College, city partner to provide para-medicine program

The College and Tuscaloosa Fire and Rescue Services have partnered to provide a first of its kind in Alabama program that seeks to reduce costly hospital emergency room transports of people with low-emergency conditions.

The program is aimed at “low acuity” patients who might call 911 for back or stomach pain, fever, weakness or bleeding, for example, which might be treatable at the scene.

Under the program, nurse practitioners and social workers, and possibly psychologists, will ride with fire department first responders on low-acuity calls and offer treatment at a patient’s location, eliminating the need for an ambulance ride and a hospital emergency room visit. While care can be delivered at the scene, low-acuity patients will have the option of being transported to the hospital if they wish.

The nurse practitioners will have back-up from physicians, and the social workers can ensure that patients have the resources they need and can connect patients with primary care physicians. The psychologists can offer assistance on managing the nearly 30 percent of low-acuity calls related to mental health.

“This is a way to change how health care is delivered,” said Tuscaloosa Fire and Rescue Chief Alan Martin.

The para-medicine program is modeled after a similar Arizona program, although that program doesn’t have a university as a partner. Based on preliminary results from the Arizona program, the medical cost savings for the Tuscaloosa program could be $6 for every $1 that’s invested, said Dr. Richard Friend, chair of the College’s Department of Family, Internal, and Rural Medicine and co-director of the program along with Dr. John C. Higginbotham, chair of the College’s Department of Community Medicine and Population Health.

The para-medicine program is funded with a legislative allocation through Alabama’s Medicaid program and will use College nurse practitioners and social workers to provide care. The funding is expected to be available Oct. 1.

In fiscal year 2015, in Tuscaloosa there were 11,122 calls to 911, of which 23 percent, or 2,558, were low-emergency calls. At a cost of approximately $645 per call for an ambulance ride, treating callers at the scene would save $1.65 million.

“Trying to stop use of the emergency room for routine care is the goal,” Friend said.

Mental illness hits closer to home than you might think

By Kim Eaton

Did you know?

In an average US city with 20,000 people, 840 will have been diagnosed with depression. That is an average of 13.3 million people in the US with diagnosed depression.

Mental illness does not discriminate. It can impact anyone and everyone, not just in Tuscaloosa or Alabama, but nationally and internationally.

“Depression has increased by 18 percent since 2005 and is now the leading cause of ill-health and disability worldwide, with more than 300 million people suffering,” said Dr. John Burkhardt, an assistant professor of Psychiatry and Behavioral Medicine for the College of Community Health Sciences and a practicing clinical health psychologist at University Medical Center, which the College operates.

That number is only those diagnosed with depression, Burkhardt added. There are many people suffering from undiagnosed mental illness. Depression also puts people at risk for other medical conditions, like increased risk of cardiovascular disease, diabetes, stroke and Alzheimer’s disease.

May is Mental Health Awareness Month, and to raise awareness of this health issue, faculty from the College’s Department of Psychiatry and Behavioral Medicine provided, throughout the month, media interviews and patient information about various mental health topics – depression, anxiety, substance abuse, ADHD and healthy lifestyles – as well as weekly mindfulness segments for College employees.

So, what is mental health?

Mental health ultimately has to do with how someone functions in his or her world.

“All of us will go through periods when we may experience depression or anxiety,” Burkhardt said. “And for some of us, we will experience more problems functioning in one or multiple areas, whether it be work, home or interpersonally. Being in good mental health means having the resources and coping skills to manage these times, but most importantly to remain functional, which means being able to manage the various areas of your life successfully, such as work, parenting, play, relationships, exercise, home, etc.”

Since Burkhardt moved to Tuscaloosa two years ago, he has seen a broad range of mental illness in his clinic at University Medical Center. He sees a lot of depression and anxiety, but said Alabama as a whole has problems with drug abuse, either prescribed or non-prescribed. He also sees many people trying to cope with some form of trauma in their life.

“There is not one common problem,” Burkhardt said. “Mental illness exists in many forms and is closer to home than we think.”

Despite the prevalence of mental illness, access to care and being able to afford care are two of the biggest challenges for individuals. When looking at mental health provider ratios, top US providers have a 360:1 patient-to-provider ratio; Alabama is 1,260:1; and Tuscaloosa is 890:1. This is the ratio of the county population to the number of mental health providers, including psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, mental health providers who treat alcohol and other drug abuse and advanced practice nurses specializing in mental health care. About 30 percent of Alabama’s population lives in a county designated as a Mental Health Professional Shortage area.

