Sept. 4, 2019, marks an important date in advancing health care in Colorado.
UCHealth announced a significant investment that will bolster behavioral health care for patients across the state. With an infusion of $100 million and an additional $25 million in matching funds, UCHealth will ensure that behavioral health therapists and psychiatrists are an integral part of the patient care experience. By building out its intensive outpatient, preventive and telehealth services, the health system will be able to better serve more individuals in Colorado, the Rocky Mountain region and beyond.
“Together with our clinical partners, we will accelerate the pace of change in behavioral health care, and bring high-quality, integrated care to more of the millions of patients cared for each year.” – Don Elliman, Chancellor of CU Anschutz
“Our faculty have the expertise and resources to make a transformative impact on people’s lives,” said CU Anschutz Chancellor Don Elliman. “Together with our clinical partners, we will accelerate the pace of change in behavioral health care, and bring high-quality, integrated care to more of the millions of patients cared for each year.”
Dr. Neill Epperson, professor and chair of the Department of Psychiatry at the CU School of Medicine, said 20% to 40% of primary care patients have a behavioral health need.
“Attending to our patients’ behavioral health needs in a timely manner is critical to their overall health and well-being. This comprehensive approach to mental health and substance abuse treatment has the potential to improve the lives of hundreds of thousands of Coloradans,” Dr. Epperson said. “By embedding services within primary care locations, we can treat these needs in a cost-efficient manner while still providing an expert psychiatrist for patients who need a specialist.”
During her 22 years as associate dean of Clinical and Community Affairs, Professor Amy Barton spearheaded the creation of the University of Colorado College of Nursing’s clinical enterprise. The string of health centers target everyone from CU Anschutz Medical Campus students to the Denver area’s most at-risk populations.
Barton also earned numerous prestigious appointments and awards, wrote a long list of scholarly articles and books and netted the university $8.5 million in grants during that time.
It appears she listened to her parents.
Fate and upbringing guide Barton to CU
“My parents were very involved in the community, and I grew up with the ethic that to whom much is given much is expected,” said Barton, PhD, RN, FAAN, one of five children in her family. “My parents also worked hard to send us all through college. Education was very important to them,” said Barton, a native of Toledo, Ohio.
Barton, also the Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, will step down from her administrative post on Sept. 1. She will remain with CU Nursing in her professorship and endowed chair roles.
“One of the hallmarks of success to this is that our providers focus on the needs of their particular communities and figure out how to create and deliver those services.” – Amy Barton
Along with her parents, CU Nursing can thank Barton’s husband for her contributions.
“It provides a real balance between the academic world and the practice world,” Barton said of the position, which CU Nursing Professor Rosario Medina, PhD, FAANP, FNP-BC, ACNP, CNS, will take over. “I have always enjoyed working on projects that impacted patients and made a difference in people’s lives,” Barton said.
Barton’s passion to influence people’s health resulted in:
The Campus Health Center at CU Anschutz. Designed for providing faculty, staff and students with convenient health care, the on-campus clinic offers everything from flu shots and prescription refills to pregnancy tests and behavioral health counseling.
Sheridan Health Services. With two facilities (one focused on family and the other on youth), Sheridan Health Services provides targeted medical and behavioral care in areas with high at-risk populations. A 501(c)(3) federally qualified health center, the clinics are led by CU Nursing faculty who strive for equality in health care.
Belleview Point Clinic. This clinic in southeast Aurora focuses on providing integrated health care emphasizing wellness and prevention with its advanced practice nursing.
The Center for Midwifery. With a number of private practice clinics in the area, this center provides holistic health care through the pregnancy journey. Its branch in Longmont, which serves Weld and Boulder counties, will move to one central Longmont location on Sept. 3.
“I think that we’ve created a successful, sustainable practice here,” Barton said. “One of the hallmarks of success to this is that our providers focus on the needs of their particular communities and figure out how to create and deliver those services.”
Barton does not own the clinical and community enterprise success, saying it took a concerted effort. “It’s about bringing people with different expertise to the table,” she said of her achievements. “It’s recognizing that I don’t have all the answers and knowing how to find them.”
End of one job, new beginning for another
While her move marks a big shift for CU Nursing, Barton’s contributions will continue. Her far-reaching success to the rural corners of the state with the generous donations from the Daniel and Janet Mordecai Foundation are making a big difference in people’s lives.
