Research Roundup

Researchers at the College of Community Health Sciences receive funding for projects to better identify and assist patients at risk for high blood pressure, and to help reduce a significant racial disparity in infant mortality rates in Alabama

College of Community Health Sciences researchers received $100,000 in additional funding for research designed to identify and better assist University Medical Center patients with elevated blood pressure who might be at risk for, but not yet diagnosed with, hypertension.

The second phase of funding will be used to help the researchers collaborate with The University of Alabama Center for Advanced Public Safety (CAPS) to develop a mobile health app for patients identified as pre-hypertensive.

Dr. Louanne Friend, assistant professor in the Department of Community Medicine and Population Health is the principle investigator of the study. Co-principle investigators are: Suzanne Henson, RD, assistant professor in the Department of Family, Internal, and Rural Medicine and practicing dietitian at UMC; and Amy Sherwood, director of Health Information Technology for the College.

UMC is operated by the College. The Alabama Department of Public Health is funding the work.

During the first phase of the project, Hiding in Plain Sight: An Innovative Hypertension Identification and Treatment Program, the researchers received $20,000 from ADPH to identify UMC patients with elevated blood pressure who might not yet have been diagnosed with hypertension. The researchers created a hypertension template that was embedded into UMC’s electronic medical record at its Northport location to alert physicians when patients might be undiagnosed with hypertension. The template also provides physicians access to a decision-making tree for referral to lifestyle education and pharmacotherapy.

During phase two of the project, the researchers work with CAPS to develop and administer a patient friendly app designed to help users easily record and keep track of their blood pressure, weight, diet and physical activity – and then share the information with their medical providers. The app will also have an information portal providing a lifestyle curriculum for patients with information about how to control high blood pressure with diet, exercise and the reduction of stress.

Empowering rural moms

A significant racial disparity exists in infant mortality rates in Alabama, with black infants almost five times as likely to die during childbirth as white infants, said Drs. Joy Bradley and Mercedes Morales-Aleman, researchers with the College of Community Health Sciences.

Bradley and Morales-Aleman, both assistant professors in the Department of Community Medicine and Population Health and Institute for Rural Health Research, received funding for a pilot project that seeks to provide additional care and support for pregnant women in rural areas of West Alabama in an effort to reduce the disparity and improve health outcomes.

The $10,000 in funding they received was one of just 10 awards for such research made nationwide by the federal Health Resources and Services Administration.

The researchers’ pilot project, Telemedicine-toward Empowering Rural Moms (TERM), combines evidence-based practices from telemedicine, home visit programs, team-based care and family-focused care to assist and empower rural women through pregnancy and postpartum.

TERM will use community health workers and certified medical assistants to provide home visits and remote pregnancy monitoring in an effort to: facilitate access to quality prenatal care for black women in rural and medically underserved areas of Tuscaloosa County; empower women with tailored patient education and recommendations so they can better understand and monitor their health and make informed decisions; increase care coordination through use of a team-based approach and telemedicine; and ultimately improve pregnancy and health outcomes.

Higginbotham named UA senior associate vice president of research

Dr. John C. Higginbotham, associate dean for Research and Health Policy for the College of Community Health Sciences, has been tapped for the role of senior associate vice president for Research and Economic Development for The University of Alabama.

Higginbotham, who is also professor and chair of the College’s Department of Community Medicine and Population Health and director of the College’s Institute for Rural Health Research, will continue his leadership roles with CCHS.

As UA’s senior associate vice president for Research and Economic Development, Higginbotham will work to develop and enhance research initiatives across campus and serve as the chief operating officer for the Office for Research and Economic Development.

He will focus on overseeing and growing ORED’s internal grant program and the annual process for identifying federal priorities for the University. “I appreciate Dr. Higginbotham’s willingness to serve in this key leadership role and look forward to working closely with him while developing and executing a new strategic plan for the Office for Research and Economic Development,” said Dr. Russell Mumper, UA’s vice president for Research and Economic Development.

Higginbotham received a bachelor’s degree from UA, a master’s degree in Public Health from the University of Alabama at Birmingham, and his doctorate in Preventive Medicine and Community Health from the University of Texas Medical Branch. He has an extensive portfolio of funded research, and his most recent presentations and publications focus on racial and ethnic disparities related to cancer and other health issues. He has chaired standing grant review committees for NIH, received the Charles Barkley Excellence in Mentoring Award, and the Alabama Public Health Association’s Ira L Myers Award for having a significant impact on public health.

In his leadership roles with the College, Higginbotham teaches, conducts and oversees the CCHS research infrastructure. He works in partnership with all areas of the College to promote research and scholarly activities among faculty, fellows, family medicine resident physicians, medical students and others.

