Addiction, performance-enhancing substances topic of CCHS endowed lectures Alice McLean Stewart Endowed Lecture for Addiction Education

Whether it’s drugs, alcohol, smoking, food, gambling, working or shopping, addiction is costly to individuals and society, said Dr. H.E. Logue, a psychiatrist, who presented the CCHS Alice McLean Stewart Endowed Lecture on Addiction Nov. 10.

In Alabama last year, addiction cost the criminal justice system $436 million and the healthcare system $300 million, he said.

Addiction can also contribute to such co-morbid illnesses as borderline personality disorder, bipolar disorder, schizophrenia and general anxiety disorder, said Logue, founder and president of Affiliated Mental Health Services Inc. in Birmingham. His presentation was titled Understanding Addiction: Yours, Mine, Ours.

Logue said the “big three” of addiction are smoking, alcohol and opiates. In 2016, there were 51,000 opioid deaths in the US and that number is expected to be repeated this year. “That’s 102,000 deaths in the last two years, Logue said.

He said there are three stages of addiction: exhilaration, withdrawal and anticipation for more. “It’s an ongoing problem that never really goes away. The body never forgets’ it’s always there.”

Logue noted the difference between addiction and dependence. He said addiction is an insatiable desire for a substance that overpowers and neutralizes judgement and behavior in a way that is detrimental. Dependence is use of a substance or behavior to alleviate pain.

There are treatment options for addiction, he said, including Alcoholics Anonymous, 12-step programs, outpatient and inpatient programs and pharmacological treatments.

The Alice McLean Stewart Endowed Fund for Addiction Education was established in 1994 by Alice McLean Stewart to promote addiction education at CCHS through the creation of a lecture series. Stewart received a bachelor’s degree in home economics from The University of Alabama in 1941 and a master’s degree from the University of Chicago in 1942. She taught in the Tuscaloosa City School System and Partlow State School from 1960 to 1988.

The Ernest Cole Brock III Endowment for Continuing Medical Education

Performance-enhancing substances can improve athletic strength and speed, but they carry significant risk to health and sports, said Dr. John Lombardo, the NFL’s drug advisory for anabolic steroids and other performance enhancing drugs.

“That’s why they’re banned – because of the adverse health effects, and to create a level playing field and protect the integrity of the game,” Lombardo said.

Lombardo provided the CCHS Ernest Cole Brock III Endowment for Continuing Medical Education lecture on Nov. 17. His talk was titled Performance Enhancing Substances.

Lombardo listed some of the more common performance-enhancing substances. There are anabolic steroids, which are synthetic substances related to testosterone that promote the growth of skeletal muscle.

Stimulants are another, and can include amphetamine, ephedrine and pseudoephedrine. Lombardo described stimulants as “effective and dangerous,” explaining that they work to stimulate the central nervous system, giving athletes enhanced reaction time and the ability to fight fatigue. But they can also cause seizures, cardiac arrest, gastrointestinal problems and dependency.

Supplements, often consisting of herbs and plant derivatives and extracts, are another performance-enhancing substance used in sports. The US Food and Drug Administration does not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.

“No independent agency is verifying the ingredients so you’re taking something no one has tested,” Lombardo said. He said up to 20 percent of supplements contain non-labeled substances that could cause a positive drug test. “We tell athletes to beware of supplements and don’t take them, but they will take these, they always do. There’s a fear factor. They’re so intent on getting better they’ll try anything.”

Lombardo said there are times when substances that enhance performance are used for therapeutic reasons and exemptions are granted “recognizing that there are medical conditions for which they might be needed,” treating injuries and ADHD being a few. Most exemption are granted prior to use, not retroactively, “like after a positive test,” he said.

The Ernest Cole Brock III Endowment for Continuing Medical Education lecture series was established by Ernest Cole Brock Jr., MD, and his wife, Hannah Brock, with the goal of educating health professionals about the treatment of concussions and other sports injuries. They created the fund to honor the memory of their son, Ernest Cole Brock III, who died in 1999 at the age of 36. The late Dr. Ernest Cole Brock Jr. was an orthopedic surgeon who practiced for many years in Tuscaloosa and a longtime physician for the Alabama Crimson Tide.