“Because of you (the foundation), we are able to build and strengthen the rural nursing workforce across the state, bringing care to rural communities where people need it most,” Barton wrote in the foundation’s 2019 Impact Report.
Barton said she will miss the associate dean role. “What I will miss most is working with these amazing people that we have on our team. Our providers are so passionate about the work that they do and really bring their full selves to that work with their patients on a daily basis,” she said.
Yet, Barton remains confident about the future of the enterprise with its many “amazing leaders” and knows the time is right. “I think we are at a point now where the program could benefit from the vision of a new leader,” Barton said. “I’ve taken the train far enough.”
Opening doors, turning on lights, helping remove socks and shoes – for the talented service dogs in training from the non-profit Warrior Canine Connection (WCC), these skills are just the tip of the 80-command iceberg that dogs master to assist the visible and invisible injuries of their veteran partners.
For veterans dealing with the symptoms of traumatic brain injuries (TBI), the invisible wounds of war can worsen feelings of isolation and being disconnected from friends and family. Here at CU Anschutz, the Marcus Institute for Brain Health (MIBH) on campus has a new partnership with the WCC, a national nonprofit where veterans training service dogs for other veterans aims to heal those wounds.
Training dogs, training people
Currently, five special dogs on campus work with veterans, retired elite athletes and adult civilians who are receiving treatment for mild to moderate TBI at the MIBH. Importantly, the MIBH philosophy is that discharge status should not be a barrier to receiving treatment for veterans.
‘Veterans can be reluctant to focus on themselves, so helping train service dogs for others is a way for them to indirectly work on their own goals.’ – Ann Spader
After a one-week assessment, patients embark on a three-week outpatient program that includes working with professional dog trainers to help train service dogs for other veterans with disabilities. Why is it important that veterans train service dogs for other veterans? Ann Spader, service dog training instructor for WCC, said, “Veterans can be reluctant to focus on themselves, so helping train service dogs for others is a way for them to indirectly work on their own goals.”
Like many person-to-person interactions, training dogs can require significant patience. As they learn to train, patients are required to work on skills like frustration tolerance, expressing positivity, praising and rewarding good behavior and holding focus on the dog instead of turning inward on themselves.
The canine cast
The first eight weeks of life for all of WCC’s dogs can be watched with the live Puppy Cam.
Because service dogs spend their lives working on behalf of their partners, golden and Labrador retrievers are purpose-bred in the WCC headquarters in Maryland to maximize traits of health, temperament and longevity.
Here in Colorado, five dogs are currently in training: two yellow labs named Joseph and Sully; a black lab named Nate; and two golden retrievers named Candace and Poyner. Dogs are named in honor of military servicemen and women who have made outstanding contributions and sacrifices for their country. The CU Anschutz dogs join approximately 70 other service dogs being trained in facilities nation-wide.
Each dog works with up to 60 veterans during their two-year training. Much of this training is focused on mobility commands which include helping with balance support and learning to pull wheelchairs for short distances in case of emergency. WCC dogs also identify and interrupt physical stress cues such as a bouncing leg by nudging a partner’s hand or jumping into their lap to decrease anxiety and stress and provide physical grounding. As service dogs accompany their partners in their daily lives, dogs even learn to control their need for bathroom breaks, fittingly designated as the “Better hurry!” command.
During the two years of training, volunteers from CU Anschutz known as ‘Puppy Parents’ help to reinforce the training and socialization during the dogs’ off duty hours. After completing the two years of training, dogs are matched with a veteran in a manner consistent with their own personalities. The pair undergoes an intensive two-week program designed to familiarize both dog and human to the details of their new partnership. The partnership created is celebrated at a graduation ceremony attended by each dog’s namesake or their family and the dogs are transferred into the care and service of their lifelong partners.
Love hormone, unleashed
Why are dogs so skilled at healing emotional wounds? A 2015 study in the journal Science provided some clues: mutual gazing was shown to increase blood levels of oxytocin, the love hormone, in both humans and dogs. This can promote attachment and bonding between dogs and owners. Other studies have shown that petting a dog can lower blood pressure and slow heart rate. Also, dogs are also great listeners; patients have told Spader that talking to the dogs is easier than talking to people, because they don’t feel like they’re being judged.
