CHS Research News
Vol 20, Issue 1, Spring 2008
Center News
by Rebecca Hughes and Joan DeClaire
New Findings & Highlights
Men experience domestic violence, with health impact
Group Health study debunks five myths about abuse of men
Domestic violence can happen to men, not only to women, according to
Group Health research in the June American Journal of Preventive
Medicine. “Domestic violence in men is under-studied and often
hidden—much as it was in women 10 years ago,” said study leader
Robert J. Reid, MD, PhD,
an associate investigator at the Group Health Center for Health Studies. “We
want abused men to know they’re not alone.” His findings confirm some common
beliefs but also debunk five myths about abuse in men:
Myth 1: Few men experience domestic violence. Many
do. In-depth phone interviews with over 400 randomly sampled adult male
Group Health patients surprised Dr. Reid and his colleagues: 5% had
experienced domestic violence in the past year, 10% in the past five years,
and 29% over their lifetimes. The researchers defined domestic violence to
include nonphysical abuse—threats, chronic disparaging remarks, or
controlling behavior—as well as physical abuse: slapping, hitting, kicking,
or forced sex.
Myth 2: Abuse of men has no serious effects. The
researchers found domestic violence is associated with serious, long-term
effects on men’s mental health.Women are more likely than men to
experience more severe physical abuse, said Dr. Reid. “But even nonphysical
abuse—can do lasting damage.” Depressive symptoms were nearly three times as
common in older men who had experienced abuse than in those who hadn’t, with
much more severe depression in the men who had been abused physically.
Myth 3: Abused men don’t stay, because they’re free to leave.
In fact, men may stay for years with their abusive partners. “We
know that many women may have trouble leaving abusive relationships,
especially if they’re caring for young children and not working outside the
home,” said Dr. Reid. “We were surprised to find that most men in abusive
relationships also stay, through multiple episodes, for years.”
Myth 4: Domestic violence affects only poor people.
The study actually showed it to be an equal-opportunity scourge.“As we
found in our previous research with women experiencing domestic violence,
this is a common problem affecting people in all walks of life,” said Dr.
Reid. “Our patients at Group Health have health insurance and easy access to
health care, and their employment rate and average income, education level,
and age are higher than those of the rest of the U.S. population.”
Myth 5: Ignoring it will make it go away. Not so.
“We doctors hardly ever ask our male patients about being abused—and they
seldom tell us,” said Dr. Reid. “Many abused men feel ashamed because of
societal expectations for men to be tough and in control.” Younger men were
twice as likely as men age 55 or older to report recent abuse. “That may be
because older men are even more reluctant to talk about it,” he added.
This study extends Group Health’s research on domestic violence, a.k.a.
intimate partner violence. The team’s previous publications have documented
the prevalence, persistence, and health effects of domestic violence on
women. In the current study, they asked men the same questions that they had
asked of women. “Our team is concerned about abuse of people: of women as
well as men,” Dr. Reid added. “We do not want to downplay the seriousness of
domestic violence as experienced by women.”
Dr. Reid said more research is needed to determine the best ways for
doctors to ask men if they have experienced domestic violence—and how best
to help them into couples counseling, leaving their partners, or getting
protection orders. The National Domestic Violence Hotline is toll-free
1-800-799-SAFE (7233).
“At Group Health, we health care providers have access to system-wide
Web-based tools on our intranet that are gender-neutral,” said Jane Ann
Dimer, MD, Group Health’s chief of women’s health and an advocate
representing Group Health with local and regional agencies concerned with
domestic violence. “These tools help us connect our abused patients with
local agencies and support networks that can help them.”
The Agency for Healthcare Research and Quality and the Group Health
Center for Health Studies funded this work, co-authored by
Melissa Anderson, MS,
Paul Fishman, PhD, David
Carrell, PhD, and
Robert Thompson, MD of the
Group Health Center for Health Studies; Amy Bonomi, PhD, MPH, now an Ohio
State University associate professor of human development and family science
in Columbus; and Group Health Center for Health Studies affiliate scientific
investigator Frederick Rivara, MD, MPH, of Harborview Injury Prevention and
Research Center and the University of Washington.
