Crimson White: UA professor lectures on key issues with over-the-counter drugs

To help society become smarter consumers in pharmacies, Dean and professor of Family Medicine in College of Community Health Sciences Dr. Rick Streiffer presented a lecture entitled, “Over-the-Counter Drugs: A Prescription for Confusion” on Thursday.

Streiffer initially spoke about how common the confusion in buying over-the-counter drugs is for most ages, and how people in the United States make trips to drug store regularly for various concerns, spending a lot of money on items they do not need. According to him, many products can cause adverse effects for people as well.

Immunizations in older adults, addiction and teens, schizophrenia and cholesterol topics in weekly Mini Med School lecture series

About one-third of people will get shingles in their lifetime, and while the shingles vaccine is only about 50 percent effective, it is still worth it to avoid getting the virus, said Dr. Jane Weida, director of clinical affairs for the College of Community Health Sciences’ Department of Family, Internal, and Rural Medicine.

Weida gave her talk, “Immunizations for Older People — Staying Sharp on Shots,” on Feb. 9 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. The lecture series is open to OLLI participants and to the public.

Shingles is caused by the same virus that causes chickenpox. A painful rash develops, usually on a single area on one side of the body, that can be very painful, said Weida, who is also an associate director of The University Family Medicine Residency, operated by CCHS, and an associate professor of Family Medicine.

View Fox 6’s report on Weida’s talk:

Someone who has had chickenpox can get shingles.

“When you’re little you get chickenpox and then the virus stays in the nerves along the back and neck,” said Weida. “Sometimes, we don’t know how, it reactivates.”

Being older, having poor immune function and having had chickenpox before 18 months of age increases the risk of shingles.

“If you never have had the chickenpox, you can’t get shingles first,” she said. “If you’ve never been immunized for chickenpox or shingles, you should get immunized for both. You can catch chickenpox from someone with shingles, but not shingles.”

Insurance will cover the shingles vaccine after age 60, though it can be given starting at age 50.

Older people need immunizations to boost immunity to diseases, even those to which they have already been immunized, such as tetanus, diphtheria and whooping cough, and to protect against diseases that affect older adults preferentially, including shingles and pneumonia, said Weida.

Weida also encouraged attendees to get their flu shot each year, as 3 million to 5 million people are infected by influenza each year, and 250,000 to 500,000 die each year from the flu. The best time to get your flu shot is about mid-October to November, said Weida.

The flu shot’s effectiveness can fade, Weida said, so it is important not to get it  too early, especially for those older than 65.

The flu is spread through coughing or sneezing and by touching surfaces with the virus. However, soap and water deactivates the virus, Weida said.

Schizophrenia
On Feb. 2, Dr. Thaddeus Ulzen, associate dean of Academic Affairs and chair of Psychiatry and Behavioral Medicine, gave his talk on schizophrenia, which is a chronic and severe mental disorder that affects 1 percent of people worldwide.

Symptoms typically present between late adolescence and early adulthood. Ulzen said that symptoms may be subtle, but those around the person may notice that “something is just not quite right, or the person is not his or herself.”

Symptoms include hallucinations, delusions, thought disorders and movement disorders. Reduced emotions and feelings of pleasure and reduced speaking may also be symptoms.

“I describe it as a disruption of what I call ‘security of thought’—that your thoughts belong to you,” said Ulzen. “The feeling is that someone is intruding on your thoughts.”

Medication can be used to treat schizophrenia, but other aspects must be introduced into the treatment, said Ulzen, including psychosocial interventions and cognitive behavioral therapy. Community treatment, which includes family education and support, is also important.

Schizophrenia cannot be cured, and those affected with the disorder have it for life.

“As a child psychiatrist, I always say that we are in preventive psychiatry. Most disorders we see, including schizophrenia, start quite young.”

Ulzen said he works with general physicians to help them identify the signs of schizophrenia and other psychiatric disorders.

“My job is to help physicians understand that this is the beginning of the big tsunami about to come and never to say ‘It’s just a phase.’ If the patient is concerned enough to walk into the room, they know something is wrong.”

