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SPRING 2019

PREVENTION

P R E VA I L S A PATH TO PEAK HEALTH EXERCISE

HEALTHY EATING REDUCING STRESS STOP SMOKING LIVE LONGER

> TRANSLATING CARE

Using technology to leap the language barrier

> GLOBAL HEALTH

Experiences provide important skills for doctors

C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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WE ARE DEDICATED TO IMPROVING AND PROMOTING THE HEALTH OF INDIVIDUALS AND COMMUNITIES IN ALABAMA AND THE REGION THROUGH LEADERSHIP IN MEDICAL EDUCATION AND PRIMARY CARE; THE PROVISION OF HIGH QUALITY, ACCESSIBLE HEALTH CARE SERVICES; AND SCHOLARSHIP.

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A MESSAGE FROM THE DEAN

SPRING 2019

GROWING PAINS Making Strides to the Future

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he College of Community Health Sciences has experienced tremendous growth since I first joined as director of our Family Medicine Residency in 2013. It has been exciting and rewarding to watch the College thrive and expand in medical education, patient care and research. Last year, CCHS launched a new medical education track, the only one of its kind in the University of Alabama School of Medicine system. Our Primary Care Track prepares medical students to become skilled primary care physicians by utilizing a longitudinal curriculum in the third year of medical education. These students are working with our faculty physicians, providing continuity of care for patients and learning in diaerent settings across the core disciplines of medicine, a departure from the traditional hospital-based model of disciplinespecific clerkships. Twenty-nine students are currently mission to educate and train rural family doctors for the region, and 50% of our graduates elect to serve in on the track and the program attracted more than 150 rural areas. We continue to recruit the best and brightest applicants last year. That’s good news as we work to candidates from across the world as our graduate medical provide desperately needed primary care physicians for education programs have grown. Our residency annually Alabama and the region. attracts more than 2,000 applicants for the 16 spots Our Family Medicine Residency continues to be we oaer. CCHS is also nationally recognized for having one of the nation’s leaders in producing well-trained the largest number of fellowships for family medicine family medicine physicians. We have not wavered in our physicians. These are board-certified physicians who seek additional training after residency – in behavioral health, emergency medicine, hospital medicine, geriatrics, obstetrics, rural public psychiatry and sports medicine. We are exploring additional fellowship opportunities in pediatrics and addiction medicine. This post-graduate training translates into more medical expertise for the communities our graduates serve. Forthefirsttimeinitshistory,CCHSisnowadegreegranting college. Students in our Master of Science in Population Health Sciences program began in fall 2018, andinfall2019wewilloaerourmaster’sdegreeinRural

“ W e work to provide desperately needed primary care

physicians for

A labama .

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DEAN’S MESSAGE

and Community Health, which had been housed in UA’s nationwide All of Us Research project, one of the largest College of Human Environmental Sciences. As with studies ever conducted by The National Institutes of our fellowships, we will look for opportunities to Health. oaerWith funding from the US Centers for Disease additional degree programs in areas most needed across Control and Prevention and the Alabama Department of campus and throughout the UA system. Public Health, CCHS researchers are working with UA’s Our ambulatory clinic and hospital encounters Center for Advanced Public Safety to develop a mobile continue to increase, approaching 150,000 visits during application to help people suaering from hypertension the previous fiscal year. This included approximately better manage their high blood pressure and communicate 60,000 University Medical Center patient visits at DCH more easily with their providers. The College also received Regional Medical Center by our hospitalists, who are now continued state funding for two important projects: the morecloselyalignedwithourmajorteachinghospital UA-Pickens and County Partnership, led by CCHS and that working together with DCH to provide quality hospital care is helping address the health status of the county; and in our Hospital and Neuro-Hospital programs. ACTION, a CCHS and city of Tuscaloosa partnership to Outpatient visits at the main University Medical Center treat 911 callers with low-level emergency conditions at on the UA campus in Tuscaloosa totaled approximately the scene, providing financial savings for patients and the 63,000 last year, and patient visits at our other locations city and reducing hospital readmissions. are also growing. UMC clinics in Northport and Demopolis How are we keeping up with this tremendous growth? have provided much-needed health care services to these We are starting with infrastructure, and I am dedicated communities. CCHS is also partnering with hospitals in in my eaorts to provide and ensure that we have the neighboring counties as the US struggles with a rural necessary bricks and mortar and other systems in place to continue the projects outlined above, and to make those currently on the drawing board a reality. With the help of my leadership team, I am continuously examining and reexaminingouruseofspace,findingwaystomoreebciently ur nstitute for ural ealth and eaectively utilize the resources we have – and we will look toward expansion in the future. esearch is implementing an Keeping up with our growth and the needs of our patients and communities throughout West Alabama also ambitious growth plan and the requires recruitment and retention of faculty and staa, including clinicians with more specialized skills. We recently efforts have already paid off added an endocrinologist, who provides specialized care for diabetic patients and those with thyroid disorders. We arelookingtooaeradditionalspecialtyservicessothatwe can further enhance the care we provide the population of patients we serve. hospital closure crisis. There will be challenges ahead, but we are committed CCHS was awarded nearly $2.5 million in federal and to working each and every day to fulfill the mission of our stategrantandcontractfundingduringthepreviousfiscal College – to improve the health of communities in Alabama year, a substantial increase over past years. Submissions and the region. by our researchers and clinicians were up more than 200%, and funding received increased more than 30%. ResearcheaortsatCCHShelpedcontributetoUA’sfirstever Carnegie Classification as one of the top doctoral research universities in the US in 2018. There is room for growth in our research eaorts and we are ready. Our Institute for Rural Health Research is implementing an ambitious growth plan, adding faculty, research analysts and assistants, post-doctoral and -DR. RICHARD FRIEND graduate students – and the eaorts have already paid INTERIM DEAN, oa. We are a site for and an important contributor to the COLLEGE OF COMMUNITY HEALTH SCIENCES

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WINTER 2018

SPRING 2019 | VOLUME 26 | NUMBER 21

TABLE OF CONTENTS

INTERIM DEAN Dr. Richard Friend

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Dean's Message

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News

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Feature - Preventing Placement Disruptions

EDITOR

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Feature - Community Education

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PREVENTION: A Path to Peak Health

Leslie Zganjar, MPA

ASSOCIATE EDITORS Kaylin Bowen Erin Tech

CREATIVE DIRECTOR

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Fitness Trends

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The Best Exercise? Just Move

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Find What Moves You with Dr. Ray Stewart

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Sports Medicine Fellows

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Millennials Changing Food, Eating Trends

Kaylin Bowen Erin Tech Nicholas Jones

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Hiding in Food, Harming Health

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Healthy Eating in Your Community

COVER PHOTOGRAPHER

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Being Mindful of Stress

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Working Together

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Lighting Up Electronically

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Preventable Health Risks and Deaths

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Scholarly Activism

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Discouraging Dementia

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Geriatricians: A Rare Breed

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Feature - Translating Care

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Feature - Global Health

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Snapshots

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New Faculty

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Accolades

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Academia

Erin Tech

WRITERS

Leslie Zganjar, MPA

DESIGNERS

Greg Randall

PHOTOGRAPHERS Greg Randall Zachary Riggins UA Photography

ON THE COVER Mindfulnessisjustone thing to consider on your path to peak health. Learn from UMC providers about how to create your own path to a longer and healthier life (page 13).

On Rounds is a semiannual publication of The University of Alabama College of Community Health Sciences. Please send address changes and correspondence to Erin Tech, College of Community Health Sciences, The University of Alabama, Box 870326, Tuscaloosa, AL, 35487 or erin.tech@ua.edu.

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NEWS

UMC-Northport Recognized as Patient-Centered Medical Home University Medical Center-Northport was recently and interim chair of the College’s department of nationally certified as a Patient-Centered Medical family, internal, and rural medicine, who led the UMCHome in recognition of its commitment to place Northport team that met weekly for 18 months to patients at the center of care and to advance quality in achievetheNCQAcertification. the health care it provides. Along with UMC-Northport, CCHS also operates UMC-NorthportjoinstheTuscaloosaUMClocation University Medical Center in Tuscaloosa and UMCin receiving the PCMH accreditation. The recognition Demopolis, which together comprise the largest multiby the National Committee for Quality Assurance specialty medical practice in West Alabama with more means medical practices have made a commitment than 150,000 patient visits last year. The practice to provide health care that is patient-centered, provides primary care-focused health services accessible, continuous, comprehensive, coordinated in family medicine, internal medicine, pediatrics, and quality-focused. women’s health, psychiatry, geriatrics, neurology, “This is an important recognition because research endocrinology and sports medicine. shows that being patient-centered and having PCMH UMC’s Tuscaloosa location received PCMH accreditation improves patient care,” said Dr. Richard accreditation for its family medicine and pediatrics Friend, interim dean of UA’s College of Community clinics in December 2017. Weida also serves as Health Sciences, which operates UMC-Northport. “As clinical director of the Family Medicine Clinic at UMC we move into a quality-based reimbursement system, in Tuscaloosa. it will be important that all of our clinics reach these Some of the categorical benchmarks needed standards. We are certainly working toward that goal.” to meet PCMH accreditation include: enhancing The PCMH model uses a health care team, led by access to care and continuity of care; planning and a primary care physician, that delivers coordinated managing care; identifying and managing specific and integrated care and that is proactive in providing patient populations; providing self-care support and preventive, wellness and chronic illness care – all with community resources; tracking and coordinating care; the patient at the center of the healthcare experience. and measuring and improving performance. Research shows that the PCMH model builds These eaorts can translate into reminders to better relationships between patients and their clinical patients about their chronic and preventive care care team, improves quality of care as well as the needs, more regular screenings, after-hours care, patientexperienceandstaasatisfaction,andreduces use of electronic health records to improve ebciency health-care costs. The PCMH has also been shown to of care and to monitor chronic diseases, and use of help patients be more compliant and more successful multiple channels of communication, including webin managing chronic health conditions. based portals for patients to request appointments “We are leaders in practice transformation,” said andprescriptionrefills. Dr. Jane Weida, associate professor of family medicine

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SPRING 2019

College Partners with Alabama Statewide Area Health Education Centers Helping Alabama’s Rural Students Return Home as Health Professionals

The College of Community of the academy, students receive Health Sciences has partnered two hours per week of preparation with the Alabama Statewide Area for the ACT college entrance exam, Health Education Centers (AHEC) college and career exploration, work program. AHECs are committed toward certification in phlebotomy to expanding the health care and tour local hospitals. workforce and maximizing For the past 25 years, the CCHS workforce diversity, especially Rural Programs have operated as in underserved communities, in a pipeline system that starts in high school, for juniors an eaort to increase access to care and improve the and seniors, to prepare students for opportunities in overall health of communities - a mission that is highly health care professions following graduation and before reflective,andoverlapping,oftheCCHSmission. they begin higher education and training. In recognition The College began working directly with the West of the positive impact that AHECs have had throughout Central Alabama AHEC, based in Demopolis, last the state, the College determined that the opportunities year. The College’s rural scholastic-year programs for advancement for Alabama students would be have already transferred to AHEC implementation and exponentially higher with the network that AHEC has in include the in-school Health Careers 101 and the afterplace statewide, beyond medical school and including school Health Profession Academy. other health care professions. Health Careers 101 provides health career exploration workshops and is oaered at five high schools in West “It serves the mission of the College to continue to support the region in terms of leadership in medical Alabama - Francis Marion School in Marion, Selma education through assistance to our area partners,” High School in Selma, Robert C. Hatch High School in said Dr. Richard Friend, interim dean of CCHS. “AHEC Uniontown, Choctaw County High School in Butler, and has become established nationwide, in the majority of Greene County High School in Eutaw. To date, more states, and this is a historic role in which they have deep than 300 students at the schools have participated. experience and success.” Students in the Health Professions Academy are The partnership will extend opportunities to high nominated by their teachers and the program accepts school students in rural areas of Alabama, enabling 12 students from each school, with two students from each grade. The academy is oaered at the same high the College to expand guidance and support to rural students throughout their school careers in a more schools as Health Careers 101, although Demopolis High meaningful way. School takes the place of Selma High School. As part