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Osteoporosis drug Fosamax linked to heart problem
Finding from Group Health and University of Washington study
Women who have used Fosamax are nearly twice as likely to develop the
most common kind of chronically irregular heartbeat (atrial fibrillation)
than are those who have never used it, according to research from Group
Health and the University of Washington published in the April 28
Archives of Internal Medicine.
Merck markets Fosamax, the most widely used drug treatment for the
bone-thinning disease osteoporosis, explained study leader Susan Heckbert,
MD, PhD, MPH, a professor of epidemiology and scientific investigator in the
Cardiovascular Health Research Unit at the University of Washington. The
Food and Drug Administration (FDA) approved the first generic versions
(called alendronate) in February.
“We studied more than 700 female Group Health patients whose atrial
fibrillation was first detected during a three-year period,” said Dr.
Heckbert. She and her colleagues compared those women to over 900 randomly
selected female Group Health members matched on age and high blood pressure
to serve as controls.
“Having ever used alendronate was associated with an 86 percent higher
risk of newly detected atrial fibrillation compared with never having used
the drug,” said Dr. Heckbert, who is also an affiliate investigator at the
Group Health Center for Health Studies.
Osteoporosis mostly affects older women and can set the stage for
fractures that can impair the quality of their lives, said Dr. Heckbert.
“Careful judgment is required to weigh the risks and benefits of any
medication for any individual patient,” she added. “For most women at high
risk of fracture, alendronate’s benefit of reducing fractures will outweigh
the risk of atrial fibrillation.”
However, said Dr. Heckbert, “women who are at high risk of fractures but
also have risk factors for atrial fibrillation—such as heart failure,
diabetes, or coronary disease—might want to discuss alternatives to
alendronate with their health care providers.” Other medications that can
lower the risk of fractures include estrogen, she said. But the Women’s
Health Initiative, on which she has also served as an investigator, showed
other heart risks from hormone therapy combining estrogen with progesterone.
The National Heart, Lung, and Blood Institute funds Dr. Heckbert’s Atrial
Fibrillation Study, which collects data on all Group Health patients as they
are first diagnosed with atrial fibrillation. The study aims to find new
factors that raise the risk of developing this quivering of the heart’s
upper chambers (atria).
About one in 100 people—and nearly nine in 100 people over age 80—have
atrial fibrillation, said Dr. Heckbert. In many cases, atrial fibrillation
has no symptoms, and it isn’t necessarily life threatening. But it can cause
palpitations, fainting, fatigue, or congestive heart failure.
Atrial fibrillation can also make blood pool—and sometimes clot—in the
atria, said Dr. Heckbert. When parts of clots break off and leave the atria,
they can lead to embolic strokes, as happens in over 70,000 Americans a
year. That’s why atrial fibrillation is often treated with the anticoagulant
warfarin. Other results from her study have suggested that maintaining a
healthy body weight may help protect people from atrial fibrillation.
“This study will help medical teams better inform their patients about
the risks associated with Fosamax, helping us make the best treatment
decisions for managing osteoporosis,” commented Christine Himes Fordyce, MD,
a Group Health family practitioner. “Now with this increased understanding
of potential irregular heartbeats, both physicians and their patients
should be alert to any problems, report them immediately, and treat them
appropriately.”
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Study shows active seniors curb health care costs
Group Health seniors are not only sweating to the oldies in local health
clubs, they are also keeping health care costs down, according to a study by
researchers at Group Health and the University of Washington (UW). The study
appears in the January 2008 issue of the journal
Preventing Chronic Disease.
The research found long-term total health care costs grew more slowly for
older Group Health patients who regularly used their
SilverSneakers health club benefit. Group Health members age 65 and
older can choose either or both of two activity programs:
EnhanceFitness, or SilverSneakers, which includes access to a health
club and free physical activity classes geared to seniors' needs. Group
Health helped develop both programs.