Service dogs vs. ‘dogs who want to be served’
Not every dog is meant to be a service dog, Spader said. “Instead of being born to serve, some dogs want to be served,” she laughed. Dogs that are too social or attention-loving to maintain the necessary level of focus on their partner choose a different career path since being a service dog is not the only option for these talented canines. For example, some dogs provide comfort as therapy dogs at veterans’ care facilities, hospitals, and court rooms. Other dogs serve as military family support dogs, where they help heal the rifts within families.
How to get involved
WCC is supported entirely through grants and donations. With the two years of intensive training and care, each dog is estimated to be worth $35,000. Yet, the dog is provided to a veteran at no cost.
When it comes to veterans helping other veterans, Spader said that WCC’s mission-based trauma recovery model relies on the warrior ethos; leave no man behind. She added, “It’s a no-fail mission. The dogs have to be trained, they need to be socialized, because they have such important work to do.”
Guest contributor: Shawna Matthews, a CU Anschutz postdoc
With an armed police officer and grocery cart stuffed with backpacks and suitcases behind him, Scott Harpin snapped on his latex gloves and fished out his supplies from a six-pack cooler.
“Which side?” Harpin asked, as he de-capped a needle. His patient tapped his left arm in response and rolled up his sleeve.
“I’ll try to avoid the ink,” Harpin said, quick with some tattoo-related wit designed for relaxing his patient as he aimed the needle just below the man’s left shoulder.
Hardly the sterile, quiet scene of a medical office, Harpin’s mobile clinic environment that bright July morning included trees, fountains and the roar of traffic as he circled Denver’s central Civic Center Park in search of people in need of hepatitis A shots.
“This is my chance to come out and be a nurse,” said Harpin, whose research and community service projects focus largely on the nation’s homeless health issues. “I miss the one-to-one contact,” said the popular instructor, whose genuine smile and upbeat personality worked well with the day’s slightly leery clientele.
‘One shot is better than no shot’
“No, I’m good,” a lone woman on a park bench said, rejecting the free vaccine offer after hearing Harpin and his partner’s spiel about the viral liver disease spreading through homeless encampments nationwide.
“Are you sure? We’re in an outbreak. People are getting sick, and it’s really easy to spread,” said Harpin, co-director of the DNP/MPH dual degree program educating tomorrow’s public health nurse leaders.
The woman shared a common concern expressed that day — the vaccine requires a booster in six months, a tough commitment with a transient lifestyle.
Although the woman stuck with her decision, a few people changed their minds after Harpin explained an initial dose supplied at least 75% protection (up to 95%) against the liver disease. “One shot is better than no shot,” he told them.
Homeless conditions feed outbreaks
The threat is serious, particularly within large homeless populations. The unsanitary conditions of street living feed hepatitis A outbreaks. The virus spreads through infected stool, including via traces on the ground and unwashed hands. Washing hands with soap and water, often hard for people experiencing homelessness, was a chief message of the day.
Other routes of infection include sexual contact, shared smoking materials and IV drug use, with the opioid and homeless crises both boosting infection.
Although rarely fatal, the disease can kill people with compromised livers, such as those already infected with cirrhosis or hepatitis B or C. And it can make people really sick for as long as six months. A 2017 California outbreak centered on its homeless population, infecting 700 people and killing 21.
On the streets: ‘I can’t afford to get sick’
As of July 31 in Colorado, 106 cases and 75 hospitalizations had been reported in the state.
“Shoot me up,” one man said, sticking out his arm, after learning the disease’s transmission routes.
“I don’t want to get sick,” another man said. “I’m out here on the street, and I can’t afford to get sick. My health is already bad enough.”
With upwards of half of Colorado’s 10,000-plus homeless population entrenched in the Denver-metro area, health providers are offering free vaccine clinics across the city until the threat ceases.
Officer helps with team’s success
“This isn’t even the tip of the iceberg,” Denver Police Department Officer Toby Wilson said of the scores of homeless people filling the park.
Wilson works on the Homeless Outreach Team, monitoring and educating people generally in or near the city’s shelters.
Although it was his first time escorting a mobile vaccine clinic, his caring demeanor and ability to connect with people dramatically increased Harpin’s team’s success that day.
“He’s the hero,” Harpin said of Wilson, who, at times, was convincing people to get a vaccine faster than Harpin could keep up.
