Whitney Howell

Healthcare. Politics. Family.

Partnering with communities

Published in the Spring 2015 UNC at Chapel Hill Gillings School of Global Public Health Carolina Public Health Magazine

Students use capstone projects to improve public health

By Whitney L.J. Howell

Throughout North Carolina, Master of Public Health students from the UNC Gillings School of Global Public Health are hard at work in communities — designing, reviewing and improving community-based programs to improve health outcomes statewide. They’re doing it for course credit — and they’re loving the learning process.

Caitlyn Snider, Adébukola Oni and Hyun Namkoong meet with potential capstone community partners. (Photo by Linda Kastleman)

Caitlyn Snider, Adébukola Oni and Hyun Namkoong meet with potential capstone community partners. (Photo by Linda Kastleman)

Since 2009, instead of writing lengthy theses, health behavior master’s students participate in the capstone program, an initiative that embeds them within a community project, giving them opportunity to gather new skills while they apply in their neighborhoods what they’ve learned in the classroom. The capstone course was the result of a comprehensive review of the Master of Public Health program, led by Laura Linnan, ScD, professor of health behavior at the Gillings School.

Now in its sixth year, capstone accomplishes something its community partners had long wanted, says Megan Landfried, MPH, capstone program manager and health behavior lecturer.

“A program evaluation revealed that many stakeholders were ready for a new form of field training,” Landfried says. “We really wanted to strike an optimal balance between student learning and service to our community partners.”

Landfried, who participated as a student in Action-Oriented Community Diagnosis, a

Students in spring 2013 display their capstone accomplishments at a poster exhibition. (Photo by Branson Moore)

Students in spring 2013 display their capstone accomplishments at a poster exhibition. (Photo by Branson Moore)

prior iteration of the year-long field experience, says the current program affects real change in communities while preparing students for their own careers. That students work on projects proposed by community partners ensures that their efforts truly benefit the communities in which they work.

Each year, capstone invites 15 to 17 community partners to the School for a “pitch day,” when program leaders present their project ideas to students. Students rank the five programs in which they are most interested, and capstone leaders assign between four and six students to each of 10-12 selected projects. On average, 80 percent of students are assigned to their first choices.

Student Impact

According to Landfried, students spend about 7.5 hours each week with their projects, working alongside program leaders and learning from these real-world mentors.

Dr. Geni Eng (center), professor and capstone adviser, attends a planning session with students and their community partners. (Photo by Linda Kastleman)

Dr. Geni Eng (center), professor and capstone adviser, attends a planning session with students and their community partners. (Photo by Linda Kastleman)

For example, PORCH (porchnc.org), a Chapel Hill-based, all-volunteer, hunger-relief organization, has worked with capstone to evaluate the efficacy of its food distribution and referral process, says program founder Debbie Horowitz. Without capstone students, the group could not have obtained that information.

“The students have provided us with a lot of data that we would have had to do without otherwise,” Horowitz says. “Are we helping the right people? Is the food we provide being used? Are we providing enough? As an all-volunteer organization, we just don’t have the time and expertise to go after that research.”

Based on capstone work, for example, PORCH leaders learned that 50 percent of the Hispanic families served by the organization don’t use peanut butter. That’s useful information, Horowitz says, because historically, volunteers have worried about not having enough of what they considered a basic nutritious food for every family. Now, they can distribute the product more efficiently.

Next year, she says, she hopes capstone students will help redesign PORCH’s referral process, improving communication and making it more seamless for social workers to help connect families to the service.

Safe Teens Think First, a program based in Cleveland County (N.C.), engaged capstone students to re-invigorate their efforts to teach safe driving skills to teens. Sharon Schiro, PhD, program leader and UNC assistant professor of general and acute care surgery at the UNC School of Medicine, says the program initially presented lectures about driving to between 30 and 60 teens.

Dr. Laura Linnan, professor and adviser (far right) listens to a community partner describe a project and invite capstone students to be part of it. (Photo by Linda Kastleman)

Dr. Laura Linnan, professor and adviser (far right) listens to a community partner describe a project and invite capstone students to be part of it. (Photo by Linda Kastleman)

Being closer to the young drivers’ ages (15 and 16 years old), she says, capstone students were able to identify ways to keep teens more engaged. Not only were the teens divided into smaller groups for direct interaction, but they also were given more activities.

In the future, Schiro says, she hopes capstone students will help expand the program and take Safe Teens Think First beyond Cleveland County to the rest of North Carolina.

Program benefits

Although capstone is the culminating academic element of the Master of Public Health degree, its benefits are far-reaching, both for student and community partner.

“For the community organizations, capstone students offer a fresh perspective on how each program runs,” Horowitz says. “It certainly forces us to change and improve. When you have people asking questions and thinking outside the box, it will inform the changes that we make to our own programs.”