 

Addiction and Teens
In a 2015 study, one out of 17 high school seniors were daily smokers of tobacco, said Dr. Sara Phillips, assistant professor of Pediatrics at CCHS, during her talk “Addiction and Teens” on Feb. 16.

According to the CDC, cigarette smoking causes about one of every five deaths in the US each year and life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, said Phillips.

“I think if we target young people and try to get them to quit early on, it could be like they never smoked.”

Most teens want to quit, she said, and nicotine replacement and cognitive behavioral intervention can be helpful forms of treatment.

While there are other dangerous drugs that teenagers use, smoking causes annually more deaths than overdoses have in 15 years, said Phillips.

More money is spent on tobacco advertising than any other drug, though there are regulations.

Advertising for alcohol is not regulated, and people aged 12 to 20 years drink 11 percent of all alcohol consumed in the US. More than 100,000 deaths can be attributed to excess alcohol consumption, including the deaths of 5,000 people younger than 21 years, said Phillips.

Younger drinkers are more likely to develop alcohol dependence or abuse later in life, and they are at higher risk of suicide and death from alcohol poisoning. This is for a couple of reasons, said Phillips.

“One, their brains are not fully developed, and two, they’re novices to drinking. They don’t know their limits,” she said.

Of illegal drugs, marijuana is the most commonly used and adolescents can become addicted, despite popular belief, said Phillips.

One study showed an average loss of eight IQ points with heavy marijuana use as a teen and continued use as an adult. It can also lead to memory problems, breathing issues and hallucinations and paranoia.

Genetics can play a role in addiction in teens. Children whose parents are alcohol-dependent are four to six times more likely to develop alcohol dependence compared to others with no family history. Teens with mental health issues are also more at risk to use or abuse substances, Phillips said.


Cholesterol
Treating cholesterol isn’t about treating a number—it’s about treating the risk factors and the disease process, said Dr. Ed Geno, assistant professor of Family Medicine in the College’s Department of Family, Internal, and Rural Medicine.

Cholesterol is essential in the human body, said Geno. Two types of cholesterol levels are checked: LDL and HDL. The two have different clinical implications:

LDL carries cholesterol from the liver to the tissues and deposits it. Geno called this “lousy cholesterol,” which is how he helps patients remember it is not good for that number to be too high.

“Happy cholesterol” is how Geno helps patients remember HDL, which carries cholesterol from the tissues back to the liver.

High levels of the LDL cholesterol can lead to plaque buildup in arteries and lead to cardiovascular disease (CVD).

Statins may be used to prevent CVD in adults.

“We are trying to use primary prevention in treating cholesterol,” Geno said. “That means we are trying to keep someone from ever having a heart attack. Secondary prevention would be keeping a heart attack from happening again.”

When treating a person’s cholesterol, risk factors and the disease process is taken into account—not just the patient’s cholesterol numbers.

Adults without a history of CVD may be prescribed a statin for the prevention of a CVD event and mortality  depending on if: 1) the adult is between age 40 and 75; 2) the adult has one or more CVD risk factors, which include dyslipidemia, diabetes, hypertension or smoking; and 3) the there is a calculated risk by the physician of a cardiovascular event within 10 years.

College’s magazine honored for excellence

The College’s semi-annual magazine, On Rounds, received an Award of Excellence from the Council for Advancement and Support of Education, earning recognition as one of the best university magazines in the Southeast.

OR-Winter-2016_Reduced-1The award-winning 72-page issue, published in winter 2016, featured a package of articles about the College’s core values and the employees who exemplify them, and the College’s ongoing work to meet its mission of improving health in Alabama and the region. View the winter 2016 issue here. 

Brett Jaillet, assistant director of Communications for the College, is editor of On Rounds and oversaw all aspects of the issue’s production—from conception and development of content, to layout, creative design and publication.

On Rounds is a key component of the College’s communications efforts.

CASE is an international professional association serving educational institutions and the professionals who work on their behalf in communications, alumni relations, development, marketing and advertising and related areas.