University Medical Center hosts fifth annual Brussels Sprout Challenge at Heart Walk

The fifth annual Brussels Sprout Challenge, hosted by University Medical Center as part of the American Heart Association’s West Alabama Heart Walk, will be held Saturday, March 2.

University Medical Center is operated by The University of Alabama’s College of Community Health Sciences.

Partnering again with Manna Grocery and Deli in Tuscaloosa, which prepares and donates the Brussels sprouts served at the walk, University Medical Center uses the challenge to promote 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.

Last year, more than 600 people participated in the Brussels Sprout Challenge.

To complete the challenge, participants have to eat one Brussels sprout at each mile of the 3.1-mile walk. Those who complete the challenge by eating all three Brussels sprouts, which are roasted, receive a t-shirt and other items at the completion of the walk.

University Medical Center also provides Brussels sprout recipes and information about the health benefits of Brussels sprouts, which include heart health and cancer protection.

The West Alabama Heart Walk begins at the Tuscaloosa Amphitheater and continues along the downtown river walk. Activities begin at 8 am and the walk and Brussels Sprout Challenge begin at 9 am.

The mission of University Medical Center and the College of Community Health Sciences is to improve and promote the health of individuals and communities in Alabama and the region.

The Value of Vaccines

“Vaccines are one of our best tools for prevention and health protection,” said Dr. Pamela Payne-Foster, a professor of Community Medicine and Population Health at the College of Community Health Sciences and a preventive medicine physician.

During a presentation as part of Mini Medical School, the College’s collaborative program with The University of Alabama OLLI program, Payne-Foster said vaccines have eradicated such infectious diseases as small pox, polio and measles – although she noted that some diseases, like measles “are creeping back because there are fewer mandatory vaccination requirements.”

“The benefits of vaccines are greater than the risks,” she said, adding that prior to the small pox vaccine, the disease killed up to 80 percent of children infected and up to 60 percent of adults.

Speaking to an audience largely comprised of senior citizens, Payne-Foster listed four vaccines that seniors should prioritize: flu, pneumonia, shingles and tetanus. She said pneumonia and other respiratory illnesses increase as people age, so vaccines to protect against flu and pneumonia are important. In addition, those with chronic health conditions, such as diabetes, are at risk for infectious diseases because their immune systems are already compromised.

Vaccines work by stimulating the immune system to guard against a pathogen, and they can prevent infectious diseases, especially when a sufficiently large percentage of the population is vaccinated.

“Prevention is good for everyone, especially seniors,” Payne-Foster said. “You need to protect your health and the health of those around you by getting the recommended vaccines.”

The Mini Medical School program has been put on by faculty and resident physicians of the College since 2016. It provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.

Grand Rounds: The Great Masquerader- GYN Edition

Between 5 and 12 percent of emergency visits to hospitals in the US are for complaints of abdominal pain. The cause can range from something as simple as indigestion to a ruptured colon. The difficult part for medical staff is knowing how to diagnose this common ailment.

Women, especially those who are sexually active and within childbearing age, add in another level of possible explanations for the discomfort.

Drs. Kristine Graettinger, Nicholas Ruth and Nathan Boles discussed a case involving a patient who came to DCH Regional Medical Center emergency facilities complaining of severe lower left abdominal pain at a Grand Rounds presentation held by the College of Community Health Sciences.

During the presentation, the doctors led medical students, resident physicians, DCH medical staff and University Medical Center physicians through the process of diagnosis in this complicated case. The College operates UMC.

The onset of the patient’s pain occurred during intercourse, which led the team to believe that the cause could be pelvic inflammatory disease, a condition that affects 1 million U.S. women every year. However, despite receiving treatment the patient worsened.

Graettinger, chair of the College’s Department of Obstetrics and Gynecology, warned the audience against tunnel vision directed toward a specific diagnosis.

“It’s important to look at all the scans, lab results, patient history and your own physical assessment,” said Graettinger, who also cares for patients at UMC.

After the patient’s doctors consulted with colleagues across multiple departments, the patient underwent surgery to treat what was found to be diverticulitis with focal perforation and marked abscess formation. In short: a packed sigmoid colon from frequent constipation that had turned toxic and had to be removed.

The College’s Grand Rounds program, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case, the doctors assigned had to step back and look at all the information while using a hands-on approach with the patient to make a successful diagnosis.

Colonoscopies the Gold Standard: Other Screening Tools 

Colorectal cancer is a leading cause of mortality in the US, and last year the American Cancer Society began recommending screening at age 45 for those at average risk. The age had previously been 50.

But many health insurers only pay for colonoscopies, considered the gold standard of colorectal cancer screening, for people beginning at age 50, said Dr. Drake Lavender, assistant professor of family medicine for the College of Community Health Sciences.