Master’s candidates also benefit from the capstone experience. Although

Meg Landfried (left) poses with capstone teaching assistants Melissa Cox (center) and Christine Agnew-Brune during a final presentation of team projects. (Photo by Linda Kastleman)

Meg Landfried (left) poses with capstone teaching assistants Melissa Cox (center) and Christine Agnew-Brune during a final presentation of team projects. (Photo by Linda Kastleman)

time spent in Gillings School classrooms gives students a solid foundation for meeting public health needs, working with capstone partners gives them first-hand experience and a taste of what to expect in their future jobs.

An added benefit, Schiro says, is that the program exposes students to potential employers and provides students with work references outside academia.

“Capstone is a fusion of academic instruction and real-world endeavors that prepares MPH candidates to better meet the public health needs they will encounter in their careers,” Landfried says. “The program is a unique opportunity to carry out important field work while having a wonderful, supportive safety net.”

To read the story at its original location: http://sph.unc.edu/cphm/partnering-with-communities/

July 31, 2015 Posted by | Education, Healthcare | , , , , , , | Leave a comment

Dilshad Jaff

Published in the Spring 2015 UNC at Chapel Hill Gillings School of Global Public Health’s Carolina Public Health’s Magazine

Passionate about the safety of patients and health-care providers during war

By Whitney L.J. Howell

For Master of Public Health candidate Dilshad Jaff, MBChB, war-zone health crises are more than 10-second sound bites on the evening news. As a Baghdad-trained physician, he was neck-deep in those crises and found them to be complicated and very real. Now solving them is his mission.

“The nature of conflict has changed, and things have become more complex,” says Jaff, who worked as primary health district manager under the Iraqi Ministry of Health from 2003 to 2008. “We can’t improve global health without looking at conflict and resolution.”

Between 2010 and 2013, Dr. Jaff regularly visited primary health-care centers in disputed areas of Iraq to support staff members. Here, at a rural center low on supplies, he devises a disposal box for used needles from an empty medicine box. (Contributed photo)

Between 2010 and 2013, Dr. Jaff regularly visited primary health-care centers in disputed areas of Iraq to support staff members. Here, at a rural center low on supplies, he devises a disposal box for used needles from an empty medicine box. (Contributed photo)

Jaff pairs his public health training with conflict-zone experiences — both as physician and as Rotary World Peace Fellow (sponsored by the Rotary Club in Cary, N.C.) — to determine how to safeguard soldiers’ and civilians’ health needs during times of war.

Jaff ’s path has been winding. After the 2003 war in Iraq, he managed the emergency room as a volunteer in a hospital without power or water. He led mental health care, health education and vaccination programs at a primary health care center in Iraq, supervising nurses and other health professionals. There, he witnessed an undeniable truth — that the lack of wartime medical infrastructure compromises public health needs. Victims of violence — the wounded and displaced — remain vulnerable, and health workers also are endangered, he says.

He discovered a serious lack of training among in-field health professionals. As a physician with the International Committee of the Red Cross, he taught triage procedures, pharmacy management, waste management and infection control to nurses and other staff members — but he also had to educate about the most basic hygiene practices. He trained emergency workers to use ambulances properly.

After studying conflict management and peace through a Rotary Club scholarship in Thailand and Cambodia and returning to the field with the Red Cross, Jaff found that it was impossible to track attacks, kidnappings

Dr. Jaff (standing) delivered a lecture in 2010 to a group of medical doctors and nurses in Iraq as part of a program to strengthen emergency services through training in communication and teamwork, infection control, waste management and other topics. (Contributed photo)

Dr. Jaff (standing) delivered a lecture in 2010 to a group of medical doctors and nurses in Iraq as part of a program to strengthen emergency services through training in communication and teamwork, infection control, waste management and other topics. (Contributed photo)

and other incidents that put health-care workers in danger. Without that information, improving safety and infrastructure is unlikely.

“There is a big gap in knowledge because people aren’t communicating or sharing, and no one is looking at the problem,” he says. “We don’t know the number of people affected because we can’t collect the data. What we see, believe me, is the tiny tip of the iceberg.”

Jaff had the necessary negotiation, facilitation and communication skills to navigate conflict zones, but if he were to affect change, he knew he needed to improve his credentials in public health. With additional Rotary Club support, he came to the Gillings School in 2013 to focus on women’s and children’s health. The specialization is important, he says, because violence now so often catches civilians in the crossfire.

His goal is to unite the objectives of public health and conflict resolution through education. Colleges of law, medicine and military science, he says, must teach students that medical missions are protected during war. Ultimately, he wants to teach local communities how to handle emergency cases, displacements and epidemic threats, as well as how to ensure that women and children have access to health care that is equal to access by men.

Jaff (second from left) and other members of the 2014-2015 Student Global Health Committee presented at the GillingsX talks in April. (Contributed photo)

Jaff (second from left) and other members of the 2014-2015 Student Global Health Committee presented at the GillingsX talks in April. (Contributed photo)

“This is part of my dream for the future,” Jaff says. “I would love to be involved in teaching or building a connection between UNC and other organizations to address these issues. I want to use the university’s considerable educational resources to bring people together. It’s unacceptable to ignore the problem. Physically, we can’t be everywhere, but we still can do something.”