To help fill in the gap, The University of Alabama and the College offer multiple resources to students, faculty and staff, as well as the community. These include the Betty Shirley Clinic at University Medical Center, Student Health Center, Counseling Center, Psychology Clinic, Employee Assistance Program and the Capstone Family Therapy Clinic.

Another challenge is the stigma surrounding mental illness, which might prevent someone from seeking help. There are several misconceptions, the most common being that it does not happen to “everyday or regular people” and if someone gets diagnosed then there is something severely wrong with them.

“Stigma plays a big role in this,” Burkhardt said. “Negative emotions and reactions are apparent when the topic of mental illness arises. People get these negative pictures in their head whether it be from movies they have seen or their own perceptions of what people with poor mental health present like. They don’t understand that the severity can range from mild to severe, so they always assume it’s severe. We are now just getting to a point where people can talk about mental illness without feeling like they have been hiding a dirty secret.”

Another misconception is that people should just be able to “get over it” because life is not easy. While it is true life is full of challenges, having poor mental health does not mean they are a failure or cannot manage their life. But it also doesn’t mean they can do it themselves.

“There is help for you,” Burkhardt said. “Just because you have a diagnosis does not mean your life has to stop. Many individuals live a full life managing their mental illness.”

 

Bringing attention to a mental health crisis in jails

In a mental health crisis, people are more likely to encounter police than get medical help, according to the National Alliance on Mental Health. As a result, more than 2 million people with mental illness are booked into jails each year, and the vast majority of these individuals are not violent criminals.

“They get arrested instead of getting into treatment,” said Dr. Marisa Giggie, associate professor of psychiatry and behavioral medicine at the College of Community Health Sciences and chief psychiatrist for the Tuscaloosa County Jail.

“The correctional system becomes the safety net.”

Once in jail, however, these individuals might not receive the treatment they need and might end up getting worse.

The College hosted a presentation and panel discussion April 25 to bring attention to the mental health crisis in jails. “Mental Health in Correctional Settings in Tuscaloosa” was held at DCH Regional Medical Center in Tuscaloosa. In addition to Giggie, presenters included Tuscaloosa County Sheriff Ron Abernathy and the Honorable M. Bradley Almond, presiding judge of Tuscaloosa’s Mental Health Court.

Giggie provided stark statistics about the mental health crisis in jails. She said there are 10 times more people with mental illness in jail than in state-funded mental health facilities. She said 30 percent of the 9 million inmates in Cook County Jail in Chicago have mental illnesses making the jail “the largest provider of mental health services in the country.”

Giggie said the mental illness inmates experience can include drug addiction, depression, Bipolar disorder, schizophrenia and post-traumatic stress disorder. She said confinement to jail cells can increase the symptoms of these inmates.

She sees approximately 30 percent of the total Tuscaloosa County Jail population, a daily average of 536 inmates, for a variety of mental health issues.

The issue of mental illness among offenders in the criminal justice system is not new, but now there is better information about the scope of the issue. The rise in inmates with mental disorders began decades ago when policies were enacted nationwide that moved mentally ill people out of state institutions in an attempt to allow them to return to their families and live independently.

To try to deal with the influx of mentally ill inmates, Tuscaloosa County, in 2012, implemented a mental health court that was established by Almond, Abernathy and Indian Rivers Mental Health Facility in Tuscaloosa. The Tuscaloosa County Mental Health Court is a jail diversion program for nonviolent mentally ill offenders.

Almond said to date, a total of 440 inmates have been assessed by the mental health court and of those, 140 have received mental health treatment and 81 have graduated, averting jail time.

“The last place a person with mental illness needs to be at is the county jail,” Abernathy said.

He and Almond estimate the mental health court keeps 30 to 40 inmates out of the system annually. “That’s saved us hundreds of thousands of dollars, but the most important issue is that these people don’t need to be there,” Abernathy said.

A jail diversion program for the mentally ill in Massachusetts has saved that state $1.3 million in health services costs, Giggie said. “A jail diversion program is less costly and more humane.”

