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A PUBLICATION FOR ALUMNI, FRIENDS & SUPPORTERS FALL 2018

THE HEALTH ISSUE Examining the Road to the UH College of Medicine


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Fall 2018

DEPARTMENTS 4 Leadership

Dr. Mohan & Lupus Study

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11 Disparities 29 Mental Health 42 Health Science

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52 Health Education

FEATURES 8 UH Global Health

University of Houston students study health abroad.

20 Primary Focus

Examining the road to a UH College of Medicine.

26 One-Stop Shopping

Partnership will allow UH to offer comprehensive health care to more people.

34 Adolescent Brain

UH researcher sees promise in low-cost treatment for adolescents.

38 Today’s Nurse

UH College of Nursing shows that it’s more than giving shots.

A digital version of this publication is available at uh.edu/magazine

On the Cover The “cougar sign,” a hand gesture made by Cougars since 1953 as a symbol of pride; seen in an x-ray to celebrate this issue of the UH Magazine.

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Sleep Study Clinic

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ZZ Z

20 Primary Focus


PUBLISHER

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Lisa Holdeman Associate Vice President, University Marketing, Communication and Media Relations

Today’s Nurse

EDITOR

Keidra Gaston (’04) Executive Director, University Marketing

CREATIVE DIRECTOR

Enita Torres (’89)

ART DIRECTOR

Tom Newton

LEAD DESIGNER

Katie Horrigan

GRAPHIC & WEB DESIGNERS Damisi DeLaney (’11) Melanie Lankford

PHOTOGRAPHERS

Jessica Almanza Brian Boeckman (M.B.A. ’18)

CREATIVE TEAM INTERNS Lucero Hernandez Jacob Nicholie

18 Food for Fuel

COPY EDITORS

Oscar Gutiérrez (’67) Shawn Lindsey Mike Rosen (’92)

WRITERS

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UH Global Health

Laurie Fickman Eric Gerber (’72, M.A. ’78) Oscar Gutiérrez (’67) Carolyn Hartmann Jeannie Kever Shawn Lindsey Ericka Mellon Marisa Ramirez Mike Rosen (‘92) Chris Stipes Carrie Ann Taylor Sara Tubbs

PRESIDENT

Renu Khator

UNIVERSITY OF HOUSTON SYSTEM BOARD OF REGENTS

Tilman J. Fertitta (’78), Chairman Peter K. Taaffe, J.D. (’97), Vice Chairman Paula M. Mendoza, UHD (’95), M.S. (’17), Secretary Durga D. Agrawal, M.S. (’69), Ph.D. (’74) Doug H. Brooks (’75) Steve I. Chazen Beth Madison (’72) Gerald W. McElvy (’75) Jack B. Moore (’77) Andrew Z. Teoh

Send address and email updates to: University of Houston Gift Processing and Records Technology Bridge 5000 Gulf Freeway, Building 1, Room 272 Houston, Texas 77204-5035 uh.edu/magazine Send feedback to: magazine@uh.edu The University of Houston Magazine is published by the Division of University Marketing, Communication and Media Relations. Printed on recycled paper The University of Houston is an EEO/AA institution. 11.2018  Copyright © 2018 by the University of Houston


LEADERSHIP

MESSAGE FROM THE PRESIDENT Dear Cougars and Friends,

Poets have sung its praises, and philosophers confirmed its necessity. And the common man and woman all agree. There is no substitute for good health. We can quote Buddha, who advised us that “To keep the body in good health is a duty … otherwise we shall not be able to keep our mind strong and clear.” We have the Roman bard Virgil reminding us that “The greatest wealth is health.” Even Winston Churchill, no paragon of personal fitness, weighed in on the subject, proclaiming that “Healthy citizens are the greatest asset any country can have.” At the University of Houston, we have had a longstanding appreciation of how important health is—not quite as long as Buddha’s perhaps, but our commitment to educating health care professionals, conducting health sciences research and providing support for community well-being definitely runs deep. Our establishment of the College of Pharmacy, the College of Optometry and the original College of Nursing stretch back nearly three-quarters of a century! In the ensuing years, we have steadily expanded and enhanced our academic offerings, research-driven enterprises and clinical services that are available to the public. From my earliest days in Houston, I immediately recognized the importance of health and health care to this city, not only as a general community concern but also as a professional matter. The health

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industry plays a tremendous role in our city’s economy and, as Houston’s University, UH has an obligation to support that by training a skilled workforce, educating astute leaders and encouraging innovative research and technology transfer. That’s why we made “Health” one of our Big Rocks. In this issue of the magazine, you will find fascinating examples of the depth and breadth of UH’s continuing commitment to health. What’s most notable, I believe, is this University’s forward-looking approach. We are not content to have achieved as much as we have, but determined to do more and be even better. That is the philosophy behind our most ambitious health-related undertaking to date—the creation of a medical school. But not just “a” medical school, of course. Texas has a troubling lack of primary care physicians—we rank 47th out of 50 states. So, our proposed medical school would emphasize that discipline and, in doing so, play a key role in addressing our statewide deficit and treating Houston’s own underserved communities. The UH medical school would help solve a pressing current problem, and it will also provide a beneficial model for future medical schools of this type. Just as Houston is often hailed as “the city of the future” for its economic vitality, diverse community and innovative spirit, UH shares those same qualities—and they will be reflected in our medical school. If we need one last reminder about the significance of the classic instruction mens sana in corpore sano (a sound mind in a sound body), let us turn to Publilius Syrus. He was a slave who, after gaining his freedom and pursuing a first-rate education, became one of Rome’s most cogent writers. “Good health and good sense,” he observed, “are two of life’s greatest blessings.” At the University of Houston, we are working hard to share those blessings with as many people as possible. With warm regards,

RENU KHATOR PRESIDENT, UNIVERSITY OF HOUSTON


INTRODUCING

LEADING FROM THE FRONT Meet the New University of Houston System Regents BY CARRIE ANN TAYLOR AND OSCAR GUTIÉRREZ

G

uiding the institutions of

the University of Houston System are nine women and men serving on its Board of Regents. Together, they oversee the four UHS universities and ensure each institution is fulfilling its commitment to the communities they serve. This summer, four new members joined the Board: Doug H. Brooks (’75), former chairman of the Board, CEO and president of Brinker International, Inc., Steve I. Chazen, chairman and CEO of Magnolia Oil & Gas Corporation, Jack B. Moore (’77), retired president and CEO of Cameron International, and Andrew Z. Teoh (’20), a UH senior in the Honors College and the C. T. Bauer College of Business. Three Regents bring to the Board extensive business acumen and a long history of community leadership. The fourth, Teoh, will serve for a year as a representative of the more than 70,000 students attending UHS universities. Knowing the significant role each will play in the oversight of the System, we asked them to share their plans for, and impressions of, the UH System.

In your opinion, what is the role of public higher education in building a strong economy and healthy communities? Chazen:

STEVE I. CHAZEN

chairman and CEO of Magnolia Oil & Gas Corporation

JACK B. MOORE

retired president and CEO of Cameron International

An educated workforce is critical to a strong economy. Higher education should continue to focus on building 21st century skills in their graduates. These skills should include mathematical and scientific facility as well as a thoughtful understanding of global politics and economics. People who have meaningful jobs will build healthy communities.

Moore:

I am a firm believer that higher education inspires and enables individuals to compete

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LEADERSHIP

What do you hope your legacy will be to the UH System? Brooks: I hope I can be remembered as a student, alumnus and Regent who helped make my alma mater (UH) and the UH System better places for the next generation of students.

Chazen:

I hope I can contribute, in a small way, to strengthening the UH System’s professional colleges while improving access to students from under-represented communities.

DOUG H. BROOKS former chairman of the Board, CEO and president of Brinker International, Inc.

What words of wisdom do you have for students who are preparing to enter a competitive job market? Chazen:

I don’t know how much wisdom I can contribute, but I can say that a focus on mathematical skills will help differentiate our graduates from other job seekers.

Moore:

on a global stage and provides a partnership great cities must have to attract and retain businesses and to advance prosperity in their communities. I can’t imagine our great city without a premier public university that educates and empowers our future leaders to be an engine of intellectual and economic success.

What do you consider the greatest challenge facing higher education, and how will that influence your service on the Board? Brooks:

Delivering quality higher education while controlling rising costs is the biggest challenge facing us moving forward.

Moore:

I see three main challenges. Program relevance—the world is changing rapidly, and universities must constantly evolve their degree programming to prepare students to succeed in the marketplace. Costs —keeping college education affordable requires being efficient in how we manage cost structure while not compromising program excellence. Competitiveness—in all we do, from academics to athletics, the bar is constantly being raised, and that requires resources to reinvest in our programming, faculty and infrastructure. I want to ensure we are focused on student success while providing education excellence and relevance in the most efficient manner.

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I would tell them to focus on being the best you can be at whatever role you are given—it will get you noticed. Also, be a team player and share your successes with others; be the first to raise your hand for new assignments, and don’t be afraid to take a risk.

How does your extensive experience as a CEO prepare you to serve on the Board of Regents? Chazen:

CEOs have two major duties. They set the narrative or tone for the organization so that all of a firm’s constituencies know why the company exists. Secondly, CEOs take responsibility for the actions of the enterprise. Being a Regent and understanding the proper role of the Regent as compared with the UH System’s administration is good preparation.

Moore:

Running a global corporation taught me a lifetime of lessons: Being accountable and responsible for your enterprise, being a good financial steward as well as a good corporate citizen, listening and engaging diverse perspectives, people and cultures, and being competitive—winning builds pride and loyalty to your brand.


What are your strongest memories of the campus as a student? Brooks:

My fondest memories are of dorm life, especially my two years as a resident advisor in Moody Towers, when the towers were brand new.

Moore:

Living in Taub Hall as a freshman and meeting new friends from a multitude of different cultures and the campus buzz after beating UT (The University of Texas) 30-0 in Austin our first year in the Southwest Conference.

ANDREW Z. TEOH

UH senior in The Honors College and the C.T. Bauer College of Business

What was your proudest moment as a student? Brooks: Most definitely, being the first in my family to earn a college degree.

Chazen:

Getting my degree. Between studying at night and working during the day, I have no memories of student life, except being tired all the time.

What is one thing people might be surprised to learn about you? Brooks:

I started in the restaurant industry as a busboy and dishwasher and rose to CEO and chairman of the Board of Directors of a Fortune 500 company.

Moore:

I can drive most any form of farm equipment.

ANDREW Z. TEOH You have a demanding course schedule and still manage to find time to volunteer your time to the UH System. How do you do it? Teoh:

I love everything that I do. Whether learning in the classroom, leading an organization or serving as Student Regent, I’m passionate about the experience and appreciative of the opportunity. A positive mentality makes “work” enjoyable. Of course, I couldn’t do any of it without supportive family and friends.

There are 70,000 students in the UH System. How are you going to best represent your fellow students? Teoh:

My background in student organizations has helped shape my understanding of the student experience. Over the coming year, I want to continue to be engaged in student life at all four UH System institutions. Attending events, sitting in on meetings and simply talking to my peers will help me develop a holistic student perspective that I can share with the Board.

What example would you like to set for your fellow students? Teoh:

I want to be ethical, humble and kind. I’ve always tried to live by these tenets, and the next year will be no exception. Sometimes, it’s easy—and tempting—to sweep these values under the rug, but I hope to embrace them at every turn.

What are your goals after graduation? Teoh:

Right now, I’m keeping my options open. I’m considering both pursuing more education and diving directly into the workforce, but I have a little time before I need to finalize my post-graduation plans. I’m excited to see where I end up.

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going

GLOBAL UH Students Study Health Abroad BY ERICKA MELLON

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T

Two hours outside the Dominican Republic’s capital city, students from the University of Houston observed a lone doctor examining a stream of patients from her home office with crumbling walls and paper files piled high. Mothers had walked miles to get their children checked. “Her personality touched me,” Kayla Franklin, one of 20 students on the learning abroad trip last summer, said of the doctor. “You could tell she’s caring. If she can do anything to help them, she’s there, even if it’s out of her own pocket.” The UH students had brought backpacks filled with supplies for the local children. The doctor began to cry. “She was like, ‘People need these things,’” Franklin recalled. “I wouldn’t think a backpack could make that much difference.” The trip is one of several UH study abroad opportunities for students interested in global health. The experiences typically combine learning and service, with students gaining invaluable insights they can apply to careers in the United States or around the world. “Students really experience the challenges of providing health care in resource-poor communities,” said Dr. Stephen J. Spann, UH vice president for medical affairs and founding dean of the College of Medicine. Over the last few years, Spann has led trips of UH pre-med students to assist in a clinic he helped launch in rural Honduras. “Students, to a person, say it’s a great learning experience,” Spann said. “Many of them aspire to go back. I think it helps a lot of them solidify their desire to study medicine.” Spann, who grew up in Uruguay as part of a missionary family and worked as chief medical officer of a hospital in the United Arab Emirates, said lessons on global health and learning abroad opportunities will be integrated into the new UH medical school. By visiting developing countries, medical students get a chance to hone their skills without the luxury of advanced technologies and abundant medications. They also gain cultural insights that can improve patient care in a diverse city like Houston. “You don’t have all the diagnostic tests,” Spann said. “You have to learn how to depend on the medical history and physical exam. It teaches you to use your five senses.” During the summer trip to the Dominican Republic, students focused on various aspects of public health, such as medical and environmental. They visited hospitals and clinics in poor and wealthier parts of town, met with doctors, took Spanish lessons, toured an organic coffee farm and hiked in a cloud forest. When they returned, they each did a presentation for their Global Health course. “It was truly real-world practice, observation and education,” said professor Kayce Solari Williams, who led the trip with professor Rachel Afi Quinn of the UH women and gender studies program. “There’s nothing like getting out of a book and getting into what the book is all about.” Solari Williams, who directs the undergraduate health program in the UH College of Education, said she organized the trip based on the experience she had there as a doctoral student—going beyond the “postcard view” of the Caribbean and understanding the underbelly of health problems. “It forever changed me,” she said. Franklin, a senior in the health program, said the Dominican Republic trip changed her too, especially seeing the need for more medical professionals there.

