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First
African-American
graduate honored
The first African-American
to graduate from the School of Medicine has been honored with
a new scholarship, which once fully endowed will help recruit
and support outstanding students from underrepresented groups
entering public health. After his graduation in 1857, Cortlandt
Van Rensselaer Creed, M.D., became a prominent New Haven physician
and a Civil War surgeon. He was consulted in the shooting of
President Garfield in 1881, and his forensic work in the investigation
of a New Haven woman’s murder played a part in Virginia
A. McConnell’s novel about Victorian New Haven, Arsenic
under the Elms. The Creed/ Patton/Steele Scholarship Campaign
was initiated with gifts by alumnus Robert E. Steele, M.P.H.
’71, Ph.D. ’75, and also honors Creed historian Curtis
L. Patton, Ph.D., professor of epidemiology (microbiology) and
public health. To date, $64,000 of the $100,000 fund goal has
been raised. |
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What’s
in a name?
Physicians at
medical schools around the country usually provide their services
through umbrella faculty practice organizations that streamline
administration, financial services, compliance programs and practice
standards. Yale is no exception. But in recent years the Yale
Faculty Practice, which represents the medical school’s
650 full-time clinical practitioners, has evolved into a more
complex organization in order to accommodate the changing landscape
of academic medicine. Reflecting this, the practice announced
in March that it is changing its name to the Yale Medical Group.
According to Director David J. Leffell, M.D., HS ’86, the
school’s senior associate dean for clinical activity, “the
words ‘faculty practice’ suggested to some people that
care was delivered by interns and residents who were practicing
to become physicians. The new name conveys a clear message about
our academic medical group and the clinical care we provide.” |
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Parental
prospects
A national survey
of 3,000 adults, one-third of them parents of young children,
found a surprising lack of understanding about basic principles
of child development. According to the survey, many parents spank
their children although they know it doesn’t work and expect
a 15-month-old to share, even though that doesn’t happen
until children are at least two. “Parents seem to think
development is some sort of race. It’s a dance, not a race,”
says Kyle D. Pruett, M.D., a clinical professor at the Child
Study Center and past president of Zero to Three, the child development
advocacy and expertise organization that conducted the survey.
One finding he found particularly disturbing was “the lack
of understanding adults have about the enormously active absorption
abilities of the very young within the first months of life,
both of the good and the bad in their surrounding environment.” |
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Caffeine
study quells
tempest in a coffeepot
The caffeine
in over-the-counter pain relievers won’t get you hooked,
according to a review of the literature by an international committee
of scientists chaired by Alvan R. Feinstein, M.D., HS ’54,
Sterling Professor of Medicine and Epidemiology. Fears percolating
in Europe that caffeine in analgesics such as aspirin and acetaminophen
might lead to dependency had spurred groups in Germany, Austria
and Switzerland to seek protective regulations. Federal drug
authorities in the three countries, along with the pharmaceutical
industry, assembled the committee, which reported its findings
in the November issue of Clinical Pharmacology and Therapeutics. |
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15
years later,
a surprise from Chernobyl
During the 1995-1996
academic year, Jack van Hoff, M.D., HS ’84, associate professor
of pediatric oncology, took a sabbatical leave from the School
of Medicine to coordinate pediatric data for a cancer registry
project in Belarus, the former Soviet republic. That was where
the heaviest fallout occurred outside of the immediate area surrounding
the Chernobyl power station following the meltdown of one of
its nuclear reactors 15 years ago this spring. Along with Clinical
Professor of Medicine Nicholas Dainiak, M.D., van Hoff has since
worked with the International Consortium for Research on the
Health Effects of Radiation to study childhood leukemia in the
region. The results have been surprising. “While the social
effects on people within the area have been very significant,”
says van Hoff, “the physical impact of radiation exposure
has been small. There has been a remarkable increase in rates
of thyroid cancer for individuals exposed as children. However,
there has been no detectable effect on the rates of other cancers
to date.” |
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Race
not a factor
Race did not
affect the quality of psychiatric care or clinical outcomes in
a study of white and African-American patients who were homeless
and mentally ill. The study, reported in the October issue of
Psychiatric Services, also showed that the race of case
managers made no difference, said author Robert A. Rosenheck,
M.D., HS ’77, professor of psychiatry and public health.