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NEWS

PICKENS COUNTY

20,000 PEOPLE 2 AMBULANCES

Telemedicine Grant Saving Lives Through Communication The College of Community Health Sciences was on the grant. awarded a $128,664 grant to bring telemedicine capacity The technology system that will be implemented to Pickens County, a rural and underserved county in West provides for improved communication between Alabamawheremanyresidentssuaerwithchronichealth physicians and EMS teams both before or during an conditions and live long distances from the hospital. ambulance trip. A clinic workstation will be established The funding will be used to provide telehealth within the Pickens County Medical Center emergency equipment to Pickens County ambulances and the room that will be fully compatible with the ambulancePickens County Medical Center Emergency Department based system. to enhance communication between paramedics and “Improved communication between health care emergency room physicians. professionals at the hospital and paramedics is needed to “The goal is to improve health and health care by maximize the quality of care given to patients at the point equipping and training emergency personnel to respond of need,” Culmer said. He said the project also seeks to to and treat emergency situations, and to reduce care reduce the cost of care by preventing unnecessary and costs by improving their ability to determine an emergency expensive ambulance rides and emergency room visits. situation from a non-emergency,” said Dr. Nathan Culmer, Crawford will provide medical oversight, training and assistant professor of Medical Education for CCHS and quality assurance as medical director of the project. lead investigator on the grant. The three-year grant is part of the US Department WorkingwithCulmerare:GlennDavisandTravisParker of Agriculture’s Distance Learning and Telemedicine of the CCHS Emergency Medical Services Program; Dr. Grant Program, which is administered by the WilliamCrawford,aboard-certifiedemergencyphysician Rural Utilities Service. and medical director for the Alabama Department of CCHS has a strong relationship with Pickens County Public Health State EMS Program; Dr. Todd Smith, a and is partnering with the county on a number of initiatives faculty member from UA’s Capstone College of Nursing; to support the healthcare system there. and Catanya Stager, a graduate research assistant Pickens County Medical Center is a 56-bed hospital in for the College in Academic Technologies and Faculty Carrollton that serves the county of nearly 20,000 people. Development. Pickens County Medical Center and the Northstar EMS operates emergency services in Pickens Pickens County branch of Northstar EMS are partners County via the only two ambulances in the county. BY LESLIE ZGANJAR

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SPRING 2019

Reducing Infant Mortality Rates in Rural Areas Family medicine physicians trained in obstetrics can have a profound impact on infant mortality rates in rural areas, according to research conducted by physicians and faculty of the College of Community Health Sciences. Their research shows obstetrics services provided by family medicine physicians in rural Pickens County, Alabama, resulted in an improved infant mortality rate for the county, and that the availability of local prenatal care was also associated with a lower infant mortality rate. The results were published in The Journal of the American Board of Family Medicine, July-August 2018 issue. Drs. Jessica Powell, Catherine Skinner, Drake Lavender, Daniel Avery and James Leeper authored the article and conducted the research. The results are especially impactful for Alabama, a largely rural state. Despite a declining national infant mortality rate, the state’s rate has shown less improvement. In 2013, Alabama ranked 49th in the nation for infant mortality. The College, meanwhile, continues to work to reverse those numbers, particularly through its Obstetrics Fellowship, which trains family medicine

physicians in obstetrics care. According to the journal article, Pickens County had no obstetrics services, including prenatal care, from 1986 to 1991, and the infant mortality rate was 17.9. The rate is defined as the number of deaths among infants less than one year of age per 1,000 live births. From 1993 to 2002, full obstetrics services, including prenatal care and delivery, were available in the county and the infant mortality rate dropped by 60%, resulting in a rate lower than both the state and national rates during that period. Unfortunately, Pickens County lost local labor delivery services in 2002 when the Pickens County Medical Center closed its labor and delivery unit, and from 2005 to 2013 only prenatal care was available – provided by one family medicine physician trained through an obstetrics fellowship. While the infant mortality rate increased during this period, the rate was less than the period when no obstetrics care – prenatal or delivery services – was available locally.

In 2016

534 Infants Died in Alabama* Dr. Catherine Skinner is an obstetrics-trained family medicine physician at University Medical Center. *United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics (DVS). Linked Birth / Infant Death Records 2016. Rate of 9.03/1,000 births. Ranking last in the nation. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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NEWS

Combatting Pediatric Obesity charts, is a screening method to determine if children and adolescent-aged patients have healthy weights, or if they are overweight or obese. Previous funding for pediatric weight management eaorts sponsored a physician specializing in pediatric weight management for a general session to train the College’s physicians, residents and medical students. Funding also enabled the Department of Nutrition Services to establish a program that brings a produce stand inside UMC, enabling UMC health providers to showpatientsdiaerentwaystoincorporateproduce into their diets. BY LESLIE ZGANJAR Suzanne Henson is a registered dietitian who cares for patients at University Medical Center. A College of Community Health Sciences program to help combat childhood obesity received funding from BlueCross BlueShield of Alabama. The funding will be used to provide ongoing training for the College’s family medicine residents in addressing pediatric overweight and obesity using a patient-sensitive and family-centered approach. Guest speakers who specialize in pediatric overweight and obesity will be brought in to train residents on how to diagnose pediatric weight issues. The College considers the diagnoses of childhood overweight and obesity critical health issues,anditseaortstoaddresstheseconcernsare conducted through the proposed Think, Eat, Move! Interdisciplinary Clinic housed within University Medical Center, which is operated by the College. “Our intent is to provide nutrition education for the children and adolescent patients and their parents and caregivers in our clinics so that they do not enter adulthood with chronic diseases, such as Type 2 diabetes,” said Suzanne Henson, a registered dietitian who directs UMC’s Department of Nutrition Services. During a one-year period in 2017, UMC’s Family Medicine Clinic documented the body mass index for age (BMI-for-Age) in 64% of encounters for patients ages 2 to 18 years and found that 42% of the patients were overweight or obese. Ten percent of the documented BMIs-for-Age were between the 85th and 94th percentile (overweight), and 32% were at or above the 95th percentile (obese). BMI-for-Age, as plotted on pediatric growth 8

UMC 2017 Pediatric Obesity Rates

32% OBESE

10% OVERWEIGHT

58% AVERAGE


Preventing Placement

WPI N S R ITNEGR 22 00 11 98

disruptions

BY LESLIE ZGANJAR

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he last thing foster parents want is to send a fosterchildtoanotherhome.Butdibcultand trying behavior, which can be the result of previous trauma, sometimes makes that unavoidable. It’s known as placement disruption. Dr. Nancy Rubin, professor of psychiatry and behavioral medicine at the College of Community Health Sciences, believes placement disruption can be prevented by identifying disruption predictors, and then intervening with services already available in the community. Rubin, also a clinical psychologist at University Medical Center, which CCHS operates, is working with other University of Alabama faculty and social services providers in Tuscaloosa to implement an intervention intended to help manage problem behaviors in foster children who have experienced trauma. Together with Dr. Debra Nelson-Gardell, associate professor of social work at UA, UMC’s Pediatrics Clinic, the Alabama Department of Human Resources, Indian Rivers Behavioral Health, Youth Services Institute and community

physicians, the group is working to implement Trauma Systems Therapy for foster children, an evidence-supported,trauma-specificintervention that focuses on environmental factors related to a child’s traumatic experiences. Rubin and Nelson-Gardell, co-coordinators of the project, decided to focus the Trauma Systems Therapy model on foster care placement disruption, to assist foster children in Tuscaloosa who have been removed from their homes and placed in foster homes, and who are in danger of being removed from those homes and placed into residential care. It’s not that these are bad kids, Rubin and Nelson-Gardell said. “These are traumatized kids. There are triggers, and then these kids experience fight, flight or freeze, which are survival states,” Rubin said. “If you can see that the behaviors traumatized children show are a result of their trauma and are a result of them trying to survive that trauma, that’s fundamentally diaerent than thinking, ‘You’re a bad kid,’” said Nelson-Gardell. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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F E AT U R E

Dr. Nancy Rubin believes placement disruption can be prevented by identifying disruption predictors, and then intervening with services already available in the community. Added Rubin: “We want to take resources that are already here in the community and combine them in diaerentwaystogetdiaerentresults.” Nelson-Gardell was somewhat familiar with the Trauma Systems Therapy model, developed by Dr. Glenn Saxe of New York University Medical School and now used in 16 states. She and Rubin got Saxe’s book, Trauma Systems Therapy for Children and Teens, and started reading. In August, Rubin, Nelson-Gardell and more than 100 foster parents, social workers, therapists and child services professionals attended a TST community training session at the Alabama Fire College in Tuscaloosa.

down and function and learn how to deal with dibcult situations,” Rubin said. “Environments can’t necessarily be made stress and trigger free, so children need to be taughthowtohandledibcultsituations.” Nelson-Gardell said the approach provides a very thorough and systematic review of what’s going on aroundthechild.“Theeaortistochangewhathappened in the environment that triggered the child so that you can modify and be aware of that, which will allow the therapy to help the child better manage their feelings and have better behavior,” she said. Rubin said the goal for the first year of TST in Tuscaloosa,thefirstsuchprograminAlabama,istoserve 25 children. Foster children, typically between the ages of These are traumatized kids. 4 and 18 years, will be referred by DHR, and some in that group may be at risk of disrupting their home placements. There are triggers, and then Tuscaloosa’s TST program has a system of assessments, program evaluations, in-home trainings and these kids experience fight, therapy by the Alabama Youth Services Institute, DHR, Indian Rivers, and UA researchers and doctoral students. flight or freeze, which are Foster children might be referred to a mental health care survival states. provider, including Rubin, for regulation-focused therapy. “We want to settle them down, make sure they have a Attendees received an overview and rationale of the TST safeenvironmentandteachthemskillsthatfocusfirston model, as well as information about how trauma aaects the immediate and later on the original trauma,” she said. brain development and behavior. Saxe provided the The multidisciplinary approach may see as many as 10 training, which focused on team members functioning people interacting with the child each week, and they are as detectives. all part of each child’s case review, which strengthens the “What I love about this treatment is that we’re looking foundationofwhatmakesTSTbothuniqueandeaective: at it like we’re detectives. First, we want to make the understanding the numerous triggers that can lead to environment safe. Then we look for other triggers and problem behavior, even if a child’s trauma isn’t known. remove those triggers so that the children can calm

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SPRING 2019

Community Education

initiative of Dr. Thomas Weida, a family medicine physician and chief medical obcer of University Medical Center, which CCHS operates and where its faculty practice and care for patients. He established a similar program while faculty at Penn State Hershey College of Medicine that lasted for 16 years and educated hundreds of community members about health-related topics. When Weida joined CCHS several years ago, he couldn’tfindanythinglikeMiniMedicalSchoolalreadyin the community, so he decided to start a program. OLLI’s he College of Community Health Sciences is dedicated course structure made the organization an ideal partner, to improving and promoting the health of individuals and he said. “This is a way to get patient information out into our communities in Alabama, and one way it works to achieve this community, and to get the name of the College out there mission is through education. But not just education of medical students and familyand to tell people what we do and what all we can do,” medicine resident physicians. Via community education Weida said. Eight lectures are given each spring and fall semester, courses and guest lectures, CCHS is extending access to health education and knowledge to residents of West Alabama. with topics chosen based on both OLLI member requests The College’s Mini Medical School Program, a partnership and subjects that CCHS faculty physicians believe are of CCHS and The University of Alabama’s OLLI Program, important for people to better understand. In 2018, the Mini Medical School Program expanded to features lectures provided by College faculty physicians about current topics, issues and advances in medicine and health. include quarterly lectures on geriatric topics to residents OLLI, short for Osher Lifelong Learning Institute, is a member- of Capstone Village, a retirement community located on the UA campus. led program catering to those aged 50 and older. “We are about education,” Weida said. “The battlefront Mini Medical School, which launched in 2016, was an

T

“ The battlefront of medicine in

the future is not an antibiotic. It’s lifestyle. And that needs education.