For now, Jaff, who is co-chair of the School’s Student Global Health Committee, is focused upon learning all he can and informing all who will listen about the plight of those who live and provide health care in conflict zones. In spring 2014, for example, he presented a GillingsX talk on health-care delivery in war zones.

Jaff poses with his wife and daughter at his 2009 graduation from the Rotary peace and conflict resolution program at Thailand’s Chulalongkorn University. (Contributed photo)

Jaff poses with his wife and daughter at his 2009 graduation from the Rotary peace and conflict resolution program at Thailand’s Chulalongkorn University. (Contributed photo)

There’s no doubt that his earnestness, dedication and courage will play a big part in the change to come.

To read the story at its original location: http://sph.unc.edu/cphm/dilshad-jaff/

July 31, 2015 Posted by | Education, Healthcare | , , , , , | Leave a comment

Medical Schools Taking Active Role in Helping Students Manage Debt

Published in the AAMC Reporter July/August 2015 issue

By Whitney L.J. Howell

The incoming student’s strategy for covering his costs at Drexel University College of Medicine was a financial disaster waiting to happen, said Michael Clancy, the school’s director of financial planning. The student planned for a parent to cover most of the bill through a broker loan, while the remainder was charged to a credit card. A consistently paid minimum balance would avoid any interest charges, the student believed.

Clancy recognized the flawed reasoning and knew he had to speak up. “I calmly explained that wasn’t how credit cards worked and asked if his parent understood how broker loans—margin loans based on the value of a securities account—[functioned],” he said. “Based on that interaction and another consultative meeting, they changed their approach.”

While most financial planning conversations focus more on loan repayment details than avoiding potential catastrophe, this scenario underscores the need for medical schools to help students navigate tuition and repayment of debt. A 2014 AAMC report revealed that 84 percent of medical students graduated with an average debt of $180,000.

Many repayment options exist, such as loans linked to income level and the federal Pay As You Earn program that establishes monthly payments equal to 10 percent of discretionary income. Other loan forgiveness options, including the Public Service Loan Forgiveness Program and National Health Service Corps, also are available. But the existence of these programs does not mean that students understand the financing of their education. Increasingly, the onus of clarifying the process falls to medical schools, and many are adopting creative strategies tailored to each student’s circumstances. Cookie-cutter approaches to managing medical education debt usually don’t work because each student’s financial situation is unique.

Oregon Health & Science University (OHSU) and Drexel both hired certified financial planners to provide personalized guidance for their students. Kribs and Clancy make presentations during student orientation and at mandatory meetings. Often, the planners work with students for all four years and offer one-on-one sessions. “It’s taking their personal puzzle and putting the pieces together with them,” said Justin Kribs, OHSU’s certified financial planner, who has created webinars on financial topics for students as well. “What’s great is we’re starting students at square one and getting to ask them what they want to accomplish, how they will get there, and what things are in their way.”

Since joining OHSU, Kribs said he has advised more than 1,000 students. Third- and fourth-year students are required to meet with him at least once. Many students want to know how to minimize the amount of money they borrow, he said. Others want advice on managing the financial aspects of getting married or having a child while in school.

Julie Fresne, AAMC student financial planning director, acknowledges that the debt the typical medical student incurs is high, but noted that after controlling for inflation, the figure has remained relatively constant for roughly six years. And it is a burden worth assuming, she added. “The AAMC believes a career in medicine is an excellent investment with very good job security and excellent income potential. There are enough flexible ways to repay student loans and provide a secure living and retirement,” Fresne said.

Improving financial literacy

Financial aid professionals at Tufts University School of Medicine begin early during the admissions process to engage students in discussions about the intricacies of loans, debt management, and repayment. Launched in 2010, Tufts’ Planning for $uccess program provides students with “financial literacy education that dives much deeper than typical debt management and loan repayment,” said Tara Olsen, Tufts director of financial aid.

Workshops and lunch-and-learn sessions teach Tufts students about credit, mortgages, contract negotiations, and taxes. The financial aid office also publishes quarterly newsletters with spending tips, student discounts, and low-cost local activities.

The University of Missouri (MU) School of Medicine introduced its financial literacy program in the 2009–10 school year. Available to all students, the initiative addresses financial topics in 30-minute sessions that are posted online as well. Students receive incentives to attend the sessions, too, explained Cheri Marks, MU’s student financial aid and records coordinator. When they show up or complete a task such as submitting a budget sheet, they are entered into a $500 scholarship drawing.

“It takes a while for this new language to sink in because [it uses] terms students are unfamiliar with,” Marks continued. “In the past, they might have thought about [their financial situation] when they got their financial aid package and not again until after they got their money.”

The MU initiative incorporates the AAMC’s FIRST (Financial Information, Resources, Services, and Tools) program, which is available to medical students around the country seeking support to manage finances, understand loan repayment options, and learn about various types of loans. FIRST provides access to the MedLoans® Organizer and Calculator, helping students track loans and test sample repayment scenarios, and $ALT®, a money-management skills program. The program also offers loan and debt management webinars.

