Traci Toomey, professor of epidemiology and community health, will present a Ted-like talk about alcohol policy featuring outstanding faculty and research in the School of Public Health. Chance for Q&A after the presentation.
Andrew Huff, a graduate of the Division of Environmental Health Sciences, is the investigator on a $4.6 million grant awarded to EcoHealth Alliance from the Defense Threat Reduction Agency.
Huff is a senior research scientist at EcoHealth Alliance, a nonprofit organization that focuses on conservation and global health issues.
The grant was awarded to continue the development of the Global Rapid Identification Tool System (GRITS), a software program that is designed to monitor early-warning signals from a possible emerging infectious disease outbreak. The software is being developed in partnership with ProMED and the International Society for Infectious Disease.
Climate change, land use change, and urbanization are all potential factors that contribute to the risk of diseases like Ebola, MERS, and other zoonotic pathogens. Environmental change to the global landscape increases the risk of disease emergence.
GRITS analyzes textual data sources by identifying, extracting, and visualizing critical public health information and suggesting possible associated infectious diseases. The multitude of news, social media, and existing biosurveillance systems makes it is increasingly difficult to digest all of the available information to monitor possible disease threats. GRITS enables infectious disease analysts to examine dynamic visualizations of historical disease emergence events and monitor new patterns that could point to new infectious disease outbreaks.
“GRITS is an open source technology that is going to change how ‘One Health’ disease surveillance is conducted into the foreseeable future,” says Huff.
~ Post by Joy Archibald
Lately, it may seem impossible to visit the gym without spotting someone sporting a Fitbit, Garmin watch or some sort of exercise tracking device. As the newest exercise accessories help make logging workouts a breeze, Health Talk spoke with Bill Roberts, from the Department of Family Medicine and Community Health, and Jean Abraham, from the School of Public Health, to determine which workout devices and incentives motivate people to get off the couch and on their feet.
“On a circumstantial basis, there are many stories showing great success for people, but effects can vary among individuals,” said Roberts. “These devices are not going to have the same outcomes for every person. Ultimately, a person’s level of motivation determines their results.”
Specific workout trackers can monitor heart rate, steps, calories consumed and burned, and even sleeping patterns. These devices can appeal to people striving to keep their activity consistent and avoid holes in workout patterns. However, it is important to understand that even the most advanced devices may not be suited for everyone’s lifestyle or workout goals.
“When determining which device works best for a person, they should consider prices, the type of data they want to track, and what they want to gain by using the device,” said Roberts. “There are also devices available for simpler tracking such as pedometers, that can be used to motivate people to reach their recommended 10,000 steps per day. Smartphone apps can also be used to enter workouts and to manually track activities. GPS-based exercise apps can map walks or runs, measuring distance and calories burned.”
Workout incentives are not limited to technology devices as other tactics can help promote regular exercise. Finding a workout partner to help get you outside for a walk or run, or determining rewards can be successful alternatives.
“Many health promotion or wellness programs use financial incentives to promote healthy behaviors, such as engaging in regular exercise,” said Abraham. “Some research evidence suggests that providing monetary rewards for regular attendance can increase fitness center utilization.”
The key is to get moving – whatever the motivation may be.
“Exercise is good, cheap medicine that can reap many health benefits when done in moderation,” said Roberts. “A truly motivated person will find an incentive to make exercise work and I am for anything that gets people moving.”
~ Post written by Katie Huggins and originally published on Health Talk
The results from a new University of Minnesota-sponsored global HIV study show that when it comes to beginning drug treatments, the sooner patients start, the better—and the discovery could trigger a dramatic shift in how the disease is dealt with around the world.
Each year, roughly 2.1 million people contract HIV across the globe and an estimated 1.5 million people die from its AIDS-related illnesses.
The trial, called Strategic Timing of AntiRetroviral Treatment (START), began in 2009 and looked at what would happen if a group of HIV-positive—but otherwise healthy—people were put on antiretroviral drugs when their immune system’s CD4+ “t-cell” count was greater than 500. They were compared to a group who didn’t receive drugs until their t-cell counts dropped to 350. The 4,685 people in the study came from 35 countries around the world.
