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RPS/MSS Joint Newsletter October 2011
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In this issue:

MSS Interview with a Fogarty Scholar
RPS Q&A with Valentina Vinante, MD, MPH
This Thanksgiving Make the Turkey a Side
WANTED: Practicum Rotation Descriptions!


MSS Interview with a Fogarty Scholar
By Hyun Ouk Hong, MS IV


This month, we interviewed a recent "Future Leader of Preventive Medicine” Award recipient and Fogarty Scholar, Daria Szkwarko. Daria is a fourth year medical student at UMDNJ - School of Osteopathic Medicine. She shares with us her experience as a Scholar, and gives advice on how you can apply as well!

What is the Fogarty Program?
The Fogarty International Clinical Research Scholars program is a one-year clinical research training experience for US students in the health professions in developing countries.

 

How did you pick your site?
Students are placed at a site through a match process similar to the residency match. All finalists undergo two days of interviews with the principal investigators at the NIH. I did not have a specific project in mind; instead, I was looking for a mentor who was interested in teaching and introducing his/her student to the global health field.

I was particularly interested in implementing evidence-based guidelines to improve healthcare in low-resource settings. My mentor introduced me to the field of ‘operations research’. I was completely hooked. Fortunately, I matched with her site in Eldoret, Kenya at the Academic Model Providing Access to Healthcare (AMPATH).

 

What aspects of preventive medicine did your project involve?
My projects were intertwined with preventive medicine. My project was focused on improving child contact tracing. The World Health Organization recommends all patients with tuberculosis (TB) disease be asked about children in the home and encouraged to bring them in for screening. If TB disease is ruled out, children can be given Isoniazid Preventive Therapy that can decrease incidence of TB disease and TB related mortality in children. In high burden TB countries, resources are often limited so child contact tracing does not occur. I created a child contact registry to identify the children exposed and start to address the most vulnerable (children < 5 and HIV infected children).

 

What was your most memorable experience?
One of my Kenyan coworkers identified an HIV infected child who was uncovered through the registry, and diagnosed her with TB in the pediatric HIV clinic. It was very gratifying to see my coworker realize how the registry she helped create may have saved a child's life. It was even more amazing when I ran into the mother and her child in the TB clinic on my last day and the child looked fantastic!

 

What was it like to live and work in another country?
Living and working in another country is a challenging adventure. It's important to keep an open mind and expect the worst but hope for the best! I lived in a compound with a fairly large expat community so it was nice to have people around to laugh with when the electricity went out or the supermarket was out of cheese. Working in a developing country was definitely a transition because of the different culture, tribal languages spoken by patients, and work expectations. There are times it was frustrating because I was accustomed to the fast paced hospital environment on the East coast. I learned how to be very patient, and I gained an incredible appreciation for the technology and resources we have in the states.

 

How can I apply for a Fogarty Scholarship?
Any third year medical student interested in global health research should apply for Fogarty! The website is: https://fogartyscholars.org/scholars.

 

Dr. Valentina Vinante is a visiting Resident physician from Italy. She has been studying Public Health and Preventive Medicine at the University of Florence in Italy. In 2010, she began collaborating with the Yale-Griffin Prevention Research Center in Derby, Connecticut, where she has been involved with grant writing, research activities and project development mostly focused on obesity prevention. Aside from Dr. Vinante’s research duties, she participates as member of the patient care team at the Integrative Medicine Center at Griffin Hospital and other primary care offices in the area. Her primary focus is nutrition, integrative medicine, women's health and strategies to support and implement behavior modification. She is passionate about classical music and Eastern philosophies. She enjoys yoga, skiing and being in nature.

Why did you choose Preventive Medicine as a career?
A Chinese proverb says "The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness". My goal is not to become a superior doctor; rather, my goal is to prevent people from suffering as much as possible. During the 6th year of my medical school training, while doing my clinical internships and rotations, I often felt frustrated. My biggest question was not only how to cure the patient, but most of all how to prevent them from suffering. I couldn’t stand the idea that most of the disease I was seeing could be prevented, but I couldn’t do anything. I had to find a way to do something effective. That’s when I discovered Preventive Medicine.

Preventive medicine means applying the education and philosophy of life that I’ve used throughout my life. I am lucky because I grew up in a very healthy family. Once, while I was jogging with my father, he said to me, "I may lose everything, but I will do everything not to lose my health. My investments in the future are this run, my food and the fact that I am not smoking….” My Grandpa, a super healthy 91 year-old-man, keeps the same mentality. He cycles for one and a half hours a day and keeps a very strict diet. With these kinds of examples how can I not believe and practice Preventive Medicine?

In addition, since starting medical school, one of my dreams has been to collaborate with the WHO. I came to see the factors determining the state of health of a person go far beyond the individual/person. I discovered in order to be a complete doctor I had to study public health in order to learn how to intervene on a larger scale and have a greater impact.

What are your future goals?
On the one hand, I would love to work as a preventive medicine clinician mostly focusing on women’s health, but on the other side, I’d love to practice preventive medicine and public health on a larger scale. At the current moment, I am getting more and more interested in lifestyle medicine. For all the preventive medicine doctors who want to continue their career working with patients, prescribing lifestyle medicine is essential. The biggest challenge is helping people change their behavior.

Why women’s health?
I wrote my dissertation on early diagnosis of endometriosis in adolescence. I loved being in the department of OB/GYN. What I have noticed is women start to talk about prevention when they are pregnant. But what about adolescence, what about older women with chronic diseases or cancer? I love working with and for women. They are a key figure in our society. It is my observation that if a woman works on her health, the whole family will tend to live a healthier lifestyle.

