July 9, 1999
Volume XXXII No. 27


Schools of Nursing and Public Health
complete diabetes study

The figures are startling: In the last 20 years diabetes has increased threefold in San Antonio. Now one in every four or five people in Bexar County has the disease, according to statistics from the Texas Department of Health and other sources.

That comes as no surprise to the project staff of a recent report to the Texas Diabetes Institute (TDI). The study, "Knowledge and Awareness of Diabetes and the Burden of Diabetes on Families in Central San Antonio," was a collaborative effort of the Health Science Center's School of Nursing and the U. T. Houston Health Science Center School of Public Health, San Antonio campus.

The community-based study took place within the boundaries of the San Antonio Independent School District (SAISD), which was subdivided into the eight high school regions. Eight teams of combined graduate nursing and public health students in community assessment courses, taught by Dr. Edward Gruber in the School of Nursing and Dr. Frank Moore in the School of Public Health, conducted the study. They analyzed existing data, interviewed community leaders and health care providers, and held focus groups of community residents in each high school region. A report was written for each region, then the data were combined to provide a complete picture of the study area.

One surprise, says Olive Roen, project director, was the fear the disease creates. "People are truly afraid. It's a great cause of stress within a family."

The challenge facing health care professionals, says Dr. Moore, principal investigator, is how to communicate risk to a population without engendering more fear. The first hurdle is denial. People tend to ignore the symptoms of the disease until they start to have major complications from it, and by then it requires extensive treatment.

Although many community members surveyed knew that diet and exercise were important in controlling the disease, they cited the expense of buying "special foods" and the poor condition of neighborhood streets as reasons for not eating well and exercising. Yet families that had been able to incorporate diet and exercise recommendations into their lifestyle were enthusiastic about the positive health and relationship benefits for the whole family.

Another important finding, say the investigators, is the huge gap between medical and community knowledge of the disease. "Popular knowledge is very limited," says Dr. Moore. The disease is known as "sugar in the blood" or "high blood sugar," and insulin is widely thought to cause blindness or kidney damage. "Diabetes is where cancer was 30 or 40 years ago," says Roen. "There's a stigma attached."

Investigators found that information must be highly visible and accessible. Focus groups favored pictorial and spoken information over printed material. Most important, the study concluded, education efforts must be personalized and in a family setting, ideally with home visits.

"We see this study as a springboard to identify interventions and set up a community-wide coalition on diabetes," says Dr. Mary Helen Mays, director of special projects with TDI. The organization is looking for highly visible spokespeople, representing multiple facets of the community, says Dr. Mays.

This study is one of many assessments the Texas Diabetes Council is conducting throughout Texas. Over the next four years TDI will identify and evaluate community-based interventions such as school-based initiatives, a media campaign and targeting age-specific groups.




Older residents sought
for shingles prevention study

About 1,800 South Texans age 60 or older are sought for a study on preventing shingles, a painful viral disorder that affects 15 percent of the U.S. population. Interested individuals may call ext. 9258 at the Health Science Center or toll free at 1-877-841-6251.

The study is part of the U.S. Department of Veterans Affairs (VA) Cooperative Studies Program, which includes 15 sites. The Health Science Center is one of the six National Institutes of Health (NIH)-affiliated sites nationwide to offer the trial.

Prospective enrollees must not have had shingles previously. A painful rash marks the condition, which is caused by the chicken pox virus, varicella zoster, one of the herpes viruses.

"We are testing a vaccine to try to prevent shingles," said Dr. Jean Smith, associate professor of medicine. "We are targeting people 60 and older because the incidence of shingles increases as people get older and the complications also increase. The most difficult complication is post-herpetic neuralgiapain persisting after the rash."

Researchers will test the same vaccine given to children to prevent chicken pox, but in this case a stronger version of it. "To stimulate immunity to varicella zoster in adults, you need a jazzed up version of the children's vaccine," Dr. Smith said.

The virus inflames nerves in affected areas, typically involves only one side of the body and most commonly strikes the chest or upper abdomen. The legs or face also may be affected.

