Updated: January 23, 2013
December 17, 2009: U.S. FDA recommendations debate —
Lee A. Green, M.D., M.P.H., professor, is concerned about a “U.S. Food and Drug Administration panel's recommendation that some adults with no prior heart problems should take the “cholesterol-busting” statin Crestor” (other statins may be available also). In detail, those people over 50 (in men) and 60 (in women) with an elevated blood level of an inflammation marker known as C-reactive protein, or CRP, would be eligible. Among other family physicians that disagree with cardiologists interviewed, Dr. Green states that “…extending it (to a larger population) would most certainly be bad science and bad patient care." View ABC News Health story online
December 17, 2009: Cancer Screening Guidelines — Mack T. Ruffin IV, M.D., M.P.H., professor, quoted in his defense of his agreement with new federal recommendations that discourage screenings for breast cancer, prostate cancer and pap smears in people that have not reached a certain age (as compared to earlier ages advised previously). Cancer survivors are upset by the new guidelines. Article appears in the online Health Section of The Detroit News.
December 17, 2009: Screening for Depression with Acute MI Patients — Donald E. Nease Jr., M.D., associate professor, writes an editorial on the benefit of guidelines written to encourage family practice physicians to screen for depression in patients with post Myochardial Infarction (MI). He served on a panel that convened to initiate this guideline upon the request by the AAFP Commission on Public Health and Science’s for an evidence review from the Agency for Healthcare Research and Quality. Editorial appears in Am Fam Physician 80(9):917, titled “Depression in Post-MI Patients: An Opportunity for Primary Care.”
December 17, 2009: Hawthorn treatment of chronic heart failure — Suzanna M. Zick, N.D., M.P.H., research assistant professor, led a study to learn whether administration of Hawthorn would increase submaximal exercise capacity when added to standard medical therapy for those with heart failure. Secondary outcomes were also examined. Findings were reported in the European Journal of Heart Failure’s November issue, titled “Hawthorn Extract Randomized Blinded Chronic Heart Failure (Herb CHF) Trial.”
December 16, 2009: Residency Training within Family Medicine — Results of a needs assessment survey developed to guide curriculum design incorporating a core Integrative Medicine curriculum in residency training in family medicine are presented and discussed in a journal article written by lead author Rita K. Benn, Ph.D., and others. The article is titled “Integrative Medicine in Residency: Assessing Curricular Needs in Eight Programs” and appears in the November-December issue of Family Medicine (Fam Med 41(10):708-14).
December 3-4, 2009: 18th Annual Primary Health Care of Women Conference held at the Towsley Center in Ann Arbor, Michigan. The event was hosted by the Departments of Family Medicine and Obstetrics and Gynecology.
Margaret A. Riley, M.D., lecturer — “Evidence-Based Health Maintenance in Women.”
Karen L. Musolf, M.D., assistant professor, & Caroline L. King, M.D., lecturer — “Vitamin D & Osteoporosis Case Studies.”
Caroline L. King, M.D. — “Vitamin D: Importance in Women’s Health.”
Karen L. Musolf, M.D. — “Screening Guidelines for Osteoporosis.”
Mack T. Ruffin, IV, M.D., M.P.H., professor — “Update on HPV Vaccinations.”
Sara L.Warber, M.D., associate professor — “Holistic Benefits of Time Spent in Nature.”
Amy B. Locke, M.D., assistant professor — “ Integrative Medicine Approach to Common Office Problems.”
December 1, 2009: Cardiology Research — Data from late-breaking clinical trials presented at several national and international meetings were considered important enough to prompt a focused update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction and the ACC/AHA 2005 Guidelines for Percutaneous Coronary Intervention. As the AAFP's representative on the STEMI panel, Lee A. Green, M.D., M.P.H., professor, met with colleagues from the ACC and AHA to consider the new data, evaluate its impact on the guidelines, and draft the revisions.
The results appear in the following journals: Circulation 120(22):2271-306, 2009. [Epub Nov 18]; Catheter Cardiovasc Interv 74(7):E25-E68, 2009. [Epub ahead of print]; and J Am Coll Cardiol 54(23):2205-41, 2009.
November 30, 2009: Gastroenterology — A systematic review of the literature was conducted by Joel J. Heidelbaugh, M.D., associate professor, to evaluate the most rigorous studies linking the potential risk of Proton Pump Inhibitor (PPI) therapy with adverse events. The article is titled “Adverse risks associated with proton pump inhibitors: A systematic review” and appeared in Gastroenterology and Hepatology 5(10):725-734, 2009.
November 14-18, 2009: 37th NAPCRG Annual Meeting in West Montreal, Quebec, Canada.
Michael D. Fetters, M.D., M.P.H., M.A., associate professor — “What Computer Games Do Medical Students Like And Why? Results of a Qualitative Assessment," and co-presenting a preconference workshop entitled, “Mixed Methods Research: Introduction, Research Questions, Study Design And Implementation.”
Caroline Richardson, M.D., associate professor — co-presenting “Workshop: Maybe It's The Egg?: A Dialogue Between Researchers and Chairs About Family Medicine Research, and How to Work, Survive and Thrive Together.”
Donald E. Nease, Jr., M.D., associate professor — “Long-term Sustainability of Depression Care Improvements Following an Improvement Collaborative Emphasizing Practice Change.”
Dr. Nease also led a presentation on this subject titled “The overlap of depression and anxiety with unhealthful behaviors in primary care”in which he concludes that unhealthy behaviors and mood disorders are often found within the same patients and recommends interventions targeting multiple health behaviors and integrating approaches that address mood disorders.
Masahito Jimbo, M.D., Ph.D., M.P.H., associate professor — “Women Adhere Less Often than Men to Physician Recommendation for Complete Diagnostic Evaluation.”
Michael S. Klinkman, M.D., M.S., associate professor, led apresentation with other authors titled “Progress in building a community-academic partnership: The greater Flint depression in primary care partnership.” Dr. Klinkman also led a presentation titled “Impact of an electronic medical record (EMR) intervention on diagnosis and follow-up of depression in primary care: A national network study,” where the researchers concluded that “EMR-based PHQ-9 scores and prompts led to increased diagnosis and improved follow-up for new episodes of depression in primary care.”
November 16, 2009: Menís Health — Joel J. Heidelbaugh, M.D., associate professor, presents and discusses implications for case study of a 31-year-old man who presents to a urologist for the evaluation of chronic right testicular pain (orch-ialgia) and treatment options for this patient in an article titled ďAcademic menís health: Case studies in clinical practice: Chronic orchialgia.Ē Article appeared in Journal of Menís Health 6(3):220-5, 2009.
November 16, 2009: Disability Week — Philip Zazove, M.D., professor, was on a panel at the Michigan Union in October for the U-M’s Disability Week talking about hearing loss and ways of dealing with it. Dr. Zazove noted that “The biggest impact is, and always has been, communication with society. There’s also the negative perceptions and putdowns that people with hearing loss always experience, and the barriers that are put up by society.” In addition, some discussion focused on “The importance of persistence - i.e., persisting in one's endeavors often leads to success despite the barriers.”
November 15, 2009: Evidence-based Medicine — Joel J. Heidelbaugh, M.D., associate professor, presented “Evidence-Based Management of Sexual Dysfunction” at the American Academy of Family Physicians Scientific Assembly in Boston, Mass. on October 17, 2009.
November 14, 2009: Men's Health — Joel J. Heidelbaugh, M.D., associate professor, in October presented a workshop titled “How to establish a men’s health centre” at the 6th World Congress on Men’s Health in Vienna, Austria.
October 29, 2009: Balint president visits Australia
Don Nease, M.D. will travel to Sydney Australia on November 3 to meet with the Balint Society of Australia. He is the current president of the American Balint Society.
October 20, 2009: New Clinical Project in Qatar — A new international research investigation has begun under the leadership of Michael D. Fetters, M.D., M.P.H., M.A., associate professor, and Maya Hammoud, M.D., associate professor, Obstetrics and Gynecology. Dr. Fetters states the grant grew out of a need for “culturally and linguistically specific tools … to generate data to understand health care quality in Qatar and make international comparisons.” This $1 million dollar, three-year project was funded by the Qatar National Research Fund, the national research organization in Qatar that is equivalent to the NIH in the US. The multimember US team is partnering with colleagues from the Weill Cornell Medical College-Qatar and Hamad Medical Corporation to develop the multilingual instrument.
This work is in keeping with the efforts of several U-M family medicine faculty who are concerned about the need for improved health care quality internationally as well as domestically, and as a result have worked abroad in Japan, Ecuador, Jamaica and Ghana, as featured in the last three department newsletters.