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“There’s

Top: Biology major Saad Sidiq captured a reminder of the families who sought medical aid at a school in Honduras in May 2017; Bottom: A hike through Ébano Verde Scientific Reserve in the Dominican Republic gave students a lesson in environmental health.

nothing like getting out of a book and getting into what the book is all about.”

“Maybe I could be a nurse in the U.S. and make trips back to the Dominican Republic,” Franklin said. “I may want to be more of a public health official, but maybe I can be hands on, too.” Solari Williams plans to add a trip to Puerto Rico next summer, while faculty from the College of Education’s school psychology program are working to offer students a summer practicum experience in Querétaro, Mexico. “It’s the judgment part we’re trying to address so students don’t take a deficit perspective when working with families who are culturally different,” said professor Jorge Gonzalez, who’s teamed with program director Milena Keller-Margulis to launch the practicum. From the UH Graduate College of Social Work, associate dean Luis Torres partnered with the Boston University School of Social Work to lead a trip to hurricane-ravaged Puerto Rico last summer. Students learned from local social workers about disaster response, addressing public health and environmental issues and the importance of selfcare.

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“These are people who have tremendous determination to do whatever they can to help others, but they also have the training and the skill,” said Torres, a Puerto Rico native who has led other trips to El Salvador, Bolivia, Mexico and Cuba through his course, Social Work: A Comparative Approach. Torres’ colleague, professor Patrick Leung, organizes annual student trips to China. For the students who study abroad, no matter the trip, the experiences leave a lasting impression. As biology major Saad Sidiq said, he will never forget the long line of families he saw waiting for medical care outside a schoolturned-free clinic in Honduras during his trip in May 2017. Sidiq and other volunteers with the Global Medical Brigades UH Chapter helped triage patients and took blood pressure, shadowed doctors and sang songs to remind kids to brush their teeth. “We couldn’t treat all the patients that came,” he said. “We did our best.” Sidiq, an aspiring doctor, said he hopes to take a similar trip again someday. “The least I can do now is become more aware of helping the disadvantaged in my own community,” he said.


DISPARITIES

POWERHOUSE TEAM FIGHTS CANCER UH, MD Anderson Partner on Mentorship Program BY ERICKA MELLON

K

rystal Christopher’s mind raced with questions

after an aunt she was close to died from stomach cancer in 2013. An immigrant from Antigua, her aunt wasn’t diagnosed until it was too late. The disease already had spread to her stomach and chest. “I just remember thinking, ‘How does this happen?’” Christopher said. “Where did we lose track of her health? Socioeconomically, she wasn’t the best off. Would that have changed the outcome if she had access to the resources she needed?” Christopher, now a doctoral student in counseling psychology at the UH College of Education, has channeled her frustration into action. She’s part of the inaugural class of UH students selected to participate in a new collaboration between UH and The University of Texas MD Anderson Cancer Center that’s aimed at reducing cancer rates and increasing survivorship among traditionally underserved populations. The project, called the UHAND Partnership, also seeks to grow a diverse pipeline of cancer researchers and doctors who reflect and better understand the communities they serve. UH students and junior

faculty members in the program are paired with mentors from UH and MD Anderson, as well as mentors from community organizations, so they gain invaluable research and in-the-trenches experience. “The UHAND program is the exact reason I came to Houston,” said Christopher, who grew up in Antigua and Florida and was the first in her family to graduate from college. “I would have talks with my old boss and say, ‘If there was any chance I could get an opportunity to work in the Med Center, it would be perfect.’” UHAND co-director Lorraine Reitzel, who chairs the department of psychological, health and learning sciences in the UH College of Education, said program participants all are driven to address the troubling disparities in cancer risk, rates and outcomes among racial and ethnic groups. According to the American Cancer Society, the disease is the leading cause of death among Hispanics, and African Americans have the highest death rate for most cancers. A survivor of thyroid cancer, Reitzel said she feels “blessed” she had access to top-notch medical care. “Not everyone has that experience,” she said. “And it shouldn’t be that way.” UHAND co-director Lorna McNeill, who chairs MD Anderson’s department of health disparities research, said she’s inspired by the students’ determination—many want to attend medical school—and passion. “They are interested in gaining knowledge they can bring back to the community,” she said. The program, supported by a $1.3 million grant from the National Cancer Institute, had its official launch ceremony in August. “What a pleasure it was to celebrate the early achievement of our collaboration!” UH President Renu Khator tweeted after the event. “When two leading institutions share a vision for a community,” MD Anderson President Peter WT Pisters added, “transformative things can happen.”

CHISOM ODOH College of Education, UHAND Partnership Postdoctoral Fellow Growing up in Nigeria, Chisom Odoh saw stark differences in the health care available to the rich and the poor. Her dad’s death from liver cancer further fueled her interests in medicine—especially for improving outcomes in marginalized communities. Her family didn’t have a lot of money, but her dad, an accountant, prioritized education, she said. Odoh, who went on to earn a Ph.D. in public health from the University of Louisville, joined the UH College of Education in August as a

postdoctoral fellow affiliated with the UHAND Partnership. The program is a collaboration between UH and MD Anderson that involves students and early career faculty in research and community engagement designed to address cancer disparities. “I’m already learning a lot,” Odoh said. “I’m really thankful to have this type of experience to gain the skills I need to become an independent researcher to help improve lives.” •

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DISPARITIES

? l o ñ a p bla es

ha

VIRMARIE CORREAFERNÁNDEZ College of Education

Assistant Professor, Psychological, Health and Learning Sciences

CULTURALLY SENSITIVE CARE Addressing the Health Care Needs of the Hispanic Population BY CHRIS STIPES

C

lear communication between patients and health

care practitioners is critical to effective treatment. However, important information is often lost in translation among the fast-growing Hispanic population. While working as a pharmacy technician during her freshman year at UH, Grace Hwang saw firsthand the challenges of treating Spanish-speaking patients. “It was very hard because we had to guess what they were saying or call the interpreter on the phone,” she recalls. “We couldn’t provide the same level of care because of the language barrier.” Texas is home to more than 11 million Hispanics, on pace to become the largest population group in the state by 2022. According to the Pew Research Center, 32 percent have limited or no English proficiency. In collaboration with the department of Hispanic studies, the College of Pharmacy offers a Certificate in Hispanic Health Care—the first program of its kind in the nation. The 18-hour program provides students with advanced skills and knowledge to deliver culturally and linguistically competent pharmacy care services to Hispanic and Spanish-speaking populations. “The program includes extensive experiential learning, fieldwork and public service opportunities in Hispanic communities that enhance cultural sensitivity leading to better quality care,” said Andrea Smesny, executive associate dean at the College of Pharmacy. Hwang recently graduated from UH and is now working as a pharmacist at a Houston hospital. Completing the certificate program was essential to her success, she said, and ultimately the success and health of her patients. “It opened my eyes to the needs of other cultures and how to communicate effectively.”

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Virmarie Correa-Fernández is determined to help Latinos who have anxiety and/or depression quit smoking. According to national statistics, Latino adults generally have lower prevalence of cigarette smoking than other racial and ethnic groups. However, their main causes of death are smokingrelated diseases such as heart disease and cancer. They also experience tobacco-related disparities, including suboptimal assistance with quitting. With a five-year, $717,000 grant from the American Cancer Society, Correa-Fernández and her team are developing and testing a wellness program based on Acceptance and Commitment Therapy in order to reduce this health disparity. A counseling approach guides participants to connect with their thoughts and emotions without judgment and choose behaviors consistent with their values. “Those values could include the autonomy of being smoke-free, being healthy to enjoy their lives or being a role model for their children,” Correa-Fernández added. “Our goal is to empower them to develop skills to maintain a healthy mind and body beyond the program.” •


THE RIGHT PRESCRIPTION FOR MOBILE HEALTH CARE UH Engineer is Driving Results BY LAURIE FICKMAN

S

eems a disconnect,

the notion that an industrial engineer would be bridging the health disparity gap, but no mystery here. Jiming Peng, associate professor of industrial engineering, is an “optimization guy,” as he says, so it’s a good fit. Industrial engineers improve different areas of life with industrial solutions. They make wait times shorter for rides at amusement parks and streamline the manufacturing processes of automobiles to make cars more affordable. Peng is creating efficient routes to send mobile health care clinics into at-risk communities in Houston, where thousands of children who attend school in the Houston Independent School District need vaccinations. Peng’s work is supported by a National Science Foundation Early-concept Grant for Exploratory Research (EAGER), which funds potentially transformative research to improve lives. Peng and project partner Rigoberto Delgado of The University of Texas Health Science Center at Houston collected data from three mobile clinic programs and pored over census data. Based on their analysis, they created a demand map highlighting vaccination needs per school zone. Texas Children’s Hospital (TCH) has used it to improve its mobile-clinic efficiency.

Still, it’s not enough, notes Peng, who reports that in HISD first and seventh grades alone, more than 8,000 students need vaccinations. If scheduled carefully, on average a mobile clinic can service 40 students per day. Historical clinic data shows that the mobile clinic program at TCH serves fewer than 2,000 students per year, which is 50 percent below its capacity. “There is a large gap between the capacity of the program and its actual performance. The demand in HISD is beyond what they can handle,” said Peng. The hospital is working to improve efficiency and grow capacity. Peng’s mission grows with the increasing demand. He’s building a network of mobile clinics, including all the service providers and target communities in Harris County, to improve the overall efficiency of the network. “I feel, with my training, part of my obligation is to help create a system where health care can be more evenly distributed,” said Peng. That’s a shot in the arm for children who need vaccines.

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DISPARITIES

“OUR PRIMARY GOAL IS TO INTEGRATE HEALTH CARE AND OFFER PREVENTION AND TREATMENT.” of three slices of bacon, a couple of eggs, grits, toast and “lot and lots” of butter or margarine. Not anymore. “Now, I eat a half a cup of oatmeal, a good grain bread and I monitor my fat intake. The program has taught me that what I put in my mouth is medicine for my body,” she said. For Jefferson, the medicine is working—she’s dropped more than 40 pounds since attending.

Pockets of Trouble

A NEW TOUCHPOINT Fighting Obesity Among Houston’s Underserved, Project TOUCH Expands its Reach BY LAURIE FICKMAN

A

fter 35 years as a teacher and 15 more as a

registered nurse, long-time Third Ward resident Margaret Jefferson knew how to educate others, but when it came to her own health, she struggled. And slowly through the years, the pounds just seemed to creep up on her. In early 2017, Jefferson, diagnosed as pre-diabetic at 190 pounds, heard about the YMCA’s Diabetes Prevention Program provided through Project TOUCH, a partnership between the United Health Foundation (UHF) and the University of Houston. At the Houston Texans YMCA on Griggs Road, her journey back to good health began. “I’ve become so aware of what I put in my mouth now,” said Jefferson, admitting a typical breakfast before the program consisted

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In Houston, two populations seem most at risk for diabetes. According to the Centers for Disease Control and Prevention, 72 percent of African-Americans and 78 percent of Latinos in Houston are overweight or obese, a common precursor to the disease. Project TOUCH (Treating Obesity in Underserved Communities in Houston) was born out of concern over these stats. The program set out to help identify residents of Houston’s Third Ward and East End at risk for chronic diseases and connect them with programs and services to help them maximize their health potential. With a $2 million grant from UHF, Project TOUCH began popping up in churches, community centers and other partner outlets last year. Professors Ezemenari Obasi and Dan O’Connor, fellows at the UH institute fighting health disparities aptly called UH HEALTH (Helping Everyone Achieve a Life Time of Health) Research Institute, direct Project TOUCH. “The ultimate objective is to create a model that can be duplicated and sustained not only in communities across the greater Houston


PIETRO CICALESE

Cullen College of Engineering Biomedical Engineering Master’s Student

area but also throughout Texas and the United States, where treatment intervention will fill a gap in existing health-related services,” said O’Connor. First tested in the Third Ward, the community collaboration expanded to the East End, teaching nutrition, referring patients to the YMCA Diabetes Prevention Program and encouraging exercise and a healthy lifestyle. “When we go into the communities, we’re finding a high proportion of the people we screen have high risk for Type 2 diabetes,” said Obasi. Risk factors include chronic exposure to stress, lack of insurance to cover medical expenses, intergenerational poverty and medical deserts. “There aren’t a whole lot of mental or physical health services built into the community,” said Obasi. “Our primary goal is to integrate health care and offer prevention and treatment.” During a patient’s visit, a referral might be made to the Diabetes Prevention Program or to seek treatment at federally-qualified health clinics that partner with Project TOUCH. Project TOUCH also provides health fairs and screenings and a program to train the trainers, providing community leaders with tools they can use to better serve their neighbors. “On behalf of the nearly 18,000 UnitedHealthcare employees in Texas, we are grateful for the opportunity to partner with a leading organization like the University of Houston to address this important public health issue,” said Dave Milich, CEO, UnitedHealthcare of Texas. As the program expands, Jefferson says she’s eager to see others learn to take control of their lives by making better choices. “Balance in our lives keeps us from going to extremes,” she said. “I’ve recognized that my food choices, the simple act of picking up an apple rather than a potato chip, makes me realize I can make better choices in the finer details of life.”