Early treatment with an anti-viral drug decreases the extent of the rash and its severity. Rash and pain usually subside within four to six weeks.

"An older person faces a higher risk of pain persisting," Dr. Smith said. "For some people, even touching the bed covers causes a pain sensation. If the rash is on the face, even going out in the sun or wind is painful. It is an unusual discomfort and not easy to treat."

Scientists are searching for a drug to treat the symptoms. "So far, nothing works all that well," Dr. Smith said.

Patients will be enrolled through the Frederic C. Bartter General Clinical Research Center at the Audie Murphy Hospital Division, South Texas Veterans Health Care System. The trial is a randomized, vaccine-placebo study.

"If the vaccine works, everyone will be offered the vaccine as soon as the study data are analyzed. This will be before the vaccine is commercially available," Dr. Smith said.

Participants will receive free treatment for shingles if they contract it during the study period. Patients will be tracked through four to five years of telephone follow-up, and will be asked to give blood samples if they develop shingles. "We will measure cell-mediated immunity to the virus and correlate to whether someone had the vaccine or not," Dr. Smith said.

"One reason people thought of using a vaccine is that when people have shingles, their immunity to varicella zoster virus is boosted," she said. "Someone who has had shingles usually has greater immunity against recurrence."

Patients will be enrolled in 1999 and 2000. Dr. Smith is the principal investigator for the San Antonio portion of the trial, which is a collaborative study among the VA, NIH and Merck Inc., maker of the varicella zoster vaccine.



Shingles incidence

  • If you live to be 85, you have a 50 percent chance of having shingles.

  • About 15 percent of all people will have shingles.

  • Risk of incidence increases gradually until age 60 to 65, then climbs.

Source: Dr. Jean Smith




Chancellor visits HSC

Dr. Cunningham



Dr. William H. Cunningham, chancellor of The University of Texas System, visited the Health Science Center June 30 for a report on the university's progress. Chancellor Cunningham, who spoke at a luncheon for the Health Science Center President's Council, touched on a number of topics, including the initial brainstorming and planning that led to the establishment of the legislatively supported South Texas/Border Initiative.




Media Report

National

Dr. Donald J. Gordon, emergency medical technology, was interviewed by ABC-TV's 20/20 about Texas' new rules on regulation of ephedrine.

The New York Times interviewed Dr. Russel Reiter, cellular and structural biology, for an article on the possible link between nighttime light exposure and cancer.

The magazine Hispanic Outlook in Higher Education published a feature story by Joanne Shaw, graphics, on Dr. Martha Medrano, director of the Medical Hispanic Center of Excellence at the Health Science Center. Dr. Medrano was also quoted in a story on the National Hispanic Medical Association. The magazine ran a piece on the rising enrollment of Hispanics in the Medical School as well.

The AAMC Reporter interviewed Dr. David Jones, anesthesiology, in a roundtable discussion about professionalism in medicine.



State

The Harlingen Valley Morning Star ran a story on Health Science Center President Dr. John Howe's keynote address to the Harlingen Area Education Foundation.

Robert Price, executive vice president, was quoted in the Austin American-Statesman in a column on the tobacco settlement funds earmarked for medical research.



San Antonio Express-News

Dr. William H. Cunningham,
chancellor of the U. T. System, wrote an editorial on the recent legislation benefiting San Antonio and South Texas. An article covering Dr. Cunningham's resignation appeared on Page 1.

The Health Science Center was featured in an editorial on the proposed children's cancer research center.

Dr. Roberto Villarreal, South Texas Health Research Center, was quoted in an article on the U.S.-Mexico Border Health Association forum. The Health Science Center was mentioned in an article and an editorial on the growth of high-tech jobs in Texas.

"On the Scene" ran a photo of Dr. Leonard Lawrence, dean of student affairs, who emceed the opening reception for two exhibits at the Institute of Texan Cultures.

Drs. Emilio Romero, James Stedman and Stephen Brannan, psychiatry, were quoted in an article on post-Spurs blues.