Through collaboration with other U-M investigators with interests in Arab and Muslim health issues, the assembled project team draws on a growing expertise at the U-M Health System. The research team will develop a health care quality assessment tool based in part on the Consumer Assessment of Health Plans Survey that was developed with support from the Agency for Healthcare Research and Quality (AHRQ). The resulting instrument will be culturally and linguistically adapted for Qatar using four languages commonly spoken in Qatar, namely, Arabic, English, Hindi, and Urdu. The product of this research will be a multilingual, standardized health care quality assessment tool that can be used to improve health care quality in Qatar and make international quality comparisons.
October 20, 2009: Clinical decision-making research — Lee A. Green, M.D., M.P.H., professor, Michael S. Klinkman, M.D., M.S, associate professor, and Donald E. Nease, Jr., M.D., associate professor, to speak on “Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Do Not Produce ‘Reminder Fatigue’” at the 31st Annual Meeting of the Society for Medical Decision Making in Los Angeles, CA.
October 19, 2009: Health Behavior and Epidemiology Research
Mack T. Ruffin, IV., M.D., M.P.H., professor, is among authors whose study results "...provide insight into the prevalence of Appalachian self-identity and further our knowledge about what it means to be “Appalachian.” The authors state that “If Appalachian self-identity is shown to affect health and health behaviors in future research, the results presented… could then be applied in designing health intervention programs aimed at reducing health disparities among Appalachian residents.“ The Appalachian self-identity article is available at:http://www.marshall.edu/jrcp/ ; is titled “Appalachian self-identity among women in Ohio Appalachia,” and appears in the Journal of Rural Community Psychology E12(1), 2009.
October 19, 2009: Article on Bacterial Pneumonias During Influenza Pandemic — Co-author Phillip E. Rodgers, M.D., assistant professor, and others …”summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize [their] committee’s guiding principles for allocating antibiotics during a pandemic.” The title of the journal article referred to is “Bacterial Pneumonias during an Influenza Pandemic: How Will We Allocate Antibiotics?” and appears in Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, Volume 7, Number 3, 311-16, 2009.
October 19, 2009: Article on Pandemic Influenza and Acute care Centers — Co-author Phillip E. Rodgers, M.D., assistant professor, outlines how the University of Michigan Health System (UMHS) has made plans to set up an Acute Care Center in case of a world-wide influenza pandemic and encourages other health systems to do the same in an article titled, “Pandemic Influenza and Acutecare Centers: Taking Care of Sick Patients in a Nonhospital Setting,” featured in Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science,” Volume 6, Number 4, 335-49, 2008.
October 15, 2009: Women’s Health — Mack T. Ruffin, IV, M.D., M.P.H., professor, to give talk on “HPV” at the Ob/Gyn Grand Rounds at St. Joseph Mercy Hospital in Ypsilanti, Michigan.
October 15-16, 2009: Update in Family Medicine Conference — to be held at Kensington Court in Ann Arbor, Michigan.
CME Presentations include:
Catherine M. Bettcher, M.D., lecturer — “Common Ambulatory Problems in Pregnancy” and “Case Examples of Outpatient Problems in the Pregnant Patient.”
Ebony C. Parker-Featherstone, M.D., resident — “Perimenopause: Case Studies.”
Barbara D. Reed, M.D., M.S.P.H., professor — “Vulvodynia."
Joel J. Heidelbaugh, M.D., associate professor — “Testosterone Replacement Update” and “Case Studies on Testosterone Replacement.”
Laurie J. Legocki, Ph.D., post-doctorate fellow — "Vaginitis."
Eric P. Skye, M.D., assistant professor — “Which Mole to Biopsy?” and “Procedures in Dermatology.”
Hobart H. Lee, M.D., lecturer — “Update on Information Technology” and “Case Studies Utilizing Information Technology.”
Caroline L. King, M.D., lecturer — “Vitamin D: The Sunshine Cure?” and “Vitamin D Deficiency: Screening and Treatment.”
Anne L. Kittendorf, M.D., assistant professor — “Evidence-Based Update on PCOS” and “PCOS: Case Studies.”
See the U-M Medical School CME website for more information about these presentations.
October 14, 2009: Grand Rounds — Evaluation of Hematuria
Masahito Jimbo, M.D., Ph.D., M.P.H., associate professor, presented “Evaluation of Hematuria: When to work up, when to refer” at the University of Michigan Health System (UMHS) Family Medicine Grand Rounds in Ann Arbor, Michigan.
October 14, 2009: Sports Medicine for the Primary Care Physician conference to be held at Kensington Court in Ann Arbor, Michigan.
CME presentations include:
Robert B. Kiningham, M.D., M.A., associate professor — “Musculoskeletal Injuries Through the Lifespan,” an “Update on the Pre-Participation Exam,” and “Dermatologic Conditions in Athletes.”
Amy M. Bohn, M.D., assistant professor — “Special Concerns of Female Athletes.”
Caroline R. Richardson, M.D., associate professor — “Office Promotion of Exercise.”
Taranum A. Master-Hunter, M.D., assistant professor — “An Evaluation of Foot and Ankle Injuries.”
Thomas L. Schwenk, M.D., the George A. Dean, M.D., Chair of Family Medicine — “Supplements and Ergogenic Aides.”
See the U-M Medical School CME website for more information about these presentations.
October 8, 2009: Clinical Research — Feedback critical in online clinical trials. Findings show it may be beneficial to provide personalized feedback to potential participants indicating their status in a complex multi-step enrollment process for an online clinical trial, according to co-author Caroline R. Richardson, M.D., associate professor. See article entitled “Barriers encountered during enrollment in an internet-mediated randomized controlled trial,” written by Buis LR, Janney AW, Hess ML, Culver SA, Richardson CR in Trials ;10(1):76, 2009. [Epub ahead of print]
October 6, 2009: Clinical Decision-making — Donald E. Nease, Jr., M.D., associate professor, presented “Decision Support: Using Guidelines and Specialist Interactions” at the Michigan IPIP: Learning Collaborative #2” meeting in Lansing, Michigan September 23, 2009.
October 6, 2009: Women's Health — ISSVD World Congress & Post Graduate Course in Edinburgh, Scotland September 11-17, 2009. Presentations include:
Laurie J. Legocki, Ph.D., post-doctorate fellow, James E. Aikens, Ph.D., associate professor, and Barbara D. Reed, M.D., M.S.P.H., professor, presented on “Sexual function questionnaire interpretation among women with and without vulvodynia.”
Barbara D. Reed, M.D., M.S.P.H., professor, gave presentation entitled, "World Congress: Workshop on research needs in managing localized provoked vulvodynia” and a Post Grad Course entitled “Presentation on Prevalence of VVD."
October 5, 2009: Health Information Technology Presentation —
Michael D. Fetters, M.D., M.P.H., M.A., associate professor, presented a talk entitled, “Chronic Disease Management using Health Information Technology: Friend or Foe for Free Clinics” at the Free Clinics of the Great Lake Region conference in Detroit, Michigan.
October 5, 2009: Visiting Professorship in Japan
In September 2009, Masahito Jimbo, M.D., Ph.D., M.P.H., gave a five-day visiting professorship consisting of lectures, hospital rounds, outpatient precepting, and case presentations for the faculty, residents, and students at Saint Marianna University School of Medicine in Kawasaki, Kanagawa, Japan.
September 30, 2009: Clinical Research in Depression — Co-author Donald E. Nease Jr., M.D., associate professor is among those whose primary care study findings support the thesis that successful quality improvement efforts [for depression care] should address both clinical content and change processes. Article is titled, “Integrating practices' change processes into improving quality of depression care.” Results can be found in Jt Comm J Qual Patient Saf 35(7):351-7, 2009.
September 11, 2009: Sports Medicine — Catastrophic injuries rise in young female cheerleaders.
September 10, 2009: Physical Activity Research — In an eight-week, Internet-mediated physical activity intervention at the U-M, Caroline Richardson, M.D., associate professor, was among authors that learned that “focus on physical activity logging and goal setting while incorporating team competition may help a significant percentage of the target population maintain their physical activity during the winter months.” Article is entitled, “Evaluating Active U: An internet-mediated physical activity program” and co-authored by Buis LR, Poulton TA, Holleman RG, Sen A, Resnick PJ, Goodrich DE, and Palma-Davis LV. It was published in the September 10th issue of BMC Public Health 9:331, 2009.
September 1, 2009: Cancer Screening — According to the ABC News Medical Unit, two studies released on August 30th, one looking at prostate cancer and the other at breast cancer, appearing in the Journal of the National Cancer Institute, show that increased screening brings false positives and sometimes unnecessary treatment. "The fact that it is a surprise to so many physicians and so many patients is a symptom of the debate taking place now regarding health care reform," said Thomas L. Schwenk, M.D., the George A. Dean, M.D. Chair of Family Medicine, commenting on the prostate cancer study. He added that there is data showing that “doing more can cause harm.”