"Physical activity can help seniors improve their balance to prevent
falls, boost cardiovascular health to prevent heart attacks, and improve
overall metabolism to help delay diabetes onset and complication of
diabetes," said study co-author Dr. James LoGerfo, a professor of medicine
and health services at the UW and an affiliate investigator at the Group
Health Center for Health Studies.
The researchers studied nearly 5,000 senior Group Health members who
participated in SilverSneakers. More than 9,000 control members were matched
to participants by age and sex. By year two, compared with control
participants, SilverSneakers participants had significantly fewer inpatient
admissions and lower total health care costs.
Lorraine and Jack Swisher of Bellevue are Group Health members and
regulars at the Bellevue Family YMCA SilverSneakers. Age 73 and 75,
respectively, they both have chronic conditions and believe their increased
physical activity has let them stay healthy and save their funds to travel
to Antarctica, snorkel the Great Barrier Reef, and go on a recent safari in
Africa. Granted, few seniors are quite as active—or well-traveled—as the
Swishers, but the researchers said that all people can benefit from regular
physical activity.
"The class is a very social time for everyone, plus it helps me with my
balance and flexibility," said Lorraine. "The exercises can be adapted to
any ability, and you can easily practice them while traveling or at home."
Dr. Huong Q. Nguyen, assistant professor of biobehavioral nursing systems
at the UW, is the study's lead author. She stresses the important takeaway
from this study is for older adults, especially on fixed incomes, to remain
active and incorporate physical activity in their lives for many reasons,
including cutting down on unexpected health care costs. The other important
message is for health plans to set up an infrastructure to support and
encourage wide adoption of a physical activity benefit for seniors.
"SilverSneakers is just one of many programs that health plans can offer
as a benefit to their senior population," said LoGerfo. "Another is
EnhanceFitness, a program for seniors available locally in community and
senior centers around Puget Sound and Spokane. The program focuses on simple
exercises that build not only flexibility and aerobic fitness but also
balance and strength, which are the most important elements for preventing
falls."
LoGerfo and his colleagues found similar cost-saving results for
participants in EnhanceFitness, formerly called Lifetime Fitness, in a
previous Group Health study published in 2003 in the American Journal of
Preventive Medicine.
LoGerfo and Nguyen collaborated on the current study of SilverSneakers
with colleagues at Indiana University, Veterans Affairs, University of North
Carolina, Dartmouth Medical School, and the U.S. Army. The study was
conducted jointly by Group Health and the UW's Health Promotion Research
Center, with funding from the Centers for Disease Control and Prevention and
Group Health.
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Health needs higher for kids of abused mothers
Children whose mothers have a history of abuse by intimate partners have
higher health care needs than children whose mothers have no history of
abuse, according to a study conducted at Group Health.
These needs—expressed in terms of the cost of providing care and use of
health services—were higher even if the abuse occurred before the children
were born, the research team found. Scientists from Group Health Center for
Health Studies, Harborview Injury Prevention and Research Center (HIPRC),
and Seattle Children's Hospital Research Institute conducted the study,
which appeared in the December 2007 issue of the journal Pediatrics.
"Children are the other victims when intimate partner violence (IPV)
occurs in the home," said lead author Frederick P. Rivara, MD, MPH. "This
study shows that children require more health care—especially for mental
health—when their mothers are victims of such violence."
The study compared medical records and utilization data from 631 children
of mothers with a history of IPV with those of 760 children whose mothers
had not experienced IPV. The mothers—who participated in a randomly sampled
telephone survey of Group Health female members aged 18 to 64—provided the
information regarding their lifetime history with IPV. The study defines IPV
as both physical abuse (slapping, hitting, forced sex) and nonphysical abuse
(threats and chronic disparaging remarks or controlling behavior). The
researchers looked at 11 years worth of data.
Among the mothers in the study, 46.6 percent reported experiencing IPV
since age 18. Among the children of mothers with IPV, 21.8 percent said the
violence stopped before the children were born. For 23.6 percent, the
violence happened during the children's lifetime.
Previous studies have shown that children exposed to IPV in the home have
increased risk for many problems including: also being abused at home,
problems at school, poor health, risk-taking behavior, and becoming
perpetrators of violence.
