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Students envision solutions to opioid epidemic

Opioid abuse is one of the nation’s most severe public health crises. The problem strikes close to home, with nearly 900 Coloradans dying of intentional or unintentional drug overdoses in 2014. Many of those deaths came from misusing prescription medications such as Vicodin, Percocet and OxyContin, three of the most prescribed opioid painkillers. Addiction to those drugs also is leading to a surge in heroin use.

2016 public health case competition winners
The winners of the 2016 competition, along with Colorado School of Public Health dean David Goff.

Public health experts, health care practitioners and lawmakers are among those working hard to find solutions to the epidemic, and recently teams of University of Colorado Denver | Anschutz Medical Campus students joined the cause. About 55 students competed in this year’s Rocky Mountain Region Public Health Case Competition, competing to find innovative solutions that could alleviate the crisis. The annual event was hosted by the Colorado School of Public Health (ColoradoSPH) and run by its students.

Inventive ideas were not in short supply—including one proposal that would create specially equipped buses and design smartphone apps that could give addiction sufferers an accessible and discreet way to receive help recovering.

The proposal, named “Heals on Wheels” by the team, would use the vehicle to take back drugs, screen patients and give them referrals for treatment, educate and train people about drugs that stop overdoses and exchange needles.

Christy Colalancia, a student getting a master’s degree in public health, was a member of the winning team. She said a model for the idea was mobile mammography clinics, and the team considered the challenge of creating effective outreach strategies.

“We were thinking about what has worked and what didn’t work in the past. Our idea was as original as we could make it, but by taking into consideration evidence-based approaches,” Colalancia said.

Inventive ideas

Competition was stiff, with the panel of judges impressed by each of the proposals.

“We had a real belief that if any one of them were implemented, it would improve the public health of Colorado,” said ColoradoSPH Dean David Goff, MD, PhD, one of the judges.

Finishing second was a team with an idea to improve the rehab system in southeast Colorado by adding case managers who would work to educate and support patients. The case workers also would become liaisons between patients and doctors.

The third-place team proposed developing a drug takeback program that would allow people to return unused medication any day of the year by dropping the medications in secured bins at pharmacies around the state. Currently, some communities, government agencies and others including the Skaggs School of Pharmacy and Pharmaceutical Sciences will collect drugs for disposal, but most programs are one-day events. Additionally, many rural areas, where the opioid abuse problem is most severe, do not have those programs.

A growing problem

Colorado is one of the states hit hardest by the opioid epidemic, according to the Centers for Disease Control and Colorado Health Institute. In 2014, Colorado had 899 deaths related to drug overdoses. That works out to 16.3 deaths per 100,000 residents, which is up 68 percent since 2002. Colorado’s fatality rate is above the national average of 14.7 drug-related deaths per 100,000.

Twelve counties, including Denver and Adams counties, had rates of more than 20 deaths per 100,000 residents, making them among the highest in the nation.

Research also shows that prescription pain killers are a gateway drug, with 75 percent of heroin users saying they abused painkillers before switching drugs, according to nationwide stats from the CDC.

Real-world challenges

The goal of the annual competition is to give students across varied disciplines the experience of working as members of interdisciplinary teams, Goff said. It also gives them the chance to design innovative solutions to real-world health problems. Up to six students had to research the problem, develop a proposal, craft a presentation and answer questions from judges. They also needed to ensure their ideas could be implemented for less than $3 million and address challenges to implementation.

“I think one of the greatest parts of the program is getting a real-world scenario to try to solve in a limited amount of time, using limited funds and resources, and having an integrated approach,” Colalancia said.

The teams also had to beat the clock—students had 24 hours before their presentations were due. It led to some bleary eyes at the awards ceremony.

The competition was open to students from the ColoradoSPH, the School of Medicine, College of Nursing, Graduate School and the pharmacy school, among others. Students from CU Boulder, Colorado State University and the University of Northern Colorado also participated.

Representing CU Anschutz on the judges’ panel for the final round were Goff and Robert Valuck, PhD, a professor in the pharmacy school and director of the Colorado Consortium for Prescription Drug Abuse Prevention. Colorado Department of Public Health and Environment Executive Director and Chief Medical Officer Dr. Larry Wolk, state Sen. Jim Smallwood and state Senator-elect Dominick Moreno also were judges.

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Long-term oxygen treatment does not benefit some COPD patients

Newly published data from the Long-Term Oxygen Treatment Trial (LOTT) show that oxygen use is not beneficial for most people with chronic obstructive pulmonary disease (COPD) and moderately low levels of blood oxygen. It neither boosted their survival nor reduced hospital admissions for study participants.

