Physician Faculty Scholars
In a study published in the May 18, 2011 issue of the Journal of the American Medical Association, Renee Hsia, M.D., M.Sc., (’09) and colleagues explore the reasons why, despite an increase in hospital emergency department (ED) visits, so many EDs closed their doors between 1990 and 2009. The study evaluates general, acute, nonrural and short-stay hospitals in the United States. Hsia and colleagues found that there was a 27-percent decline in hospital EDs in nonrural areas, “with for-profit ownership, location in a competitive market, safety-net status and low profit margins associated with increased risk of ED closure.” The study received media coverage in many news outlets, including CBS News, the New York Times, USA Today, the San Francisco Chronicle and FOX News.

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• Clinical Scholars
• Harold Amos Medical Faculty Development Program
• Health & Society Scholars
• Investigator Awards in Health Policy Research
• New Connections
• Physician Faculty Scholars

Clinical Scholars
In a study published in the May issue of Archives of Dermatology, Kate V. Viola, M.D., (’08) and colleagues sought to evaluate the proportion of suspicious lesions identified by non-dermatologists that are found to be malignant compared to the number of secondary skin lesions identified at the time of dermatology referral. They found that among patients referred by non-dermatologists to dermatologists for evaluation of skin lesions suspected of being malignant, only about one-fifth were found to be cancerous, although dermatologists identified and biopsied other incidental lesions, approximately half of which were malignant. The study received media coverage in Medscape, U.S. News & World Report and Insidermedicine.

In a paper published in the May 2011 issue of the American Journal of Roentgenology, Christoph Lee, M.D., (’10) makes an impassioned plea to elevate health services research within the specialty of radiology. Reforms from the American Recovery and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act of 2010 aim to tie financial compensation for all specialties, including radiology, more directly to their ability to increase patient well-being. Lee and Howard Forman, M.D., M.B.A., a professor at Yale University, argue that radiologists are currently less well-equipped to effectively demonstrate quality and value for their services compared to other specialties. The study was covered by numerous trade publications including Health Imaging, Advance for Imaging & Radiation Oncology and Medscape Today.

Raina Merchant, M.D., (’07) assistant professor at the University of Pennsylvania in the department of emergency medicine and senior fellow in the Leonard Davis Institute of Health Economics, and colleagues, examine hospital racial composition in cardiac arrest survival disparities in a study published in the April 2011 issue of the American Heart Journal. The authors found that hospitals with large black patient populations had worse cardiac arrest outcomes than predominantly white hospitals, and blacks were more likely to be admitted to these high-mortality hospitals. The study received media coverage in HealthCanal.com, e! Science News, and the Providence Journal, among others.

Jeremy Sussman, M.D., (’08) and Rodney Hayward, M.D., (’86) Clinical Scholars alumnus and Michigan site director, published “Individual and Population Benefits of Daily Aspirin Therapy: A Proposal for Personalizing National Guidelines” in the April 2011 issue of Circulation: Cardiovascular Quality & Outcomes. Sussman, Hayward, and colleagues assessed the net benefit from taking daily aspirin to estimate the individual and public health implications of a more individualized approach to preventive therapy. They found that the benefits of aspirin therapy depend substantially on an individual’s risk of cardiovascular disease and adverse treatment effects. They suggest that understanding who benefits from aspirin use and how much they benefit can help clinicians and patients develop a more patient-centered approach to preventive therapy.

Previous studies have shown that race and ethnicity play into preferences for heroic measures and resuscitative care at the end of life among adults, the terminally ill, and pediatric populations. However, little is known about racial and ethnic differences in resuscitation of periviable newborns. In a study published on April 18, 2011, in Pediatrics, Brownsyne Tucker-Edmonds, M.D., M.P.H., (’10) reveals higher utilization of neonatal intubation for periviable neonates born to black and Hispanic women. These findings may reflect differences in preferences for resuscitative care in periviability similar to those seen in end-of-life decision-making.

Harold Amos Medical Faculty Development Program
Justin R. Ortiz, M.D., (’10) released “Monitoring Influenza Activity in the United States: A Comparison of Traditional Surveillance Systems with Google Flu Trends,” in PLoS ONE. The study finds that while Google’s flu-tracking system, Google Flu Trends, is highly correlated with rates of influenza-like illness (ILI), it has a lower correlation with surveillance for laboratory-confirmed influenza. Google Flu Trends was developed to estimate U.S. influenza-like illness rates from Internet searches, but ILI does not necessarily correlate with actual influenza virus infections.

