Several "new epidemics" in U.S. society are in great need of innovative research, clinical strategies, program development, and social policy. Among these epidemics are work-related illnesses, injury and death due to violence, HIV infection and AIDS, and substance abuse. In each of these areas, the University of Washington has major strengths for graduate-level training and research. The UWCSP has a record of successful mentorship for Scholars in each of these areas, and all areas now include Clinic al Scholar alumni as active investigators, program leaders, and potential collaborators.
A major resource in this area is the Occupational Medicine Clinic at Harborview Medical Center, directed by Scott Barnhart (Departments of Medicine and Environmental Health). This program includes diagnostic and surveillance clinics for occupational-related illnesses, serves as a referral resource for physicians in the WAMI service area, receives referrals from government and labor organizations, and hosts a fellowship program in Occupational Medicine. The program has been cited in an Institute of Medicine report and a follow-up article in the New England Journal of Medicine as a model for academic occupational medicine services. Scott Barnhart has specialty training in pulmonary medicine, and is principal investigator of an NIH-su pported preventive pulmonary disease program, one of only four in the country. Bill Daniell, who coordinates field-based epidemiologic research for the Department of Environmental Health and the Occupational Medicine Fellowship, opens an array of indust ry-based sites to Clinical Scholars.
A second major resource is the Department of Environmental Health within the School of Public Health and Community Medicine. Among others, this department includes Gil Omenn, Dean of the School of Public Health and a nationally known expert in genetic predisposition to environmental hazards and risk assessment; Harvey Checkoway, an expert in occupational health epidemiology; and Sharon Morris, formerly Director of Legislation for NIOSH, who is now active in occupational health policy.
The state Department of Labor and Industries provides statewide workers' compensation coverage, and is an additional resource with direct involvement in the policy-making process. Gary Franklin is the department's Medical Director, as well as a faculty member in Environmental Health. Gary has collaborated with UW faculty members and Clinical Scholars in studies of technology assessment, clinical guideline development, and cost containment strategies, using data from Washington's uniq ue state-run industrial insurance fund. The state Department of Labor and Industries also includes the Safety and Health Assessment and Research Program (SHARP), which conducts field investigations and surveillance programs aimed at identifying and corre cting occupational risk factors for musculoskeletal illnesses, lead intoxication, and other work-related diseases. Finally, two specific projects examining factors related to work disability due to back pain involve Stanley Bigos (Orthopaedics), and Rick Deyo.
A major resource in this area is the Harborview Injury Prevention and Research Center, funded by CDC. It is directed by Fred Rivara (Pediatrics), and co-directed by David Grossman (Pediatrics), both UWCSP alumni. Tom Koepsell, UWCSP Co-Director, heads the injury center's Epidemiology Section. Fred Rivara's research interests are in the epidemiology and prevention of childhood injury, including identifying dangerous consumer products. Center activities include research, surveillance , intervention, fellowship training, and policy advocacy on topics as diverse as motor vehicle collisions, gun-related deaths, bicycle and equestrian helmet use, and falls in the elderly. David Grossman is just completing a randomized trial of a violence prevention curriculum for second and third graders in Seattle Public Schools and is currently working on firearm safety programs in King County and through pediatricians and family physicians at Group Health Cooperative. Abraham Bergman (Pediatrics) provides support to trainees interested in political aspects of injury prevention.
The nationally recognized Anger Management and Domestic Violence program at Harborview Medical Center is directed by Roland Maiuro (Psychiatry), who also edits the journal Violence and Victims. The clinic conducts biopsychosocial stud ies of domestically violent men, their partners, and children exposed to violence and abuse. The program is integrated with social and health agencies in the community, creating research opportunities at both clinical and systems levels. The Sexual Assa ult Clinic is coordinated by Karil Klingbeil (School of Social Work). Nancy Sugg, Clinical Scholar Alumna (Medicine), provides additional expertise in the investigation of domestic violence and physician responses to this problem. Finally, the availabil ity of nearby British Columbia has permitted past Clinical Scholars to compare the impact of different regulatory approaches to injury prevention (e.g. gun-control laws) in demographically similar areas.
