news, awards, grants and other UMDNJ happenings in brief
Young Women and Heart Attacks
A study by researchers at Robert Wood Johnson Medical School (RWJMS) shows that women ages 35 to 54 are more likely to die in hospitals following heart attacks than men of a similar age. This finding, from a sample of more than 423,000 patients, may be surprising since women, on average, develop their first acute myocardial infarction — or heart attack — about 10 years later than men, and are overall less likely to develop myocardial infarction than are men. The study was published in the July 2010 issue of the American Journal of Cardiology.
Led by John B. Kostis, MD, the John G. Detwiler Chair of Cardiology and chair of the Department of Medicine at RWJMS, the research team examined a statewide New Jersey database known as Myocardial Infarction Data Acquisition System (MIDAS) that tracks myocardial infarction hospitalizations and coronary heart disease deaths from 1990 to 2004. The team looked at data in four age groups: 35 to 54, 55 to 64, 65 to 74 and greater than age 75.
“During the 15-year period of study, fewer women ages 35 to 54 were hospitalized with myocardial infarction than men, however a greater percentage of them died,” says Kostis. The marked difference of in-hospital deaths of young women compared with young men could be attributed most directly to the fact that a greater percentage of young men died out-of-the-hospital from coronary heart disease, he says.
However, the study also indicated that gender-related differences in treatment appeared to play a role in in-hospital deaths of young women versus young men, and that these differences narrowed with each increasing age group. Young women were less likely to undergo invasive cardiovascular procedures.
New Degree Programs
Two new advanced degree programs designed for college graduates who want to strengthen their training and education in biomedical science have been announced by the Graduate School of Biomedical Sciences (GSBS) at RWJMS. The Master of Biomedical Sciences (MBS) and Master of Science in Biomedical Sciences (MSBS) admitted students in September 2010, providing interdisciplinary training for those wishing to pursue a career in medicine, research or biotechnology.
The MBS degree can be completed in as little as one year. The MSBS degree requires a laboratory-based research thesis at the culmination of the program, which may take two to three years. Students may enter the program on either a full- or part-time basis.
Phthalates in Plastics Linked to Inflammation in Infants
Researchers at Robert Wood Johnson Medical School (RWJMS) have identified a direct link between phthalates, the substances that make plastics more pliable and durable, and inflammation in premature infants – and are encouraging more limited use of the plasticizers. The exposure of these infants to phthalates is particularly high since many tubes and catheters are used in their care, and this high exposure may contribute to the development of serious inflammatory diseases.
“Many of the diseases unique to premature babies, including bronchopulmonary dysplasia, a chronic lung disorder, and necrotizing enterocolitis, an intestinal ailment, are triggered by, or associated with, excessive inflammation,” explains Anna Vetrano, PhD, adjunct assistant professor in the RWJMS Department of Pediatrics and a GSBS alum. The team’s paper, entitled “Inflammatory Effects of Phthalates in Neonatal Neutrophils,” was published in Pediatric Research, August 2010.
Funding for Start-Up to Develop Alzheimer’s Blood Test
Robert Nagele, PhD, founder of Durin Technologies and a professor of medicine at the New Jersey Institute for Successful Aging at the School of Osteopathic Medicine (SOM), received a $175,000 commitment from Foundation Venture Capital Group, LLC. The funds will be used to advance research toward developing a blood test that measures the likelihood that an individual will develop Alzheimer’s disease.
“The main thrust of our test is to detect the risk for Alzheimer’s disease — in much the same way physicians now check cholesterol levels — so that appropriate steps and treatments can be taken before significant loss of function takes hold,” Nagele explains. “My research centers on the role of autoantibodies and amyloid beta peptides in the degenerative mechanism of Alzheimer’s. Once these substances leak into brain tissue, they selectively bind to neurons in the brain that are most affected by Alzheimer’s — especially neurons that are critical to memory and higher thinking.”