Event highlights College’s research and scholarly activity

Research and scholarly efforts of CCHS faculty, staff, residents, medical students and graduate students were highlighted during the College’s 9th Annual Research and Scholarly Activity Day.

Thirty-nine poster presentations were displayed at the Nov. 9 event, held at the Northeast Medical Building. Judges were: Dr. Alan Blum, professor of Family Medicine at CCHS; Dr. Cassandra Ford, associate professor of Nursing at UA’s Capstone College of Nursing; Dr. Michele Montgomery, assistant professor of Nursing at UA’s Capstone College of Nursing; and Dr. Raheem Paxton, associate professor of Community Medicine and Population Health at CCHS.


Winners were named in three categories:

Student Division

First Place – Paul Strickland, William Riley, Jared Willis, Dr. Dan Avery, Glenn Davis, ET-P, Travis Parker, EMT-P, and Jared Halstrom, for Developing a Comprehensive Obstetrics Training Program for Alabama Emergency Medical Service Providers.

Second Place – Hillary Dorman, Amy Albright, Kaleb Murry, Deanna Dragan, Dr. Jermaine Mitchell, Dr. Pamela Payne-Foster, Dr. JoAnn Oliver, Chris Spencer, and Dr. Rebecca Allen, for The Holt Potted Plant Project: Older Adult Wellness & Community Engagement.

Third Place – Caroline Whittington, and Dr. Patricia Parmelee, for Effects of Activity Levels on Emotional Well-Being in Osteoarthritis: Global vs. Momentary Effects.


Resident Division

First Place – Dr. Paul Manhas, Dr. Richard Giovane, Paul Strickland, Dr. Jennifer Clem, Dr. Catherine Skinner, and Dr. Drake Lavender, for Basics of Clinical Medicine Lecture Series: A Novel Student-/Resident-directed Learning Initiative.

Second Place (tie) – Dr. Brittany McArthur, Dr. Dakota Acton Jones, Dr. Jackie Luker, Dr. Anne Halli, Dr. Clifton Scott, and Dr. Sam Lee, for Identifying Barriers Associated with the Discussion and Completion of Advanced Directives.

Second Place (tie) – Dr. Lisa Tsugios, Dr. Alan Blum, and Dr. Louanne Friend for Pet Therapy.

Third Place – Dr. Blake DeWitt, Dr. Catherine Skinner, and Dr. Louanne Friend, for The Effects of an Advanced Life Support Obstetrical Interprofessional Class on Participant Interprofessional Socialization and Readiness to Function in Interprofessional Teams.


Faculty Division

First Place – Dr. Martha Crowther, Dr. Cassandra Ford, Dr. Latrice Vinson, Dr. Chao-Hui Huang, Dr. Ernest Wayde, and Susan Guin, MSN, CRNP, for Recruitment of Mid-life and Older Adults for Mental Health and Physiological Measures.

Second Place – Dr. Abbey Gregg, and Shreya Roy, for Exploring the Impact of Medicaid Expansion for Former Foster Youth: Associations between Health Insurance and Adult Outcomes.

Third Place (tie) – Dr. Mercedes Morales-Aleman for Sexual Healthcare Access among Adolescent Latinas in Alabama.

Third Place (tie) – Dr. Drake Lavender for Melanosis Coli: A Case Report.


Of the posters, 14 were presented in the Student Division, 12 in the Resident Division and 13 in the Faculty Division.

CCHS brings Mini Medical School to Capstone Village

The CCHS Mini Medical School presentations are now offered at Capstone Village, a residential retirement community on The University of Alabama Campus.

The Mini Medical School series was created several years ago by the College in collaboration with UA’s OLLI program and lets adults and community learners explore trends in medicine and health. Lectures are provided by CCHS faculty and resident physicians who also care for patients at University Medical Center.