Previous research showed that long-term oxygen treatment improves survival in those with COPD and severely low levels of blood oxygen. However, a long-standing question remained whether a different group of COPD patients—those with moderately low levels of blood oxygen—also benefit.

“This important study addressed a common patient care question for which there was very little data in the literature,” said Rick Albert, MD, professor of medicine and vice chair of clinical affairs at the University of Colorado Anschutz Medical Campus who took part in the study.  “The results should help guide providers when they encounter patients who have moderate hypoxemia (those whose oxygen levels are not normal but are higher than those meeting CMS criteria for oxygen administration) as well as those who only have oxygen desaturation during exercise.”

Anne Fuhlbrigge, MD, visiting associate professor of medicine and senior associate dean for clinical affairs at the University of Colorado School of Medicine said the LOTT study helps fill the gaps in the long-standing question about oxygen use in patients with COPD.

“This is the largest study of its kind and included patients from 42 medical centers throughout the U.S.,” she said. “The results highlight the importance of continued efforts to develop new therapies for COPD and primary and secondary prevention by not smoking tobacco.”

The study, the largest ever to evaluate the effectiveness of home oxygen in this group of patients, is published in the current online issue of the New England Journal of Medicine.  The 738 patients enrolled in this study had COPD and moderately low levels of blood oxygen (in contrast to severely low blood oxygen levels) at rest or during exercise.

In the current study, patients with moderately low levels of blood oxygen are defined as those with a blood oxygen saturation (SpO2) between 89 and 93 percent at rest (moderate resting hypoxemia), or a SpO2 below 90 percent during the 6-minute walk test.  Patients with severely low blood oxygen levels are defined as those with a SpO2 equal to or less than 88 percent at rest. This later group was excluded from the LOTT study because prior studies showed that they benefit from long-term oxygen treatment.  Blood oxygen saturation or SpO2 refers to the percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the blood and is measured through a pulse oximeter. A pulse oximeter is a special probe that indirectly measures oxygen levels in the blood, often by attachment to the finger.

“These results provide insight into a long-standing question about oxygen use in patients with COPD and moderately low levels of blood oxygen. For the most part, this treatment did not improve or prolong life in study participants,” said James P. Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases. “The findings also underscore the need for new treatments for COPD.”

Researchers say patients with any form of COPD should check with their doctors before making changes in their treatment plans. “We want to make it clear that LOTT was not designed to assess individual responses to oxygen treatment and that individual responses can vary. Each COPD patient should discuss their own personal situation with their healthcare provider,” said William C. Bailey, M.D., Professor Emeritus at the University of Alabama at Birmingham School of Medicine, and study Chair.

COPD, the third leading cause of death in the United States, is a progressive lung disease triggered primarily by cigarette smoking, although up to 20 percent of patients with COPD never smoked. Symptoms include shortness of breath, chronic coughing, and wheezing. The disease also causes low oxygen levels in the blood. About 15 million people have been diagnosed with COPD in the United States and another 10 million may be undiagnosed.

For decades, oxygen has been one of the main treatment tools for patients with COPD and low oxygen levels. It involves the use of metal tank cylinders containing oxygen or concentrators that extract oxygen from air; both systems deliver the gas through a nasal tube or mask.

The LOTT study is a randomized clinical trial to determine whether oxygen use could help COPD patients with moderately low levels of blood oxygen.  The seven-year study, which included patients from 42 medical centers throughout the United States, began in 2009 and was completed in 2015.

In the study, half of the patients received long-term oxygen and the other half did not. The researchers found no significant differences between the two groups based on how long patients survived, and the amount of time leading to their first hospitalization. They also found no differences in other important benchmarks, such as the rates at which the patients were hospitalized or experienced worsening of COPD symptoms. Nor did researchers find statistically significant differences between the groups in quality of life, levels of depression or anxiety, lung function, or ability to walk for short periods.

Although no cure for COPD exists, there are a number of treatment options, including the use of bronchodilators and steroids, as well as pulmonary rehabilitation, surgery, and lung transplantation. Researchers worldwide are also studying new medications and exploring other approaches such as gene therapy. They continue to emphasize the importance of not smoking tobacco in preventing or slowing the progression of COPD.

The study was funded by the National Heart, Lung, and Blood Institute (NHLBI)—a part of the National Institutes of Health—and the Centers for Medicare & Medicaid Services.

