The partnership, now underway, is providing needed health resources to the rural county while UA students receive training and experience in their fields
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.
Lissa Handley Tyson is a Birmingham native, but she says she has come to love the smaller city of Enterprise.
Tyson came to Enterprise to work with Dr. Beverly Jordan and others with Professional Medical Associates. She is a third-year medical student at the University of Alabama Birmingham’s Tuscaloosa campus and is one of nine medical students taking part in the Tuscaloosa Longitudinal Community Curriculum offered through the University of Alabama School of Medicine. This is the third “pilot” year of the program.
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.
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.
Faculty at the College of Community Health Sciences presented about dementia, obesity in the media, pediatric limp and other topics at the annual meeting of the Alabama Academy of Family Physicians, which was held June 15-19 in Sandestin, Florida.
The meeting allows family medicine physicians throughout the state to connect, earn continuing medical education and learn more about representing family medicine in the legislative, regulatory and public arenas.
Your child can’t sleep because his or her legs ache, something parents call growing pains. Doctors refer to this as non-specific limb pains of childhood and estimate that 20 percent of children aged 2 to 12 report mild to severe pain in their legs at night. There are no symptoms in the morning.
“The leg pain must be bilateral and it only occurs at night. The cause is unknown and there is no pain, limp or symptoms during the day,” said Dr. Richard Friend, an associate professor of family medicine for the College and director of its Family Medicine Residency. “We think it’s related to increased activity – moving around a lot during the day, and increased sports.”
Growing pains are often described as an ache or throb in the legs, often in the front of the thighs, the calves or behind the knee. Studies indicate the pains could be a sign of overused muscles.
In addition to growing pains, Friend also touched on other walking-related pain children might face in his presentation, “Pediatric Limp.” Juvenile rheumatoid arthritis can onset between the ages of 4 and 10, he said, and leg pain in children ages 11 to 16 often is a result of overuse.
Friend said when physicians exam children with leg pain, they need to take a good health history of the patient and perform a physical exam. “Observe the patient crawling and walking. Get the child or caretaker to localize the pain. Is it morning or evening pain, or all-day pain? This is important because arthritic pain is a morning pain while leukemia is mostly a night pain.”
When performing a physical evaluation, Friend said “listen to the sound of the feet hitting the floor. Have them stand on their toes and heels and hop on one foot.”
If needed, take x-rays of the area in question, from the hips to the feet, he said, adding that ultrasounds and bone scans can also be useful.
Dementia: Differentiating the Types
Physical and mental activity are among the best ways to treat or slow dementia, which affects 25 million people in the developed world and is the sixth leading cause of death, said Dr. Tom Weida, a professor of family medicine for the College and associate dean for Clinical Affairs.
Alzheimer’s dementia is the most common form of dementia and is a clinical loss of memory. “It’s the inability to lay down new memory, and it can lead to paranoia, delusions and an inability to swallow,” Wedia said in his presentation, “Dementia: Differentiating the Types.” He said the clinical presentation of Alzheimer’s dementia is a loss of: memory, executive function, visual-spatial orientation and social graces.
While age is the most common risk factor for dementia, family history, head trauma, depression and obesity also contribute to the risk. Weida said a strong screening tool is a verbal fluency test that requires patients to name as many animals as they can in 60 seconds. If patients name fewer than 15 animals, “it is suggestive of dementia. This is a highly specific and highly sensitive test.”
There are medications that can be prescribed for dementia, but they have side effects and there is limited evidence that they are effective, although they might slow dementia a bit, Weida said. He said non-medication treatments like physical activity and cognitive activity “seem to work the best. Brain stimulation seems to quell dementia states – art, music, reading, crossword puzzles and number puzzles.”
Good health is also important, Weida said, particularly a diet low in saturated fat, and high in fruits, vegetables and folic acid.
Interviewing for Residency
The College’s Family Medicine Residency, a three-year program that provides specialty training for physicians, accepts 16 new residents each year but annually receives approximately 2,000 applications. Of those, 150 applicants are interviewed.
“You are competing against a lot of people,” residency Director Dr. Richard Friend told an audience of more than 50 medical students ready to enter residencies.
Across Alabama, family medicine residencies accept only 55 medical school graduates per year. There are just 470 family medicine residencies in the United States. Funding for residency training slots is provided by Medicare, the US health program for the elderly. “There won’t be any new slots any time soon,” Friend said, which makes residency interviews vitally important.
