56:59,600 --> 02:57:00,480
REACH OUT TO THE PARENT.

5235
02:57:00,480 --> 02:57:02,880
THEY FOUND THAT THIS IS A REALLY

5236
02:57:02,880 --> 02:57:04,960
GOOD WAY TO HELP GET WOMEN

5237
02:57:04,960 --> 02:57:05,800
CONNECTED TO THAT IMPORTANT

5238
02:57:05,800 --> 02:57:07,120
SERVICE.

5239
02:57:07,120 --> 02:57:09,840
WE ALSO ARE EXPERIMENTING WITH

5240
02:57:09,840 --> 02:57:12,080
ONLINE IMMEDIATE CONNECTION TO

5241
02:57:12,080 --> 02:57:12,960
TELEHEALTH WITH BEHAVIORAL

5242
02:57:12,960 --> 02:57:14,560
HEALTH CONSULTANT AND THEN

5243
02:57:14,560 --> 02:57:15,880
FINALLY WE ARE WORKING ON THE

5244
02:57:15,880 --> 02:57:18,760
TECHNOLOGY TO ALLOW US TO DO

5245
02:57:18,760 --> 02:57:20,360
LIVE INSTANT TEXT MESSAGING THAT

5246
02:57:20,360 --> 02:57:21,200
IS SECURE.

5247
02:57:21,200 --> 02:57:22,600
SO THEY CAN TAP A LITTLE BUTTON

5248
02:57:22,600 --> 02:57:24,040
THAT SAYS I WANT TO CHAT WITH

5249
02:57:24,040 --> 02:57:26,640
SOMEBODY RIGHT NOW.

5250
02:57:26,640 --> 02:57:28,080
AND GET INFORMATION GET HELP,

5251
02:57:28,080 --> 02:57:31,680
GET SET UP FOR OTHER SERVICES OR

5252
02:57:31,680 --> 02:57:33,480
SIMPLY ASK QUESTIONS.

5253
02:57:33,480 --> 02:57:35,480
SO THIS IS A LITTLE BIT HOW WE

5254
02:57:35,480 --> 02:57:36,680
HAVE BEEN USING TECHNOLOGY THE

5255
02:57:36,680 --> 02:57:39,240
ADDRESS CHALLENGES RELATED TO

5256
02:57:39,240 --> 02:57:41,120
REACH AND TO TRY TO BETTER

5257
02:57:41,120 --> 02:57:44,240
INTEGRATE SERVICES AROUND A

5258
02:57:44,240 --> 02:57:44,840
PARTICULAR PREGNANT PATIENT.

5259
02:57:44,840 --> 02:57:48,240
SO MUCH MORE THAT COULD BE DONE.

5260
02:57:48,240 --> 02:57:49,480
I'M SURE THERE ARE GREAT IDEAS

5261
02:57:49,480 --> 02:57:51,080
OUT THERE, THIS IS SOME OF WHAT

5262
02:57:51,080 --> 02:57:52,880
WE HAVE BEEN DOING, GRATEFUL FOR

5263
02:57:52,880 --> 02:57:56,240
YOUR ATTENTION AND WE WILL YIELD

5264
02:57:56,240 --> 02:57:58,080
TO THE NEXT SPEAKER.

5265
02:57:58,080 --> 02:57:59,680
THANK YOU VERY MUCH.

5266
02:57:59,680 --> 02:58:02,200
>> THANK YOU SO MUCH, DOCTOR.

5267
02:58:02,200 --> 02:58:22,800
FOR THAT GREAT TALK.

5268
02:58:22,800 --> 02:58:23,520
ALL RIGHT.

5269
02:58:23,520 --> 02:58:24,360
HERE WE GO.

5270
02:58:24,360 --> 02:58:26,400
ACTUALLY THE PREVIOUS TWO TALKS

5271
02:58:26,400 --> 02:58:28,680
I THINK A NICE JOB TALKING ABOUT

5272
02:58:28,680 --> 02:58:30,320
SOME OF THE WAYS TO INTEGRATE

5273
02:58:30,320 --> 02:58:31,480
TREATMENT TO MENTAL HEALTH AND

5274
02:58:31,480 --> 02:58:33,480
SUBSTANCE USE DISORDERS AND TO

5275
02:58:33,480 --> 02:58:36,680
PRIMARY CARE, DR. ONDERMAN

5276
02:58:36,680 --> 02:58:39,480
LISTED SEVERAL WAYS THAT ARE

5277
02:58:39,480 --> 02:58:41,680
GREAT TO DO THAT.

5278
02:58:41,680 --> 02:58:47,560
TODAY I AM -- WILL TALK ABOUT AN

5279
02:58:47,560 --> 02:58:49,800
EXAMPLE, ONE EXAMPLE AS A WAY TO

5280
02:58:49,800 --> 02:58:53,240
MAKE LARGER POINT.

5281
02:58:53,240 --> 02:58:54,240
I WAS WORKING IN FLINT,

5282
02:58:54,240 --> 02:58:54,760
MICHIGAN.

5283
02:58:54,760 --> 02:58:56,200
HERE IS AN EXAMPLE FROM WHERE I

5284
02:58:56,200 --> 02:58:57,000
AM.

5285
02:58:57,000 --> 02:59:02,320
SO I'M SITTING IN FLINT.

5286
02:59:02,320 --> 02:59:05,040
OUR RATE IS ABOUT 40%, IN THE

5287
02:59:05,040 --> 02:59:07,320
COUNTY THE POVERTY RATE IS 18%,

5288
02:59:07,320 --> 02:59:11,000
MICHIGAN OVERALL IS ABOUT 14%.

5289
02:59:11,000 --> 02:59:13,880
KEEP IN MIND THAT ABOUT 47% OF

5290
02:59:13,880 --> 02:59:15,480
U.S. BIRTHS ARE COVERED BY

5291
02:59:15,480 --> 02:59:16,600
MEDICAID SO IF YOU LOOK AT THE

5292
02:59:16,600 --> 02:59:21,040
RISK FACTORS FOR POOR MATERNAL

5293
02:59:21,040 --> 02:59:24,320
INFANT HEALTH OUTCOMES, YOU SEE

5294
02:59:24,320 --> 02:59:26,560
BETWEEN INFANT DEATH LOW BIRTH

5295
02:59:26,560 --> 02:59:29,680
WEIGHT BIRTH MOTHERS WHO SMOKED,

5296
02:59:29,680 --> 02:59:31,240
THAT THEY ARE ONE RATE MICHIGAN

5297
02:59:31,240 --> 02:59:33,120
HIGHER IN THE COUNTY AND MUCH

5298
02:59:33,120 --> 02:59:34,080
HIGHER IN FLINT.

5299
02:59:34,080 --> 02:59:35,760
THESE THINGS TEND TO BE

5300
02:59:35,760 --> 02:59:38,960
CORRELATED WITH SOCIOECONOMIC

5301
02:59:38,960 --> 02:59:41,080
DISADVANTAGE.

5302
02:59:41,080 --> 02:59:46,440
SO IT HAS TO DO WITHSOME

5303
02:59:46,440 --> 02:59:47,080
DETERMINANTS AND THESE LARGER

5304
02:59:47,080 --> 02:59:48,680
SYSTEMIC ISSUES.

5305
02:59:48,680 --> 02:59:50,880
SOCIAL DETERMINANTS AND LARGER

5306
02:59:50,880 --> 02:59:51,600
ISSUES.

5307
02:59:51,600 --> 02:59:54,480
MANY SYSTEMS SERVING MEDICAID

5308
02:59:54,480 --> 02:59:57,680
WOMEN OR WOMEN ON MEDICAID ARE

5309
02:59:57,680 --> 02:59:59,360
LOW RESOURCE SYSTEMS, WE HAVE

5310
02:59:59,360 --> 03:00:01,280
FEDERALLY QUALIFIED HEALTH

5311
03:00:01,280 --> 03:00:03,320
CENTERS, HERE IS A SIGN FROM

5312
03:00:03,320 --> 03:00:05,080
SOMEBODY WHO WAS TRYING TO

5313
03:00:05,080 --> 03:00:06,880
CONVINCE OUR HEALTH SYSTEM NOT

5314
03:00:06,880 --> 03:00:09,040
TO CLOSE DOWN LOCAL HOSPITALS,

5315
03:00:09,040 --> 03:00:10,680
OR THEY ARE NOT TREATMENT

5316
03:00:10,680 --> 03:00:18,680
SYSTEMS AT ALL.

5317
03:00:18,680 --> 03:00:22,400
DR. -- JUSTICE SYSTEMS AND HOW

5318
03:00:22,400 --> 03:00:24,160
THEY END UP INTERSECTING WITH A

5319
03:00:24,160 --> 03:00:25,600
LOT OF FOLKS WITH MENTAL ILLNESS

5320
03:00:25,600 --> 03:00:27,640
THAT WE HAVE HOUSING SYSTEMS,

5321
03:00:27,640 --> 03:00:31,080
CHILD WELFARE, CRISIS SERVICES,

5322
03:00:31,080 --> 03:00:32,960
MINIMUM WAGE FOOD QUALITY

5323
03:00:32,960 --> 03:00:34,880
SOCIETAL GENDER BASED VIOLENCE

5324
03:00:34,880 --> 03:00:37,520
PEOPLE WAGE EQUAL OPPORTUNITY

5325
03:00:37,520 --> 03:00:38,520
EDUCATION JOB CHILD CARE

5326
03:00:38,520 --> 03:00:41,960
ENVIRONMENTAL EQUITY, ALL OF

5327
03:00:41,960 --> 03:00:44,080
THESE EFFECT OBVIOUSLY HEALTH OF

5328
03:00:44,080 --> 03:00:45,840
WOMEN, HEALTH OF FAMILIES AND

5329
03:00:45,840 --> 03:00:47,800
HEALTH OF PREGNANT WOMEN.

5330
03:00:47,800 --> 03:00:50,480
AND THEY ARE NOT EQUITABLY

5331
03:00:50,480 --> 03:00:55,400
DISTRIBUTED AND ESPECIALLY LOWER

5332
03:00:55,400 --> 03:00:58,080
INCOME WOMEN AND WOMEN OF COLOR.

5333
03:00:58,080 --> 03:01:01,280
HERE IS THE EXAMPLE I'M GOING TO

5334
03:01:01,280 --> 03:01:02,560
GIVE, LOOP AROUND TO LARGER

5335
03:01:02,560 --> 03:01:05,960
POINT.

5336
03:01:05,960 --> 03:01:11,720
IT IS FROM STUDY DR. KAREN AND I

5337
03:01:11,720 --> 03:01:13,200
-- TOGETHER AND LET ME TELL YOU

5338
03:01:13,200 --> 03:01:14,440
A LITTLE BIT ABOUT THAT.

5339
03:01:14,440 --> 03:01:16,680
SO POSTPARTUM DEPRESSION EFFECTS

5340
03:01:16,680 --> 03:01:21,680
ONE IN SEVEN MOM, ONE AND THREE

5341
03:01:21,680 --> 03:01:22,440
OR FOUR LOWER INCOME MOMS.

5342
03:01:22,440 --> 03:01:24,880
THE REASONS FOR THAT ARE

5343
03:01:24,880 --> 03:01:26,720
MANIFOLD, THEY HAVE HIGHER

5344
03:01:26,720 --> 03:01:28,840
STRESS LEVELS, THERE IS A LOT

5345
03:01:28,840 --> 03:01:29,960
GOING ON.

5346
03:01:29,960 --> 03:01:31,200
LOWER INCOME MOMS ARE LESS

5347
03:01:31,200 --> 03:01:32,880
LIKELY TO GET CONNECTED TO CARE.

5348
03:01:32,880 --> 03:01:35,680
SO THEY ARE NOT ONLY MORE LIKELY

5349
03:01:35,680 --> 03:01:37,080
TO BE DEPRESSED, LESS LIKELY TO

5350
03:01:37,080 --> 03:01:40,000
BE ABLE TO EFFECTIVELY PREPARE

5351
03:01:40,000 --> 03:01:42,080
AND EFFECTS OF POSTPARTUM

5352
03:01:42,080 --> 03:01:45,080
DEPRESSION ARE MORE SEVERE IN

5353
03:01:45,080 --> 03:01:47,120
TERMS OF MATERNAL CARE GIVING

5354
03:01:47,120 --> 03:01:49,920
INFANT DEVELOPMENT AND WHAT NOT.

5355
03:01:49,920 --> 03:01:51,800
MY POINT HERE, IT GOES NICELY

5356
03:01:51,800 --> 03:01:53,800
WITH SLIDES YOU SEE LATER --

5357
03:01:53,800 --> 03:01:55,440
EARLIER TODAY IS THAT SCREENING

5358
03:01:55,440 --> 03:01:57,000
AND TREATMENT ARE IMPORTANT BUT

5359
03:01:57,000 --> 03:01:59,160
PREVENTION IS EVEN BETTER.

5360
03:01:59,160 --> 03:02:03,040
OVER ON THE LEFT IS ACOG

5361
03:02:03,040 --> 03:02:04,080
RECOMMENDATION ABOUT SCREENING

5362
03:02:04,080 --> 03:02:06,440
DURING THE PERINATAL PERIOD OR

5363
03:02:06,440 --> 03:02:08,360
MOOD AND EMOTIONAL WELL BEING

5364
03:02:08,360 --> 03:02:11,680
AND FOLLOWING UP WITH REFERRALS.

5365
03:02:11,680 --> 03:02:13,720
THERE IS SOME TRACTION MADE WITH

5366
03:02:13,720 --> 03:02:15,240
THIS, I KNOW SEVERAL HEALTH

5367
03:02:15,240 --> 03:02:16,480
SYSTEMS STILL WORKING ON THIS

5368
03:02:16,480 --> 03:02:19,160
BUT FOLKS ARE TRYING.

5369
03:02:19,160 --> 03:02:21,240
AND YET IF THERE WAS A WAY THAT

5370
03:02:21,240 --> 03:02:24,240
WE COULD PREVENT POSTPARTUM

5371
03:02:24,240 --> 03:02:24,880
DEPRESSION ENTIRELY, THAT WOULD

5372
03:02:24,880 --> 03:02:28,760
BE GREAT ESPECIALLY FOR THESE

5373
03:02:28,760 --> 03:02:30,320
MOMS LOWER INCOME MOMS WHO LIKE

5374
03:02:30,320 --> 03:02:32,720
I SAID HAVE HIGHER RATES OF

5375
03:02:32,720 --> 03:02:34,280
DEPRESENTATION AND MORE

5376
03:02:34,280 --> 03:02:47,000
DIFFICULTY GETTING CONNECTED.

5377
03:02:47,000 --> 03:02:50,760
SO ROSE MY COLLEAGUE DEVELOPED A

5378
03:02:50,760 --> 03:02:53,160
CLASS, A FOUR SESSION CLASS

5379
03:02:53,160 --> 03:02:54,720
CALLED ROSE, REACH OUT STAND

5380
03:02:54,720 --> 03:02:56,840
STRONG ESSENTIALS FOR MOTHERS,

5381
03:02:56,840 --> 03:02:58,360
FOUR SESSIONS DURING PREGNANCY,

5382
03:02:58,360 --> 03:03:02,000
ONE POSTPARTUM CHECK IN, SHE

5383
03:03:02,000 --> 03:03:04,960
INTENTIONALLY FRAMED AS A CLASS

5384
03:03:04,960 --> 03:03:07,880
RATHER THAN TREATMENT TO SET

5385
03:03:07,880 --> 03:03:09,960
ASIDE MENTAL HEALTH STIGMA.

5386
03:03:09,960 --> 03:03:11,280
IT IS PREVENTION NOT TREATMENT.

5387
03:03:11,280 --> 03:03:14,680
IT IS STRUCTURED,

5388
03:03:14,680 --> 03:03:15,320
PSYCHOEDUCATIONAL, DELIVERED BY

5389
03:03:15,320 --> 03:03:17,360
NURSE, COMMUNITY HEALTH WORKERS

5390
03:03:17,360 --> 03:03:21,200
DO HEALTH EDUCATORS WITH GOOD

5391
03:03:21,200 --> 03:03:22,640
FIDELITY AND WE HAVE

5392
03:03:22,640 --> 03:03:23,400
INTERVENTION MATERIALS IN

5393
03:03:23,400 --> 03:03:25,640
ENGLISH AND SPANISH AND WISH

5394
03:03:25,640 --> 03:03:28,640
LIST OF OTHER LANGUAGES.

5395
03:03:28,640 --> 03:03:32,680
YOU CAN HERE THE SENSE OF CLASS

5396
03:03:32,680 --> 03:03:34,160
MEMBER WORK SHE DESIGNED IT TO

5397
03:03:34,160 --> 03:03:38,400
BE WELCOMING FRIENDLY.

5398
03:03:38,400 --> 03:03:41,280
ROSE -- I THINK FOR PSYCHOSOCIAL

5399
03:03:41,280 --> 03:03:44,080
INTERVENTION DELIVERED IN PERSON

5400
03:03:44,080 --> 03:03:46,280
IS HAS NICE FEATURES TO MAKE IT

5401
03:03:46,280 --> 03:03:48,200
FLEXIBLE AND SCALABLE DOESN'T

5402
03:03:48,200 --> 03:03:49,400
MATTER GROUP OF INDIVIDUALS,

5403
03:03:49,400 --> 03:03:51,840
DOESN'T MATTER OFFICE HOME

5404
03:03:51,840 --> 03:03:53,280
TELEMEDICINE, DOESN'T MATTER

5405
03:03:53,280 --> 03:03:56,600
WHEN DURING PREGNANCY OR SESSION

5406
03:03:56,600 --> 03:03:58,720
CAN BE DIFFERENT FOR NURSE

5407
03:03:58,720 --> 03:04:00,920
VISITING HOME VISITING PROGRAMS,

5408
03:04:00,920 --> 03:04:03,040
IF THEY WANT TO DO IT IN MORE 20

5409
03:04:03,040 --> 03:04:05,800
MINUTE PIECES THAT'S FINE, IF

5410
03:04:05,800 --> 03:04:07,000
THEY WANT TO LUMP SESSIONS

5411
03:04:07,000 --> 03:04:08,240
TOGETHER THAT'S FINE.

5412
03:04:08,240 --> 03:04:11,400
IN THIS PROJECT WE WERE

5413
03:04:11,400 --> 03:04:13,120
TARGETING ANY SETTING OFFERING

5414
03:04:13,120 --> 03:04:15,880
OUTPATIENT PRE-NATAL SERVICES,

5415
03:04:15,880 --> 03:04:19,080
THAT MORE THAN HALF OF THEIR

5416
03:04:19,080 --> 03:04:24,000
MOMS THEY SAW WERE ON MEDICAID.

5417
03:04:24,000 --> 03:04:28,200
THE GOOD NEWS IS, THIS SIMPLE

5418
03:04:28,200 --> 03:04:30,400
INTERVENTION WORKS REMARKABLY

5419
03:04:30,400 --> 03:04:34,120
WELL FOR PREVENTING POSTPARTUM

5420
03:04:34,120 --> 03:04:34,720
DEPRESSION.

5421
03:04:34,720 --> 03:04:36,480
FIVE CLINICAL TRIALS,

5422
03:04:36,480 --> 03:04:37,720
INTERVENTION PREVENT ABOUT HALF

5423
03:04:37,720 --> 03:04:41,360
CASES POSTPARTUM DEPRESSION

5424
03:04:41,360 --> 03:04:43,240
AMONG MOMS LOWER INCOME MOMS ON

5425
03:04:43,240 --> 03:04:44,240
MEDICAID.

5426
03:04:44,240 --> 03:04:46,280
AS A RESULT OF THAT IT IS NOW

5427
03:04:46,280 --> 03:04:48,080
RECOMMENDED BY THE U.S.

5428
03:04:48,080 --> 03:04:49,440
PREVENTIVE SERVICES TASK FORCE

5429
03:04:49,440 --> 03:04:51,080
TO PREVENT POSTPARTUM

5430
03:04:51,080 --> 03:04:53,280
DEPRESSION.

5431
03:04:53,280 --> 03:04:55,800
SO THE SUSTAINMENT STUDY LOOKS

5432
03:04:55,800 --> 03:05:00,880
AT PARTNERING WITH 98 AGENCIES

5433
03:05:00,880 --> 03:05:02,960
NATIONALLY, EVERYTHING FROM S

5434
03:05:02,960 --> 03:05:05,160
2HCs TO SAFETY NET OBGYN

5435
03:05:05,160 --> 03:05:08,400
CLINICS TO DUAL ORGANIZATION, TO

5436
03:05:08,400 --> 03:05:12,120
HEALTHY START TO VARIETY OF

5437
03:05:12,120 --> 03:05:13,480
AGENCIES.

5438
03:05:13,480 --> 03:05:14,400
THAT SERVE PREGNANT WOMEN.

5439
03:05:14,400 --> 03:05:16,280
WE ARE LOOKING AT HOW MUCH

5440
03:05:16,280 --> 03:05:19,240
TRAINING AND TECHNICAL

5441
03:05:19,240 --> 03:05:21,440
ASSISTANCE DO THESE AGENCIES

5442
03:05:21,440 --> 03:05:23,520
NEED TO IMPLEMENT, SUSTAIN OVER

5443
03:05:23,520 --> 03:05:24,920
TIME AND WHAT ARE COST AND

5444
03:05:24,920 --> 03:05:28,840
BENEFITS OF THIS SUPPORT.

5445
03:05:28,840 --> 03:05:31,920
SO BRIEFLY WHAT WE DO IS TRAIN

5446
03:05:31,920 --> 03:05:35,520
AGENCIES AT THE BEGINNING IT IS

5447
03:05:35,520 --> 03:05:38,400
THOROUGH, WE GO THROUGH THAT

5448
03:05:38,400 --> 03:05:39,480
PROCESS, HELP IMPLEMENT IF THEY

5449
03:05:39,480 --> 03:05:41,680
ARE STRUGGLING THEY CAN GET

5450
03:05:41,680 --> 03:05:45,520
RANDOMIZE TO RECEIVE ONE OF TWO

5451
03:05:45,520 --> 03:05:49,480
OTHER SUPPORTS WHICH IS

5452
03:05:49,480 --> 03:05:50,600
FEEDBACK, MONTHLY COACHING AND

5453
03:05:50,600 --> 03:05:51,120
FEEDBACK.

5454
03:05:51,120 --> 03:05:52,640
WE ARE LOOKING AT THIS IN TERMS

5455
03:05:52,640 --> 03:05:55,520
OF OUTCOMES OF HOW MANY MONTHS

5456
03:05:55,520 --> 03:05:59,400
SUSTAIN WITH ADEQUATE FIDELITY,

5457
03:05:59,400 --> 03:06:01,920
THE REACH DR. ONDERMAN TALKED

5458
03:06:01,920 --> 03:06:03,840
ABOUT RECEIVING AGENCY, COST AND

5459
03:06:03,840 --> 03:06:05,760
COST EFFECTIVENESS OF THESE

5460
03:06:05,760 --> 03:06:06,040
SUPPORTS.

5461
03:06:06,040 --> 03:06:08,320
TO THE AGENCIES.

5462
03:06:08,320 --> 03:06:11,960
AGENCY CAPACITY AND ON THE OTHER

5463
03:06:11,960 --> 03:06:12,680
HAND SHIP OF ROSE EFFORTS, WE

5464
03:06:12,680 --> 03:06:14,760
ARE LOOKING AT QUANTITATIVE

5465
03:06:14,760 --> 03:06:16,280
MEASURES OVER 30 MONTHS BUT

5466
03:06:16,280 --> 03:06:18,520
QUALITATIVE INTERVIEWS, AT 12

5467
03:06:18,520 --> 03:06:19,840
MONTHS AND 30 MONTHS, IT IS FROM

5468
03:06:19,840 --> 03:06:21,400
THAT IN THE TECHNICAL ASSISTANCE

5469
03:06:21,400 --> 03:06:23,080
THAT I WANT TO TELL YOU THIS

5470
03:06:23,080 --> 03:06:26,080
LARGER POINT THAT RELATE

5471
03:06:26,080 --> 03:06:27,480
INTEGRATING SYSTEMS FOR WOMEN AT

5472
03:06:27,480 --> 03:06:34,440
RISK OF MULTI-MORBID CONDITIONS.

5473
03:06:34,440 --> 03:06:36,200
LIKE I SAID THERE'S SEVERAL

5474
03:06:36,200 --> 03:06:38,480
THINGS WE TRY TO DO BOTH IN

5475
03:06:38,480 --> 03:06:40,480
TERMS OF DEVELOPING AND IN TERMS

5476
03:06:40,480 --> 03:06:43,040
OF IMPLEMENTING TO ADDRESS

5477
03:06:43,040 --> 03:06:47,200
DISPARITY, RACIAL ETHNIC AND

5478
03:06:47,200 --> 03:06:48,000
SOCIAL ECONOMICS.

5479
03:06:48,000 --> 03:06:50,000
IT WAS CREATE AS A CLASS THAT

5480
03:06:50,000 --> 03:06:52,280
TEACHES USEFUL SKILLS FOR ALL

5481
03:06:52,280 --> 03:06:55,040
MOMS, TREATMENT FOR STIGMA, IT

5482
03:06:55,040 --> 03:06:57,040
WAS TESTD WITH DIVERSE

5483
03:06:57,040 --> 03:07:00,200
POPULATIONS USES PRINCIPLES,

5484
03:07:00,200 --> 03:07:01,640
RELATIONSHIP SKILLS SOCIAL

5485
03:07:01,640 --> 03:07:02,200
SUPPORT HEALTHCARE THAT

5486
03:07:02,200 --> 03:07:06,120
TRANSLATES ACROSS CULTURES.

5487
03:07:06,120 --> 03:07:08,480
IT CAN BE DELIVERED VIA VIDEO

5488
03:07:08,480 --> 03:07:11,640
CONFERENCE, EASIER FOR RURAL

5489
03:07:11,640 --> 03:07:14,080
PROGRAMS, AND WE HAVE BEEN HAPPY

5490
03:07:14,080 --> 03:07:16,200
THAT A LOT OF AGENCIES INVOLVED

5491
03:07:16,200 --> 03:07:19,920
IN THE LARGER PROJECT ARE RUN BY

5492
03:07:19,920 --> 03:07:23,600
OR HAVE MANY MINORITY PROVIDERS.

5493
03:07:23,600 --> 03:07:25,840
WE ARE ALSO LOOKING AT COST

5494
03:07:25,840 --> 03:07:27,480
EFFECTIVENESS TO INFORM POLICY

5495
03:07:27,480 --> 03:07:28,240
CHANGE.

5496
03:07:28,240 --> 03:07:30,240
SO ALL THAT IS CONTEXT FOR WHAT

5497
03:07:30,240 --> 03:07:36,320
I AM ABOUT TO SAY.

5498
03:07:36,320 --> 03:07:41,080
SO AS WE ARE TALKING, WE HAVE

5499
03:07:41,080 --> 03:07:43,400
THESE INTERVIEWS AT 12 AND 30

5500
03:07:43,400 --> 03:07:44,840
MONTHS, A GROUP OF AGENCIES

5501
03:07:44,840 --> 03:07:46,280
HAVING STRUGGLES IMPLEMENTING

5502
03:07:46,280 --> 03:07:47,640
THAT WE ARE TALKING TO QUARTERLY

5503
03:07:47,640 --> 03:07:49,240
IF NOT MONTHLY.

5504
03:07:49,240 --> 03:07:51,440
WE TALKED WITH A LOT OF FOLKS

5505
03:07:51,440 --> 03:07:53,040
ALL ACROSS THE COUNTRY.

5506
03:07:53,040 --> 03:07:54,920
HERE IS WHAT WE ARE FINDING.

5507
03:07:54,920 --> 03:07:56,600
SO THIS GETS TO THIS LARGER

5508
03:07:56,600 --> 03:07:59,680
ISSUE OF HOW DO YOU INTEGRATE

5509
03:07:59,680 --> 03:08:01,880
HEALTH SERVICES INTO PRIMARY

5510
03:08:01,880 --> 03:08:05,520
CARE OR MORE STANDARD CARE

5511
03:08:05,520 --> 03:08:06,000
SETTING.

5512
03:08:06,000 --> 03:08:08,240
WHAT WE ARE FINDING IS IT IS A

5513
03:08:08,240 --> 03:08:09,680
LOT BETTER IF ROSE CAN BE

5514
03:08:09,680 --> 03:08:10,640
INTEGRATED TO REGULAR WORK FLOW

5515
03:08:10,640 --> 03:08:12,440
AND NOT SET UP AS A NEW PROCESS.

5516
03:08:12,440 --> 03:08:17,160
FOR EXAMPLE, THERE ARE SOME

5517
03:08:17,160 --> 03:08:18,960
GROUPS THAT WORK WITH CHILDBIRTH

5518
03:08:18,960 --> 03:08:21,240
EDUCATION OR HAVE A CHILDBIRTH

5519
03:08:21,240 --> 03:08:22,920
EDUCATION GROUP THEY REGULARLY

5520
03:08:22,920 --> 03:08:24,800
REFER TO AS MUCH EASIER TO DO IT

5521
03:08:24,800 --> 03:08:26,680
AS PART OF THAT THAN IT IS FOR

5522
03:08:26,680 --> 03:08:30,760
AGENCY TO SET UP AN ENTIRELY NEW

5523
03:08:30,760 --> 03:08:32,440
GROUP MEETING STRUCTURE OR FOR

5524
03:08:32,440 --> 03:08:34,080
VISITING NURSES, IF THEY ARE

5525
03:08:34,080 --> 03:08:35,840
SEEING PEOPLE INDIVIDUALLY THAT

5526
03:08:35,840 --> 03:08:38,680
INCORPORATED THAT DON'T TRY TO

5527
03:08:38,680 --> 03:08:40,680
CREATE A WHOLE SYSTEM SYSTEM IS

5528
03:08:40,680 --> 03:08:41,200
HARDER.

5529
03:08:41,200 --> 03:08:42,480
THE OTHER THING WE ARE SEEING,

5530
03:08:42,480 --> 03:08:47,120
IMPORTANT TO NOTICE HERE IS THAT

5531
03:08:47,120 --> 03:08:55,520
THE AGENCY THEY ARE NOT HAVING

5532
03:08:55,520 --> 03:08:57,280
TROUBLE INTEGRATING AS MUCH AS

5533
03:08:57,280 --> 03:09:00,400
HAVING TROUBLE KEEPING DOORS

5534
03:09:00,400 --> 03:09:01,000
OPEN.

5535
03:09:01,000 --> 03:09:07,560
EVEN WITHIN HEALTH SYSTEMS

5536
03:09:07,560 --> 03:09:10,240
FAIRLY WELL RESOURCED.

5537
03:09:10,240 --> 03:09:15,680
OB CLINIC THAT HE'S THE MEDICAID

5538
03:09:15,680 --> 03:09:23,600
MOM WE MOVE ACROSS THE STREET, I

5539
03:09:23,600 --> 03:09:26,000
HOPE YOU DON'T MIND AND NOT

5540
03:09:26,000 --> 03:09:29,360
PROVIDE SERVICES.

5541
03:09:29,360 --> 03:09:30,680
IT'S HARD FOR HEALTHCARE

5542
03:09:30,680 --> 03:09:31,560
PROVIDERS RIGHT NOW BECAUSE OF

5543
03:09:31,560 --> 03:09:35,560
COVID AND OTHER REASONS, SO

5544
03:09:35,560 --> 03:09:36,680
PROVIDERS PEOPLE WHO ARE THERE

5545
03:09:36,680 --> 03:09:40,120
ARE TRYING TO ALSO COVER THE

5546
03:09:40,120 --> 03:09:45,880
FRONT DESK OR LIKE I SAID,

5547
03:09:45,880 --> 03:09:49,840
POWERS THAT BE OH, BASIC THINGS

5548
03:09:49,840 --> 03:09:51,800
KEEPING DOORS OPEN AND THAT IS A

5549
03:09:51,800 --> 03:09:53,720
REAL EYE OPENER FOR ME BECAUSE I

5550
03:09:53,720 --> 03:09:56,240
EXPECT THAT IN THE IMMUNITY

5551
03:09:56,240 --> 03:10:02,200
BASED ORGANIZATION, DULA GROUPS,

5552
03:10:02,200 --> 03:10:05,160
SOMEBODY SAID THESE ARE NOT THE

5553
03:10:05,160 --> 03:10:06,680
SERVICES THAT MONEY PUBLIC

5554
03:10:06,680 --> 03:10:07,880
HEALTH YOU WOULD HI THEY WOULD

5555
03:10:07,880 --> 03:10:09,800
VALUE THOSE DOING WORK MORE BUT

5556
03:10:09,800 --> 03:10:11,880
THEY DON'T.

5557
03:10:11,880 --> 03:10:14,680
EVEN OBs, MIDWIVES MEDICAL

5558
03:10:14,680 --> 03:10:18,800
PROVIDERS.

5559
03:10:18,800 --> 03:10:21,480
THAT IS A CONCERN.

5560
03:10:21,480 --> 03:10:27,680
LIKE I SAID, FOR A WILD --

5561
03:10:27,680 --> 03:10:29,240
95%ICALLY MIX WHO STRUGGLE TO

5562
03:10:29,240 --> 03:10:30,680
IMPLEMENT ROSE HASN'T BEEN

5563
03:10:30,680 --> 03:10:34,840
BECAUSE OF POOR FIDELITY BUT IT

5564
03:10:34,840 --> 03:10:35,600
WAS PROVIDER COTED OR KICKED THE

5565
03:10:35,600 --> 03:10:37,480
DOORS OPEN OR CLINIC WAS MOVED,

5566
03:10:37,480 --> 03:10:40,480
ALL THESE THINGS THAT HAPPEN.

5567
03:10:40,480 --> 03:10:42,120
SO STRUCTURAL CHALLENGE AT THE

5568
03:10:42,120 --> 03:10:44,200
AGENCY SO MY FIRST TAKE HOME

5569
03:10:44,200 --> 03:10:49,080
WOULD BE AGAIN, ECHOS WHAT WAS

5570
03:10:49,080 --> 03:10:52,080
SAID IN THE FIRST SESSION TO DR.

5571
03:10:52,080 --> 03:10:55,760
WILK CALLED IT WHOLE PERSON

5572
03:10:55,760 --> 03:10:56,240
PAYER.

5573
03:10:56,240 --> 03:10:57,240
IF I WAS GOING TO INVEST A

5574
03:10:57,240 --> 03:10:58,880
DOLLAR IN PUBLIC HEALTH IT WOULD

5575
03:10:58,880 --> 03:11:02,240
BE TOWARD PREGNANT WOMEN AND YET

5576
03:11:02,240 --> 03:11:04,160
EVEN THEN THESE AREN'T THE

5577
03:11:04,160 --> 03:11:09,160
SERVICES GETTING PRIORITIZED,

5578
03:11:09,160 --> 03:11:12,080
ESPECIALLY WOMEN WITH CHALLENGES

5579
03:11:12,080 --> 03:11:13,040
SUCH AS SOCIAL DETERMINANTS OF

5580
03:11:13,040 --> 03:11:16,200
HEALTH.

5581
03:11:16,200 --> 03:11:18,200
THIS IS LARGER INTEGRATION PLAN

5582
03:11:18,200 --> 03:11:20,280
TO MAKE ABOUT MEDICAL CARE AND

5583
03:11:20,280 --> 03:11:21,080
MENTAL HEALTHCARE.

5584
03:11:21,080 --> 03:11:25,440
UNDER MY UNDERSTANDINGS UNDER

5585
03:11:25,440 --> 03:11:27,200
THE ABARD FORDABLE CARE ACT WITH

5586
03:11:27,200 --> 03:11:27,920
INTERVENTION WITH U.S.

5587
03:11:27,920 --> 03:11:31,000
PREVENTIVE SERVICES TASK FORCE

5588
03:11:31,000 --> 03:11:32,480
WHICH HAS -- ROSE HAS, ARE

5589
03:11:32,480 --> 03:11:34,240
SUPPOSED TO BE FULLY COVERED BY

5590
03:11:34,240 --> 03:11:35,640
HEALTH INSURANCE INCLUDING

5591
03:11:35,640 --> 03:11:39,800
MEDICAID BUT ALL INSURANCE.

5592
03:11:39,800 --> 03:11:41,920
THIS HAPPENED IN 2019, IT IS

5593
03:11:41,920 --> 03:11:44,320
2021 AND WE HAVE BEEN IN

5594
03:11:44,320 --> 03:11:46,560
CONVERSATION SOME WITH A

5595
03:11:46,560 --> 03:11:47,360
MECHANICSA, WITH DIFFERENT FOLKS

5596
03:11:47,360 --> 03:11:52,640
Z LET ME TELL YOU WHERE THE

5597
03:11:52,640 --> 03:11:56,800
CHALLENGE S. ROSE IS

5598
03:11:56,800 --> 03:11:58,240
PSYCHOEDUCATIONAL, IT CAN BE

5599
03:11:58,240 --> 03:11:59,880
DELIVERED BY FIDELITY BUT THEY

5600
03:11:59,880 --> 03:12:01,720
ARE NOT BILLABLE PROVIDERS SO IN

5601
03:12:01,720 --> 03:12:03,480
HONESTLY THIS IS NOT THE BEST

5602
03:12:03,480 --> 03:12:06,320
USE OF PHYSICIAN TIME, THIS IS

5603
03:12:06,320 --> 03:12:07,720
BASIC, PRETTY STRAIGHT FORWARD,

5604
03:12:07,720 --> 03:12:09,880
IT WAS MEANT TO BE THAT WAY.

5605
03:12:09,880 --> 03:12:11,800
BUT PEOPLE AVAILABLE PROVIDERS,

5606
03:12:11,800 --> 03:12:16,000
LIKE MENTAL HEALTH TREATMENT

5607
03:12:16,000 --> 03:12:17,200
STAFF, NOT THE BEST USE OF THEIR

5608
03:12:17,200 --> 03:12:18,440
TIME, THEY ARE DEALING WITH

5609
03:12:18,440 --> 03:12:19,960
CRISES AND TREATMENT, AND

5610
03:12:19,960 --> 03:12:21,160
THEREFORE THE PEOPLE IN THE

5611
03:12:21,160 --> 03:12:22,480
SYSTEM, THAT CAN DO THESE

5612
03:12:22,480 --> 03:12:25,120
PREVENTSIVE INTERVENTIONS ARE

5613
03:12:25,120 --> 03:12:26,600
BILLABLE PROVIDERS GENERAL FOR

5614
03:12:26,600 --> 03:12:29,120
VARY OF BILLING CODES SO THAT IS

5615
03:12:29,120 --> 03:12:31,320
A CHALLENGE TO INTEGRATING SOME

5616
03:12:31,320 --> 03:12:36,000
OF THESE EASIER TO USE SERVICES.

5617
03:12:36,000 --> 03:12:38,440
IN ADDITION IN THEORY IF THERE

5618
03:12:38,440 --> 03:12:41,560
IS A MENTAL HEALTH PERSON WHO

5619
03:12:41,560 --> 03:12:46,080
HAS TIME, WE ARE SEEING

5620
03:12:46,080 --> 03:12:47,960
POSTPARTUM PSYCHOSIS, SAY YOU

5621
03:12:47,960 --> 03:12:52,240
DID HAVE TIME,ED THE MENTAL

5622
03:12:52,240 --> 03:12:53,680
HEALTH TREATMENT CODES REQUIRE

5623
03:12:53,680 --> 03:12:56,200
THE PROCEDURE CODE AND DIAGNOSIS

5624
03:12:56,200 --> 03:12:58,920
CODE AND THE MENTAL HEALTH

5625
03:12:58,920 --> 03:13:00,920
PROVIDERS MOST TIME IN MOST

5626
03:13:00,920 --> 03:13:02,080
STATES YOU CAN'T BILL UNDER

5627
03:13:02,080 --> 03:13:05,160
PREGNANCY DIAGNOSIS.

5628
03:13:05,160 --> 03:13:07,320
SO YOU HAVE TO BILL UNDER MENTAL

5629
03:13:07,320 --> 03:13:10,480
HEALTH WHICH UNDERMINES THE

5630
03:13:10,480 --> 03:13:12,200
PURPOSE OF PREVENTION.

5631
03:13:12,200 --> 03:13:13,600
SO PREVENTION IS TRYING TO

5632
03:13:13,600 --> 03:13:14,320
PREVENT DIAGNOSIS.

5633
03:13:14,320 --> 03:13:15,760
SO IF YOU HAVE A MENTAL HEALTH

5634
03:13:15,760 --> 03:13:16,920
PROVIDERS THERE IS A CHALLENGE

5635
03:13:16,920 --> 03:13:17,920
THAT WAY.

5636
03:13:17,920 --> 03:13:19,360
THERE ARE SOME PATIENT EDUCATION

5637
03:13:19,360 --> 03:13:20,760
CODES THAT CAN BE BILLED TO

5638
03:13:20,760 --> 03:13:22,320
PHYSICIANS OR OTHER QUALIFIED

5639
03:13:22,320 --> 03:13:24,480
HEALTHCARE PROFESSIONALS, BUT

5640
03:13:24,480 --> 03:13:25,880
THERE ARE NOT -- ONLY REIMBURSED

5641
03:13:25,880 --> 03:13:29,880
IN ONE STATE THAT I KNOW OF.

5642
03:13:29,880 --> 03:13:32,960
IF PERINATAL SETTING RECEIVESES

5643
03:13:32,960 --> 03:13:34,960
BUNDLE PATIENTS AS MOST

5644
03:13:34,960 --> 03:13:35,680
PERINATAL SERVICE DOS, THESE

5645
03:13:35,680 --> 03:13:36,920
EXTRA SERVICES CAN'T BE BILLED

5646
03:13:36,920 --> 03:13:41,560
SEPARATELY.

5647
03:13:41,560 --> 03:13:43,520
EACH STATE DECIDES WHAT MEDICAL

5648
03:13:43,520 --> 03:13:45,080
TO BE REIMBURSED.

5649
03:13:45,080 --> 03:13:46,160
IT IS INTERESTING BECAUSE AS WE

5650
03:13:46,160 --> 03:13:48,480
HAVE BEEN TALKING TO PEOPLE THAT

5651
03:13:48,480 --> 03:13:49,680
HAVE -- I DON'T THINK THIS IS

5652
03:13:49,680 --> 03:13:50,680
THE CASE FOR THIS PARTICULAR

5653
03:13:50,680 --> 03:13:54,720
ISSUE BUT IT GOES BACK TO

5654
03:13:54,720 --> 03:13:57,320
TIMING.

5655
03:13:57,320 --> 03:13:59,200
THERE'S TIMES AS STATE

5656
03:13:59,200 --> 03:14:00,680
LEGISLATURE WILL PASS LAW THAT

5657
03:14:00,680 --> 03:14:02,000
SOMETHING PARTICULAR HAS TO BE

5658
03:14:02,000 --> 03:14:03,840
REIMBURSED BUT THEN PUT

5659
03:14:03,840 --> 03:14:05,040
STIPULATIONS SO IT IS BASICALLY

5660
03:14:05,040 --> 03:14:07,600
IMPOSSIBLE TO DO.

5661
03:14:07,600 --> 03:14:09,040
EVEN WHEN SOMETHING IS MANDATED

5662
03:14:09,040 --> 03:14:13,280
WE ARE IN A FUNNY CASE WHERE

5663
03:14:13,280 --> 03:14:14,520
THIS IS SUPPOSED TO BE COVERED

5664
03:14:14,520 --> 03:14:16,080
UNDER THE AFFORDABLE CARE ACT

5665
03:14:16,080 --> 03:14:17,640
YET FOR THE LIFE OF US WE ARE

5666
03:14:17,640 --> 03:14:22,240
STRUGGLING TO TRY TO FIGURE HOUR

5667
03:14:22,240 --> 03:14:23,880
TO WORK AROUND THE CODES SO NO

5668
03:14:23,880 --> 03:14:25,480
PERSON IS RESPONSIBLE FOR MAKING

5669
03:14:25,480 --> 03:14:27,160
SURE THAT HAPPENS.

5670
03:14:27,160 --> 03:14:29,920
IN A PERFECT WORLD I WOULD LOVE

5671
03:14:29,920 --> 03:14:32,040
PEOPLE TO MANDATE THAT

5672
03:14:32,040 --> 03:14:33,360
POSTPARTUM DEPRESSION PREVENTION

5673
03:14:33,360 --> 03:14:36,160
IS PART OF BUNDLED PRE-NATAL

5674
03:14:36,160 --> 03:14:38,160
SERVICES AND INCREASE

5675
03:14:38,160 --> 03:14:38,640
ACCORDINGLY.

5676
03:14:38,640 --> 03:14:40,280
ALLOW MENTAL HEALTH

5677
03:14:40,280 --> 03:14:42,200
PROFESSIONALS TO BILL UNDER

5678
03:14:42,200 --> 03:14:44,960
PREGNANCY DIAGNOSIS CODE.

5679
03:14:44,960 --> 03:14:46,760
THAT WOULD SOFA LOT OF PROBLEMS

5680
03:14:46,760 --> 03:14:50,240
OR MAKE PREVENTION KEY CODE,

5681
03:14:50,240 --> 03:14:52,040
MANDATE MEDICAID HAS TO

5682
03:14:52,040 --> 03:14:53,600
REIMBURSE CPT CODES USED FOR

5683
03:14:53,600 --> 03:14:54,080
THIS.

5684
03:14:54,080 --> 03:14:56,240
FINE SOME WAY TO MAKE THESE

5685
03:14:56,240 --> 03:14:59,160
CONDITIONALLY BILLABLE PROVIDERS

5686
03:14:59,160 --> 03:15:02,680
ABLE TO PROVIDE SOME OF THESE

5687
03:15:02,680 --> 03:15:03,480
PREVENTIVE SERVICES BECAUSE THEY

5688
03:15:03,480 --> 03:15:05,280
ARE ONLY ONES IN AGENCY WHO WILL

5689
03:15:05,280 --> 03:15:12,240
HAVE TIME.

5690
03:15:12,240 --> 03:15:14,680
I WANT TO MAKE A POINT, SO

5691
03:15:14,680 --> 03:15:19,240
INTERESTING IN THIS CASE WITH

5692
03:15:19,240 --> 03:15:22,080
ROSE WHERE SOLUTION WE DON'T

5693
03:15:22,080 --> 03:15:24,000
HAVE ENOUGH PEOPLE TOLL PROVIDE

5694
03:15:24,000 --> 03:15:27,400
INTERVENTION HOW BETTER

5695
03:15:27,400 --> 03:15:28,880
SCREENING TO GET PREVENTSIVE

5696
03:15:28,880 --> 03:15:29,520
INTERVENTION.

5697
03:15:29,520 --> 03:15:33,280
RECENTLY WE WERE LOOKING AT THIS

5698
03:15:33,280 --> 03:15:35,600
FOR ROSE AND ROSE TO DELIVER IS

5699
03:15:35,600 --> 03:15:37,600
SO LOW COST DEPENDING ON GROUP

5700
03:15:37,600 --> 03:15:41,560
INDIVIDUALS MAYBE 100 TO $200

5701
03:15:41,560 --> 03:15:44,960
MOST AGENCIES WE TALK WITH DON'T

5702
03:15:44,960 --> 03:15:46,680
HAVE GOOD SCREENING AND REFERRAL

5703
03:15:46,680 --> 03:15:48,840
SYSTEMS LIKE FOR THEM TO MOUNT A

5704
03:15:48,840 --> 03:15:50,840
SCREENING REFERRAL SYSTEM.

5705
03:15:50,840 --> 03:15:51,520
WOULD BE HARD.

5706
03:15:51,520 --> 03:15:53,480
THEY ARE NOT -- THEY DON'T HAVE

5707
03:15:53,480 --> 03:15:56,360
GOOD TECHNOLOGY, THEY DON'T HAVE

5708
03:15:56,360 --> 03:15:58,800
GOOD INFRASTRUCTURE SOURCES TO

5709
03:15:58,800 --> 03:16:01,200
CREATE IT.

5710
03:16:01,200 --> 03:16:03,440
SO MOST WANT TO GIVE IT TO

5711
03:16:03,440 --> 03:16:04,400
EVERYONE WHERE RATHER THIS THAN

5712
03:16:04,400 --> 03:16:05,880
FIGURE WHO TO GIVE IT TO IS

5713
03:16:05,880 --> 03:16:06,600
EASIER.

5714
03:16:06,600 --> 03:16:09,840
TURNS OUT THE COST IF YOU MISS

5715
03:16:09,840 --> 03:16:13,600
THE ONE WHO WOULD HAVE GOTTEN

5716
03:16:13,600 --> 03:16:15,880
POST TO PARTUM DEPRESSION, EVEN

5717
03:16:15,880 --> 03:16:16,840
THE HEALTH SYSTEM COST OF THAT

5718
03:16:16,840 --> 03:16:20,480
IS TENS OF THOUSANDS OF DOLLARS

5719
03:16:20,480 --> 03:16:24,080
VERSUS INTERVENTION THAT CALL IT

5720
03:16:24,080 --> 03:16:25,240
150-DOLLARS IT IS COST EFFECTIVE

5721
03:16:25,240 --> 03:16:26,760
MORE COST EFFECTIVE TO GIVE IT

5722
03:16:26,760 --> 03:16:29,840
TO EVERYONE THAN IT IS TO CREATE

5723
03:16:29,840 --> 03:16:30,840
SCREENING REFERRAL SYSTEM IN

5724
03:16:30,840 --> 03:16:35,960
SETTINGS THAT JUST AREN'T SET UP

5725
03:16:35,960 --> 03:16:36,480
TO DO THAT.

5726
03:16:36,480 --> 03:16:37,880
SO I WANT TO PUT THAT OUT AS

5727
03:16:37,880 --> 03:16:38,480
POSSIBILITY.

5728
03:16:38,480 --> 03:16:39,280
UNIVERSAL PREVENTION IS MORE

5729
03:16:39,280 --> 03:16:42,320
EFFECTIVE.

5730
03:16:42,320 --> 03:16:44,080
MORE COST EFFECTIVE THAN

5731
03:16:44,080 --> 03:16:45,040
PINPOINTING WHO YOU SHOULD GIVE

5732
03:16:45,040 --> 03:16:47,560
IT TO.

5733
03:16:47,560 --> 03:16:51,720
I WANT TO MAKE THIS POINT, IN

5734
03:16:51,720 --> 03:16:53,680
THE SETTINGS, I SAID TO SOME

5735
03:16:53,680 --> 03:16:57,200
EXTENT THE SAFETY NET OB CLINIC

5736
03:16:57,200 --> 03:17:00,240
S 2 HC EVEN MORE SYSTEM SERVICE

5737
03:17:00,240 --> 03:17:02,080
JUSTICE INVOLVED INDIVIDUAL

5738
03:17:02,080 --> 03:17:03,160
THERE'S NOT ENOUGH PROVIDERS

5739
03:17:03,160 --> 03:17:05,200
THAT WILL NEVER BE.

5740
03:17:05,200 --> 03:17:07,520
SO LOOKING MORE SAYING THIS

5741
03:17:07,520 --> 03:17:11,600
HAPPENED AROUND THE WORLD I HAVE

5742
03:17:11,600 --> 03:17:13,560
COLLEAGUES IN ETHIOPIA, TEN

5743
03:17:13,560 --> 03:17:16,280
YEARS AGO IF YOU HAD ONE

5744
03:17:16,280 --> 03:17:18,880
PSYCHIATRIST PER 11 MILLION

5745
03:17:18,880 --> 03:17:21,080
PEOPLE THAT WILL BE RAY WILL

5746
03:17:21,080 --> 03:17:22,880
HARD SO MORE GREAT RESEARCH, IT

5747
03:17:22,880 --> 03:17:26,160
IS EFFECTIVE, BUT QUESTION IS

5748
03:17:26,160 --> 03:17:28,640
HOW WE MAKE POLICY BILLING CODES

5749
03:17:28,640 --> 03:17:32,240
WHATEVER FIT SO THAT YOU CAN USE

5750
03:17:32,240 --> 03:17:33,680
YOUR COMMUNITY HEALTH WORKER OR

5751
03:17:33,680 --> 03:17:37,000
SOMEONE ELSE TO DO THIS WORK AND

5752
03:17:37,000 --> 03:17:40,000
NOT REQUIRE OB CAN'T DO IT.

5753
03:17:40,000 --> 03:17:41,800
SO ONE OF TAKE HOME POINTS ABOUT

5754
03:17:41,800 --> 03:17:44,680
INTEGRATION OF PRIMARY CARE AND

5755
03:17:44,680 --> 03:17:46,120
MENTAL HEALTH AND SUBSTANCE USE

5756
03:17:46,120 --> 03:17:48,080
WE HAVE IT IN SOME WAY A PERFECT

5757
03:17:48,080 --> 03:17:49,880
CASE IN RESEARCH PERSPECTIVE, WE

5758
03:17:49,880 --> 03:17:51,160
HAVE INTERVENTION THAT IS SHOWN

5759
03:17:51,160 --> 03:17:54,800
TO BE EFFECTIVE, COST EFFECTIVE,

5760
03:17:54,800 --> 03:17:56,440
DELIVERED BY CARE PROFESSIONALS

5761
03:17:56,440 --> 03:18:00,680
WITH SCALABLE TRAINING IS

5762
03:18:00,680 --> 03:18:02,000
SCALABLE, BUT REIMBURSABLE BUT

5763
03:18:02,000 --> 03:18:05,240
IT ISN'T.

