The Crisafi-Monte Endowment Fund has supported a number of research projects including:
A Summer Medical Student Research Participation Program
PI: Patricia M. Schwirian, PhD, RN
Time Period: 9/1/06 – 10/31/06
Amount Awarded: $18,686
Abstract: The purpose of this project was to provide a supervised clinical research learning opportunity for six medical students. These Medical Student Researchers participated for six weeks in the MOMS Project study, “Can Changing How Moms Eat Prevent Obesity in Toddlers?” (1 R21 HD50944001 National Institute of Child Health & Development). This study was a cooperative venture between Children’s Hospital Department of Ambulatory Pediatrics and The Ohio State University Department of Family Medicine.
The students were provided with three types of learning opportunities. First, they worked in one of the three participating Children’s Hospital Clinics (Westside, Whitehall,and Primary Care). They recruited mothers of newborns for the study, conducted a base-line interview, and entered the data into the MOMS Project database. Second, the Medical Student Researchers participated in a weekly research-focused seminar led by members on the MOMS Project research team. Finally, the Medical Student Researchers participated in the weekly MOMS Project research team meetings. This combination of learning opportunities afforded the students a glimpse into the philosophy and processes involved in the conduct of primary care research in a clinical setting.
The Correlation of Health Literacy, Diabetes Knowledge, Diabetes Self-Management, and Glycemic Control in Patients with Diabetes Mellitus
PI: W. Fred Miser, MD
Time Period: 2/1/07 – 10/31/08
Amount Awarded: $ 39,732
Abstract: Diabetes mellitus is a leading cause of morbidity, diminished quality of life, and mortality in the United States. Considered a cardiac risk equivalent, diabetes is a major cause of cardiovascular disease, and is often associated with hypertension and dyslipidemia. Clinical guidelines exist that aim for better glucose, blood pressure, and lipid control in those with diabetes, yet most individuals do not achieve targeted goals. Although the reason for this lack of good control is multifactorial, the role of health literacy has recently been raise. Health literacy is a constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information. Recent studies have suggested that further research is required to determine whether health literacy is associated with diabetes knowledge and with diabetes self-management, and whether these three factors are associated with improved glycemic control.
This cross-sectional survey of over 500 adults with type 2 diabetes mellitus consisted of administering a battery of previously validated health literacy, diabetes knowledge, and diabetes self-management tests and the collection of health information related to diabetes care from the subjects and their medical records. The purpose of this study was to determine the strength of relationships, if they exist, of health literacy, diabetes knowledge, diabetes self-management, and glycemic control. Specifically, the researchers determined the relationships between: 1) health literacy and diabetes knowledge, 2) health literacy and diabetes self-management, 3) diabetes knowledge and diabetes self-management, 4) health literacy and glycemic control, 5) diabetes knowledge and glycemic control, and 6) diabetes self-management and glycemic control. The researchers then determined which of these relationships (health literacy, diabetes knowledge, and diabetes self-management) had the strongest correlation with glycemic control.
Urban Diabetic Cardiovascular F.I.T.N.E.S.S. Program – Pilot Study Fitness Improved Through Nutrition and Exercise Sustained by Support of Family and Friends
PI: Leon McDougle, MD
Time Period: 1/1/08 – 6/30/09
Amount Awarded: $ 41,023
Abstract: Study Objective: To determine the effectiveness of a culturally sensitive lifestyle modification program in an urban African American adult population. Design: Randomized, translational, pilot study over a 6-month period. Setting: OSU Family Medicine at University Hospital East located in Near East Columbus. Intervention: Enrollment of 200 Near East Columbus diabetic patients along with two family members or friends who sign a support agreement to 1) undergo nutrition and physical activity education modeled after the Diabetes Prevention Program and 2) volunteer to walk with the diabetic patient at least 3 to 5 times weekly for 30 to 60 minutes. In this way both primary prevention of diabetes and cardiovascular disease for friends and family, and secondary prevention of diabetic and cardiovascular morbidity for the diabetic patient is promoted. Measurements and Main Results: All baseline and demographic information from the participants, both diabetics and family/friends, were summarized. The change in attitudes, physical activity, body weight and BMI, blood pressure, fasting blood glucose measurements, and fasting lipids and Hemoglobin A1C (for diabetics) after completing the training program were summarized and tested using simple paired tests and regression analysis.
Development of Culturally Acceptable Patient Centered Self Management Materials for African American Patients with Hypertension
PI: Randy Wexler, MD
Time Period: 7/1/07 – 6/30/09
Amount Awarded: $ 33,266
Abstract: Hypertension is a major cause of morbidity and mortality in the United States especially in African American patients. The self-management of chronic disease (which includes medication adherence and lifestyle changes) are recommended for all patients with hypertension. Unfortunately, control of blood pressure in the United States is poor and more so within the African American population. Although not used at significant levels, patient lifestyle changes or self-management of chronic disease such as hypertension provides a multitude of benefits, including improved disease control. The researchers developed culturally acceptable educational materials to improve self-management of hypertension in African American patients.
