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Podiatric Health
Section Newsletter
Winter 2011

Chair's Report: James J. DiResta, DPM, MPH

Welcome to the Podiatric Health Section of APHA

As the new chair of the APHA Podiatric Section I want to introduce myself to you. I am Dr. Jim DiResta who, along with our new Chair-elect Dr. Emily Cook, want to extend a warm welcome to all members of our Section as we begin what we hope will be another fruitful year for podiatric public health. Our predecessor, Dr. Janet Simon ,has worked tirelessly the past two years to assure the continued place for podiatric health at the APHA table, and we are committed to continue her legacy as we move our Section forward over the next several years. We are a small Section, and we need to turn around our dwindling membership by providing our members with real value in their APHA membership both for themselves and for our profession of podiatry, and we are determined to do just that. Both Dr Cook and I have, in addition to our podiatry training, an MPH degree, Emily from the Harvard School of Public Health and myself from Dartmouth Medical School. Together we feel we can bring the Section a credible and working knowledge for podiatric public health application, but we need your help.

As immediate past chair, Janet has promised to continue to assist us in this bridge of leadership to make our efforts successful, but we need all members to step up and make this Section stand out and shine among the other 26 sections at APHA. Your present Section leadership is reaching out to each state podiatric medical association to ask for their help to assist us in membership recruitment and in providing a public health contact person and/or a public health committee that will greatly assist us in our efforts. We ask all individual Section members to also consider getting involved on the state public health level by joining your state component public health affiliates and extending a hand in the interest of podiatric public health. It is this grassroots effort that will allow for the contacts we need to advance our agenda.

Many of our members have paved the podiatric path and worked within different capacities with their state affiliates in the past, as has Dr. Art Helfand with the PPHA, Dr. Marv Rubin at OPHA and of course Dr. Drew Harris who is past president of the NJPHA. Myself along with Drs. Emily and Jeremy Cook have been successful over the last few years in partnering with our state affiliate, the Massachusetts Public Health Association, in the formation of our Amputation Prevention Initiative. Please consider having your voice heard at the affiliate level in advancing the mission of our Section.

This year’s Annual Meeting will be held in Washington, D.C., from Oct. 29 through Nov. 2 of 2011, and the theme for this year’s meeting is Healthy Communities Promote Healthy Minds and Bodies. Our scientific chairman, Dr. Jim Christina, is accepting abstracts through the APHA website for oral and poster presentations for this year’s meeting. Please consider submitting and having your work considered for presentation as this is a wonderful venue to have your work seen and heard.

Finally, let me state that I am honored to be your chair and to represent your interest and the interests of podiatric public health at APHA. Please join me in our Section's initiatives as we can accomplish so much more if we work together. I welcome your questions in addition to your support and assistance, and I look forward to hearing from you.

James J. DiResta, DPM, MPH james.j.diresta.DMS04@alum.dartmouth.org

Editor's Perspective: Emily A. Cook, DPM, MPH, CPH

A Call To Arms...

Author: Emily A. Cook, DPM, MPH, CPH

Recently I had the opportunity to visit two podiatric colleges in California and Arizona. The purpose of these visits was to explain the externship and residency process to the enrolled students. In the course of introducing myself I mentioned my research background, particularly as it relates to public health. Among the throngs of questions related to residency, several students inquired “how can podiatry contribute to research?”  What became evident in our discussions was that there really isn’t a formal mechanism that gives students access to research opportunities.

For my part, I directed students toward a textbook that would give them introductory definitions related to epidemiology. I also explained that the arena of public health is full of research opportunities for the field of podiatry. I further encouraged them to get involved with national organizations whose membership have both the interest and means to pursue research and public health activities. I expect that several students will join APHA in an effort to meet individuals who can provide those opportunities. These students have a desire to participate but lack the means to be effective. I hope APHA members will recognize the enthusiasm of these young leaders and will contribute in whatever way they can.