September 30, 2009: Clinical care presentation in Japan — Michael D. Fetters, M.D., M.P.H., M.A., associate professor, presented “Abdominal Pain in Outpatient Care: Skills for a Patient-Centered Physical Examination” for the Japan Academy of Family Medicine at the Iwata City General Hospital in Shizuoka, Japan on August 24, 2009.
August 27, 2009: Women’s Health — Barbara D. Reed, M.D., M.S.P.H., professor, responds to editorial by Dr. Grame J. Dennerstein, F.R.C.O.G., F.R.A.N.Z.C.O.G., in letter challenging Dennerstein’s assertion that “Vulvodynia” is a symptom, asserting that it is in fact a diagnosis. Response published in the Journal of Reproductive Medicine 54:529, 2009.
August 18, 2009: Primary Care Psychiatry
James E. Aikens, Ph.D., associate professor, spoke on “Office Management of Anxiety Disorders” at the Department of Family Medicine Resident Conference at the U-M.
August 3, 2009: Health care disparity for deaf patients — A special feature relates the story behind the success of Dr. Philip Zazove, and focuses on his article on difficulty of communication deaf persons have with their physicians. “Deaf persons have been found to be the non-English speaking minority at greatest risk for miscommunication with their physicians,” according to Philip Zazove, M.D., professor, whose story of his success in becoming a physician and other achievements, in spite of his being deaf, is shared in a special article appearing in the Medicine at Michigan, Summer 2009 publication. In addition, he states, “If we can help this group, there’s potential for helping other non-English speaking minorities. People who have a profound hearing loss in general have a lower understanding of how to cope.” View story at: http://www.medicineatmichigan.org/magazine/2009/summer/limelight/
August 3, 2009: Catastrophic Injury in young female athletes — “Cheerleading has become the leading cause of catastrophic injury in young female athletes,” says Amy M. Bohn, M.D., assistant professor, according to a UMHS press release in which she recommended better training for coaching staff. Dr. Bohn is also cited in the U-M University Record August 4th, regarding the alarming rise in serious injuries due to the growing competitive nature of the sport as well as a lack of safety measures. Learn more at: WWJ News Radio, ABC News and the AnnArbor.COM.
August 3, 2009: Clinical research on Type 2 Diabetes — James E. Aikens, Ph.D., associate professor, led researchers in six-month study that found diabetic patients with poor glycemic control had higher chance of experiencing depressive symptoms. He added, “Our findings suggest an opportunity for physicians to more carefully monitor these patients for intensified depressive symptoms, or perhaps to initiate treatment for depression.” This study is considered one of the few longitudinal studies relating glycemic control to depression. The study appears in the American Diabetes Association publication Diabetes Care, volume 32, number 7, pages 1177-1181. Read more about this topic on the Michigan Diabetes Training and Research Center website.
August 3, 2009: Clinical Research on Depression — Authors of article reveal “that nearly all practices that showed the greatest improvement in depression care also used more effective process for change.” Donald E. Nease Jr., M.D., associate professor, among authors of “an exploratory qualitative study [that] was conducted to examine primary care practices’ adoption of effective change processes.” The article titled “Integrating practices' change processes into improving quality of depression care” appears in Jt Comm J Qual Patient Saf, volume 35, issue 7, pages 351-7.
July 21, 2009: McCurry (Residency 1985) is Colorado Family Physician of the Year — A family doctor who has been bestowed with Colorado’s top honor feels he is making a difference in many lives despite practicing in the small town of Cañon City. In fact, he believes that being in a small town is where he can be most helpful.
Robert D. McCurry, D.O. (Residency 1985), has been honored by the Colorado Academy of Family Physicians as the 2008 family physician of the year. The academy represents more than 1,800 doctors in the state. In response, Dr. McCurry said, “It was a very humbling experience.”
Dr. McCurry has been taking care of Cañon City, Colo. patients from infants to nursing home elderly for 16 years. He practiced in Texas before moving to Colorado.
“Some of the things I do that help me feel more of a close connection with a family is having young adults as patients who go on to have their own children and I care for them, and, essentially, I am a part of their family,” McCurry said.
A former fellow family medicine resident, Michael S. Klinkman, M.D., M.S., associate professor (Residency 1985), remembers that “he was a down-to-earth, utterly solid and reliable colleague - even during our residency training, it was clear that he would be a great family doctor. I thoroughly enjoyed working with him. I’m not at all surprised to see him earn this great honor.”
Currently McCurry serves as chair of the ethics committee as well as the pharmacy and therapeutics committee at St. Thomas More Hospital in Cañon City where he has served as chief of staff. He also teaches advanced cardiac life support and since 2004 has been a part-time snowboard and skiing instructor.
July 20, 2009: Cervical Cancer Research — Mack T. Ruffin IV, M.D., M.P.H., professor, is co-author of journal article in which researchers have developed and validated …"a risky sexual behavior index level" from the Community Awareness Resources and Education (CARE) study…for [the benefit of] cervical cancer research.” The article is entitled “Measuring cervical cancer risk: development and validation of the CARE Risky Sexual Behavior Index.”
July 16, 2009: Physical Exercise Research — The “Impact of Adding an Online Community to an Internet Mediated Walking Program” will be highlighted by Caroline R. Richardson, M.D., assistant professor, in the upcoming Center for Health Communications Research (CHCR) monthly seminar at the U-M in Ann Arbor, Michigan.
July 14, 2009: Michael D. Fetters, M.D., M.P.H., M.A., associate professor and James M. Cooke, M.D., residency director and medical co-director of Clinical Simulation Center, are two of three authors whose article entitled “Introduction of block month orientation (in Japanese)” appears in the current issue of the Japanese Academy of Family Physicians (JAFM) 15(1):32-43.
July 14, 2009: Women's Health in Japan - Michael D. Fetters, M.D., M.P.H., M.A., associate professor, is lead author of an article written in Japanese entitled “Why women's health training is needed in Japan,” published in JAFM, appearing in the current issue 15(1):44-51.
July 7, 2009: Connection Found Between Heart Attacks and Depression — Can a heart attack, also known as a myocardial infarction (MI), lead to a case of depression? Worse still, can such an experience of a co-morbid condition (existence of two or more disease processes) increase the risk of a recurrence of an MI? According to the “New Guidelines Issued for Diagnosis and Management of Post-Myocardial Infarction Depression” by the American Academy of Family Physicians, both possibilities certainly are risks and do occur frequently.
As many as 65 percent of patients with acute MI report experiencing symptoms of depression, and major depression is present in 15 to 22 percent of these patients. Because of these statistics, the American Association of Family Practice (AAFP) released new clinical practice guidelines recommending screening for depression regularly and for patients diagnosed with depression to be treated with antidepressant medication, psychotherapeutic counseling or both.
The impact of these guidelines cannot be overstated. In an editorial written in response and recently accepted by Annals of Family Medicine, Donald E. Nease Jr., M.D., associate professor, notes how “there is substantial evidence that post-MI depression is independently associated with [an] increased cardiac [death rate].” Further, lead author of the guideline panel Lee A. Green, M.D., M.P.H., professor, states that “Depression is relatively common among patients recovering from heart attacks, and causes significant suffering. Fortunately, it can readily be diagnosed and treated helping patients to feel better.“
Finally, Dr. Nease notes that “The high prevalence of depression in the post-MI patient highlights the importance of the whole person orientation of family physicians. As continuity providers for patients often during acute hospitalizations for MI and certainly for post hospitalization outpatient care, we are positioned to play an important role in the early recognition and treatment of depression in post-MI patients.“
July 6, 2009:
"Congratulations, Class of 2009!"
Please see the following names and future destinations of Family Medicine’s graduates:
Jennifer B. Clem, M.D. - Indian Health Service Phoenix, Arizona
Laura M. Distel, M.D. - Ohio State University Sports Medicine Fellowship
Miranda S. (McCann) Huffman, M.D. - MetroSouth Medical Center Blue Island, Ill.
Scott A. Kelley, M.D. - University of Michigan Department of Family Medicine Briarwood Family Medicine
Caroline L. King, M.D. - University of Michigan Integrative Medicine Fellowship
Hobart H. Lee, M.D. - University of Michigan Department of Family Medicine Academic Fellowship
Eric E. McLaughlin, M.D. - Tenwek Hospital Bomet, Kenya, Africa
Ebony C. Parker-Featherstone, M.D. - University of Michigan Department of Obstetrics and Gynecology Women’s Health Fellow
Holly E. Ross, M.D. - Packard Road Clinic Ann Arbor, MI
Joshua S. Smith, M.D. - Unconfirmed
July 6, 2009: Search Engine for EMR —“Using a search engine optimized for finding clinical information in the free-text sections of the EMR [Electronic medical records] can provide significant time savings while preserving clinical accuracy,” according to the journal article entitled “Enhanced identification of eligibility for depression research using an electronic medical records search engine.” Article is in press and is now on Int J Med Inform’s website, and co-authored by Donald E. Nease, Jr., M.D., associate professor. See: www.intl.elsevierhealth.com/journals/ijmi
July 2, 2009: Culturally Appropriate Health Care — Michael D. Fetters, M.D., M.P.H., M.A, associate professor, awarded funding for his work in Qatar entitled “Providing Culturally Appropriate Health Care Services in Qatar: Development of a Multilingual “Patient Cultural Assessment of Quality” Instrument.’” He notes that “Culturally and linguistically specific tools are needed in Qatar to generate data to understand health care quality disparities and make international comparisons.”
