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Students devise strategies to combat prevalence of suicide

The fifth Rocky Mountain Region Public Health Case Competition was held at the Health Science Library at the CU Anschutz Medical Campus earlier this month.

Fifteen teams received a realistic case-study about suicide prevalence, a public health issue especially relevant to Colorado. Each team had approximately 24 hours to analyze the case, create a public health solution and present it to a panel of judges.

First-place team in Public Health case competition
The first-place winning team in this year’s competition focused on veteran suicide prevention. Team members are, from left, Sujeith Barraza, Kacy Lorber, Phuong Banh, Elizabeth Ko and Morgan Nestingen. Photo by Katie Brumfield, Colorado School of Public Health.

The prizes for the top three teams were varying amounts of scholarship money up to $1,000. Three teams were chosen as the people’s choice recipients, with each member receiving $100.

The teams were specifically chosen to include different disciplines surrounding healthcare, including the Colorado School of Public Health (Colorado SPH), the CU School of Medicine, College of NursingCollege of Engineering and Applied Sciences, the Skaggs School of Pharmacy and Pharmaceutical Sciences, School of Public Affairs, College of Liberal Arts and Sciences and the Graduate School.

“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”

This year’s winning team included three graduate public health students from the ColoradoSPH — two from its program at CU Anschutz and one student from their program at the University of Northern Colorado — as well a graduate student in pharmacy and another in nursing. Fitting for Veterans Day, their focus was on veteran suicide prevention with a project title of “Serve and Support: You Stood for Us, Now Let Us Stand for You.” Their project included media outreach ads and posters with grabbing headlines like “It’s Okay to Not Be Okay” and a peer navigation program that enrolls veterans at the time of discharge. Their case competition plan also included a mobile app and social media outreach to stay top of mind for veteran health.

First-place team member, Kacy Lorber (ColoradoSPH) posted photos of her experience on Instagram and said: “I got to present to so many important people but specifically two House Representatives in Colorado! The highlight was when state Rep. Dafna Michaelson Jenet told us that she got bill ideas from our presentations. I am so grateful for this experience.”

Judges panel at public health case competition
Judges in the final round of the case competition are, from left, Carol Runyan, PhD, director of PIPER in the ColoradoSPH; state Rep. Kim Ransom; state Rep. Dafna Michaelson Jenet; Larry Wolk, MD; and Jon Samet, MD. Photo by Katie Brumfield, Colorado School of Public Health.

Diana Ir, current president of the case competition planning committee and student in the ColoradoSPH, participated in the competition last year.

“I had such a great experience,” said Ir. “I enjoyed it so much that I wanted to be a part of putting it together this year. I encourage everyone to participate in the future. Between the potential scholarship money and the awesome collaborative environment, you shouldn’t miss it!”

RESULTS – Rocky Mountain Regional Case Competition 

1st Place ($1,000 each student scholarship)

“Serve and Support

You Stood for Us, Now Let Us Stand with You!

Comprehensive Veteran Suicide Prevention”

Team Members and Affiliations

Sujeith Barraza, ColoradoSPH (UNC home campus)

Phuong Banh, ColoradoSPH

Elizabeth Ko, Skaggs School of Pharmacy and Pharmaceutical Science

Kacy Lorber, ColoradoSPH

Morgan Nestingen, College of Nursing

2nd Place ($500 scholarship to each student):

“PACT: Patience Assistance Continuing Treatment: Expanding CDPHE’s Warm Handoff

Team Members and Affiliations

Angie Kim, Skaggs School of Pharmacy and Pharmaceutical Science

Alison Hoffman, ColoradoSPH

Cheryl A. Jones, ColoradoSPH (UNC home campus)

Randy Xun, ColoradoSPH

3rd Place ($250 scholarship to each student):

“PRIDE ALIVE”

Team Members and Affiliations

Charlotte Whitney, School of Public Affairs

Naga Srinija Gummadi, ColoradoSPH

Johnny Williams, ColoradoSPH

Vikasini Mahalingam, School of Medicine

Three teams received People’s Choice Awards ($100 scholarship to each student):

People’s Choice

“Hometown Platoon: A Mobile Mentorship Program”