 

Podiatric Public Health Alert: Pharmacist, Podiatrist, Optometrist and Dental Care (PPOD) Coalition

PPOD Public Health Coalition Moves Forward on the State Level

The Community Service Foundation and the Public Health Committee of the Massachusetts Podiatric Medical Society have continued to move the National Diabetes Educational Program forward on the state level through their own MDEP coalition. MPMS has partnered with Massachusetts Pharmacy Association, Massachusetts Dental Society and the Massachusetts Society of Optometrists.

The Massachusetts Diabetes Education Program (MDEP) Coalition is a statewide coalition based on the National Diabetes Education Program (NDEP) model. This unique MDEP Coalition has a communications program aimed at educating the public, and its members, regarding the important role that the coalition's providers play in diabetes management, education and prevention.

Coalition member pharmacy, podiatry, optometry and dental care (PPOD) professionals are often a primary point of care for people with type 2 diabetes. Working with primary care providers, these professionals play an important role in ensuring that diabetes care is continuous and patient centered. PPOD professionals educate people with diabetes about the disease, encourage them to practice self-management, provide appropriate treatment and refer those who require the care of other health professionals.

You can link to their new website and view the 30-second public health service announcement at: http://mdepcoalition.org.build.officite.com/index.html

Podiatric Public Health Alert: Moving Toward A Public Health Fellowship

Post Doc Podiatric Public Health Fellowship

Our Section has been diligently working on the formation of a Fellowship in Public Health for a graduating podiatric resident through Dartmouth Medical School. The fellowship curricula is designed to provide the fellow with the fundamental skills, knowledge base, and philosophical foundation in health policy and clinical practice, with specific attention paid to public health, clinical/health services research, and health care leadership and will provide the post doc fellow under supervision of his/her mentor, James J. DiResta, DPM, MPH, with the unique opportunity to pursue an internship and research project within the TDI curricula in podiatric public health and upon completion of the 12 month program the fellow will receive an MPH degree from Dartmouth Medical School.    

The Dartmouth Institute for Health Policy and Clinical Practice (TDI) is a dynamic force within Dartmouth College, dedicated to improving health care through education, research, policy reform, leadership improvement, and communication with patients and the public.

The Dartmouth Institute for Health Policy and Clinical Practice (TDI) was founded in 1988 by Dr. John E. Wennberg as the Center for the Evaluative Clinical Sciences (CECS). Among its 30 years of accomplishments, it has established a new discipline and educational focus in the Evaluative Clinical Sciences, introduced and advanced the concept of shared decision-making for patients, demonstrated unwarranted variation in the practice and outcomes of medical treatment, and shown that more health care is not necessarily better care. Healthy skepticism about new treatments and medical “breakthroughs,” an understanding of the risks and benefits of many common therapies and surgeries, and unique educational programs have produced more informed agents of change among physicians, health professionals, the media and the public.

The Dartmouth Institute aspires to be the preeminent research and educational institution devoted to the ongoing reform of the U.S. health care system.

Podiatric Public Health Alert: California School Of Podiatric Medicine, Medical Mission Trips

Dear Friend:

 

We are writing to ask for your support for the annual Student Medical Mission at the California School of Podiatric Medicine (CSPM) at Samuel Merritt University (SMU). This community service event will help support the mission statement of SMU: “To educate students to become highly skilled and compassionate healthcare professionals who positively transform the experience of care in diverse communities."

 

Building on the experience of the first three medical missions, first with Katrina victims in New Orleans in spring 2008, and in 2009 and 2010 to underserved Latinos in San Ysidro, Calif., we are preparing for a new three-day mission trip April 7 – 9, 2011, in collaboration with the United Church of Christ’s Centro Romero, once again, in San Ysidro, Calif. This year, students from SMU’s Family Nurse Practitioner program will join the podiatric students to provide a more comprehensive approach to foot care.

