Advances - Winter 2008

Advances

Richard Carmona to headline Alumni and Friends Scholarship Gala • page 17

WINTER

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from the University of Minnesota School of Public Health

INFORMATICS

New Frontiers in Public Health

RETURNING TO WORK AFTER CANCER LAB LEARNING HITS THE WEB FIGHTING THE FLU WITH THE VIKINGS MEDICINE VS. MEDICARE

FROM THE DEAN Dear Friends,

Photo: Richard Anderson

I am looking forward to welcoming you to the first-ever School of Public Health Alumni and Friends Scholarship Gala. The gala, along with two other reunion-themed events, will be held on April 10 in Minneapolis. The events offer a one-of-a-kind opportunity to reconnect with classmates and professors, network with public health colleagues from around the country, and support the next generation of public health leaders. The gala will feature what no doubt will be a rousing keynote address by former Surgeon General Richard Carmona. Please see page 17 and visit www.mmf.umn.edu/sph/nphw for more information.

I hope to see you there!

I am proud to report that in 2007 the SPH generated $92 million in extramural research, the second largest contribution in the University of Minnesota, behind the School of Medicine, and we have the most productive faculty, per capita, of any unit at the University (or any other school of public health, for that matter). This is remarkable in the face of what amounts to decreased funding for research from the National Institutes of Health and Centers for Disease Control and Prevention. I can’t thank our faculty and staff enough for their continued commitment to advancing critical health research.

The cover story features the all-encompassing topic of informatics, a discipline that blends health data and information systems in myriad ways to foster a greater understanding of the health status of a community, health trends, and the efficiency of the practice of health care in all its facets. The SPH has great depth in many areas of health informatics that is greatly bolstered by a new leader at the helm of the Academic Health Center’s Institute for Health Informatics, Julie Jacko. Dr. Jacko holds a joint appointment in the School of Nursing and the School of Public Health.

Yours in health,

John R. Finnegan Jr., Ph.D. Dean and Professor Assistant Vice President for Public Health

SCHOOL OF PUBLIC HEALTH LEADERSHIP

Advances

John R. Finnegan Jr. Dean

John Connett Head, Division of Biostatistics

Editor Diana Harvey

Judith Garrard Senior Associate Dean for Research and Academic Affairs

Bernard Harlow Head, Division of Epidemiology and Community Health

Managing Editor Kristin Stouffer

Debra Olson Associate Dean for Public Health Practice Education

François Sainfort Head, Division of Health Policy and Management

William Riley Associate Dean for Student Affairs

William Toscano Head, Division of Environmental Health Sciences

Diana Harvey Assistant Dean for External Affairs

Joe Weisenburger Chief Administrative Officer/Chief Financial Officer

Contributing Writers Nicole Endres Robyn White Art Direction Todd Spichke Riverbrand Design

Contents Table of

Advances

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Feature: Informatics

New technologies are making research methods that were once impossible a reality. Learn about how SPH teams are

WINTER 2008

designing and using information systems to forge new discoveries across the public health spectrum, from vast care systems to community prevention to DNA analysis.

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Division News

The silent danger of peripheral arterial disease, an alarming trend in breast cancer survivors, why smokeless tobacco is as dangerous as cigarettes, and more.

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School News

The SPH launches health disparities concentration, faculty take top awards, school leaders visit partners in India, and more.

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Student News

One student teams up with the Minnesota Vikings to vaccinate children, while another challenges police officers in a weight-loss competition.

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Philanthropy

The school’s newly formed Alumni Society Board ramps up support for student scholarships.

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Alumni News

A new installment of Class Notes, and CEO alumnus takes

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home the Baldrige Award.

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National Public Health Week

The school celebrates with the first-ever Alumni and Friends Scholarship Gala and fourth annual film festival.

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University of Minnesota School of Public Health

F E AT U R E S TO RY Informatics is a scientific field that, simply put, uses information technology to convert data to knowledge so people can make sense of it. It’s a big, multidisciplinary field that is data focused and computationally intensive. And it’s a field that will be changing the face of public health.

Heading up the institute is Julie Jacko, an expert in the area of human-computer interaction. She holds appointments as professor in the School of Nursing and in the School of Public Health. “The institute will serve as an incubator for ideas and a way to mobilize faculty around projects,” she says.

“Informatics allows us to process gigantic amounts of information to get insights in ways we never thought we could,” says School of Public Health Dean John Finnegan. “The potential of informatics for public health is amazing to me.”

To encourage collaborative research, the IHI will establish about a dozen faculty fellows who will work as a multidisciplinary team in areas of strategic research importance for the institute, while maintaining ties to their home department or discipline. The fellows will also serve as a resource for those seeking guidance on their own research, and they will help foster ongoing and new collaborations with existing centers on campus.

While informatics is used to gain insight into complex data at the biological level, like DNA patterns, it’s also being applied to vast health care systems through methods such as electronic health records. At the community level, informatics

INFORMATICS

New Frontiers in Public Health The rise of digital technology has led to a surge of information. For the first time in human history, virtually anyone, anywhere can access a wealth of information on any topic. But are we merely swimming in a sea of facts and figures? How do we use information to advance our knowledge and better our world?

could be key to achieving real-time public health surveillance by combining all sorts of data that could alert us earlier to important changes in population health—good and bad.

For those who think this is the stuff of science fiction, Finnegan says, “When you’re smack in the middle of the digital revolution it is hard to appreciate how fast things are changing. But just look back 10 to 20 years. It’s astonishing how things have changed in just that time.”

Informatics Institute As the practice of informatics becomes increasingly central to improving health, the University of Minnesota is stepping up to be a leader with the newly established Institute for Health Informatics (IHI). Housed in the Academic Health Center, the institute aims to bring together researchers from across the health sciences, as well as other fields like engineering and information technology.

Bringing new technologies to market is a strategic goal of the institute. Researchers will be building new, innovative tools and methods such as database engines, predictive models, software, and devices that physicians, patients, or other informatics researchers may use.