Team Members and Affiliations

Heather Hergert, ColoradoSPH (CSU home campus)

Hailee Griffin, Skaggs School of Pharmacy and Pharmaceutical Science

Isaiah Francis, ColoradoSPH

Hannah LaDow, ColoradoSPH

Scott Cao, School of Medicine

People’s Choice ($100 scholarship to each student):

“Welcome to My Life: CO Health Care Workers’ Wellness Program”

Team Members and Affiliations

Jenny Duong, ColoradoSPH

Heather Marshall, ColoradoSPH (CSU home campus)

Meena Mattamana, Skaggs School of Pharmacy and Pharmaceutical Science

Hailey Hyde, ColoradoSPH

People’s Choice ($100 scholarship to each student):

“It’s Okay, To Not Be Okay”

Team Members and Affiliations

Madeline Huey, School of Medicine

Victoria Laskey, School of Public Affairs

Allison Seidel, ColoradoSPH

Katie Schweber, ColoradoSPH

Mackenzie Wilderman, College of Engineering and Applied Science (Bioengineering)

Editor’s note: Tonya Ewers, director of communications and alumni relations for the Colorado School of Public Health, contributed to this report. 

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Enough vitamin D when young associated with lower risk of diabetes-related autoimmunity

Getting enough vitamin D during infancy and childhood is associated with a reduced risk of islet autoimmunity among children at increased genetic risk for type 1 diabetes, according to a study published this week in the journal Diabetes.

The study’s lead author, Jill Norris, MPH, PhD, of the Colorado School of Public Health, and her co-authors examined the association between vitamin D levels in the blood and islet autoimmunity. Islet autoimmunity, detected by antibodies that appear when the immune system attacks the islet cells in the pancreas that produce insulin, is a precursor to type 1 diabetes.

Professor Jill Norris, PhD, MPH, is lead author of the study.
Professor Jill Norris, PhD, MPH, is lead author of the study.

“For several years there has been controversy among scientists about whether vitamin D lowers the risk of developing of islet autoimmunity and type 1 diabetes,” said Dr. Norris.

Type 1 diabetes is a chronic autoimmune disease that is increasing by 3-5 percent annually worldwide. The disease is now the most common metabolic disorder in children under age 10. In younger children, the number of new cases is particularly high. And the risks seem to be greater at higher latitudes, further north from the equator.

Vitamin D represents a candidate protective factor for type 1 diabetes as it regulates the immune system and autoimmunity. Moreover, vitamin D status varies by latitude. But associations between vitamin D levels and islet autoimmunity have been inconsistent. This may be due to different study designs, population variation in vitamin D levels, or a failure to account for the combined effect of exposure and underlying genetic variation in the vitamin D pathway.

The findings are part of The Environmental Determinants of Diabetes in the Young (TEDDY) study, a large, multi-national study funded by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases.

TEDDY’s effort began in 2004 with children from six clinical centers: three in the U.S. (Barbara Davis Center for Childhood Diabetes at CU Anschutz, the Pacific Northwest Research Institute in Seattle, and Augusta University in Georgia) and three in Europe (Universities of Turku, Oulu, and Tampere in Finland, Helmholtz Zentrum München in Germany, and Lund University in Sweden). The aim of the study is to search for triggers and protective factors for type 1 diabetes in 8,676 children with elevated type 1 diabetes risk.

The TEDDY children were followed with blood samples drawn every three to six months from infancy, to determine the presence of islet autoimmunity, as well as levels of vitamin D.

The authors compared 376 children who developed islet autoimmunity with 1,041 children who did not.  The authors found that in children with a genetic variant in the vitamin D receptor gene, vitamin D levels in infancy and childhood were lower in those that went on to develop islet autoimmunity compared with those that did not develop autoimmunity.

This study is the first to show that higher childhood vitamin D levels are significantly associated with a decreased risk of IA.

“Since this association does not prove cause-and-effect, we look to future prospective studies to confirm whether a vitamin D intervention can help prevent type 1 diabetes,” Dr. Norris said.