 

The purpose of this trip is to help meet the podiatric needs of people who cannot afford treatment on their own and to provide practical, hands-on experience for 21 SMU students under the supervision of faculty and other fully licensed clinicians. Our current fundraising goal is to raise $8,000 to cover all related expenses for the entire team of faculty and students involved in the mission trip. We recognize that we are facing challenging times as a country, but we are also aware that serving others with much greater needs than our own is a reminder of the essence of our profession as health care providers. Your contribution is critical to this mission trip and is tax-deductible.

 

All donors to the Medical Mission trip will be recognized in the University’s Report to the Community. If you have any questions or concerns do not hesitate to contact us at (415) 509-7049. We thank you in advance for your consideration and appreciate any support you can provide.

 

Sincerely,

 

Olivia Stransky, PMS-2,  Peter Barbosa, PhD, Tim Dutra, DPM

pbarbosa@samuelmerritt.edu

tdutra@samuelmerritt.edu

Olivia.Stransky@samuelmerritt.edu

(415) 509-7049

 

SAMUEL MERRITT UNIVERSITY STUDENT MEDICAL MISSION

Three Easy Ways to Donate:

 

Mail a check written to Samuel Merritt University

In the Memo portion write: CSPM/SMU Medical Mission

 

Mail check to:

SAMUEL MERRITT UNIVERSITY

OFFICE OF DEVELOPMENT AND ALUMNI AFFAIRS

450 30TH STREET, SUITE 2840

OAKLAND, CALIFORNIA 94609

 

OR

Call with your Visa or MasterCard donation to (510) 869-8628

 

OR

Provide your name, address, phone number, and e-mail with your credit card information and mail it to same address above.

Credit Card information: __ Visa __ MC

Card number: _____________________ Expiration date: ___________ V# _________

(3 digit number found on back of card)

Billing address (if different from above): ___________________________________________

Signature: ________________________

 

Need more information about the Medical Mission?

Contact our faculty advisor Peter Barbosa, PhD, (415) 509-7049, pbarbosa@samuelmerritt.edu

 

Need more information about how to make a contribution?

Call Gena Caya, Office of Development and Alumni Affairs, (510) 869-8628

 

All donors will receive a letter of acknowledgement from the

Office of Development and Alumni Affairs

Student's Corner: Katherine Koh, 1st Year Harvard Medical Student, The Need for Medical School Courses in Evidence Based Medicine

 Epidemiology and Public Health:

A Medical Student’s Perspective

 

 

As a first-year medical student, I have been whisked into a whole new medical world — one that is complex, fascinating and beautiful. Since stepping into medical school, my mind has been filled with studying cell pathways, dissecting the human body and understanding advances in the human genome. Though I have greatly enjoyed this important scientific foundation, it was not until recently that I uncovered my passion in medical school. This January, the curriculum shifted to a focus on how societal forces outside the human body can determine health — in essence, the study of epidemiology and public health.

 

My desire to become a doctor stemmed from my belief that an integrated approach to medicine — one that involves patient care, research and public health — will have the greatest benefit to others. Public health is central to my life’s mission and one of my core reasons for pursuing a career in medicine. To me, public health is a means by which to reach out to all populations; it ensures an equal opportunity for health so that all may reach their full potential.  

 

Thus, I was delighted that Harvard Medical School offers a month-long epidemiology class as part of its first-year curriculum, entitled “Clinical Epidemiology and Population Health.” The course teaches fundamental principles of epidemiology in the context of public health, addressing pressing issues such as tobacco, obesity and emergency preparedness. Epidemiology is the backbone of public health: it is the foundation for clarifying needs and generating solutions. Epidemiology can offer both a longitudinal view of trends in diseases and a snapshot view that captures diseases at a single point in time.

 

However, I have discovered through this course that epidemiology is critical not only for understanding health on a population level, but also at the individual level. My understanding of medical decision-making has been sharpened by an array of concepts such as the hierarchy of evidence, causation criteria, diagnostic testing, and cost-effectiveness analyses. For example, the quality of evidence helps us decide what type of drug to prescribe to our patient. Diagnostic tests enable us to talk with a patient about the causes of his or her symptoms. Cost-effectiveness analyses teach us how to think about the benefits and drawbacks of specific treatments. My classmates and I have realized how epidemiology joins hands with both medicine and public health to improve outcomes.

