Spring 2018 Semester

Please join us for the free Texas Department of State Health Services Grand Rounds presentations during the Spring semester, from 11:00-12:30 p.m. in the M100 Conference Room, located in Austin, in the Moreton building (see Central Campus-Austin map), and via live webinar.

April 4 - First, Do No Harm: Talking with Children and Families about Making Healthy Changes
April 11 - Things You May Not Know About Rabies, but Should!
April 18 - Utilizing Community Health Workers to Combat Hypertension in Northeast Texas
April 25 - Evidence-based Approaches to Treating Opioid Use Disorders
May 2 - Tuberculosis - The Challenges to Outsmarting this Disease
May 9 - Why the Death Certificate Really is a Vital Statistic - Part 1

 
Stephen Pont MD, MPH
Texas Department of State Health Services Medical Director, Office of Science and Population Health Assistant Professor of Pediatrics, University of Texas at Austin, Dell Medical School

First, Do No Harm: Talking with Children and Families about Making Healthy Changes

Presenter:
Stephen Pont MD, MPH
Texas Department of State Health Services Medical Director, Office of Science and Population Health Assistant Professor of Pediatrics, University of Texas at Austin, Dell Medical School

Description:
Childhood obesity affects all communities and all sectors of Texas. If not reversed obesity remains on track to cause this generation of children to live shorter lives than their parents. The causes are simple yet complex and so multi-faceted solutions are needed. However, often many turn to guilt and blame in an attempt to motivate health behavior change. 

Please join nationally recognized childhood obesity expert Stephen Pont, MD, MPH, co-founder and inaugural chair of the American Academy of Pediatrics Section on Obesity, lead author of the AAP Policy Statement on Weight Stigma in Children and Adolescents, and now DSHS medical director for the Office of Science and Population Health for a discussion about the complexity of making health changes as individuals and as communities and how guilt and blame most often result in shame and less healthy behaviors rather than positive change.

Learning Objectives:

• Define weight bias and its negative impact on patient well-being and health behavior change, and demonstrate. increased awareness of our own and societal weight stigma. 
• Identify best practice approaches for empathetic & effective communication with patients & families challenged by obesity.
• Discuss the prevalence, causes, and strategies for achieving childhood wellness and reversing the obesity pandemic.
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health
• Licensed Marriage and Family Therapists
• Licensed Professional Counselors
• Licensed Psychologists
• Registered Sanitarians
• Social Workers
  

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources: 
Dietz WH, Solomon LS, Pronk N, et al. An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases. Health Aff. 2015 Sep;34(9):1456-63. 

Butte NF, Hoelscher DM, Barlow SE, et al. Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT. Obesity. 2017 Sep;25(9):1584-1593. 

Daniels SR, Hassink SG; COMMITTEE ON NUTRITION. The Role of the Pediatrician in Primary Prevention of Obesity. Pediatrics. 2015 Jul;136(1):e275-92. 

Pont SJ, Puhl R, Cook SR, Slusser W; SECTION ON OBESITY; OBESITY SOCIETY. Stigma Experienced by Children and Adolescents With Obesity. Pediatrics. 2017 Dec;140(6). 

Dietz, W. H., B. Belay, D. Bradley, et al. A model framework that integrates community and clinical systems for the prevention and management of obesity and other chronic diseases. 2017. National Academy of Medicine. Viewed 3/12/2018 at 
https://nam.edu/wp-content/uploads/2017/01/A-Model-Framework-That-Integrates-Community-and-Clinical-Systems-for-the-Prevention-and-Management-of-Obesity-and-Other-Chronic-Diseases.pdf 

Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation: Recommendations. MAY 2012. National Academy of Medicine. Viewed 3/12/2018  at http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2012/APOP/APOP_insert.pdf 

Committee on Accelerating Progress in Obesity Prevention. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation: Report Brief. May 2012. National Academy of Medicine. Viewed 3/12/2018 at http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2012/APOP/APOP_rb.pdf

