Alumni Notes

By Kate Levinson Awsumb

Exactly two years ago, I was recovering from my MPH and MA graduations. I was putting the final touches on my master's project in preparation for my defense. I was packing for what would be an epic trip to Greece and Turkey with three other (almost) newly minted MPHs. I was maybe almost sort of kind of mentally preparing for the next chapter of my life.

By Maureen Ayers Looby

The Monday before the Match: I was in surgery that day (doing a robot assisted prostatectomy for my urology rotation). I knew the email would come at 11am, and I had my eye on the clock, but I was scrubbed in, so I couldn't find out right away. As soon as I scrubbed out, I checked my email, and there it was, the coveted email: "Congratulations, You Have Matched!"

Thursday before the Match: We had a Pre-Match Day retreat. All fourth year students were excused from rotations and we went to the Como Conservatory for the day. It was a day to hang out, talk, listen to some speakers about residency, take photo booth pictures, and get EXCITED!

Photo booth pics

People from our med school class going into Ob/Gyn

Match Day: AHHH! The day finally arrived! Woke up early and couldn't fall back asleep. Got ready, just trying to stay calm, but getting more and more excited. By the time I arrived at the McNamara Alumni Center for the event, I was feeling really happy but actually pretty calm. I met up with two of my guests inside (my mom and my aunt), and they were on pins and needles. My boyfriend hadn't arrived yet -- he was on a red-eye flight coming from an Epi conference on the West Coast, and his flight landed about 30 minutes before the envelopes. I found a table with two of my best friends from med school and their families, and we settled in with some coffee and pastries. Then we just hung out and waited, every minute just crawling by! Then the school officials came out and started putting the envelopes on the tables. The room buzzed. I got a text that the plane landed -- he might make it in time! They started the ceremony, explaining how everything would work (they set a timer for 10:59 and when it went off, everyone could go get their envelope and open it), and then they proceeded to talk and I swear I can't remember a single thing they said. It couldn't have been more than 2 or 3 minutes before the envelopes were freed that I finally felt a little pat on the back, and there he was! He made it!!!! For a little bit I was distracted, then all of a sudden I saw one of my friends jump up from the table and run toward the wall. Was this it? I saw that many more people were doing the same thing, so I snapped to it and tried to calmly walk over to the table with my letter -- but they are in alphabetical order, and I didn't know if I should go to "A" or "L." I went to "L" and almost missed it, but then it caught the corner of my eye, and I grabbed the envelope. By that time I could already hear shrieks from other students, and as I headed back to my table, I watched my friend opening her letter, seemingly in slow motion. Her head heaved with emotion and her hair bobbed up and down. I tried to make out her face to discern if this was a happy or sad expression, and I saw a HUGE smile. I don't know what I was thinking but I walked up and gave her a big hug before realizing I still had to open my own envelope. I went around to the other side of the table where my family was waiting, opened my envelope, and read the result: Ob/Gyn at the University of Minnesota! I then realized I hadn't even asked her where she ended up, so I asked her . . . Ob/Gyn at the University of Minnesota! And our third friend at the table? Ob/Gyn at the University of Minnesota! Wow, wow, wow. What a morning. I think the Ob/Gyn program at the University of Minnesota really lucked out ☺

three amigos, waiting for the letters

opening the letter with shaky hands

you too?!

Mom and me with my letter

By Elizabeth Walsh

Every now and then, I will spark up a conversation with friends, relatives, or colleagues that leads to talking about health issues. Usually this is in the context of someone's current job or talking about family members who are not doing so well. In these conversations, I always find myself recommending that they look into the Chronic Disease Self Management Program, or CDSMP.

By Hitakshi Sehgal

Though belated, Happy new Year to everyone. Hope this year will bring significant advances in public health. I for one, plan to update my blog regularly.

Yesterday, I was at Tata Institute of Social Sciences, Mumbai. As part of their platinum jubilee celebrations they are hosting a conference: 'Globalization and Social Transformation: The Indian Experience'. I attended a day long session on Nutrition, which was a part of the sub-theme: Inequalities, Vulnerabilities, Human Health and Well Being.

