Black History Month 2013 – research mission
Feb. 20, 2013 College News - In honor of Black History Month, the Medical College of Wisconsin has created a series of video vignettes and stories that will be posted on InfoScope during the month of February. The vignettes highlight some of our African-American and Black faculty, staff and students and the contributions they have made. The stories highlight MCW programs that improve the health of underserved populations (including African-American and Black), offer these populations improved access to health care and education, and reduce health disparities.
The fourth story in the series features some of the research being conducted at MCW on health problems that impact the African American and Black populations disproportionately. All of the vignettes and stories will be added to the College’s Black History Month 2013 Web page as they are published.
For the past two decades, investigators at the Medical College of Wisconsin have been conducting studies to determine the physiologic and genetic determinants of hypertension, focusing primarily on African Americans and Blacks. Hypertension, or high blood pressure, is a key risk factor for stroke, heart disease, and kidney disease. It is also a major contributor to racial health disparities. The prevalence of hypertension is 50% higher in African Americans and Blacks than in Caucasians. Nationally, more than 40% of African Americans and Blacks ages 20 years and older suffer from hypertension, and in 60% of these individuals, blood pressure is not controlled. In 1997, investigators at the Medical College of Wisconsin conducted a random survey of households in Milwaukee’s central city and found that high blood pressure was uncontrolled in 75% of African Americans and Blacks with hypertension.
An unanticipated observation of the studies being conducted was the finding that compared to Caucasians and to African Americans with normal blood pressure, hypertensive African Americans and Blacks have slightly higher blood levels of aldosterone, a hormone that causes the kidney to retain salt. Avoiding a high dietary intake of salt is an important approach for the prevention and treatment of hypertension in the general population. In view of the fact that aldosterone levels are high in hypertensive African Americans and Blacks with high blood pressure, salt restriction may be a particularly effective strategy for lowering blood pressure in these individuals. To date, no convincing evidence for specific genetic determinants of hypertension has been consistently demonstrated.
A community/academic partnership involving Progressive Community Health Centers (a federally qualified health center in Milwaukee) and the Medical College of Wisconsin was recently funded by the Healthier Wisconsin Partnership Program to design and implement a pilot project to reduce racial health disparities by improving blood pressure control in African Americans and Blacks with uncontrolled hypertension. The intervention strategy will be a series of group sessions, led by a community health worker, focusing on self-management of overall cardiovascular risk through appropriate lifestyle interventions and drug therapy. Topics will include nutrition, obesity, cholesterol, tobacco use, and stress management. If successful, this approach will be extended to other primary care settings.
Sickle Cell Disease
Faculty and staff at the Medical College of Wisconsin (MCW) and the BloodCenter of Wisconsin (BCW) are conducting basic, translational and outcomes research on sickle cell disease (SCD), which affects one in 400 African American and Black newborns in the United States. It is a genetic disorder affecting hemoglobin, which are the protein molecules in red blood cells that carry oxygen through the bloodstream, and patients with it can experience numerous symptoms including bouts of extreme pain and shortness of breath.
These sickle cell clinical and research faculty have been significant contributors to the study of hydroxyurea (a drug used to treat SCD) in children, participated in numerous multicenter SCD clinical trials, laid the ground work for understanding patient-reported SCD outcomes, and developed the only health-related quality of life tool specific to children with SCD. The group has also been instrumental in expanding the knowledge of health care utilization for children and adults with SCD, including re-hospitalizations and emergency department use at a population level.
The sickle cell faculty and staff work with partners in the community, including the Milwaukee Public School system, to provide outreach communication and education to the public. These faculty and staff have a national presence in the sickle cell community. Faculty members participate in standing and ad hoc NIH study sections, strategic planning groups, and data safety monitoring boards. They are also active members of the American Society of Hematology. Dr. Hillery is a new member of the NHLBI Sickle Cell Disease Advisory Committee.
Ongoing patient-centered research currently being conducted include patient-reported outcomes and quality of life in children with SCD; improvement of communication process and outcomes after newborn genetic screening; reducing hospital readmissions for children with SCD; and Emergency Department utilization.
Areas of ongoing basic research at MCW and BCW include cell free hemoglobin, lipid oxidation and nitric oxide in SCD; role of coagulation and inflammatory pathways in SCD vaso-occlusion; red blood cell adhesion and vascular injury in SCD; HDL dysfunction and vascular inflammation in SCD; and oxidative stress in murine heritable hemolytic anemia.
Areas of ongoing clinical and translational research include asthma and nocturnal hypoxemia in SCD; cysteinyl leukotrienes receptor inhibitors: a target for decreasing SCD-related morbidity; pain in mouse models of SCD and hemolytic anemia; neurobiology of pain in patients with SCD; pain outcomes in individuals with SCD; psychosocial factors (sleep, mood) impacting pain in SCD; and neuropsychological complications of SCD; multicenter clinical trial using Intravenous magnesium for acute painful crisis; pulmonary complications of SCD; Dr Field has pioneered Phase I clinical trials in SCD on our campus (regadenoson) and is exploring novel techniques to measure blood flow in individuals with SCD.
As a result of all of the above efforts, this is one of only a few sickle cell clinical and research groups in the country able to translate basic science discovery in SCD into clinical protocols aimed to benefit patients, exemplifying bench to bedside research.