Margaret Lamar and Cathy Jordan. Building a National Movement for Green Schoolyards in Every Community. 2016. Children & Nature Network. Viewed 3/12/2018 at https://www.childrenandnature.org/wp-content/uploads/2015/03/CNN_GSY_Report2016_Final.pdf 

Laura E. Robinson,
DVM, MS
Assistant State Public Health Veterinarian, Zoonosis Control Branch, DSHS

Pamela J. Wilson,
MEd, LVT, MCHES
Zoonosis Control Program Specialist, Zoonosis Control Branch, DSHS

Things You May Not Know About Rabies, but Should!

Presenters:
Laura E. Robinson, DVM, MS
Assistant State Public Health Veterinarian, Zoonosis Control Branch, DSHS

Pamela J. Wilson, MEd, LVT, MCHES
Zoonosis Control Program Specialist, Zoonosis Control Branch, DSHS

Description: 
Rabies is a viral zoonosis that affects the central nervous system (CNS) of warm-blooded animals. Although it is a disease recognized since antiquity, many factors pertaining to rabies remain elusive and misunderstood. Even given all the advancements in the medical field throughout history, rabies remains almost universally fatal once clinical signs and symptoms develop. There is an effective postexposure prophylaxis (PEP) if given before the virus enters the CNS, which illuminates the importance of being aware of the existence of this disease, how it can be transmitted, the nature of its incubation period, and when to administer PEP. Rabies should also be considered as a differential diagnosis as its clinical signs and symptoms mimic those of other diseases involving the CNS.  

This presentation will cover the fundamentals of rabies, including potential routes of exposure, clinical signs and symptoms, incubation periods epidemiology, and modes of prevention. It will also clarify common misunderstandings and dispel some of the myths associated with rabies. Thought-provoking rabies exposure and prevention scenarios will be detailed.

Learning Objective:

• Describe the potential routes of exposure, clinical signs and symptoms, incubation period, epidemiology, and modes of prevention pertaining to rabies.
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• Doctors of Veterinary Medicine
• Licensed Veterinary Technicians
• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health 
• Registered Sanitarians
• Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources:
www.TexasRabies.org

Rabies Prevention in Texas (.pdf)

Birhane MG, Cleaton JM, Monroe BP, et al. Rabies surveillance in the United States during 2015. J Am Vet Med Assoc. 2017 May 15;250(10):1117-1130. 

Davis BM, Rall GF, Schnell MJ. Everything you always wanted to know about rabies virus (but were afraid to ask). Annu Rev Virol. 2015 Nov;2(1):451-71.

Fooks AR, Banyard AC, Horton DL, et al. Current status of rabies and prospects for elimination. Lancet. 2014 Oct 11;384(9951):1389-99.

Mayes BC, Wilson PJ, Oertli EH, Hunt PR, Rohde RE. Epidemiology of rabies in bats in Texas (2001-2010). J Am Vet Med Assoc. 2013 Oct 15;243(8):1129-37.

Webber BJ, Ayers KJ, Winterton BS, et al. Assessment of rabies exposure risk in a group of U.S. Air Force basic trainees - Texas, January 2014. MMWR Morb Mortal Wkly Rep. 2014 Aug 29;63(34):749-52.

Willoughby RE Jr. Rabies: rare human infection - common questions. Infect Dis Clin North Am. 2015 Dec;29(4):637-50.