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Researchers find creosote bush could treat Giardia and brain-eating amoeba infections

Compounds produced by the creosote bush, a desert shrub common to American Southwest, exhibit potent anti-parasitic properties against two deadly parasites responsible for Giardia infections (Giardia lamblia) and the amoeba that causes an often-lethal form of encephalitis (Naegleria fowleri), according to researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at CU Anschutz and UC San Diego.

Daniel LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at Skaggs School of Pharmacy and Pharmaceutical Sciences.
Daniel LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at Skaggs School of Pharmacy and Pharmaceutical Sciences.

The findings, published online this month in PLOS Neglected Tropical Diseases, may give scientists the chance to widen their arsenal of antimicrobial agents effective against deadly parasitic infections. The current standard treatment for both infections involve antibiotics and anti-parasitic drugs.

The World Health Organization estimates giardiasis, a diarrheal illness, is linked to approximately 846,000 deaths worldwide each year. Infection usually occurs through ingestion of contaminated water or food. Though rarely lethal in the United States, it’s estimated there are more than a million cases of giardiasis in the country annually. Infections due to N. fowleri, sometimes called the `brain eating amoeba,’ are much less common than Giardia.

Compounds from the creosote bush may fight two deadly parasitic infections.
Compounds from the creosote bush may fight two deadly parasitic infections.

“However, it is a far deadlier parasite that is found in warm fresh waters and infects the central nervous systems of their victims through the nasal passages causing lethal brain damage known as primary amoebic meningoencephalitis (PAM),” said principal investigator Dan LaBarbera, PhD, associate professor of drug discovery and medicinal chemistry at the Skaggs School of Pharmacy and Pharmaceutical Sciences at CU Anschutz.

Due to its rapid infection cycle and high mortality rate, the CDC has been given special approval to provide the drug miltefosine to clinicians as a treatment option for N. fowleri infection. But it is still not FDA approved and has limited availability in the U.S. This new compound potentially provides a less expensive, more effective treatment option.

Scientists from CU Anschutz and UC San Diego collaborated as part of the Skaggs Scholars program, which matches investigators from Skaggs-funded schools of pharmacy with complementary expertise to discover potential drug breakthroughs. UC San Diego scientists provided expertise in parasitology, while the CU Skaggs School of Pharmacy provided expertise in natural products, compound libraries and active compounds from plants. The researchers investigated these tropical diseases because of their occurrence in Mexico and South America and found indigenous peoples treating infections with creosote compounds.

“The significance and intrigue about our study is that it shows the value of prospecting for new medicines from plants traditionally used by indigenous people as medicine,” said co-principal investigator Anjan Debnath, Ph.D., an assistant adjunct professor at Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego.

The creosote bush (Larrea tridentata), is a tough evergreen bush with small waxy leaves, yellow flowers and a distinctive turpentine-like scent. Native Americans in both the United States and Mexico have long used the plant for a variety of ailments, including intestinal complaints. There is also an existing body of scientific work documenting the plant’s pharmacologically active compounds, notably nordihydroguaiaretic acid (NDGA). NDGA has antiviral, antibacterial, anti-inflammatory and anticancer properties.  The study is the first to show that NDGA and five other compounds are active against both pathogenic parasites.

In other studies, NDGA has been shown to be a neuroprotective agent. It protects human monocytes and other cells and tissues through its powerful antioxidant activity.

“In our study the creosote natural product, NDGA, proved to be a more potent anti-parasitic agent against N. fowleri compared to miltefosine,” LaBarbera said. “Therefore, NDGA may lead to a more effective drug therapy option for N. fowleri infection.”

This research was funded in part, by a grant from The ALSAM Foundation and National Institutes of Health.

 

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Dr. Jonathan Samet is new dean of Colorado School of Public Health

Following an extensive national search, the chancellor of the University of Colorado Anschutz Medical Campus, Don Elliman, announced Tuesday the hiring of Dr. Jonathan Samet, MD, MS, as the new dean of the Colorado School of Public Health.

Dr. Samet, an accomplished medical professional and administrator, has occupied top positions in leading universities around the country.