5764
03:18:05,240 --> 03:18:07,760
THERE IS SYSTEM SIC ADVOCACY

5765
03:18:07,760 --> 03:18:10,840
NEEDED AROUND FUNDING POLICY,

5766
03:18:10,840 --> 03:18:11,920
SPECIFICALLY AROUND GREAT MENTAL

5767
03:18:11,920 --> 03:18:13,480
HEALTH PROVIDERS BILL UNDER

5768
03:18:13,480 --> 03:18:16,240
PREGNANCY DIAGNOSIS AND WE CAN

5769
03:18:16,240 --> 03:18:18,240
MAKE OTHER PARAPROFESSIONAL

5770
03:18:18,240 --> 03:18:21,600
PROVIDERS BILLABLE BUT EVEN THEN

5771
03:18:21,600 --> 03:18:23,560
OVERALL SYSTEMIC SUPPORT FOR

5772
03:18:23,560 --> 03:18:25,080
SAFETY NET AGENCIES ISN'T THERE,

5773
03:18:25,080 --> 03:18:26,960
THEY ARE NOT THE MONEY MAKERS

5774
03:18:26,960 --> 03:18:29,760
AND ARE GOING TO THE BOTTOM OF

5775
03:18:29,760 --> 03:18:32,160
THE RUN TO THE EXTENT IT HAS

5776
03:18:32,160 --> 03:18:36,080
BEEN SHOCKING TO ME AS WE HAVE

5777
03:18:36,080 --> 03:18:37,560
TALK WITH THEM OVER SEVERAL

5778
03:18:37,560 --> 03:18:42,640
YEARS.

5779
03:18:42,640 --> 03:18:48,320
HERE IS MY OTHER POINT.

5780
03:18:48,320 --> 03:18:50,000
NOT LIKE WE DON'T KNOW HOW TO DO

5781
03:18:50,000 --> 03:18:53,200
THESE, THESE MEANING SCREENING

5782
03:18:53,200 --> 03:18:54,240
PREVENTION TREATMENT CREATING

5783
03:18:54,240 --> 03:18:55,240
SYSTEMS THAT GET THEM TO THE

5784
03:18:55,240 --> 03:18:59,640
PEOPLE WHO NEED THEM THE MOST.

5785
03:18:59,640 --> 03:19:01,240
PART OF THE MULTI-MORBIDITY IS

5786
03:19:01,240 --> 03:19:03,280
WOMEN AT RISK WENT THROUGH

5787
03:19:03,280 --> 03:19:04,960
SOCIAL DETERMINANTS OF HEALTH

5788
03:19:04,960 --> 03:19:09,480
INTERSECT TO CREATE DIFFICULT

5789
03:19:09,480 --> 03:19:10,680
CIRCUMSTANCES TO OVERCOME.

5790
03:19:10,680 --> 03:19:13,440
I WOULD ADD MY VOICE TO OTHERS,

5791
03:19:13,440 --> 03:19:15,680
SO FAR IN THE WORKSHOP, WE KNOW

5792
03:19:15,680 --> 03:19:18,040
HOW TO DO THIS, THE SCIENTIFIC

5793
03:19:18,040 --> 03:19:20,680
KNOWLEDGE IN CASES EXIST, HOW TO

5794
03:19:20,680 --> 03:19:22,240
GET IN THE WORLD AND MAKE IT

5795
03:19:22,240 --> 03:19:29,120
HAPPEN, CREATE THE POLITICAL

5796
03:19:29,120 --> 03:19:35,400
WILL HOW TO REALIGN INCENTIVES

5797
03:19:35,400 --> 03:19:37,960
FROM A FUNDING PERSPECTIVE TO

5798
03:19:37,960 --> 03:19:39,400
ENSURE WHAT WE KNOW SHOULD

5799
03:19:39,400 --> 03:19:39,880
HAPPEN DOES HAPPEN.

5800
03:19:39,880 --> 03:19:45,680
THIS IS MY TEAM.

5801
03:19:45,680 --> 03:19:47,120
REACH OUT IF UP QUESTIONS OR

5802
03:19:47,120 --> 03:19:53,160
COMMENTS, I WILL STOP THERE.

5803
03:19:53,160 --> 03:19:57,320
I AM MODERATING QUESTIONS.

5804
03:19:57,320 --> 03:19:59,040
CORRECT?

5805
03:19:59,040 --> 03:20:00,680
>> CURRENTLY WE DON'T HAVE ANY

5806
03:20:00,680 --> 03:20:03,240
IN THE Q&A BOX BUT I WOULD

5807
03:20:03,240 --> 03:20:05,920
ENCOURAGE ATTENDEES TO POST ANY

5808
03:20:05,920 --> 03:20:07,440
QUESTIONS THAT YOU HAVE FOR

5809
03:20:07,440 --> 03:20:08,280
PANELISTS SPEAKERS IN THIS

5810
03:20:08,280 --> 03:20:11,880
SESSION INTO THE Q&A BOX.

5811
03:20:11,880 --> 03:20:13,200
THERE IS A QUESTION IN THE

5812
03:20:13,200 --> 03:20:14,760
COMMENT WHICH I WILL READ, IT IS

5813
03:20:14,760 --> 03:20:17,840
NOT -- IT SAYS IS THERE A SCREEN

5814
03:20:17,840 --> 03:20:20,480
TO TEST RISK FOR POSTPARTUM

5815
03:20:20,480 --> 03:20:20,880
DEPRESSION?

5816
03:20:20,880 --> 03:20:24,320
AND WHY IS PREGNANCY NOT VALID

5817
03:20:24,320 --> 03:20:29,000
DIAGNOSIS CODE SECOND QUESTION

5818
03:20:29,000 --> 03:20:29,480
FIRST.

5819
03:20:29,480 --> 03:20:31,040
IT IS NOT ROSE, THE DIAGNOSIS

5820
03:20:31,040 --> 03:20:32,160
CODES AND THE PROCEDURE CODES

5821
03:20:32,160 --> 03:20:33,600
ARE LINKED TO THE KINDS OF

5822
03:20:33,600 --> 03:20:40,440
PROVIDER.

5823
03:20:40,440 --> 03:20:41,680
MENTAL HEALTH PROFESSIONALS

5824
03:20:41,680 --> 03:20:43,720
AREN'T ALLOWED TO BILL UNDER

5825
03:20:43,720 --> 03:20:46,720
PREGNANCY DIAGNOSIS CODE.

5826
03:20:46,720 --> 03:20:49,560
SO YOU CAN HAVE AN OB DELIVERIES

5827
03:20:49,560 --> 03:20:50,800
BILLABLE BUT NOT GOOD USE OF

5828
03:20:50,800 --> 03:20:55,440
THEIR TIME.

5829
03:20:55,440 --> 03:20:58,400
IF YOU HAD A MENTAL HEALTH

5830
03:20:58,400 --> 03:20:59,480
PROFESSIONAL, LIKE AS MENTAL

5831
03:20:59,480 --> 03:21:03,200
HEALTH PROFESSIONAL I HAVE TO

5832
03:21:03,200 --> 03:21:05,160
PUT DEPRESSION OR ANXIETY, IF

5833
03:21:05,160 --> 03:21:06,600
SOMEBODY DOESN'T HAVE A

5834
03:21:06,600 --> 03:21:07,680
DIAGNOSIS ALREADY FOR PREVENTION

5835
03:21:07,680 --> 03:21:09,880
THEY DON'T, I CAN'T BILL UNDER A

5836
03:21:09,880 --> 03:21:11,960
PREGNANCY DIAGNOSIS CODE AND THE

5837
03:21:11,960 --> 03:21:13,360
PEOPLE REALLY DOING THIS

5838
03:21:13,360 --> 03:21:14,360
INTERVENTION MORE

5839
03:21:14,360 --> 03:21:15,440
PARAPROFESSIONAL, THEY ARE NOT

5840
03:21:15,440 --> 03:21:16,560
BILLABLE.

5841
03:21:16,560 --> 03:21:24,600
SO THAT'S THE CHALLENGE.

5842
03:21:24,600 --> 03:21:26,360
IT IS RECOMMENDED U.S.

5843
03:21:26,360 --> 03:21:28,800
PREVENTIVE SERVICES TASK FORCE

5844
03:21:28,800 --> 03:21:30,040
STILL HAVE FUNDING POLICY

5845
03:21:30,040 --> 03:21:30,880
ISSUES.

5846
03:21:30,880 --> 03:21:35,840
REIMBURSEMENT ISSUES.

5847
03:21:35,840 --> 03:21:36,760
THEN THERE WAS THE FIRST

5848
03:21:36,760 --> 03:21:38,840
QUESTION, IS THERE A SCREEN TO

5849
03:21:38,840 --> 03:21:40,280
TEST RISK FOR DEPRESSION, THAT

5850
03:21:40,280 --> 03:21:45,800
IS AN INTERESTING QUESTION.

5851
03:21:45,800 --> 03:21:47,240
THE ANSWER IS YES KIND OF BUT

5852
03:21:47,240 --> 03:21:50,080
WHAT AGENCY DOS BUT IS NOT

5853
03:21:50,080 --> 03:21:54,840
EMPIRICALLY SUPPORTED IS TEST

5854
03:21:54,840 --> 03:21:59,280
FOR SYMPTOMS.

5855
03:21:59,280 --> 03:22:00,960
THERE IS THE COOPER SURVEY

5856
03:22:00,960 --> 03:22:02,240
QUESTIONNAIRE, NOT USER

5857
03:22:02,240 --> 03:22:02,800
FRIENDLY.

5858
03:22:02,800 --> 03:22:09,880
SO THERE ARE THINGS PEOPLE DO

5859
03:22:09,880 --> 03:22:11,520
THEY WILL TALK ABOUT PAST E

5860
03:22:11,520 --> 03:22:13,960
PRESSSIVE EPISODES, EDENBURG BUT

5861
03:22:13,960 --> 03:22:18,000
MOSTLY NOT SCREENING FOR RISK

5862
03:22:18,000 --> 03:22:19,560
AND TO SCREEN FOR RISK IS

5863
03:22:19,560 --> 03:22:20,680
SURPRISINGLY CHALLENGING FOR A

5864
03:22:20,680 --> 03:22:22,800
LOT OF THE AGENCIES AND THEY

5865
03:22:22,800 --> 03:22:25,680
HAVE DECIDED TO USE ROWS ACROSS

5866
03:22:25,680 --> 03:22:27,120
THE BOARD, MANY THINK THAT IS

5867
03:22:27,120 --> 03:22:28,840
EASIER.

5868
03:22:28,840 --> 03:22:30,680
CAN I SAY A LITTLE BIT ABOUT

5869
03:22:30,680 --> 03:22:32,520
WHAT THE CLASS INTERVENTION

5870
03:22:32,520 --> 03:22:35,240
ENTAILS AND INCLUDES, YES.

5871
03:22:35,240 --> 03:22:37,680
THAT SLIDE TO TRY TO GO FASTER

5872
03:22:37,680 --> 03:22:40,680
BUT BASED ON PRINCIPLES OF

5873
03:22:40,680 --> 03:22:41,440
INTERPERSONAL PSYCHOTHERAPY ONE

5874
03:22:41,440 --> 03:22:43,600
OF THE FRONT LINE TREATMENT

5875
03:22:43,600 --> 03:22:47,440
PERINATAL DEPRESSION, IT IS CORE

5876
03:22:47,440 --> 03:22:50,320
COST, ABOUT AN HOUR EACH.

5877
03:22:50,320 --> 03:22:52,880
IT IS BASIC SEGUE TO PATIENT

5878
03:22:52,880 --> 03:22:54,480
ABOUT WHAT IS POSTPARTUM

5879
03:22:54,480 --> 03:22:57,840
DEPRESSION, WHAT IS POSTPARTUM

5880
03:22:57,840 --> 03:22:59,640
PSYCHOSIS, HOW DO YOU KNOW, IT

5881
03:22:59,640 --> 03:23:01,280
USES THIS IDEA OF THIS IS A TIME

5882
03:23:01,280 --> 03:23:05,160
IN YOUR LIFE THAT YOU WILL NEED

5883
03:23:05,160 --> 03:23:06,080
MORE HELP THAN USUAL.

5884
03:23:06,080 --> 03:23:07,600
DON'T TRY TO BE A HERO, GET

5885
03:23:07,600 --> 03:23:09,640
SUPPORT SYSTEMS SETS UP, TEACH

5886
03:23:09,640 --> 03:23:10,480
COMMUNICATION SKILLS HOW TO TALK

5887
03:23:10,480 --> 03:23:14,360
WITH PEOPLE, SELF CARE SKILLS

5888
03:23:14,360 --> 03:23:16,000
AND HELP THEM FOLLOW THROUGH.

5889
03:23:16,000 --> 03:23:19,960
INTERESTING BECAUSE IT IS NOT ON

5890
03:23:19,960 --> 03:23:21,880
THE ONE HAND NOT ROCKET SCIENCE,

5891
03:23:21,880 --> 03:23:24,520
OTHER HAND MASSIVELY EFFECTIVE.

5892
03:23:24,520 --> 03:23:27,440
I WISH THAT I THINK THINKING

5893
03:23:27,440 --> 03:23:29,000
BACK TO WHEN I WAS PREGNANT

5894
03:23:29,000 --> 03:23:31,080
COUPLE OF DECADES AGO BUT I WISH

5895
03:23:31,080 --> 03:23:32,080
SOMEBODY SAT DOWN AND TOLD ME

5896
03:23:32,080 --> 03:23:32,800
THESE THINGS.

5897
03:23:32,800 --> 03:23:34,240
SOMETHING ABOUT HAVING SOMEONE

5898
03:23:34,240 --> 03:23:35,880
SIT DOWN AND WALK YOU THROUGH IT

5899
03:23:35,880 --> 03:23:37,760
HELPS AND PREVENTS ABOUT HALF

5900
03:23:37,760 --> 03:23:39,880
THE CASES OF POSTPARTUM

5901
03:23:39,880 --> 03:23:41,640
DEPRESSION.  ARE THERE OTHER

5902
03:23:41,640 --> 03:23:42,440
QUESTIONS, I DON'T SEE OTHER

5903
03:23:42,440 --> 03:23:48,160
QUESTIONS.

5904
03:23:48,160 --> 03:23:48,960
ARE THERE OTHER QUESTIONS?

5905
03:23:48,960 --> 03:23:50,920
YOU CAN PUT IN THE Q&A.

5906
03:23:50,920 --> 03:23:52,880
>>S IN MARRAH, I WONDER IF WE

5907
03:23:52,880 --> 03:23:55,680
CAN ENGAGE YOU AND THE OTHER TWO

5908
03:23:55,680 --> 03:23:59,720
SPEAKERS ON HOW MAYBE THE SBIRT

5909
03:23:59,720 --> 03:24:04,240
COULD BE APPLIED TO OTHER

5910
03:24:04,240 --> 03:24:05,480
INTERVENTIONS THAT WE HAVEN'T --

5911
03:24:05,480 --> 03:24:07,480
WE DIDN'T -- WE GAVE EXAMPLES OF

5912
03:24:07,480 --> 03:24:10,560
WHAT HAS BEEN DONE BUT HOW

5913
03:24:10,560 --> 03:24:11,880
EASILY APPLIED TO OTHER

5914
03:24:11,880 --> 03:24:14,840
INTERVENTIONS TO ADDRESS

5915
03:24:14,840 --> 03:24:16,960
CO-MORBIDITIES AND WHAT MAYBE

5916
03:24:16,960 --> 03:24:17,760
THE OPPORTUNITIES ARE OR THE

5917
03:24:17,760 --> 03:24:23,080
CHALLENGES MIGHT BE.

5918
03:24:23,080 --> 03:24:24,240
>> WOULD YOU LIKE THE TAKE THAT

5919
03:24:24,240 --> 03:24:24,960
ONE?

5920
03:24:24,960 --> 03:24:26,760
>> SURE, I WOULD LOVE TO SPEAK

5921
03:24:26,760 --> 03:24:30,880
ON THAT A LITTLE BIT.

5922
03:24:30,880 --> 03:24:35,080
THERE IS A STUDY I CITE QUITE

5923
03:24:35,080 --> 03:24:39,920
OFTEN 2003 I BELIEVE IN AJPH

5924
03:24:39,920 --> 03:24:41,680
THEY ADDED UP PREVENTIVE

5925
03:24:41,680 --> 03:24:43,280
SERVICES TASK FORCE A AND B

5926
03:24:43,280 --> 03:24:44,720
RECOMMENDATIONS AND FIGURED HOW

5927
03:24:44,720 --> 03:24:46,360
LONG IT WOULD TAKE AVERAGE

5928
03:24:46,360 --> 03:24:47,320
PRIMARY CARE PHYSICIAN TO DO

5929
03:24:47,320 --> 03:24:48,520
THEM.

5930
03:24:48,520 --> 03:24:53,720
IT WORKED OUT TO 4.8 HOURS PER

5931
03:24:53,720 --> 03:24:58,680
WORKING DAY TO DO THOSE.

5932
03:24:58,680 --> 03:25:00,760
I THINK THAT THERE IS A LOT WE

5933
03:25:00,760 --> 03:25:02,800
WANT TO HAVE HAPPEN THAT DOESN'T

5934
03:25:02,800 --> 03:25:04,880
NECESSARILY FIT WELL IN TO THOSE

5935
03:25:04,880 --> 03:25:05,960
SETTINGS.

5936
03:25:05,960 --> 03:25:07,640
THAT TECHNOLOGY MAY BE ONE WAY

5937
03:25:07,640 --> 03:25:08,720
THAT WE CAN BUILD A LOT OF THAT

5938
03:25:08,720 --> 03:25:09,440
IN.

5939
03:25:09,440 --> 03:25:14,800
SO TO THE QUESTION, IF WE USE

5940
03:25:14,800 --> 03:25:16,280
TECHNOLOGY AS NATURAL PART OF

5941
03:25:16,280 --> 03:25:16,640
THE WORK FLOW.

5942
03:25:16,640 --> 03:25:19,040
YOU COME IN OR BEFORE YOU COME

5943
03:25:19,040 --> 03:25:21,800
IN, YOU ANSWER QUESTIONS BRIEFLY

5944
03:25:21,800 --> 03:25:23,920
LIKE A SYMPTOM CHECKLIST, GIVE

5945
03:25:23,920 --> 03:25:25,160
THEM GOOD -- CARE TEAM GOOD

5946
03:25:25,160 --> 03:25:27,680
SENSE OF WHERE YOU ARE AT AND

5947
03:25:27,680 --> 03:25:28,680
WHAT YOU STRUGGLE WITH, ET

5948
03:25:28,680 --> 03:25:29,840
CETERA, THAT INCLUDES A LOT OF

5949
03:25:29,840 --> 03:25:34,080
QUESTIONS AND DRIVE A LOT OF

5950
03:25:34,080 --> 03:25:35,200
THINGS, IT DOESN'T HAVE TO BE

5951
03:25:35,200 --> 03:25:35,680
JUST ONE.

5952
03:25:35,680 --> 03:25:37,080
IT IS BETTER THAN JUST ONE.

5953
03:25:37,080 --> 03:25:38,480
SO WHEN I'M SCREENING EVEN IF

5954
03:25:38,480 --> 03:25:43,240
I'M DOING A STUDY SPECIFICALLY

5955
03:25:43,240 --> 03:25:44,920
ABOUT ALCOHOL OR TOBACCO USE, I

5956
03:25:44,920 --> 03:25:46,880
CERTAINLY DONE JUST ASK, I ASK

5957
03:25:46,880 --> 03:25:47,240
WHOLE HEALTH.

5958
03:25:47,240 --> 03:25:50,160
TRY THE GET A SENSE OF THIS IS

5959
03:25:50,160 --> 03:25:52,640
JUST A HEALTH CHECK UP THAT IS

5960
03:25:52,640 --> 03:25:54,640
BROAD AND SUPPORTIVE.

5961
03:25:54,640 --> 03:25:57,760
SO BEING ABLE TO DRIVE DIFFERENT

5962
03:25:57,760 --> 03:26:02,680
RESPONSES EVIDENCE BASED

5963
03:26:02,680 --> 03:26:03,360
RESPONSES FORKY PRESENTATION,

5964
03:26:03,360 --> 03:26:08,880
PARTNER VIOLENCE, SUBSTANCE USE,

5965
03:26:08,880 --> 03:26:10,560
HEALTHCARE NEEDS, SOCIAL

5966
03:26:10,560 --> 03:26:12,480
DETERMINANTS, ANY SOCIAL NEEDS,

5967
03:26:12,480 --> 03:26:16,880
THAT IS AN IMPORTANT AND LIKELY

5968
03:26:16,880 --> 03:26:21,000
REALLY POSITIVE WAY TO TAKE THIS

5969
03:26:21,000 --> 03:26:24,200
TREMENDOUS AMOUNT OF NEED OUT

5970
03:26:24,200 --> 03:26:24,800
THERE, AND NUMBER SOME WAY AND

5971
03:26:24,800 --> 03:26:27,520
DEAL WITH IT IN SOME WAY THAT

5972
03:26:27,520 --> 03:26:28,720
DOESN'T PUT ON TOP OF HEALTHCARE

5973
03:26:28,720 --> 03:26:33,560
SYSTEM.

5974
03:26:33,560 --> 03:26:34,960
>> DID YOU HAVE ANYTHING TO ADD

5975
03:26:34,960 --> 03:26:37,440
TO THAT?

5976
03:26:37,440 --> 03:26:42,160
>> I DON'T KNOW THAT I CAN.

5977
03:26:42,160 --> 03:26:47,520
PROVIDE AD GREAT RESPONSE.

5978
03:26:47,520 --> 03:26:48,840
WHETHER SCREENING BRIEF

5979
03:26:48,840 --> 03:26:50,240
INTERVENTION OR HOW ADDRESS

5980
03:26:50,240 --> 03:26:51,600
HEALTHCARE IN GENERAL IS SO

5981
03:26:51,600 --> 03:26:53,480
IMPORTANT TO THINK HOLISTICALLY

5982
03:26:53,480 --> 03:26:55,160
AND COORDINATING CARE AS BEST

5983
03:26:55,160 --> 03:26:56,120
THEY CAN AT EVERYTHING THAT WE

5984
03:26:56,120 --> 03:27:02,760
ARE DOING.

5985
03:27:02,760 --> 03:27:04,000
>> WE HAVE A QUESTION IN THE

5986
03:27:04,000 --> 03:27:04,360
QUESTION BOX.

5987
03:27:04,360 --> 03:27:05,400
I UNDERSTAND THE QUESTION BUT I

5988
03:27:05,400 --> 03:27:06,280
WILL ANSWER THE QUESTION, I

5989
03:27:06,280 --> 03:27:08,480
THINK IS THERE AND IF NOT RIGHT

5990
03:27:08,480 --> 03:27:11,000
YOU CAN TYPE IT IN.

5991
03:27:11,000 --> 03:27:12,360
THE QUESTION IS HAS EXPERIENCE

5992
03:27:12,360 --> 03:27:14,040
BEEN MOST WOMEN DON'T ASK

5993
03:27:14,040 --> 03:27:16,400
SUPPORT FOR POSTPARTUM

5994
03:27:16,400 --> 03:27:17,040
DEPRESSION BECAUSE THEY FEEL HAY

5995
03:27:17,040 --> 03:27:20,080
RISK NOT BEING ABLE TO STAY HOME

5996
03:27:20,080 --> 03:27:21,080
WITH CHILDREN WHILE RECEIVING

5997
03:27:21,080 --> 03:27:22,480
SERVICES.

5998
03:27:22,480 --> 03:27:24,880
WHAT I DO KNOW, IT IS RARELY

5999
03:27:24,880 --> 03:27:25,920
INTERESTING, WE ARE WORKING WITH

6000
03:27:25,920 --> 03:27:27,760
VARIETY OF AGENCIES ALL ACROSS

6001
03:27:27,760 --> 03:27:29,880
THE COUNTRY.

6002
03:27:29,880 --> 03:27:32,640
WE ARE FINDING THAT THE MORE

6003
03:27:32,640 --> 03:27:34,840
MARGINALIZED, THE MORE

6004
03:27:34,840 --> 03:27:39,240
INTERSECTIONAL IDENTITIES WOMEN

6005
03:27:39,240 --> 03:27:45,320
THEY SERVE HAVE IN SOME WAYS

6006
03:27:45,320 --> 03:27:48,840
LESS AMENABLE TO SCREEN I MIGHT

6007
03:27:48,840 --> 03:27:50,760
SEE COMMENTS ON THIS AFTER.

6008
03:27:50,760 --> 03:27:53,080
WE HAVE AGENCY WORKING WITH THAT

6009
03:27:53,080 --> 03:27:58,320
HAVE UNDOCUMENTED MOMS, AND IT

6010
03:27:58,320 --> 03:28:00,320
IS MUCH LESS THREATENING FOR

6011
03:28:00,320 --> 03:28:02,080
THEM TO OFFER ROSE AS UNIVERSAL

6012
03:28:02,080 --> 03:28:06,200
PREVENTION FOR EVERYONE, LIKE

6013
03:28:06,200 --> 03:28:08,000
EVERYONE GETS IT SCREENING, I

6014
03:28:08,000 --> 03:28:09,960
THINK YOU ARE AT RISK WITH

6015
03:28:09,960 --> 03:28:12,280
POSTPARTUM DEPRESSION, THAT MOM

6016
03:28:12,280 --> 03:28:13,640
IS TERRIFIED BECAUSE SHE IS

6017
03:28:13,640 --> 03:28:15,000
AFRAID THAT PUTS HER ON A

6018
03:28:15,000 --> 03:28:18,480
GOVERNMENT LIST AND SHE WILL

6019
03:28:18,480 --> 03:28:25,120
FIND AND REPORT IT.

6020
03:28:25,120 --> 03:28:28,000
LOW COST INTERVENTION

6021
03:28:28,000 --> 03:28:29,800
PREVENTIVE, UNIVERSAL PREVENTION

6022
03:28:29,800 --> 03:28:31,760
IS GOOD IN SOME WAYS, SEEMED

6023
03:28:31,760 --> 03:28:35,840
GOOD ESPECIALLY MARGINALIZED

6024
03:28:35,840 --> 03:28:39,080
GROUPS BECAUSE IT DOESN'T SINGLE

6025
03:28:39,080 --> 03:28:39,640
FOLKS OUT.

6026
03:28:39,640 --> 03:28:41,520
I WOULD BE CURIOUS TO SEE WHAT

6027
03:28:41,520 --> 03:28:44,360
YOUR EXPERIENCE WITH THIS

6028
03:28:44,360 --> 03:28:45,680
WHETHER WOMEN FIND IT LESS

6029
03:28:45,680 --> 03:28:46,600
THREATENING, IF YOU HAD A

6030
03:28:46,600 --> 03:28:47,960
DIFFERENT EXPERIENCE WITH THAT.

6031
03:28:47,960 --> 03:28:51,840
OUR AGENCIES SERVE THE MOST

6032
03:28:51,840 --> 03:28:52,920
MARGINALIZED WOMEN ARE YEAH WE

6033
03:28:52,920 --> 03:28:54,480
ARE NOT DOING THAT, WE'RE GOING

6034
03:28:54,480 --> 03:29:00,120
TO DO UNIVERSAL PREVENING.

6035
03:29:00,120 --> 03:29:01,680
>> WE CERTAINLY HAD IT WELL

6036
03:29:01,680 --> 03:29:04,000
RECEIVED IN TERMS OF WILLING TO

6037
03:29:04,000 --> 03:29:04,480
DO IT.

6038
03:29:04,480 --> 03:29:07,680
AND SEEING THAT WAS POSITIVE AND

6039
03:29:07,680 --> 03:29:09,160
NOT SAYING PLEASE TAKE THIS AWAY

6040
03:29:09,160 --> 03:29:10,160
OR I DON'T WANT TO DO THIS, IT

6041
03:29:10,160 --> 03:29:14,720
IS RARE.

6042
03:29:14,720 --> 03:29:21,880
IN TERMS OF UNIVERSAL PRIMARY

6043
03:29:21,880 --> 03:29:29,920
PREVENTION, JUST ABOUT ANYTHING

6044
03:29:29,920 --> 03:29:31,080
INTERESTED IN IT.

6045
03:29:31,080 --> 03:29:32,960
WHY SCREEN IF IT COSTS MONEY AND

6046
03:29:32,960 --> 03:29:35,080
DOESN'T GIVE YOU ANY BENEFIT.

6047
03:29:35,080 --> 03:29:36,680
IF IT IS EASIER SIMPLY TO

6048
03:29:36,680 --> 03:29:40,000
PROVIDE THE SERVICE.

6049
03:29:40,000 --> 03:29:42,280
I'M TRYING TO THINK ABOUT HOW

6050
03:29:42,280 --> 03:29:45,280
THAT MIGHT CONNECT TO KINDS OF

6051
03:29:45,280 --> 03:29:49,480
WORK THAT I DO IDENTIFICATION OF

6052
03:29:49,480 --> 03:29:51,920
SUBSTANCE USE, AND HOW I PROVIDE

6053
03:29:51,920 --> 03:29:54,000
A SERVICE TO EVERYBODY

6054
03:29:54,000 --> 03:29:56,680
REGARDLESS, IT WOULD HAVE TO BE

6055
03:29:56,680 --> 03:29:58,440
-- IT WOULD HAVE TO A BROAD

6056
03:29:58,440 --> 03:30:00,200
INTERVENTION ABOUT HEALTHY

6057
03:30:00,200 --> 03:30:01,080
PREGNANCY.

6058
03:30:01,080 --> 03:30:04,800
GIVING ABSOLUTELY EVERYBODY

6059
03:30:04,800 --> 03:30:06,400
INFORMATION ABOUT SUB STANCE

6060
03:30:06,400 --> 03:30:07,640
USE, AND DEPRESSION AND SLEEP

6061
03:30:07,640 --> 03:30:09,560
AND NUTRITION.

6062
03:30:09,560 --> 03:30:11,880
BUILDING IT ALL IN THERE.

6063
03:30:11,880 --> 03:30:13,120
GIVING IT TO EVERYBODY AND

6064
03:30:13,120 --> 03:30:14,320
GIVING THEY WILL AN OPTION IF

6065
03:30:14,320 --> 03:30:17,200
THEY WANT MORE HERE IS WHERE

6066
03:30:17,200 --> 03:30:19,080
THEY MIGHT GO.

6067
03:30:19,080 --> 03:30:21,720
SEEMS LIKE THAT MIGHT BE

6068
03:30:21,720 --> 03:30:26,520
ANALOGOUS.

6069
03:30:26,520 --> 03:30:27,240
THAT MAKES SENSE.

6070
03:30:27,240 --> 03:30:31,600
I WORRY ABOUT NOT HAVING THE

6071
03:30:31,600 --> 03:30:35,480
DATA TO DO MORE TARGETED

6072
03:30:35,480 --> 03:30:37,240
INTERVENTION WHAT WE DO NOW IS

6073
03:30:37,240 --> 03:30:38,880
PRETTY BASED HEAVILY ON

6074
03:30:38,880 --> 03:30:40,920
INFORMATION THEY HAVE GIVEN US.

6075
03:30:40,920 --> 03:30:42,240
IN TERMS OF ACTUAL SUBSTANCE

6076
03:30:42,240 --> 03:30:44,040
USE, HOW THEY FEEL ABOUT IT.

6077
03:30:44,040 --> 03:30:45,680
THE THINGS GOOD FOR THEM ABOUT

6078
03:30:45,680 --> 03:30:46,080
IT.

6079
03:30:46,080 --> 03:30:49,080
NOT SO GOOD FOR THEM ABOUT IT.

6080
03:30:49,080 --> 03:30:50,640
VERY DETAILED CONVERSATION SO

6081
03:30:50,640 --> 03:30:54,560
THAT NECESSARILY INVOLVES

6082
03:30:54,560 --> 03:30:56,920
GETTING THE INFORMATION.

6083
03:30:56,920 --> 03:30:59,240
PERHAPS COULD BE FLIPPED, AND

6084
03:30:59,240 --> 03:31:02,240
MAYBE THAT IS SOMETHING THAT

6085
03:31:02,240 --> 03:31:04,200
MAYBE THAT IS PARTLY WHAT YOU

6086
03:31:04,200 --> 03:31:06,200
HAVE IN MIND SO EVERYBODY GETS

6087
03:31:06,200 --> 03:31:08,080
COMPUTER DELIVERED HEALTHY

6088
03:31:08,080 --> 03:31:09,480
PREGNANCY, THESE ARE SOME THINGS

6089
03:31:09,480 --> 03:31:10,320
THAT ARE GOOD.

6090
03:31:10,320 --> 03:31:13,680
AND THEN IF THEY SAY MAYBE I

6091
03:31:13,680 --> 03:31:15,320
WOULD LIKE MORE ON THIS OR MAYBE

6092
03:31:15,320 --> 03:31:17,440
NEED MORE ON THIS, FLIPPING,

6093
03:31:17,440 --> 03:31:22,800
SORT OF A BIS INSTEAD OF SBI.

6094
03:31:22,800 --> 03:31:25,360
>> AND WHEN YOU ARE TALKING,

6095
03:31:25,360 --> 03:31:26,840
SOMEBODY -- I WANT TO MAKE ONE

6096
03:31:26,840 --> 03:31:28,480
DISTINCTION, NOT SAYING DON'T

6097
03:31:28,480 --> 03:31:31,480
SCREEN, THAT NOT WHAT I'M

6098
03:31:31,480 --> 03:31:33,040
SAYING.

6099
03:31:33,040 --> 03:31:33,960
SOMEBODY ASKED A QUESTION IN THE

6100
03:31:33,960 --> 03:31:34,920
CHAT THERE IS A DISTINCTION

6101
03:31:34,920 --> 03:31:35,680
HERE.

6102
03:31:35,680 --> 03:31:36,440
OUR PREGNANT WOMEN TYPICALLY

6103
03:31:36,440 --> 03:31:37,880
SCREENED FOR SUBSTANCE USE

6104
03:31:37,880 --> 03:31:39,640
SYMPTOMS AND DEPRESSIVE

6105
03:31:39,640 --> 03:31:40,200
SYMPTOMS?

6106
03:31:40,200 --> 03:31:42,720
THE ANSWER IS THEY ARE SUPPOSED

6107
03:31:42,720 --> 03:31:43,240
TO BE.

6108
03:31:43,240 --> 03:31:44,800
THAT IS THAT ACOG

6109
03:31:44,800 --> 03:31:45,800
RECOMMENDATION.

6110
03:31:45,800 --> 03:31:47,880
RIGHT?

6111
03:31:47,880 --> 03:31:52,360
ARE THEY, YOU HAVE SEEN PEOPLE

6112
03:31:52,360 --> 03:31:54,360
WORKING IF I HAD TO BALLPARK

6113
03:31:54,360 --> 03:32:01,840
MAYBE 50 TO 70% MAYBE PART WITH

6114
03:32:01,840 --> 03:32:04,240
UNIVERSAL PREVENTION LIKE

6115
03:32:04,240 --> 03:32:05,880
ABSOLUTELY EXISTING PROBLEMS

6116
03:32:05,880 --> 03:32:07,920
100% SHOULD BE SCREENED BUT PART

6117
03:32:07,920 --> 03:32:10,120
ISSUE WITH ROSE IS PREVENTING

6118
03:32:10,120 --> 03:32:11,800
SOMETHING IN THE FUTURE SO

6119
03:32:11,800 --> 03:32:13,480
SCREENING FUTURE RISK OF

6120
03:32:13,480 --> 03:32:14,520
SOMETHING IS PREDICTION IS NOT

6121
03:32:14,520 --> 03:32:19,240
SUPER GOOD.

6122
03:32:19,240 --> 03:32:21,680
EVEN THEN THOUGH I GUESS ONE

6123
03:32:21,680 --> 03:32:22,960
THING I'M NOT SAYING DON'T

6124
03:32:22,960 --> 03:32:23,680
SCREEN.

6125
03:32:23,680 --> 03:32:25,200
I'M SAYING ABSOLUTELY SCREEN FOR

6126
03:32:25,200 --> 03:32:28,040
CURRENT DEPRESSIVE SYMPTOMS

6127
03:32:28,040 --> 03:32:28,560
CURRENT SUB STANCE USE AND

6128
03:32:28,560 --> 03:32:30,720
WHATEVER BUT IN THIS CASE WE ARE

6129
03:32:30,720 --> 03:32:32,400
PREVENTING FUTURE THING FUTURE

6130
03:32:32,400 --> 03:32:34,760
PREDICTION IS ALWAYS A LITTLE

6131
03:32:34,760 --> 03:32:36,440
DICEY AND SO INTERVENTION LOW

6132
03:32:36,440 --> 03:32:38,600
COST, A LOT OF AGENCIES,

6133
03:32:38,600 --> 03:32:40,160
EVERYONE WE DON'T WANT TO TRY TO

6134
03:32:40,160 --> 03:32:41,480
GO WITH THAT.

6135
03:32:41,480 --> 03:32:42,360
IF THAT MAKES SENSE.

6136
03:32:42,360 --> 03:32:43,200
>> TON OF SENSE.

6137
03:32:43,200 --> 03:32:43,680
THANK YOU.

6138
03:32:43,680 --> 03:32:46,680
THAT HELPS A GREAT DEAL.

6139
03:32:46,680 --> 03:32:49,680
NOT ONLY SCREENING FOR THIS

6140
03:32:49,680 --> 03:32:54,240
FUTURE RISK BE UNNECESSARILY

6141
03:32:54,240 --> 03:33:02,360
IMPERFECT AT BEST BUT ALSO IS

6142
03:33:02,360 --> 03:33:03,480
UNNECESSARY IF YOU HAVE AN

6143
03:33:03,480 --> 03:33:05,120
INTERVENTION THAT IS EASY TO

6144
03:33:05,120 --> 03:33:06,600
IMPLEMENT THAT FIND POSITIVE AND

6145
03:33:06,600 --> 03:33:09,040
ENGAGING AND WANT TO DO

6146
03:33:09,040 --> 03:33:10,800
REGARDLESS WHY WOULD YOU LIMIT

6147
03:33:10,800 --> 03:33:11,200
IT?

6148
03:33:11,200 --> 03:33:13,400
SO IF A WOMAN DOESN'T SCREEN

6149
03:33:13,400 --> 03:33:15,240
POSITIVE BUT WOULD HAVE AGREED

6150
03:33:15,240 --> 03:33:19,320
TO DO IT, WHY WOULD YOU RULE

6151
03:33:19,320 --> 03:33:21,240
THAT PARTICULAR PERSON OUT.

6152
03:33:21,240 --> 03:33:23,640
AGREE, THAT SIMPLY MAKING IT

6153
03:33:23,640 --> 03:33:24,600
AVAILABLE AND TO ANYBODY WHO IS

6154
03:33:24,600 --> 03:33:27,000
WILLING TO DO IT.

6155
03:33:27,000 --> 03:33:28,280
WOULD ABSOLUTELY MAKE A GREAT

6156
03:33:28,280 --> 03:33:29,560
DEAL OF SENSE.

6157
03:33:29,560 --> 03:33:34,240
>> 100% THAT'S WHERE MOST AGENCY

6158
03:33:34,240 --> 03:33:35,240
ARE, TRYING TO IMPLEMENT -- A

6159
03:33:35,240 --> 03:33:38,240
LOT OF HEALTH SYSTEMS AND REALLY

6160
03:33:38,240 --> 03:33:40,680
WORK TO GETTING IDEALLY

6161
03:33:40,680 --> 03:33:43,040
PRENATALLY AND POSTPARTUM, THE

6162
03:33:43,040 --> 03:33:43,800
DEPRESSION SCREENING SUBSTANCE

6163
03:33:43,800 --> 03:33:47,440
USE SCREENING, BUT IF NOT AT

6164
03:33:47,440 --> 03:33:48,240
LEAST ONCE.

6165
03:33:48,240 --> 03:33:49,680
WHAT PERCENT OF PREGNANT WOMEN

6166
03:33:49,680 --> 03:33:51,240
DO YOU THINK GET SCREENED FOR

6167
03:33:51,240 --> 03:33:52,960
SUBSTANCE USE IN ANY EFFECTIVE

6168
03:33:52,960 --> 03:33:54,760
VALIDATED WAY.

6169
03:33:54,760 --> 03:33:59,080
>> HE IS THAT LAST LITTLE --

6170
03:33:59,080 --> 03:34:00,840
THAT IS VERY IMPORTANT.

6171
03:34:00,840 --> 03:34:03,920
VERY HIGH PROPORTION DO GET

6172
03:34:03,920 --> 03:34:05,680
ASKED BUT IT IS OFTEN IN A

6173
03:34:05,680 --> 03:34:10,440
NON-EVIDENCE BASED WAY, SIMPLY

6174
03:34:10,440 --> 03:34:14,680
THE -- IT IS KIND OF STEREOTYPE

6175
03:34:14,680 --> 03:34:15,960
BUT UNFORTUNATELY OFTEN TRUE,

6176
03:34:15,960 --> 03:34:17,960
YOU DON'T USE, YOU DON'T DRINK A

6177
03:34:17,960 --> 03:34:21,440
LOT DO YOU OKAY NO.

6178
03:34:21,440 --> 03:34:23,440
IT IS DONE IN -- SO IT IS A

6179
03:34:23,440 --> 03:34:25,240
PERSON DELIVERED WAY, WHICH WE

6180
03:34:25,240 --> 03:34:27,680
KNOW SUPPRESSES DISCLOSURE, NOT

6181
03:34:27,680 --> 03:34:30,000
USING EVIDENCE BASED APPROACH

6182
03:34:30,000 --> 03:34:32,680
AND PROBABLY THE BEST, ANDERSON

6183
03:34:32,680 --> 03:34:39,600
ET AL, SURVEY ACOG WAS PART OF

6184
03:34:39,600 --> 03:34:43,080
THAT SURVEY I BELIEVE.

6185
03:34:43,080 --> 03:34:45,560
SHOWING THAT MOST OBGYN REPORTED

6186
03:34:45,560 --> 03:34:46,520
SCREENING EVERYBODY IN THEIR

6187
03:34:46,520 --> 03:34:47,120
CLINICS.

6188
03:34:47,120 --> 03:34:51,400
BUT VERY FEW USED EVIDENCE BASED

6189
03:34:51,400 --> 03:34:52,160
SCREENER.

6190
03:34:52,160 --> 03:34:54,080
VERY FEW USED ALL RECOMMENDED

6191
03:34:54,080 --> 03:34:56,720
BRIEF INTERVENTION ELEMENTS EVEN

6192
03:34:56,720 --> 03:34:58,480
WHEN THEY DID SOME FORT OF

6193
03:34:58,480 --> 03:34:58,840
INTERVENTION.

6194
03:34:58,840 --> 03:35:01,480
WE GET A LOT HIGHER RATES OF

6195
03:35:01,480 --> 03:35:02,800
DISCLOSURE USING EVIDENCE BASED

6196
03:35:02,800 --> 03:35:05,040
COMPUTER DELIVERED SCREENING.

6197
03:35:05,040 --> 03:35:07,800
OR DIGITAL SCREENING TREATMENT

6198
03:35:07,800 --> 03:35:08,640
IS USUAL.

6199
03:35:08,640 --> 03:35:10,720
>> BEAUTY OF THAT IS PROVIDER

6200
03:35:10,720 --> 03:35:11,880
ONLY HAS TO REMEMBER OR NOT

6201
03:35:11,880 --> 03:35:12,840
EVEN, THEY DON'T HAVE TO

6202
03:35:12,840 --> 03:35:16,960
REMEMBER THE RIGHT WAY TO ASK A

6203
03:35:16,960 --> 03:35:17,400
QUESTION,.

6204
03:35:17,400 --> 03:35:18,640
>> IT HAPPENS IN THE WAITING

6205
03:35:18,640 --> 03:35:21,480
AREA OR BEFORE THEY GET THERE,

6206
03:35:21,480 --> 03:35:24,080
IT IS A REPORT WITH INFORMATION

6207
03:35:24,080 --> 03:35:26,880
AND WITH RECOMMENDATION TALKING

6208
03:35:26,880 --> 03:35:27,080
POINTS.

6209
03:35:27,080 --> 03:35:28,440
>> SO WE HAVE TWO QUESTIONS IN

6210
03:35:28,440 --> 03:35:33,760
OUR Q&A THAT HAVE COME UP.

6211
03:35:33,760 --> 03:35:37,800
NOW CERTIFIED PEER SPECIALIST

6212
03:35:37,800 --> 03:35:39,480
RECOVERY SPECIALIST WHAT WOULD

6213
03:35:39,480 --> 03:35:41,520
THE ROLE BE AS POSSIBLE WARM

6214
03:35:41,520 --> 03:35:43,520
HAND OFF RESOURCES TO WORK WITH

6215
03:35:43,520 --> 03:35:45,920
INDIVIDUALS IN GETTING THEM TO

6216
03:35:45,920 --> 03:35:47,600
AVAILABLE RESOURCE, TYPE

6217
03:35:47,600 --> 03:35:48,720
REFERRAL COST EFFECTIVE

6218
03:35:48,720 --> 03:35:52,920
RESOURCE.

6219
03:35:52,920 --> 03:35:54,400
>> AMY, DO YOU WANT TO TAKE THAT

6220
03:35:54,400 --> 03:35:57,440
ONE?

6221
03:35:57,440 --> 03:35:58,680
>> BE HAPPY TO.

6222
03:35:58,680 --> 03:36:03,800
SO WHEN THERE IS PEER RECOVERY

6223
03:36:03,800 --> 03:36:05,000
COACH, PEER NAVIGATOR AVAILABLE

6224
03:36:05,000 --> 03:36:06,760
IN A CLINIC WHERE WE ARE

6225
03:36:06,760 --> 03:36:08,720
IMPLEMENTING THE TECHNOLOGY, I

6226
03:36:08,720 --> 03:36:12,680
AM THRILLED TO DEATH THAT I HAVE

6227
03:36:12,680 --> 03:36:14,040
THAT ABILITY TO SAY ONE OF THE

6228
03:36:14,040 --> 03:36:16,760
THINGS AVAILABLE TO YOU IS THIS

6229
03:36:16,760 --> 03:36:18,680
PERSON WHO IS PROBABLY JUST A

6230
03:36:18,680 --> 03:36:20,960
FEW FEET AWAY RIGHT NOW, KNOW

6231
03:36:20,960 --> 03:36:22,640
SOMETHING ABOUT WHAT YOU ARE

6232
03:36:22,640 --> 03:36:24,480
GOING THROUGH AND WOULD BE HAPPY

6233
03:36:24,480 --> 03:36:25,680
TO TALK WITH YOU, I WOULD LOVE

6234
03:36:25,680 --> 03:36:26,840
TO DO THAT AND WHERE IT IS

6235
03:36:26,840 --> 03:36:29,040
AVAILABLE I TAKE ADVANTAGE OF

6236
03:36:29,040 --> 03:36:29,560
IT.

6237
03:36:29,560 --> 03:36:31,160
EXACTLY WHAT WE WANT TO LEVERAGE

6238
03:36:31,160 --> 03:36:32,080
WITH THAT LIFE CHAT FEATURE THAT

6239
03:36:32,080 --> 03:36:33,880
WE ARE BUILDING IN FOR CLINICS

6240
03:36:33,880 --> 03:36:34,760
THAT DON'T HAVE SOMEBODY LIKE

6241
03:36:34,760 --> 03:36:36,840
THAT AVAILABLE, RIGHT THEN AND

6242
03:36:36,840 --> 03:36:37,960
THERE THEY CAN CLICK AND

6243
03:36:37,960 --> 03:36:38,960
ACTUALLY CHAT WITH SOMEONE.

6244
03:36:38,960 --> 03:36:43,800
I THINK A LOT OF PEOPLE YOUNGER

6245
03:36:43,800 --> 03:36:45,960
CERTAINLY THAN ME REALLY PREFER

6246
03:36:45,960 --> 03:36:48,080
TO COMMUNICATE THROUGH THAT SORT

6247
03:36:48,080 --> 03:36:50,400
OF LIVE CHAT TEXTING MEDIUM.

6248
03:36:50,400 --> 03:36:52,160
AND THEN THAT CAN THEN BE USED

6249
03:36:52,160 --> 03:36:54,040
TO PROMOTE OTHER SORTS OF

6250
03:36:54,040 --> 03:36:57,400
SERVICES PERHAPS IN PERSON.

6251
03:36:57,400 --> 03:36:59,680
I'M A HUGE PROPONENT OF THAT,

6252
03:36:59,680 --> 03:37:04,440
THE LITERATURE IS GOOD ON THAT

6253
03:37:04,440 --> 03:37:05,480
APPROACH MAKING AVAILABLE

6254
03:37:05,480 --> 03:37:07,600
REMOTELY OR IN PERSON TO EXTENT

6255
03:37:07,600 --> 03:37:08,600
POSSIBLE.

6256
03:37:08,600 --> 03:37:11,720
IS REALLY A PERFECT OPTION FOR

6257
03:37:11,720 --> 03:37:13,200
BRIDGING THAT GAP FOR SOMEBODY

6258
03:37:13,200 --> 03:37:15,920
WHO NEEDS MORE INTENSIVE

6259
03:37:15,920 --> 03:37:16,480
SERVICES.

6260
03:37:16,480 --> 03:37:18,320
BUT MAJORITY OF WHOM AREN'T

6261
03:37:18,320 --> 03:37:19,880
READY AND WILLING TO TAKE

6262
03:37:19,880 --> 03:37:21,800
ADVANTAGE OF THEM.

6263
03:37:21,800 --> 03:37:22,880
HAVING A CHAT WITH SOMEBODY

6264
03:37:22,880 --> 03:37:24,680
THERE IN CLINIC FOR A MINUTE WHO

6265
03:37:24,680 --> 03:37:26,880
HAS BEEN THROUGH IT WHO ISN'T

6266
03:37:26,880 --> 03:37:30,920
PSYCHIATRIST OR PSYCHOLOGIST,

6267
03:37:30,920 --> 03:37:31,920
THAT IS GREAT VERSION I WOULD

6268
03:37:31,920 --> 03:37:33,640
LOVE TO SEE.

6269
03:37:33,640 --> 03:37:36,080
>> WE ARE GETTING MORE

6270
03:37:36,080 --> 03:37:36,440
QUESTIONS.

6271
03:37:36,440 --> 03:37:39,840
THERE IS ONE THAT SAYS HOW TO

6272
03:37:39,840 --> 03:37:40,920
ACKNOWLEDGE BOOTS ON THE GROUND

6273
03:37:40,920 --> 03:37:42,040
OPPOSED TO SCIENTISTS IN THE

6274
03:37:42,040 --> 03:37:42,480
LAB.

6275
03:37:42,480 --> 03:37:43,840
I WANT TO SAY SOMETHING I FORGOT

6276
03:37:43,840 --> 03:37:47,040
TO SAY WHEN I WAS TALKING WAS SO

6277
03:37:47,040 --> 03:37:50,400
INTERESTING, LIKE I SAID,

6278
03:37:50,400 --> 03:37:55,120
AGENCIES THE AGENCIES ALL

6279
03:37:55,120 --> 03:37:56,480
PROVIDERS WE ARE WORKING WITH

6280
03:37:56,480 --> 03:37:57,760
ARE SO PASSIONATE AND COMMIT AND

6281
03:37:57,760 --> 03:38:02,240
THEY ARE TRYING TO KEEP THE

6282
03:38:02,240 --> 03:38:06,040
SERVICES GOING ON SHOE STRING

6283
03:38:06,040 --> 03:38:08,720
AND DESPITE OBSTACLES IT IS IN A

6284
03:38:08,720 --> 03:38:10,480
QUALITATIVE INTERVIEW BECAUSE

6285
03:38:10,480 --> 03:38:12,120
SOME CAN DO IT RIGHT OFF THE

6286
03:38:12,120 --> 03:38:13,680
BAT, SOME STRUGGLE BARRIERS

6287
03:38:13,680 --> 03:38:16,080
WORKING TO GET IT STARTED BUT

6288
03:38:16,080 --> 03:38:18,200
ONE OF THE THINGS THAT IS

6289
03:38:18,200 --> 03:38:20,160
INTERESTING BUT SORT OF

6290
03:38:20,160 --> 03:38:22,240
QUALITATIVE INTERVIEW HOW GUILT

6291
03:38:22,240 --> 03:38:26,160
THEY FEEL THEY CAN'T DO MORE WE

6292
03:38:26,160 --> 03:38:27,440
CAN TRY TO SAY THIS IS NOT --

6293
03:38:27,440 --> 03:38:30,640
YOU ARE DOING AMAZING EFFORTS

6294
03:38:30,640 --> 03:38:32,240
WITH RESOURCES YOU HAVE BEEN

6295
03:38:32,240 --> 03:38:33,640
GIVEN, TO DO ANY OF THIS IS

6296
03:38:33,640 --> 03:38:36,840
AMAZING.

6297
03:38:36,840 --> 03:38:39,840
BUT THIS IS ALMOST UNIVERSAL.

6298
03:38:39,840 --> 03:38:41,800
SO THE BOOTS ON THE GROUND WITH

6299
03:38:41,800 --> 03:38:43,480
PROVIDERS, WITH THE PEOPLE WHO

6300
03:38:43,480 --> 03:38:46,040
ARE TRYING TO MAKE THE AGENCIES

6301
03:38:46,040 --> 03:38:47,240
RUN, WHO ARE SEEING THEM ON DAY

6302
03:38:47,240 --> 03:38:51,840
TO DAY AND TRYING TO CREATE A

6303
03:38:51,840 --> 03:38:53,440
SYSTEM OF CARE WE ARE TALKING

6304
03:38:53,440 --> 03:38:55,720
ABOUT WHERE IT DOESN'T EXIST

6305
03:38:55,720 --> 03:38:56,680
ACROSS SOCIAL DETERMINANTS,

6306
03:38:56,680 --> 03:38:58,320
THERE'S PEOPLE PUTTING

6307
03:38:58,320 --> 03:39:00,240
THEMSELVES IN TO FILL THOSE

6308
03:39:00,240 --> 03:39:03,000
GAPS.

6309
03:39:03,000 --> 03:39:04,680
HEROIC AND ALSO THE FACT THE

6310
03:39:04,680 --> 03:39:07,240
SYSTEM ISN'T REALLY SET UP TO

6311
03:39:07,240 --> 03:39:08,320
SUPPORT THEM OR THE MOM BECAUSE

6312
03:39:08,320 --> 03:39:11,040
IT IS FRAGMENTED.