Nagele’s research shows that these autoantibodies and amyloid beta peptides are abundant in the blood of healthy individuals but can cross the blood-brain barrier through defects caused by degenerative conditions common to vascular systems of older individuals. The new test being developed by Durin Technologies will attempt to identify and measure the amount of each brain-reactive autoantibody in an individual’s blood, providing important information about the risk of developing Alzheimer’s as well as the expected rate of progression in those already afflicted with this disease.
Expert on Aging Becomes Editor
Rachel Pruchno, PhD, professor of medicine and director of research at the New Jersey Institute for Successful Aging (NJISA) at the School of Osteopathic Medicine (SOM), has been selected by The Gerontological Society of America (GSA) as the next editor of The Gerontologist. GSA is the country’s largest interdisciplinary organization devoted to the field of aging. The Gerontologist, published by Oxford Journals, features peer-reviewed articles that provide a multidisciplinary perspective on human aging through research and analysis in gerontology, including social policy, program development and service delivery.
Pruchno earned her PhD in Human Development and Family Studies from Pennsylvania State University and has been the principal investigator on NIH-funded grants totaling close to $7 million and foundation grants of more than $3 million. She joined the faculty of the medical school in 2004 and is the first University Professor and Endowed Professor of Gerontology in the school’s history.
She has published more than 60 peer-reviewed articles and 10 book chapters; and is co-editor of the book, Challenges of an Aging Society: Ethical Dilemmas, Political Issues. Pruchno has been actively involved on the institutional review boards of UMDNJ and Boston College. She served on the editorial boards of the International Journal of Aging & Human Development and the Journal of Gerontology: Psychological Sciences.
Research Looks at Malaria Drugs to Treat Colorectal Cancer
Researchers at The Cancer Institute of New Jersey (CINJ) are looking at a drug, commonly used to treat malaria and certain types of arthritis, to help patients with advanced stages of colorectal cancer. Research indicates that hydroxychloroquine may prevent cancer cells from becoming resistant to chemotherapy or other drugs that prevent the growth of cancer blood vessels.
According to the American Cancer Society, nearly 147,000 new cases of colorectal cancer were diagnosed in the U.S. last year with 4,600 new cases in NJ. With a five-year survival rate of 68 percent for disease that has metastasized to nearby organs, this type of cancer has only an 11 percent, five-year survival rate for disease that has spread beyond nearby organs. It is the advanced state of disease that investigators are targeting in this study.
The standard treatment for colorectal cancer that has spread beyond where surgery can cure it is chemotherapy. The current standard of chemotherapy, which includes a drug (bevacizumab) that prevents the growth of cancer blood vessels, shrinks the cancer in fewer than half of the patients treated, and usually this shrinkage is only temporary.
Rebecca Moss, MD, medical oncologist at CINJ and assistant professor of medicine at RWJMS, is the lead researcher on the study, which will look at adding hydroxychloroquine to the standard treatment. Research in the laboratories of CINJ associate director for basic science Eileen White, PhD, adjunct professor of surgery at RWJMS, and CINJ medical oncologist Vassiliki Karantza, MD, PhD, assistant professor of medicine at RWJMS, indicates drugs such as hydroxychloroquine may prevent cancer cells from becoming resistant to chemotherapy or drugs that prevent the growth of cancer blood vessels.
Low-Risk Prostate Cancer Often Treated Aggressively
There has been long-standing controversy over the benefit of the prostate specific antigen (PSA) test used to screen for the presence of prostate cancer. New research published in the latest edition of the Archives of Internal Medicine by a Cancer Institute of New Jersey (CINJ) team explores the therapy choices of patients whose PSA level was at or below what is considered “normal.” The findings show that most men with prostate cancer who tested below the normal PSA level and had low-risk disease nevertheless underwent aggressive treatment.