There are five phases of this project:
Phase 1 – translate Consumer Assessment of Health Plans (CAHPS) into five languages
Phase 2 – conduct qualitative interviews to identify cultural influences and translation dilemmas
Phase 3 – conduct qualitative validity assessment interviews to refine items and produce Q CAHPS
Phase 4 – field test Q CAHPS with patients
Phase 5 – use ANOVA and regression analysis to examine for inter-group variability and differences.
July 2, 2009: Mediterranean Diet Research Award — Zora Djuric, Ph.D., research professor, was awarded funding for her study “A Mediterranean Diet in Colon Cancer Prevention” in which she seeks to employ two students from the Undergraduate Research Opportunities Program (UROP) for the summer of 2009 and two for the summer of 2010 to assist with the parent grant. She notes that “We are also adding Aim 4 to the parent grant, in which we’ll measure the relative effects of two diets on mucosal epithelial cell proliferation using Ki67 labeling assessed with a novel, computer-assisted image analysis protocol.”
June 22, 2009: “Six things patients do that frustrate their doctors…”
Thomas L. Schwenk, M.D. the George A. Dean, M.D. Chair of Family Medicine, and Lee A. Green, MD, MPH, professor are quoted in ABC news article entitled “Six things patients do that frustrate their doctors: Things patients do that drive their doctors crazy, and how to break the cycle.” For instance, Dr. Green commented, “"The most frustrating thing for me is patients whose lifestyle is making them miserable but they won't change it," Green noted that problems “…such as sleep apnea and chronic tiredness, can be attributed to eating too much and moving too little. In that case, the treatment isn't disease, but ‘lack of health.’ " [It's] people whose knees are killing them, because they're 80 pounds overweight, and they're dead set on the idea that the fix is a drug, or an injection, or surgery," he added. In addition, Dr. Schwenk noted, "For me, what is most frustrating is when patients view doctors as simply a source of a signature for something they want, without really wanting the physician's guidance or opinion." Nevertheless, he adds “"I don't mind when patients do their own research on the Internet; I actually value it, as long as their purpose is to be informed so they can engage in complex discussions and decision-making."
June 15, 2009: New ACC/AHA guidelines — Lee Green, M.D., M.P.H., professor, among authors of the new ACC/AHA guideline updating the 2004 guideline for the management of patients with ST-segment elevation myocardial infarction. The guideline was released by The American College of Cardiology and American Heart Association, in collaboration with the Canadian Cardiovascular Society.
Specifically, “…early recognition and prompt initiation of reperfusion therapy remains the cornerstone of management of ST-segment elevation myocardial infarction.”
June 9, 2009: Clinical care — Talk on “Evaluation and management of osteoporosis (in Japanese)” was presented by Masahito Jimbo, M.D., Ph.D., M.P.H., associate professor, at the Kawasaki Tama Municipal Hospital in Kawasaki, Kanagawa, Japan.
June 9, 2009: Nutrition — Jenna Wunder, R.D., M.P.H., researcher and dietician, quoted for her advice to shop for a colorful variety of fruits and vegetables, among other words of wisdom for one’s diet with connections to the resulting health benefits in a recent article featuring the Healing Foods Pyramid. See the Spring 2009 issue of the U-M’s SPH Findings Alumni Magazine.
June 1, 2009: Health Behavior Research — Caroline Richardson, M.D., assistant professor, is among authors who state, “Physical activity levels measured objectively by accelerometer demonstrated that Hispanic men are, in general, more active than their white and black counterparts. (In addition, “Hispanic women are more active at middle age (40-59 years) compared to younger or older age and not significantly less active than men in middle or older age groups (i.e. age 40-59 or age 60 and older.”) “This appears to be in contrast to self-reported physical activity previously reported in the literature and identifies the need to use objective measures in situations where the contribution of light intensity and/or unstructured physical activity cannot be assumed homogenous across the populations of interest.” The study results were reported in Int J Behav Nutr Phys Act, Volume 6, page 31, 2009.
June 1, 2009: Human Papillomavirus Research — Mack T. Ruffin IV, M.D., M.P.H., professor, is among researchers who demonstrate that their specially designed “prototypePCR-MS assay performs at least as well as the Hybrid Capture 2 High Risk HPV DNA test (HC2) assay, while offering the additional, unique advantages of type-specific identification and 360 quantitation” for detection of Human Papillomavirus (HPV). Results are released with the title “Development and Evaluation of a PCR and Mass Spectroscopy-based (PCR-MS) Method for Quantitative, Type-specific Detection of Human Papillomavirus” in the J Virol Methods [Epub ahead of print]. Other authors include Patel DA, Shih YJ, Newton DW, Michael CW, Oeth PA, Kane MD, Opipari AW, Kalikin LM, and Kurnit DM.
May 21, 2009: Family Medicine Research Day XXXII
Location: Genoa Woods Conference Center, Brighton, Michigan.
The planning committee for the Michigan Family Medicine Research Day invites submission of abstracts of original research pertinent to family medicine and primary care. This annual event is designed to encourage and assist new researchers and scholars in family medicine, nursing and the behavioral sciences in a collegial atmosphere where we can all learn and exchange ideas that may improve patterns of practice and the health of patients under our care.
For additional information, contact:
Deb Richardson, Conference Assistant at (517) 884-0400, or firstname.lastname@example.org
Blythe Bieber, Conference Assistant at (734) 615-2688 or email@example.com.
Lodging is available at the Brighton Courtyard by Marriott directly adjacent to the conference center. For reservations, please call (810) 225-92000.
May 19, 2009: Sedatives Questioned in Treatment of Mothers of Stillborn Infants — Half of the obstetricians surveyed in 2007 by Katherine J. Gold, M.D., M.P.H., M.S., lecturer, reported that sedatives could be helpful for a grieving mother after stillbirth. Although it is true sedatives may dull the pain and help sleep at first, there is no evidence they are helpful for grief; they are not the first-line drug for insomnia; and these drugs may even be harmful, since they potentially can cause addiction and/or side effects. In addition, mothers who are sedated may not be able to sort through important issues at or after the time of loss.
“These survey results were quite surprising to me,” notes Dr. Gold. “I think we need to ask whether physicians are actually prescribing benzodiazepines to bereaved patients in practice, improve our understanding of the impact on patients, and do a better job in helping both parents and physicians cope with the impact of a stillborn baby.”
May 18, 2009: American Thoracic Society International Conference Poster presentation — The abstract entitled “An Internet-Mediated Walking Program Promotes Free-Living Ambulation in COPD,” written by Caroline R. Richardson, M.D., assistant professor will be presented at the 2009 ATS (American Thoracic Society) International Conference in San Diego, California. The poster will appear in the Poster Discussion session, B107 - FUNCTIONAL STATUS AND ACTIVITY IN PATIENTS WITH CHRONIC RESPIRATORY DISEASE.
May 8, 2009: Breast Cancer research - Zora Djuric, Ph.D., research professor, presented “Body weight and breast cancer survivorship” during the Population Studies and Prevention Annual Retreat for the Barbara Ann Karmanos Cancer Institute at Wayne State University, Mich.
May 8, 2009: Thomas L. Schwenk, M.D., the George A. Dean, M.D. Chair of Family Medicine, was appointed as a member of the Forum on Children’s Mental Health Services for the Institute of Medicine Board on Children, Youth, and Families in Washington, DC.
May 6, 2009: Promotion — James M. Cook, M.D., assistant professor, residency director and medical co-director of Clinical Simulation Center, announces that “Kristy K. Brown, D.O., has agreed to serve as the next Ypsilanti Assistant Residency Director for the Department of Family Medicine effective July 1.” Recognized by many residents for her special teaching ability, she has served as the core preceptor at Chelsea Family Medicine and as an attending on the Family Mother Baby obstetrics service at the University Hospital for the last two years.
May 6, 2009: Physician Shortage — Thomas L. Schwenk, M.D. the George A. Dean, M.D., Chair of Family Medicine, responded to the growing issue of physician shortage in the state of Michigan by stating, "The larger issue is that the country really has to come to grips with what they believe to be truly important about their personal health care." He continued by saying, "People by default end up sitting in emergency rooms and getting horrible primary care; And yet no one is saying, 'I'm fed up; I want a family doctor to go to.'" These and other comments were reported by himself and other local physicians and health experts in an Ann Arbor News article titled “Ann Arbor area not feeling the pinch of growing statewide physician shortage” written by Tracy Davis.