Dr. Thomas Weida Associate Dean of Clinical Affairs Chief Medical Officer, University Medical Center

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F E AT U R E

of medicine in the future is not an antibiotic. It’s lifestyle. And that needs education.”

Education is key in the self-management of diabetes.

Angela Hammond Nurse Practitioner

patients, other practices in West Alabama can refer patients and they, too, can participate in the program. The average age of class participants is 50 years, but there have been patients as young as 13 years and many in their 80s, Hammond said. “Education is key in the self-management of diabetes and in the prevention of future complications,” she said. “It is (the program’s) mission to empower patients to achieve optimal health by increasing knowledge through education classes and other learning opportunities.”

InadditiontoMiniMedicalSchool,UMCoaersdiabetes education classes to UMC patients. The Diabetes SelfManagement Education (DSME) classes are designed to provide diabetics with skills to help manage their disease and with lifestyle modification to help improve their condition. Each class covers a diaerent topic, provides opportunities for patients to ask questions of UMC health care providers and allows participants to share tips and learn from their classmates. “We live in the (US Centers for Disease Control and Prevention) designated Diabetes Belt,” said Angela Hammond, a nurse practitioner at UMC and DSME quality coordinator. “Our patient population has a high percentage of diabetics and pre-diabetics, and patient education is very much needed in order for patients to be active participants in preventing diabetic-associated complications.” DSME classes started at UMC in 2010, and in 2012, the program received the American Diabetes Association RecognitionandCertification,whichcontinuestoday. While most patients in the DSME program are UMC

HOW MILLENIALS ARE CHANGING FOOD TRENDS Suzanne Henson, RD, LD

PRECISION MEDICINE Dr. John C. Higginbotham

COLONOSCOPIES Dr. Drake Lavender

THE VALUE OF VACCINES Dr. Pamela Payne-Foster

DIABETES Dr. Ed Geno

SPORTS CONCUSSIONS AND CTE Dr. Catherine Ikard

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PREVENTION

P R E VA I L S

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SPRING 2019

A PATH TO PEAK HEALTH

e often look to medications and medical treatments to achieve good health, but prevention can playavitalroleinstavingoasomediseases and poor health conditions. It turns out those healthy habits we always hear about really can make a diaerence when it comes to good health, whether you’re in your 20s and 30s, and even in your 60s and 70s – and research shows it’s never too late to start. Eat a healthy diet and exercise, if you smoke quit, and try and reduce stress. That’s according to experts at the College of Community Health Sciences and University Medical Center. The College, which provides medical education and training to medical students and resident physicians, also operates UMC, the largest multi-specialty community medical practice in West Alabama. UMC also forms the base for the College’s academic and clinical teaching programs. On the following pages, CCHS faculty and UMChealthcareprovidersoaerinformation about prevention and improving health, and they provide insights about emerging trends in health. Read on to learn how a focus on prevention and wellness in medical education and patient care is one way the College is fulfilling its mission of improving health in communities.

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PREVENTION PREVAILS

EXERCISE

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2019

SPRING 2019

FITNESS TRENDS Every year, the American College of Sports Medicine surveys thousands of fitness professionals about health and fitness trends and publishes the results in the ACSM Health and Fitness Journal. The top 10 fitness trends for 2019:

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WEARABLE TECHNOLOGY

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GROUP TRAINING

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HIGH-INTENSITY INTERVAL TRAINING

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FITNESS PROGRAMS FOR OLDER ADULTS

Usingsmartwatches,fitnesstrackersandheartmonitors.

Workingoutwithmorethanfiveotherparticipants,aswellasonlinegroupworkoutclasses.

Short bursts of high-intensity exercise followed by short periods of rest.

Cateringtooldergenerationsandprovidinghealthbenefitsthatcomewithbeing active, including maintenance of bone density and muscle mass.

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BODY WEIGHT TRAINING Using your body weight to exercise (push-ups and planks).

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EMPLOYING CERTIFIED FITNESS PROFESSIONALS

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YOGA

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PERSONAL TRAINING

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FUNCTIONAL FITNESS TRAINING

Individualized instruction and goal setting with a trainer.

Improving activities of daily living by improving balance, coordination, strength and endurance.

10 EXERCISE IS MEDICINE

Encouraging health providers to get patients on an exercise regimen and analyzing physical activity at regular check-ups. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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PREVENTION PREVAILS

THE BEST EXERCISE?

JUST

MOVE

The American College of Sports Medicine recommends between 22 to 35 minutes of moderate to vigorous out to the point of exhaustion, daily exercise to lose weight. If cardiovascular health is your Robinson said. He likes to use the term activity, noting that goal, “moderately intense activity of many daily activities – walking, 3 0 minutes a day for five days of the Dr. James Robinson, endowed chair housework, taking the stairs week” is required, Robinson said. Brisk of sports medicine. instead of the elevator, parking walking, cycling, swimming and even farther from the door when going dancing elevate the heart rate and BY LESLIE ZGANJAR shopping or to work, and getting keep it elevated for a sustained period up from your desk periodically oftime,whichimprovesbloodflowand hat exercise is right for and walking around the obce – the body’s ability to deliver oxygen and you? That depends on what are ways to be active. energy to working muscles. you want to accomplish, said Dr. Exercise makes it easier for those If losing weight is your goal, James Robinson, endowed chair taking in fewer calories, or with type 2 diabetes to control blood of sports medicine for the College burning more, will do the trick. sugar levels, Robinson said, adding of Community Health Sciences. Decreasing calories by 500 a that with exercise, muscles get the Trying to lose weight? day, either by consuming less or glucose they need and the body’s Maintain cardiovascular fitness? burning more, translates into a overall blood sugar level decreases. Control your diabetes? While loss of one pound of fat per week. Exercise not only lowers blood glucose exercise can benefit all of these Losing weight more quickly levels but can help with weight loss and goals, “each requires diaerent requires burning more calories, lead to improved outcomes, or even intensities of exercise,” said and that demands high intensity eventual cure of adult onset diabetes. Robinson, who cares for patients activity or longer exercise periods, There is not an organ system or at University Medical Center, Robinson said. Aerobic exercise, disease process that is not improved which the College operates, and such as walking, running, cycling with increased activity, Robinson said. University of Alabama athletes as and swimming, is a popular type “Everything from osteoporosis to head team physician for the UA of weight-loss exercise. High mental health can be improved, and it Athletic Department. intensity interval training, which doesn’t require spending a lot of money People are often afraid of the alternates between short bursts or joining a gym. All it takes is a little word exercise, thinking it means of intense exercise and periods time – 3 0 minutes a day, five days a joining a gym, buying expensiveof lower intensity, is also an week, and this can even be broken up exercise equipment or working eaective way to burn calories. into separate 10- to 15-minute bouts.”

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SPRING 2019

FIND WHAT MOVES YOU DR. RAY STEWART

is a sports medicine physician at University Medical Center and assistant professor of family medicine at the College of Community Health Sciences, which operates UMC. He is also a team physician for The University of Alabama Athletic Department.

WHAT DO YOU DO TO STAY ACTIVE? Cycling. I do mountain biking and road biking, and I have a stationary bike at home. I mostly do the stationary bike at home on weekdays and then on the weekends I’ll do a road ride or a mountain bike trip, usually in the local area. I also do charitable rides. Last year, I did five Century Rides (10 miles) for charity. The rides are on rural roads in Alabama. It’s very peaceful and they’re all for good causes. I also occasionally run with my son, who is 10 years old.

WHAT ARE SOME TIPS YOU HAVE FOR SOMEONE WHO WANTS TO LIVE A HEALTHIER LIFE? Whateveryoudo,itneedstobeenjoyableand sustainable. I started taking the stairs instead of the elevator. I don’t need to park right next to the door at Target. I can park farther away and walk. Those little things add up. Finding what youenjoyandlittlethingsyoucanincorporate throughoutthedaymakesabigdiaerence.

ARE THERE ANY HEALTH-RELATED GOALS YOU HAVE ACHIEVED RECENTLY OR PLAN TO ACHIEVE?

WHAT MOTIVATES YOU TO STAY My cholesterol is better than it has ever been. ACTIVE? A big motivator of being healthy is to be around in the future for my kids. My dad passed away at (age) 60 from heart disease, so I want to live longer. I want to give myself the best opportunity to be around years from now.

WHAT ARE SOME BARRIERS BEING PHYSICALLY ACTIVE?

TO

My blood sugar is controlled without medicine. My cardiovascular fitness level went from average to excellent. I’m planning to do more thanfiveCenturyRides(thisyear).

WHAT IS AN ITEM ON YOUR BUCKET LIST?

I want to go to France in the summer during the tour de France and follow the entire race Beingadoctor,I’msobusy,justlikeeveryoneelse for the three weeks. It’s a beautiful ride on the is. I have to make sure I do some type of physical countryside with the scenery. I love cycling so activityusuallyfirstthinginthemorning. it would be a great trip.

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PREVENTION PREVAILS

SPORTS MEDICINE FELLOWS

CARING FOR HIGH SCHOOL ATHLETES F

amily medicine physicians are often called on to Alabama and the region as fellows graduate and establish serve as team physicians for high school sports their practices. programs in their communities. To help them fill that Sports medicine fellows also care for patients at the role, the Sports Medicine Fellowship at the College College’s Dr. Bill deShazo Sports Medicine Center, located of Community Health Sciences oaers education and within University Medical Center, which is operated by training in sports medicine care. the College. The center is named in honor of the late Dr. The year-long fellowship is designed for physicians William F. deShazo, a longtime College faculty member who who have completed a family medicine residency. introduced a sports medicine rotation into the College’s During the year, fellows work with local high school curriculum. deShazo also chaired the College’s Department athletes, as well as University of Alabama athletic team of Family Medicine and directed its Family Medicine physicians, coaches, trainers and athletes, including Residency. In addition, he served as the team physician at UA sporting events. for the UA Athletic Department from 1972 to 1985 and as The fellowship, which launched in 2010, has a personal physician to former head football Coach Paul impacted community sports programs throughout “Bear” Bryant.