Volunteers make a difference
“Before we’d even gotten started, he called us over to check out a man who was sick,” Harpin said of Wilson. The man’s yellow skin and eyes were telltale hepatitis signs, and the team gave him a taxi voucher and sent him off for care.
Hepatitis A symptoms
Yellow eyes or skin, diarrhea, pale stools, cola-colored urine, nausea, fatigue.
“It’s an important drop in the bucket for public health,” Harpin said of his couple of hours of work that morning, which he does regularly. “Even if people have already been vaccinated, we are making connections with them and educating them,” he said. “We are letting them know that we are here for them and that we care.”
To volunteer for the city’s campaign, which has resulted in more than 4,200 people being vaccinated since October 2017, contact Allison Seidel at firstname.lastname@example.org or 303-602-3587.
Guest contributor: Debra Melani, CU College of Nursing.
The Colorado Consortium for Prescription Drug Abuse Prevention has a simple but important message for all Coloradans: Bring naloxone home.
The message is straightforward, but it packs an important punch. In Colorado in 2018, an opioid overdose occurred every 16 hours – many of which could have been prevented by administering naloxone, an easy-to-use medication available without a prescription to anyone at most pharmacies across the state.
State leaders recognize the scope of the crisis and the importance of naloxone. Gov. Jared Polis has declared August to be Colorado Naloxone Awareness Month. The proclamation recognizes that “prescription opioid misuse and abuse is a public health crisis in Colorado, with long-term health consequences, including addiction, overdose, and death, and has a profound impact on Colorado families and communities.”
The governor’s proclamation emphasizes that Coloradans should learn about and obtain naloxone. So does U.S. Surgeon General Jerome Adams, who recommends that any person exposed to opioids either through prescriptions, illicit drug use or via a friend or loved one using the drugs should know how to use naloxone and keep it within reach.
Ending opioid overdose deaths is an urgent issue in Colorado – in 2018, 543 people died from overdoses that involved prescription opioids such as oxycodone and hydrocodone or illegally obtained opioids such as heroin and fentanyl.
“We’re following the Surgeon General’s lead by encouraging Coloradans to understand how important it is to know what naloxone is, how to use it, how to purchase it, and to keep it in your home, car or on your person so it’s available when needed,” said Robert Valuck, PhD, RPh, executive director of the Colorado Consortium for Prescription Drug Abuse Prevention and a professor at the University of Colorado Skaggs School of Pharmacy. “The bottom line is: If you have opioids in your home, you should also have naloxone. If someone you know or love is taking opioids, be sure to tell them about naloxone.”
When administered at the moment of an opioid overdose, naloxone blocks opioid receptors in the body, effectively reversing the impact of the overdose and saving the person’s life – thereby allowing time to call 911 to receive medical assistance. Available as a nasal spray or injectable, naloxone is portable, affordable and easy to administer. Although naloxone (also known by the brand names Narcan and Evzio) requires a prescription, a standing order issued by the Colorado Department of Public Health and Environment allows any Colorado resident to purchase the drug at a pharmacy simply by requesting it. Naloxone has been used to reverse more than 1,122 opioid overdoses in Colorado since mid-2017.
A common misconception is that opioid overdoses only impact people who use heroin or others using illicit drugs. However, many people are prescribed opioids by their doctors to manage pain, which can cause accidental overdoses if used incorrectly or mixed with other medications or alcohol. People might be at risk even if they have a prescription and might only be taking opioids for a few days – which is why it’s critical for consumers to purchase naloxone and know how to use it.
“The opioid epidemic is a public health crisis for Colorado. We’ve lost far too many of our fellow citizens,” Sen. Brittany Pettersen and Rep. Chris Kennedy, the chair and vice-chair of the General Assembly’s Opioid and Other Substance Use Disorders Interim Study Committee, said in a joint statement. “Many overdose deaths occur at home by people who might not realize they’re at risk, and naloxone could have saved their lives. People should know if they or a loved one take an opioid medication, they should have naloxone, just to stay safe.”
Throughout the summer and fall, the Colorado Consortium for Prescription Drug Abuse Prevention is running paid advertisements throughout Colorado with the “Bring Naloxone Home” message, encouraging residents to visit their pharmacy, ask about naloxone and purchase it. In addition, many of the Consortium’s partners across the state will be holding events throughout the month to generate awareness of the issue in communities across all regions of Colorado.
