Human Sexuality | Minnesota Medical Foundation

U researchers identify compound that prevents SIV transmission

2009-04-01T20:20:39Z

Researchers at the University of Minnesota have identified a compound that, when applied vaginally in monkeys, can prevent transmission of the primate version of HIV, called simian immunodeficiency virus, or SIV.

Department of Microbiology investigators Ashley Haase, Ph.D., and Pat Schlievert, Ph.D., found that glycerol monolaurate (GML), a naturally occurring compound the FDA recognizes as safe, prevented SIV infection in monkeys that were exposed to large doses of the virus. The inexpensive compound is widely used as an antimicrobial and anti-inflammatory agent in food and cosmetics.

Although GML is not a cure and still must go through human clinical trials before it’s used to protect against HIV, the research is a step toward preventing the devastating disease, which affects 33 million people worldwide.

Schlievert began using GML in 1992 to combat toxic shock syndrome, a potentially lethal bacterial infection. More recently, research has shown that GML acts against a variety of toxins and microbes and inhibits cytokines and chemokines, small molecules that play key roles in triggering the body’s defense system.

The researchers found that following sexual exposure to SIV, the primates’ natural defense system is activated, rushing immune cells (T-cells) to the site of infection. The virus uses these T-cells as fuel to expand infection locally and spread it throughout the body.

Since it was the defense system the researchers wanted to inhibit, it made sense to see whether GML might prevent transmission, Haase explains.

During the study, researchers applied GML to five monkeys; five other monkeys were left untreated as a control group. By the end of the study, four of five monkeys in the control group had contracted SIV, while none of the five in the GML-treated group showed any evidence of acute infection after receiving as many as four large doses of the virus.

The researchers believe GML has the potential to effectively prevent transmission of HIV to women, who account for close to 60 percent of new infections at the pandemic’s center in sub-Saharan Africa.

“After 25 years, an effective vaccine for HIV is still on the distant horizon, so … all research into ways to prevent the continued spread of this lethal virus remain critically important,” Haase says. “If GML as a topical microbicide can add to our prevention, it could contribute to saving millions of lives.”

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Researchers at the University of Minnesota have identified a compound that, applied vaginally, can prevent transmission of the primate version of HIV, called SIV.

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Former dean was committed to students, international collaboration

2009-01-01T21:42:41Z

N. L. (“Neal”) Gault Jr., M.D., beloved former dean and alumnus of the University of Minnesota Medical School, died December 11 of pancreatic cancer at his St. Paul home. He was 88.

“We are saddened at the loss of Neal Gault, who was a devoted advocate for our Medical School and its students throughout his tenure as dean and well into his retirement,” says Medical School Dean Deborah Powell, M.D. “During his time as a student and faculty member, he inspired countless classmates, colleagues, and students; established partnerships with medical schools across the world; advocated tirelessly for medical students; and healed patients from all walks of life.”

A member of the Class of 1950 and dean of the Medical School from 1972 to 1984, Gault was known for his commitment to students, especially for helping them deal with the financial pressures of medical school. On a few occasions, he had even offered cash to students when they were flat broke. This commitment led Gault and his wife, Sarah, a University alumna and physician who died in 1994, to create several funds to help medical students finance their education.

In addition to his devotion to students, Gault also was passionate about facilitating international collaborations. In the wake of the Korean War, Gault and his family lived in Seoul, where he helped to rebuild the medical education system while at Seoul National University. This visit sparked the Medical School’s first international collaboration, a partnership that continues to flourish today.

Gault provided exemplary service and leadership to the Minnesota Medical Foundation, serving on its board of trustees from 1959 to 1992, and he continued to raise philanthropic support for scholarships and research for many years thereafter. He also served on the Medical Alumni Society Board from 1973 to 1991 and as a mentor for medical students long after his retirement in 1996.

Additionally, Gault helped establish the world’s first endowed chair in sexual health at the University and served on the leadership advisory council for the Program in Human Sexuality.

Among his many awards were the University of Minnesota Alumni Service Award, presented to him in August of 2008; the Harold S. Diehl Award, the highest award given by the Medical Alumni Society; the University’s Outstanding Achievement Award; and the Order of the Rising Sun, Gold Rays with Neck Ribbon, given by the emperor of Japan in 1992. He was also made honorary alumnus of Seoul National University College of Medicine in 1994.

A memorial service was held January 16 at the University of Minnesota’s Mayo Auditorium. In lieu of flowers, Gault requested that memorials be directed to the Drs. Neal and Sarah Gault Medical Student International Study Fund through the Minnesota Medical Foundation.

Make a gift

To make a gift to the Drs. Neal and Sarah Gault Medical Student International Study Fund, visit www.mmf.umn.edu/giveto/gault.

To view a brief slideshow on Gault and learn more about his life, visit www.ahc.umn.edu/news/gault.