In addition to Giggie, the Tuscaloosa County Jail also employs a full-time social worker and recently hired a health officer with the authority to seek mental health care for an individual rather than making an arrest.

College hosts third annual Brussels Sprout Challenge at Heart Walk

For the third straight year, UA’s College of Community Health Sciences hosted the Brussels Sprout Challenge during the American Heart Association West Alabama Heart Walk on March 25.

The College and its University Medical Center partnered with Manna Grocery and Deli in Tuscaloosa to roast and serve Brussels sprouts at the walk, which began at the Tuscaloosa Amphitheater and continued along the downtown river walk. More than 900 Brussels sprouts were distributed at the challenge.

To complete the Brussels Sprout Challenge, participants had to eat one roasted Brussels sprout at each mile marker of the 3.1 mile walk. Those who completed the challenge by eating all three Brussels sprouts were awarded a T-shirt at the end of the walk.

The College also provided handouts about the health benefits of Brussels sprouts, which include heart health and cancer protection, as well as Brussels sprout recipes.

The goal of the Brussels Sprout Challenge is to offer a challenge that promotes healthy lifestyle choices – a healthy diet and exercise – while complementing the American Heart Association’s mission to build healthier lives free of heart disease and stroke.

The mission of the College is to improve and promote the health of individuals and communities in Alabama and the region.

College receives grant to provide colonoscopy training to faculty and residents

By Kimberly Florence

The College of Community Health Sciences wants to increase the number of colonoscopy procedures performed by family medicine physicians in underserved communities of rural Alabama, and it plans to accomplish this goal through a grant from the American Cancer Society.

Dr. Richard Friend, director of the College’s Family Medicine Residency, applied for the grant in early 2016. In June 2016, the College received an endowment of $70,000 that matched an additional $70,000 from CCHS.

The money will be used to fund colonoscopy training for the Family Medicine faculty and residents, said Friend.

“The purpose of this grant is to train more providers to do colonoscopies throughout the state,” he said. “The way we are approaching that is by training more faculty who will in turn train more residents.”

The grant will fund the purchase of a high-fidelity simulator that faculty and residents will use to learn. The simulator uses computerized manikins to guide providers through performing the procedure and records proficiency. Once providers have met certain requirements, they can to move on to assisted cases in surgery with live patients. Friend says the simulator will be purchased in about a month.

Residents will begin their training under the direction of Friend. Dr. Drake Lavender, associate professor of Family Medicine.

Two faculty members will also receive training: Dr. Jared Ellis, associate director of the Residency, and Dr. Ed Geno, associate professor of Family Medicine. Once they complete their training, they will join Friend and Lavender in training residents.

The majority of residencies across the country do not provide colonoscopy training and family medicine physicians perform only 8 percent of colonoscopies in the state, said Friend. By training more family physicians to perform the procedure, the College hopes to provide greater access to patients in rural areas who may not be able to get to an urban setting where the majority of colonoscopies are performed, said Friend.

“There are people in our region who can’t get to the larger metropolitan areas like Tuscaloosa and Birmingham,” Friend said. “We hope to provide these services in smaller rural medical centers where they’re needed the most.”

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region through the provision of high quality, accessible healthcare, and one of the ways it does that is by sending its trained physicians into Alabama’s rural and underserved communities.

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.

Pickens County high school students visit College

Two dozen Pickens County high school students interested in health careers visited the College as part of a program of The University of Alabama-Pickens County Partnership.

The students are members of Exploring Professional Opportunities (EXPO), a program for sophomore and junior high school students to learn about career opportunities, scholarships and college life.

The UA-Pickens County Partnership, which is led by CCHS, works to place UA students in medicine, nursing, social work, nutrition, psychology and health education – and potentially others – in Pickens County for internships and other experiences. The rural county is provided with additional health resources, and UA students receive real world training in their respective areas of study.

Patti Pressley-Fuller, Pickens County Cooperative Extension Coordinator and a member of the partnership’s Advisory Committee, said EXPO gives students “an opportunity to open their minds to careers, a bigger world and a brighter future.”

During their time at the College, the students heard from Dr. Dan Avery, director of medical student admissions. Avery said the most frequent question he gets from students is how can they pay for medical school? “Don’t let that be an impediment. There are scholarships, grants, all kinds of things that are available,” he said. “We desperately need primary care physicians in this state and in this country, and the most likely people to practice in rural and underserved areas are people who grew up there.”

