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Anowara Begum’s journey

Anowara Begum and three women from her village
Anowara Begum and three women from her village

Anowara Begum’s journey from a remote village in Bangladesh to the CU Anschutz Medical Campus is an inspiring tale of courage and determination. She enrolled in the Colorado School of Public Health after a chance conversation at a conference in Germany, which left her with a strong opinion about CU Anschutz.

“It will be a very supportive and accepting environment,” she said. “I can make a home away from home there.”

From Bangladesh to CU Anschutz

Women’s education is not a priority in Begum’s home village. The woman’s role is confined to cooking and raising children, and the cooking is completed inside using biomass fuels like grass, dung and leaves. Past research suggests that the smoke released from these types of fuels may lead to several types of respiratory diseases.

Anowara Begum
Anowara Begum in her home village

“I saw my mother cooking inside with different fuels like cow dung and straw,” Begum said. “She never questioned is the smoke from these fuels bad for me?”

Begum’s inquisitive nature led her to think about these health implications, and she envisioned that one day she could provide solutions. In order to follow her dream, she moved away from her family to a larger city in Bangladesh to complete her secondary education and undergraduate degree in Public Health.

After her undergraduate career, Begum was at a crossroads: Should she stay in Bangladesh? Should she go to another country to get more experience? She made her decision after a serendipitous encounter with a CU Anschutz student she met at a conference in Germany. Begum was enamored by the student’s amicable attitude. “I thought to myself, ‘Well, if this person is so nice from there, then maybe that place is nice as well,’” Begum explained.

She had never even visited the United States and yet, decided to make a leap of faith and apply exclusively to the Colorado School of Public Health.

Taking research back to Bangladesh

While studying at CU Anschutz, Begum realized a unique opportunity to cultivate her researching skills and passions. Ultimately, she wants to implement culturally appropriate public health solutions in Bangladesh.

Anowara Begum
Anowara Begum

“There is a great amount of research being done, but many researchers are missing that cultural appropriation aspect,” Begum said. “That part is the most important to me, because you can’t implement effective changes in public health unless you understand the big picture of the local culture.”

Begum believes she can change the way research has been applied in her home country because of her personal experiences growing up there. She believes her uniquely personal touch could make lasting impacts on communities in need. For her practicum, she was afforded the opportunity to apply her acquired skills by traveling back to Bangladesh.

In summer 2016, Begum received a grant to work with the University of Southern California to study biomass-fueled indoor air pollution exposure in Bangladesh. She helped develop culturally appropriate survey questions that consider regional specific housing characteristics. These considerations included the type of house the resident lives in, and what kind of stove they used.

The research was successful, but her real accomplishment lay in the new attitude of the women in her home village. She realized she had become a beacon of hope for other women in her village. “I am the first-generation woman with higher education in my family,” Begum said. “I realized when I went back home that I can be a role model beyond public health, that I can influence the society by showing how I am getting an education.”

That experience was overwhelmingly emotional for Begum. “I always said I would come back, but then I actually did,” she said. “It gave hope to the village to see me back.” It is Begum’s dream to return to Bangladesh after continuing her studies and practical training in Colorado.

A New Home in CU Anschutz

Begum’s experience at CU Anschutz has not only been rich in academics, but also in extracurricular activities. During orientation, the International Student Group approached her.  “I felt like I had known them for ages,” she said. “They guided me as an international student from the beginning. They hung out with me and kept me connected to campus. If I did not have that group, I would not be the person who I am today.”

Anowara Begum and women from the International Student Group
Anowara Begum and women from the International Student Group

Begum believes she must give back, so she now serves as president of the International Student Group. There are 50 members of international background and 20 members of domestic background. “Anyone who believes in diversity should be a part of this group,” she said. “You don’t have to be international; you just have to want friends.”

Begum’s determination led her to Colorado, and CU Anschutz provided her a beneficial, safe learning environment. She strongly believes that her experiences here will provide a great background to conduct future research in Bangladesh. “I’m very root-oriented,” she said. “I am drawn back to where I came from, my family. But I also have a great support system here; the professors and friends, they are family to me. They are going to be my lifelong friends. This is why I call it a home away from home.”