Paul McGaha, DO, MPH
Chair, Department of Community Health,
School of Community and Rural Health
and Director of the Northeast Texas Center for Rural Community Health, University of Texas Health Science Center in Tyler

Kate Philley Starnes, JD, MEd
Program Director, Northeast Texas Center for Rural Community Health, University of Texas Health Science Center at Tyler

S. Kim Bush, MPA, CHW, CHW-I
Program Manager, CHW Training and Patient Navigator projects, University of Texas Health Science Center at Tyler

Abygayl Alvarez, CHW
Community Health Worker, Hypertension Project, Center of Rural Community Health, University of Texas
Health Science Center at Tyler

Utilizing Community Health Workers to Combat Hypertension in Northeast Texas

Presenters:
Paul McGaha, DO, MPH
Chair, Department of Community Health, School of Community and Rural Health and Director of the Northeast Texas Center for Rural Community Health, University of Texas Health Science Center in Tyler

Kate Philley Starnes, JD, MEd
Program Director, Northeast Texas Center for Rural Community Health, University of Texas Health Science Center at Tyler

S. Kim Bush, MPA, CHW, CHW-I
Program Manager, CHW Training and Patient Navigator projects, University of Texas Health Science Center at Tyler

Abygayl Alvarez, CHW
Community Health Worker, Hypertension Project, Center of Rural Community Health, University of Texas Health Science Center at Tyler

Description: 
Uncontrolled hypertension continues to plague the Northeast Texas region.  In March 2017, University of Texas Health Science Center at Tyler (UTHSCT) developed and implemented a hypertension program utilizing a Community Health Worker to offer a specialized program for hypertension self-management.  The program provides forty patients with blood pressure monitors and enrolls these patients in a 12 -week educational program.  This presentation provides an overview of hypertension prevalence in Northeast Texas, defines the CHW role in managing chronic disease, describes the UTHSCT hypertension program and showcases program success stories from the CHW perspective.  

Learning Objectives:

• Describe the severity of hypertension and its prevalence in the Northeast Texas.
• Discuss the important role of a Community Health Worker (CHW) as an extension of the clinical practice
• Examine a hypertension program utilizing a CHW to provide education in chronic disease self-management
• Analyze a case study of a CHW hypertension program focused on blood pressure self-monitoring.
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health
• Registered Dietitians
• Registered Sanitarian
• Social Workers
  

Certified Community Health Worker (DSHS-certified CEUs) will be offered. 

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources: 
Institute of Medicine. (2010). A population-based policy and systems change approach to prevent and control hypertension. Washington, DC: National Academy of Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK220091/#ddd00096

Brownstein, J.N., Hirsch, G.R., Rosenthal, E.L., & Rush, C.H. (2011). Community health workers “101” for primary care providers and other stakeholders in health care systems. Journal of Ambulatory Care Management, 34(3), 210-220. doi: 10.1097/JAC.0b013e31821c645d

Fernandes, R., Braun, K.L., spinner, J.R., Sturdevant, C., Ancheta, S.J., Yoshimura, S.R., Compton, M., Wang, J.H., & Lee, C.J. (2012). Healthy heart, healthy family: A NHLBI/HRSA collaborative employing community health workers to improve heart health. Journal of Health Care for the Poor and Underserved, 23(3), 988-999. doi: 10.1353.hpu.2012.0097

Kangovi, S., Mitra, N., Grande, D., Huo, H., Smith, R.A., & Long, J. (2017). Community health worker support for disadvantaged patients with multiple chronic diseases: A randomized clinical trial. American Journal of Public Health, 107(10), 1660-1667. doi: 10.2105/AJPH.2017.303985

Bennett, H.D., Coleman, E.A. Parry, C, Bodenheimer, T., & Chen, E.H., (2010, Sept-Oct). Health Coaching for Patients. Retrieved from https://www.aafp.org/fpm/2010/0900/p24.html

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017

Fang J, Gillespie C, Ayala C, Loustalot F. Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use Among Adults Aged ≥18 Years — United States, 2011–2015. MMWR Morb Mortal Wkly Rep 2018;67:219–224. DOI: http://dx.doi.org/10.15585/mmwr.mm6707a4

Garcia MC, Faul M, Massetti G, et al. Reducing Potentially Excess Deaths from the. MMWR Surveill Summ 2017;66(No. SS-2):1–7. DOI: http://dx.doi.org/10.15585/mmwr.ss6602a1