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Researcher gets Gates grant for HIV stem cell research

2009-01-01T21:37:51Z

The Bill & Melinda Gates Foundation awarded the University of Minnesota a $100,000 Grand Challenges Exploration grant for a global health research project that will explore the use of new stem cell-based therapies to fight the human immunodeficiency virus (HIV).

Project leader Dan S. Kaufman, M.D., Ph.D., is an associate professor of medicine in the Division of Hematology, Oncology, and Transplantation and associate director of the Stem Cell Institute. He has previously demonstrated that natural killer cells—blood cells that work as part of the body’s immune system to attack tumors and HIV-infected cells—can be developed from human embryonic stem (ES) cells. For this project, he is testing the ability of these natural killer cells to fight HIV infections.

Kaufman is also investigating the potential of a newly described kind of stem cell, an induced pluripotent stem (iPS) cell, to generate natural killer cells to fight HIV. The iPS cells are derived from skin cells but reprogrammed to have the potential to act as ES cells. Both approaches provide a novel means of harnessing stem cells to treat patients infected with HIV.

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Ensuring a lasting impact

2008-10-01T21:05:29Z

Director of the Program in Human Sexuality makes another commitment to his program through an estate gift

For years Eli Coleman, Ph.D., has been the media’s go-to source for stories about sexual health. Need to know about the effectiveness of sex education in schools? Need a quote about how to rehabilitate sex offenders? How about stopping the spread of HIV? Coleman’s your man.

A longtime professor and director of the Program in Human Sexuality in the Department of Family Medicine and Community Health, Coleman has built his career at the University of Minnesota.

As he was completing his Ph.D. in counseling and student personnel psychology here in 1978 during the “sexual revolution,” he noticed a lack of knowledge about human sexuality. So immediately after receiving his doctorate, he joined the faculty of the Medical School’s Program in Human Sexuality, which had been established seven years earlier.

“Trying to understand and help resolve sexual problems became a very critical need, and I became aware of how little research was done in the area,” he says. “There were never-ending questions to answer.”

The Program in Human Sexuality has since grown into one of the world’s largest and most comprehensive centers for sexual health treatment, research, and education. And although he believes there are still plenty of questions left to answer, today Coleman’s work is nationally and internationally known. His research covers a wide variety of topics: sexual orientation, compulsive sexual behavior, gender identity disorder, psychological and pharmacologic treatment of sexual disorders, and sexual health promotion.

To recognize his achievements, the Medical School last year named Coleman the inaugural holder of its Chair in Sexual Health, the first of its kind in the world.

The endowed chair is currently funded with more than $4 million in private donations made through the Minnesota Medical Foundation. The funding, to be used at the chair holder’s discretion, supports research, education, patient care, public policy advocacy, and efforts to recruit and retain top faculty members.

Coleman is proud to be recognized in this way, and he wants to make sure someone else will have this honor in the future. Through a planned gift, Coleman in October pledged his entire estate in support of the Chair in Sexual Health.

“I wanted to ensure that the program’s legacy would continue, recognizing that many sexuality programs have disappeared when faculty retired or died,” he says. “The program has been my life’s work. I owe the University of Minnesota for giving me this opportunity, and I want to make sure that it’s there for others in the future.”

Medical School Dean Deborah E. Powell, M.D., says Coleman’s gift further proves his “profound” commitment to the field of sexual health. “Dr. Coleman already gives so much as the first holder of this chair,” she says. “To have him dedicate his estate to the future of the chair is extraordinary.”

Coleman also hopes his gift will encourage more faculty members to support their academic departments.

“I hope that they will think about the needs of the institution in the future and realize that we simply cannot take the University for granted,” he says.

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An altruistic attitude: Health-care professionals and patients partner up to advance medical knowledge through clinical research

2008-10-01T15:57:35Z

Not everyone helping to advance medical knowledge at the University of Minnesota is a researcher, physician, or nurse. Some of the most important contributors to health research are the patients who participate in clinical research studies.

They are not only learning about and getting access to leading-edge medical treatments, says Linda Carson, M.D., chair of the Department of Obstetrics, Gynecology, and Women’s Health, “these women are contributing to the growth of scientific knowledge,” she says. “It’s altruism.”

The process of bringing a promising new treatment from the lab to the market is lengthy and involved. Before a treatment can be made available to patients, it must be tested through clinical research with human volunteers. According to the Food and Drug Administration (FDA), clinical research is designed to study prevention options, new treatments or new ways to use existing treatments, new screening or diagnostic tools and techniques, and options for improving quality of life for people with serious medical conditions.

Not every patient with the disease that’s being studied in a given trial is eligible for inclusion, however; researchers set specific criteria for participation. Those criteria often include age, type and stage of disease, previous treatment history, and the ability to manage the logistics of the clinical trial.

June LaValleur, M.D., associate professor in the department, acknowledges that participating in a research study can sometimes be time-consuming. “You’ve got to find time to come in for frequent visits and sometimes find time to keep a diary,” she explains. For that reason, most participants in the University’s clinical studies live in the Twin Cities area.