In 2006, the Group Health study team published evidence that IPV resulted
in significantly higher health utilization and costs for women. This current
study is the largest ever to examine the link between mother's exposure to
IPV and their children's health utilization and costs. The study is also
unique in that it examined a large middle-class population and one that is
very representative of Seattle, said Rivara.
"Intimate partner violence harms everyone in our society and it must be
viewed as not acceptable either for women or their children," he added.
The researchers found:
- Health care utilization and health care costs were
higher in most categories of care for children whose mother had a history
of IPV, with significantly higher levels of mental health costs and
services, primary care visits, primary care costs, and laboratory costs.
Overall, the annual costs of health care were 11 percent higher than those
for children of mothers without IPV.
- Children of mothers with a history of IPV that
ended before the child was born had significantly greater utilization of
mental health, primary care, specialty care, and pharmacy services. Health
care costs were 24 percent higher for children in this group compared to
children whose mothers had experienced no IPV in their lifetime.
- Children exposed directly to IPV after birth had
greater emergency department and primary care use during the IPV and were
three times as likely to use mental health services after the intimate
partner violence ended. They had 16 percent higher primary care costs than
did children of mothers without IPV.
The authors recommend that health care providers routinely screen women
for IPV and provide appropriate referrals to community agencies and mental
health care both for mothers and children affected.
They also state that interventions for women and their children are
needed to minimize the effects of IPV in the family. "Such interventions are
unlikely to be cost effective in the short term," they write, because the
victims' increased health care utilization seems to be higher for years
after IPV stops. "Nonetheless, such services are necessary to attend
appropriately and responsibly to the long-term consequences of violence,"
the authors conclude.
The research was funded by the Agency for Healthcare Research and
Quality, the Health Services arm of the U.S. Department of Health and Human
Services.
Rivara is a researcher with HIPRC and Children's. The principal
investigator for the study is Robert S. Thompson, MD, senior investigator at
Group Health Center for Health Studies. Other authors of the paper include
researchers from Group Health Center for Health Studies: Melissa L.
Anderson, MS; Paul Fishman, PhD; Robert J. Reid, MD, PhD; David Carrell,
PhD; and Amy Bonomi, now at Ohio State University.
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Accuracy of diagnostic mammograms depends on radiologist
For women with breast symptoms such as lumps, the ability of diagnostic
mammograms to detect breast cancer accurately depends strongly on which
radiologist reads them, according to a Group Health study published online
Dec. 11, 2007 in the Journal of the National Cancer Institute.
"When a woman gets a mammogram, she wants to know that if she has breast
cancer, the mammogram will be likely to detect it," said study leader
Diana Miglioretti, PhD, an
associate investigator at Group Health Center for Health Studies. "This is
especially important when the woman has a breast concern such as a lump."
Ideally, this ability to accurately detect cancer (known as sensitivity)
would be consistently high, with few false-positives—biopsies performed
despite the absence of cancer. And it wouldn't depend on which radiologist
was reading the mammograms.
But in a study of 123 radiologists at 72 U.S. facilities, including six
at Group Health, that's not what the Group Health researchers found. The
team examined how well the radiologists interpreted nearly 36,000 diagnostic
mammograms done to evaluate breast problems, such as lumps, from 1996
through 2003.
For different radiologists, sensitivity ranged from 27 percent to 100
percent and false-positives from 0 to 16 percent. These differences were
only partially explained by the characteristics of the patients and the
experience of the radiologists.
The radiologists who read diagnostic mammograms most accurately (with
highest sensitivity, without too many false-positives) tended to be those
who were based at academic medical centers or spent at least 20 percent of
their time on breast imaging.
"We need to reduce the wide variability among radiologists in how they
interpret diagnostic—and screening—mammograms," said Miglioretti. "A good
way to do that may be to identify the radiologists who are least accurate at
reading mammograms—and to improve their performance with extra training."
Miglioretti and her colleagues at the national Breast Cancer Surveillance
Consortium are working on ways to accomplish these goals, including
developing an interactive training program that would be distributed
nationally.