The speakers and panelists discussed nutrition at length ranging from severe malnutrition to whether it is time to include 'nutrition security' to food security. In India, it is hard to segregate food security and nutrition security. I found a discussion by Dr. G Subbulakshmi, particularly interesting. She presented the alarming figures of malnutrition in India and the socio- cultural factors affecting nutrition insufficiency. The demand for a male child, its effects on nutrition security of female children, and therefore future mothers, and therefore future generations, were striking. I found hers to be an overarching presentation for the most part. She spoke about empowering mothers with community gardens where they could grow vegetables.

I don't know if it comes with toiling experience of working with malnourished children, or with an immediate understanding of the dire calamity we face in the form of malnutrition. She was open to all types of nutrition ideas. She did not criticize empty calories, she was open to food fortification, she was open to the role of pharmaceutical companies in manufacturing fortified products/ supplements, community gardens, new farming techniques, soil fortification, basically anything! She said that different things are catered to different socio-economic strata and if it helps to tilt the balance towards the positive side, sure. I think it comes from seeing malnourished children and the enormity of the issues that affect this one condition. The task is GIGANTIC!

The discussions that followed were very interesting. Someone from the audience pointed out that working with individuals at a tertiary level and presenting examples of success in village communities are vertical examples, often difficult to replicate. The question was longer, and the discussion routed in the direction of the challenges and priorities. I had hoped that we could route the discussion to another level: how do we address this at a 1.2 billion population level? After all, malnutrition is an epidemic in India. It is great that women in some villages are trying to become self sufficient in nutrition by having a small garden where they grow veggies. However, I don't know how many is 'some'. I don't think anyone does. We don't know the sustainability of these ideas, no matter how great these are for now. In the factors that affect nutrition the most daunting are water supply for agriculture, socio-cultural factors such as lack of nutrition to the female child, socio- economic factors: affordability and accessibility. The poor absolutely cannot afford nutritious food. The quality of fruits and vegetables that reaches some of them is poor.

A family that earns 100 rupees(~ 2 USD) / day will never afford fruits and vegetables. If we double the income of the family, they will still not afford fruits and vegetables. Maybe they will add lentils. I will not shift to poverty and human rights because it will be some light years before those issues resolve themselves. It is estimated that over 50% of the population are facing these SES challenges. How do we then address nutrition insufficiency, today?

I find that societal/ community/ state/ country leadership are missing the responsibility of nutrition for better health and evolution, in India. There was a strong push yesterday, to move the responsibility away from the mother. No data required to state that 'mothers' are burdened with responsibilities. Women deal with poverty to become the second earning members (often underpaid for their work), they deal with household chores and responsibilities, they must rear the children, and now the garden that is required for adequate nutrition. We have not addressed the issues of the mother in the urban slums. No gardens when you are squatting on airport land, are there? It is not surprising that she allows her children to buy 'empty calories' such as cheap junk food. There is an urgent need for division of labor in families and this has to be promoted at a mass level rather than counseling at individual level.

It was discussed that after the green revolution addressed food security in the 1950's, it was not strengthened further. It should have progressed into a nutritional revolution. The agricultural sector and health sector must collaborate in the future so that nutrition can be prioritized at a primary level. The Public Distribution System (PDS) in India played a role in addressing food security. While PDS needs further strengthening, nutrition should be integrated into the existing system.

The Integrated Child Development Scheme (ICDS) addresses nutritional needs of children, especially those living below poverty line. It is a comprehensive project addressing the health of the mother and child, as well as education. The ICDS is run by the Department of Social Welfare in India. It was pointed out that there is a need for collaboration with the Department of Health. Thus, an inter-sectoral approach was stressed upon all the way.

In addition to all of this, I believe that 'health promotion' has a huge role in decisions made by families. This was not discussed but I feel it is the dark horse in the race for nutrition. In India, one hardly sees true health promotion. The private sector promotes 'healthy products' as well as empty calories. However, there needs be regulation at every level. At the level of production, in India, food labels don't mean much. The only regulation that succeeded is the 'vegetarian' and 'non vegetarian' labels. If the product has a green dot, then it is vegetarian, and that also means sans eggs. If it has a red dot, it contains eggs or meat. This came from public demand because a large population in the country practices 'vegetarianism'. However, for there to be a demand for nutritious food, as there is in some countries, there has to be awareness. This brings in so many new factors, quality education for one. This could prove to be a slow process. We cannot wait to inculcate nutrition until the day the entire population is empowered to make the right choices in food and demand a healthy supply of food at affordable prices. In the mean time, societies/ communities/ state bodies/ and federal leadership must come into action to provide correct information to the people who largely rely on mass media for information regarding their food choices. An orange juice ad declares that juice can replace eggs and milk at breakfast. A potato chips ad shows that girls will eat as many and talk with their mouths full, if the chips are 'baked'.