Faculty currently involved in sickle cell research include: Amanda M. Brandow, DO, MS, Assistant Professor of Pediatrics (Hematology/Oncology); David C. Brousseau, MD, MS, Professor of Pediatrics (Emergency Medicine); Michael Farrell, MD, Assistant Professor of Medicine (General Internal Medicine); Joshua Field, MD, Assistant Professor of Medicine and Associate Investigator at the BloodCenter of Wisconsin; Cheryl A. Hillery, MD, Professor of Pediatrics (Hematology/Oncology); Neil Hogg, PhD, Professor of Biophysics; Matthew Myrvik, PhD, Assistant Professor of Pediatrics (Hematology/Oncology); Robert F. Newby, PhD, Associate Professor of Neurology; Julie A. Panepinto, MD, MSPH, Professor of Pediatrics, (Hematology/Oncology); Kirkwood A. Pritchard, PhD, Professor of Surgery (Pediatric Surgery); J. Paul Scott, MD, Professor of Pediatrics (Hematology/Oncology); Cheryl L. Stucky, PhD, Professor of Cell Biology, Neurobiology and Anatomy; and Nancy Wandersee, PhD, Assistant Professor of Pediatrics (Hematology/Oncology).
An MCW research team in the comprehensive Asthma, Chronic Obstructive Lung Disease and Smoking Cessation Continuity Clinic Program is evaluating patient outcomes data to determine risk factors for asthma, which disproportionately impacts African-Americans and Blacks. The clinical program, in collaboration with Froedtert Hospital, has provided guidelines-directed medical care, patient education and counseling, and medication and lung function testing resources to more than 1,300 patients in the past nine years.
A recent study looked at the role of insurance status and outcomes from asthma. It was found that regardless of whether a patient has private or government-based insurance, African American and Black outcomes were not as good as Caucasian outcomes; however, after at least one year in our program, all patients improved significantly, but African Americans without insurance or with private insurance, and Caucasians with government insurance, still did not do as well as Caucasians with private insurance. Data also showed that once a patient is in a guidelines-directed program for asthma and has access to education and medications, obesity, not insurance status or race, was most related to greater morbidity.
The Center for AIDS Intervention Research (CAIR) at MCW is currently conducting studies which seek to reduce HIV/AIDS disparities in African American and Black communities.
HIV infection in the United States places disproportionate burden on communities of color. African American and Black men who have sex with men (MSM) constitute much less than 1% of the country’s population but nearly 25% of new HIV infections, and sharp increases in HIV rates among young African American and Black MSM in Milwaukee have been the subject of national public health attention and concern.
Throughout the country, African American and Black women are also disproportionately affected by HIV disease. Prevention of HIV infection and early detection and treatment of the disease requires research that discovers the reasons for these racial/ethnic health disparities and that then develops intervention approaches culturally tailored to meet the needs of African Americans and Blacks vulnerable to the disease. Studies being undertaken at CAIR in cooperation with community partner agencies are intended to improve HIV/AIDS health-related outcomes in the African American community.
Implementation, Effectiveness, and Cost-Effectiveness of an Evidence-Based Intervention Conducted by Frontline HIV Prevention Service Providers
In a five-year project funded by NIMH, dual principal investigators Jill Owczarzak, PhD, Assistant Professor of Psychiatry and Behavioral Medicine, and Steven D. Pinkerton, PhD, Professor of Psychiatry and Behavioral Medicine at CAIR, are collaborating with service agencies in cities throughout the United States that offer HIV prevention programs designed for African American women. The study examines how frontline health and social service providers implement evidence-based HIV prevention programs being disseminated by the Centers for Disease Control and Prevention (CDC); how the agencies adapt, tailor, and modify interventions to meet the needs of Black women; and how organizational, community, structural, and client factors impact an agency’s ability to offer HIV prevention programs for minority women. The study also measures the effectiveness and cost-effectiveness of HIV prevention programs carried out by frontline service providers.
Structural and Social Contexts of Substance Use, Violence and HIV Risk among Adolescent Gangs
Julia Dickson-Gomez, PhD, Associate Professor of Psychiatry and Behavioral Medicine, directs a CAIR research team that is carrying out a four-year study funded by the National Institute on Drug Abuse (NIDA) to explore the role of gangs and environmental factors on gang members’ sexual activity, drug use, and violence. The project will interview members of African American and Latino gangs in Milwaukee in order to understand factors that influence substance use and high-risk sexual behavior, with a particular focus on social contexts and settings that contribute to risk. Study results will be used to develop a multilevel prevention intervention that targets multiple social health problems among adolescents involved in gang activities.
Prevention of HIV Infection in High-Risk Social Networks of African American Men Who Have Sex with Men
Jeffrey A. Kelly, PhD, Professor of Psychiatry and Behavioral Medicine and CAIR’s Director, and Yuri A. Amirkhanian, PhD, Associate Professor of Psychiatry and Behavioral Medicine, lead a team of CAIR investigators who are conducting a five-year study funded by NIMH to evaluate the effectiveness of an HIV prevention intervention undertaken with social networks of African-American and Black gay or bisexual men in Milwaukee, Cleveland, and Miami. The project is conducted in partnership with the AIDS Task Force of Greater Cleveland and the South Beach AIDS Project in Miami. It uses a friends-reaching-friends approach to bring HIV prevention messages to Black and African-American MSM, including men hidden in the community and inaccessible to most traditional prevention counseling. The study determines the impact of the social network intervention in reducing risk behavior and also decreasing the incidence of HIV infection and other sexually transmitted diseases among men of color who have sex with men.
CAIR is one of five HIV prevention research centers in the United States funded by the National Institute of Mental Health. CAIR’s missions are the development of improved ways to prevent HIV infection, the development of new approaches to improve the health of persons affected by HIV/AIDS, and disseminating the Center’s research findings to service providers in the United States and throughout the world so they directly benefit from CAIR’s work.