School of Public Health News from UNC

Rimer awarded American Cancer Society's Medal of Honor for benchmark cancer research

kastlema@email.unc.edu (Linda Kastleman) — Thu, 23 May 2013 06:00:00 PDT

Barbara K. Rimer, DrPH, MPH, dean of The University of North Carolina�s Gillings School of Global Public Health, was presented with the American Cancer Society�s Medal of Honor on May 22 at the Society�s 100th Birthday Summit in Atlanta.

Past recipients of the award include former U.S. president George H.W. Bush and former first lady Barbara Bush; the late Honorable Edward M. Kennedy, senator from Massachusetts; George N. Papanicolau, MD, inventor of the Pap test; Robert C. Gallo, MD, recognized for achievements in pioneering the field of human retrovirology; the late Judah Folkman, MD, a leading researcher in the field of antiangiogenesis; and the late C. Everett Koop, MD, former U.S. Surgeon General.

Rimer received the Medal of Honor for Cancer Control for her seminal cancer research efforts, particularly her work in breast cancer screening, which has guided national research, practice and policy for more than 20 years. Her work has evolved with the field � from raising awareness of screening and increasing screening initiation to promoting screening maintenance. She has informed national policy and expert group recommendations and addresses disparities and translation into practice.

A UNC faculty member since 2003 and dean since 2005, Rimer holds the Alumni Distinguished Professorship in health behavior at the Gillings School and is a member of the UNC Lineberger Comprehensive Cancer Center. She chairs the national President�s Cancer Panel, is vice chair of the Center for Disease Control and Prevention�s Task Force on Community Preventive Services and is an elected member of the prestigious Institute of Medicine.

She has served in a number of leadership positions in cancer research. She was founding director of the National Cancer Institute�s Division of Cancer Control and Population Sciences and chair of the Institute�s National Cancer Advisory Board. She served as deputy director for population sciences at UNC Lineberger, associate director for cancer control at the Duke Comprehensive Cancer Center and director of behavioral research at the Fox Chase Cancer Center in Philadelphia. She also has published extensively on a wide range of topics including cancer screening, tobacco control, and genetic and genomics-based testing.

Also receiving this year�s Medal of Honor were Isaiah J. Fidler, DVM, PhD, for basic research, and Kathleen M. Foley, MD, for clinical research. Fidler, director of the Metastasis Research Laboratory at The University of Texas MD Anderson Cancer Center, was honored for his contributions to the study of the biology and therapy of cancer metastasis. Foley, attending neurologist in the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City and professor in Cornell University�s Weill Medical College, was honored for her national and international efforts in the treatment of patients with cancer pain.

About the American Cancer Society
The American Cancer Society is a global grassroots force of more than three million volunteers saving lives and fighting for every birthday threatened by every cancer in every community. As the largest voluntary health organization, the Society's efforts have contributed to a 20-percent decline in cancer death rates in the U.S. since 1991, and a 50 percent drop in smoking rates.

Thanks in part to the Society�s progress, nearly 14 million Americans who have had cancer � and countless more who have avoided it � will celebrate more birthdays this year.

As ACS marks its 100th birthday in 2013, the organization is determined to finish the fight against cancer. It aims to find cures as the nation�s largest private, not-for-profit investor in cancer research, ensuring people facing cancer have the help they need and continuing the fight for access to quality health care, lifesaving screenings, clean air and more. For more information, to seek help, or to join the fight, call 800-227-2345 or visit www.cancer.org.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Pink named outstanding researcher by National Rural Health Association

kastlema@email.unc.edu (Linda Kastleman) — Wed, 22 May 2013 14:46:35 PDT

The National Rural Health Association (NRHA) has honored George Pink, PhD, with its Outstanding Researcher Award, presented May 9 during the NRHA�s 36th annual Rural Health Conference in Louisville, Ky.

Pink, Humana Distinguished Professor of health policy and management at The University of North Carolina�s Gillings School of Global Public Health, is also senior research fellow at UNC's Cecil G. Sheps Center for Health Services Research and senior research fellow at the North Carolina Rural Health Research and Policy Analysis Center.

He annually disseminates the Critical Access Hospital (CAH) Financial Indicators Report, an industry standard distributed to 1,341 CAHs, which includes empirical assessment of relevant benchmarks and peer groupings for CAHs. The report has significant impact upon practice and policy in rural hospital finance.

He has authored several textbooks in health-care finance, written more than 60 peer-reviewed articles and co-authored numerous issue briefs and working papers designed to make his research accessible to policy makers.