A combination of scientific research, applied research, regulation, and inter- sectoral collaboration is an immediate need to begin building in 'nutrition sufficiency' in India.

By Elizabeth Walsh

Last week, I hit my 2 year anniversary as an epidemiologist for KDHE. It hardly seems like I have been here for two years, but the evidence was there, right on my calendar.

I can't even begin to list all of the things I have learned since I graduated from SPH and took this position. I have learned about health promotion, chronic disease epidemiology, program evaluation, weighted data analysis, evidence-based programming, and so many more things.

And, in this next year, I have more to learn. As always, I'm expanding my horizons and taking a lead in working on descriptive epidemiology for obesity, physical activity and nutrition in Kansas. This issue really hits home for me, because I was slightly overweight as a kid and not very physically active or the best eater for a very long time. In fact, it wasn't until I was doing coursework at SPH, and specifically learning about the pathophysiology of heart disease that I really started taking better care of myself. Now, I can't imagine going back to the sedentary and fast food-eating lifestyle I used to have. I feel so much better, have so much more energy, I feel (almost) like a different person.

I realize that not everybody will look at data and scientific information and want to make a change in their lives. But, what I'm hoping is that legislators and other decision makers will see this information and start to work on policies that will encourage people to become more physically active and make it easier for them to make healthier meals.

I'm also expanding my horizons in terms of the types of data I work with. The past two years have largely been focused on survey and evaluation data. This year, I'm working with hospital discharge, mortality and medicaid data. I will have to learn some new statistical programming techniques and think about these types of data in a slightly different way. I'm sure I'll come home at the end of the day with a mushy brain.

Can't wait.

By Maureen Ayers Looby

I recently did a rotation in dermatology at HCMC and the U of M, which was awesome! Apart from all of the interesting diagnostics I learned, there was also a lot of practical information I wanted to pass on. Some of things you maybe already know, but I felt like we said some of the same things over and over.

1) UVA rays are the ones that cause wrinkles, brown age spots, and allergies to the sun. They can penetrate through glass windows, so even though you can't get sunburn through a window, you should still be cautious spending too much time in front of windows without sunscreen. I love this picture below, which demonstrates this phenomenon. It shows both sides of a woman's face, one that received an abundance of UVA through a window she sat in front of for years, the other which was protected.

2) UVB rays cause sunburn and skin cancer. They break DNA bonds which is what is believed to cause skin cancer. They're most responsible for the long-lasting tan. They also induce the production of Vitamin D. UVB rays are filtered out by glass windows.

3) UVC rays are the most dangerous type but are absorbed by the ozone, so we don't have to protect against them (unless you live in Australia beneath the hole in the ozone!)

4) If you have truly dry skin, the only way to get it to moisturize is to soak for 10 minutes in a bath and apply moisturizer immediately when you get out to trap the water in. Moisturizing lotions only make the skin more supple but don't actually get water into the epidermis. One of the doctors I worked with recommended taking at least one bath a week in the winter, and two per week if it is below zero (because the temperature in MN also has a lot to do with the moisture level in the air). You can sort of appreciate how it might take 10 minutes for the water to get all the way through the stratum spinosum (the top layer of skin). You can't moisturize your skin by drinking a lot of water, because there are no blood vessels directly to the skin to carry the water there.

5) Moles that don't change tend to not be worrisome. Moles that change in shape, color, or texture are the ones to worry about. Doctors can assess the moles they see, but they can't know if the moles are changing. This is why looking at yourself and keeping track of what your moles look like is important. And if one is changing, tell your doctor.

6) There is no good treatment for stretch marks. Stretch marks are defects in the dermal layer of the skin (which is the deep layer), so putting creams/ointments/lotions on the epidermis isn't likely to do anything for them. Plus, nothing has really been shown to work. Save your money.

