Dr. Baojiang Chen, PhD, Research on Biostatistical Methodological Development and Applications

source: nihseniorhealth.gov

Spotlight on Research at COPH – Dr. Chen’s current research focuses on both methodological development and statistical applications to research, such as in Alzheimer’s disease (AD) studies and cancer studies.

Dr. Chen has been working on statistical methods and analyses for Alzheimer’s disease (AD) in the National Alzheimer’s Coordinating Center (NACC). Approximately 5 million people in the United States and more than 37 million people worldwide are affected by AD. With AD, a person’s memory and ability to learn and carry out daily activities such as talking and eating are gradually destroyed. As the disease progresses, individuals may also experience changes in personality and behavior. Unfortunately, there is no cure for AD, and there is no way to predict how fast the disease will progress. However, early AD diagnosis and treatment can slow the progression of symptoms. Therefore, it is desirable to identify risk factors that affect the progression of the disease. The NACC maintains a Uniform Data Set of standardized clinical and neuropathological research data collected from each of 29 National Institute on Aging-funded AD centers. This database is a valuable resource for both exploratory and explanatory AD research. It is challenging to analyze this data set because people with AD are often lost to follow-up over time due to a decline in health or death. Dr. Chen has developed innovative statistical methods to correct the estimate biases caused by non-randomly missing data and thereby provide valid inference.

Dr. Chen’s research also contributes to public health by examining characteristics of subgroups at greatest risk of progression to dementia. It is believed that disease-modifying therapies may have greater efficacy in subjects who have not yet developed AD and therefore have not experienced neuronal loss. Identifying risk factors for conversion to AD will help target interventions prior to the onset of symptoms to subjects who are at increased risk of progression. Risk factor identification may also assist in streamlining the drug development process, by targeting interventions to high risk subjects.

Baojiang Chen, PhD, is an assistant professor in the UNMC COPH Department of Biostatistics.

Travel tips

source: news.tn.gov

Public Health Community Advisory – The American Red Cross has travel tips holiday travelers can follow to arrive safely at their destination.

ON THE ROAD: Most holiday travelers get to where they are going by car. To arrive safely, the Red Cross recommends these safety steps for travelers who will drive to visit their loved ones over the holidays.

  • Make sure the vehicle is in good working order.
  • Start out with a full tank of gas, check the tire air pressure and make sure the windshield fluid is full.
  • Buckle up, slow down, don’t drive impaired. Designate a driver who won’t drink.
  • Be well rested and alert.
  • Use caution in work zones.
  • Give your full attention to the road. Avoid distractions such as cell phones.
  • Observe speed limits – driving too fast or too slow can increase the chance of being in a collision.
  • Make frequent stops. During long trips, rotate drivers. If the driver is tired, stop and get some rest.
  • Be respectful of other motorists and follow the rules of the road.
  • Don’t follow another vehicle too closely.
  • Clean the vehicle’s headlights, taillights, signal lights and windows.
  • Turn the headlights on as dusk approaches, or if using windshield wipers due to inclement weather.
  • Don’t overdrive the headlights.
  • If car trouble develops, pull off the road as far as possible.

It’s also recommended to keep an emergency preparedness kit in the vehicle. Useful items include water, snacks, a flashlight, first aid kit, extra cash, and blankets,

PLANES, BUSES, TRAINS: For people traveling by air, bus or train, the Red Cross reminds them that if they have been sick with seasonal flu or have come in contact with someone who is sick, perhaps the trip should be postponed as they may be contagious for a week before symptoms appear.

Other safety tips to avoid the flu while traveling include the following:

  • Remember that everything someone touches has to be touched by someone else—luggage handlers, etc. Handle your own belongings as much as possible. Wash hands often with soap and water.
  • Carry hand sanitizer and antibacterial wipes and use them to wash hands or wipe down surfaces such as armrests.
  • Bring your own pillows and blankets—they can act as a shield against the seat itself.
  • If you have to cough or sneeze, do so into a tissue or sleeve.
  • Avoid touching the face or eyes.

About the American Red Cross: The American Red Cross shelters, feeds, and provides emotional support to victims of disasters; supplies about 40% of the nation’s blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission. For more information, please visit redcross.org or join the blog at http://blog.redcross.org.

The Role of Public Health Training Centers in Public Health

Public Health in the National News – In October 2011, the College of Public Health (COPH) was awarded funding to launch the Great Plains Public Health Training Center (Great Plains PHTC). The purpose of the PHTC program nationally is to improve the nation’s public health system by strengthening the technical, scientific, managerial, and leadership competence of the current and future public health workforce. The program is funded through the Affordable Care Act Prevention and Public Health Fund, and is administered through the Health Resources and Services Administration’s Bureau of Health Professions via a cooperative agreement. Currently, there are 37 PHTCs across the country (http://bhpr.hrsa.gov/grants/publichealth/phtcoverviewdocument.pdf).

The Great Plains PHTC at the COPH is unique in its efforts to address the needs of not only the governmental public health workforce, but also tribal entities and public health care providers (such as Federally Qualified Health Centers) in the state.