It has been suggested that the PSA level for concern be reduced to 2.5 ng/mL. A 2005 study in the Journal of the National Cancer Institute indicates that threshold reduction would double the amount of abnormal PSA results to approximately six million. That, says senior author Grace Lu-Yao, PhD, MPH, cancer epidemiologist at CINJ and a faculty member at RWJMS and SPH, could result in even more men receiving unnecessary treatment. “Because the inability still exists to determine whether prostate cancers are slow growing or aggressive, lowering the PSA threshold might increase the risk of over-diagnosis, which could lead to treatment that holds no benefit for the patient or could have adverse side effects,” she notes.
“It is clear from our current study that men are choosing aggressive forms of treatment when they may not need to. This is especially concerning for older men, as previous studies done by our team show excellent disease-specific survival for men with low-risk cancer following conservative management,” says Lu-Yao.
Raising Dental IQs
The mouth speaks volumes about a person’s health without a word ever being spoken. Hundreds of diseases — HIV/AIDS, leukemia and diabetes, for example — produce telltale signs in the oral cavity, sometimes before a person feels ill. And many disorders of the mouth, such as periodontal disease, can impact the entire body. Dental students learn to recognize these signs, but medical students often do not.
“Recent research, however, has shown a link. We know periodontal disease in mothers is associated with low birth weights and preterm deliveries, for example, and oral sepsis is associated with cardiovascular disease. There are many conditions linked this way,” says Arnold Rosenheck, DMD, associate professor of oral and maxillofacial surgery and assistant dean at New Jersey Dental School (NJDS).
To increase future physicians’ awareness, dental school faculty members are teaching students at two UMDNJ medical schools how to do comprehensive oral exams and recognize oral symptoms of disease. NJDS is one of only a handful of dental schools in the country to do so.
At Robert Wood Johnson Medical School (RWJMS) in Piscataway, third-year students learn to do a comprehensive oral examination as part of the Patient Centered Medicine course. Second-year RWJMS students learn the oral manifestations of diseases — with emphasis on oral cancer — during the Pathology Lecture Series.
At the School of Osteopathic Medicine (SOM) in Stratford, second-year students study the oral cavity as part of a lecture and workshop in physical diagnosis. Students also learn to identify and diagnose pre-malignant lesions and squamous cell carcinoma in the early stages during a module on prevention. Third-year students take Orientation Enrichment, which consists of case-based, interactive discussions. Students are asked to analyze cases and discuss the differential diagnoses, etiology and pathogenesis.
Geriatric Fellows at SOM take a course on oral health covering a variety of topics that include financial considerations of oral health care for older patients (Medicare generally does not cover dental care), the dentist’s role as part of multidisciplinary teams, and systemic/oral health connections.
“It’s crucial that physicians have the skills and knowledge to do comprehensive assessments of patients, from the top of their heads to the soles of their feet, including the oral cavity,” states Rosenheck.
Quicker, More Accurate Test for TB
An experimental sputum test for tuberculosis, which appears to be more than 97 percent accurate, can diagnose the disease in less than two hours. The “Xpert MTB/RIF” identifies Mycobacterium tuberculosis as well as resistance to rifampin (RIF), an antibiotic commonly used to treat TB. The study results were published in the September 2 issue the New England Journal of Medicine.
Early detection of tuberculosis is crucial to prevent transmission and cut the death rate. The World Health Organization estimates that one third of the world’s population is infected with Mycobacterium tuberculosis; 8 million people develop active TB each year and almost 2 million die of the disease. Most people who are infected with Mycobacterium tuberculosis do not have symptoms, but some will develop the disease.
Individuals from Lima, Peru; Baku, Azerbaijan; Cape Town and Durban, South Africa; and Mumbai, India participated in the study. Each of the 1,730 individuals, suspected of having drug-sensitive or multidrug resistant pulmonary TB, provided three sputum specimens. The sputum samples were assessed with the Xpert MTB/RIF test, and these results were compared to conventional tests including sputum microscopy and bacterial culture. Researchers found that the Xpert MTB/RIF test diagnosed TB in less than two hours in 99.2 percent of the patients. Importantly, a single Xpert MTB/RIF test detected TB in 72.5 percent of individuals with TB who did not appear to have TB on conventional microscopic examination, but who were later found to have positive TB cultures.