While there’s a degree of risk involved in any clinical trial, the advantages can be well worth it, Carson says. Clinical trial participants are able to take an active and informed role in their own health care. They have access to up-andcoming therapies, as well as expert care from specialists who are leaders in their field.

“Most women, if offered a chance to participate in a trial that might improve their chances for survival, will be eager to do it,” Carson says.

Improving survival rates

Carson recently wrapped up a Phase I trial to establish the safe dosage of two chemotherapy drugs, topotecan and cisplatin, when used together with radiation therapy to treat cervical cancer. Topotecan and cisplatin make tumor cells more sensitive to radiation, and the hope is that the drug combination improves survival rates for cervical cancer patients. Eighteen patient volunteers participated in Carson’s study.

Most Phase I trials are aimed at determining the maximum tolerated dose of a promising treatment. That generally involves increasing the amount of the medication given to patients until they encounter dose-limiting side effects, Carson says.

Help for low libido

LaValleur has led a few clinical trials over the years, but her recent testing of a propitious new treatment for hypoactive sexual desire disorder, or low libido, in menopausal women was unique in some ways.

“This was the easiest study I’ve ever recruited for,” LaValleur says. “Women are just wanting help. The FDA has not approved anything for sexual dysfunction in women… There is a device, but it doesn’t work for everyone.”

She’s hopeful that her recent study will be a big step toward changing that. The treatment she tested was a testosterone patch designed to enhance sex drive. Doctors have prescribed testosterone, which is known to increase sexual desire, in other forms—injections, creams, and gels—but it’s harder to regulate dosage when it’s administered in those ways, she says.

LaValleur’s study offers the possibility of a safer and more effective delivery route. Its outcome was hopeful, she says; participants were having more frequent sexual encounters with their partners and reported no serious side effects.

A tried approach for a new cancer

Gynecologic oncologist and assistant professor Melissa Geller, M.D., talks enthusiastically about the clinical research she’s collaborating on with Jeffrey Miller, M.D., in the Department of Medicine involving natural killer (NK) cells as weapons against ovarian cancer.

“It’s really exciting, and it’s different from anything we’ve ever done before,” Geller says.

The study’s premise is that NK cells from related donors—parents, siblings, or children who are at least 14 years old—can be used to stimulate a patient’s own immune system to fight the cancer. The cells are harvested from donors fairly easily, in a process Geller likens to donating blood, and then infused into the patient.

In this case, Geller is studying the treatment’s effectiveness in treating advanced, recurrent ovarian cancer. The principle is being tested in other ongoing University studies on blood and bone marrow cancers and breast cancer.

Four patients are currently enrolled in the study, and Geller hopes to have 10 in the next year. She’ll follow their progress for another year while refining the way the treatment is given.

Patient volunteer Angela Cabrera said participating was a fairly easy decision for her. She had tried three forms of chemotherapy to treat her ovarian cancer, none of which yielded good results. “There are no really great options for treating my ovarian cancer,” she says.

Plus, the concept behind the study is intuitive, Cabrera adds. “It just makes sense. Some people aren’t risk-takers, but [this study] presents a relatively low risk. And I almost always find that good things happen when I take risks.”

Having a physician she likes and trusts in Geller makes all the difference in deciding to participate in the study, as well.

“She knows me and is looking out for my best interests,” Cabrera says.

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Because with your support, anything is possible.

Acting on impulse

2008-04-01T21:20:36Z

U physician-scientists help patients control destructive urges—from compulsive gambling to paranoia

Though it was nearly 40 years ago, Shelley (not her real name) vividly remembers her first experience with shoplifting. The troubled then 16-year-old happened to like what she stole—a stylish maroon sweater—but it was the act of shoplifting itself that electrified her.

“My whole nervous system was excited,” Shelley recalls. “It was like coming close to the fire and then escaping the danger; the relief and gratification were overwhelming.”

For three decades, Shelley shoplifted—putting her career, relationships, and reputation at risk. By her own estimate, she stole at least $50,000 worth of goods. The thrill of stealing produced a high as addictive as that of any drug.

Now a 55-year-old fourth-grade teacher, Shelley is a patient of Jon Grant, J.D., M.D., M.P.H., who cofounded and codirects the Impulse Control Disorders Clinic at the University of Minnesota Medical Center, Fairview.

Grant and clinic codirector Suck Won Kim, M.D., treat more than 200 patients a year for impulse control disorder, an umbrella term for a set of behavioral addictions that includes kleptomania, compulsive gambling, pyromania, trichotillomania (compulsive hair-pulling), and compulsive sexual addictions. The clinic, which the two founded a decade ago, is one of only a few of its kind in the United States and sees patients from all over the country.

Overpowering urges

Together and separately, Grant and Kim have authored several books on impulse control disorders, including one aimed at the general public: Stop Me Because I Can’t Stop Myself: Taking Control of Impulsive Behavior.