SPORTS MEDICINE CARE IN YOUR COMMUNITY

The team of sports medicine physicians and fellows at University Medical Center cares for Alabamacollegiateandhighschoolathletes:

HIGH SCHOOL

COLLEGIATE

COMMUNITY

Tuscaloosa County High School Athletics

THE UNIVERSITY OF ALABAMA

Tuscaloosa Hot Hundred Bike Ride

Sipsey Valley High School Athletics

Football

Tuscaloosa Half Marathon

Hillcrest High School Athletics Alabama High School Athletic Association All-star games Alabama High School Athletic Association All-star championship events

Gymnastics Softball Women’s Basketball Swimming Track Rowing Cheerleading and dance teams Recreation Center club sports Adapted Athletics Theatre and Dance Department SHELTON STATE ATHLETICS

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Alabama Sports Festival Alabama Boxing Commission Alabama Fighting Championship/ Mixed Martial Arts Good Samaritan Musculoskeletal Clinic


SPRING 2019

HEALTHY EATING

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PREVENTION PREVAILS

MILLENNIALS CHANGING FOOD AND EATING TRENDS

We can make these trends and things millennials are demanding work for everyone.

Suzanne Henson, registered dietitian

BY LESLIE ZGANJAR Among the trends they are driving, and grocery stores and other businesses are working to deliver, are convenience, customization and illennials are driving new trends healthy food. Henson said millennials in the food industry, but those want convenient grab-and-go food changes can help everyone, from the grocery store, like hardsaid Suzanne Henson, a registered boiled eggs and fresh prepared dietitian at University Medical Center meals. They want meal kits that can and assistant professor of family, be ordered online and delivered to internal, and rural medicine at the the home, and shopping and food College of Community Health Sciences. delivery services like Shipt, Instacart, She said millennials, those born Ubereats and Waitr. They want between 1981 and 1996, according to food that is natural, organic, locally the Pew Research Center, and aged 22 sourced and made with earth friendly to 37, are the largest segment in the US practices and sustainable packaging. workforceandtheywanttwokeythings: Henson said millennials also spend healthier food and easier access. more of their budget eating out or

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eating take-out, so restaurants and fastcasual chains have increased healthier options and delivery services. She said these developments can benefit everyone. When people order online, they get only what they order; in grocery stores, there are more opportunities to make impulse decisions. Restaurants and fast-casual chains have improved their menu options, making many of them healthier. Even grocery stores have embraced the changes, oaering more simplified foods (low sugar, fewer ingredients), plant-sourced meat (quinoa burgers) and pre-packaged healthier meals that can be prepared or microwaved at home. “We can make these trends and things millennials are demanding work for everyone,” Henson said.


HIDING IN FOOD, HARMING HEALTH

WINTER 2018

BY LESLIE ZGANJAR

P

eople consume more sugar and salt than they should and it’s harmful to their health. According to the federal 2015-2020 Dietary Guidelines for Americans, people in the US currently consume more than twice the recommended daily amount of sugar and up to four times the amount of salt, increasing their risk for obesity, diabetes, high blood pressure and heart disease. A large portion of the sugar people consume comes from sugar-sweetened beverages, including sodas and, particularly in the South, sweet tea, said Suzanne Henson, a registered dietitian at University Medical Center. She said limiting sugary drinks, and drinking water instead of soda, means fewer calories and better blood sugar levels. Consumption of sugar-sweetened beverages can also lead to unhealthy food choices, said Henson, also assistant professor of family, internal, and rural medicine at the College of Community

Health Sciences, which operates UMC. “None of us craves an apple or a banana or an orange when we drink a soda. We want salty snack foods,” she said. According to the American Heart Association, much of the hidden salt people consume comes from processed and prepared foods.Hensonsaidsaltistypicallythetradeoa for convenience. “When you go into a restaurant, whether it’s fast food, take out, or sit down, you’re getting more salt than you realize. If you tend to run to a sandwich and soup shop for lunch, that’s one of the highest sources of salt that you can get eating out.” Henson said people can reduce the amount of sugar and salt they consume with careful attention to food choices, reading food labels and modifying how they prepare food. Among her suggestions: use herbs and spices instead of salt, and replace those spice packages in rice and pasta pre-packaged meals with lowsodium chicken broth.

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PREVENTION PREVAILS

HEALTHY EATING IN YOUR COMMUNITY DIABETES EDUCATION UniversityMedicalCenter,whichisoperatedbytheCollegeofCommunityHealthSciences,oaersdiabetes education for patients at all of its locations – Tuscaloosa, Northport and Demopolis. The Diabetes SelfManagement Education course consists of two classes that are three hours each. The classes are taught by CCHS faculty and UMC providers and cover the following topics: the basics of diabetes – how to monitor glucose and blood sugar levels, how and where to give insulin shots and how insulin works with the body; diabetes medications and their potential side eaects; the importance of exercise; and dealing with depression,amajorsideeaectofthedisease.UMCfirststartedtheDiabetesSelf-ManagementEducation program in 2011 at its Tuscaloosa location.

MANAGING DIABETES THROUGH FOOD UniversityMedicalCenteroaersguidedgrocerystoretourstoitsdiabeticpatientsaspartofitsDiabetesSelfManagement Education course. The tours were added after receiving feedback from patients who wanted to better apply what they learned in the diabetes education course at the grocery store. UMC nutritionist Suzanne Henson, a registered dietitian and assistant professor of family, internal, and rural medicine at the College of Community Health Sciences, which operates UMC, leads the guided tours. During the tours, patients are introduced to new foods and new ways to use them, and they learn how to decipher nutrition labels to better understand what is in the foods they buy.

DIABETES DOCTOR Alabama ranks third in the US for the percentage of adults who have diabetes and is located squarely in the diabetes belt, according to the US Centers for Disease Control and Prevention. People who live in the diabetes belt are more likely to have Type 2 diabetes, which is associated with obesity and a lack of exercise. Now, in addition to diabetes education classes and guided grocery store tours, University Medical Center oaersspecialtycarefordiabeticandpre-diabeticpatientsviaDr.RobertOsburne,anendocrinologistwho joinedUMClatelastyear.Endocrinologistsarephysicianswhodiagnoseandtreatdiseasesanddisorders of the endocrine system, including diabetes and thyroid disorders. Osburne has 35 years of clinical practice experienceandwasattheSimonWilliamsonClinicinBirmingham,Alabama,beforejoiningUMC,whichis operated by the College of Community Health Sciences.

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HEALTHY EATING IN YOUR COMMUNITY BETTER BITES EmployeesatTheUniversityofAlabamacannowparticipateinafive-sessionnutritionprogramtaughtby University Medical Center nutritionist and registered dietitian Suzanne Henson. The program, Better Bites, is oaered by WellBAMA, UA’s signature wellness program for faculty and staa. Better Bites guides UA employees through ways to improve their food choices and to help them improve their health “one bite at a time.”Employeeslearntomakesmartchoicesinthesupermarket,tryquick-fixmealsandfillingsnacks,and learnhowfoodfuelsthebody.Twoserieswereoaeredthisspringandincludedgrocerystoretoursprovided by Henson, also an assistant professor of family, internal, and rural medicine at the College of Community Health Sciences, which operates UMC.

HEALTH CARE MEETS FOOD TheCollegeofCommunityHealthSciencesoaersaCulinaryMedicineelectivecourseforitsmedicalstudents and resident physicians to teach the important connection between good health and healthy eating. The course is a partnership of CCHS and The University of Alabama College of Human Environmental Sciences and includes lectures and interactive cooking demonstrations. The course seeks to better educate medical students and resident physicians about nutrition and diets so that they can better educate patients and provide helpful information when addressing chronic disease management and obesity.

U M C FA R M E R ’ S M A R K E T This summer, the farmer’s market came to University Medical Center. UMC joined forces with Ingram’s Farmers Market and Garden Center to bring fresh vegetables to employees and introduce patients to foods they might not have tried. The farmer’s market was located in the lobby of UMC every other Thursday throughout the summer.

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PREVENTION PREVAILS

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o highlight the benefits of exercise and healthy eating, the College of Community Health Sciencesfiveyearsagolauncheditsfirst-ever–and possibly the only one of its kind anywhere – Brussels Sprout Challenge. On March 2, the College and University Medical Center, which it operates, held the 5th annual Brussels Sprout Challenge in downtown Tuscaloosa. CCHS and UMC host the unique challenge each year as part of the American Heart Association’s West Alabama Heart Walk. Partnering again with Manna Grocery and Deli in Tuscaloosa, which roasts and donates the Brussels sprouts served at the walk, UMC and CCHS use the challenge to promote healthy lifestyle choices – a healthy diet and exercise – while complementing the American Heart Association’s mission to build healthier lives free of heart disease and stroke. This year, more than 700 people participated in the Brussels Sprout Challenge. To complete the challenge, participants have to eat one Brussels sprout at each mile of the 3.1-mile walk. Those who complete the challenge by eating all three Brussels sprouts receive a t-shirt, Brussels sprout recipes and other items at the completion of the walk. The mission of UMC and CCHS is to help improve and promote the health of individuals and communities in Alabama and the region.

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SPRING 2019

REDUCING STRESS

C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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PREVENTION PREVAILS

BEING MINDFUL OF STRESS

BY LESLIE ZGANJAR

S

tress is a normal part of life and, it is bringing attention to experiences at times, serves a useful purpose, occurring in the present moment. “It’s paying attention in a certain way,” challenging us and helping us grow. But too much stress over a long said Boxmeyer, who also cares for patients at University Medical Center, which the College period of time can be unhealthy. Chronic stress causes wear and tear on operates. “It’s noticing the types of things that the body, leading to and aggravating more are on your mind, noticing what’s going on serious health issues. It can cause high blood around you in the present moment, noticing pressure, abnormal heartbeat, a weaker how your body is feeling – and noticing with intentionandwithoutjudgment.” immune system, depression and anxiety. Focusing on the present is key, she said. One way to cope is with mindfulness, said Dr. Caroline Boxmeyer, professor of Dwelling on the past, or experiencing fear and psychiatry and behavioral medicine at the insecurity about the future, can be stressful andmakeitdibculttoenjoythepresent. College of Community Health Sciences. Boxmeyer said mindfulness is a way Mindfulness is talked about and practiced more today because research shows that of being, “where you go through your day it is good for health, Boxmeyer said. “It’s more aware of the present, rather than being becomingtobethoughtof,justlikeexerciseisfocused on the past or future. “We can never really turn oa our brains, good at making our body healthy, mindfulness is a psychological practice that can make us but with regular practice, you can learn to still or calm your thoughts so you’re not as mentally healthy.” What, exactly, is mindfulness? Essentially, frantic,” she said.