The College, which also functions as a regional campus of the University of Alabama School of Medicine, educates and trains medical students and resident physicians, with a focus on primary care.

The students asked Avery what undergraduate degrees help students get into medical school. “Make sure you get the required courses in biology and chemistry, but medical schools want students who are well rounded,” he said. “Medicine is problem solving.”

He said communications skills are essential. “Doctors have to talk to patients long enough, and they have to listen.”

Shawn McDaniel, a Pickens County high school teacher who accompanied the students, added that “people skills and communication are a big thing. Young people can text, but face-to-face communication is harder. But you have to be able to do that because as a doctor you’re taking care of people.”

In addition to visiting the College and touring its University Medical Center, the students observed a mock hospital simulation at UA’s Capstone College of Nursing, visited UA biology laboratories, heard a presentation from the director of UA’s Early College program, ate lunch at a dormitory cafeteria and received a tour of Bryant-Denny Stadium.

UMC clinic helps children and families navigate foster care

By Amelia Neumeister

As a foster parent, Dr. Brian Gannon knows that children and families in foster care can face challenges navigating medical care, paperwork, state agencies, schools and other aspects of case management. He has eight children—six of which were adopted. And four of those adoptions were through foster placements.

Physicians can legally request information on foster children, says Gannon, an assistant professor of Pediatrics at the College of Community Health Sciences and a pediatrician at University Medical Center, which the College operates. So he wanted to streamline the flow of information, help to gather all of a foster child’s relevant information in one place and provide them access to health care and resources. To do that, he started the FRESH Start Clinic at UMC.

FRESH stands for Fostering Resilience through Education, Support and Healthy choices. Since opening its doors in July 2016 at UMC, the FRESH Start Clinic provides care for children in foster care and for families and professionals who support them. The clinic is held on Thursday afternoons.

The goal of the clinic is to advocate for the specialized needs of children in foster care and to change the way children in foster care are obtaining medical care, says Gannon.

He and his team of nurses, a receptionist and social work students wanted to create a clinic for foster children based off the Patient-Centered Medical Home, a model of health care that is patient-centered, accessible, continuous, comprehensive and coordinated, and that focuses on quality and safety.

The clinic works in partnership with the Tuscaloosa County Department of Human Resources, and includes all members of the foster child’s team in health care decisions as appropriate, including the foster parents, birth parents, DHR caseworkers and investigators, noncustodial family members, residential home staff and mental health providers.

“There are different [foster care clinic] models across the country,” says Gannon. “A lot of the larger cities will have foster care clinics that are much more involved than what we are starting right now. We’d like to work into that. The goal would be to have mental health, development and social work all on-site as part of the process, because these kids are known to have more needs than your average pediatric population.”

Gannon had the idea for the FRESH Start Clinic after studying similar clinics in urban areas where foster care is more commonly found, he says. By partnering with UMC, he hopes the clinic can serve as a state-wide model and can bring access to rural areas where foster homes are less common.

Gannon says he drew from his experiences as a both a doctor and a foster parent to help plan the clinic.

“There are so many little things that make it difficult as a foster parent to get the care   that the child needs,” he says. “So, my goal was to make all that easier.”

Foster parents can call to set up an appointment in the clinic as soon as the child is placed in their care, Gannon says. They can be seen within a week. At the first visit, the child’s medical, social and psychiatric history will be collected and requests will be submitted for any  additional records needed. Gathering this information helps to streamlines the process of medical care for children in the foster system, Gannon says.

Once additional records are obtained, another visit will be scheduled. The clinic will assess the child’s adjustment to his or her foster placement and will look into any behavioral concerns a foster parent might have. A trauma assessment will also be performed to help families address needs of children who have suffered from abuse or neglect.

From there, the FRESH Start Clinic can provide primary care for children in state custody or can serve as a consultant to their chosen doctor. The clinic also stays in touch with DHR and is notified of any changes in the child’s placement or goals.

The FRESH Start Clinic knows how to gather background information and navigate paperwork that many foster parents simply don’t have time for, Gannon says. If the parents are not dealing with paperwork, they will have less difficulty making appointments, he says.