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CU in the Community returns with focus on volunteering, veterans

With the holiday season about to begin, the University of Colorado Denver | Anschutz Medical Campus once again is asking faculty, staff, students and alumni to volunteer for local organizations as part of the CU in the Community campaign.

2016 CU in the Community -- CU Anschutz volunteers at the VA Hospital
Volunteers from the CU in the Community trip to the Denver VA Hospital. From left, Graduate School Dean David Engelke; CU Anschutz Chancellor Donald Elliman; Linda Gallegos, the chancellor’s executive assistant; College of Nursing Dean Sarah Thompson; Mariana Ledezma, an associate director for the CU Anschutz Community-Campus Partnership; Neil Krauss, director of initiatives and outreach in the CU Anschutz chancellor’s office; and VA volunteer specialist Jack Fletcher.

This is the sixth annual CU in the Community program, which gives staff the opportunity to volunteer a half-day of work time. Departments are encouraged to volunteer as a group so they can work together outside the normal workplace setting while contributing to the university’s mission of improving the health and well-being of people in Colorado.

The 2016-17 campaign began on Nov. 11, which is Veteran’s Day. The starting date reflects CU Denver and CU Anschutz Medical Campus’ focus on supporting area veterans this year.

Members of CU Anschutz’s leadership staff, including Chancellor Donald Elliman, started the campaign by visiting the U.S. Department of Veterans Affairs Hospital in Denver.

Supporting those who served

On that afternoon, CU Anschutz staff welcomed vets in the various outpatient clinic waiting rooms by passing out coffee and tea and talking to the patients about their experiences. They also dropped into patients’ rooms to chat and kept them company as they received treatment in the infusion clinic.

“Volunteering with the VA Hospital was particularly meaningful. Our veterans have sacrificed for us – it feels good to give them more than a heartfelt ‘thank you.’” — Chancellor Donald Elliman

That’s where Elliman, Graduate School Dean David Engelke, PhD, and College of Nursing Dean Sarah Thompson, PhD, RN, FAAN, spent much of their visit. The infusion clinic is where vets go to receive chemotherapy or intravenous treatment for conditions such as multiple sclerosis and rheumatoid arthritis.

Depending on the treatment, a patient could be in that clinic for five minutes or for a few hours. The infusion rooms have recliners and televisions for each patient, but sometimes the best way to pass the time is by chatting. Elliman, Engelke and Thompson spoke to about 10 vets of varying ages and service backgrounds as they received treatment.

The vets welcomed the chance to talk, and CU Anschutz’s volunteers were grateful for the opportunity to offer support.

“Volunteering with the VA Hospital was particularly meaningful. Our veterans have sacrificed for us – it feels good to give them more than a heartfelt ‘thank you,’” Elliman said afterward.

The help will be appreciated, VA volunteer specialist Jack Fletcher said as he walked the CU Anschutz visitors through the hospital. The VA relies on volunteers to help make patients feel welcome and comfortable, and it has a list of more than a dozen jobs around the hospital volunteers can staff, plus more roles in which volunteers can help veterans out outside of the hospital.

Contributing to the community

While employees are free to choose the organizations and causes they support, this holiday season the university has formed partnerships with organizations in Denver and Aurora. In addition to the VA, the Volunteers of America is a partner. CU Denver Chancellor Dorothy Horrell is scheduled to volunteer at the VOA’s Veterans Resource Center in January.

CU Anschutz Chancellor Donald Elliman at 2016 CU in the Community trip to VA hospital
CU Anschutz Chancellor Donald Elliman at 2016 CU in the Community trip to VA hospital. Elliman is talking with Paul Bruns, an RN in the infusion clinic.

Another option is the university’s Veteran & Military Student Services’ Adopt-a-Vet program, which gives gifts to veterans who reside in the Colorado Veterans Community Living Center at Fitzsimons.

The CU in the Community web page has a list of other featured partners, stories from volunteers, details about the program and sign-up forms. The program runs through Feb. 20, which is Presidents’ Day.

While CU in the Community’s focus is on serving others, members of CU’s community also reap benefits.

“Taking the time to volunteer together with colleagues is rewarding on many levels. It’s good to interact outside of the workplace. And it’s satisfying to contribute to a cause you believe in,” Elliman said.

Joining Elliman, Engelke and Thompson were Mariana Ledezma, an associate director for the CU Anschutz Community-Campus Partnership; Neil Krauss, director of initiatives and outreach in the CU Anschutz chancellor’s office; and Linda Gallegos, the chancellor’s executive assistant.

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Guatemala partnership aids farm worker health

lee-newman
Lee Newman, MD, director of the Center for Work, Health and Environment and professor at the Colorado School of Public Health at CU Anschutz.