“We’ve recently experienced a slight decrease in drug overdoses in Colorado, which is an encouraging sign,” said Valuck. “However, we still lost 543 people to opioid overdoses in 2018, which is a significant number of people to lose to something that is so preventable. Our goal is to continue that downward trend by getting naloxone into the hands and homes of as many Coloradans as possible.”
Ever since I was a child, I’ve hated the Fourth of July.
Don’t get me wrong, I love barbecues, red, white and blue and baseball games, but fireworks are not for me. I remember hiding under blankets in the car when my parents took me to a fireworks show, because the loud noises really hurt my ears.
1. I find fireworks to be extremely loud. About how many people experience this sensitivity?
Sensitivity to loud sounds, like fireworks, is part of a set of hearing disorders called “Decreased Sound Tolerance” disorders. About 9 percent of adults find some types of loud sounds uncomfortable to their ears, and it is normal for young children to find fireworks bothersome. Young children will reflexively cover their ears for loud sounds, and sometimes find fireworks to be scary. For anyone, it’s normal to find extremely loud sounds, like nearby explosions, uncomfortable.
Some people also have emotional associations with the sounds of explosions or gunshots. Individuals with a history of trauma from firearms or fireworks may find fireworks shows upsetting or stressful.
2. Is it safe to bring children/babies to a fireworks show?
This is a great question! In general, we advise the use of hearing protection during fireworks shows. This is especially important if the show is close to you. There are a couple of brands of earmuffs that fit children well, and we recommend that children wear hearing protection any time they are near fireworks, gunshots or other high-level sounds. Make sure you’re choosing hearing protection made for children, like EMs for Kids or BabyBanz brands.
3. Can you sustain lasting hearing damage from fireworks shows?
Yes, there is a high risk of hearing damage with nearby fireworks. Nearby explosions can do instantaneous damage to the hearing mechanism, including damaging both the eardrum and inner-ear structures. If you are setting off exploding fireworks yourself, you should be wearing hearing protection. For large fireworks shows that are at a distance, the risk is lower, but it’s still worth considering protecting your ears.
4. Any tips for someone with the sensitivity around the Fourth of July?
If you have sensitivity to loud sounds, you might consider wearing well-fit hearing protection (earplugs or earmuffs) when you’re around fireworks shows. That said, it’s not a good idea to wear earplugs all the time – this can actually make sound sensitivity worse! Instead, wearing them only when you know sound will be at high levels is the best choice. And, of course, if your decreased sound tolerance interferes with your daily life, you should see an audiologist who specializes in decreased sound tolerance.
The UCHealth Hearing and Balance Clinic can help you with management strategies and desensitization therapies designed to reduce the impact of decreased sound tolerance on your life.
Local legendary sports television and radio host Vic Lombardi knows what most men are thinking when someone nudges them to go to the doctor.
“When they hear ‘Men’s Health Month,’ they’re like, ‘Oh quit bothering me!’”
But, as Vic knows personally, that nudge to go the doctor can actually help save a life.
“If nobody had bothered to bother me, I probably wouldn’t be standing here talking about my health.”
Both now and in recent decades, men in all age groups visit their primary care/general physician at lower rates than women. It’s a persistent problem, and Vic acknowledges he didn’t see anything wrong. “I thought I was in the best health possible: I was in great shape, I had no symptoms, no family history, nothing.”
See Vic Lombardi discuss Men’s Health Month in the video below.
Last winter, however, Vic decided to go in and see his doctor. “Something was gnawing at me and I decided to go in and get a physical. One thing leads to another and I have a [prostate] cancer diagnosis, and it’s growing pretty aggressively.”
By acting quickly Vic and his doctors at UCHealth University of Colorado Hospital were able to get surgery completed, and continue to monitor his health. “That’s the beauty of what’s happening at the CU Anschutz Medical Campus,” he said, speaking to the campus’ collaborative and interconnected nature, “you can walk in there, you can get seen, you can be seen, and you can see others.”
“Even if you don’t think you’re sick,” Vic said, “There might be things developing that you may not see, feel, hear.”
So, as for being a bother about visiting the doctor, Vic has a clear message for the stubborn and reticent men out there: “It’s my goal and my duty to bother you in Men’s Health Month to go get checked out. Bother to go get checked!”
