Resident speaks about hypertension at Mini Medical School

One in three adults in America has hypertension, according to the US Centers for Disease Control and Prevention. However, hypertension can be treated with lifestyle modifications and medications, said Dr. Brittney Anderson, a third-year resident physician at The University of Alabama Family Medicine Residency.

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Dr. Brittney Anderson, third-year resident at The University of Alabama Family Medicine Residency

Anderson provided a presentation on hypertension on Nov. 3 as part of the Mini Medical School program conducted by the UA College of Community Health Sciences 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 residents 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.

Anderson started her presentation by illustrating hypertension, or high blood pressure.

“Think of it the way you would think of pressure from a water hose. What would alter that pressure? The size of the hose, and what the fluid in the hose is having to overcome,” she said.

Cholesterol buildup, for instance, can inhibit blood from moving at a normal pressure through blood vessels, she said.

Diagnosing hypertension starts with an accurate blood pressure reading, which can sometimes be challenging due to faulty or inaccurate measuring cuffs or other factors with the patient and environment, Anderson said.

She offered tips for an accurate blood pressure reading. First, be at your calmest—don’t worry about engaging in conversation. Second, support your back and feet, and keep your legs uncrossed. Third, empty your bladder so that it doesn’t affect your body’s stress level. And fourth, keep your arm supported at your heart level and make sure the cuff is over your bare arm (and not your clothes).

If patients are using an automated cuff for measuring blood pressure at home, the physician may ask that it be brought in for the exam to compare, Anderson said.

Normal blood pressure less than 120 mm Hg systolic and less than 80 mm Hg diastolic. Prehypertension is between 120-139 mm Hg systolic and 80-89 mm Hg diastolic. When the systolic reads 140-159 mm Hg, and diastolic reads 90-99 mm Hg, the patient may be diagnosed as Hypertension Stage 1. Hypertension Stage 2 is when the systolic is 160 mm Hg or higher, and the diastolic reading is 100 mm Hg or higher. A Hypertensive Crisis, which requires emergency intervention, is when the systolic is read at higher than 180 mm Hg and higher than 110 mm Hg diastolic.

If a patient has an elevated blood pressure reading of greater than or equal to 180/110 mm Hg, then the diagnosis is clearly hypertension, Anderson says.

“But if not, then we have to do some more digging,” she said. It could be that the patient suffers from “white coat hypertension,” which means the patient is nervous simply from being in the doctor’s office. Patients in that case would be asked to wear an ambulatory blood pressure cuff 24 hours a day for a few days for an accurate measurement.

Or, if a patient is diabetic, it causes damage to blood vessels. That means that if a reading is greater than 130/80 mm Hg and the patient is diabetic, then it is a diagnosis of hypertension.

There are risk factors that lead to hypertension, Anderson said. Primary risk factors include age, obesity, family history, race, diet and exercise and alcohol use. Secondary risk factors include medicines (like decongestants, birth control and steroids), illicit drugs, sleep apnea and renal disease.

Hypertension can be treated through lifestyle modifications, like weight loss, adopting an eating plan, adding physical activity and reducing alcohol and sodium intake, Anderson said. There are many medications, too. Thiazides, ACE inhibitors and calcium channel blockers are some of the most common.

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

Parkinsonism, ADHD in Grandchildren and Geriatric Depression topics in fall semester of Mini Med School

Mini Medical School is back in session this fall semester. The University of Alabama College of Community Health Sciences kicked off its second semester of the lecture series for UA’s OLLI program that has been put on by faculty and resident physicians at CCHS.

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.

Parkinsonism — Dr. Catherine Ikard

Many people think of Parkinson’s disease as a single disorder, but it is actually more complicated than that, said Dr. Catherine Ikard, a neurologist at University Medical Center and assistant professor of Internal Medicine and Psychiatry and Behavioral Health for the College.

Parkinsonism is a syndrome characterized by decreased movement and is associated with tremors and a loss of balance, Ikard said at her lecture, titled “Parkinsonism and Parkinson’s Disease,” which she presented as part of the Mini Medical School series on Sept. 15.

Parkinsonism can appear in an array of disorders, some even as a result of repeated head trauma or medication, but the most common one—the one most people refer to when they think of Parkinson’s Disease—is Idiopathic Parkinson’s Disease.

Idiopathic Parkinson’s Disease is the progressive loss of dopamine-producing cells in the brain. The disease is slow and degenerative. “We don’t know why this happens,” Ikard said.

There are motor symptoms, which include shaking, smaller and slower movements, becoming stiff and losing balance more easily. Motor symptoms usually start on one side of the body. Tremors can worsen when the patient is at rest, and they are suppressible by concentration.