6313
03:39:11,040 --> 03:39:15,400
IT IS UNNECESSARY HUMAN TOLL ON

6314
03:39:15,400 --> 03:39:16,480
THE PROVIDERS.

6315
03:39:16,480 --> 03:39:17,280
>> GREAT ANSWER.

6316
03:39:17,280 --> 03:39:19,640
I WOULD ADD THAT KINDS OF THINGS

6317
03:39:19,640 --> 03:39:23,240
JENNIFER AND I ARE DOING WHICH

6318
03:39:23,240 --> 03:39:25,880
INVOLVE NOT AN RA OR A

6319
03:39:25,880 --> 03:39:27,480
SCIENTIFIC TEAM COMING IN AND

6320
03:39:27,480 --> 03:39:29,720
DOING IT WITH THE ACTUAL

6321
03:39:29,720 --> 03:39:30,720
HEALTHCARE TEAM DOING THESE

6322
03:39:30,720 --> 03:39:33,680
SORTS OF PREVENTIVE ACTIVITIES,

6323
03:39:33,680 --> 03:39:36,200
IS A HUGE STEP AND GIVES THEM A

6324
03:39:36,200 --> 03:39:38,280
TOOL, GIVES THEM SOMETHING THEY

6325
03:39:38,280 --> 03:39:40,480
CAN DO THEY CAN KNOW WORKS WE

6326
03:39:40,480 --> 03:39:41,680
HAVE TO BE CAREFUL ABOUT HOW

6327
03:39:41,680 --> 03:39:43,240
MUCH WE ASK AND HOW MUCH WE ADD.

6328
03:39:43,240 --> 03:39:44,840
THERE IS THAT FINE LINE THERE.

6329
03:39:44,840 --> 03:39:46,360
THEY NEED TOOLS THAT WANT TO

6330
03:39:46,360 --> 03:39:47,840
HELP -- THEY WANT TO DO THINGS,

6331
03:39:47,840 --> 03:39:49,840
WE HAVE TO MAKE IT POSSIBLE AND

6332
03:39:49,840 --> 03:39:51,240
FEASIBLE FOR THEM.

6333
03:39:51,240 --> 03:39:53,240
>> I WAS TALKING ABOUT MY

6334
03:39:53,240 --> 03:39:54,680
BUILDING SUGGESTION, ONE OF MY

6335
03:39:54,680 --> 03:39:58,240
THINGS WAS MANDATED AND I HAD A

6336
03:39:58,240 --> 03:39:59,320
RESPONSE FROM COLLEAGUE WHO

6337
03:39:59,320 --> 03:40:03,720
CANNOT MANDATE ONE MORE THING,

6338
03:40:03,720 --> 03:40:04,440
CAN'T DO IT.

6339
03:40:04,440 --> 03:40:06,880
I MET WITH MORE PAYMENT, MORE

6340
03:40:06,880 --> 03:40:08,520
RESOURCES.

6341
03:40:08,520 --> 03:40:11,080
I NEED -- WITHOUT RESOURCES.

6342
03:40:11,080 --> 03:40:13,280
HERE IS A QUESTION THAT SAYS

6343
03:40:13,280 --> 03:40:15,280
WOULD UNIVERSAL HOME VISITING

6344
03:40:15,280 --> 03:40:17,080
BEING SOMETHING YOU SEE FEASIBLE

6345
03:40:17,080 --> 03:40:18,760
AND THAT EVERYONE WOULD BENEFIT.

6346
03:40:18,760 --> 03:40:19,880
I DON'T KNOW THAT I KNOW THE

6347
03:40:19,880 --> 03:40:21,480
ANSWER TO THAT.

6348
03:40:21,480 --> 03:40:23,040
I DON'T THINK IT IS FEASIBLE

6349
03:40:23,040 --> 03:40:23,880
RIGHT NOW.

6350
03:40:23,880 --> 03:40:27,120
I THINK FOLKS MIGHT BENEFIT FROM

6351
03:40:27,120 --> 03:40:27,560
IT.

6352
03:40:27,560 --> 03:40:28,680
IT WOULD BE GREAT IF AN OPTION

6353
03:40:28,680 --> 03:40:29,840
IS AVAILABLE TO EVERYONE.

6354
03:40:29,840 --> 03:40:33,440
ONE OF THE THINGS WE HAVE IN

6355
03:40:33,440 --> 03:40:35,120
MICHIGAN, HOW IT IS IN OTHER

6356
03:40:35,120 --> 03:40:39,400
STATES BUT HOME VISITING

6357
03:40:39,400 --> 03:40:41,720
PROGRAMS THE COMMUNITIES MOST AT

6358
03:40:41,720 --> 03:40:43,120
RISK, THERE IS LOWER UPTAKE

6359
03:40:43,120 --> 03:40:44,760
THERE IS TRUST BUILDING THAT

6360
03:40:44,760 --> 03:40:45,480
NEEDS TO BE DONE.

6361
03:40:45,480 --> 03:40:48,480
BUT I DON'T -- I GUESS I DON'T

6362
03:40:48,480 --> 03:40:51,440
-- I DON'T HAVE A STRONG THOUGHT

6363
03:40:51,440 --> 03:40:54,880
ABOUT WHETHER IT IS FEASIBLE.

6364
03:40:54,880 --> 03:40:57,640
IT WOULD BE NICE.

6365
03:40:57,640 --> 03:40:59,680
DR. BOHR, DO YOU HAVE THOUGHTS

6366
03:40:59,680 --> 03:41:02,240
ABOUT THAT?

6367
03:41:02,240 --> 03:41:04,520
>> ONE OF THE THINGS INTERESTING

6368
03:41:04,520 --> 03:41:06,640
IN MICHIGAN, ANY WOMAN WITH

6369
03:41:06,640 --> 03:41:08,760
MEDICAID CAN GET HOME VISITING,

6370
03:41:08,760 --> 03:41:11,600
AND IN MANY OF THE MORE RURAL

6371
03:41:11,600 --> 03:41:14,680
AREAS, THAT'S JUST ABOUT WHAT IS

6372
03:41:14,680 --> 03:41:15,800
AVAILABLE IS BACK TO THEM IN

6373
03:41:15,800 --> 03:41:17,680
TERMS OF SERVICES.

6374
03:41:17,680 --> 03:41:18,880
SO THAT IS BECAUSE THAT IS WHAT

6375
03:41:18,880 --> 03:41:20,560
THEY HAVE, THAT IS WHAT WE

6376
03:41:20,560 --> 03:41:22,280
PROMOTE AND WE CERTAINLY COULD

6377
03:41:22,280 --> 03:41:22,960
DO WORSE.

6378
03:41:22,960 --> 03:41:24,480
I'M DELIGHTED TO HAVE THAT

6379
03:41:24,480 --> 03:41:27,480
SERVICE AVAILABLE TO THEM,

6380
03:41:27,480 --> 03:41:30,840
THERE'S RICH LITERATURE ON THE

6381
03:41:30,840 --> 03:41:32,280
STRENGTHS AND THE PROS AND CONS

6382
03:41:32,280 --> 03:41:34,520
OF PROVIDING THAT PARTICULAR

6383
03:41:34,520 --> 03:41:37,080
SERVICE, I WISH WE HAD MORE.

6384
03:41:37,080 --> 03:41:39,960
BUT ANYTHING THAT PEOPLE CAN

6385
03:41:39,960 --> 03:41:43,600
ACCESS EASILY AND THAT COMES TO

6386
03:41:43,600 --> 03:41:46,240
THEM, THAT IS A GREAT STARTING

6387
03:41:46,240 --> 03:41:47,400
POINT FOR SURE.

6388
03:41:47,400 --> 03:41:49,080
>> SOMEBODY SAID FEASIBLE IN

6389
03:41:49,080 --> 03:41:51,520
CALIFORNIA, CALIFORNIA IS BY

6390
03:41:51,520 --> 03:41:53,080
DELAY THE ONLY STAY THAT HAS

6391
03:41:53,080 --> 03:41:54,960
GOOD REIMBURSEMENT STRUCTURE FOR

6392
03:41:54,960 --> 03:41:56,920
ROSE SO KUDOS TO CALIFORNIA.

6393
03:41:56,920 --> 03:41:58,880
THEY SHOULD BE A MODEL FOR REST

6394
03:41:58,880 --> 03:42:03,400
OF US AROUND THIS.

6395
03:42:03,400 --> 03:42:04,480
SO WE HAVE STEVE THERE IS A

6396
03:42:04,480 --> 03:42:05,680
QUESTION FOR YOU IN THE CHAT.

6397
03:42:05,680 --> 03:42:07,080
I WILL LET YOU TRY TO ANSWER IN

6398
03:42:07,080 --> 03:42:07,480
THE CHAT.

6399
03:42:07,480 --> 03:42:11,080
I WILL TAKE THIS ONE ABOUT PTSD.

6400
03:42:11,080 --> 03:42:13,320
AND SO WANTED TO ASK REQUEST

6401
03:42:13,320 --> 03:42:15,440
INFORMATION ABOUT PTSD AND MAJOR

6402
03:42:15,440 --> 03:42:16,960
COMPLICATIONS DURING PREGNANCY.

6403
03:42:16,960 --> 03:42:20,240
YES, I DO WORK IN THAT AREA, IT

6404
03:42:20,240 --> 03:42:25,640
IS INTERESTING -- SO -- CAN BE

6405
03:42:25,640 --> 03:42:29,080
TRAUMATIC HIGH RATE OF PTSD, IT

6406
03:42:29,080 --> 03:42:32,040
DOES LAST, THIS IS ABSOLUTELY AN

6407
03:42:32,040 --> 03:42:33,080
UNDERRECOGNIZE CONCERN THERE ARE

6408
03:42:33,080 --> 03:42:35,960
THINGS THAT CAN HELP WITH IT AND

6409
03:42:35,960 --> 03:42:40,240
I GUESS I WILL -- I WILL PUT MY

6410
03:42:40,240 --> 03:42:41,480
EMAIL IN THE CHAT FOR EVERYONE

6411
03:42:41,480 --> 03:42:43,360
AND IF YOU WANT TO EMAIL ME,

6412
03:42:43,360 --> 03:42:44,920
EMAIL ME.

6413
03:42:44,920 --> 03:42:46,360
PTSD FOR PREGNANCY

6414
03:42:46,360 --> 03:42:50,080
COMPLICATIONS, ABSOLUTELY.

6415
03:42:50,080 --> 03:42:52,920
>> ONE QUESTION I THINK WAS

6416
03:42:52,920 --> 03:42:54,000
ABOUT BRIEF INTERVENTION

6417
03:42:54,000 --> 03:42:56,800
AVAILABILITY RATHER THAN HOME

6418
03:42:56,800 --> 03:42:58,560
VISITATION IN TERMS OF THE BRIEF

6419
03:42:58,560 --> 03:42:59,480
INTERVENTION WE HAVE FUNDING

6420
03:42:59,480 --> 03:43:00,480
FROM THE MICHIGAN DEPARTMENT OF

6421
03:43:00,480 --> 03:43:02,880
HEALTH AND HUMAN SERVICES, TO

6422
03:43:02,880 --> 03:43:04,680
MAKE AVAILABLE ANYWHERE AT ANY

6423
03:43:04,680 --> 03:43:07,000
CLINIC THAT WANTS IT, WE PROVIDE

6424
03:43:07,000 --> 03:43:09,800
IT FOR FREE.

6425
03:43:09,800 --> 03:43:13,720
THE CHALLENGE IS NOT SO MUCH THE

6426
03:43:13,720 --> 03:43:16,280
COST BUT HIPAA AND SECURITY

6427
03:43:16,280 --> 03:43:21,440
SORTS OF REGULATIONS THAT SLOW

6428
03:43:21,440 --> 03:43:22,320
US DOWN.

6429
03:43:22,320 --> 03:43:23,800
STEVE WILL YOU ANSWER THERE IS A

6430
03:43:23,800 --> 03:43:26,560
QUESTION ABOUT AI CAN YOU TYPE

6431
03:43:26,560 --> 03:43:28,080
IT -- AN ANSWER.

6432
03:43:28,080 --> 03:43:29,440
TO THE Q&A.

6433
03:43:29,440 --> 03:43:31,640
>> LET ME GRAB THAT, I WAS

6434
03:43:31,640 --> 03:43:32,600
LOOKING AT THE OTHER.

6435
03:43:32,600 --> 03:43:35,480
>> WE GOT TO BE DONE BY I THINK

6436
03:43:35,480 --> 03:43:38,920
THAT WANT AN ANSWER TO THAT ONE

6437
03:43:38,920 --> 03:43:40,240
SO ANSWER THAT WILL BE GREAT.

6438
03:43:40,240 --> 03:43:41,480
>> LET ME GRAB THAT.

6439
03:43:41,480 --> 03:43:43,440
>> THANK YOU FOR ANSWERING THE

6440
03:43:43,440 --> 03:43:45,000
LAST QUESTION.

6441
03:43:45,000 --> 03:43:46,880
I WANT TO THANK SESSION TWO

6442
03:43:46,880 --> 03:43:47,320
PANELIST.

6443
03:43:47,320 --> 03:43:49,080
AS WE MOVE FROM SESSION ONE

6444
03:43:49,080 --> 03:43:51,080
WHICH SET THE STAGE FOR BROAD

6445
03:43:51,080 --> 03:43:53,960
ISSUES THE SESSION TWO PROVIDED

6446
03:43:53,960 --> 03:43:56,160
DATA ON SBIRT AS APPROACH TO

6447
03:43:56,160 --> 03:43:57,240
DELIVERY OF EARLY INTERVENTION

6448
03:43:57,240 --> 03:43:58,560
AND TREATMENT FOR VARIOUS TYPES

6449
03:43:58,560 --> 03:44:00,960
OF INTERVENTIONS WHICH DURING

6450
03:44:00,960 --> 03:44:01,920
THE DISCUSSION WE FOUND THAT

6451
03:44:01,920 --> 03:44:04,080
MIGHT BE ABLE TO APPLY TO NEW

6452
03:44:04,080 --> 03:44:05,080
PROGRAMS AND NEW MEDICAL

6453
03:44:05,080 --> 03:44:05,840
INTERVENTIONS FOR WOMEN AND

6454
03:44:05,840 --> 03:44:07,680
GIRLS.

6455
03:44:07,680 --> 03:44:09,160
IN ORDER FOR SOMETHING REALLY TO

6456
03:44:09,160 --> 03:44:11,920
BE MOVED INTO EVIDENCE BASED

6457
03:44:11,920 --> 03:44:13,360
PRACTICE, NEW INTERVENTIONS DO

6458
03:44:13,360 --> 03:44:15,200
NEED TO BE TESTED TO UNDERSTAND

6459
03:44:15,200 --> 03:44:17,680
THE INTERVENTION WORKS OR

6460
03:44:17,680 --> 03:44:18,840
IMPROVES THE CONDITIONS THAT

6461
03:44:18,840 --> 03:44:20,640
INTERVENTION IS TRYING TO TREAT.

6462
03:44:20,640 --> 03:44:21,880
THAT CONCEPT PROVIDING

6463
03:44:21,880 --> 03:44:24,760
INTERVENTION THAT MAY PREVENT

6464
03:44:24,760 --> 03:44:25,960
FUTURE RISK GLOBALLY WAS ALSO AN

6465
03:44:25,960 --> 03:44:26,960
INTERESTING QUESTION POSED IN

6466
03:44:26,960 --> 03:44:29,200
THE DISCUSSION.

6467
03:44:29,200 --> 03:44:31,160
SHOULD LOW COST EASY UPTAKE

6468
03:44:31,160 --> 03:44:32,240
INTERVENTIONS BE MORE WIDELY

6469
03:44:32,240 --> 03:44:32,640
AVAILABLE.

6470
03:44:32,640 --> 03:44:34,320
SO WE SHOULD THINK ABOUT THIS A

6471
03:44:34,320 --> 03:44:35,000
LITTLE BIT MORE THROUGHOUT THE

6472
03:44:35,000 --> 03:44:37,320
WORKSHOP.

6473
03:44:37,320 --> 03:44:38,720
ALSO WE SAW SEVERAL EXAMPLES HOW

6474
03:44:38,720 --> 03:44:41,000
WE CAN USE MODERN TECHNOLOGIES

6475
03:44:41,000 --> 03:44:42,880
FOR OUTREACH AND MEANS FOR

6476
03:44:42,880 --> 03:44:45,200
INTERVENTION TO IMPROVE HEALTH

6477
03:44:45,200 --> 03:44:46,760
CARE DELIVERY AND CARE OVERALL.

6478
03:44:46,760 --> 03:44:48,640
WE ALSO SAW EXAMPLES OF HOW

6479
03:44:48,640 --> 03:44:50,720
PREVENTION IS KEY FOR REDUCING

6480
03:44:50,720 --> 03:44:53,360
HEALTHCARE DISPARITIES IN BOTH

6481
03:44:53,360 --> 03:44:55,880
PRE- AND POSTPARTUM PERIODS SO

6482
03:44:55,880 --> 03:44:57,320
THE SPEAKERS HERE REALLY

6483
03:44:57,320 --> 03:44:58,480
PRESENTED THAT THERE ARE MANY

6484
03:44:58,480 --> 03:45:00,000
GOOD MODELS THAT COULD BE

6485
03:45:00,000 --> 03:45:02,120
APPLIEDED TO NEW AREAS WE ARE

6486
03:45:02,120 --> 03:45:04,320
THINKING ABOUT ACROSS MULTIPLE

6487
03:45:04,320 --> 03:45:05,560
CONDITIONS THAT REQUIRE NEW

6488
03:45:05,560 --> 03:45:07,400
INTERVENTION TO ADDRESS

6489
03:45:07,400 --> 03:45:09,720
CO-MORBIDITIES IN WOMEN AND

6490
03:45:09,720 --> 03:45:10,080
GIRLS.

6491
03:45:10,080 --> 03:45:11,480
SO WE SHOULD KEEP TALKING ABOUT

6492
03:45:11,480 --> 03:45:14,240
THESE AND CONSIDER THESE AS

6493
03:45:14,240 --> 03:45:17,680
POTENTIAL RESEARCH OPPORTUNITIES

6494
03:45:17,680 --> 03:45:18,480
SO AT THIS TIME WHICH ARE GOING

6495
03:45:18,480 --> 03:45:19,880
TO TAKE ANOTHER SHORT BREAK THEN

6496
03:45:19,880 --> 03:45:21,520
WE'LL RETURN FOR SESSION 3 WHICH

6497
03:45:21,520 --> 03:45:22,640
WILL BE OUR FINAL SESSION FOR

6498
03:45:22,640 --> 03:45:25,400
THE DAY.

6499
03:45:25,400 --> 03:45:26,480
THANK YOU.

6500
03:45:26,480 --> 03:45:28,560
>> WELCOME BACK.

6501
03:45:28,560 --> 03:45:30,920
WE WILL HAVE OUR FINAL SESSION

6502
03:45:30,920 --> 03:45:33,160
OF TODAY.

6503
03:45:33,160 --> 03:45:34,480
TITLED IMPLEMENTING ESSENTIAL

6504
03:45:34,480 --> 03:45:36,160
COMPONENTS OF INTEGRATIVE

6505
03:45:36,160 --> 03:45:37,800
HEALTHCARE SYSTEMS FOR WOMEN AND

6506
03:45:37,800 --> 03:45:40,480
GIRLS, CHALLENGES AND SUCCESSES.

6507
03:45:40,480 --> 03:45:42,480
THIS SESSION WILL BE MODERATED

6508
03:45:42,480 --> 03:45:47,400
BY DR. LAURIE DONZE FROM NHLBI.

6509
03:45:47,400 --> 03:45:49,400
I'LL TURN IT OVER TO LAURIE.

6510
03:45:49,400 --> 03:45:51,720
>> HI, EVERYONE.

6511
03:45:51,720 --> 03:45:54,560
I'M LAURIE FRIEDMAN DONZE,

6512
03:45:54,560 --> 03:45:56,120
PROGRAM DIRECTOR MARKNAL HEART

6513
03:45:56,120 --> 03:45:57,720
LUNG AND BLOOD INSTITUTE AT NIH.

6514
03:45:57,720 --> 03:46:00,400
I'M PLEASED TO MODERATE THIS

6515
03:46:00,400 --> 03:46:02,800
SESSION AND INTRODUCE OUR FOUR

6516
03:46:02,800 --> 03:46:03,480
ESTEEMED PRESENTERS.

6517
03:46:03,480 --> 03:46:05,560
I'M GOING TO INTRODUCE THEM

6518
03:46:05,560 --> 03:46:07,440
TOGETHER AND TURN IT OVER TO THE

6519
03:46:07,440 --> 03:46:08,720
FIRST PRESENTER.

6520
03:46:08,720 --> 03:46:13,120
SO OUR FIRST PRESENTER WILL BE

6521
03:46:13,120 --> 03:46:14,840
DR. DOOR CHAR MEHTA, INTERNAL --

6522
03:46:14,840 --> 03:46:16,160
DARSHAN MEHTA, ASSISTANT

6523
03:46:16,160 --> 03:46:17,280
PROFESSOR MEDICINE HARVARD

6524
03:46:17,280 --> 03:46:18,200
MEDICAL SCHOOL.

6525
03:46:18,200 --> 03:46:20,440
WHERE HE SERVES AS THE DIRECTOR

6526
03:46:20,440 --> 03:46:22,400
OF EDUCATION FOR THE OSHA CENTER

6527
03:46:22,400 --> 03:46:24,720
AT BRIGHAM AND WOMEN'S HOSPITAL

6528
03:46:24,720 --> 03:46:26,600
AND HARVARD MEDICAL SCHOOL.

6529
03:46:26,600 --> 03:46:29,360
THE MEDICAL DIRECTOR OF THE BOSS

6530
03:46:29,360 --> 03:46:30,640
-- BENEFITSON HENRY INSTITUTE

6531
03:46:30,640 --> 03:46:34,000
FOR MIND BODY MEDICINE,

6532
03:46:34,000 --> 03:46:34,800
MASSACHUSETTS GENERAL HOSPITAL

6533
03:46:34,800 --> 03:46:36,560
AND DIRECTOR OF THE OFFICE FOR

6534
03:46:36,560 --> 03:46:38,520
WELL BEING WITH CENTER FOR

6535
03:46:38,520 --> 03:46:40,080
FACULTY DEVELOPMENT AT MASS

6536
03:46:40,080 --> 03:46:40,680
GENERAL.

6537
03:46:40,680 --> 03:46:43,000
HIS EDUCATIONAL AND RESEARCH

6538
03:46:43,000 --> 03:46:45,800
INTEREST INCLUDE CURRICULAR

6539
03:46:45,800 --> 03:46:47,040
DEVELOPMENT IN COMPLIMENTARY

6540
03:46:47,040 --> 03:46:48,360
INTEGRATIVE MEDICINE AND MIND

6541
03:46:48,360 --> 03:46:50,240
BODY EDUCATIONAL INTERVENTION

6542
03:46:50,240 --> 03:46:52,920
AND HEALTH PROFESSIONS TRAINING.

6543
03:46:52,920 --> 03:46:56,480
THE SECOND SPEAKER WILL BE DR.

6544
03:46:56,480 --> 03:46:58,800
LISA MASINTER, BOARD CERTIFIED

6545
03:46:58,800 --> 03:47:00,280
GENERAL OBSTETRICIAN

6546
03:47:00,280 --> 03:47:01,760
GYNECOLOGIST WITH BACKGROUND IN

6547
03:47:01,760 --> 03:47:03,200
PUBLIC HEALTH AND HEALTH

6548
03:47:03,200 --> 03:47:03,920
SERVICES RESEARCH.

6549
03:47:03,920 --> 03:47:07,080
SHE IS SENIOR DIRECTOR OF

6550
03:47:07,080 --> 03:47:09,520
RESEARCH AT ALLIANCE CHICAGO SHE

6551
03:47:09,520 --> 03:47:11,880
OVERSEES TEAM OF TEN MANAGING A

6552
03:47:11,880 --> 03:47:14,320
PORTFOLIO OF APPROXIMATELY 40

6553
03:47:14,320 --> 03:47:15,320
ACTIVE PROJECTS.

6554
03:47:15,320 --> 03:47:17,280
SHE WAS PREVIOUS LEMEDCAL

6555
03:47:17,280 --> 03:47:19,200
DIRECTOR BUREAU OF MATERNAL

6556
03:47:19,200 --> 03:47:22,160
INFANT CHILD AND ADOLESCENT

6557
03:47:22,160 --> 03:47:24,800
HEALTH CHICAGO DEPARTMENT OF

6558
03:47:24,800 --> 03:47:25,720
HEALTH WHERE SHE SPEARHEADED

6559
03:47:25,720 --> 03:47:26,840
INCREASE IN DATA DRIVEN

6560
03:47:26,840 --> 03:47:27,360
PRACTICE.

6561
03:47:27,360 --> 03:47:29,560
T DR. MASINTER IS CONTENT EXPERT

6562
03:47:29,560 --> 03:47:31,600
WITH FUNDING AND PEER REVIEW

6563
03:47:31,600 --> 03:47:33,600
PUBLICATIONS IN REPRODUCTIVE AND

6564
03:47:33,600 --> 03:47:37,640
MATERNAL HEALTH EQUITY.

6565
03:47:37,640 --> 03:47:38,560
DR. RACHEL CHAMBERS IS

6566
03:47:38,560 --> 03:47:39,680
BEHAVIORAL SCIENTIST AND PUBLIC

6567
03:47:39,680 --> 03:47:42,200
HEALTH RESEARCHER WITH OVER TEN

6568
03:47:42,200 --> 03:47:43,840
YEARS EXPERIENCE WORKING TO

6569
03:47:43,840 --> 03:47:45,480
IMPROVE HEALTH OUTCOMES, ALONG

6570
03:47:45,480 --> 03:47:47,560
NATIVE AMERICAN FAMILIES.

6571
03:47:47,560 --> 03:47:49,800
SHE IS AN ASSISTANT SCIENTIST AT

6572
03:47:49,800 --> 03:47:51,200
JOHNS HOPKINS BLOOMBERG SCHOOL

6573
03:47:51,200 --> 03:47:53,400
OF PUBLIC HEALTH AND CURRENTLY

6574
03:47:53,400 --> 03:47:55,360
COMPLETING A FELLOWSHIP AT THE

6575
03:47:55,360 --> 03:47:58,040
CENTER FOR AIDS RESEARCH IN THE

6576
03:47:58,040 --> 03:47:58,800
IMPLEMENTATION SCIENCE.

6577
03:47:58,800 --> 03:48:03,760
DR. CHAMBERS UTILIZES COMMUNITY

6578
03:48:03,760 --> 03:48:05,000
BASED PARTSTORY RESEARCH TO

6579
03:48:05,000 --> 03:48:06,840
IDENTIFY IMPLEMENT AND EVALUATE

6580
03:48:06,840 --> 03:48:08,640
COMMUNITY DRIVEN SOLUTIONS THAT

6581
03:48:08,640 --> 03:48:10,560
ADDRESS PRESSING HEALTH

6582
03:48:10,560 --> 03:48:13,080
DISPARITIES IN INDIAN COUNTRY.

6583
03:48:13,080 --> 03:48:16,560
OUR LAST PRESENTATION WILL BE

6584
03:48:16,560 --> 03:48:19,520
FROM DR. LAUREN FIECHTNER BOARD

6585
03:48:19,520 --> 03:48:21,800
CERTIFIED PEDIATRICIAN,

6586
03:48:21,800 --> 03:48:23,160
PEDIATRIC GASTROENTEROLOGIST,

6587
03:48:23,160 --> 03:48:24,600
CLINICAL EPIDEMIOLOGIST AND

6588
03:48:24,600 --> 03:48:27,560
OBESITY AND FOOD INSECURITY

6589
03:48:27,560 --> 03:48:28,200
RESEARCHER.

6590
03:48:28,200 --> 03:48:30,360
SHE DIRECTOR NUTRITION AT

6591
03:48:30,360 --> 03:48:32,040
MASSACHUSETTS GENERAL HOSPITAL

6592
03:48:32,040 --> 03:48:33,120
FOR CHILDREN, ASSISTANT

6593
03:48:33,120 --> 03:48:35,200
PROFESSOR PEDIATRICS AT HARVARD

6594
03:48:35,200 --> 03:48:36,920
MEDICAL SCHOOL, AND SENIOR

6595
03:48:36,920 --> 03:48:39,160
HEALTH AND RESEARCH ADVISOR AT

6596
03:48:39,160 --> 03:48:40,840
GREATER BOSTON FOOD BANK.

6597
03:48:40,840 --> 03:48:42,400
NOW I WOULD LIKE TO TURN IT BACK

6598
03:48:42,400 --> 03:48:44,800
TO OUR FIRST PRESENTER, DR.

6599
03:48:44,800 --> 03:48:47,920
DARSHAN MEHTA.

6600
03:48:47,920 --> 03:48:49,280
>> THANK YOU, LAURIE.

6601
03:48:49,280 --> 03:48:55,880
SHARE MY SCREEN HERE.

6602
03:48:55,880 --> 03:48:58,400
THANK YOU AGAIN, AN HONOR

6603
03:48:58,400 --> 03:49:02,680
PRIVILEGE TO BE WITH YOU THIS

6604
03:49:02,680 --> 03:49:05,600
AFTERNOON.

6605
03:49:05,600 --> 03:49:07,040
I WILL TALK IN THE NEXT 20

6606
03:49:07,040 --> 03:49:09,200
MINUTES ABOUT TAKING A BIG BIRDS

6607
03:49:09,200 --> 03:49:11,480
EYE VIEW OF INTEGRATIVE HEALTH

6608
03:49:11,480 --> 03:49:12,720
IN THE MODERN HEALTHCARE SYSTEM

6609
03:49:12,720 --> 03:49:18,760
AS RELATES WE THINK ABOUT WOMEN

6610
03:49:18,760 --> 03:49:20,640
AN GIRLS AND OFFER PERSPECTIVES

6611
03:49:20,640 --> 03:49:24,680
AS WHICH I IN ADDITION, AS A

6612
03:49:24,680 --> 03:49:27,000
CLINICIAN, MEDICAL DIRECTOR AND

6613
03:49:27,000 --> 03:49:28,400
HOW SYSTEMS AND HOW SYSTEMS COME

6614
03:49:28,400 --> 03:49:29,600
TOGETHER ESPECIALLY THINKING

6615
03:49:29,600 --> 03:49:31,040
ABOUT INTEGRATIVE HEALTH AND

6616
03:49:31,040 --> 03:49:32,760
THEN ALSO AS EDUCATOR.

6617
03:49:32,760 --> 03:49:36,200
P P SO WHAT I HOPE TO ACHIEVE

6618
03:49:36,200 --> 03:49:37,640
MT. NEXT FEW MINUTES TOGETHER IS

6619
03:49:37,640 --> 03:49:38,800
TO UNDERSTAND HOW INTEGRATIVE

6620
03:49:38,800 --> 03:49:42,840
HEALTH IS INCORPORATED IN

6621
03:49:42,840 --> 03:49:44,720
PRIMARY CARE, WOMEN GIRL AND

6622
03:49:44,720 --> 03:49:46,240
REVIEW SUCCESS AND CHALLENGES IN

6623
03:49:46,240 --> 03:49:48,560
IMPLEMENTATION AND UNDERSTAND

6624
03:49:48,560 --> 03:49:52,080
THE NEED TO INCREASE

6625
03:49:52,080 --> 03:49:53,280
PARTICULARLY INPATIENT ANALYSIS

6626
03:49:53,280 --> 03:49:59,480
VIRTUAL SETTINGS AS WELL.

6627
03:49:59,480 --> 03:50:01,800
IF I WANT TO THINK ABOUT FROM A

6628
03:50:01,800 --> 03:50:05,000
BIG PICTURE PERSPECTIVE, THIS IS

6629
03:50:05,000 --> 03:50:07,400
A DR. HERBERT BENSON SOME OF YOU

6630
03:50:07,400 --> 03:50:09,080
MAY BE FAMILIAR WITH, HE TALKED

6631
03:50:09,080 --> 03:50:10,400
ABOUT THE THREE LEGGED STOOL AND

6632
03:50:10,400 --> 03:50:15,200
HE IS ONE MENTOR AT THE BENSON

6633
03:50:15,200 --> 03:50:15,800
HENRY INSTITUTE FOR MIND BODY

6634
03:50:15,800 --> 03:50:16,120
MEDICINE.

6635
03:50:16,120 --> 03:50:18,600
WHEN WE THINK ABOUT THE OVERALL

6636
03:50:18,600 --> 03:50:20,320
PARADIGM OF HEALTH WE WANT TO

6637
03:50:20,320 --> 03:50:22,880
OBVIOUSLY MAKE SURE WE HAVE THE

6638
03:50:22,880 --> 03:50:25,840
BEST PHARMACEUTICALS OR EVEN

6639
03:50:25,840 --> 03:50:28,200
NUTRI SUITCALS AS WE THINK ABOUT

6640
03:50:28,200 --> 03:50:31,640
IT, SURGERY AND PROCEDURES OR

6641
03:50:31,640 --> 03:50:35,600
ANY LOGICALLY BASED

6642
03:50:35,600 --> 03:50:37,040
INTERVENTIONS AND THEN THE THING

6643
03:50:37,040 --> 03:50:39,320
THAT IS LEFT OUT IS SELF CARE

6644
03:50:39,320 --> 03:50:41,200
PIECE PARTICULARLY, THAT SORT OF

6645
03:50:41,200 --> 03:50:43,480
BECAME THE FRAMEWORK FOR

6646
03:50:43,480 --> 03:50:46,920
THINKING MIND BODY MEDICINE.

6647
03:50:46,920 --> 03:50:48,800
I WILL TALK MORE DETAIL IN A

6648
03:50:48,800 --> 03:50:49,840
MOMENT.

6649
03:50:49,840 --> 03:50:52,280
ONE OF THE THINGS IS WE OFTEN

6650
03:50:52,280 --> 03:50:56,800
FOCUS ON THE PHARMACEUTICAL

6651
03:50:56,800 --> 03:50:59,640
SURGERY OR PROCEDURAL PIECES,

6652
03:50:59,640 --> 03:51:00,880
THERE MAYBE VARIOUS INCENTIVES

6653
03:51:00,880 --> 03:51:03,800
TO WHY THAT IS THE CASE BUT WE

6654
03:51:03,800 --> 03:51:06,800
LEAVE OUT SELF CARE PIECE AND

6655
03:51:06,800 --> 03:51:10,360
HOPE TO LEAVE YOU WITH THE

6656
03:51:10,360 --> 03:51:12,040
PEELING ONE THING INTEGRATED IF

6657
03:51:12,040 --> 03:51:13,400
WE THINK TRUE INTEGRATIVE HEALTH

6658
03:51:13,400 --> 03:51:16,400
IN MEDICINE, IT IS A BLEND OF

6659
03:51:16,400 --> 03:51:18,720
ALL THREE OF THESE, HOW WE

6660
03:51:18,720 --> 03:51:19,720
COTHAT IN A COMPLEX HEALTHCARE

6661
03:51:19,720 --> 03:51:22,560
ENVIRONMENT.

6662
03:51:22,560 --> 03:51:25,400
SO I WANT TO GIVE GIVE YOU A

6663
03:51:25,400 --> 03:51:27,160
SENSE WHERE I'M BASED AT THE

6664
03:51:27,160 --> 03:51:30,440
MIND BODY MEDICINE AT MG AGE AND

6665
03:51:30,440 --> 03:51:32,840
THIS IS A INDEPENDENT TEAM

6666
03:51:32,840 --> 03:51:34,520
CENTER MASSACHUSETTS GENERAL

6667
03:51:34,520 --> 03:51:35,640
HOSPITAL WHICH INVOLVES CLINICAL

6668
03:51:35,640 --> 03:51:37,320
PRACTICE RESEARCH AND EDUCATION,

6669
03:51:37,320 --> 03:51:39,000
THAT BUILDING THAT YOU SEE IN

6670
03:51:39,000 --> 03:51:41,000
THE PICTURE WHERE WE ARE

6671
03:51:41,000 --> 03:51:42,480
LOCATED, IRONICALLY ONE OF THE

6672
03:51:42,480 --> 03:51:44,920
MOST STRESSFUL LOCATIONS IN

6673
03:51:44,920 --> 03:51:47,200
BOSTON BUT WE STUDY THE WAYS TO

6674
03:51:47,200 --> 03:51:50,880
COMBAT STRESS ENHANCE RESILIENCY

6675
03:51:50,880 --> 03:51:52,160
RESILIENCY, OUR WORK FOCUSED ON

6676
03:51:52,160 --> 03:51:53,880
LOOKING AT RESILIENCE FROM

6677
03:51:53,880 --> 03:51:55,680
MULTIPLE DOMAIN, ONE IS

6678
03:51:55,680 --> 03:51:57,680
OBVIOUSLY THINKING THE MECHANISM

6679
03:51:57,680 --> 03:52:00,280
LOOK AT EPIGENETIC AND

6680
03:52:00,280 --> 03:52:02,400
NEUROSCIENTIFIC MECHANISMS OF

6681
03:52:02,400 --> 03:52:03,880
RESILIENCY AND WELL BEING.

6682
03:52:03,880 --> 03:52:08,400
WE ARE LOOKING AT HEALTH OUTCOME

6683
03:52:08,400 --> 03:52:09,600
AS WELL.

6684
03:52:09,600 --> 03:52:13,040
HOW WE ACTUALLY TRAIN PROVIDERS

6685
03:52:13,040 --> 03:52:15,880
TO DELIVER THIS WORK AND

6686
03:52:15,880 --> 03:52:17,120
BEGINNING LOOK CRITICALLY WHAT

6687
03:52:17,120 --> 03:52:18,680
DOES IT TAKE TO TRAIN SOMEONE IN

6688
03:52:18,680 --> 03:52:19,840
THIS WORK AND SO THEY CAN

6689
03:52:19,840 --> 03:52:21,960
DELIVER IT IN THE WAYS WE THINK

6690
03:52:21,960 --> 03:52:24,200
ARE MEANINGFUL EFFECTIVE FOR

6691
03:52:24,200 --> 03:52:25,640
EFFECTIVE HEALTH OUTCOMES SO WE

6692
03:52:25,640 --> 03:52:27,400
FOCUS ON MIND BODY PRACTICE MANY

6693
03:52:27,400 --> 03:52:31,400
THE HEALTHCARE SYSTEM INCLUDING

6694
03:52:31,400 --> 03:52:38,200
MED AGENT THE OTHER PLACE

6695
03:52:38,200 --> 03:52:40,800
MENTIONED WAS OSHA SENT FOR

6696
03:52:40,800 --> 03:52:43,800
INTEGRATIVE MEDICINE HARVARD

6697
03:52:43,800 --> 03:52:46,000
MEDICAL SCHOOL HARVARD, SO THE

6698
03:52:46,000 --> 03:52:47,960
INSTITUTE IS FOCUSED ON THE SELF

6699
03:52:47,960 --> 03:52:50,720
CARE APPROACHES, LIKE MEDITATION

6700
03:52:50,720 --> 03:52:55,080
AND SUCH THE OSHA CENTER IS

6701
03:52:55,080 --> 03:52:57,200
UNIQUE SITE AND IT IS LOOKING

6702
03:52:57,200 --> 03:52:59,520
PROVIDER BASED APPROACHES OFTEN

6703
03:52:59,520 --> 03:53:02,280
TIMES SO THIS IS A CENTER THAT

6704
03:53:02,280 --> 03:53:04,800
FOCUS ON RESEARCH AND CLINICAL

6705
03:53:04,800 --> 03:53:06,160
ACTIVITY AROUND HOLISTIC PATIENT

6706
03:53:06,160 --> 03:53:08,680
CARE BY COMBINING THE BEST

6707
03:53:08,680 --> 03:53:11,080
TREATMENT AVAILABLE TO

6708
03:53:11,080 --> 03:53:12,320
UNDERSTAND INNOVATIVE RESEARCH

6709
03:53:12,320 --> 03:53:14,280
BETTER UNDERSTANDING PHYSICAL

6710
03:53:14,280 --> 03:53:16,280
PSYCHOLOGICAL BENEFITS O VARIOUS

6711
03:53:16,280 --> 03:53:17,680
THERAPIES, APPROACHES LIKE

6712
03:53:17,680 --> 03:53:19,680
CHIROPRACTIC CARE, MASSAGE

6713
03:53:19,680 --> 03:53:21,760
THERAPY, AMONG OTHERS

6714
03:53:21,760 --> 03:53:23,080
ACUPUNCTURE EDUCATING THE EX IN

6715
03:53:23,080 --> 03:53:24,400
GENERATION OF INTEGRATIVE

6716
03:53:24,400 --> 03:53:27,040
MEDICINE PRACTICERS AND LOOKING

6717
03:53:27,040 --> 03:53:28,800
AT CHRONIC PAIN CONDITIONS AND

6718
03:53:28,800 --> 03:53:30,240
AS WELL AS STRESS RELATED

6719
03:53:30,240 --> 03:53:33,520
CONDITIONS.

6720
03:53:33,520 --> 03:53:37,400
SO MY FOR RAY INTO THIS WORK, I

6721
03:53:37,400 --> 03:53:38,720
THINK FOR OFTEN TIME MANY OF US,

6722
03:53:38,720 --> 03:53:41,560
WE ARE INFORMED BY PATIENT I

6723
03:53:41,560 --> 03:53:43,800
DISTINCTLY REMEMBER IN

6724
03:53:43,800 --> 03:53:46,000
RESIDENCY, DURING MY RESIDENCY

6725
03:53:46,000 --> 03:53:47,400
IN INTERNAL MEDICINE IN

6726
03:53:47,400 --> 03:53:48,760
UNIVERSITY OF ILLINOIS PATIENT

6727
03:53:48,760 --> 03:53:52,280
CAME TO ME, THIS 44-YEAR-OLD

6728
03:53:52,280 --> 03:53:54,680
WOMAN, WITH PAST MEDICAL HISTORY

6729
03:53:54,680 --> 03:53:56,400
SIGNIFICANT FOR ROUTINE PHYSICAL

6730
03:53:56,400 --> 03:53:57,680
EXAM CAME WITH COMPLAINTS OF

6731
03:53:57,680 --> 03:53:59,680
MILDLY PAIN ASSOCIATED WEIGHT

6732
03:53:59,680 --> 03:54:03,920
GAIN, FAMILY HISTORY WAS NOT

6733
03:54:03,920 --> 03:54:05,840
CONTRIBUTORY, SOCIAL HISTORY

6734
03:54:05,840 --> 03:54:08,720
TOBACCO ALCOHOL ELICIT DRUG USE,

6735
03:54:08,720 --> 03:54:11,160
AND EAT A LOT OF FAST FOOD.

6736
03:54:11,160 --> 03:54:13,280
I'M PHYSICAL EXAM BODY MASS

6737
03:54:13,280 --> 03:54:16,320
INDEX WAS 31, BLOOD PRESSURE 135

6738
03:54:16,320 --> 03:54:18,560
OVER 90 NO REMARKABLE FINDINGS,

6739
03:54:18,560 --> 03:54:23,760
LABORATORY TESTING WAS PRIMARILY

6740
03:54:23,760 --> 03:54:25,760
UNREMARKABLE EXCEPT KNEE

6741
03:54:25,760 --> 03:54:27,000
RADIOGRAPH DEGENERATIVE CHANGE.

6742
03:54:27,000 --> 03:54:30,240
AT THAT TIME WE WERE BASICALLY

6743
03:54:30,240 --> 03:54:32,320
OKAY DO SOME DIET EXERCISE

6744
03:54:32,320 --> 03:54:33,440
COUNSELING, BLOOD PRESSURE AT

6745
03:54:33,440 --> 03:54:36,200
THE BORDER LINE LEVEL MAYBE

6746
03:54:36,200 --> 03:54:37,840
THINK ABOUT DO YOU WANT TO START

6747
03:54:37,840 --> 03:54:39,080
MEDICATION OR NOT.

6748
03:54:39,080 --> 03:54:41,040
BUT DIET AND EXERCISE WAS QUITE

6749
03:54:41,040 --> 03:54:43,400
LIMITED IN HOW WE WERE EDUCATED.

6750
03:54:43,400 --> 03:54:44,640
WHICH IS DIET COUNSELING

6751
03:54:44,640 --> 03:54:46,320
BASICALLY WE TOLD PATIENTS EAT

6752
03:54:46,320 --> 03:54:49,160
LESS AND EXERCISE COUNSELING WAS

6753
03:54:49,160 --> 03:54:49,760
DO MORE.

6754
03:54:49,760 --> 03:54:51,880
WHEN SHE SAID WELL, SHE WANTED

6755
03:54:51,880 --> 03:54:54,800
TO ASK THE FOLLOWING, WHAT DO

6756
03:54:54,800 --> 03:54:56,200
YOU THINK, THIS IS -- I HAVE NO

6757
03:54:56,200 --> 03:54:58,840
FINANCE, TIES TO THESE PRODUCTS

6758
03:54:58,840 --> 03:55:02,280
BUT I LITERALLY WHAT SHE BROUGHT

6759
03:55:02,280 --> 03:55:07,560
IN WAS SAMI OR ME THIONEINE.

6760
03:55:07,560 --> 03:55:09,200
HELP SUPPORT HEALTHY MOOD AND

6761
03:55:09,200 --> 03:55:10,880
JOINT COMFORT.

6762
03:55:10,880 --> 03:55:13,080
THE OTHER WAS THE -- MIDDLE OF

6763
03:55:13,080 --> 03:55:16,200
MY RESIDENCY TRAINING IN 2003,

6764
03:55:16,200 --> 03:55:18,080
HIGHER MIND CAN -- HOW YOUR MIND

6765
03:55:18,080 --> 03:55:20,320
CAN HEAL YOUR BODY, NEW WAYS TO

6766
03:55:20,320 --> 03:55:21,240
BEAT THE BLEW BLUES.

6767
03:55:21,240 --> 03:55:22,560
THIS IS SPECIAL ISSUE IN TIME

6768
03:55:22,560 --> 03:55:24,840
MAGAZINE.

6769
03:55:24,840 --> 03:55:27,800
ONE THING YOU SEE OFF THE BAT IS

6770
03:55:27,800 --> 03:55:29,560
CHALLENGES ASSOCIATED IN

6771
03:55:29,560 --> 03:55:30,440
HEALTHCARE SYSTEM HOW DO YOU

6772
03:55:30,440 --> 03:55:30,920
ADDRESS THIS.

6773
03:55:30,920 --> 03:55:32,360
IF YOU LOOK AT ANY BOX OF

6774
03:55:32,360 --> 03:55:34,040
DIETARY SUPPLEMENTS THAT SAYS IF

6775
03:55:34,040 --> 03:55:40,320
YOU HAVE ANY QUESTION, TREAT

6776
03:55:40,320 --> 03:55:42,240
CONDITION OR MEDICAL CONDITION,

6777
03:55:42,240 --> 03:55:46,440
AND ASK YOUR HEALTHCARE PROVIDER

6778
03:55:46,440 --> 03:55:49,120
BEFORE USING WHICH IS A VERY

6779
03:55:49,120 --> 03:55:50,040
DIFFICULT ONUS PUT ON MANY

6780
03:55:50,040 --> 03:55:51,200
HEALTHCARE PROVIDERS

6781
03:55:51,200 --> 03:55:52,720
PARTICULARLY PHYSICIANS, BECAUSE

6782
03:55:52,720 --> 03:55:54,000
THEY HAVE NO IDEA HOW TO ANSWER

6783
03:55:54,000 --> 03:55:56,960
SOME OF THESE QUESTION.

6784
03:55:56,960 --> 03:55:58,520
WE ARE NOT TRAINED IN HOW TO

6785
03:55:58,520 --> 03:56:00,560
ANSWER THESE QUESTIONS, OUR BUT

6786
03:56:00,560 --> 03:56:02,920
YET THESE ARE READILY AVAILABLE

6787
03:56:02,920 --> 03:56:05,000
PRODUCT, AND NOT TO SAY THEY ARE

6788
03:56:05,000 --> 03:56:06,200
BAD PRODUCTS NECESSARILY BUT

6789
03:56:06,200 --> 03:56:08,520
EVEN IF YOU UNTHINK OF WHAT IS

6790
03:56:08,520 --> 03:56:10,000
THE BENEFIT ASSOCIATED IS VERY

6791
03:56:10,000 --> 03:56:11,360
CHALLENGING.

6792
03:56:11,360 --> 03:56:12,720
WHAT TRAINING IS NEEDED BECOMES

6793
03:56:12,720 --> 03:56:15,640
A VERY INTERESTING ISSUE IN A

6794
03:56:15,640 --> 03:56:18,400
COMPLEX HOW DO YOU FEEL

6795
03:56:18,400 --> 03:56:19,480
PROFICIENT TO COUNCIL PATIENT

6796
03:56:19,480 --> 03:56:21,200
AROUND THIS AND WHAT SKILLS ARE

6797
03:56:21,200 --> 03:56:22,880
NEEDED, AND THE SECOND QUESTION

6798
03:56:22,880 --> 03:56:26,920
IS WHO IS ENGAGING IN THIS

6799
03:56:26,920 --> 03:56:27,400
THING?

6800
03:56:27,400 --> 03:56:28,840
ONE THING THAT OCCURRED THE PAST

6801
03:56:28,840 --> 03:56:32,200
COUPLE OF YEARS AS WE BEGIN TO

6802
03:56:32,200 --> 03:56:35,080
LOOK AT HOW WHO HAS ACCESS TO

6803
03:56:35,080 --> 03:56:38,400
THIS YOU CAN SEE IMAGES HERE OF

6804
03:56:38,400 --> 03:56:40,600
THIS PARTICULAR INDIVIDUAL IN

6805
03:56:40,600 --> 03:56:43,120
THE TINY PICTURE WHAT IS

6806
03:56:43,120 --> 03:56:44,680
PERPETUATED THE PROTOTYPICAL

6807
03:56:44,680 --> 03:56:46,800
INDIVIDUAL THAT ACTS ANDEAN YOU

6808
03:56:46,800 --> 03:56:49,520
CAN SEE THAT WE RARELY SEE

6809
03:56:49,520 --> 03:56:51,200
INDIVIDUALS PEOPLE FROM PERSONS

6810
03:56:51,200 --> 03:56:54,080
OF COLOR ENGAGING IN THIS TYPE

6811
03:56:54,080 --> 03:56:58,560
OF HAVING FRONT PAGE SORT OF

6812
03:56:58,560 --> 03:57:01,800
DEPICTION ON POPULAR USE PIECE

6813
03:57:01,800 --> 03:57:03,920
MAGAZINE, IT IS I THINK

6814
03:57:03,920 --> 03:57:04,800
PERPETUATES AGAIN THIS IS

6815
03:57:04,800 --> 03:57:06,440
PERHAPS AS LONGER TALK FOR

6816
03:57:06,440 --> 03:57:07,560
ANOTHER TIME BUT JUST SOMETHING

6817
03:57:07,560 --> 03:57:10,560
TO THINK ABOUT, BEDO NEED TO BE

6818
03:57:10,560 --> 03:57:12,920
AWARE OF WHAT UNCONSCIOUS BIASES

6819
03:57:12,920 --> 03:57:14,880
ARE CREATING AND BODY TYPE IS

6820
03:57:14,880 --> 03:57:17,560
ALLOWED TO ENGAGE IN THESE TYPES

6821
03:57:17,560 --> 03:57:19,200
OF PRACTICES.

6822
03:57:19,200 --> 03:57:21,320
WE EXCLUDING PEOPLE.

6823
03:57:21,320 --> 03:57:23,560
PREVALENCE IS THAT WE KNOW ABOUT

6824
03:57:23,560 --> 03:57:26,200
A THIRD HAVE U.S. ADULTS USE

6825
03:57:26,200 --> 03:57:28,560
COMPLIMENTARY HEALTH APPROACH OF

6826
03:57:28,560 --> 03:57:30,880
8TH OF CHILDREN USED IT IN THE

6827
03:57:30,880 --> 03:57:32,280
PAST YEAR, THOSE NUMBERS HAVE

6828
03:57:32,280 --> 03:57:32,600
BEEN STABLE.

6829
03:57:32,600 --> 03:57:37,800
THE CORRELATES OF USE ARE

6830
03:57:37,800 --> 03:57:38,880
INDIVIDUALS WHERE WHITE WOMEN

6831
03:57:38,880 --> 03:57:40,360
USE SIGNIFICANTLY MORE THAN MEN

6832
03:57:40,360 --> 03:57:42,120
IN HIGHER SOCIOECONOMIC STATUS

6833
03:57:42,120 --> 03:57:44,920
HIGHER EDUCATION LEVELS AND

6834
03:57:44,920 --> 03:57:45,800
INCOME LEVELS.

6835
03:57:45,800 --> 03:57:49,320
SO WHAT IS THE -- NOW TO GET

6836
03:57:49,320 --> 03:57:50,400
INTO VOCABULARY BECAUSE

6837
03:57:50,400 --> 03:57:52,520
SOMETIMES WE HEAR WORDS AND --

6838
03:57:52,520 --> 03:57:56,480
ACCORDING AGAIN THIS IS NCCIH

6839
03:57:56,480 --> 03:57:57,480
DEFINITION, MAINSTREAM PRACTICE

6840
03:57:57,480 --> 03:57:59,240
IS USED WITH CONVENTIONAL

6841
03:57:59,240 --> 03:58:00,400
MEDICINE IT IS CONSIDERED

6842
03:58:00,400 --> 03:58:01,040
COMPLIMENTARY.

6843
03:58:01,040 --> 03:58:04,080
IF A NON-MAINSTREAM PRACTICE

6844
03:58:04,080 --> 03:58:06,320
USED IN PLACE OF CONVENTION IT

6845
03:58:06,320 --> 03:58:07,480
IS ALTERNATIVE.