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Type 2 diabetes diagnosis in youth leads to increased health complications

A new report published this month in the Journal of the American Medical Association points to a significantly higher burden of diabetes-related complications in adolescents and young adults with type 2 diabetes compared to type 1 diabetes, with greater health complications in minority youth.

The study, from researchers involved with the nationwide SEARCH for Diabetes in Youth Study, looked at five health complications and co-morbidities of diabetes, including: retinopathy (eye disease), diabetic kidney disease, peripheral neuropathy (altered sensation in the feet), arterial stiffness and high blood pressure.

The researchers studied 1,746 adolescents and young adults with type 1 diabetes and 272 with type 2 diabetes. Their findings showed that, after less than eight years following a diagnosis, approximately one-third of teenagers and young adults with type 1 diabetes and almost 75 percent of those with type 2 diabetes had at least one health complication or comorbidity. Additionally, any adjustment for differences in age, sex, race/ethnicity, and levels of glucose control over time, did not remove the excess prevalence among those with type 2 diabetes.

“The high burden of early complications in youth with diabetes requires additional research to clarify the underlying causes and to identify effective intervention strategies,” said Dr. Dana Dabelea, lead author and co-chair of the national SEARCH Study and professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. “It is extremely useful to have these estimates of the presence of complications in adolescents and young adults who are being treated with current therapies, especially because the complications are frequent. We need to make sure each risk factor is under the best control possible to reduce future problems.”

The SEARCH for Diabetes in Youth Study has been monitoring the burden of diabetes in youth with onset less than 20 years of age since 2000. Five U.S. clinical centers and principal investigators participated, including: Seattle Children’s Hospital, (Dr. Catherine Pihoker); Kaiser Permanente Southern California, (Dr. Jean Lawrence); Colorado School of Public Health (Dr. Dana Dabelea); Cincinnati Children’s Hospital, (Dr. Larry Dolan); and the Universities of North and South Carolina Schools of Public Health, (Dr. Elizabeth Mayer-Davis, SEARCH co-chair). The central laboratory is at the Northwest Lipid Research Laboratory, (Dr. Santica Marcovina) and the Coordinating Center is at the Wake Forest School of Medicine (Dr. Ralph D’Agostino and Dr. Lynne Wagenknecht, co-directors).

SEARCH is funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

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Water fluoridation saves Americans over $6 billion in dental work

Americans enjoyed savings of $32 per capita in tooth decay prevention, according to a national assessment of fluoridation by Colorado School of Public Health (ColoradoSPH) researchers published in Health Affairs.

The work updates a 2001 comprehensive study of U.S. community water fluoridation program costs and benefits. Joan O’Connell, PhD, associate professor in the Community & Behavioral Health Department of the ColoradoSPH at CU Anschutz, and coauthors developed a model to update that national study using more recent information on fluoridation costs, the incidence of tooth decay and treatment costs.

They used data from multiple sources including the Centers for Disease Control, NNER, 2013 administrative data from private dental insurers and from water systems located throughout the U.S. They estimated the types of initial and follow-up treatment for dental caries, or tooth decay, and their associated costs to treat over time.

Researchers found that in 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. They estimated 2013 savings associated with caries averted as a result of fluoridation to be $6.8 billion, or $32 per capita. The estimated cost to community water fluoridation programs providing fluoridation was $324 million, with net savings estimated at $6.5 billion and a $20 return on investment for each $1 spent. Estimates of per capita savings associated with community water fluoridation may be used by states to estimate net savings and a return on investment using local data on fluoridation costs.

Approximately 75 percent of Coloradans served by public water systems receive optimal levels of fluoride.  Community water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of race/ethnicity, age, gender, educational attainment or income.

The Colorado Department of Public Health and Environment’s Oral Health Unit oversees the Community Water Fluoridation program. The Oral Health Unit, in collaboration with the Safe Drinking Water Program, administers the community water fluoridation program, ensuring that the addition of fluoride is in accordance with the latest scientific, dental and health guidelines.

The Oral Health Unit collaborates with local communities to increase awareness of the benefits, safety and efficacy of water fluoridation; provide technical assistance to communities who are considering implementing a water fluoridation program; address possible community water fluoridation rollback attempts, provide funding for new or replacement fluoridation equipment, and support public water systems that are fluoridating meet operational guidelines.