Often, Grant says, the public confuses impulse control disorders with issues of will power and control. “This is not an issue of moral character,” he says, and not necessarily a question of whether a person can’t control a behavior or chooses not to control it. “The idea of treatment is often to reduce the drive as well as to increase the ability to control.”

Shelley recalls long periods when she kept “the demon” at bay. “It would come and go,” she says. But when it came, there was no fighting it.

Grant likens the urge to eating. “One will always have the desire to eat at some point. But we control it—until the desire is very intense,” he says. “Ultimately, you have to give in to the desire. People with these disorders will say, ‘Sometimes I won’t gamble, or I won’t shoplift. But when the desire is very strong, I can try all day to resist the urge, but I am going to give in.’”

Shame and secrecy

In Shelley’s case, when the demon prevailed, the relief and triumph that followed shoplifting invariably gave way to feelings of self-loathing. She was overcome by “the shame of knowing that what I was doing was immoral and harmful to society.” That reaction is common among patients with impulse control disorders, Grant says.

“Pyromania and shoplifting [in particular] cut against people’s beliefs about moral ways of living. People are devastated to realize that they’re breaking the law and going against the kind of person they think they should be,” Grant says. “I’ve had patients who feel that the only way they could stop [their impulsive actions] would be to commit suicide—and that they probably deserve [to die] because they’re such bad people.”

In Stop Me, Grant and Kim write that “the shame and secrecy the behavior engenders appear to be inherent in these disorders, and are probably the first and sometimes greatest enemies to overcome.”

‘Horribly underdiagnosed’

Both Grant and Kim believe that impulse control disorders are far more common than generally thought. Pathological gambling and compulsive shopping, for example, may affect up to 10 percent of the population.

Other shame-inducing behavioral addictions, such as kleptomania and compulsive sexual behavior, are probably vastly underreported and, Grant believes, “horribly underdiagnosed.” In a 2005 study published in the American Journal of Psychiatry, Grant and Kim found that one-third of 204 psychiatric inpatients had at least one impulse control disorder, but the disorder had been previously diagnosed in only three of those patients.

Clearly, not everyone who shoplifts is a kleptomaniac. Grant estimates the percentage of shoplifters with impulse control disorder—those who steal compulsively—to be between 5 and 25 percent. In many cases, they’re taking items they don’t want and can’t possibly use. Shelley recalls stealing a massive $300 dictionary, taking it from the store in her infant daughter’s stroller.

Shoplifters who are kleptomaniacs are not in control, Grant says. “People don’t like feeling out of control. Patients can usually tell me the year, or even the month, when they realized they were no longer in control.”

Impulse control disorders may be underdiagnosed, but they are not new. Grant says there’s evidence that medical practitioners recognized similar behaviors hundreds of years ago. He’s read, with fascination, the writings of early 19th-century French physician Jean-Étienne Esquirol, who was intrigued by what he called “monomanias,” cases of uncontrollable fire-setting and stealing.

“One complaint that’s often levied against psychiatry is that we’re always making up new problems to explain poor character—that we’ll ‘pathologize’ anything,” Grant says. “These are actually age-old problems. [Esquirol] would see people who could control their behavior in all other spheres of life—they could work, they could run a household, but they had this one area that was out of control. Some of these observations made 200 years ago still hold true.”

Raising awareness

To increase physician awareness, Grant recently published Impulse Control Disorders: A Clinician’s Guide to Understanding and Treating Behavioral Addictions, which includes a detailed screening and assessment tool for family practice physicians, psychiatrists, and other clinicians.

“We are desperately trying to get funding to disseminate this information,” says Kim. He and Grant frequently hold workshops and give lectures on impulse control disorders in an effort to improve prevention and early intervention efforts.

As is true of most diseases, the sooner behavioral addictions are diagnosed and treated, the better the chance for success. Says Grant, “It’s much easier to treat mild versions of these illnesses than it is to treat severe versions when there are multiple consequences—damage to family life, unemployment, bankruptcy.”

Patients with impulse control disorders often have coexisting mental health problems, such as depression or chemical dependency, and Kim says that substance abuse can exacerbate some behavioral addictions. “We believe someone who drinks and smokes will be more likely to gamble. [Drugs] whet the appetite,” he says.

For those who experience depression, it may be the primary or secondary problem, Grant says. “Some say, ‘I don’t think I’d be depressed if I could just stop this behavior. I get in the car to drive home from the casino, and I realize I’ve ruined my family again.’ A smaller number will say, ‘You know, I’ve been depressed my whole life. The only thing that [mitigates it] is when I get a little rush out of doing these behaviors.’”

Seeking treatment and sticking with it

The act of seeking treatment has always been uniquely difficult for people with impulse control disorders. As Shelley puts it, “Where do you go [for help] when you’re engaging in criminal behavior?”

While many of his patients haven’t been caught, Grant says, “they’re terrified they’re going to be.”