The first Mini Medical School presentation at Capstone Village was provided Nov. 16 by Robert McKinney, MSW, LCSW, PIP, ACSW, an assistant professor of Social Work at CCHS and director of UMC’s Department of Social Services. The topic was anxiety.

McKinney said anxiety is normal and most people experience anxiety at some point in their lives. “The difference between regular anxiety and anxiety that we need to pay attention to has to do with the way those feelings affect our lives – if the same thing is bothering you for more than six months, and if you change your life because of the anxiety.”

He explained that common anxiety disorders are generalized anxiety disorder, panic disorder, social anxiety disorder and phobias, and symptoms include uncontrollable feelings of panic and fear, sleep disturbances, shortness of breath, increased heart rate, inability to sit still, nausea and dizziness.

McKinney said 40 million Americans suffer from anxiety disorders, but only one-third receive treatment, and that takes a toll on health. “Chronic stress has negative effects on the body and can create disease.”

So, how do you know if you have an anxiety disorder? “It’s about intrusive feelings that cause us to change something in our lives – going out of our way to avoid a perceived stressor, avoiding social situations, feelings of being watched or judged, panic attacks, sleeping less, or more, due to intrusive thoughts,” McKinney said.

The good news is that anxiety disorders respond well to treatment, he said, including therapy, medication, meditation, yoga and exercise.

“Anxiety is real, not imagined, and it should be treated like any other medical condition,” McKinney said.

Emphasis on primary, preventive care has improved health outcomes in Cuba

“It all starts in the neighborhood.” That’s how Dr. Richard Streiffer, dean of CCHS and a family medicine physician, described the Cuban healthcare system to faculty, residents and medical students during a presentation November 29 as part of the College’s global health curriculum.

While there are hospitals and specialty care centers in Cuba, most care takes place in neighborhood poly clinics. Doctors and nurses who work in poly clinics live in the same neighborhoods where they practice, and they make house calls, getting to see patients in the context of their home and families.

There are also grandparent and maternity homes. Casa del Abuelo, or grandparent homes, are centers where the elderly can spend the day doing Tai Chi and other exercises, eating and playing games. The services are free of charge.

Cuba also utilizes community-based maternity homes to provide live-in, comprehensive care for women with high-risk pregnancies, a strategy that has significantly lowered infant and maternal mortality rates. Today, Cuba has achieved neonatal and infant mortality rates that are better than or on par with rich nations, including the US.

“The health care goes to the patient,” Streiffer said. “And everywhere they go, prevention is at the core of what they do.”

He said health-care providers in Cuba “really know their patients and they do remarkable population health, in the poly clinics and at the home visits. They know more about their patients without computers than we do in this country with computers.”

The revolution in Cuba in 1959 brought a set of principles, Streiffer said, including that all Cubans have a right to health care. The country constructed a healthcare system of integrated services built around primary care and prevention. “They are no longer a third-world country with regard to health,” Streiffer said. Cuba’s health outcomes have steadily improved and today the country ranks just below the US in health outcomes – 39th to the US ranking of 37.

In addition, Cuba’s medical education “largely mimics the emphases they have as a country,” said Dr. Cecil Robinson, who, like Streiffer, has made several trips to Cuba as part of The UA Center for Cuba Collaboration and Scholarship. All medical students become family medicine physicians first, and then can go on to specialize. Their education is multi-disciplinary, and public health is integrated. As a result, 70 percent of doctors in Cuba are primary care physicians, and studies have shown that countries with a strong primary care physician workforce have healthier populations.


College part of national efforts to advance precision medicine

The College of Community Health Sciences is participating in a nationwide network of academic and health-care institutions charged with implementing the National Institutes of Health’s All of Us Research Program, an effort to advance research into precision medicine.

The overall project seeks to enroll one million individuals living in the US and gather their health information and other data over time, with the ultimate goal of accelerating research and improving health. Researchers will use the data for studies on a variety of health conditions to learn more about the impact of individual differences in lifestyle, environment and biological makeup.

By taking into account individual differences in lifestyle, environment and biology, researchers hope to find ways to deliver precision medicine.