Pink volunteers as a member of the board and finance committee chair at Piedmont Health Services, a large federally qualified health center (FQHC) that provides primary health care to residents of five largely rural counties in North Carolina. Prior to coming to UNC in 2002, he served on the faculty at the University of Toronto and as a sought-after health management consultant.

�George is a true collaborator, says Ira Moscovice, PhD, Mayo Professor and health policy and management division head at the University of Minnesota and founding director of the UM Rural Health Research Center. �He has outstanding quantitative skills and a penchant for meticulous and policy-relevant work. His research has served as a foundation for improving the financial capabilities of small rural hospitals and is widely recognized by his peers in academia and practitioners in the field.�

The NRHA is a nonprofit organization working to improve the health and well-being of rural Americans and provide leadership on rural health issues through advocacy, communications, education and research. Its more than 22,000 members, comprised of diverse individuals and organizations, share the common bond of an interest in raising awareness about the 62 million Americans who live in rural areas and lack access to affordable health care.

The organization�s annual conference is the largest gathering of rural health professionals in the U.S., typically attracting more than 900 health professionals and students.

Pink is the second UNC recipient of the award, which was first presented by the NRHA in 1999. Rebecca Slifkin, PhD, Gillings School alumna and former director of the UNC Sheps Center�s N.C. Rural Health Research and Policy Analysis Center, won the award in 2005.

Pink thanked the NRHA for recognizing the contributions of the North Carolina Rural Health Research and Policy Analysis Center. �This is a team award, and it�s an honor to receive it,� he said.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Study finds link between chemical air pollutants and cardiovascular diseases.

branson_moore@unc.edu (Branson Moore) — Wed, 15 May 2013 06:19:57 PDT

A new study that utilizes a previous novel approach has revealed clues about certain chemical properties of air pollutants and their association with cardiovascular disease

The study applied quantitative ion character-activity relationships (QICAR) to estimate associations of human cardiovascular diseases with a set of metal properties commonly observed in ambient air pollutants. Results indicated that specific cardiovascular disease outcomes were statistically significant and associated with many ion properties reflecting ion size, solubility, oxidation potential and abilities to form covalent and ionic bonds. The properties are relevant for reactive oxygen species generation, which has been identified as a possible mechanism leading to cardiovascular diseases.

�We found that cardiovascular diseases such as heart attacks and strokes were associated with chemical air pollutant properties,� said Karin Yeatts, PhD, research assistant professor of epidemiology at the Gillings School of Global Public Health at The University of North Carolina at Chapel Hill. �The properties we found to be important included size of the ion, its solubility, and the ion's ability to bond with other compounds. These properties influence a specific mechanism called reactive oxygen species generation, which may affect some cardiovascular diseases.�

The study, �Cardiovascular Outcomes and the Physical and Chemical Properties of Metal Ions Found in Particulate Matter Air Pollution: A QICAR Study,� appeared in the recent issue of the journal Environmental Health Perspectives. Researchers included atmospheric chemists, toxicologists, environmental scientists, epidemiologists and biostatisticians.

Co-authors from UNC�s Gillings School of Global Public Health also included Amy Herring, ScD, professor of biostatistics, and Eric Whitsel, MD MPH, research associate professor of epidemiology. Co-author Jennifer Richmond Bryant received her PhD from the Environmental Sciences and Engineering Department at UNC Gillings School of Global Public Health.

The full study can be found online.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Yeatts leads study to analyze incidence and burden of COPD-related emergency department visits in NC

kastlema@email.unc.edu (Linda Kastleman) — Wed, 08 May 2013 09:05:26 PDT

The U.S. Centers for Disease Control and Prevention reports that more than 15 million adults may be living with a lower respiratory ailment called chronic obstructive pulmonary disease (COPD) and that millions more may be unaware they have it.

Responding to the CDC�s call for increased analysis and dissemination of COPD-related public health data, researchers from The University of North Carolina at Chapel Hill examined records available through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) surveillance system to determine the population-based burden imposed on N.C. hospital systems by COPD-related emergency room visits.

The results of their analysis were published online April 11 in CHEST, the official publication of the American College of Chest Physicians.

Led by Karin Yeatts, PhD, research assistant professor of epidemiology at Gillings School of Global Public Health, the study examined data on a cohort of 33,799 patients with a COPD diagnosis who received emergency department (ED) care between Jan. 1, 2008 and Dec. 31, 2009 in North Carolina.