McKinney Selected for Fellowship

Robert McKinney, assistant professor of social work in the department of Psychiatry and Behavioral Medicine at The University of Alabama’s College of Community Health Sciences, was among 16 faculty nationwide chosen for the 2018 class of the Society of Teachers in Family Medicine’s Behavioral Science/Family Systems Educator Fellowship.

Dean talks to Alabama Public Radio about potential impact of Affordable Care Act repeal

The Affordable Care Act is seen as one of the defining pieces of President Obama’s legacy – and the new Republican majority has targeted it for repeal. Leading lawmakers in both houses of Congress have begun work dismantling Obamacare – despite not having any plan in place for a replacement, and despite polling that suggests an overwhelming majority of Americans oppose its repeal without a replacement ready.

In Remembrance: Dr. Ernest Cole Brock, Jr.

Dr. Ernest Cole Brock, Jr., a longtime physician for the Alabama Crimson Tide and the creator of a sports medicine lecture series for the College of Community Health Sciences, passed away on Nov. 5 at his home in Tuscaloosa. He was 91.

Dr. Ernest Cole Brock, Jr., with his wife, Hannah Brock

Dr. Ernest Cole Brock, Jr., with his wife, Hannah Brock

Brock was an orthopedic surgeon who practiced in Tuscaloosa for many years, in addition to serving as a physician for the Alabama football team.

He and his wife, Hannah Brock, created The Ernest Cole Brock III Endowment for Continuing Medical Education at the College to support a lecture series on treating concussions and other athletic 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 inaugural lecture was held in January 2013.

Brock grew up in Fairfield, Alabama. In 1943, at age 18, he entered the United States Air Force and fought as a gunner in 32 combat missions in Guam and Japan. After he returned to the US, he accepted a scholarship to play football at Wake Forest University in North Carolina.

Brock had plans to be a football coach and a science teacher, but after he suffered a career-ending leg injury during his second year of college, he decided to pursue medical school. He received his medical degree from Wake Forest University and then completed his residency in orthopedic surgery at University Hospital in Birmingham (now UAB Hospital).

After residency, he joined the hospital’s staff and served as the physician for high school football players at Legion Field.

“[Orthopedic surgery] is a good field to be in,” Brock said to the College in a 2014 interview. “Most of the patients are young and can heal.”

Brock later formed an orthopedic surgery and sports medicine practice in Tuscaloosa and began traveling as a surgeon with the Crimson Tide and head coach Paul “Bear” Bryant.

“I enjoyed working for the team, and Coach Bryant was nice to work for,” Brock said.

For 25 years, Brock was the team orthopedist for Alabama. He also served as an orthopedic preceptor for the College, training residents and medical students on the diagnosis and treatment of musculoskeletal conditions. He practiced in Tuscaloosa until he retired in 1992.

Dr. James Robinson, chair of Sports Medicine, team physician for Alabama and an alumnus of the College’s Residency, said Brock was a mentor to him when he was training.

“Dr. Brock’s legacy to CCHS will be maintained by the annual lecture series that bears his name and by the continuation of the physician care of the athletic department through the deShazo Sports Medicine Clinic,” he said.

Brock’s funeral was held Nov. 9 at Calvary Baptist Church in Tuscaloosa.

CCHS hosts two Cuban physicians, discusses health care topics as part of UA Cuba Week

October Mini Med School Topics: Women’s Health, Injury Prevention and Telemedicine

Breast cancer is the second leading cause of death among women, so prevention and screening are important, not only for breast cancer but also for other gynecologic cancers, according to Dr. Kristie Graettinger, associate professor and chair of the College’s Department of Obstetrics and Gynecology.

Graettinger provided a presentation, “Women’s Health Update: Cancer Prevention,” at the Oct. 20 Mini Medical School program conducted in collaboration with UA’s OLLI program.