The results of the trial weren’t expected until 2016, seven years after the study began.
However, in a surprise development, accumulated evidence showed in late May that the results of the trial were already obvious:
Across the board—and in every country—early drug therapy helped bolster the health of HIV patients and it reduced their viral load, making them potentially less infectious to others as well.
The study is being run by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT). School of Public Health biostatistician Jim Neaton is the principal investigator for INSIGHT and shares more about the trial and its potential ramifications.
SPH: How were people selected to participate in the study?
Neaton: People were eligible for the study if they were infected with HIV, asymptomatic, and generally healthy—including having two CD4+ t-cell counts above 500. A cell count of 600-1200 is considered healthy.
They also had to be “treatment naive,” meaning they hadn’t taken antiretroviral medication yet. If they were women, they’d couldn’t be pregnant or breastfeeding, because in most of those cases they would have already been treated to avoid transmission to their babies.
Once the individuals consented to testing, they were randomized to begin therapy immediately or to wait until their CD4+ cell count declined to 350 or until they developed an AIDS event.
SPH: What made this the right time to do the trial?
Neaton: This type of global trial has been discussed for a long time. What made this an important study to do now were two things:
One, there was concern that the therapy itself increased the risk of what we call “non-AIDS diseases” like cardiovascular diseases, cancers, and renal diseases. We determined in a previous trial, called SMART, that interrupting therapy actually increased the risk of those diseases.
The other thing that made the trial important to consider doing was that shortly before the START trial began, another study showed that by taking therapy, you could reduce your risk of transmitting the virus to someone else.
From a public health point of view, it became clear that getting somebody on therapy was important for transmission prevention, but the overall risk-benefit to someone’s health was still uncertain. So that’s why we did the trial.
SPH: What were the main hurdles to performing the trial?
Neaton: This study was a challenge from the beginning.
For one, the University of Minnesota had to be the sponsor for the study because European trial regulations made it very difficult for the NIH to do so. The NIH basically told us that it would fund the trial, but the University had to sponsor it.
After several months of discussion with the University, the Board of Regents agreed to be the sponsor, to take on the liability of the trial.
In general, the disharmony in trial regulations around the world also makes what we’re doing very difficult. That said, I think we’ve learned how to do it the best it can be done within the various national health systems.
The effort is worth it because when you do a global trial and lots of sites and countries are involved, and the results are consistent across countries, it’s going to have worldwide impact. That’s important for a disease like HIV, which is far more prevalent in other parts of the world than in the U.S.
SPH: What sort of team effort did it take to complete this trial?
Neaton: This trial involved hundreds and hundreds of staff around the world and many people at the University of Minnesota.
I’m the principal investigator of the INSIGHT research group and part of the study leadership along with three co-chairs, Abdel Babiker in London, Jens Lundgren in Copenhagen, and Fred Gordin in Washington D.C.
The statistical and data management center and the operations core for the study are based at the School of Public Health. The four international coordinating centers in London, Copenhagen, DC, and Sydney help work with the sites around the world and really pay attention to detail on the day-to-day management of how studies like this should be run.
SPH: What do you want people to takeaway from the success of this trial?
Neaton: It’s important to do global trials with clinical outcomes to understand the risk-benefits of treatments. Too many studies are done using laboratory markers that don’t necessarily directly measure a person’s health. When you can do a trial on a global basis that concerns clinical disease and shows, in this case, that early treatment is beneficial, it can be much more convincing.
I tell the students that the world is becoming a much smaller place and global trials like this will be the norm in the next decade. Such studies are questioned because they’re expensive, and it involves sending funding to places outside the sponsoring country. But, people move around, diseases move around, and so there’s a real argument for doing global trials in many areas.
We’ve shown now that it’s possible to do them, and hopefully, they can have a big impact once they’re done.
