Health Sciences Report (2000)

HEALTH SCIENCES REPORT UNIVERSITY OF UTAH Vol. 24, No. 2 Published by the Office of Public Affairs, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, Utah 84132. Telephone ( 801) 581- 7387. Health Sciences Report is mailed to faculty, staff, alumni and friends of the University of Utah School of Medicine; to the staffs of University Hospitals & Clinics, University Health Network and Spencer S. Eccles Health Sciences Library; and to the faculties and alumni of the colleges of Pharmacy, Nursing and Health. Articles may be reprinted with permission. Editor: Susan Sample Editorial Consultant: Anne Brillinger Contributing Writers: Anne Brillinger, Mary Chachas, John Dwan, Christopher Nelson Photographers: Brad Nelson and Steve Leitch, Medical Illustration Service Visit the University of Utah Health Sciences Center web site at: ivww. mcd. utali. edu. Q f Health Sciences Report is printed on recycled paper. F E A T U R E S High Impact 8 A U cardiologist is ranked 12th in the nation for publishing research papers cited extensively during a five- year span. OBESITY WEIGHS IN AT EPIDEMIC PROPORTIONS The Ignored Medical Problem 12 Chronic obesity is a disease that needs to be treated, says a family practitioner. If You Go " On" a Diet, You're Bound to Go " Off" 14 At the Nutrition Clinic, overweight clients develop lifestyles that keep them healthy and happy- and thinner. Gender Makes a Difference 17 When it comes to diets, " individualized" may be the key to helping people lose weight. Foods Factor in New Medications 18 Bioactive compounds in foods may aid the development of a new generation of disease- fighting drugs. Maybe Your Genes Made You Eat It 19 Utah researchers have " some very good leads" on finding a genetic link to being severely overweight. Fun or Function? 20 What motivates females to exercise depends upon age, says a nursing professor who's studied fitness for 15 years. Using Weight to Control the Uncontrollable 23 Although eating disorders patients use food to cope with feelings, the physiological changes can be very serious. D E P A R T M E N T S Headlines 2 People 7 From the Bookshelf 26 A U medical school faculty member writes honestly of her own and others' experiences of surviving domestic violence. Research in Brief 28 Gift of Health 30 Contributions fund a College of Pharmacy scholarship and five new chairs in the School of Medicine and College of Nursing. Opinion 33UNIVERSITY OF UTAH HEALTH SCIENCES Weighs in at Epidemic Proportions Liz Joy has given her scheduling receptionist strict guidelines: no more than three eating disorders patients a day. The physician isn't being unkind; she simply knows her limits. One day, five out of 12 patients she treated had eating disorders. That was too many. " I'm a family doctor," she tells me. There's another reason. When she listens to the heart of an eating disorders patient, asking about an anorexic's chest pains, a bulimic's sore throat, she hears something else. " Painful stories-," she says, turning in her chair to stare at a stack of patient files, the voices slipping out like torn sheets of paper. She shakes her head,"- painful to hear." Sexual abuse, dysfunctional families, adolescent women and men crying out for attention by starving, binging, purging not just food but the emotions they can handle no other way. Eating disorders are the result of complex cultural and biological interactions. They've been described as the most lethal of psychiatric disorders, because the consequences can be devastating. Not eating is like not breathing; you can only do it for so long. Anorexia nervosa, bulimia nervosa and binge eating are also symptoms of a cultural disease: the unhealthy and contradictory ways we view food. Eating is no longer a matter of physical survival- supplying our body with the nutrients it needs to function- it's become our life, socially and emotionally. We have " fun," not hamburgers, at McDonalds. We pop a frozen Red Baron pizza into the oven, hoping that romantic fantasies will swirl out with the steam. Yet, as a culture, we point fingers at those whose bodies don't mirror the emaciated young females of fashion or the steroid-induced muscles of male models. We coat every chocolate bar with moral judgments: if you succumb to these empty calories, it's a sign of your weak character. Until we change our perceptions, we'll have people with eating disorders at one end of the spectrum and, at the other, the severely obese. Physicians like Liz Joy will continue to hear painful stories. And, if we each look closely, we'll see many more people hiding stories that hurt deep below the skin, e Susan Sample How do you know which web sites offer reliable, trustworthy information about health problems? I 1 U Cardiologist Wins Award to Direct $ 9.4 Million NIH Study of Sudden Cardiac Death obert L. Lux, Ph. D., professor of internal medicine in the medical school's Division of Cardiology, was awarded a five- year $ 9.4 million grant from the National Heart, Lung and Blood Institute, National Institutes of Health ( NIH), to direct research into the causes and prevention of sudden cardiac death. He will lead a multidisciplinary team of scientists, cardiologists, geneticists, electrophysiologists and engineers from the University's Nora Eccles Harrison Cardiovascular Research and Training Institute ( CVRTI), and the George and Dolores Eccles Institute of Human Genetics, as