Public Health

Working Together for Better Public Health

Q&A with Dr. Raul Pino, commissioner of the Connecticut Department of Public Health and a UConn Health board member

Q

What are some of the major public health issues facing Connecticut?

There are many public health issues facing both Connecticut and the nation as a whole. At the Department of Public Health, our emphasis is on the Centers for Disease Control and Prevention’s 6|18 initiative, which targets six major health conditions — asthma, high blood pressure, tobacco use, hospital-acquired infections, teen pregnancy, and diabetes — with 18 evidence-based public health interventions.

Each of these conditions is common, preventable, and costly, but importantly, all have proven interventions that can be effectively employed across the health care spectrum to improve both individual and community health, saving lives and dollars. Other areas where I believe we can see good results in Connecticut by employing evidence-based interventions include addressing HIV and the rising number of syphilis cases.


Q

How can physicians assist the DPH daily to address and reduce these issues?

Doctors, particularly primary care physicians, are the main point of contact with the public for health education. We need to engage practitioners in addressing the six major health conditions with their patients — screening for the conditions; educating in advance to enhance prevention of disease; and providing effective, evidence-based treatments when needed. Physicians play a critical role on the front lines of health care to shift our focus from treatment to prevention through lifestyle changes and other healthy choices. They are an indispensable part of the continuum of care between DPH, health care practitioners, and public health.


Q

As DPH commissioner, what drives your daily public health passion and mission?

I am convinced that we — as a nation, a state, and as public health professionals — can do more than we are currently doing to impact public and population health. Addressing the health disparities that continue to plague our population, costing millions of lives and countless health care dollars, is what drives me. We are so fortunate to live in one of the richest countries, and states, in the world, yet we spend so little on public health. My mission is to spread the message that modest investments of money, time, and effort in proven education and prevention methods can lessen these disparities, which will save millions of dollars in health care costs and, more importantly, save lives.


Q

Tell us about your connection to UConn Health and what you hope to accomplish as a member of the board of directors.

I am a 2009 graduate of the UConn Master of Public Health program and receive my own health care at UConn Health. Spending time there for my education and health care has really crystallized for me that UConn Health is the epicenter of clinical care and education in Connecticut. UConn Health is where advances in science and medicine happen, which allows patients to get the best in cutting-edge care. As a member of the board of directors, I am looking to learn and understand better the role that this large institution plays in public health work. I hope my passion for public health and the elimination of health disparities will allow me to give a voice to the importance of integrating education, prevention, public health, and clinical care in order to strengthen our health care system, curb rising health care costs, and foster healthy communities and individuals.

The Healing Power of Fat

digital rendering of inside throat


Fat cells are increasingly being used in cosmetic and reconstructive plastic surgery, and now UConn Health has restored one patient’s lost voice by leveraging the power of fat.

In 2013, Ed Favolise, 70, a retired superintendent of schools in Connecticut, had surgery to remove a precancerous tumor from his chest. Part of the tumor encased a nerve that was severed during surgery, leaving his right vocal cord paralyzed and a major gap between his vocal cords.

For three years, Favolise’s voice was limited to a squeaky, high-pitched whisper while he pursued remedies at three different medical centers. After five surgeries and continuous vocal therapy, Favolise turned to the Voice Center at UConn Health.
Dr. Denis Lafreniere, chief of the Division of Otolaryngology, teamed up with Dr. Andrew Chen, chief of the Division of Plastic Surgery, to offer an innovative solution.

In the operating room, Lafreniere and Chen withdrew fat cells from Favolise’s abdomen, processed and measured them to make sure they had enough pure fat cells, and placed them directly into his injured vocal cord via a needle injector through a laryngoscope. The result? A permanently plumped vocal cord that’s in the proper position to contact the left vocal cord.

“My speech improved immediately and significantly,” says Favolise. “My experience shows that sometimes you need to be willing to take a chance on a pretty surprising, promising alternative medical solution and procedure.”

Connecticut’s Effective Formula for Cystic Fibrosis Screening

small child held in the arms of mother while doctor (in background) consults


While all states require newborns to be screened for cystic fibrosis, Connecticut does it differently than most.

A unique collaboration — in which UConn Health screens the newborns, Connecticut Children’s Medical Center provides timely clinical intervention, and University of Florida Health (UF Health) offers genetic counseling via telemedicine — leads to early diagnosis and treatment, which can add years to patients’ lives.

Cystic fibrosis (CF) is a progressive genetic disease. A thick mucus buildup forms in the lungs, making patients prone to infections, lung damage, and respiratory failure. The pancreas doesn’t release enzymes, inhibiting the body’s ability to digest food and absorb nutrients.

If UConn Health screenings within days of birth show a CF gene mutation, a sweat test — considered the most reliable way to diagnose CF — is recommended to determine whether the baby is a carrier or has the disease.

And it’s at this stage when the process becomes unique.

On the same visit as the sweat test, parents have a no-cost, private, video consultation with a UF Health genetic counselor, made possible by a grant from the Cystic Fibrosis Foundation, to help them understand the implications of
the mutations.

Three other clinical sites in the U.S. partner with UF Health. UConn Health screens 7 of 10 infants born in the state, accounting for more than half the screenings done under the UF Health partnerships.

Though it wasn’t mandated by state law until 2009, UConn Health has screened newborns for CF since 1993. The collaboration with UF started in 2014.

“With the addition of the genetic counseling piece, our program has significantly decreased the time to sweat test and ultimately CF diagnosis,” says Dr. Melanie Sue Collins, associate director of the Central Connecticut Cystic Fibrosis Center at Connecticut Children’s.

The approach is well received by parents, says Sidney Hopfer, UConn professor in the Department of Pathology and Laboratory Medicine.