Opportunities through the Great Plains PHTC include the following:

  • Field Placements for undergraduate and graduate level students in local and tribal health departments across the state of Nebraska
  • Collaborative Project Stipends for trio teams of faculty, students, and local health departments to address an unmet need of the community
  • Leadership Speaker Series to showcase leaders in the field for practice-centered grand rounds
  • Support and subsidy to the Great Plains Public Health Leadership Institute, providing a year-long leadership development experience to public health leaders in Nebraska, Iowa, and South Dakota
  • Online Learning Modules and additional Education and Training Events tailored to the workforce needs in Nebraska

After just one year, the Great Plains PHTC has collected stories of how these programs benefit public health in Nebraska. For example, field placements have had great impact on the students and the local health agencies. The competitive paid fellowship program places students in health departments for the summer (11 students were placed in rural and tribal health departments in summer 2012). One student placed in a rural health department was the first ever bilingual Spanish-English speaking staff member. As part of her activities, she planned a Hispanic Family Health Night. The purpose of the event was to uncover health concerns of the Latino community. Through the event, the health department learned that economic help, tornado preparedness, and basic prevention knowledge were unmet needs. After the field placement experience the student said, “My feelings about forwarding my education in public health are stronger than ever now. The time that I spent at the health department opened my eyes about how important it is to promote health, teach individuals how to prevent sickness, and how to protect themselves from possible hazards.” The student’s commitment to this work has led her to volunteer for the health department as a translator . . . even though it is a four-hour drive round trip.

For more information on the Great Plains PHTC, contact Brandon Grimm: blgrimm@unmc.edu, 402-559-5645.

This article was written by Brandon Grimm, PhD, director of the UNMC COPH Office of Public Health Practice, and Katie Brandert, MPH, CHES, workforce and leadership development manager in the COPH Office of Public Health Practice.

Kendra Schmid, PhD

Kendra Schmid, PhD

Faculty Highlight – Dr. Kendra Schmid teaches BIOS 823/CPH 653, Categorical Data Analysis. While this course is an MPH biostatistics concentration course, students in other programs also enroll. Dr. Schmid is developing an online section of the MPH biostatistics core course, BIOS 806/CPH 506, to be offered in spring 2013.

Dr. Schmid’s methodological research focuses on statistical shape analysis, and more specifically, on methods of describing, mapping, and matching shapes using landmark coordinates. As a biostatistician, she serves as a statistician for research projects across the UNMC campus. Additionally, she is a statistician for the Core Center for Communication Disorders at Boys Town National Research Hospital, where she provides statistical support for several research project grants funded by the National Institutes of Health and assists with the submission of new proposals.

Dr. Schmid was appointed the director of master’s programs in the College of Public Health (COPH) in June 2012, and she very much enjoys this role. She also serves as chair of the COPH Curriculum Committee and is an active member of several other COPH committees. External to campus, she is a member of the editorial board for the Journal of Biocomputing and is the chapter representative to the American Statistical Association for the state of Nebraska.

Kendra Schmid, PhD, is an assistant professor in the UNMC COPH Department of Biostatistics.

Shinobu Watanabe-Galloway, PhD, Research on Mental Illness and Substance-Related Disorders

source: dmh.dc.gov

Spotlight on Research at COPH – Across the United States, two million persons with serious mental illnesses are booked into jails each year. According to the National Center on Addiction and Substance Abuse at Columbia University, about 40% of state prison and local jail inmates have substance use disorders, and 25% have substance use disorders with mental illness. There is a substantial overlap between the behavioral health and criminal justice systems. Dr. Shinobu Watanabe-Galloway and her research team worked with the Behavioral Health Division of the Nebraska Department of Health and Human Services and county jail and state corrections systems to conduct a study to examine the characteristics of individuals with mental illness who have had criminal justice encounters, and the patterns of those encounters. The study found that half of adults who receive Nebraska’s behavioral health services in a community setting had been to jail at least once in five years. Substance abuse alone and in combination with mental illness appears to increase the risk for a criminal justice encounter. The study also found that about 70% of people in substance abuse treatment had been to jail or prison at least once in five years.

Mental illness and substance-related disorders are also over-represented in the homeless population. In 2011, at least 7,013 people experienced homelessness in Douglas, Sarpy, and Pottawattamie Counties. Our community trails the national rates of reductions in the homeless population in all respects except for homeless people who have mental illness and other disabling conditions. Scarce resources are a reality in our community’s future. The US Department of Housing and Urban Development and the US Department of Health and Human Services are increasingly pushing for human services systems to understand client/patient use patterns in order to achieve systemic outcomes. In the case of homelessness, the Homeless Emergency and Rapid Transition to Housing Act of 2009 set forth system performance expectations that motivate communities to understand the return-on-investment of federal dollars. Dr. Watanabe-Galloway has been partnering with the Metro Area Continuum of Care for the Homeless to plan and conduct a study to investigate health care utilization patterns among chronically homeless adults and the impact of housing support services. The study was funded through the UNMC College of Public Health’s Mutual Fund Program and is expected to be completed in the spring of 2013.

Shinobu Watanabe-Galloway, PhD, is an associate professor in the UNMC COPH Department of Epidemiology.