In addition to her presentation, three other faculty members presented during the month of October. Dr. Ray Stewart, assistant professor of Sports Medicine, talked about “Preventing Injury” on Oct. 6, and Dr. Karen Burgess, chair of Pediatrics, gave a presentation on “Telemedicine” on Oct. 13.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

In her presentation, Graettinger said to think of cancer prevention as three tiers: “prevention, screening and treatment.” Prevention is interventions to reduce the risk of cancer, including maintaining a healthy weight, being physically active, having a diet high in fruits, vegetables and whole grains and low in processed foods and red meats, and receiving vaccinations that can protect against cancer, such as the HPV vaccine for cervical cancer. Examples of screening include mammograms for breast cancer and pap smears for cervical cancer.

“The goal is first to try and prevent cancer, and also to identify people at risk for the disease,” Graettinger said.

Breast cancer is the second leading cause of death among women, right behind lung cancer, and will affect 1 in 8 women in their lifetimes. Approximately 250,000 cases of breast cancer are diagnosed every year.

Having a first-degree relative, such as a mother or sister, with breast cancer doubles the risk, but that amounts to only 15 percent of women diagnosed. Breast cancer screening includes mammograms, clinical exams performed by a physician or health professional, breast self-exams and genetic testing.

A mammogram is an x-ray of the breast. Currently there is not a consensus among organizations about the age a woman without a family history of breast cancer should be – ranging from 40 to 50 – to begin receiving annual mammograms.

There is recent evidence that clinical breast exams might not be helpful for women without symptoms of breast cancer, “but have that discussion with your doctor,” Graettinger said. She added that the concept of breast self-exams has shifted to “being aware of your breasts.”

For women with the inherited BRCA gene mutation, “this is serious business and increases the risk of breast cancer from 1 in 8 to 1 in 2, or by 50 percent, and the risk of ovarian cancer is 10 times greater,” Graettinger said. Having the BRCA gene is “not extremely common, but it’s not rare,” she said, adding that women with a personal history of breast cancer should consult with their physicians about this genetic testing.

Other gynecologic cancers include cervical, ovarian and uterine cancer. Of those, only cervical cancer has a screening test – pap smears, which detect precancerous changes on the cervix. Pap smears are now recommended every three years for women ages 21 to 65.

Ovarian and uterine cancers are detected by signs and symptoms, “which is scary because sometimes these are found in the later stages,” Graettinger said. Symptoms of ovarian cancer are vague and include pelvic and abdominal pain and pressure, bloating and feeling full quickly, and irregular bleeding. Approximately 20,000 cases of ovarian cancer are diagnosed annually. Pressure, pain and bleeding after menopause are common symptoms of uterine cancer, which primarily strikes women over the age of 50.
In Stewart’s presentation, he said that “sprains and strains are where the vast majority of injuries are occurring.” The most common sports injury is an ankle sprain, followed by a groin sprain and a hamstring sprain.

Stewart said the goal is to introduce preventive measures to avoid the injury. A warm up is a good way to do that. A warm up should get the body moving, introduce a light sweat and “literally warm up the muscles,” he said.

Stretching is a good way to prevent injuries, too. There is dynamic stretching, which are bouncing, jerking movements, static stretching, which are slow, deliberate movements that are held for about 20 seconds, and then proprioceptive neuromuscular facilitation, or PNF stretching, which combines static stretching with isometric movements to increase flexibility.

To prevent an ankle sprain, Stewart suggested wearing an ankle support to reduce the risk and to conduct balance training: stand on one leg in order to train muscles to support the ankle.

To prevent a hamstring sprain, Nordic hamstring exercises are best, Stewart said.

There is a higher injury rate of the ACL in women, and prevention requires regular exercises. Plyometrics, known as “jump training” help may reduce an ACL injury, but must be performed throughout the athlete’s season. After the participant stops performing the training exercises, he or she becomes at risk for injury again.
Burgess introduced many of participants in the Mini Medical School series to the concept of telemedicine for the first time.

Telemedicine is any medical information exchanged from one site to another through the use of technology. It could be a phone or computer.

“We use it to improve access to care,” said Burgess.

Many parts of Alabama are rural and are underserved in primary care and specialty care providers. Unfortunately, many of the underserved areas in Alabama are also areas with limited connectivity, which makes it difficult to access telemedicine, Burgess said.