The institute will work to leverage existing partnerships and forge new partnerships in the name of technology and health care. The collaborations will be sought with industry, health systems, and government. “I’m looking forward to partnering with the institute,” says SPH alumnus Marty LaVenture, director of the Center for Health Informatics and e-Health at the Minnesota Department of Health. “The school’s increased innovation and collaboration around health informatics is very exciting. It will help transform public health practice and improve the health of our communities.” continued on page 4

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FEATURE STORY continued from page 3

Jacko echoes those sentiments when discussing the University’s role. “By looking at health informatics in a holistic way, I see Minnesota as a trailblazer,” she says. “I believe the University is poised to become a national and international leader in this area.”

Decision Science The work of SPH professor François Sainfort centers on helping people make decisions that will improve health.

While the concept can be put in simple terms, the practice of conducting medical decision-making research is complex.

It requires not only working with vast amounts of data but also analyzing how individuals encounter and process information to make decisions—and whether those decisions lead to changes in behavior or intended outcomes. It’s an area of research that benefits from interdisciplinary teamwork, something that Sainfort will foster as the new head of the school’s Division of Health Policy and Management.

Medical decision-making almost always occurs under risk and uncertainty, and the scenarios run the gamut. At an individual level, it could be a patient facing tough choices about cancer treatment. At an organizational level, it could be hospital administrators deciding whether to invest in costly medical technology. And at the policy level, it could be legislators weighing issues on how to best invest taxpayer money for prevention strategies.

While Sainfort works in hard numbers, he also faces the challenge of applying those numbers to concepts that can be difficult to measure. And he must consider the psychological elements related to decision-making. “How do you quantify subjective terms like ‘health’ and ‘quality,’” he asks. “You must define, measure, model, and test.”

Sainfort is currently leading a study to analyze the implementation of electronic medical records (EMR) and other clinical decision-support systems at Children’s Healthcare of Atlanta, one of the largest pediatric hospital systems in the country. Sponsored by the Agency for Healthcare Research and Quality, Sainfort’s team is evaluating EMR’s impact on patient safety and quality of care and sharing their findings with the hospital, EMR vendor, and scientific community. The aim is to develop a set of best practices and guidelines that will help large hospitals implement an EMR system. Initial findings have shown that EMR can significantly cut down on medical errors, especially in the area of drug prescriptions.

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University of Minnesota School of Public Health

Cancer Screening Informatics is playing a major role in the largest cancer screening study to date. Launched in 1993, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) follows close to 155,000 U.S. adults with the aim of reducing death from the most common cancers.

SPH professor Timothy Church leads the PLCO center at the University of Minnesota. With nearly 30,000 participants, Minnesota is by far the largest of the 10 PLCO centers located throughout the United States. For close to 15 years, researchers have been collecting data on participants, including medical information, demographics, family history, and lifestyle habits.

The sheer amount of data has prompted Church’s team to create information systems that minimize the manual handling of data, such as requesting medical records from a health care provider. The systems have also been key in quickly and inexpensively recruiting participants for sub-studies within the larger PLCO trial. For example, the researchers were able to recruit 600 people in two months for a pilot lung screening study. “We did it without breathing

hard,” jokes Church. When it came time to recruit 10 times the participants for the National Lung Screening Trial, the researchers already had the data on who would be eligible and interested.

On the biological side, researchers are studying blood samples from each study participant, which has led to a major discovery concerning lung cancer risk in smokers. Researchers can now show, for the first time, that a tobacco-related carcinogen is linked to lung cancer in humans. Tobacco-related carcinogens have long been linked to cancer in animals but until now, scientists haven’t been able to make the connection in humans. The next steps will be to look at the metabolic activation of the carcinogen and to use gene chips to discover mutations in the DNA sequence that further increase the risk of lung cancer.

The carcinogen discovery is one of many to come out of the PLCO trial. So far, some 200 publications have come from Church and his PLCO colleagues. That body of work includes new findings on diet’s connection to colon cancer, potential biomarkers for ovarian cancer, and how body mass index is related to PSA, the prostate cancer screening test. “We try to squeeze the most information out of our research,” says Church.

Leading in Bioinformatics With participants undergoing six screenings since 1993, the study is on track to address what Church calls “the bigticket question,” namely, whether these screening methods are effective at preventing deaths from cancer. Those findings will start rolling out in 2011.

Testing Ideas SPH associate professor Beth Virnig is an expert in using large national data sets to gain a better understanding of a spectrum of health issues, including quality of care, endof-life-care, and cancer survivorship. The data she uses may come from various sources like Medicare, managed care organizations, or the National Cancer Institute, but her research always begins with a hypothesis.

While primary data collection is costly and can take years, especially in long-term studies of diseases like cancer, existing datasets offer an expedient way to test an idea.

“From my perspective, using these large datasets offers a way to fine-tune a hypothesis,” says Virnig. “It’s also an efficient, scientifically sound method.”

Clinicians come to Virnig to investigate a variety of issues.

This work has revealed that radiation treatment for prostate cancer nearly doubles the risk of developing rectal cancer. continued on page 6

If the big end of the informatics spectrum is studying large populations and vast systems, then the small end is studying health at the molecular level. This is where the field of bioinformatics comes into play.

Several SPH faculty in the Division of Biostatics are collaborating with researchers across the University to pinpoint the genes that lead to illnesses, such as cancer and heart disease. Statistical models that can handle vast amounts of data are critical in DNA study, where hundreds of thousands of possible gene combinations must be analyzed.

SPH professor Wei Pan is an emerging leader in the field of bioinformatics. While some researchers study genes one by one and treat them independently, Pan contends that it’s essential to apply existing biological knowledge to single out the genes that lead to disease. He is leading a bioinformatics working group in the school to foster research collaborations.

Beyond the SPH, he is partnering with researchers from medicine, statistics, and biochemistry. He and colleagues recently launched a study to pinpoint the genes behind organ rejection in transplant patients.

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FEATURE STORY

the MINTS team has been working on for more than five years. The first phase entailed assessing the risks undertaken by men seeking sex with other men through online venues.

continued from page 5

It has shown that some 332,000 Americans live in rural areas without access to home-based hospice care. And it has uncovered an alarming trend among women who have experienced breast cancer (see page 10).