 

In addition, this epidemiology course has provided my classmates and me with a general framework for critically evaluating research. From day one in medical school, journal article references were presented as the building blocks of our medical knowledge. It is an essential part of a responsible education to be able to assess this research in a structured manner. The twenty-first century represents a new era of medicine in which research is rapidly disseminated due to advances in information technology, electronic medical records, and research and statistical methods. The ability to understand and critique evidence is more crucial than ever.

 

I will strive to apply these lessons in my own research. My previous work in epidemiology has focused on the prevalence of obesity in the homeless, an urgent issue that has received little attention. Despite stereotypes of the homeless as underweight, I conducted a study that found that the prevalence of obesity in the homeless is high and comparable to that of the general population. My aim is to build on this research and ultimately create policy change, such as increasing nutritional standards in shelters or education efforts. Without epidemiology, the needs of these individuals would remain uncertain and solutions unexplored.

 

Personally, I want to continue to pursue epidemiology not only for the reasons above, but also for its ability to shed light on the needs of all people, even those that have been ignored. In short, it tells us not merely about how our world is, but rather how it can be. In my view, epidemiology and public health are integral to healing. I am grateful to have discovered a passion that will carry me forward and enrich my scientific learning as I continue on the journey of medicine.

Scientific Report: APHA 2010 Meeting, Podiatric Health

138th APHA Annual Meeting

November 6-10, 2010   Denver

Podiatric Health Presentations and Pictures

1.  Sandra Gotman, DPM:  Low back pain/radiculopathy and its impact on health care costs. Need for early assessment and treatment to avoid future disability

2.  Kelly Powers, DPM, MS Candidate:  Exposure to High Levels of Fluoride in the Ground Water of the Ethiopian Rift Valley Results In Lower Extremity Skeletal Fluorosis & Neuropathy

3.  Lisa Nhan, DPM:  American Podiatric Medical Association Spearheading the Efforts to Combat Mycobacterium fortuitum in Nail Salon Footbaths

4.  Bright Chen, DPM (Albert Schweitzer Fellow, Presenter), Analiza Mitchell, DPM and David Tran, DPM, MS:  "Step Up For Foot Care" - Addressing podiatric care needs for the homeless in San Francisco, CA

5.  Jeffrey Ross, DPM, MD:  Predicting Lower Extremity Injuries in a Two Week Overweight Obese Children's Two-Week Summer Camp Exercise Program - A Two-Year prospective Study Utilizing Computerized gait Analysis

6.  James R. Christina, DPM:  Podiatric Care and the Likelihood of Amputation or Hospitalization for People with Diabetes and Foot Ulcers

7.  John Steinberg, DPM, Farah Siddiqui, DPM (Presenter):  One Year Retrospective Study of Limb Salvage Versus Amputation in Patients Presenting to the Emergency Department with Diabetic Foot Infections

8.  Jean-Jacques Kassis, DPM and Jasmaine Shelford, MPH (Presenter):  Incidence of depression in diabetic patients with lower extremity wounds utilizing the PHQ-9

 

APHA: Podiatric Health Booth and Group Pictures

APHA Announcements: APHA Public Health Materials Contest

TWENTY-FIRST Annual APHA Public Health Materials Contest

The APHA Public Health Education and Health Promotion Section is soliciting your best health education, promotion and communication materials for the 21st annual competition. The contest provides a forum to showcase public health materials during the APHA Annual Meeting and recognizes professionals for their hard work.

 

All winners will be selected by panels of expert judges prior to the 139th APHA Annual Meeting in Washington, D.C.  A session will be held at the Annual Meeting to recognize winners, during which one representative from the top materials selected in each category will give a presentation about the winning materials.