Lifestyle Behaviors and Correlates of Hypertension in U. S. African American Adults
PI: Chris A. Taylor, PhD, RD, LD
Time Period: 7/1/09 – 6/30/10
Amount Awarded: $ 30,759
Abstract: Background: Hypertension continues to be a serious public health concern in the U.S., with complications resulting in congestive heart failure, stroke, and chronic renal failure. African Americans suffer a disproportionate risk for hypertension, which affects over a third of adults in this population. Lifestyle behaviors, specifically diet, physical activity,and smoking, are significant contributors to etiology; these behaviors are targeted for disease treatment and prevention. An analysis of nationally-representative sample provided the opportunity to identify key factors related to hypertension in the African American community. Methods: The study examined data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) to identify the correlates of hypertension in African American adults. A nationally representative sample of approximately 4,700 African American participants was stratified by hypertension status to identify differences in sociodemographics, access and utilization of healthcare, dietary intakes, physical activity habits, smoking status and presence of comorbidities by hypertension. Hypertension status was evaluated using: 1) a self-reported diagnosis of hypertension; 2) measured blood pressure values by a trained examiner; and 3) use of an anti-hypertensive medication. Individuals were classified into normotensive, pre-hypertensive and hypertensive (Stage I or Stage II) using Joint National Commission guidelines. Sociodemographic characteristics were compared across hypertension status to describe the subpopulations at greatest risk for hypertension. Dietary and physical activity habits were compared across hypertension status to assess factors that may explain disease prevalence. The presence of comorbities, including obesity and metabolic syndrome, were also assessed to describe the profile of African Americans with hypertension. Finally, an exploratory objective of the proposed study was to examine the differences in lifestyle behaviors and other risk factors by severity using stage of hypertension. Analyses described the populations more likely to progress to advance stages of hypertension, identify the prevalence of known long-term consequences and estimate the potential benefits in blood pressure from the adoption of therapeutic lifestyle behaviors. Conclusion: Understanding the current lifestyle behaviors of African Americans provided valuable formative data for the development of culturally-specific lifestyle modification interventions for the prevention and treatment of hypertensive African Americans in central Ohio.
Efficacy of Quinapril plus Alpha-lipoic Acid (ALA) on Patients with Insulin Resistance Syndrome – A Randomized Cross Over Study
PI: Gowrishankar Gnanasekharan, MD, MPH
Time Period: 9/1/09 – 8/31/11
Amount Awarded: $ 63,350
Abstract: The renin-angiotensin system (RAS) is a critical component for maintenance of physiological homeostasis. However, its over-activity can lead to the development of pathological cardiovascular processes such as inflammation, increased oxidative stress and Insulin Resistance (IR) syndrome. Preliminary data from our group has suggested that targeted blockade of the RAS with an ARB may improve vascular function, insulin resistance and prevent premature aging of blood vessels. Further data from our lab has shown that ALA which is a common neutricetical when administered to humans with an ACE inhibitor can potentiate endothelial function and decrease inflammatory markers. In this study, we hypothesize that the combination of the ACE inhibitor and ALA can improve insulin sensitivity, vascular compliance and inflammatory markers in patients with Insulin Resistance (IR) syndrome. Subjects who are 65 years and older will be recruited for the study purpose. This study will analyze the effects of 12 week administration of quinapril plus lipoic acid versus quinapril plus placebo on indices of insulin sensitivity, vascular compliance, inflammatory markers and adiponectin. This crossover study will consist of 2 treatment arms, (Treatment A: Quinapril and Treatment B: Quinapril+ ALA), each 12 weeks in duration with a 4 week washout period followed by cross-over.The change in insulin sensitivity (Homeostasis Model Assessment, HOMA-IR) and vascular compliance will be primary end-points for the study while change in inflammatory markers and adiponectin will be secondary end points. Arterial compliance will be measured using a validated system that measures pulse wave velocity and augmentation index. The proposed studies have the potential to develop new preventive treatment paradigms for the elderly that are cheap inexpensive and free of side-effects.
Medical Student Partners in Health
PI: Douglas M. Post, PhD
Time Period: 9/1/09 – 8/31/10
Amount Awarded: $ 40,000
Abstract: Preparing medical students to care for an aging population with chronic disease is critically important to the future of health care in the U.S. Future physicians need to understand how to establish long-term relationships with older patients and how to help them effectively manage their disease. In 2001, an educational program on geriatrics for OSU medical students was established, titled the “Senior Partners Program.” In this curriculum, students are paired with healthy seniors in the community and complete a series of assignments. Some students have benefited from an understanding that aging is not synonymous with infirmity, but have not learned key concepts in this program , such as health care delivery systems, aging and chronic disease management. The proposed study aims to enhance their learning in these key areas. Its purpose is to develop and test an innovative education curriculum designed for first-year students and investigate the effects of this program on patient and medical student outcomes, and to examine primary care physicians’ responses to the educational intervention. During the first three months of the project, a group of OSU primary care physicians will be recruited to participate in the pilot study. Those who agree to participate will be asked to refer patients from their practices to help create a cohort of 30 patients who are age > 65 years and have been diagnosed with uncontrolled Type 2 diabetes. These patients will be paired with 30 first-year medical students randomly selected from all students who express interest in the new curriculum. Students will receive training on the effective delivery of the curricular intervention prior to implementation. The intervention program will be delivered over the next eight months of the study. Students will perform a needs assessment with their senior partner and will work with the patient to develop and implement a personalized chronic disease management program. The effects of the intervention on patient and medical student outcomes will be investigated in a quasi-experimental two group pretest-posttest design. Participating primary care physicians will be asked to respond to a survey to assess their responses to the intervention. The final month of the project will focus on the completion of data analysis and writing of study reports. Pilot data from this project will be an important component of a proposal to the National Institute of Aging for support of a full-scale implementation of our innovative curriculum.