In 2015, the U.S. Public Health Service updated its recommendation on fluoridation levels to 0.7 milligrams per liter (mg/L) from the previous 1962 recommendation range of 0.7 to 1.2 mg/L. This updated recommendation was initiated in 2011 and decided by a panel of scientists from several federal agencies after public comment. The panel reviewed a substantial body of peer-reviewed evidence to ensure optimal health and reduction in tooth decay while minimizing the risk of cosmetic fluorosis in the general population.

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Data Science to Patient Value initiative strives to maximize big data

Jean Kutner, MD
Jean Kutner, MD, is one of the leaders of the Data Science to Patient Value initiative

When Jean Kutner, MD, MSPH, provides care for patients, she wishes she could spend more time talking with patients about their health and the care they want to receive—and not spending her time on a computer, trying to sort through volumes of health records.

“That’s probably not a good use of our valuable and limited time together,” said Kutner, a general internist and palliative care specialist, chief medical officer of University of Colorado Hospital and associate dean for clinical affairs at the University of Colorado School of Medicine (SOM).

Despite her occasional frustration, Kutner is not against technology—far from it. She wants to unlock its potential to create effective care personalized for each patient.

Kutner co-leads the Data Science to Patient Value (D2V) initiative, a new multidisciplinary program at the University of Colorado Anschutz Medical Campus. The initiative, supported with a $20 million grant from the SOM’s Transformational Research Funding program, has big ambitions.

“Our work could revolutionize how we think about how health care is provided, the patient experience, and how we make decisions,” Kutner said. “Our goal is to make CU Anschutz a leader in the intersection between data and value and the application of cutting-edge data science to the value equation.”

Personalizing big data

Right now, the volume of clinically relevant data in health records and from other sources can be overwhelming. Initiatives like D2V could fix that and develop technologies that create a new era in health care. Kutner thinks in the future supercomputers will help diagnose and treat patients, and that will lead to real improvements in their health and maximize the doctor-patient relationship.

“This is personalized medicine focused on a patient’s goals and values, and not necessarily on their genome,” Kutner said.

She gives the hypothetical example of a patient just discharged from the hospital. In a few years, a doctor could use an activity tracker like a Fitbit to see if the patient exercises and gets out of the house. The doctor would look for signs the patient is not recovering or has developed other health problems.

Kutner said the clinical team could see the data and reach out to the patient, checking on their status and, if necessary, asking the patient to come in to be evaluated. Before the visit, a supercomputer could analyze the patient’s data and compare it to data collected from tens of millions of other people. The analysis could create a personalized risk profile with suggestions for a custom treatment plan based on proven therapies. At the start of the next appointment, a doctor could see that information in single user-friendly dashboard.

“With all that data already synthesized, I could get the most value out of face-to-face time with a patient and help them make decisions about their treatment,” Kutner said. “That would be my ideal world.”

Physicians would still have important roles, Kutner said. The doctor and patient would use their time together to talk about what problems are arising and focus on their patients’ priorities. They would work together to get back on track.

Value from the patient’s perspective

While D2V is working on technological innovation in fields such as medical informatics, biostatistics and data visualization, Kutner said it also will address the more philosophical question of how to define value. It is not a simple question.

“If I’m a patient, I might define value differently than an insurer or a health care provider,” Kutner said. Patients can have unsatisfactory experiences despite being what doctors might consider success stories.

D2V will address that disconnect by including stakeholders such as patient advocates and experts in public health and the insurance industry. Kutner believes that will keep the project focused on the ultimate goal, which is improving care.

Building technology and a team

D2V started work in 2016 by recruiting experts from across CU Anschutz. Kutner wants to take advantage of CU Anschutz’s collaborative environment and current faculty members, researchers and staff.

“We have unique expertise here. We have outstanding data scientists. We have people who do world-leading work in care decision making and understanding stakeholder perspectives,” Kutner said. “We need to connect them behind a common goal.”

D2V also recruits researchers from around the world, with more people hired each month. Guest speakers from other leading institutions have given seminars to spark ideas.

Eight pilot projects are underway. They include a team trying to improve the databases that track children who have severe asthma attacks. That project’s goal is to test whether risk profiles can help create personalized predictions of when children might suffer attacks.

D2V will fund an additional six pilot projects in 2017 and is accepting project proposals through March 15.

