TBFs First Health Equity Grant Awarded

Natalia Vasconcellos, MD, MSc awarded for “Worldwide Disparities in Aneurysmal Subarachnoid Hemorrhage Risk Factors, Gender, Ethical Groups, Clinical Outcomes, and Mortality: A Multicenter Study”

 

TBF’s first health equity grant – a milestone in our track record of innovative grant giving – originated with the vision of one woman who wanted to recognize her personal history and ‘pay it forward.’ TBF Ambassador Elizabeth Ratta’s goal was to honor her grandmother, Rita Skertich, who had an aneurysm in the 1970’s at a time when the condition was little understood and treatment options limited. The result: The TBF Rita Skertich Brain Aneurysm Health Equity grant. Elizabeth hoped to award her grant to a female researcher and one whose work was focused on Black, female, and Hispanic populations who have a higher propensity to experience aneurysms. Hopefully, the grant would also help to break the barriers that often exist for women in medical and research fields. In short, Elizabeth says, “We wanted to make an impact in an underserved area.”

The grant application, submitted by Natalia and sponsoring faculty, Prof. Dr. Vitor Mendes Pereira from St Michaels Hospital in Toronto and Dr. Giselle Silva, Professor of Neurology at the Federal University of São Paulo, underwent review by the TBF’s Scientific Advisory Board. The SAB was joined in their review by Mesha Martinez, MD, Neurointerventionalist and Assistant Professor at Texas Childrens and Chair of SNIS affinity group Black Neurointerventists and Allies (BNAA), who provided critical oversight. Ultimately, the review board determined that Natalia’s grant did all that Elizabeth had envisioned – and more. In addition to the actual project outline and qualifications, the team got a welcome sense of Natalia’s personality and approach to relationships. “It echoed the familial connections in my own family,” Elizabeth says. She’s enthusiastic also about the opportunity of the grant to contribute to Natalia’s career as well as to future directions in research. “Paying it forward” on several levels!

Recently, Elizabeth and Erin Kreszl, TBFs Executive Director, interviewed Natalia to get more insight into her background, what drives her, and what she hopes her research will accomplish.

ERIN: SO FIRST, CAN YOU TELL US A LITTLE ABOUT YOUR BACKGROUND?
Natalia: Well, first, I want to say how honored I am to receive this opportunity. It’s big for me. I’m 33 years old, a neurologist and neurointerventionalist from São Paulo, Brazil. I’ve been a doctor for ten years, getting my degree at the University of Espírito Santo in São Paolo, Brazil. My first contact with research was as a third-year medical student while I spent one year at the University of Glasgow, Scotland, studying Neuroscience. After college, I started Neurology at the Federal University of São Paulo (UNIFESP), where I fell in love with vascular neurology. I started my master’s project in Subarachnoid Hemorrhage at the end of my neurology residency program under
supervision of a prestigious neurologist Dr Gisele Sampaio (a great leader in stroke research in Brazil and South America), and I continued it while I was in the Neurointerventional Radiology fellowship program at the University of São Paulo (USP-SP).

ERIN: YOU CLEARLY BEGAN TO FOCUS IN ON VASCULAR NEUROLOGY, AND SPECIFICALLY ANEURYSMS – EARLY ON. HOW DID YOU FIRST GET INTERESTED IN THE FIELD?
Natalia: You know, I think most medical students know right away whether they love neuro or don’t like it at all! I’m in the “love it” category. Since the beginning of mystudies, I fell in love with neurology and anatomy, and I stayed involved in that field for my whole college career. As far as “why aneurysms” and why intervention, I’ve always been more interested in patients with severe illnesses or conditions, patients in the ICU and, I guess you could say, life and death situations. It makes me think that still in 2024 brain aneurysms rupture still has a 50% mortality rate, with a high percentage of handicap patients. That sense of working in an area with such dire outcomes and consequences, and the corresponding opportunity for compelling work, has driven my interest.