Virnig has used Medicare data on a number of studies investigating racial and ethnic disparities in quality of health care. She has shown that African Americans are less likely to receive hospice care, despite having comparable health care plans to other ethnic and minority groups. In studying race and geography together, Virnig has shown that the larger the minority population in an area, the worse quality of care is for all the people in that area. This is especially true in the southern part of the United States, an area that in Virnig’s words, “suffers from a double disparity” of race and geography.

Fighting HIV SPH professor B. R. Simon Rosser is heading up a multidisciplinary team that is developing a new Web-based software program to help fight HIV. The Men’s INTernet Study (MINTS) researchers have launched a randomized controlled trial to test the software, which aims to reduce sexual risk-taking behaviors associated with the spread of HIV and other sexually transmitted infections. It’s the second phase of a project

The intervention, dubbed “Sexpulse,” prompts users to answer questions about issues such as body image, selfesteem, sexual health, and risk-taking behaviors. The program then offers users information about HIV/AIDS, along with instructive stories. “The goal of this research is to create a genuine online experience that promotes healthier sexual behavior and encourages people to take fewer risks in sexual encounters outside of cyberspace,” says Joseph Konstan, the study’s computer science specialist. The group is joining with a technology company, Allen Interactions, to develop the intervention techniques.

Rosser, program director for the HIV/STI Intervention and Prevention Studies program, says that it’s crucial to use the Internet for disease prevention because his team’s research shows that seeking sex is the most popular use of the Internet among high-risk populations. “If we don’t do [HIV prevention outreach] right or in a way that’s most responsive, we’re going to have a new HIV epidemic.

There’s enormous urgency in addressing gaps in HIV prevention,” he says.

Professors B. R. Simon Rosser, left, and Joseph Konstan work on the the Men’s INTernet Study (MINTS).

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University of Minnesota School of Public Health

Photo: Richard Anderson

In addition to HIV prevention, the researchers hope their model can be used for other public health purposes. “The importance of the MINTS study is not just addressing HIV prevention,” Rosser says. To that end, Rosser and Konstan are coteaching a course focused on developing online prevention interventions for public health issues like cancer, substance abuse, and obesity.

The course has drawn students from public health, medicine, information technology, and liberal arts. “We believe it’s the first e-public health course in the nation to teach the design and development of online public health interventions,” says Rosser.

EPIDEMIOLOGY AND COMMUNITY HEALTH

The Silent Danger of Peripheral Arterial Disease More than 8 million people—one in 20 adults—have peripheral arterial disease (PAD), a condition that puts them at risk for heart attack, stroke, or leg amputation. The symptoms of PAD—such as fatigue, pain, and cramping in the leg muscles when walking that go away with rest—are often mistaken for signs of aging and ignored. More often the disease is silent, causing no noticeable symptoms.

SPH adjunct professor Alan Hirsch has helped to create national PAD care standards and is now working to raise awareness of this common danger as chair of the PAD Coalition, a nonprofit alliance of health organizations, professionals, and government agencies.

PAD occurs when arteries in the legs become clogged with fatty deposits that limit blood flow. The obstructions signal an increased risk of heart attack or stroke. Despite these dangers, a recent national survey found that three quarters of American adults have never heard of PAD. “Because the public is largely unaware of PAD, it is usually left untreated until it is most severe, leaving people vulnerable to heart attack, stroke, and considerable disability,” says Hirsch. “At a time when the public is bombarded with health messages, it would seem wise for those at risk for one of the single most common cardiovascular diseases to be aware of that risk.”

The best way to fight PAD is through increased awareness and early detection. Those most at risk are people over the age of 50, diabetics, smokers, African Americans, and people with high blood pressure.

“PAD is one of the most dangerous cardiovascular diseases that no one has ever heard of,” says Hirsch. “By increasing public awareness, we can reduce unnecessary suffering and improve the nation’s vascular health.”

To learn more, visit www.aboutpad.org or WEB EXTRA WEB EXTRA www.padcoalition.org.

To hear a Public Health Moment about PAD, go to WEB EXTRA www.sph.umn.edu/moment.

WEB EXTRA

WEB EXTRA

Diabetics May Face Higher Risk of Colon Cancer Women with diabetes are 50 percent more likely to suffer from colorectal cancer than those who do not have the metabolic disorder, according to a study by School of Public Health researchers.

“Colorectal cancer and type 2 diabetes share a number of common factors, including obesity, so it is interesting to see the direct line between these two conditions,” says lead investigator and SPH assistant professor Andrew Flood.

The researchers followed 45,000 women with no history of colorectal cancer or diabetes from 1987 to 1989 and from 1995 to 1998 to examine the association between the two conditions.

Flood says it is unknown why diabetics have a higher risk of colorectal cancer. But one possibility is that the risk may be related to the elevated concentration of insulin typically seen in type 2 diabetes patients.

“In the early stages of the disease, people become insulin resistant, meaning they must produce more and more insulin to regulate their blood sugar,” Flood says. “Even after frank diabetes begins, insulin levels remain chronically elevated for extended periods before the pancreas can no longer supply the level of insulin the body demands.”

The team found no elevated risk of colorectal cancer in pre-diabetic women. The researchers believe this may have something to do with the length of time and the degree of elevated insulin in the body.

WEB EXTRA Flood says the WEB bestEXTRA way women with diabetes can reduce their risk of colorectal cancer is through management of WEB EXTRA blood sugar.

To hear a Public Health Moment about this study, WEB EXTRA go to www.sph.umn.edu/moment.

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BIOSTATISTICS

An infrared photo shows the thermal chemical reaction University researchers are using to destroy cancerous tissue in the liver.

New Methods for Treating Liver Cancer Smokeless Tobacco As Hazardous as Cigarettes It may not be inhaled into the lungs, but smokeless tobacco exposes users to some of the same potent carcinogens as cigarettes. The discovery comes from the University of Minnesota Transdisciplinary Tobacco Use Research Center (TTURC).