Next up: Integrative Medicine in Hawaii!!!
A glimpse:

By Maureen Ayers Looby

If you've ever known someone who graduated from medical school, you've probably heard of "The Match." It is the process that all med school graduates must go through in order to place into a residency. It's more than just an application, though. Here's a NYTimes article about it.

To contrast it with other applications -
When you apply to college/graduate/medical school, you're allowed to apply to as many places (or as few) as you want, and you can also get in to as many as accept you. So, if you find out you got into a school, you can hold your spot at that school until you hear from the ones you wanted to go even more, and then drop your application from the first one. The Match does NOT work that way. In The Match, you only get into ONE PROGRAM, or in other words, every person is matched to one position. (It's sort of how the sorority rush works, as opposed to how the fraternity rush works, from my understanding)

The good part to doing it this way: everyone finds out in March, and you have a couple of months to get things in order if you're going to move, etc (as opposed to med school, where people sometimes get in from the wait list the week before school starts!). The bad part: it is extremely stressful since you only get ONE CHANCE to do it right. What this means for med students is that even though you might love a certain program, and they might really like you, there is no guarantee that you'll get placed in that program, so you are forced to apply at many other programs. And when I say apply, I also mean travel to and spend a day and a half doing an interview. So you spend a pretty penny on applying and interviewing. But there's no way around it, it's just what everyone has to do.

If you're doing a really competitive specialty, you have to apply to a lot of programs, because you'll want to put more places on your Rank List (some of my friends applied to 40, 50, or more programs!). And keep in mind that these are often all over the country, since there might be only one or two programs in an entire state (for example, MN only has two Ob/Gyn residency programs -- the U and Mayo).

So it starts in September, you submit your application and wait for the interview offers to roll in. As you start to hear back, you buy plane tickets, book hotels, arrange to take time off from rotations, and keep crossing your fingers to hear back from your top choice programs. Interviews typically start in November and are done by the end of January. For those couple of months, life is hectic and intense. But also fun! You get to visit new cities, meet new people, and usually you even get a free meal or two out of the deal. You ask tons of questions and take notes, and try to keep track of which programs had which different features. Typically you try to get a good feel of the current residents to see if they're truly happy to be there, and you also want to know if you'd fit in with them.

Heading out to my first interview

Once interviews are all over, the Rank List comes. Every program makes a list of the candidates they interviewed, and they put them in a list of who they'd like to have (and in what particular order). Every applicant makes his or her own list, from their top choice program down to their I'd-rather-go-there-than-not-go-anywhere choice. Then the lists all go into a big computer algorithm with everyone else in the country, and this whole process ends with Match Day.

Match Day is the third Friday in March, and at noon Eastern time, fourth year med students all over the country (and the world, for that matter, since many international doctors want to train at residency programs in the US) take a collective breath and open the envelope that tells them their future!!! Some programs make the students read their envelope on a stage in front of their whole class -- SCARY!!!!

At the U, everyone gets their envelopes at the same time but can open them whenever they want, in front of whomever they want, like Columbia, seen here:

At Johns Hopkins, they have everyone open their envelope at the same time:

I will leave you with these videos for now. Hopefully I will be rejoicing on March 16!

Up Next: What I learned on my Dermatology rotation

--

By Elizabeth Walsh

I've talked a lot about the Kansas Arthritis Program and, specifically, things that I do as the Epidemiologist and Evaluator for the program.
Today, I'm going to veer a little bit from what I do to share something really exciting: our first YouTube video!
Currently, one of the community-based programs that we are promoting for people with arthritis and also those with other chronic diseases is Walk with Ease. Walk with Ease was developed by the Arthritis Foundation to help people start walking and stay committed to walking or other physical activity throughout the year. The self-directed version of Walk with Ease (which we mainly promote) is done on your own with the help of a guidebook.
Since starting promotion of Walk with Ease less than a year ago, we've already had almost 400 people sign up to participate in the self-directed version!
It's super exciting and it's been wonderful to see the progress we've made (because all of the marketing materials and program infrastructure, including an online registration page, we made from scratch!)
So, click here to see our YouTube video on Walk with Ease, starring my colleague and very good friend, Missty! (I tried to embed it in this blog, but I guess it's not possible on here ... or I'm experiencing technical difficulties ...)

