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Reid talks about global, U.S. health care in talk to Tuscaloosa community

Nearly all of the world’s advanced industrialized countries provide health care to all of their citizens, achieve better health outcomes and spend less, according to TR Reid, a well-known journalist, author and documentary filmmaker.

The lone exception: the United States.

“Approximately 40 million people nationwide, or about 20 percent or 1 million people in Alabama, don’t have health insurance,” Reid said during a talk to the Tuscaloosa community Nov. 13 at Tuscaloosa River Market. “Every day somebody in America dies because they don’t have insurance and can’t get care. We could do better.”

Reid’s talk, “Better Health, Lower Costs: One Man’s Global Quest to Fix a Bum Shoulder,” was hosted by UA’s College of Community Health Sciences, College of Communication and Information Sciences and Culverhouse College of Commerce and Business Administration. The presentation was based, in part, on Reid’s New York Times bestseller, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, which documented his travel to various countries to learn about their health-care systems – and to try and “fix my bum shoulder.” In addition to books, Reid writes for the Washington Post newspaper, is a commentator on NPR’s Morning Edition and makes documentaries for PBS’s Frontline.

During his community talk, Reid outlined health-care models used by different countries, starting with England. The country believes keeping people healthy is the responsibility of government, much like providing for trash pickup and funding libraries, he said. While Reid acknowledged that people in England pay taxes to fund the country’s socialized system of medicine (their sales tax is 20 percent) “since no one pays insurance premiums, deductibles or co-pays, they still pay half of what we do for health care.”

The German model has its roots in efforts to bring citizens together as a single country using the provision of social services, including “the most radical idea, that this new nation should provide health care for everyone,” Reid said. Today, there are 220 insurance companies operating in Germany, all hospitals are private and citizens split the cost of their insurance premiums with their employers. But there is some government control with regard to cost of health services and when physicians must be paid. “This is a private system with some government control,” Reid said.

A marriage of the England and German models can be found in the Canadian approach – government payment of private providers, similar to the US Medicare program, which provides health care for older citizens. In fact, the United States used the Canadian model when setting up its own Medicare program, even borrowing the name.

Finally, Reid touched on the model used by many of the world’s underdeveloped countries. He called it the Out-of-Pocket Model: “If you have no money, you don’t see a doctor and you don’t get care.”

All four models are in use in the United States, Reid said. Care provided by the Veteran’s Administration mirrors England’s socialized system of medicine. Many US citizens are similar to those in Germany, who share the cost of insurance premiums with their employers, while older US citizens are similar to those in Canada, who receive their care through Medicare programs. “And if you’re the 40 million Americans without insurance, you’re in the Out-of-Pocket Model,” Reid said.

“I learned that every country’s health system reflects its values,” Reid said. “If you make that commitment (to cover everyone), you can create the system. In the United States, we haven’t done that. I don’t think we’ve ever had that conversation.”

He continued: “If we could find the political will to provide health coverage for everyone, the other rich countries can show us the way.”

Rural Medical Scholar is UA Homecoming Queen

140920_Rural_Medical_ScholarsAllison Montgomery, a member of the College’s current Rural Medical Scholars class, was elected University of Alabama homecoming queen last week by the University’s student body.

The Rural Medical Scholars Program is exclusively for rural Alabama students who wish to become physicians and practice in rural communities. The program includes a year of study leading to a master’s degree in Rural Community Health, and provides early admission to the University of Alabama School of Medicine. Rural Medical Scholars spend their first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to the College for their final two years of clinical education.

Montgomery, of Talladega, Ala., plans a career as a rural Alabama physician. Alabama has a shortage of primary care and family medicine physicians, particularly in rural areas of the state.

A senior majoring in Biology, Montgomery is a member of the UA Blackburn Institute and XXXI, a women’s honorary organization on campus. She has served as president of the Mortar Board honor society and in the Student Government Association. As director of the SGA’s Sunday Service Initiative, Montgomery oversaw student efforts for tornado relief in Tuscaloosa, and traveled to Haiti and the Dominican Republic on medical service trips.

Boothe serves as AAFP President

131108_MW_dept_of_family_medicineThe Alabama Academy of Family Physicians includes more than 900 members and more than 400 students and residents across the state, and serving as their leader for 2014 was Dr. Julia Boothe, assistant professor of Family Medicine at the College of Community Health Sciences.

Boothe, a former Rural Medical Scholar who completed two years of medical school and her Family Medicine Residency at the College, is the 2014 president of the AAFP, which is year two of a three-year leadership appointment.