TTURC researchers compared the urine of 182 oral snuff users with 420 cigarette smokers. They found that snuff users were exposed to higher levels of NNK, a carcinogen known to produce lung and pancreatic cancer. Stephen Hecht of the University of Minnesota Cancer Center led the research.

SPH faculty members Chap Le and Xianghua Luo served on the study’s data and analysis team. Their primary role was to analyze the baseline data from three cigarette reduction studies and three smokeless tobacco reduction studies to compare carcinogen levels between the smokers and snuff users.

The research team found that smokeless tobacco products —despite what some have proposed—are not a safe alternative to cigarettes. In fact, the study supports the idea that oral use of tobacco actually provides a more efficient means for delivering certain carcinogens into the body through the bloodstream. Findings were published in Cancer Epidemiology, Biomarkers, and Prevention, a journal of the American Association for Cancer Research.

“No one can say that smokeless tobacco is a safe substitute for cigarettes,” says Luo. “The only truly safe alternative to smoking is to quit.”

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University of Minnesota School of Public Health

University of Minnesota researchers are launching research aimed at improving treatment for a deadly form of liver cancer found in people who have developed cirrhosis.

Treating this type of cancer, known as hepatocellular carcinoma (HCC), is difficult because surgically cutting out the cancer can destroy an already poorly functioning liver.

Erik Cressman, an assistant professor of radiology in the Medical School, is developing a minimally invasive method that destroys cancerous tissue by injecting two chemicals into the liver tumor. When the chemicals combine and react, they produce intense heat that destroys cells around the injection site. He has done pilot testing on pig livers.

As biostatistician on the two-year project, SPH associate professor Lynn Eberly will analyze different types of chemical injections. Using a method called response surface modeling, she will determine which type of injection, in terms of volume and chemical molarity, results in the largest volume of cell destruction. The model allows Eberly to evaluate all combinations of volume and molarity—within the bounds of the specific values tested—to find the optimal combination.

The long-term goal of the research is to develop a minimally invasive treatment that may also be used for other types of malignancies, including breast cancer. But the treatment is urgently needed for HCC, a cancer that is becoming more prevalent, is often unresponsive to chemotherapy and radiation therapy, and has low survivorship.

“Part of the problem is that not enough liver transplants are available,” says Eberly. “So new treatment methods are needed. We’re searching for a treatment that is aggressive enough to destroy the cancer but also safe for the patient.”

ENVIRONMENTAL HEALTH SCIENCES

Taconite Worker Project Progresses Flexibility and Support Help The second meeting of the Minnesota Taconite Worker Cancer Survivors Return to Work

Lung Health Partnership, led by SPH Dean John Finnegan Improved screening and treatment means more and more and representing organizations with an interest in mine cancer survivors are returning to the work force. Despite worker health, took place in December in Eveleth, Minn. this trend, little is known about what helps these employees The partnership was formed to study whether particles return to work successfully. generated by taconite mining are causing lung disease SPH assistant professor Nancy Nachreiner is combining on Minnesota’s Iron Range. her expertise in occupational health and interest in cancer Finnegan and Jeffrey Mandel, SPH Environmental Health survivorship to investigate the factors associated with a Sciences associate professor and lead researcher, updated positive return-to-work experience. She recently led a pilot partners on the project. They were joined by colleagues from the study in which women ages 31-54 who had been diagnosed University of Minnesota-Duluth’s Natural Resources Research and treated for cancer in the previous year participated in a Institute, who will study the geology of the Iron Range. focus group.

The highlight of the meeting came when a representative Nachreiner’s team identified common factors that the women of Cleveland Cliffs Corp., operator of a mine in Silver Bay, said helped them return to work, including job flexibility, Minn., announced that the company would not conduct its coworker support, and health care provider engagement. own research into mine worker health, as previously Factors that hindered return to work were ignorance about planned, and instead support the University in its efforts. cancer in the workplace, lack of emotional support, and the The announcement was met with approval from partnership physical effects of cancer. The findings can serve as a members, including several state legislators representing starting point to consider the provisions offered to survivors Iron Range communities. under the Americans with Disability Act. In addition to reviewing the details of the proposed threeThe study also underscores the important role of occupational stage, five-year research project, Mandel announced that health nurses. “Occupational health nurses can work nurses from the University of Minnesota’s Center for Lung directly with cancer survivors and health care providers to Science and Health would staff a toll-free phone line to establish a healthy workplace and comply with any legal answer health questions from mine workers and their families. requirements,” explains Nachreiner.

The number is 888-840-7590.

Because the return-to-work experiences of cancer survivors The project must still be funded through an appropriation vary greatly, Nachreiner says there won’t be any easy policy from the Minnesota Legislature during the 2008 session. solutions. “But so little is known about this issue right now EXTRA WEB EXTRA million.

Mandel said the research is projected to cost $5WEB that great improvements can be made to help survivors and Rep. Tom Rukavina (DFL-Virginia) assured University officials employers,” she says. “With the growing number of survivors, that he and his colleagues would work to find funding despite WEB EXTRA it’s a prime time to start finding answers.” the bleak state budget forecast.

To hear a Public Health Moment about this study, For the latest news on the partnership, visit WEB EXTRA WEB EXTRA go to www.sph.umn.edu/moment. www.sph.umn.edu/lunghealth.

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HEALTH POLICY AND MANAGEMENT

Medicare Lacks Tools to Enforce Coverage Policies Breast Cancer Survivors May Opt for Unnecessary Surgery More and more women who have been diagnosed with cancer in one breast are choosing to have a double mastectomy, even though statistically the risk of cancer developing in the second breast is less than 1 percent. This trend was found by a University of Minnesota team in the first study of double-mastectomy use at a national level.

The researchers found that from 1998 to 2003 double mastectomies increased from 4.2 percent to 11 percent.

Women younger than 40 were much more likely to choose the more aggressive approach.

Advances in cancer prevention through drug treatment and imaging technology means surgeons are trying to do less surgery, not more. “Some would argue that the need for aggressive surgery should going down, not up,” says SPH associate professor Beth Virnig, one of the study authors.

