An Ounce of Prevention...

A Publication of the
Program on Prevention
In Education & Practice

June 2000 - Volume 1, Number 4

We apologize about the delay in getting out this newsletter. Because we changed our office location the first of May, it's been a pretty rocky month and by the time I found the newsletter file, it was almost June. And so, here we are with the May/June issue of "An Ounce of Prevention".

We are now located in room 383 on the third floor of Wing D, next to the Department of Social Medicine.
Our phone, fax, and CB numbers are the same.

Living Well

UNC Hospitals is planning and will ultimately construct a 52,000 square foot Wellness Center in the new Meadowmont development in Chapel Hill. Construction should begin this fall with an anticipated opening date of mid-2002. The Wellness Center will include a membership-based fitness center (open to the community) along with integrated clinical services (physical and occupational therapy, cardiac rehabilitation, complementary therapies)and a major focus on community health education. Center amenities include over 10,000 square feet of dedicated workout areas with exercise equipment, a five-lane lap/fitness pool, 1/9 mile indoor walking track, aerobics studios, classrooms and a teacher kitchen. For more information, contact Dan Lehman, Administrative Director, Cardiovascular and Wellness Services, 966-2136 or dlehman@unch.unc.edu.

Newsworthy Notes

Prevention News Around The Program...

Prevention Education Program- Summer 2000

We are delighted that seven rising second year medical students will be spending their summer working with faculty members on prevention-friendly projects here at UNC. The students will be funded by the program but will work with a variety of faculty in order to see prevention in action and take part in prevention-related clinical experiences. Students will end the experience by participating in a poster/presentation day for faculty and other summer students. This day is a cooperative activity by Family Medicine, Emergency Medicine and the Program on Prevention. More to come on the student experiences in the next newsletter.

Prevention In ACTion

PACT students met last month to discuss the future of the PACT group as CO-presidents Rachel Reisner and Miriah Teeter leave the group and enter into their clerkship year. Rising second year students Brian Lewis and Anna Frick were elected CO-Presidents and will begin their work during the summer to establish some overall goals for the upcoming year. Amy will be working very closely with PACT presidents this year to not only continue programs from last year but integrate with existing prevention-related programs.

Health Care & Prevention MPH

The Health Care & Prevention (HC&P) MPH program recently graduated 10 students and plans to graduate several more in August. There will be approximately 27 HC&P students in the upcoming year which includes Clinical Scholars, Primary Care Fellows, Preventive Medicine residents, other health care providers and UNC medical students. A total of 14 UNC medical students will be taking a year off to get their MPH this coming year. Six of those students will be enrolled in the HC&P Program. We are delighted to welcome all UNC medical students into this program.

Health Communication Centers

The Program has recently begun an initiative to create clinical practices that model effective patient education centers. We are working with Chatham Crossing and Chapel Hill North to develop patient education areas where patients will have computers, video and audio tapes and printed materials at their fingertips to find reliable and credible resources to help them learn about particular health concerns. An integral part of this endeavor is the creation of student learning experiences in these health communication centers. We expect that Clerkship students as well as 1st and 2nd year PACT students, and possibly others will have the opportunity to see patients using state-of-the-art patient education centers and will take part in the learning process. Peter Kranz, a rising 2nd year medical student, is working with the Program this summer to set up the health communication centers at the practices. A similar center has already been developed at the Ambulatory Care Center. The literature provides suggestions as to what types of patient education are most effective and these suggestions are being considered in center development.

According to a new article in the Archives of Family Medicine, physicians are important catalysts for behavioral change. The study explored a "priming effect" of physician advice on patient responses to behavioral change interventions. Interventions included printed education material designed to encourage patients to quit smoking, eat less fat, and increase physical activity. The study showed that patients who received physician advice to quit smoking, eat less fat or get more exercise before receiving written materials were more likely to remember the materials, show them to others, and perceive the materials as important to them. They were also more likely to try to quit smoking and make some major changes in diet and physical activity. The take-home message is that an integrated model of doctors and nurses working together to help patients adopt and maintain healthy behaviors may be particularly effective.

Kreuter M, Chheda S, Bull F. How Does Physician Advice Influence Patient Behavior? Archives of Family Medicine. 2000;9:426-433.

Around Campus...