At Michigan State University College of Human Medicine, fourth-year medical student Joseph Meleca proposed a one-credit business and finance elective inspired by his front-office experience at his uncle’s private cardiology practice. He got the idea from observing that he and his peers had little understanding of how to finance their education or manage their living expenses. Approved by school administrators, the 11-week program invites financial experts to speak at all of the school’s campuses to elevate students’ understanding of medical school financing, debt management, billing and coding, and practice management.

After the first year, 85 percent of students reported that they benefited from the course and believed it would be helpful for incoming students. Thirty percent said it should be in the permanent curriculum. In fact, this elective, now in its third year, is the basis for a potential 60-credit MD/MBA program at Michigan State University’s Eli Broad College of Business.

It’s imperative for medical students to understand how their financing choices will affect their future decisions in practice, Meleca said. “If medical students don’t have this knowledge, they go into residency without it, and then they have even less time to learn it.”

To read the article at its original location: https://www.aamc.org/newsroom/reporter/julyaugust2015/439854/medicalschoolstakingactiveroleinhelpingstudentsmanagedebt.html

July 31, 2015 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , | Leave a comment

Medical Schools Put Radiology in the Spotlight

Published on the July 23, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

Although radiology stands as one of the most technologically forward-moving specialties, it has suffered a drop-off in interest over the past 15 years in the National Residency Match Program. Residency programs, though, are now learning more about what’s keeping medical students away and are implementing strategies to reverse this trend.

According to radiology faculty currently or previously involved with residency programs nationwide, turning the tide to increase radiology residency numbers requires changing how medical schools approach introducing students to the specialty. Residency programs must also participate in the process for appeal in radiology to rebound.

There are a variety of reasons medical students give for avoiding radiology as a residency choice, these faculty said. Waning attraction seems to stem from misunderstanding radiology, perceptions about lack of job opportunities, beliefs about little patient contact, and the increased use of computer technology. As it turns out, these perspectives are misplaced or inaccurate.

“The question is how much of what medical students see is real or fictitious,” said Saurabh Jha, MD, MS, assistant professor of radiology at the Hospital of the University of Pennsylvania who also participated in residency interviews in the past. “I’m not sure, to a large extent, that the distinction is important from their position.”

In an environment where medical schools are more focused on producing primary care or internal medicine practitioners, the onus of enticing students to choose radiology lies with current radiologists. To be successful, Jha said, the industry must exude more confidence in literature, blogs, and in teaching.

“It’s not simply saying ‘Look at the pretty pictures we can take.’ It’s going and telling them about diagnostic radiology and revealing to them how the radiologist – not the CT – made the difference,” he said. “We have to make sure medical students understand that it’s people who make the difference.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/residents/medical-schools-put-radiology-spotlight?cid=top

July 31, 2015 Posted by | Healthcare | , , , , , , , , , | Leave a comment

Brittany Stresing, Owner, LimBonics

Published in the May 2015 Durham Magazine

By Whitney L.J. Howell

At 14, Brittany Stresing received news that both changed her life and planned her future. She was diagnosed with scoliosis and spina bifida, and she learned one leg was shorter than the other. As a result, she was fitted with orthotic braces.

The experience solidified her belief that patient care should be personal and launched her down a path to improve the healthcare process for others.

“I was handed this profession through dealing with surgery and orthotic intervention with braces,” said Stresing, 28. “I received bad care followed by good care. I realized it’s better to treat people as individuals rather than numbers.”

Today, she’s a certified prosthetist and orthotist, as well as the owner of LimBionics, a prosthetic/orthotic company in Durham. She is secretary for the N.C. Orthotics and Prosthetics Trade Association, and she is also president-elect of the N.C. Chapter of the Academy of Orthotists and Prosthetists – the first woman to hold this position. In addition, she was the first woman spotlighted for the Ossur Women’s Leadership Initiative, an organization helping promote women in leadership roles.

Her goal, she said, is to maintain open communication with patients and give them a sense of security around their treatment and therapy. She provides those services in rehabilitation facilities, hospitals, nursing homes, or doctor’s offices. Patients also come to her from across the state.

“Whenever someone works with us, they’re always going to the same person who knows them and what they’re going through,” she said. “We take the time to find a therapy that will work with their wants and lifestyle – not just a textbook approach.”

Reaching this point wasn’t always easy, though. She was accepted to a 15-person prosthetics program at the University of Texas Southwestern Medical Center in Dallas and completed a rigorous residency at the University of North Carolina at Chapel Hill. But, she was still one of few women in a heavily male-dominated field.

She fought against the stereotype that female prosthetists were more suited for a practice’s administrative work than building prosthetics or orthotics. Now, she consistently designs and builds some of the most technologically-advanced patient care devices available, including prosthetics that replace missing body parts and braces that strengthen feet, ankles, knees, or hips.

Every step, she said, is devoted to working with the patient to identify their needs and to design a treatment plan all parties – patients, physicians, and Stresing’s colleagues – can agree upon.

“With every patient, we evaluate how they walk, how the use their arms, or whatever body part is affected,” she said. “We work to reduce their pain and make that body part functional again.”