Dr. Jonathan Samet, new dean of the Colorado School of Public Health
Dr. Jonathan Samet is the new dean of the Colorado School of Public Health

He is currently distinguished professor and chair of the Department of Preventive Medicine at the Keck School of Medicine at the University of Southern California. He also directs both the USC Institute for Global Health and the Workforce Development and KL2 Program of the Southern California Clinical and Translational Science Institute.

“I am honored by being selected as the third dean of the Colorado School of Public Health,” Dr. Samet said.  “A key goal will be to enhance the school’s impact on public health in the state and region through our research and training activities.”

Previously, he chaired the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and was clinical division chief for Pulmonary and Critical Care Medicine at the University of New Mexico.

Chancellor Elliman said the new dean will strengthen and deepen the impact of the Colorado School of Public Health (ColoradoSPH).

“Since its establishment just nine years ago, the ColoradoSPH – a partnership of CU Anschutz, Colorado State University and the University of Northern Colorado – has made remarkable strides toward becoming one of the country’s premier institutions of public health,” Elliman said. “As its third dean, Dr. Samet, who brings the experience of a long and distinguished career in academic medicine and public health, is uniquely qualified to take the ColoradoSPH to new heights.”

Dr. Samet comes to ColoradoSPH with nearly 40 years of experience in education, health care and research.

Throughout his career, he’s fostered and mentored faculty members, created new lines of research, initiated curricular advances and maintained fiscal stability.

Along with teaching everyone from undergraduate to postdoctoral students, Dr. Samet has conducted a wide array of research into health issues.  In many cases, he’s translated that research into action. His work led to advancing tobacco controls nationally and around the world, tightening air quality regulations and winning compensation for underground uranium miners suffering health problems.

The new dean is past-president of the American College of Epidemiology and the Society of Epidemiologic Research. He was elected to the National Academy of Medicine, one of the highest honors in medicine, and holds a bachelor’s degree from Harvard College, an MD from the University of Rochester and a master’s degree from the Harvard School of Public Health.

“We are fortunate to have someone as accomplished and versatile as Dr. Samet taking the helm of the Colorado School of Public Health at this critical juncture in its growth,” Chancellor Elliman said. “I am grateful to Dr. Elaine Morrato who, as interim dean since December, has helped the school continue to build on its momentum while ensuring we are set up for a smooth handoff to new leadership.”

Dr. Morrato, DrPH, MPH, will continue as interim dean until Dr. Samet assumes his new post in October.

 

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Researchers to study neurological effects of Zika virus in young children

Researchers at the University of  Colorado Anschutz Medical Campus and the Baylor College of Medicine will join with Guatemalan investigators in a major study examining the clinical outcomes of children infected with the Zika virus after being born, focusing on long-term brain development.

“We now know the severe effects of Zika in the fetus and the unborn child if the mother gets the infection during pregnancy,” said Edwin Asturias, MD, co-principal investigator of the study and director of Latin American Projects at the Center for Global Health at the Colorado School of Public Health. “But if the virus is able to affect the developing brain of an infant or a child, this will have enormous consequences to a generation of children in areas where the virus has spread.”

Dr. Edwin Asturias of the Center for Global Health at the Colorado School of Public Health.

 

The study, funded by the National Institutes of Health, has been approved by the Ministry of Health in Guatemala and will take place in the rural southwestern coast of that country. Along with the Zika virus, the region is also endemic for the dengue and chikungunya virus transmitted by the same mosquito that carries Zika.

“We are enrolling infants in the first year of life and children up to 5 years of age who will be followed over one year to see if they become infected with Zika virus, and then we will be looking at the effects of the infection in the infants’ and children’s neurodevelopment,” said Dr. Flor M. Muñoz, associate professor of pediatrics in the section of infectious diseases at Baylor and principal investigator of the study. “We will look for neurologic or neurodevelopmental effects specifically, including effects on hearing and eye problems, because we know that the virus has the potential to cause central nervous manifestations.”

Zika virus has been known to affect babies in utero when the mother is infected during pregnancy, but little is known about what happens when infants are infected in early life, Muñoz said.

“Our concern is that a developing brain in early life can be impacted significantly,” she said. “It’s an important question to address not just for children that live in the endemic areas, but also for children who travel to these areas.”