The findings depart from those of other studies showing that
non-whites may have less access to medical care or poorer outcomes
than white patients. “It is difficult to generalize from
these findings to other areas of health care,” Rosenheck
said. “The kinds of people who work with the homeless are
generally those who have a special commitment to fairness and
social justice, so these results don’t necessarily translate
elsewhere.” |
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Endoscopic surgery
is easier
to swallow
People with a common swallowing disorder can now be treated
at Yale using a procedure that is markedly less invasive than
the conventional surgery through the neck. The surgery is used
to treat Zenker’s diverticulum, which occurs when the lining
of the mucous membrane protrudes through the muscular wall just
below the voice box in the high esophagus. Food easily becomes
trapped in the pouch, making it difficult to swallow. Using an
endoscopic procedure popularized at Duke called stapler-assisted
diverticulostomy, the surgeons remove the pouch through the mouth
and repair the lining with a stapler. The procedure is a breakthrough,
according to Douglas A. Ross, M.D., associate professor of surgery
and otolaryngology, who performs the surgery along with colleague
Clarence T. Sasaki, M.D. ’66, HS ’73, the Charles W.
Ohse Professor of Surgery and chief of the otolaryngology section. |
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New take on tubal transfers
The two standard procedures for in vitro fertilization involve
transfer of the embryo to either the uterus or the fallopian
tube. A national database published by the Centers for Disease
Control and Prevention (CDC) has supported the long-held belief
that tubal transfer has a higher pregnancy success rate although
it is more invasive, expensive and prone to complications. An
analysis directed by Steven F. Palter, M.D., assistant professor
of obstetrics and gynecology, of all previously published studies
found that uterine transfers have just as great a likelihood
of success as tubal transfers. Palter suggested that fertility
clinics, which are required to publish their success rates, select
which patients to accept or direct toward certain therapies based
on their likelihood of success. That, he believes, skewed the
database. His findings, presented at the American Society of
Reproductive Medicine meeting, contradict statistics published
by the CDC and the Society for Assisted Reproductive Technology,
he believes. |
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Shorter stays, but what
about outcomes?
Managed care has reduced the time older patients with pneumonia
spend in the hospital and has led to a corresponding drop in
the costs and hospital death rates associated with the illness.
But according to a study by researchers at Yale and other institutions,
more patients are dying in the month after they leave the hospital,
and many of the discharged hospital patients are being sent to
nursing homes rather than home. Thomas P. Meehan, M.D., M.P.H.,
assistant clinical professor of medicine, was senior author of
the study, which appeared in the Archives of Internal Medicine
in December. The researchers found that the rate of mortality
within 30 days after discharge increased from 6.9 percent to
9.3 percent during the six-year study of pneumonia patients 65
and older who were discharged from Connecticut hospitals. During
that period, fall 1991 to fall 1997, the length of stay dropped
from a mean of 11-12 days to 7-8 days. Said Meehan, “We
can’t continue to decrease the length of stay and not have
an eye as to the consequences.” |
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Higher risks for younger
women
Women under the age of 60 face a higher risk of dying during
the two years following a heart attack than do men in the same
age group, according to a study by a Yale researcher and collaborators.
These sex-based differences in mortality rates were independent
of the severity of the heart attack and other health problems,
and were found only in the under-60 group of patients, the authors
wrote in the Feb. 6 issue of Annals of Internal Medicine.
The women’s survival rate might have been affected more
than the men’s by “behavioral, psychosocial, and social
factors such as continuing to smoke, social isolation, emotional
stress and depression,” said Harlan Krumholz, M.D., a co-author
of the article and associate professor of internal medicine.
“The next challenge is to understand why these differences
exist.” |
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A
scholarly archive,
in bits and bytes
As more journals
move to electronic format and more scholars access information
using these online databases, serious questions have arisen about
how to preserve knowledge that in some cases may exist only in
digital form. To address the dilemmas of digital preservation,
the Yale University Library and Elsevier Science are collaborating
to create the infrastructure for a model archive for the 1,100
journals published electronically by Elsevier, the world’s
largest scientific, technical and medical information provider.
Their goal is to have the model infrastructure developed within
two years. They have already begun studying how people use digital
collections and are investigating formats for encoding content
in digital form; one challenge is predicting which formats are
likely to remain stable over time. The planners hope that the
archive will serve as a model for other publishers. |
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Breastfeeding
reduces cancer risk
Breastfeeding
for two or more years reduces a woman’s risk of developing
breast cancer by 50 percent, according to a study conducted in
China by a Yale researcher. Tongzhang Zheng, Sc.D., associate
professor of epidemiology and public health, said he conducted
the study in China because, unlike in Western nations, long-term
breastfeeding is part of the Chinese culture. Zheng’s group
found a 50 percent reduction in breast cancer risk among women
who had breastfed for more than 24 months per child, compared
to women who breastfed for less than 12 months. Studies in Western
countries showing that breastfeeding does not play a significant
role in reducing breast cancer risk might be explained by the
fact that many women in the West breastfeed for weeks or months
rather than years. The study was published in the Dec. 15 issue
of American Journal of Epidemiology. |