The Center for Health, Work & Environment and the Center for Global Health at the Colorado School of Public Health announced a new partnership with Pantaleon, one of the largest sugar producers in Central America, to further understand the health risks of sugar cane workers and improve prevention efforts.

The study will evaluate Pantaleon’s health promotion program in Guatemala and researchers will offer recommendations to the company based on their findings. The team is initially focusing on improving current health and safety practices and understanding how to reduce the risk of chronic kidney disease, an illness commonly found in workers performing strenuous labor in hot climates.

With growing international concerns about the impact of heat stress and climate change on farm workers, researchers from the Colorado School of Public Health hope the findings of this investigation will help protect not only Pantaleon’s nearly 30,000 workers but potentially millions of workers worldwide.

“Agricultural workers have always had an unacceptably high risk for work-related injuries and illness. Now the stakes are even higher because of rising global temperatures and increasing rates of chronic illness,” said Dr. Lee Newman, director of the Center for Work, Health and Environment and professor at the Colorado School of Public Health at CU Anschutz. “We are excited to work with companies like Pantaleon that show a commitment to improving worker safety, health, and well-being. What we learn here has the potential to help workers back in the U.S. and abroad,” he added.

Pantaleon agricultural worker harvesting sugarcane (Pantaleon)
Pantaleon agricultural worker harvesting sugarcane (Pantaleon)

Over the last 15 years, Pantaleon has prioritized worker health as part of their sustainability goals and has adjusted its policies and practices overtime in response to calls from clients, stakeholders, and the public. Pantaleon’s health promotion program began in 2002 and in November of last year, the group sought out assistance from experts at the Colorado School of Public Health to evaluate and further improve their worker health and safety program.

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Center for Global Health receives Gates Foundation grant for groundbreaking research

CU Anschutz announced today that it is a Grand Challenges Explorations winner, an initiative funded by the Bill & Melinda Gates Foundation. Kathryn Colborn, PhD, assistant research professor at the CU School of Medicine and senior investigator with the Center for Global Health at the Colorado School of Public Health, will pursue an innovative global health and development research project titled “Development of an automated early warning system for malaria transmission using machine learning.”

Kathrun Colborn
Kathryn Colborn

Grand Challenges Explorations (GCE) supports innovative thinkers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Colborn’s project is one of more than 55 Grand Challenges Explorations Round 17 grants announced today by the Bill & Melinda Gates Foundation.

To receive funding, Colborn and other Grand Challenges Explorations winners demonstrated in a two-page online application a bold idea in one of six critical global heath and development topic areas.  The foundation will be accepting applications for the next GCE round in February 2017.

Using data from Mozambique, Colborn, in collaboration with her husband, James, seeks to show how novel statistical models and online tools can change the way people are surveying, predicting and responding to areas of high malaria transmission. It focuses on innovations in malaria elimination analytics, specifically the training of algorithms using supervised learning, an advanced computing task, on demographic health surveys and satellite data. The methods will be disseminated through GitHub, a code repository and version control system, and can be made available for free to anyone in the world.

“Ideally, the malaria analytics tools we develop would be used by Mozambique’s Ministry of Health to predict future monthly case rates and to help in their prevention planning,” Colborn said.

At CU Anschutz, scientists engage in high-profile studies that contribute new information about the nature and treatment of disease to the rest of the world.

mosquito
Malaria is transmitted among humans by female mosquitoes of the genus Anopheles.

Grand Challenges Explorations is a US$100 million initiative funded by the Bill & Melinda Gates Foundation.  Launched in 2008, over 1228 projects in more than 65 countries have received Grand Challenges Explorations grants.  The grant program is open to anyone from any discipline and from any organization.  The initiative uses an agile, accelerated grant-making process with short two-page online applications and no preliminary data required.  Initial grants of US$100,000 are awarded two times a year. Successful projects have the opportunity to receive a follow-on grant of up to US$1 million.

 

 

 

 

 

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Researchers find association between gene mutation and rare heart disease

A strong association between a genetic mutation and a rare kind of heart muscle disease has been discovered by researchers at the University of Colorado Anschutz Medical Campus.

The finding, published this week in the Journal of the American College of Cardiology, could improve understanding of the disease and lead to new treatments.

Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine
Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine.

“There are many kinds of cardiomyopathies that can lead to heart failure so this is a serious problem,” said Teisha J. Rowland, PhD, a post-doctoral fellow in the lab of Luisa Mestroni, MD, and Matthew R. G. Taylor, MD, PhD, at the University of Colorado School of Medicine and first author of the study.