She was named president-elect at the 2013 annual AAFP meeting, has served as president in 2014, and in 2015 she will be the chair of the Alabama Academy Board. Dr. Drake Lavender, assistant professor in Family Medicine at the College, was appointed as the 2015 president-elect.

During this year, Boothe has traveled Alabama and the United States as a representative of the AAFP, cultivating relationships with leaders and other health-care providers.

“Our Academy does a great job of championing the importance of primary care and our state leaders are familiar with our purpose,” she says.

Boothe hopes to continue to share with other physicians and medical communities the importance of family medicine and primary care in the ever-changing landscape of health-care delivery.

“We have evolved considerably in the last five years, and as the old saying goes, ‘You ain’t seen nothing yet,’” she says. “I see family physicians poised to answer many of the questions in current healthcare delivery, especially as we partner with different health care professionals and as we are already in such mass that we can be effective with any change very quickly.”

Boothe says her varied experiences helped prepare her for the role: she’s worked in traditional family medicine (which includes inpatient care, clinical work, nursing homes and hospice work), in urgent care clinics, outpatient care, academic roles and solo private practice. Her diverse background lets her speak to the various faces of family medicine, she says.

“Family physicians are the workhorse of our health care delivery,” Boothe says. “We hope to encourage these dedicated people to join us on the journey to change the impact of family physicians in the direction of our health care delivery.”

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Medical students present research at Larry Mayes Research Society Dinner

Two medical students at the College of Community Health Sciences presented their research and scholarly activity to CCHS faculty at the most recent Larry Mayes Research Society Faculty and Student Dinner.

The dinner, which took place Monday, Nov. 17, at Surin of Thailand, is held twice a year and serves as an opportunity for students to formally present their research and projects to faculty.

Melanie Wooten, a fourth-year medical student, presented her ongoing research: “The Art of Empathy: Does Exposure to a Humanities-Based Extracurricular Activity Affect Empathy Changes in Third-Year Medical Students?”

Wooten began her presentation by differentiating between empathy, which is cognitive, and sympathy, which is emotional.

“Empathy can be taught,” she said. “The more empathy you have of a patient’s perspective, the better outcome you can have with a patient. Sympathy, on the other hand, initially may be good, but in the end it can cloud your judgment.”

Wooten’s study has included monitoring CCHS third-year medical students’ attendance of the Art of Medicine series presented by the College and its Health Sciences Library. The students are tested for empathy at three different points in a several-week timeline to determine if attending the monthly gatherings, which are not mandatory for medical students and open to all faculty, staff, residents and students, could have an effect on their levels of empathy.

To test for empathy, Wooten is using the Jefferson Scale of Empathy, which is a test developed at the Center for Research in Medical Education and Health Care at Sidney Kimmel Medical College to measure empathy in physicians, other health professionals, medical students and health professional students.

Wooten’s research is being done with Dr. Melanie Tucker, assistant professor of Health Education for the Department of Family Medicine, and Dr. Lloyda Williamson, associate professor for the Department of Psychiatry and Behavioral Medicine.

Cory Smith, a third-year medical student, did his presentation on the “Evaluation of a Novel Catalytic Oxidoreductant to Protect the Brain after Concussion.”

Smith said his experience playing football in high school and suffering from multiple concussions and post-concussion syndrome, coupled with his father’s career as an athletic trainer and working to prevent concussions, spurred his interest in this research.

“Concussions are still happening despite efforts to prevent them, so what can we do on the clinical side to treat them?”

Smith’s role in the research, which is in the beginning stages of testing a drug that could potentially treat the after-effects of a concussion, was to induce and verify concussions in anesthetized mice before giving them doses of the drug and measuring its effects.

“My main goal right now is to validate our model,” he said.

Smith’s research is being done with Dr. Candace Floyd in the Department of Glial Biology and Physical Medicine and Rehabilitation at the University of Alabama School of Medicine.

In its role as a regional campus of the University of Alabama School of Medicine, headquartered in Birmingham, the College provides clinical education for a portion of third- and fourth-year medical students.

Dr. Heather Taylor, director of Medical Education, says the dinner gives students a chance to practice formally presenting their research and to get feedback from peers and faculty before giving oral presentations at conferences.

“It also give students a chance to share what they have been working on and to encourage others to get involved in scholarly activity projects. Our students are often involved in diverse and innovative projects and the dinner gives everyone a chance to hear about some of the exciting things in which our students are involved.”