But there are other screening tools, Lavender said during a presentation as part of the Mini Medical School program, a collaboration of the College and The University of Alabama OLLI program. Among them:

The fecal-occult blood test is the most common worldwide and detects blood in the entire gastrointestinal track. The test is inexpensive and can be done at home. The fecal immunochemical test detects blood in the lower GI track and is more effective than the fecal-occult blood test, but, like that test, doesn’t have the best sensitivity for detecting pre-cancerous polyps, Lavender said. Same for the Cologuard test, which combines the fecal immunochemical test with DNA bio markers, he said.

The CT colonography provides good sensitivity for detecting pre-cancerous polyps, but if such polyps are found a colonoscopy is recommended to remove the polyps, Lavender said. He said a flexible sigmoidoscopy can be performed in a doctor’s office, doesn’t require sedation and is more convenient than a colonoscopy. But it only looks at one-third of the colon, and if polyps are found a colonoscopy would be recommended to remove them.

A colonoscopy is the most widely used colorectal screening tool in the US. The test allows visualization of the entire colon and allows physicians to detect – and remove – polyps. Colonoscopies are recommended every 10 years for people at average risk of colorectal cancer and if their colonoscopies are normal.

When should colorectal screening stop? Lavender said between the ages of 76 and 85, taking into account a patient’s overall health considerations and risks versus benefits.

There are things people can do to reduce the risk of colorectal cancer, Lavender said, including a diet low in red and processed meats, not smoking and reducing consumption of alcohol.

The Mini Medical School program has been put on by faculty and resident physicians of the College since 2016. It provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.

Health equity still out of reach

African-American women are more likely to die of breast and cervical cancer than white women. African-American men are more likely to die of prostate cancer than white men. Hispanic and Native American women have higher rates of cervical cancer than women of other racial and ethnic groups.

These disparities, as reported by the National Cancer Institute, are important because “disparity is the tool we use to measure health equity,” said Dr. Deanah Maxwell Stafford, a family medicine physician with Prime Care Medical Center in Tuskegee, Alabama.

Stafford provided the presentation, “Working Toward Health Equity,” hosted by the College of Community Health Sciences January 22 and part of The University of Alabama’s Annual Martin Luther King, Jr. Realizing the Dream Celebration.

Stafford, an alumna of the College’s Family Medicine Residency, said health equity refers to the differences in quality of health and health care across different populations. Differences in health outcomes between Caucasians, African-Americans and other minority and ethnic groups began to be noticed in the early 1980s. At the time, disparities existed for cancer, cardiovascular disease and stroke, diabetes, infant mortality, cirrhosis, and homicides and accidents.

The disparities existed despite an explosion in scientific knowledge and the ability to treat diseases, said Stafford, also a physician consultant for the Alabama Department of Public Health’s Bureau of Family Health Services and president of the Alabama Academy of Family Physicians.

Many of these health disparities persist today, she said. “In 2019, we have not achieved health equity. We have not achieved the reduction of health disparities. We have not achieved a level playing field.”

There are consequences, Stafford said. Health disparities affect the overall health of the nation and drive up health care costs. “As our diversity as a nation increases, so will costs to the healthcare system,” she said.

She cited an Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, that recommends: create diversity in health professions by increasing the number of racial and ethnic minority providers; increase health-care providers awareness of health disparities; and avoid fragmentation of health services along socio-economic lines.

“We need diversity in health professions so we can learn from each other,” Stafford said.

African films, Oscar-nominated Alabama documentary to spotlight annual film festival

The 7th Annual Tuscaloosa Africana Film Festival, co-sponsored by The University of Alabama College of Community Health Sciences, will be held Saturday, February 16, at Central High School in Tuscaloosa.

The event begins at 2 pm with a children’s movie, and regular programming is from 6 pm to 11 pm with a showing of four movies, including an Alabama-based and Oscar-nominated documentary, “Hale County This Morning, This Evening.”

The film festival is presented by the Edward A. Ulzen Memorial Foundation and Afram South Inc., two non-profit organizations that support education and public health initiatives in West Alabama and in Ghana, West Africa. The event is also co-sponsored by Central High School.

The children’s movie, “Queen of Katwe,” is a 2016 American biographical drama starring David Oyelowo, Lupita Nyong’o and Madina Nalwanga. The film depicts the life of Phiona Mutesi, a Ugandan girl living in a slum in Katwe, where she learns to play chess and later becomes a Woman Candidate Master following victories at the World Chess Olympiads. The movie was produced by Walt Disney Pictures and ESPN Films.

Regular programming for the film festival starts with “The Man Who Mends Women – The Wrath of Hippocrates,” featuring 2018 Nobel Peace Prize winner Dr. Dennis Mukwege and his work to restore the health of thousands of women who have been victims of brutal sexual violation by soldiers in the eastern Democratic Republic of the Congo.