Yeatts and colleagues focused upon the frequency of return visits to the ED within the following year, hospital admission(s) that followed ED care, and the potential risk of return visits for COPD patients with several comorbid conditions, including heart and respiratory disease.

COPD comprises a set of conditions, including emphysema and chronic bronchitis, which limit air flow and cause breathing difficulties. In the U.S., its main causes are tobacco use, air pollutants in home and work environments (e.g., secondhand smoke and fumes) and genetic factors.

Nationally, the more than 10 million adults with diagnosed COPD had an estimated 1.5 million ED visits and 726,000 hospitalizations in 2000.

Yeatts and colleagues found that 97,511 COPD-related ED visits were made by adults 45 years of age and older during the two-year study period, with more visits made by women ages 60-69. The highest percentage of visits was among men 75 years of age and older.

Twenty-eight percent of the cohort had at least one return ED visit within 365 days, and 7 percent returned within 30 days. Medicare, Medicaid and non-insured patients were more likely to have a COPD-related return visit to the ED and to have more than three COPD-related ED visits within one year.

As a result of the first ED visit considered in the analysis (index), 51 percent of the COPD-related emergencies were admitted to the hospital, an admission rate twice as high as the overall hospitalization rate for all ED visits made by patients 45 years of age and older. Patients with congestive heart failure, substance-related disorders or respiratory failure were more likely to have subsequent hospital admission(s) compared to patients without those comorbidities.

Patients enrolled in Medicare and Medicaid were 29 percent and 35 percent more likely, respectively, to have one or more hospital admissions compared to those with private insurance. Patients with no insurance were 28 percent less likely than the privately insured to have a subsequent hospital admission.

Comorbidities of respiratory failure and congestive heart failure had the highest association for increased hospital admissions. Though �substance-related disorders� was comorbid only in a small percentage of the cohort (1.5 percent), that condition, particularly cocaine use, had the most significant association with subsequent hospital admission.

�We found a high burden of care both for repeat visits and hospital admissions for COPD-related illness in this North Carolina population,� Yeatts said. �Our analysis suggests that the smoking rate in N.C. may have impact, the uninsured do not get all the care they need, and older women are at equal risk compared with men.�

Other study co-authors from the Gillings School of Global Public Health are epidemiology doctoral student Steven J. Lippmann, MSPH; and Kristen Hassmiller Lich, PhD, research assistant professor, and Morris Weinberger, PhD, Vergil N. Slee Distinguished Professor of Healthcare Quality Management, both in the Department of Health Policy and Management.

Co-authors from the UNC School of Medicine are Anna E. Waller, ScD, research associate professor at the Carolina Center for Health Informatics and Department of Emergency Medicine, and James F. Donohue, MD, professor of medicine in the Department of Pulmonary Diseases and Critical Care Medicine.

Debbie Travers, PhD, RN, is an assistant professor in the School of Nursing the Department of Emergency Medicine and the Carolina Center for Health Informatics.

Weinberger also is in the Center for Health Services Research in Primary Care at the Durham (N.C.) VA Medical Center.

The authors wish to note the collaborative and interdisciplinary nature of this effort, which was conducted by researchers in epidemiology, emergency medicine, health policy and management, nursing, and pulmonary diseases and critical care medicine. Their collaboration began through a 2008 Gillings Innovation Laboratory (GIL) grant awarded to David Richardson, PhD, associate professor of epidemiology.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Powell Hammond: Helping African-American men live longer, healthier lives

kastlema@email.unc.edu (Linda Kastleman) — Tue, 07 May 2013 06:30:38 PDT

When Wizdom Powell Hammond, PhD, was nine years old, she lost her grandfather to a preventable cancer. The impact of that loss on Powell Hammond and her family has shaped her academic life.

Now a clinical psychologist and assistant professor of health behavior at the Gillings School of Global Public Health, Powell Hammond studies the psychological factors that lead to disparities in health outcomes, particularly for African-American men.

From 2005 to 2007, Powell Hammond served as a Health and Society Scholar through the Robert Wood Johnson Foundation (RWJF). The Scholars program provides two years of support to postdoctoral fellows to address determinants of population health and contribute to policy change.

On May 1, RWJF posted a profile article as a tribute to Powell Hammond and her work. The article is available on the Foundation website.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

HPM student offers efficient, humane care to Medicare patients with chronic illness

kastlema@email.unc.edu (Linda Kastleman) — Wed, 01 May 2013 08:52:20 PDT

The innovative health care provided by Ken Coburn, MD, MPH, caught the attention of The Washington Post recently.