ERIN: I’M CURIOUS ABOUT YOUR EXPERIENCE WORKING IN A MALE DOMINATED FIELD. WHAT IS IT LIKE BEING A WOMAN NEUROSURGEON?
Natalia: There’s a little bit more male-female equality in neurology, but when I got into intervention, it was more apparent, especially in Brazil which tends to be a more male-dominated society in general. In fact, at the University of São Paulo, for eight years there were no women in the program – I was the first in all that time. And I won’t lie – it was challenging! I think that when you are a minority you need to show you are willing to work harder, show a little more drive and skill to earn respect. I’m certainly not alone, many women face this situation. After a while, with hard work, I feel I began to get that respect from my superiors and colleagues and they opened a lot of doors for me – for instance, getting the opportunity to go to France, which gave me now the opportunity to go to Toronto, where I am now, both for research and intervention under supervision of Dr Vitor Pereira. I’m very grateful for all those opportunities. I also want to point out that as far as men dominating in many fields in medicine, there are practical reasons for that. For instance, look at radiology. In that field, there are a lot of risks associated with that for women, specifically relating to fertility.

ELIZABETH: I’M SO EXCITED ABOUT YOUR RESEARCH PLAN AND WHAT YOU ARE HOPING TO DO! CAN YOU TALK A LITTLE ABOUT IT AND HOW IT WILL SPECIFICALLY IMPACT THE POPULATIONS I WAS INTERESTED IN – BLACK, HISPANIC. FEMALE?
Natalia: When I was looking into possible research, I first considered what was out there. I thought it would be important to do something that looked at the epidemiological risk factors of different populations in different countries. It is very important in medicine to look back to get a better understanding of how we can prevent and positively impact patients with the condition we are trying to treat. This is a retrospective study, so we will approach it by taking a sample of patients from multiple countries – about 1500 patients with ruptured subarachnoid hemorrhages – both those who survived and those who did not – across four centers in Jacksonville, Florida, Toronto, Canada, and São Paulo and Rio de Janeiro, Brazil. In the demographic groups we are focusing on – women, Hispanics and Blacks – we’ll be looking at their risk factors, such as hypertension or smoking, genealogical makeup, the severity of the disease they had, how they were discharged and how they are doing currently, to identify those predictors of both worse and better outcomes. We hope to get a better understanding of how these populations are affected by these factors and how it impacts their outcomes. Currently, there is great work being done on genetic linkages to risk of aneurysm development, and a future goal would be to connect this retrospective study with gene identification studies.

ERIN: WHAT ABOUT THE VARYING INCOME LEVELS OF THE DIFFERENT CENTERS – HOW WILL YOU BE INCORPORATING THAT FACTOR?
Natalia: One remark about subarachnoid hemorrhage is that even though 70% of the globe lives in lower middle-income countries, most clinical data comes from higher income countries. Our work will hopefully fill that gap a bit, as we will be addressing how different income levels impact, for instance, access to care, time of transport, length of stay, hospital discharges, etc. This should hopefully shed more light on how the outcomes differ for patients based on variables such as economics and demographics.

ERIN: WHAT WOULD YOU POINT TO AS BEING NEW, OR NOVEL, IN THIS RESEARCH STUDY?
Natalia: This study is a real-world scenario in which we are working with three different
realities and three different health care systems. In Brazil, for example, we have a mix of public and private health care, with many differences between rich and poor. So here, we will be looking at two public health care centers that are reference for patients from all over, which I believe will be very representative of the entire country. In the U.S. we are talking about a private system with seemingly unlimited resources, and in Canada we are talking about a vast public health care system – one that is very well designed, but may not always deliver the desired results, such as the ability to get to the right Doctor in a reasonable amount of time. Hopefully the findings will allow us to begin to prioritize needed actions to address gaps in the systems in these countries, specifically in the case of subarachnoid hemorrhage patients. As a byproduct, we hope to get some very practical insights into what is missing and what needs to be done in the various health care systems: for instance, in a low-income country, what should be done first to improve outcomes vs. what should be done in a high-income country like the U.S.

ERIN: WHAT DO YOU THINK SUCCESS WOULD LOOK LIKE FOR YOUR PROJECT?
Natalia: We’re incredibly honored and excited for this grant from TBF. Hopefully, it will drive relevant conclusions for the subarachnoid hemorrhage population and drive treatment protocols in the future. We’re excited to get started!

Erin has been selected as one of the 2024 Be Well Philly Health Hero semi-finalists and we need your help!
It’s up to YOU to vote once a day, every day through 7/29 for our chance to receive $15,000 for TBF.

VOTE NOW