Brad Fitzwater, MD
Medical Director, Substance Use Disorders Unit, Texas Health and Human Services Commission (HHSC)

Katie Sherman
Opioid Treatment Expert, Texas Targeted Opioid Response, HHSC

Evidence-based Approaches to Treating Opioid Use Disorders

Presenters:
Brad Fitzwater, MD
Medical Director, Substance Use Disorders Unit, Texas Health and Human Services Commission (HHSC)

Katie Sherman
Opioid Treatment Expert, Texas Targeted Opioid Response, HHSC

Description:
This presentation will focus primarily on the use of medications in the treatment of opioid use disorders. This will include a historical overview, rationale for medication use, the role of behavioral therapy and details on each of the FDA approved medications. Time permitting, there will also be a very brief overview of neurobiology of addiction and diagnostic criteria for opioid use disorders.  

Learning Objectives:

• Describe the rationale for medication use in the treatment of opioid use disorder
• Discuss the FDA-approved medications for treatment of opioid use disorder
• Examine the mechanism of action, benefits and risks associated with each of these medications.
• Examine substance use disorders as chronic diseases.
• Describe the diagnostic criteria for substance use disorder.
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health 
• Licensed Chemical Dependency Counselors
• Licensed Marriage and Family Therapists
• Licensed Professional Counselors
• Licensed Psychologists
• Registered Sanitarians
• Social Workers
  

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources: Coming Soon

Barbara Seaworth, MD, FISDA, FACP
Medical Director, Heartland National Tuberculosis Center and Consultant, Texas Center for Infectious Disease, DSHS

Tuberculosis - The Challenges to Outsmarting this Disease

Presenter:
Barbara Seaworth, MD, FISDA, FACP
Medical Director, Heartland National Tuberculosis Center and Consultant, Texas Center for Infectious Disease, DSHS

Description: Coming Soon

Learning Objectives:

• Discuss the epidemiology of the disease in Texas and the U.S and the impact of global TB epidemic. 
• Review recent changes in the methods diagnosis and medical management of TB infection and disease
• Identify strategies to stop the transmission of TB in our communities.
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health
  
• Registered Sanitarians
• Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources: 
Lessem E, Cox H, Daniels C, et al. Access to new medications for the treatment of drug-resistant tuberculosis: patient, provider and community perspectives. Int J Infect Dis. 2015 Mar;32:56-60.

Marks SM, Flood J, Seaworth B, et al. Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005-2007. Emerg Infect Dis. 2014 May;20(5):812-21.

Marks SM, Hirsch-Moverman Y, Salcedo K, et al. Characteristics and costs of multidrug-resistant tuberculosis in-patient care in the United States, 2005-2007. Int J Tuberc Lung Dis. 2016 Apr;20(4):435-41.

Moonan PK, Teeter LD, Salcedo K, et al. Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study. Lancet Infect Dis. 2013 Sep;13(9):777-84.

Seaworth BJ, Armitige LY, Aronson NE, et al. Multidrug-resistant tuberculosis. Recommendations for reducing risk during travel for healthcare and humanitarian work. Ann Am Thorac Soc. 2014 Mar;11(3):286-95.

Why the Death Certificate Really is a Vital Statistic - Part 1

Presenter:
D. Kimberley Molina, MD
Deputy Chief Medical Examiner and Fellowship Program Director, Bexar County Medical Examiner's Office

Description: 
Death certificates serve dual purposes. They are legal documents as well as public health instruments that underlie vital statistics. Death certificate data describe the health of a community, identify priority public health needs, allocate resources, and evaluate interventions. Incomplete, inaccurate, or nonspecific reporting can lead to under- or over-counting of causes of deaths, which can incorrectly affect interventions, policy, and funding.