"Group Health radiologists who read mammograms spend a significant
percentage of their time in that capacity," said Group Health Medical
Director Hugh Straley, MD. The cooperative has internal audits to ensure
that its radiologists meet the national Medical Quality Standards Act and
accurately interpret mammograms, he added.
He encourages women to continue getting regular screening mammograms.
While the Group Health study points to imperfections in the technology,
mammography is the best way to detect breast cancer early when it has the
greatest chance of being cured.
Also, if a woman has a breast concern such as a lump, she should contact
her health care team right away, even if she has had a mammogram recently.
Miglioretti's coauthors included colleagues at Group Health; Harborview
Medical Center; University of Washington; University of California, San
Francisco; and Oregon Health & Science University.
Grants from the Agency for Healthcare Research and Quality, the National
Cancer Institute, and the Breast Cancer Surveillance Consortium funded the
study.
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Research Highlights
The “business case” is strong for enhanced depression outreach
and care programs for employees, according to a Journal
of Occupational and Environmental Medicine
article
co-authored by CHS Senior Investigator
Greg Simon, MD, MPH
with Harvard and National Institute of Mental Health (NIMH) colleagues. They
focused on the randomized NIMH-Harvard Work Outcomes Research and
Cost-Effectiveness Study, which improved depression outcomes, work
retention, and hours worked among employees at large national corporations.
The researchers concluded that these programs represent a human capital
investment opportunity for employers.
The Pathways program for collaborative care of depression
improved outcomes without raising long-term costs, according to an
article
in the March 10 Diabetes Care. This study
involved over 300 Group Health patients with both diabetes and depression.
At five years, trends suggested an actual reduction of costs among those
patients with more severe diabetes and medical problems. Co-authors included
CHS Senior Investigator
Michael Von Korff, ScD,
Senior Research Associate
Evette Ludman, PhD,
and three affiliate investigators: Group Health Family Practitioner
Elizabeth Lin, MD, MPH; and Paul Ciechanowski, MDCM, MPH
and Wayne Katon, MD of the UW.
A team approach to depression treatment can cut total health care
costs, according to an
article in
the February American Journal of Managed Care.
Adults over 60 who received a year of team care for depression had lower
mean costs for all their health care over 4 years: $3,000 less than patients
receiving traditional care, even including the cost of the team care
treatment. This multi-site Improving Mood—Promoting Access to Collaborative
Treatment for Late Life Depression (IMPACT) study includes Group Health
patients. Co-authors are three CHS affiliate investigators—Group Health
Family Practitioner Elizabeth Lin, MD, MPH; and
Jürgen Unützer, MD, MPH and Wayne Katon, MD, of
the University of Washington (UW)—with Kaiser Permanente and National
Institute of Mental Health colleagues.
A 25-mm needle should be used for the fifth diphtheria-tetanus-acellular
pertussis vaccination, regardless of injection site, according to a
study of
more than 1,300 Group Health children. CHS Senior Investigator
Lisa Jackson,
MD, MPH led the study, published in the March
Pediatrics. Local redness and swelling reactions were common
after this vaccination, especially with shorter (16-mm) needles. For parents
and providers who want to lower the risk of these reactions further,
vaccination in the thigh (rather than arm) is an option. Authors included
CHS Research Interventionists Patty Starkovich, RN and
Maya Dunstan, RN, Biostatistician
Onchee Yu, MS,
Assistant Investigator
Jennifer
Nelson, PhD, Project Coordinator Ann Zavitkovsky, MPH,
Group Health Pediatrician John Dunn, MD, MPH, and Sanofi
Pasteur Vaccines and UW colleagues.
The biggest barrier to providing high-quality cancer care is
unnecessary variation from lack of standardization or adherence to
guidelines during diagnosis, treatment, and surveillance, according to an
article in the February Cancer.