Following through with treatment, Kim says, is even tougher. Many sufferers—especially those, such as compulsive gamblers, for whom the symptoms can be rewarding—are ambivalent about their addiction. Kim says that’s one reason that a “huge percentage”—50 to 60 percent—don’t follow through with treatment.

“The first thing I like to ask them is if there is someone—a spouse, a parent, a friend—who can help” by holding them accountable. “If you get that recruit, success is more likely,” Kim says. But many patients balk at revealing their behavioral addiction, even to close friends or family members.

Some impulse control disorders, such as compulsive shopping and sexual addiction, are especially challenging to treat because giving up the behavior altogether isn’t a reasonable option.

“Often our first goal for people with gambling addiction is to have them quit gambling,” Grant explains. “Well, everybody needs to buy something at some point, and most adults in relationships [have sex]. So the goals become a little bit grayer: You go for a reduction of unhealthy behavior—unhealthy spending or unhealthy sex.”

Effective results

Treatment for impulse control disorders typically involves some combination of therapy and medication. Grant is wrapping up a promising study of the drug Naltrexone, formerly used to treat alcoholism, as a treatment for kleptomania and pyromania. For Shelley, who participated in the eight-week trial, Naltrexone has so far proved startlingly effective.

“[The results were] amazing and immediate,” Shelley says. “For the first time in my life, my brain knew what it felt like to feel normal. That drug helped me go to Al-Anon. I told the group, and I felt freer than a bird…. Now that my secret is out of the bag, I don’t feel so tormented.” She’s also found cardiovascular exercise helpful in managing the anxiety that feeds her disorder.

For patients with gambling addiction, Grant says, an amino acid supplement appears to help. In a clinical trial last year, 27 people were given increasing doses of the amino acid N-acetyl cysteine, which affects the chemical glutamate, often associated with reward in the brain. At the end of the trial, 60 percent of the participants reported fewer urges to gamble.

Kim and Grant also have been studying a specific form of cognitive behavior therapy to treat gambling addiction in only five sessions. They’re passionate about their research and their work in the clinic. Helping to free patients from what Shelley describes as “the deepest, darkest prison” of behavior addiction is immensely fulfilling.

“Nothing is more thrilling,” Kim says. “That’s one thing you never get immune to.”

By Susan Maas
Illustrations by Emiliano Ponzi

Web Extras

Audio

Hear Suck Won Kim, M.D., describe how patients react to new treatments for impulse control disorders..

Companion story: The neurobiology of addiction

Thanks to a four-year, $2.4 million grant from the National Institutes of Health, University of Minnesota researchers have launched a multidisciplinary effort to examine the role impulsivity plays in addiction. Read more.

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Targeting teen health

2008-01-01T22:41:27Z

U’s adolescent health experts work to help teens survive these risk-filled years

If you are reading this page, you have lived it: The hormone-driven emotional highs and lows. The risk and resilience. The vulnerability and invincibility. The rite of passage that Carol Burnett called “one big walking pimple.”

It’s adolescence, and it’s no joke. In 2003, motor vehicle accidents, homicide, and suicide were the three leading causes of death among individuals aged 10 to 24—or 57 percent of all deaths in that age group, according to the National Adolescent Health Information Center. One in five 12th graders reported using cigarettes or taking drugs, and one in four said they were binge drinking. A new report from the Centers for Disease Control and Prevention indicates that the teen birthrate has increased for the first time since 1991.

Not surprisingly, experts in the University of Minnesota Medical School’s Division of Adolescent Health and Medicine will tell you that the teen years demand health-care professionals’ undivided attention.

“Members of this age group are not dying primarily of tumors and infectious diseases. They are dying of drinking while driving, accidents, depression, drugs, and violence,” says Nimi Singh, M.D., M.P.H., head of the adolescent medicine division and assistant professor of pediatrics. “If 80 percent of what kills people between ages 11 and 21 is emotional and behavioral, any clinician who is providing care for that population has to be looking for warning signs.”

Singh and her colleagues have made it their mission to help teens survive these risk-filled years, and the team is training new physicians to think differently about the way they provide care for these uniquely challenging patients.

Says Singh: “We want clinicians to pick up on when a teenager is upset about a negative interaction at school, for instance, so they can help that teen learn to cope with the event emotionally rather than have him or her show up in the ER six months later because the social fallout became too much to handle.

“Anxiety, depression, poor eating habits—identifying the risky behaviors early and helping adolescents make healthy choices is the only sensible way of addressing this country’s growing challenges in adolescent health,” she says.

In fact, the University of Minnesota has been a pacesetter in teaching doctors and other health professionals to do just that. In 1978, it became one of seven academic institutions in the nation to host a federally funded interdisciplinary adolescent health fellowship program, supported by the U.S. Maternal and Child Health Bureau to train future leaders in adolescent health. And in 1988, the University’s Department of Pediatrics began requiring all of its residents to complete an adolescent health rotation—long before the Accreditation Council for Graduate Medical Education made that a mandate for all pediatric residents in 1996.