By Elizabeth Walsh

I can hardly believe that 2011 has come and gone already. It doesn't seem like an entire year has passed! Around this time last year, I posted a blog about what goals I had for myself. So ... how did I do?

1. I hope to be challenged and stretched in my position - that I will be given requests and asked questions that I can't answer in 5 or 10 minutes or even a few hours. I want to have to dig to find those answers.

Well, I was definitely challenged this past year. I submitted abstracts for conferences using some more advanced statistical techniques (which made my brain hurt), I did more in-depth analyses for data requests, short reports, and fact sheets, and I even had my patience tested by the peer-review process when I was trying (and finally succeeded!) to publish one of the projects I worked on while getting my MPH at the U.

 
2. I hope to be able to present at conferences in 2011 - and to have people actually be interested in the work that I'm presenting.

I presented at 3 conferences in the past year - the National BRFSS Conference, the National CDC Arthritis Grantee's Meeting, and the Kansas Public Health Association Conference - and had the best time talking to my peers from others states about the work that I had done and the work that they are doing. It was absolutely wonderful.

 3. I hope to be published in a peer-reviewed journal.

AND I AM!!!! My work with Dr. Keith Horvath, Assistant Professor in Epi & Community Health, was published as an in-press work in the Journal of the Association of Nurses in AIDS Care. The paper, whose abstract can be found here, was a qualitative analysis of 20 interviews with heterosexual women that had been diagnosed with HIV within a year of their interview. Working on this project instilled within me a great desire to continue to work in prevention, because it's just not enough for me to know that we have amazing medical advances and can treat and keep people alive for a very long time. All of those tests and medications still cannot eliminate the devastation those women felt when they were told they were HIV positive. They only thing that can eliminate the emotional toll is to keep others from getting infected at all. And it's in that area of work that I truely belong.

 
4. I hope that I will continue to enjoy working with my colleagues.

Some of my closest friends I have met only because we are colleagues. The people that I work with at KDHE in the Bureau of Health Promotion are absolutely wonderful. When it is time to move on from this position (and that time will come, sooner or later), I will be very sad to leave them.

5. I hope that chronic disease risk reduction will become a priority - not just in public health, but for everyone - and that people won't just shrug it off and say "There will be a drug I can take if I need to."

This was more of a hope rather than a goal for myself. I can see that Public Health has made some progress in this area, but it never seems to be enough, does it?

6. Along those same lines ... I hope we can find a new way to tell people to exercise more and eat healthier (any ideas?!?!).

I never did figure this one out ...

7. I hope that the work I do will continue to contribute to the work my programs are doing.

I really feel like I was able to contribute to the progress our programs made on our grant activities and in helping make the lives better and healthier for the people of Kansas. Not only did I create all kinds of data reports for my program, but I also took the time to suggest different ways to put the statistical information into layman's terms, and I really think that helped.  

8. I hope that the new Kansas legislature will realize the value of public health legislation passed in 2010 - like Clean Indoor Air - and not repeal them.

Clean Indoor Air NOT repealed! Yay!

 9. I hope that I will learn as much - if not more - as I did in 2010.

Wow. I can't even begin to list how much I've learned, both professionally and personally. It was a great year for learning.

10. I hope that I will actually get to attend an 'Epi reunion' party with all my closest grad school friends (unable to make the trip both times - shoot!).

=( This did not happen. I have kept in touch and have had short conversations here and there, but we never got anything planned as far as a 'reunion'. Maybe this year ...

11. I hope that you all will have the same fortune that I've had.

Well .... you tell me!

What will 2012 bring? 

I have absolutely no idea. But I cannot wait to find out! And as far as goals, hopes, resolutions for this new year ... I have 15. No really. But, they can all be summed up in just one:

Stop accepting 'good enough'. Push for better.

Here's to a better-than-the-best 2012! 

By Elizabeth Walsh

Things are winding down at KDHE as the year comes to a close. I'm finishing up abstract submissions that are due in the next few weeks and checking out other state health department websites for the next big project: and obesity, physical activity and nutrition burden document. This is a big one, folks. More about that later. For now, I simply want to wish everyone a wonderful rest of the holiday season and an even better 2012: