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BRINGING BENEFITS OF TRANSLATIONAL RESEARCH TO THE COMMUNITY

BRINGING BENEFITS OF TRANSLATIONAL RESEARCH TO THE COMMUNITY. Michael J. Klag, MD, MPH Dean Johns Hopkins Bloomberg School of Public Health. OUTLINE. Definitions Origins The institution The community Success stories. DEFINITIONS. Yager, 2008. ORIGINS .

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BRINGING BENEFITS OF TRANSLATIONAL RESEARCH TO THE COMMUNITY

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  1. BRINGING BENEFITS OF TRANSLATIONAL RESEARCH TO THE COMMUNITY Michael J. Klag, MD, MPH Dean Johns Hopkins Bloomberg School of Public Health

  2. OUTLINE • Definitions • Origins • The institution • The community • Success stories

  3. DEFINITIONS Yager, 2008

  4. ORIGINS “In all your arrangements in relation to this hospital, you will bear constantly in mind that it is my wish and purpose that the institution should ultimately form a part of the medical school of that university for which I have made ample provision by my will.” Johns Hopkins, “Letter of Instruction to Trustees” March 10th, 1873

  5. ORIGINS “We may form an idea of what this hospital may become by the study of a like institution in London. About a century and a half before Johns Hopkins died, the days of Thomas Guy were ended.... Finally, if this hospital becomes the seat of knowledge in all that pertains to the nature of disease, its treatment, its prevention and its cure, it will of necessity be a constant guide to the people of the city and the State in which it is placed; it will promote the general health of its inhabitants. There is an altar in one of the churches of Messina, which bears an inscription to Aesculapius and Hygiea, the God of Medicine and the Goddess of Health; and their statues are found together on the façade of Guy’s Hospital. May they always be associated in Baltimore.” Charity and Knowledge, Daniel Coit Gilman, 1889

  6. ORIGINS • Population based • International scope • Focus on research (hygiene) • Mentorship and teaching • “Investigation has thus been among us the duty of every leading professor, and he has been the guide and inspirer of fellows and pupils, whose work may not bear his name, but whose results are truly products of the inspiration and guidance which he has freely bestowed.” • Daniel Coit Gilman First dean of the Schools of Medicine and of Hygiene and Public Health

  7. GRANTS AND CONTRACT EXPENDITURES, SCHOOLS OF PUBLIC HEALTH, 2007

  8. CURRENT RESEARCH SITES © 2006, Johns Hopkins University. All rights reserved.

  9. EAST BALTIMORE

  10. EAST BALTIMORE: SOBERING STATISTICS • Poverty The median household income is half that of the city as a whole. • Violence The neighborhood’s crime rate is double that of the rest of Baltimore City. • School Failure Less than 30% fifth-through-eighth graders score at the proficient level or above in reading and math. Fewer than 3 out of 5 graduate from high school. • Life Expectancy At a little more than 68 years, life expectancy is about 10 years shorter than it is in Baltimore County.

  11. LIFE EXPECTANCY IN TWO BALTIMORE COMMUNITIES, 2008

  12. TUSKEGEE STUDY OF UNTREATED SYPHILIS IN NEGRO MALES

  13. URBAN HEALTH INSTITUTE • University wide; previously headquartered at Homewood campus, now BSPH, funded by divisions (schools) • Brings together faculty, students and community organizations to improve health • Headed by adolescent health specialist • Developed integrated health, education and human service initiative with 5 schools as well as an Early Childhood Development Initiative • Community-Faith-Hopkins Forums: establishing a geographically defined area in East Baltimore in which Johns Hopkins will be the primary care provider • Maryland Institute College of Art (MICA): Developed course on the role of design in health communication; plans for a community arts and health center

  14. COMMUNITY HEALTH WORKERS 30 CHW’s conductscreenings, provide lifestyle and health coaching, coordinate care of more than 7,000 residents.

  15. CENTER FOR INJURY RESEARCH AND POLICY One of the first centers for excellence in injury research, funded by CDC in 1987 Home to 42 Core and Adjunct faculty 10 injury courses and an annual summer institute Multi-disciplinary research spans prevention, acute care, and rehabilitation unintentional and intentional injury foundational studies through translation and dissemination research

  16. BURDEN OF CHILDHOOD INJURY IN BALTIMORE CITY • Unintentional injury is the leading cause of death for ages 1-14 • 38% due to fires • 37% due to motor vehicles • Baltimore children ages 1-17 are four timesas likely to die from residential fires as children nationwide • In a single year, nearly 20,000 children ages 1-14 treated in EDs or hospitalized because of injury • Children younger than 5 in Medicaid managed care experience injury at rates nearly twice the national average Injuries...represent a critical public health problem in Baltimore... Dr. Joshua M. Sharfstein Commissioner of Health