“The aim of the [adolescent health] rotation is to round out residents’ education so they become sensitive to a population that’s more independent about the health-care decisions they make,” says John Andrews, M.D., director of the pediatric residency program and associate head of education in the Department of Pediatrics.

“When you provide care to a 7-year-old, while you are holding the interests of that child in highest regard, you are also negotiating with a concerned caregiver, like a parent, to do what’s best. With adolescent patients, you need to relate more directly with them and respect their priorities.”

A memorable month

University pediatrics resident Tonya Brakey, M.D., entered her adolescent health rotation with some apprehension. Like many of her fellow residents, she was intimidated by teens. “I had this presumption that they are secretive and have a lot going on behind the scenes that they wouldn’t want to tell a doctor,” recalls Brakey. “I was concerned that when I’d talk to them, I’d look like a square or be transformed into my mother.”

But Brakey, who completed her rotation in fall 2006, found the experience to be highly rewarding. “My approach to working with youths changed fundamentally based on the training I got,” she says. “The teens were refreshing. They were funny. They were a lot more candid than I thought they would be, and they were eager to have someone listen to them and answer their questions. It was really satisfying.”

The U’s pediatric residency program packs a lot into its month-long adolescent health rotation, combining clinical assignments with training sessions, lectures, and innovative approaches to teaching communication skills.

Residents spend 20 to 25 hours a week in a variety of locations, including the Fairview Children’s Clinic affiliated with the University of Minnesota Children’s Hospital; Hennepin County Medical Center’s adolescent medicine specialty clinic; and Face to Face, a multiservice center, for disadvantaged and homeless youths.

“The residents tend to move around a lot during the 30 days,” says Mae Seely Sylvester, M.S., coordinator of the rotation. “We try to give them the experience of seeing adolescents in a variety of settings.”

Two mornings a week, residents learn about such critical topics as reproductive health, mental health issues, contraception, teen pregnancy counseling, sports medicine, and gay/lesbian/bisexual/transgender youth issues.

The first two Friday afternoons of the rotation are devoted to clinical communication. Singh spends the initial hour talking about how to conduct a useful psychosocial interview, using the acronym HEADDSSS (asking about the patient’s home life; education; activities; diet;
drugs, alcohol, and tobacco; sexuality; suicidal thoughts or depression; and safety).

“The single most critical tool when working with teens in a health-care setting is the psychosocial interview, which involves connecting with young people, asking them how they are doing,” says Singh. “I tell students and residents that it’s more important than listening to their patients’ hearts.”

Often, threats to an adolescent’s health have little to do with teens’ primary reasons for visiting their doctor. “Even if a 14-year-old comes in for a refill on his asthma medications, you’ve got to do the psychosocial screening because you have no idea which young person may be struggling. The physical exam alone is not going to reveal what is putting their health at risk,” Singh says. “That’s adolescent medicine in a nutshell: identifying stressors in the life of a young person, then making sure they have healthy coping strategies for dealing with them.”

That message struck a chord with adolescent health fellow Stephanie Walters, M.D., who realized that she wanted to specialize in adolescent health when Singh spoke in one of her second-year medical school classes.

“She spoke passionately about serving teens, what the typical teen visit is like and the kind of impact we can make as physicians. I chased her down to learn more,” recalls Walters, who completed her family medicine residency in 2006. “I love the psychosocial part of medicine and the chance to sit down and hear about patients’ lives. This is the bread and butter of adolescent medicine, which cannot be said for many other specialties.”

One highlight of the rotation, the Adolescent Actors Teaching Project, allows residents to practice their interviewing skills through role playing. During the session, trained adolescent actors ages 14 to 20 come into the classroom “clinic” for predetermined reasons.

“Residents do the practice interview for 15 to 20 minutes. Then the actors provide feedback on how the interaction felt for them, what areas require improvement, what they liked and disliked, and what the residents could have done differently,” explains Sylvester. “The feedback from residents has been very positive. What I hear most often is, ‘I was anxious about role playing, but now I understand that talking to teens is doable and important.’”

The promise of youth

Amid the sobering statistics regarding adolescent health, Singh says there is much good news, too. First, clinical communication skills are easy to teach, easy to learn, and incredibly effective. Second, adolescents bounce back. “When practitioners can speak with adolescents in a respectful, nonjudgmental way, adolescents really will open up and tell you everything you need to know to provide effective care, and that puts us on a path toward the positive,” she says.

Three years ago, when Walters was talking with a 15-year-old patient during a well-care visit at a North Minneapolis clinic, she asked the teen if he had any questions about safe sex. With great enthusiasm, he described his role as a peer educator at Minneapolis North High School.

“I felt energized all day long after that visit; he had given me such a charge with his positive energy and his healthy understanding of how to protect himself and his friends,” recalls Walters. “The best part of my job has been identifying teens’ innate sense of health and wellness and focusing on those assets to help them avoid future risks—or handle current struggles.”