6846
03:58:07,480 --> 03:58:09,560
INTEGRATED HEALTH EMPHASIZE THE

6847
03:58:09,560 --> 03:58:11,680
HOLISTIC PATIENT FOCUS

6848
03:58:11,680 --> 03:58:12,600
APPROACHES TO HEALTHCARE AND

6849
03:58:12,600 --> 03:58:15,240
WELLNESS OFTEN INCLUDING MENTAL

6850
03:58:15,240 --> 03:58:17,040
EMOTIONAL FUNCTIONAL SPIRITUAL

6851
03:58:17,040 --> 03:58:18,000
SOCIAL COMMUNITY ASPECT.

6852
03:58:18,000 --> 03:58:20,160
TREATING THE WHOLE PERSON IT

6853
03:58:20,160 --> 03:58:22,160
AIMS FOR WELL COORDINATED CARE

6854
03:58:22,160 --> 03:58:23,000
BETWEEN PROVIDERS AND

6855
03:58:23,000 --> 03:58:24,800
INSTITUTIONS.

6856
03:58:24,800 --> 03:58:27,960
IT IS COMBINING THE BEST

6857
03:58:27,960 --> 03:58:29,920
EVIDENCE BASED INTEGRATIVE

6858
03:58:29,920 --> 03:58:32,240
THERAPIES, EMPHASIZES PATIENT

6859
03:58:32,240 --> 03:58:33,640
PARTICIPATION INCLUDING EXERCISE

6860
03:58:33,640 --> 03:58:35,000
DIET STRESS MANAGEMENT AND

6861
03:58:35,000 --> 03:58:36,120
MAXIMIZING HEALTH, THERE IS

6862
03:58:36,120 --> 03:58:37,680
IMPORTANCE OF PATIENT PROVIDER

6863
03:58:37,680 --> 03:58:38,600
RELATIONSHIP AND IMPORTANCE OF

6864
03:58:38,600 --> 03:58:42,240
SHARED DECISION MAKING, THERE IS

6865
03:58:42,240 --> 03:58:43,800
EMPHASIS CONTRIBUTION OF

6866
03:58:43,800 --> 03:58:44,920
THERAPEUTICKENT COUNTER AND

6867
03:58:44,920 --> 03:58:47,880
SEEKS TO OPTIMIZE INDIVIDUAL

6868
03:58:47,880 --> 03:58:52,280
INNATE HEELING CAPACITY.

6869
03:58:52,280 --> 03:58:54,200
IF YOU THINK DOMAINS OF

6870
03:58:54,200 --> 03:58:55,200
INTEGRATED MEDICINE THERE ARE

6871
03:58:55,200 --> 03:58:56,920
WAYS IT IS SEPARATED, THERE IS

6872
03:58:56,920 --> 03:58:59,720
ALWAYS DEBATE BUT JUST TO GIVE

6873
03:58:59,720 --> 03:59:02,640
YOU A BROAD SORT OF DEPICTION

6874
03:59:02,640 --> 03:59:04,400
BIOLOGICALLY BASED PRACTICE

6875
03:59:04,400 --> 03:59:06,400
INCLUDE HERBAL DIETARY

6876
03:59:06,400 --> 03:59:08,920
SUPPLEMENTS DIET AS WELL, ENERGY

6877
03:59:08,920 --> 03:59:11,000
THERAPIES HEALING AND

6878
03:59:11,000 --> 03:59:13,760
THERAPEUTIC TOUCH AND MIND BODY

6879
03:59:13,760 --> 03:59:15,280
MEDICINE, MEDITATION YOGA AND

6880
03:59:15,280 --> 03:59:19,800
TAI CHI MANIPULATION BODY SIZE

6881
03:59:19,800 --> 03:59:21,440
PRACTICES AND WHOLE SYSTEMS LIKE

6882
03:59:21,440 --> 03:59:23,400
TRADITIONAL CHINESE MEDICINE

6883
03:59:23,400 --> 03:59:24,600
NATUREOPATHY THAT HAVE

6884
03:59:24,600 --> 03:59:27,120
COMPONENTS THAT SPAN ACROSS

6885
03:59:27,120 --> 03:59:32,400
THESE DOMAINS.

6886
03:59:32,400 --> 03:59:34,200
ONE THING TO RECOGNIZE IS IN

6887
03:59:34,200 --> 03:59:37,080
THIS FIELD THERE ARE HUDDLES --

6888
03:59:37,080 --> 03:59:39,480
HURDLES INCLUDING CLINICAL

6889
03:59:39,480 --> 03:59:41,200
EFFICACY AND SPECIFIC CONDITIONS

6890
03:59:41,200 --> 03:59:43,480
DETERMINING SPECIAL -- SPECIFIC

6891
03:59:43,480 --> 03:59:44,520
BIOLOGICAL MECHANISM COST

6892
03:59:44,520 --> 03:59:46,200
EFFECTIVENESS OVERCOMING BIAS AN

6893
03:59:46,200 --> 03:59:48,280
CONVINCING SKEPTICS CREATING

6894
03:59:48,280 --> 03:59:50,240
CULTURE CHANGE IN MEDICINE

6895
03:59:50,240 --> 03:59:52,200
BROADENING ACCESSIBILITY AND

6896
03:59:52,200 --> 03:59:54,120
SUSCEPTIBILITY AND USING

6897
03:59:54,120 --> 03:59:57,000
EVIDENCE TO CONVINCE PAYERS AND

6898
03:59:57,000 --> 03:59:57,560
GOVERNMENTS,.

6899
03:59:57,560 --> 03:59:58,720
ACCEPTABILITY AND ACCESSIBILITY

6900
03:59:58,720 --> 04:00:01,640
IN THE COMMUNITY MARGINALIZED

6901
04:00:01,640 --> 04:00:02,360
VULNERABLABLE POPULATIONS ARE

6902
04:00:02,360 --> 04:00:06,000
NOT ABLE TO ACCESS INTEGRATE

6903
04:00:06,000 --> 04:00:06,800
I'VE HEALTH SERVICES LIKE

6904
04:00:06,800 --> 04:00:08,440
COMPARED TO THOSE THAT CAN'T

6905
04:00:08,440 --> 04:00:09,560
AFFORD IT.

6906
04:00:09,560 --> 04:00:12,200
SO WHERE DO WE BEGIN.

6907
04:00:12,200 --> 04:00:13,800
I THINK THE OPPORTUNITIES HERE'S

6908
04:00:13,800 --> 04:00:14,880
SPECIALLY FOR WOMEN AND GIRLS IS

6909
04:00:14,880 --> 04:00:17,480
THINKING HOW TO BEGIN EARLY.

6910
04:00:17,480 --> 04:00:19,480
IN -- WE OFTEN THINK OF THIS AS

6911
04:00:19,480 --> 04:00:22,800
A TREATMENT O OPTION BUT

6912
04:00:22,800 --> 04:00:25,800
OPPORTUNITIES IN THE EDUCATIONAL

6913
04:00:25,800 --> 04:00:27,400
SYSTEM CAN WE BEGIN EARLY THERE

6914
04:00:27,400 --> 04:00:30,200
IS SKILLS BASED CURRICULUM, THIS

6915
04:00:30,200 --> 04:00:32,320
PRIMORDIAL PREVENTION BEFORE IT

6916
04:00:32,320 --> 04:00:34,960
IS EVEN -- REALLY CREATING A

6917
04:00:34,960 --> 04:00:37,000
REALLY A SKILLS THAT CAN ALLOW

6918
04:00:37,000 --> 04:00:41,600
PEOPLE TO -- ALLOW CHILDREN TO

6919
04:00:41,600 --> 04:00:46,240
BE FULLEST SORT OF POSSIBILITIES

6920
04:00:46,240 --> 04:00:47,920
TO FULLEST EXTENT THEY CAN.

6921
04:00:47,920 --> 04:00:49,040
CHALLENGE IS WHO DOES TEACHING

6922
04:00:49,040 --> 04:00:51,720
WHO IS GOING TO FUND IT.

6923
04:00:51,720 --> 04:00:52,800
PREVIOUSLY WHAT ACTUALLY IS

6924
04:00:52,800 --> 04:00:55,000
BEING PERPETUATED, IF YOU USE

6925
04:00:55,000 --> 04:00:57,680
DIVERSITY EQUITY INCLUSIVE LENS

6926
04:00:57,680 --> 04:00:59,680
WHAT ARE WE PERPETUATING WHEN WE

6927
04:00:59,680 --> 04:01:01,200
SEND UM IMAGINES AROUND

6928
04:01:01,200 --> 04:01:03,480
INTEGRATIVE HEALTH.

6929
04:01:03,480 --> 04:01:06,280
WE KNOW FOR EXAMPLE, HERE IS A

6930
04:01:06,280 --> 04:01:08,360
BEAUTIFUL DRAMATIC REVIEW MEHTA

6931
04:01:08,360 --> 04:01:11,200
ANALYSIS HA SHOWED THAT

6932
04:01:11,200 --> 04:01:12,840
CURRICULUM BASED INTERVENTIONS

6933
04:01:12,840 --> 04:01:15,480
INCLUDING YOGA MINDFULNESS

6934
04:01:15,480 --> 04:01:16,400
SOCIAL PERSONAL SKILLS

6935
04:01:16,400 --> 04:01:19,160
INTERVENTION, BASIC ENTERSIZE

6936
04:01:19,160 --> 04:01:21,200
INTERVENTION ON AVERAGE REALLY

6937
04:01:21,200 --> 04:01:23,560
PROMOTE UNIVERSAL

6938
04:01:23,560 --> 04:01:27,640
SELF-REGULATION IN CHILDREN AND

6939
04:01:27,640 --> 04:01:29,200
ADOLESCENTS, BUT AGAIN ONE OF

6940
04:01:29,200 --> 04:01:32,320
THE THINGS WE SEE IS THAT ON ONE

6941
04:01:32,320 --> 04:01:34,960
HAND WE HAVE THIS ABILITY TO

6942
04:01:34,960 --> 04:01:36,560
PROMOTE REGULATION AT THE SAME

6943
04:01:36,560 --> 04:01:40,120
TIME CONTENDING WITH IMAGES THAT

6944
04:01:40,120 --> 04:01:44,760
ARE OFTEN PARTICULAR BODY TYPE

6945
04:01:44,760 --> 04:01:48,800
PARTICULAR RACE AND PARTICULAR

6946
04:01:48,800 --> 04:01:49,240
IMAGE.

6947
04:01:49,240 --> 04:01:51,680
KNOW WHEN WE INCOOPERATE

6948
04:01:51,680 --> 04:01:52,600
INTEGRATIVE HEALTH SERVICES MIND

6949
04:01:52,600 --> 04:01:54,600
BODY APPROACHES THEY ACTUALLY

6950
04:01:54,600 --> 04:01:56,760
HAVE HEALTH EFFECTS THAT ARE

6951
04:01:56,760 --> 04:01:58,760
QUITE SIGNIFICANT THAT INCLUDES

6952
04:01:58,760 --> 04:01:59,960
MORTALITY BENEFITS THREE MONTH

6953
04:01:59,960 --> 04:02:03,560
THIS IS AN EXAMPLE CARDIAC

6954
04:02:03,560 --> 04:02:04,240
REHABILITATION, INCORPORATED

6955
04:02:04,240 --> 04:02:06,800
MIND BODY COMPONENTS ACTUALLY

6956
04:02:06,800 --> 04:02:09,120
DECREASE MORTALITY THREE YEARS

6957
04:02:09,120 --> 04:02:10,120
VERSUS THOSE WENT TO CARDIAC

6958
04:02:10,120 --> 04:02:11,880
REHAB BUT DIDN'T HAVE THAT

6959
04:02:11,880 --> 04:02:13,320
COMPONENT.

6960
04:02:13,320 --> 04:02:14,880
IRONICALLY THESE TURN INTENSIVE

6961
04:02:14,880 --> 04:02:17,680
CARDIAC REHAB PROGRAMS APPROVED

6962
04:02:17,680 --> 04:02:19,080
BY MEDICARE SEPARATE BILLING

6963
04:02:19,080 --> 04:02:22,440
CODE ASSOCIATED WITH THAT.

6964
04:02:22,440 --> 04:02:24,360
UTILIZATION WE KNOW THAT WHEN

6965
04:02:24,360 --> 04:02:27,360
INDIVIDUALS ENGAGE IN MIND BODY

6966
04:02:27,360 --> 04:02:28,880
PRACTICES PARTICULARLY THEY

6967
04:02:28,880 --> 04:02:31,000
ACTUALLY USE THE HEALTH SYSTEM

6968
04:02:31,000 --> 04:02:33,560
LESS AND THEY ARE POTENTIAL COST

6969
04:02:33,560 --> 04:02:35,120
SAVINGS, THIS IS RETROSPECTIVE

6970
04:02:35,120 --> 04:02:36,320
STUDY, THESE TYPES OF STUDIES

6971
04:02:36,320 --> 04:02:38,560
ARE THE ONES THAT NEED TO BE

6972
04:02:38,560 --> 04:02:40,080
THOUGHT THROUGH MORE CRITICALLY,

6973
04:02:40,080 --> 04:02:42,400
AND ESPECIALLY THINKING

6974
04:02:42,400 --> 04:02:44,400
INTEGRATED HEALTH SYSTEM FOR

6975
04:02:44,400 --> 04:02:45,720
WHAT THAT MEANS ESPECIALLY FOR

6976
04:02:45,720 --> 04:02:47,280
WOMEN AND GIRLS THINKING ABOUT

6977
04:02:47,280 --> 04:02:49,080
WHAT IS UTILIZATION PATTERNS AND

6978
04:02:49,080 --> 04:02:51,080
HOW DO THESE THINGS AFFECT

6979
04:02:51,080 --> 04:02:52,200
HEALTHCARE UTILIZATION PATTERNS.

6980
04:02:52,200 --> 04:02:53,560
WHEN WE THINK ABOUT PROVIDER

6981
04:02:53,560 --> 04:02:56,960
BASED APPROACHES, LIKE

6982
04:02:56,960 --> 04:02:59,400
ACUPUNCTURE WE KNOW ALREADY

6983
04:02:59,400 --> 04:03:03,880
STUDIES OUT THERE, THAT SUPPORT

6984
04:03:03,880 --> 04:03:06,400
USE CONSIDERATION IN THE

6985
04:03:06,400 --> 04:03:09,040
MANAGEMENT AND TREATMENT OF

6986
04:03:09,040 --> 04:03:12,560
CONDITIONS, BOTHERSOME MENOPAUSE

6987
04:03:12,560 --> 04:03:15,480
SYSTEM, THESE A STUDY THAT FOUND

6988
04:03:15,480 --> 04:03:17,560
INDIVIDUALS HAD IMPROVEMENT IN

6989
04:03:17,560 --> 04:03:18,680
SYMPTOMS IN AS LITTLE AS SICK

6990
04:03:18,680 --> 04:03:22,120
WEEKS.

6991
04:03:22,120 --> 04:03:26,560
SO I THINK WE ESPECIALLY AS A

6992
04:03:26,560 --> 04:03:28,560
CLINICIAN LEADER ADMINISTRATOR,

6993
04:03:28,560 --> 04:03:30,000
HOW DO WE ACTUALIZE THESE

6994
04:03:30,000 --> 04:03:32,280
PRACTICES INTO CLINICAL CARE,

6995
04:03:32,280 --> 04:03:35,520
THE RESEARCH OFTEN TIMES MANY

6996
04:03:35,520 --> 04:03:37,280
TIMES SUGGESTIVE AND SOMETIMES

6997
04:03:37,280 --> 04:03:42,600
QUITE COMPELLING, BUT HOW DO WE

6998
04:03:42,600 --> 04:03:45,400
ACTUALLY -- WHAT IS SYSTEMS

6999
04:03:45,400 --> 04:03:47,280
PERSPECTIVE AND CHIROPRACTIC

7000
04:03:47,280 --> 04:03:50,120
MIGRAINE WORKING WITH NEUROLOGY

7001
04:03:50,120 --> 04:03:52,640
COLLEAGUES HOW BEST TO RECRUIT

7002
04:03:52,640 --> 04:03:55,280
PATIENTS INTO THESE TYPES OF

7003
04:03:55,280 --> 04:03:56,720
CARE OPTIONS UNDERSTANDING

7004
04:03:56,720 --> 04:03:59,720
ACTIVE INGREDIENT, AND OBVIOUSLY

7005
04:03:59,720 --> 04:04:03,080
THERE IS A BIAS THAT HAS TO BE

7006
04:04:03,080 --> 04:04:05,800
FACED, THE QUESTION IS AS A

7007
04:04:05,800 --> 04:04:07,800
CLINICIAN WHO TO REFER TO WHEN

7008
04:04:07,800 --> 04:04:10,560
AND HOW IS NOT PROVIDERS OF THE

7009
04:04:10,560 --> 04:04:13,640
SAME BUT IT DOES ALLOW POSSIBLY

7010
04:04:13,640 --> 04:04:15,200
NEW OPPORTUNITY AS

7011
04:04:15,200 --> 04:04:17,320
NON-PHARMACOLOGIC INTERVENTION.

7012
04:04:17,320 --> 04:04:21,160
THE OTHER THINGS THAT THAT CAN

7013
04:04:21,160 --> 04:04:23,360
BE COST EFFECTIVE CHALLENGES ARE

7014
04:04:23,360 --> 04:04:25,400
NOT OFTEN COVERED BY THIRD PARTY

7015
04:04:25,400 --> 04:04:27,160
PAYERS THOUGH CHIROPRACTIC CARE

7016
04:04:27,160 --> 04:04:30,720
IS, ACUPUNCTURE IS BEGINNING TO

7017
04:04:30,720 --> 04:04:33,520
AND MASSAGE THERAPY IS NOT, IT

7018
04:04:33,520 --> 04:04:35,320
IS HETEROGENEITY OF TREATMENT,

7019
04:04:35,320 --> 04:04:37,120
AROUND IMPORTANTLY HOW WE

7020
04:04:37,120 --> 04:04:38,560
COMMUNICATE WITH ALLO PATHIC

7021
04:04:38,560 --> 04:04:39,160
CONVENTIONAL HEALTHCARE

7022
04:04:39,160 --> 04:04:40,400
PROVIDERS?

7023
04:04:40,400 --> 04:04:46,680
AGAIN AS I MENTION, LICENSURE,

7024
04:04:46,680 --> 04:04:48,240
ONE THING JUST TO THINK ABOUT

7025
04:04:48,240 --> 04:04:49,800
FRAMEWORKS THAT WE WANT TO DO IS

7026
04:04:49,800 --> 04:04:52,640
HOW DO WE THINK ABOUT SHOULD

7027
04:04:52,640 --> 04:04:54,240
THERAPY BE RECOMMENDED AVOIDED

7028
04:04:54,240 --> 04:04:57,320
BEGIN TO THINK ABOUT LOOKING AT

7029
04:04:57,320 --> 04:05:00,760
DOMAINS OF SAFETY EFFICACY,

7030
04:05:00,760 --> 04:05:03,080
BALANCING THAT WITH QUALITY BUT

7031
04:05:03,080 --> 04:05:04,360
CENTER OF THIS IS PATIENT

7032
04:05:04,360 --> 04:05:05,680
PREFERENCE AND H IS GOING TO BE

7033
04:05:05,680 --> 04:05:07,800
CRITICAL IN THINKING DEVELOPING

7034
04:05:07,800 --> 04:05:10,000
A -- AS WE BEGIN TO THINK ABOUT

7035
04:05:10,000 --> 04:05:11,800
MU TYPES OF HEALTHCARE SYSTEMS.

7036
04:05:11,800 --> 04:05:14,200
SO JUST FINISH UP, JUST TO TALK

7037
04:05:14,200 --> 04:05:15,720
LALE BIT ABOUT ONE OF THE

7038
04:05:15,720 --> 04:05:19,040
PROGRAMS WE HAVE OFFERED AT THE

7039
04:05:19,040 --> 04:05:20,240
HENRY INSTITUTE AROUND STRESS

7040
04:05:20,240 --> 04:05:22,200
MANAGEMENT RESILIENCY TRAINING

7041
04:05:22,200 --> 04:05:24,280
PROGRAM, AND THAT FRAMEWORK

7042
04:05:24,280 --> 04:05:25,560
RESILIENCY CAN BE BUILT THROUGH

7043
04:05:25,560 --> 04:05:26,680
THREE TIERED PROCESS WHICH

7044
04:05:26,680 --> 04:05:28,320
INCLUDE ONGOING PRACTICE OF

7045
04:05:28,320 --> 04:05:30,400
TECHNIQUES WHICH ELICIT

7046
04:05:30,400 --> 04:05:31,560
RELAXATION RESPONSE BUILDING

7047
04:05:31,560 --> 04:05:33,080
AWARENESS OF STRESS AND NEGATIVE

7048
04:05:33,080 --> 04:05:36,200
EFFECT AND PROMOTING SOCIAL

7049
04:05:36,200 --> 04:05:38,400
CONNECTEDNESS AND LIFESTYLE

7050
04:05:38,400 --> 04:05:39,720
BEHAVIOR SO EIGHT WEEK

7051
04:05:39,720 --> 04:05:41,040
MULTI-MODAL PROGRAM, WHICH

7052
04:05:41,040 --> 04:05:43,000
INCORPORATE ELEMENTS WITH

7053
04:05:43,000 --> 04:05:44,280
TRADITIONS THROUGH MIND BODY

7054
04:05:44,280 --> 04:05:45,000
PRACTICE.

7055
04:05:45,000 --> 04:05:48,400
THERE'S SIGNIFICANT HEALTHCARE

7056
04:05:48,400 --> 04:05:49,960
EFFECT IN THE -- IN TERMS OF

7057
04:05:49,960 --> 04:05:51,480
HEALTH OUTCOMES, INCLUDING

7058
04:05:51,480 --> 04:05:53,400
MEDICAL PSYCHIATRIC SYMPTOMS AND

7059
04:05:53,400 --> 04:05:55,400
HELPING INDIVIDUALS INCREASE

7060
04:05:55,400 --> 04:05:57,600
HEALTH PROMOTING LIFE STYLES BUT

7061
04:05:57,600 --> 04:05:58,720
ALSO FOUND IT IMPROVES

7062
04:05:58,720 --> 04:06:01,680
HEALTHCARE PROVIDER WELL BEING

7063
04:06:01,680 --> 04:06:04,320
WITH NON-CLINICAL SETTING AND

7064
04:06:04,320 --> 04:06:06,120
HAVE PUBLISHED THESE TYPES OF

7065
04:06:06,120 --> 04:06:07,120
WORK.

7066
04:06:07,120 --> 04:06:08,680
AGAIN AS WE THINK ABOUT PANDEMIC

7067
04:06:08,680 --> 04:06:10,160
AND THE DOUBLE PANDEMIC OF

7068
04:06:10,160 --> 04:06:13,120
HEALTHCARE PROVIDERS BURN OUT,

7069
04:06:13,120 --> 04:06:14,440
THESE TYPES OF INTERVENTIONS ARE

7070
04:06:14,440 --> 04:06:15,800
GOING TO BE CRITICAL.

7071
04:06:15,800 --> 04:06:17,720
SO FINALLY, REALLY THIS IS THE

7072
04:06:17,720 --> 04:06:19,240
-- I THINK REALLY WE THINK ABOUT

7073
04:06:19,240 --> 04:06:21,360
THIS IN A HEALTHCARE SYSTEM WHAT

7074
04:06:21,360 --> 04:06:25,960
WE NEED TO DO IS TEACH CONTINUE

7075
04:06:25,960 --> 04:06:28,400
TO ASK OPEN ENDED NON-JUDGMENTAL

7076
04:06:28,400 --> 04:06:29,640
QUESTIONS ABOUT USE OF

7077
04:06:29,640 --> 04:06:31,200
INTEGRATED HEALTH, YOU WILL

7078
04:06:31,200 --> 04:06:32,880
CURLY SENSITIVE AND APPROPRIATE

7079
04:06:32,880 --> 04:06:34,640
QUESTIONS -- CURL CHURLLY

7080
04:06:34,640 --> 04:06:36,680
SENSITIVE AND APPROPRIATE

7081
04:06:36,680 --> 04:06:38,000
QUESTIONS, USING EXPECTATIONS

7082
04:06:38,000 --> 04:06:39,480
AND UNDERSTANDING THEM FOR

7083
04:06:39,480 --> 04:06:39,960
INTEGRATED MEDICINE.

7084
04:06:39,960 --> 04:06:41,400
WE WANT TO MAKE SURE THESE ARE

7085
04:06:41,400 --> 04:06:42,720
INTEGRATED NOT AS INDEPENDENT

7086
04:06:42,720 --> 04:06:45,800
SYSTEMS WHERE PEOPLE OPERATE

7087
04:06:45,800 --> 04:06:48,000
SEPARATELY OR WHERE THERE IS A

7088
04:06:48,000 --> 04:06:50,000
QUOTE UNQUOTE PHYSICIAN LEAD

7089
04:06:50,000 --> 04:06:51,200
THAT ONLY PHYSICIAN GETS TO DO

7090
04:06:51,200 --> 04:06:53,760
IT BUT THINK OF

7091
04:06:53,760 --> 04:06:54,960
INTERPROFESSIONAL MODEL THAT IS

7092
04:06:54,960 --> 04:06:56,960
COLLABORATIVE IN NATURE AND HAS

7093
04:06:56,960 --> 04:07:00,040
PATIENT CENTERED CARE FOCUS.

7094
04:07:00,040 --> 04:07:03,120
>> TWO MINUTES.

7095
04:07:03,120 --> 04:07:05,600
>> SO TO FINISH, REALLY WE

7096
04:07:05,600 --> 04:07:08,120
WANTED TO BE CAREFUL ABOUT NOT

7097
04:07:08,120 --> 04:07:09,880
-- IF WE HAVE A MISA APPLIED

7098
04:07:09,880 --> 04:07:11,880
MODEL THE FOCUS ON HEALING WHEN

7099
04:07:11,880 --> 04:07:12,920
CURE IS MORE APPROPRIATE FAILING

7100
04:07:12,920 --> 04:07:15,000
TO CURE THE CURABLE AND AGAIN,

7101
04:07:15,000 --> 04:07:16,800
THAT IS ONE THING COMPLICATES

7102
04:07:16,800 --> 04:07:19,200
THE INTERVENTIONS.

7103
04:07:19,200 --> 04:07:20,960
AND WASTES RESOURCES AN LIVES

7104
04:07:20,960 --> 04:07:22,800
BUT ULTIMATELY WHAT WE ARE

7105
04:07:22,800 --> 04:07:24,440
TALKING ABOUT HERE IS WHEN

7106
04:07:24,440 --> 04:07:26,200
PEOPLE FOCUS ON CURING WHEN

7107
04:07:26,200 --> 04:07:28,280
HEALING IS MORE APPROPRIATE AND

7108
04:07:28,280 --> 04:07:30,800
IN THIS -- IF WE DO THIS IT ENDS

7109
04:07:30,800 --> 04:07:32,520
UP DEPERSONALIZING INTERACTION

7110
04:07:32,520 --> 04:07:34,480
FAVORING SCIENCE OVER VALUES AND

7111
04:07:34,480 --> 04:07:37,720
DISENFRANCHISING THE PATIENT.

7112
04:07:37,720 --> 04:07:39,680
SO INTEGRATIVE HEALTH MEDICINE

7113
04:07:39,680 --> 04:07:41,640
FILE CONTINUOUS HEALTH HEALING

7114
04:07:41,640 --> 04:07:42,960
RELATIONSHIPS CUSTOMIZATION

7115
04:07:42,960 --> 04:07:43,600
BASED ON PATIENT NEED AND

7116
04:07:43,600 --> 04:07:44,000
VALUES.

7117
04:07:44,000 --> 04:07:45,760
THE PATIENT IS SOURCE OF

7118
04:07:45,760 --> 04:07:47,080
CONTROL, EVIDENCE BASED DECISION

7119
04:07:47,080 --> 04:07:48,600
MAKING AND SHARED KNOWLEDGE FREE

7120
04:07:48,600 --> 04:07:50,160
AND FULL OF INFORMATION.

7121
04:07:50,160 --> 04:07:55,400
SO I WILL PAUSE THERE AND WE

7122
04:07:55,400 --> 04:07:56,840
WILL WELCOME DISCUSSION LATER

7123
04:07:56,840 --> 04:07:59,440
ON.

7124
04:07:59,440 --> 04:08:00,360
>> OKAY.

7125
04:08:00,360 --> 04:08:04,400
THANK YOU, VERY MUCH, DR. MEHTA,

7126
04:08:04,400 --> 04:08:05,440
VERY INTERESTING.

7127
04:08:05,440 --> 04:08:08,640
OUR NEXT PRESENTER IS DR. LISA

7128
04:08:08,640 --> 04:08:13,360
MASINTER.

7129
04:08:13,360 --> 04:08:14,800
>> HELLO, THANK YOU FOR HAVING

7130
04:08:14,800 --> 04:08:16,360
ME, I WILL SHARE MY SCREEN SO

7131
04:08:16,360 --> 04:08:28,240
BARE WITH ME.

7132
04:08:28,240 --> 04:08:29,920
>> THANK YOU SO MUCH, HONOR TO

7133
04:08:29,920 --> 04:08:33,240
BE HERE, MY NAME IS LISA

7134
04:08:33,240 --> 04:08:35,320
MASINTER AND I WANT TO SAY I

7135
04:08:35,320 --> 04:08:36,640
DEFINITELY STAND HERE ON BEHALF

7136
04:08:36,640 --> 04:08:40,040
OF A LARGE GROUP OF

7137
04:08:40,040 --> 04:08:41,040
COLLABORATIVE EFFORT LOCATED

7138
04:08:41,040 --> 04:08:46,760
HERE IN CHICAGO AS A PLEASURE

7139
04:08:46,760 --> 04:08:48,400
AND JOY TO SHARE THE WORK THAT

7140
04:08:48,400 --> 04:08:50,560
WE HAVE BEEN ABLE TO DO.

7141
04:08:50,560 --> 04:08:54,520
I WILL GIVE BACKGROUND WHERE

7142
04:08:54,520 --> 04:08:57,800
WHAT WE ARE DOING WHO WE ARE,

7143
04:08:57,800 --> 04:08:58,560
OVERVIEW AND SHOG SHYING

7144
04:08:58,560 --> 04:09:02,560
COLLABORATIVE MATERNAL HEALTH

7145
04:09:02,560 --> 04:09:05,160
WITH TOUCHING BASE ON CHALLENGES

7146
04:09:05,160 --> 04:09:07,400
IN THIS EFFORT.

7147
04:09:07,400 --> 04:09:10,200
SO AGAIN A LITTLE BACKGROUND AND

7148
04:09:10,200 --> 04:09:12,400
INTRODUCTION TO WHY WE WERE

7149
04:09:12,400 --> 04:09:15,040
INVITED HERE.

7150
04:09:15,040 --> 04:09:18,800
ALLIANCE CHICAGO IS A HRSA

7151
04:09:18,800 --> 04:09:22,440
FUNDED NETWORK OVER 70 SAFE ANY

7152
04:09:22,440 --> 04:09:24,240
NET CENTERS FEDERALLY QUALIFIED

7153
04:09:24,240 --> 04:09:26,440
HEALTH CENTERS FOR COMMUNITY

7154
04:09:26,440 --> 04:09:27,880
HEALTH CENTERS SPANNING 20

7155
04:09:27,880 --> 04:09:30,960
STATES YOU CAN SEE THE

7156
04:09:30,960 --> 04:09:32,400
DISTRIBUTION ACROSS THE COUNTRY

7157
04:09:32,400 --> 04:09:33,400
HEALTH CENTERS ACROSS THE

7158
04:09:33,400 --> 04:09:33,760
PARTNERSHIP.

7159
04:09:33,760 --> 04:09:37,200
WE PROVIDE A COMMON

7160
04:09:37,200 --> 04:09:39,880
INFRASTRUCTURE WITH MANY HEALTH

7161
04:09:39,880 --> 04:09:41,680
CENTERS RECEIVING ELECTRONIC

7162
04:09:41,680 --> 04:09:43,040
HEALTH RECORD WE SUPPORT ON THE

7163
04:09:43,040 --> 04:09:44,480
FRONT END.

7164
04:09:44,480 --> 04:09:48,480
ON THE BACK END GIVES ABILITY TO

7165
04:09:48,480 --> 04:09:52,160
COLLECT DATA IN ELECTRONIC DATA

7166
04:09:52,160 --> 04:09:54,480
WAREHOUSE WE HAVE DATA

7167
04:09:54,480 --> 04:09:55,120
REPRESENTING OVER 3 HILL PATIENT

7168
04:09:55,120 --> 04:09:58,280
LIVES IN OUR DATA WAREHOUSE.

7169
04:09:58,280 --> 04:09:59,720
AND WHAT I WANT TO SAY IS THE

7170
04:09:59,720 --> 04:10:02,160
REASON WHY I'M IN ALLIANCE

7171
04:10:02,160 --> 04:10:03,600
CHICAGO IS TO WORK ON THE FRONT

7172
04:10:03,600 --> 04:10:05,240
LINES AND SUPPORT THE FRONT LINE

7173
04:10:05,240 --> 04:10:06,880
PROVIDERS IN THESE COMMUNITY

7174
04:10:06,880 --> 04:10:12,720
HEALTH SETTINGS TO LEVERAGE DATA

7175
04:10:12,720 --> 04:10:13,800
TO IMPROVE OUTCOMES TORR

7176
04:10:13,800 --> 04:10:15,240
PATIENTS THAT SEEK CARE IN THE

7177
04:10:15,240 --> 04:10:15,840
SAFETY NET.

7178
04:10:15,840 --> 04:10:18,280
FOR THOSE THAT ARE NOT FAMILIAR

7179
04:10:18,280 --> 04:10:20,600
WITH FQHCs THESE ARE FEDERALLY

7180
04:10:20,600 --> 04:10:22,920
FUNDED CLINICS IN AREAS OF

7181
04:10:22,920 --> 04:10:24,600
HIGHEST NEED ACROSS THE COUNTRY.

7182
04:10:24,600 --> 04:10:25,960
THEY PROVIDE COMPREHENSIVE

7183
04:10:25,960 --> 04:10:27,000
SERVICES AND OPEN TO ALL

7184
04:10:27,000 --> 04:10:29,920
PATIENTS REGARDLESS OF ABILITY

7185
04:10:29,920 --> 04:10:31,120
TO PAY.

7186
04:10:31,120 --> 04:10:32,800
ONE INTERESTING THING ABOUT

7187
04:10:32,800 --> 04:10:34,120
FEDERALLY QUALIFIED HEALTH

7188
04:10:34,120 --> 04:10:36,000
CENTERS IS GOVERNING BODY AND

7189
04:10:36,000 --> 04:10:39,200
BOARDS CONSIST OF PATIENTS THAT

7190
04:10:39,200 --> 04:10:40,880
REPRESENT DECISION MAKERS IN

7191
04:10:40,880 --> 04:10:41,800
THESE CLINICS.

7192
04:10:41,800 --> 04:10:44,200
THE MOST RECENT ESTIMATE PUTS

7193
04:10:44,200 --> 04:10:46,200
FQHCs ACROSS THE COUNTRY SERVE

7194
04:10:46,200 --> 04:10:49,520
CLOSE TO 30 MILLION PATIENTS.

7195
04:10:49,520 --> 04:10:52,040
SO IT IS A VAST HEALTH CENTER

7196
04:10:52,040 --> 04:10:53,360
MODEL AND PLACE I'M PROUD TO

7197
04:10:53,360 --> 04:10:55,120
HAVE PRACTICE MEDICINE IN SINCE

7198
04:10:55,120 --> 04:10:59,200
I GRADUATED FROM RESIDENCY.

7199
04:10:59,200 --> 04:11:01,200
A BIT ABOUT ME, I WORK IN

7200
04:11:01,200 --> 04:11:03,000
ALLIANCE CHICAGO AS THE SENIOR

7201
04:11:03,000 --> 04:11:07,000
DIRECTOR OF RESEARCH ALSO

7202
04:11:07,000 --> 04:11:09,120
GENERAL OBGYN AS MENTIONED

7203
04:11:09,120 --> 04:11:10,560
BEFORE AND SEE PATIENTS IN

7204
04:11:10,560 --> 04:11:11,600
PARTNER HEALTH CENTERS IN

7205
04:11:11,600 --> 04:11:12,800
CHICAGO AND HA IS WHERE I WAS

7206
04:11:12,800 --> 04:11:20,680
THIS MORNING.  SO ZOOMING IN ON

7207
04:11:20,680 --> 04:11:22,160
CHICAGO ONE THING WE THINK ABOUT

7208
04:11:22,160 --> 04:11:23,720
A LOT ARE THE HEALTH DISPARITIES

7209
04:11:23,720 --> 04:11:28,320
THAT WE HAVE IN OUR CITY.

7210
04:11:28,320 --> 04:11:30,640
THIS WAS A STUDY IN 2019 AND

7211
04:11:30,640 --> 04:11:32,200
MADE THE LOCAL NEWSPAPER IN

7212
04:11:32,200 --> 04:11:35,360
MAINSTREAM NEWS ABOUT THE REAL

7213
04:11:35,360 --> 04:11:36,800
GAP IN HEALTH OUTCOMES FOR

7214
04:11:36,800 --> 04:11:37,680
RESIDENTS THROUGHOUT THE CITY.

7215
04:11:37,680 --> 04:11:39,600
THIS WAS A 30 YEAR DIFFERENCE IN

7216
04:11:39,600 --> 04:11:42,800
LIFE SPAN.

7217
04:11:42,800 --> 04:11:45,600
THIS WAS USING DATA FROM CDC

7218
04:11:45,600 --> 04:11:48,800
DEATH BY 2020 AND 2015 COMMUNE

7219
04:11:48,800 --> 04:11:49,800
TEARIA IN CHICAGO.

7220
04:11:49,800 --> 04:11:51,160
FURTHER STUDIES SHOW THIS AND WE

7221
04:11:51,160 --> 04:11:52,800
KNOW ACROSS THE CITY THERE ARE

7222
04:11:52,800 --> 04:11:56,480
TREMENDOUS HEALTH DISPARITIES.

7223
04:11:56,480 --> 04:11:59,000
FROM 2012 TO 2017 THE LIFE

7224
04:11:59,000 --> 04:12:00,280
EXPECTANCY GAP BETWEEN BLACK

7225
04:12:00,280 --> 04:12:05,680
RESIDENTS AND NON-BLACK GREW SO

7226
04:12:05,680 --> 04:12:07,120
THERE IS WORK TO BE DONE IN

7227
04:12:07,120 --> 04:12:09,320
LOCAL AREA IN CHICAGO IN TERMS

7228
04:12:09,320 --> 04:12:11,680
OF HEALTH EQUITY.

7229
04:12:11,680 --> 04:12:14,880
WHEN WE TALK ABOUT MATERNAL

7230
04:12:14,880 --> 04:12:17,000
MORTALITY WHICH SAN AREA

7231
04:12:17,000 --> 04:12:18,080
MATERNAL MORTALITY PREVENTION I

7232
04:12:18,080 --> 04:12:22,480
THINK ABOUT ALL THE TIME, THE

7233
04:12:22,480 --> 04:12:23,800
STATISTICS MIRROR GENERAL

7234
04:12:23,800 --> 04:12:24,840
MORTALITY STATISTICS THAT I JUST

7235
04:12:24,840 --> 04:12:27,440
SHARED.

7236
04:12:27,440 --> 04:12:29,000
STATE OF ILLINOIS PUBLISHES A

7237
04:12:29,000 --> 04:12:33,600
REPORT ANNUALLY AROUND MATERNAL

7238
04:12:33,600 --> 04:12:34,240
MORBIDITY AND MORBIDITY IN THE

7239
04:12:34,240 --> 04:12:36,400
STATE AND 2021 REPORT BASED ON

7240
04:12:36,400 --> 04:12:39,320
DATA FROM 2016 AND 2017.

7241
04:12:39,320 --> 04:12:40,640
WHAT THEY FOUND WAS THAT WHEN

7242
04:12:40,640 --> 04:12:43,000
YOU ARE THINKING -- LOOKING AT

7243
04:12:43,000 --> 04:12:44,760
THE RATES OF PREGNANCY RELATED

7244
04:12:44,760 --> 04:12:48,400
MORTALITY DUE TO MEDICAL CAUSES,

7245
04:12:48,400 --> 04:12:49,920
CHICAGO HAS HIGHEST RATE IN THE

7246
04:12:49,920 --> 04:12:54,000
STATE, CHICAGO AREA, LIKEWISE A

7247
04:12:54,000 --> 04:12:56,400
LARGE DISPARITY AGAIN BETWEEN

7248
04:12:56,400 --> 04:12:58,520
BLACK INDIVIDUALS AND WHITE

7249
04:12:58,520 --> 04:12:59,000
PATIENTS.

7250
04:12:59,000 --> 04:13:02,720
LIKEWISE THERE IS A MEDICAL

7251
04:13:02,720 --> 04:13:05,160
COVERAGE DISPARITY WITH PATIENTS

7252
04:13:05,160 --> 04:13:06,760
RECEIVING MEDICAID MORE LIKELY

7253
04:13:06,760 --> 04:13:08,160
TO DIE THAN THOSE WITH PRIVATE

7254
04:13:08,160 --> 04:13:08,720
COVERAGE.

7255
04:13:08,720 --> 04:13:10,520
WHAT IS IMPORTANT TO NOTE IN

7256
04:13:10,520 --> 04:13:12,960
TERMS OF THINKING MATERNAL

7257
04:13:12,960 --> 04:13:14,800
MORTALITY IS IN ILLINOIS AND

7258
04:13:14,800 --> 04:13:15,920
LIKEWISE NATIONAL DATA ARE

7259
04:13:15,920 --> 04:13:17,240
STARTING TO SHOW THAT A LOT OF

7260
04:13:17,240 --> 04:13:19,040
THE DEATH ARE ACTUALLY HAPPENING

7261
04:13:19,040 --> 04:13:20,680
OUTSIDE AND AFTER PATIENTS GO

7262
04:13:20,680 --> 04:13:22,000
HOME AFTER BIRTH.

7263
04:13:22,000 --> 04:13:23,400
SO THE MOST RECENT DATA IN

7264
04:13:23,400 --> 04:13:26,320
ILLINOIS SHOW THAT ABOUT 63%

7265
04:13:26,320 --> 04:13:30,240
DEATH POSTPARTUM AND 33 PERSES

7266
04:13:30,240 --> 04:13:30,960
HAPPENING AFTER TWO MONTHS

7267
04:13:30,960 --> 04:13:32,600
POSTPARTUM.

7268
04:13:32,600 --> 04:13:34,560
ACROSS THE BOARD MAJORITY OF

7269
04:13:34,560 --> 04:13:37,480
DEATH ARE PREVENTABLE.

7270
04:13:37,480 --> 04:13:41,440
THERE IS A LOT OF EFFORT PUT

7271
04:13:41,440 --> 04:13:43,000
INTO MATERNAL MORTALITY

7272
04:13:43,000 --> 04:13:44,200
PREVENTION AND REDUCTION EFFORTS

7273
04:13:44,200 --> 04:13:45,760
IN THE HOSPITAL SETTING BUT

7274
04:13:45,760 --> 04:13:47,320
THESE DATA SUGGEST WE NEED TO BE

7275
04:13:47,320 --> 04:13:49,880
BROADENING OUR PERSPECTIVE AND

7276
04:13:49,880 --> 04:13:51,520
LOOKING AT COMMUNITY BASED

7277
04:13:51,520 --> 04:13:53,320
EFFORTS TO SUPPORT PATIENTS

7278
04:13:53,320 --> 04:13:54,440
AFTER PREGNANCY.

7279
04:13:54,440 --> 04:13:58,800
TO PROMOTE HEALTH AND PROMOTE --

7280
04:13:58,800 --> 04:14:01,000
PREVENT MORTALITY.

7281
04:14:01,000 --> 04:14:03,400
WHAT ARE WE DOING AND WHY AM I

7282
04:14:03,400 --> 04:14:04,360
HERE?

7283
04:14:04,360 --> 04:14:06,800
IN 2019 THIS PARTNERSHIP OF

7284
04:14:06,800 --> 04:14:11,400
BROAD ARRAY OF ORGANIZATIONS

7285
04:14:11,400 --> 04:14:12,720
SUBMIT PROPOSAL THAT WE ARE

7286
04:14:12,720 --> 04:14:18,560
GRATEFUL WAS FUNDED TO THE MERCK

7287
04:14:18,560 --> 04:14:19,920
SAFER CITIES FOR CHILD BIT.

7288
04:14:19,920 --> 04:14:21,720
WE FORMED THE CHICAGO

7289
04:14:21,720 --> 04:14:23,080
COLLABORATIVE WITH MATERNAL

7290
04:14:23,080 --> 04:14:25,240
HEALTH WITH CHICAGO ALLIANCE AND

7291
04:14:25,240 --> 04:14:26,800
OUR COLLEAGUES AT EVERY THRIVE

7292
04:14:26,800 --> 04:14:28,360
ILLINOIS BEING LEAD ORGANIZES TO

7293
04:14:28,360 --> 04:14:29,440
TAKE THIS EFFORT FORWARD ON

7294
04:14:29,440 --> 04:14:30,680
BEHALF OF THE STAKEHOLDERS

7295
04:14:30,680 --> 04:14:39,520
THERE.

7296
04:14:39,520 --> 04:14:40,720
BROADLY, WE ENVISION CHICAGO

7297
04:14:40,720 --> 04:14:44,800
WHERE ALL PEOPLE IN COMMUNITIES,

7298
04:14:44,800 --> 04:14:46,360
THRIVE BECAUSE HEALTHCARE

7299
04:14:46,360 --> 04:14:47,600
PROVIDERS POLICY MAKERS

7300
04:14:47,600 --> 04:14:48,160
COMMUNITY ORGANIZATIONS

7301
04:14:48,160 --> 04:14:49,920
INDIVIDUALS AND FAMILIES PARTNER

7302
04:14:49,920 --> 04:14:50,800
WITH INTENTION TO IMPROVE

7303
04:14:50,800 --> 04:14:52,960
MATERNAL HEALTH.

7304
04:14:52,960 --> 04:14:55,480
THIS EFFORT HAS THREE MAIN AIMS

7305
04:14:55,480 --> 04:14:58,600
AND TODAYLY FOCUS ON ONE WHICH

7306
04:14:58,600 --> 04:15:00,320
IS THE AIM ALLIANCE CHICAGO AND

7307
04:15:00,320 --> 04:15:02,200
NETWORK OF FQHCs ARE WORKING

7308
04:15:02,200 --> 04:15:04,040
ON BUT WHAT WE ARE DOING IS WE

7309
04:15:04,040 --> 04:15:06,200
DEVELOPED A QI COLLABORATIVE FOR

7310
04:15:06,200 --> 04:15:08,200
AMBULATORY CARE PROVIDERS

7311
04:15:08,200 --> 04:15:10,480
FOCUSED ON BEST PRACTICE

7312
04:15:10,480 --> 04:15:12,480
MATERNAL HEALTH FOR SYSTEMS AND

7313
04:15:12,480 --> 04:15:13,040
CULTURE CHANGE.

7314
04:15:13,040 --> 04:15:15,000
OUR PARTNERS AT EVERY THRIVE

7315
04:15:15,000 --> 04:15:17,440
ILLINOIS STATE ADVOCACY MATERNAL

7316
04:15:17,440 --> 04:15:19,200
HEALTH COMMUNITY EDUCATION AND

7317
04:15:19,200 --> 04:15:20,800
COMMUNITY ENGAGEMENT

7318
04:15:20,800 --> 04:15:21,680
ORGANIZATION ARE DOING A

7319
04:15:21,680 --> 04:15:24,080
COMMUNITY ENGAGEMENT EFFORT AS

7320
04:15:24,080 --> 04:15:26,760
WELL AS POLICY EFFORT BUT FOR

7321
04:15:26,760 --> 04:15:29,200
PURPOSES OF TODAY I WILL FOCUS

7322
04:15:29,200 --> 04:15:31,480
ON AIM 1.

7323
04:15:31,480 --> 04:15:33,840
THIS GIVES AN IDEA OF THE

7324
04:15:33,840 --> 04:15:36,200
STRUCTURE OF THE COLLABORATIVE

7325
04:15:36,200 --> 04:15:38,400
THAT WE DEVELOPED AND AGAIN

7326
04:15:38,400 --> 04:15:40,160
TODAY I WILL FOCUS ON THE

7327
04:15:40,160 --> 04:15:42,240
QUALITY IMPROVEMENT SUBCOMMITTEE

7328
04:15:42,240 --> 04:15:43,680
WHICH OUR TEAM AT ALLIANCE

7329
04:15:43,680 --> 04:15:48,360
CHICAGO IS SUPPORTING.

7330
04:15:48,360 --> 04:15:52,240
THIS GIVES AN IDEA OF ACTIVITIES

7331
04:15:52,240 --> 04:15:55,120
WE HAVE TAKEN ON TO DATE.

7332
04:15:55,120 --> 04:15:57,240
WE STARTED BY IDENTIFYING AND

7333
04:15:57,240 --> 04:15:58,760
WORKING WITH A GROUP OF

7334
04:15:58,760 --> 04:16:00,120
STAKEHOLDERS WHO CAMING TO TO

7335
04:16:00,120 --> 04:16:02,200
WANT TO ENGAGE MANY THE QUALITY

7336
04:16:02,200 --> 04:16:03,120
IMPROVEMENT EFFORT TO IDENTIFY

7337
04:16:03,120 --> 04:16:04,440
WHAT WE WANTED TO DO, WE WANTED

7338
04:16:04,440 --> 04:16:06,120
TO DO A NEEDS ASSESSMENT AND

7339
04:16:06,120 --> 04:16:08,800
ENSURE THAT WHATEVER WE TAKE ON

7340
04:16:08,800 --> 04:16:12,120
WE ARE NOT BRINGING TO PARTNERS

7341
04:16:12,120 --> 04:16:13,600
BUT ALLOWING PARTNERS TO CHOOSE

7342
04:16:13,600 --> 04:16:14,880
AS WELL AS DEVELOPING COMMITTEE

7343
04:16:14,880 --> 04:16:21,240
OF STAKEHOLDERS, ONCE WE HAD A

7344
04:16:21,240 --> 04:16:23,040
TOPIC TAKE ON DO LITERATURE AND

7345
04:16:23,040 --> 04:16:23,680
UNDERSTAND WHAT EVIDENCE MIGHT

7346
04:16:23,680 --> 04:16:25,000
BE OUT THERE IN TERMS OF WHAT WE

7347
04:16:25,000 --> 04:16:27,040
CAN DO AND DECIDE WHAT ARE WE

7348
04:16:27,040 --> 04:16:29,080
GOING TO DO.

7349
04:16:29,080 --> 04:16:34,040
WE DEVELOP A PROTOCOL WE ARE

7350
04:16:34,040 --> 04:16:35,520
FINISHING NOW WITH SITES,LY GET

7351
04:16:35,520 --> 04:16:41,160
INTO THE DETAILS MORE, STARTING

7352
04:16:41,160 --> 04:16:42,600
TO EVALUATE THE PROTOCOL WE

7353
04:16:42,600 --> 04:16:44,320
DEVELOPED AND WE ARE THINKING

7354
04:16:44,320 --> 04:16:46,760
ABOUT NEXT STEPS SUSTAINABILITY

7355
04:16:46,760 --> 04:16:50,000
BEYOND THIS FIRST EFFORT.

7356
04:16:50,000 --> 04:16:51,400
THIS SLIDE I WANT TO SHOW THAT

7357
04:16:51,400 --> 04:16:54,840
WE AT THE BEGINNING BROUGHT

7358
04:16:54,840 --> 04:16:57,200
TOGETHER A GROUP WE HAD 13

7359
04:16:57,200 --> 04:16:59,040
AMBULATORY CARE SITES THAT

7360
04:16:59,040 --> 04:17:01,160
WANTED TO PARTICIPATE AS MANY OF

7361
04:17:01,160 --> 04:17:03,000
YOU MIGHT IMAGINE GETTING PEOPLE

7362
04:17:03,000 --> 04:17:05,960
WHO WANT TO PARTICIPATE IN ANY

7363
04:17:05,960 --> 04:17:07,600
INTERVENTION ESPECIALLY DURING

7364
04:17:07,600 --> 04:17:10,000
COVID IS INCREDIBLY CHALLENGING.

7365
04:17:10,000 --> 04:17:13,520
IF YOU ARE THINKING ABOUT

7366
04:17:13,520 --> 04:17:15,480
RELATIVELY RESOURCE POOR

7367
04:17:15,480 --> 04:17:16,800
ORGANIZATIONS LIKE FEDERALLY

7368
04:17:16,800 --> 04:17:19,600
QUALIFIED HEALTH CENTERS THAT

7369
04:17:19,600 --> 04:17:21,080
ARE STRAPPED, TO GET THEM TO THE

7370
04:17:21,080 --> 04:17:22,720
TABLE IN OUR OPINION AS EVEN

7371
04:17:22,720 --> 04:17:24,560
BIGGER ACCOMPLISHMENT SO WE ARE

7372
04:17:24,560 --> 04:17:27,720
PROUD THAT 13 STAKEHOLDERS CAME

7373
04:17:27,720 --> 04:17:29,560
TOGETHER TO THINK HOW TO DO THIS

7374
04:17:29,560 --> 04:17:30,800
HOW TO IMPLEMENT THIS AND DECIDE

7375
04:17:30,800 --> 04:17:33,480
WHAT TO DO.