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SPRING 2019

Working Together Behavioral health and primary care BY LESLIE ZGANJAR

P

rimary care physicians are often on the front Collaborative Care Model. The most common lines of mental health care and among the diagnoses were depression, anxiety and Postfirst providers to identify possible mental Traumatic Stress Disorder, conditions that health issues in patients. often require systematic follow-up due to their For that reason, and as a way to extend persistent nature. access to mental health care services to patients, The patients received between one and four the College of Community Health Sciences appointments monthly with a social worker and implemented an integrated model of care at between one and two psychiatric consultations University Medical Center, which it operates. each month. The Collaborative Care Model at UMC works Dr. Thad Ulzen, chair of the College’s by having primary care physicians identify Department of Psychiatry and Behavioral patients who might be struggling with mental Medicine, said the integration of behavioral health issues. If a patient agrees, a mental health health and primary care services brings mental professional evaluates the patient on the same health care expertise in a timely manner to day, and in the same exam room, where the primary care patients who might otherwise go patient was seen by the primary care physician. months before receiving care. Follow-up visits with the mental health and UMC’s chief medical obcer, Dr. Tom Weida, primary care providers allow for collaboration on said primary care physicians benefit as well diagnosis and treatment. because they have access to mental health care Between June 2018 and January of this year, support from mental health care providers. 13 UMC patients were cared for through the

C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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PREVENTION PREVAILS

STOP SMOKING

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SPRING 2019

LIGHTING UP

ELECTRONICALLY BY LESLIE ZGANJAR

In 2017, e-cigarette use by high school students increased

78%

T

he number of people in the US who smoke has declined in recent years, but the use of electronic cigarettes has skyrocketed, particularly among the nation’s youth. According to the Food and Drug Administration, e-cigarettes have become the most commonly used tobacco product by US teens. While rates of use generally declined between 2015 and 2017, data for 2018 showed a sharp reversal of that trend. E-cigarette use from 2017 to 2018 by high school students (defined by use on at least one day in the past 30 days), increased 78%, from 11.7% to 20.8%, resulting in 3 million high school students using e-cigarettes last year. The FDA noted that the rise in

a USB or flash drive, “in keeping with the adolescent and collegeage wired generation,” Blum said. The JUUL starter kit includes the electronic device, a battery charger that can be plugged into a computer, andtwodiaerentflavoreddisposable e-cigarette use is likely due to pods, each of which contains the the recent popularity of one type same amount of nicotine as a pack of of e-cigarettes, JUUL, as well as 20 cigarettes. “I’m concerned about JUUL flavoredtobaccoproducts. “JUUL is something that didn’t because it has one of the highest even exist three years ago, and now concentrations of nicotine of any everybody is doing it,” said Dr. Alan tobacco product,” Blum said. The makers of e-cigarettes, Blum, professor and the Gerald cigarette Leon Wallace, MD, Endowed Chair who include major of Family Medicine at the College manufacturers, claim these products of Community Health Sciences, reduce the risks of conventional and founder and director of The smoking because they don’t produce University of Alabama Center for the the cancer-causing chemicals that result from burning tobacco. Study of Tobacco and Society. But research recently published in E-cigarettes contain a nicotine-based liquid, not tobacco. the Journal of the American Medical When the user inhales, a tiny Association showed that, compared battery-powered device triggers with non-users, teenagers who take the heating of the “e-liquid” and its up e-cigarettes are more likely to transition to conventional cigarettes, nicotine, flavorings and propylene risking a lifetime of addiction to glycol (to produce a vapor). and resulting in smokingUnlike the first generation smoking of e-cigarettes that have the look and related diseases. “It’s almost like we haven’t learned feel of a conventional cigarette, including a red LED light that glows anything from our horrific experience when one inhales, JUUL resembles with cigarettes,” Blum said. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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PREVENTION PREVAILS

PREVENTABLE HEALTH RISKS AND DEATHS

BY LESLIE ZGANJAR

Lung cancer is a man-made “I think it’s a tragedy that we’re still talking about this issue more than 50 years after the US Surgeon General’s report on smoking showed proof positive that it [smoking] is the leading preventable cause of cancer and the leading preventable cause of heart disease,” said Dr. Alan Blum, professor and Gerald Leon Wallace, MD, Endowed Chair of Family Medicine at the College of Community Health Sciences. Approximately 480,000 smoking-related deaths occur each year in the US, and those who smoke often don’t experience illness until 20 to 30 years after theyfirstlightup,Blumsaid. According to the National Institutes of Health, cigarette smoking remains the most avoidable cause of death. Upward of 90% of lung cancers are due to cigarette smoking. Half of all heart disease-related deaths are attributed to smoking, as well as more than 80% of cases of emphysema. Blum, who also directs The University of Alabama Center for the Study of Tobacco and Society, which he founded in 1998, believes the ongoing smoking pandemic is one of the worst health care failures of the 20th and 21st centuries. “Lung cancer is a man-made tragedy that we could and should have prevented.” A big part of the problem is that everyone thinks the war on smoking and tobacco has been won, he said. While smoking is banned in many places (the College and UA have been smoke-free campuses since 2015), and while the number of US individuals who smoke has declined from more than 55 million 50 years ago, there were still 34.4 million adults smoking cigarettes in 2017. More than 16 million Americans are living with smoking-related diseases, according to 30

tragedy that we could and should have prevented. Dr. Alan Blum, professor and family medicine physician the US Centers for Disease Control and Prevention. According to Blum, the best way to stop smoking is to go cold turkey and buddy up with a friend or relative who has stopped smoking or who is also trying to stop. Medications can help some people, but they can be expensive and often unnecessary, he said. “Many people make stopping harder than it really is. A simple oral substitute such as mints, sugarless gum, unsweetened iced tea, a piece of fruit or kissing can make stopping [smoking] a pleasurable experience. Doing simple one-minute relaxation exercises in a quiet room or taking a quick walk around the block or around the house can help postpone each cigarette. So, too, can trying never to light up onawakening,withdrinkingacupofcoaeeorwhiledriving,” Blum said. Money saved by not buying cigarettes is huge, he said, adding that a-pack-a-day habit amounts to $2,000 annually. Blum also said that smoking a pack of cigarettes a day translates to more than 72,000 inhalations, over the course of a year, of carbon monoxide, ammonia and formaldehyde, as well as more than 40 known cancer-causing chemicals. The good news is that it’s never too late to stop smoking. Although risk of lung cancer may not decline for many years, therearebothimmediateandlong-termbenefitstotheheart, lungs, eyes, teeth, gums and reproductive system when one kicks cigarettes, Blum said.


SCHOLARLY ACTIVISM

SPRING 2019

THE CENTER FOR THE STUDY OF TOBACCO AND SOCIETY BY LESLIE ZGANJAR

T

he University of Alabama Center for the Study of Tobacco and Society, a part of the College of Community Health Sciences, holds the world’s largest collection of original materials related to the tobacco industry – newspaper and television coverage, books, rare advertising, photographs and promotional artifacts that document promotion of tobacco products and the history of eaortstocombatsmoking. WhenhejoinedtheCollege’sDepartmentofFamily Medicine in 1999, Dr. Alan Blum established the center totellthestorynotjustofthesuccessesincountering cigarette smoking and its promotion, but also of the failures and fear of confronting the tobacco industry. Blum, who directs the center, is professor and Gerald Leon Wallace, MD, Endowed Chair in Family Medicine. He is an expert on the history of tobacco use, cigarette marketing and the anti-smoking movement. He also serves as a public health advocate on the topic of smoking and tobacco use through his writing of op-eds for newspapers and editorials for medical journals, original presentations and research posters at national and international conferences, as well as museum and online exhibitions created from the center’s vast collection. Blum and his staa, including Collection ManagerDr. Alan Blum, professor of family medicine and director Kevin Bailey and graduate students in The University of the Center for the Study of Tobacco and Society. of Alabama School of Library and Information Studies, have created nearly a dozen exhibitions advertisements with celebrity endorsements from world heavyweight boxing champion Joe Louis and baseball greats on tobacco-related subjects, including one in 2014 commemorating the 50th anniversary of the landmark Jackie Robinson and Hank Aaron. An exhibition released in November 2018, “The Makin’s of US Surgeon General’s Report on Smoking and Health a Nation,” coincided with the 100th anniversary of the end of thatconfirmedcigarettesmokingasaleadingcauseof lung cancer and other health problems. The exhibition World War I, which introduced a new generation to smoking debuted at UA’s Gorgas Library before traveling to the via free cigarettes provided to soldiers. Cigarette advertising has been largely out of sight for Lyndon Baines Johnson Presidential Library in Austin, Texas, the Texas Medical Center Library in Houston, nearly two decades, since an agreement was signed by the state attorneys general and US cigarette manufacturers to and the LSU Health Sciences Center in New Orleans. end cigarette billboards and remove tobacco advertising Online exhibitions produced in fall 2018 include from television and sponsorship of sporting events. But the “BigTobaccointheBigApple:HowNewYorkBecame tobacco industry continues to maintain a firm grip on the the Heart of the Tobacco Industry…and Anti-Smoking Activism,” and “Of Mice and Menthol,” showing 18-34-year-old population with internet-based marketing, the history of the tobacco industry’s targeting of entertainment sponsorship and retail promotions of new African Americans. This exhibition featured cigarette products, such as electronic cigarettes, Blum said. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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PREVENTION PREVAILS

LIVE LONGER

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SPRING 2019

DISCOURAGING DE M E N T I A said Dr. Anne Halli-Tierney, a geriatrician and director of the Geriatric Clinic at University Medical Center, which the College operates. She said a healthy lifestyle can slow or possibly keep ealthy habits that help you dementia from gaining a foothold. live longer could also help In a word, prevention – a healthy diet, reduce your risk of developing exercise for the body and the mind, and dementia and Alzheimer’s disease social engagement. when you are older. “People ask me, ‘What do I need Dementia represents a category of to do to not get Alzheimer’s?’ I say, syndromes characterized by deficits ‘You need to eat a heart-healthy diet, in memory, cognitive function and because dementia can be compounded behavior. Alzheimer’s is the most by cardiovascular events. And, you need common form of dementia. to be physically active, mentally active Five million people in the US, or and socially active,’” Halli-Tierney said. 1.6% of the population, had Alzheimer’s “To be mentally active, do something disease and related dementias in you enjoy that uses your brain. Read, 2014, according to the US Centers garden, knit. Being socially active with for Disease Control and Prevention. friends and groups keeps your mind That number is projected to grow to engaged. This is the advice I give 13.9 million people, nearly 3.3% of the patientstostaveoadementia.” population, by 2060. She said there are medications that But it’s not hopeless. can slow the progression of dementia While mild forgetfulness is a part of and Alzheimer’s and stabilize memory, normal aging, that’s not necessarily the but “we don’t have medications that can case with dementia and Alzheimer’s, bring back memory that’s been lost.”

BY LESLIE ZGANJAR

H

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GERIATRICIANS A RARE BREED BY LESLIE ZGANJAR

A

s of 2017, there were only 62 board-certified Halli-Tierney said about 200 geriatricians graduate from geriatricians in Alabama and only half a dozen in fellowship programs each year in the US – not nearly enough Tuscaloosa. Estimates show there’s a need for to sustain the number of retiring practitioners who have about 200 geriatricians in the state. training to care for older adults. And with baby boomers “We’re kind of a rare breed,” said Dr. Anne Halli-Tierney, surging toward old age, family medicine and other primary a board-certified geriatrician who practices at University care physicians will need training in how to manage health Medical Center and directs its Geriatric Clinic. issues of the elderly. Nationwide as of 2018, there were only 6,950 boardcertified geriatricians – physicians who specialize in caring for and managing the health needs of older people. The number of geriatricians in full-time clinical work is even smaller at 3,590. With an older population in the US last year of 49.2 million, the American Geriatrics Society estimates that 22,940 full-time clinical geriatricians are needed to meet the complex health care needs of older adults. To help improve those statistics, the College of The US Census Bureau projects 2.1% of the US Community Health Sciences, which operates UMC, began population will be 65 years and older in 2050, up from a geriatrics fellowship several years ago to provide family 14.9% in 2015. medicine physicians additional training in caring for the “At CCHS, we are preparing physicians who will go out aging population. The fellowship program currently includes into communities and practice and impact patients’ lives two fellows and is led by Halli-Tierney. through direct care,” Halli-Tierney said. “When our fellows The physician fellows receive specialty training to better graduate, they are able to function eaectively in multiple understand the complex health issues of the geriatric arenas, whether it be long-term care, end-of-life care or population and to better assist with those needs. They quality primary care for elders in their communities.” have opportunities to practice in nursing homes, assisted In addition, patients in some rural areas may not be able living facilities, hospice and in behavioral health. They also to travel to see a specialist, “so if their primary care provider maintain a heavy focus on geriatrics care in rural areas in has geriatrics training, this will help the elderly there receive keeping with the College’s mission to train physicians for the aging appropriate care close to home,” she said. rural areas in Alabama and the region.