Coburn, a student in the executive doctoral program in health leadership offered by the Gillings School of Global Health�s Department of Health Policy and Management, is founder, chief executive officer and medical director for Health Quality Partners, based in Doylestown, Pa.

According to Ezra Klein, in an April 28 article in The Post, "[Health Quality Partners] enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every other month, whether they're healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary."

Klein goes on to say:

Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients.

This is a radical redefinition of the health-care system�s role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management.

Health Quality Partners� results have been extraordinary. According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent.

Suzanne Hobbs, DrPH, associate professor of health policy and management at the Gillings School and an adviser to Coburn, says his efforts exemplify the leadership and health care quality goals of the executive doctoral program.

�Ken�s visionary leadership is transforming the way we think about care delivery in this country and holds great promise for improving health care quality for us all,� Hobbs said.

Read the complete article on The Washington Post website.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Kohlmeier honored with award for excellence in medical education

kastlema@email.unc.edu (Linda Kastleman) — Thu, 25 Apr 2013 13:47:32 PDT

Martin Kohlmeier, MD, PhD, research professor of nutrition at Gillings School of Global Public Health and at the Nutrition Research Institute in Kannapolis, N.C., has received the 2013 Roland L. Weinsier Award for Excellence in Medical/Dental Nutrition Education from the American Society for Nutrition.

�This award is presented in recognition of an outstanding career in medical/dental nutrition education, [including] innovations in medical/dental education,� said Teresa A. Davis, PhD, ASN president, and Robert Russell, MD, ASN Foundation president, in making the award announcement.

�Our Society annually grants over $452,068 in scientific awards, student grants, travel awards and honoraria to experts and emerging leaders in nutrition science and practice,� they said. �Congratulations on joining this group of highly regarded scientists and clinicians!�

Kohlmeier was recognized with a monetary award and plaque at an awards ceremony during the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2013.

Kohlmeier is a faculty member and primary investigator in the UNC NRI Nutrigenetics Laboratory, focusing on laboratory diagnostics and nutritional genetics. His research explores how to help individuals safely navigate daily food choices and the potential impact of those choices on cancer risk. He is developing software that uses detailed genetic information to teach consumers about healthy foods.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

Gourlay wins clinical research achievement award

kastlema@email.unc.edu (Linda Kastleman) — Tue, 23 Apr 2013 10:52:37 PDT

For leading a study that was the first to define appropriate bone density screening intervals for older women, Margaret Gourlay, MD, MPH, has been honored with a Top 10 Clinical Research Achievement Award from the Clinical Research Forum.

Gourlay is assistant professor in the Department of Family Medicine in The University of North Carolina at Chapel Hill School of Medicine and adjunct assistant professor in UNC�s Gillings School of Global Public Health.

The winning projects are compelling examples of the scientific innovation that results from the nation�s investment in clinical research that can benefit human health and welfare.

Gourlay�s study, published in January 2012 in The New England Journal of Medicine, calculated time estimates that doctors can use for bone-density screening in primary care practice, based on a woman�s first bone density T-score at age 65 or older. The study found that when women had good T-scores upon first testing, it took about 15 years for 10 percent of them to develop osteoporosis. Women with lower T-scores on their first tests developed osteoporosis sooner; it took about 1 to 5 years for 10 percent of them to develop osteoporosis.

�Dr. Gourlay�s study has proven to be very influential in the field of bone and mineral research, and it has the potential to change the way doctors order bone density tests,� said Eugene P. Orringer, MD, professor of medicine and Gourlay�s nominator for the award.

�The results should help doctors target the bone density screening so that they test patients with lower T-scores and thinner bones more frequently,� Orringer said. �The results also mean that older women with very good bone density on their first test don�t need tests to be performed nearly as often as was originally thought.�

Gourlay and other winners were honored April 18 during the Clinical Research Forum annual meeting and awards dinner in Washington, D.C.

The Clinical Research Forum is a nonprofit organization dedicated to providing national leadership in clinical research. Its mission is to generate support for clinical research and promote understanding of its impact on health and health-care delivery. Members are among the nation's most prestigious academic medical centers and health systems.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

UNC team takes first prize at global health case competition

kastlema@email.unc.edu (Linda Kastleman) — Fri, 19 Apr 2013 12:57:31 PDT

An interdisciplinary team of graduate students, some of whom attend Gillings School of Global Public Health, won first prize at the Triangle Global Health Case Competition, held April 13.