7376
04:17:33,480 --> 04:17:34,680
THIS SLIDE SHOWS WE HAD

7377
04:17:34,680 --> 04:17:35,920
BASICALLY A SURVEY AT THE

7378
04:17:35,920 --> 04:17:37,400
BEGINNING TO WORK WITH ALL OF

7379
04:17:37,400 --> 04:17:39,880
OUR DIFFERENT STAKEHOLDERS, WHAT

7380
04:17:39,880 --> 04:17:41,200
ARE THE THINGS WE WANT TO WORK

7381
04:17:41,200 --> 04:17:42,800
ON, WHAT WE WANT TO TAKE ON AND

7382
04:17:42,800 --> 04:17:44,200
THE ONE WITH THE STAR WHICH IS

7383
04:17:44,200 --> 04:17:46,880
WHAT WE FOCUSED ON OVER THE LAST

7384
04:17:46,880 --> 04:17:49,120
YEAR, WHAT I WILL SHARE ABOUT

7385
04:17:49,120 --> 04:17:50,880
TODAY IS TOPIC QUALITY

7386
04:17:50,880 --> 04:17:52,680
IMPROVEMENT INITIATIVE WE CAME

7387
04:17:52,680 --> 04:17:54,560
UP WITH P AMONG PATIENT WITH

7388
04:17:54,560 --> 04:17:57,080
HIGH RISK MEDICAL PREGNANCY TO

7389
04:17:57,080 --> 04:17:59,200
LINK THEM TO BACK TO PRIMARY

7390
04:17:59,200 --> 04:18:00,880
CARE PROVIDER MEDICAL HOME AFTER

7391
04:18:00,880 --> 04:18:02,760
THE POSTPARTUM PERIOD, THE

7392
04:18:02,760 --> 04:18:05,320
IMMEDIATE POSTPARTUM PERIOD

7393
04:18:05,320 --> 04:18:10,160
ENDS, MANY KNOW THAT PEOPLE COME

7394
04:18:10,160 --> 04:18:11,280
AFTER BIRTH, RECOMMENDED TO BE

7395
04:18:11,280 --> 04:18:13,840
SEEN AS POSTPARTUM VISIT BY SIX

7396
04:18:13,840 --> 04:18:16,040
WEEKS AND NOW THERE IS EARLY ONE

7397
04:18:16,040 --> 04:18:18,880
RECOMMENDED AS WELL.

7398
04:18:18,880 --> 04:18:20,960
WHAT ARE PARTNER FOUND AND SHARE

7399
04:18:20,960 --> 04:18:23,200
ANECDOTALLY AS CLINICIAN AND WE

7400
04:18:23,200 --> 04:18:25,080
DO HAVE FAIRLY GOOD RETENTION

7401
04:18:25,080 --> 04:18:26,880
FOR THOSE POSTPARTUM VISITS BUT

7402
04:18:26,880 --> 04:18:28,160
IT IS AFTER THAT FOR THE

7403
04:18:28,160 --> 04:18:31,640
PATIENTS THAT HAVE HIGH RISK

7404
04:18:31,640 --> 04:18:32,760
MEDICAL CONDITIONS WE WANT THE

7405
04:18:32,760 --> 04:18:35,200
GET BACK INTO MEDICAL CARE AND

7406
04:18:35,200 --> 04:18:36,400
PREVENTIVE CARE, WE DON'T KNOW

7407
04:18:36,400 --> 04:18:39,840
IF THEY ARE FOLLOWING UP.

7408
04:18:39,840 --> 04:18:43,000
THIS IS WHAT OUR COLLEAGUES

7409
04:18:43,000 --> 04:18:45,600
WANTED TO WORK ON, SEVERAL OTHER

7410
04:18:45,600 --> 04:18:47,360
POSTPARTUM INITIATIVES WERE

7411
04:18:47,360 --> 04:18:48,240
IDENTIFIED, THEY ARE ALL IN THE

7412
04:18:48,240 --> 04:18:48,760
BOX THERE.

7413
04:18:48,760 --> 04:18:52,440
THAT YOU CAN SEE.

7414
04:18:52,440 --> 04:18:54,240
SO THOSE THE POSTPARTUM PERIOD

7415
04:18:54,240 --> 04:18:57,200
WAS WHAT THE FOCUS OF THIS

7416
04:18:57,200 --> 04:19:00,600
EFFORT WAS GOING TO BE.

7417
04:19:00,600 --> 04:19:03,400
THIS IS WHAT WE CALL OUR KEY

7418
04:19:03,400 --> 04:19:05,080
DRIVER DIAGRAM WITH GLOBAL AIM

7419
04:19:05,080 --> 04:19:06,200
TO IMPROVE NUMBER OF PATIENTS

7420
04:19:06,200 --> 04:19:08,600
WITH PREGNANCIES COMPLICATED BY

7421
04:19:08,600 --> 04:19:09,320
MEDICAL CONDITIONS WHO WERE

7422
04:19:09,320 --> 04:19:11,040
LINKED TO PRIMARY CARE OR

7423
04:19:11,040 --> 04:19:12,160
MEDICAL HOME WITHIN SIX MONTHS.

7424
04:19:12,160 --> 04:19:18,640
THAT IS WHAT WE DECIDED TO DO.

7425
04:19:18,640 --> 04:19:19,880
ALL THINGS TO THE RIGHT INCLUDE

7426
04:19:19,880 --> 04:19:20,800
MEASURES FOLLOWING OVER THE

7427
04:19:20,800 --> 04:19:22,680
COURSE OF THE INTERVENTION BUT

7428
04:19:22,680 --> 04:19:25,560
THE ONE HIGHLIGHTED IN YELLOW IS

7429
04:19:25,560 --> 04:19:27,240
AGAIN BOTTOM LINE METRIC WE ARE

7430
04:19:27,240 --> 04:19:28,360
LOOKING AT AS PERCENT OF

7431
04:19:28,360 --> 04:19:29,920
PATIENTS LINKED TO PRIMARY CARE

7432
04:19:29,920 --> 04:19:31,200
PROVIDER OR BACK INTO THE

7433
04:19:31,200 --> 04:19:32,760
MEDICAL HOME.

7434
04:19:32,760 --> 04:19:38,360
SIX MONTHS AFTER POST DELIVERY.

7435
04:19:38,360 --> 04:19:41,120
AS I MENTIONED BEFORE 13 SITES

7436
04:19:41,120 --> 04:19:42,800
CAME TO TABLE TO TALK TO US TO

7437
04:19:42,800 --> 04:19:43,800
HELP US THINK ABOUT WHAT WE WERE

7438
04:19:43,800 --> 04:19:44,400
GOING TO DO.

7439
04:19:44,400 --> 04:19:46,520
SIX AMAZING SITES THAT FORM THE

7440
04:19:46,520 --> 04:19:49,000
PARTNERSHIP TO TAKE ON THIS

7441
04:19:49,000 --> 04:19:50,760
WORK.

7442
04:19:50,760 --> 04:19:51,960
AND TAKE A LOOK AT PERCENTAGES

7443
04:19:51,960 --> 04:19:53,000
AND SEE IF WE CAN MOVE THE

7444
04:19:53,000 --> 04:19:54,280
NEEDLE IN TERMS OF KEEPING

7445
04:19:54,280 --> 04:19:59,400
PEOPLE ENGAGED IN CARE.

7446
04:19:59,400 --> 04:20:01,080
WHEN WE TALK ABOUT WHAT WE ARE

7447
04:20:01,080 --> 04:20:02,720
GOING TO DO, WE HAVE TO THINK

7448
04:20:02,720 --> 04:20:04,280
THROUGH WHAT WE HAVE CHOSEN TO

7449
04:20:04,280 --> 04:20:06,200
DO IS WE WANT PRIORITIZE HEALTH

7450
04:20:06,200 --> 04:20:07,600
SERVICES TO BE RECEIVED IN THE

7451
04:20:07,600 --> 04:20:10,400
POSTPARTUM PERIOD WITH BOLDED

7452
04:20:10,400 --> 04:20:12,080
ONE BEING ONE WHO WANTED TO

7453
04:20:12,080 --> 04:20:13,520
FOCUS ON FOR THIS FIRST

7454
04:20:13,520 --> 04:20:13,920
INITIATIVE.

7455
04:20:13,920 --> 04:20:16,640
SO HOW ARE WE GOING TO DO THIS.

7456
04:20:16,640 --> 04:20:18,080
MANY SMALLER GROUP OF THREE

7457
04:20:18,080 --> 04:20:20,080
HEALTH CENTERS CAME TO SUPPORT

7458
04:20:20,080 --> 04:20:20,960
DETERMINING THAT WHAT WAS OUR

7459
04:20:20,960 --> 04:20:23,880
APPROACH GOING TO BE.

7460
04:20:23,880 --> 04:20:25,640
WHAT WE ENDED DECIDING IS

7461
04:20:25,640 --> 04:20:27,000
APPROACH WOULD BE A POPULATION

7462
04:20:27,000 --> 04:20:27,960
HEALTH INTERVENTION MEANING WE

7463
04:20:27,960 --> 04:20:29,680
WERE GOING TO DEVELOP

7464
04:20:29,680 --> 04:20:31,360
ESSENTIALLY A REGISTRY OR LIST

7465
04:20:31,360 --> 04:20:34,040
OF ALL THE PATIENTS AT

7466
04:20:34,040 --> 04:20:35,520
PARTICIPATING SITES THAT WANT TO

7467
04:20:35,520 --> 04:20:37,320
TAKE PART IN THIS INITIATIVE WHO

7468
04:20:37,320 --> 04:20:39,880
THEIR HIGH RISK PATIENTS WERE.

7469
04:20:39,880 --> 04:20:41,800
WE WORK WITH THE SITES TO NUMBER

7470
04:20:41,800 --> 04:20:43,040
ONE WE HAVE TO FIGURE OUT WHO

7471
04:20:43,040 --> 04:20:45,560
WERE THE PATIENTS THEY WANTED TO

7472
04:20:45,560 --> 04:20:47,240
FOLLOW AND NUMBER TWO WE WANT TO

7473
04:20:47,240 --> 04:20:48,880
DETERMINE HOW, HOW ARE WE GOING

7474
04:20:48,880 --> 04:20:50,400
TO FOLLOW THE PATIENTS, WHAT WAS

7475
04:20:50,400 --> 04:20:51,200
THE MECHANISM WHICH WE WERE

7476
04:20:51,200 --> 04:20:55,120
GOING TO KEEP TRACK OF THEM.

7477
04:20:55,120 --> 04:20:57,400
WHO WAS KEEPING TRACK, WHO WAS

7478
04:20:57,400 --> 04:20:58,200
COMMUNICATING WITH THEM BECAUSE

7479
04:20:58,200 --> 04:21:00,840
THIS IS A CASE MANAGEMENT

7480
04:21:00,840 --> 04:21:02,000
INTERVENTION WHEREBY SOMEBODY IS

7481
04:21:02,000 --> 04:21:03,760
FOLLOWING THESE PATIENTS

7482
04:21:03,760 --> 04:21:05,080
CONNECTING WITH THEM AND MAKING

7483
04:21:05,080 --> 04:21:08,000
SURE FACILITATING THEY GET BACK

7484
04:21:08,000 --> 04:21:10,360
INTO CARE.

7485
04:21:10,360 --> 04:21:13,000
THIS JUST DEMONSTRATES WHAT WE

7486
04:21:13,000 --> 04:21:14,800
DID WITH THE SIX PARTICIPATING

7487
04:21:14,800 --> 04:21:16,560
SITES THAT WE ARE WORKING WITH,

7488
04:21:16,560 --> 04:21:17,880
WE WORK WITH THEM TO IDENTIFY

7489
04:21:17,880 --> 04:21:19,440
WHAT ARE THE HIGH RISK CRITERIA

7490
04:21:19,440 --> 04:21:20,880
FOR THE PATIENTS THAT YOU WOULD

7491
04:21:20,880 --> 04:21:22,960
WANT TO MOST PRIORITIZE FOR

7492
04:21:22,960 --> 04:21:25,640
COMING BACK TO THE MEDICAL HOME.

7493
04:21:25,640 --> 04:21:27,760
YOU CAN SEE ALL THE SITES WANTED

7494
04:21:27,760 --> 04:21:28,840
TO WORK WITH PATIENTS WITH

7495
04:21:28,840 --> 04:21:32,800
DIABETES OR GESTATIONAL

7496
04:21:32,800 --> 04:21:33,040
DIABETES.

7497
04:21:33,040 --> 04:21:34,480
LARGE MAJORITY WANTED TO WORK

7498
04:21:34,480 --> 04:21:37,560
WITH HYPERTENSION PREECLAMPSIA.

7499
04:21:37,560 --> 04:21:39,000
SOME HAD OTHER ADDITIONAL HIGH

7500
04:21:39,000 --> 04:21:40,680
RISK CONDITIONS INCLUDING BEING

7501
04:21:40,680 --> 04:21:42,400
TRANSFERRED OUT TO A HIGH RISK

7502
04:21:42,400 --> 04:21:45,400
OB PROVIDER AND A THIRD SITE

7503
04:21:45,400 --> 04:21:46,520
WANTED TO WORK AND FOLLOW

7504
04:21:46,520 --> 04:21:54,760
PATIENTS WHO HAD DEPRESSION.

7505
04:21:54,760 --> 04:21:56,840
PROGRESSION OF COLOR IS PROCESS.

7506
04:21:56,840 --> 04:22:01,480
OVER TO THE LEFT WE FOLLOWED THE

7507
04:22:01,480 --> 04:22:02,800
PROCESS AND WANTED TO SHOW HERE

7508
04:22:02,800 --> 04:22:03,680
AND WHAT WE ARE TRACKING IS

7509
04:22:03,680 --> 04:22:05,840
BEGINNING OF THIS INITIATIVE

7510
04:22:05,840 --> 04:22:08,000
NONE OF OUR SITES WERE FOLLOWING

7511
04:22:08,000 --> 04:22:10,040
OR HAD ANY PROCESS IN PLACE TO

7512
04:22:10,040 --> 04:22:11,840
COORDINATE CARE FOR PATIENTS TO

7513
04:22:11,840 --> 04:22:14,600
MEDICAL HOME AFTER HIGH RISK

7514
04:22:14,600 --> 04:22:15,480
PREGNANCY.

7515
04:22:15,480 --> 04:22:17,320
AND WE WERE PROUD TO SAY BY

7516
04:22:17,320 --> 04:22:19,600
OCTOBER ALL OUR SITES HAD

7517
04:22:19,600 --> 04:22:22,200
PROCESS IN PLACE.

7518
04:22:22,200 --> 04:22:23,640
IT IS A JOURNEY WITH OUR SITES

7519
04:22:23,640 --> 04:22:25,760
TO WORK THROUGH THIS POPULATION

7520
04:22:25,760 --> 04:22:28,960
HEALTH PROCESS BUT THEY ARE ALL

7521
04:22:28,960 --> 04:22:32,480
MOVING ON ALL CYLINDERS NOW.

7522
04:22:32,480 --> 04:22:34,400
MORE PROCESS MEASURES TO SHOW

7523
04:22:34,400 --> 04:22:35,920
THE NUMBER OF STAFF TRAINED

7524
04:22:35,920 --> 04:22:37,200
ACROSS THE SIX ORGANIZATIONS

7525
04:22:37,200 --> 04:22:38,720
THAT WERE WORKING WITH AND THE

7526
04:22:38,720 --> 04:22:40,800
NUMBER LLC MEANS LOCATION OF

7527
04:22:40,800 --> 04:22:42,040
CARE, HOW MANY INDIVIDUAL

7528
04:22:42,040 --> 04:22:46,680
CLINICS SITES IN CITY OF CHICAGO

7529
04:22:46,680 --> 04:22:48,120
ARE IS THIS INTERVENTION TAKING

7530
04:22:48,120 --> 04:22:49,800
PLACE, ONE THING THAT I WANT TO

7531
04:22:49,800 --> 04:22:51,840
KNOW ABOUT OUR PARTNER SITES IS

7532
04:22:51,840 --> 04:22:55,320
THAT IN 2020 ACROSS THESE SITES

7533
04:22:55,320 --> 04:22:56,920
THESE ORGANIZATIONS SAW OVER

7534
04:22:56,920 --> 04:22:58,280
12,000 PRE-NATAL PATIENTS IN

7535
04:22:58,280 --> 04:23:00,000
EACH OF THESE SITES ARE LOCATED

7536
04:23:00,000 --> 04:23:02,040
IN NEIGHBORHOODS IN CHICAGO WITH

7537
04:23:02,040 --> 04:23:04,360
HIGHER RISK OF ADVERSE PERINATAL

7538
04:23:04,360 --> 04:23:10,800
OUTCOMES.

7539
04:23:10,800 --> 04:23:11,840
THIS SHOWS PROGRESS ON MAIN

7540
04:23:11,840 --> 04:23:15,920
OUTCOME.

7541
04:23:15,920 --> 04:23:17,800
WHAT YOU SEE TO LEFT OF PURPLE

7542
04:23:17,800 --> 04:23:19,040
LINE IS BASELINE PERCENT OF

7543
04:23:19,040 --> 04:23:21,440
PATIENTS IDENTIFIED HIGH RISK IN

7544
04:23:21,440 --> 04:23:22,840
EACH DIFFERENT SITES THAT WERE

7545
04:23:22,840 --> 04:23:25,320
DOCUMENTED IN THE YEAR 2020 TO

7546
04:23:25,320 --> 04:23:27,200
HAVE BEEN RECONNECTED TO A

7547
04:23:27,200 --> 04:23:29,080
PRIMARY CARE VISIT AFTER THE

7548
04:23:29,080 --> 04:23:32,000
POSTPARTUM PERIOD.

7549
04:23:32,000 --> 04:23:34,160
DEFINE THE TIME LINE WE WERE

7550
04:23:34,160 --> 04:23:35,200
FOLLOWING WAS SIX MONTHS.

7551
04:23:35,200 --> 04:23:38,200
ONCE WE STARTED THE INITIATIVE

7552
04:23:38,200 --> 04:23:42,680
YOU CAN SEE OVER TIME WE MORE

7553
04:23:42,680 --> 04:23:43,920
THAN DOUBLE NUMBER OF PATIENTS

7554
04:23:43,920 --> 04:23:45,480
IN THIS EFFORT RECONNECTED AND

7555
04:23:45,480 --> 04:23:47,160
HAD A VISIT WITH THE PRIMARY

7556
04:23:47,160 --> 04:23:49,600
CARE PROVIDER AROUND THEIR

7557
04:23:49,600 --> 04:23:50,800
PREVENTIVE HEALTH OPTIMIZATION

7558
04:23:50,800 --> 04:23:57,920
FOR THEIR CHRONIC CONDITION.

7559
04:23:57,920 --> 04:24:01,000
BECAUSE OF THE FINDING WE HAD OR

7560
04:24:01,000 --> 04:24:02,360
ANECDOTAL FINDING THAT WE

7561
04:24:02,360 --> 04:24:03,920
THOUGHT PATIENTS WERE DROPPING

7562
04:24:03,920 --> 04:24:05,440
OFF BETWEEN POSTPARTUM VISIT AND

7563
04:24:05,440 --> 04:24:07,400
PRIMARY CARE VISIT, WE WANTED TO

7564
04:24:07,400 --> 04:24:09,920
DO A SECONDARY DATA ANALYSIS,

7565
04:24:09,920 --> 04:24:12,040
USING THE DATA WAREHOUSE THAT I

7566
04:24:12,040 --> 04:24:13,440
MENTIONED HAS THREE MILLION

7567
04:24:13,440 --> 04:24:13,840
LIVES.

7568
04:24:13,840 --> 04:24:15,400
WHAT WE LOOK AT IS WHAT WAS

7569
04:24:15,400 --> 04:24:16,840
HAPPENING ACROSS ALL THE SITES

7570
04:24:16,840 --> 04:24:20,080
FOR WHOM ALLIANCE CHICAGO HAS

7571
04:24:20,080 --> 04:24:20,880
DATA.

7572
04:24:20,880 --> 04:24:23,200
WERE PATIENTS COMING BACK TO

7573
04:24:23,200 --> 04:24:24,720
PRIMARY CARE SIX MONTHS

7574
04:24:24,720 --> 04:24:25,960
POSTPARTUM IF THEY WERE HIGH

7575
04:24:25,960 --> 04:24:27,480
RISK AND PREDICTORS WESTERN

7576
04:24:27,480 --> 04:24:29,480
LOOKING AT IS HIGH RISK STATUS

7577
04:24:29,480 --> 04:24:31,360
IF THEY LOST INSURANCE AFTER 12

7578
04:24:31,360 --> 04:24:34,080
WEEKS POSTPARTUM, AND WE USE A

7579
04:24:34,080 --> 04:24:35,800
METRIC OF ENGAGEMENT AND CARE

7580
04:24:35,800 --> 04:24:37,680
WHETHER ENGAGED IN CARE

7581
04:24:37,680 --> 04:24:39,400
PRE-PREGNANCY, THEY STARTED THIS

7582
04:24:39,400 --> 04:24:40,920
PREGNANCY IN FIRST TRIMESTER AND

7583
04:24:40,920 --> 04:24:44,000
OR IF THEY WENT TO POSTPARTUM

7584
04:24:44,000 --> 04:24:45,640
VISIT.

7585
04:24:45,640 --> 04:24:47,240
WE DID UNADJUSTED AND ADJUSTED

7586
04:24:47,240 --> 04:24:49,640
ANALYSES.

7587
04:24:49,640 --> 04:24:51,880
WHAT WE FOUND LARGER COHORT OF

7588
04:24:51,880 --> 04:24:54,760
OVER 7,000 PATIENTS WAS THAT

7589
04:24:54,760 --> 04:24:56,280
ABOUT 85% DOCUMENTED POSTPARTUM

7590
04:24:56,280 --> 04:24:57,720
VISIT BUT AS SUSPECTED THAT

7591
04:24:57,720 --> 04:25:01,760
DROPPED OFF TREMENDOUSLY WITH

7592
04:25:01,760 --> 04:25:02,520
17% FOLLOWING PRIMARY CARE

7593
04:25:02,520 --> 04:25:06,480
VISIT.

7594
04:25:06,480 --> 04:25:07,720
RISK INSURANCE LOSS OF

7595
04:25:07,720 --> 04:25:09,600
ENGAGEMENT WERE PREDICTORS OF

7596
04:25:09,600 --> 04:25:11,520
PRIMARY CARE VISIT WITH

7597
04:25:11,520 --> 04:25:13,080
INSURANCE LOSS BEING NEGATIVELY

7598
04:25:13,080 --> 04:25:13,480
ASSOCIATED.

7599
04:25:13,480 --> 04:25:15,280
THEN AGAIN, EVEN AMONG THE HIGH

7600
04:25:15,280 --> 04:25:17,600
RISK COHORT WE LIMITED THE

7601
04:25:17,600 --> 04:25:20,400
COHORT TO JUST THE ONE -- UNDER

7602
04:25:20,400 --> 04:25:23,000
2000 PATIENTS WHO MET HIGH RISK

7603
04:25:23,000 --> 04:25:25,120
CRITERIA AND ONLY 25% PATIENTS

7604
04:25:25,120 --> 04:25:28,560
WENT TO PRIMARY CARE VISIT.

7605
04:25:28,560 --> 04:25:30,560
WHAT THESE LARGER DATA SHOW PLUS

7606
04:25:30,560 --> 04:25:32,600
OUR DATA FROM OUR PILOT IN

7607
04:25:32,600 --> 04:25:34,000
ANECDOTALLY AS A CLINICIAN IS

7608
04:25:34,000 --> 04:25:35,880
MAJORITY OF PATIENTS DON'T MAKE

7609
04:25:35,880 --> 04:25:37,440
THAT TRANSITION AND THAT HAPPENS

7610
04:25:37,440 --> 04:25:40,280
EVEN AMONG HIGHEST RISK PATIENTS

7611
04:25:40,280 --> 04:25:41,600
AND WHILE INSURANCE LOSS

7612
04:25:41,600 --> 04:25:44,320
CONTRIBUTES WE KNOW THAT

7613
04:25:44,320 --> 04:25:45,800
INSURANCE LOSS ALONE ISN'T THE

7614
04:25:45,800 --> 04:25:48,000
ONLY THING AT PLAY AND EVEN WITH

7615
04:25:48,000 --> 04:25:49,800
PATIENTS WHO HAD INSURANCE THEY

7616
04:25:49,800 --> 04:25:52,080
STILL HAVE -- HAD OR STABLE

7617
04:25:52,080 --> 04:25:55,160
INSURANCE THEY HAD LOW RATES OF

7618
04:25:55,160 --> 04:25:56,360
POSTPARTUM UTILIZATION OF

7619
04:25:56,360 --> 04:26:00,200
PRIMARY CARE PROVIDER.

7620
04:26:00,200 --> 04:26:01,360
KEY MILESTONES WHAT I WOULD SAY

7621
04:26:01,360 --> 04:26:04,120
ARE SUCCESSES IS THAT WE BROUGHT

7622
04:26:04,120 --> 04:26:06,640
TOGETHER A ROBUST COLLABORATIVE

7623
04:26:06,640 --> 04:26:10,920
OF VOLUNTARY PARTICIPATION OF

7624
04:26:10,920 --> 04:26:12,360
FQHCs AND AMBULATORY CARE

7625
04:26:12,360 --> 04:26:13,240
CENTERS WHO CAME TOGETHER TO

7626
04:26:13,240 --> 04:26:16,480
WORK WITH US TO DEVELOP THIS

7627
04:26:16,480 --> 04:26:17,720
PROTOCOL WE HAD SIX SITES THAT

7628
04:26:17,720 --> 04:26:22,120
CAME TO THE TABLE RARING TO GO

7629
04:26:22,120 --> 04:26:24,440
TO IMPLEMENT AND WE ARE PROUD OF

7630
04:26:24,440 --> 04:26:26,640
THE WORK THEY HAVE DONE, THEY

7631
04:26:26,640 --> 04:26:28,880
HAVE TAKEN THIS WORK, THEY ARE

7632
04:26:28,880 --> 04:26:30,320
THE ONES DOING CASE MANAGEMENT,

7633
04:26:30,320 --> 04:26:33,960
WE DEVELOPED AN EHR ALGORITHM TO

7634
04:26:33,960 --> 04:26:35,320
IDENTIFY AND TRACK HIGH RISK

7635
04:26:35,320 --> 04:26:37,800
PATIENTS USED TO CREATE THE

7636
04:26:37,800 --> 04:26:40,160
COHORT AND BUILD POPULATION AS

7637
04:26:40,160 --> 04:26:42,800
WELL AS USE IN OUR EHR SECONDARY

7638
04:26:42,800 --> 04:26:44,520
DATA ANALYSIS.

7639
04:26:44,520 --> 04:26:48,240
WE ARE IN THE PROCESS OF

7640
04:26:48,240 --> 04:26:49,200
DISSEMINATION OF DATA AND

7641
04:26:49,200 --> 04:26:52,440
FINALIZING EVALUATION AND

7642
04:26:52,440 --> 04:26:53,720
SUSTAINABILITY ONGOING.

7643
04:26:53,720 --> 04:26:55,920
THE L CHALLENGES HAVE BEEN

7644
04:26:55,920 --> 04:26:57,600
VARIATION ELECTRONIC HEALTH

7645
04:26:57,600 --> 04:26:59,480
RECORD DOCUMENTATION, OBVIOUSLY

7646
04:26:59,480 --> 04:27:03,520
RESOURCES AND CAPACITY AND

7647
04:27:03,520 --> 04:27:06,680
RECOGNIZING THAT WE ARE VISITING

7648
04:27:06,680 --> 04:27:08,680
TESTING WHETHER VISIT ACTUALLY

7649
04:27:08,680 --> 04:27:09,960
HAPPENED AND WE NEED TO START

7650
04:27:09,960 --> 04:27:13,360
DIVING INTO THE QUALITY OF THOSE

7651
04:27:13,360 --> 04:27:16,200
VISITS, PATIENT EXPERIENCE AND

7652
04:27:16,200 --> 04:27:17,880
OTHER METRICS EQUALLY AS

7653
04:27:17,880 --> 04:27:19,640
IMPORTANT AND UNDERSTAND WHY

7654
04:27:19,640 --> 04:27:23,920
PATIENTS MIGHT DROP OUT OF CARE.

7655
04:27:23,920 --> 04:27:26,880
SO WITH THAT I WANT TO MAKE A

7656
04:27:26,880 --> 04:27:28,560
QUICK ACKNOWLEDGMENT FOR STAFF

7657
04:27:28,560 --> 04:27:29,560
AT ALLIANCE CHICAGO.

7658
04:27:29,560 --> 04:27:32,040
I HAVEN'T READ THE PERSON WHO IS

7659
04:27:32,040 --> 04:27:34,400
MY RIGHT HAND AND I COULDN'T DO

7660
04:27:34,400 --> 04:27:35,760
THIS WITHOUT HER, SHE IS DRIVING

7661
04:27:35,760 --> 04:27:37,920
THIS BUS.

7662
04:27:37,920 --> 04:27:39,800
SHE IS ON HERE TODAY AND I

7663
04:27:39,800 --> 04:27:40,880
PUBLICLY THANK HER FOR ALL

7664
04:27:40,880 --> 04:27:43,240
AMAZING WORK SHE'S DONE.

7665
04:27:43,240 --> 04:27:45,240
THESE ARE PARTNER ORGANIZATIONS

7666
04:27:45,240 --> 04:27:47,800
AND JUST TO GIVE OUR THANKS TO

7667
04:27:47,800 --> 04:27:49,240
MARK FOR MOTHERS FOR SUPPORT TO

7668
04:27:49,240 --> 04:27:50,760
DO THIS.

7669
04:27:50,760 --> 04:27:51,840
THESE ARE SOME OF THE SOURCES

7670
04:27:51,840 --> 04:27:55,480
FOR THE THINGS THAT I MENTIONED

7671
04:27:55,480 --> 04:27:58,200
EARLIER AND I THANK YOU AND WISH

7672
04:27:58,200 --> 04:28:00,160
Y'ALL A VERY HAPPY HOLIDAY

7673
04:28:00,160 --> 04:28:00,600
SEASON.

7674
04:28:00,600 --> 04:28:01,800
I WILL PASS IT ON TO THE NEXT

7675
04:28:01,800 --> 04:28:02,040
SPEAKER.

7676
04:28:02,040 --> 04:28:05,360
THANK YOU.

7677
04:28:05,360 --> 04:28:11,960
>> THANK YOU, DR. MASINTER.

7678
04:28:11,960 --> 04:28:13,840
NEXT IS DR. RACHEL CHAMBERS.

7679
04:28:13,840 --> 04:28:16,240
PASSING IT TO YOU.

7680
04:28:16,240 --> 04:28:30,160
>> SHARE MY SCREEN HERE.

7681
04:28:30,160 --> 04:28:41,440
SORRY ABOUT THAT.

7682
04:28:41,440 --> 04:28:42,640
SORRY.

7683
04:28:42,640 --> 04:28:46,120
CAN EVERYBODY SEE MY SCREEN?

7684
04:28:46,120 --> 04:28:48,280
>> LOOKS GOOD.

7685
04:28:48,280 --> 04:28:49,200
>> WONDERFUL.

7686
04:28:49,200 --> 04:28:52,760
BEFORE I START I WANT TO DO A

7687
04:28:52,760 --> 04:28:53,360
LAND ACT KNOW LENG.

7688
04:28:53,360 --> 04:28:54,960
, JOHNS HOPKINS CENTER FOR

7689
04:28:54,960 --> 04:28:56,640
AMERICAN INDIAN HEALTH.

7690
04:28:56,640 --> 04:28:59,760
JOHNS HOPKINS IS IN BALTIMORE

7691
04:28:59,760 --> 04:29:01,080
MARYLAND AND I STAY MYSELF IN

7692
04:29:01,080 --> 04:29:02,800
MADISON WISCONSIN SO IN THE

7693
04:29:02,800 --> 04:29:05,960
SPIRIT OF HEALING I HONOR THE

7694
04:29:05,960 --> 04:29:07,520
NATIONS THE ORIGINAL PEOPLE OF

7695
04:29:07,520 --> 04:29:09,400
THE LAND WHICH JOHNS HOPKINS

7696
04:29:09,400 --> 04:29:12,160
UNIVERSITY OCCUPIES THE ORIGINAL

7697
04:29:12,160 --> 04:29:14,440
PEOPLES OF THE LAND I SIT TODAY

7698
04:29:14,440 --> 04:29:16,240
IN MADISON, WISCONSIN.

7699
04:29:16,240 --> 04:29:17,440
WE GIVE THANKS TO THE PAST

7700
04:29:17,440 --> 04:29:19,400
PRESENT AND FUTURE STEWARDS OF

7701
04:29:19,400 --> 04:29:20,960
THE LAND AND RESPECT TRIBAL

7702
04:29:20,960 --> 04:29:22,640
NATION SOVEREIGNTY AND RIGHT TO

7703
04:29:22,640 --> 04:29:23,080
SELF-DISCRIMINATION.

7704
04:29:23,080 --> 04:29:25,200
WE AIM TO HOLD OURSELVES

7705
04:29:25,200 --> 04:29:26,200
UNIVERSITY COMMUNITY ACCOUNTABLE

7706
04:29:26,200 --> 04:29:28,720
TO TRIBAL NATIONS.

7707
04:29:28,720 --> 04:29:31,560
WITH THAT MY NAME IS RACHEL

7708
04:29:31,560 --> 04:29:32,120
CHAMBERS.

7709
04:29:32,120 --> 04:29:33,800
I AM ASSISTANT SCIENTIST AT

7710
04:29:33,800 --> 04:29:35,400
JOHNS HOPKINS SCHOOL OF PUBLIC

7711
04:29:35,400 --> 04:29:37,600
HEALTH IN THE INTERNATIONAL

7712
04:29:37,600 --> 04:29:39,720
HEALTH DEPARTMENT AND I SIT

7713
04:29:39,720 --> 04:29:42,360
WITHIN A CENTER HOUSEDDE
HOUSEDDED IN THE

7714
04:29:42,360 --> 04:29:42,920
INTERNATIONAL DEPARTMENT OF

7715
04:29:42,920 --> 04:29:44,600
HEALTH CALLED THE JOHNS HOPKINS

7716
04:29:44,600 --> 04:29:45,720
CENTER FOR AMERICAN INDIAN

7717
04:29:45,720 --> 04:29:48,400
HEALTH.  I WANT TO TALK A LITTLE

7718
04:29:48,400 --> 04:29:50,480
BIT ABOUT THE CONTINUUM OF CARE

7719
04:29:50,480 --> 04:29:53,320
SPECIFICALLY ONE PROGRAM THAT

7720
04:29:53,320 --> 04:29:55,520
ADDRESSES CERTAIN TIME OF LIFE

7721
04:29:55,520 --> 04:29:57,640
BUT I WILL TALK ABOUT OUR CENTER

7722
04:29:57,640 --> 04:29:59,400
AND HOW IT WORKS ACROSS THE

7723
04:29:59,400 --> 04:30:00,480
CONTINUUM OF CARE.

7724
04:30:00,480 --> 04:30:02,560
SO WHEN WE THINK WOMEN'S HEALTH

7725
04:30:02,560 --> 04:30:05,600
IT IS IMPORTANT TO THINK ABOUT

7726
04:30:05,600 --> 04:30:07,000
NOT ONLY REPRODUCTIVE HEALTH

7727
04:30:07,000 --> 04:30:08,920
YEARS BUT STAGES OF LIFE AND

7728
04:30:08,920 --> 04:30:10,960
EACH CONTRIBUTE TO CYCLE OF

7729
04:30:10,960 --> 04:30:12,240
GROWTH OUTCOMES AND IMPORTANCE

7730
04:30:12,240 --> 04:30:14,000
OF INTERVENING ACROSS THE LIFE

7731
04:30:14,000 --> 04:30:14,600
CYCLE.

7732
04:30:14,600 --> 04:30:18,000
SO HERE WE HAVE SOME HEALTH

7733
04:30:18,000 --> 04:30:19,400
RELATED OUTCOMES HOW THEY FEED

7734
04:30:19,400 --> 04:30:22,280
INTO EACH OTHER ACROSS THE LIFE

7735
04:30:22,280 --> 04:30:24,040
CYCLE SO NOT BEING PREPARE FORD

7736
04:30:24,040 --> 04:30:27,160
PREGNANCY ADOLESCENT MAY LEAD TO

7737
04:30:27,160 --> 04:30:29,480
LATE PRE-NATAL CARE.

7738
04:30:29,480 --> 04:30:32,000
THIS IS TRUE ACROSS DIABETES AND

7739
04:30:32,000 --> 04:30:36,240
OBESITY SO THERE IS A LOT OF

7740
04:30:36,240 --> 04:30:37,800
RESEARCH ABOUT THE TRANSFER OF

7741
04:30:37,800 --> 04:30:39,760
OBESITY AND DIABETES ACROSS THE

7742
04:30:39,760 --> 04:30:41,600
GENERATIONS SO THIS IS JUST A

7743
04:30:41,600 --> 04:30:45,320
CYCLE ACROSS ONE GENERATION TO

7744
04:30:45,320 --> 04:30:49,000
THE NEXT ACROSS PERSON'S LIFE

7745
04:30:49,000 --> 04:30:51,160
SPAN, OPHIDIANS OVERWEIGHT AND

7746
04:30:51,160 --> 04:30:52,400
PREGNANCY AND OFTEN LEADS TO

7747
04:30:52,400 --> 04:30:53,840
HIGH BIRTH WEIGHT, THAT LEADS TO

7748
04:30:53,840 --> 04:30:57,960
LATER OBESITY, OBESITY DIABETES

7749
04:30:57,960 --> 04:30:59,720
AND AGAIN DIABETES OVERWEIGHT

7750
04:30:59,720 --> 04:31:01,640
AND PREGNANCY.

7751
04:31:01,640 --> 04:31:04,440
SO AT THE CENTER WE THINK ABOUT

7752
04:31:04,440 --> 04:31:06,160
EACH STAGE OF OUR LIVES AND HOW

7753
04:31:06,160 --> 04:31:09,000
WE CAN INTERVENE IN EACH STAGE

7754
04:31:09,000 --> 04:31:12,400
TO IMPROVE REPRODUCTIVE HEALTH

7755
04:31:12,400 --> 04:31:14,280
OUTCOMES AND IMPROVE DIABETES

7756
04:31:14,280 --> 04:31:16,200
OBESITY PROVIDED OUTCOMES.

7757
04:31:16,200 --> 04:31:18,400
SO WACK GROUND ON NATIVE

7758
04:31:18,400 --> 04:31:21,280
AMERICAN POPULATIONS, WE ARE

7759
04:31:21,280 --> 04:31:23,600
GENERALIZING I WORK PRIMARILY

7760
04:31:23,600 --> 04:31:26,520
WITH TRIBAL COMMUNITIES IN SOUTH

7761
04:31:26,520 --> 04:31:27,840
WESTERN UNITED STATES.

7762
04:31:27,840 --> 04:31:29,040
SO THESE STATISTICS ARE

7763
04:31:29,040 --> 04:31:30,000
NATIONWIDE BUT I WANT TO

7764
04:31:30,000 --> 04:31:32,520
RECOGNIZE THAT THERE IS A BIG

7765
04:31:32,520 --> 04:31:33,440
DIFFERENCE TRIBAL NATION ARE NOT

7766
04:31:33,440 --> 04:31:34,800
ALL THE SAME AND TRIBAL PEOPLE

7767
04:31:34,800 --> 04:31:37,600
ARE NOT ALL THE SAME.

7768
04:31:37,600 --> 04:31:39,720
BUT OVERALL NATIVE AMERICAN VIEW

7769
04:31:39,720 --> 04:31:43,200
SO WITH THE YOUTH ADOLESCENCE

7770
04:31:43,200 --> 04:31:44,080
PRE-CONCEPTION NATIVE AMERICAN

7771
04:31:44,080 --> 04:31:47,720
YOUTH HAVE HIGHEST TEEN BIRTH

7772
04:31:47,720 --> 04:31:49,960
WEIGHT, ALSO HAVE SUFFER FROM

7773
04:31:49,960 --> 04:31:52,240
HIGH BURDEN OF CHLAMYDIA

7774
04:31:52,240 --> 04:31:54,600
GONORRHEA AND OTHER SEXUALLY

7775
04:31:54,600 --> 04:31:55,280
TRANSMITTED INFECTION.

7776
04:31:55,280 --> 04:31:58,000
LESS LIKELY TO USE CONTRACEPTION

7777
04:31:58,000 --> 04:31:59,360
COMPARED TO NON-HISPANIC WHITE

7778
04:31:59,360 --> 04:31:59,880
POPULATION.

7779
04:31:59,880 --> 04:32:02,560
IN ADDITION TO THESE SEXUAL

7780
04:32:02,560 --> 04:32:07,560
HEALTH DISPARITIES WE HAVE THIS

7781
04:32:07,560 --> 04:32:09,400
DIABETES AND OBESITY DISPARITIES

7782
04:32:09,400 --> 04:32:11,080
GOING ON SO NATIVE YOUTH HAVE

7783
04:32:11,080 --> 04:32:13,160
HIGH PREVALENCE OF TYPE 2

7784
04:32:13,160 --> 04:32:15,520
DIABETES AND OBESITY WHEN

7785
04:32:15,520 --> 04:32:20,120
COMPARED TO OTHER RACIAL ETHNIC

7786
04:32:20,120 --> 04:32:20,360
GROUPS.

7787
04:32:20,360 --> 04:32:21,600
SO NOW LOOKING AT PREGNANCY AND

7788
04:32:21,600 --> 04:32:23,800
MATERNAL HEALTH AND THESE ARE

7789
04:32:23,800 --> 04:32:26,240
JUST STATISTICS, ALL OF THEM BUT

7790
04:32:26,240 --> 04:32:28,560
SO NATIVE WOMEN ARE MUCH LESS

7791
04:32:28,560 --> 04:32:31,560
LIKELY TO RECEIVE PRE-NATAL CARE

7792
04:32:31,560 --> 04:32:34,000
AT ALL OR MORE LIKELY TO RECEIVE

7793
04:32:34,000 --> 04:32:35,200
PRE-NATAL CARE LATER IN

7794
04:32:35,200 --> 04:32:35,840
PREGNANCY.

7795
04:32:35,840 --> 04:32:37,400
THEY ARE ALSO THREE TO FOUR MORE

7796
04:32:37,400 --> 04:32:40,120
TIMES LIKELY TO DIE DURING

7797
04:32:40,120 --> 04:32:41,560
CHILDBIRTH, OF COMPLICATIONS

7798
04:32:41,560 --> 04:32:42,880
DURING CHILDBIRTH.

7799
04:32:42,880 --> 04:32:44,920
IN ADDITION TO THAT, THERE ARE

7800
04:32:44,920 --> 04:32:48,240
ALSO MUCH MORE LIKELY TO BE

7801
04:32:48,240 --> 04:32:50,160
DIAGNOSED WITH GESTATIONAL

7802
04:32:50,160 --> 04:32:52,240
DIABETES AND DIAGNOSED WITH

7803
04:32:52,240 --> 04:32:54,440
GESTATIONAL HYPERTENSION SO WE

7804
04:32:54,440 --> 04:32:57,320
HAVE THESE REPRODUCTIVE HEALTH

7805
04:32:57,320 --> 04:33:00,160
DISPARITIES GOING ON SUCH AS

7806
04:33:00,160 --> 04:33:02,800
PRE-NATAL CARE AND WE HAVE SOME

7807
04:33:02,800 --> 04:33:04,320
OBESITY DIABETES OUTCOME

7808
04:33:04,320 --> 04:33:06,720
DISPARITIES GOING ON.

7809
04:33:06,720 --> 04:33:09,400
INFANT HEALTH AMERICAN INDIANS

7810
04:33:09,400 --> 04:33:11,720
HAVE TWICE INFANT MORTALITY

7811
04:33:11,720 --> 04:33:14,280
RATE, AS NON-HISPANIC WHITES,

7812
04:33:14,280 --> 04:33:16,200
44% LIKELY TO HAVE BASE LOW

7813
04:33:16,200 --> 04:33:17,880
BIRTH WEIGHT BUT FLIP SIDE HAVE

7814
04:33:17,880 --> 04:33:21,400
GREATER PERCENTAGE OF AMERICAN

7815
04:33:21,400 --> 04:33:22,840
INDIAN WOMEN GIRTH BIRTH TO

7816
04:33:22,840 --> 04:33:25,200
LARGE FOR GESTATIONAL AGE BABY.

7817
04:33:25,200 --> 04:33:26,360
SO DOUBLE BURDEN.

7818
04:33:26,360 --> 04:33:28,080
LOW BIRTH WEIGHT AND

7819
04:33:28,080 --> 04:33:29,600
MALNUTRITION BUT ALSO HAVE THE

7820
04:33:29,600 --> 04:33:30,960
HIGH BIRTH WEIGHT AND

7821
04:33:30,960 --> 04:33:31,720
OVERNUTRITION HERE.

7822
04:33:31,720 --> 04:33:34,800
SO THAT IS SORT OF WHAT BRINGS

7823
04:33:34,800 --> 04:33:37,960
US TO WHAT CENTER HAS BEEN DOING

7824
04:33:37,960 --> 04:33:39,840
LATELY AND I WANT TO GIVE A

7825
04:33:39,840 --> 04:33:41,240
QUICK BACKGROUND ON WHAT THE

7826
04:33:41,240 --> 04:33:43,600
CENTER IS AND WHO WE ARE.

7827
04:33:43,600 --> 04:33:50,200
WE WERE FOUNDED BY A DOCTOR IN

7828
04:33:50,200 --> 04:33:51,880
1991, HE MOVED -- HE WAS DOING

7829
04:33:51,880 --> 04:33:53,320
RESIDENCY IN PEDIATRICS AND

7830
04:33:53,320 --> 04:33:56,920
MOVED OUT TO THE APATCHY

7831
04:33:56,920 --> 04:33:59,640
RESERVATION AND DID -- APATCHY

7832
04:33:59,640 --> 04:34:00,360
AND DID WORK THERE AS

7833
04:34:00,360 --> 04:34:01,360
PEDIATRICIAN AND DID RESEARCH

7834
04:34:01,360 --> 04:34:03,160
FOR THE TRIBAL COMMUNITIES

7835
04:34:03,160 --> 04:34:05,120
THERE, WHO ARE FIVE TO TEN YEARS

7836
04:34:05,120 --> 04:34:07,360
AND THEN HE CAME BACK TO HOPKINS

7837
04:34:07,360 --> 04:34:08,800
AND SAID WE NEED TO DO SOMETHING

7838
04:34:08,800 --> 04:34:10,440
ABOUT SOME OF THESE HEALTH

7839
04:34:10,440 --> 04:34:12,240
DISPARITIES IN NATIVE

7840
04:34:12,240 --> 04:34:13,520
POPULATIONS SO HE FOUNDED THE

7841
04:34:13,520 --> 04:34:14,760
CENTER FOR AMERICAN INDIAN

7842
04:34:14,760 --> 04:34:17,280
HEALTH AND YOU CAN READ OUR

7843
04:34:17,280 --> 04:34:17,840
MISSION THERE.

7844
04:34:17,840 --> 04:34:21,360
THE CENTER NOW HAS THREE CORE

7845
04:34:21,360 --> 04:34:23,160
AREAS, WE HAVE A TRAINING ARM,

7846
04:34:23,160 --> 04:34:25,680
THE TRAINING ARM IS TASKED WITH

7847
04:34:25,680 --> 04:34:28,240
DOING IS HELPING TO RAISE

7848
04:34:28,240 --> 04:34:30,680
SELF-SUFFICIENCY AND EDUCATION.

7849
04:34:30,680 --> 04:34:32,360
MOST OF NATIVE POPULATIONS.

7850
04:34:32,360 --> 04:34:37,520
SO WE PROVIDE SCHOLARSHIPS, TO

7851
04:34:37,520 --> 04:34:40,200
NATIVE SCHOLARS, AT HOPKINS AND

7852
04:34:40,200 --> 04:34:42,280
OTHER ORGANIZATIONS, WE PROVIDE

7853
04:34:42,280 --> 04:34:44,160
INSTITUTE COURSE THAT IS FOCUSED

7854
04:34:44,160 --> 04:34:47,800
ON NATIVE HEALTH AND PROVIDE

7855
04:34:47,800 --> 04:34:49,800
SUPPORT TO NATIVE PEOPLES

7856
04:34:49,800 --> 04:34:52,320
PURSUING BACHELORS DEGREE OR

7857
04:34:52,320 --> 04:34:53,840
MASTERS OR DOCTORATE.

7858
04:34:53,840 --> 04:34:57,160
WE ALSO HAVE INFECTIOUS DISEASE

7859
04:34:57,160 --> 04:34:58,400
PREVENTION ARM WHICH

7860
04:34:58,400 --> 04:35:01,240
HISTORICALLY IS FOCUSED MORE ON

7861
04:35:01,240 --> 04:35:03,440
PNEUMOCOCCAL DISEASE AND RSV IN

7862
04:35:03,440 --> 04:35:05,320
LAST TWO YEARS SHIFTED TO COVID

7863
04:35:05,320 --> 04:35:08,960
BUT WE STILL DO OTHER INFECTIOUS

7864
04:35:08,960 --> 04:35:10,600
DISEASE ESPECIALLY THOSE THAT

7865
04:35:10,600 --> 04:35:12,480
ARE LARGE BURDEN WITH INFANTS

7866
04:35:12,480 --> 04:35:16,040
AND BABIES.

7867
04:35:16,040 --> 04:35:17,720
WE HAVE BEHAVIORAL HEALTH MENTAL

7868
04:35:17,720 --> 04:35:18,960
HEALTH PROMOTION.

7869
04:35:18,960 --> 04:35:24,400
THIS STARTED IN EARLY 2000 AS

7870
04:35:24,400 --> 04:35:25,600
BURDEN OF DISEASE SHIFTING FROM

7871
04:35:25,600 --> 04:35:26,920
MENTAL HEALTH PROMOTION.

7872
04:35:26,920 --> 04:35:30,400
THIS IS WHERE THE WORK THAT I DO

7873
04:35:30,400 --> 04:35:32,000
IS WORK IS IN REPRODUCTIVE

7874
04:35:32,000 --> 04:35:33,480
HEALTH AND SOME WORK ON DIABETES

7875
04:35:33,480 --> 04:35:35,520
AND OBESITY.

7876
04:35:35,520 --> 04:35:38,800
WE HAVE A WIDE BREADTH OF WORK

7877
04:35:38,800 --> 04:35:46,040
IN THIS AREA.

7878
04:35:46,040 --> 04:35:47,560
SO THE HEADQUARTERS IS IN BALL

7879
04:35:47,560 --> 04:35:49,600
MORE MARYLAND SCHOOL OF PUBLIC

7880
04:35:49,600 --> 04:35:51,040
HEALTH, WE HAVE ADMINISTRATIVE

7881
04:35:51,040 --> 04:35:53,680
OFFICES IN DULUTH MINNESOTA AND

7882
04:35:53,680 --> 04:35:55,760
IN ALBUQUERQUE NEW MEXICO, AND

7883
04:35:55,760 --> 04:35:57,920
WE HAVE SITE OFFICES ACROSS THE

7884
04:35:57,920 --> 04:35:59,200
SOUTHWEST.

7885
04:35:59,200 --> 04:36:02,120
WE EMPLOY 120 PEOPLE AND

7886
04:36:02,120 --> 04:36:04,760
MAJORITY ARE NATIVE AND MANY ARE

7887
04:36:04,760 --> 04:36:07,640
FROM THE COMMUNITIES IN WHICH

7888
04:36:07,640 --> 04:36:11,240
THEY WORK.

7889
04:36:11,240 --> 04:36:14,000
SATISFY AT SITES ARE OFTEN FROM

7890
04:36:14,000 --> 04:36:14,920
COMMUNITIES.

7891
04:36:14,920 --> 04:36:16,760
SO THERE IS THREE ASPECT OF A

7892
04:36:16,760 --> 04:36:18,320
MODEL FOR ALL THE WORK THAT WE

7893
04:36:18,320 --> 04:36:20,280
DO AT THE CENTER THAT IS

7894
04:36:20,280 --> 04:36:21,600
IMPORTANT ESPECIALLY WHEN DOING

7895
04:36:21,600 --> 04:36:23,040
RESEARCH WITH TRIBAL COMMUNITIES

7896
04:36:23,040 --> 04:36:25,800
AND ONE IS COMMUNITY BASED

7897
04:36:25,800 --> 04:36:26,720
PARTICIPATORY RESEARCH.

7898
04:36:26,720 --> 04:36:29,480
WE WORK WITH THE TRIBE TO

7899
04:36:29,480 --> 04:36:31,960
IDENTIFY WHAT ISSUES ARE SALIENT

7900
04:36:31,960 --> 04:36:34,160
FOR THE COMMUNITY AND IDENTIFY

7901
04:36:34,160 --> 04:36:35,600
SOLUTIONS TOGETHER AND REALLY

7902
04:36:35,600 --> 04:36:37,040
COMMUNITY BASED PARTICIPATORY

7903
04:36:37,040 --> 04:36:38,920
RESEARCH IS ABOUT MUTUAL RESPECT

7904
04:36:38,920 --> 04:36:40,600
AND MUTUAL TRUST.

7905
04:36:40,600 --> 04:36:42,800
AND IS REALLY HELPFUL THAT WE

7906
04:36:42,800 --> 04:36:44,600
HAVE STAFF IN THE COMMUNITIES TO

7907
04:36:44,600 --> 04:36:48,080
HELP GUIDE THE WORK.