To read the profile at its original location: http://issuu.com/shannonmedia/docs/binderdmmay/79?e=13657385/12589504 pg. 56

June 28, 2015 Posted by | Profiles | , , , | Leave a comment

Dr. Brenda Armstrong, Dean of Admissions, Duke University School of Medicine

Published in the May 2015 Durham Magazine

By Whitney L.J. Howell

As a student in a segregated Rocky Mount, N.C., high school, Brenda Armstrong, M.D., knew she wanted to be a scientist of some sort. But, she didn’t know far her determination and the support of her family and friends would take her.

But, now, Armstrong points to events and people in her life that positioned her to use her gifts to help others.

“My life, and whatever roles I’ve been fortunate enough to find, has been about giving back,” she said. “I have wonderful gifts that no dollar amount could bring.”

Today, Armstrong, 66, has been the Duke University School of Medicine Dean of Admissions for nearly 20 years. (She’s also an associated dean for medical education, a professor of pediatrics, and a pediatric cardiologist for children, adolescents, and adults with congenital heart disease — a woman who wears many hats!) She’s changed the School’s demographic make-up to better reflect the Durham community, more than doubling the number of black applicants in her first few years and continuing to enhance diversity.

It’s an accomplishment close to her heart. While at St. Louis University School of Medicine, Armstrong was the only black woman student for three out of her four years of training. She recruited the second black woman who joined her for her final year.

Her road to steering medical school admissions was a winding one, though. It was a teaching job right out of Duke undergraduate that revealed Armstrong’s future career.

For four years, she taught science and math to the same students as they progressed through school. With her, the students rose from “C” and “D” achievers to the honor roll. That experience prompted her to pursue medical school so she could heal and teach others about their well-being.

She even had the opportunity to hone her teaching skills in medical school – this time with a support network. The custodial staff frequently asked her about her work as she studied late at night.

“When I studied by myself, the folks cleaning up would ask me what I was doing,” she said. “It was great to have someone who looked like me care about my work. They were my study aids, and they knew it.”

Because the community bolstered her, she works to give back. For more than 30 years, she’s served as the physician for the Durham Striders, a local youth track association.

“Being of the community and in the community makes me a better person,” she said. “The community has kept me grounded, has given me values, and has allowed me to use whatever gifts I have to make my community better.”

To read the profile at its original location: http://issuu.com/shannonmedia/docs/binderdmmay?e=13657385/12589504 pg. 38

June 28, 2015 Posted by | Profiles | , | Leave a comment

Federal Regulations and Radiology

Published on the June 11, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed. 

Few things can impact radiology as directly or significantly as changes to health care regulations and policies. They’re initiatives that require you to change your workflow, to adopt new strategies, and even abandon long-used systems.

From the Affordable Care Act to coding overhauls to new value-based payment systems, industry experts are watching the next set of regulatory efforts to determine the impact on your daily practice.

“In many cases, you take the approach of preparing for the worst and hoping for the best,” said Tom Dickerson, MD, chief executive officer of Illinois-based Clinical Radiologists, SC.

The coming changes will build upon an uneven playing field for radiologists and the patients who need imaging services.

Despite long-standing fears that radiology volumes were lagging, the past four years have actually seen a nationwide bump of 8%. According to Sarah Mountford, client services manager with billing services company Zotec Partners, this boost can be attributed to the expansion of Medicaid services in some states, as well as the growth of health information exchanges and a recovering economy.

In fact, thanks to the Medicaid expansion, the percentage of uninsured patients using radiology services dropped from 7.5% to 6.5% between 2012 and 2014, respectively. On the flipside, states that didn’t expand Medicaid are seeing increases in uninsured patients accessing imaging services. That’s an uptick from 9% in 2012 to 12% in 2014 – more than 4 million patients.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/federal-regulations-and-radiology

June 17, 2015 Posted by | Healthcare, Politics | , , , , , , , , , , , , | Leave a comment

Harmful Or Harmless? New Studies Light Up Debate on E-cigarettes

Published on the June 8, 2015, N.C. Health News website

Even as more people use e-cigarettes, questions arise about their safety and whether they actually do help smokers kick the habit.

By Whitney L.J. Howell

When e-cigarettes hit the market in 2007, they were embraced as an effective and safe strategy for smokers to break their addiction to traditional cigarettes. Since then, they’ve grown in popularity among all age groups. But research has revealed mixed success in helping to quit.

And now North Carolina researcher are questioning their safety.

Some of the e-cigarette liquids for sale in N.C. today. Flavors, from left to right: watermelon, Irish cream and appletini. Photo credit: Rose Hoban

Some of the e-cigarette liquids for sale in N.C. today. Flavors, from left to right: watermelon, Irish cream and appletini. Photo credit: Rose Hoban

A new study from Research Triangle Park-based RTI International points to many e-cigarette characteristics that could pose intrinsic, and yet unidentified, health dangers. The research comes on the heels of reports that e-cigarette use is on the rise.

In North Carolina, according to the North Carolina Youth Tobacco Study, e-cigarette use sky-rocketed 325 percent among high school students from 2011 to 2013. A full 10 percent of students are now considering using e-cigarettes.