The College, through its University Medical Center, is an awardee of a part of the program known as the Southern All of Us Network (see list of awardees below). Combined, the awardees will receive $13.8 million from NIH.

“This is the project that will change the way we practice medicine in the future,” says Dr. John C. Higginbotham, associate dean for Research and Health Policy for CCHS and associate vice president for Research for The University of Alabama.

CCHS has been asked to enroll 400 individuals into the All of Us Research Program in the first year, says Higginbotham, who is coordinating the College’s efforts along with Dr. Tom Weida, the College’s associate dean for Clinical Affairs.

“We will be collecting data and following these folks for 10 years,” Weida says. “This is on the forefront of precision medicine and this is where medicine is going. We’re staying on the forefront of how we deliver care and the type of care we deliver.”

According to the NIH, precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle.” This approach allows doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people, in contrast to a one-size-fits-all approach with treatment and prevention strategies developed for the average person with less consideration for individual differences.

According to the NIH, All of Us participants will extend the geographic coverage of the program and strengthen its reach within underserved communities, including lower-income, Hispanic and Latino, African-American, rural and American Indian communities.

“We want this program to reflect the rich diversity of our country,” says Eric Dishman, director of the All of Us Research Program at NIH. “Expanding our national network of health care provider organizations enhances our ability to reach communities traditionally underrepresented in medical research. Working with participants across the country, we hope to contribute to medical breakthroughs that may lead to more tailored disease prevention and treatment solutions in the future.”

Adds Higginbotham: “This program will be a catalyst for innovative research and policies.”

Awardees include:

Southern All of Us Network: University of Alabama at Birmingham; Cooper Green Mercy Hospital, Birmingham, Alabama; Huntsville Hospital, Alabama; Louisiana State University Health Sciences Center, New Orleans; Tulane Medical Center, New Orleans; Tuskegee University, Alabama; UAB Hospital, Birmingham, Alabama; UAB School of Medicine’s Montgomery Internal Medicine and Selma Family Medicine programs, Birmingham, Alabama; University of Mississippi Medical Center, Jackson; University of South Alabama Health System, Mobile; and The University of Alabama College of Community Health Sciences/University Medical Center, Tuscaloosa, Alabama.

SouthEast Enrollment Center: University of Miami Miller School of Medicine, Florida; Emory University, Atlanta; Morehouse School of Medicine, Atlanta; and the OneFlorida Clinical Research Consortium led by the University of Florida in Gainesville.

All of Us Wisconsin: Marshfield Clinic Research Institute; BloodCenter of Wisconsin, Milwaukee; Medical College of Wisconsin, Milwaukee; and the University of Wisconsin-Madison.


Note: The All of Us Research Program plans to continue building the network of health care provider organizations over time to engage a large participant community that reflects the geographic, ethnic, racial and socioeconomic diversity of the country. The network will include regional medical center, community health centers and medical centers operated by the US Department of Veterans Affairs.

The challenges of rural health care

The College of Community Health Sciences hosted a panel discussion focused on rural health care challenges in Alabama during its October Board of Visitors meeting to share perspectives, brainstorm ideas and build collaborations.

Panel members included: James Cowan, administrator of Choctaw General Hospital in Butler; W.O. Buddy Kirk, a retired district judge from Pickens County; Don Lilly, senior vice president of UAB Health System in Birmingham; Nisa Miranda, director of The University of Alabama Center for Economic Development; Wallace Strickland, CEO of Rush Health System in Meridian, Miss.; and R.B. Walker, director of Government Relations for UA.

The panel discussion was moderated by Pat Duggins, news director at Alabama Public Radio.

The Board of Visitors is made up of volunteers, including alumni, donors, community physicians and other friends of CCHS who help the College develop relationships and partnerships with Alabama communities and with organizations at the state and national levels.

“Alabama is more rural than most of the US and the concern for sustaining rural communities and their health and economies is great. So are the challenges,” said Dr. Richard Streiffer, dean of CCHS, as he provided a framework for the panel discussion. “Rural communities have populations that are older, sicker and poorer. They have difficulty attracting and retaining young people and families because of a lack of jobs, inadequate education and few services and amenities. Rural communities struggle to attract and retain physicians and other health-care professionals, and to support hospitals and health-care services.”