well as from the universities of Kentucky, Pittsburgh, Rochester and Pavia, Italy. They will study the causes of sudden cardiac death, assess new methods to identify patients at risk of sudden death and develop new therapies to prevent it. Of some 500,000 Americans who suffer heart attacks each year, a high percentage die suddenly and without warning. The NIH grant, awarded last April, is a renewal of a previously funded five- year grant of more than $ 7 million. In January, Lux was awarded a two- year $ 100,000 grant for research into possible links between the brain's electrical signals and abnormal cardiac function in patients at risk of expe-riencing potentially lethal arrhythmias, or sudden cardiac death. The study, funded by The Charles A. Dana Foundation's Clinical Hypotheses Program in Brain- body Interaction, " is the first to try to link directly the brain's electrical activity with the electrophysiologic conditions in the heart known to precede, and possibly even cause, abnormal heart rhythms," said Lux. The research aims to improve methods for identifying patients at risk and to monitor the effectiveness of prescribed therapies. With colleagues at CVRTI, Lux will study patients suffering from Long QT Syndrome, a genetic disease in which structural abnormalities occur in specialized electrical pathways of heart cells. They will record simultaneously the electrical signals of patients' brains and hearts. The award will enable the research team to build a computerized recording system to measure and analyze the relationship between these complex electrical signals, E U Hospitals & Clinics Cited by State as ' Family- friendly' Dhe State of Utah Department of Workforce Services named University Hospitals & Clinics one of the 10 most family- friendly companies. The hospital also received the state's Work/ Life Award for a large employer, an honor presented to the top three companies for commitment to flexible scheduling and promoting a family- friendly work environment. Richard A. Fullmer, hospital executive director, accepted both awards at the state's Utah Employer Conference held at the University last January. Hospital programs cited by judges included a nearby hospital-sponsored child development center, flexible work schedules and an employee assistance program providing counseling and other services. Employee benefits include medical and dental insurance for staff and immediate families, retirement plans, paid maternity leave, generous vacation and sick leave, tuition reduc-tion for employees and their families, a reward and recognition program, and employee health fairs. Hospital employees also receive discounted admission to the University's recreation facilities, museums and athletic and cultural events. University Hospitals & Clinics, employing more than 2,800 people, is the state's largest hospital- based provider of ambulatory care services with more than 80 general and specialty outpatient clinics. The 400- bed hospital is an EMS- designated Level 1 Trauma Center and provides care for residents from the six- state Intermountain region. The U Neuro-psychiatric Institute is a full- service, 90- bed psychiatric hospital, providing inpatient, intensive outpatient and residential treatment for adult and pediatric patients, e $ 2.2 Million HHMI Grant Supports Medical Program The School of Medicine was awarded $ 2.2 million over the next four years from the Howard Hughes Medical Institute ( HHMI) to find new ways to combine basic biomedical research and clinical treatment of patients. The grant, awarded last December, supports Utah's Fellowship to Faculty Transition Program ( FTFT), an inter-departmental program to identify and support new biomedical investigators at the junior faculty level. The funds help faculty launch their research and pilot studies. Institutions also can use the money to establish or improve shared research facilities, purchase major equipment and foster collabo-rations among basic scientists and clinical researchers. The U is one of 41 medical schools receiving grants, ranging from $ 1.6 to $ 4 million, for a total of $ 29 million. Utah's FTFT program was initiated after a successful application to HHMI in 1995. Since that time, 10 new physician- scientists have been recruited and supported by the program. FTFT operates in concert with the Human Molecular Biology and Genetics Program, another inter-departmental research effort at the U medical school, e 2 Health Sciences Report Spring 2000 New ICU for Newborns- Thirty- six infants were moved into University Hospital's new Newborn Intensive Care Unit ( NBICU) last February. Once renovation of the old NBICU is completed this fall, the unit will have a total of 48 beds- up from eight when the hospital opened the region's first NBICU in 1968. More than 500 newborns are cared for each year in the specialized unit. Faculty Members Recognized for Outstanding Teaching Two faculty members from the School of Medicine and College of Nursing received University Distinguished Teaching Awards at commencement in May. The honor includes a $ 5,000 base- salary increase. John F. Ash, Ph. D., professor of neurobiology and anatomy, serves as course master for the medical school's first- year histology course and teaches graduate students in the molecular biology program. He also has direct-ed the develop-ment of computer programs that allow students to work and learn on their own. A graduate