Other research, including a March 2014 Journal of the American Medical Association Internal Medicine study, showed e-cigarette use among Americans leaped from 2 percent of U.S. smokers in 2010 to more than 30 percent in 2012.

Whether e-cigarettes are helping smokers quit has been the subject of pretty fierce debate in the research world. A May 2014 study published in Addiction showed the alternative cigarettes helped 60 percent of aspiring quitters reach their goal. Other studies suggest that e-cigarette users quit smoking but keep using the e-cigarette as a way to get nicotine.

Many of those former cigarette smokers argue the newer devices are safer.

But to date, said Jonathan Thornburg, RTI’s director of exposure and aerosol technology and lead study author, there’s been no way to prove e-cigarettes are any safer than traditional cigarettes. And, it turns out, he said, they may be just as dangerous.

“The visible smoke from e-cigarettes dissipates just after exhale, but those particles are still there – there’s still a high potential that the public will breathe them in,” Thornburg said. “Other research has found that second-hand nicotine exposure from e-cigarettes is similar to that of conventional cigarettes.”

Current use

Traditional cigarette use is falling among American high school students, but, based on Centers for Disease Control and Prevention data, e-cigarettes are the popular substitute. An April CDC report, based on the National Youth Tobacco

N.C. tobacco users by gender. Data source: N.C. Youth Tobacco Survey, 2013

N.C. tobacco users by gender. Data source: N.C. Youth Tobacco Survey, 2013

Survey, revealed e-cigarette use has tripled among American teenagers.

From 2011 to 2014, e-cigarette use nationwide among middle-schoolers rose from 1.1 percent to 3.9 percent and from 4.5 percent to 13.4 percent among high-schoolers. Those rates translate to approximately 450,000 middle school students and 2 million high school students.

E-cigarette dangers

Although the Food and Drug Administration has deemed many e-cigarette ingredients safe for consumption, that categorization doesn’t necessarily mean they’re safe to inhale. That’s where the safety of e-cigarettes becomes ambiguous, Thornburg said.

A man “vapes” an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

A man “vapes” an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons

E-cigarette vapor particles are small – only slightly larger than a bacteria, at a width of 100 to 800 nanometers. But, even at that size, they pose a threat, he said. Nearly half of all inhaled e-cigarette particles remain in the lungs to grow in the respiratory system, and the remaining exhaled particles can be as dangerous as second-hand smoke.

“People need to know the potential for significant second-hand smoke with e-cigarette vapors,” Thornburg said. “Danger doesn’t just come from inhaling the nicotine, but from the other chemical vapors too.”

Lighting an e-cigarette also presents a risk. E-cigarettes don’t ignite like traditional ones, so there’s no carcinogen from combustion, but starting one produces a slightly altered form of formaldehyde, a disinfectant and embalming fluid. That form has a greater potential for getting stuck in lung tissue.

In addition, little is understood about what happens when other e-cigarette ingredients get into lungs. The glycerin, propylene glycol (a syrupy liquid added to food, cosmetics and some medicines to help them absorb water and stay moist), food preservatives and artificial flavorings could be dangerous to breathe in.

In fact, it’s already well known, Thornburg said, that inhaling artificial butter flavoring, one of the popular flavors in the liquid used in e-cigarettes, is dangerous.

He said that while there could be a level of preservatives and flavors that’s safe to breathe in, “we don’t know what that is yet.”

To answer that question, Thornburg’s team is conducting a study to determine if e-cigarette second-hand exposure to the nicotine and other ingredients is high enough to warrant concern. The goal is to inform public policy on how and when e-cigarettes should be regulated.

But until that data exists, he said, cities and towns can’t create any ordinances addressing e-cigarette use.

Social risks

Determining the actual health risks associated with e-cigarettes goes beyond giving teeth to public health regulations. It’s also critical to combating advertising and marketing efforts that present these products as completely safe alternatives to traditional cigarettes, said Annice Kim, a social scientist in RTI’s public health policy research program.

From 2011 to 2014, money spent on publicizing e-cigarettes ballooned from $6.4 million to more than $100 million, reaching

In this commercial, actress Jenny McCarthy says, “I get to have a blu without the guilt, because there’s only vapor, not tobacco smoke.” Image via youtube screen shot

In this commercial, actress Jenny McCarthy says, “I get to have a blu without the guilt, because there’s only vapor, not tobacco smoke.” Image via youtube screen shot

approximately 24 million youths.

“It’s a big public health concern because these ads might make e-cigarettes appealing to young people,” Kim said. “It’s alarming from a social, medicine and public-science perspective that these ads feature celebrities espousing the benefits of e-cigarettes when their safety has not been established.”

Despite heavy advertising and lack of safety data, some states are already implementing measures to curb e-cigarette use. In most states, including North Carolina, e-cigarettes cannot be sold to anyone under age 18. North Carolina also taxes the sale of e-cigarettes.

Other states have implemented e-cigarette bans on school property, and several states, also including North Carolina, specifically prohibit the use of e-cigarettes in 100 percent smoke-free sites.