Burgess spoke about CCHS Telemedicine and Telehealth efforts, including the asthma education program that she and Beth Smith, a nurse practitioner in pediatrics at University Medical Center, have led. Students at Greensboro Elementary School in Hale County and their parents are taught through telemedicine about asthma symptoms, medication and treatment. The program teaches  students how to use a spacer with their asthma inhaler for more effective usage of their medicine.

The program so far has revealed that students and parents are learning more about asthma and how to treat it.

One participant said: “Until today I had no idea what telemedicine was. Thank you for coming here and telling us about that today.”

 

Faculty members, Pediatrics department honored at Argus Awards ceremony

Two faculty from The University of Alabama’s College of Community Health Sciences were honored at the annual Argus Awards ceremony on Friday, Oct. 7. The awards are given by medical students to faculty and mentors for outstanding service to medical education.

Dr. Heather Taylor, an associate professor ­­­in the Department of Pediatrics, received an Argus Award in the Clinical Awards category for Best Clinical Educator, and Dr. Quinton Matthews, an associate professor in the Department of Surgery and a physician with University Surgical Associates, received an award in the Excellence in Education category for Best Community-Based Physician.

The Department of Pediatrics also received an Argus Award in the category of Best Clinical Department at the Tuscaloosa Campus. Other departments nominated were Obstetrics and Gynecology and Surgery.

“It’s always an honor to be recognized by the students,” says Taylor. “That’s why we have the jobs that we have so that we can work with students and do something valuable that gives back to them.”

Those who received nominations were: Dr. Bradley Bilton, associate professor in the Department of Surgery; Dr. Ashley Evans, associate professor in the Department of Pediatrics; and Dr. Robert Slaughter, hospitalist in the Department of Neurology.

One of the College’s functions is to serve as the Tuscaloosa Regional Campus for the University of Alabama’s School of Medicine, which is headquartered in Birmingham. A cohort of third- and fourth-year medical students receive their clinical education at the College.

The Argus Awards were created in 1996 to recognize faculty members and allow medical students to honor faculty and mentors for their service and dedication to medical education. Faculty are­ nominated based on their course evaluations and students vote to select winners in each category.

—Kimberly Florence

CCHS to host two physicians as part of UA’s Cuba Week

The University of Alabama’s Cuba Center will host its 2016 Cuba Week Monday, Oct. 24, through Friday, Oct. 28, and Cuban guests have been invited to visit UA and present with faculty from across campus throughout the week.

The College of Community Health Sciences is participating in the week by hosting two physicians—Dr. José de Jesús Portilla García and Dr. Nancy de la C. Milián Melero.

The CCHS presentations as part of UA Cuba Week will be held on Wednesday, Oct. 26, at the Bryant-Jordan Performing Arts Center on the UA campus. Portilla will present “Achievements of the Cuban National Healthcare System: The 1950s to the Present,” and Milián will present “Training Doctors  for Cuba and the World.” Together, they will present “The Mother and Child Care Program in Cuba.”

Some CCHS faculty, including Dr. Richard Streiffer, dean of the College, have spent time in Cuba learning about its healthcare system and approach to medical education. Streiffer says there is much the US can learn from Cuban medicine.

“Politics aside, most agree that in the 50 years since the Cuban Revolution, Cubans have systematically built a rational, if not relatively resource frugal healthcare system,” Streiffer says. “It is grounded in holistic primary care with a family doctor and nurse-run consultorios (clinics) located in every neighborhood across the country. Every physician becomes a family doctor first; some then go on to specialize.”

Portilla and Milian will also meet with CCHS faculty, medical students and residents to discuss their country’s approach to health care and medical education. Some of the topics of conversation and discussion will include maternity care, geriatric care and what it is like to be a patient in Cuba.

The College will also facilitate a trip to a rural community so that Cubans can understand some of the issues facing the state, such as a shortage of health care resources and primary care physicians.

For more information about UA’s Cuba Week, visit cuba.ua.edu.