of the University of Illinois, Ash received a doctorate from Stanford University. He joined the U of U faculty in 1980. Helen Zsohar, Ph. D., associate professor of nursing, is coordinator of student affairs at the College of Nursing. A U faculty member since 1985, she is the former director of the college's Division of Parent-child and Adult Nursing, with expertise in medical- surgical nursing, pharmacology and instruc-tional technology. A graduate of the University of Texas at Galveston, Zsohar received her doctorate from Arizona State University, E Scientists Find Genetic Clue to Neurological Diseases Researchers at the University's Eccles Institute of Human Genetics localized to chromosome 5 the gene causing adult- onset autosomal domi-nant leukodystrophy ( ADLD), which may provide a clue to the cause of other similar neurodegenerative diseases, such as multiple sclerosis ( MS). Investigators for the study, reported in the March 22,2000, issue of the journal Human Molecular Genetics, are Ying- Hui Fu, Ph. D., research associate professor of neurobiology and anatomy; Louis J. Ptacek, M. D., associate profes-sor of neurology, adjunct assistant professor of human genetics and an investigator with the Howard Hughes Medical Institute; and Kevin Flanigan, M. D., research assistant professor of neurology, all at the School of Medicine. Both ADLD and MS result from degeneration of a nerve cell insulator, causing progressive loss of movement and shorter life expectancy. Due to ADLD's clinical similarity to some forms of MS, patients often are mis-diagnosed. However, ADLD patients experience unusual symptoms early in the disease progression. From ages 30- 45, they may suffer from decreased sweating, bowel/ bladder dysfunction and a drop in blood pressure when standing up; males may experience impotence. Loss of fine motor skills typically begins several years later and progresses to complete loss of voluntary movement and death after 20- 30 years. Genetics appear to play a larger role in ADLD than in MS; 50 percent of children born to a person with ADLD will develop the disorder, while the role of genes in MS is not clear. The gene causing ADLD is likely involved in the production and maintenance of myelin, a sheath comprised of lipids and proteins, which works as an insulator for nerve cells. The recent finding is significant, because it will provide " insight into a novel mechanism of myelin metabolism," according to Ptacek. Contributing to the study were researchers from the Albany Medical College, Neurology of Arkansas, Johns Hopkins University and University of Louisville, E John F. Ash, Ph. D. Helen Zsohar, Ph. D. Health Sciences Report Spring 2000 Medical Informatics Program Joins International Effort The medical school's Department of Medical Informatics- the first in the country- was selected as one of two North American programs to join a new international partnership in medical informatics education. After visiting American and Canadian campuses, the University of Heidelberg/ University of Applied Sciences Heilbronn and the University of Amsterdam chose the U and the University of Minnesota as partners. For the first exchange, two Utah faculty members and two graduate students will attend a weeklong master class in Heidelberg this summer. Additional classes will follow, with the second scheduled in Utah. Semester-long student exchanges enabling students to research medical language development also are planned. " Medicine is computerized in Europe, but not as much as here," said Reed M. Gardner, Ph. D., professor and chair of the U Department of Medical Informatics. " We will not only consider technical strategies, but also the whole of health care and cost- effectiveness of computerized medical systems." European schools are about a decade behind the United States in the practical implementation of medical informatics to health- care problems, according to Gardner. While 75 percent of the students in the U medical informatics program are physicians, the majority of Europeans are computer or basic scientists, he noted. In 1964, U graduate students first formally studied computer applications in medicine under Homer R. Warner, M. D., Ph. D. Faculty and staff now work in clinical decision support, medical vocabulary, genetics, clinical data repositories and medical imaging. In addition to the medical school, they work at LDS Hospital and other Intermountain Health Care facilities, and at the Salt Lake Veterans Affairs Medical Center, E E. Martin Caravati, M. D., M. P. H. Caravati New UPCC Director; Rollins Focuses on Olympics E Martin Caravati, M. D., M. P. H., * professor of surgery in the medical school's Division of Emergency Medicine, was named medical director of the Utah Poison Control Center ( UPCC) last April, when Douglas E. Rollins, M. D., Ph. D., stepped down to focus on his role as doping control medical director for the Salt Lake Organizing Committee ( SLOC) for the 2002 Winter Olympics. Caravati, who served as UPCC associate medical director since 1987, is the only board- certified medical toxicologist in Utah. He also directs University Hospital's Medical Toxicology Consult Service, the only medical toxicology inpatient consult service in the state. Rollins served as UPCC medical director for 20 years and will remain with the center as associate medical director. He also retains his position of professor of pharmacology and toxicology at