The Mestroni and Taylor lab sequenced nearly 5,000 genes in 335 patients with a family history of heart muscle disease, looking for mutations that could cause a variety of cardiomyopathies.

“Many kinds of heart disease are caused by genetics. When that happens, the disease is often more severe and happens at an earlier age,” said Rowland, who studies genetics and cardiology. “So we look at the DNA in entire families to see what sort of genetic variants those with the illness have in common.”

They found that several people with left ventricular noncompaction (LVNC) had a mutation in a gene called Obscurin. Obscurin is part of the sarcomere, the basic unit of striated muscles that pull and glide past each other when muscles contract.  That includes the heart muscle. If there is a mutation in Obscurin that process may not function properly.

Image of human heart
A strong association between a genetic mutation and a rare kind of heart muscle disease has been discovered by CU Anschutz researchers.

“We found a strong association between this gene, which has not been studied much, and this rare form of genetic heart disease,” Rowland said. “Left ventricular noncompaction is thought to happen during early human development. It would be interesting to see if mutated Obscurin affects heart formation during development.”

Rowland said the findings point to areas warranting further attention.

“We expect this will ultimately improve our understanding of the disease,” she said.

The other authors include: Sharon L. Graw, PhD; Mary E. Sweet, BA; Matthew R.G. Taylor MD, PhD and Luisa Mestroni, MD all of the Cardiovascular Institute and Adult Medical Genetics Program at the University of Colorado Anschutz Medical Campus.

And Marta Gigli, MD, of the collaborating research group at the Cardiovascular Department, University of Trieste Hospital and SOM, Trieste, Italy.

 

 

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Housestaff Association advocates for residents and fellows

There is a diverse group of health care professionals on the CU Anschutz Medical Campus who work rather quietly – often into skinny hours of the night – but register a significant impact.

Jeremy Hosein, MD
Jeremy Hosein, MD, co-president of the Housestaff Association

“We’re a pretty large population on campus,” said Jeremy Hosein, MD, a third-year neurosurgery resident. “You can’t walk around on campus without rubbing elbows with a resident or a fellow.”

Hosein and Christie Osborne, MD, are this year’s co-presidents of the Housestaff Association (HA), which represents 1,100 residents and fellows at CU Anschutz Medical Campus. Most of that number – about 800 – are residents, who are collectively known as the “house staff” or “houseofficers” of a hospital.

Front lines of health care

Christie Osborne, MD
Christie Osborne, MD, co-president of the Housestaff Association

The HA is a nonprofit organization, solely funded through houseofficer dues, which advocates on behalf of members who, as trainee physicians, often serve on the front lines of health care in area hospitals. The HA represents houseofficers who serve at University of Colorado Hospital (UCH), Children’s Hospital Colorado, Denver Health, Rose Medical Center, Swedish Medical Center and National Jewish Health.

Hosein said the HA wants to improve its visibility as some members are unaware that the association serves as a resource for their unique circumstances. Added Osborne, “We try to work as best as we can within the system to try to advocate for resident and fellow interests.”

For example, the HA negotiates on issues such as work conditions, health coverage and stipends which, ideally, reflect the area’s cost of living.

Improve conditions, reduce burnout

The HA is affiliated with the CU Graduate Medical Education (GME) but is not a training program and does not fall under GME’s direction. The HA Executive Committee meets monthly, while Housestaff representatives serve on standing committees including in the GME, the School of Medicine and UCH. Representatives also give feedback to the Accreditation Council of Graduate Medical Education (ACGME) when the ACGME makes campus visits.

More Housestaff Association information

Reach the Housestaff Association at its website, or call 303-724-3039. Want to get more CU Anschutz news? Subscribe to the CU Anschutz Today newsletter here.

Each year, the HA sends out a confidential education survey to all houseofficers. In addition to fair stipends, the co-presidents say, members are generally interested in ways to reduce burnout amid a national health care environment that is seeing rising patient volumes. On average, medical residents put in 80 hours a week.

Osborne is a third-year pediatrics resident. “My residency program director has often said, ‘I’d like to see what would happen if the residents didn’t show up one day,’” Osborne said. “They’re such an integral part of the day-to-day operations of the hospitals.”

‘Residents and fellows work extremely hard’

Both Osborne and Hosein said they enjoy the collaborative environment in which they work with administrators and other leaders across the CU Anschutz Medical Campus. They also point to the exceptional service the organization has received for many years from HA Administrator Sally Robben.