“We have all the pieces: the tests are easily obtainable; the patients don’t have to travel far; there is coordination between the lab, CF Center, and primary care physician regarding testing and genetic counseling,” Hopfer says. “In my opinion, this is something that should be done nationally.”

America’s Opioid Epidemic: What Doctors Need to Know

Q&A with Dr. Surita Rao, UConn Health assistant professor of psychiatry

Q

Can you characterize the U.S. opioid epidemic?

Our country’s opioid epidemic has been going on for several years. The U.S. is the biggest global consumer of prescription opioids. In 1997, 76 million prescriptions were written, more than doubling by 2013 to 207 million. Americans consume nearly 100 percent of the world’s hydrocodone (Vicodin) and 81 percent of its oxycodone. The majority of those physically addicted or overdosing are getting opioid prescriptions from their doctors’ offices.


Q

What are the dangers of opioids?

These strong pain pills are very physically addictive and it’s often hard for patients to live without them, even after their pain subsides. The biggest dangers of opioids are overdose and death. After doctors stop prescribing them, some patients turn to the street to illegally get their pills, while some may even switch to heroin. When mixed with heroin, anxiety medications, or alcohol, opioids are even more likely to lead to overdose.


Q

What do the new Centers for Disease Control and Prevention guidelines call for?

In March the CDC called on primary care doctors to more carefully assess each individual patient’s risk of taking an opioid and to take extreme caution when prescribing it for longer than seven days for acute pain, unless for terminal cancer or palliative care. The lowest-effective dose of non-slow-release pain pills should always be used, and patient use needs to be continuously reevaluated. Guidelines stress the critical need for increased education and communication about opioid risks including constipation, drowsiness, stopping breathing, drug and alcohol interaction, addiction, overdose, and death.


Q

What should medical providers keep top-of-mind?

For patients, physicians should always consider first NSAIDS (such as acetaminophen and ibuprofen), routine exercise, physical therapy, hot and cold compresses, and possibly steroidal injections. If opioids are necessary, beware that long-term opioid use can lead to physical dependence and intense withdrawal. Patients should be slowly weaned off. Patients who have developed an addiction to opioids that goes beyond a physical dependence will need to undergo medical detox, or take agonist maintenance medication to curb their brain-receptor cravings. Psychotherapy specifically targeted for substance abuse disorders, including individual counseling and group therapy, is always needed for successful recovery from an addictive illness. Patients should be encouraged to proactively lower their daily pain risk factors, not abuse or share opioids, and seek medical attention if they start to experience withdrawal symptoms or addiction.

Summer Breaks Help Prevent Burnout, Especially Among Physicians

Young man jumps into a body of pristine water on a summer day


It’s summertime, and you need a break! The U.S. has a culture of working too hard, and physicians are some of the worst offenders. Don’t let Labor Day pass without spending at least one afternoon at the beach.

We can joke about it, but there’s rising concern about burnout and depression among physicians. One recent study of 7,000 residents found that 50 percent showed depressive symptoms and 8.1 percent reported suicidal thoughts over a 12-month period.

“Physicians are given enormous workloads, make near-impossible life-and-death decisions regularly, and are expected to be alert and ready to go constantly. It’s unsustainable,” says Dr. Adam Perrin, a professor of family medicine and director of student wellness at UConn Health. “To enjoy life, you need balance and a break.”

Working too much can lead to burnout, or at the very least, a lack of enthusiasm. And that can be bad news not only for doctors, but for patients.

Taking care of yourself is taking care of your patients, too — even when the worst happens.

Studies show that depression and burnout make doctors significantly less likely to read about the next day’s cases, and up to five times more likely to make errors when prescribing medication.

Many doctors work too much because they don’t want to ‘abandon’ their patients. But taking care of yourself is taking care of your patients, too – even when the worst happens. Telling a dying patient that you have a vacation coming up, you regret the timing, and you wanted to tell them how much you care before you leave is very respectful, and patients are usually understanding,
Perrin says.

And while vacations are essential, your recovery and rest shouldn’t center on them. Rest and self-reflection should be a regular pursuit. For example, Perrin sings in a community choir.

“I’ve made many friends, we sing gorgeous music, and it fills the soul,” Perrin says. However you choose to take a break this summer, we hope it does the same for you.

When Getting Your Flu Shot, Timing is Everything

Elderly patient being tended to by a nurse


Pharmacies advertising flu vaccinations in August and September are doing their elderly clients a disservice, say UConn Center on Aging researchers. The immunity they gain from vaccine in late summer may wane by the time flu season hits hard in late winter.

As summer temperatures peaked this August, pharmacies were already advertising the influenza vaccine. But if you thought that was too early to be getting a flu shot — you were right.

If you’re interested in volunteering for the study, contact Lisa Kenyon at the UConn Center on Aging at 860.679.3956.

“When adults get the vaccine in September, the peak effect wears off by late December. But flu season peaks in January and February,” warns Laura Haynes, an immunologist and gerontologist at UConn Health.

October or November is a much better time to get the vaccine. That way, you’re still protected when virus season is at its worst.

This is especially important for the elderly, who are at particular risk from flu. People over 65 are much more likely than younger adults to have serious complications or even die from a bout with the virus.

One way to better stimulate the immune response is to administer a high-dose vaccine, which contains four times as much flu antigen as the regular version. But the high-dose vaccine has stronger side effects, is more expensive, and may not be best for everyone.

Haynes and her colleagues at UConn Health, funded by a Program Project Grant from the National Institute on Aging, will run two studies this autumn to better understand older people’s responses to the regular flu vaccine and the high-dose version. The studies will look at how the immune system reacts to the flu vaccine, as well as how to identify patients who would benefit from the high-dose version.