Recruitment for the study will take place through a clinic created by the University of Colorado’s Center for Global Health in Guatemala. The goal is to follow 500 infants and their mothers for one year to determine if they become infected by the Zika virus. Neurologic exams and age-appropriate neurodevelopmental testing will be run for the duration of the study to identify changes in children infected with Zika virus.

Researchers will also be enrolling 700 children between the ages of 1 and 5 years, including 300 children known to have been exposed to dengue or Zika viruses while participating in a previous dengue study, and 400 who are siblings of the infants in this study. They will be tested periodically and evaluated for symptoms of flavivirus-like illness to determine if they have been infected by Zika, dengue or chikungunya viruses. Investigators will monitor serial neurologic examinations and developmental milestones in the children to determine if the Zika virus infection is associated with any neurologic or developmental changes.

Dr. Edwin Asturias examining children in Guatemalan clinic.
Dr. Edwin Asturias examining a child in Guatemalan clinic.

Muñoz and Asturias will collaborate with colleagues from the Fundacion para la Salud Integral de los Guatemaltecos (FUNSALUD) clinic in Guatemala. The clinic, affiliated with the Colorado School of Public Health and Children’s Hospital Colorado, is led by Dr. Antonio Bolaños. It has a full complement of local investigators, nurses and laboratory technicians along with Emory University’s Vaccine Treatment and Evaluation Unit (VTEU) research laboratory led by Dr. Mark Mulligan.

Neurodevelopmental testing will be conducted by three local psychologists under the leadership of Dr. Amy Connery of Children’s Hospital Colorado in Aurora, Colo. The study will last three years and results will be reported throughout the study. More information can be found at the NIH Zika website.

 

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National study shows interventions like telephone calls can reduce suicides

In perhaps the largest national suicide intervention trial ever conducted, researchers at the University of  Colorado Anschutz Medical Campus and Brown University found that phone calls to suicidal patients following discharge from Emergency Departments led to a 30 percent reduction in future suicide attempts.

The study was published recently in JAMA Psychiatry.

The year-long trial, which involved 1,376 patients in eight locations nationwide, provided suicidal patients with interventions that included specialized screening, safety planning guidance and follow-up telephone calls.

Dr. Michael Allen, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz, co-authored the study.
Dr. Michael Allen, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center, co-authored the study.

“People who are suicidal are often disconnected and socially isolated,” said study co-author Dr. Michael Allen, MD, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz. “So any positive contact with the world can make them feel better.”

Allen is also medical director of Rocky Mountain Crisis Partners in Denver which has already implemented a similar program where counselors call suicidal patients following their discharge from Emergency Departments (EDs).

Suicide is the 10th leading cause of death in the U.S. In 2015, there were 44,193 deaths by suicide nationally. Over one million people attempt to take their own life every year.

Colorado routinely ranks among the top 10 states for suicide with about 1,000 deaths a year. Last year, it was number seven in the country. The state Legislature has set a goal of reducing suicides by 20 percent by 2024.

Allen said simply handing a suicidal patient a psychiatric referral when discharged isn’t enough.

“We call them up to seven times to check on them after discharge,” he said. “If they aren’t there we leave a message and call again. For many, this telephone call is all they get.”

The crisis center has worked with 17 of Colorado’s 88 EDs and is hoping to increase that number and eventually go statewide.

“We don’t need more brick and mortar buildings, we can reduce suicide risk by simply calling people on the phone,” Allen said.

Dr. Emmy Betz, associate professor of emergency medicine.
Dr. Emmy Betz, associate professor of emergency medicine.

His colleague and study collaborator Dr. Emmy Betz agreed.

“Telephone follow-up programs offer a great way to help bridge an ED visit to outpatient mental health care and hopefully save lives,” said Betz, an associate professor of emergency medicine at CU Anschutz who has conducted extensive research on suicide. “It would be great to see such programs become more widely implemented. Suicide is a leading cause of death, especially in Colorado, and a shortage of inpatient and outpatient mental health care options make innovative approaches like telephone counseling even more attractive.”

The study was led by Brown University and Butler Hospital psychologist Ivan Miller.