~ Post by Charlie Plain
Co-Managing Partner and CEO, Link Capital
Co-Managing Partner and COO, Link Capital
Student Loan Repayment for Medical Professionals:
A New Approach to a Growing Problem
LinkCapital® has developed an alternative to traditional student lending for a range of health care professionals, including nurses, physicians, and residents. With its health system partners, LinkCapital® helps employees refinance their student loan debt. The refinancing provides lower rates, deferment for some residents, and an enhanced level of service. The loans are tailored to the stage of a medical professional’s career, and its medical loan specialists help borrowers navigate the refinancing process.
[i]KH: In 2014, more than 43 percent of public university graduates reported debts of $200,000 or more.[ii] And since the elimination in 2009 of the government program known as the “20/220 Pathway,” interest on government student loan debt accrues during residency, when most don’t yet have the income to support the monthly payments. This means residents either need to repay from their residency salary—often a nearly impossible proposition—or go into forbearance, which can lead to the debt level doubling or even tripling. Today, balances of $400,000 or more are not uncommon for specialized physicians.This problem is particularly pressing for physicians considering the potential for compression of physician incomes for these higher-end specialties. While those in fields on the lower end of incomes for physicians, such as primary care, may increase in the coming years, incomes for specialists are likely to see a flattening or decline in the compensation curve in the future. The expected flattening is largely the result of new physicians’ desire in moving away from single site practices and trading off higher compensation potential for security (that groups can provide).
With these increases in debt levels, are student loans the next financial bubble to burst?
KH: Student loans have surpassed credit cards with a higher average rate of defaults in 2014—or 13.7 percent. However, with the federal government funding more than 90 percent of the financial markets, the implication for capital markets tends to be muted.[iii] The effect for individuals is different given that, for all student loans, borrowers pay the same interest rate regardless of credit quality and income potential. What that means is those who do repay are over-charged with rates that subsidize those who default. The fact is, repayment can vary greatly from person-to-person. For example, the cohort default rate (CDR) for college dropouts is 16.8 percent while the CDR for college graduates is only 3.7 percent. In addition, during the past three years the CDR of Grad PLUS loans has been less than one percent. For select standalone medical schools supported by non-profit health systems, the weighted/average CDR rate is even lower at 0.52%.[iv]
How has all this debt load affected physicians?
BC: There are conflicting reports on the effect of student loan debt on a physician’s decisions. While some studies, including a 2009 report by the U.S. Government Accountability Office, insist that personal interests, rather than economic factors—such as income expectations and education debt—continue to drive specialty selection, recent surveys suggest otherwise.[v]
Physicians with higher debt relative to their peers reported choosing a specialty with higher income potential and they may be less inclined to work in underserved locations. Students with higher debt levels also reported they felt higher levels of stress related to debt and that it, and the constraints of their repayment obligation, caused them to delay personal long-term goals such as getting married, starting a family, or buying a home.
Further, some reported they would be less likely to choose to become a physician again if presented with the opportunity to revisit that decision.[vi] Additionally, there are indications that medical student debt also affects the diversity of candidates being drawn to the profession.[vii]
What is the LinkCapital® solution to the increased student loan debt borne by health professionals?
BC: We offer lower rates than the industry standard and repayment options designed for different medical professionals.
For example, there are refinancing options for residents that include reduced interest rates and fully deferred payments throughout residency and fellowship, which are generally not available to residents through the most common government loan programs.
For employed physicians, nurses, and other practitioners, the rates are reduced even further. For all of our loans, there are no upfront costs and the loan can be repaid at any time, without penalty. The products can also work as a supplement to the loan repayment programs currently in place at many health systems, which significantly reduces the cost to the organization while still providing benefit to the borrower/employee.
Can you give us some examples of how the LinkCapital® model works?