When medical school graduates apply for residency positions, they use the Electronic Residency Application System, or ERAS, which is a system that collects common information from all graduates. “Interviews provide what can’t be seen in ERAS,” Friend said. “Applicants can explain their strengths and weaknesses … and showcase themselves.”
He said the interview process starts when the application is submitted to ERAS. “Don’t do your application the night before. Work hard on it and don’t take it lightly. Proofread it and make sure it’s complete. Spend time on your personal statement. Remember, you’re competing against a lot of people.
Friend said the College’s program, The University of Alabama Family Medicine Residency, ranks the applicants it brings in prior to their interviews. “Some candidates have moved up in rank after the interview,” he said.
Other advice? “Have a professional email address and voice mail message. And find out how you appear online. Social media is a good resource for us,” Friend said.
Updates in Adult Primary Care
Dr. Scott Arnold, chair of Internal Medicine for the College, provided a review in literature of the previous year in primary care and shared his recommended changes in practice.
One study he shared looked at the relationship between the use of lipid-lowering statins and a heightened risk for diabetes. More than 3,000 non-diabetic statin users and more than 3,000 non-diabetic statin non-users were studied retroactively, and diabetes developed in 31 percent of the statin users versus 19.4 percent of the statin non-users.
This is consistent with other prior studies, Arnold said.
“This appears to be a real entity,” he said. “It should give us pause only with those with primary prevention patients with borderline benefits. When do the benefits outweigh the risks?”
Another study he shared looked at identifying the community acquired pneumonia (CAP) pathogen and whether or not antibiotics should be used to treat this pathogen.
The study examined 2,200 adults in five hospitals in Chicago and Nashville who demonstrated CAP. Only 38 percent of the cases had an identifiable pathogen, and of those, 23 percent were viruses, 11 percent bacterium, 3 percent were both and 1 percent fungus or mycobacterium.
“We are overusing antibiotics for CAP,” he said. “We need to figure out in the future who needs antibiotics and who doesn’t.”
Obesity in the Media
When doctors have conversations with their patients about weight loss, realistic goals must be set, said Dr. Alan Blum, the Gerald Leon Wallace Endowed Chair of Family Medicine for the College.
One-third of the United States is obese and Alabama has led the nation in obesity trends, Blum said in his presentation. But with the media littered with advertisements for sugary drinks and supersized fast food portions, coupled with magazines and TV advertising touting extreme weight loss goals, like losing 30 pounds in 30 days, reality gets skewed, he said.
As a result, many patients arrive into the exam room with unrealistic expectations.
“Many people might suggest that a pound a week is normal weight loss,” Blum said. “But we’re really not ever giving good advice if we’re going to suggest that to our patients. I ask instead, ‘What would you like to weigh?’ People usually have a number. Then I ask, ‘When was the last time you weighed that much?’”
The reality test, he said, is when he asks the patient how long they think it will take to lose the weight.
“If it took 10 years to get there, why would they think it should take three months to get it off?” he says.
Blum thinks more action must be taken to prevent obesity in the first place. He says physicians should make the following suggestions to patients: support breastfeeding, limit sugary beverages, encourage family meals with less fast foods and more fruits and vegetables, get exercise and spend two hours a day or less on a phone or at a TV.
Wilamena Hopkins has joined the College of Community Health Sciences as the project coordinator for the UA-Pickens County Partnership, an effort that seeks to provide sustainable health care for the rural county and “real world” training for UA students.
The partnership of UA and Pickens County and its medical center will allow students in medicine, nursing, social work, psychology, health education and other UA disciplines to gain practice from internships and other learning opportunities in Pickens County, and the rural county will gain additional health resources.
Hopkins will be located primarily in Pickens County at its medical center and will direct and facilitate overall development, oversight implementation and administration for the project and serve as a liaison into the community and promote the partnership and its projects to the people of Pickens County and the UA community.
Approximately $600,000 was obtained from the Alabama Legislature in 2015 for the project, and the funds will be used for projects that address health needs in Pickens County, for fellows to serve in health-related capacities in Pickens County and for the project coordinator.
Four recent UA graduates have been selected for a one-year fellowship that will provide opportunities to serve in health-related capacities in Pickens County.
The projects that address an identifiable health issue or priority within the Pickens County community must involve UA faculty, students and a Pickens County community organization or similar entity.
The grant projects include:
1. 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
2. TelePlay: Connecting physicians, families and autism professionals to increase early autism identification in Pickens County
PI: Dr. 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
3. 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
4. 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
5. 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
6. 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
7. Alabama Literacy Project
PI: Carol A. Donovan, professor of special education and multiple abilities at UA
Collaboration: Jamie Chapman, Superintendent of Pickens County Schools
8. 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
A Pickens County community organization and partner of the College of Community Health Sciences at The University of Alabama received a community engagement award from UA.