Miller, a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, said he was encouraged that they were able to impact suicide attempts among this population with a relatively limited intervention.

While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions are much rarer, Miller said.

“We were happy that we were able to find these results,” he said.

This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts and Dr. Carlos Camargo of Massachusetts General Hospital and Harvard University.

Dr. Betz was the principal investigator for Colorado’s ED-SAFE site.

The trial took place in three phases to create three comparison groups. In the first phase, 497 patients received each ED’s usual treatment as a control group. In phase two universal screening was implemented and 377 patients received additional attention in the ED. In the third phase, 502 patients received the experimental intervention.

Those patients received the same Phase 2 care including additional suicide screening from ED physicians, suicide prevention information from nurses and a personal safety plan they could fill out to prepare for times when they might begin harboring suicidal thoughts again.

Over the next year, they also received periodic phone calls from trained providers at Butler Hospital in Providence, R.I., who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving.

The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group.

“This is a remarkably low cost, low tech intervention that has achieved impressive results,” Dr. Allen said.

 

 

 

 

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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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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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Colorado School of Public Health receives accreditation

The Colorado School of Public Health (ColoradoSPH), the first school of public health in the Rocky Mountain West, has been reaccredited through July 1, 2023, by the Council on Education for Public Health (CEPH).

CEPH is an independent agency directed by the U.S. Department of Education to accredit schools of public health and public health programs.

2015 School of Public Health graduating class
Colorado School of Public Health Dean David Goff surrounded by 2015 spring graduates

Founded in 2008, ColoradoSPH, which comprises students and faculty from CU Anschutz, Colorado State University and the University of Northern Colorado, is the only school of public health in the region and the only accredited multi-university collaborative school of public health in the nation. CU Anschutz is the lead and largest campus.

“I am so proud of the incredible team effort that went into reaccrediting the Colorado School of Public Health,” said David Goff, Jr., MD, PhD, dean of the school. “We are quickly becoming a world-class school of public health and a leader in education, research, community outreach and practice.”

The accreditation review began in 2013 and included a self-study process by school constituents, the preparation of a document describing the school and its features in relation to the criteria for accreditation and a visit in September 2015 by a team of external peer reviewers.

The final accreditation made note of many outstanding facets of school’s programs including:

  • “The school actively recruits a diverse student body and focuses on the retention and graduation of those students.”
  • “The school conducted employer interviews in 2015, and the manager of career and employer relations engages in outreach with potential employers to gather data on the needs of the field and to determine when updates of competency sets are warranted.”
  • “The majority of the school’s research is initiated through the 12 programs and centers. These are collaborative by nature and cut across several campuses and schools.”
  • “A number of service activities have been organized for students by the Office of Student Affairs, and many students choose to perform additional community service outside of the structured school environment.”

ColoradoSPH has more than 600 degree-seeking students, more than 1,400 alumni and more than 200 faculty members. Included among many successful alumni is Larry Wolk, MD, MSPH, executive director and chief medical officer of the Colorado Department of Public Health and Environment.

Among many areas of public health education and research, the school addresses issues of American Indian and Alaska Native health, cancer prevention and control, diabetes and obesity prevention, global health, maternal and child health, and worker health and wellness.

In the eight years since it was founded, the school has achieved national recognition for a variety of programs.

  • In partnership with Children’s Hospital Colorado, the school’s Center for Global Health was recently re-designated as a World Health Organization Collaborating Center on Promoting Family and Child Health.
  • ColoradoSPH is the state-designated training center for ongoing education for regional public health practitioners.
  • Its Center for Health, Work and Environment is a Centers for Disease Control and Prevention (CDC)/National Institute for Occupational Safety and Health (NIOSH)-funded Total Worker Health Center of Excellence.
  • Its Rocky Mountain Public Health Training Center is one of 10 U.S. Health & Human Services Administration’s HRSA regional public health training centers in the United States.
  • In partnership with the Colorado Department of Public Health and Environment (CDPHE), the school is home to the Colorado Integrated Food Safety Center of Excellence, one of six national centers designated by the CDC.