Additional research

Alongside the RTI study, research is starting to reveal that e-cigarettes carry their own health hazards. A recent study out of UNC-Chapel Hill showed that five of 13 liquid flavors – including hot cinnamon candies, banana pudding and menthol tobacco – are toxic in high doses and can change cell life, cell reproduction and cell communication in the lungs.

Work out of the University of Alabama School of Medicine discovered that the temperature of the e-cigarette coil is directly associated with the production of harmful chemicals, such as acrolein (used in herbicides), acetaldehyde (a toxic irritant) and formaldehyde. And inhaling the vapor suppresses one’s ability to cough.

Albert Einstein University researchers found that after 30 e-cigarette puffs in 15 minutes, users were far less sensitive to capsaicin, a component of chili peppers that can induce coughing. A reduced ability to cough can be dangerous because coughing can prevent choking and it removes infectious agents from the lungs.

New research with mice from Indiana University found that just the nicotine in e-cigarettes is enough to negatively impact lung function. The effects are greater with higher doses, but nicotine inhalation causes acute lung inflammation, decreased lung cell growth and a change in lungs’ ability to act as a barrier to outside insult.

Even substances found in nicotine-free e-cigarettes attacked the molecules that hold together the endothelial cells that line the lungs and protect from infection.

The hope, Kim said, is this current and future research will continue to highlight the yet-unknown dangers of e-cigarettes both to the user and those in the vicinity. Data that reveals the potential negative impacts, she said, could be the best arrow in the quiver to fight against marketing efforts that support e-cigarette use.

“If we don’t make an effort to educate people, we’re only going to be flooded by counter messages that e-cigarettes are perfectly safe,” Kim said. “Perceptions, correct or not, will be spread by word of mouth and on social media.”

To read the story at its original location: http://www.northcarolinahealthnews.org/2015/06/08/harmful-or-harmless-new-studies-light-up-debate-on-e-cigarettes/

June 8, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , , , , , , | Leave a comment

When Testing Becomes Overtesting

Published on the May 15, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

On April 1, Mark Cuban, billionaire entrepreneur, NBA team owner, and actor, took to Twitter, sharing his philosophy on how patients can best be engaged with their health care. In a series of tweets, he advocated – among those who can afford it – for having a quarterly blood test in an effort to establish an individualized health baseline.

Not only would this strategy give patients and their children more knowledge about their health care over time, he said, but it would also allow patients to be more proactive about their medical treatment. No more waiting to get sick – patients could, potentially, identify problems early and ask for intervention.

The wake of those tweets has been filled with mixed responses from the medical community. Within radiology, a specialty constantly concerned with the specter of overtesting, providers are in heated disagreement over whether Cuban’s advice is reckless or revolutionary for health care.

To determine the pros and cons of a quarterly blood-test strategy, Diagnostic Imaging interviewed two industry experts. Saurabh Jha, MD, MS, assistant professor of radiology at the Hospital of the University of Pennsylvania, and Stephen Hunt, MD, PhD, an interventional radiologist and co-director of the Penn Image-Guided Interventions Laboratory shared their thoughts.

To read the debate at its original location: http://www.diagnosticimaging.com/practice-management/when-testing-becomes-overtesting?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=15052015

May 15, 2015 Posted by | Healthcare | , , , , , , | Leave a comment

New Research Points to Feeding Peanuts Early to Avoid Allergy

Published on the May 5, 2015, North Carolina Health News Network website

New findings about peanut allergies is turning the advice pediatricians give to parents of young children on its head. Scientists from North Carolina are in the thick of this new research.

By Whitney L.J. Howell

As a 15-month-old, Brayden Baylor touched his first peanut butter cracker. Within minutes, his face turned red, he broke out in hives and he began rubbing his eyes until they were swollen shut.

It was a classic peanut-allergy reaction. But, because he hadn’t actually eaten the cracker, or the peanut butter on it, his parents didn’t realize what was happening – until a second reaction erupted within hours.

“We had given him a dose of Benadryl, and, at the time, we still didn’t really know what caused the problem. There’s no history of food allergies in either of our families,” said Karrie Baylor, Brayden’s mother and a Charlotte resident. “But when it happened a second time, he was sitting in my lap and suddenly turned red and swollen. That’s when we took him to the emergency room.”

After a blood test, a local allergist diagnosed Brayden with a peanut allergy – a potentially deadly immune response affecting between three million and six million Americans, the majority of whom are children. According to a 2001 Archives of Internal Medicine study on food allergies, peanut allergies rank worst, accounting for more than 50 percent of the 200 annual food allergy-related deaths nationwide.

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

In fact, the fear of peanut allergy and its potentially fatal outcomes prompted the American Academy of Pediatrics, in 2000, to issue guidelines recommending children consume no peanut protein before age 3. The hope was that delayed exposure would give a child’s immune system time to strengthen and prevent peanut allergies.

But that hasn’t happened. Between 1997 and 2010, peanut-allergy prevalence among American children has skyrocketed 50 percent, according to the Centers for Disease Control and Prevention. And, based on existing data, occurrence within North Carolina mimics the national population.