That’s just the lesson Singh wants to share. “What we find through our research and practice is that there is a lot of resilience built into these patients,” she says. “Tapping into that resilience—serving as a facilitator in bringing that out and then teaching others to do the same—is hands down the most rewarding, most hopeful part of my specialty.”

By Jeanne Mettner

Web Extras

Companion story: Fellowship Training

When Stephanie Walters, M.D., finished her family medicine residency in 2006, she knew she wanted to make a difference in the lives of adolescents but wondered how she could have a bigger impact. Read more.

Division of Adolescent Health and Medicine

In collaboration with medicine, nursing, nutrition, psychology, public health, and social work, the Division of Adolescent Health and Medicine conducts research and provides training and clinical services that help build resilience in youth.

Healthy Youth Development Prevention Research Center: One of 33 federally funded Prevention Research Centers in the United States, this U of M center studies the best methods for providing teens with the skills and opportunities they need to live healthy, purposeful lives, and it is working on measures to reduce health disparities among Minnesota’s youth populations. The center is a collaboration of the Medical School and the Schools of Nursing and Public Health.

Konopka Institute for Best Practices in Adolescent Health: Inspired by the pioneering work of Gisela Konopka, Ph.D., M.S.W., the institute provides evidence-based, leading-edge information to individuals, organizations, and institutions that serve youth.

Minnesota Youth Learning Initiative: Backed financially by the W. K. Kellogg Foundation, the initiative pairs Konopka Institute staff with seven Minnesota communities to provide mentoring and parental support, education, and assistance that foster youths’ connections to their schools, communities, and skill-based adult mentors.

State Adolescent Health Resource Center: Launched in January 2001 with support from the U.S. Maternal and Child Health Bureau, this Konopka Institute-based center builds the knowledge, skills, and capacities of the nation’s state adolescent health coordinators.

Youth and AIDS Projects: For almost two decades, the Youth and AIDS Projects have been helping to prevent HIV in high-risk young people and caring for youth and families living with HIV.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Sexual health expert receives award, takes leadership roles

2007-10-01T22:00:54Z

Eli Coleman, Ph.D., director since 1991 of the Medical School’s Program in Human Sexuality, was elected president of the International Academy of Sex Research at the academy’s annual meeting in August.

Coleman’s election to the position followed his recent appointment as inaugural holder of the University’s endowed chair in sexual health—the first of its kind in the world—and his receipt in April of the Gold Medal Award 2007 at the XVIII World Congress of the World Association for Sexual Health.

Coleman has written more than 130 articles and book chapters on sexual health. Under his leadership, the Program in Human Sexuality has become one of the world’s largest and most comprehensive centers for sexual-health treatment, research, and education.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Promoting health through the lifespan: From adolescence to menopause, women of all ages turn to U physicians for expert care

2007-10-01T15:42:21Z

When one of her young cancer patients wants to have a baby, gynecologic oncologist Rahel Ghebre, M.D., will send her to colleague Kirk Ramin, M.D., who specializes in high-risk pregnancy.

June LaValleur, M.D., who specializes in mature women’s health, has steered patients with new cancer diagnoses to Ghebre. And cancer specialists with midlife and older patients experiencing sexual function concerns have referred those patients to LaValleur.

These are just a few examples of how faculty members in the Department of Obstetrics, Gynecology, and Women’s Health at the University of Minnesota collaborate to serve patients from young womanhood through maturity. “It’s seamless,” LaValleur says.

In the past, obstetric and gynecologic care was mainly associated with treating women in their childbearing years. Today, the department offers continuity of care—and guidance on a vast array of health issues—throughout the lifespan.

LaValleur says she appreciates “having colleagues that I absolutely trust to deliver the same kind of care that I would want to have delivered to me, or to my family.”

Protecting young women’s health

Starting in puberty, patients can avail themselves of expertise in adolescent gynecology and teenage women’s health. The department has played a major role in promoting the health of young women through its ongoing testing of vaccines to prevent the human papillomavirus (HPV). HPV is a sexually transmitted infection and is the most common cause of cervical cancer. Approved for use in girls and women ages 9 to 26, the vaccine is most effective when given to girls before they become sexually active.

Carolyn Torkelson, M.D., M.S., assistant professor of family medicine and community health, sees many patients in their late teens and early 20s. She says some are under intense pressure, juggling schoolwork, employment, and extracurricular activities—while lacking sleep and good nutrition. “It’s a prescription for disaster,” she says.

“They think they’re handling it. Then it manifests as a physical complaint,” such as gastrointestinal distress, Torkelson says. She uses a holistic approach, drawing upon both Western and complementary and alternative medicine, to help young patients develop good self-care skills.

Torkelson adds that the University’s Deborah E. Powell Center for Women’s Health, a nationally designated Center of Excellence in Women’s Health, has fostered unprecedented collaboration across departments and disciplines, which has made more resources available to female patients of all ages.