Non-motor symptoms include affective disorders, such as depression, orthostatic hypotension (when blood pressure falls significantly when standing up too quickly), memory impairment, fatigue, constipation and sleep disturbances.

There is no test for Idiopathic Parkinson’s Disease, Ikard said. The diagnosis is clinical. “We often have to watch a tremor over time—months, sometimes years,” Ikard said.

Medication and therapy can help treat symptoms, Ikard said. The most common medication is Levodopa, and physical and speech therapy can help improve lifestyle. “I cannot emphasize enough how important therapy is for patients with Parkinsonism,” said Ikard. Exercise improves symptoms, too, she said.

There are clues that the disorder might not be traditional Idiopathic Parkinson’s Disease, Ikard said.

Some of these include: rapid progression of the disease, absence of tremors, frequent falls early in the disease, abnormal eye movement and poor response to Levodopa. If that is the case, the Parkinsonism could be tied to another disorder.

Grandchildren and ADHD — Dr. Brian Gannon

Children are very active from the ages of 2 to 5, but that busyness should decrease over time, said Dr. Brian Gannon, a pediatrician at University Medical Center and an assistant professor of Pediatrics for the College.

But as children get older and if they are easily distracted, can’t stick with a task for a reasonable amount of time and their activity level is not appropriate for their age, they could suffer from ADHD, or attention deficit hyperactivity disorder.

“ADHD is defined as an activity level that is inappropriate for age, that interferes with school work, that causes trouble in dealing with adults,” Gannon said during a lecture on Sept. 22, titled “Grandparents and ADHD.”

Gannon said about 5 percent of the general population in the US qualifies for an ADHD diagnosis. He said sometimes the markers of what appears to be ADHD are actually caused by other medical issues. He said hearing, vision and speech problems can cause some of the same symptoms of ADHD, as can developmental delays, autism and sensory processing disorder.

“We want to look at medical issues because they may cause similar issues to ADHD,” Gannon said.

A child’s living situation – unstable home environment, varying and inconsistent rules and food insecurity – is also a factor. “My job as a physician is to advocate for the child and help parents problem solve. We don’t want to just throw medicine at a child.”

Gannon said medication can help and should be part of efforts to manage ADHD, but is only part of the answer. “Children still need to follow the rules, and do their work. With medication, they can do it without your help.”

Geriatric Depression — Dr. John Burkhardt

Older adults are at risk for depression. One reason: The more medical burdens one has, the higher the risk of depression, said Dr. John Burkhardt, a clinical psychologist with University Medical Center-Northport.

“Chronic pain conditions can be managed, but you never get a break from them. Heart problems can precipitate depressive episodes, and then you have to eat differently, go to physical therapy and deal with a chronic condition. What does that do to your mood?” said Burkhardt, also an assistant professor of Psychiatry and Behavioral medicine for UA’s College of Community Health Sciences, which operates UMC-Northport.

His remarks came in a lecture titled “Geriatric Depression” that he provided on Sept. 29 as part of the Mini Medical School lecture series.

Burkhardt said changes in previous functioning, pain and sleep disruption, significant weight gain or loss, a loss of interest in activities, a sad and depressed mood, a feeling of being a burden – and if those conditions and feelings go on for two weeks or more – could signal possible depression. “A lot of people go through sad times. But when it starts to impact your functioning, that could be depression.”

With older couples, depression can also be “contagious,” Burkhardt said. “If one spouse is depressed, the other spouse is at an increased risk of depression.”

Late-life depression, which happens after the age of 60, can carry added risk because it can transition to dementia, Burkhardt said.

He stressed that depression needs to be treated, particularly in the elderly, who might not seek care because of an associated perceived stigma. He noted that suicide is the 17th leading cause of death in those aged 65 and older.

“When you’re depressed, you’re not good at coping with your physical conditions. Depression impacts the person who is experiencing it, and their families. Who wants to visit people when they aren’t happy? Then they’re alone.”

Burkhardt recommended that people watch for changes in behavior, thoughts, appetite, sleep and whether they lose interest in activities once important to them. “See a provider if you suspect depression. Don’t let stigma keep you from getting help. Don’t isolate yourself. Be social, stay active and have a daily structure.”


Flu Shot Campaign Begins

The annual University of Alabama flu shot campaign, an effort by the University to protect students, faculty and staff from the flu, kicked off Sept. 7. Flu shots will be provided during the months of September, October and November at locations across campus, including the Quad, University buildings and student residence halls. The shots are free and no insurance is required. The goal of the flu shot campaign, which is led by UA’s College of Community Health Sciences, is to make getting a flu shot as easy and convenient as possible. Last year, more than 8,000 vaccinations were given.