In Alabama, 55 of its 67 counties are considered rural. There’s a critical shortage of doctors and other health-care professionals in rural counties, and eight counties have no hospital at all. Over the last eight years, seven rural hospitals have closed in the state, placing Alabama near the top of the list for rural hospital closures nationwide.

A key recurring theme during the panel discuss was the need for the state to include health care and rural hospitals in economic development efforts. “A hospital is an industry unto itself and should be recognized as that,” Strickland said. Lilly added: “Hospitals are good economic development for the state. When an industry comes, the state rolls out the red carpet.”

Walker noted that larger employers in rural areas are generally school systems and hospitals. Cowan pointed out that a single physician in a rural community can potentially create 23 additional jobs and $1 million in economic benefit for the local community. “It’s economic development worthy of the state’s attention,” he said.

“It’s hard to recruit industry if you don’t have health care or a hospital,” Walker added. “The state needs to look at health care as part of the economy. That’s the way to make it important to the Legislature.”

Miranda said it might be difficult for officials to know how to bring hospitals, including rural hospitals, into the economic development equation because of the complex way that health care is financed, and because hospitals are often recognized not as an industry but as a public service. She also said industrial recruitment is easier “because that structure is in place.”

Strickland said better planning is needed to match health-care resources with health-care needs. “No health planning exists in this country, whether it’s a rural area or an urban area. Right now, we’re scatter shooting.” Lilly said there is likely duplication of services from one rural area to the next “so it’s not sustainable because there’s not the volume. It’s like rural hospitals exist on an island.”

Panel members stressed the importance of considering creative solutions.

Walker said more programs are needed like one currently being launched by the College and Tuscaloosa Fire and Rescue Services that treats low-emergency conditions at the scene, reducing costly emergency room transports. Cowen suggested telemedicine could bring needed health care to areas.

Strickland explained that Rush Health System has, when building rural hospitals, placed admissions and cafeteria sections in space separate from traditional hospital space. The reason – $110 per square foot in construction costs as compared to $300-plus per square foot typically required for in-patient space.

In addition, Strickland said Choctaw General Hospital in Butler, which is owned by Rush Health System, has “swing beds” that can switch from acute care status to skilled care status, something that Medicare provides coverage for and that particularly serves the needs of smaller hospitals and communities.

Lilly said some rural hospitals might need to provide emergency care only “so they can get the reimbursement they need to stay open.”

Cowan said it’s important for rural hospitals to be an active part of a community. He said Choctaw General Hospital provides space for town hall meetings, and the cafeteria also operates as a place for the public to eat. “You have to engage with the community and keep it fresh and new. You can’t just build it and they keep coming back. You have to work at it.”

Kirk agreed, adding that it is important to get local citizens involved well before a rural hospital faces possible closure. “That speaks volumes to the Legislature and elected officials.”

UMC-Demopolis hosts open house

In August, University Medical Center added a permanent location in Demopolis, Alabama, adjacent to the Bryan W. Whitfield Memorial Hospital, within the hospital’s outpatient facility. The establishment of UMC-Demopolis is a way that the College of Community Health Sciences, which also operates UMC locations in Tuscaloosa and Northport, can help that community directly and support the local hospital, while also developing a model that combines a full spectrum rural practice with medical education – all linked to the larger infrastructure of University Medical Center and CCHS.

To celebrate the progress that has been made at the new location, the College hosted an open house October 19 within the UMC-Demopolis clinic. Leadership from CCHS and UMC were in attendance, along with the hospital’s CEO, Arthur Evans, Board Chairman Rob Fleming, and Board Member Don Lilly, who is also Senior Vice Pre

sident of Network Development and Affiliate Operations at UAB.

“It’s important to be here for our entire community. Demopolis has gotten in new business and major employers have made monetary commitments toward our development. We just need a hospital. That’s why there are so many people here. Everyone here is committed to this town.” — Hunter Compton, local civil lawyer

The clinic was packed at the open house with Demopolis citizens, including families with young children, as well as members of the City Council, the Rotary Club and city school representatives. Also attending was state Rep. AJ McCampbell, whose district includes Demopolis.