Health & Society Scholars
Jason M. Fletcher, Ph.D., (’10) and David E. Frisvold, Ph.D., a Scholars in Health Policy Research alumnus (’06), released research that finds that students who attend more selective colleges are less likely to use tobacco or marijuana during and after college. Selectivity was measured using a school’s national ranking in the median SAT score of entering students. In addition, the study suggests evidence between attending a high-quality college and maintaining a healthy weight through diet. The study, “College Selectivity and Young Adult Health Behaviors,” released online on May 4, 2011, in Economics of Education Review, presents the first evidence of the short and intermediate effects of college selectivity on an important set of health behaviors.

Mark L. Hatzenbuehler, Ph.D., (’10) released a study finding that a negative social environment is associated with a major increase in suicide attempts among lesbian, gay, and bisexual (LGB) youth. The study,“The Social Environment and Suicide Attempts in a Population-Based Sample of LGB Youth,” was published on April 18, 2011, in Pediatrics. The study of more than 31,000 11th-grade students in Oregon found that LGB youth were more than five times as likely to attempt suicide in the previous 12 months, compared to heterosexuals. The Oregonian published an April 25, 2011, editorial addressing the challenges faced by gay youth, which cited Hatzenbuehler’s study. The study also received media coverage in the Huffington Post, the Los Angeles Times, the San Francisco Chronicle, MSNBC, and the Boston Globe, among others.

Emily Jacobs, Ph.D., (’10) published “Estrogen Shapes Dopamine-Dependent Cognitive Processes: Implications for Women’s Health” in the April 6, 2011 issue of The Journal of Neuroscience. The study found that estrogen impacts working memory, but the effect is not the same in all women. Jacobs determined that the direction of estrogen’s effect—whether it enhances or impairs performance—was highly dependent on a woman’s baseline of dopamine. Women with naturally low dopamine showed a cognitive boost when estrogen levels were elevated, while women with naturally high dopamine performed better when estrogen levels were low.

Janxin Leu, Ph.D., M.A., (’04) released a study in Emotion that reveals that pursuing happiness may not be beneficial across all cultures. In a survey of college students, Asian respondents showed no relationships between positive emotions and levels of stress and depression. For European-American participants, however, the more stress and depression they felt, the fewer positive emotions they reported. Leu argues that the findings have implications for helping the Japanese recover from the natural disasters and subsequent nuclear crisis in March, and for Chinese citizens coping with the post-traumatic stress following the 2008 Sichuan Province earthquake. The study was released online on March 28, 2011.

James Macinko, Ph.D., (’06) co-authored “The Brazilian Health System: History, Advances, and Challenges,” a study that finds that universal and equitable coverage remains elusive in Brazil, despite the country’s broad expansion of health care coverage and recognition of health as a right for all citizens. While federal expenditures in Brazil have nearly quadrupled over the past 10 years, the health sectors’ share in the federal budget has not grown, resulting in constraints on health care financing, infrastructure and human resources. The study appeared in the May 9, 2011 issue of the Lancet.

Alexander C. Tsai, M.D., Ph.D., (’10) and his colleague, Nicholas Rosenlicht, of the University of California, San Francisco, released a review that questions the long-term use of the popular drug Abilify (aripiprazole) for bipolar disorder. The evidence base for the prescribing of aripiprazole in maintenance treatment of bipolar disorder is limited to a single trial, sponsored by the manufacturer of aripiprazole. The findings, published on May 3, 2011, in PLoS Medicine, received media coverage on CNN and in the Los Angeles Times.

Investigator Awards in Health Policy Research
General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. According to David Meltzer, M.D., Ph.D., (’07) associate professor in the departments of medicine, economics, and the graduate school of public policy studies at the University of Chicago, care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. In a paper published by the National Bureau of Economic Research, Meltzer and colleagues develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians’ costs switching between ambulatory and hospital settings in the traditional model. Their findings, which suggest opportunities to improve care, received media coverage in UChicagoNews, e! Science News and MedicalXpress.com, among other media.

In an article published in the March 2011 issue of Academic Medicine, Joseph J. Fins, M.D., (’06), the chief of the Division of Medical Ethics at Weill Cornell Medical College in New York, and Pablo Rodriguez del Pozo, M.D., associate professor of public health at Weill Cornell Medical College in Doha, Qatar, explain how forces beyond the medical school can influence education in the classroom and at the bedside. They argue that because of the contextual factors that influence the relative importance of what is implicit and explicit in the student’s educational experience, medical educators need to be aware of their local cultural contexts in order to engage in effective pedagogy.