Learning Objectives:

• Explain the importance of death certificates and of accuracy in reporting cause of death
• Describe how to complete the cause of death section on the death certificate
  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live event only):

• AMA PRA Category 1 Credits^TM
• Continuing Nursing Education
• Certified Health Education Specialists & Master-Certified Health Education Specialists
• Certified in Public Health
  
• Registered Sanitarians
• Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources: 
NCHS and state COD Resources (.pdf)

Brooks EG, Reed KD. Principles and Pitfalls: A Guide to Death Certification. Clin Med Res. 2015 Jun;13(2):74-82; quiz 83-4. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/26185270

Ong P, Gambatese M, Begier E, Zimmerman R, Soto A, Madsen A. Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital deaths, New York City, 2008-2010. Prev Chronic Dis. 2015 Jan 15;12:E04. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/25590598

Howland RE, Madsen AM, Nicaj L, Noe RS, Casey-Lockyer M, Begier E. Assessing electronic death registration and American Red Cross systems for mortality surveillance during Hurricane Sandy, October 29-November 10, 2012, New York City. Disaster Med Public Health Prep. 2014 Dec;8(6):489-91. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/25859690

Korin L, Das T, Madsen A, Soto A, Begier E. Test of an electronic program to query clinicians about nonspecific causes reported for pneumonia deaths, New York City, 2012. Prev Chronic Dis. 2014 Nov 26;11:E210. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/25427318

Randall B. Death certification: a primer. Part I--an introduction to the death certificate. S D Med. 2014 May;67(5):196-7, 199. 

Randall B. Death certification: a primer. Part II--The cause of death statement. S D Med. 2014 Jun;67(6):231-3, 235. 

Randall B. Death certification: a primer part III--certainty and the unknown cause of death. S D Med. 2014 Jul;67(7):269, 271. 

Randall B. Death certification: a primer, Part IV--problems in death certification. S D Med. 2014 Aug;67(8):315-7, 319. 

Govindan S, Shapiro L, Langa KM, Iwashyna TJ. Death certificates underestimate infections as proximal causes of death in the U.S. PLoS One. 2014 May 30;9(5):e97714. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/24878897

Castle IJ, Yi HY, Hingson RW, White AM. State variation in underreporting of alcohol involvement on death certificates: motor vehicle traffic crash fatalities as an example. J Stud Alcohol Drugs. 2014 Mar;75(2):299-312. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/24650824

Bedford RL, Lourens SG, Lynch CF, Smith BJ, Field RW. Utility of death certificate data in predicting cancer incidence. Am J Ind Med. 2014 Feb;57(2):153-62. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/24037961

Bancroft EA, Lee S. Use of electronic death certificates for influenza death surveillance. Emerg Infect Dis. 2014 Jan;20(1):78-82. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/24377489

Romero JP, Benito-León J, Louis ED, Bermejo-Pareja F. Under reporting of dementia deaths on death certificates: a systematic review of population-based cohort studies. J Alzheimers Dis. 2014;41(1):213-21. 

Madsen A, Begier E. Improving quality of cause-of-death reporting in New York City. Prev Chronic Dis. 2013 Jul 18;10:E118. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/23866162

Wexelman BA, Eden E, Rose KM. Survey of New York City resident physicians on cause-of-death reporting, 2010. Prev Chronic Dis. 2013 May 9;10:E76. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/23660118

Johnson CJ, Hahn CG, Fink AK, German RR. Variability in cancer death certificate accuracy by characteristics of death certifiers. Am J Forensic Med Pathol. 2012 Jun;33(2):137-42. 

Madsen A, Thihalolipavan S, Maduro G, Zimmerman R, Koppaka R, Li W, Foster V, Begier E. An intervention to improve cause-of-death reporting in New York City hospitals, 2009-2010. Prev Chronic Dis. 2012;9:E157. Free full text available at https://www.ncbi.nlm.nih.gov/pubmed/23078668