Opposite: Third Ward resident Margaret Jefferson says she’s been called a “gym rat” now that she’s made exercise a part of her life as an eager participant in the UH Project TOUCH program. Above: UH Project TOUCH fills a gap in existing healthrelated services and will reach at least 7,000 people, most of whom will be Black or Hispanic and socioeconomically disadvantaged.

No doubt in his mind, Pietro Cicalese is going to be a doctor. But first, he’s going to grab his master’s in biomedical engineering after completing his thesis on the use of machinelearning algorithms in the diagnosis of Alzheimer’s disease. When not busy polishing up the thesis, Cicalese spends his time as a medical humanitarian. In 2016, he founded the Global Humanitarian Student Initiative at UH to offer student services for humanitarian relief efforts around the world. For the next two summers, the group traveled to Italy and Greece, where they pre-screened migrant and refugee populations. In the remote areas, he visited, Cicalese noticed mistrust toward medical professionals, but the students were able to build it by simply being honest. Born in Italy to two doctors, Cicalese said his parents inspired him to do this work with their philosophy on medicine—that the well-being of a person should be put above all else. Cicalese has found exactly where he belongs, at the corner of health care and humanitarianism. •

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DISPARITIES years or so, researchers, public health officials and health care providers have become more focused on understanding the causes of these disparities and finding solutions. Dr. Stephen J. Spann, UH vice president for medical affairs and founding dean of the UH College of Medicine, said it’s more complicated than just making sure everyone can see a doctor. So-called social determinants of health—race, poverty, education, substandard housing and lack of access to healthy food, transportation and a safe place to exercise—account for up to 80 percent of preventable illness and death. Health policy can both address and exacerbate disparities. Jessica Mantel, co-director of the Health Law & Policy Institute at the UH Law Center, said policies that reward providers when patients meet certain benchmarks—fewer emergency room visits, for example—could cause physicians to drop patients who don’t follow their advice, even if that is caused by lack of money for medications or transportation to return for an office visit. Insurance policies requiring high out-ofpocket expenditures mean some patients are likely to avoid seeking treatment, Mantel said. But she sees a positive side, too, especially from policies that reward providers for keeping patients healthy. “A patient with asthma who lives in a mold-infested apartment, traditionally that’s not the health care system’s problem,” she said. “But, now these policies are nudging providers to address these social and environmental problems that affect health.”

HEALTH DISPARITIES Researchers and Health Care Providers Are Focused on Solving Inequities in Health Care Outcomes BY JEANNIE KEVER

A

frican-American babies born in an economically depressed Northeast

Houston zip code are more than eight times more likely to die within their first year of life than those born in an affluent neighborhood just a few miles away. Rural women are twice as likely to die from cervical cancer as their urban counterparts. Health disparities—the ways in which some groups are disproportionately affected by preventable differences in the risk and outcome of disease—aren’t new. But, over the past 20

16 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

The Houston area is a living laboratory

for health disparities, and Shainy Varghese’s Stafford clinic sits squarely at the nexus. Varghese, a pediatric nurse practitioner and associate professor in the UH College of Nursing, says most of her patients are on Medicaid, so they have health insurance. But they often lack health literacy, the knowledge that would help them make decisions about everything from immunizations to diet. She and her staff spend a lot of time on health education. Nutrition is an issue, both because healthy food is expensive and because many parents continue to serve what they ate as children.


“The United States spends far more money than anyone else on health care, and yet we don’t have the best health.” “I explain the importance of green leafy vegetables, but for some of them, it’s rice and beans because that’s what they are used to,” she said. Varghese’s clinic is next door to the Women, Infants and Children Nutrition Service. Some of her patients receive food stamps. Even so, she said that may not be enough to feed a growing family. “They fill their children up with chips, because that’s less expensive,” she said. It also can lead to obesity, Type 2 diabetes and other problems, especially when coupled with lack of exercise, problems too complex to solve with a quick visit to the doctor or nurse practitioner. “A higher prevalence of diabetes may not be fixed by giving everyone diabetes medicine,” Spann said. “Doctors can’t fix it all.” They can’t, but the training of future health care practitioners is changing to reflect the growing recognition of health disparities. Sandra Lee is part of that at the College of Nursing, where she is an assistant clinical professor.

Inequality leads to unequal health outcomes, she said, and educators are addressing racial and other forms of implicit bias. For example, Lee developed a module on the LGBTQ community for a nursing course on mental health care, noting the group has higher rates of depression and suicide than the general population. Another piece of the solution involves building a more diverse health care workforce. Lee said diversifying the workforce is about more than allowing people to be treated by someone who looks like them. It also means providers will be able to draw upon their colleagues for a wider range of ideas to care for disparaged groups. If the goal is to eliminate health disparities, the end is not yet in sight. “I think it’s a moral imperative,” Spann said. “But it’s also an economic issue. The United States spends far more money than anyone else on health care, and yet we don’t have the best health.” He is guardedly optimistic. “I don’t think we’ll solve it overnight, but there’s a lot of low-hanging fruit.”

Access to Care

35

80

147 158

have no physicians of any kind.

have five or fewer physicians.

have no obstetrician/ gynecologist.

Texas counties

Texas counties

Texas counties

Texas counties have no general surgeon.

RANDY NGUYEN College of Natural Sciences and Mathematics Senior Biology Major

Senior biology major Randy Nguyen has dreams of one day starting a primary care clinic in an underserved community. With plans to attend both nursing school and medical school first, he’s not waiting until after graduation to make a difference. As part of the recruitment and development team for Honors in Community Health (HICH), Nguyen helps cultivate programs and partnerships with community health organizations that promote mental, physical and emotional health in communities with limited access to resources. The Creative Care project, for example, uses art, meditation and yoga to raise awareness and advocacy at a Third Ward public housing complex. “Pursuing a career in the health care field has taught me the importance of empathy,” he said. “Being able to see different perspectives and experiences allows us to construct effective solutions.” UH students don’t have to be affiliated with the Honors College to join HICH. They just need a passion for helping people. •

SOURCE: ASSOCIATION OF AMERICAN MEDICAL COLLEGES

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DISPARITIES

FOOD FOR FUEL Tackling Obesity, Food Insecurity and Poor Nutrition BY CHRIS STIPES

are not as sweet and heavy in Sweden as they are in the United States

can be up to 25% fat because they absorb so much of the fat they are fried in

naturally fat free and cholesterol free

may help boost the immune system, build strong bones

while also being around 95% water they contain several vitamins

Americans consume about 2 billion cookies each year

18 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

L

ife got really tough when

Schmeaker Swoopes was diagnosed with multiple sclerosis. The longtime nurse was out of work for several years, saddled with mounting medical bills as she and her husband struggled to feed their three teenagers and adult son. Five years later, many challenges still exist. “It took me down,” she said. “I take a lot of expensive meds, so buying enough food is very difficult at times.” Swoopes’ oldest son, Darrel, has Down syndrome and lives at home. She calls the 26-year old who is studying culinary arts at Houston Community College (HCC) a “magician in the kitchen.” It’s ironic, considering their family is often challenged to have enough food on the table. Nearly 17 percent of Harris County residents are food insecure, defined by the U.S. Department of Agriculture as having a lack of consistent access to enough food for an active, healthy life. “It’s harder to eat healthy because it costs more than the unhealthy food,” said Swoopes. The family receives 60 pounds of free food twice a month through HCC’s Food Scholarship Program. Researchers at the University of Houston’s department of health and human performance are tracking Darrel, and thousands of other low-income HCC students, through funding from the Kresge and William T. Grant foundations. Research shows that more than half of community college students are food insecure. “Food insecurity is a barrier to graduation for these students,” said Daphne Hernandez, UH associate professor and co-principal investigator on the study. While financial issues can limit access to healthy food, geography plays a role too. More than 23 million Americans live in “food deserts”—areas that are more than a mile away from a supermarket. Regardless of socioeconomic status, the typical American diet is poor. Only one in 10 adults eats the


“More than 23 million Americans live in ‘food deserts’—areas that are more than a mile away from a supermarket.” recommended amount of fruits and vegetables each day. Hernandez recalls a woman at the HCC food distribution site who refused to take a free cabbage, a vegetable packed with nutrients and many health benefits. “She said ‘I don’t know what to do with that.’ So instead of trying it, she just didn’t take the cabbage because it’s unfamiliar,” said Hernandez, who now provides recipes so students can prepare appealing dishes that are also healthy. A recent report projects that by 2030, half of all adults in the United States will be obese. Changing peoples’ attitudes about food and nutrition is among the biggest challenges to tackling the obesity epidemic, according to Norma Olvera, professor in the department of psychological, health and learning Sciences at the College of Education. Until people start viewing food as fuel instead of comfort, she said, America’s collective waistline will keep getting bigger, leading to costly chronic diseases including heart disease, Type 2 diabetes and some cancers. Olvera’s BOUNCE (Behavior Opportunities Uniting Nutrition, Counseling and Exercise) program provides cooking demonstrations, grocery store tours, nutrition classes and fitness instruction to low-income minority children and their families. “Parents plead with us all the time, ‘Show me how to eat healthy.’ Everyone knows they should eat more fruits, vegetables and less sugar, but they still want it to taste good,” said Olvera. Dieticians and chefs offer recipes and healthy alternatives to some unhealthy favorites. Plain Greek yogurt is a great

substitute for sour cream, for example, while guacamole can replace mayonnaise. The children are also schooled in the science behind the food so they can make better choices. During a presentation on food labels by the Houston Food Bank, only six of the 32 kids in the class raised their hands when asked if they read nutrition labels. Sandy Hernandez, 13, was shocked to learn how much sugar was in one 12-ounce can of peach juice—46 grams. Experts recommend getting less than 50 grams of added sugar daily. “I thought that juice was healthy, but when I saw the amount of sugar in it, I was blown away,” she said. “There’s not even any real fruit in there.” Like all of the children in the BOUNCE program, Sandy struggles with her weight. Now armed with information and motivation, she’s eager to adopt a healthier lifestyle. “I’m getting slimmer and I can move around more, which boosts my self-esteem and academic focus,” she said. It’s a different way to look at food. You wouldn’t put bad fuel in your vehicle, so why put it in your body?

KATHERINE ARLINGHAUS

College of Liberal Arts and Social Sciences Ph.D. Candidate

Doctoral candidate Katherine Arlinghaus helped develop an effective obesity intervention for Hispanic middle school students. Her team found that with consistent guidance from high school health mentors, called compañeros, students not only lost significantly more weight but also kept it off longer. Trained as peer health mentors by their physical education teachers, high school students at several YES Prep charter school campuses in Houston offered daily support and advice about exercise and nutrition to middle school kids during PE class. “The younger kids might perceive the high school students to be cool. So, if they’re telling them it’s awesome to eat carrots, then maybe they’ll start eating them too,” said Arlinghaus. After six months, 80 percent of the kids who worked with the compañeros decreased or maintained their standardized body mass index, which is 16 percent higher than students who didn’t work with mentors. Arlinghaus won the annual student research paper contest organized by Preventing Chronic Disease, a peer-reviewed journal. •

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PRIMARY 20 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018


FOCUS

The UH Road to a College of Medicine By Mike Rosen

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Shortly after medical school

during his residency at Baylor College of Medicine, and years before he became founding dean of the UH College of Medicine, Stephen Spann realized he was not on the right career path caring for the sickest of patients toward the end of their life. He was much more interested in keeping people well earlier. So he left Houston and headed for the hills of Arkansas where he tested the waters of family medicine. It was exactly what he had hoped. Being involved earlier in the stream of care allowed him to prevent the early onset of debilitating conditions and watch his patients thrive. Convinced this was his calling, Spann completed a residency in family medicine at Duke University and set up practice in rural North Carolina to take on what he viewed as the ultimate challenge: providing care in regions where both doctors and resources were sparse. He took care of people “womb to tomb.” Like working in a small shop, he did everything. He was the doctor for the high school football team, and he made house calls, including newborn visits after every birth. “I’d sit on the floor, talk to the parents or grandparents,” Spann said. “It was a chance to really learn about the home, the family, the environment. Sometimes get invited for supper.” He spent three years in North Carolina, where he established a network of clinics. From there, he taught at the University of Oklahoma College of Medicine, headed up Family Medicine at both The University of Texas Medical Branch-Galveston and Baylor College of Medicine and taught medicine under the Johns Hopkins umbrella in the United Arab Emirates.

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DR. STEPHEN J. SPANN UH Vice President for Medical Affairs and Founding Dean of the UH College of Medicine


GROWING DEFICIT To put it plainly, he’s been around and he understands the importance of primary care. It is why Spann, more than many, understands the significance of Texas, and Houston, having a doctor shortage. It’s not obvious if you live in an urban middle class neighborhood or in the shadows of the largest medical center in the world. But in rural areas and woven throughout the fourth largest city in the nation are health care deserts—vast neighborhoods where hospitals and clinics are rare or nonexistent, and residents have little means. Texas has a little more than 20,000 active primary care physicians. But, according to the Association of American Medical Colleges, the state will need to add another 6,400 by 2030. Just to meet the national average, that’s a 32 percent increase over roughly the next decade of a medical commodity declining in popularity. That deficit is what has driven the University of Houston to navigate a path laden with political, financial and administrative hurdles to establish a College of Medicine. One that takes an approach unlike the other three schools in Houston—the last of which opened in 1972 when the population of the metropolitan area was a third of today’s six million plus. Existing medical schools produce primary care physicians. But as the economic reality of becoming a doctor has set in, more and more students have chosen to specialize in disciplines such as orthopedics or cardiology. Such subspecialties often pay twoto three-times higher salaries and better ensure a comfortable living as the cost of their education; the delivery of care and medical malpractice premiums have all risen, and government reimbursement rates for care provided to Medicare and Medicaid patients have declined. Among the chief supporters of a UH College of Medicine are the collective 60 institutions that comprise the Texas Medical Center, whose president, Bill McKeon, views the University’s model as “extremely complimentary” to existing hospitals. “I am a huge supporter of this for many reasons,” McKeon said. While TMC boasts a great depth of specialists, among them some of the most renowned in the world, McKeon emphasizes the need for a broad-based net of primary care physicians as essential to support the day-to-day needs of communities and improve the health of large populations.