May 4, 2009: Mack T. Ruffin IV, M.D., M.P.H., professor and Associate Chair for Research Programs, is among a team of researchers who have learned about the barriers, complexities of belief systems and attitudes toward HPV vaccination programs in efforts to increase vaccination rates among women living in Ohio Appalachia. They “highlight the need for [creating] comprehensive and understandable HPV vaccine educational materials and programs about cervical cancer prevention to underserved populations, especially rural populations,” in a journal article in Vaccine, published in April, 2009.
May 1, 2009: Visiting Professor - Michael D. Fetters, M.D., M.P.H., M.A., associate professor, served as Visiting Professor at Louisiana State University in Baton Rouge, La. The title of his presentation was “Introduction to mixed methods research: ‘Why the whole is greater than the sum of the parts.’”
May 20, 2009: FamilyHealthware™, a self-administered, web-based tool -
Mack T. Ruffin IV, M.D., M.P.H., professor, was co-author of article entitled, "Familial Risk for Common Diseases in Primary Care: The Family Healthware Impact Trial." The trial evaluated the tool called FamilyHealthware™, a self-administered, web-based tool that assesses familial risk for CHD; stroke; diabetes; and colorectal, breast, and ovarian cancer, and provides a personalized prevention plan based on familial risk. The study was successful in determining the prevalence of these common chronic diseases. See American Journal of Preventive Medicine 36(6):506-14.
May 5, 2009: James E. Aikens, Ph.D., associate professor, is co-author of study that finds that employment of an empowerment-based Diabetes Self-Management Consultant (DSMC) intervention results in modest diabetes related improvements. This intervention proved “…unique, because it applied a systematic, theory-based approach to establishing a therapeutic alliance and a collaborative, patient-centered approach to facilitating self-directed behavior change.” Article appears in Ther Patient Educ 1(1):3-11.
April 29-May 3, 2009: Family Medicine faculty present at the Society of Teachers in Family Medicine (STFM) annual spring conference in Denver, Colorado.
Katherine Gold, M.D., M.S.W. lecturer, co-presented “An Obstetrical Challenge: Psychosocial And Medical Complications Associated With The Delivery of Stillborn Infants.” Results from this study enable the conclusion that, “Mothers with stillbirth have significant psychosocial risk factors and delivery of a stillborn infant is associated with serious complications. Both have implications for patient management.”
Joel J. Heidelbaugh, M.D., assistant professor, presented “Primary Care Urology and Men’s Health: Development of a Niche Curriculum In Family Medicine.” He wrote, “The development of a primary care urology and men’s health curriculum is both novel and innovative…This collaboration between the departments of family medicine and urology can serve as a model for the development of other niche curricula and specialty clinics at other institutions.”
Joel J. Heidelbaugh M.D., assistant professor, presented “Electronic Web Sign-out As an Interactive Tool to Improve Patient Safety.”
Hobart Lee, M.D., lecturer; Joel J. Heidelbaugh, M.D., assistant professor, presented “Electronic Web Sign-out As an Interactive Tool to Improve Patient Safety,” stating “Standardized paradigms [for residents] can improve sign-out practices and reduce preventable medical errors related to miscommunication in transfer of patient care.”
Amy B. Locke, M.D., assistant professor, presented a poster session entitled, “Integrating Integrative Medicine Into a Residency Curriculum (Scholastic Poster).”
Caroline R. Richardson, M.D., assistant professor, presented “Statistics 101 for Family Medicine” where she noted, “In this review of statistical methods, we will cover basic statistical analysis for survey research, quality improvement projects, and chart reviews,” including “…the review [of] the pros and cons of various statistical software packages.”
Caroline R. Richardson, M.D., assistant professor, was among researchers who presented “Share Your Work and Build Community Using STFM’s Family Medicine Digital Resources Library (FMDRL).” Because “The Family Medicine Digital Resources Library has been a powerful collaborative tool for family medicine educators and STFM[,] presenters will discuss how FMDRL can help [attendees] do [their] daily work, as well as how it can help advance [their] careers.”
Caroline R. Richardson, M.D., assistant professor, presented a “Research Training and Career Development” poster.
Margaret Riley, M.D., lecturer, presented, “The Impact of Clinical Prompts on Prenatal Care at Two Family Medicine Teaching Clinics (Peer Completed).” She stated, “This study assessed the effect of automated prenatal care reminders on adherence to standards of prenatal care by resident and attending family physicians at two family medicine teaching clinics.”
Margaret A. Riley, M.D., lecturer and Joel J. Heidelbaugh, M.D., assistant professor, presented “Developing a Billing and Coding Curriculum for Family Medicine Residents.” They wrote, “We authored a review article highlighting common billing and coding “pearls” to serve as a teaching tool for residents to help maximize appropriate coding practices. This article, as well as focused lectures and dedicated one-on-one teaching sessions, will serve as a model to augment billing and coding knowledge and practices within a family medicine-based practice management curriculum.”
Eric Skye, M.D., assistant professor; Taranum A. Master-Hunter, M.D., assistant professor; Sara L. Warber, M.D., associate professor; Elizabeth Wilson, M.F.A., instructional design & development/web project manager; and Leslie Wimsatt, Ph.D., educational planning and development administrator, presented “Online, Self-paced Learning Modules In the Family Medicine Residency: A Pilot Intervention.” They noted that “During this session, we …. present[ed] data collected during the module development process and share[d] results of usability/functionality testing and preliminary outcomes assessment. The implications are broadly applicable to faculty involved in curricular planning.”
Eric Skye, M.D., assistant professor; Taranum A. Master-Hunter, M.D., assistant professor; Sara L. Warber, M.D., associate professor; Elizabeth Wilson, M.F.A., instructional design & development/web project manager; Leslie Wimsatt, Ph.D., educational planning and development administrator; and, presented “Faculty Development In Transforming Traditional Lecture Material to Online Instructional Delivery.” They stated, “This session will explore a team-initiated approach undertaken by the presenters to create a series of online learning modules for use by medical students and residents.”
April 30, 2009: Research methods presentation - Michael D. Fetters, M.D., M.P.H., M.S., presented as visiting professor at Louisiana State University in Baton Rouge, LA., on “Introduction to Mixed Methods Research: Why the whole is greater than the sum of the parts.”
April 29-30, 2009: Clinical Research in Depression - Michael S. Klinkman, M.D., M.S., associate professor, presented “Assessing Functional Outcomes in Clinical Practice” at the meeting entitled, Wyeth Functional Outcomes: Key Endpoints in the Management of Major Depressive Disorder, in Atlanta, GA. Dr Klinkman also presented “MDD Treatment: Optimizing the Delivery of Care in Real-World Settings at the Wyeth Focus on Treatment Adherence and Functional Outcomes Advisory Board meeting in Atlanta, GA.
April 17, 2009: Study led by Philip Zazove, M.D., professor, et al., reveals findings in which Deaf persons have difficulty in learning cancer prevention information. “Deaf persons have been found to be the non-English speaking minority at greatest risk for miscommunication with their physicians. If we can figure out how to help this group, there’s potential for helping other non-English speaking minorities,” says lead author Philip Zazove, M.D. In summary, they have poor health literacy as well as an inadequate ability to exercise good use of the health care system. See press release.
April 15, 2009: UMHS in 7th place among top 15 Major Teaching Hospitals - Thomson Reuters Announces 1000 Top Hospitals Award Winners. Thomson Reuters’ “National Balanced Scorecard” evaluates performance in nine areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. See press release
April 15, 2009: Collaboration to increase public understanding of medical research - Michael D. Fetters, M.D., M.P.H., M.A., associate professor, and the Detroit Science Center have received a $100,000 NIH grant to attempt to increase public understanding of translational medical and behavioral research. They will also create and focus on the effectiveness of an interactive display in a science museum setting for improving public research literacy and willingness to participate in translational research. View press release entitled “UMHS, Science Center collaborate to increase medical research participation."
April 23, 2009: Type 2 Diabetes Research - Depression can be an effect, not a cause for insulin-prescribed diabetes type 2 patients. James E. Aikens, Ph.D., associate professor, learns that diabetes type 2 patients who are prescribed insulin are more likely to experience depressive symptoms six months later than those who are prescribed oral medication alone; in other words, these depressive symptoms are an effect rather than a cause. These findings resulted from a “Longitudinal analysis of depressive symptoms and glycemic control in type 2 diabetes” as reported in Diabetes Care.
April 22, 2009: Joel J. Heidelbaugh, M.D., assistant professor, and Kent J. Sheets, Ph.D., professor, presented “Educating Medical Students on the Appropriateness of Specialty Referral from Family Medicine” at The Society of Teachers of Family Medicine (STFM) Annual Predoctoral Education Conference, Savannah, Ga.