Authors were CHS Research Associate
Erin Aiello Bowles, MPH; Cancer Research
Network (CRN) Project Director Leah Tuzzio, MPH; Survey
Program Manager Cheryl Wiese, MA; Research Specialist
Beth Kirlin; Research Associate
Sarah
Greene, MPH; MacColl Institute for Healthcare Innovation
Director
Ed Wagner, MD, MPH; and Steven Clauser,
PhD, chief of the Outcomes Research Branch of the National Cancer
Institute (NCI)’s Applied Research Program. When 23 peer-nominated national
experts with diverse backgrounds in policy, health care, patient advocacy,
and research were interviewed, they suggested improving cancer patients'
experiences by standardizing care, adhering to guidelines, and using
“patient navigators” and an interoperable electronic medical record
accessible to patients and providers at multiple facilities.
Most older women with early-stage hormone-positive breast cancer
do not stick with the standard of treatment—five years of tamoxifen—according
to a
study e-published in December 2007 and to be published
in the February 2008 Journal of Clinical Oncology.
The study examined data, from six integrated health plans in the Cancer
Research Network, on 961 women over age 65. Nearly half stopped taking
tamoxifen before five years. Those most likely to stop taking the treatment
were older than 75, developed other medical illnesses, and/or received no
radiation after their surgery. Quitting tamoxifen before five years may
result in earlier recurrences, and ultimately, increased breast cancer
mortality, according to the study team. The team included CHS Associate
Investigator
Diana
Buist, PhD and colleagues from the Ireland Cancer Center,
University Hospitals of Cleveland, University of Massachusetts, Boston
University, Wake Forest University, Kaiser Permanente, Yale University,
Henry Ford Health System, and HealthPartners Research Foundation.
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New Funding
MacColl Institute partners with Qualis to spread medical home
model to 50 safety-net clinics nationally
The MacColl Institute at Group Health Center for Health Studies will
partner with Qualis Health, a Seattle-based nonprofit quality improvement
organization, in a five-year initiative to support 50 safety-net clinics to
adopt the patient-centered medical home model of health care delivery.
The project is supported by a grant from The Commonwealth Fund, which is
an independent foundation working toward health reform and a
high-performance health system.
Safety-net clinics include practices such as community health centers
that provide care for underserved or economically disadvantaged communities,
including many Medicaid enrollees and uninsured individuals. Commonwealth is
especially interested in the challenges and opportunities of implementing
the medical home in systems that treat America’s safety-net population,
since there is evidence that health disparities are lessened in a medical
home practice.
Qualis Health and MacColl Institute staff will provide technical
assistance to participating practices in four U.S. regions. The assistance
will include training to improve timeliness and availability of
appointments, to improve communication, and to support improvement of
team-based care delivery, customized according to each patient’s needs.
In the initiative’s first year, project staff will develop the training
curriculum, engage key stakeholders, develop a request for proposals, and
select the regions and clinics that will participate in the program. Funding
is expected to total $6.7 million for the five-year initiative. The MacColl
Institute expects to receive about $700,000 of that total.
Three staff members from the MacColl Institute--Director Ed Wagner, MD,
MPH, Research Associate Katie Coleman, PhD, and Associate Director Brian
Austin--are named on the project, and other MacColl staff will join the work
as needed.
A growing number of health policy experts, physician groups, government
agencies, and health care purchasers have concluded that implementation of
the medical home model will result in improvements in quality, patient
satisfaction, and effective use of health care resources.
The initiative defines the medical home model is an approach to primary
care that emphasizes timely access to medical services, enhanced
communication between patients and their health care team, coordination and
continuity of care, and an intensive focus on quality and safety.
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Group Health part of UW's new Northwest Institute for Genetic Medicine
On April 18, 2008, the Life Sciences Discovery Fund (LSDF) granted
University of Washington (UW) scientists and researchers a $5.3 million,
four-year grant to support the translation of human genetic research into
clinical medicine. The grant will be used to launch the Northwest Institute
of Genetic Medicine, a collaborative effort between researchers at the UW,
Seattle Children’s Hospital Research Institute, Group Health, and local
biotechnology companies.
The institute will bring together leaders in genetics and genomics as
well as related topics such as bioethics.
Eric B.