Future physicians create an English-Spanish tool kit while learning to better communicate with Latino patients

When University of Alabama medical student Roshmi Bhattacharya saw a problem in her community, she created a course to help solve it.

“Roshmi noticed when she was doing her rotation that some of the nurses were treating Latino patients unfairly or inappropriately,” says Dr. Pamela Payne-Foster, faculty advisor for the class and deputy director of the UA Institute for Rural Health Research. “One part of the course concentrates on cultural competency and Latino health, and the other part is where students learn Spanish so they can interact better with patients.”

Medical students provide personalized treatment while learning how social and cultural factors influence patient outcomes

When one of Elizabeth Junkin’s patients, a man in his 50s, came to a rural family-medicine clinic with abdominal pain, she suspected appendicitis. She recommended a CT scan that confirmed her diagnosis, then drove to the local hospital in Carrollton, Ala., to check on the man. No surgeons were available, so the emergency surgery he needed could not be performed there. With all ambulances at least a 2-hour drive away, Junkin helped arrange a helicopter flight to DCH Regional Medical Center in Tuscaloosa. She met the man there, assisted with his surgery and followed up with him the next day.

Junkin did all this not as a doctor, but as a third-year medical student at the University of Alabama School of Medicine’s Tuscaloosa Regional Campus. She’s part of an innovative program called the Tuscaloosa Longitudinal Community Curriculum, or TLC², created by

Rural Medical Scholars and Rural Community Health Scholars attend orientation

This year’s classes of Rural Medical Scholars and Rural Community Health Scholars were welcomed to the College of Community Health Sciences with a day of orientation on Aug. 16 at Camp Tuscoba in Northport.

The College works to address the shortage of primary care physicians in Alabama through the Rural Medical Scholars Program, which is for rural Alabama students who want to become physicians and practice in rural communities. The program includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in rural community health and early admission to the University of Alabama School of Medicine. Rural Medical Scholars spend the first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to the College for their final two years of clinical education.

Rural Community Health Scholars are graduate students not enrolled in the Rural Medical Scholars Program who are interested in health care careers. The program prepares students to assume leadership roles in community health in rural areas. Graduates of the program have entered the fields of public health, health administration, nursing and physical therapy. They have continued their professional training to become nurse practitioners, physician assistants, public health practitioners, physicians, teachers and researchers.

The orientation included program expectations, introductions and allowed students to get to know each other and CCHS faculty, including Dr. Richard Streiffer, dean of the College, who opened the orientation with a welcome.

Rural Medical Scholars:
Rebecca England—Demopolis (Marengo County)
Veronica Coleman—Butler (Choctaw County)
Andrew Seth Griffin—Centre (Cherokee County)
Colby James—Empire (Walker County)
Jessica Luker—Camden (Wilcox County)
Dustin Cole Marshall—Cottondale (Tuscaloosa County)
Brionna McMeans—Fort Deposit (Lowndes County
Johnny Pate—Moundville (Tuscaloosa County)
Madison Peoples—Hamilton (Marion County)
Madilyn Tomaso—Barnwell (Baldwin County)

Rural Community Health Scholars:
Sierra Cannon—Haddock, Georgia
Chelsey Clark—Birmingham (Jefferson County)
Raven Eldridge—Montgomery (Montgomery County)
Paris Long—Coosada (Elmore County)
Kendra Mims—McCalla (Jefferson County)
Januar Page—Enterprise (Dale County)
Kristin Pressley—Montgomery (Montgomery County)
Jeremy Watson—Northport (Tuscaloosa County)

Including the incoming class, there are 210 Rural Medical Scholars from 56 counties across Alabama. The 20th class entered medical school at the University of Alabama School of Medicine in August.

Medical Students Connect with Community

Forty first-year medical students picked tomatoes, eggplants and peppers, cleared and raked foliage, cut back overgrown brush and even laid down a wall as part of their orientation to Tuscaloosa and to The University of Alabama College of Community Health Sciences on Thursday, July 28, 2016.

The students are part of a class of 186 at the University of Alabama School of Medicine. After they complete their two years of education at the School of Medicine’s main campus in Birmingham, these students will return to the College for their third and fourth years of clinical education. One of the College’s functions is to serve as the Tuscaloosa Regional Campus for the School of Medicine.