“So when we think about this world being more about preventive care, about managing chronic illness, that needs to be done largely by primary care physicians,” McKeon said. He notes only about 20 percent of medical graduates currently go into primary care practice.

THE 50% STRATEGY To buck that trend, the UH College of Medicine has a goal for 50 percent of its graduates to practice in primary care specialties. The strategy to reach what is considered an ambitious mark starts with recruiting students whose characteristics are more predictive to a career in family practice, said Spann. “That goes beyond GPA and MCAT score to a more holistic approach.” As examples, Spann points to students from rural areas or whose parents worked in service professions such as teaching, clergy or in nonprofit, who tend to be more interested. So are those who have taken a hiatus between college and medical school to do something altruistic, perhaps joining the Peace Corps. He knows this because the data backs it up, and he’s lived it. He grew up in Uruguay, where his parents were missionaries. It is with this global view from the deserts of the Middle East to the countryside of the American Southeast that Spann understands what it takes to improve health in the far reaches of society. And, the background and teachings that demonstrate the need and instill the empathy that ultimately sets newly minted doctors on a career path less taken. That’s why, in addition to recruiting goals, the UH culture and curriculum is also vastly different. Built into the program is a heavy dose of learning in a primary care setting. Rather than spending a four- to six-week rotation in family medicine, common

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33%

lower health costs for U.S. adults who have a primary care physician

6,400

projected number of additional primary care physicians needed in Texas by 2030

among most medical schools, UH medical students will experience a longitudinal primary care clerkship, in which they will spend a half-day per week for the duration of their studies in a primary care setting. “So they will be immersed from day one, over four years, heavily exposed to primary care,” said Spann. Part of that exposure is through a Household Center Care component in which inter-professional teams of UH students from medicine, nursing, pharmacy and social work will be assigned families with complex medical-social problems who live in underserved communities. They will follow those families monthly. The strategy is modeled in part after similar medical programs Spann toured at Florida State University and Florida International University. Both medical schools have reached the goal of half their graduates committing to careers in primary care. Florida State achieved 55 percent through its first six years. “This is an investment in our future that will pay huge dividends to our communities. It will start to change the way medical students are delivering care,” said TMC’s McKeon. Access to health care across the entire socioeconomic spectrum is something that Bob Harvey, president and CEO of the Greater Houston Partnership, recognizes as essential to economic growth. Harvey has found health care is typically in the top three on the list of questions from businesses considering expanding or moving to the Houston area. “There’s a greater concern today among employers that the overall state of Houston’s health care system is not what we need it to be,” he said.

24 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

$67 billion

annual national savings if everyone used a primary care provider as their usual source of care

4 million

new residents in the Houston metropolitan area since the last medical school was established in 1972

Whether it’s building an innovative economy or ensuring a skilled workforce, Harvey has embraced academia and research contributions to solving civic challenges and paving the way for economic success. The same model applies to increasing access to health care. In Harvey’s view, the University of Houston “has always found that balance between quality and access.” “I think taking that model now and applying it to health care is a very logical step for the University.”

THE ROAD AHEAD A few hurdles remain on the path to welcoming the first class of students to the UH College of Medicine. While the University of Houston System Board of Regents approved the college last year, the University is seeking national accreditation from the Liaison Committee on Medical Education, approval from the Texas Higher Education Coordinating Board as early as this fall and partial funding from the Texas Legislature after it gavels in in January.


“This is an investment in our future that will pay huge dividends to our communities. It will start to change the way medical students are delivering care.” —Bill McKeon, president, Texas Medical Center

In the run-up, Spann and Jason Smith, UH’s vice president for governmental relations, have blazed a trail between Houston and Austin, and points afar, meeting with elected officials and their staff who will ultimately decide whether a UH solution to the state’s unmet health care needs is worth taxpayer support. That’s a high bar for any initiative, more so in light of new budget demands. “They are open to listening to us, which is the first step,” said Smith. In addition to the demonstrated need, the University has in its favor a plan to build the UH College of Medicine on long-existing health programs and research. Nursing, pharmacy, optometry, psychology, audiology, social work and innovation from engineering and architecture are just some of the disciplines that will contribute to the College’s holistic educational approach. UH is also finalizing an agreement with HCA Houston Healthcare for nearly 400 residency slots in area hospitals. Throw in an anonymous $3 million gift that will pay for the entire inaugural class of students, and Smith has found it makes for productive conversations with influential audiences. “I’ve literally had some legislators tell me ‘I was walking in prepared to have to tell you ‘no,’ but your message is so strong, you’ve designed it so well, I can’t say ‘no,’’’ said Smith.

University of Houston and Humana A Partnership for Quality Health Care BY CAROLYN HARTMANN

The University of Houston and Humana Inc., one of the nation’s leading health and well-

being companies, have announced a long-term partnership to train the health care leaders of tomorrow. Both organizations will create the Humana Integrated Health System Sciences Institute at the University of Houston, uniting the University’s new College of Medicine, as well as the existing colleges of nursing, pharmacy, social work and optometry. A $15 million gift over 10 years from Humana will help defray start-up and operational costs for the College of Medicine and also fund endowed chairs for each of the five colleges. UH and Humana expect this strategic alliance will create ample opportunities for collaboration, including: • Adjunct professorships and teaching opportunities for Humana subject matter experts • Opportunities to partner in shaping curricula in a wide range of topics, including value-based payment, home-based care, population health, data analytics and more • Partnership on research and publications • The establishment of value-based care clinic labs for University of Houston health sciences students and medical residents • Internships and rotation programs to provide practical experience With its emphasis on underserved communities, the partnership aligns with Humana’s “Bold Goal” to improve the health of the communities it serves by 20 percent by 2020. While working to address social determinants of health, Humana is taking a population health approach to pursue this objective. The University’s partnership with Humana will build a talent pipeline of graduates that believe in, train and practice population health.

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ONE-STOP SHOPPING

UH Looks to Establish Health Clinic for Houston’s Medically Underserved BY SHAWN LINDSEY

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C

onstruction had just been completed on the Ezekiel W. Cullen Building on the University of Houston campus when, in 1950, psychology professor Richard Evans joined the faculty. He’d just completed his doctorate at Michigan State and was about to do very big things that are still relevant to his field and the University nearly 70 years later. “In 1950, when Dr. Evans founded the social psychology program at UH, he was one of the first people to introduce the idea of health psychology and behavioral medicine,” said Jack Fletcher, chair of the UH department of psychology and Hugh Roy and Lillie Cranz Cullen Distinguished Professor of Psychology. Today, the link between behavioral health and health care has never been greater, due in part to pioneering work that began at UH in the

1950s, although integrating the two remains a challenge. “Today, we have a much more integrated view about how the behavioral sciences fit in health care in general … a greater recognition that chronic health conditions like diabetes, obesity have a big behavioral health component,” said Fletcher. Fast forward to 2018: the Health 2 building has just been completed, and big things continue to happen in the areas of mental and behavioral health and health care. The University of Houston is seeking approval to partner with a nonprofit Federally Qualified Health Center (FQHC). The partnership would establish a full-service health care facility in Health 2, on the southeastern corner of campus. The center, open to the public, would provide comprehensive primary and preventive care, including dental, mental and behavioral health services, to people of all ages, regardless of their ability to pay. UH’s plan is currently under review by the Health Resources and Services FALL 2018 • UNIVERSI T Y OF HOUS TON Magazine 

27


Administration, an agency of the U.S. Department of Health and Human Services tasked with “improving health care to people who are geographically isolated, economically or medically vulnerable.” “Partnering with a FQHC will allow the health center to qualify for federal reimbursements from Medicare and Medicaid and charge on a sliding scale for patients without insurance,” said Dr. Stephen J. Spann, vice president for medical affairs and founding dean of the UH College of Medicine. “The partnership would allow us to offer care to more people, including people without any (insurance) coverage.” UH’s vision is a primary care clinic that will provide much needed medical services to Houston’s underserved populations while training UH students studying health-related fields in the latest protocols and therapeutic, research-based treatments. In addition to hiring more licensed practitioners, faculty experts from the College of Liberal Arts and Social Sciences Department of Psychology, College of Education Department of Psychological, Health & Learning Sciences, and the Graduate College of Social Work (GCSW) would provide behavioral health services. “It will be one-stop shopping. Patients could come in and get their physician and behavioral health needs met in a seamless fashion, which ultimately leads to better health,” said Luis Torres, GCSW associate dean of research and strategic partnerships. We’ve come a long way since 1950 when professor Evans took psychology to the mainstream. The relationship between behavioral health and health care is now well established, but integration between the two in the primary care setting has been slow. “At an international level, as much as 50 percent of patients seen in a primary care setting have a mental health problem as their fundamental issue,” said Spann. “Well-trained primary care clinicians recognize that. In an ideal setting, they’d make a diagnosis, prescribe medication, if necessary, and

28 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

immediately walk them over to a counselor in the same practice who can see them immediately, a so-called ‘warm handoff’ model of integrated behavioral health care in a primary care setting.” The traditional model of referrals to counseling requires the patient to seek additional treatment on their own. Some simply won’t go. Others are discouraged because it’s not covered by their health insurance. Experts say integration is desperately needed. Texas consistently ranks at or near the bottom for access to primary care and mental health services, despite a growing need. There is a shortage of mental health and other health professionals. The UH department of psychology, for example, receives more than 500 applications for just 12 spots in its Ph.D. program every year as graduate students vie to learn under the department’s world-class faculty and researchers. But the department’s clinics were developed for training students and are able to treat a relatively small group of patients. “We have never advertised our clinics, because we don’t have the resources to do it. A partnership with a FQHC would allow us to appoint full-time clinicians to provide services to have a bigger flow of patients,” said Fletcher. It also creates an opportunity for medical, nursing, social work, pharmacy, clinical psychology, optometry, even law students to observe a new kind of care. It is this type of integrated care approach, leveraging the University’s vast existing health related disciplines, that will serve as the foundation of the new UH College of Medicine. “We would use this as a teaching opportunity, a place for students to observe and participate in this kind of care under supervision of trained, licensed practitioners,” said Spann. Will these students be ultimately working in a more integrated world? “We hope so,” he says.

Today we have a much more integrated view about how the behavioral sciences fit in health care in general … a greater recognition that chronic health conditions like diabetes, obesity have a big behavioral health component.


MENTAL HEALTH

JEFFREY RIMER

Cullen College of Engineering Professor

Jeffrey Rimer is known for his groundbreaking work in crystal engineering, including the discovery that a natural fruit extract can dissolve human kidney stones, small mineral deposits that form inside the kidneys which affect up to 12 percent of men and seven percent of women. High blood pressure, diabetes and obesity can increase the risk. Rimer and colleagues reported in 2016 that the compound hydroxycitrate is an effective inhibitor of calcium oxalate crystals, the most common component of human kidney stones, a finding that could lead to the first advance in treatment in three decades. Human clinical trials are underway, and research to find new drug candidates is ongoing. Rimer, the Abraham E. Dukler Professor of Chemical and Biomolecular Engineering, received the 2018 Norman Hackerman Award in Chemical Research given by the Welch Foundation to chemical scientists working in Texas designed to encourage the fundamental understanding of chemistry. •

FINDING REST FOR THE WEARY Troubled Sleepers Often Battle Anxiety BY CARRIE ANN TAYLOR

T

he sound of horns blaring

can be startling—especially when you’re asleep at the wheel. Scares, like nodding off at red lights, combined with involuntarily falling asleep in class—or any time he sat idly—convinced Tyler*, a University of Houston student, to seek help. Tyler found relief at the Sleep and Anxiety Center of Houston (SACH), a clinical research center in UH’s department of psychology. The Center is directed by Candice Alfano, professor of psychology and licensed clinical psychologist. SACH offers low-cost, evidencebased clinical services for children and adults with sleep- and anxiety-related problems. “We see a lot of college students who think they are suffering from a serious sleep disorder because they have trouble maintaining wakefulness during the day and can’t concentrate,” Alfano said.

After an extensive evaluation, Tyler’s treatment included learning to dedicate adequate time for sleep, keeping consistent bed and wake times, avoiding caffeine late in the day and reducing light exposure in the evening hours, while maximizing sunlight exposure in the morning. In addition to helping students stay awake long enough to achieve academic success, the SACH team is committed to research. Currently, understanding the mental impact of Hurricane Harvey on youth is a priority at the clinic. “We are interested in how sleep-wake patterns predict psychological responses to trauma over time,” Alfano explained. “Hurricane Harvey, while a devastating event, offers an important opportunity to understand these relationships among children right here in Houston.” Funded by a $178,590 grant from the National Science Foundation, the study follows children originally assessed years before Hurricane Harvey. Researchers plan to examine how the children’s pre-disaster sleep patterns and emotional functioning predict risk or resilient outcomes related to a traumatic event. According to Alfano, children who suffer from poor or inadequate sleep are much more likely to be adults who are anxious and troubled sleepers. Intervening early is key, because these relationships are bidirectional, meaning one can worsen the other and escalate over time. “More than 70 million Americans suffer from a sleep disorder, so our clinic serves a large and ever-growing need,” Alfano said. *Tyler is a pseudonym to protect the patient’s privacy.