UMC to join IMPLICIT family medicine network

Dr. Heidi Knoll, from Mountain Area Health Education Center in North Carolina, visited the College October 17 to present the IMPLICIT Interconception Care program. IMPLICIT stands for Interventions to Minimize Preterm and Low birthweight Infants through Continuous Improvement Techniques.

The infant mortality rate in Alabama is 7.8 deaths per 1,000 births, compared to the US rate of 5.8 deaths per 1,000 births.

“This [program] would work to improve those rates,” Knoll said. “This [program] is going to help babies be born into healthier families.”

University Medical Center, which the College operates, received a grant from the March of Dimes to start the IMPLICIT Network in Alabama. IMPLICIT is a family medicine network that looks at modified risk and works to improve the health of pregnant women before pregnancy.

The modified risks identified by IMPLICIT are smoking, depression, family planning and multivitamin use. The goal is to talk to women of childbearing age at primary care physician visits. If the woman is already a mother, then she will be screened at well-child visits, from zero  to 24 months, and if any factors are identified, the mother is connected with either a primary care physician or other resources. If the woman plans on getting pregnant, she will be screened at primary care visits and introduced to preconception health visits to ensure a healthier pregnancy.

There are currently 25 sites nationwide in the IMPLICIT Network, but  only a few locations in the South; UMC is the only location in Alabama. Other Southern locations include the University of Mississippi Medical Center in Jackson Mississippi, and locations in North Carolina, including MAHEC.

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Celiac Disease

During a presentation for the Mini Medical School Program, a lecture series the College of Community Health Sciences provides in collaboration with UA’s Osher Lifelong Learning Institute, Dr. Ed Geno spoke about the identification and treatment of celiac disease.

“What I’m going to do is take you on a journey of gluten through the body,” said Geno.

Throughout the lecture, Geno described the various actions and reactions the human body goes through if a person has celiac disease or is gluten intolerant. The symptoms of celiac disease are common and can often be interpreted as other diseases, making it difficult to diagnose. Symptoms include: malabsorption, diarrhea, bloating, and vitamin deficiency.

“You tend to see this disease in families,” said Geno. “It can occur in kids, and it can occur later in life as well.”

Because celiac disease can affect a wide-range of people and shows symptoms common to other diseases, it can be difficult to diagnose. If a parent, sibling or child has celiac disease, it is wise to get screened.

About 1 percent of the North American population has celiac disease and most people who suffer from gluten intolerance are not born with the disease, rather they develop it over time. Once developed, the only treatment is to maintain a gluten-free diet. Symptoms of celiac disease may resolve while being gluten-free, but the disease is lifelong.

Being gluten-free requires cutting any foods that contain wheat, rye, barley and malt. This includes bread, pastas, beer, and even some over-the-counter medications.

While many people can see health benefits of going gluten-free, it is very important to replace the nutrients lost by avoiding wheat in your diet. There are alternative sources for carbohydrates, fiber, iron, and folic acid that are gluten-free. Many of these sources are alternative grain products (such as rice, corn, or potato based products), green leafy vegetables, and meat, fish, and poultry.

Pickens County Heart Walk

The annual Pickens County Heart Walk took place in Gordo, Alabama, on Saturday, Oct. 28. The walk was organized by members of the Pickens County community and sponsored by the American Heart Association. The walk started and ended at Gordo City Hall and despite the cold and rain, attendance was good.

As part of the partnership between the College of Community Health Sciences and the American Heart Association, the Pickens County Partnership had a presence at the Pickens County Heart Walk. The Pickens County Partnership offered handouts containing general information about the partnership as well as information about the Pickens County Medical Center Cardiac Rehab Clinic.

After the walk, the College offered participants apple cinnamon chips, a seasonal and heart healthy snack.

The College hosts the Brussels Sprouts Challenge each year at the West Alabama Heart Walk in Tuscaloosa.