TB cultures can take as long as six weeks to become positive, which can lead to long delays in starting treatment. The addition of a second and third Xpert MTB/RIF test permitted TB to be detected in 90.2 percent of sputum microscopy-negative individuals. The new test also detected the presence of rifampin-resistance in 97.6 percent of individuals who were later found to be rifampin-resistant on TB culture. Rifampin-resistance is a good predictor of infection with multi drug-resistant TB, which requires different treatment compared to drug-susceptible TB.
“The test that we developed finally makes it possible to detect TB in a single clinic visit,” says David Alland, MD, chief of infectious diseases at New Jersey Medical School (NJMS) and one of the study’s co-authors. “The test also indicates rapidly whether difficult-to-treat, drug-resistant forms are present. This is a major advance over other rapid TB detection methods which are complex, labor-intensive, and technically challenging. The Xpert MTB/RIF test is also much simpler than sputum microscopy and is days to weeks faster than bacterial culture.”
The test was developed as a result of a public-private partnership between scientists at NJMS, Cepheid and the Foundation for Innovative New Diagnostics (FIND). Currently, only a small fraction of the estimated 500,000 patients who have multidrug resistant TB and 1.37 million patients who have co-infection with tuberculosis and HIV worldwide each year have access to sufficiently sensitive case detection or drug susceptibility testing.
SN Receives Federal Grant to Establish Nurse-Managed Health Center in Newark
An $851,000 federal grant to the School of Nursing (SN) will provide start-up funds for a nurse-managed health center providing comprehensive care to low-income Newark residents. Cindy Sickora, DNP, MSN, RN, assistant professor at the school, is project director for the grant, which will establish the new Community Center for Health Empowerment and Care (CCHEC).
Staffed by faculty and students from SN and other UMDNJ schools and facilities, the CCHEC will be located at the Newark Housing Authority’s (NHA) Hyatt Court public housing facility at Roanoke and Hawkins Courts. Slated for a January opening, it will also serve residents of two additional NHA properties: Terrell Homes and Pennington Court.
The CCHEC will provide onsite primary care, case management and coordination, health education and health promotion, as well as home visitation to high-need populations such as new mothers, the elderly and infirm, explains Sickora. “We’ll be working closely with community-based organizations and the residents themselves to create a center that truly addresses residents’ critical needs with cultural sensitivity and compassion,” she says.
The three-year grant was awarded to SN by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. In addition to the new center, School of Nursing community service initiatives include the New Jersey Children’s Health Project, a mobile health program serving Essex and Union counties, and the Camden Health Center.
Learning More About Teens and Tobacco
The School of Public Health (SPH) has been awarded a $2.1 million, four-year grant from the National Cancer Institute. The grant will be used to develop and implement an innovative sampling approach designed to improve knowledge about tobacco use by young adults and associated use risk factors.
With a cell phone in practically everyone’s pocket or purse, many people are difficult to reach on traditional landline phones. That is especially true for young adults, persons ages 18-25, who have the highest smoking rate of any age group. To successfully and accurately survey this group’s tobacco use, public health researchers have found a need to move beyond traditional survey strategies that generate a random sample of household landline phone numbers. By devising a new sampling method that accesses cell phones, UMDNJ researchers hope to make the quality of data better than ever.
“The research will provide real-world solutions for improving tobacco surveillance for this high risk population and have far reaching implications for health surveys more generally,” says award recipient Cristine Delnevo, PhD, MPH, associate professor and director of the Center for Tobacco Surveillance and Evaluation Research (CTSER) at SPH.