KH: Take Anna, who is in a five-year pediatric oncology residency and had a $325,000 student loan balance at an average rate of 6.9 percent. Once her training is complete, Anna would have faced a total repayment obligation of $415,000 over a 10-year period and a payment of $4,200 per month. If Anna works with us, her rate has dropped to 5.75 percent, and she is able to defer payments through her residency without going through the process of forbearance. In doing so, Anna will accrue $21,000 less during her training period. Once repayment begins, this translates into $575 per month of savings, or $69,000 during the life of the loan.
For physicians, nurses, and all other health system employees, our fixed rates are lower than the federal government rates, with variable rate options as low at 2.51% APR.
What advice do you have for younger physicians?
KH: Develop a budget to get a picture of what your future spending habits would look like as you work to pay off your student debt. Spend the time to come up with a plan to repay your loans, then stick to it.
While coming up with an effective strategy for whittling down a six-figure debt can certainly be daunting, the ramifications for falling behind on your debt can be disastrous—in some states physicians can lose their medical licenses for not making payments.
Repayment alternatives such as income based repayment (IBR), pay-as-you-earn (PAYE), and income-contingent repayment (ICR) all seek to help students eliminate debts over time. That said, those with high debt loads and high interest rates will need to do a careful analysis to ensure they select the right repayment plan, as well as an analysis of the rates and types of loans in order to decide whether consolidation is a wise move.
Additionally, carefully consider the implications of adding more debt such as zero down home mortgages, credit cards, and auto loans. It’s not uncommon to make decisions based on what financial institutions will approve, but keep in mind that some banks don’t incorporate a physician’s student loan in their debt to income requirements for mortgages. That oversight could result in you qualifying for a mortgage loan greater than what you can realistically afford.
So what is the catch?
BC: As a group, physicians can be skeptical about financial products, and wisely so. With a non-profit as our larger investor, transparency is important to us. We know our loans are not for everyone, and we’re upfront with potential borrowers when that’s the case.
For example, medical professionals looking to use Public Service Loan Forgiveness (PSLF) or the National Health Service Corps (NHSC) loan forgiveness options will not find a comparable option among our offerings. We source our loans with private investment capital, and the expectation is that it will be repaid. Therefore, while we can offer reduced interest rates and flexible repayment terms, public service loan forgiveness is not a part of our platform. Link suggests having a review with one of our medical loan specialists to determine if PSLF actually provides any benefit, given in many cases the savings don’t outweigh the potential liability if the program is capped, taxed or eliminated completely.
KH: Those who do plan to take advantage of PSLF should know that President Obama’s FY 2016 budget includes a cap on PSLF at $57,500 and limits the education tax incentives to only the first five years.[viii] These changes could have a major impact on borrowers who plans to make use of PSLF in the future or those who plan to use education tax incentives.
With so many student loan refinancing alternatives available, what should borrowers be asking?
KH: Most borrowers will focus on repayment terms, interest rates, and monthly payments. Those are the basics, but there are a few other questions that often get overlooked:
- Do you charge an upfront fee to refinance my loans and are there any prepayment penalties?
- Do I have to change my checking account to get your rates?
- What happens to my family or co-signer if I die or become disabled before repaying my loan?
- For residents and fellows, am I required to make payments during my residency or fellowship?
- For residents and fellows, do I need a USMLE license? Do I need to be board certified?
Many of our alumni are health care executives, how can they play a role in assisting medical professionals with their student debt loads?
BC: From the employer perspective, there are a variety of avenues for helping the medical professionals they employ. Some employers go the avenue of sponsoring a Loan Repayment Assistance Program, though there are specific tax and regulatory issues that must be considered. Beyond sponsoring their own programs, employers should provide employees information and resources to help them improve their financial picture. It’s an employee benefit that can help improve the stability of your workforce.
How might these executives as employers assist their employees in taking advantage of the LinkCapital® model?
BC: Given the busy schedules of residents, fellows, and practicing physicians, executives can participate by partnering with us in communicating the opportunities to their employees.