Larson, MD, MPH, executive director of the Group Health Center for
Health Studies, will also team up with UW researchers as a subcontractor for
the institute, with a subcontract of $700,000. Collaborating with Group
Health offers researchers access to unique Group Health resources, including
electronic health-care information dating back to the 1980s, a health plan
with some 580,000 members in 20 of Washington’s 39 counties, and
interactions with the nationally recognized research efforts at Group
Health.
The institute will facilitate the design, development and execution of
translational genetic studies that bridge the gap between basic-science
research and clinical studies at academic institutions and biotechnology
companies. The goal of the institute’s research will be to prevent illness
and speed recovery by identifying which patients are at high risk for
disease or best-suited to a specific treatment. For example, institute
scientists are now working to identify infants with congenital heart defects
who are at greatest risk for poor neurological outcomes. Identifying this
genetic profile of at-risk infants may lead to modification of related
surgeries or even an altering of therapies to prevent or reduce neurological
problems.
“We are thrilled to receive this generous grant from the Life Sciences
Discovery Fund,” said the institute’s leader, UW’s Dr. Gail Jarvik, Arno G.
Motulsky Professor of Medicine and Genome Sciences and head of the Division
of Medical Genetics. “Launching this collaborative effort will help us
efficiently and cost-effectively apply existing and emerging genetic
technologies to clinical data.”
Genetic medicine is poised to improve health-care outcomes, and the
institute aims to ensure that patients in the Pacific Northwest and across
the country will benefit from research that strives to prevent disease and
improve medical treatments. Study findings from the institute may help
prevent adverse outcomes of medications and surgery, predict the most
effective treatment for patients, and prevent disease in high-risk subjects.
For example, Jarvik said, priorities for the researchers include predicting
which patients will have muscle pain from cholesterol-lowering statin drugs
and preventing complications from surgery. Investigators also will study
ways to prevent adverse drug reactions and drug treatment failures, heart
disease, immune disease and prematurity.
To learn more about medical genetics at the University of Washington,
visit
depts.washington.edu/medgen/. The Life Sciences Discovery Fund, a
Washington state agency established in May 2005, makes grant investments in
innovative life sciences research to benefit Washington and its citizens.
For more information on the Life Sciences Discovery Fund, visit
www.lsdfa.org.
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New study examines diabetes and gum disease
People with diabetes, and their health care providers, know they’re at
risk of stroke, heart disease, kidney disease—and losing their sight and
limbs. But they may not know they’re also at risk of losing their teeth, as
serious gum disease (periodontal disease, not mere gingivitis) and diabetes
also tend to happen together. Periodontal disease is a gum infection that is
a major cause of tooth loss in adults. Usually painless, it often goes
undetected.
That’s why Group Health and the Washington Dental Service (WDS) are
teaming up on a new study to explore the relationship between diabetes and
gum disease. The study is part of an ongoing partnership to strengthen the
links between medical and dental care. It builds on the WDS-Group Health
pilot program to build oral health preventive-care services into routine
well-child visits.
“People really care about their teeth and their smiles,” said study
leader Robert Reid, MD, PhD, a
Group Health doctor who is an associate medical director of
Group Health’s Department of
Preventive Care and an assistant investigator at the Group Health Center
for Health Studies. “So detecting and treating periodontal disease may help
motivate patients to keep their diabetes under control.”
“Diabetics have a significantly higher risk of periodontal disease than
non-diabetics,” noted Ron Inge, DDS, vice president and dental director for
WDS. “Periodontitis may be a key contributor to complications of diabetes.”
In the new one-year study, funded by a grant from WDS, researchers will
examine records from people age 40–74 who belong to both Group Health and
WDS. They will see whether gum disease is linked to diabetes, blood sugar
levels, and other health problems and costs related to diabetes.
Group Health is an established leader in diabetes care, said Dr. Reid.
“Yet even at Group Health, we doctors and nurses who care for people with
diabetes may not recognize when they have periodontal disease and require
treatment, because we don’t do dental care.” And dentists don’t always
know which of their patients have diabetes. “The collaboration between WDS
and Group Health is helping to bridge the divide between medicine and
dentistry.” As an innovative leader in dental care, Washington Dental
Service believes that oral health is essential to overall health.