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MENTAL HEALTH

ADVANCING ADOLESCENT MENTAL HEALTH CARE Adapting Mental Health Care to Adolescents’ Needs

NORMA NGO

Counseling and Psychological Services Director and Licensed Clinical Psychologist

BY SHAWN LINDSEY

T

he statistics are staggering:

approximately one in five youth, ages 13-18, will experience a severe mental disorder at some point during their lives. For half of all people who have a mental illness, symptoms first appear by age 14. By age 24, it’s noticeable in 75 percent, according to the National Alliance on Mental Illness. “In the U.S., suicide rates are higher than ever. We have more kids not getting access to mental health care, because people think they’re too hard to manage,” said Carla Sharp, director of the UH Adolescent Diagnosis Assessment Prevention Treatment center (ADAPT), which offers assessments and individual psychotherapy to children ages 12-17 dealing with emotional and relationship difficulties. Even when adolescents do get access to care, she said the majority don’t respond to treatment, making them vulnerable to dropping out of school or entering the juvenile justice system. Clearly, better mental health care for adolescents is critical. Cutting-edge treatments are making a difference. ADAPT offers traditional cognitive behavioral therapy, as well as other cutting-edge evidence-based treatments. It is one of the clinics offered by the Psychological Research Service Center in the department of psychology, and it deals with some of the most difficult cases. “Katie” has borderline personality disorder. When she sought treatment at ADAPT last year, she was 17 and had just been released from inpatient care following a suicide attempt. She had a history of self harm and marijuana use, and her relationships with friends and family were strained. She had entered foster care after being taken from her birth mother because of substance abuse and was adopted at age three.

30 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

At the clinic, Katie underwent mentalization-based therapy (MBT)—a form of psychotherapy that is relatively new to the United States, designed to treat people with borderline personality disorder and first tested in Europe about 20 years ago. Through MBT therapy, Katie was eventually able to recognize how she interacted with other people around her and work through her relationship difficulties. “You have to know how to interact with people in order to promote positive outcomes,” said Sharp. “If you can do that, you take ownership of your problems, and you are the solution to your problems.” Katie was treated at ADAPT for about a year. During that time, she quit using drugs and later enrolled in community college— something that was “never in the cards for her.” “By all accounts she is doing very well,” said Sharp.

Norma Ngo is on the frontlines of battling a public health crisis twice as prevalent as homicide. Suicide is the second leading cause of death among college-age adults in America. As director of Counseling and Psychological Services (CAPS) at UH, Ngo is training “gatekeepers” around campus who are informed and ready to intervene on behalf of individuals considering suicide. “The gatekeepers increase the CAPS team by broadening outreach and awareness,” she said. “People struggling with mental health issues need to know there is hope and help. We can provide that.” Each year, Ngo and her team lead a nationally recognized suicide prevention program for the UH community, including all housing and residential life staff. QPR, which stands for “Question, Persuade, Refer,” teaches participants how to ask the suicide question, persuade the person to contact appropriate assistance and identify referral options. Research has shown that persons who ultimately attempt suicide often provide numerous direct or indirect clues as to their intentions. •


JOHN SHIFLET

Cougars in Recovery Program Director

THE LOVE CONNECTION Unhealthy Relationships Affect Your Health BY CHRIS STIPES

C

ontrary to popular belief and the premise behind most dating apps,

compatibility does not guarantee a happy relationship. Relationships are messy. Differences are inevitable. If a couple is using ineffective tactics to manage their differences, it can lead to defensiveness and emotional distance. Relationship discord can be hazardous to your mental, emotional and even physical health, according to UH psychology professors John Vincent and Julia Babcock, codirectors of the UH Center for Couples Therapy. “People in unhappy relationships can develop anxiety, depression and substance abuse. For those who divorce, the emotional and financial toll can be staggering, not to mention the negative emotional fallout for children,” said Vincent. Research shows psychological stress can suppress our immune system, which can increase susceptibility to illness while slowing down recovery. In the most severe cases, troubled relationships can escalate to violence, serious injury or even death. By contrast, good relationships can have positive health advantages, including reduced pain and stress, longer life, a greater sense of purpose, stronger bones, career success, positive body image, healthier habits and improved cardiovascular function. The mission of the UH Center for Couples Therapy is to train doctoral students in clinical psychology in effective approaches to couples therapy, conduct research on marital accord/ discord and provide services to the community to help troubled couples. So, what are the most effective strategies to foster a healthy relationship?

Effective Relationship Tactics Personal responsibility:

Take positive, constructive actions to show your partner that you really care.

Gratitude:

Acknowledge and show appreciation for your partner’s efforts to do the same.

Accountability:

Own up when you mess up.

John Shiflet likes to say, “I recover out loud.” He doesn’t mind sharing with the world who he was, because it’s who he is today that is making a difference in the lives of UH students in recovery. Thanks to a collegiate recovery program offered through Texas Tech University, Shiflet was able to transcend his troubled past that included incarceration, probation and seven courtordered stays in treatment facilities. Proudly sober since May 1, 2007, Shiflet says if he can do it, anyone can. He walks his talk every day as program director for Cougars in Recovery. Since August 2013, Cougars in Recovery has provided more than 150 individuals a safe and sober environment as they pursue their academic and professional goals. Students participate in peer-to-peer process groups, on-campus 12-step meetings and an outdoor adventure learning experience where they learn leadership skills. “I clawed my way out of the system. I am living proof that you can come out of addiction, reclaim your life, be successful and happy, and live your dreams.” •

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MENTAL HEALTH

FEELING ANXIOUS? YOU’RE NOT ALONE TrACH Provides Support for Those Struggling with Trauma and Anxiety BY CARRIE ANN TAYLOR

E

arly in Anka Vujanovic’s

career, she was inspired by the hope and strength of trauma survivors and humbled by their ability to overcome intense pain

and suffering. Today, she is turning inspiration into action. Vujanovic, associate professor of psychology at UH, co-directs the Trauma and Anxiety Clinic of Houston (TrACH) with Matthew Gallagher, associate professor of psychology. Launched in 2016, the UH-based specialty mental health treatment clinic provides a place for underserved communities to receive specialized, evidence-based mental health services in addition to serving as a research and education center. “Many of our clients are from low-

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income, high-crime areas in Houston, and they present with complex histories and circumstances,” Vujanovic shared. “A good proportion of our clients are survivors of childhood abuse, sexual assault and domestic violence. They may be struggling with post-traumatic stress, depression or anxiety, and many have current or past histories of substance abuse.” The clinic also serves UH students referred by the Counseling and Psychology Services Center (CAPS) and UH Health. They are seeking help for test anxiety, obsessivecompulsive disorder and generalized stress about juggling school, work and finances. “Education and awareness are the first steps,” said Tannah Chase, UH postdoctoral fellow and assistant director of TrACH. “We

always start out educating people about anxiety and emotions, how emotions work and how to work the relationship between thoughts and emotions and behaviors.” Chase focuses on teaching patients healthy coping skills. She said breathing techniques, mindfulness and being non-judgmental of the present moment are ways to keep from getting wrapped up ruminating about the past and anticipating what hasn’t yet happened. “Often people view anxiety as a stigmatized concept; if you have anxiety, something’s wrong with you,” Chase added. “But, anxiety is actually a very normal human process built into our system and has a lot of benefits for us. It’s what keeps us alive and should not be suppressed or avoided. If you struggle with anxiety, you’re not alone.”


PIECE BY PIECE, FINDING PEACE Putting the Puzzle Together During Postpartum Depression BY CHRIS STIPES

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fter giving birth to her third child in four

PHOTO COURTESY OF ERICA MONCADA

years, Felicia, a child care worker from Phoenix, was overwhelmed. She persevered, despite being exhausted and emotionally disconnected from her new baby boy while also struggling to care for her other kids. Her traditional Mexican family said it was normal for new moms to be tired. But she knew better—the debilitating, roller coaster of emotions she was experiencing couldn’t be normal. “It was awful. I couldn’t even breastfeed my son because I was so stressed and emotional,” she said. “I’d cry the whole time, and that made me feel guilty because I remember how much I enjoyed time with my first baby.” Felicia, 29, was diagnosed with postpartum depression (PPD), which affects about one in eight women after the birth of a child. It’s different than regular “baby blues,” because it lasts longer than the first

two weeks after childbirth. While changing hormones can contribute to PPD, so can societal factors. Research shows mothers from lower socioeconomic backgrounds—who often live with chronic stress—are twice as likely to suffer from PPD. The doctor prescribed medication to treat Felicia’s depression and sleep issues, but the pills clouded her already fragile psyche. With little hope, she discovered an outreach center for impoverished families. Sunday school director Ericka Martinez was trained as a community health worker by the University of Houston to administer a home-based intervention called PST4PPD, or the “problem solving tools” intervention. During five sessions at Felicia’s home, together they focused on developing problem-solving skills and improving selfconfidence. Solving problems is like fitting pieces into a puzzle. You need to look at one piece at a time. “You have to take baby steps to gain confidence instead of looking at one big problem,” said Martinez, who’s worked at Neighborhood Ministries for 16 years. “By accomplishing small goals every day, you can make a real difference in your daily life.” The two-year research project, developed and led by associate professor McClain Sampson at the UH Graduate College of Social Work in partnership with Urban Strategies, had impressive results. Depression levels were cut in half among the 75 Hispanic women who completed the intervention in five cities, including Houston. Depression went down consistently every session, and a sense of selfcompetency went up. “Mothers with postpartum depression often go untreated because of stigma or lack of access to treatment. The peer-to-peer aspect of having health workers based in the community and from the same culture lowers the stigma,” said Sampson, director of the Center for Latina Maternal & Family Health Research. “Barriers to getting help can include cost, transportation and child care. The home-based nature eliminates those barriers.” Felicia had been neglecting her own wellbeing, sometimes not bathing for days. “I couldn’t take care of myself when I thought I wasn’t taking good enough care of my kids,” she thought. Setting simple goals like taking a shower or a nap, while choosing to forego less essential tasks such as cooking a three-course meal for her family every night was empowering, she said. The less there was to juggle, the more control she had. Felicia even stopped taking sleeping pills en route to what she calls a “complete turnaround.” “I was sleeping better when I could process my issues out loud and then look at the worksheet and checklist to see realistic goals and needs,” she said. “The intervention stopped me from overwhelming myself with all the nonessential stuff.” The intervention, typically given in Spanish, doesn’t require a credentialed mental health counselor to administer, making it attractive to community organizations that often lack resources. Martinez, after all, is a Sunday school director with no previous mental health experience … except her own. She too suffered from postpartum depression for several years. She uses her own experience to better identify with struggling new moms. “So much of working through depression is being able to have a fresh perspective. To have the moms view me as someone they could check in with and give them the footing they needed felt really good,” said Martinez. “UH is at the center of solving real problems for real people. This is what I hope a university would be about.”

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Understanding the

Adolescent Brain UH Researcher Sees Promise in Low-Cost Treatment for Adolescents BY SHAWN LINDSEY

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a

dolescents, especially teens, often get a bad rap: they sleep too late; they’re self-absorbed, dramatic and moody. A breakup or being snubbed by a friend can seem catastrophic.

As a result, adolescents are often characterized as “difficult,” and parents can be unsympathetic. We often blame the usual suspects: hormones and puberty. Carla Sharp, UH professor of psychology, says adolescent behavior is actually their brains at work. Much like a clinical pathologist searches for the cause of a disease by examining clues in blood or tissue, Sharp studies personality pathology—how our personalities and identities develop and how it can all go wrong, starting at a young age. Sharp’s work—incorporating what we know about a child’s developmental stage into any diagnosis and treatment—is changing our understanding of mental illness in adolescents and what that developmental stage can mean for relationships with parents and other caregivers, including what happens when those relationships go awry. The work offers lessons for anyone who deals with children, halfway around the world and here in Houston. “Forming an identity is the big developmental task of adolescents. It’s what helps us make decisions, like where we’re going to go for college or what we’re going to do for our job. There needs to be some solid sense of self that will guide all of these decisions,” said Sharp. Brain development goes into hyperdrive during the adolescent years—ages 10 to 18—as kids begin to form an identity. For some people, it’s a difficult time and can strain relationships with family and friends. For others, it can be nothing short of devastating, resulting in personality disorders, emotional detachment, substance abuse, self-harm, anger, impulsivity, even suicidal thoughts and actions.