Experts say that for women with cancer in one breast, the risk of cancer spreading to other parts of the body is greater than the risk of it spreading to the other breast.

The annual risk of cancer developing in the other breast is about .5 percent to .75 percent.

The researchers believe that fear coupled with an increased public awareness about the genetics of breast cancer have led to increased double mastectomies. But the aggressive approach does nothing to improve outcomes in terms of cancer.

“Double mastectomies may not always be necessary,” says Virnig. “We need to understand why more women are choosing this treatment so that we can better counsel them about their risks for cancer in the other breast and the other treatment options available to them.”

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University of Minnesota School of Public Health

New School of Public Health research finds that Medicare lacks the tools and incentives necessary to enforce its evidencebased coverage policies. And Medicare appears reluctant to aggressively enforce policies that affect medical judgments, even if those decisions are inconsistent with scientific evidence.

“There has been much discussion among providers, payers, and policymakers to encourage evidence-based medicine as a means to improve quality and reduce costs,” says SPH professor Susan Bartlett Foote, who led the study. “We’ve found that there are considerable barriers to achieving that goal in Medicare.”

By law, Medicare must pay only for items or services deemed “reasonable and necessary.” The program has developed evidence-based coverage policies to evaluate which medical procedures will be covered and under what clinical circumstances. Medicare contractors who process claims for payment are directed to apply these policies to determine when to pay or deny a claim.

While policymakers may assume that Medicare’s coverage policies change physician behavior, Foote’s research shows that they don’t. She says improving information and education, aligning incentives, and investing in compliance are ways to improve the coverage policies.

When Medicare was passed in 1965, professionals were assured that the program would not interfere with the practice of medicine. But Medicare is also directed not to pay for procedures unless they are “reasonable and necessary.”

Foote says there’s an inherent tension between these goals.

“Public and private payers are often reluctant to secondguess doctors and other professionals,” says Foote. “However, in an era of rising costs and questionable quality, we must refine tools to ensure that patients get care based on scientific evidence.”

PUBLIC HEALTH EDUCATION AND OUTREACH

Lab Learning Hits the Web

Photo: Paul Bernhardt

Lab classes at the University of Minnesota are getting a futuristic facelift, thanks to a partnership of the Digital Learning Group (DLG) and Clinical Laboratory Sciences.

The two groups are working together to make portions of the University’s most popular clinical laboratory sciences courses available online. Hands-on exercises and experiments will still take place on campus, but lectures, pre-lab tutorials, and simulations will be available online.

The technology achieves multiple goals, says Joe MayoCullen, marketing and business manager of the DLG. “The Web-based lectures and tutorials make curriculum consistent,” he says. “The fact that students can view the clips any time, anywhere, and as often as they need in order to grasp concepts means that learning is both convenient and tailored to different styles.”

To ensure that the online curriculum complements the in-lab exercises, the DLG is collaborating closely with Clinical Laboratory Sciences faculty, who serve as subject-matter experts and appear in the videos.

Sixteen courses are set to launch in the upcoming academic year. Subject matter includes the basics of clinical lab sciences, examining blood and bone marrow, and diagnosing infectious and metabolic diseases and viral and parasitic infections. The courses will be offered at the Twin Cities and Rochester, Minn. campuses simultaneously, with the hope of expanding availability to other campuses and possibly other schools.

The DLG is a team in the School of Public Health that provides solutions in the ever-evolving world of technologically enhanced learning. The group has expertise in data-driven Web solutions, instructional design, course development, online conferencing, and more.

To learn more about the DLG, go to http://cpheo1.sph.umn.edu/dlg.

Firefighters and other emergency responders rush to the scene of an explosion near Clearbrook, Minn.

Communication Skills Put to Test in Pipeline Explosion Jeanine Brand’s hectic schedule almost kept her from attending a risk communications course offered through Minnesota Emergency Readiness Education and Training (MERET). But Brand, a county attorney in Northern Minnesota, managed to make the class. Little did she know that in the weeks ahead a deadly emergency would force her to put her new skills to use.

On November 28, 2007, Brand was informed that crude oil fumes had sparked an explosion at Enbridge Energy, near Clearbrook, Minn. Two workers were killed in the blast.

Brand immediately went to the sheriff’s office, listened to the 911 calls, and drafted a press release. She stayed at the emergency site until midnight, talking with local and national media. The next day she toured the site with the sheriff and gathered updates about the smoke risk, evacuee status, and steps for cleanup. Next up: a press conference.

“As I learned in training, I thanked the responders,” says Brand. “I also thanked the public and media for respecting the law enforcement boundaries at the site.”

Brand says the MERET training provided her with the skills to create an informative press release that didn’t cause panic. It also made her a confident public spokesperson.

“I had many residents thanking me for representing Clearwater County intelligently, and, in fact, I received compliments from the press about doing a good job,” says Brand. “Thank you for providing this training, and may we never have to use it again.”

To learn more about MERET, a joint effort of the School of Public Health and School of Nursing, go to http://cpheo.sph.umn.edu/cpheo/meret.

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SCHOOL NEWS SPH Faculty Take Top Awards J. Michael Oakes has been named a McKnight Presidential Fellow by the University of Minnesota.

The McKnight Presidential Fellowship is awarded to the University’s most promising midcareer faculty to recognize their accomplishments and support their ongoing research and scholarship. In recent years, Oakes has become a noted expert J. Michael Oakes in the emerging field of social epidemiology, the examination of how society affects and is affected by the health of populations. In 2006, he co-authored one of the first textbooks on the subject.

Michael Osterholm has received the State Excellence in Public Health Award from the Association of State and Territorial Health Officials. The award recognizes outstanding service on behalf of the public health community at both the state and national levels. Osterholm was honored for his outstanding leadership in public health over the Michael Osterholm past 30 years. He is an international leader on global preparedness for an influenza pandemic.

Osterholm directs the Center for Infectious Disease Research and Policy.

Vernon Weckwerth has received the Award for Global Engagement from the University of Minnesota Office of International Programs.