Students and faculty have established long-standing relationships throughout the Rocky Mountain West, serving the public health needs of six states including Colorado, Utah, Wyoming, Montana, North Dakota, and South Dakota as well as 32 tribal nations on reservations in that region.

CEPH currently accredits 59 schools and 109 programs. In addition to the United States, accredited schools and programs are located in Canada, Mexico, Lebanon and the West Indies. Read CEPH’s full report as well as the ColoradoSPH self-study on their website at coloradosph.ucdenver.edu.

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Researchers aim to curb Zika virus in South America

Within days of graduating with a master’s in public health, Naveed Heydari flew to the tropics of Ecuador, a hot spot for Dengue virus and, just this year, confirmed cases of the dangerous and much-publicized Zika virus.

Heydari studied Environmental and Occupational Health at the Colorado School of Public Health (ColoradoSPH) and already has a big job to do. He’s leading a team of researchers for a long-term research program of the Center for Global Health & Translational Science (CGHTS) at the State University of New York (SUNY) Upstate. The program aims to stanch vector-borne viruses by learning what environmental conditions promote these diseases.

Just months before Heydari returned to Ecuador – he performed his practicum in Machala last summer – the World Health Organization sounded the alarm over Zika, saying the virus was “spreading explosively” across the Americas. In recent studies, according to the National Science Foundation, Machala had the highest abundance of Aedes aegypti larvae (the mosquito that carries Zika, Dengue and chikungunya viruses) of all sites surveyed in 10 countries in Latin America and Asia.

Top health concern

Machala, a port city in southern Ecuador, provides perfect egg-laying habitat for Aedes aegypti, which find the crowded conditions of lower-income neighborhoods especially hospitable. “Here, especially in the coastal areas, infectious diseases and these mosquito-borne illnesses are the No. 1 health concern for the public and the Ministry of Public Health,” Heydari says. “They’re a product of lack of infrastructure and inequities in housing. You see the higher burden of the disease in the disadvantaged communities.”

This summer, Heydari led a team of 17 researchers and eight students, including three from the ColoradoSPH – Reese Garcia, Jiayi Liew, and Keith Suter. Upstate Medical University in New York is the lead institution on the collaborative project, which is outlined on this Facebook page.

Sadie Ryan and Naveed Heydari conduct Zika research

Sadie Ryan, an assistant professor at the University of Florida, and Naveed Heydari, an alumnus of the Colorado School of Public Health, deploy a mini-sensor that measures temperature and humidity in a cane-constructed house in Machala, Ecuador, as part of their study into vector-borne viruses.

The idea is to study the “risk landscape” of mosquito-borne pathogens, allowing scientists and public health officials to guard against future illness. “If you know what the risk factors are, you can predict where these outbreaks will be,” Heydari says. “And if you know that, you can use resources to stop the outbreaks before they occur.”

‘Passionate about this’

Garcia, Liew and Suter will return to CU Anschutz Medical Campus this academic year to present their capstone projects, while Heydari expects to work in Ecuador on the front lines of this public health threat for at least a couple more years. “The more you get into this work, the more you realize, ‘Wow, I love this!’” he says. “I’m really passionate about it.”

Ecuador is one of 26 countries in the Americas that has reported Zika virus transmission, according to the U.S. Centers for Disease Control and Prevention. Brazil remains the hardest-hit country, with 1,600 confirmed cases of microcephaly – infants with abnormally small heads – linked to the virus. In addition to its vector-borne illness study, Heydari’s team is providing continued assistance to victims of Ecuador’s April earthquake. Heydari noted that the Upstate Foundation international funding site is still open and accepting donations.

A class in his MPH program at ColoradoSPH – Infectious Disease and Environmental Context, taught by Beth Carlton, PhD, MPH, assistant professor, Environmental and Occupational Health, and Rosemary Rochford, PhD, professor of Immunology-Microbiology, SOM, and Environmental and Occupational Health – fueled Heydari’s passion for this project. Meanwhile, Ecuador feels familiar to Heydari as his mother is a native Ecuadoran and he visited the country previous to his practicum.

Heydari, who earned his bachelor’s degree in economics from Northwestern University, focused his capstone study on the economic burden imposed on households in the prevention of mosquito control. One of his findings: in general, households in Machala spend about 2 percent of their total income on mosquito control.