Which projects have you enjoyed working on the most?
When I look back at the last few years, I see how amazing they have been and am overwhelmed by how much I’ve learned. From being part of a big project aimed at decreasing the rate of voluntary abortions in immigrant women in Tuscany to my last rotation at the Yale PRC, I have really enjoyed my work. I have specifically enjoyed working with Dr. David Katz, the director of the PRC. While there, I took part in grant-writing and studies focused on childhood obesity. I also developed a few interesting projects that I hope will have a great impact on the population. One such project is ABE for Fitness (http://abeforfitness.com/index.html). It is a video-library of 3 to 8 minute evidence-based physical activity bursts that can be done anywhere. Another project I really enjoyed working on is the National Exchange for Weight Loss Resistance (www.newlr.com) - a platform and registry to better understand weight loss resistance and obesity. Dr. Katz was, and still is, a great role model for me. Along with my rotation duties, I am also involved in the activity of a small non-profit organization called Engera (www.engera.org) operating in Ethiopia. Through this organization, I spent a few weeks in Ethiopia working in a small clinic, and I am now involved in projects to improve the quality of the health care service.

Do you see any difference in between practicing preventive medicine in Italy and in the US?
Yes I do. In Italy we have a universal health care system. Preventive Medicine is fully in the hands of family doctors and the department of preventive medicine within the health care system. This system guarantees every citizen is supported throughout the network for preventing disease and living a better lifestyle. Preventive medicine doctors normally work in the department of preventive medicine, choosing to work mostly on large public health projects. They generally do not see patients.

Do you, as a preventive medicine physician, practice what you preach?
I strongly believe a preventive medicine doctor should lead by example. I try to workout at least 3 times a week. I eat healthy, do yoga and meditate. I know with a healthy lifestyle I can achieve more and enjoy a more full and satisfying life.


This Thanksgiving Make the Turkey a Side
By Michael Crupain, MD, MPH

There is nothing that better symbolizes a Thanksgiving meal than turkey. According to the turkey industry, between 80% and 95% of Americans consume this bird on the last Thursday in November each year. While we can’t be sure if turkey was really eaten at the first Thanksgiving, it has certainly been an important part of the tradition and American culture for at least 200 years.

The modern Turkey however, is a far different bird than the turkey Benjamin Franklin told his daughter would be a better symbol for America than the Bald Eagle. Today the majority of turkeys represent a single breed, the Broad Breasted White, which has been bred to have a small frame and large breasts. These birds grow very fast, reaching slaughter weight after only 14-18 weeks and have a taste best described by the word bland.

Ninety-nine percent of turkeys produced in this country never see the light of day, because they are raised in an industrial system.After their birth in a lab (due to their anatomical proportions, this breed can only reproduce by artificial insemination), the animals have their beaks and toes clipped and are transferred to a brooding house where they will live for about 6 to 8 weeks. From here they will go to one or two more similar houses where they will be fattened quickly on a diet of grains and medications.Their homes are long barns without windows, where there is a continuous flow of food, water, air, and artificial light.The birds stand all day on piles of litter and are packed tightly together. Like other industrial food animal production facilities, turkey farms represent a potential problem not only for the turkeys, but also for public health. The pollution and antibiotic resistant bacteria that may be produced on these farms can cause issues for the health of works, neighbors, and the environment.

Fortunately due to increasing awareness by the public about the practices of industrial agriculture, small farmers are starting to grow Heritage Breed Turkeys. These breeds, which have names like Bourbon Red and Narragansett, also have much more natural proportions and a much more interesting flavor than industrial birds.Typically heritage birds are raised outdoors in large fields where they can engage in more natural turkey behaviors like foraging. Heritage breed may take up to twice a long as factory birds to reach slaughter weight and cost more.

There are a number of websites from which you can order heritage breeds birds, but your best bet is to find a farmer at your local farmers market who is raising them. This way you can find out more about how the birds are raised and help support the local economy. It’s best to start looking early though, because these birds are often in limited supply.

While turkey is healthy lean meat filled with protein and important vitamins and minerals, I recommend making the vegetables the focus of your Thanksgiving meal and make the turkey a side. Focusing on dishes with super foods like mashed sweet potatoes (instead of mashed white potatoes), roasted cauliflower, raw tuscan kale salad, and roasted carrots will ensure a delicious and healthy meal.

For turkey recipes, I recommend this one from famed chef Daniel Boulud.

PLEASE REMEMBER, that even if your turkey has a "pop-up" temperature indicator, it is recommended that you also check the internal temperature of the turkey in the innermost part of the thigh and wing and the thickest part of the breast with a food thermometer. The minimum internal temperature should reach 165 °F for safety.


WANTED: PRACTICUM ROTATION DESCRIPTIONS!!
WE NEED YOUR HELP!

Did you do an interesting rotation that improved your practicum year???

Did you do one that you thought was not as beneficial???

What about a global health experience???

WE WANT TO KNOW!!

Please send us a short description of your practicum rotation experiences (past, present, future) and your opinion of them (overall, was it useful or not; what can be done to improve the rotation; what did you like about it, etc). Don't forget to include details like the name of the site, name of your preceptor and their contact info, and whether or not you thought the experience was worthwhile (and why). Please do this in short paragraphs as we are just working on the basics for now, and send the descriptions by email to acpmrps@gmail.com.

Your time and dedication to improving the Preventive Medicine residency experience is greatly appreciated!



JOIN US AT PREVENTIVE MEDICINE 2012!






If you had an interesting experience related to Preventive Medicine or would like to submit an article for the RPS-YPS-MSS Newsletter, please send an email to acpmrps@gmail.com.


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