The award is given to faculty and staff members in recognition of outstanding contributions to global education and international programs in their field. Weckwerth was honored for his life’s work to improve the delivery of health Vernon Weckwerth services throughout the world. A pioneer in the field of global education, he developed the University’s ISP Executive Study Programs in health care administration in 1969, the first program of its kind.

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University of Minnesota School of Public Health

SPH Launches Health Disparities Concentration The School of Public Health has launched an interdisciplinary concentration (similar to a minor) in health disparities. Now SPH students who are pursuing a Master of Public Health can enrich their degree with this secondary area of study.

The health disparities concentration examines the unequal burden of health risk, illness, and mortality experienced by minority cultural and social groups in the United States. The program also looks at inequalities in care and the barriers to care faced by various U.S. populations.

Addressing health disparities has become a growing area of importance nationally. A central goal of the federal initiative Healthy People 2010 is to achieve optimum health for all segments of society. But the subject is also a concern in Minnesota.

“Despite Minnesota’s ranking as one of the nation’s healthiest states, it has some of the largest health disparities in the country,” says Kathleen Thiede Call, who along with Jean Forster, serves as co-director of the health disparities concentration.

Minnesota is also home to 11 sovereign American Indian nations and a population of immigrants that more than doubled in the 1990s.

Students work with an academic advisor to select courses and fieldwork that fit with their learning and career goals.

A minimum of 12 credits is required for the concentration.

The health disparities concentration joins three other interdisciplinary concentrations offered by the school. Those include global health, public health policy, and complementary and alternative medicine.

To learn more about SPH interdisciplinary concentrations, go to www.sph.umn.edu/education/inter. To learn about the Health Disparities Working Group, go to www.sph.umn.edu/faculty/research/hdwg.html.

Daniel Zismer to Head ISP Program Daniel Zismer was named director of the School of Public Health’s ISP Executive Study Programs in health care administration. He has also been appointed as associate professor in the school’s Division of Health Policy and Management.

Daniel Zismer Zismer comes to the University with a 25-year history in health care delivery.

Most recently, he served on the senior leadership team of Essentia Health, a multi-state health system headquartered in Duluth, Minn. Zismer takes the role that ISP founding director Vernon Weckwerth held for more than 30 years.

The ISP program enhances health care leadership throughout the world by engaging top-level health care executives who are unable to take time away from their professional careers to attend an on-campus educational program. The curriculum is offered almost entirely off campus, under the philosophy that networking in the student’s home region is of the utmost value. ISP alumni include hospital CEOs and national health ministers.

SPH Calls for Entries in PSA Contest The School of Public Health invites entries for the second annual “Beautiful People,” a PSA advocating “It’s Global” Public organ donation, won the 2007 contest.

Service Announcement (PSA) contest.

The contest allows amateur and professional filmmakers to showcase their work while making a statement on global public health topics, such as pollution, nutrition, refugee health, climate change, clean water, infectious disease, and preparing for natural disasters. Entrants will get to test their talent as they describe a public health problem, identify a potential solution, and present a clear call to action.

PSAs, due by March 17, must be 30 seconds or less (without credits).

Select entries will be showcased at the National Public Health Week Film Festival (see page 17) on Monday, April 7, WEB EXTRA WEB EXTRA and a $500 first-place prize will be awarded.

For more information, go to www.sph.umn.edu/psa or WEB EXTRA e-mail film@umn.edu.

To see last year’s PSA entries go to WEB EXTRA www.sph.umn.edu/psa.

WEB EXTRA

SCHOOL NEWS

SPH Dean John Finnegan, right, speaks during a panel discussion in Bangalore, India. Panel members include Frank Cerra, senior vice president for health sciences at the University of Minnesota, and Thomas Kalam, director of the St. John’s National Academy of Health Sciences, site of the discussion.

U Delegation Visits Partners in India SPH Dean John Finnegan was part of a delegation from the University’s Academic Health Center (AHC) that returned to India last October to advance the school’s research and education partnerships.

The first stop was New Delhi, where Finnegan, Frank Cerra, senior vice president for health sciences, and a team of AHC researchers met with the Indian Council of Medical Research (ICMR), India’s equivalent of the U.S. National Institutes of Health. The University of Minnesota has an agreement to pursue joint research projects with the ICMR. A scientific symposium highlighting the two institutions’ research was followed by a meeting of ICMR and University steering committee members who discussed future research initiatives. Researchers from both institutions were encouraged to partner on proposals to be considered by the steering committee this spring.

The next stop was Bangalore, India’s high-tech hub. The University team met with researchers at St. John’s National Academy of Health Sciences and discussed joint projects in environmental health and cardiovascular disease prevention.

They also met with legendary Indian heart surgeon Devi Shetty at his mega-hospital, Narayana Hrudayalaya.

The final stop was the city of Manipal, situated along the Arabian Sea on India’s southwestern coast. There, progress was made in establishing a joint Master of Public Health degree program with Manipal University.

“I am delighted with the progress we are making with our partners in India,” says Finnegan. “The public health challenges in India are immense, and we are committed to pursuing research and education partnerships to build that country’s public health capacity, advance our understanding of disease, and improve the health of its citizenry.”

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STUDENT NEWS

With scale in hand, Katie Seitz is ready to launch the UMPD Biggest Loser competition.

Minnesota Viking Ben Leber cheers on vaccination efforts at the University of Minnesota Children’s Hospital, Fairview.

Photo: Paula Keller

UMPD Officer Challenges Coworkers to Lose Big

SPH Student Teams up with Vikings to Fight Flu

For the past five years Katie Seitz has made campus a safer place through her work as an officer with the University of Minnesota Police Department (UMPD). Now she’s hoping to make it a healthier place by launching the UMPD Biggest Loser weight-loss competition.

Seitz modeled the competition on the Biggest Loser television show in which teams compete to drop the largest percentage of body weight. For the UMPD game, each participant pays $25 toward a kitty to be awarded to the winning individual and team. Winnings could be big, considering that the four-month competition is open to some 45 officers as well as other UMPD workers.