 

Entries will be accepted in three categories; printed materials, electronic materials, and other materials. Entries for the contest are due by March 25, 2011.  Please contact Stephanie Parsons at sparsons@jhsph.edu for additional contest entry information. 

APHA Announcements: HCUP

2008 Nationwide Emergency Department Sample (NEDS) Released

 The Agency for Healthcare Research and Quality is pleased to announce the release of its newest HCUP database, the 2008 Nationwide Emergency Department Sample (NEDS).  The NEDS is the largest all-payer emergency department database in the United States.  The NEDS was created to enable analyses of emergency department utilization patterns and support public health professionals, administrators, policy-makers, and clinicians in their understanding and decision-making regarding this critical source of health care. 

The NEDS has many research applications as it contains information on hospital characteristics, patient characteristics, geographic region and the nature of the emergency department visits (e.g., common reasons for visits, including injuries).  The database includes information on all visits to the emergency department, regardless of payer – including persons covered by Medicare, Medicaid, private insurance, and the uninsured. 

The 2008 NEDS contains data from 28 million emergency department visits, and encompasses all encounter data from nearly 1,000 hospital-based emergency departments in 28 states.  The NEDS approximates a 20 percent stratified sample of emergency departments from community hospitals. Weights are provided to calculate national estimates pertaining to the 125 million emergency department visits that took place in 2008.  The database was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID).  The NEDS provides information on "treat-and-release" emergency department visits, as well as emergency department visits in which the patient was admitted to the same hospital for further care. 

2008 HCUP Facts and Figures Report Released

Provides Statistics on Hospital Visits

The Agency for Healthcare Research and Quality has released HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008, available online on the HCUP-US Website.  The new report uses the HCUP Nationwide Inpatient Sample (NIS) database to present information about hospital care in 2008, as well as trends in care from 1993 to 2008.

HCUP Facts and Figures features an overview of numerous hospital-related topics, including general characteristics of U.S. hospitals and the patients treated; the most common diagnoses, conditions, and procedures associated with inpatient stays; the costs and charges associated with hospitalizations; and the payers for inpatient stays.  A special section of this year’s report is an examination of trends in inpatient and emergency department care for mental health and substance abuse conditions.  HCUP’s 2007 Nationwide Emergency Department Sample database provided data on this topic.  Funding for this section came from the Substance Abuse and Mental Health Services Administration.

As an example, one topic in the report shows that the number of hospital admissions among Americans ages 45 and older for medication and drug-related conditions doubled between 1997 and 2008. Medication and drug-related conditions include effects of both prescription and over-the-counter medications, as well as illicit drugs.

 

Hospital Charges for 1 in 20 Hospital Stays Averaged $18,000 per Day

Hospital charges for the most expensive patient stays at U.S. hospitals in 2008 averaged about $18,000 per day, according to a recent report from AHRQ.  These patients were most likely to be in the hospital for treatment of septicemia (or blood infection), hardening of the arteries, and heart attacks.

According to the analysis by the federal agency, the average was based on the top 5 percent most expensive hospitalizations, or about two million patient stays. These stays lasted an average of 19 days.  In contrast, daily hospital bills for the remaining 95 percent of patient stays in 2008 averaged just under $7,000 and four days, and were most likely for childbirth, pneumonia, and heart failure.

Compared to the less expensive stays, patients with the more expensive hospital stays also were:

- More severely ill: about 10 times more likely to experience extreme loss of function (39 percent versus 4 percent).

- At greater risk of dying in the hospital: nine times more likely to be in the highest category for risk of death in the hospital (28 percent versus 3 percent).

- Were older: average age of 59 versus 48 years.

These findings are based on data described in Most Expensive Hospitalizations, 2008.  The report uses data from the 2008 Nationwide Inpatient Sample, a database of hospital inpatient stays in all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 95 percent of all discharges in the United States and include patients, regardless of insurance type, as well as the uninsured.