“I’ve gotten a lot of positive feedback from the foster parents that I’ve worked with as well as the caseworkers, because the DHR caseworkers will have dozens of children on their caseload,” Gannon says. “Often they’ve had more negative experiences than foster parents have as far as interacting with doctors’ offices and things being challenging and not running smoothly, and they’ve been very pleased with the efficiency that we’ve been able to provide to them.”

The long-term goal for the clinic is to create an infrastructure to bring the clinic to a wider audience.

“I would love for this to be a model for the state and have interested doctors all over the state who have extra training and special interests,” he says. “And we could have case managers that make sure all these children get what they need. I think over time that would be a really good goal. But we are starting small—starting with one county.”

Sleep problems, adapted athletics topics at Mini Med School

More than 50 percent of adults in the US experience intermittent sleep disturbances, and only 30 percent of adults report regularly getting enough sleep.

Chronically tired individuals face increased risk of illnesses and an overall lower quality of life, says Dr. Katie Gates, assistant professor of Family Medicine at The University of Alabama College of Community Health Sciences.

Gates gave her talk, “Sleep Problems,” on Jan. 26 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program. On Jan. 19, Dr. Jimmy Robinson, endowed chair of Sports Medicine at CCHS, gave his talk, “Adapted Athletics.”

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.

Gates broke down sleep disorders into four categories: Those who can’t sleep includes sufferers of insomnia and restless leg syndrome. Those who won’t sleep likely have delayed sleep phase syndrome. Those with excessive daytime sleepiness may suffer from narcolepsy or obstructive sleep apnea. And those with increased movements during sleep include REM sleep behavior disorder sufferers, or those with periodic limb movement.

Three criteria must be met for a diagnosis of insomnia: First, the patient must complain of difficulty sleeping, difficulty staying asleep or waking up too early. Second, the sleep difficulty must occur despite adequate opportunity and circumstances to sleep. And third, the lack of sleep must negatively affect daytime function.

“Insomnia is a very common complaint, and it does increase with age, unfortunately,” Gates said. Women report insomnia 50 percent more often than men. It can be treated with cognitive behavior therapy or with medications.

Delayed sleep phase is a circadian rhythm disorder, meaning “the brain has gotten off its track,” said Gates. It’s characterized by the person going to bed very late and waking up late.

“This can be genetic or socially reinforced,” she said.

Obstructive sleep apnea is the most common sleep breathing disorder, and it affects 20 to 30 percent of males and 10 to 15 percent of females.

“With my patient population, it seems higher than this,” Gates said.

Risk factors for sleep apnea include age, obesity, craniofacial abnormalities and smoking. Continuous positive airway pressure, or a CPAP machine, is recommended treatment.

In some instances of diagnosing a sleep disorder, a physician may order a polysomnography, or a sleep study.

Cognitive behavioral therapy can be a treatment for some sleep disorders, said Gates, and a therapist may focus on changing false beliefs and attitudes about sleep. One of these might be that everyone needs at least eight hours of sleep, she said.

Music therapy can be another way to treat a lack of sleep.

“Choose music you are familiar with,” Gates said.

She said the music should have a slow and stable rhythm with low-frequency tones and relaxing melodies.

“Try out different genres, like classical or acoustic, to find what works for you.”

View a WVUA report on Gates’ lecture here:

Robinson, in his talk about adapted athletics, said the number of adapted athletes is rising. In the 1960 Summer Paralympic Games in Rome, 400 athletes came from 23 countries. In 2016, 4,316 athletes came to Rio from 159 countries.

The International Paralympic Committee assigns points to athletes based on their impairments. The classification systems differ by sport and are developed to govern the sport. Players are allocated points based on an evaluation by the International Paralympic Committee.

A lower score indicates a more severe activity limitation than a higher score. A team is not allowed to have more than a certain maximum sum of points on the field of play at the same time in order to ensure equal competition with the opposing team.

As time progresses, a disability may get worse, so a player can be reviewed again.

“Disabilities are evolving,” said Robinson. “It’s important to have this avenue to challenge their disability, especially if it’s progressive.”

Robinson, also spoke about the Alabama Adapted Athletics Program, which was started in 2003 by husband and wife Brent Hardin and Margaret Stran. Though the program received an initial funding of only $5,000 from the Christopher Reeve Foundation, it now operates off an annual budget of $450,000, offers six full scholarships and supports five sports: women’s and men’s basketball, tennis, rowing and golf.