“We take the developmental stage of the child into account when we try to figure out what’s going on with their problems.” Adolescents Respond Poorly to Treatment Sharp’s research has focused on personality pathology for the past 10 years. It is also why she and the Developmental Psychopathology Laboratory, which she directs at the University of Houston, have become international leaders in this area. “We take the developmental stage of the child into account when we try to figure out what’s going on with their problems,” she said. Mental disorders like depression, anxiety and substance use in adolescents are well-researched. Mental disorders are the single biggest cause of disabilities in young people, according to the World Health Organization. But there are huge gaps in what we know about treating mental illness in youth. Seventy percent of young people don’t respond to treatment. “If left untreated, it can impact the overall health of the child and their outcome in life,” Sharp said. “One of the reasons we believe teens don’t respond is because there is a big part of being an adolescent that is being left out of treatment. Specifically, these treatments don’t address the personality, identity and relationship function.” Keeping the Kids’ Minds in Mind Sharp’s work includes creating effective, evidence-based therapies, not just for adolescents with personality disorders but for any parent or caregiver who has a strained or difficult relationship with a child. At the core of an intervention framework she’s developed for treating adolescents is what she calls the “literacy of interaction.” In short, the intervention teaches parents and caregivers to go back to the basics, always “keeping the child’s mind in mind.” For the past three years, Sharp and her research collaborators at the University of the Free State, South Africa; Bar Ilan University in Israel; Michigan State University; and University College London have been training caregivers at community-based organizations that care for orphans in South Africa, Uganda and Ethiopia in Mediated Intervention for Sensitizing Caregivers, or MISC. As part of clinical trials federally funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, care workers who look after children orphaned by HIV/AIDS are trained to be more sensitive and responsive to the kids in their care. “Our research indicates that at the core of identity development gone astray is the caregiver’s capacity to mirror and regulate the child’s mental state. Adult-child interactions are of central importance,” said Peter Fonagy, professor and head of the Division of Psychology and Language Sciences at University College London, and a member of the research team.

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Children in very stressful, dramatic circumstances tend to shut down—it’s universal, whether the child is an orphan in Africa or an American child whose parent has mental illness or substance abuse issues. Experts say some kids will act out, but most will withdraw. Both scenarios result in poor outcomes educationally, emotionally and generally in life. “All children can reach their developmental potential if the grownups in their life interact with them in a way that stimulates their learning,” said Sharp, who has seen it first hand while training caregivers in Africa. In Uganda, for example, more than a million children have lost a parent to AIDS. A Critical Window for Mental Health But it’s not all bad news. Adolescence offers a critical window in which mental health can be promoted. The MISC intervention has two parts, addressing the emotional and cognitive components of the adult-child interaction. It centers on establishing a relationship that stimulates learning—not just about math and reading but also about the connection between thoughts and emotions so the child can apply it to future situations. “It could be highly beneficial for kids with a personality disorder, but this can be done with anybody. The kids we work with in South Africa don’t necessarily have a psychiatric disorder; they are vulnerable because they’re orphans,” said Sharp. The treatment, which is in clinical trials in Africa and soon in the United States, is ideal for “low-resource settings”—health systems with few resources and where kids are often more vulnerable. There are no required materials or expensive technology. The MISC trainer videotapes interactions between the care worker and the child and discusses the quality of the interaction with the adult, who is taught to build his or her skills over time. UH will soon take this innovative treatment into the Houston community—partnering with hospitals and schools to deliver MISC training to parents in Houston. With a grant from the UH Division of Research and Technology Transfer, graduate students in the department of psychology have been trained to coach parents using the MISC model. “This is a low-cost way for a parent to start changing the interpersonal dynamics between them and their kids,” said Francesca Penner, a UH doctoral student in the Developmental Psychopathology Lab who was recently trained to deliver MISC. Sharp says parents and caregivers can do endless test preparation and tutoring and use the latest, most cutting-edge technology to teach a child, but if it’s not done with the right interactions and a secure relationship, the child simply will not learn. Her advice is simple: Slow down. “For me as a parent, this intervention has meant a lot to me personally in helping me slow down my interactions with my children and not be so goaloriented all the time. The funny thing is, when you do slow down, your goals are met anyway, but it’s done in a calm, joyful way.” FALL 2018 • UNIVERSI T Y OF HOUS TON Magazine 

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UH College of Nursing Shows It’s More Than Giving Shots By Marisa Ramirez

38 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018


“My love and heart have always been in elder care.” Sandy Lee entered the nursing profession 29 years ago after completing a gerontological nurse residency program in the Texas Medical Center. She spent the next two years as a bedside-care nurse doing what was typical and expected of nurses then. “I would come on board in the morning, get reports, assess my patients, perform treatments, administer medication and then document all of that at the end of the day,” Lee said. “Everything was paper-based, all handwritten notes.” Lee now is an assistant clinical professor in the University of Houston College of Nursing and manager of the college’s RN to BSN program. The program is for nurses who have associate’s degrees and want to complete their bachelor’s. Lee says

the last two decades have seen a tremendous leap forward for the profession. “The profession has changed significantly and demonstratively,” she said. “In professional and educational opportunities, in technology, certainly. It’s related to patient safety.” In 1999, a report from the Institute of Medicine —To Err is Human: Building Safer Health Systems—described an environment of high error rates in U.S. hospitals resulting in a human cost in the thousands and a systems cost in the billions. It called for better controls on quality care. The Institute of Medicine is a nonprofit organization and component of the U.S. National Academy of Sciences that provides research and recommendations on public health. The call for patient safety became a catalyst for changes that included technological advances and educational

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Sandy Lee, assistant clinical professor at the UH College of Nursing, says the profession has changed significantly and demonstratively, particularly in the areas of technology, and professional and educational opportunities.

“We are change agents, leaders, innovators, collaborators and partners with the health care team,” Lee said. “And, in order to do that it takes a comprehensive education, well-grounded in general education and sciences and the arts, but also encompasses all aspects of health care. We save lives.”

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opportunities for nurses. Then, in 2010, the Institute of Medicine issued a challenge for 80 percent of nurses to secure a four-year degree in nursing by the year 2020 in the report, “The Future of Nursing: Leading Change, Advancing Health.” “We found through that report that nurses were not operating at their capacity of educational background and competencies. That’s when we began the national effort to push and create the RN to BSN programs. They’d been there all along, but there wasn’t a ‘market drive,’” Lee said. Nurses today, she said, want to pursue advanced roles in health care. She said in many nursing situations today, a four-year degree is required, and not having one can limit advancement. “There are nurses now who want leadership or management roles and are coming back for the BSN. The demographic has changed. They’re coming straight from community college. They want to be an ICU nurse but can’t get that job. Or their employer is now requiring it (BSN) and helping them.” While the challenge from the Institute of Medicine was an important change influence in nursing, there was another that cannot be ignored—technology. In the past, to ask an X-ray technician for immediate results on a patient may have meant waiting several hours at least. With digital images, the X-ray can be transmitted almost immediately with an answer just as quickly. Ask a veteran nurse about charting and you will likely hear about all the time it took to write out—physically, with a pen, on a chart—all medications dispensed to a patient, all care plans, prescriptions and changes in the patient’s conditions in the course of his or her shift. “I started when everything was on paper, charts weighed 80 pounds and each shift wrote in their designated color (black or blue on days, green on evenings

and red for night shift),” said Lisa Cannon, a 23-year veteran of the nursing profession. “We slowly moved to charting vitals and I & Os (intake and output) and sometimes ordered labs. Eventually, everything moved to computers. I don’t even need to carry a pen. Even the pharmacy delivery person has me ‘sign’ his phone!” Using computers and other technology to ensure quality care for patients may have ushered in something new—the nursing specialization. Nursing Informatics is a specialized area of study that integrates nursing, computer and information science to create and maintain patient information and systems. Nursing students can pursue graduate degrees or certifications in nursing informatics—an indication of the opportunities that have expanded for nurses in the last 20 years. Specialization in nursing is almost the norm today— pediatric nursing, intensive care nursing, forensic nursing, nurse practitioner, public health nursing, to name a few. Nurses today are essential participants in patient care, working with health care teams, physicians or as independent nurse practitioners in every part of life, spending the greatest amount of time with patients in the health profession. “Nurses play a critical role in patient care,” said Kathryn Tart, professor and founding dean of the UH College of Nursing. “By having a nurse who is educated, who has had real-world experiences and hands-on training from faculty with access to expanded instruction and research opportunities, you create a health care professional prepared to lead through the challenges of the industry with creativity and skill.” “We are change agents, leaders, innovators, collaborators and partners with the health care team,” Lee said. “And, in order to do that, it takes a comprehensive education, well-grounded in general education and sciences and the arts, but also encompasses all aspects of health care. We save lives.”

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HEALTH SCIENCE

center of the brain, while damaged brains tend to show stronger connections along the perimeter. The work is still in the lab but ultimately could be adapted to a portable system, allowing soldiers, athletes and others to be diagnosed and begin treatment immediately, he said.

Wearable Technology

APPS, ALGORITHMS AND NANOPARTICLES Researchers Lead a Wave of Tech Innovation to Improve Health Care BY JEANNIE KEVER

Y

our child takes a hit in youth soccer, but insists she’s fine.

What to do? Concussions and mild traumatic brain injury have drawn increasing concern in recent years, from the military to the National Football League and youth sports. But diagnosis remains tricky. A University of Houston researcher is seeking to change that, developing a test that could allow for immediate testing to definitively show signs of trauma to the brain. Technology has revolutionized everything, from the way we shop to the way we listen to music and keep up with friends. Health care hasn’t been immune. From efforts to quickly and accurately diagnose brain trauma to more closely targeting nanoparticles in drug delivery, researchers at the University of Houston are creating state-of-the-art technologies to improve the delivery of health care. Here’s a look at some of what we’re working on: “The idea is, instead of the patient going to the lab, we ultimately want to bring the lab to the patient in the form of a portable device that can do on-the-spot testing,” said George Zouridakis, professor of engineering technology and associate dean for research and graduate studies in the College of Technology. The work, funded by the U.S. Department of Defense and conducted with colleagues at the Huntington Medical Research Institutes and elsewhere, is focused on neurons in the brain and the way they work to connect different portions of the brain. Damage from a concussion doesn’t show up on conventional imaging systems, and diagnosis now involves a standard questionnaire and, often, self-reported symptoms. The damage can be cumulative, so it’s important to effectively diagnose and treat initial injuries. Zouridakis and his collaborators record brain activity through electroencephalography and magnetoencephalography and compare the result with those of healthy brains. He said the resulting images show clear differences—healthy brains have strong connections toward the

42 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

Can your smartwatch check out your mental state? UH engineer Rose Faghih is working to make it happen. Faghih, assistant professor of electrical and computer engineering, studies how wearable devices such as Fitbits and Apple watches could be used to track brain function. Now that requires attaching electrodes to the scalp to measure brain activity. Current wearable technologies track heart rate as an indicator of stress, but Faghih is using a $175,000 grant from the National Science Foundation to instead analyze data from the skin to measure cognitive brain states related to stress. “Using cortisol data, we could see that a patient is at risk of developing chronic fatigue syndrome before it occurs, for example,” she said. “Instead of waiting to go see the doctor, the patient would have information that they need to be seen sooner.”

Targeted Nanotechnology

Targeted drug delivery holds promise for improving treatment for a number of conditions, while limiting side effects. Biomedical engineer Sheereen Majd is focused on tailoring nanoparticles to deliver drugs with increased precision. Nanoparticles can be loaded with tiny amounts of medication and used to deliver treatment to tumors and other disease sites. But there are limits to how precisely they can be targeted. Majd, backed by a $500,000 NSF CAREER Award, is working to tag the nanoparticles with recognition molecules to improve targeting. To do that, she will draw upon two different systems used as nanodelivery vehicles: nanoliposomes and polymer nanoparticles. “Our hope is to marry the two so we can overcome their limitations and have a truly tremendous delivery vehicle—robust, highly specific and highly efficient,” Majd said. “We are hoping to minimize the off targeting and to use less medicine to get an effective dose where it needs to be.”


LISTEN UP A Decline in Your Hearing Can Lead to a Free Fall of Your Health BY SARA TUBBS

F

or two years, 76-year-old Austin Theriot fought

the idea of wearing hearing aids. He thought they were expensive, bulky and just plain ugly. Earlier this year, an appointment at the University of Houston Speech, Language and Hearing Clinic (USLHC) changed his mind and, ultimately, his life. “If you know someone is wearing a hearing aid, you are going to treat them differently, and you tend to talk louder,” Theriot explained. “If people don’t know you have one, they will talk to you naturally.” UH audiologist and associate clinical professor Chereece Andrews says without listening devices, older patients like Theriot risk losing more than just their ability to hear. Hearing-impaired

individuals may experience social isolation, which increases the risk of cognitive decline. “With hearing loss, the area of the brain that processes and receives sound can shrink if it doesn’t receive adequate sound stimulation,” said Andrews. “The brain isn’t getting a complete signal for it to process words well. You will see a change in brain structure and brain function.” A pair of hearing aids can cost upwards of $8,000. At the USLHC, which is underwritten by the United Way of Greater Houston, patients can participate in a hearing aid assistance program, which allows them to pay for treatment on a sliding scale. For Theriot, who was able to buy his hearing aids at a reduced price, the world he’s lived in for nearly eight decades suddenly seems new again. “It’s a whole new world, and I enjoy listening to what’s going on in the world.” The USLHC assists adults and children ages 10 and up who may have hearing difficulties. The clinic provides diagnostic services, hearing aid evaluation and selection. In addition, diagnostic services and treatments are available for children and adults suspected of having communication disorders.

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HEALTH SCIENCE It’s the first of its kind in Texas. “We can’t stop or reverse myopia, but we can slow down the progression,” said Richdale. “We use certain eye drops or specialty multifocal or orthokeratology lenses.” The orthokeratology lenses are worn while users are sleeping and temporarily re-shape the eyes so users don’t need glasses during the day. If patients continue wearing the lenses, they slow down the progression of myopia, Richdale said.

The Persistence of a Preteen

CONTACTS AT NIGHT CAN PREVENT GLASSES BY DAY Specialty Treatments Slow Down Nearsightedness BY LAURIE FICKMAN

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y 2050, if you’re not wearing glasses, chances are

the person sitting next to you will be, according to the National Eye Institute, suggesting that almost 50 percent of the world will be myopic, or unable to see far, by then. The World Health Organization has called the rapid increase “alarming.” Myopia typically appears when children are in their early school years and can be associated with long-term eye health problems. No conclusive studies link the rise of myopia in children to their increased use of technology, but enough research and anecdotal evidence exist to validate theories. “Children are doing a lot more ‘near work’ even before kindergarten, especially on digital devices, and not getting outside as much,” said UH’s Kathryn Richdale, associate professor and optometrist. Responding to the sharp reality of a population with blurry vision, the University Eye Institute is offering its new Myopia Control Service to correct and control nearsightedness in children.