As of 2017, there were only

62

board-certified geriatricians in Alabama.

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SPRING 2019

TRANSLATING CARE

Using knowledge and technology to leap over the language barrier

HELO HOLA NIHAO

BONJUR

U

niversity Medical Center cares for a diverse it just provides for a better physician-patient population of patients and for some, relationship overall.” Englishisnottheirfirstlanguage.Inaneaortto Guin began learning Spanish in high school extend access to health care for these patients, and continued through college, receiving a minor UMC, which is operated by the College of in Spanish. He doesn’t consider himself fluent Community Health Sciences, provides on-site but said he does use his Spanish speaking skills translation and interpretation services. when caring for UMC patients whose native Patients who might not speak English have language is Spanish. access to bilingual interpreters and physicians, Along with bilingual physicians, UMC patients as well as a specialized online system that also have access to a full-time interpreter, Andrea connects them with interpreters who speak a Castellanos,whoisfluentinSpanish.Shebegan variety of languages. learning the language when she was seven years “As a physician, it is very helpful to speak the old and can also read and write in Spanish. patient’s native language,” said Dr. Russ Guin, And, she is more than an interpreter. chief resident of The University of Alabama Castellanos works closely with patients to ensure Family Medicine Residency, also operated by they understand the care they are receiving. CCHS. “The patient has a better appreciation “For those patients who cannot read or for the care you are giving them, and I think write – Spanish or English – I help with updating

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F E AT U R E

Our patients feel

comfortable having

someone who they can speak with and, in a sense, build a relationship with.

see the patient and physician and hear the doctor visit. paperwork,fillingoutsign-insheets,renewingMedicaid If information needs to be translated, or a physical applications, doing development questionnaires and any otherpaperworkthatneedstobefilledout,”shesaid.“Iexam explained, the interpreter can assist. The app includes interpreters who speak Arabic, German, Italian also interpret for patients during the sign-in process with and French, among other languages. receptionists, with the nurse while they get vitals, and for “I think it’s really unique that we are able to go into the physician when they see the patient.” the patient’s room and be able to use that service if In addition, Castellanos works with UMC receptionists we’re not comfortable being able to speak to them who might receive phone calls from Spanish-speaking in their own language,” Guin said. “I think it makes patients, helping to answer questions of both the callers patients feel more comfortable when we are able to and the receptionists. She is typically the one who calls speak their language.” Spanish-speaking patients to let them know about Like Guin, Castellanos believes that speaking a laboratoryresults,appointmentswithaspecialistorjust patient’s native language creates a better relationship to follow up from a doctor visit. And, she translates patient between the physician and the patient. “I think our medical records and other paperwork from Spanish to Spanish-speaking patients appreciate and see we English, and from English to Spanish if needed. care for them. Our patients feel comfortable having For patients who speak a language other than someone who they can speak with and, in a sense, Spanish, UMC nurses and physicians have access to build a relationship with.” an online video interpretation system – an iPad app that connects directly with a service that provides video interpreters. Through the app, an online interpreter can

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SPRING 2019

GLOBAL HEALTH I

SKILLS HELP DOCTORS CARE FOR RURAL AND UNDERSERVED COMMUNITIES

n impovershd nteriaol etings, doctrs often must ecar for patiens withou het help of medical tes, equipmnt and medicaton. They might only have edicalm histore and physical exams to elyr on. particuly those who might practie in rual and undersv easr of the US, includg in Alabm, whic is why. DrJane id W wanted the study and exprinc of globa healt part of The Universty of Alabm Family Medicne Residency curilm. The esidncyr is operatd by the Coleg of Comunity Health Sciens. “Is t’ importan to se doctrs ecar for patiens in a low-incme onmet,”vir sad ei, W a family medicn physican and asocite esidncyr ectordi who has traveld interaoly to ovidepr healt e,car most ecntlyr in Hait. ou “Y have to use listeng skil and thinkg skil emor becaus you might not have aces to tes. And you tcan’ just escribp medicatons becaus they might not be avilbe e.”thr The skil ear importan evn for family medicn physican who might not practie in rual and undersv comunites becaus doctrs ned to ecar for an easinglycr divers US domestic poulatin tha includes milons of peol not born in the US. “Experincg alterniv oachespr to healt ecar delivry in seting of limted ces,our ewhr the diagnos is based primaly on the medical history and physical exam, ear skil tha ear very helpfu,” eida W said. In aditon, having os-cultra exprincs withn medicn can help physican becom emor cultray competn. eida W devlop a globa healt curilm in Machr 2017 for esidntr of the Coleg, and by July of tha year the curilm

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Dr. Jane Weida, associate professor and interim chair of the Department of Family, Internal, and Rural Medicine, and associate director of the UA Family Medicine Residency. 38

launched, with presentations by Weida and several residents who had made international medical trips earlier in their residency training (page 39). The UA Family Medicine Residency is a three-year program that educates and trains physicians in the specialty of family medicine and is one of the largest and oldest such programs in the US. As part of the two-year Global Health Curriculum, residents meet at least once a month, often twice a month, to hear formal presentations from CCHS faculty and residents on global health topics, including tuberculosis, water and food safety, malaria, zika, Ebola and malnutrition. Residents are required, during either their second or third year of residency, to spend two weeks working and providing health care in a developing country. They also write reflective essays, and present about their experiences to fellow residents. At the conclusion of the two years, residents receive a Certificate in Global Health. Weida said the certificate looks good on a resume, particularly when residents apply for fellowships, “and it’s just a really good experience for residents.” Residents travel to Ghana, Egypt, Haiti, Cuba and a domestic Native American site, where CCHS faculty have global health experience and connections, but they can also select their own sites. Weida said she hopes the residency can do more in Cuba, where UA has an educational exchange program “and provide medical sites in Cuba in which residents and faculty can work, and possibly an exchange program.”


SPRING 2019

HAITI Dr. Jane Weida has made a number of trips to Haiti as part of Family Medicine Cares, a humanitarian program of the American Academy of Family Physicians. She first traveled to Haiti shortly after a 7.0 magnitude earthquake in 2010 devastated the country, one of the poorest in the Western Hemisphere, and hospitals were overwhelmed with patients. She returned to Haiti in 2015, again as part of Family Medicine Cares, and the group provided patient care, medical education andserviceprojects.

EL SALVADOR AND HONDURAS Chief resident Dr. Elizabeth Junkin made trips in 2016 as a fourth-year medical student to El Salvador and Honduras. In El Salvador, she and members of the group she was with assisted at medical clinics and purchased medications with donated money – “Ibuprofen, antibiotics, simple things, but these people don’t have access even to the simple things,” she said. During her time in Honduras, she worked in a oneroom clinic at a school. “The people there would wait for hours and hours to see us,” Junkin said. “It’s always a very humbling experience. It makes you appreciate what you have.”

GUATEMALA Third-year resident Dr. John Lundeen said his experience in Guatemala was “eye-opening. There was no clean or reliable water, food or health care for the people there.” He accompanied a group that had constructed a compound in the country with water treatment and electricity plants, a school and a hospital. “Outside the compound was the most crushing poverty I’ve seen in my life,” Lundeen said. The American group set up a clinic in a school in the mountains where he helped treat everything from dog bites to malnutrition. The group also provided meals to the local residents “to try and minimize the suaering that way. There was never enough to go around.”

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LECTURE TOPICS OF THE CCHS

GLOBAL HEALTH CURRICULUM Malaria

Ebola

Dengue

Malnutrition

Tuberculosis

Vitamin deficiencies

Round worms

Reproductive health

Yellow fever

Treating diabetes in resource-poor areas

Typhoid fever Cholera Zika

40

Treating chronic diseases such as COPD, asthma and hypertension in resource-poor areas


SPRING 2019

Residents and faculty from The University of Alabama Family Medicine Residency last year attended the American Association of Family Physicians National Conference in Kansas City – the largest recruiting event for prospective family medicine residents. The UA Family Medicine Residency, which is operated by the College of Community Health Sciences, gave away hundreds of stress-relief elephants and footballs, bags and cups at the conference, but the biggest hit was mini Dreamland BBQ sauce bottles – a taste of Tuscaloosa.

The Board of Visitors of the College of Community Health Sciences includes donors, alumni, retired faculty and community physicians who help the College develop partnerships with Alabama communities and state and national organizations, secure financialresources,anddevelopopportunities for medical students and resident physicians. The board meets biannually.

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SNAPSHOTS

The College of Community Health Sciences last year unveiled newly renovated meeting and classroom space to accommodate the growth of CCHS and its medical education programs. Pictured here is the Community Room.

The College of Community Health Sciences annually awards scholarships and other awards to medical students, resident physicians, and students in the College’s Rural Health Leaders Pipeline programs. Names of all recipients are included on plaques that hang in the College’s main building on The University of Alabama campus.

The College of Community Health Sciences on The University of Alabama campus encompasses classroomsformedicaleducation,administrativeobcesandUniversityMedicalCenter,thelargest community medical practice in West Alabama.

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Physicians and staa from University Medical Center in Demopolis attended the city’s Christmas on the River annual celebration to promote the new UMC location there. UMC is operated by the College of Community Health Sciences.

TheCollegeofCommunityHealthSciencesBoardofVisitorsmembers,facultyandstaagatheredfor the annual fall cocktail party at the Historic Drish House in Tuscaloosa. The house, built by the late physician Dr. John R. Drish, is a distinctive mix of the Greek Revival and Italianate styles.

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S PI N R TI N W EG R 2019 8

A vibrant sunset over University Medical Center, a multi-specialty community medical practice that cares for nearly 150,000 patients annually and is operated by the College of Community Health Sciences.

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

DR. JOY BRADLEY Dr. Joy Bradley joined the College as assistant professor in the Department of Community Medicine and Population Health. She also works with the College’s Institute for Rural Health Research. Bradley originally joined the College as a postdoctoral fellow in 2017. She received a PhD in Health Promotion and Behavior from the University of Georgia. She received her master’s degree in Marriage and Family Therapy/Counseling from the University of Louisiana at Monroe, and her bachelor’s degree in Psychology from Albany State University in Albany, Georgia.