This meteoric rise has baffled allergy and immunology researchers and sparked many investigations into the body’s response to peanut protein and how it can be calmed. Now there’s a watershed study, funded by the National Institutes of Health, that experts say conclusively proves the existing approach to combating peanut allergies has been wrong.

In short, the AAP guidelines meant to safeguard children like Brayden are actually causing more allergy cases to break out.

“This study is definitive. That’s unusual in this business,” said Herman Mitchell, vice president for Rho, the Chapel Hill-based contract research organization that handled the study’s statistical and data coordination. “We usually see trends, but this is a whopping finding that is very clear. It’s a reason to completely change the recommendations about avoiding peanuts at an early age.”

Problem peanuts?

While peanut-allergy rates are high in the United States and United Kingdom, that’s not the case everywhere. A 2008 Journal of Allergy and Clinical Immunology study revealed British children were 10 times more likely to have a peanut allergy than Israeli children.

Those nation’s health care systems are roughly equivalent, but there’s a significant cultural difference. Israeli families introduce children to peanut products far earlier. A snack called Bamba – a peanut butter-flavored corn puff – is present in 90 percent of Israeli homes and helps transition infants to solid food.

As part of the NIH’s Immune Tolerance Network, Gideon Lack, pediatric allergy professor at King’s College London, launched a study to investigate whether eating peanut-protein products, such as Bamba, early has a protective effect, Mitchell said.

Lack’s five-year study enrolled 600 4-to-11-month-old children who were at risk for developing a peanut allergy.

They either had another existing food allergy, a family history of peanut allergy or eczema. Half of the children were introduced to Bamba, while the other half followed the existing guidelines that prohibit exposure. The children who received Bamba ate it three times a week for five years.

The study ended with a food challenge that escalated the peanut-protein amount participants ate over several hours.

The results, published in a February New England Journal of Medicine issue, showed children who ate Bamba were 81 percent less likely to develop peanut allergy. Among non-consumption participants, 13.7 percent developed a peanut allergy, while only 1.9 percent of the Bamba group did.

According to Wesley Burks, chair of pediatrics at the UNC-Chapel Hill School of Medicine, Lack’s study will change how doctors advise parents about peanuts.

Burks leads a long-standing peanut-allergy study designed to help children with existing peanut allergies, including Brayden, develop a tolerance to peanut protein.

“These studies will change the paradigm with respect to feeding in the first six months of life for kids with allergic diseases. The guidelines for introducing peanut protein will change within the next year,” he said. “That will be the easy part; but medical guidelines take years to be disseminated.”

It will take between five and 10 years, he said, for pediatricians to abandon the current guidelines and begin advising parents based on these new findings.

Testing the idea

While the results of Lack’s study seem to indicate that preventing peanut allergy before it occurs is possible, it’s not yet clear whether that’s the case, Mitchell said. The effect could be desensitization, meaning participants who exhibit no current allergic responses could have reactions to peanut protein later in life.

To answer that question, several Bamba group participants agreed to avoid peanut protein for a year and then complete another food challenge. This new group will also include 40 children who don’t have peanut-allergy risk factors but had a positive allergy skin test. Results of this new study will also help doctors treat children with peanut allergies.

“It would be ideal if we could understand exactly who’s at risk,” he said. “Then pediatricians could measure a child’s risk and could recommend early [peanut-protein] exposure.”

Mitchell advised that parents have their child evaluated by an allergist if any peanut-allergy risk factor exists. An allergist can provide guidance on how to introduce peanut protein into the diet.

Slow buildup

These study results and new guidelines will help prevent peanut allergies in

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

infants and newborns, but it can’t help the children who already live with peanut intolerance.

That’s where Burks’ work comes in. For more than 25 years, he has worked toward treatments that help children – most of whom are over age 2 – develop a peanut-protein tolerance that reduces the severity of allergic reaction. The therapy is considered a success if a child can ingest a peanut or peanut protein without being thrown into a debilitating or potentially fatal immune response.

To date, Burks, who is also physician in chief at North Carolina Children’s Hospital, and his team have developed three treatment forms, all of which culminate with a food challenge similar to Lack’s study. In some cases, participants drip peanut protein-infused liquid under their tongue, while others wear patches impregnated with peanut protein. The most effective strategy though has been mixing peanut-protein powder with other well-tolerated foods, such as applesauce or ice cream.

“When the protein powder is introduced regularly – and in increasing quantities – it can make changes to the immune system,” Burks said.

Based on Rho’s data, Burks said he will begin to enroll and treat younger children in a continued effort to reduce peanut-allergy impact.

In the meantime though, he will continue to treat children Brayden’s age and younger, helping them overcome their peanut allergies. Brayden’s therapy has already been declared a success after three years: He passed his final food challenge without exhibiting any signs of allergic reaction.

His celebratory feast? His first-ever Reese’s Peanut Butter Cup.

To read this story at its original location: http://www.northcarolinahealthnews.org/2015/05/05/new-research-points-to-feeding-peanuts-early-to-avoid-allergy/

May 5, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , , , , , | Leave a comment

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