Internationally prominent experts in this area are abundant here, organized under an umbrella coordinating group called the UW Center for AIDS and STD, which receives approximately $12 million per year for biological, behavioral, and s ocial research on HIV infection. Components include the AIDS Clinical Trials Group, the Center for AIDS Research, the STD Cooperative Research Center, the International AIDS/STD Unit, AIDS Vaccine Development and Evaluation Units, and the Northwest AIDS Education and Training Center. Key faculty include King Holmes (Medicine); Joan Kreiss (Medicine and Epidemiology, alumna of UCLA Clinical Scholars Program); Ann Collier (Medicine); Connie Celum (Medicine, alumna of the UWCSP), and Walter Stamm (Medicine ). King Holmes' interests include the international epidemiology of HIV infection, co-factors for transmission, and HIV as a cause of malignancies. Joan Kreiss is especially interested in the epidemiology of HIV infection in Africa, heterosexual transmi ssion of HIV, and perinatal transmission of the virus. Key faculty in HIV therapeutic research include Ann Collier and Heather Watts (Ob/Gyn). David Eschenbach (Ob/Gyn), Denise Galloway (Pathology), and Ann Collier are key faculty for an international A IDS research consortium which includes the UW, the University of Nairobi, and the University of Manitoba. Faculty from Public Health who are involved with these activities include Noel Weiss and Hjordis Foy (Epidemiology) and Lloyd Fisher and Thomas Flem ing (Biostatistics).
The Seattle-King County Department of Public Health provides an array of important clinical education and research activities, including a gay male cohort study supported by CDC. These activities are directed by Robert Wood, Associate Professor of Medicine and AIDS Control Officer for the Health Department. The Department is also involved with public policy development regarding screening and surveillance for HIV infection.
A novel resource which recently opened to patients is the Bailey-Boushay House, a widely acclaimed long-term care facility for persons with AIDS. For many of its patients recently discharged from acute care hospitals, the Bailey-Boush ay House serves as a "step down" facility, reflecting the increasingly chronic nature of HIV infection. The medical director is Wayne McCormick, former UW Clinical Scholar and Assistant Professor of Medicine. Other community agencies with major roles in the AIDS epidemic include the Northwest AIDS Foundation (education, case management, support and advocacy), Seattle Counseling Service (individual and group counseling), and the Seattle Gay Clinic (STD screening, HIV screening and counseling).
Other faculty with AIDS-related projects include William Longstreth (UWCSP alumnus and Chief of Neurology at Harborview), with a major interest in HIV-related neuropsychiatric disease, and Paul Ramsey, Chairman of Medicine, who is studying HIV-related educational needs and strategies for primary care physicians.
A growing array of resources at the University of Washington is devoted to the problems of alcohol and drug abuse. The Alcohol and Drug Abuse Institute includes multi-disciplinary research projects on drunken driving, drug-related sex ual risk-taking, and biologic studies of addiction. Key faculty include its director, Dennis Donovan (Psychiatry), and Alan Marlatt (Psychology). Intramural small grants, mentorship, and research librarian support are available through the Institute. D ale Walker (Psychiatry) is director of an addictions treatment center based at the VA Medical Center. Among other projects, he is conducting a three-generation study of drinking problems in Native Americans, sponsored by the NIAAA. The Minority Youth Pr oject, described below, also has a major substance abuse intervention component, headed by David Hawkins (Social Work).
The specific problem of substance-abusing mothers is being addressed by at least two major projects. The Birth-To-Three project, headed by Ann Streissguth (Psychiatry) is testing interventions at the time of delivery for substance-abusing mothers who receive no prenatal care. The MOMS project is a randomized trial of three treatment approaches for addicted pregnant women, headed by Heather Watts (Ob/Gyn) and James Farrow (Adolescent Medicine).
The UWCSP also offers training opportunities in other important societal health problems. These include:
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Last modified: 1/6/97