7908
04:36:48,080 --> 04:36:49,920
ANOTHER MODEL WE OFTEN USE, NOT

7909
04:36:49,920 --> 04:36:51,120
ALL THE TIME BUT IS THE

7910
04:36:51,120 --> 04:36:54,000
COMMUNITY HEALTH WORKER MODEL,

7911
04:36:54,000 --> 04:36:55,600
COMMUNITY HEALTH WORKERS HAVE A

7912
04:36:55,600 --> 04:36:56,720
HUGE ADVANTAGE, THEY UNDERSTAND

7913
04:36:56,720 --> 04:36:58,520
THE LOCAL CONTEXT AND BELIEF,

7914
04:36:58,520 --> 04:37:01,280
THEY SPEAK A LOT OF THEM SPEAK

7915
04:37:01,280 --> 04:37:02,320
THE NATIVE LANGUAGE ESPECIALLY

7916
04:37:02,320 --> 04:37:04,600
THE OLDER POPULATION SOME DON'T

7917
04:37:04,600 --> 04:37:05,800
SPEAK ENGLISH SO YOU NEED

7918
04:37:05,800 --> 04:37:07,640
SOMEONE THERE THAT UNDERSTANDS

7919
04:37:07,640 --> 04:37:08,880
THE NATIVE LANGUAGE.

7920
04:37:08,880 --> 04:37:10,800
THEY DON'T NEED A FORMAL DEGREE

7921
04:37:10,800 --> 04:37:13,000
AND WHILE MORE NATIVE AMERICAN

7922
04:37:13,000 --> 04:37:14,680
PEOPLE ARE PURSUING DEGREES AND

7923
04:37:14,680 --> 04:37:17,680
BECOMING NURSES AND AND GETTING

7924
04:37:17,680 --> 04:37:19,720
OTHER ADVANCE DEGREES IT IS HARD

7925
04:37:19,720 --> 04:37:20,800
IN SOME RESERVATION COMMUNITIES

7926
04:37:20,800 --> 04:37:24,800
TO FIND PEOPLE WITH DEGREES.

7927
04:37:24,800 --> 04:37:27,560
YOU HAVE TO PROVIDE EXTENSIVE

7928
04:37:27,560 --> 04:37:29,440
TRAINING AND FOR MOST PROJECTS

7929
04:37:29,440 --> 04:37:33,480
WE ALSO PROVIDE MANUALIZED

7930
04:37:33,480 --> 04:37:37,280
CURRICULA TO HELP GUIDE

7931
04:37:37,280 --> 04:37:39,040
CONVERSATION.

7932
04:37:39,040 --> 04:37:41,960
THEN LAST WHICH I SORT OF TALKED

7933
04:37:41,960 --> 04:37:43,280
ABOUT IS WE BELIEVE THAT WE DO

7934
04:37:43,280 --> 04:37:44,760
IMMEDIATE TO INTERVENE ACROSS

7935
04:37:44,760 --> 04:37:46,760
THE LIFE SPAN, THAT ONE -- NOT

7936
04:37:46,760 --> 04:37:48,960
ONE PART OF HUMAN LIFE CYCLE IS

7937
04:37:48,960 --> 04:37:50,320
NOT NECESSARILY MORE IMPORTANT

7938
04:37:50,320 --> 04:37:51,320
THAN ANOTHER.

7939
04:37:51,320 --> 04:37:53,000
ESPECIALLY WHEN THINKING ABOUT

7940
04:37:53,000 --> 04:37:56,680
ACROSS THE GENERATION.

7941
04:37:56,680 --> 04:37:58,600
SO IN MANY POPULATIONS ACROSS

7942
04:37:58,600 --> 04:38:00,440
THE U.S. INCLUDING NATIVE

7943
04:38:00,440 --> 04:38:02,440
COMMUNITIES, IS REALLY NOT

7944
04:38:02,440 --> 04:38:04,920
THINKING ABOUT TODAY, THINKING

7945
04:38:04,920 --> 04:38:06,160
ABOUT THE NEXT GENERATIONS GOING

7946
04:38:06,160 --> 04:38:07,600
TO DO SO WE WANT OUR WORK TO

7947
04:38:07,600 --> 04:38:10,080
THINK ABOUT HOW CAN WE IMPACT

7948
04:38:10,080 --> 04:38:11,280
GREAT, GREAT, GREAT

7949
04:38:11,280 --> 04:38:12,960
GRANDCHILDREN AND WHERE WE NEED

7950
04:38:12,960 --> 04:38:14,400
TO INTERVENE IN ORDER TO STOP

7951
04:38:14,400 --> 04:38:18,040
THE CYCLE OF THESE HEALTH

7952
04:38:18,040 --> 04:38:18,960
DISPARITIES WE ARE SEEING.

7953
04:38:18,960 --> 04:38:21,160
SO THIS IS JUST SOME OF OUR

7954
04:38:21,160 --> 04:38:22,520
PROJECTS WE HAVE MANY MORE GOING

7955
04:38:22,520 --> 04:38:26,200
ON BUT THE PROJECTS THAT ARE

7956
04:38:26,200 --> 04:38:28,120
HIGHLIGHTED IN BLUE FOCUS ON

7957
04:38:28,120 --> 04:38:30,320
REPRODUCTIVE HEALTH AND ONES

7958
04:38:30,320 --> 04:38:32,720
THAT ARE BOLDED ARE FOCUSED ON

7959
04:38:32,720 --> 04:38:34,880
DIABETES OBESITY TYPE OUTCOMES.

7960
04:38:34,880 --> 04:38:37,480
SO YOU CAN SEE SOME OF THEM

7961
04:38:37,480 --> 04:38:38,000
OVERLAP BOTH.

7962
04:38:38,000 --> 04:38:40,480
TODAY I WILL TALK ABOUT FAMILY

7963
04:38:40,480 --> 04:38:43,600
SPIRIT WHICH IS PROGRAM THAT IS

7964
04:38:43,600 --> 04:38:47,280
FOR PARENTS AND YOUNG CHILDREN.

7965
04:38:47,280 --> 04:38:49,840
SO FAMILIES SOME PEOPLE MAY BE

7966
04:38:49,840 --> 04:38:51,800
FAMILIAR WITH THIS BUT LARGEST

7967
04:38:51,800 --> 04:38:54,280
ONLY EVIDENCE BASED CULTURALLY

7968
04:38:54,280 --> 04:38:56,000
TAILORED HOME VISITING IS

7969
04:38:56,000 --> 04:38:57,640
INTERVENTION PROGRAM FOR EVERY

7970
04:38:57,640 --> 04:38:59,000
NATIVE AMERICAN FAMILIES.

7971
04:38:59,000 --> 04:39:00,800
IT IS DELIVERED BY

7972
04:39:00,800 --> 04:39:02,120
PARAPROFESSIONALS OR INDIAN

7973
04:39:02,120 --> 04:39:03,560
HEALTH SERVICE, OFTEN DELIVERED

7974
04:39:03,560 --> 04:39:04,600
BY COMMUNITY HEALTH

7975
04:39:04,600 --> 04:39:07,200
REPRESENTATIVES.

7976
04:39:07,200 --> 04:39:09,000
IT IS SUPPORT YOUNG NATIVE

7977
04:39:09,000 --> 04:39:10,320
PARENTS FROM PREGNANCY TO THREE

7978
04:39:10,320 --> 04:39:13,520
YEARS POSTPARTUM.

7979
04:39:13,520 --> 04:39:18,360
SO IN THIS PROGRAM HOME VISITORS

7980
04:39:18,360 --> 04:39:21,960
TALK ABOUT A SLEW OF TOPICS OVER

7981
04:39:21,960 --> 04:39:23,560
63 LESSONS.

7982
04:39:23,560 --> 04:39:26,200
A LONG PROGRAM BUT HELPS GUIDE

7983
04:39:26,200 --> 04:39:28,160
THESE MOMS FROM LAST TRIMESTER

7984
04:39:28,160 --> 04:39:32,000
OF PREGNANCY THROUGH THREE YEARS

7985
04:39:32,000 --> 04:39:34,000
AGO CHILDBIRTH.

7986
04:39:34,000 --> 04:39:36,200
SO FAMILY SPIRIT HAS HAD GREAT

7987
04:39:36,200 --> 04:39:38,200
OUTCOMES WE HAVE DONE RANDOMIZED

7988
04:39:38,200 --> 04:39:41,120
CRIMINAL TRIALS OF IT, THESE ARE

7989
04:39:41,120 --> 04:39:42,280
OUTCOMES THAT WAS CONSTRUCT

7990
04:39:42,280 --> 04:39:44,040
CONDUCT MISDEMEANOR THE LATE

7991
04:39:44,040 --> 04:39:45,680
2000s, AND REALLY WE SAW

7992
04:39:45,680 --> 04:39:49,400
POSITIVE IMPACT ACROSS THE

7993
04:39:49,400 --> 04:39:51,000
PARENTING DOMAIN, MOTHERS

7994
04:39:51,000 --> 04:39:53,080
OUTCOME INCLUDING DECREASED

7995
04:39:53,080 --> 04:39:54,480
DEPRESSION AND CHILD OUTCOME

7996
04:39:54,480 --> 04:39:55,480
INCLUDING SOME OF THESE

7997
04:39:55,480 --> 04:39:58,000
IMPORTANT FACTORS THAT WE KNOW

7998
04:39:58,000 --> 04:40:00,000
ARE SET THE STAGE FOR AD LESS

7999
04:40:00,000 --> 04:40:01,520
DENSE AND LATER HEALTH

8000
04:40:01,520 --> 04:40:04,080
DISPARITIES INCLUDING SOCIAL

8001
04:40:04,080 --> 04:40:05,600
EMOTIONAL BEHAVIORAL PROBLEMS

8002
04:40:05,600 --> 04:40:07,800
THROUGH AGE 3 SO INTERNALIZED

8003
04:40:07,800 --> 04:40:10,760
EXTERNALIZING FACTORS BEGIN MUCH

8004
04:40:10,760 --> 04:40:11,840
LOWER AMONG THOSE WHO RECEIVED

8005
04:40:11,840 --> 04:40:13,040
THE INTERVENTION COMPARED TO

8006
04:40:13,040 --> 04:40:17,800
THOSE WHO DIDN'T AT AGE 3.

8007
04:40:17,800 --> 04:40:19,000
SO THIS PROGRAM HAS BEEN

8008
04:40:19,000 --> 04:40:21,600
REPLICATED IN MANY NATIVE

8009
04:40:21,600 --> 04:40:24,040
COMMUNITIES AND IT'S GOT STRONG

8010
04:40:24,040 --> 04:40:27,440
EVIDENCE BASE, BASED ON SOME OF

8011
04:40:27,440 --> 04:40:28,600
THE FEEDBACK WE RECEIVED FROM

8012
04:40:28,600 --> 04:40:31,120
OUR LOCAL COMMUNITIES REALLY

8013
04:40:31,120 --> 04:40:33,000
UNDERSTANDING THE LITERATURE

8014
04:40:33,000 --> 04:40:35,000
THAT HAS COME OUT OVER DECADE

8015
04:40:35,000 --> 04:40:36,920
EVEN LONGER, ABOUT THE

8016
04:40:36,920 --> 04:40:38,920
IMPORTANCE OF THIS THOUSAND DAYS

8017
04:40:38,920 --> 04:40:40,680
OF LIFE FROM PREGNANCY THROUGH

8018
04:40:40,680 --> 04:40:43,080
TWO YEARS AS A CRITICAL POINT

8019
04:40:43,080 --> 04:40:45,000
FOR INTERVENING FOR OBESITY

8020
04:40:45,000 --> 04:40:47,920
ACROSS THE ENTIRE LIFE SPAN.

8021
04:40:47,920 --> 04:40:49,360
YES RECEIVED FUNDING FROM THE

8022
04:40:49,360 --> 04:40:52,840
ROBERT WOOD JOHNSON FOUNDATION

8023
04:40:52,840 --> 04:40:55,120
TO DEVELOP FAMILY SPIRIT NURTURE

8024
04:40:55,120 --> 04:40:57,760
WHICH IS A COMPLIMENT FAMILY

8025
04:40:57,760 --> 04:41:00,800
SPIRIT PROGRAM AND FOCUSES ON

8026
04:41:00,800 --> 04:41:02,840
CHILDHOOD MALL NUTRITION OBESITY

8027
04:41:02,840 --> 04:41:04,680
FOOD AND WATER INSECURITY.

8028
04:41:04,680 --> 04:41:06,000
THE RATIONALE BEHIND THIS WHICH

8029
04:41:06,000 --> 04:41:08,600
I DESCRIBED IS THAT WE KNOW

8030
04:41:08,600 --> 04:41:11,960
CHILDREN WHO ARE INTRODUCE

8031
04:41:11,960 --> 04:41:13,040
BEFORE SIX MONTHS ARE MORE

8032
04:41:13,040 --> 04:41:15,480
LIKELY TO BE OBESE AT AGE SIX,

8033
04:41:15,480 --> 04:41:19,640
WE KNOW THE MORE SERVICE

8034
04:41:19,640 --> 04:41:21,720
SWEETENED SUGAR BEVERAGES UNDER

8035
04:41:21,720 --> 04:41:23,200
AGE 1 THE MORE LIKELY OBESE

8036
04:41:23,200 --> 04:41:25,840
LATER IN LIFE.

8037
04:41:25,840 --> 04:41:27,520
WE ALSO KNOW AS I HAD PREVIOUS

8038
04:41:27,520 --> 04:41:29,400
SLIDE THAT NATIVE AMERICAN

8039
04:41:29,400 --> 04:41:31,360
CHILDREN ARE SUFFERING FROM

8040
04:41:31,360 --> 04:41:33,600
HIGHEST RATES OF OVERWEIGH AND

8041
04:41:33,600 --> 04:41:36,600
OBESE, IN A STUDY CONDUCTED A

8042
04:41:36,600 --> 04:41:39,720
BIT AGO ABOUT 42% NATIVE

8043
04:41:39,720 --> 04:41:41,040
PRE-SCHOOLERS WERE OVER WEIGHT.

8044
04:41:41,040 --> 04:41:43,480
WE ALSO KNOW THERE ARE KNOWN

8045
04:41:43,480 --> 04:41:44,960
RISK AMONG HEALTH AND CHILDREN

8046
04:41:44,960 --> 04:41:46,600
SO EARLY INTRODUCTION TO

8047
04:41:46,600 --> 04:41:47,960
SWEETENED BEVERAGES AND POOR

8048
04:41:47,960 --> 04:41:50,400
FEEDING PRACTICES.

8049
04:41:50,400 --> 04:41:53,400
OUR TEAM IN CONSULTATION WITH

8050
04:41:53,400 --> 04:41:56,360
SOME EXPERTS AROUND CHILD

8051
04:41:56,360 --> 04:41:58,880
FEEDING AND BREAST FEEDING,

8052
04:41:58,880 --> 04:41:59,920
SPECIFICALLY RESPONSIVE FEEDING

8053
04:41:59,920 --> 04:42:02,400
WITH OUR COMMUNITY PARTNERS, PUT

8054
04:42:02,400 --> 04:42:05,120
TOGETHER A PROGRAM THAT WE CALL

8055
04:42:05,120 --> 04:42:05,920
FAMILY SPIRIT NURTURE AND TESTED

8056
04:42:05,920 --> 04:42:10,000
THROUGH A STUDY THAT WE CALL

8057
04:42:10,000 --> 04:42:11,560
PICO 1, THERE IS A # I WON'T

8058
04:42:11,560 --> 04:42:13,280
TALK ABOUT TODAY BUT I HAVE MY

8059
04:42:13,280 --> 04:42:14,080
CONTACT INFORMATION AND CONTACT

8060
04:42:14,080 --> 04:42:16,000
INFORMATION OF A COLLEAGUE IF

8061
04:42:16,000 --> 04:42:17,800
YOU WANT MORE INFORMATION ABOUT

8062
04:42:17,800 --> 04:42:21,880
PICO 2 A MUCH LONGER

8063
04:42:21,880 --> 04:42:22,480
INTERVENTION.

8064
04:42:22,480 --> 04:42:25,560
ESSENTIALLY LOOKING AT SIX HOME

8065
04:42:25,560 --> 04:42:28,840
BASE LESSONS FOCUSED ON REDUCING

8066
04:42:28,840 --> 04:42:31,160
SUGAR SWEETENED BEVERAGE INTAKE

8067
04:42:31,160 --> 04:42:32,200
RESPONSIVE FEEDING BREAST

8068
04:42:32,200 --> 04:42:33,240
FEEDING COMPARED TO CONTROL

8069
04:42:33,240 --> 04:42:35,560
WHICH ARE HOME BASED INJURY

8070
04:42:35,560 --> 04:42:36,960
PREVENTION EDUCATION.

8071
04:42:36,960 --> 04:42:37,960
THOSE WERE DELIVERED WHEN THE

8072
04:42:37,960 --> 04:42:40,800
KIDS WERE 3 TO 6 MONTHS OF AGE

8073
04:42:40,800 --> 04:42:42,920
AND THEN WE ALSO DELIVER WATER

8074
04:42:42,920 --> 04:42:46,640
FROM SIX TO NINE MONTHS OF AGE.

8075
04:42:46,640 --> 04:42:48,120
I WILL SHOW IN ANOTHER SLIDE

8076
04:42:48,120 --> 04:42:51,440
WATER IS A SECURITY ISSUE ON

8077
04:42:51,440 --> 04:42:53,760
NAVAHO NATION, SOME STUDIES 40%

8078
04:42:53,760 --> 04:42:56,040
WATER INSECURE MANY THIS STUDY

8079
04:42:56,040 --> 04:42:57,640
MOMS 60% REPORTED THEY ARE WATER

8080
04:42:57,640 --> 04:42:59,200
INSECURE.

8081
04:42:59,200 --> 04:43:02,000
WE'LL GET TO THAT IN A MINUTE.

8082
04:43:02,000 --> 04:43:03,440
FIRST I WANT TO SHOW YOU THE

8083
04:43:03,440 --> 04:43:07,600
STUDY DESIGN AND TALK ABOUT THE

8084
04:43:07,600 --> 04:43:09,520
FAMILY SPIRIT CURRICULUM LESSONS

8085
04:43:09,520 --> 04:43:11,960
THREE TO SIX MONTHS POSTPARTUM,

8086
04:43:11,960 --> 04:43:14,480
SO ESSENTIALLY WE RECRUITED MOMS

8087
04:43:14,480 --> 04:43:17,000
WHO ENROLLED IN THE STUDY AND

8088
04:43:17,000 --> 04:43:18,800
EITHER RANDOMIZE TO INTERVENTION

8089
04:43:18,800 --> 04:43:21,000
CONTROL AND WE DID CONTROL FOR

8090
04:43:21,000 --> 04:43:23,200
WATER SECURITY STATUS INSECURE

8091
04:43:23,200 --> 04:43:26,840
VERSUS SECURE, AND WE DELIVERED

8092
04:43:26,840 --> 04:43:28,600
THE INTERVENTION FROM 3 TO 6

8093
04:43:28,600 --> 04:43:30,280
MONTHS POSTPARTUM.

8094
04:43:30,280 --> 04:43:32,800
FROM SIX TO NINE MONTHS WHEN

8095
04:43:32,800 --> 04:43:35,080
KIDS ARE SIX TO NINE MONTHS OF

8096
04:43:35,080 --> 04:43:37,400
AGE WE DELIVERED WATER AND

8097
04:43:37,400 --> 04:43:38,400
DELIVERED TO EVERYONE TO EVEN

8098
04:43:38,400 --> 04:43:41,440
THE PLAYING FIELD.

8099
04:43:41,440 --> 04:43:44,240
HERE ARE FOCUS AREAS FAMILY

8100
04:43:44,240 --> 04:43:46,440
SPIRIT NURTURE CURRICULUM, WE

8101
04:43:46,440 --> 04:43:49,000
TALKED -- WE TRIED TO FOCUS ON

8102
04:43:49,000 --> 04:43:52,040
MATERNAL OUTCOMES AND MATERNAL

8103
04:43:52,040 --> 04:43:53,800
BEHAVIORS AND BEHAVIORS WITH

8104
04:43:53,800 --> 04:43:56,240
THEIR CHILDREN INCLUDING ROUTINE

8105
04:43:56,240 --> 04:43:57,680
SO WE KNOW MEALS AND SLEEPING

8106
04:43:57,680 --> 04:43:59,240
AND PHYSICAL ACTIVITY IS REALLY

8107
04:43:59,240 --> 04:44:01,760
IMPORTANT WITH THESE LITTLE

8108
04:44:01,760 --> 04:44:02,240
ONES.

8109
04:44:02,240 --> 04:44:05,880
SO INCORPORATING THAT INTO THE

8110
04:44:05,880 --> 04:44:10,200
LESSONS.

8111
04:44:10,200 --> 04:44:12,240
SO AT THE END OF ONE STUDY

8112
04:44:12,240 --> 04:44:14,520
MOTHERS AN INFANTS IN

8113
04:44:14,520 --> 04:44:16,080
INTERVENTION GROUP INCREASED

8114
04:44:16,080 --> 04:44:18,920
SUGAR SWEETENED INCREASE BREAST

8115
04:44:18,920 --> 04:44:20,480
-- INCREASE RESPONSE TO FEEDING

8116
04:44:20,480 --> 04:44:23,480
COMPARED TO CONTROL GROUP, THEY

8117
04:44:23,480 --> 04:44:27,560
HAD HEALTHIER BMI SCORES

8118
04:44:27,560 --> 04:44:29,800
COMPARED TO CONTROL SO I WILL

8119
04:44:29,800 --> 04:44:31,200
SHOW SOME I WILL FLY THROUGH

8120
04:44:31,200 --> 04:44:32,600
THESE SLIDES BUT THIS IS THE

8121
04:44:32,600 --> 04:44:34,680
RESPONSE OF FEEDING SCALE SO

8122
04:44:34,680 --> 04:44:38,200
BASELINE IS WHEN KIDS ARE THREE

8123
04:44:38,200 --> 04:44:39,600
MONTHS AND THEN THIS IS THREE TO

8124
04:44:39,600 --> 04:44:42,040
SIX MONTHS SO WE SAW IMPROVEMENT

8125
04:44:42,040 --> 04:44:44,400
IN RESPONSE TO FEEDING AMONG THE

8126
04:44:44,400 --> 04:44:45,600
INTERVENTION GROUP AND CONTROL

8127
04:44:45,600 --> 04:44:49,600
GROUP WENT DOWN AND AT SIX TO

8128
04:44:49,600 --> 04:44:51,000
NINE MONTHS IT WAS SIGNIFICANT

8129
04:44:51,000 --> 04:44:53,720
BUT WE ARE TAPERING -- HAVE A

8130
04:44:53,720 --> 04:44:54,840
TAPERING EFFECT AT 12 MONTH TIME

8131
04:44:54,840 --> 04:44:56,880
POINT.

8132
04:44:56,880 --> 04:45:00,120
BEALSO SAW LONGER BREAST FEEDING

8133
04:45:00,120 --> 04:45:01,720
DURATION.

8134
04:45:01,720 --> 04:45:03,600
87% MOMS INITIATED BREAST

8135
04:45:03,600 --> 04:45:06,480
FEEDING AND BREAST FEEDING AND

8136
04:45:06,480 --> 04:45:08,600
RATES WERE COMPARABLE BETWEEN

8137
04:45:08,600 --> 04:45:10,360
STUDY GROUP AND RAPID DECLINE IN

8138
04:45:10,360 --> 04:45:12,120
THOSE WHO ARE IN THE CONTROL

8139
04:45:12,120 --> 04:45:12,520
GROUP.

8140
04:45:12,520 --> 04:45:14,000
LONGER DURATION IN THE

8141
04:45:14,000 --> 04:45:16,880
INTERVENTION GROUP.

8142
04:45:16,880 --> 04:45:19,320
AND THEN WE HAVE INFANT SSV

8143
04:45:19,320 --> 04:45:20,840
SUGAR SWEETENED BEVERAGE

8144
04:45:20,840 --> 04:45:22,280
CONSUMPTION AND YOU CAN SEE HERE

8145
04:45:22,280 --> 04:45:24,960
THE CONTROL SLOWLY INCREASES

8146
04:45:24,960 --> 04:45:27,800
WITH THE BIG SPIKE AT 12 MONTHS,

8147
04:45:27,800 --> 04:45:32,720
INTERVENTION STAYS A LITTLE BIT

8148
04:45:32,720 --> 04:45:34,080
LOWER.

8149
04:45:34,080 --> 04:45:36,840
WE SAW DECREASE CHILDHOOD

8150
04:45:36,840 --> 04:45:38,760
OBESITY, ON AVERAGE KIDS IN THE

8151
04:45:38,760 --> 04:45:40,520
CONTROL GROUP WERE STARTING TO

8152
04:45:40,520 --> 04:45:45,000
REACH THAT 85TH PERCENTILE AT

8153
04:45:45,000 --> 04:45:46,560
YEAR OF LIFE WHEREAS

8154
04:45:46,560 --> 04:45:47,920
INTERVENTION GROUP IS LITTLE

8155
04:45:47,920 --> 04:45:53,120
FURTHER DOWN HERE.

8156
04:45:53,120 --> 04:45:55,520
WE HAVE SSB INTAKE AMONG THE

8157
04:45:55,520 --> 04:45:57,280
MOMS AND WITH THE CONTROL GROUP

8158
04:45:57,280 --> 04:45:59,360
AND INTERVENTION THEY BOTH

8159
04:45:59,360 --> 04:46:01,440
DECREASE IN THE FIRST COUPLE OF

8160
04:46:01,440 --> 04:46:04,520
MONTHS, THE CONTROL REBOUNDS

8161
04:46:04,520 --> 04:46:05,720
INTERVENTION CONTINUES TO FALL

8162
04:46:05,720 --> 04:46:07,240
AND REBOUNDS SLOWER RATE.

8163
04:46:07,240 --> 04:46:09,760
SO THOSE ARE SOME OF THE

8164
04:46:09,760 --> 04:46:11,880
OUTCOMES JUST ON FACE VALUE, BUT

8165
04:46:11,880 --> 04:46:13,000
I THINK I WANTED TO TALK A

8166
04:46:13,000 --> 04:46:17,280
LITTLE BIT BECAUSE IN THINKING

8167
04:46:17,280 --> 04:46:19,360
ABOUT THIS EDUCATION WE ARE

8168
04:46:19,360 --> 04:46:20,560
PROVIDING WHAT ENVIRONMENTAL

8169
04:46:20,560 --> 04:46:22,000
CONTEXT ARE THESE WOMEN LIVING

8170
04:46:22,000 --> 04:46:22,400
IN.

8171
04:46:22,400 --> 04:46:23,680
AND ONE OF THE THINGS THAT WE

8172
04:46:23,680 --> 04:46:25,480
STARTED TO THINK A LOT ABOUT IS

8173
04:46:25,480 --> 04:46:26,840
THIS WATER.

8174
04:46:26,840 --> 04:46:30,160
WE HAD DECIDED WHEN WE WROTE THE

8175
04:46:30,160 --> 04:46:34,080
GRANT TO THINK ABOUT WHY DOES

8176
04:46:34,080 --> 04:46:35,520
WATER MATTER WE DECIDED WE

8177
04:46:35,520 --> 04:46:37,520
PROVIDE WATER TO THE FAMILIES,

8178
04:46:37,520 --> 04:46:39,280
AND EXPLORE PROVISION OF WATER

8179
04:46:39,280 --> 04:46:42,080
REDUCES SSB INTAKE.

8180
04:46:42,080 --> 04:46:43,880
ALSO INTERVENTION OR EDUCATION

8181
04:46:43,880 --> 04:46:45,840
CHANGE EITHER OF THESE.

8182
04:46:45,840 --> 04:46:47,280
THIS WORK AND WE ARE DIGGING

8183
04:46:47,280 --> 04:46:49,160
INTO THIS DATA RIGHT NOW SO NOT

8184
04:46:49,160 --> 04:46:53,240
GOING TO PRESENT FINDINGS.

8185
04:46:53,240 --> 04:46:54,000
I WILL PRESENT SOME STUFF WE ARE

8186
04:46:54,000 --> 04:46:55,440
THINKING IN TRYING TO FIGURE OUT

8187
04:46:55,440 --> 04:46:57,000
WHAT IT MEANS.

8188
04:46:57,000 --> 04:47:00,080
AS I SAID BEFORE 60%

8189
04:47:00,080 --> 04:47:01,320
PARTICIPANTS WERE WATER INSECURE

8190
04:47:01,320 --> 04:47:05,520
SOME POINT IN STUDY.

8191
04:47:05,520 --> 04:47:06,840
62% HAVE BETTER IN THEIR HOME

8192
04:47:06,840 --> 04:47:09,600
BUT 82% REPORTED BOTTLED WATER

8193
04:47:09,600 --> 04:47:10,520
PRIMARY SOURCE OF DRINKING.

8194
04:47:10,520 --> 04:47:12,400
WE ARE DOING INTERVIEWS AND

8195
04:47:12,400 --> 04:47:13,760
FOCUS GROUPS TO UNDERSTAND WHAT

8196
04:47:13,760 --> 04:47:17,360
IS GOING ON HERE, 62% HAVE --

8197
04:47:17,360 --> 04:47:19,320
MOST USING BOTTLED WATER AS MAIN

8198
04:47:19,320 --> 04:47:22,480
SOURCE OF DRINKING.

8199
04:47:22,480 --> 04:47:24,600
WITH HISTORY OF WHAT IS HAPPENED

8200
04:47:24,600 --> 04:47:27,320
OUT ON THE NAVAHO NATION WITH

8201
04:47:27,320 --> 04:47:29,400
MINING AND ARSENIC IS NOT

8202
04:47:29,400 --> 04:47:31,920
SURPRISING PEOPLE ARE NOT

8203
04:47:31,920 --> 04:47:33,560
TRUSTING COMING INTO THEIR HOMES

8204
04:47:33,560 --> 04:47:35,560
BUT WE ARE DOING INTERVIEW AND

8205
04:47:35,560 --> 04:47:36,560
FOCUS GROUPS TO UNDERSTAND WHAT

8206
04:47:36,560 --> 04:47:38,200
IS GOING ON AND WHY PEOPLE DON'T

8207
04:47:38,200 --> 04:47:39,440
WANT TO DRINK THE WATER IN THEIR

8208
04:47:39,440 --> 04:47:44,600
HOMES.

8209
04:47:44,600 --> 04:47:47,000
SO NEXT I WANT TO SHOW YOU THIS

8210
04:47:47,000 --> 04:47:49,120
I CAN'T GO TOO MUCH DETAIL, THIS

8211
04:47:49,120 --> 04:47:50,200
IS SOMETHING WE ARE THINKING

8212
04:47:50,200 --> 04:47:51,880
ABOUT.

8213
04:47:51,880 --> 04:47:55,280
THIS IS SSB INTAKE BY TIME

8214
04:47:55,280 --> 04:47:55,800
POINT.

8215
04:47:55,800 --> 04:47:57,840
BY THOSE INSECURE VERSUS THOSE

8216
04:47:57,840 --> 04:47:58,400
SECURE.

8217
04:47:58,400 --> 04:48:01,000
WATER SECURE.

8218
04:48:01,000 --> 04:48:03,600
YOU CAN SEE WATER SECURE IS MUCH

8219
04:48:03,600 --> 04:48:07,320
NICER THE INTERVENTION SEEM TO

8220
04:48:07,320 --> 04:48:09,320
DECREASE SSV INTAKE AMONG MOMS

8221
04:48:09,320 --> 04:48:12,200
AN IT SORT OF SLOWLY INCLINE BUT

8222
04:48:12,200 --> 04:48:13,480
STILL STAY BELOW CONTROL GROUP.

8223
04:48:13,480 --> 04:48:15,120
WE ARE TRYING TO FIGURE OUT WHAT

8224
04:48:15,120 --> 04:48:16,880
IS GOING ON HERE, THIS IS WHEN

8225
04:48:16,880 --> 04:48:19,360
THE WATER DELIVERY OCCURRED.

8226
04:48:19,360 --> 04:48:21,200
YOU CAN SEE INTERVENTION UP AND

8227
04:48:21,200 --> 04:48:23,000
SLOWLY DOWN AGAIN BUT CONTROL

8228
04:48:23,000 --> 04:48:25,840
GROUP GOES UP AND DOWN.

8229
04:48:25,840 --> 04:48:29,040
THE NEXT ONE IS THE KIDS AND

8230
04:48:29,040 --> 04:48:30,800
AGAIN WITH WATER SECURE FAMILIES

8231
04:48:30,800 --> 04:48:32,840
THAT REALLY SEEMS LIKE THE

8232
04:48:32,840 --> 04:48:36,360
INTERVENTION STAGE OFF THIS SSB

8233
04:48:36,360 --> 04:48:38,600
INTAKE.

8234
04:48:38,600 --> 04:48:40,800
REGARDLESS WHEN WATER DELIVERY

8235
04:48:40,800 --> 04:48:42,720
OCCURRED, HERE WE THINK IS

8236
04:48:42,720 --> 04:48:45,160
PRETTY INTERESTING BUT THERE NO

8237
04:48:45,160 --> 04:48:49,640
STATISTICAL SIGNIFICANCE, A LOW

8238
04:48:49,640 --> 04:48:51,760
N BUT YOU HAVE SORT OF IN THE

8239
04:48:51,760 --> 04:48:54,960
INTERVENTION STAYING LOW HERE,

8240
04:48:54,960 --> 04:48:56,080
INSECURE WATER INSECURE FAMILIES

8241
04:48:56,080 --> 04:48:58,040
YOU HAVE INCREASE BUT THEN IT

8242
04:48:58,040 --> 04:48:59,400
SLOWLY GOES DOWN AS WE DELIVER

8243
04:48:59,400 --> 04:49:00,640
THE WATER.

8244
04:49:00,640 --> 04:49:01,920
SO AGAIN DIGGING A LITTLE MORE

8245
04:49:01,920 --> 04:49:02,640
INTO THAT.

8246
04:49:02,640 --> 04:49:07,200
TO FIGURE OUT WHAT THAT MEANS.

8247
04:49:07,200 --> 04:49:09,200
WE ARE DOING A HYDRATION PROJECT

8248
04:49:09,200 --> 04:49:10,960
I WON'T GO INTO DETAIL ABOUT, WE

8249
04:49:10,960 --> 04:49:12,720
ARE ALSO DOING A LONGER TERM

8250
04:49:12,720 --> 04:49:14,040
FOLLOW-UP SO FOLLOWING THESE

8251
04:49:14,040 --> 04:49:15,800
KIDS UNTIL THEY ARE FIVE YEARS

8252
04:49:15,800 --> 04:49:18,600
OF AGE TO SEE IF THESE TRENDS WE

8253
04:49:18,600 --> 04:49:22,480
SEE STICK.

8254
04:49:22,480 --> 04:49:24,480
WE ARE DISSEMINATING THE FAMILY

8255
04:49:24,480 --> 04:49:25,960
SPIRIT PROGRAM NURTURE

8256
04:49:25,960 --> 04:49:28,800
JURISTHOSE BOOSTER SESSIONS

8257
04:49:28,800 --> 04:49:29,400
ACROSS THE COUNTRY.

8258
04:49:29,400 --> 04:49:32,800
HERE IS WHERE WE DISSEMINATED

8259
04:49:32,800 --> 04:49:34,800
THE PROGRAM TO THUS FAR AND

8260
04:49:34,800 --> 04:49:38,040
THERE ARE NEW AFFILIATES THAT

8261
04:49:38,040 --> 04:49:39,320
ARE TRAINED IN THIS PROGRAM ALL

8262
04:49:39,320 --> 04:49:41,320
THE TIME.

8263
04:49:41,320 --> 04:49:43,880
FINALLY I WANT TO SAY THANK YOU

8264
04:49:43,880 --> 04:49:46,600
TO NAVAHO NATION AS WELL AS OUR

8265
04:49:46,600 --> 04:49:48,720
-- NAVAJO NATION AS WELL AS OUR

8266
04:49:48,720 --> 04:49:49,080
STAFF.

8267
04:49:49,080 --> 04:49:53,800
THIS IS A STAFF TEAM WHO WORK ON

8268
04:49:53,800 --> 04:49:56,320
HYDRATION PROJECT NOW AND THEN

8269
04:49:56,320 --> 04:49:59,400
FAMILY SPIRIT NURTURE TEAM.

8270
04:49:59,400 --> 04:50:01,960
ALSO THANKS TO STAFF AND YOU CAN

8271
04:50:01,960 --> 04:50:04,520
EMAIL MYSELF OR SUMMER IF YOU

8272
04:50:04,520 --> 04:50:05,600
HAVE QUESTIONS ABOUT ME OF WHAT

8273
04:50:05,600 --> 04:50:06,560
I DISCUSSED.

8274
04:50:06,560 --> 04:50:07,400
THANK YOU.

8275
04:50:07,400 --> 04:50:09,800
THANK YOU FOR INVITING ME AND

8276
04:50:09,800 --> 04:50:11,000
THE CENTER TO TALK ABOUT OUR

8277
04:50:11,000 --> 04:50:14,240
WORK.

8278
04:50:14,240 --> 04:50:15,680
>> THANK YOU SO MUCH, DR.

8279
04:50:15,680 --> 04:50:16,280
CHAMBERS, EXCELLENT.

8280
04:50:16,280 --> 04:50:19,280
SO OUR LAST TALK TODAY WILL BE

8281
04:50:19,280 --> 04:50:44,160
DR. LAUREN FIECHTNER.

8282
04:50:44,160 --> 04:50:50,920
>> GREAT, IS THAT BETTER?

8283
04:50:50,920 --> 04:50:52,880
THANKS SO MUCH FOR HAVING ME,

8284
04:50:52,880 --> 04:50:54,440
EXCITED TO CLOSE TODAY'S AMAZING

8285
04:50:54,440 --> 04:50:55,680
DAY OFF OFFER LOTS OF GREAT

8286
04:50:55,680 --> 04:50:58,440
SPEAKERS.

8287
04:50:58,440 --> 04:51:00,000
I WILL BE SPEAKING PRIMARY CARE

8288
04:51:00,000 --> 04:51:01,000
INTERVENTION AND CHILDHOOD

8289
04:51:01,000 --> 04:51:02,880
OBESITY AND I WILL FIRST TALK

8290
04:51:02,880 --> 04:51:04,440
ABOUT THREE TRANSLATIONAL

8291
04:51:04,440 --> 04:51:07,360
INTERVENTION THAT HAVE INFORMED

8292
04:51:07,360 --> 04:51:09,880
OUR CURRENT DISSEMINATION AND

8293
04:51:09,880 --> 04:51:10,800
IMPLEMENTATION GRANT.

8294
04:51:10,800 --> 04:51:12,800
THE FIRST STUDY IS CONNECT FOR

8295
04:51:12,800 --> 04:51:16,440
HEALTH WHICH WAS A RANDOMIZE

8296
04:51:16,440 --> 04:51:20,520
TRIAL IN CHILDREN TWO TO 12

8297
04:51:20,520 --> 04:51:22,200
YEARS WITH OVERWEIGHT OR

8298
04:51:22,200 --> 04:51:24,480
OBESITY, WE TARGETED SIX

8299
04:51:24,480 --> 04:51:25,720
PEDIATRIC IN MASSACHUSETTS WE

8300
04:51:25,720 --> 04:51:27,240
LOOK FOR PRACTICES CARING FOR

8301
04:51:27,240 --> 04:51:30,920
CHILDREN WITH HIGHEST PREVALENCE

8302
04:51:30,920 --> 04:51:33,400
OVERWEIGHT AND/OR OBESITY.

8303
04:51:33,400 --> 04:51:36,160
WE ENROLLED 721 CHILDREN AND

8304
04:51:36,160 --> 04:51:38,360
THEIR PARENTS AND GUARDIANS IN

8305
04:51:38,360 --> 04:51:38,760
THE INTERVENTION.

8306
04:51:38,760 --> 04:51:41,480
THE INTERVENTION WAS ONE YEAR IN

8307
04:51:41,480 --> 04:51:42,680
DURATION, INTERVENTION

8308
04:51:42,680 --> 04:51:45,880
COMPONENTS INCLUDED ELECTRONIC

8309
04:51:45,880 --> 04:51:46,640
DECISION SUPPORT TOOLS WHICH

8310
04:51:46,640 --> 04:51:49,760
INCLUDED BMI FOR THE

8311
04:51:49,760 --> 04:51:50,240
PEDIATRICIAN.

8312
04:51:50,240 --> 04:51:53,400
THEY WOULD ALSO BE ENCOURAGED TO

8313
04:51:53,400 --> 04:51:55,280
COUNCIL CHILDREN AND PARENTS

8314
04:51:55,280 --> 04:51:56,040
NUTRITIONAL AND PHYSICAL

8315
04:51:56,040 --> 04:51:57,440
ACTIVITY.

8316
04:51:57,440 --> 04:51:59,360
THEY ALSO RECEIVE BEHAVIORAL

8317
04:51:59,360 --> 04:52:00,440
CHANGE MATERIALS FOR PATIENTS

8318
04:52:00,440 --> 04:52:04,400
AND FAMILIES AND THEN THE

8319
04:52:04,400 --> 04:52:06,280
PARENTS RECEIVED MESSAGING AND

8320
04:52:06,280 --> 04:52:08,600
NEIGHBORHOOD RESOURCES.

8321
04:52:08,600 --> 04:52:10,720
ONE ARM WAS -- THOUGH WE FOUND

8322
04:52:10,720 --> 04:52:13,040
IT TO BE NOT STATISTICALLY

8323
04:52:13,040 --> 04:52:14,040
SIGNIFICANTLY DIFFERENT IN

8324
04:52:14,040 --> 04:52:15,520
IMPROVING BMI.

8325
04:52:15,520 --> 04:52:18,480
OUR OUTCOMES MEDIA EVALUATED

8326
04:52:18,480 --> 04:52:20,400
WERE IMPROVING BMI MANY CHILD

8327
04:52:20,400 --> 04:52:22,120
QUALITY OF LIFE FAMILY CENTERED

8328
04:52:22,120 --> 04:52:28,480
CARE AND PARENTAL EMPOWERMENT ON

8329
04:52:28,480 --> 04:52:30,680
THE LEFT YOU CAN SEE BMI OVER

8330
04:52:30,680 --> 04:52:33,200
TIME, BETWEEN BASELINE AND

8331
04:52:33,200 --> 04:52:35,280
PRE-BASELINE BOTH ARMS IN THE

8332
04:52:35,280 --> 04:52:36,600
INTERVENTION BMI SCORES

8333
04:52:36,600 --> 04:52:37,080
INCREASE.

8334
04:52:37,080 --> 04:52:39,960
HOWEVER FROM BASELINE TO

8335
04:52:39,960 --> 04:52:41,160
FOLLOW-UP YOU CAN SEE THERE WAS

8336
04:52:41,160 --> 04:52:42,360
STATISTICALLY SIGNIFICANT

8337
04:52:42,360 --> 04:52:50,680
DECREASE IN BMI SCORE.

8338
04:52:50,680 --> 04:52:52,760
THE SECOND IS MATH IN MOTION,

8339
04:52:52,760 --> 04:53:02,400
WHOLE COMMUNITY INTERVENTION.

8340
04:53:02,400 --> 04:53:05,480
WE ENROLLED 2 TO 12-YEAR-OLDS TO

8341
04:53:05,480 --> 04:53:08,240
ON SITE HEALTHY WEIGHT CLINIC.

8342
04:53:08,240 --> 04:53:09,720
187 CHILDREN AND PARENTS AND

8343
04:53:09,720 --> 04:53:11,800
PARENTS AND GUARDIANS

8344
04:53:11,800 --> 04:53:13,800
PARTICIPATED IN THIS

8345
04:53:13,800 --> 04:53:14,400
INTERVENTION.

8346
04:53:14,400 --> 04:53:15,480
INTERVENTION WAS TWO YEARS IN

8347
04:53:15,480 --> 04:53:16,560
DURATION.

8348
04:53:16,560 --> 04:53:21,120
THE COMPONENTS INCLUDED

8349
04:53:21,120 --> 04:53:22,760
ELECTRONIC DECISION SUPPORT

8350
04:53:22,760 --> 04:53:24,200
TOOLS SIMILAR TO CONNECT FOR

8351
04:53:24,200 --> 04:53:25,000
HEALTH SO FLAGGING AGAIN OF

8352
04:53:25,000 --> 04:53:26,600
CHILD ELEVATED BMI AND

8353
04:53:26,600 --> 04:53:29,840
ENCOURAGING THE PEDIATRICIAN TO

8354
04:53:29,840 --> 04:53:31,200
COUNCIL CHILD AND FAMILY ON

8355
04:53:31,200 --> 04:53:34,520
NUTRITION AND PHYSICAL ACTIVITY

8356
04:53:34,520 --> 04:53:35,000
CHANGES I WANT THEY WERE

8357
04:53:35,000 --> 04:53:37,000
PROVIDED BEHAVIORAL CHANGE

8358
04:53:37,000 --> 04:53:39,200
MATERIALS AND THEN REFERRAL TO

8359
04:53:39,200 --> 04:53:41,440
HEALTHY WEIGHT CLINIC ON SITE

8360
04:53:41,440 --> 04:53:42,480
MULTI-DISCIPLINARY WEIGHT

8361
04:53:42,480 --> 04:53:43,080
MANAGEMENT.

8362
04:53:43,080 --> 04:53:44,640
THIS WAS CONDUCTED BY COMMUNITY

8363
04:53:44,640 --> 04:53:47,200
HEALTH WORKER DIETITIAN AND

8364
04:53:47,200 --> 04:53:49,720
PEDIATRICIAN OR NURSE

8365
04:53:49,720 --> 04:53:50,000
PRACTICERS.

8366
04:53:50,000 --> 04:53:53,240
WE HAVE TRAINED THE OTHER

8367
04:53:53,240 --> 04:53:55,560
PRIMARY CARE PROVIDERS AND

8368
04:53:55,560 --> 04:53:57,560
PRACTICE, TO PEDIATRIC WEIGHT

8369
04:53:57,560 --> 04:53:59,200
MANAGEMENT INTERVENTION AND WELL

8370
04:53:59,200 --> 04:53:59,680
CHILD VISITS.

8371
04:53:59,680 --> 04:54:01,560
OVER TIME THE BMI FOR THESE

8372
04:54:01,560 --> 04:54:03,120
CHILDREN WHO ARE PARTICIPATING

8373
04:54:03,120 --> 04:54:04,880
IN THE HEALTHY WEIGHT CLINIC

8374
04:54:04,880 --> 04:54:07,600
DECREASE EACH YEAR BY .07 DURING

8375
04:54:07,600 --> 04:54:10,880
THE INTERVENTION.

8376
04:54:10,880 --> 04:54:13,200
SOP THIS LAST TRIAL IN OUR MOST

8377
04:54:13,200 --> 04:54:14,520
RECENT TRIAL IS WHAT I WILL

8378
04:54:14,520 --> 04:54:17,200
SPEAK MOST ABOUT.

8379
04:54:17,200 --> 04:54:18,840
AND THIS IS CLINIC COMMUNITY

8380
04:54:18,840 --> 04:54:20,160
APPROACHES TO HEALTHY WEIGHT

8381
04:54:20,160 --> 04:54:24,880
TRIAL, IT WAS A RANDOMIZE

8382
04:54:24,880 --> 04:54:25,960
NON-INFERIORITY TRIAL.

8383
04:54:25,960 --> 04:54:28,200
HEALTHY WEIGHT CLINIC TO MASS IN

8384
04:54:28,200 --> 04:54:30,440
MOTION EQUALLY EFFECTIVE AS THE

8385
04:54:30,440 --> 04:54:33,600
YMCA HEALTHY WEIGHT AND YOUR

8386
04:54:33,600 --> 04:54:35,080
CHILD PROGRAM.

8387
04:54:35,080 --> 04:54:38,600
IN THIS INTERVENTION WE ENROLLED

8388
04:54:38,600 --> 04:54:41,280
WITH SIX OVERWEIGHT OBESITY TO

8389
04:54:41,280 --> 04:54:43,040
FEDERALLY QUALIFIED HEALTH

8390
04:54:43,040 --> 04:54:44,600
CENTERS THAT SERVE HISPANIC

8391
04:54:44,600 --> 04:54:45,400
POPULATION AND LOW INCOME

8392
04:54:45,400 --> 04:54:45,760
POPULATION.

8393
04:54:45,760 --> 04:54:49,400
WE ARE ABLE TO ENROLL 407

8394
04:54:49,400 --> 04:54:50,640
CHILDREN AND PARENTS AND

8395
04:54:50,640 --> 04:54:52,040
GUARDIANS TO THE INTERVENTION

8396
04:54:52,040 --> 04:54:54,720
AND IT WAS ONE YEAR IN DURATION.

8397
04:54:54,720 --> 04:54:56,600
I WILL GET MORE DETAIL AROUND

8398
04:54:56,600 --> 04:54:59,000
HEALTHY WEIGHT CLINIC.

8399
04:54:59,000 --> 04:55:02,320
BUT THEY WERE INDIVIDUAL GROUP

8400
04:55:02,320 --> 04:55:03,840
VISITS, STAFFED BY DIETITIAN AND

8401
04:55:03,840 --> 04:55:08,760
COMMUNITY HEALTH WORKER AND

8402
04:55:08,760 --> 04:55:10,520
MEDICAL PROVIDER AND 30 HOURS OF

8403
04:55:10,520 --> 04:55:12,840
CONTACT WHICH IS CONSISTENT WITH

8404
04:55:12,840 --> 04:55:14,720
USPSTF GUIDELINES FOR CHILDHOOD

8405
04:55:14,720 --> 04:55:17,160
OBESITY TREATMENT AND THE YMCA

8406
04:55:17,160 --> 04:55:21,760
PROGRAM, THIS WAS STAFFD BY TWO

8407
04:55:21,760 --> 04:55:24,720
TRAINED GROUP LEADER THEY WERE

8408
04:55:24,720 --> 04:55:26,280
OFFERED OVER 50 HOURS CONTACT

8409
04:55:26,280 --> 04:55:28,240
AND OUTCOMES WE STUDY WERE

8410
04:55:28,240 --> 04:55:32,240
IMPROVEMENT IN BMI SLEEP, DIET

8411
04:55:32,240 --> 04:55:34,400
PHYSICAL ACTIVITY AND COST.

8412
04:55:34,400 --> 04:55:36,680
HERE YOU CAN SEE OVERALL FLOW OF

8413
04:55:36,680 --> 04:55:39,440
THE STUDY WE HAD TEN FEDERALLY

8414
04:55:39,440 --> 04:55:41,560
QUALIFIED HEALTH CENTERS IN

8415
04:55:41,560 --> 04:55:43,080
MASSACHUSETTS, WE CHOSE

8416
04:55:43,080 --> 04:55:45,080
COMPARISON SITES TO ACT AS USUAL

8417
04:55:45,080 --> 04:55:47,000
CARE AND IN THOSE COMPARISON

8418
04:55:47,000 --> 04:55:49,400
SITES WE TRIED IF GET THEM AS

8419
04:55:49,400 --> 04:55:51,080
DEMOGRAPHICALLY MATCHED AS OUR

8420
04:55:51,080 --> 04:55:52,800
TWO INTERVENTION SITES.

8421
04:55:52,800 --> 04:55:54,600
WE LOOK AT 6 TO 12-YEAR-OLDS IN

8422
04:55:54,600 --> 04:55:56,760
SITES WITH BMI GREATER THAN 85

8423
04:55:56,760 --> 04:55:58,680
PERCENTILE AND WE ARE ABLE TO

8424
04:55:58,680 --> 04:56:00,000
PULL ABOUT 4,000 RECORDS FROM

8425
04:56:00,000 --> 04:56:01,600
THAT.

8426
04:56:01,600 --> 04:56:02,840
OUR INTERVENTION SITES AGAIN,

8427
04:56:02,840 --> 04:56:05,840
THE ENROLLMENT CRITERIA WAS SIX

8428
04:56:05,840 --> 04:56:08,600
TO 12-YEAR-OLDS WITH BMI OVER 85

8429
04:56:08,600 --> 04:56:11,000
PERCENTILE AND PRIMARY CARE

8430
04:56:11,000 --> 04:56:12,240
PHYSICIAN WOULD RECOGNIZE THEY

8431
04:56:12,240 --> 04:56:15,240
MET THAT CRITERIA PRIMARY CARE

8432
04:56:15,240 --> 04:56:16,720
VISIT.

8433
04:56:16,720 --> 04:56:18,000
AND THEN THEY WOULD REFER THEM

8434
04:56:18,000 --> 04:56:19,760
TO STUDY COORDINATOR

8435
04:56:19,760 --> 04:56:21,200
INDIVIDUALLY RANDOMIZE THEM TO

8436
04:56:21,200 --> 04:56:23,800
HEALTHY WEIGHT CLINIC OR YMCA

8437
04:56:23,800 --> 04:56:26,040
BASE PROGRAM.

8438
04:56:26,040 --> 04:56:28,440
ALL INTERVENTIONS RECEIVE

8439
04:56:28,440 --> 04:56:29,720
PRIMARY CARE TRAINING AROUND

8440
04:56:29,720 --> 04:56:31,400
WEIGHT MANAGEMENT, INCLUDING

8441
04:56:31,400 --> 04:56:33,640
STIGMA AND WE ALLOWED FOR

8442
04:56:33,640 --> 04:56:34,640
EDUCATIONAL MATERIALS AND

8443
04:56:34,640 --> 04:56:38,200
INTERACTIVE TEXT MESSAGES FOR

8444
04:56:38,200 --> 04:56:41,400
ALL PARTICIPANTS IN THE

8445
04:56:41,400 --> 04:56:42,800
INTERVENTION, THEY ALSO GOT

8446
04:56:42,800 --> 04:56:44,360
RESOURCES FOR UNMET SOCIAL NEEDS

8447
04:56:44,360 --> 04:56:46,240
SO WE WOULD SCREEN THEM AT

8448
04:56:46,240 --> 04:56:47,680
BASELINE SEX MONTHS AND 12

8449
04:56:47,680 --> 04:56:49,560
MONTHS AND REPORT THIS BACK TO

8450
04:56:49,560 --> 04:56:51,800
THE PCP AND ALSO PROVIDE FAMILY

8451
04:56:51,800 --> 04:56:56,200
WITH LOCAL RESOURCES.