“Sleep tight! Don’t let the bed bugs bite!”

source: home2.nyc.gov

Public Health Community Advisory – Over the last two years, bed bugs have increasingly been found in hotels, apartments, houses, shelters, cruise ships, buses, trains, airplanes, dorm rooms, schools, hospitals, and department stores. Bed bugs even invaded the New York Ritz Carlton Hotel in January 2012, showing that bed bugs know no boundaries regardless of income bracket. The cause for the rise in infestations remains unclear, but is likely due to bed bug populations developing resistance to pesticides, increased domestic and international travel aiding transport, and the increased use of wooden furniture that bed bugs can climb.

So why all the fuss? Although bed bugs are not known to spread disease, they are a nuisance whose bites may result in rashes. Bed bugs require blood to live, which they acquire by biting their sleeping victims, who often remain asleep. Bites may produce a wide variety of skin rashes on humans, but at least 30% of people show no signs of being bitten. In some cases couples report bed bugs only biting one person.

How to avoid being a blood meal. Ways to avoid becoming a bed bug meal include the following: thoroughly check hotel rooms or a new apartment, or used furniture or other items brought into your home. Inspect hotel beds before placing luggage in bedroom; check the seam of the mattress under the sheets and behind the headboard for bugs and dark reddish brown spots that are known to indicate the presence of bed bugs. Bed bugs don’t fly and are typically transported by humans or their belongings to new locations. Bed bugs stay close to their food source and are usually found within 15 feet of where people sleep, but they have been known to travel up to 100 feet in a day to find food. Upon returning from travel, launder clothing promptly and inspect luggage seams for stowaways. Placing clothing directly into a dryer on high for 10 to 20 minutes will often kill bed bugs.

Once bed bugs have been introduced to a home, they spread to neighboring bedrooms or apartments and can live more than six months between feedings. Getting rid of bed bugs is difficult but possible. Nonchemical treatment such as vacuuming, steam cleaning, laundering, and using mattress covers can be helpful but will not eliminate them. Chemical bed bug treatment should be carried out by a professional, and it requires multiple applications of more than one pesticide. A recent report showed the dangers of do-it-yourself chemical treatment for bed bugs, since more than 100 poisonings and a death have been associated with chemicals used to kill bed bugs. Although bed bugs have achieved newsworthy status, remember that while they may be unpleasant they do not spread disease. Photos and thorough information on inspecting and eradicating bed bug infestation can be found at:

University of Nebraska Extension

Center for Disease Control

This article was written by Shawn Gibbs, PhD, associate professor in the UNMC COPH Department of Environmental, Agricultural, and Occupational Health, and the UNMC COPH associate dean for student affairs, and by John Lowe, MS, disaster exercise outreach coordinator in the UNMC COPH Center for Preparedness Education, and an instructor in the UNMC COPH Department of Environmental, Agricultural, and Occupational Health.

New Developments in the Fight to End HIV Infection

source: state.gov

Public Health in the National News – The Food and Drug Administration approval of a pre-exposure prophylaxis, or PrEP, is an exciting development in the fight to end HIV infection. The public health community working to prevent new infections now has another in a wide array of tools with which to prevent HIV transmission.

Clinical studies have shown those who start a PrEP regimen do not engage in behaviors that transmit HIV with any greater frequency than before using the drug. Despite this, some public health officials are concerned that some may engage in those behaviors more often if they are on a PrEP. Changing behavior is difficult; if someone is engaging in activities that have high potential for transmission of HIV and he or she is not likely to reduce or stop those behaviors in the near future, PrEP could be a life-saving option. For these reasons, it is important that anyone beginning a PrEP regimen also receive counseling and education around HIV prevention and be tested for HIV on a regular basis. A comprehensive approach to HIV prevention is the best scientifically justified prevention method recommended.

As with many newly approved treatments for HIV, PrEP regimens are not cheap—some estimate costs of up to $13,000 a year. It is unclear yet how insurance companies will handle the newly approved on-label use of the drug. While PrEP may be a great new tool in the HIV prevention specialist’s toolkit, it will likely not be available to many of those who most need it because of the cost. Policymakers and drug company marketers will need to take costs of the drug into account when determining how best to implement PrEP as part of a multipronged approach to HIV prevention in the United States.

For those who are good candidates for PrEP and can afford it, the once-a-day pill is not a magic bullet. PrEP doesn’t work for everyone and is not 100% effective, even when taken every day as directed. In addition, numerous side effects can interfere with daily quality of life. In addition, some major side effects could be life-threatening. It is important that those who are considering using PrEP get all the facts and be presented with all prevention options to determine what works best for them.

While we may soon be saying “HIV?! There’s a pill to prevent that,” we need to remember that prevention has never come in a magic bullet. We still need to carry out the multipronged approach to HIV prevention as outlined in the National HIV/AIDS Strategy. We need to ensure that EVERYONE is included in our prevention efforts, not just those who can afford a pill and have the sociocultural support to take it every day.

This article was written by Christopher Fisher, PhD, assistant professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health. Dr. Fisher is also director of the Midlands Sexual Health Research Collaborative and chair of the APHA HIV/AIDS Section.