the U College of Pharmacy. The UPCC is a 24- hour resource for poison informa-tion, clinical toxicology consultation and poison prevention intervention. It is a program of the pharmacy college and a cooperative public service of the Utah State Department of Health and the U health sciences center, e Library Grant Funds Health Project in Spanish The Spencer S. Eccles Health Sciences Library and University Hospitals & Clinics' Office of Patient Education are expanding the hospital's existing patient education web site by adding 225 Spanish- language documents in women's health, diabetes and nutrition. The collaborative project, funded by a National Library of Medicine ( NLM) grant, includes creation of a bilingual search engine for easier access to the materials. On- site training in accessing and using the materials will be pro-vided to academic and public library staff, health- care professionals affiliated with the U Hospitals & Clinics, and Hispanic organizations statewide. The new documents, designed to meet the needs of Utah's Hispanic population, can be accessed on the hospital's patient education web site: http:// www. med. utah. edu/ pated/. The project is coordinated by Deborah E. Hile, Eccles acquisitions librarian, and Jackie A. Smith, Ph. D., patient education coordinator for U Hospitals & Clinics. The NLM provided a total of $ 1 million for 49 projects in 34 states, e Medical School Earns GME Reaccreditation The School of Medicine received a five- year reaccreditation from the Accreditation Council for Graduate Medical Education ( ACGME) last February. The University is the sponsoring institution for more than 50 GME programs, each of which is separately accredited by ACGME. Judi Short directs the University's GME office. With 505 residents, the U has the largest GME program in the Inter-mountain West. Residencies range from three years in fields such as pediatrics and internal medicine to seven years in neurosurgery and cardiothoracic surgery. U residents complete portions of their training in Salt Lake City at the Veterans Affairs Medical Center, LDS Hospital, Primary Children's Medical Douglas E. Rollins, M. D., Ph. D. 4 Health Sciences Report Spring 2000 Center, Salt Lake Regional Medical Center, Shriners Hospital for Children, U Neuropsychiatric Institute and Valley Mental Health, n U Pharmacy Researchers to Celebrate Birthdays at International Symposia Two College of Pharmacy researchers who co- direct the U Center for Controlled Chemical Delivery are being honored on their 60th birthdays this summer with special scientific symposia. " Polymers in Medicine," the 40th microsymposium of the Prague Meetings on Macromolecules, is scheduled July 17- 20 in Prague, Czech Republic, to honor Jindrich Kopecek, Ph. D., professor and chair of the U Department of Pharmaceutics and Pharmaceutical Chemistry, and professor of bioengineering. The symposium is sponsored by the Institute of Macromolecular Chemistry, Academy of Sciences of the Czech Republic. Kopecek serves on the editorial boards of numerous journals, including Pharmaceutical Research and PharmSci. His most recent honors include the 1999 Founders Award from the Controlled Release Society, the J. Heller Award for Best Paper in 1999 in the Journal of Controlled Release and being named a Fellow in the International Union of Societies of Biomaterials Science and Engineering. Kopecek received his doctorate in macromolecular chemistry from the Institute of Macromolecular Chemistry, Czechoslovak Academy of Sciences, and was a postdoctoral fellow in applied chemistry at the National Sung Wan Kim, Ph. D. Research Council of Canada. He joined the U of U faculty in 1989. Sung Wan Kim, Ph. D., professor of pharmaceutics and pharmaceutical chemistry, is being honored Aug. 20- 22 in Cheju Island, Korea, at the Interna-tional Symposium on Biomaterials and Drug Delivery Systems, sponsored by the Korea Institute of Science and Technology. Kim received a bachelor's degree in chemistry from Seoul National University and completed his doctorate at the U of U in 1969. Elected last fall to the Institute of Medicine of the National Academy of Sciences, Kim is recognized worldwide for his pioneering research into controlled drug delivery and blood- compatible polymers. His contributions and seminal work will be the theme of the summer symposium, E U- Fit Provides Fitness, Fun for Kids with Disabilities U- Fit, a new College of Health program, offers noncompetitive physical activities for children and youth with disabilities that not only increase their fitness and self- esteem, but also provide research opportunities for what has been called " an emerging national priority." " One of the major challenges of the coming years is to improve our under-standing of the needs of the full range of people with disabilities," reports the federal government's Healthy People 2000: National Health Promotion and Disease Prevention Objectives. U- Fit will provide Utah faculty and students with opportunities to gather data to establish fitness guidelines for those with physical disabilities. U- Fit began last spring with weekly sessions in a University gym, where children with disabilities and their families met with faculty and students. While helping the children improve motor skills and levels of physical fitness, U- Fit also enabled the youth to build friendships and increase their self- esteem and confidence as they worked towar