Gillings students PhuongGiang Nguyen (health policy and management) and Mariamu Mases-Amadi and Lakshmi Gopalakrishnan (maternal and child health) were members of the winning team, along with Peter Hur (pharmacy/business) and Aniket Bera (computer science).

The competition, hosted by UNC-Chapel Hill, N.C. State University and Duke University, invites teams of four to six students to develop concise, strategic recommendations for addressing a real-life global health challenge. Team members have about four days to work on their case study and prepare to compete with other teams before a panel of distinguished judges.

This year�s case involved a plan to strengthen local health systems in Pakistan.

When Pakistan�s Ministry of Health was abolished in June 2011, health care access in the country went from bad to worse. Administrative planning and budgeting were turned over to provincial health departments, which previously had been able to focus only upon the implementation of health programs.

Now, 30 percent of children under age five are malnourished in the country, and nearly nine percent of them die in their first five years. Sanitation infrastructure in rural areas is poor. Infectious diseases including acute respiratory infections, malaria, diarrhea and dystentery, tuberculosis, cholera, HIV/AIDS and polio claim many lives.

Proposals are judged on creativity and innovation, rationale and feasibility, delivery of the solution, and clarity and organization.

The UNC team�s recommendations included the use of mobile phone applications to enhance the work of a network of lay health workers.

The competition is sponsored each year by the Triangle Global Health Consortium, an organization aimed at establishing North Carolina as an international center for research, training, education, advocacy and business dedicated to improving the health of the world�s communities.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.

'Obesity genes' identified among people with African ancestry

kastlema@email.unc.edu (Linda Kastleman) — Mon, 15 Apr 2013 14:51:22 PDT

The largest genetic search for "obesity genes" in people of African ancestry has led to the discovery of new regions of the human genome that influence obesity in these populations and others.
The study, �A meta-analysis identifies new loci associated with mass index in individuals of African ancestry,� was published online April 14 in the journal Nature Genetics.

Led by researchers at the University of North Carolina�s Gillings School of Global Public Health and the University of Southern California�s Keck School of Medicine, the study was a collaboration of hundreds of scientists worldwide.

�What we found in this study sheds new light on the genes that can influence obesity,� said the study�s co-principal investigator Kari North, PhD, associate professor of epidemiology at the Gillings School. �This included discovering three new genetic variants that not only are associated with body mass index (BMI) in populations with African ancestry, but that have implications for other populations, as well.�

Specifically, the study involved more than 70,000 men and women of African ancestry. Within that population, researchers were able to identify three new genetic variants, known as single nucleotide polymorphisms (SNPs), which are associated with BMI and obesity in the sample population. Researchers found it intriguing that the SNPs are common in that population but also appear among those with no known African ancestry.

�While having these risk SNPs does not mean the individual will have a higher BMI or become obese, it does signal a predisposition,� said Christopher Haiman, PhD, professor of preventive medicine at the Keck School of Medicine. �Just to be clear, these genes account for a very small fraction of the differences in BMI noted between individuals in the population. Poor diet and reduced physical activity continue to be the main driving forces for obesity.�

However, North says, these genes are indicators of unique biological processes that may lead to increased BMI and obesity. Importantly, their identification could in the future lead to the development of medicines to reduce or even prevent obesity.

�It�s an important finding,� North said. �It provides substantial evidence that genes can influence obesity and that this genetic predisposition is likely shared across populations. The research also opens the door for more genetic studies in this area and for examination of other potential shared traits in diverse populations.�

Other study co-authors from the University of North Carolina at Chapel Hill include Mariaelisa Graff, PhD, postdoctoral associate in epidemiology; Joanne Jordan, MD, MPH, Joseph P. Archie Jr., Eminent Professor of medicine and director of UNC�s Thurston Arthritis Research Center; Leslie Lange, PhD, research associate professor of genetics, in the School of Medicine; Youfang Liu, MD, PhD, research assistant professor of genetics, Thurston Arthritis Research Center and School of Medicine; and William Maixner, DDS, PhD, Kenan Distinguished Professor of endodontics and director of the Center for Neurosensory Disorders, in the School of Dentistry.

When the study was conducted, Keri L. Monda, PhD, was a research associate professor and Sarah Nyante, PhD, and Kira C. Taylor, PhD, were postdoctoral associates, all in the Gillings School of Global Public Health�s epidemiology department.

The complete study can be found in Nature Genetics.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.