Obesity in the police force is a subject that Seitz has studied as a student in the Public Health Certificate in Core Concepts program. Designed for working professionals, most of the program’s coursework is online. “I love the flexibility,” says Seitz, who works the nightshift. “I can do schoolwork on my own time.”

After getting her certificate this spring, Seitz plans to apply her credits toward a Master of Public Health. Working on the certificate has shown her the valuable connections between police work and public health.

“When I first started my coursework, I had no idea of the strong correlation between law enforcement and public health,” says Seitz, who cites mental health, suicide, homelessness, and alcohol use as some of the shared issues. “The things I learn in school relate to what I see on the job.”

As a practicing infectious disease specialist in the University of Minnesota’s Department of Pediatrics, Mark Robien is familiar with the importance of giving kids an annual influenza vaccination. Now with a grant from the Minnesota Vikings, the epidemiology student is launching a three-year campaign aimed at vaccinating children.

Robien, along with his colleague Patricia Ferrieri, is focusing on two at-risk populations. The first are Twin Cities children from families who often face barriers to health care. The second are households undergoing a bone marrow transplant or other long-term treatments at the University. “Families come here from around the world to get transplants,” explains Robien. “They may not have insurance or they may not have an established physician for the members of the family who aren’t receiving a transplant.”

Vikings linebacker Ben Leber was on hand at a kickoff event where vaccines were offered to family members. Next up: working with neighborhood clinics to deliver vaccines. “We plan to vaccinate at least 6,000 medically and socioeconomically vulnerable kids in the next two and a half years,” says Robien.

Robien and Ferrieri also plan to analyze existing health care data to develop a big picture of household flu immunization— what socioeconomic and medical factors influence it and how many households are fully immunized.

Robien hopes to add scientific findings to the emerging theory that vaccinating children is key to curbing influenza outbreaks. “It’s highly possible that kids are a major determinant of the flu and that they sustain it in the community,” says Robien. “But there’s very little data to support this.

We’re hoping to help change that.”

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University of Minnesota School of Public Health

PHILANTHROPY

New Alumni Board Puts the Spotlight on Scholarships Photo: Richard Anderson

What’s important to alumni of the School of Public Health?

Students.

Alumni and other public health professionals in Minnesota have been helping students gain valuable real-world experience through the SPH’s mentor program for more than a decade.

But now the school’s newly formed Alumni Society Board is asking alumni to support students’ educational pursuits by contributing to the SPH Alumni Scholarship.

“The amount of student scholarship support we have at this school is really not where it needs to be to continue to attract the best and brightest students who will become the public health professionals of the future,” says Judy Beniak (M.P.H. ’81), chair of the alumni board.

And given increasing tuition costs, Beniak says the board hopes that new gifts to the SPH Alumni Scholarship will help reduce financial barriers for students considering careers in public health.

Alumnus Brian Osberg (M.P.H. ’86) has been a leader in that charge. He and his wife, Jean Marie Hamilton, last fall donated $10,000 to the scholarship fund.

Osberg, who majored in public health administration, has worked in both the public and private sectors in his 35 years in the field. He has served for the past six years as

SPH Alumni Society Board. Front row, from left: Linda Olson Keller, Gizaw Tsehai, Brenna Vuong, Cynthia Kenyon, Mary Kay Hunt, Brigid Riley. Back row: Judy Beniak, Richard Person, James Anderson, Amos Deinard, Mary Sheehan, An Liu. Not pictured: Cecilia Amor Kramer, Michael Trujillo, Gita Uppal.

15

Photo: Tim Rummelhoff

Brian Osberg and Jean Marie Hamilton

assistant commissioner of health care at the Minnesota Department of Human Services, where he is responsible for buying health care for more than 650,000 of the state’s most vulnerable people: children, the elderly, and the disabled.

Osberg is excited by the prospect of helping students advance in their own careers in this important line of work.

“We wanted to give back to the school, by and large, because it’s the primary reason I was able to have a successful career in health policy and management,” Osberg says. “It’s allowed me to be in a position to perform public service at the state level and do something that is very rewarding.”

To involve more alumni in the school’s efforts, the SPH is hosting an Alumni and Friends Scholarship Gala on April 10 as part of National Public Health Week (see page 17).

The evening’s celebration includes a social hour, dinner, and keynote speech by former U.S. Surgeon General Richard Carmona.

Event proceeds will benefit the SPH Alumni Scholarship fund. The school’s Alumni Society Board hopes to raise enough money to apply for the President’s Scholarship Match, a University-wide program that matches scholarship payout dollars, doubling the impact for students.

For more information about the Alumni and Friends Scholarship Gala or to purchase tickets, visit www.mmf.umn.edu/sph/nphw.

ALUMNI NEWS Mercy Health System Wins Baldrige Award Mercy Health System has received the Malcolm Baldrige Quality Award for 2007. The award, given by the U.S. Department of Commerce, is the nation’s Presidential honor for quality. This is the third organization led by an SPH alumnus to win the Baldrige award.

“It is a great honor to receive this prestigious award,” says Javon Bea (M.H.A. ’78), president and CEO of Mercy Health System. “It celebrates our strength as a system and recognizes our unwavering commitment to organizational excellence.”

Headquartered in Janesville, Wis., Mercy is a nonprofit, multi-specialty health system that serves more than one million indi- Javon Bea viduals through 63 facilities in 24 southern Wisconsin and northern Illinois communities. The system includes three hospitals, 285 physicians, a homeless center, and an insurance company.

“Javon is a wonderful supporter of the Master in Healthcare Administration (M.H.A.) program, especially through his recruitment of young talent from our program through his organization’s fellowships,” says SPH associate professor Sandy Pothoff, major chair for the M.H.A. program.

Several SPH alumni work for Mercy Health System, and two current M.H.A. students have accepted fellowships with the organization beginning this summer.

Two other SPH alumni have won the Baldrige award. The 2006 award went to the Premier Inc. health care alliance, led by Richard Norling (M.H.A. ’75). The 2003 award went to Saint Luke’s Hospital of Kansas City, led by Richard Hastings (M.H.A. ’77).