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Research Roundup: Undiagnosed ADHD and traffic accidents

Screening young drivers for ADHD and providing treatment may reduce car accidents. These are the findings of research by Thad Ulzen, MD, professor and chair of the College’s Department of Psychiatry and Behavioral Medicine.

Ulzen conducted the research in his native country of Ghana in West Africa.

Road traffic accidents are consistently among the leading causes of mortality in sub-Saharan Africa, and in Ghana are the ninth leading cause of death.

Ulzen explored the relationship between the presence of ADHD, as determined by the ASRS (ADHD Self-Report Scale) and the driving behaviors in young workers for driver’s unions.

“In Ghana, many male school dropouts find employment by joining driver’s unions,” Ulzen says.

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Mission Moment: Providing preventive care

The College led The University of Alabama’s campaign this year to vaccinate faculty, staff and students against the flu.

Nurses from University Medical Center, and from the University’s Capstone College of Nursing and Student Health Center, traveled to sites across campus during September, October and November – including the Quad, University buildings and student dormitories – to provide the free flu shots. WellBAMA also participated in the flu shot campaign.

Flu shots were also offered at the UA Employee Health Fair and the UA Student Health Fair, and at University Medical Center and its Faculty-Staff Clinic.

As of early November, more than 8,200 shots had been given on campus.

The goal of the campaign was to make getting a flu shot as easy and convenient as possible. The University covered the cost of the flu vaccines. This is the third year the College has led the University’s efforts to protect its employees and students against the flue.

In 2013, the College received the prestigious University of Alabama Sam S. May Commitment to Service Award for its leadership of the campaign.

The U.S. Centers for Disease Control and Prevention recommends that everyone age six months and older get a flu vaccine annually. According to the CDC, a flu vaccine is needed every year because flu viruses are constantly changing and it is not unusual for new flu viruses to appear. The flu vaccine is formulated each year to keep up with the flu viruses as they change.

“Getting a flu vaccine is the first and most important step in protecting against this serious disease,” says Dr. Richard Streiffer, dean of the College.

Risks associated with receiving a flu shot are extremely small, and the viruses in the flu shot are inactivated so they cannot cause the flu.

 

(The flu shot campaign supports the College’s mission – Improving and promoting the health of individuals and communities in Alabama and the region through leadership in medical education and primary care; the provision of high-quality, accessible health care services; and scholarship.)

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Mission Moment: Using telemedicine to provide asthma education

The College of Community Health Sciences launched a school-based asthma education program in DeKalb County in September.

Seven elementary students at the Ruhama Junior High School in Fort Payne, Ala., which serves students in Kindergarten through the eighth grade, participated in the first session of the program on Sept. 18. Also participating were five parents, two school nurses and the school principal.

The education program was conducted from CCHS via telemedicine by Dr. Karen Burgess, associate professor and chair of the Department of Pediatrics, and Beth Smith, a nurse practitioner in the Faculty-Staff Clinic at University Medical Center, which the College operates.

This first group of participants will attend three more session, on consecutive Thursdays, from 1 pm to 1:30 pm. Then, a new group will participate, also on four consecutive Thursdays.

The asthma education program is being funded with a $25,000 gift from BlueCross BlueShield of Alabama.

According to the U.S. Centers for Disease Control and Prevention, an estimated 137,091 children in Alabama had asthma in 2007, a prevalence rate of 12.3 percent, which compares to the U.S. rate of 9 percent.

CCHS has provided specialty health care via telemedicine across the state for a number of years, including: telepsychiatry services to the DeKalb County Youth Services; telepsychiatry services to West Alabama Mental Health Care Center, with sites in Marengo, Choctaw, Greene, Hale and Sumter counties; and diabetes education via telemedicine to a number of rural Alabama communities in Sumter, Pickens and Clarke counties.

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Research roundup: An intervention program for childhood obesity

Faculty from The University of Alabama and community members from Alabama’s Black Belt region have been awarded $45,000 to support a childhood obesity prevent plan through Project UNITED’s Intervention Pilot Program. The project will run through June 2015.

UA faculty members on the project are Harriet Myers, PhD, associate professor and clinical psychologist in the College; Linda Knol, PhD, associate professor in the department of Human Nutrition and Hospitality Management in the College of Human Environmental Sciences; and Shelia Black, PhD, an associate professor of Psychology in the College of Arts and Sciences.

Community members are Debra Clark, founder of the Health and Wellness Educational Center in Livingston; Darlene Robinson, a community health advocate in Eutaw; and Yawah Awolowa, founder of Mahalah Farm in Cuba, Ala.

The project will focus on the home environment of children between the ages of 2 and 5 living in Greene and Sumter counties.