The University of Colorado School of Medicine is in the planning stages of establishing a medical school branch in Fort Collins in partnership with Colorado State University.
The partnership aims to create a training program that builds on the strengths of both universities, joining CU School of Medicine’s leading medical education and research programs with CSU’s expertise in human, animal, and public health. The partners expect to enroll the first students in the program in 2021.
“We are pleased to forge this partnership with CSU to expand the opportunities for medical education in the state of Colorado,” said Donald Elliman, Jr., chancellor for the University of Colorado Anschutz Medical Campus. “Together, we are able to offer an education based on outstanding programs at both campuses and to improve the quality of health care for all in Colorado.”
CSU President and Chancellor Tony Frank, PhD, said: “As university leadership, we have long contemplated and discussed bringing together our two world-class medical education programs at CSU and CU. In the last year and half, our teams have worked together on this project, and I am enormously proud of everyone who has worked so diligently to make it a reality.”
Initial plans for the new branch call for maintaining current enrollment levels in the CU School of Medicine, with the possibility of expansion of the class size in the future. The first class in the CSU program would include about a dozen students, who would be conducting all four years of their studies on the Fort Collins campus. Eventually, the branch could enroll as many as 48 students per year. Students at the branch would earn medical degrees from the CU School of Medicine.
One of the first tasks is for the CU School of Medicine to hire an assistant dean for its Fort Collins branch. The School also will recruit faculty and prepare the documentation required by the School of Medicine’s accrediting body, which must approve the branch before it can open.
Suzanne Brandenburg, MD, professor of medicine at the CU School of Medicine, is coordinating the process of establishing the medical school branch. She has already been working to recruit providers in the Northern Colorado medical community because a successful medical education program will depend on outstanding clinical learning opportunities.
“At the new medical school branch, students will learn in and from the local community alongside other health professionals.” Brandenburg said. “With this expansion, we hope to capitalize on the diverse expertise at CSU, to frame health care broadly, instilling in medical students a comprehensive view of our impact on society, considering not just the patient but also communities, populations and the planet.”
Brandenburg also serves as director of interprofessional education on the Anschutz Medical Campus, focusing on educating students across health professions to effectively work in teams and tackle the complex health care problems of patients and society.
CSU and CU have collaborated for many years on health education and research, with partnerships in the Colorado School of Public Health, the CU Cancer Center, and the Colorado Clinical and Translational Sciences Institute. In addition, several graduates from CSU each year matriculate to the CU School of Medicine.
Mark Stetter, DVM, dean of the College of Veterinary Medicine and Biomedical Sciences at CSU, said: “We’re looking forward to working even more closely together to help train physicians for Colorado through this collaboration. There are still an incredible number of details to be worked out, from building out our facilities here in Fort Collins to hiring faculty and assuring that all the programs are accredited and aligned. It’s a complex process, but I’m excited to be a part of it.”
The process of building out the fourth floor of the CSU Health and Medical Center, opened at the corner of College Avenue and Prospect Street in Fort Collins in 2017, to accommodate classrooms and administrative offices is underway, while the medical school has begun creating the new curriculum. Existing faculty from both CSU and CU will be teaching at the branch and new positions will be hired as needed.
About the University of Colorado School of Medicine
Faculty at the University of Colorado School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at UCHealth University of Colorado Hospital, Children’s Hospital Colorado, Denver Health, National Jewish Health, and the Veterans Affairs Eastern Colorado Health Care System. The school is located on the Anschutz Medical Campus, one of four campuses in the University of Colorado system.
About Colorado State University
Founded in 1870 as the Colorado Agricultural College, Colorado State University is now among the nation’s leading research universities, with annual research expenditures above $300 million. The CSU System includes the flagship campus in Fort Collins as well as CSU-Pueblo and CSU-Global. In Fort Collins, CSU currently enrolls about 33,000 students, including 4,000 graduate students and 580 in the Doctor of Veterinary Medicine program, and has more than 1,800 faculty members working in eight colleges. CSU’s DVM program consistently ranks among the top three veterinary medicine programs in the nation.
Indira Sriram, PhD, and Robin Harland, who are graduating in this year’s University of Colorado School of Medicine class of MD students, with Steven Lowenstein, MD, MPH, professor of emergency medicine and associate dean for faculty affairs, wrote an article published on May 10 by the Journal of Hospital Medicine from the perspective of the much unloved electronic health record (EHR).
Here’s an excerpt: “We need to have an honest chat. My name is EHR, although you may call me Epic, Athena, Centricity, or just ‘the chart.’ You may have called me something worse in a moment of frustration. However, I do not hold grudges. I am your silent, stoic partner, a ubiquitous presence when you are at work, and sometimes even when you are at home.”
The article is a thoughtful and entertaining way to reconsider how to incorporate the EHR into our clinical care. One bit of proffered advice is crucial and timeless: “Though your practice is increasingly imbued with technology, there is still space to stop and hear your patients’ stories, as physicians have done for centuries. Listen. Make eye contact. Touch. Stop typing.”
Well, not literally. The aforementioned air pollution agents were the focus of an Air Quality & Health Symposium hosted by the Colorado Air Quality Control Commission and the Colorado School of Public Health (ColoradoSPH). A series of speakers presented information about the most significant challenges to Colorado in maintaining safe air quality, including traffic increases, wildfires, accelerating growth and climate change, while the attending commissioners were updated on the latest evidence on air pollution and health.
Colorado is just one player in a global struggle to clean the air, noted ColoradoSPH Dean Dr. Jonathan Samet. After reviewing the scientific evidence and often contentious debate involved in setting air quality standards, Samet offered a blunt observation.
“There are billions around the world not breathing clean air,” he said.
Colorado’s efforts to reduce emissions
The symposium occurred in the aftermath of Colorado’s recently concluded legislative session, which saw passage of a number of bills aimed at reducing emissions that dirty the air. These include House Bill 1261, which establishes goals to reduce greenhouse gas emissions in the state at least 26 percent by 2025 and 90 percent by 2050. In addition, Governor Jared Polis in January issued an executive order supporting a “transition” to zero-emission vehicles in the state.
That transition is “our highest priority,” Jill Hunsaker Ryan, executive director of the Colorado Department of Health and Environment (CDPHE) told the crowd. “Transportation is the single greatest source of climate-changing emissions.”
Transportation is the only one of the big three sources of greenhouse gas emissions – power sources and the built environment round out the trio – that is expected to grow in the coming years, noted Taryn Finnessey, senior climate change specialist with the Colorado Department of Natural Resources.
Changing our sources of power
“We are changing our sources of power, but we are not necessarily changing the ways that we move as rapidly as we should be,” Finnessey said. She added that steps to “clean up our energy grid” by continuing to adopt renewable sources – there are now more than 57,000 clean energy jobs across the state – work hand-in-hand with electrifying transportation. Construction of charging stations for electric vehicles, begun in 2017, is well underway. Nearly three dozen stations, placed roughly every 50 miles along major highway corridors, are slated to be in place by 2020.
“Start car-shopping,” Finnessey quipped.
Rob McConnell, a professor at the University of Southern California (USC), pointed to the health risks posed by vehicle emissions, particularly to those who live nearby busy roadways. McConnell summarized the findings of USC’s 25-year Children’s Health Study, which followed some 12,000 children living in Southern California.
Researchers used spirometry tests to measure lung function in the participants and established a clear association between abnormally low lung function and living in communities with high particulate levels, McConnell said. The study also showed increased rates of childhood asthma among children who lived within 150 meters of a roadway.
Costs of poor air quality
The costs have been considerable: In Los Angeles County alone, some $400 million annually for asthma exacerbations attributable to pollution, and about half of that tied to near-roadway pollution, McConnell said. In the South Coast Air Basin, which encompasses much of greater Los Angeles, between 430 and 1,300 heart attacks were attributed to near-roadway pollution, generating costs of between $3.8 billion and $11.5 billion, he added.
‘There are billions around the world not breathing clean air.’ – Jonathan Samet, dean of the Colorado School of Public Health
Confronting these sobering statistics should be on the board for Colorado, McConnell said, noting the upcoming widening of I-70. He described steps taken in California to mitigate people’s exposure to pollution near roadways, including expanding mass transit, building high-density housing, and creating parks and other green spaces as buffers.
“By ignoring roadway pollution, we are missing an opportunity to improve air quality,” McConnell said.