Area Television

Dr. Richard Haines, laboratory animal resources, was interviewed on KABB, Channel 29, about dog bites.

KENS, Channel 5, interviewed Dr. Jean Smith, medicine, about developing a new drug for shingles; Dr. Terry LeGrand, respiratory care, on asthma; and Dr. Ron Grimwood, medicine, about sunscreens and Apligraf, a skin grafting procedure.

Dr. Jean Petershack, pediatrics, spoke to KENS about colic, and Dr. Bill Watson, South Texas Poison Center/clinical surgery, discussed bee stings. Also interviewed on KENS were Dr. Linda Rhodes, psychiatry, on psychological effects of taking children to crime scenes; Dr. Joel Baseman, microbiology, on Gulf War illnesses; and Dr. Alex Nikitin, molecular medicine, who spoke about lung cancer rates in mice.

The station also interviewed Dr. James Rogers, anesthesiology, on pain management; Dr. Deborah Conway, obstetrics and gynecology, about ultrasound scans during pregnancy; Dr. Jeffrey Kreisberg, pathology, about the confocal microscope; Dr. Connie Mobley, community dentistry, about the new margarine Benecol; and Dr. Peggy Gragg, dental diagnostic science, on diet drinks' effects on teeth.

In addition, KENS ran a live shot of the Health Science Center's Spurs rally on June 16.



Area Radio

WOAI-AM, 1200, interviewed Dr. Donald J. Gordon. The station also spoke with Dr. Ron Grimwood on the need for sunscreen; Dr. Stephen Brannan about the letdown following the Spurs' championship season; and Dr. Bill Watson, clinical surgery, on bee stings.



Area Media

The Medical Gazette featured Dr. Peter Fox, director of the Research Imaging Center, in an article on stuttering treatments. The Gazette also ran a profile of Dr. Andrew K. Diehl, medicine.




Child Fatality Review reports decrease
in motor vehicle-related deaths

Although most child fatalities in Bexar County are due to natural causes, many children who die in Texas are killed in accidents and homicides. But while motor vehicle accidents (MVAs) are still the number-one cause of childrens' death by injury in Bexar County, says Dr. Juan Parra, pediatrics, this year the death rates due to MVAs have dropped.

Dr. Parra, member of the Bexar County Child Fatality Review Team (CFRT), is one of the organizers of the statewide CFRT network meeting to be held July 14 through 16 at the Menger Hotel.

"Of course we would like to see a reduction in all deaths, but there were some positives to report this year," says Dr. Parra. In addition to the drop in MVA-related deaths, instances of Sudden Infant Death Syndrome (SIDS) fell by half, and there were fewer deaths by drowning.

CFRT professionals investigate every death of a child that occurs in the community and much of South Central Texas. Bexar County team members include representatives from the Texas Department of Child Protective and Regulatory Services, the District Attorney's Office, the Medical Examiner's Office, the San Antonio Police Department, the Bexar County Sheriff's Office and the Alamo Children's Advocacy Center.




Open Enrollment Period benefits fair
scheduled for July 14-15

The Health Science Center employee Open Enrollment Period began July 1 and will continue through July 31. Employees may need to fill out the Evidence of Insurability form, which is required if an employee wants to add a dependent to his or her current coverage or make other changes.

The deadline for completing Evidence of Insurability forms has been extended to July 31.

The following is a breakdown of the medical coverage being offered during this year's Open Enrollment Period. The University of Texas System has added the Texas Universities Health Plan Point of Service option and the United Healthcare Point of Service plan to the benefits package. Employees may continue to get coverage through U. T. Select/CIGNA or Prudential HMO, which are the current medical plans.

The U. T. Select/CIGNA plan

  • Provides network, out-of-network and out-of-area benefits

  • Annual deductible of $250 per person for in-network visits, with 85 percent paid on most benefits after the deductible is met. A $500 annual deductible for out-of-network services.

  • $10 co-pay for in-network office visits.

  • $50 co-pay for emergency care.