“Christie, Sally and I feel very strongly that residents and fellows work extremely hard on this campus,” Hosein said. “We are a resource for them and are proud to represent them.”

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Vitamin D reduces respiratory infections

AURORA, Colo. (Nov. 16, 2016) – Researchers at the University of Colorado Anschutz Medical Campus have found that high doses of vitamin D reduce the incidence of acute respiratory illness (ARI) in older, long-term care residents.

The findings of the clinical trial, published today in the Journal of the American Geriatrics Society, could help reduce one of the leading causes of serious illness, debilitation and death among patients in nursing homes and other long-term care facilities.

Vitamin D reduces incidence of acute respiratory illness
Vitamin D reduces incidence of acute respiratory illness, study shows.

“After studying these patients for a year, we found a 40 percent reduction in acute respiratory illness among those who took higher doses of vitamin D,” said the study’s lead author, Adit Ginde, MD, MPH, professor of emergency medicine at the University of Colorado School of Medicine. “Vitamin D can improve the immune system’s ability to fight infections because it bolsters the first line of defense of the immune system.”

Ginde said in older people that first line of defense is often impaired. But vitamin D can reinforce it and prevent illnesses like pneumonia, influenza and bronchitis. It may also prevent infections and exacerbations of Chronic Obstructive Pulmonary Disease (COPD) like emphysema.

At the same time, Ginde found that those who received higher doses of vitamin D also saw an increase in falls. The falls were lower in those given smaller doses rather than higher monthly doses of vitamin D.

adit-gine-portrait
Adit Ginde, MD, MPH, professor of emergency medicine at the University of Colorado School of Medicine

The clinical trial, the first to examine vitamin D’s impact on respiratory infections in nursing home residents, looked at 107 patients with an average age of 84 over a 12 month period. Of those, 55 received high doses of vitamin D or 100,000 units monthly (averaging 3,300-4,300 units daily). And 52 received lower doses averaging between 400-1,000 units daily. Those with higher doses saw ARIs cut nearly in half. They also had over double the incidence of falls, the study said.

“This finding requires a confirmatory trial, including whether high daily doses of vitamin D, rather than high monthly doses, makes patients less likely to fall,” Ginde said.

But Ginde said the primary finding that vitamin D can reduce ARI is a major step forward in treating these dangerous infections.

“This is a potentially life-saving discovery,” Ginde said. “There is very little in a doctor’s arsenal to battle ARI, especially since most are viral infections where antibiotics don’t work. But vitamin D seems able to potentially prevent these infections.”

He cautioned that the study is not definitive proof that vitamin D can prevent ARI but it suggests that it can and at little risk to the patient.

“If our results are confirmed by a larger trial, high dose vitamin D, ideally using daily dosing to minimize fall risk, has the potential for substantial public health benefit through ARI prevention for the large and growing population of long term care residents,” Ginde said.

The study co-authors include Patrick Blatchford, PhD, Keith Breese, MA, Lida Zarrabi, MPH, Sunny Linnebur, PharmD, Jeffrey Wallace, MD, MPH and Robert Schwartz, MD. All are from the University of Colorado Anschutz Medical Campus.

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More than 120 presentations by ColoradoSPH at American Public Health Association

ColoradoSPH’s booth in the APHA conference expo hall was a popular gathering place for the school’s faculty, staff, students and alumni

ColoradoSPH’s booth in the APHA conference expo hall was a popular gathering place for the school’s faculty, staff, students and alumni

 

 

Last week, the American Public Health Association held its annual 2016 conference in Denver at the Colorado Convention Center, with a focus on “Creating the Healthiest Nation: Ensuring the Right to Health”. More than 12,000 public health practitioners, educators and students descended on the Mile High City from across the nation and globe, and more than 100 of the Colorado School of Public Health’s faculty, students and alumni showcased the school’s  work at more than 120 presentations or research abstract exhibits over the five-day conference.

<img class="wp-image-26383 size-Content-Small" src="http://www.cuanschutztoday como obtener viagra.org/wp-content/uploads/2016/11/GAscoigne-384×226.jpg” alt=”From left: APHA President-Elect Tom Quade and Assistant VC for Student Affairs at CU Anschutz Jan Gascoigne” width=”384″ height=”226″ />

From left: APHA President-Elect Tom Quade and Assistant VC for Student Affairs at CU Anschutz Jan Gascoigne

The APHA organization hosted keynote sessions featuring popular speakers like Colorado’s own Governor John Hickenlooper, Cecile Richards—president of Planned Parenthood nationwide—who charged conference attendees to address healthcare access and equity, and Tom Frieden, MD, MPH, the current director of the Centers for Disease Control and Prevention (CDC) addressed the audience alongside four other past directors about the role of public health and the CDC to keep Americans safe. Other popular sessions also focused on the public health and prevention in the context of the 2016 Election—including one such session with David C. Goff, MD, PhD, dean of the Colorado School of Public Health (ColoradoSPH), who sat on a panel to discuss recommended public health priorities for the next U.S. Congress and new Administration to consider.