By collecting weather data and social information, such as household income and how much is spent on mosquito control, the team hopes to learn the socioeconomic and environmental conditions that put people most at risk for the vector-borne illnesses.

Multi-pronged study

Heydari says his team is conducting a multi-pronged study:

  • Diagnostics of Zika, Dengue and chikungunya viruses in community members who are suspected of possible infection.
  • Mosquito collection by using vacuums mounted on backpacks. The vectors are classified and sent to a lab in Quito, Ecuador, where viruses carried by the mosquitoes are identified.
  • Household surveys that provide insight into risk factors that predict infectious disease: Factors include homes that have interruptions in water supply, forcing the use of standing water containers that attract mosquitoes; trash around the house; number of people living in the home; amount of shade around house. Also, surveys asking residents how seriously they take threats of vector-borne illnesses and what interventions they use to control mosquitoes.
  • Install climate sensors in homes. The sensors provide information about micro climates – temperature, humidity, etc. – that make homes conducive to mosquito exposure.

The research is focused on environmental factors such as climatic conditions that translate to human exposure and socio-economic factors such as housing type, household size and wealth.

Naveed Heydari in Ecuador

Naveed Heydari, an alumnus of the Colorado School of Public Health, studies how conducive a house in Machala, Ecuador, is for the transmission of vector-borne pathogens.

“It all comes together to paint a nice narrative of the burden of the disease here,” Heydari says. “We’re really trying to capture just what is the economic burden of the diseases and how we can strengthen our surveillance system.”

The Upstate Medical University research project is among nine projects to collectively receive $1.7 million in rapid response, or RAPID, grants from the National Science Foundation (NSF). Upstate’s study, which received nearly $200,000, is led by Anna Stewart Ibarra, PhD, MPA, a faculty member in the Department of Medicine and director of the Latin America Research Program in the CGHTS.

Stewart Ibarra is joined in the project by co-investigators Timothy Endy, MD, MPH, chief of infectious disease at Upstate and a founding member of the CGHTS; Marco Neira, PhD, assistant professor at Center for Infectious Disease Research, Pontifical Catholic University of Ecuador; and Sadie Ryan, PhD, MPH, assistant professor in College of Liberal Arts and Sciences, University of Florida.

‘Good research platform’

Heydari says the project has provided a “good research platform” on which to apply interdisciplinary research – clinical-, sociological survey- and mathematical model-based approaches – toward the overall goal of safeguarding human health.

“You don’t get this kind of coordination and universities coming down to this part of Ecuador doing this kind of project,” Heydari says. “The researchers understand they’re doing work that has really significant implications. That’s what brought me back.”

The team received permission from the Ministry of Health to expand its work into two other southern Ecuadoran cities. The sites allow data collection in cities of varying elevation, climate and socioeconomic factors, as well as amount of vector-borne illnesses.

The scientists hope to discover when and where interventions might be most effective. The vaccine for Dengue is found to have a 60 percent efficacy rate. Heydari says he and Suter, continuing last year’s economic study, are asking residents if they’d be willing to pay for the Dengue vaccine. They will forward their findings to the Ecuador Ministry of Health and other stakeholders.

Safeguarding worker health

The collaboration extends to the local university – Technical University of Machala – where Heydari’s team uses an entomology lab and provides English lessons to the locals, who return the favor by teaching Spanish to the research group.

Heydari wants to expand on the research platform in Machala by bringing in more investigators to perform clinical trials on potential vaccines. He enjoys the freedom he’s been given by Upstate, and wants to branch out into new areas of study. “Another of my interests is worker health,” he says. “I’d like to look into pesticide use and see how it’s affecting workers in this hot, tropical climate.”

He hopes to return to Colorado next spring when Suter, Liew and Garcia present their capstones in their final semester. Heydari flourished at the ColoradoSPH and he looks forward to visiting his many friends on the CU Anschutz campus.

“I took one class (in the ColoradoSPH) and that was enough to get me hooked,” he says. “I had such a good relationship with the faculty and my peers. We had that shared vision of wanting to help others.”

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