Texas Universities Health Plan
  • Point of Service plan that provides both HMO and out-of-network services. Employees are able to select the type of benefits they want each time they seek services.

  • No annual deductible for HMO services. For out-of-network services, the annual deductible is $500.

  • $10 co-pay for office visits with HMO benefits. For out-of-network services, the plan covers 70 percent after the deductible.

  • $50 co-pay for emergency care, which is waived if patient is admitted.

United Healthcare

  • Point of Service plan that provides both HMO and out-of-network services. Employees are able to select the type of benefits they want each time they seek services.

  • No annual deductible for HMO benefits. A $500 deductible for out-of-network plan.

  • $10 co-pay for office visits. For out-of-network services, the plan covers 70 percent after the deductible.

  • $50 co-pay for emergency care, which is waived if patient is admitted to the hospital.

Prudential HMO

  • Employees designate a primary care physician who coordinates all medical care and makes necessary referrals to HMO network specialists.

  • There is no deductible or out-of-pocket maximum with this plan.

  • $10 co-pay each office visit.

  • Plan pays 100 percent after the $75 co-pay for emergency care.

The U. T. System also has made changes to the PCS prescription drug program this year, affecting the cost of co-payments for generic and brand-name prescriptions. Employees enrolled in the prescription drug program will pay a $10 co-pay for generic drugs and a $20 co-pay for brand-name items. Employees who are Prudential members are required to use the Prudential Prescription Drug Program. Effective Sept. 1, the PCS prescription card will no longer be accepted for Prudential customers.

For more information regarding the benefit plan changes, employees will have an opportunity to attend a health benefit fair on July 14-15 from 9 a.m. to 3 p.m. in the auditorium foyer.

Employees can make changes to their benefit plans during the Open Enrollment Period through the U. T. Touch system using a touch-tone phone or personal computer. Personal identification numbers (PIN) for employees to use with the U. T. Touch System have been mailed to the employees' home addresses. For more information on benefit changes, call the Human Resources' benefits section at ext. 2610 or send e-mail to <Casanova@uthscsa.edu>. E-mails and phone calls are preferred during the Open Enrollment process.




HSC mecca for aging research

Aging Research and Education Center garners grant money

The Health Science Center garnered more federal dollars for aging research than any other institution in the state, according to a new report.

Scientists in the Health Science Center's Aging Research and Education Center (AREC) received 25 grants in FY 1998 for a total of more than $5.2 million from the National Institute on Aging (NIA), the federal agency that supports the majority of aging research in this country.

AREC coordinates the efforts of more than 150 Health Science Center faculty members involved in research studies and clinical care with an emphasis on aging. AREC officials announced receipt of the NIA report last month. The NIA is part of the National Institutes of Health.

The AREC is leveraging the federal funding with donations from private philanthropies, including a $1 million donation in late 1998 from Houston's Brown Foundation. That gift is enabling the AREC to develop proposals for a stand-alone research building where scientists will explore the molecular biology of aging.

Contributions made by AREC scientists will yield understandings and discoveries about aging, resulting in improved quality of health throughout the human life span, said Dr. Arlan Richardson, AREC director.

AREC faculty in the Health Science Center's graduate, medical, dental, nursing and allied health schools conduct projects supported by $28 million in federal and private grants.

The projects pose fundamental questions such as, "What activates genes in the elderly to cause them to be more susceptible to developing cancer?"

Other projects include improving the life of seniors through specialized geriatric care programs and instructing teachers about classroom curricula on aging.




Making the Rounds

  • Congratulations to Charles Garoni, emergency medical technology, on the marriage of his daughter, Heather Ann, to Douglas Cacurak of Lompac, California, on May 15 at St. Matthew's Catholic Church.

  • All the best to Dr. Harold V. Gaskill, III, surgery, and Euphemia Bauer Harkrader, director of nursing at University Hospital, who were married May 22 at First Presbyterian Church.

