Judson Russell, a fellow with The University of Alabama-Pickens County Partnership, conducts a health screening on a student at Reform Elementary School. (Photo by Andrea Mabry)

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.

Dr. John Sullivan, an alumnus of The University of Alabama Family Medicine Residency, gave a lecture on snake venom poisoning on Nov. 11 at the College.

Alumnus, antivenin developer speaks to med students about snakebites

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.

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.

fotorcreated

Scholarships awarded to medical students, Rural Medical Scholars

Scholarships were recently awarded to four medical students receiving their clinical education at The University of Alabama College of Community Health Sciences. Rural Medical Scholars also received awards.

UA News: UA’s Rural Medical Scholars Program Adds 10 New Students

Ten students from rural Alabama have been accepted into The University of Alabama’s Rural Medical Scholars Program this year.

The Rural Medical Scholars Program, which is part of UA’s College of Community Health Sciences and has been cited nationally as a model program for educating rural physicians, is a five-year medical education program for rural Alabama students leading to the M.D. degree.

The program provides specialized training and field experiences, as well as a peer network between the students and rural doctors who serve as preceptors and mentors, and former students who graduated from the program and have entered practice.

30286157725_4838a95268_z

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

cubaweekgraphic

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.

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.”

 

PamFoster

Payne-Foster receives research award for cultural competency training program

Dr. Pamela Payne-Foster recently received the University of Alabama School of Medicine Dean’s Research Award for the “Development of a Culturally Competent Training Program for Medical Students and Residents at the Tuscaloosa Regional Campus.”

Payne-Foster, associate professor of Community and Rural Medicine and deputy director of the Institute for Rural Health Research at the College of Community Health Sciences, won the award for developing a half-day training session for The University of Alabama’s Rural Health Conference, which will be held on March 30 and 31, 2017. The topic for the 18th annual conference, hosted by the College and the Institute, is women’s health.

The training session will be for resident physicians, medical students and faculty at the College on the topic of cultural competency.

“I know that is an important skill that students need in the future, and it is not offered much in their curriculum,” Payne-Foster says. “It also builds on some foundational work that the College has been doing for several years.

Payne-Foster learned of the award in August and received $1,000 of funding.

A planning committee comprised primarily of medical students and residents has started to develop the training session with pre- and post-evaluations that will be held in conjunction with the Rural Health Conference.

Learn more about the annual conference at rhc.ua.edu.