As part of their orientation, the students spent the morning working at the newly-established Jeremiah’s Community Garden in Tuscaloosa. The community service was followed by lunch with CCHS faculty and tours of University Medical Center, which is a multispecialty practice operated by the College and a clinical education site for students.

The garden, started four months ago by Holy Spirit Catholic Church, has donated about 3,000 pounds of fresh vegetables to the West Alabama Food Bank and Tuscaloosa VA Medical Center since harvesting began about two months ago, says Roy Lofton, who, with his wife Bettye, has spearheaded the development of the garden.

Allison Montgomery, a second-year medical student who helped lead first-year students in the community service, says she is glad the day allows students to connect to the community, understand its needs and learn about ways to serve.

“You can just lose your focus and get caught up in the stress of applying, taking tests and getting into medical school,” she says. “Now that we’re in and we’re here, we need to refocus on why we’re studying medicine in the first place.”

Dr. Harriet Myers, assistant dean for medical education, told the students at their lunch with faculty that working in the garden was about building understanding.

“We are hopeful that each of you can maintain the broader perspective that is really demanded today in health care,” she said. “If this morning you were able to help get fresh fruits and vegetables to those who needed it—to those who might not be able to get to a supermarket—you are keeping that broad perspective.”

Lofton says the medical students made a great impact in the garden, but there is plenty more work to be done, and volunteers are always welcome.

“I couldn’t be more proud of the young people who came out here today,” he says. “I look forward to welcoming them back any time.”



College merges departments to create Department of Family, Internal and Rural Medicine

The College of Community Health Sciences’ departments of Family Medicine and Internal Medicine have joined, and along with the College’s Rural Health Leaders Pipeline programs, now form the Department of Family, Internal, and Rural Medicine, or FIRM. The University of Alabama Board of Trustees approved the merger at its June 2016 meeting.

Dr. Richard Streiffer, dean of the College, said the departments of Family Medicine and Internal Medicine were already collaborating in many ways, including a joint inpatient teaching service created in 2015 and through the College’s geriatrics program. Rather than continuing as two separate departments, consolidation will benefit patients, medical students and residents, says Streiffer.

“Medical practice and training are becoming much more interdisciplinary, interprofessional and collaborative than ever before,” Streiffer says. “Our structure dates back to the origins of the College, for the most part, and has perpetuated ‘silos’ that no longer make sense.”

Plus, the primary aim of the Rural Health Leaders Pipeline is to prepare students from rural areas of Alabama to provide health care in rural areas—particularly as family medicine physicians.

“Hence, the creation of FIRM into a single administrative unit gives us the unique opportunity to realign these key programs and disciplines, resources and strategies to be more collaborative and, ultimately, more effective,” Streiffer says.

Dr. Richard Friend, director of the College’s Family Medicine Residency and chair of FIRM, says the merger will also allow the College to reexamine its use of clinical space in University Medical Center for efficiency.

Being part of a single unit, FIRM will be able to more easily implement clinical guidelines and processes as part of the College’s ongoing effort to become certified as a Patient-Centered Medical Home, as well as continue to increase collaboration in research and education.

Dr. Scott Arnold will serve as vice chair of FIRM and division director for internal medicine. Dr. Catherine Scarbrough, associate residency director, will provide oversight of curricular aspects of residency and fellowship education within the department. Dr. Jane Weida, associate residency director, will serve as director of all FIRM clinics. Dr. John Wheat continues as director of the Rural Health Leaders Pipeline.

Partnership joins UA and Pickens County in improving rural community’s health and educating students


The University of Alabama has teamed up with Pickens County to provide learning opportunities for students while improving the health and wellbeing of the rural county of nearly 20,000.

The University of Alabama-Pickens County Partnership seeks to provide sustainable health care for the county and “real world” training for UA students in medicine, nursing, social work, psychology, health education and other disciplines. Students will gain practice from internships and other learning opportunities, while Pickens County will gain additional and needed health resources.

When it was feared that Pickens County Medical Center, a 56-bed hospital that has provided inpatient, outpatient and emergency care for the rural county since it opened in 1979, would close, members of the community took action.

They met with UA leaders, including Dr. Richard Streiffer, dean of the UA College of Community Health Sciences, and former president Dr. Judy Bonner, and what began as a discussion about how to keep the medical center open evolved into a conversation about sustaining health care in the county.

CCHS hosted a meeting in December 2014 that included Pickens County leaders and citizens and UA vice presidents and deans. The conversation centered on envisioning a new model of health care for the county via an academic-community partnership. The idea was coined a Health Care Teaching County.

“A health care teaching county is novel in that in that it provides help for a community and learning opportunities and experiences for students,” says Streiffer. “It will train future physicians and other health care providers where most will practice, and sustain health care in communities that most need it.”