In the April 2011 issue of Current Problems in Pediatric and Adolescent Health Care, John D. Lantos, M.D., (’06) director of the Children’s Mercy Bioethics Center at Children’s Mercy Hospital in Kansas City, provides the forward to a collection of essays in which physicians, medical ethicists, parents and caregivers address one of the most contentious topics in pediatric and clinical ethics today: the assessment of quality of life. Lantos states that “any assessment of quality of life necessarily incorporates value judgments about the subjective state of another human being. The stakes go up when such judgments are used to deny people access to medical care or to justify the withholding or withdrawing of life-sustaining treatment. Before making such significant decisions, we need to be clear about what, exactly, we are talking about and why we talk about it the way we do.”

The April 21, 2011 issue of the New England Journal of Medicine includes publications by two Investigators. In a Health Policy Report titled, “New Directions in Medical Liability Reform,” Michele Mello, J.D., Ph.D., M.Phil., (’07) and colleague Allen Kachalia, M.D., J.D., review the evidence on outcomes of traditional tort reforms and find little improvement in liability metrics and little or no evidence of improved clinical care. They also look at nontraditional reforms that focus on improving clinical care and communication and at new federally-sponsored demonstration projects, which hold promise for moving “closer to a liability system that fosters, rather than obstructs, progress toward safe and high-quality health care.” In a Perspective piece, Aaron Kesselheim, M.D., J.D., M.P.H., (’09) reviews the recent U.S. Supreme Court ruling in Bruesewitz v. Wyeth that vaccine makers are immune from lawsuits charging that the design of a vaccine is defective. Kesselheim questions whether the federal no-fault compensation system alone provides sufficient safety protections for children harmed by adverse events after vaccine administration.

In a study published on April 20, 2011, in PLoS ONE, S. V. Subramanian, Ph.D, M.Phil., (’09) associate professor in the department of society, human development and health at the Harvard School of Public Health, and colleagues, found that in recent decades, the average height of women has declined in Africa, stalled in several South American countries and varied considerably in other low- to middle-income countries. The declines or stagnation are most noticeable among disadvantaged women and can reflect poor nutrition, exposure to infections and other environmental factors that may stunt or hamper children’s growth. The study received news coverage in the New York Times and Harvard Public Health Now.

New Connections
Wrenetha Julion, D.N.Sc., (’07) received an NIH RO1 grant to fund her research study, “The African American Non-Resident Fatherhood Program.” Through this study, non-resident African American fathers will help guide the development of a video-based intervention that addresses child development and parenting skills, communication and problem-solving strategies, parenting self-efficacy and father self-esteem, and strategies for reducing stress.

Raphael Travis, Dr.P.H., (’08) received a Texas State University Library Research grant to study hip-hop culture and positive youth development.

Physician Faculty Scholars
Peter Cram, M.D., M.B.A., (’07) published a study in the April 20, 2011 issue of the Journal of the American Medical Association that showed people who have hip replacement surgery now spend a much shorter recovery time in hospitals than they did almost two decades ago, but discharges to nursing facilities and readmissions to hospitals have soared as a result. “As patients’ lengths of stay go down, there is less time to recuperate, and even if they’re not yet ready to go home, they have to go somewhere else quickly, and more are being admitted to rehabilitation centers,” explained Cram. The study received coverage in U.S. News & World Report and Health.com.

Ray Dorsey, M.D., M.B.A., (’08) led a study showing that group appointments among patients suffering from the same medical condition have benefits for patients who are battling chronic illness. These checkups are stretched over 90 minutes and offer more time for patients to talk to doctors about their concerns, learn more about managing the disease, and get tips from fellow patients. Doctors benefit from learning more about how their patients are doing by watching them interact with others. “This is a new way of delivering health care,” said Dorsey. The study received coverage in Yahoo! News, CBSNews.com, the Boston Globe, WebMD, U.S. News & World Report, Forbes, and the Times Leader, among others.

On April 19, 2011, Pediatrics published “Validating Office-Based Screening for Psychosocial Strengths and Difficulties Among Youths in Foster Care,” by Sandra Jee, M.D., M.P.H., (’07). Jee’s study used psychological, home-administered interviews to assess accuracy of mental health screening in the primary care setting. The study found that although most youth in foster care have social-emotional problems, most have strengths as well, and that the perspectives of youth and foster parents on these problems differ. A systematic social-emotional screening in primary care that includes reports from both youth and foster parents can better identify those youth who will benefit from services.

Elsie Taveras, M.D., M.P.H., (’07) was the lead author of “Randomized Controlled Trial to Improve Primary Care to Prevent and Manage Childhood Obesity,” published on April 4, 2011, in Archives of Pediatrics & Adolescent Medicine. The study showed that a program including regular follow-ups with nurses and focused attempts to cut back on TV, fast food and sodas helped keep some overweight children from gaining more weight. Specifically, girls and kids from households earning less than $50,000 were less likely to gain weight over the course of a year if they were in the program. Taveras’ study received media coverage in the Chicago Tribune, Reuters and Yahoo! News.