Class Notes Patricia Adams (M.P.H. ’85) was appointed assistant commissioner of health for the Minnesota Department of Health, where she is responsible for overseeing the department’s Community and Family Health Promotion Bureau.

Mark Dixon (M.H.A. ’84) was named president and CEO of Community Health Network, a nonprofit health system based in Indianapolis, Ind. David Fine (M.H.A. ’74) received an honorary degree from the University of Southern Mississippi. Since 2004, Fine has served as president and chief executive officer of St. Luke’s Episcopal Health System in Houston, Tex. Christopher Karam (M.H.A. ’92), president and chief executive officer of Christus St. Michael Health System in Texarkana, Tex., has been elected to a three-year term on the board of trustees for the Texas Hospital Association.

Nurudeen Olaniran (M.S. ’78, Ph.D. ’79) is a senior lecturer in public health at the University of Calabar in Nigeria.

Nancy Omondi (M.S. ’07) has been accepted into the Emerging Leaders Network, a yearlong training program designed to strengthen public health leadership in Minnesota.

Gaynell Schandel (M.P.H. ’79) was appointed chief financial officer of the Minneapolis Police Department.

Schandel has been with the City of Minneapolis since 1986, holding positions in the health department, city coordinator’s office, and police department.

Karla Weng (M.P.H. ’02), a program manager at Twin Citiesbased Stratis Health, was named a Rural Health Fellow by the National Rural Health Association, a national nonprofit organization that provides leadership on rural health issues.

Connect to the SPH! Share news, join the alumni networking directory, and subscribe to alumni news e-mails at www.sph.umn.edu/alumni.

16

University of Minnesota School of Public Health

NATIONAL PUBLIC HEALTH WEEK

SPH Hosts Annual Film Festival

Richard Carmona speaking at SPH commencement in 2006.

Carmona to Keynote SPH Alumni and Friends Scholarship Gala Photo: Bill Alkofer

Richard Carmona, 17th surgeon general of the United States (2002-2006), will deliver the keynote address for the first-ever School of Public Health Alumni and Friends Scholarship Gala on April 10.

Carmona is a distinguished professor of the Zuckerman College of Public Health at the University of Arizona. He is also president of the Canyon Ranch Institute and chairman of Canyon Ranch, an award-winning facility that promotes healthy living.

All SPH alumni are invited to the gala and to two other reunion-themed events scheduled for the same day. The first two events are free to attend. The SPH Alumni Society’s reunion kickoff will take place at 3 p.m. Major-specific social hours will begin at 5 p.m. And the Alumni and Friends Scholarship Gala featuring Carmona is scheduled for 6 p.m.

“The hope is that our alumni will ‘come home’ to connect with classmates, faculty, and staff,” says Michelle LianAnderson, director of alumni relations for the SPH. “The reunion is also an opportunity to hear from our newly re-established Alumni Society Board.”

The gala is designed to support the next generation of public health leaders by raising funds for SPH students.

Proceeds from ticket sales for the fundraiser will go toward the creation of new alumni scholarships. The goal is to build an endowment to provide scholarships for each of the school’s academic majors (see page 15). Tickets are $55, but attendees are encouraged to donate more.

All three events will be held at the Nicollet Island Inn and Nicollet Island Pavilion in Minneapolis. To purchase gala tickets, or for directions and parking information, go to www.mmf.umn.edu/sph/nphw.

Sex education, oil dependence, and global health are some of the topics to be featured in the School of Public Health’s fourth annual film festival.

This year’s event promises to be educational, entertaining, and thought provoking.

Hosted in conjunction with National Public Health Week, the festival begins on Monday, April 7 and concludes on Friday, April 11. The week’s events begin at 5:30 p.m. in the Mayo Memorial Auditorium on the East Bank of the University’s Twin Cities campus.

One of the films to be shown is ¡Salud!, which examines how the cash-strapped country of Cuba has what some experts refer to as one of the world’s best health systems.

Also to be screened are three segments of Unnatural Causes, a new PBS documentary that examines America’s socioeconomic and racial inequities in health. The documentary A Crude Awakening: The Oil Crash tells the story of how our civilization’s addiction to oil puts it on a collision course with geology. Festival organizers are proud to showcase SPH alumnus Jim Winkle’s (M.P.H. ’07) documentary Sex Ed and the State, a look at Minnesota’s state legislature and the fate of a comprehensive sexuality education bill.

Winners of the school’s second annual “It’s Global” Public Service Announcement (PSA) contest will be screened the first night of the festival. The contest invites filmmakers to create a 30-second PSA focused on a global health topic. For more on the contest, see page 13.

The film festival is free and open to the public. For more information, including a full listing of film descriptions, screening times, and directions to the theater, visit www.sph.umn.edu/filmfest08. City Pages is the exclusive media sponsor of the film festival.

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Upcoming Events

Next Issue

National Public Health Week Film Festival

Superproductive!

April 7-11 Mayo Memorial Auditorium, Twin Cities campus

In 2007, the SPH generated $92 million in extramural research, making the school’s 102 faculty members one of the most productive public health research teams in the country.

SPH Reunion-Themed Events

SPH SP H

April 10 • 3 p.m. SPH Alumni Society Reunion Kickoff • 5 p.m. Major-Specific Social Hours • 6 p.m. Alumni and Friends Scholarship Gala, Featuring 17th U.S. Surgeon General Richard Carmona Nicollet Island Inn and Nicollet Island Pavilion, Minneapolis

SPH Commencement May 19, 5 p.m.

Featuring Minnesota Commissioner of Health, Sanne Magnan Northrop Memorial Auditorium, Twin Cities campus

Public Health 24/7 Access a wealth of public health research, lectures, blogs, and more at www.sph.umn.edu.

Public Health Institute May 27-June 13 Featuring new courses, including: • Public Health Accreditation Review • Globalization and Health • Leadership for Change • The Politics of Policy: Turning Good Ideas Into Better Health University of Minnesota, Twin Cities campus

More information on these and other events can be found at www.sph.umn.edu/about/news.

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