In 2015, $600,000 was obtained from the Alabama Legislature to initiate the Partnership, and with CCHS as the coordinator, the funds will be used to support the Partnership in the following ways:

1. A Partnership Coordinator was hired. Wilamena Hopkins joined the Partnership in May 2016 as coordinator. Originally from rural Archer, Florida, Hopkins, studied health care management at UA and has worked as an event and training coordinator for Maude Whatley Health Services in Tuscaloosa.

“My role is to make sure the community is aware of the Partnership and understands the Partnership, and I’ll be making sure that we are headed in the right direction and that at the end of this year, funding will continue,” Hopkins says. “I will be making sure that we are introducing innovative ideas into the community and providing needed resources.”

2. A portion of funding obtained will support eight projects that address Pickens County health issues. Each project includes a UA faculty, UA student and a Pickens County community organization or similar entity.

Disseminating the Power PATH mental health preventive intervention to Pickens County Community Action Head Start Program
Principal Investigator: Dr. Caroline Boxmeyer, associate professor of Psychiatry and Behavioral Medicine at CCHS
Co PIs: Dr. Ansley Gilpin, assistant professor of psychology at UA, and Dr. Jason DeCaro, associate professor of anthropology
Collaboration: Pickens County Community Action Head Start Program

TelePlay: Connecting physicians, families and autism professionals to increase early autism identification in Pickens County
PI: Lea Yerby, assistant professor of Community and Rural Medicine at CCHS
Co PIs: Dr. Angela Barber, assistant professor of Communicative Disorders and the clinical research director of Autism Spectrum Disorders Clinic at UA
Collaboration: Dr. Julia Boothe, family medicine physician in Pickens County

Improving Pickens County Residents’ Knowledge of Risk Factors for Cardiovascular Disease and Type 2 Diabetes
PI: Dr. Michele Montgomery, assistant professor at the Capstone College of Nursing
Co PI:  Dr. Paige Johnson, assistant professor at the Capstone College of Nursing
Collaboration: Pickens County Community Action Committee & CDC, Inc., Pickens County Board of Education, Pickens County Head Start, and the Diabetes Coalition

Development of a Rural Family Medicine Residency in Pickens County
PI: Dr. Richard Friend, director of the College’s Family Medicine Residency
Collaboration: Jim Marshall, CEO of Pickens County Medical Center; Deborah Tucker, CEO of Whatley Health Services

Pickens County Medical-Legal Partnership for the Elderly
PI: Gaines B. Brake, staff attorney with the Elder Law Clinic at The University of Alabama School of Law
Collaboration: Jim Marshall, CEO of Pickens County Medical Center

Improving Access to Cardiac Rehabilitation Services in Pickens County
PI: Dr. Avani Shah, assistant professor of Social Work at UA
Co PI: Dr. Jonathan Wingo, associate professor of Kinesiology at UA
Collaboration: Sharon Crawford Wester, RRT, Cardiopulmonary Rehab Pickens County Medical Center

Alabama Literacy Project
PI: Carol A. Donovan, professor of special education and multiple abilities at UA
Collaboration: Jamie Chapman, Superintendent of Pickens County Schools

Bringing Healthy Food options and ease of preparation home to our senior adults
PI: Jennifer Anderson, director of Osher Lifelong Learning Institute at UA
Co PI: Suzanne Henson, dietitian and assistant professor in Family Medicine at CCHS
Collaboration: Anne Jones, Pickens County Family Center and Mayor Joe Lancaster, City of Carrollton, Alabama


3. The Partnership also sought recent UA graduates for one-year paid fellowships that provide opportunities to serve in health-related capacities in Pickens County. Four fellows joined the Partnership: August Anderson, Laura Beth Hurst, Courtney Rentas and Judson Russell.

They will spend time in Pickens County in community engagement and leadership development activities, which include seminars on health and public policy as well as social determinants of health. They will also work on projects throughout the year.


Across the country, rural hospitals struggle to survive. Since 2011, Alabama rural hospitals have closed in Florala, Elba, Clanton, Hartselle, Thomasville and Roanoke. Others cut services, notably obstetrical care.

Pickens County Medical Center, which is county-owned and located in Carrollton, Alabama, had seen layoffs and furloughs and had cut programs and reduced services over the years.

What makes this worse is that rural areas are in more need of health care, as their citizens are typically older, sicker and poorer.

In Pickens County, 27 percent of the population lives below the poverty line and health outcome rankings show that the county is 41st among the state’s 67 counties.

Learn more about the Partnership at