According to data from the U.S. Centers for Disease Control and Prevention, approximately one-fourth of all children in these counties are obese. The study first will use questionnaires to better understand the many aspects of the home environment as it relates to eating behaviors.

With this information and previous intervention research as a guide, the research team will develop and implement a home-based, multi-generational program intended to teach eating mindfulness to children and their caretakers.

The funding has been awarded through Project UNITED (Using New Interventions Together to Eliminate Disparities), a program that was developed by UA faculty and staff in partnership with the Black Belt Community Foundation to promote community-based participatory research to reduce and eliminate health disparities in Alabama’s Black Belt, an impoverished region originally named for its dark, rich soil.

Project UNITED is supported by a planning grant from the Community Based Participatory Research Program of the National Institute on Minority Health and Health Disparities.

Research roundup: Mindful intervention

130124_JH_Caroline_BoxmeyerExamining the integration of mindfulness and yoga practice into the existing Coping Power preventive intervention for at-risk children and their families is the focus of a $700,000 grant awarded to Caroline Boxmeyer, PhD, an associate professor in the College’s Department of Psychiatry and Behavioral Medicine.

Boxmeyer, a clinical psychologist, is the grant’s principal investigator, along with Shari Miller-Johnson, PhD, a child clinical and research psychologist at Duke University.

The grant’s co-PIs are John Lochman, PhD, professor and Saxon Chair of Clinical Psychology at UA and director of the University’s Center for the Prevention of Youth Behavior Problems, and Nicole Powell, PhD, a research psychologist at the center. Boxmeyer is also a research psychologist at the center.

The researchers anticipate that their study will show that integrating mindfulness and yoga practices with the Coping Power program will reduce children’s emotional impulsivity, increase parental warmth and mindful parenting, and prevent possible later substance abuse and negative developmental outcomes. Boxmeyer and Miller-Johnson will test the effectiveness of yoga and mindfulness techniques with at-risk youth from 100 families and four schools.

“We think we can enhance the Coping Power program’s effects on emotion regulation by incorporating these strategies, which have been proven to enhance self-regulation,” Boxmeyer says. “As a practicing clinician, I’ve seen the benefits of mindfulness, which is a way of focusing your attention on the present moment, noticing how your body is feeling and what is on your mind, and practicing awareness and acceptance of those thoughts and feelings rather than judging them. We’ll work on building that practice with children.”

The research project began in September and will continue through August 2017. It is funded by the National Institute on Drug Abuse.

The Coping Power program is a preventive intervention delivered to at-risk children in late elementary school and early middle school years and addresses key factors, including social competence, self-regulation and positive parental involvement.

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Skinner, Elsayed join Family Medicine Department

Dr. Catherine Skinner, who has practiced as a family physician in Pickens County for the past 10 years, and Dr. Tamer Elsayed have joined the College’s Department of Family Medicine as assistant professors.

Skinner worked at Pickens County Medical Center and Carrollton Primary care before joining the College. She was also a member of the Pickens County Medical Center’s Hospital Board and its Medical Staff Executive Committee.

Since 2005, Skinner has served as a community professor for the College’s Department of Family Medicine, a volunteer preceptor for the College’s medical students and residents and as an assistant affiliate professor for the College’s Department of Obstetrics and Gynecology.

She completed an obstetrics fellowship at Austin Medical Education Program in Texas. She did her residency training at the College’s Family Medicine Residency. Skinner received her medical degree from the University of Alabama School of Medicine, and graduated magna cum laude with a bachelor’s degree in biology from The University of Alabama School of Medicine.

Skinner is a fellow of the American Academy of Family Physicians and a member of the Alabama Academy of Family Physicians and the Medical Association of the State of Alabama.

She has received numerous awards from the University of Alabama School of Medicine, including Excellence and Dedication in Teaching, Outstanding Services in Obstetrics and Gynecology and Outstanding Research Award.

Dr. Tamer Elsayed will see patients in University Medical Center’s Family Medicine Clinic in addition to participating in the clinical education of medical students and residents.

The College operates University Medical Center.

Elsayed completed his residency training at the College’s Family Medicine Residency, where he received the outstanding research award for an influenza vaccine acceptance study.

He earned a Master’s Degree of Internal Medicine and a Bachelor of Science Degree in Medicine from the Medical School, Cairo University, Egypt, where he graduated with honors. He also received an Award of Excellence from the Kuwait Ministry of Health.

Elsayed is a member of the American Academy of Family Physicians and the American Medical Association.