The age of motherhood

Some of the department’s work stems from evolving expectations concerning age and aging. According to the National Center for Health Statistics, childbearing by women in their 30s and 40s continues to increase.While older women bring assets such as life experience and greater maturity to parenthood, they’re also more likely to face significant health issues in pregnancy.

“If you go into a pregnancy healthy and fit, even over 40, you can do fine,” Ramin says.

But 40-something moms are more apt to encounter fertility problems and higher rates of multiple births, such as twins or triplets, he says. They also are more likely to confront diabetes, as well as preeclampsia, stroke, and other blood-clotting disorders.

Ramin would like to see family physicians, obstetricians, and gynecologists trained to teach patients to get in shape well in advance of planning a pregnancy. A preconception consultation could help prevent some of the more common complications that make a pregnancy high-risk, Ramin says.

Changing norms

In generations past, women in their 50s might have been gearing up for retirement—if they had held paid employment. Today, they may well be in the prime of their careers, and part of the “sandwich generation” with children at home and aging parents who need care, all while dealing with the challenges of menopause.

“They’re facing that midlife issue of looking at your life: where have you been, where are you, and most importantly, where are you wanting to go,” LaValleur says.

The combination of these factors can make hot flashes, night sweats, and other menopausal symptoms that much more burdensome, LaValleur says. She’s grateful to be able to call upon psychologist Sue Petzel, Ph.D., to help patients struggling with mental and emotional well-being.

For many patients in midlife, osteoporosis is also a real risk. Ghebre says she and her colleagues try to educate patients about important lifestyle choices they can make to prevent or mitigate it.

“Osteoporosis is very diet-dependent,” Ghebre says. “We try to make patients aware of calcium and vitamin D intake, exercise, and nutrition to help them maintain bone density.”

A focus on wellness

Through wellness education and outreach, faculty physicians in the Department of Obstetrics, Gynecology, and Women’s Health are reaching out to the community to help improve the lives of women, whether they’re 18 or 80.

Ghebre says wellness promotion is a major focus of the department. “One of the biggest cancer prevention strategies is helping women quit smoking,” she says. “Most people understand that smoking is directly linked to lung cancer but don’t know that it also increases your risk for other subtypes of cancer such as cervical cancer and bladder cancer.”

People who smoke suffer other morbidities, as well, including cardiovascular disease, premature aging, and premature failure of the ovaries, Ghebre adds.

Torkelson emphasizes the impact of nutrition and fitness, or lack thereof, on issues ranging from headaches to heart disease.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

Discovery paves way for new drugs to halt retroviruses, including HIV

2007-01-01T16:35:39Z

A discovery by University researchers provides a target for developing new types of drugs to stop retroviruses, including HIV, from infecting cells and spreading through the body.

The research team, led by Nikunj Somia, Ph.D., assistant professor of genetics, cell biology, and development, identified a cell line that is resistant to three types of retroviruses, including human immunodeficiency virus type 1.

Because HIV does not have enough proteins of its own to complete its life cycle, it must use proteins in the cells it infects in order to survive. Currently, the drugs available to fight HIV act on proteins that the virus itself produces.

“The downfall of existing HIV drugs is that since the virus is constantly changing, the drugs eventually stop working, and the virus becomes drug-resistant,” Somia says. “We hypothesized that if we could find the proteins within the cells that HIV uses to make more copies of itself, we would find a potential new and more effective way to fight HIV.”

To search for these proteins, the researchers chemically induced random mutations in the DNA of certain cell lines. Then they infected the mutated cell lines with HIV to which they had added a protein that immediately kills cells.

In the HIV-infected cell lines that lived, the virus was able to get into the cell, but it was attacked by the cell’s protein-destroying proteasome, which prevented the virus from making more copies of itself.

“Finding the switch that activates cells to seek and destroy the virus could be a powerful therapeutic agent in the fight against HIV and in controlling AIDS,” Somia says.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.

FDA approves vaccine to protect against HPV‚ cervical cancer

2006-10-01T15:35:47Z

The Food and Drug Administration (FDA) this summer approved a vaccine to protect women against cervical cancer. The vaccine prevents infection by four strains of the human papillomavirus (HPV)‚ a sexually transmitted infection that is the most common cause of cervical cancer.

Levi Downs Jr., M.D., assistant professor in the Division of Gynecologic Oncology and a member of the University of Minnesota Cancer Center‚ was one of the principal investigators on the international study.

“There is nothing in my career as a physician that will be more important than this‚” Downs says.

HPV infection is linked to 10‚000 cases of cervical cancer every year in the United States and about 200‚000 cases worldwide‚ says Downs. Cervical cancer causes 3‚700 deaths each year in the United States alone.

The vaccine‚ approved for use in girls and women ages 9 to 26‚ is most effective when given to girls before they become sexually active and risk an HPV infection. It may not protect against cervical cancer in those who have already been infected with HPV‚ according to the FDA.

You can make a difference

Help the University of Minnesota save lives, inspire hope, and prepare the world’s future health care leaders. Make a gift today.

Because with your support, anything is possible.