Because many younger medical professionals are comfortable with social media and online relationships, we have developed online content, virtual webinar events, and one-on-one web-based conferencing to educate prospective borrowers and to navigate them through the application process. While keeping information confidential, our back-end analytics can report back adoption to senior management on an aggregate level (read email, viewed website, called our support line with questions, watched webinars, or started application) up until the application begins. Organizations can further reduce the borrowing rate for their employees by incorporating some of our private structures.
Our world is graduates of health care administration programs. Are they eligible?
KH: Yes, once employed they are eligible to participate in our programs as well.
Disclosure: Daniel Zismer serves on the Advisory Board of Link Capital. This publication is not an endorsement or recommendation of products or services provided by the company.
A recent study involving researchers at the University of Minnesota School of Public Health found parenting practices related to eating and weight differ between food-secure and food-insecure mothers.
The research was part of Minnesota’s Project EAT, conducted by Dianne Neumark-Sztainer, professor in the School of Public Health, and Katherine Bauer, assistant professor in the College of Public Health at Temple University.
Food insecurity, or having limited access to nutritional food, has many negative effects on children’s overall health. Children who lack vital access to food often have less healthy diets and are prone to micronutrient deficiencies, such as anemia. In some studies, growing up in a food-insecure household has been associated with a higher risk of obesity. Food insecurity is also related to educational and behavioral issues among children.
“We were very disturbed by the high percentage of adolescents and their families from Minneapolis and St. Paul, who participated in EAT 2010, who experienced food insecurity,” said Neumark-Sztainer. “In fact, over one-third of the families had some level of food insecurity.”
Studies of families with young children have found that food insecure mothers pressure their children to eat and use parenting strategies that encourage the consumption or overconsumption of high-calorie foods. Families with low food security also report more frequent fast food trips for family meals and less frequent inclusion of fruits and vegetables in family meals.
The study by Neumark-Sztainer and Bauer was the first to look at the parenting of teenagers in food-secure versus insecure homes. Results showed that mothers in food-insecure homes were more likely to report using parenting practices that encouraged restriction of eating and dieting among their teenagers. Mothers from food-insecure families were also more likely to comment on their child’s weight compared to mothers from food-secure homes.
These findings suggest that contrary to how food insecure mothers approach eating with their young children, food-insecure mothers of teens are more likely to use parenting practices aimed at limiting eating. The use of these parenting practices may be driven by a belief that teens can go without food more easily than young children or eat at locations other than home such as school or friends’ homes.
To address these issues tied to food insecurity, Neumark-Sztainer and Bauer suggest that in addition to increasing access to healthy food for food-insecure families, programs may have longer-lasting effects on families’ health if they help parents develop more health-promoting parenting strategies related to food and eating.
“Many parents, both food-insecure or not, may benefit from understanding how often well-intentioned parenting messages can be counter-productive,” said Bauer. “Encouraging children to diet, commenting on children’s weight, and excessively restricting food, even less healthy food, has been associated with use of maladaptive eating behaviors and harmful weight control methods among adolescents.”
~ Originally posted on AHC Health Talk by Katie Huggins
Keeping up with the Ikramuddins
Farha and Sayeed Ikramuddin are married physicians who recently completed the University of Minnesota’s Executive Master of Healthcare Administration (MHA) together. They both teach and practice at the University of Minnesota and University of Minnesota Medical Center where Farha is a stroke rehabilitation specialist and Sayeed is a bariatric surgeon.
“Going through the program, our mutual support was valuable and the experience of two perspectives was remarkable,” says Sayeed. “It was my wife who suggested that I pursue this degree.”
While the 25-month program was a challenge and required sacrifices on a daily basis, the Ikramuddins emerged with new tools that allow them to interact, negotiate, build bridges and network. “It taught me to focus on projects in a holistic manner,” says Farha. “Most of the principles learned I immediately applied to my work.”
As physicians, the Ikramuddins are used to delivering health care one patient at a time. The Executive MHA program was a gateway to understanding and owning process for the greater good of the patients. Emphasis on process of care has been a dramatic step forward in the national approach to improve outcomes.