UNC Hospitals- Medicine/Pediatrics Grand Rounds

The Program on Prevention sponsored the combined Medicine-Pediatrics Grand Rounds on June 1. Dr. Harold Koenig, Assistant Professor of Medicine and Psychiatry at Duke University, spoke on "Religion, Spirituality, and Physical Health: What are the Connections?" He reviewed the long intertwined history of religion and medical care and then presented a number of studies that have found associations between religiosity/spirituality and positive health outcomes. He urged physicians to regularly ask patients about their sources of strength and support when coping with chronic or serious illnesses and to be supportive of patients' religious/spiritual beliefs. Dr. Koenig has written extensively on this topic and will have an article appearing in an upcoming JAMA.

UNC Preventive Medicine Residency Program

The UNC Preventive Medicine Residency Program recently sponsored the 4th Annual John A. Ferrell Lectureship and Awards. The Prize for Outstanding Contributions to Preventive Medicine was awarded to Suzanne Fletcher, MD, MSc, Professor, Department of Ambulatory Care and Prevention, Harvard Medical School. She was formerly Co-Cheif, Division of General Medicine and Clinical Epidemiology, Department of Medicine at UNC. She is one of the authors of Clinical Epidemiology by Fletcher, Fletcher, and Wagner, used in the Clinical Epidemiology course for second year medical students.

Dr. Fletcher spoke about lessons for prevention from the experience in breast cancer screening and mammography over the past 40 years. She felt, most importantly, breast cancer screening has demonstrated the importance of rigorous evaluation of medical interventions, using both clinical and epidemiologic methodology. Other lessons learned include: 1) the importance of mortality as the gold standard by which screening efforts should be judged for lethal conditions; 2) the fact that effects from screening for cancers tend to appear very slowly, usually taking more than a decade; 3) the trade-0ff between effects from screening and effects from treatment - an issue which has been all but ignored; and 4) the importance of evaluating screening in terms of the degree of benefit in relation to hazards and costs of screening. In the case of screening, the benefit is reduction in mortality from breast cancer and the most important hazards include those resulting from false-positive tests and from over-diagnosis. The lessons from breast cancer screening for prevention are far more complicated than originally anticipated. The job of medical scientists is to determine the benefits, hazards and costs of a medical intervention and then figure out how to convey this information as clearly as possible to those who must live with the consequences of the decision to screen or not to screen. \

Do Risks Outweigh Benefits of Newborn Hearing Test?

Drs. Alex Kemper and Steve Downs, from the Department of Pediatrics, recently published in the Archives of Pediatrics and Adolescent Medicine results of a study looking at risks and benefits of newborn hearing tests.

This study looked at the effectiveness of universal hearing screening for newborns attempting to determine the impact of false positives and the benefits of detecting hearing loss early on.

Although universal screening would detect 40% more cases of hearing loss than targeting testing to high risk newborns only, there is a significant increase in cost per case detected. In addition, universal screening would result in about 20 times more false-positive diagnoses which "may harm families because of unnecessary worry about their child."

Drs. Kemper and Downs call for children who undergo universal screening to enroll in clinical trials "to answer questions regarding the efficacy of treatment and to better define optimal treatment plans."

Kemper, A and Downs, S. A Cost-effectiveness Analysis of Newborn Hearing Screening Strategies Archives of Pediatric and Adolescent Medicine.
2000;154:484-488

Around the World Wide Web...

People have more access to health care information than ever before. Not only do they hear about health news in the media but more and more individuals are looking to the WWW for information. There is a whirlwind of information out there but directing your patients to credible and reliable information is the key. The Web can be a valuable resource for educational material for patients and providers alike if it is used wisely.

Koop.com is a great site that provides general information for patients on a variety of health concerns. Although articles are written by specialists in their fields, the site is written to be understood by patients. They can build their own health profile and receive information about the particular health topics they choose. A prevention questionnaire that assesses how healthy you are and the steps you can take to stay healthy is available. There is also a section on specific preventive care issues for men, women and children. A drug checker is available to retrieve information about different types of drugs. The information at this site is thorough and reliable, but the home page may be somewhat overwhelming as it is jam packed with topics of interest- don't let that scare you off. http://www.koop.com/

A portion of the Journal of the American Medical Association, the patient page, is a weekly section that is dedicated to covering a health topic, providing user-friendly information for patients. A new topic is presented each week and is designed to help increase doctor-patient communication. http://www.ama-assn.org/insight/spec_con/patient/patient.htm

Look for our next edition of "An Ounce of Prevention" in August, 2000.
If you have comments or questions about this newsletter or its contents, please e-mail alward@med.unc.edu.

Program CO-Directors: Russ Harris, MD, MPH and Linda Kinsinger, MD, MPH
Education Coordinator & Editor: Amy L. Ward

Go to the Program on Prevention Homepage