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Other notable awards
Genome-Wide Case-Only Study to Identify Hypertension Drug-Gene
Interactions: A five-year, $751,006 grant from National Heart,
Lung, and Blood Institute. Major Goals: To conduct a whole-genome case-only
association study to identify new regions that are candidates for drug-gene
interactions for each of the four major anti-hypertensive drug classes on
the outcomes of MI, sudden death, and stroke; and then within those regions
to identify common patterns of genomic variation that influence the efficacy
and safety of anti-hypertensive therapies in terms of major cardiovascular
events. The principal investigator is Bruce M. Psaty.
Kaiser Permanente Northern California HEAL-CHI External
Evaluation: A three-year, $744,647 grant from Kaiser Permanente.
Major Goals: To evaluate the community benefits of the Healthy Eating and
Active Living grant funded by Kaiser Permanente's Community Benefits in
Northern California. The principal investigator is William L. Beery.
Outcomes of Community Naturopathic Medical Care for Type 2
Diabetes: A three-year, $626,244 grant from National Center for
Complementary and Alternative Medicine. Major Goals: This prospective pilot
study will evaluate the effect of whole system naturopathic medical care for
persons with type 2 diabetes. The principal investigator is Daniel
C. Cherkin.
Patient Portal To Support Treatment Adherence: A
five-year, $3,627,534 grant from National Institute of Mental Health. Major
Goals: Guided by the Information-Motivation-Behavioral Skills (IMB) model of
patient adherence, this project will develop and field test a Health
Information Technology delivered intervention to increase anti-retroviral
medication adherence among persons living with HIV in a managed care
setting. The principal investigator is Sheryl L. Catz.
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People and Programs
CHS Senior Investigator and Group Health Director of
Preventive Care
David
Grossman, MD, MPH, was recently appointed to the U.S.
Preventive Services Task Force (USPSTF),
one of the nation's leading independent panels of experts in prevention and
primary care. Sponsored by the Agency for Healthcare Research and Quality (AHRQ),
the Task Force has 16 members who conduct rigorous, impartial assessments of
the scientific evidence for the effectiveness of a broad range of clinical
preventive services, including screening, counseling, and preventive
medications. Its recommendations are considered the "gold standard" for
clinical preventive services. Grossman, who is also a UW professor of health
services and adjunct professor of pediatrics, is widely recognized for his
research on injury prevention among children and teens.
The featured speaker for Group Health’s 2008
Birnbaum Lecture will be
Richard
Deyo, MD, MPH, theKaiser Permanente Professor of Evidence-Based
Family Medicine at Oregon Health & Science University, who was at the UW for
two decades. Presented by CHS and the Group Health Community Foundation,
this year’s lecture will be held at the Westin Hotel, on June 10. Deyo will
discuss the influence of commercial, political, and media forces on
scientific inquiry. He will also sign copies of
Hope or Hype: The Obsession with Medical Advances and
the High Cost of False Promises, which he co-wrote with the UW’s
Donald Patrick, PhD. CHS Senior Investigators
Bruce Psaty, MD, PhD
and Greg Simon, MD, MPH
will join in a panel discussion.
CHS Associate Investigator
Jennifer McClure, PhD
has agreed to succeed Senior Investigator
Dan Cherkin, PhD
as CHS associate director for internal research. Their leadership
responsibilities will overlap during a May–June transition period. McClure
will fully assume her duties as associate director no later than July 1.
Special thanks go to Dan for his outstanding leadership service in various
director roles."
Laura Paul Richardson, MD was named a
new CHS affiliate investigator. She is an investigator at the
Child Health Institute and an assistant professor of pediatrics and
adolescent medicine at the UW. Her research focuses on the interplay of
mental and physical health in adolescents—and on improving detection and
management of child and adolescent depression in primary care. She has
worked with CHS Associate Investigator
Paula Lozano, MD, MPH
and Affiliate Investigator Wayne Katon, MD, also of the UW.
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