  • Dr. Rosalie Christine Uriegas, a 1999 Medical School graduate, and Dr. Rutilo Martinez, also a recent graduate, were married June 5 at El Carmen Catholic Church.

  • Best wishes to Rodrigo Lozano, housekeeping, and Mariana Gonzales, dental diagnostic science, who were married June 19.

  • Dr. Martin L. Meltz, radiology professor and director of the Center for Environmental Radiation Toxicology (CERT), has been elected to the Board of Directors of the Bioelectromagnetics Society. Dr. Meltz represents the biological/medical sciences on the board, and will serve as co-chair of the society's development committee.




Surgical alumni society celebrates 25 years

Twenty-five years ago a surgical resident alumni society was formed at the Health Science Center in an effort to foster fellowship and support resident educational opportunities. The initial idea came from Dr. Arvin Short, a graduate of the surgical program in 1974.

Today the J. Bradley Aust Society, named for the first Department of Surgery chair at the Health Science Center, is still growing. The group, now more than 200 strong, recently held its annual meeting, complete with a luncheon, clinical research presentations, a symposium, and banquet with awards.

"It is a great opportunity for each class of residents to get together once a year and renew their friendships," said Dr. J. Bradley Aust, who was chair of surgery at the Health Science Center for 30 years before retiring. "It is a very tight-knit group. I hope the society will continue as a tribute to the residency training program."

Each year during its meeting, surgical residents currently in the Medical School program compete for awards by participating in clinical research presentations. As part of its commitment to supporting residents' educational endeavors, the society offers six monetary prizes for the top research papers.

The Aust group has long provided funds for lecture series and similar activities through a trust fund administered by the San Antonio Area Foundation. Beginning in 1998, the Aust Society also is offering a traveling fellowship for a fourth-year resident; and plans are complete to open a resident's library and office space at University Hospital.

"It is very special that this society has been going for 25 years and that Dr. Aust is still an integral part," said Dr. William Strodel, chairman of the Department of Surgery. "To have the society developed under Dr. Aust's tutelage has been wonderful."

Strodel said he believes the society will continue to expand its role in the Department of Surgery by offering more educational opportunities to residents, and it will survive to celebrate the next 25 years.




In Memoriam

Health Science Center flags were lowered to half-staff this week (July 5-9) in memory of David LeCroy, programmer/analyst with facilities management, who passed away on July 3. He is survived by his wife, Shelly, and their three children.

The family has asked that donations in David's memory be sent to his children's trust fund in care of Oak Hills Church of Christ, 19595 I-H 10 West, San Antonio, TX 78257.




Calendar for July 12 - 18

MONDAY, JULY 12
7:00 a.m.
Orthopaedic Teaching Conf. "Complications of Elbow Injuries" (MED: 309L) (call ext. 5125)
8:00 a.m.
Medical Housestaff Specialty Conf. "Emergency Series: Endocrine Emergencies," Dr. Jan Bruder (MED: 409L)
8:00 a.m.
Rehab Medicine PM&R Conf. "Partial Foot & Symes Prosthesis," Drs. Rhondel McCann & Norman Gall (UH: Reeves Rehab Center 3rd-floor classroom)

TUESDAY, JULY 13
8:00 a.m.
Rehab Medicine PM&R Conf. "Incidence & Causes of Limb Amputations, Excluding Congenital Causes," Drs. David LeMay & Norman Gall (UH: Reeves Rehab Center 3rd-floor classroom)
8:00 a.m.
Medical Housestaff Specialty Conf. "Emergency Series: Asthma," Dr. Jay Peters (MED: 409L)
9:00 a.m.
Training Office "Copy Machine Orientation" (call ext. 2320 for information)
10:00 a.m.
TNT "Health Information Management: Common Statistical Process Tools Used in Performance Improvement," Toni Cade, University of South Louisiana (call ext. 2700 for information)
1:30 p.m.
TNT "Laboratory Technology Issues: Correlating Stress & Immune Function in the Elderly," Dr. Dianne Cearlock, Northern Illinois University (call ext. 2700 for information)