New Outreach for Vet2Vet Program
In August 31, UMDNJ’s University Behavioral HealthCare (UBHC) outlined a series of enhancements to its NJ Vet2Vet program to reach members of the Individual Ready Reserve and encourage them to access the NJ Vet2Vet services. UBHC manages a statewide system of behavioral healthcare.
UBHC and the New Jersey Department of Military and Veterans Affairs collaborated in developing NJ Vet2Vet five years ago as a system of outreach to soldiers, veterans and their families based on peer-to-peer contact. UBHC provides and manages four primary service components of the NJ Vet2Vet program: peer support; veteran telephonic clinical assessment; referrals to the New Jersey Department of Military and Veterans Affairs PTSD provider network, veterans’ centers, veterans’ affairs services, and military behavioral healthcare providers; and case management in collaboration with veterans’ service organizations, family assistance centers, and national and regional military specific resources.
The primary point of entry for NJ Vet2Vet is a peer-operated helpline, 1-866-838-7654 (1-866-VETS-NJ4), which provides callers with immediate, direct contact to a fellow veteran counselor. It is available to all military personnel and their families for issues ranging from stress reactions, PTSD and other behavioral health problems, to marital and financial matters.
Services to the families of soldiers and veterans have always been essential components of the program. The value of and the need for family supports have become increasingly evident. The focus on families will, therefore, be enhanced. As a first step, outreach and liaison activities will be provided in the communities in which military personnel and their families reside. Based on the data gathered from these activities, military family peer counselors will offer community outreach, family support and education sessions. Additionally, several different Web-based means of communicating with peer specialists will be available.
Celebrating University Day
William F. Owen, Jr, MD, president of UMDNJ, presented the first-ever Credo in Action award to four individuals whose words and actions epitomize the spirit of the UMDNJ Credo. The recipients are:
- Dare Ajibade, a candidate for an MD/PhD/MPH in 2011, New Jersey Medical School (NJMS).
- Tereena James, MBA, acting business administrator, School of Osteopathic Medicine (SOM);
- Richard Nowakowski, PhD, New Jersey Professor of Spinal Cord Research, Robert Wood Johnson Medical School (RWJMS);
- Bernadette West, PhD, associate professor, associate dean for Stratford/Camden, associate dean for community health, School of Public Health (SPH);
Peter Carmel, MD, president-elect of the American Medical Association and professor and chair of neurological surgery at NJMS, was the keynote speaker. He offered a frank look at how changing healthcare legislation affects both physicians and patients.
In celebration of its tenth anniversary, the Master Educators Guild presented a guest lecture from Mel L. Kantor, DDS, MPH, PhD, Hunterdon Professor of Dental Public Health, New Jersey Dental School (NJDS). Opening remarks were made by Peter Amenta, MD, PhD, RWJMS Dean, and Elaine Diegmann, MD, professor of primary care, School of Health Related Professions and outgoing president of the Guild.
The Master Educators’ Guild recognizes University faculty who set the highest standards of academic excellence and have a true gift for teaching whether they are in the classroom, in the research laboratory, or in a patient care setting. Seven new members were inducted: (l-r)
- James H. Millonig, PhD, associate professor, neuroscience and cell biology, RWJMS;
- Pamela M. Basehore, EdD, MPH, assistant professor and associate director of education, New Jersey Institute for Successful Aging at SOM;
- Neil Kothari, MD, assistant professor of medicine, NJMS;
- Sarang Kim, MD, clinical assistant professor of medicine, RWJMS;
- Howard Drew, DMD, clinical associate professor, periodontics, NJDS;
- Dula F. Pacquiao, EdD, professor and director, Stanley S. Bergen Center for Multicultural Education, Research and Practice, School of Nursing;
- Stephen Garrett, PhD associate professor, microbiology and molecular genetics, Graduate School of Biomedical Sciences at NJMS.
A high point of the presentation was the introduction of the new Master Educators by UMDNJ students, who spoke from the heart about being inspired and encouraged by their teachers.