8452
04:56:56,200 --> 04:56:58,000
HERE YOU CAN SEE TABLE ONE OR

8453
04:56:58,000 --> 04:57:00,200
BASELINE CHARACTERISTICS OF

8454
04:57:00,200 --> 04:57:01,520
THOSE CHILDREN PARTICIPATING IN

8455
04:57:01,520 --> 04:57:02,960
THIS TRIAL.

8456
04:57:02,960 --> 04:57:05,200
AND THIS IS COMPARING THE

8457
04:57:05,200 --> 04:57:06,960
INTERVENTION SITES TO OUR

8458
04:57:06,960 --> 04:57:08,200
COMPARISON GROUPS AND YOU CAN

8459
04:57:08,200 --> 04:57:11,200
SEE THERE WAS A HIGHER

8460
04:57:11,200 --> 04:57:12,240
PREVALENCE OF PATIENT

8461
04:57:12,240 --> 04:57:15,200
IDENTIFYING AS HISPANIC IN

8462
04:57:15,200 --> 04:57:17,480
INTERVENTION GROUPS WITH 93% OF

8463
04:57:17,480 --> 04:57:20,120
THOSE CHILDREN IDENTIFYING AS

8464
04:57:20,120 --> 04:57:21,440
HISPANIC VERSUS 46 PERCENT IN

8465
04:57:21,440 --> 04:57:25,080
OUR COMPARISON SITES.  WE HAD A

8466
04:57:25,080 --> 04:57:27,600
HIGHER PREVALENCE OF SEVERE

8467
04:57:27,600 --> 04:57:29,480
PIECETY AND TWO INTERVENTION

8468
04:57:29,480 --> 04:57:30,760
SITES COMPARED TO COMPARISON

8469
04:57:30,760 --> 04:57:33,400
SITE SO WITH 30% THOSE CHILDREN

8470
04:57:33,400 --> 04:57:34,840
ENROLLED IN THE INTERVENTION

8471
04:57:34,840 --> 04:57:37,840
HAVING SEVERE OBESITY VERSUS THE

8472
04:57:37,840 --> 04:57:40,160
18% IN COMPARISON SITE.

8473
04:57:40,160 --> 04:57:42,480
THE NICE THING ABOUT THIS IS

8474
04:57:42,480 --> 04:57:45,240
THAT WE USED EHR BMI

8475
04:57:45,240 --> 04:57:46,600
MEASUREMENTS AS OUTCOME SO WE

8476
04:57:46,600 --> 04:57:49,560
HAD FOLLOW-UP UP TO 1.8 YEARS

8477
04:57:49,560 --> 04:57:51,360
AFTER INTERVENTION.

8478
04:57:51,360 --> 04:57:53,560
WHICH ALLOWED US TO SEE THE LONG

8479
04:57:53,560 --> 04:57:54,560
LASTING EFFECT OF THESE

8480
04:57:54,560 --> 04:57:57,840
INTERVENTIONS.

8481
04:57:57,840 --> 04:57:59,720
HERE YOU CAN SEE PARTICIPANT

8482
04:57:59,720 --> 04:58:00,720
CHARACTERISTICS OF JUST THOSE

8483
04:58:00,720 --> 04:58:02,360
CHILDREN WHO ARE ENROLLED IN TO

8484
04:58:02,360 --> 04:58:05,360
THE HEALTHY WEIGHT CLINIC OR THE

8485
04:58:05,360 --> 04:58:06,080
YMCA PROGRAM.

8486
04:58:06,080 --> 04:58:08,600
THE AVERAGE HEALTHY WEIGHT

8487
04:58:08,600 --> 04:58:11,160
CLINIC VISITS ATTENDED WERE 3.2

8488
04:58:11,160 --> 04:58:13,200
COMPARED TO THE Y WHICH WAS ABLE

8489
04:58:13,200 --> 04:58:15,240
TO ACHIEVE A BETTER ATTENDANCE

8490
04:58:15,240 --> 04:58:18,240
OF FIVE VISITS.

8491
04:58:18,240 --> 04:58:20,200
ALSO YOU CAN SEE THAT THE

8492
04:58:20,200 --> 04:58:21,680
PARENTS HAD HIGH PREVALENCE OF

8493
04:58:21,680 --> 04:58:24,880
OVERWEIGHT AND OBESITY WITH 26%

8494
04:58:24,880 --> 04:58:26,400
OF PARENTS ENROLLED IN THE

8495
04:58:26,400 --> 04:58:30,400
INTERVENTION HAVING OVERWEIGHT,

8496
04:58:30,400 --> 04:58:33,080
24% CLASS 1 OBESITY, 18% HAVING

8497
04:58:33,080 --> 04:58:35,800
CLASS 2 OBESITY AND 13% HAVING

8498
04:58:35,800 --> 04:58:39,080
CLASS 3 OBESITY.

8499
04:58:39,080 --> 04:58:41,320
68% FAMILIES MAKING LESS THAN

8500
04:58:41,320 --> 04:58:43,080
$20,000 PER YEAR.

8501
04:58:43,080 --> 04:58:45,080
THERE WAS A HIGH PREVALENCE OF

8502
04:58:45,080 --> 04:58:48,840
PARENTAL DEPRESSION AT 35% FOOD

8503
04:58:48,840 --> 04:58:51,400
INSECURITY AT 48% AND HOUSING

8504
04:58:51,400 --> 04:58:54,560
INSECURITY AT 30%.

8505
04:58:54,560 --> 04:58:56,400
THESE ARE THE FIGURES THAT

8506
04:58:56,400 --> 04:58:58,560
DEPICT THE PREDICTED VALUES OF

8507
04:58:58,560 --> 04:59:01,280
BMI OVER TIME AND MANY THE BLUE

8508
04:59:01,280 --> 04:59:03,480
DASH FIGURE YOU CAN SEE THE

8509
04:59:03,480 --> 04:59:05,600
HEALTHY WEIGHT CLINIC SLOPE OF

8510
04:59:05,600 --> 04:59:08,920
BMI OVER TIME SO FROM

8511
04:59:08,920 --> 04:59:10,720
PRE-BASELINE TO ENROLLMENT YOU

8512
04:59:10,720 --> 04:59:12,880
CAN SEE BMI WERE INCREASING.

8513
04:59:12,880 --> 04:59:18,160
BUT AFTER ENROLLMENT TWO AND A

8514
04:59:18,160 --> 04:59:19,680
HALF YEARS BEYOND DECREASE

8515
04:59:19,680 --> 04:59:22,200
SIGNIFICANTLY.

8516
04:59:22,200 --> 04:59:25,440
THE YMCA AND COMPARISON SITE BMI

8517
04:59:25,440 --> 04:59:27,320
SLOPES REMAIN THE SAME.

8518
04:59:27,320 --> 04:59:30,200
YOU CAN SEE PERCENT OF THE 95

8519
04:59:30,200 --> 04:59:31,200
PERCENTILE WHICH IS BETTER

8520
04:59:31,200 --> 04:59:32,920
MEASURE FOR CHILDREN WITH SEVERE

8521
04:59:32,920 --> 04:59:35,600
OBESITY AND WE HAD A BETTER

8522
04:59:35,600 --> 04:59:36,800
HEALTHY WEIGHT CLINIC USING THAT

8523
04:59:36,800 --> 04:59:39,640
MEASURE.

8524
04:59:39,640 --> 04:59:40,880
THIS SLIDE SHOWS CHILDREN WITH

8525
04:59:40,880 --> 04:59:42,440
OVERWEIGHT AND OBESITY AND NOT

8526
04:59:42,440 --> 04:59:44,760
SEVERE OBESITY.

8527
04:59:44,760 --> 04:59:46,000
AND WE HAVE EVEN STRONGER

8528
04:59:46,000 --> 04:59:47,520
IMPROVEMENT IN BMI IN THOSE

8529
04:59:47,520 --> 04:59:48,800
CHILDREN IN THE HEALTHY WEIGHT

8530
04:59:48,800 --> 04:59:50,840
CLINIC.

8531
04:59:50,840 --> 04:59:53,760
THESE ARE THE ADJUSTED HEALTHY

8532
04:59:53,760 --> 04:59:55,280
LIFESTYLE BEHAVIOR CHANGES OF

8533
04:59:55,280 --> 04:59:56,240
PARTICIPANTS FROM BASELINE TO

8534
04:59:56,240 --> 04:59:57,000
ONE YEAR.

8535
04:59:57,000 --> 04:59:59,080
AND YOU CAN SEE THAT THE HEALTHY

8536
04:59:59,080 --> 05:00:00,000
WEIGHTICALLY MIC PARTICIPANTS

8537
05:00:00,000 --> 05:00:02,400
IMPROVE THEIR SUGARRY BEVERAGE

8538
05:00:02,400 --> 05:00:04,840
INTAKE, FAST FOOD INTAKE SLEEP

8539
05:00:04,840 --> 05:00:07,800
DURATION, SCREEN TIME AND

8540
05:00:07,800 --> 05:00:11,000
PHYSICAL ACTIVITY.

8541
05:00:11,000 --> 05:00:11,600
AND PERCH INTAKE AND PHYSICAL

8542
05:00:11,600 --> 05:00:14,600
ACTIVITY.

8543
05:00:14,600 --> 05:00:16,040
BECAUSE THEY WERE TALKING ABOUT

8544
05:00:16,040 --> 05:00:19,440
MOMS AND WOMEN, ACROSS THE LIFE

8545
05:00:19,440 --> 05:00:20,440
SPAN AND BECAUSE PARENTS WERE

8546
05:00:20,440 --> 05:00:23,760
INVOLVED IN THIS INTERVENTION WE

8547
05:00:23,760 --> 05:00:26,600
ALSO HAD NON-BMI BASELINE AND 12

8548
05:00:26,600 --> 05:00:28,480
MONTHS, YOU CAN SEE THERE WASN'T

8549
05:00:28,480 --> 05:00:30,480
A STATISTICALLY SIGNIFICANT

8550
05:00:30,480 --> 05:00:33,320
DIFFERENCE IN IMPROVEMENT OF BMI

8551
05:00:33,320 --> 05:00:34,640
BUT WE WERE FORTUNATE ENOUGH TO

8552
05:00:34,640 --> 05:00:37,000
SEE THE BMI REMAIN STABLE IN

8553
05:00:37,000 --> 05:00:40,320
BOTH INTERVENTIONS.

8554
05:00:40,320 --> 05:00:43,440
WE DID ALSO EXAMINE PARENTAL

8555
05:00:43,440 --> 05:00:44,040
STRESS DURING THE INTERVENTION

8556
05:00:44,040 --> 05:00:45,360
AND FOR THOSE IN HEALTHY WEIGHT

8557
05:00:45,360 --> 05:00:46,720
CLINIC AND OVERALL THERE WAS

8558
05:00:46,720 --> 05:00:49,880
DECREASE IN PARENTAL STRESS FROM

8559
05:00:49,880 --> 05:00:51,800
BASELINE TO 12 MONTHS.

8560
05:00:51,800 --> 05:00:54,000
WE ALSO EXAMINED PARENTING

8561
05:00:54,000 --> 05:00:56,000
BEHAVIOR SO WE LOOK AT PARENTS

8562
05:00:56,000 --> 05:00:58,160
EXERCISING REGULARLY WHICH MIGHT

8563
05:00:58,160 --> 05:01:01,680
NOT BOTH INTERVENTION WE ALSO

8564
05:01:01,680 --> 05:01:04,000
EXAMINE WHETHER THEY TOOK CHILD

8565
05:01:04,000 --> 05:01:06,600
EXERCISE AND INCREASE MANY THE

8566
05:01:06,600 --> 05:01:09,040
YMCA PROGRAM, WHETHER PARENTS

8567
05:01:09,040 --> 05:01:11,600
ARE MODELING EATING HEALTHY

8568
05:01:11,600 --> 05:01:13,040
FOODS INCREASE IN BOTH PROGRAMS

8569
05:01:13,040 --> 05:01:14,600
FROM BASELINE TO 12 MONTHS AND

8570
05:01:14,600 --> 05:01:17,280
KEEPING HEALTHY FOOD AT HOME

8571
05:01:17,280 --> 05:01:20,960
INCREASE IN BOTH INTERVENTIONS.

8572
05:01:20,960 --> 05:01:23,280
SO SUMMARY RESULTS FOR THE

8573
05:01:23,280 --> 05:01:25,680
CLINIC AND COMMUNITY HEALTHY

8574
05:01:25,680 --> 05:01:27,200
WEIGHT TRIAL SHOW COMPARED TO

8575
05:01:27,200 --> 05:01:28,360
COMPARISON SITES FOR A YEAR

8576
05:01:28,360 --> 05:01:31,000
CHILDREN IN HEALTHY WEIGHT

8577
05:01:31,000 --> 05:01:34,480
CLINIC AT .23 BMI DECREASE.

8578
05:01:34,480 --> 05:01:35,800
HEALTHY WEIGHT CLINIC ASSOCIATED

8579
05:01:35,800 --> 05:01:37,800
WITH IMPROVEMENT IN HEALTHY

8580
05:01:37,800 --> 05:01:39,400
LIFESTYLE BEHAVIORS, THERE WAS

8581
05:01:39,400 --> 05:01:42,840
NO BE,MI EFFECT IN YMCA PROGRAM

8582
05:01:42,840 --> 05:01:44,760
UNFORTUNATELY.

8583
05:01:44,760 --> 05:01:47,720
MATERNAL BMI DID NOT DECREASE,

8584
05:01:47,720 --> 05:01:49,040
REMAIN STABLE IN BOTH

8585
05:01:49,040 --> 05:01:50,600
INTERVENTION PARENTAL STRESS

8586
05:01:50,600 --> 05:01:51,720
IMPROVE MISDEMEANOR THE HEALTHY

8587
05:01:51,720 --> 05:01:53,480
WEIGHT CLINIC AND PARENTING

8588
05:01:53,480 --> 05:01:55,280
BEHAVIOR IMPROVED IN BOTH

8589
05:01:55,280 --> 05:01:56,160
INTERVENTIONS.

8590
05:01:56,160 --> 05:01:59,920
I WILL TALK ABOUT CLASS FINDINGS

8591
05:01:59,920 --> 05:02:01,480
WHICH OTHER PAMELA TALKED HOW

8592
05:02:01,480 --> 05:02:05,600
IMPORTANT THIS IS, SO WE

8593
05:02:05,600 --> 05:02:07,080
COLLABORATED WITH HARVARD SCHOOL

8594
05:02:07,080 --> 05:02:10,240
OF PUBLIC HEALTH CHOICES TEAM

8595
05:02:10,240 --> 05:02:11,800
THEY HAVE A MODEL WHICH SIMILAR

8596
05:02:11,800 --> 05:02:14,600
RATES U.S. POPULATION OVER TEN

8597
05:02:14,600 --> 05:02:15,920
YEARS AND THEY THEN ESTIMATE

8598
05:02:15,920 --> 05:02:17,680
THAT COST EFFECTIVENESS OF

8599
05:02:17,680 --> 05:02:20,080
INTERVENTION TO PREVENT OBESITY

8600
05:02:20,080 --> 05:02:22,080
FOLLOWING GUIDELINES OF SECOND

8601
05:02:22,080 --> 05:02:24,160
U.S. PANEL ON CLASS

8602
05:02:24,160 --> 05:02:25,480
EFFECTIVENESS, SO THIS MODEL

8603
05:02:25,480 --> 05:02:27,240
PROJECTS INTERVENTIONS TO REACH

8604
05:02:27,240 --> 05:02:31,120
IMPACT BMI AND ALSO ON BMI

8605
05:02:31,120 --> 05:02:32,960
ASSOCIATED HEALTHCARE

8606
05:02:32,960 --> 05:02:34,480
EXPENDITURES SO IN CHILDREN THIS

8607
05:02:34,480 --> 05:02:37,160
LEADS TO ROUGHLY ESTIMATE OF

8608
05:02:37,160 --> 05:02:39,360
$200 PER YEAR OF EXCESS ANNUAL

8609
05:02:39,360 --> 05:02:42,320
MEDICAL EXPENDITURES DUE TO

8610
05:02:42,320 --> 05:02:42,800
OBESITY.

8611
05:02:42,800 --> 05:02:45,640
IN THIS MODEL WE INCLUDE COSTS,

8612
05:02:45,640 --> 05:02:47,200
INCLUDING DIRECT AND INDIRECT

8613
05:02:47,200 --> 05:02:48,200
OPPORTUNITY COSTS IN FACT WE

8614
05:02:48,200 --> 05:02:49,480
SURVEY THE FAMILIES ON HOW LONG

8615
05:02:49,480 --> 05:02:51,280
IT WAS TAKING FOR THEM THE GET

8616
05:02:51,280 --> 05:02:54,920
TO CLINICS OR GET THE GROCERY

8617
05:02:54,920 --> 05:02:56,800
STORE TO BUY EXTRA FRUITS AND

8618
05:02:56,800 --> 05:02:58,560
VEGETABLES FOR THEIR CHILDREN

8619
05:02:58,560 --> 05:03:00,200
AND EXTRA COSTS THEY WERE PAYING

8620
05:03:00,200 --> 05:03:03,400
FOR POTENTIAL PHYSICAL ACTIVITY

8621
05:03:03,400 --> 05:03:04,320
GROUPS KIDS ARE PARTICIPATING

8622
05:03:04,320 --> 05:03:10,480
IN.

8623
05:03:10,480 --> 05:03:11,760
AND HEALTHCARE COSTS CONSIDERED.

8624
05:03:11,760 --> 05:03:13,600
USING THIS MODEL WE IMPLEMENTED

8625
05:03:13,600 --> 05:03:14,720
THIS IN EVERY FEDERALLY

8626
05:03:14,720 --> 05:03:16,440
QUALIFIED HEALTH SEPTEMBERER IN

8627
05:03:16,440 --> 05:03:17,600
THE UNITED STATES FOR CHILDREN

8628
05:03:17,600 --> 05:03:20,040
SIX TO 12 YEARS OF AGE WITH

8629
05:03:20,040 --> 05:03:21,640
OVERWEIGHT OR OBESITY AND WE USE

8630
05:03:21,640 --> 05:03:22,880
THE ENROLLMENT PERCENTAGE OF

8631
05:03:22,880 --> 05:03:27,000
WHAT WE SAW IN OUR TRIAL WE

8632
05:03:27,000 --> 05:03:27,760
REACH ABOUT MILLION CHILDREN

8633
05:03:27,760 --> 05:03:31,720
OVER TEN YEARS.

8634
05:03:31,720 --> 05:03:35,200
THE COST IS LOW AT 6606 AND 450

8635
05:03:35,200 --> 05:03:38,520
BY IS PAID BY INSURER OR THE

8636
05:03:38,520 --> 05:03:40,960
HEALTH CENTER THE REST PAID BY

8637
05:03:40,960 --> 05:03:41,280
FAMILY.

8638
05:03:41,280 --> 05:03:43,600
SO WE ESTIMATE THAT WE WOULD

8639
05:03:43,600 --> 05:03:45,760
SAVE ABOUT $9.2 MILLION

8640
05:03:45,760 --> 05:03:48,000
HEALTHCARE SYSTEM.

8641
05:03:48,000 --> 05:03:51,440
WITH THIS INTERVENTION BEING

8642
05:03:51,440 --> 05:03:53,080
IMPLEMENTEDNA,NALLY.

8643
05:03:53,080 --> 05:03:56,400
60,000 YEARS WITH OBC PREVENTED.

8644
05:03:56,400 --> 05:03:59,640
THIS IS A HEALTH EQUITY

8645
05:03:59,640 --> 05:04:01,840
INDICATOR WHICH ESSENTIALLY IS

8646
05:04:01,840 --> 05:04:03,960
COMPARING THE LIKELIHOOD OF

8647
05:04:03,960 --> 05:04:05,720
DIFFERENT POPULATIONS RESPONDING

8648
05:04:05,720 --> 05:04:09,800
TO THE INTERVENTION VERSUS WHITE

8649
05:04:09,800 --> 05:04:10,520
NON-HISPANICS.

8650
05:04:10,520 --> 05:04:11,840
BECAUSE MORE BLACK HISPANIC

8651
05:04:11,840 --> 05:04:13,160
CHILDREN ARE CARED FOR BY

8652
05:04:13,160 --> 05:04:15,160
FEDERALLY QUALIFIED HEALTH

8653
05:04:15,160 --> 05:04:17,040
CENTERS AND ALSO MORE IMPACTED

8654
05:04:17,040 --> 05:04:18,960
BY OVERWEIGHT OBESITY.

8655
05:04:18,960 --> 05:04:20,560
THERE IS GREATER LIKELIHOOD THAT

8656
05:04:20,560 --> 05:04:22,000
THESE POPULATIONS WOULD BENEFIT

8657
05:04:22,000 --> 05:04:23,600
FROM THE INTERVENTION AND THAT

8658
05:04:23,600 --> 05:04:25,560
WE WOULD BE ABLE TO REDUCE

8659
05:04:25,560 --> 05:04:27,400
DISPARITIES IF WE WERE ABLE TO

8660
05:04:27,400 --> 05:04:30,680
DISSEMINATE IT NATIONALLY.

8661
05:04:30,680 --> 05:04:32,920
SO JUST TO SUMMARIZE COST

8662
05:04:32,920 --> 05:04:35,000
RESULTS IF IMPLEMENTED

8663
05:04:35,000 --> 05:04:36,440
NATIONALLY FOR SIX TO

8664
05:04:36,440 --> 05:04:38,360
12-YEAR-OLDS AT ALL FEDERALLY

8665
05:04:38,360 --> 05:04:40,240
QUALIFIED HEALTH CENTERS WE

8666
05:04:40,240 --> 05:04:41,600
ESTIMATE 60,000 YEARS OF OBESITY

8667
05:04:41,600 --> 05:04:44,200
WOULD BE PREVENTED IN 2030.

8668
05:04:44,200 --> 05:04:46,800
WE ESTIMATE PROGRAMS COST ABOUT

8669
05:04:46,800 --> 05:04:49,960
660 PER CHILD OR 450 BY

8670
05:04:49,960 --> 05:04:51,200
HEALTHCARE SYSTEM.

8671
05:04:51,200 --> 05:04:53,800
AND WE WOULD SAVE $9.2 MILLION

8672
05:04:53,800 --> 05:04:54,480
IN HEALTHCARE COSTS OVER TEN

8673
05:04:54,480 --> 05:04:56,600
YEARS.

8674
05:04:56,600 --> 05:04:58,400
AND THEN WE PROJECT THAT GREATER

8675
05:04:58,400 --> 05:05:00,920
HEALTH BENEFITS ACCRUE AMONG

8676
05:05:00,920 --> 05:05:04,480
HISPANIC AND BLACK POPULATIONS.

8677
05:05:04,480 --> 05:05:06,240
THIS WORK HAS INFORMED OUR

8678
05:05:06,240 --> 05:05:08,200
CURRENT DISSEMINATION

8679
05:05:08,200 --> 05:05:09,600
IMPLEMENTATION GRANT AND WE ARE

8680
05:05:09,600 --> 05:05:13,840
LUCKY TO BE ONE OF FIVE GRANTEES

8681
05:05:13,840 --> 05:05:17,720
ON SOME CDC TO TAKE PEDIATRIC

8682
05:05:17,720 --> 05:05:19,600
WEIGHT MANAGEMENT INTERVENTIONS

8683
05:05:19,600 --> 05:05:22,240
DEVELOP IMPLEMENTATION PACKAGE,

8684
05:05:22,240 --> 05:05:23,680
TEST IN DIFFERENT AREAS USE

8685
05:05:23,680 --> 05:05:24,400
IMPLEMENTATION SCIENCE TO

8686
05:05:24,400 --> 05:05:25,840
IMPROVE IT.

8687
05:05:25,840 --> 05:05:27,440
AND THEN THEIR GOAL IS FOR THESE

8688
05:05:27,440 --> 05:05:30,480
TO BE OFF THE SHELF PACKAGES

8689
05:05:30,480 --> 05:05:32,000
THAT DIFFERENT ORGANIZATIONS CAN

8690
05:05:32,000 --> 05:05:35,800
IMPLEMENT.

8691
05:05:35,800 --> 05:05:38,800
SO WHAT ARE PACKAGES BASED ON

8692
05:05:38,800 --> 05:05:41,160
HEALTHY WEIGHT CLINIC YOU HEARD

8693
05:05:41,160 --> 05:05:43,400
IN THE OTHER TRIALS AND WE ARE

8694
05:05:43,400 --> 05:05:45,200
LUCKY TO BE PARTNERING WITH

8695
05:05:45,200 --> 05:05:46,600
AMERICAN AKEYPAD MY OF

8696
05:05:46,600 --> 05:05:47,600
PEDIATRICS TO DESIGN THIS

8697
05:05:47,600 --> 05:05:49,360
PROGRAM AND WHAT OUR PACKAGE

8698
05:05:49,360 --> 05:05:51,400
INCLUDES IS TRAINING TECHNICAL

8699
05:05:51,400 --> 05:05:53,600
ASSISTANCE AND TOOLS AND

8700
05:05:53,600 --> 05:05:55,360
RESOURCES FOR COMMUNITY HEALTH

8701
05:05:55,360 --> 05:05:56,880
CENTER TO BUILD THEIR OWN

8702
05:05:56,880 --> 05:05:59,720
HEALTHY WEIGHT CLINIC AND HAVE A

8703
05:05:59,720 --> 05:06:02,200
SUCCESSFUL SUSTAIN PROGRAM SO WE

8704
05:06:02,200 --> 05:06:05,320
ON BOARD THE THE PROVIDERS WE

8705
05:06:05,320 --> 05:06:07,600
CAN BUILD THEIR SYSTEM, ENGAGE

8706
05:06:07,600 --> 05:06:10,280
HELP ENGAGE FAMILIES AND REFINE

8707
05:06:10,280 --> 05:06:11,320
OUR SYSTEMS.

8708
05:06:11,320 --> 05:06:12,640
HELP IMPLEMENT HEALTHY WEIGHT

8709
05:06:12,640 --> 05:06:14,200
CLINIC AND LEARN ABOUT BILLING

8710
05:06:14,200 --> 05:06:16,960
AND REIMBURSEMENT SO THIS CAN BE

8711
05:06:16,960 --> 05:06:18,400
SUSTAINABLE FOR THEM.

8712
05:06:18,400 --> 05:06:20,480
SO WHAT DOES HEALTHY WEIGHT

8713
05:06:20,480 --> 05:06:23,080
CLINIC LOOK LIKE AT A GLANCE?

8714
05:06:23,080 --> 05:06:24,080
STARTS ATWELLNESS WHERE THE

8715
05:06:24,080 --> 05:06:25,200
ELECTRONIC DECISION SUPPORT

8716
05:06:25,200 --> 05:06:28,280
TOOLS I TALKED ABOUT WOULD BE

8717
05:06:28,280 --> 05:06:30,200
IMPLEMENTED AND IT GOES TO AN

8718
05:06:30,200 --> 05:06:31,400
INDIVIDUAL CLINIC VISIT WITH THE

8719
05:06:31,400 --> 05:06:33,480
COMMUNITY HEALTH WORKER THAT

8720
05:06:33,480 --> 05:06:35,280
DIETITIAN AND MEDICAL PROVIDER,

8721
05:06:35,280 --> 05:06:37,480
THIS ALTERNATES WITH GROUP

8722
05:06:37,480 --> 05:06:39,280
SESSIONS ONCE A MONTH AND THEN

8723
05:06:39,280 --> 05:06:41,520
WE RECEIVED HELP ON CHECK INs

8724
05:06:41,520 --> 05:06:43,440
WITH COMMUNITY HEALTH WORKER AND

8725
05:06:43,440 --> 05:06:45,200
DIETITIAN TWICE PER MONTH TO

8726
05:06:45,200 --> 05:06:47,200
SUPPORT THEM OUTSIDE OF THE

8727
05:06:47,200 --> 05:06:48,720
CLINIC.

8728
05:06:48,720 --> 05:06:50,360
THE TEXT MESSAGING MANY THE

8729
05:06:50,360 --> 05:06:51,240
TRIALS IS PART OF THIS

8730
05:06:51,240 --> 05:06:52,920
INTERVENTION.

8731
05:06:52,920 --> 05:06:54,800
THE LAST SIX MONTHS IS THE

8732
05:06:54,800 --> 05:06:56,600
MAINTENANCE AND THEY ONLY

8733
05:06:56,600 --> 05:06:57,600
RECEIVE INDIVIDUAL VISITS WITH

8734
05:06:57,600 --> 05:06:59,360
THE COMMUNITY HEALTH WORKER THE

8735
05:06:59,360 --> 05:07:01,240
DIETITIAN AND THE MEDICAL

8736
05:07:01,240 --> 05:07:03,200
PROVIDER, THEY CONTINUE TO

8737
05:07:03,200 --> 05:07:04,400
RECEIVE TELEPHONE CHECK INs

8738
05:07:04,400 --> 05:07:07,920
WITH COMMUNITY HEALTH WORKER

8739
05:07:07,920 --> 05:07:09,440
DIETITIAN TWICE PER MONTH.

8740
05:07:09,440 --> 05:07:10,920
SO I HAVE COVERED THE HEALTHY

8741
05:07:10,920 --> 05:07:12,600
WEIGHT CLINIC TEAM MEMBER AND

8742
05:07:12,600 --> 05:07:15,840
ROLES WE HAVE MEDICAL PROVIDER

8743
05:07:15,840 --> 05:07:17,600
WHICH COULD BE A NURSE PRACTICE

8744
05:07:17,600 --> 05:07:19,440
EVERYTHING, PEDIATRICIAN AND

8745
05:07:19,440 --> 05:07:20,880
FAMILY MEDICINE DOCK, TO WE HAVE

8746
05:07:20,880 --> 05:07:22,680
A DIETITIAN OR NUTRITIONIST AND

8747
05:07:22,680 --> 05:07:24,000
THEN COMMUNITY HEALTH WORKER

8748
05:07:24,000 --> 05:07:26,400
WHICH IS REALLY IMPORTANT TO

8749
05:07:26,400 --> 05:07:28,000
LINK TO RELEVANT COMMUNITY

8750
05:07:28,000 --> 05:07:31,960
RESOURCES, AND ADDRESSING UNMET

8751
05:07:31,960 --> 05:07:32,800
SOCIAL NEEDS.

8752
05:07:32,800 --> 05:07:33,640
THIS IMPLEMENTATION GRANT WE

8753
05:07:33,640 --> 05:07:35,440
HAVE EXPANDED THE POPULATION AS

8754
05:07:35,440 --> 05:07:36,680
WE HEARD FROM STAKEHOLDERS, IT

8755
05:07:36,680 --> 05:07:38,560
IS REALLY IMPORTANT FOR THIS

8756
05:07:38,560 --> 05:07:42,120
PACKAGE TO ADDRESS ALL KIDS IN

8757
05:07:42,120 --> 05:07:43,200
NEED.

8758
05:07:43,200 --> 05:07:45,320
AND THEN TO GIVE A FLAVOR WHAT

8759
05:07:45,320 --> 05:07:47,640
THIS LOOKS LIKE INCLUDES VIRTUAL

8760
05:07:47,640 --> 05:07:49,880
LEARNING SESSIONS FOR ALL OF OUR

8761
05:07:49,880 --> 05:07:51,880
TEAMS IMPLEMENTING THE PROGRAM,

8762
05:07:51,880 --> 05:07:54,200
THERE IS RECORDED MODULES FOR

8763
05:07:54,200 --> 05:07:55,360
PROVIDERS AND WE HAVE SOME

8764
05:07:55,360 --> 05:07:56,560
RESOURCES AND TOOLS THAT THEY

8765
05:07:56,560 --> 05:08:01,720
CAN USE FOR ENGAGEMENT AND

8766
05:08:01,720 --> 05:08:03,120
TECHNICAL ASSISTANCE AS WELL SO

8767
05:08:03,120 --> 05:08:04,760
H IS ONE OF THE PROVIDER

8768
05:08:04,760 --> 05:08:07,320
TRAINING MODULES, AND THERE IS

8769
05:08:07,320 --> 05:08:08,280
ABOUT 15 HOURS OF TRAINING

8770
05:08:08,280 --> 05:08:10,760
ONLINE THEY DO, SEPARATE FROM

8771
05:08:10,760 --> 05:08:12,000
THE VIRTUAL LEARNING

8772
05:08:12,000 --> 05:08:15,080
COLLABORATIVE.

8773
05:08:15,080 --> 05:08:16,480
THIS IS IMPORTANT TO ME BUT WE

8774
05:08:16,480 --> 05:08:18,960
HAVE A COMMUNITY RESOURCE GUIDE

8775
05:08:18,960 --> 05:08:21,200
MODULE WHERE THEY LEARN TO

8776
05:08:21,200 --> 05:08:23,400
REALLY CREATE THEIR OWN TAILORED

8777
05:08:23,400 --> 05:08:25,960
COMMUNITY RESOURCE GUIDE.

8778
05:08:25,960 --> 05:08:28,280
SOME GROUP SESSION RESOURCES ARE

8779
05:08:28,280 --> 05:08:31,760
HERE YOU CAN SEE POWERPOINT THAT

8780
05:08:31,760 --> 05:08:32,320
FAIL AT A TIME OUR GUIDE AND

8781
05:08:32,320 --> 05:08:34,360
PATIENT HAND OUTS AND ALSO SHOW

8782
05:08:34,360 --> 05:08:35,920
YOU A VIDEO THAT SUMMARIZES WHAT

8783
05:08:35,920 --> 05:08:38,040
WE DO IN THE CURRICULUM IN ONE

8784
05:08:38,040 --> 05:08:40,760
AND A HALF MINUTES.

8785
05:08:40,760 --> 05:08:42,200
EVERYONE ASKS ME WHAT IS IN THE

8786
05:08:42,200 --> 05:08:45,080
GROUP CONTENT AND YOU CAN SEE

8787
05:08:45,080 --> 05:08:48,000
FOCUSES ON NUTRITION, PHYSICAL

8788
05:08:48,000 --> 05:08:49,200
ACTIVITY THREE TIMES WEEK AND

8789
05:08:49,200 --> 05:08:55,240
SOCIAL EMOTIONAL WELLNESS.

8790
05:08:55,240 --> 05:08:56,400
>> GREAT.

8791
05:08:56,400 --> 05:08:57,880
I WILL PLAY THIS VIDEO.

8792
05:08:57,880 --> 05:08:59,400
>> AS PARENTS AND GUARDIANS YOU

8793
05:08:59,400 --> 05:09:00,600
ARE POWERFUL AND IMPORTANT

8794
05:09:00,600 --> 05:09:02,600
PARTNERS IN KEEPING YOUR

8795
05:09:02,600 --> 05:09:04,360
CHILDREN HEALTHY, STILL

8796
05:09:04,360 --> 05:09:06,600
PARENTING CAN BE CHALLENGING AND

8797
05:09:06,600 --> 05:09:08,720
SOMETIMES VERY STRESSFUL.

8798
05:09:08,720 --> 05:09:10,160
NOTICING WHEN YOUR CHILD IS

8799
05:09:10,160 --> 05:09:11,600
DOING SOMETHING WELL AND

8800
05:09:11,600 --> 05:09:12,640
ACKNOWLEDGING IT IS EFFECTIVE

8801
05:09:12,640 --> 05:09:15,960
WAY TO ENCOURAGE GOOD HABITS.

8802
05:09:15,960 --> 05:09:17,520
PRAISE WHEN SPECIFIC GENUINE

8803
05:09:17,520 --> 05:09:19,600
HELPS KIDS FEEL CONFIDENT AND

8804
05:09:19,600 --> 05:09:20,000
CAPABLE.

8805
05:09:20,000 --> 05:09:22,400
YOU MAY WANT THE START SMALL BY

8806
05:09:22,400 --> 05:09:24,040
PRAISING A FEW BEHAVIORS AND

8807
05:09:24,040 --> 05:09:26,960
LIMBING ANY NEGATIVE COMMENTS.

8808
05:09:26,960 --> 05:09:28,600
BE PATIENT AND KIND.

8809
05:09:28,600 --> 05:09:31,560
LOVE TO YOUR CHILD AND YOURSELF

8810
05:09:31,560 --> 05:09:33,200
CHANGE TAKES TIME.

8811
05:09:33,200 --> 05:09:34,680
CHILDREN RESPOND WELL TO

8812
05:09:34,680 --> 05:09:36,320
ROUTINES AN LIMITS, WHEN

8813
05:09:36,320 --> 05:09:37,760
CHILDREN KNOW WHAT WE EXPECT OF

8814
05:09:37,760 --> 05:09:39,600
THEM THEY ARE CALMER.

8815
05:09:39,600 --> 05:09:41,120
FOR TEENS AND LIMITS ALLOW US TO

8816
05:09:41,120 --> 05:09:43,000
SPEND MORE TIME ON POSITIVE

8817
05:09:43,000 --> 05:09:44,800
INTERACTIONS WITH OUR KIDS.

8818
05:09:44,800 --> 05:09:46,200
GIVING CHILDREN A COUPLE OF GOOD

8819
05:09:46,200 --> 05:09:48,800
CHOICES IS ALSO IMPORTANT.

8820
05:09:48,800 --> 05:09:50,800
ALLOWING THEM TO CHOOSE BETWEEN

8821
05:09:50,800 --> 05:09:52,200
TWO HEALTHY OPTIONS BUILDS

8822
05:09:52,200 --> 05:09:53,600
DECISION MAKING SKILLS AND

8823
05:09:53,600 --> 05:09:55,800
ENCOURAGES THEM TO TALK TO US.

8824
05:09:55,800 --> 05:09:57,800
VALUABLE WAY TO SUPPORT OUR

8825
05:09:57,800 --> 05:09:59,240
CHILDREN IS ROLE MODELING.

8826
05:09:59,240 --> 05:10:00,600
OUR CHILDREN LOOK UP TO US.

8827
05:10:00,600 --> 05:10:02,800
AND WE ARE THEIR FIRST TEACHERS

8828
05:10:02,800 --> 05:10:03,720
AND ROLE MODELS.

8829
05:10:03,720 --> 05:10:05,600
SO WE NEED TO SHOW THEM HOW TO

8830
05:10:05,600 --> 05:10:07,200
MAKE HEALTHIER CHOICES LIKE

8831
05:10:07,200 --> 05:10:08,920
EATING HEALTHY AND BEING

8832
05:10:08,920 --> 05:10:10,600
PHYSICALLY ACTIVE.

8833
05:10:10,600 --> 05:10:13,240
WHEN MODELING PREFERRED HEALTHY

8834
05:10:13,240 --> 05:10:14,480
BEHAVIOR BE CONSISTENT.

8835
05:10:14,480 --> 05:10:16,720
WHEN SUPPORTING HEALTHY BEHAVIOR

8836
05:10:16,720 --> 05:10:19,480
BE KIND AND OFFER PRAISE.

8837
05:10:19,480 --> 05:10:20,680
MORE INFORMATION ON THESE AND

8838
05:10:20,680 --> 05:10:22,480
OTHER STRATEGIES FOR HEALTHY

8839
05:10:22,480 --> 05:10:23,800
LIFESTYLES, TALK TO YOUR HEALTHY

8840
05:10:23,800 --> 05:10:26,200
WEIGHT CLINIC TEAM.

8841
05:10:26,200 --> 05:10:27,800
>> AS YOU CAN SEE THIS --

8842
05:10:27,800 --> 05:10:29,360
>> AS PARENTS AND GUARDIANS YOU

8843
05:10:29,360 --> 05:10:30,920
ARE POWERFUL AND IMPORTANT

8844
05:10:30,920 --> 05:10:32,160
PARTNERS IN KEEPING --

8845
05:10:32,160 --> 05:10:33,800
>> OKAY.

8846
05:10:33,800 --> 05:10:38,320
SO THAT AS YOU CAN SEE A FAMILY

8847
05:10:38,320 --> 05:10:39,560
APPROACH AND HOPING TO I DRESS

8848
05:10:39,560 --> 05:10:40,760
THE PARENT AND THE CHILD AND

8849
05:10:40,760 --> 05:10:42,760
THEN JUST LIKE TO ACKNOWLEDGE MY

8850
05:10:42,760 --> 05:10:46,200
TEAM AT THE AMERICAN ACADEMY OF

8851
05:10:46,200 --> 05:10:49,160
PEDIATRICS AND MY MGHS TEAM

8852
05:10:49,160 --> 05:10:50,160
SUPPORTED ME THROUGHOUT THIS

8853
05:10:50,160 --> 05:10:52,800
WORK AND ALL OUR FUNDERS SO

8854
05:10:52,800 --> 05:10:55,960
THANK YOU SO MUCH.

8855
05:10:55,960 --> 05:10:56,600
>> GREAT.

8856
05:10:56,600 --> 05:11:03,040
THANK YOU, SO MUCH.

8857
05:11:03,040 --> 05:11:06,800
DR. FIECHTNER.

8858
05:11:06,800 --> 05:11:07,720
LET'S SEE.

8859
05:11:07,720 --> 05:11:09,400
SCREEN LOOKS DIFFERENT WE ARE

8860
05:11:09,400 --> 05:11:25,640
STILL SHARING DR. FIECHTNER.

8861
05:11:25,640 --> 05:11:26,000
THANKS.

8862
05:11:26,000 --> 05:11:30,240
NOW WE ARE GOING TO DO THE YEAH

8863
05:11:30,240 --> 05:11:31,760
AND ANSWER.

8864
05:11:31,760 --> 05:11:35,000
SO IF YOU HAVE QUESTIONS PLEASE

8865
05:11:35,000 --> 05:11:37,640
PUT THEM IN THE QUESTION AND

8866
05:11:37,640 --> 05:11:38,200
ANSWER BOX.

8867
05:11:38,200 --> 05:11:42,320
THERE WAS ONE IN THERE THAT I

8868
05:11:42,320 --> 05:11:45,200
WANTED TO POSE TO DR. MEHTA

8869
05:11:45,200 --> 05:11:46,560
THOUGH HE ANSWERED IT FOR THE

8870
05:11:46,560 --> 05:11:50,680
BENEFIT OF EVERYONE ELSE.

8871
05:11:50,680 --> 05:11:52,760
THIS COMMENT SAYS THANK YOU

8872
05:11:52,760 --> 05:11:53,560
DARSHAN GREAT PRESENTATION.

8873
05:11:53,560 --> 05:11:55,320
DO YOU SEE ANY WAY FOR

8874
05:11:55,320 --> 05:11:56,240
RESEARCHERS TO DEVELOP AND TEST

8875
05:11:56,240 --> 05:11:58,240
MIND BODY INTERVENTIONS TO

8876
05:11:58,240 --> 05:12:00,280
IMPROVE GENERAL WELL BEING AND

8877
05:12:00,280 --> 05:12:01,680
PREVENT ILLNESS AMONG

8878
05:12:01,680 --> 05:12:03,640
UNDERSERVED AND VULNERABLE

8879
05:12:03,640 --> 05:12:06,000
POPULATIONS THAT CAN BE

8880
05:12:06,000 --> 05:12:06,640
IMPLEMENTED WITHIN HEALTHCARE

8881
05:12:06,640 --> 05:12:07,280
SETTING.

8882
05:12:07,280 --> 05:12:08,800
THESE INTERVENTIONS EXIST BUT

8883
05:12:08,800 --> 05:12:10,720
OUTSIDE THE HEALTHCARE SETTING

8884
05:12:10,720 --> 05:12:13,440
MOSTLY TO THE POPULATION YOU

8885
05:12:13,440 --> 05:12:17,080
MENTIONED HIGH SES, PETS OR

8886
05:12:17,080 --> 05:12:19,160
SLIGHTLY MORE AVAILABLE FOR

8887
05:12:19,160 --> 05:12:20,840
PEOPLE WITH DIAGNOSE ILLNESS.

8888
05:12:20,840 --> 05:12:22,840
THEY ARE USUALLY NOT AVAILABLE

8889
05:12:22,840 --> 05:12:24,720
AS PREVENTATIVE CARE FOR

8890
05:12:24,720 --> 05:12:26,480
INDIVIDUALS OF HIGH RISK OF

8891
05:12:26,480 --> 05:12:27,160
DEVELOPING ILLNESS.

8892
05:12:27,160 --> 05:12:30,520
WHAT WILL IT TAKE FOR INSURANCE

8893
05:12:30,520 --> 05:12:32,920
TO COVER MINDFULNESS BASE STRESS

8894
05:12:32,920 --> 05:12:34,920
REDUCTION COMMUNITY ADAPTED AND

8895
05:12:34,920 --> 05:12:37,560
CULTURALLY RELEVANT SO THAT IS A

8896
05:12:37,560 --> 05:12:39,880
VERY INTERESTING QUESTION.

8897
05:12:39,880 --> 05:12:41,560
DR. MEHTA, WOULD YOU MIND

8898
05:12:41,560 --> 05:12:44,160
SHARING YOUR ANSWER TO THAT.

8899
05:12:44,160 --> 05:12:48,720
>> IT IS A GREAT QUESTION AND

8900
05:12:48,720 --> 05:12:50,240
VERY IMPORTANT ONE SO THERE ARE

8901
05:12:50,240 --> 05:12:53,880
TWO PARTS TO THE ANSWER, ONE IS

8902
05:12:53,880 --> 05:12:57,120
THAT WE ARE -- I THINK WE ARE

8903
05:12:57,120 --> 05:12:59,720
SEEING MORE THINGS BEING COVERED

8904
05:12:59,720 --> 05:13:02,000
THAT AND THEN I THINK IT TAKES A

8905
05:13:02,000 --> 05:13:04,440
BIG DISRUPTER LIKE IN THE COVID

8906
05:13:04,440 --> 05:13:05,880
PANDEMIC TO CREATE NEW

8907
05:13:05,880 --> 05:13:07,640
INNOVATIONS AND SOLUTIONS, FOR

8908
05:13:07,640 --> 05:13:10,080
EXAMPLE, THE ADVENT OF VIRTUAL

8909
05:13:10,080 --> 05:13:11,200
HEALTH PLATFORMS ET CETERA

8910
05:13:11,200 --> 05:13:13,720
SPECIALLY MIND BODY MEDICINE WAS

8911
05:13:13,720 --> 05:13:16,680
NEVER A POSSIBILITY NOW IT IS

8912
05:13:16,680 --> 05:13:18,280
95% OF THE CLINICAL PRACTICE I

8913
05:13:18,280 --> 05:13:21,400
CURRENTLY LEAD IS THAT IS A VERY

8914
05:13:21,400 --> 05:13:22,480
PRIME EXAMPLE WHERE SOMETHING

8915
05:13:22,480 --> 05:13:24,160
LIKE THIS REALLY IF THERE IS A

8916
05:13:24,160 --> 05:13:25,800
SILVER LINING TO BE SEEN

8917
05:13:25,800 --> 05:13:27,720
DISRUPTED THE WAY WE DELIVERED

8918
05:13:27,720 --> 05:13:28,400
HEALTHCARE AND THOUGHT OF

8919
05:13:28,400 --> 05:13:30,040
HEALTHCARE AND NOW WE HAVE NEW

8920
05:13:30,040 --> 05:13:30,400
WAYS.

8921
05:13:30,400 --> 05:13:33,440
THE SECOND PIECE IS THAT IT IS A

8922
05:13:33,440 --> 05:13:37,200
MESSAGING PIECE, I SEE AGAIN HOW

8923
05:13:37,200 --> 05:13:39,600
WE THINK ABOUT SOME OF THESE

8924
05:13:39,600 --> 05:13:40,600
APPROACHES ET CETERA SPECIALLY

8925
05:13:40,600 --> 05:13:42,360
SELF CARE AND MIND BODY MEDICINE

8926
05:13:42,360 --> 05:13:44,560
AS AN EXAMPLE, WE AREN'T

8927
05:13:44,560 --> 05:13:46,440
OPTIMIZING THE LAST FEW SLIDES

8928
05:13:46,440 --> 05:13:49,120
THAT YOU HAVE IN THE -- WHICH I

8929
05:13:49,120 --> 05:13:50,000
DIDN'T GET A CHANCE TO DISCUSS

8930
05:13:50,000 --> 05:13:52,200
IS LOOKING AT -- WE KNOW FOR A

8931
05:13:52,200 --> 05:13:53,680
FACT LIFESTYLE FACTORS ARE THE

8932
05:13:53,680 --> 05:13:57,040
BIGGEST RISK FACTORS FOR THOSE

8933
05:13:57,040 --> 05:13:59,800
BY SEVERE CONSEQUENCES OF

8934
05:13:59,800 --> 05:14:00,720
COVID-19 PANDEMIC AND WHEN YOU

8935
05:14:00,720 --> 05:14:01,960
THINK ABOUT THE MESSAGING WE DO

8936
05:14:01,960 --> 05:14:05,160
A LOT OF MESSAGING AROUND RISK

8937
05:14:05,160 --> 05:14:06,520
MITIGATION HAND WASHING MASK

8938
05:14:06,520 --> 05:14:09,600
WEARING VACCINES BUT WE DON'T

8939
05:14:09,600 --> 05:14:11,720
TALK ABOUT -- WE SEE LITTLE

8940
05:14:11,720 --> 05:14:13,600
DIALOGUE ATTORNEY CERTAINLY LAY

8941
05:14:13,600 --> 05:14:15,400
MEDIA BUT ALSO SCIENTIFIC HOW WE

8942
05:14:15,400 --> 05:14:17,400
ADDRESS THIS IF THAT IS A INDEED

8943
05:14:17,400 --> 05:14:20,520
WE KNOW IT IS A MAJOR FACTOR AND

8944
05:14:20,520 --> 05:14:22,560
WE HAVEN'T DONE A GOOD JOB DOING

8945
05:14:22,560 --> 05:14:22,760
THAT.

8946
05:14:22,760 --> 05:14:25,000
ON THE FLIP SIDE, THINKING NOW

8947
05:14:25,000 --> 05:14:27,040
THAT WE ARE THINKING BOOSTERS AN

8948
05:14:27,040 --> 05:14:28,480
VACCINES, WHAT IS BOOSTING A

8949
05:14:28,480 --> 05:14:29,080
VACCINE?

8950
05:14:29,080 --> 05:14:34,560
TURNS OUT THAT WE HAVE CERTAINLY

8951
05:14:34,560 --> 05:14:36,600
SUGGESTIVE EVIDENCE AT LEAST BUT

8952
05:14:36,600 --> 05:14:38,400
CERTAINLY MORE THAN SUGGESTIVE

8953
05:14:38,400 --> 05:14:40,920
EVIDENCE WHEN PEOPLE LEARN THEY

8954
05:14:40,920 --> 05:14:44,600
ARE VACCINE RESPONSE IS BOOSTED,

8955
05:14:44,600 --> 05:14:46,200
WE HAVE NOT DONE A GOOD JOB

8956
05:14:46,200 --> 05:14:48,200
SENDING MESSAGING SO ONCE WE

8957
05:14:48,200 --> 05:14:51,440
BEGIN TO SEE HOW PANDEMIC CAN

8958
05:14:51,440 --> 05:14:52,200
DISRUPT EVERYTHING.

8959
05:14:52,200 --> 05:14:54,560
AND BEGIN TO INVADE MIX MESSAGES

8960
05:14:54,560 --> 05:14:57,200
THESE ARE MESSAGES I SAY WHEN I

8961
05:14:57,200 --> 05:14:58,600
GIVE PRESENTATIONS BUT I HAVE N

8962
05:14:58,600 --> 05:15:00,760
OF ONE AND I HI THE OTHER MORE

8963
05:15:00,760 --> 05:15:02,360
THAN THIS HAPPENS ESPECIALLY IN

8964
05:15:02,360 --> 05:15:03,800
THE SCIENTIFIC AUDIENCE CREATES

8965
05:15:03,800 --> 05:15:06,200
OPPORTUNITIES FOR FUNDING.

8966
05:15:06,200 --> 05:15:07,280
BECAUSE WAIT WILL IS SOMETHING

8967
05:15:07,280 --> 05:15:08,280
HERE HA NEED TORR FURTHER

8968
05:15:08,280 --> 05:15:09,600
INVESTIGATED AND WE COME UP WITH

8969
05:15:09,600 --> 05:15:11,200
MORE INVASIONS AND RESEARCH AND

8970
05:15:11,200 --> 05:15:14,480
SOLUTIONS FOR IMPLEMENTATION.

8971
05:15:14,480 --> 05:15:17,440
>> THANK YOU, I HAVE A FOLLOW-UP

8972
05:15:17,440 --> 05:15:20,400
QUESTION TO THAT TO THE FIRST

8973
05:15:20,400 --> 05:15:21,120
QUESTION AND I WAS WONDERING IF

8974
05:15:21,120 --> 05:15:24,200
YOU CAN SAY MORE ABOUT WHO

8975
05:15:24,200 --> 05:15:26,320
UTILIZES THE STRESS MANAGEMENT

8976
05:15:26,320 --> 05:15:31,160
AND RESILIENCE PROGRAM, WHO IS

8977
05:15:31,160 --> 05:15:34,120
UTILIZING IT AND HAVE GREATER

8978
05:15:34,120 --> 05:15:34,800
REACH.