WEDNESDAY, JULY 13
7:00 a.m.
Vascular Surgery Grand Rounds, Dr. Mellick Sykes (LEC: 2.042)
8:00 a.m.
Medical Grand Rounds "Go Asthma Go (Away)," Dr. Stephen Jenkinson (MED: 409L)
8:30 a.m.
Training Office "Managing Your Time" (call ext. 2320 for information)
9:00 a.m.
Surgery Trauma M&M Conf., Dr. Ronald Stewart (MED: 309L)
10:00 a.m.
TNT "Environmental Services: Don't Be a Human Speed Bump," Barbara Burnham, Burnham Radiology Consultants, Willowbrook, Ill. (call ext. 2700 for information)
10:00 a.m.
TNT "Laboratory Management: Performance Appraisals: A Manager's Challenge Made Easier," Dolores Scotto, Pharmaceuticals Formulations Inc., Edison, N.J. (call ext. 2700 for information)
1:00 p.m.
Training Office "Accounting Fund Groups" (call ext. 2320 for information)

THURSDAY, JULY 15
7:30 a.m.
Thoracic Surgery Resident Teaching Conf. (UH: 5th-floor neonatal ICU classroom)
8:00 a.m.
Neurology Grand Rounds "Ophthalmic & Neuro-ophthalmic Headache," Dr. Jack Carter (MED: 444B)
10:00 a.m.
TNT "Health Care Education & Training: Educational Offerings," Dr. Whitney Bischoff, Texas A&M University (call ext. 2700 for information)
Noon
Seminars in Aging Research "Delayed Aging in Hypopituitary Dwarf Mice," Dr. Andrzej Bartke, Southern Illinois University School of Medicine (LEC: 3.078V)
Noon
Pulmonary, Thoracic & Oncology Conf. (MED: 309L)
12:30 p.m.
TNT "Comprehensive Care & Management of Diabetes: The Role of the Diabetes Nurse Educator," Mary Ann Morgester, South Texas Veterans Health Care System (call ext. 2700 for information)
4:00 p.m.
Surgery Tumor Conference, Dr. Anatolio Cruz (MED: 209L)
4:30 p.m.
Citywide Thoracic Grand Rounds Conf. "Case Presentation," Dr. Claudio Guareschi (MED: 309L)

FRIDAY, JULY 16
7:30 a.m.
Pediatric Grand Rounds "Short Bowel Syndrome & Small Bowel Transplantation," Dr. Samuel Kocoshis, University of Pittsburgh Medical School (MED: 409L)
8:00 a.m.
Medical Housestaff Specialty Conf. "Emergency Series: Hematologic Emergencies," Dr. Cesar Freytes (MED: 409L)
8:00 a.m.
Rehab Medicine Lecture Series "Pediatric Prosthetics," Dr. Ellen Leonard (UH: Reeves Rehab Center 3rd-floor classroom)
8:30 a.m.
Training Office "The Art of Delegating" (call ext. 2320 for information)
Noon
TNT "Histotechnology: Safeguarding the Laboratory Professionals & the Pathologist," Gwendolyn Gross, Cleveland Clinic Foundation, Cleveland, Ohio (call ext. 2700 for information)

SATURDAY, JULY 17
9:00 a.m.
General Surgery Grand Rounds, Dr. Wayne Schwesinger (MED: 409L)


Index of issues



THE NEWS is published Fridays by the Office of Public Affairs for faculty and staff of The University of Texas Health Science Center at San Antonio.
Vice President for University Relations.....Judy Petty Wolf
Executive Director of Development & Public Affairs.....Dr. Charles Rodriguez
Editor.....Will Sansom
Writers.....Myong Covert, Catherine Duncan, Heather Feldman, Jennifer Lorenzo
Photographers.....Jeff Anderson, Lee Bennack, Lester Rosebrock
Designer.....Kris Doyle
Web Editor.....Joanne Shaw
Production.....Printing Services


Office of Public Affairs, 7703 Floyd Curl Drive, San Antonio, Texas 78284-7768
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