“I am interested in Academic surgery – optimizing outcomes with less invasive technologies and understanding the mechanism of surgical interventions so that we do not need to operate, “ explains Sayeed. “I want to improve surgical quality through process.”
Why the Minnesota MHA?
The Ikramuddins believe there are numerous opportunities to obtain the MHA degree nationally, but the Minnesota program’s long track record, its influence nationally, and the relationship of the U of M to healthcare industry payers and device companies made this the right choice.
“The MHA degree has been a catalyst to allow me to improve care for my patients and the work environment for my colleagues,” says Sayeed.
“Not a day goes by without using some of the learning from the Executive MHA program—from communication, strategic development, financial planning, operations, ethics and human resources.”
~Post by Mona Rath
James Begun, professor, was named MHA instructor of the year as voted by the full-time MHA Class of 2015. Begun received the Class of ’81 Award for Excellence in Teaching at the MHA graduation banquet, May 18. He teaches PubH 6542 Management of Healthcare Organizations. More about Begun >
~Post by Mona Rath
Alumni from the Division of Health Policy & Management’s MHA and MPH-PHAP programs were recognized for their outstanding professional achievements at the School of Public Health’s Celebration of Giving 2015 Alumni Awards, May 4.
Andrew R. McCulloch, MHA ‘80, received the Gaylord Anderson Leadership Award. McCulloch is president of Kaiser Permanente Northwest Region where he has made high quality, affordable and fully integrated health care services widely available to the community. More about McCulloch >
Meng-Chih Lee, MD, PhD, MPH-PHAP ‘87, received the Alumni Award of Merit for his leadership in Taiwan with public health, medicine and geriatrics education programs. Currently, as superintendent, Taichung Hospital, Ministry of Health and Welfare, Lee he as led the development of a new initiatives in clinical care for older adults, including a geriatric outpatient clinic, intermediate care, and health promotion and chronic disease management. More about Lee >
Olivia Mastry, JD, MPH-PHAP ‘93, received the Alumni Innovator award for her work as founding partner of The Collective Action Lab, a collaborative forum that fosters cross-sector, large scale systems change in the health, older service and disability arenas. Mastry combines her training and experience in law, health administration, public health, and conflict resolution to support a disciplined collaboration process that enables organization to accomplish together what they cannot do alone. More about Mastry >
~Posted by Mona Rath
The School of Public Health’s Student Ebola Action Committee (SEAC) was honored with the 2015 Tony Diggs Excellence Award for Innovation on April 2.
The award is one of a series of Diggs awards handed out each year by the University of Minnesota’s Student Unions & Activities. The honors recognize student groups that demonstrate creativity through recruitment, marketing, outreach to campus community, and other initiatives. They’re given in memory of Tony Diggs, a former director of UMN’s Student Activities Office who died of cancer in 2006.
“It’s nice to be recognized by the University for our efforts,” says SEAC committee co-chair and SPH student Shruthi Murali.
SEAC won the Innovation award for its mission to raise awareness on-campus of the Ebola epidemic and for putting on the forum, “Ebola: Local and Global Impact,” held on November 12, 2014.
The forum featured a keynote presentation by SPH McKnight Professor Michael Osterholm and a panel discussion with local zoonotic disease, medical and African community experts.
“We gave the campus community an opportunity to learn more about Ebola, and specifically, how the epidemic in West Africa was affecting the African communities within our own state,” says Murali. “It made what we were studying all the more real and gave us a feel for the types of things we could be doing in our later careers.”
In addition to holding the forum, SEAC also produced Ebola-related multimedia, raised money for the American Refugee Committee, and partnered with the Blake School for its own event on the epidemic.
SEAC recently renamed itself the Active Responsive Coalition (ARC) for Public Health in a move to expand on the success of its Ebola campaigns. The new name also comes with a revised mission of promoting “a culture of wellbeing at the University of Minnesota and serving as a rapid-response organization to address state, national, and global health efforts by engaging in the community through education and action.”
SEAC 2014/15 Members
Jane Frances Anyamele
~ Post by Charlie Plain