The second feature is the 2018 “Hale County, This Morning, This Evening,” a documentary set in Alabama’s Black Belt region and composed of intimate moments of people in a community, allowing viewers an emotive impression of the historic South – both its beauty and the consequences of the social construction of race. The film received an Oscar nomination in January for best documentaries.

The third film is “The Birth of Afro Beat,” a 2017 look at 77-year-old Nigerian drummer Tony Allen, who was invited to record the album “What Goes Up” with the American band Chicago Afrobeat Project. Allen recounts how he and his late partner, Fela Kuti, created the Afrobeat genre in Lagos, Nigeria.

The final movie, “Keteke,” is a Ghanaian drama in which a couple are determined to deliver their first-born child in Akete. But after missing the train, the only reliable means of transportation from the outskirts of their town, they journey miles to their destination, along the way making a wrong decision and finding themselves in the middle of nowhere.

Tickets for the film festival are $10 for general admission. Tickets are available online at Brown Paper Tickets at

For more information, contact, Bill Foster at (334) 322-8024 or Thad Ulzen at (205) 552-6078.

New CCHS Faculty

Dr. Maryam Jafari Bidgoli joined the College as assistant professor of Health Economics in the Department of Community Medicine and Population Health and the Institute for Rural Health Research. Bidgoli earned doctoral and master’s degrees in Economics from Wayne State University in Detroit, Michigan. She served as a visiting assistant professor of Health Economics for the University of Connecticut’s Business School Finance Department, and has taught a wide range of economics courses, including microeconomics, health care management, health care industry analysis, statistics and econometrics and health economics. She was the recipient of the BlueCross BlueShield of Michigan Foundation Doctoral Student Award for her proposal, “Health Shocks and Labor Markets: Cancer in Michigan.” Her professional interests include health economics, health care management and labor economics.

Dr. Jean Pointon joined the College as assistant professor of Psychiatry and Behavioral Medicine. She will also care for patients at of University Medical Center and teach and supervise the College’s family medicine residents, medical students and clinical learners. Pointon earned bachelor’s and master’s degrees in chemical engineering from Mississippi State University. After working for Exxon as a chemical engineer with positions in the Peoples Republic of China and the United Kingdom, she earned her medical degree from the University of Texas Southwestern Medical School in Dallas. She completed residency training at Baylor College of Medicine in Houston, Texas, and a fellowship at the University of Houston Health Science Center. She is board certified in child and adolescent and general psychiatry and has extensive inpatient and outpatient experience.

Robert Sheppard and Nathan Culmer

January 2019 Accolades: Dr. Robert Sheppard and Dr. Nathan Culmer

Dr. Robert Sheppard, associate professor of medicine and founder and director of the College’s Hospitalist Medicine Services and Hospitalist Medicine Fellowship, was awarded the 2019 Distinguished Service Award from The University of Alabama Medical Alumni Association.

The award is given “For superior accomplishments and contributions to the University of Alabama School of Medicine.”

Sheppard was in private practice for 25 years before joining the College and beginning the hospitalist medicine program at DCH Regional Medical Center in Tuscaloosa. He has primary clinical teaching responsibilities for the College’s medical students, residents and hospitalist fellows.

He has received numerous teaching awards from the College and the University of Alabama School of Medicine, including the Argus Award, Patrick McCue Award, Golden Stethoscope Award and Best Clinical Instructor Award.

Sheppard received bachelor’s degrees in biology and chemistry from The University of Alabama and his medical degree from the University of Alabama School of Medicine. He completed residency training in categorical internal medicine, with a focus on cardiology, at the University of South Alabama Medical College in Mobile, and also was chief resident.

The Distinguished Service Award will be presented to Sheppard at an awards luncheon in Birmingham on February 23, during the annual University of Alabama Medical Alumni Weekend.

Dr. Nathan Culmer, assistant professor of Medical Education and director of Academic Technologies and Faculty Development for the College, was selected by the Society of Teachers of Family Medicine Foundation as one of 10 recipients of the 2019 New Faculty Scholar Award.

The award recognizes leadership potential and provides financial support to attend this year’s Society of Teachers of Family Medicine spring conference in Toronto, Canada. As part of the award, Culmer will provide a presentation at a conference breakfast roundtable.

In his role with the College, Culmer leads the utilization of educational and simulation technology, as well as distance technology aspects of telehealth services. He also oversees faculty development.

Culmer received his bachelor’s degree from Utah State University, his master’s in human communication studies from California State University-Fullerton, and a doctorate in higher education from the University of Iowa. Before joining the College, he spent four years at Pennsylvania State University with responsibilities in instructional design.