  17. CARES (Children ARE Safe) Mobile Safety Center--Disseminating Safety PARTNERSHIP: Baltimore City Fire Department ; Johns Hopkins Center for Injury Research and Policy;Johns Hopkins Children’s Safety Center ; Johns Hopkins Pediatric Trauma Service; East Baltimore Medical Center, Johns Hopkins Health Care; Maryland Institute College of Art; Maryland Science Center FUNDERS:FEMA, BP, Annie E. Casey Foundation, Weinberg Foundation, CareFirst BlueCross BlueShield RESEARCH GRANTS: Centers for Disease Control, NCIPC; National Institutes of Health, NICHD

  18. Scald burns, choking, stair and bath safety exhibits Baltimore City Fire Chief Clack and Public Health Educator Parsons with a group of visitors

  19. BALTIMORE CITY CANCER PLAN AT JOHNS HOPKINS Community outreach and education Partnership of Cancer Center, BSPH, and health system Prostate and colorectal cancer screening Diagnostic evaluation and treatment for eligible participants, at no cost Ongoing input of Baltimore City Community Health Coalition, BCHD and Sinai Hospital

  20. PROSTATE CANCER IN BALTIMORE CITYAge-Adjusted Incidence (1999-2002)and Mortality Rates (1999-2002 vs. 2003-2005) by Race 217.9 Age-adjusted rate per 100,000 population 50.3 28.4 23.3 • 32% decline in prostate cancer mortality among African Americans • 41% reduction in the difference between AA & CA prostate cancer mortality rate www.fha.state.md.us/cancer/pdf/ann_can_rpt_crf/Prostate_Cancer_2006.pdf; www.wonder.cdc.gov, 5/01/2008

  21. All Cancer Mortality Rank Among States and D.C. 2nd 4th 22nd 1985 1995 2003 Maryland is no longer in the top ten states with the highest cancer mortality rates.

  22. CANCER DEATHS AVERTED IN MARYLAND  2,220 cancer deaths averted each year 430 880 375 360

  23. proteasome degradation Ub • CHEMOPROTECTIVE • INDUCERS • oltipraz • sulforaphane • triterpenoids Ub Ub Ub Nrf2 Cell Survival SH SH Keap1 Cul3 Nrf2 Roc1 Ub KINASES E2 Importin TARGET GENE FUNCTIONS • electrophile detoxication • free radical metabolism • glutathione homeostatsis • generation of reducing equivalents • solute transport • proteasome function • inhibition of inflammation P CRM1 CBP/p300 cytoplasm sMaf Nrf2 nucleus ARE gene transcription Dinkova-Kostova, Holtzclaw and Kensler, Chem. Res. Toxicol. 2005.

  24. Mortality from Liver Cancer by Township: Jiangsu Province < 1 per 105/yr 25-fold change in HCC rate in 200 km > 50 per 105/yr Qidong • Median age of liver cancer • death is 45-50 years • Median survival from Dx • is 6 months Shanghai

  25. State District School Classroom Student CeaseFireThe Campaign to STOP the Shooting

  26. CENTER FOR PREVENTION OF YOUTH VIOLENCE CeaseFire: The Campaign to STOP the Shooting School Level • 467 PBIS Teams (one per school) - Team leaders (one per school) - Behavior Support Coaches (250+) District Level (24 local school districts) • Point of contact in every school district in Maryland State Level • State Leadership Team – meets monthly - Maryland State Department of Education (MSDE) - Sheppard Pratt Health System - Johns Hopkins Bloomberg School of Pubic Health - 24 Local school districts - Department of Juvenile Services, Mental Health Administration • Management Team – meets bi-weekly • Advisory Group

  27. Support for using guns to resolve disputes 41% lower where Safe Streets in place 5 months No homicides in McElderry Park in 17+ months versus 4 expected Some evidence of homicide reductions in bordering posts www.jhsph.edu/preventyouthviolence SAFE STREETS: INTERIM EVALUATION

  28. TRANSLATING RESEARCH TO THE COMMUNITY • Understand past history in order to move forward • Academic health care centers are complex for outsiders to navigate—build bridges and lines of communication • Efforts must be perceived as providing community benefit • Faculty must derive academic product and credit toward career advancement (publications/grants) • Need to publicize efforts and especially successes

  29. © 2008, Johns Hopkins University. All rights reserved.

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