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Even after treatment, brains of anorexia nervosa patients not fully recovered

Even after weeks of treatment and considerable weight gain, the brains of adolescent patients with anorexia nervosa remain altered, putting them at risk for possible relapse, according to researchers at the University of Colorado Anschutz Medical Campus.

Dr. Guido Frank, associate professor of psychiatry and neuroscience, is an expert in eating disorders

The study, published last week in the American Journal of Psychiatry, examined 21 female adolescents before and after treatment for anorexia and found that their brains still had an elevated reward system compared to 21 participants without the eating disorder.

“That means they are not cured,” said Guido Frank, MD, senior author of the study and associate professor of psychiatry and neuroscience at the University of Colorado School of Medicine. “This disease fundamentally changes the brain response to stimuli in our environment. The brain has to normalize and that takes time.”

Brain scans of anorexia nervosa patients have implicated central reward circuits that govern appetite and food intake in the disease. This study showed that the reward system was elevated when the patients were underweight and remained so once weight was restored.

The neurotransmitter dopamine might be the key, researchers said.

Dopamine mediates reward learning and is suspected of playing a major role in the pathology of anorexia nervosa. Animal studies have shown that food restriction or weight loss enhances dopamine response to rewards.

With that in mind, Frank, an expert in eating disorders, and his colleagues wanted to see if this heightened brain activity would normalize once the patient regained weight.

Study participants, adolescent girls who were between 15 and 16 years old, underwent a series of reward-learning taste tests while their brains were being scanned.

The results showed that reward responses were higher in adolescents with anorexia nervosa than in those without it. This normalized somewhat after weight gain but still remained elevated.

At the same time, the study showed that those with anorexia had widespread changes to parts of the brain like the insula, which processes taste along with a number of other functions including body self-awareness.

The more severely altered the brain was, the harder it was to treat the illness, or in other words, the more severely altered the brain, the more difficult it was for the patients to gain weight in treatment.

“Generalized sensitization of brain reward responsiveness may last long into recovery,” the study said. “Whether individuals with anorexia nervosa have a genetic predisposition for such sensitization requires further study.”

Frank said more studies are also needed to determine if the continued elevated brain response is due to a heightened dopamine reaction to starvation and whether it signals a severe form of anorexia among adolescents that is more resistant to treatment.

In either case, Frank said the biological markers discovered here could be used to help determine the likelihood of treatment success. They could also point the way toward using drugs that target the dopamine reward system.

“Anorexia nervosa is hard to treat. It is the third most common chronic illness among teenage girls with a mortality rate 12 times higher than the death rate for all causes of death for females 15-24 years old,” Frank said. “But with studies like this we are learning more and more about what is actually happening in the brain. And if we understand the system, we can develop better strategies to treat the disease.”

The study co-authors include Marisa DeGuzman, BA, BS, Megan Shott, BS, Tony Yang, MD, PhD and Justin Riederer, BS.

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Start health detective work at upcoming campus Biometric Screenings

CU Anschutz faculty and staff no longer have to be alone in their search for answers to their health questions.

Running March 8 through April 5, Biometric Screenings will offer free body composition measurements, blood glucose testing and a full lipid panel to catch the culprits of health woes. Screenings will be held on the CU Anschutz campus on March 9, March 13, March 22 and April 3.

Register

The first 500 people to register will be entered into a drawing for free Bose SoundSport Wireless Headphones.

Register Today

All CU Health Plan members and covered spouses will receive this trio of tests with no additional charges or out-of-pocket payments. CU Health Plan has you covered. Members and spouses must bring along their plan ID card to the clinic to receive coverage. Student employees are not eligible for Biometrics Screenings as CU Health is not the primary student insurance provider.

Need more clues? Additional tests including blood typing and a full blood chemistry analysis with prices ranging from $12 to $50 a test. Preview your screening options and prices.

Results can be shared with a primary care physician* through My Health Connection, an interactive platform that keeps private medical information in a secure place minus the paper trail. Screening participants will be sent information to create an account after their screening. (*Limited to providers affiliated with UCHealth’s Epic Electronic Medical Record and the Colorado Regional Health Information Organization.)

For more information, consult a handy FAQ and take the steps towards a healthier lifestlye.

Guest Contributor:  RyAnne Scott, Manager of Communications and Outreach, Employee Services, University of Colorado, Office of the President

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