8979
05:15:34,800 --> 05:15:36,200
>> SO AGAIN IN CLINICAL

8980
05:15:36,200 --> 05:15:39,200
POPULATION WE -- THERE IS A

8981
05:15:39,200 --> 05:15:40,280
CERTAINLY ET CETERA SPECIALLY

8982
05:15:40,280 --> 05:15:42,200
PROGRAMS LIKE MINDFULNESS BASE

8983
05:15:42,200 --> 05:15:43,680
STRESS REDUCTION THE PROGRAM WE

8984
05:15:43,680 --> 05:15:45,880
HAVE AT THE HENRY STRESS

8985
05:15:45,880 --> 05:15:47,520
MANAGEMENT RESILIENCE TRAINING

8986
05:15:47,520 --> 05:15:48,960
PROGRAM USE IN WIDE VARIETY OF

8987
05:15:48,960 --> 05:15:51,600
PATIENT POPULATION AND AGAIN

8988
05:15:51,600 --> 05:15:54,920
PART OF INTERVENTION CAN YOU

8989
05:15:54,920 --> 05:15:57,320
TREAT THE CONDITION OR BE PART

8990
05:15:57,320 --> 05:16:00,360
OF ADJUNCT TREATMENT OPTION,

8991
05:16:00,360 --> 05:16:02,000
WHAT IS NOW BEING FURTHER

8992
05:16:02,000 --> 05:16:03,200
INVESTIGATED AGAIN THROUGH SOME

8993
05:16:03,200 --> 05:16:05,800
OF THE INTERESTING MECHANISTIC

8994
05:16:05,800 --> 05:16:08,200
STUDIES IS WE CAN START EARLIER,

8995
05:16:08,200 --> 05:16:10,440
ON AND SEE CAN WE PREVENT AND WE

8996
05:16:10,440 --> 05:16:12,800
ARE USING IT IN NON-CLINICAL

8997
05:16:12,800 --> 05:16:14,680
POPULATIONS AND ONE THAT COMES

8998
05:16:14,680 --> 05:16:17,000
TO MIND IS HEALTHCARE PROVIDERS,

8999
05:16:17,000 --> 05:16:21,400
USING AGAIN BECAUSE OF THE

9000
05:16:21,400 --> 05:16:22,320
PANDEMIC HEALTHCARE PROVIDERS

9001
05:16:22,320 --> 05:16:24,840
EXITING THE WORK FORCE FOR HOST

9002
05:16:24,840 --> 05:16:26,440
OF REASONS PRESENT PRIOR TO THE

9003
05:16:26,440 --> 05:16:29,280
ACTUAL COVID-19 PANDEMIC ONLY

9004
05:16:29,280 --> 05:16:31,920
AMPLIFIED AND THAT BECOMES A BIG

9005
05:16:31,920 --> 05:16:34,800
-- WE ARE SEEING EXACTLY THE

9006
05:16:34,800 --> 05:16:36,360
CONSEQUENCE WHICH IS THERE IS

9007
05:16:36,360 --> 05:16:37,800
VERY LITTLE WIGGLE ROOM FOR US

9008
05:16:37,800 --> 05:16:39,600
TO SUSTAIN ANY INCREASE MANY THE

9009
05:16:39,600 --> 05:16:41,200
NEED FOR ACUTE HEALTHCARE.

9010
05:16:41,200 --> 05:16:43,200
SO I THINK AGAIN WE ARE

9011
05:16:43,200 --> 05:16:45,680
UTILIZING IT EXTENSIVELY AT OUR

9012
05:16:45,680 --> 05:16:48,320
HOSPITALS AROUND ESPECIALLY IN

9013
05:16:48,320 --> 05:16:50,800
OUR CLINICAL AMONG PEERS AND

9014
05:16:50,800 --> 05:16:52,560
EMPLOYEE IN OUR SYSTEM IS

9015
05:16:52,560 --> 05:16:54,800
EMPLOYEE BENEFIT TURNS OUT.

9016
05:16:54,800 --> 05:16:56,640
WE HAVE BEEN ABLE TO CREATE

9017
05:16:56,640 --> 05:16:58,000
EMPLOY BENEFIT AROUND THIS AS

9018
05:16:58,000 --> 05:16:58,400
WELL.

9019
05:16:58,400 --> 05:16:59,960
>> THAT IS GREAT.

9020
05:16:59,960 --> 05:17:00,680
THANK YOU.

9021
05:17:00,680 --> 05:17:07,120
SO THERE IS A QUESTION FOR DR.

9022
05:17:07,120 --> 05:17:08,040
FIECHTNER, HOW DO YOU IMPLEMENT

9023
05:17:08,040 --> 05:17:10,040
YOUR MODELS IN COMMUNITIES WITH

9024
05:17:10,040 --> 05:17:11,720
FOOD DESERTS AND HOW TO ADAPT

9025
05:17:11,720 --> 05:17:12,680
YOUR MODEL TO REACH THESE

9026
05:17:12,680 --> 05:17:15,360
COMMUNITIES?

9027
05:17:15,360 --> 05:17:17,400
>> OUR CURRENT INTERVENTION TWO

9028
05:17:17,400 --> 05:17:20,120
CURRENT INTERVENTION SITES ARE

9029
05:17:20,120 --> 05:17:24,320
IN THE DELTA WORLD, MAY ONLY

9030
05:17:24,320 --> 05:17:25,880
HAVE ONE GROCERY STORE WAL-MART

9031
05:17:25,880 --> 05:17:28,200
AND THEY RUN OUT OF FOOD AND WE

9032
05:17:28,200 --> 05:17:31,040
KNOW FAMILIES ARE RELYING ON

9033
05:17:31,040 --> 05:17:32,640
DOLLAR STORE ET CETERA FOR FOOD

9034
05:17:32,640 --> 05:17:34,640
SO WE ARE WORKING THERE, THEY

9035
05:17:34,640 --> 05:17:37,440
HAVE A LARGEING A YOU WILL CHURL

9036
05:17:37,440 --> 05:17:40,640
COMMUNITY AND SO WORKING ON WITH

9037
05:17:40,640 --> 05:17:41,880
BARNES TO SEE IF WE CAN HELP

9038
05:17:41,880 --> 05:17:44,120
PROVIDE ACCESS TO FRUITS AND

9039
05:17:44,120 --> 05:17:45,680
VEGETABLES, WE ALSO HEARD FROM

9040
05:17:45,680 --> 05:17:47,280
FAMILIES USE FROZEN FRUITS AND

9041
05:17:47,280 --> 05:17:49,400
VEGETABLES AND THEN I THINK YOU

9042
05:17:49,400 --> 05:17:50,760
MIGHT HAVE HEARD MY ROLE IN MY

9043
05:17:50,760 --> 05:17:53,120
LICENSE TO BE THE SENIOR HEALTH

9044
05:17:53,120 --> 05:17:55,560
AND RESEARCH ADVISOR THE GREATER

9045
05:17:55,560 --> 05:17:57,520
BOSTON FOOD BANK SO REALLY

9046
05:17:57,520 --> 05:17:59,960
PARTNERING WITH OUR FOOD

9047
05:17:59,960 --> 05:18:01,280
PANTRIES AND FOOD BANKS AS MUCH

9048
05:18:01,280 --> 05:18:03,400
AS WE CAN TO ADDRESS THIS HAS

9049
05:18:03,400 --> 05:18:06,040
BEEN WHAT WE HAVE BEEN DOING.

9050
05:18:06,040 --> 05:18:07,640
I THINK THAT THERE WILL BE MORE

9051
05:18:07,640 --> 05:18:08,960
ENGAGEMENT WITH FAMILIES AN

9052
05:18:08,960 --> 05:18:11,840
LEARN MORE AS WE IMPLEMENT THIS

9053
05:18:11,840 --> 05:18:12,640
FURTHER IN RURAL MISSISSIPPI FOR

9054
05:18:12,640 --> 05:18:15,400
SURE.

9055
05:18:15,400 --> 05:18:16,640
BUT IT IS SOMETHING I THINK NEED

9056
05:18:16,640 --> 05:18:19,480
TO BE ADDRESSED CURRENTLY WITH

9057
05:18:19,480 --> 05:18:20,680
TREATMENT OF CHILDHOOD OBESITY

9058
05:18:20,680 --> 05:18:25,840
FOR SURE.

9059
05:18:25,840 --> 05:18:26,200
>> THANK YOU.

9060
05:18:26,200 --> 05:18:29,760
ANOTHER QUESTION FOR YOU, JUST

9061
05:18:29,760 --> 05:18:31,200
TO CLARIFY WHERE INTERVENTION IT

9062
05:18:31,200 --> 05:18:33,040
IS SAME IN THE HEALTHY WEIGHT

9063
05:18:33,040 --> 05:18:37,080
CLINIC AND THE YMCA?

9064
05:18:37,080 --> 05:18:39,600
IF SO, WOULD YOU EXPLAIN THE

9065
05:18:39,600 --> 05:18:41,000
DIFFERENCE IN RESILIENCE?

9066
05:18:41,000 --> 05:18:42,160
>> THEY WEREN'T THE SAME.

9067
05:18:42,160 --> 05:18:47,400
THE YMCA IS STAFFED BY TWO

9068
05:18:47,400 --> 05:18:49,040
USUALLY HIGH SCHOOL EDUCATED

9069
05:18:49,040 --> 05:18:51,800
LEADERS AND WE HAD HOPED THAT

9070
05:18:51,800 --> 05:18:55,000
THEY WOULD BE EQUALLY EFFECTIVE,

9071
05:18:55,000 --> 05:18:57,280
BASED OFF THE MEN PROGRAM THE

9072
05:18:57,280 --> 05:18:59,400
ADAPTED THAT WHICH HAS A LOT OF

9073
05:18:59,400 --> 05:19:01,880
EFFECTIVENESS DATA.

9074
05:19:01,880 --> 05:19:04,280
TURNS OUT AFTER THE TRIAL, THE

9075
05:19:04,280 --> 05:19:07,200
YMCA MODIFIED THEIR PROGRAM THEY

9076
05:19:07,200 --> 05:19:09,120
DISSEMINAYED NATIONALLY, SO I

9077
05:19:09,120 --> 05:19:12,520
DON'T THINK IT IS COMPLETELY

9078
05:19:12,520 --> 05:19:16,080
CONGRUENT TO COMPARE THOSE TWO.

9079
05:19:16,080 --> 05:19:17,760
THE HUGE BENEFIT OF THE HEALTHY

9080
05:19:17,760 --> 05:19:19,400
WEIGHT CLINIC IS THE

9081
05:19:19,400 --> 05:19:21,960
PEDIATRICIAN BEING PART OF THAT

9082
05:19:21,960 --> 05:19:23,720
TEAM.

9083
05:19:23,720 --> 05:19:25,400
FAMILIES IN THE COMMUNITY HEALTH

9084
05:19:25,400 --> 05:19:26,720
CENTERS THAT DON'T HAVE TO

9085
05:19:26,720 --> 05:19:29,160
TRAVEL AS FAR TO GET TO THE

9086
05:19:29,160 --> 05:19:29,600
WMCA.

9087
05:19:29,600 --> 05:19:31,800
SO WE SAW A BENEFIT OF THAT, BUT

9088
05:19:31,800 --> 05:19:33,200
I THINK IT IS THIS PROVIDER

9089
05:19:33,200 --> 05:19:36,360
CHAMPION WE ARE SEEING

9090
05:19:36,360 --> 05:19:38,960
IMPLEMENTATION TO THAT IS SO KEY

9091
05:19:38,960 --> 05:19:39,960
TO GETTING FAMILIES TO COME BACK

9092
05:19:39,960 --> 05:19:41,560
AND BE INVOLVED AND BE MAKING

9093
05:19:41,560 --> 05:19:43,040
THESE CHANGES.

9094
05:19:43,040 --> 05:19:44,600
THE OTHER THING I THINK IS

9095
05:19:44,600 --> 05:19:46,680
IMPORTANT TO THE HEALTHY WEIGHT

9096
05:19:46,680 --> 05:19:48,200
MODEL IS THOSE CALLS FROM THE

9097
05:19:48,200 --> 05:19:50,200
COMMUNITY HEALTH WORKER AND

9098
05:19:50,200 --> 05:19:52,200
DIETITIAN IN BETWEEN VISITS TO

9099
05:19:52,200 --> 05:19:54,400
MAKE SURE THEY AREN'T ABLE TO

9100
05:19:54,400 --> 05:19:56,720
ACCESS FOOD IN FOOD DESERTS WHAT

9101
05:19:56,720 --> 05:19:59,520
RESOURCES COULD THERE BE, ET

9102
05:19:59,520 --> 05:20:01,000
CETERA.

9103
05:20:01,000 --> 05:20:02,000
I THINK THAT IS IMPORTANT AND

9104
05:20:02,000 --> 05:20:04,640
THAT IS NOT BUILT INTO THE YMCA

9105
05:20:04,640 --> 05:20:05,880
PROGRAM.

9106
05:20:05,880 --> 05:20:07,880
AND I KNOW DR. JOHNSON MENTIONED

9107
05:20:07,880 --> 05:20:09,360
BEFORE THESE ARE THINGS THAT ARE

9108
05:20:09,360 --> 05:20:11,280
NOT COVERED BY INSURANCE SO I

9109
05:20:11,280 --> 05:20:14,480
THINK AS WE MOVE FORWARD WE NEED

9110
05:20:14,480 --> 05:20:17,040
TO THINK ABOUT THESE SIMPLE

9111
05:20:17,040 --> 05:20:18,400
INTERVENTIONS THAT COULD WORK

9112
05:20:18,400 --> 05:20:22,360
THAT DON'T REQUIRE SOMEBODY WHO

9113
05:20:22,360 --> 05:20:23,080
CAN BUILD BILL.

9114
05:20:23,080 --> 05:20:30,160
>> THANK YOU FOR THAT ANSWER.

9115
05:20:30,160 --> 05:20:31,800
THIS IS A QUESTION FOR DR.

9116
05:20:31,800 --> 05:20:33,680
CHAMBERS IS WATER DELIVERED IN

9117
05:20:33,680 --> 05:20:35,360
PLASTIC OR GLASS, THAT MAKES A

9118
05:20:35,360 --> 05:20:39,640
HUGE DIFFERENCE ON THE

9119
05:20:39,640 --> 05:20:41,400
ENVIRONMENTAL TOW LOAD.

9120
05:20:41,400 --> 05:20:43,040
>> THANKS FOR YOUR QUESTION.

9121
05:20:43,040 --> 05:20:47,360
SO IT WAS DELIVERED IN MASSIVE

9122
05:20:47,360 --> 05:20:49,880
PLASTIC THINGS.

9123
05:20:49,880 --> 05:20:51,960
WE SPENT HOURS AND HOURS NO IDEA

9124
05:20:51,960 --> 05:20:54,560
HOW MUCH TIME TRYING TO FIGURE

9125
05:20:54,560 --> 05:20:55,920
LOGISTICS IN WATER FOR THESE

9126
05:20:55,920 --> 05:20:57,360
REMOTE COMMUNITIES A LOT HOURS

9127
05:20:57,360 --> 05:20:59,200
AWAY FROM OUR SITES.  ON A

9128
05:20:59,200 --> 05:21:00,320
REGULAR BASIS FOR THREE MONTHS

9129
05:21:00,320 --> 05:21:03,760
ON ISSUES -- ON A SHOE STRING

9130
05:21:03,760 --> 05:21:06,920
BUDGET AND WHAT I -- WE

9131
05:21:06,920 --> 05:21:08,040
RECOGNIZE THE ENVIRONMENTAL

9132
05:21:08,040 --> 05:21:10,280
STRAIN OF WHAT WE DID BUT WE DID

9133
05:21:10,280 --> 05:21:11,800
COLLECT THE PLASTIC AND REFILL

9134
05:21:11,800 --> 05:21:13,520
IT AND BRING IT BACK OUT SO IT

9135
05:21:13,520 --> 05:21:14,960
WASN'T TOSSED AWAY.

9136
05:21:14,960 --> 05:21:18,040
BUT REALLY, AT END OF THE DAY WE

9137
05:21:18,040 --> 05:21:20,480
HAD A BUDGET AND WE HAD TO DO --

9138
05:21:20,480 --> 05:21:22,000
IT WASN'T ABOUT SUSTAINING WATER

9139
05:21:22,000 --> 05:21:22,280
DELIVERY.

9140
05:21:22,280 --> 05:21:25,480
IT WAS REALLY ABOUT IDENTIFYING

9141
05:21:25,480 --> 05:21:28,800
IF WATER DELIVERY IMPACT SUGAR

9142
05:21:28,800 --> 05:21:31,240
SWEETENED BEVERAGE SO TAKE AWAY

9143
05:21:31,240 --> 05:21:32,200
WATER INSECURITY FOR THREE

9144
05:21:32,200 --> 05:21:36,080
MONTHS FOR THESE FAMILIES, IT IS

9145
05:21:36,080 --> 05:21:40,600
OFN'-- IT WASN'T A SOLUTION LONG

9146
05:21:40,600 --> 05:21:44,120
TEAR:  IF WE CAN FIGURE

9147
05:21:44,120 --> 05:21:45,000
SUSTAINABLY HOW IMPORTANT THE

9148
05:21:45,000 --> 05:21:47,120
ENVIRONMENTAL CONTEXT OF OBESITY

9149
05:21:47,120 --> 05:21:51,160
IS.

9150
05:21:51,160 --> 05:21:56,840
>> REALLY IMPORTANT FINDING.

9151
05:21:56,840 --> 05:21:59,040
WHEN YOU DESCRIBE AT THIS

9152
05:21:59,040 --> 05:22:00,160
SEMINATION OF INTERVENTIONS IT

9153
05:22:00,160 --> 05:22:02,920
WAS INCREDIBLE SO I'M WONDERING

9154
05:22:02,920 --> 05:22:07,600
HOW HAVE THOSE BEEN FUNDED?

9155
05:22:07,600 --> 05:22:10,120
>> THE INDIAN HEALTH SERVICE HAS

9156
05:22:10,120 --> 05:22:11,280
FUNDED THE US SEMINATION OF

9157
05:22:11,280 --> 05:22:11,800
THIS.

9158
05:22:11,800 --> 05:22:13,280
AND -- DISSEMINATION OF THIS AND

9159
05:22:13,280 --> 05:22:14,160
THE FOLKS THAT DELIVER ARE

9160
05:22:14,160 --> 05:22:15,240
CALLED COMMUNITY HEALTH

9161
05:22:15,240 --> 05:22:15,600
REPRESENTATIVES.

9162
05:22:15,600 --> 05:22:16,960
A LOT OF THEIR -- THEY ARE

9163
05:22:16,960 --> 05:22:18,080
SIMILAR TO COMMUNITY HEALTH

9164
05:22:18,080 --> 05:22:23,480
WORKER SO UNLIKE MOST HEALTH

9165
05:22:23,480 --> 05:22:25,000
ORGANIZATIONS ACROSS THE U.S.

9166
05:22:25,000 --> 05:22:26,440
INDIAN HEALTH SERVICE FUNDS

9167
05:22:26,440 --> 05:22:27,520
COMMUNITY HEALTH WORKER TO DO

9168
05:22:27,520 --> 05:22:30,720
THIS WORK.

9169
05:22:30,720 --> 05:22:32,080
SO THEY ARE ABLE TO DELIVER

9170
05:22:32,080 --> 05:22:34,520
INTERVENTIONS AND PROVIDE

9171
05:22:34,520 --> 05:22:36,640
SUPPORT TALKING ABOUT AND IT IS

9172
05:22:36,640 --> 05:22:37,000
FUNDED.

9173
05:22:37,000 --> 05:22:39,440
WHICH IS REALLY GREAT.

9174
05:22:39,440 --> 05:22:42,280
SPECIFICALLY FOR THE FAMILY

9175
05:22:42,280 --> 05:22:45,000
SPIRIT PROGRAM, OBAMA PUT IN THE

9176
05:22:45,000 --> 05:22:48,400
MATERNAL INFANT HEALTH CHILD

9177
05:22:48,400 --> 05:22:50,200
PROGRAM, THE TRIBAL

9178
05:22:50,200 --> 05:22:51,000
ORGANIZATIONS GET FUNDING FROM

9179
05:22:51,000 --> 05:22:51,800
THAT MECHANISM.

9180
05:22:51,800 --> 05:22:53,280
IN ORDER TO FUND COMMUNITY

9181
05:22:53,280 --> 05:22:55,280
HEALTH WORKER TO GO DELIVER THIS

9182
05:22:55,280 --> 05:23:01,800
PROGRAM SO IT IS A REALLY NICE

9183
05:23:01,800 --> 05:23:05,200
IT IS A HUGE ADVANTAGE ANDNDIAN

9184
05:23:05,200 --> 05:23:10,480
HEALTH PROGRAM.

9185
05:23:10,480 --> 05:23:11,080
LET'S SEE.

9186
05:23:11,080 --> 05:23:14,160
I WONDER IF YOU CAN JUST SAY A

9187
05:23:14,160 --> 05:23:16,240
LITTLE BIT MORE ABOUT THE

9188
05:23:16,240 --> 05:23:16,840
INTERVENTION.

9189
05:23:16,840 --> 05:23:19,600
THE SECOND ONE YOU DESCRIBE IN

9190
05:23:19,600 --> 05:23:22,560
THE RESPONSIVE FEEDING AND WHAT

9191
05:23:22,560 --> 05:23:26,080
HOW THAT IS TAUGHT AND WHAT THAT

9192
05:23:26,080 --> 05:23:32,800
ENTAILS.

9193
05:23:32,800 --> 05:23:34,920
IT MODELS CURRICULUM WHICH IS A

9194
05:23:34,920 --> 05:23:37,000
REALLY GOT A MANUALIZED

9195
05:23:37,000 --> 05:23:38,200
COMMUNITY HEALTH WORKER TO USE

9196
05:23:38,200 --> 05:23:41,200
AND THERE IS A FLIP CHART WITH

9197
05:23:41,200 --> 05:23:42,840
PARENTS SEE AND ALL PICTURES

9198
05:23:42,840 --> 05:23:45,400
WERE DRAFTED OR CREATED BY

9199
05:23:45,400 --> 05:23:47,920
INDIGENOUS ARTISTS SO THEY SHOW

9200
05:23:47,920 --> 05:23:50,440
A NATIVE PERSON PROVIDING FOR

9201
05:23:50,440 --> 05:23:53,320
HAIR CHILD AND AROUND RESPONSIVE

9202
05:23:53,320 --> 05:23:54,160
FEEDING WE TALK ABOUT IMPORTANCE

9203
05:23:54,160 --> 05:23:55,800
OF BREAST FEEDING, THE

9204
05:23:55,800 --> 05:23:58,240
IMPORTANCE OF REDUCTION SUGAR

9205
05:23:58,240 --> 05:23:58,920
SWEETENED BEVERAGE AND

9206
05:23:58,920 --> 05:24:00,160
RESPONSIVE FEEDING TRYING TO

9207
05:24:00,160 --> 05:24:01,320
READ YOUR CHILD QUEUES.

9208
05:24:01,320 --> 05:24:03,280
SORT OF HOW TO DO THAT AND WHAT

9209
05:24:03,280 --> 05:24:05,960
IS REALLY WONDERFUL IS FOR MOST

9210
05:24:05,960 --> 05:24:09,200
OF OUR COMMUNITY HEALTH WORKERS

9211
05:24:09,200 --> 05:24:10,840
THEY HAVE BEEN MOTHERS OR HELP

9212
05:24:10,840 --> 05:24:11,960
SIBLING WITH A CHILD SO THEY

9213
05:24:11,960 --> 05:24:14,920
HAVE EXPERIENCE AND CAN BE IN

9214
05:24:14,920 --> 05:24:17,400
THERE ON THE GROUND PROVIDING

9215
05:24:17,400 --> 05:24:18,520
SUPPORT OUTSIDE THE WRITTEN

9216
05:24:18,520 --> 05:24:19,320
CURRICULUM.

9217
05:24:19,320 --> 05:24:21,680
SO IT IS A DIDACTIC PROCESS AND

9218
05:24:21,680 --> 05:24:23,880
IT IS REALLY A LOT OF

9219
05:24:23,880 --> 05:24:26,640
INTERVENTIONS WE DO NOT ONLY

9220
05:24:26,640 --> 05:24:28,120
NURTURE BUT ALL THE OTHER

9221
05:24:28,120 --> 05:24:29,840
PROJECTS IS REALLY RELATIONSHIP

9222
05:24:29,840 --> 05:24:31,160
AND ABILITY TO COME INTO THE

9223
05:24:31,160 --> 05:24:32,120
HOME AND LOOK AT THE ENVIRONMENT

9224
05:24:32,120 --> 05:24:34,560
IN A HOME AND HELP ADDRESS

9225
05:24:34,560 --> 05:24:37,880
BARRIERS TO HEALTHY EATING OR

9226
05:24:37,880 --> 05:24:40,040
THE ABILITY TO HAVE RESPONSIVE

9227
05:24:40,040 --> 05:24:41,360
FEEDING TO TURN OFF TV THINGS

9228
05:24:41,360 --> 05:24:41,880
LIKE THAT.

9229
05:24:41,880 --> 05:24:44,560
AND IDENTIFY THOSE WITH THE

9230
05:24:44,560 --> 05:24:46,920
PARTICIPANT IS REALLY IMPORTANT.

9231
05:24:46,920 --> 05:24:50,080
SO I THINK THAT THAT -- THE

9232
05:24:50,080 --> 05:24:51,200
CURRICULUM IS VERY IMPORTANT TOO

9233
05:24:51,200 --> 05:24:53,400
BUT TRAINING REALLY DOES GO INTO

9234
05:24:53,400 --> 05:24:54,560
IDENTIFY THINGS THAT ARE

9235
05:24:54,560 --> 05:24:56,360
HAPPENING IN THE HOME, IS WILL A

9236
05:24:56,360 --> 05:24:59,360
TDM ALL THE TIME, HOW CAN YOU

9237
05:24:59,360 --> 05:25:00,520
ADDRESS THAT WITH A PARTICIPANT

9238
05:25:00,520 --> 05:25:02,600
AND ALSO TEACHING THEM THE

9239
05:25:02,600 --> 05:25:04,720
QUEUES OF CHILD WHEN A CHILD IS

9240
05:25:04,720 --> 05:25:06,240
HUNGRY, WHEN NOT HUNGRY, DON'T

9241
05:25:06,240 --> 05:25:08,200
FEED THEM WHEN THEY CRY BECAUSE

9242
05:25:08,200 --> 05:25:09,920
YOU MAY CHECK OTHER THINGS.

9243
05:25:09,920 --> 05:25:13,000
I HOPE THAT ANSWERED YOUR

9244
05:25:13,000 --> 05:25:13,680
QUESTION, I DON'T KNOW --

9245
05:25:13,680 --> 05:25:16,120
>> I FIGURED IT WAS LIKE THAT

9246
05:25:16,120 --> 05:25:17,600
BUT WANTED TO HEAR YOU

9247
05:25:17,600 --> 05:25:18,400
ARTICULATE THAT.

9248
05:25:18,400 --> 05:25:19,600
SO THANK YOU FOR SHARING THOSE

9249
05:25:19,600 --> 05:25:22,720
DETAILS.

9250
05:25:22,720 --> 05:25:24,200
HERE IS ANOTHER QUESTION FOR ALL

9251
05:25:24,200 --> 05:25:26,400
THE PANELISTS IN THIS SESSION.

9252
05:25:26,400 --> 05:25:28,240
COULD YOU SHARE ANY EXPERIENCES

9253
05:25:28,240 --> 05:25:30,440
WITH USING IMPLEMENTATION

9254
05:25:30,440 --> 05:25:33,200
THEORIES MODELS AND FRAME WORKS

9255
05:25:33,200 --> 05:25:35,200
IN YOUR RESEARCH, ARE THERE

9256
05:25:35,200 --> 05:25:37,040
PARTICULAR THEORIES MODELS

9257
05:25:37,040 --> 05:25:39,280
AND/OR FRAME WORKS YOU FAVOR IN

9258
05:25:39,280 --> 05:25:45,200
IMPLEMENTATION SCIENCE.

9259
05:25:45,200 --> 05:25:53,120
DOES ANYONE WANT TO GO FIRST?

9260
05:25:53,120 --> 05:25:54,880
>> HAPPY TO ANSWER.

9261
05:25:54,880 --> 05:25:56,400
I DON'T KNOW IF LISA WANTS TO

9262
05:25:56,400 --> 05:25:56,800
ANSWER TOO.

9263
05:25:56,800 --> 05:25:58,680
WE HAVE BEEN USING THE

9264
05:25:58,680 --> 05:26:00,600
CONSOLIDATED FRAMEWORK FOR

9265
05:26:00,600 --> 05:26:01,680
IMPLEMENTATION RESEARCH AND I

9266
05:26:01,680 --> 05:26:05,640
FIND IT TO BE EASY TO USE AND I

9267
05:26:05,640 --> 05:26:07,560
HAVE DONE WORK IN IMPLEMENTATION

9268
05:26:07,560 --> 05:26:10,080
AT THE FOOD BANK TOO AND I'M A

9269
05:26:10,080 --> 05:26:12,840
LITTLE NERVOUS, THE CLINICAL

9270
05:26:12,840 --> 05:26:14,160
WORK WITHIN TRANS-- WOULDN'T

9271
05:26:14,160 --> 05:26:15,520
TRANSLATE AS MUCH BUT I FOUND IT

9272
05:26:15,520 --> 05:26:20,440
TO BE HELPFUL, CAN BE TAILORED

9273
05:26:20,440 --> 05:26:23,760
AND USER FRIENDLY, AND FOR

9274
05:26:23,760 --> 05:26:25,240
OUTCOMES RESEARCH FRAMEWORK WE

9275
05:26:25,240 --> 05:26:26,680
-- A LOT OF PEOPLE TEND TO USE

9276
05:26:26,680 --> 05:26:28,400
REAIM AND THAT IS WHAT WE ARE

9277
05:26:28,400 --> 05:26:33,200
USING IN OUR CURRENT

9278
05:26:33,200 --> 05:26:41,840
IMPLEMENTATION GRANT AS WELL.

9279
05:26:41,840 --> 05:26:46,000
>> WOULD ANYONE ELSE LIKE TO

9280
05:26:46,000 --> 05:26:46,360
ANSWER THE --

9281
05:26:46,360 --> 05:26:48,680
>> I THINK IT DEPENDS WHERE YOU

9282
05:26:48,680 --> 05:26:51,640
ARE IN THE IMPLEMENTATION WORLD.

9283
05:26:51,640 --> 05:26:53,760
I THINK REALLY HELPFUL DESCRIBE

9284
05:26:53,760 --> 05:26:55,960
LAY OUT WHAT YOU ARE DOING AS

9285
05:26:55,960 --> 05:27:01,000
FAR AS IMPLEMENTATION BUT I ALSO

9286
05:27:01,000 --> 05:27:02,440
LIKE TRENDS TRANSDOMAIN

9287
05:27:02,440 --> 05:27:05,840
FRAMEWORK, TO IDENTIFY BARRIERS

9288
05:27:05,840 --> 05:27:08,720
AND ALMOST PRE-IMPLEMENTATION

9289
05:27:08,720 --> 05:27:10,320
STUDY TYPE THING THAT LOOKS AT

9290
05:27:10,320 --> 05:27:13,920
WHAT ARE ALL THE BARRIERS AND

9291
05:27:13,920 --> 05:27:15,600
FACILITATORS TO IN IMPLEMENTING

9292
05:27:15,600 --> 05:27:16,640
EVIDENCE BASED PROGRAM.

9293
05:27:16,640 --> 05:27:18,320
SO THAT TO ME LIKE WHEN YOU ARE

9294
05:27:18,320 --> 05:27:21,880
IN THE BEGINNING STAGE OF TRYING

9295
05:27:21,880 --> 05:27:22,920
TO FIGURE HOW TO IMPLEMENT WHAT

9296
05:27:22,920 --> 05:27:27,560
YOU ARE GOING TO DO AND IDEAS TO

9297
05:27:27,560 --> 05:27:29,400
TEST IMPLEMENTATION THAT CHEMFUL

9298
05:27:29,400 --> 05:27:31,560
AND THE REAIM I AGREE WITH

9299
05:27:31,560 --> 05:27:41,120
LAUREN IS AN OUTCOMES FRAMEWORK.

9300
05:27:41,120 --> 05:27:43,640
>> DR. MASINTER, DO YOU WANT TO

9301
05:27:43,640 --> 05:27:44,200
ADD ANYTHING TO THAT IN

9302
05:27:44,200 --> 05:27:46,360
>> I WILL SAY THAT NOT A TON

9303
05:27:46,360 --> 05:27:48,400
MOSTLY BECAUSE WE WERE WORKING

9304
05:27:48,400 --> 05:27:50,280
SORT OF IN A QUALITY IMPROVEMENT

9305
05:27:50,280 --> 05:27:51,840
MIND SET MORE THAN AT LEAST FOR

9306
05:27:51,840 --> 05:27:54,600
THIS PROJECT WE ARE WORKING ON.

9307
05:27:54,600 --> 05:27:59,680
WHEN AND IF WE MOVE TO A MORE

9308
05:27:59,680 --> 05:28:01,640
COMPARATIVE EXPERIMENTAL DESIGN

9309
05:28:01,640 --> 05:28:04,800
I WOULD AGREE REAIM IS A REALLY

9310
05:28:04,800 --> 05:28:07,080
GREAT MODEL TO USE AND

9311
05:28:07,080 --> 05:28:09,760
IMPLEMENTATION SETTING.

9312
05:28:09,760 --> 05:28:13,760
>> ANOTHER QUESTION ABOUT YOUR

9313
05:28:13,760 --> 05:28:14,800
PRESENTATION.

9314
05:28:14,800 --> 05:28:15,680
IT DID SEEM WHAT YOU WERE

9315
05:28:15,680 --> 05:28:18,000
PRESENTING IS MOSTLY TRACKING

9316
05:28:18,000 --> 05:28:19,560
THE DATA OF WHAT IS ACTUALLY

9317
05:28:19,560 --> 05:28:25,800
DONE IN TERMS OF WOMEN RECEIVING

9318
05:28:25,800 --> 05:28:29,000
FOLLOW-UP CARE DELIVERY.

9319
05:28:29,000 --> 05:28:32,400
SO GIVEN THAT THERE IS A LARGE

9320
05:28:32,400 --> 05:28:34,040
PERCENTAGE WHO DON'T HAVE THAT

9321
05:28:34,040 --> 05:28:37,480
FOLLOW-UP WHO ARE AT RISK, DO

9322
05:28:37,480 --> 05:28:40,200
YOU HAVE IDEAS OR IS YOUR

9323
05:28:40,200 --> 05:28:43,320
PROJECT GOING TO BE WORKING ON

9324
05:28:43,320 --> 05:28:45,240
SOME WAY TO CHANGE THAT?

9325
05:28:45,240 --> 05:28:47,400
TO GET THE WOMEN BACK IN?

9326
05:28:47,400 --> 05:28:49,720
>> YES, SO WE -- FIRST I THINK

9327
05:28:49,720 --> 05:28:50,960
THAT WE ARE LEARNING A LOOT

9328
05:28:50,960 --> 05:28:52,680
THROUGH THE PROCESS OF WHAT THAT

9329
05:28:52,680 --> 05:28:54,520
MIGHT BE AND I THINK THAT IS

9330
05:28:54,520 --> 05:28:56,200
ALSO ANOTHER NEXT STEP TO TRY

9331
05:28:56,200 --> 05:28:57,840
LIKE I SAID TO TALK TO PATIENTS

9332
05:28:57,840 --> 05:29:01,200
AND DO A QUALITATIVE EXPLORATION

9333
05:29:01,200 --> 05:29:03,280
TO GAIN UNDERSTANDING, I THINK

9334
05:29:03,280 --> 05:29:04,840
WE KNOW THERE IS A LOT OF

9335
05:29:04,840 --> 05:29:07,800
BARRIERS UTILIZING CARE AND I

9336
05:29:07,800 --> 05:29:10,200
THINK FOR ANYONE THAT HAD A

9337
05:29:10,200 --> 05:29:12,960
BABY, IT IS UNDERSTANDABLE THAT

9338
05:29:12,960 --> 05:29:16,600
YOU COME BACK FOR THE BABY AND

9339
05:29:16,600 --> 05:29:18,360
THE WELL CHILD VISIT.

9340
05:29:18,360 --> 05:29:19,560
OFTEN AS MANY PARENTS DO

9341
05:29:19,560 --> 05:29:22,720
PRIORITIZE THE CHILD OVER YOUR

9342
05:29:22,720 --> 05:29:25,560
OWN HEALTH WHAT WE LEARNED FROM

9343
05:29:25,560 --> 05:29:27,320
DOING THIS QUALITATIVELY WE ARE

9344
05:29:27,320 --> 05:29:31,080
STARTING TO DO QUALITATIVE

9345
05:29:31,080 --> 05:29:31,760
EXPLORE RATION.

9346
05:29:31,760 --> 05:29:34,080
IT IS INTERESTING THAT PEOPLE

9347
05:29:34,080 --> 05:29:36,200
DON'T UNDERSTAND WHAT PREVENTIVE

9348
05:29:36,200 --> 05:29:37,600
CARE MEANS OR AT LEAST THAT IS

9349
05:29:37,600 --> 05:29:39,480
WHAT WE ARE HEARING.

9350
05:29:39,480 --> 05:29:41,480
THE PEOPLE HOE EXCUSE ME IF YOU

9351
05:29:41,480 --> 05:29:45,400
CAN HEAR MY DOG BARKING.

9352
05:29:45,400 --> 05:29:47,280
THERE IS PRE-NATAL CARE

9353
05:29:47,280 --> 05:29:49,400
PEDIATRIC CARE ARE VERY -- IT IS

9354
05:29:49,400 --> 05:29:50,880
VERY CONCRETE ON COMING TO CHECK

9355
05:29:50,880 --> 05:29:52,720
THE BABY HEART BEAT, COMING TO

9356
05:29:52,720 --> 05:29:54,400
CHECK BLOOD PRESSURE AND COMING

9357
05:29:54,400 --> 05:29:56,720
TO GET SHOTS BUT PREVENTIVE

9358
05:29:56,720 --> 05:29:59,080
PRIMARY CARE AFTER THE

9359
05:29:59,080 --> 05:30:02,400
POSTPARTUM PERIOD IS MORE

9360
05:30:02,400 --> 05:30:03,080
NEBULOUS SO WE ARE TRYING TO

9361
05:30:03,080 --> 05:30:05,200
BUILD CONTENT AROUND SHARING

9362
05:30:05,200 --> 05:30:06,880
PROVIDERS PATIENTS TO HAVE THE

9363
05:30:06,880 --> 05:30:09,000
CONVERSATION PRE-NATAL PERIOD

9364
05:30:09,000 --> 05:30:10,280
ABOUT THE POSHES OF WHAT

9365
05:30:10,280 --> 05:30:11,520
PREVENTIVE CARE MEANS AFTER THE

9366
05:30:11,520 --> 05:30:13,680
BABY COMES OUT.

9367
05:30:13,680 --> 05:30:16,000
ESPECIALLY IN TERMS OF LODGE

9368
05:30:16,000 --> 05:30:17,840
TERM OUTCOMES AND THERE IS MORE

9369
05:30:17,840 --> 05:30:19,280
DATA COMING OUT ABOUT THE

9370
05:30:19,280 --> 05:30:20,680
IMPLICATION OF MEDICAL

9371
05:30:20,680 --> 05:30:22,280
CONDITIONS DURING PREGNANCY AND

9372
05:30:22,280 --> 05:30:24,760
LONG TERM OUTCOMES.

9373
05:30:24,760 --> 05:30:27,360
>> YEAH, THAT'S GREAT.

9374
05:30:27,360 --> 05:30:29,600
THAT WILL BE GOOD.

9375
05:30:29,600 --> 05:30:30,960
WELL I WAS JUST NOTICING THE

9376
05:30:30,960 --> 05:30:33,480
TIME AND WE ARE AT 5:15.

9377
05:30:33,480 --> 05:30:36,720
SO I THINK I'M GOING TO TURN IT

9378
05:30:36,720 --> 05:30:38,640
BACK OVER TO MARRAH TO CLOSE US

9379
05:30:38,640 --> 05:30:41,040
OUT AND LET ME JUST THANK ALL OF

9380
05:30:41,040 --> 05:30:44,040
MY PANELISTS IN SESSION 3,

9381
05:30:44,040 --> 05:30:45,760
REALLY GREAT PRESENTATIONS AND

9382
05:30:45,760 --> 05:30:47,120
VERY INTERESTING DISCUSSION

9383
05:30:47,120 --> 05:30:48,360
AFTERWARDS SO THANK YOU FOR

9384
05:30:48,360 --> 05:30:49,600
BEING HERE TODAY.

9385
05:30:49,600 --> 05:30:51,680
HOPEFULLY WE WILL SEE YOU AGAIN

9386
05:30:51,680 --> 05:30:53,560
TOMORROW.

9387
05:30:53,560 --> 05:30:55,240
TURNING IT OVER TO DR. MARRAH.

9388
05:30:55,240 --> 05:30:57,000
>> THANK YOU.

9389
05:30:57,000 --> 05:30:59,720
I ALSO WANT TO ECHO LORI AND

9390
05:30:59,720 --> 05:31:01,080
THANK SESSION THREE PANELISTS

9391
05:31:01,080 --> 05:31:03,760
WHO BEGAN TO MAKE THE CASE FOR

9392
05:31:03,760 --> 05:31:05,240
CONTINUUMS OF CARE PROVIDING

9393
05:31:05,240 --> 05:31:07,000
EXAMPLES OF ACTIVE PROGRAMS.

9394
05:31:07,000 --> 05:31:09,520
FIRST WE HEARD ABOUT INTEGRATED

9395
05:31:09,520 --> 05:31:11,080
HEALTH APPROACH FOCUSING ON THE

9396
05:31:11,080 --> 05:31:13,360
MIND AND THE BODY LOOK ATWELL

9397
05:31:13,360 --> 05:31:15,560
BEING REALLY IN A HOLISTIC

9398
05:31:15,560 --> 05:31:17,320
MANNER FROM BOTH SCIENTIFIC

9399
05:31:17,320 --> 05:31:20,000
PERSPECTIVE OF RISK PREVENTION

9400
05:31:20,000 --> 05:31:22,080
AND ALSO DELIVERY OF COMMUNITY

9401
05:31:22,080 --> 05:31:24,720
AND CULTURALLY RELEVANT TYPES OF

9402
05:31:24,720 --> 05:31:26,520
SELF CARE APPROACHES THAT ALLOW

9403
05:31:26,520 --> 05:31:28,840
PATIENT TO PARTICIPATE IN HER

9404
05:31:28,840 --> 05:31:30,800
OWN CARE BY PROVIDING WITH

9405
05:31:30,800 --> 05:31:32,360
EMPOWERMENT FOR HELPING PRODUCT

9406
05:31:32,360 --> 05:31:33,040
CONDITIONS.

9407
05:31:33,040 --> 05:31:36,800
NEXT WE HEARD ABOUT THE CCMH

9408
05:31:36,800 --> 05:31:39,280
MODEL THAT SHOWED THERE ARE

9409
05:31:39,280 --> 05:31:39,840
CHALLENGES BUT ALSO

9410
05:31:39,840 --> 05:31:43,240
OPPORTUNITIES TO ADDRESSING

9411
05:31:43,240 --> 05:31:44,320
MATERNAL MORBIDITY AND MORTALITY

9412
05:31:44,320 --> 05:31:46,000
WHERE THEY DEFINE MOST MATERNAL

9413
05:31:46,000 --> 05:31:48,840
DEATH OCCUR IN THE POSTPARTUM

9414
05:31:48,840 --> 05:31:49,920
PERIOD AND THEIR INTERVENTION

9415
05:31:49,920 --> 05:31:51,680
ATTEMPTS TO REDUCE RISK BY

9416
05:31:51,680 --> 05:31:53,400
CREATING A CONTINUUM FOR

9417
05:31:53,400 --> 05:31:54,600
POSTPARTUM CARE BY LINKING THE

9418
05:31:54,600 --> 05:31:57,120
MOTHERS TO PRIMARY CARE

9419
05:31:57,120 --> 05:31:59,480
FOLLOW-UP AFTER THE POSTPARTUM

9420
05:31:59,480 --> 05:31:59,720
VISIT.

9421
05:31:59,720 --> 05:32:01,400
DURING OUR SPOTLIGHT ON THE

9422
05:32:01,400 --> 05:32:03,240
INDIGENOUS COMMUNITIES WE HEARD

9423
05:32:03,240 --> 05:32:03,800
ABOUT HEALTHCARE DISPARITIES

9424
05:32:03,800 --> 05:32:05,120
THAT EXIST WITHIN THESE

9425
05:32:05,120 --> 05:32:07,000
COMMUNITIES, RELATED TO LOW

9426
05:32:07,000 --> 05:32:08,880
ACCESS TO HEALTHCARE RESOURCES

9427
05:32:08,880 --> 05:32:12,440
FOR YOUTH, HIGHER RATES OF

9428
05:32:12,440 --> 05:32:14,280
OBESITY, THESE RELATED TO

9429
05:32:14,280 --> 05:32:15,280
MATERNAL HEALTH COMPLICATIONS

9430
05:32:15,280 --> 05:32:17,520
LATER IN LIFE.

9431
05:32:17,520 --> 05:32:19,320
THIS MODEL DOES SHOW CONTINUUMS

9432
05:32:19,320 --> 05:32:21,720
OF CARE IN THE CONTEXT OF

9433
05:32:21,720 --> 05:32:23,840
COMMUNITY BASED PARTICIPATORY

9434
05:32:23,840 --> 05:32:25,480
RESEARCH ALLOWS THESE

9435
05:32:25,480 --> 05:32:28,520
COMMUNITIES TO FOCUS ON THE TRUE

9436
05:32:28,520 --> 05:32:29,720
COMMUNITY NEEDS WHERE THE

9437
05:32:29,720 --> 05:32:32,880
SOLUTIONS ARE GUIDED BY STAFF

9438
05:32:32,880 --> 05:32:34,000
FROM BEEN COMMUNITY,

9439
05:32:34,000 --> 05:32:35,120
PARTICULARLY USING COMMUNITY

9440
05:32:35,120 --> 05:32:35,920
HEALTH REPRESENTATIVES TO

9441
05:32:35,920 --> 05:32:39,080
DELIVER THE CARE AND THE

9442
05:32:39,080 --> 05:32:40,560
INTERVENTION.

9443
05:32:40,560 --> 05:32:42,000
OUR FINAL TALK ADDRESSED HOW

9444
05:32:42,000 --> 05:32:44,440
EARLY INTERVENTION AT YMCA

9445
05:32:44,440 --> 05:32:47,000
DECREASE BMI AND O BIASTY A

9446
05:32:47,000 --> 05:32:48,680
STRATEGY TO PREVENT LIFE LONG

9447
05:32:48,680 --> 05:32:50,240
OBESITY AND HEALTHY FOOD CHOICE

9448
05:32:50,240 --> 05:32:51,800
LIFE STYLES WHICH WE KNOW CAN

9449
05:32:51,800 --> 05:32:55,280
REDUCE RISK FOR LATER LIFE

9450
05:32:55,280 --> 05:32:55,680
COMPLICATIONS.

9451
05:32:55,680 --> 05:32:57,320
ALSO HOW THIS PROVIDES COST

9452
05:32:57,320 --> 05:32:58,480
SAVINGS ACROSS THE LIFE SPAN.

9453
05:32:58,480 --> 05:33:00,480
THE LAST FEW MINUTES OF OUR

9454
05:33:00,480 --> 05:33:02,480
WORKSHOP I WOULD LIKE TO INVITE

9455
05:33:02,480 --> 05:33:07,040
OUR WORKSHOP CO-CHAIRS, DR.

9456
05:33:07,040 --> 05:33:08,480
JOHNSON TO SEE IF THEY WANT TO

9457
05:33:08,480 --> 05:33:10,000
ADD ADDITIONAL THOUGHTS TO THE

9458
05:33:10,000 --> 05:33:11,760
TOPICS DISCUSSED, MAJOR TAKE

9459
05:33:11,760 --> 05:33:13,720
HOME POINTS FROM TODAY, AND

9460
05:33:13,720 --> 05:33:14,760
CONCEPTS THAT WE SHOULD CONTINUE

9461
05:33:14,760 --> 05:33:16,680
TO FOLLOW-UP WITH IN THE

9462
05:33:16,680 --> 05:33:26,600
PRESENTATIONS TOMORROW.

9463
05:33:26,600 --> 05:33:33,560
>> HAD SOME THOUGHTS EARLIER,

9464
05:33:33,560 --> 05:33:34,120
(INAUDIBLE)

9465
05:33:34,120 --> 05:33:35,800
>> HI.

9466
05:33:35,800 --> 05:33:39,720
I THINK FOR ME, WHAT I WAS

9467
05:33:39,720 --> 05:33:44,000
REALLY STRUCK BY AND I THINK

9468
05:33:44,000 --> 05:33:44,680
PERSISTED THROUGHOUT THE

9469
05:33:44,680 --> 05:33:51,360
AFTERNOON, WAS REALLY THE TRUE

9470
05:33:51,360 --> 05:33:55,240
APPRECIATION EMERGING MULTIPLE

9471
05:33:55,240 --> 05:34:00,360
CO-MORBIDITIES AND THAT IN TRUTH

9472
05:34:00,360 --> 05:34:01,800
KNOW SPECIFIC DISEASE OR MEDICAL

9473
05:34:01,800 --> 05:34:03,120
CONDITION OCCURS WITHIN A VACUUM

9474
05:34:03,120 --> 05:34:04,800
AND SO SORT OF REALLY TRYING TO

9475
05:34:04,800 --> 05:34:07,200
BREAK DOWN THESE SILOS, I HI

9476
05:34:07,200 --> 05:34:09,000
WHICH WE HAVE HEARD QUITE A BIT

9477
05:34:09,000 --> 05:34:12,200
ABOUT TODAY, HOW DO WE OPTIMALLY

9478
05:34:12,200 --> 05:34:16,160
BREAK DOWN SILOS AND BRIDGE

9479
05:34:16,160 --> 05:34:20,000
DIFFERENT ENTITIES TO REALLY

9480
05:34:20,000 --> 05:34:21,960
OPTIMIZE HEALTH WOMEN AND GIRLS

9481
05:34:21,960 --> 05:34:25,080
AND I THINK THINKING THROUGH

9482
05:34:25,080 --> 05:34:27,440
THEM EVERYONE MORE AS WE MOVE

9483
05:34:27,440 --> 05:34:30,840
FORWARD ULTIMATELY THE ONLY WAY

9484
05:34:30,840 --> 05:34:32,760
WE CAN TRULY MARKEDLY IMPROVE

9485
05:34:32,760 --> 05:34:35,160
THE HEALTH OF WOMEN AND GIRLS IS

9486
05:34:35,160 --> 05:34:39,280
TO TO REALLY THINK HOLISTICALLY

9487
05:34:39,280 --> 05:34:44,040
AND SO I HAVE BEEN IMPRESSED AND

9488
05:34:44,040 --> 05:34:46,080
ALSO AWED BY THE WORK CURRENTLY

9489
05:34:46,080 --> 05:34:47,880
BEING DONE BUT ALSO REFLECTING

9490
05:34:47,880 --> 05:34:49,880
ON HOW MUCH MORE THERE IS THAT

9491
05:34:49,880 --> 05:34:51,240
WE SHOULD BE DOING.

9492
05:34:51,240 --> 05:34:54,760
THAT IS MY GENERAL THOUGHT, WE

9493
05:34:54,760 --> 05:34:56,080
WILL HAVE MORE TOMORROW

9494
05:34:56,080 --> 05:34:59,520
AFTERNOON AS WELL.

9495
05:34:59,520 --> 05:35:06,440
>> I WILL ADD TO THAT

9496
05:35:06,440 --> 05:35:10,000
(INAUDIBLE) HOW MUCH SO MANY OF

9497
05:35:10,000 --> 05:35:12,720
US TAKE A LOOK AROUND THE

9498
05:35:12,720 --> 05:35:13,840
STRUCTURE TO MAKE IT WORK

9499
05:35:13,840 --> 05:35:14,480
BETTER.

9500
05:35:14,480 --> 05:35:16,600
COMMUNITY HEALTH WORKERS OR BY

9501
05:35:16,600 --> 05:35:19,480
DOING -- LET YOU KNOW THE HEALTH

9502
05:35:19,480 --> 05:35:22,000
SYSTEM AND LOT OF SYSTEMS

9503
05:35:22,000 --> 05:35:22,640
ADJUSTINGSOME DETERMINANTS OF

9504
05:35:22,640 --> 05:35:24,360
HEALTH DON'T ENTERSECOND AND

9505
05:35:24,360 --> 05:35:29,280
THEY ARE NOT REALLY OPTIMIZE TO

9506
05:35:29,280 --> 05:35:30,640
PRIORITIZE PREVENTION AND PUBLIC

9507
05:35:30,640 --> 05:35:34,240
HEALTH AND WHAT NOT, SO WE ARE

9508
05:35:34,240 --> 05:35:35,600
SPENDING TIME TRYING TO WORK

9509
05:35:35,600 --> 05:35:37,680
AROUND THAT AND MORE AND MORE OF

9510
05:35:37,680 --> 05:35:39,880
THAT I THINK I'M A CLINICAL

9511
05:35:39,880 --> 05:35:42,480
PSYCHOLOGIST TRAINED INDIVIDUAL

9512
05:35:42,480 --> 05:35:44,040
PSYCHOLOGY BUT MORE CHANGE

9513
05:35:44,040 --> 05:35:45,080
HEALTH POLICY MIGHT BE THE

9514
05:35:45,080 --> 05:35:46,320
NUMBER ONE THING TO IMPROVE

9515
05:35:46,320 --> 05:35:47,440
HEALTH.

9516
05:35:47,440 --> 05:35:52,760
THAT IS MY THOUGHT.

9517
05:35:52,760 --> 05:35:54,760
>> I WANT TO THANK EVERYBODY FOR

9518
05:35:54,760 --> 05:35:56,880
THE ENGAGING WORKSHOP AND

9519
05:35:56,880 --> 05:35:57,480
PARTICIPATION TODAY.

9520
05:35:57,480 --> 05:35:59,080
LOOK FORWARD TO SEEING Y'ALL

9521
05:35:59,080 --> 05:36:00,720
BACK TOMORROW FOR DAY TWO.

9522
05:36:00,720 --> 05:36:02,600
WITH THAT, I WILL CLOSE OUT THE

9523
05:36:02,600 --> 05:36:03,280
WORKSHOP FOR TODAY.

9524
05:36:03,280 --> 05:38:42,440
THANK YOU VERY MUCH.