Honoring ColoradoSPH

Many ColoradoSPH faculty, staff and students were recognized by varying APHA professional sections including Charlene Barrientos Ortiz, project manager and professional research assistant in ColoradoSPH’s Community and Behavioral Health department at the CU Anschutz Medical Campus. Barrientos Ortiz received the 2016 Henry Montes President’s Service Award from the APHA’s Latino Caucus for Public Health (LCPH) for her work as an active research community liaison for Colorado’s urban Latino community as well as director for the Colorado Clinical and Translational Sciences Institute’s (CCTSI) community immersion training programs for researchers. She is also a founding board member of the Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR), and volunteers with many other local boards advocating for Latino health. Barrientos Ortiz received the award for her commitment to using her professional skillset and passion to address health disparities and improve health equity.

From left: Eric Lucas, MPHc at ColoradoSPH at CU Anschutz; Tonya Ewers, ColoradoSPH’s director of communications and alumni relations; Georgette Vigil, alumni relations director for CU Anschutz; Christine Gillen, ColoradoSPH’s associate dean for administration and finance

From left: Eric Lucas, MPHc at ColoradoSPH at CU Anschutz; Tonya Ewers, ColoradoSPH’s director of communications and alumni relations; Georgette Vigil, alumni relations director for CU Anschutz; Christine Gillen, ColoradoSPH’s associate dean for administration and finance
goff

From left: ColoradoSPH Dean David Goff with Donna Arnett, dean of the University of Kentucky College of Public Health, and Shiriki Kumanyika, immediate past president of the American Public Health Association

Two doctoral students of ColoradoSPH at CU Anschutz were also recognized by the APHA’s professional section for Injury Control and Emergency Health Services (ICEHS). Lauren Pierpoint, an epidemiology PhD student at ColoradoSPH, was awarded the APHA ICEHS Student Oral Presentation Award for her research on the epidemiology of injuries that resulted in withdrawal from high school sports in athletes who were either cleared to play or were not medically disqualified to compete. ColoradoSPH alum and current epidemiology PhD student Patrick Carry, MS, received the Honorable Mention Award for the 2016 Student Paper Competition. Carry was recognized for a paper based on his epidemiology MS thesis that focused on the performance of a wearable inertial measurement tool as an accurate system to assess postural stability. His research and findings could be applied to the independence and well-being of Parkinson’s patients and others who are at risk of falling and fall-related injuries like construction workers, athletes, or older adults and patients with head injuries.

Another PhD candidate in Epidemiology at CU Anschutz, Danielle Ostendorf, MS, ACSM-CEP, also won an award from the APHA’s professional section for Physical Activity. Ostendorf was recognized for Outstanding Student Research in Physical Activity for her poster presentation of research related to people who lost weight and were able to keep it off. She and her colleagues used a device called ActivPAL to measure standing versus sitting, and found that weight loss maintainers spent far less time sitting and were more active overall.

presentation

Epidemiology DrPH candidate, Molly Gutilla, was one of many presentations by ColoradoSPH students, faculty and alumni

“Simply having an abstract selected for an oral presentation is quite an accomplishment given the large number of submissions and the competitiveness of the work being done by ICEHS members,” said Zachary Kerr, PhD, MPH, APHA ICEHS chair-elect and assistant professor for the Department of Exercise and Sport Science at the University of North Carolina-Chapel Hill, in an email. “I was so impressed by the quality of work that [these students] presented.”

Reconnecting with alumni

In addition to the presentations and awards, ColoradoSPH also held a special school-wide event at APHA for all alumni, students, faculty, staff and community partners to celebrate its recent re-accreditation, hosted a booth in the APHA expo hall, and co-sponsored an APHA Public Health Service Day for students that drew hundreds of local and visiting public health students to volunteer at local nonprofit organizations on Oct. 30. The school was also a sponsor of the conference and hosted the student booth for all students of public health who were learning to navigate the conference for the first time.

“Having the APHA annual conference in Colorado was an enormous opportunity to highlight the Colorado School of Public Health’s programs, campuses, faculty research and far-reaching community involvement and engagement,” said Tonya Ewers, director of communications and alumni relations. “It was a great time to connect with our alumni who live near and far, and to hear how individuals from ColoradoSPH and the greater public health community are impacting population health not only across our state and nation, but also across the world.”