April 21, 2009: Joel J. Heidelbaugh, M.D., assistant professor, presents evidence of risks of prescribing Proton Pump Inhibitors for treatment of gastroesophageal reflux disease (GERD), erosive esophagitis and stress ulcer prophylaxis (SUP). In his journal article entitled “Overutilization of proton pump inhibitors: a review of cost-effectiveness and risk,“ he states “…the use of step-down or on-demand PPI therapy should be accepted and encouraged in appropriate patients as an appropriate cost-effective option.” Article appears in Am J Gastroenterol 104(2 Suppl):S39.
April 20, 2009: Joel J. Heidelbaugh, M.D., assistant professor, discusses treatments ranging from surgical procedures to more conservative methods for healing the ingrown toenail, a condition known as “onychocryptosis”, in an article entitled, “Management of the ingrown toenail”. This paper appears in Am Fam Physician 79(4):303-8.
April 17, 2009: Mack T. Ruffin IV, M.D., M.P.H., professor, Mary E. Bieniasz, N.P., nurse practioner and Sandra I. Murray, B.S.E., conclude that results of their study of 265 women do not support theory that psychosocial factors play a role in the risk of developing abnormal cervical cytology (cervical cellular physiology and pathology). Nevertheless, behavioral risks for developing abnormal cervical cytology are associated with life stressors, family function, and perceived discrimination. This study entitled, “Psychosocial factors in risk of cervical intraepithelial lesions” appears in J Womens Health (Larchmt) 18(4):513-8.
April 8, 2009: Guidelines for Venous Thromboembolism - Lee A. Green, M.D., M.P.H., professor, leads update of clinical practice guideline for Venous Thromboembolism from Ann Arbor, MI: Faculty Group Practice, University of Michigan Health System, 2008. Available from the Agency for Healthcare Research and Quality (AHRQ); other authors include: Frey KA, Froehlich JB, Harrison RV, Kleaveland MD, Kronick S, Williams DM, Weg JG, Wakefield TW.
April 9, 2009: Women's Health — Occurrence and Remission Rates of Vulvodynia. Vulvodynia used to be referred to as a “rare” disease – one that a family physician would not expect to see in his practice more than very rarely. Yet, cross-sectional studies (those done in one point in time) have shown that vulvodynia, a chronic vulvar disorder associated with symptoms of pain and superficial irritation, is present in 3-7 percent of women. It was unknown, however, what percentage of women came down with this disorder each year, and in what percentage, if any, did the symptoms resolve.
In an article entitled “Vulvodynia Incidence and Remission Rates Among Adult Women,” published in Obstetrics and Gynecology in August, 2008, Barbara D. Reed, M.D., M.S.P.H., professor, and her colleagues did a two-year, follow-up survey study of women who had enrolled in one of her cross-sectional studies two-years previously.
Of the 1037 women members of the Women’s Health Registry at the U-M originally enrolled, 744 completed the two-year, follow-up survey. Of 372 women who had been symptom free at enrollment, 3.5 percent (or 1.75 percent per year) had developed vulvodynia in the two-year, follow-up period. Of 45 women with vulvodynia, 22.2 percent (or 11.1 percent per year) reported that their symptoms had resolved during that time.
This study of 744 women revealed that vulvodynia was again confirmed to be more common than previously thought, was found to occur in 1-2 percent of women per year and to resolve each year in approximately 1 in 10 of those afflicted.
To follow up on this project, Dr. Reed has been awarded NIH funding to perform a longitudinal study (over five years), enrolling a group of 2500 women in southeastern Michigan who are more representative of the population at large. This new study will allow Dr. Reed’s team to even more accurately assess incidence, remission, and risk factors for these in an unbiased population.
April 8, 2009: Women's Health - Barbara D. Reed, M.D., M.P.H., professor, writes chapter for book entitled Female Sexual Pain Disorders: Evaluation and Management. In it she concludes that “despite the associations in some studies,” there is not necessarily a link between women who report dispareunia (occurrence of pain during sexual intercourse) and those who’ve experienced sexual abuse (SA). Bibliograhic information: Hoboken, NJ: Blackwell Publishing Ltd., 1st Edition, 2009.
March 30, 2009: Dietary Intervention Research - Helpful, scientific results found from Greek- Mediterranean diet among women “After examining patterns of changes in plasma fatty acids and carotenoids when women were asked to follow a novel, Greek-Mediterranean exchange list diet,” Zora Djuric, Ph.D., research professor, and Ananda Sen, associate research scientist at the Center for Statistical Consulting & Research (CSCAR), found that ”The changes in blood levels indicate the exchange list diet was effective for targeting Mediterranean nutrient intakes using foods available in the United States.” Article is entitled, “A Mediterranean dietary intervention in healthy American women changes plasma carotenoids and fatty acids in distinct clusters,” and appears in the March issue of Nutrition Research 29(3):156-63.
March 27, 2009: Best Practices for Depression Screening and Case-finding in Primary Care Practice - Donald E. Nease Jr., M.D., associate professor, presented at the Depression Center Colloquium Series at the Rachel Upjohn Building. Depression Center website www.depressioncenter.org.
March 26- 27, 2009: Seminar - Impact of Integrative Medicine in Primary Care: A Practical Update. This course was designed to provide an evidence-based update in integrative approaches to common health concerns for the practicing primary care provider. Several Family Medicine and Family Medicine Integrative Medicine doctors gave presentations as follows:
March 17, 2009: Nutrition - Wunder discusses benefits of Healing Foods Pyramid during National Nutrition Month
By Heather Hamilton
Imagine a food pyramid that takes the emphasis off refined and processed foods, and places it on whole plant foods. What would it look like and could it make us healthier?
Jenna Wunder, a registered dietitian from the University of Michigans Department of Family Medicine Integrative Medicine Program, discussed the Healing Foods Pyramid March 11 in Roosevelt Auditorium. This innovative pyramid is changing the way people look at nutrition, she said.
"For me, one of the most important components of integrative medicine is that you play an active role in your own health. You have your own wellness toolbox to help you manage your health," said Wunder, the keynote speaker for EMU's celebration of National Nutrition Month. "It's a matter of knowing yourself, knowing what your issue is and feeling free to explore your wellness."
Wunder said that the Healing Foods Pyramid took two years for her and her colleagues to develop. It is used as an interactive Web tool, enabling people to go online and click into all 14 categories of the pyramid. Each category has the recommended daily servings; which foods in each category one should and should not consume; research related to why one should increase foods in each category; the impact that foods in each category have on chronic illness; and ideas for incorporating certain foods into one's diet.
Wunder said that the pyramid also encourages healing foods, plant-based choices, variety and balance, support of a healthful environment, and mindful eating. In order to follow the Healing Foods Pyramid, one does have to dedicate time and make healthy food available, she said. Wunder also touched on the importance of breakfast and not skipping meals.
"The longer you wait to eat your first meal, the more likely you are to overeat. You really need to nourish your body several times throughout the day. You'll concentrate better and you'll be able to focus," said Wunder.
One unique aspect of the pyramid is that water is at its base. Wunder said that water is essential to almost all of our bodies' functions and is a natural appetite suppressant. The Healing Foods Pyramid recommends that women drink eight cups of water per day and that men drink 12 cups.
The second largest category on the pyramid is fruits and vegetables. The Healing Foods Pyramid recommends seven to 10 servings per day. The old recommendation from the United States Department of Agriculture was five servings. Wunder said the increase in servings was due to research. She described the threshold effect. This is where the greatest impact on negating chronic illness occurs when one eats at least seven to 10 servings a day. Wunder said that variety is the answer, and to make sure one has a rainbow of fruits and vegetables on their plate. Seven to 10 servings may seem like a lot, but Wunder reassured the audience that it is doable.
"One cup of leafy greens is a serving," Wunder said. "It's not uncommon to have four or more servings in a salad, depending on the size of the salad. It does take effort, but it is easily done."
The Healing Foods Pyramid recommends four to 11 servings of grains per day. However, it is important to make sure the grains are whole grains, as opposed to milled, processed or refined grains.
"We want to see the seeds in bread and the oats. We want a hardy bread," Wunder said. "You want to look for products that have fiber because with fiber comes all the other nutrients."
Wunder also discussed the benefits of tea and chocolate. These two items, along with alcohol, fall in the second highest category on the pyramid, which are termed accompaniments. She said that the list goes on and on about the benefits of tea on many chronic illnesses. Wunder said that white and green tea are the least processed and have the most antioxidants. She also said that the Healing Foods Pyramid recommends one to two ounces of dark chocolate per day.
"The dark chocolate that we recommend is quality dark chocolate. It is a treat. When the dark cocoa bean is mixed with milk to make milk chocolate, it neutralizes the benefits of the antioxidants," said Wunder. "It is known that dark chocolate enhances mood because it increases serotonin and endorphins."