Projects underway in UA-Pickens County Partnership

In Pickens County, elementary school students in Gordo are learning how to garden and how to prepare healthy foods. Meanwhile, Head Start teachers in Carrollton are being trained to identify and prevent mental health issues. Both of these are part of ongoing projects with The University of Alabama-Pickens County Partnership.

Coordinated by the UA College of Community Health Sciences, the partnership seeks to provide sustainable health care for the rural county and real world training for UA students in medicine, nursing, social work, psychology, health education and other disciplines.

Pickens County is a medically underserved area and a primary care, mental health and dental health professional shortage area. The county ranks 41st in in the state in health outcomes.

Four recent UA graduates who are completing year-long fellowships with the partnership and are working on collective and individual projects.

The fellows, August Anderson, Laura Beth Brown, Courtney Rentas and Judson Russell, are conducting health screenings at schools across Pickens County, including Pickens Academy, Aliceville Elementary, Gordo High School and Reform Elementary School.

“While the health screenings have been a top priority for the fellows for the past couple of weeks, they have remained actively involved in their community projects,” says Wilamena Dailey, coordinator for the Partnership.

Anderson’s individual project is providing health education in Pickens County Schools. Brown is focusing on senior centers and providing the elderly with care, activities and resources. Rentas and Russell are focused on activities at the 4H House in Gordo. Rentas is educating students about nutrition through hands-on cooking demonstrations, and Russell teaches them about growing healthy foods through a teaching garden.

Eight projects that address health issues in Pickens County are also part of the partnership. Each includes UA faculty, UA students and a Pickens County community organization.

An update on some of the projects underway:

Disseminating the Power PATH Mental Health Preventive Intervention to Pickens County Community Action Head Start Program:
Dr. Caroline Boxmeyer, associate professor of Psychiatry and Behavioral Medicine at CCHS and the principal investigator of the project, has implemented the first portion of the Power PATH Program, equipping Pickens County Head Start teachers  with training and resources to use in the future to identify and help prevent mental illness. The second part of the program—a training program for parents—is underway.

Boxmeyer is working alongside Dr. Ansley Gilpin, assistant professor of psychology at UA, and Dr. Jason DeCaro, associate professor of anthropology at UA. They are collaborating with the Pickens County Community Action Head Start Program.

Improving Pickens County Residents’ Knowledge of Risk Factors for Cardiovascular Disease and Type 2 Diabetes:

Health screenings have been conducted at the Pickens County Head Start Pre-K Program and at the Board of Education as part of the project. Led by Dr. Michele Montgomery and Dr. Paige Johnson, both assistant professors at the UA Capstone College of Nursing, the project is in collaboration with the Pickens County Community Action Committee and CDC, Inc., the Pickens County Board of Education, Pickens County Head Start and the Diabetes Coalition.

Pickens County Medical-Legal Partnership for the Elderly
Gaines Brake, staff attorney with the Elder Law Clinic at UA’s School of Law, is seeing clients at Pickens County Medical Center and throughout the community to increase awareness about the Medical-Legal Partnership. The Elder Law Clinic also hosts hours at Pickens County Medical Center, where it provides free legal advice and representation to individuals aged 60 and over. Gaines is working with Jim Marshall, CEO of Pickens County Medical Center.

Improving Access to Cardiac Rehabilitation Services in Pickens County
An expansion of the Cardiac Rehabilitation Center at Pickens County Medical Center is completed. Dr. Avani Shah, assistant professor of social work at UA, and Dr. Jonathan Wingo, associate professor of kinesiology at UA, have collaborated with Sharon Crawford Webster, RRT, of the Cardiopulmonary Rehab at Pickens County Medical Center on the project.

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region, and one of the ways it seeks to do that is by engaging communities as partners, particularly in rural and underserved areas.

In Pickens County, there are nine primary care physicians per 10,000 residents, and one-third of the population lives below the poverty line. The county ranked 45th of Alabama’s 67 counties in social and economic factors that contribute to health. Thirty-six percent of adults are considered obese.

Click here to view all the planned projects for the partnership, and to learn more about Pickens County.