The Colorado School of Public Health is the first and only accredited school of public health in the Rocky Mountain Region, attracting top-tier faculty and students from across the country, and providing a vital contribution toward ensuring our region’s health and well-being. Collaboratively formed in 2008 by the University of Colorado Anschutz Medical Campus, Colorado State University, and the University of Northern Colorado, the Colorado School of Public Health provides training, innovative research and community service to actively address public health issues including chronic disease, access to healthcare, environmental threats, emerging infectious diseases, and costly injuries. Learn more and follow ColoradoSPH’s updates on Facebook, Twitter and Instagram.

Guest Contributor:  Tonya Ewers, Director of Communications & Alumni Relations, Colorado School of Public Health

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Even mild pulmonary complications following surgery can increase risk of death

 

Ana Fernandez-Bustamante
Ana Fernandez-Bustamante, MD, PhD, associate professor of anesthesiology at the CU School of Medicine

Researchers at the University of Colorado Anschutz Medical Campus, along with seven other major institutions, have found that even mild postoperative pulmonary complications (PPCs) are significantly associated with increased death within the first week after surgery.

The study, which appeared online today in the journal JAMA Surgery, examined 1,202 patients who underwent abdominal, orthopedic, neurological and other procedures under general anesthesia for at least two hours.

“We found that patients with one or more PPCs, even mild, had significantly increased intensive care unit admission, ICU/hospital length of stay and early postoperative mortality,” said Ana Fernandez-Bustamante, MD, PhD, associate professor of anesthesiology at the University of Colorado School of Medicine. She and Marcos Francisco Vidal Melo, MD, PhD, associate professor at the Massachusetts General Hospital, Harvard University, are the lead authors of the article.

Current estimates suggest that there are over a million PPCs each year in the U.S. resulting in 46,200 deaths and 4.8 million hospitalizations days. Most of these PPCs are considered mild (i.e. needing prolonged supplemental oxygen), difficult to measure and often ignored in clinical studies.

Fernandez-Bustamante and her colleagues, including Karsten Bartels, MD, assistant professor of anesthesiology at CU Anschutz, set out to understand these PPCs better and how to address them.

They studied patients classified as “physical status 3” by the American Society of Anesthesiologists, meaning they suffered severe systemic disease. The patients underwent prolonged, non-cardiac or thoracic surgery with general anesthesia and mechanical ventilation.

A third of them developed one or more PPCs after surgery. These patients were often older with hypertension, cancer or chronic obstructive pulmonary disease.

Severe complications were rare. The most common complication was simply requiring oxygen for longer than 24 hours after the operation. That was followed by atelectasis (or portions of the lungs being partially collapsed).

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New study shows that even mild pulmonary complications following surgery increase the risk of death and hospital stays.

 

But even these relatively mild complications were associated with significantly increased hospital stays, admission to the ICU or mortality the first week after surgery.

And this was observed at seven large American academic hospitals.

“This tells us that care could be improved,” said Fernandez-Bustamante. “If we could understand better and prevent mild PPCs we could improve the recovery of thousands of patients.”

Doctors know that giving patients too many fluids or too big breaths during anesthesia can cause pulmonary problems afterwards.

Fernandez-Bustamante said that paying more attention to preventing atelectasis, for example, before, during and after surgery, could reduce some of them, improve oxygenation and prevent the need of oxygen therapy and hospital stay. She noted that physicians must also optimize fluids and pain control, and minimize blood loss during operations to prevent PPCs. Doing all of this, she said, could improve patient outcomes and result in shorter hospital stays.

“Surgeons, anesthesiologists, nurses, respiratory therapists, and others, must collaborate better to make this successful. And of course patients need to know they play a critical role in their own recovery. We must work with them closely before, during and after surgery,” Fernandez-Bustamante said. “If we want patients to have less pulmonary complications, we need a truly comprehensive approach to this problem.”

The study co-authors include Karsten Bartels, MD, of the University of Colorado School of Medicine and statisticians from the Adult and Children Outcomes Research and Delivery Systems, University of Colorado School of Medicine. The other institutions that took part in the study are Massachusetts General Hospital (Boston, MA); Brigham and Women’s Hospital (Boston, MA); Mayo Clinic (Rochester, MN); Beth Israel Deaconess Medical Center (Boston, MA); University of Miami (Palmetto Bay, FL); and University of California San Francisco (San Francisco, CA).

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