The very top of the pyramid is left completely blank and labeled "personal space." Wunder said this category is for the comfort food that we crave -- like mashed potatoes and ice cream -- that don't fall into other categories. Wunder said that nutrition is about enjoying food and eating what truly nourishes you. She described her "meat eating" theory to the audience. Wunder said that people have 32 teeth, four of which are incisors. Incisors are designed for eating animal protein, which includes fish, seafood and lean meats. Since one-eighth of people's teeth are made for eating meat, Wunder reasoned that one-eighth of people's diets should be fish, seafood and lean meats.
"I think that some people's bodies work well with a vegetarian diet, but some bodies need meat. You have to maintain an attitude of not being judgmental about what works for you and what works for other people. You have to know your body and know what works for you," said Wunder.
The remaining categories consist of legumes, seasonings, healthy fats, fish and seafood, and lean meats. Learn more about the Healing Foods Pyramid.
March 2, 2009: New Outlook on Exercise - The truth seems elusive when it comes to calculating the amount of time a person really needs to exercise in order to improve weight loss and stay healthy. Caroline R. Richardson, M.D., assistant professor, has addressed this questionas co-author in an article entitled, “Objective Physical Activity Accumulation in Bouts and Nonbouts and Relation to Markers of Obesity in US Adults.” [See Preventing Chronic Disease 5(4):A131.]
She explains physical activity guidelines tend to recommend that you exercise for at least 10 minutes at a time. However, it is possible that shorter bouts of exercise may also be beneficial. Short bouts of activity include things like parking farther from your office or walking up the stairs instead of taking the elevator. The benefits of short bouts of activity are harder to document than the benefits of longer bouts of physical activity because short bouts of physical activity are difficult to measure.
A device called an accelerometer can record even short bouts of physical activity accumulated throughout the day. The Centers for Disease Control (CDC) collected accelerometer data on a large cohort of Americans from the 2003/2004 wave of the National Health and Nutrition Examination Survey. Using this data, Dr. Richardson’s team showed that physical activity accumulated in bouts lasting longer than 10 minutes is more strongly correlated with lower body mass index (bmi) and waist circumference than activity accumulated in shorter bouts. However, even shorter bouts of activity do correlate with less obesity. One of the reasons that long bouts are more strongly correlated with lower obesity than short bouts is that longer bouts of activity are often composed of higher intensity activity than shorter bouts. Dr. Richardson notes that, “Because almost nobody does activity in long bouts, shorter bouts may contribute more toward reducing obesity in the population than longer bouts of activity.”
Dr. Richardson sums the dilemma up by stating, “If you are not getting much physical activity in your day, consider starting with short bouts of moderate intensity lifestyle activity and work up to longer bouts of more vigorous activity if you can. Every step counts!”
Recent Grants Awarded
March 2009: Veterans Walk to Beat Back Pain - Caroline R. Richardson, M.D., assistant professor, receives $120,000 award from the VA of Ann Arbor Healthcare System (HSR&D). The Stepping Up to Health System, developed by a team at the University of Michigan Department of Family Medicine, will be expanded, managed and maintained for their VA HSR&D study. The primary objective is to assess the efficacy of an internet-mediated pedometer based intervention designed to increase walking among individuals with chronic back pain.
March 2009: Clinical Translational Research Aims to Improve Chronic Disease Management - Lee A. Green, M.D., M.P.H., professor, receives $100,000 award from Westat. Co-Investigators are Donald E. Nease Jr., M.D., associate professor and Michael D. Fetters, M.D., M.P.H., M.A., associate professor. This project will develop a sustainable collaboration between the Michigan Primary Care Association (MPCA), a statewide network of Federally-Qualified Health Centers (FQHCs) and the Michigan Institute for Clinical and Health Research (MICHR), focusing on clinical translational research; specifically for improving chronic disease management to benefit underserved populations. In Phase II, the Honest Broker-Cielo (the secure HIPAA-compliant information interchange system) link will be applied, providing a clinical reminder system’s ability to deliver targeted disease- and need-specific reminders at the point of care.
March 2009: Importance of Patient-Physician Dialogue about Colorectal Cancer Screening Options - Mack T. Ruffin, M.D., M.P.H., professor, Masahito Jimbo, M.D., Ph.D., M.P.H., assistant professor and Michael D. Fetters, M.D., M.P.H., M.S., associate professor, learn from working with varied populations among race, gender, and geographic region demographics that the openness of discussing colorectal cancer screening, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed suggest the importance of patient-physician dialogue about colorectal cancer screening options. Their article entitled “Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation” appears online at the Journal of Community Health. View at www.springerlink.com
February 16: Research - Indicators of psychological stress found - Zora Djuric, Ph.D., research professor, and Mack T. Ruffin, IV, M.D., M.P.H., professor, review the role of psychological stress in the cause of health disparities for an article entitled “Biomarkers of Psychological Stress in Health Disparities Research” (appearing in The Open Biomarkers Journal).
Health disparities are differences in the incidence of disease and mortality among population subgroups, such as those defined by race, ethnicity or socio-economic status (SES), that are affected by the stress of everyday life in different ways.
Physiologically, the effects of psychological stress can be evident on many aspects of an individual's metabolism, and this can be quantified using biomarkers, or markers of changes in normal metabolic processes. These biomarkers of stress include hormonal changes and adverse effects on the cardiovascular system. Many of these biomarkers can be combined to derive a single measure called “allostatic load”. Over time, this allostatic load leads to increased incidence of disease risks, such as stroke and myocardial infarction. In addition, the immune system is affected which increases susceptibility to viral infections such as AIDS, as well as age-related diseases. Finally, psychological stress can interfere with the mechanisms that protect against cancer such as the ability of the body to defend against oxidative stress and repair DNA damage.
One important step in understanding the role of psychological stress in various population groups is the ability to collect biological samples, such as blood, in appropriate ways. Collecting blood in the field, versus asking people to come to a medical center, poses a number of logistic challenges that have to be overcome. This subject is critical for a more comprehensive understanding of the causes of health disparities, and is the first step towards developing targeted interventions for the populations that can benefit the most. To summarize, these indicators of psychological stress, different for various subgroups, can affect health. Fortunately, for some biomarkers, there are simpler sampling methods that have been developed.
February 13, 2009: Veterans' health - Caroline R. Richardson, M.D., assistant professor, presented on weight loss for veterans. The presentation was titled “Outcomes from the Veterans Walk for Health Trial: A randomized controlled trial comparing three walking strategies for weight loss” at the 2009 HSR&D National Meeting (VA) in Baltimore, MD.
February 6: Clinical Simulation Center Expansion - A major renovation of the U-M Clinical Simulation Center was completed in October 2008, which, in addition to tripling its size, significantly increased teaching capabilities. Skills training in rapid sequence intubation, advanced cardiac life support team leadership, cardiac arrhythmia management, colonoscopy, neonatal resuscitation and obstetrical skills have been incorporated into the family medicine residency curriculum and more skills training are being developed. Additionally, the first family medicine simulation-based curriculum was developed and electronically published to rapidly share experiences with other residency programs around the nation (http://www.fmdrl.org/794 ).
February 2-6, 2009: 33rd Annual Boyne Highlands Midwinter Family Update presentations at Harbor Springs, Michigan.
Eric P. Skye, M.D., assistant professor, “Evidence-Based Review for the HME” and “Colon Cancer Screening & Surveillance”, “Which Moles to Biopsy & How”
John S. Stracks, M.D., lecturer, “Pain Management Alternatives,” and “Managing TBI”, “Other Approaches to Managing Depression”
Lee A. Green, M.D., M.P.H., professor, “Hypertension Updates” , “After the DVT or Embolic Event” and “Hyperlipidemia Update”
Mack T. Ruffin IV, M.D., M.P.H., professor, “Update on Adolescent Vaccine” , “Shingles Update: Vaccine, Diagnosis, & Treatment”
Joel J. Heidelbaugh, M.D, assistant professor, “Erectile Dysfunction Update” and “Testosterone Replacement in Men” , “Benign Prostatic Hyperplasia Update”
February 15: Clinical research - elevated mean corpuscule volume work up.
Joyce E. Kaferle, M.D., assistant professor and Cheryl E. Strzoda, M.D, lecturer share information for the health practitioner to evaluate the possible myriad of causes of macrocytosis, and whether or not further evaluation or treatment may be indicated for the patient in article entitled, Evaluation of Macrocytosis in Am Fam Physician 2009:79(3).
February 13: Mixed methods intervention designs - Michael D. Fetters, M.D., M.P.H., M.A., associate professor, co-authors book chapter on “Mixed Methods Intervention Trials” in textbook entitled Mixed Methods Research for Nursing and the Health Sciences. The aim of the chapter is to explore the use of qualitative research in intervention trials, wherein the trials become mixed methods research designs, referred to as “’mixed methods intervention designs.’” According to Dr. Fetters, the book is the first of its kind among the health sciences.