Other speakers also noted the health risks posed by polluted air. Dr. Jennifer Peel, a professor of Epidemiology for ColoradoSPH and Colorado State University (CSU), cited data from the Health Effects Institute’s Global 2017 Burden of Disease assessment that pegged the worldwide number of premature deaths tied to fine particulate matter at 3 million. In the United States, the toll was 100,000 lives; in Colorado the number was 650, Peel said.
There is “solid evidence” tying short- and long-term exposure to particles of 2.5 microns (PM2.5) – about one-thirtieth the diameter of a human hair – to cardiovascular and respiratory disease and mortality, Peel said. But evidence is growing that these particles also have adverse effects on the central nervous system, including depression, cognitive decline and autism, she added.
The West Is hotter than ever
Peel cited wildfires as an important source of health-threatening particulate matter. As Finnessey and others noted, fires in Colorado and the West are more frequent and hotter than ever before.
“The size and severity of wildfires has increased significantly over the past four decades,” Finnessey said. “And they are projected to continue to increase.” She noted that “science agrees” that without significant changes, the climate is expected to warm 2 to 6 degrees Fahrenheit by 2050. That rise will contribute to ever-thirstier and more heavily stressed ecosystems that are more vulnerable to prolonged drought and more intense wildfires.
And where there is fire there is smoke that can spread across states and regions. Dr. Colleen Reid, assistant professor in the Department of Geography at CU-Boulder, described her studies of the impacts of wildfires on air pollution and health. She said there is “clear evidence” associating wildfire smoke with respiratory health, including exacerbations of COPD and asthma. More studies of the long-term effects of exposure to wildfire smoke and possible public health interventions are needed, Reid added.
An important part of that effort is figuring out what exactly makes up that smoke. That’s the goal of Dr. Emily Fischer, assistant professor in the Department of Atmospheric Science at CSU. Fischer said wildfires often elevate PM2.5 levels on the ground, creating new emission-control challenges.
“Sporadic smoke events are offsetting improvements in mean PM2.5 air quality in some areas,” Fischer said.
‘Rivers of smoke’
Fischer led a National Science Foundation project called WE-CAN, which aimed to understand wildfire smoke by going to the source. She and fellow CSU scientists boarded a research airplane in 2018 that flew through “rivers of smoke” produced by western wildfires, with the aim of studying the composition of the thick plumes. Among the questions: how does the composition of smoke change as it ages and how does it contribute to rising levels of ozone, another primary air pollution issue.
The efforts to improve air quality also proceed on the ground. Dr. John Volckens, professor of Environmental and Occupational Health for ColoradoSPH and in CSU’s Department of Mechanical Engineering, described work with his team to develop an Ultrasonic Personal Aerosol Sampler (UPAS) that uses cell phone-assisted technology to measure individuals’ exposures to PM2.5. About 1,000 of the relatively inexpensive units are in operation around the globe, Volckens said.
Even more ambitiously, CSU partnered with NASA on a “citizen-science” initiative called CEAMS (Concerned and Engaged Community Members) that set up a network of air-monitoring stations around Fort Collins. The stations, manned by citizen volunteers, gather real-time air-quality data that supplement satellite imaging and the computer analysis that NASA uses to develop predictive air-pollution models.
The information from the monitoring network produced much useful information, Volckens said. For example, the team noticed elevated particle levels in the Old Town section of Fort Collins on cold winter nights. The reason: on those nights, the residents of the mostly old homes were lighting plenty of wood-burning fires.
“Science presents an opportunity to learn more about behavior and about how behavior and exposures [to air pollution] affect each other,” Volckens said. “I think we are only at the beginning of scratching the surface of that opportunity.”
Cleaner air on the horizon
But Volckens also cautioned that changing behavior is no easy task. And while Colorado now has plenty of initiatives on the table to address air-quality issues and climate change, the hard work of implementation is only beginning, Finnessey said.
“The challenge comes in figuring out what this all means and how do we achieve our goals,” she said.
Samet noted the “huge number of adverse” effects attributed to air pollution and the need for science to continue to generate as much evidence as possible about the risks dirty air poses. But in the end, he said, deciding on what to do with the data lies in policymakers’ unpredictable hands.
“The data still leaves those who make the decisions left to make those decisions,” Samet said.
This story was written by guest contributor Tyler Smith.