DR. CARRIE COXWELL Dr.CarrieCoxwelljoinedtheCollegeasassistantprofessorintheDepartmentofFamily, Internal, and Rural Medicine. Coxwell also practices family medicine and obstetrics and gynecology at University Medical Center locations in Tuscaloosa, Northport and Demopolis. UMC is operated by the College. Coxwell is a graduate of the University of Alabama School of Medicine and completed her residency training at The University of Alabama Family Medicine Residency, which is operated by the College. She also completed the Obstetrics Fellowship for Family Medicine Physicians, at the College, which trains family medicine physicians to provide quality obstetrical care and seeks to address the need for obstetric and gynecological care in rural communities.

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ES

SPRING 2019

DR. RANDI HENDERSON-MITCHELL Dr. Randi Henderson-Mitchell joined the College as assistant professor in the Department of Community Medicine and Population Health. She also works with the College’s Institute for Rural Health Research. Henderson-Mitchell previously served as a research data analyst for the Institute, and before that was a graduate research assistant with the Institute. She received her PhD and an MBA from The University of Alabama. She earned a master’s degree in Health Education from Baylor University in Waco, Texas, and completed her undergraduate degree at Texas Tech University in Lubbock.

DR. ROBERT OSBURNE Dr.RobertOsburne,aboard-certifiedendocrinologistwithyears 53 ofclinicalpractice experience, joined the College as assistant professor in the Department of Family, Internal, and Rural Medicine. Osburne also cares for patients at University Medical Center, which is operated by the College. He retired last year from Simon Williamson Clinic in Birmingham, Alabama, where his practice focused on diabetes and thyroid diseases. He has also been associated with community hospital internal medicine residency training for 30 years, including with Baptist Medical Center Princeton in Birmingham, Alabama, and Atlanta Medical Center in Georgia. Osburne received his bachelor’s degree from Emory University in Atlanta and his master’s degree in basic medical sciences from the University of Alabama at Birmingham. He received his MBA from The University of Alabama and his medical degree from the UA School of Medicine. Osburne completed an internal medicine residency at Portsmouth Naval Hospital in Portsmouth, Virginia, and a fellowship in endocrinology and metabolism at the National Naval Medical Center in Bethesda, Maryland.

DR. MICHELLE PIKE Dr. Michelle Pike joined the College as a part-time adjunct faculty member in the Department of Family, Internal, and Rural Medicine. Pike will assist with The University of Alabama-Pickens County Partnership, led by the College and which works to place UA students in medicine, nursing, social work, nutrition, psychology and health education in Pickens County for internships and learning experiences. Pike is also Emergency Services Medical Director at Pickens County Medical Center. She completed her undergraduate degree at Truman State University in Missouri, during which she also earned a paramedic license. She worked on an Advanced Life Support Unit as a paramedic on critical care and emergency patient transports before entering medical school at the American University of the Caribbean, St. Maarten, Netherlands Antilies. She completed her residency training at the UA Family Medicine Residency, which is operated by the College. She completed the College’s Emergency MedicineFellowship,whichisprovidedinconjunctionwithRushFoundationHospital in Meridian, Mississippi.

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DR. JEAN POINTON Dr.JeanPointonjoinedtheCollegeasassistantprofessorofpsychiatryandbehavioral medicine. She cares for patients at University Medical Center, which the College operates, and teaches and supervises the College’s family medicine residents, medical students and clinical learners. Pointon earned bachelor’s and master’s degrees in chemical engineering from Mississippi State University. After working for Exxon as a chemical engineer with positions in the Peoples Republic of China and the United Kingdom, she earned her medical degree from the University of Texas Southwestern Medical School in Dallas. She completed residency training at Baylor College of Medicine in Houston, Texas, and a fellowship at the University of Houston Health ScienceCenter.Sheisboardcertifiedinchildandadolescentandgeneralpsychiatry and has extensive inpatient and outpatient experience.

DR. SALAH UDDIN Dr. Salah Uddin joined the College as a neurology hospitalist. Uddin will care for University Medical Center patients at DCH Regional Medical Center in Tuscaloosa and will be part of the teaching team that works with the College’s residents and medical students. The College operates UMC. Uddin graduated from the University of Dhaka Medical College in Bangladesh. He completed a neurology residency at John F. Kennedy Medical Center in Edison, New Jersey, and a post-doctoral fellowship at StrongMemorialHospitalattheUniversityofRochesterinNewYork.Priortojoining the College, Uddin was director of Neurology and Stroke at Shelby Baptist Hospital in Alabaster, Alabama.

DR. ELIZABETH WESTERN Dr.ElizabethWesternjoinedtheCollegeasapart-timeadjunctfacultymemberinthe Department of Family, Internal, and Rural Medicine. She is primarily responsible for teaching and curriculum development for the College’s Rural Medical Scholars Program, which is exclusively for rural Alabama students who want to become physicians and practice in rural communities. The program includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in Rural Community Health and early admission to the University of Alabama School of Medicine. Western received a bachelor’s degree in Chemistry from Middle Tennessee State University, and a master’s degree and PhD in Organic Chemistry from UA. She received her medical degree from the UA School of Medicine and completed her residency training at the UA Family Medicine Residency, which is operated by the College. She was in private practice in Tuscaloosa for the past six years and currently is also a hospitalist for the TuscaloosaVeteran’sAaairsMedicalCenter.

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SPRING 2019

ANDREA WRIGHT AndreaWright,MLIS,joinedtheCollegeasassociateprofessorandclinical/technical services librarian in the Health Sciences Library. Wright is responsible for supporting evidence-based practice at University Medical Center, which the College operates, and providing access to the latest research to support patient care. She also collaborates in research and publishing eaorts at the College, provides instructional support in research and evidence-based medicine and manages online access to library resources. Wright earned her master’s degree in Library and Information Studies from The University of Alabama and a bachelor’s degree in History from the University of North Alabama. She spent nine years oaering research support and evidence-based medicine education as a technology and information services librarian at the University of South Alabama Biomedical Library before serving for a year as a digital projects librarian at UA. In,4102Wright received a Georgia/National Library of Medicine Biomedical Informatics Fellowship. Her interests include research and data management, technology and informatics services in libraries, reducing health disparities and evidence-based health care.

SEVEN FELLOWS The College of Community Health Sciences has fellows in its Obstetrics, Geriatrics and Sports Medicine fellowships. These fellowships, along with Emergency Medicine, Behavioral Health, Hospital Medicine andRuralPublicPsychiatry,comprisethesevenfellowshipsoaeredbytheCollege. Each fellowship is a year-long program designed to provide additional, specialized training to family medicine physicians.

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N E W F A C U LT Y

OBSTETRICS Drs. Cheree Melton and Ashley Wambolt are obstetrics fellows.TheObstetricsFellowship,oneofthefirstofitskindinthe country, aims to address the need for obstetric care in rural areas. Obstetrics fellows master high-risk, operative obstetrics and obce OB/GYN procedures, including ultrasound, colposcopy, cryotherapy and endometrial biopsies. They also care for patients Melton at University Medical Center, which the College operates. Melton and Wambolt are graduates of The University of Alabama Family Medicine Residency, which the College operates.

Wambolt

G E R I AT R I C S Drs. Brittany McArthur and Jackie Luker are geriatrics fellows. The Geriatric Fellowship oaers a variety of experiences, including collaborating with interdisciplinary teams and working at nursing home facilities, geriatric psychiatry facilities, hospice and assisted living facilities. The fellowship also provides opportunities to work in rural settings and the fellows care for patients at University Medical Center, which is operated by the College. McArthur and Luker are graduates of The University of Alabama Family Medicine Residency, which the College operates.

McArthur

Luker

SPORTS MEDICINE Drs. Michael Bradburn and Aloiya Earl are sports medicine fellows. The Sports Medicine Fellowship oaers education, training and certification to family medicine physicians, who are often called to serve as team physicians for high school sports programs in their communities. Bradburn completed his family medicine residency at St. Joseph Mercy Livingston in Howell, Michigan. Earl completed her residency at The Ohio State University Family Medicine Residency in Bradburn Columbus, Ohio.

Earl 50


SPRING 2019

ACCOLADES Crowther Selected for SEC Academic Leadership Program Dr. Martha Crowther, professor of community medicine and population health at the College of Community Health Sciences, was selected as a fellow for the 2018-19 SEC Academic Leadership Development Program. The fellowship program is an opportunity for faculty to prepare for advanced academic leadership roles within the Southeastern Conference. The program brings together faculty fellows from eachSECcampustoprovidehigher-educationspecificleadership and management training. The 91-8 02 program takes place at two diaerent SEC campuses – Tennessee and Kentucky – and consists of workshops focused on developing academic management skills. Through this program, Crowther is participating in The University of Alabama’s 2018-19 class of Leadership University.

Weida Appointed to Women’s Health Steering Committee Dr. Jane Weida, an associate professor of family, internal, and rural medicine at the College of Community Health Sciences, was appointed to a state committee focused on women’s health. Weidawasappointedtoatwo-yeartermontheObceofWomen’s Health Steering Committee. The obce is part of the Alabama Department of Public Health and was created in 2002 to educate the public and be an advocate for women’s health, with an emphasis on preventive health and healthylifestyles.Committeemembersassistthestatehealthobcer in identifying, coordinating and establishing priorities for programs, services and resources the state should provide for women’s health issues and concerns. Weida is also serving as interim chair of the Department of Family, Internal, and Rural Medicine, and is associate director of the College’s family medicine residency. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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ACCOLADES

Culmer Receives 2019 New Faculty Scholar Award Dr. Nathan Culmer, assistant professor of medical education and director of academic technologies and faculty development for the College of Community Health Sciences, was selected by the Society of Teachers of Family Medicine Foundation as one of 10 recipients of the 2019 New Faculty Scholar Award. Theawardrecognizesleadershippotentialandprovidesfinancial support to attend this year’s Society of Teachers of Family Medicine spring conference in Toronto, Canada. As part of the award, Culmer will provide a presentation at a conference breakfast roundtable. In his role with the College, Culmer leads the utilization of educational and simulation technology, as well as distance technology aspects of telehealth services. He also oversees faculty development. Culmer received his bachelor’s degree from Utah State University, a master’s degreee in human communication studies from California State University-Fullerton, and a doctorate in higher education from the University of Iowa. Before joiningtheCollege,hespentfouryearsatPennsylvaniaStateUniversitywithresponsibilitiesin instructional design.

Looney Recognized for Professional Leadership Wyndy Looney, director of nursing for University Medical Center, received the Janet S. Awtrey Award, which recognizes nurse leaders in practice for their contributions to the nursing profession. The award is presented by The University of Alabama Capstone College of Nursing. Dr. Suzanne Prevost, dean of the College of Nursing, said Looney has been a collaborative partner and has provided the college valuable support since she has been at UMC and while she was at DCH Health System in Tuscaloosa. Looney joined UMC, which is operated by the College of Community Health Sciences, in 2017. She serves as chief nursing obcer and has primary responsibility for implementing quality improvementactivities.BeforejoiningCCHS,Looneywasmanager of nursing operations and analytics at DCH, responsible for day-today operations of the Patient Care Services Division. 52


SPRING 2019

Yerby Receives Lahoma Adams Buford Award Dr. Lea Yerby, associate professor and vice chair of the Department of Community Medicine and Population Health at the College of Community Health Sciences, received the prestigious Lahoma Adams Buford Peace Award in 2018. The University of Alabama award is given annually to a faculty member who, in his or her teaching, research, professional practice and personal life, has demonstrated exceptional levels of involvement in mediating human disputes, helping overcome prejudice,promotingjusticeandestablishingpeace. Yerby has dedicated her career to research and service of rural health disparities and health quality outcomes in Alabama, from supporting policy changes to equitably fund HIV services, to assessingtheebcacyofMedicaid.Sheiscurrentlystudyingaccess to autism spectrum disorder screening and early interventions for rural children. Her local service in rural health has been concentrated with the Tuscaloosa Campaign to Prevent Teen Pregnancy, West Alabama AIDS Outreach (now Five Horizons), the Alabama HIV Policy and Advocacy Committee and Family Counseling Services. “The weight of getting this award is even more humbling, given our current culture and climate,” Yerbysaid.“Ifeelanevengreaterweightandresponsibilityofrunningthemarathonforjustice.”