February 1, 2009: Sexual Assault/Abuse research - Barbara D. Reed, M.D., M.S.P.H., professor, examines associations reported between sexual abuse and dyspareunia-related disorders in book chapter entitled “Sexual Assault/Abuse and its link to Female Sexual Pain,” to be published in Female Sexual Pain Disorders: Evaluation and Management, 1st edition by Wiley-Blackwell.
February 1, 2009: Women's Health research - Barbara D. Reed, M.D., M.S.P.H., professor, finds consensus among respondents to survey sent to members of the International Society for the Study of Vulvovaginal Disease and other authors on the treatment of Vulvodynia in Journal of Reproductive Medicine.
February 1, 2009: Clinical research - Reasons patients with a positive fecal occult blood test result do not undergo complete diagnostic evaluation. Ann Fam Med 7(1):11-6. Masahito Jimbo, M.D., assistant professor, shares study analysis of reasons reported by physicians for nonperformance of complete diagnostic evaluation (CDE) in a nested sample of patients with positive fecal occult blood test (FOBT) results, concluding that decision making by primary care physicians had a major effect on nonperformance of CDE.
January 23, 2009: Annual Predoctoral Education Conference of the Society of Teachers of Family Medicine (STFM) Presentations
Kent J. Sheets, Ph.D., associate professor, co-presents “Would You Want this Medical Student to be Your Doctor?” in a Workshop Presentation at the 2009 Annual Predoctoral Education Conference of the Society of Teachers of Family Medicine (STFM) in Savannah, Georgia.
Joel J. Heidelbaugh, M.D., assistant professor and Kent J. Sheets, Ph.D., associate professor
present Educating Medical Students on the Appropriateness of Specialty Referral From Family Medicine, A Peer Paper Presentation.
Joel J. Heidelbaugh, M.D., assistant professor and Kent J. Sheets, Ph.D., associate professor,
present Case Discussion as a Venue to Teach Principles of Chronic Disease Management, A Peer Paper Presentation.
January 16, 2009: Healthy gift-giving - Caroline R. Richardson, M.D., assistant professor, shares healthy gift-giving ideas in WDIV Detroit Channel 4 interview entitled "Check out these healthy, inexpensive gifts." See Clickondetroit
January 15, 2009: The Dale L. Williams, M.D. Family Medicine Scholarship - Beginning in 2009, the newly established Dale L. Williams, M.D. Family Medicine Scholarship shall be awarded to senior medical students who match into the family medicine program at the University of Michigan Department of Family Medicine. ...more
January 15, 2009: Colon cancer screening - Masahito Jimbo, M.D., Ph.D., M.P.H., assistant professor, suggests that a significant number of primary-care physicians fail to advise their patients who receive a positive FOBT result to undergo more rigorous follow-up screenings, such as a colonoscopy. Press release notes that the 5% of primary care physicians who are trained in performing colonoscopies can assist in meeting the ideal screening needs of the country's third most common cancer, colon cancer, especially in rural areas. See Healthday News http://www.healthday.com/Article.asp?AID=623019
January 14, 2009: Culturally competent care in Japanese populations - Michael D. Fetters, M.D., M.P.H., M.A., associate professor shares “Challenges in championing culturally competent care: Lessons learned from serving a Japanese population” at RWJ Clinical Scholars Program event at the U-M in Ann Arbor.
January 13, 2009: Clinical guidelines on depression and recurrent heart attack risk. Recommendations of the American Academy of Family Physicians led by Lee A. Green, M.D., M.P.H., professor and co-authored by Donald E. Nease, Jr., M.D., associate professor, call for regular screening and monitored treatment of depression in patients who have suffered a heart attack, also known as myochardial infarction, according to an AAFP press release. The guidelines are published in the January/February 2009 issue of the Annals of Family Medicine and are available online at www.annfammed.org. The guidelines are titled “AAFP Guideline for the Detection and Management of Post–Myocardial Infarction Depression,” led by the Post-Myocardial Infarction Depression Clinical Practice Guideline Panel and the bibliographic citation is 7(1):71-9.
January 6, 2009: The Jill and Thomas R. Berglund, M.D., Scholarship Fund - Dr. Berglund (M.D. 1959) and his wife, Jill, have established The Jill and Thomas R. Berglund, M.D., Scholarship Fund in the Department of Family Medicine that is presented to a graduating medical student who matches to a family practice residency...more
January 2, 2009: Department Chair visits Ghana - "Cost and Quality in the Ghanaian Health Care System: Is There a Role for Family Medicine?" The Department has launched a major collaborative initiative with the Ghana College of Physicians and Surgeons (GCPS) and academic family physicians in Ghana. The purpose of the initiative is to enhance the quality of family medicine resident training, provide faculty development opportunities for family medicine fellows and faculty members, develop collaborative research programs with Ghanaian family physicians, and develop a bilateral exchange program for residents and fellows. This initiative will hopefully become part of a major collaboration between many schools and units of the University of Michigan and their counterparts in Ghana, as part of a Bill and Melinda Gates Foundation grant to support the sustainable development of enhanced resources for health care professionals in Ghana. The initiative was launched with an initial visit by Thomas L. Schwenk, M.D., professor, and the George A. Dean, M.D., Chair of Family Medicine in December. Dr. Schwenk was the keynote speaker at the 5th Annual Scientific Assembly of the GCPS held on December 3, 2008 in Accra, speaking on "Cost and Quality in the Ghanaian Health Care System: Is There a Role for Family Medicine?"
January 9, 2009: Cancer prevention research - Philip Zazove, M.D., professor, concludes that persons with profound hearing loss have poor knowledge of recommended cancer prevention interventions and whether English is used in multiple settings is a strong factor. His study examines the effect of low reading levels and difficulty communicating with physicians among deaf persons upon knowledge of cancer prevention recommendations. Article entitled “Cancer Prevention Knowledge of People with Profound Hearing Loss” appears in J Gen Intern Med 2009 Jan 9 [Epub ahead of print].
January 5, 2009: Physical activity and menopause research - Caroline R. Richardson, M.D., assistant professor, among authors who find in study of physical activity levels among postmenopausal women that a lifestyle physical activity intervention not only increases pedometer step counts but appears to reduce some of variation in physical activity levels over the course of a year. (This study included Caucasian and African American women). Monthly Variation in Physical Activity Levels in Postmenopausal Women. Med Sci Sports Exerc. 2009 Jan 5. [Epub ahead of print]
January 5, 2009: Early Detection of Pancreatic Cancer - Mack T. Ruffin, IV, M.D., M.P.H., professor, among authors who find data suggesting that differential glycosylation patterns detected on high-throughput lectin glyco-antibody microarrays are a promising biomarker approach for the early detection of pancreatic cancer. Li C, Simeone DM, Brenner DE, Anderson MA, Shedden KA, Ruffin MT, Lubman DM. Pancreatic Cancer Serum Detection Using a Lectin/Glyco-Antibody Array Method. J Proteome Res [Epub ahead of print].
January 2, 2009: New Cardiovascular Guidelines - Lee A. Green, M.D., M.P.H., professor, among those from The American College of Cardiology (ACC) and the American Heart Association (AHA) to develop clinical performance measures and clinical registries that permit the evaluation of quality of care and stimulate quality improvement within cardiovascular care. ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Bonow RO, Masoudi FA, Rumsfeld JS, Delong E, Estes NA 3rd, Goff DC Jr, Grady K, Green LA, Loth AR, Peterson ED, Piña IL, Radford MJ, Shahian DM; American College of Cardiology; American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 52(24):2113-7.
January 2, 2009: Disease and Cancer Beliefs - Ananda Sen, Ph.D., biostatistician, Donald E. Nease, Jr., M.D., associate professor and Mack T. Ruffin IV, M.D., M.P.H., professor, are among authors of article entitled “Comparison of risk perceptions and beliefs across common chronic diseases.” In it authors address working with prior disease perceptions, including types of cancer, when communicating multiple disease risks. Other authors include: Wang C, O'Neill SM, Rothrock N, Gramling R, Acheson LS, and Rubinstein WS for the Family Healthware™ Impact Trial (FHITr) group.
Prev Med [Epub ahead of print].
NEW RESEARCH GRANTS
January 1, 2009: Depression grant - Michael S. Klinkman, M.D., M.S., associate professor, plans to design a more efficient self-management component for Michigan Depression Outreach and Collaborative Care (M-DOCC) at UMHS in study entitled “Enhancing the Sustainability of Depression Disease Management Support for Primary Care.”
January 1, 2009: Exercise for chronic back pain - Caroline R. Richardson, M.D., assistant professor and Co-PI, awarded research grant for study entitled “Veterans Walk to Beat Back Pain. ” Her plan is to assess the efficacy of an Internet-mediated, pedometer-based intervention that is designed to increase walking among individuals with chronic back pain.