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Joaquin Martinez, 12, is a patient. Only slightly myopic, he hates wearing his glasses. He puts it a bit more gently. “I strongly dislike them,” said Joaquin Martinez. Now, every night before bed, he slips in the special contact lenses, and by the next day, he can see perfectly. He rarely, if ever, misses a night. Martinez is a well-rounded seventh grader. He plays basketball and soccer, loves science and, yes, is a self-admitted video game fanatic. Much of the game time (now limited by mom) is spent playing on cell phones and tablets. She’s reduced him to two hours a day. Lots of his schoolwork is done on digital textbooks, so he’s on the computer at school, too. Martinez represents a pretty typical American preteen, and something more—a study in why myopia rates may have climbed dramatically in the last few decades. “Outdoor time appears to be very good in cutting the risk for nearsightedness,” said UH assistant professor and optometrist Sheila Morrison. “We do not fully understand why this is, but it may be related to the idea that when people are outside, there is generally brighter light and eyes are focusing on objects farther away.” “When you consider that children with progressing myopia are at increased risk as adults for developing eye complications and diseases, such as glaucoma and retinal detachments, these breakthrough myopia control treatments that we are offering are game changers for long-term ocular health,” said Earl L. Smith III, dean of the UH College of Optometry. A game changer for Martinez, too, who disliked his glasses so much he wouldn’t wear them when playing sports. “Now when I’m playing, I can see people’s faces and know who’s on my team and who’s not,” said Martinez.

Kathryn Richdale, associate professor and optometrist at the UH University Eye Institute, examines Joaquin Martinez as part of the Myopia Control Service.


WALKING THE WALK An Innovative System Helps Patients With Parkinson’s Regain Their Balance BY JEANNIE KEVER

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or Roberto Macias, diagnosed with Parkinson’s

disease three years ago, the advantages of a new system to help people with balance disorders are clear: “I can go faster. I can go farther. I am stronger. I’m more confident.” That is just what Beom-Chan Lee had hoped to hear. Lee, assistant professor in the department of health and human performance, and members of his lab developed the system, involving a smartphone app and a wearable belt equipped with sensors and actuators to help with one of the most disconcerting symptoms of the disease. Parkinson’s affects 10 million people worldwide. Because the causes are unknown, there is no scientifically validated way to reduce the risk. And while medication and surgery can help with some of the symptoms, including tremor, bradykinesia (slowness of movements) and muscle rigidity, Lee said problems with posture and balance don’t respond to currently available treatments. Falling is a major concern for people with Parkinson’s.

Macias, a retired veterinarian, was one of the first people to test the system after it was validated in the lab. People use it for prescribed exercises at home three times a week for six weeks; they are given the system afterward to continue the benefits. The system uses biofeedback, visual and “touch” feedback— actuators that vibrate to signal the patients how to move and where their body should be positioned in space. A smartphone app—the phone is placed at eye level when the patient stands inside a walker for additional stability—guides them through exercises recommended by physical therapists. That data is wirelessly transmitted to the lab, along with information from a Fitbit, allowing researchers to track not only their performance during the exercises, but also how active they are afterward. Early results are good, Lee said. “What we have observed is they improve their balance control and walking performance, and their improved balance and gait performance sustain for an extended period after using our system at home.” An extension of funding from the American Parkinson Disease Association will allow Lee and his lab to continue refining the system. In the meantime, participating patients have one more tool to improve their balance and quality of life. Gustavo Flores, who was diagnosed in 2006, participates in a number of activities through the Houston Area Parkinson Society, including tango, ballet and singing lessons. Now, the retired biochemist is using the balance belt, too. Better balance, he explained, allows him to remain busy. And staying active is important. Mike Kingman, a retired chemical engineer, kept going after his diagnosis 12 years ago, even pulling a 30-foot recreational vehicle from one end of the United States to the other. About three years ago, he fell and tore a tendon in his right foot. Balance problems snowballed. Medication gives him up to six hours a day of good “up” time, when he can walk, pursue his hobbies and otherwise feel normal. “When I’m up, my voice is normal. I feel like I’m a chemical engineer, and I can solve all my problems,” he said. The goal is for the belt to maintain and even extend his “up” time. It has worked for other patients. “When I do my exercises,” Macias said, “I am almost able to run.”

Mike Kingman is shown wearing the belt which is equipped with sensors and actuators which help with his stability.

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HEALTH SCIENCE

VIJAYKRISHNA RAGHUNATHAN College of Optometry Assistant Professor

FROM IDEA TO REALITY Medical Discoveries Push UH Higher in Global Rankings for Issued Patents BY JEANNIE KEVER

T

he journey from university

lab to commercial marketplace can be difficult. Being granted a patent is a key step. So, a utility patent issued in March 2017 by the U.S. Patent and Trademark Office marked a significant achievement for a University of Houston researcher and his collaborators. It mattered to the University, too, as UH ranked among the top 100 global universities for the number of utility patents issued in 2017. The University of Houston System was one of three public university systems in Texas to make the list, published by the National Academy of Inventors and the Intellectual Property Owners Association. It ranked No. 67, with 39 utility patents. UH ranked 5th among U.S. universities without a medical school. Jarek Wosik, a research professor in the department of electrical and computer engineering, led a multidisciplinary team to develop a high-temperature superconducting coil that allows magnetic resonance imaging (MRI) scanners to produce higher resolution images or acquire images in a shorter time

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than is possible with conventional coils. Wosik is also affiliated with the Texas Center for Superconductivity at UH. The patent, granted in 2017, was the fifth he and his collaborators have received related to MRI cryogenic receiver coils they developed, including the superconducting coil and/or array. In 2016 the researchers announced a new technology that can reveal brain structures not easily visualized with conventional MRI coils. The cryo-coil works by boosting the signal-to-noise ratio (SNR)—a measure of image quality and usefulness of provided information—by a factor of two to three, compared with conventional coils. High SNR is critical to achieving high resolution and fast imaging. The probe was optimized for rat brain imaging, useful for biomedical research involving neurological disorders. But it also has direct implications for human health care, Wosik said. “Research in animal models yields critical information to improve diagnosis and treatment of human diseases and disorders,” he said.

A biomedical engineer, Vijaykrishna Raghunathan began working in vision science as a postdoctoral researcher at the University of California-Davis. Now an assistant professor at UH, he has a $765,000 grant from the National Institutes of Health to study a little-understood facet of glaucoma, the second-leading cause of blindness. Better understanding the ebb and flow of the aqueous humor, the ocular liquid which is involved in regulating pressure within the eye, could lead to a cure. Raghunathan is focused on understanding why liquid outflow isn’t uniform across the trabecular meshwork, the key area of tissue in the eye that is implicated in the elevated intraocular pressure typical of the most common form of glaucoma. The study will address why some segments of the tissue allow more liquid to pass through, while others do not. A better understanding of the underlying mechanisms could potentially be useful in improving the newest class of drugs that have the potential to affect the trabecular meshwork approved earlier this year to treat the disease. •


MOVE IT It’s Not Just About Exercise. Sitting Still “is Very Hazardous Behavior.” BY JEANNIE KEVER

I

t’s no secret that exercise is important. It’s

built into guidelines issued by the National Institutes of Health—at least two-and-a-half hours a week of moderate intensity exercise, such as brisk walking. Not so fast, said Marc Hamilton, a pioneer in the growing field of inactivity physiology. Here’s the better news: There are other things you can do to improve your health. That’s important, especially since fewer than 10 percent of Americans meet those exercise guidelines. “Sitting is very hazardous behavior,” said Hamilton, director of the Texas Obesity Research Center at the University of Houston. “It leads to more issues than walking across the street, where you might get hit by a truck.” Hamilton is one of the world’s leading biomedical scientists studying what happens inside the body when people are too sedentary, and he says there are no easy answers. Even intense bouts of exercise can’t undo damage caused by hours of sitting and inactivity. He offers this analogy: People can’t thrive if they drink water only once a day. The body’s thirst for metabolic activity is no different. Clearly, there is something special about remaining active throughout the day. That’s been clear for a decade—Hamilton began his research in the 1990s—but people in the Western World are as sedentary as ever, tethered to our cell phones and 100-channel televisions. The average American sits between 10 and 12 hours a day. So far, however, there are no public health recommendations targeting that sedentary lifestyle. That’s where Hamilton comes in. He was a founder of the field, which has spread to thousands of research labs all over the world, and much of his research has focused on lipoprotein lipase, a genetic enzyme involved in cardiovascular and a number of metabolic diseases. He discovered the enzymes are present in far higher concentrations in the soleus muscle—found in the lower leg and involved in standing

and walking—than in other muscles. Lipoprotein lipase, or LPL, is “a vacuum cleaner for fat,” he said. Sit down, and LPL levels plummet. Without the “vacuum cleaner,” the risk skyrockets for obesity, diabetes, high cholesterol and other diseases linked to sedentary lifestyles as muscles lose the ability to convert blood glucose to energy, and the fat instead travels to the liver, the coronary arteries and adipose tissues. Hamilton, a professor in the UH department of health and human performance, hasn’t recommended quick fixes, such as standing desks or gimmicky reminders to fidget while you sit. He is waiting for results from his lab, where people come to have their oxygen levels, blood flow and a variety of chemical markers measured at rest and after specific activities designed to be safe for all kinds of people to do anywhere and any time. He also works in the community, meeting with people at home and at community centers in Houston’s Third Ward and Fifth Ward. By working with people individually—showing them the results of blood tests that demonstrate the risks of inactivity—he is changing lives one at a time. His next goal is even loftier. “We’re a university with a vision to make an international impact,” he said. A rented space near Houston’s Galleria serves as hub for meeting with physicians, insurance executives, corporate leaders and individuals passionate about optimizing their own health with the latest medical advances. Employee health and public health affect the bottom line and the broader economy, and Hamilton is enlisting the business and medical communities to spread the word that inactivity can be deadly. Despite statistics that might suggest this is a losing battle, Hamilton is just getting started. “There is so much room for improvement in human health; it’s unbelievable,” he said. “I’m not pessimistic at all.”

How much activity do you need? Researchers expect to release specific guidelines in the coming months about how much—and what type—of activity is best. Until then, here are a few suggestions: More activity is better than less. The amount of time you spend moving is more important than the intensity of that movement. Working out at the gym for an hour and then hitting the couch doesn’t cut it. You need to move throughout the entire day. The best new research has found the most effective type of activity for improving the biological factors involved in conditions like insulin sensitivity, glucose regulation, fat burn and inflammation is different than we used to think—good news for conquering epidemic levels of chronic diseases like diabetes and some cardiovascular conditions.

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HEALTH SCIENCE

BATTLING LUPUS UH Physician Researcher is on the Front Lines BY LAURIE FICKMAN

48 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018


n the mid 1980s, after studying most of his life, Chandra Mohan was successful. He was a doctor in the middle of a seropathology residency in Singapore, the country of his birth. He had a wife, a baby and a bright future. Serology is a niche science, the study of serum, the components of blood cells and other bodily fluids. The field drew Mohan’s attention because, he said, he was insatiably curious, and peering inside serum and analyzing its immune molecules was a great way to find out why diseases occur.

I

During his residency, one kind of patient commanded his attention. “A good number of patients I saw had lupus,” said Mohan. “One of the things the patients and their families would always ask me was, ‘Am I going to die?’ and ‘Is there a treatment?’ At that time, we hardly knew anything about lupus, and the literature was very sparse,” recalls Mohan. Those patients and their questions changed the trajectory of Mohan’s life. “As a doctor, recognizing diseases and prescribing medicine to help cure patients was relatively easy, the bigger challenge was to find out why they are getting sick to begin with,” said Mohan, now Hugh Roy and Lillie Cranz Cullen Endowed Professor of Biomedical Engineering at UH. He quit practicing medicine to pursue a doctoral degree at Tufts University in Boston, where he focused on the cellular immunology of lupus. He’s been at it ever since, and true to his word, today more lupus research exists and more curative and experimental science is underway, constituting a great part of what his laboratory does.

A Tricky Disease

Systemic lupus erythematosus (known as SLE or lupus) is a complex autoimmune disease that is difficult to diagnose, treat and defeat. The symptoms can fool you. You might feel tired or suspect you have a cold when, in fact, you have this disease that leads to chronic inflammation in multiple organs. Blood tests or kidney biopsy can confirm the diagnosis and extent of organ involvement, but these tests are invasive and often uncomfortable. Mohan is working to alleviate that pain by creating such diagnostics as home and saliva tests. Mohan is responsible for the study which concluded that fish oil can help lupus patients combat one of the most common features of the disease—fatigue. The study

noted lupus patients had reduced omega-3 fatty acids, which are powerful antioxidants provided by fish oil. It’s a start for the disease that has had only one treatment approved in nearly 60 years. “There are three major areas we need advances on concerning lupus,” said Mohan. “We need a better understanding of the disease; we need to know if we can diagnose and monitor the disease better using better biomarkers; and we need to know superior ways to treat the disease.”