Henson Elected to National Academy Position Suzanne Henson, RD, LD, a registered dietitian at University Medical Center, was elected Alabama’s delegate to the National Academy of Nutrition and Dietetics and will serve a three-year term. The academy is the world’s largest organization of food and nutritional professionals. In addition to her role with UMC, which is operated by the College of Community Health Sciences, Henson is also an assistant professor of family, internal, and rural medicine. She is responsible for the education, coordination and provision of nutritional information to resident physicians and medical students, and she assists UMC patients in the promotion of their health.

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ACCOLADES

Sheppard Receives Distinguished Service Award Dr. Robert Sheppard, associate professor of medicine and founder and director of Hospitalist Medicine Services and the Hospitalist Medicine Fellowship for the College of Community Health Sciences, was awarded the 2019 Distinguished Service Award from The University of Alabama Medical Alumni Association. The award is given “for superior accomplishments and contributions to the University of Alabama School of Medicine.” Sheppard was in private practice for 25 years beforejoiningtheCollegeandbeginningthehospitalist medicine program at DCH Regional Medical Center in Tuscaloosa. He has primary clinical teaching responsibilities for the College’s medical students, residents and hospitalist fellows. He has received numerous teaching awards from the College and the UA School of Medicine, including the Argus Award, Patrick McCue Award, Golden Stethoscope Award and Best Clinical Instructor Award. Sheppard received bachelor’s degrees in biology and chemistry from UA and his medical degree from the UA School of Medicine. He completed residency training in categorical internal medicine, with a focus on cardiology, at the University of South Alabama Medical College in Mobile.

College Faculty Recognized with Argus Awards Tuscaloosa campus winners of the 2018 Argus Awards: Students from the University of Alabama School of Medicine named faculty, a resident and clinical departments on the Tuscaloosa Regional Campus winners of the 2018 Argus Awards. The College of Community Health Sciences, which operates The University of Alabama Family Medicine Residency and University Medical Center, also serves as the School of Medicine’s Tuscaloosa Regional Campus and provides clinical education for a portion of third- and fourth-year medical students. The Argus Awards give medical students the chance to honor their mentors, professors, courses and course directors for outstanding service to medical education and clinical training. 54

Best Clinical Department Neurology Pediatrics Surgery

Best Clinical Educator Dr. Charles Gross, Department of Surgery Dr. Catherine Ikard, Department of Neurology Dr. Heather Taylor, Department of Pediatrics

Best Resident Educator Dr. Russ Guin, The University of Alabama Family Medicine Residency


SPRING 2019

Lavender Elected to Medical Education Council Dr. Drake Lavender, assistant professor of family medicine at the College of Community Health Sciences, was re-elected to a three-year term on the Council on Medical Education for the Medical Association of the State of Alabama. He was also elected chair of the council for 2018-19. In addition to his faculty position, Lavender also serves in leadership roles in the College’s medical student education programs.

Chief Residents 2018–2019 Academic Year

Dr. Tiffani Thomas

Dr. Elizabeth Junkin

Dr. Russ Guin

Three residents of The University of Alabama Family Medicine Residency are serving as chief residents:Drs.RussellGuin,ElizabethJunkinandTiaaniThomas.Theresidencyisathree-yearpostgraduate medical education program of the College of Community Health Sciences that leads to board certificationinfamilymedicine. Guin, of Northport, Alabama, is a graduate of the UA School of Medicine, based in Birmingham. He completed his third and fourth years of clinical education at the College, which also serves as a regional campus for the School of Medicine. After residency, Guin plans to practice outpatient family medicine. Junkin, originally from Duncanville, Alabama, also earned her medical degree from the UA School of Medicine and completed her third and fourth years of clinical training at the College. After residency, Junkin plans to practice family medicine with obstetrics in rural Alabama. Thomas, of Newburg, South Carolina, received her medical degree from the Medical University of South Carolina in Charleston. She plans to practice in a rural area after residency. The residents were elected by their peers for their outstanding clinical and leadership skills. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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ACADEMIA

ACADEMIA Gregg Receives Funding from Council Dr. Abbey Gregg, assistant professor of community medicine and population health at the College of Community Health Sciences, received funding for research and travel from The University of Alabama Council on Community-Based Partnerships. Gregg received $3,250 from the council’s Seed Funding Committeeforherproject,“ReadinessforCommunityParamedicine and Integrated Mobile Health Care Interventions in Alabama’s EMS Agencies and Hospitals.” She also received $1,000 from the council’s Academic Conference and Presentation Committee for travel this year to the Academy of Health Conference in Seattle, Washington, and the NACCHO Conference in New Orleans.

Bradley Attends Robert Wood Johnson Foundation Symposium Dr. Joy Bradley, assistant professor of community medicine and population health at the College of Community Health Sciences, participated in a Robert Wood Johnson Foundation funded symposium that brings together scholars from historically underrepresentedgroupsworkinginfieldsthatintersectwithhealth and health care. The New Connections Symposium Bradley attended, titled “From ResearchtoAction:TakingYourResearchBeyondtheJournal,”was held in February at Drexel University in Philadelphia. The RWJF, the nation’s largest philanthropy devoted to public health, built the New Connections program to create a broad network of early career researchers interested in the foundation’s goal of building a national “culture of health” that enables everyone in society to lead healthier lives. New Connections currently supports a network of more than 900 underrepresented investigators. “It’s (the symposium) given me a lot of thoughts about how to communicate my work, how to be morecommunityengagedandhowaudiencesaregoingtobenefit,”shesaid. 56


SPRING 2019

Geno and Robinson Complete STFM Fellowship

Above: Geno Left: Robinson

Dr. Ed Geno, assistant professor of family, internal, and rural medicine at the College of Community Health Sciences, and Dr. Cecil Robinson, associate professor and director of learning resources and evaluation for the College, completed the 2018 Emerging Leaders Class of the Society of Teachers in Family Medicine. The competitive STFM fellowship provides training and support to new faculty and those transitioning to leadership roles. Geno works with the College’s family medicine residents in minor surgery and hospital medicine education and training. Robinson works with undergraduate and graduate medical educators and administrators at the College to examine, assess and improve education practices, processes and outcomes. He also works to advance interprofessional education among health faculty and professionals at UA.

Boxmeyer Completes Leadership Program Dr. Caroline Boxmeyer, assistant dean for academic aaairs for the College of Community Health Sciences, completed Leadership U,aUniversityofAlabamaprogramthatpreparesfacultyandstaa in leadership positions to assume increasing levels of responsibility within their organizations and to be forward-thinking – anticipating future challenges and envisioning opportunities for success. During the program, participants met with UA leaders to learn more about the University, its goals and mission and the leadership styles of UA’s top administrators. Participants took part in professional development workshops, including at LSU and Auburn University. “A consistent theme that we learned about leadership is the importance of focusing on the mission of your organization and how each department and employee contributes to this mission,” Boxmeyer said. LeadershipU,whichbeganinis ,01 2 oaeredbytheUAObceforAcademicAaairs. C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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ACADEMIA

The Gerontologist Payne-Foster Dr. Pamela Payne-Foster, a professor of community medicine and population health at the College of Community Health Sciences, authored “Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity,” with Rebecca Allen, JoAnn Oliver, Morgan Eichorst, Lisa Mieskowski and Silvia Sorensen, to be published in The Gerontologist.

Book Chapter Publication Halli-Tierney Dr. Anne Halli-Tierney, assistant professor of family, internal, and rural medicine at the College of Community Health Sciences and a practicing geriatrician at University Medical Center, published a book chapter, “Ethical issues in palliative and end-of-life care,” with co-authors Amy Albright, Deanna Dragan, Megal Lippe and Rebecca Allen in Palliative and End of Life Care: Disease, Social and Cultural Context, edited by Rebecca Allen, Brian Carpenter and Morgan Eichorst.

Academic Articles Halli-Tierney, Williams, Culmer Drs. Anne Halli-Tierney and Nathan Culmer, and Nelle Williams, faculty at the College of Community Health Sciences, co-authored two articles, “Videoconferencing Psychological Therapy and Anxiety: A Systemic Review” and “Videoconferencing Psychotherapy and Depression: A Systematic Review” with Dr. Blake Berryhill from The University of Alabama College of Human Environmental Sciences as lead author. 58


SPRING 2019

MASTER OF SCIENCE IN POPULATION HEALTH

SPRING 2019

Population health is the future of health care and integrates clinical and public health practices with data analytics to prevent, reduce and manage human disease. Our degree program has faculty with backgrounds in business, health policy, medicine, nursing, psychology, health promotion and public health that will provide our students with the training neeeded to resolve complex health issues in the evolving landscape of the healthcare system. Our program is suitable for both practicing and future health professionals.

IMPROVE HEALTH AND HEALTH CARE Depending upon the elective courses you choose and your professional background, you can lead population health clinical practice management initiatives, conduct your own research and/or design community-based health programs. You will be better equipped to participate in care delivery redesign and achieve the triple aim of improving patient experiences, improving health outcomes and reducing health care costs.

FLEXIBLE PROGRAM OPTIONS The program is based in the College of Community Health Sciences’s Department of Community Medicine and Population Health and incorporates faculty from the UA Culverhouse College of Business. Classes are offered both in the traditional in-person setting or online for students who need more flexibility with their schedule. There are slight differences in the elective courses offered to students in the in-person and online programs. Both full-time and part-time study is allowed, and students have the option of completing a thesis or capstone project. Practicing health professionals are encouraged to use the thesis and capstone opportunities to apply their skills to a population health problem within their own place of work.

FOR MORE INFORMATION VISIT CCHS.UA.EDU/POPHEALTH C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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HIGHLIGHTS

We invite you to be one in a million to help speed up medical breakthroughs. The more researchers know about what makes each of us unique, the more tailored our health care can become. Join a research effort with one million or more people nationwide to create a healthier future for all of us.

To start your journey, go to Participant.JoinAllofUs.org and: 1 Create an account 2 Give your consent 3 Agree to share your electronic health records 4 Answer health surveys 5 Have your measurements taken (height, weight, blood

pressure, etc.) and give blood and urine samples, if asked

After completing these steps, you’ll receive $25.

To learn more and to enroll, contact us at: allofus@ua.edu | (205)348-6991 | JoinAllofUs.org/UAmedcenter 60All of Us and the All of Us logo are service marks of the U.S. Department of Health and Human Services.


C O L L E G E O F C O MMU N I T Y H E ALT H S C IEN C ES

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P.O. Box 870326 Tuscaloosa, AL 35487-O326 CHANGE SERVICE REQUESTED

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Nonprofit Organization U.S. Postage PAID The University of Alabama

Profile for College of Community Health Sciences

On Rounds Spring 2019  

On Rounds Spring 2019  

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