Buddy Kirk, Patti Presley-Fuller and Alan Harper, leaders of Friends of the Hospital in Pickens County, were awarded an Outstanding Community Partner-Initiated Engagement Effort Award last month.
Kirk is a retired attorney appointed by the Pickens County Commission to help the Pickens County Medical Center find a sustainable solution to its challenges. Presley-Fuller is County Extension coordinator for Pickens County. Alan Harper is a state representative whose district includes Pickens County.
Friends of the Hospital was created several years ago when Pickens County Medical Center was on the verge of closing. Like many rural hospitals across the country, the medical center was struggling to survive. Today, Friends of the Hospital and CCHS, as well as other UA colleges and schools, have partnered to create the Health Care Teaching County, a partnership involving Pickens County physicians and health care institutions and UA to address health care concerns in the county now and in the future.
“We recognize the efforts of students, faculty and community partners to move UA to the next level in engagement scholarship, working together as a team to make a difference in our communities and the lives of people living in those communities,” Dr. David Francko, UA’s associate provost and dean of the Graduate School, said during a luncheon to honor community engagement award recipients.
The idea behind the Health Care Teaching County partnership is to bring new energy and human capital to Pickens County, while providing useful training opportunities for students at UA. Students in medicine, nursing, social work, psychology, health education and other disciplines will gain practice from internships and other learning opportunities in Pickens County, and the rural county will gain additional health care and related resources.
Approximately $600,000 was obtained from the Alabama Legislature in 2015 for the project. To date, the funds have been used to hire a coordinator and four fellows for the partnership, and to fund seven UA-Pickens County proposals for health projects in the county. The fellows are receiving one-year paid fellowships that provide them an opportunity to serve in a health-related capacity in Pickens County and spend time in community engagement and leadership development activities.
Organizers of the partnership foresee overall improvement of health in the community and a possible boost in its economy as positive outcomes from the collaboration.
Pickens County is a Medically Underserved Area and a Primary Care, Mental Health and Dental Health Professional Shortage Area. The county ranks 41st in health outcomes among Alabama’s 67 counties.
A Head Start program in Hale County that is the beneficiary of a grant to faculty at The University of Alabama has received recognition from a national organization.
At the 12th International PATHS Conference in Chicago, the Hale County Head Start center was recognized as a PATHS Model School. The Hale County Head Start is based in Sawyerville and overseen by Community Service Programs of West Alabama.
Thirty-three posters were presented by faculty, staff, resident physicians and medical students at the College of Community Health Sciences at its 8th annual Research and Scholarly Activity Day on April 7, 2016.
Winners were named in three categories:
First Place: “Where are the CCHS Medical School Graduates and What are They Practicing”
Principal Investigator: Dr. Daniel Avery
Authors: Dr. Grier Stewart, Dr. Catherine Skinner, Nelle Williams, Dr. Thomas Weida and Dr. John Higginbotham
Second Place: “Critical Care Interprofessional Education: Perceptions Among Nursing and Medical Students: A Mixed-Methods Pilot Study”
Principal Investigator: Luanne Friend
Author: Dr. Richard Friend
First Place: “Student and Resident Effectiveness in Dietary Modification”
Principal Investigator: Dr. Bhavika Patel
Authors: Dr. Brooke Robinson, Dr. Keirsten Smith, Dr. Jennifer Clem, Dr. Melanie Tucker, Dr. Linda Knol
Second Place:“Febrile Journey”
Principal Investigator: Dr. Karen Merschman
Author: Dr. Karen Burgess
Medical Student Category
First Place: “Impact of an Interdisciplinary Geriatric Clinic on Cognition, Depression, and Anxiety in Geriatric Patients”
Principal Investigator: Brendan Meyer
Authors: Aaron Garrett, Dr. Anne Halli-Tierney, Dr. Rebecca Allen, and Dana Carroll
Second Place: “Needs Assessment of Medical Services for Sexual Assault Survivors at a Regional Medical Center Emergency Department”
Principal Investigator: Danielle Fincher
Author: Dr. Lea Yerby
Of the posters presented, 14 were by faculty and staff, four were by residents and 15 were by medical students.
The University of Alabama
College of Community Health Sciences
850 Peter Bryce Boulevard
Tuscaloosa, AL 35401
Tuscaloosa, AL 35487