Attacking on Three Fronts

A $1.6 million grant from the National Institutes of Health supports Mohan’s

translational studies and clinical trials, said Mohan, alluding to possible new drug cures for the disease. Mohan is also creating pointof-care diagnostics, including those home test kits and saliva-based diagnostics. Mohan credits his success to a large number of clinical collaborators across the U.S. and worldwide, as well as a talented and committed laboratory team. Because he wants to share his information with as many people as possible, Mohan speaks to groups about lupus and his research. Tanesha Townsend, 31, was in the audience at one of his lectures. She was diagnosed with lupus at six years old. “It’s amazing that he saw the void that needs to be filled, and he’s going to do what

We need a better understanding of the disease; we need to know if we can diagnose and monitor the disease better using better biomarkers; and we need to know superior ways to treat the disease. understanding of the disease through examining the BANK1 gene which interacts with female hormones to increase lupus in women. Under a $600,000 Target Identification in Lupus grant from the Lupus Research Alliance, Mohan is attempting to treat lupus by testing an antibody that blocks the protein ALCAM (activated leukocyte cell adhesion molecule) elevated in several kidney diseases and in the urine of patients with lupus kidney disease. If the antibody block works, he could move onto

he can within the health industry,” said Townsend. “He doesn’t even have the disease, but he saw others who were suffering. Just amazing.” Townsend continues to suffer with symptoms, missing one to two days a month from work. She said she had to teach herself to find the positive, even during the pain. “I’ll accept the pain, but I won’t dwell on the pain,” she said. Maybe if Mohan continues to dwell on solutions, she won’t have to.

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HEALTH SCIENCE

States ages 18 and older, had an alcohol use disorder in 2012. Despite increased awareness, countless prevention campaigns, and tighter laws and regulations, a 2015 Centers for Disease Control and Prevention study revealed that excessive alcohol consumption was responsible for an average of 88,000 deaths per year. To date, only three FDA-approved drugs comprise therapeutic alcohol addiction treatment. Disulfiram causes unpleasant reactions when drinking, including flushing, nausea and palpitations. Naltrexone blocks receptors involved in the rewarding effects of drinking and the craving for alcohol. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness and dysphoria. “These drugs are only effective modestly, and patient compliance is a serious issue because of several adverse side effects, necessitating the developments of newer drugs,” said Das. Current research drug development efforts remain in identifying new alcohol targets.

Attacking Tolerance

IT’S ALL IN YOUR HEAD A Protein in the Brain That Binds to Alcohol Could be the Key to Curing Alcoholism BY LAURIE FICKMAN

W

ith great self-awareness at 21, Marc joined

Alcoholics Anonymous, admitting he was “so young but so broken.” Marc said he quickly learned he was suffering from an illness and that “… when I took the very first sip of alcohol, set up this craving—this compulsion— to need more ...” Marc not only captured the crippling feeling he experienced, but also a physiological truth about alcoholism: There is a connection in the brain that allows alcohol tolerance or the need to drink more to get the same effect. The connection, according to UH College of Pharmacy professor and medicinal chemist Joydip Das, is a protein in the brain called MUNC 13-1 that binds to alcohol. It is possible that the cure to the disease of alcoholism resides inside that protein. If it could be blocked, the tolerance to alcohol could be stymied.

No Time Like Now

The National Institute on Alcohol Abuse and Alcoholism reports that approximately 7.2 percent, or 17 million, adults in the United

50 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018

Most people recognize tolerance as the ability to “hold their liquor.” It’s not the humblebrag it might be intended. Tolerance is considered a major risk factor for alcoholism, as those who are able to drink a lot without feeling the effects tend to drink more than people with low tolerance. “If a person becomes tolerant of one drink, he will have another and maybe another,” said Das, who recently published his findings on curing alcoholism through examining MUNC 13-1, in eNeuro, a journal of the Society for Neuroscience. His co-authors are biologist Gregg Roman of the University of Mississippi and University of Houston psychologist J. Leigh Leasure. “If we could stop alcohol from binding into MUNC 13-1, it will help problem drinkers in reducing tolerance. If we can reduce tolerance, we can reduce addiction,” said Das, whose study focuses on binge alcohol exposure. The process of MUNC 13-1 binding to alcohol takes place in a brain synapse, where one nerve cell, or neuron, passes a signal to another. Specifically, the binding takes place in the presynaptic space, a muchunderstudied portion of the synapse mechanism. During binge alcohol exposure, alcohol creates widespread and long-lasting changes in neural activity, altering both presynaptic and postsynaptic activity. Thus far Das and company’s work has been done using the Drosophila, or fire fly, genetic model system, a simple model with various similarities. Surprisingly, fire flies have a genetic makeup comparable to humans even though their genome is 1/26th the size. In fire flies, the activating protein is called Dunc13, the equivalent to MUNC 13-1. “Reduction in Dunc13 produces a behavioral and physiological resistance to sedative effects of ethanol,” said Das. That makes MUNC 13-1 an important target for developing drugs. “We need to develop a pill that would inhibit alcohol binding to MUNC 13 and reduce its activity. Based on our results so far, this would likely reduce the formation of tolerance, making it harder to become addicted to alcohol,” said Das. Welcome news to millions, including people like Marc. “Even before alcohol was in my life, I suffered from the illness of alcoholism. I had the ‘ism’—was just waiting on the alcohol,” he said.


SIMULATED ENVIRONMENT, REAL RESULTS Using Science and Simulation to Help Solve Health Challenges BY CHRIS STIPES

F

ear of elevators is a

relatively common phobia. To treat such an anxiety disorder, therapists expose the patient to the trigger—such as an elevator—in a safe and controlled environment to help them develop coping strategies. However, applying the same therapeutic approach to treat the anxiety and craving related to a substance use disorder is more challenging. It wouldn’t be feasible or safe for a therapist to accompany a heroin user to an actual “shooting gallery.” In an effort to recreate the same triggers and responses as real-world environments, where individuals crave and use drugs and alcohol, UH researchers are establishing safe and controlled simulated environments. Inside the “heroin cave” at the Graduate College of Social Work, individuals struggling with addiction wear virtual reality headsets, while a series of HD cameras project life-sized immersive 3D environments in which they would normally crave and use heroin. By measuring participants’ physiological reaction to these substance use cues, such as heart rate, respiration, muscle tension and galvanic skin response, research scientist Micki Washburn is developing strategies to help those with heroin addiction manage cravings in the real world. “Much of the recovery community simply encourages people with addiction issues to engage in a 12-step program and to avoid people, places and things that may trigger substance craving and substance use. That’s just not a realistic goal of recovery and often sets people up for failure,” said Washburn. “You can’t just avoid everyone and everything related to substance use, including your family or your community.” Instead, she said,

people struggling with addiction need to learn concrete skills to cope with exposure to these triggers.

The Bar is Open

A similar challenge of adapting realism in research exists for Professor Ezemenari Obasi, who investigates the relationship between chronic stress and vulnerability to alcohol consumption among AfricanAmericans. His team analyzes levels of the stress hormone cortisol and other biomarkers. Experiencing racism and inequality over time, he’s found, can impact biological processes, putting them at increased risk for chronic disease. Ideally, Obasi would like to collect data at a real bar with people in their natural element. “But I can’t just walk into a bar with a questionnaire and video camera,” he said. He needed a bar, so he built one. Complete with neon signage and liquor bottles, the black wooden bar seats eight inside Obasi’s Hwemudua Addictions & Health Disparities Lab at the College of Education. Soothing lounge music fills the air and competes with ambient noise from the TV mounted on the wall. For all intents and purposes, it’s a real bar. “It’s hard to make the case that doing research in a sterile laboratory setting translates into real life. This state-of-the-art environment puts a person in the right mindset, as if they were in a natural setting,” said Obasi. Generally, people aren’t trained to manage stress in a healthy way. After a hard day of work filled with deadlines, many go home to an alcoholic beverage and an immediate “escape.” But that instant gratification can lead to addiction. By studying the body’s response to stress, Obasi believes he can develop positive coping interventions. “We can get beyond what people are self reporting or the reasons they think they drink,” said Obasi. “Now we can get an objective assessment under the skin that unveils their actual experiences.”

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HEALTH EDUCATION

HEALTHISM Could You be a Victim of Discrimination Based on Your Health? BY SARA TUBBS

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e’ve all heard of these cases:

the employee rejected by a potential employer because she smokes, the air passenger forced to buy multiple plane tickets because he’s obese, or the individual who was denied health insurance coverage because of a pre-existing condition. But did you know there’s a term for it? It’s called “healthism,” and it can be discriminatory. Jessica Roberts, director of the Health Law & Policy Institute (HLPI) at the UH Law Center, coined the term and has written numerous publications about this topic. It’s the idea that people might face discrimination on the basis of some health-related trait or conduct. “It’s been my goal to take differential treatment based on health and encourage

lawmakers and policymakers to think more deeply about the distinctions we draw and consider if they are having unappreciated discriminatory impacts,” Roberts said. It’s important because “Stigma can lead to worse relative health and worse health outcomes,” said Roberts, who has developed a methodology to distinguish desirable healthbased classifications from the undesirable and is encouraging policy solutions that limit health-based discrimination. Roberts and her colleagues in HLPI are nationally-renowned legal experts on the forefront of emerging issues and policy analysis related to health care and biotechnology. It’s one of the reasons the Health Law program at the UH Law Center is the No. 2 health law program nationally in the U.S. News & World Report Law 2019 rankings.

KALEIGH BOULLARD

College of Education Senior pursuing Bachelor of Science in Health Promotion

A trip to the Dominican Republic with fellow University of Houston health students taught Kaleigh Boullard a powerful lesson about life. “It opened my eyes to things we take for granted,” said Boullard, who spent two weeks witnessing extreme poverty and lack of health care in the rural areas of the country. “The biggest thing for me was seeing the prevalence of malnutrition.” That experience armed her with a clear career focus: to work in a hospital as a child life specialist. “I want to educate parents about proper diet and nutrition for their babies so they can live healthy lives.” The learning abroad curriculum is a key part of the Health undergraduate program housed in the College of Education. Its mission is to educate students like Boullard about health disparities globally and locally and prepare them to pursue careers in health promotion, allied health and public health. •

52 UNIVERSI T Y OF HOUS TON Magazine • FALL 2018


HUMAN MEDICINE Putting the Humanities in Health Care BY CHRIS STIPES

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ith a resolute passion for training well-rounded

health care leaders, Helen Valier’s primary expertise isn’t in science, but instead medical humanities. So, does she read poems to future doctors and nurses in class? Not exactly. As director of the Medicine & Society Program at the Honors College, she guides undergraduate students on an exploration of the intersection between science, arts and humanities.

LENA MUSOKA College of Education Public Health student, 4+1 degree program

The mission is to develop a more humanistic and compassionate practice of medicine and an informed health policy through enhanced problem solving and communication. In science, she said, students often think there’s only one right answer based on fact. But working with real patients and problems can be more complicated. Research suggests that improving empathy improves decision-making and reduces dissatisfaction of both patients and providers. “Understanding the human situation as it relates to a patient’s personal, economical and cultural circumstances encourages an openness and flexibility in decision-making when the answer isn’t always clear,” said Valier. It’s a patient-centered, team approach often lost in today’s fragmented, highly specialized American medical system that’s led to a shortage of primary care physicians. Valier believes there’s too much focus on disease as a biological problem and not enough focus on health and the influence of societal factors. “Pain or disease reduced to physiological process lets clinicians target certain areas with pharmaceuticals. But placing more emphasis on suffering changes the dynamic. Now you’re a healer looking at a patient as a whole person.” Several years ago, the Medical College Admission Test (MCAT) started including more social and behavioral health components, marking a shift in expectations for future doctors. The UH Medicine & Society Program started in 2005 with just eight students but has grown into one of the most popular degree plans on campus. With more than 500 students, UH has one of the largest medical humanities undergraduate plans in the country. “This program isn’t anti-science at all, but it’s necessary to think creatively while considering different perspectives to solve the many challenges facing our health care system today.”

Lena Musoka, an international student from the Democratic Republic of Congo, wants to fulfill a career dream of helping people in underresourced countries. She is on track to graduate from UH next year with a Bachelor of Science in public health. This go-getter will also be halfway through earning a Master of public health degree from UTHealth School of Public Health. The UH/UTHealth partnership fast-tracks students to getting both bachelor’s and master’s degrees—a B.S. in Health and Masters in public health—in as little as five years.

“It had a profound impact on me and makes me want to continue working with diverse communities that really do not have great access to health care.” •

DEGREE PLAN REQUIREMENTS 4+1 BACHELOR OF SCIENCE IN HEALTH WITH A SPECIALIZATION IN PUBLIC HEALTH AND MASTERS IN PUBLIC HEALTH

• Have and maintain a UH GPA of 3.5. • Must complete at least 63 credit hours of the B.S.

For Musoka, it was the opportunity to help distribute flu shots to residents in a low-income neighborhood that solidified the environmental health major’s desire to help those in need.

in Health program at UH.

• Transfer students must complete 30 credit hours of the B.S. in Health Program at UH.

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LAST LOOK Today’s nurses have come a long way from wearing white uniforms and caps. While a College of Nursing existed at UH from 1948 until 1956—it closed because of mounting financial and administrative challenges. Today’s UH College of Nursing, established in 2015, teaches the next generation of highly educated professionals to make critical assessments and autonomous decisions, preparing them to become clinical nursing experts, nurse practitioners, administrators of health care, nursing faculty and nurse researchers.

Profile for uhmagazine

University of Houston Magazine Fall 2018  

Take a deeper look into UH Health, and the University’s journey to a medical school dedicated to the serving the underserved populations.

University of Houston Magazine Fall 2018  

Take a deeper look into UH Health, and the University’s journey to a medical school dedicated to the serving the underserved populations.