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In The Next Issue News from the Center for Healthy Communities Summer 2009 Feature on Vision Loss & Prevention Update on PRC Renewal Research Updates Up Close with Jessica Kennedy Di re ctor... ...... ...... ...Tho ma s Be c ker, MD , PhD As so ci ate Di re ctor... ...... Wi l l i am La mbert, PhD Progra m Manager.... ...... ..Ni chol e Hi l debrand t What’s New at the Center? Eval uator...... ...... ...... ... ........ ...Tosha Zaba ck Successful 2009 Summer Institute Resea rch A ssi stant ...... . ....... Je s si ca Kenned y Contributed by Tosha Zaback Do you want to read about something specific or have any suggestions about Re s e a rc h Ad v is o ry Bo a rd the newsletter? Email Grazia Cunningham at [email protected] Steve Man sberger, MD, MP H Wi l l i am Marti n, PhD Vol 1. Issue 4 In This Issue Each summer, the Northwest Portland Area Indian Health Board (NPAIHB), in collaboration with the Center for Healthy Communities at Oregon Health & Science University, offers an intensive three-week Joe Fi n kbonner, RPh, M HA research training for American Indian and Alaska Native (AI/AN) health Kathr yn Braun , Dr PH professionals. The overall goal of the training is to develop a cadre of Denni s M cCa rt y, PhD well-trained AI/AN investigators who will be able to increase their Ri cha rd Leman , MD research skills and assume more central roles in health-related studies. Jodi Lapi du s, Ph D Each week, trainees choose from a varied curriculum designed to JoAnn Tsar k, MP H improve research, program development, implementation, and evaluation skills. In addition to the training, students can receive long-term support for research projects, manuscripts, and grant applications if they request assistance. Page 4 Focus on Research Jolene Page 6 Special Feature on Hearing Loss & Prevention Page 11 Up Close with Nichole Hildebrandt Page 12 In the Next Issue Oregon Prevention Research Center Updates on PRC Renewal 3181 SW Sam Jackson Park Rd, CB669 Portland, Oregon 97239 Dr. Tom Becker teaching Research Design & Grant Development 3181 SW Sam Jackson Park Rd, CB669 Portland, Oregon 97239 Phone 503.494.1126 Fax 503.494.7536 www.oregonprc.org [email protected] What’s New at the Center? (continued) The 2009 Summer Research Training Institute (SI) was held June 15- July 7. In total, 98 students participated in the 2009 Summer Institute including 12 Indian Health Service Injury Prevention Fellows and12 Northwest Indian College students enrolled in a special course titled, Encounters in Science. Up Close Up Close with Nichole Hildebrandt Program Manager for the Oregon Prevention Research Center, Native Researcher’s Cancer Control Training Program, and Spirit of Eagles (M.A.Y.O) training program Under contract from Indian Health Service, the NPAIHB and the Center for Healthy Communities Nichole is an enrolled member of the collaborated to provide a series of research-related short courses to interested AI/AN trainees from Shoshone-Bannock Tribes and grew up on the across the country free of charge to AI/AN students. Fort Hall Indian Reservation. After High School, she moved to Portland, Oregon and The Summer Institute training program is broad enough to meet the needs and individual goals of attended college full-time while working full-time trainees from diverse backgrounds. SI trainees selected courses or modules that they needed or for a large insurance company. She graduated desired for professional advancement. Participants included AI/AN post-doctoral, graduate, and from Portland State University with a BS in undergraduate students and AI/AN health researchers and professionals interested in building new Business Management and Business research skills and advancing their careers. In addition, three AI/AN summer interns were required to Marketing. Nichole worked for the same take a core set of Summer Institute courses and complete a capstone research project under the insurance company for ten years and decided mentorship of one of our faculty members. to follow what her heart was telling her: to leave an Account Executive position to become a Leadership Fellow at the Northwest Portland Nichole with her two daughters Area Indian Health Board (NPAIHB). She believes this career change has been the best decision she has made. After serving as a Leadership Fellow for over a year, she was promoted to a Project Director for the Western Tobacco Prevention Project (WTPP). She was instrumental in the CDC American Indian Adult Tobacco Survey pilot study, revision of the Tribal Tobacco Policy Workbook, creation of the Northwest Tribal Tobacco Resource Guidebook, development of a WTPP website, and launch of a “Keep tobacco sacred” media campaign for the Washington state tribes. During her last year at the NPAIHB, the project received a one year grant from the Robert Wood Johnson Foundation that assisted fourteen tribes to establish and enhance tobacco related policies. She decided to take a year off of work to stay at home to care for Sydney, her newborn baby at that time, and her older daughter Lauren. She has been working in the field of tribal health promotion and disease prevention for over eight years. She joined the PRC team in July 2008, and is currently the Program Manager for the PRC (Center for Healthy Communities). In addition to that role, she also works as a consultant to the Northwest Portland Area Indian Health Board. Her desire is to continue working on projects that will have a positive impact on the health of American Indian people. When she’s not working, she enjoys running—short distances as th she chases her two young daughters around and long distances too! She’s hoping to run her 7 Chevonne Todicheeney from Utah with media expert, Dr. Larry Wallack, a Summer Institute instructor marathon by the end of this year. Nichole is a fancy shawl dancer, enjoys attending pow-wows and is relearning how to do beadwork and sew (from her grandmother). page 2 page 11 Feature on Hearing Loss & Prevention (continued) Disease, Heredity, Medications Genetic disorders, viral/bacterial infections such as cytomegalovirus (CMV), tumors and certain diseases What’s New at the Center? (continued) Courses were taught by Native and non-Native experts in the field and included: • Epidemiology • Community-Based Participatory Research • Data Into Action: Outbreak Response Epidemiology • Data Management and Analysis Using STATA • Questionnaire Design and Data Management • Conducting Focus Groups • Cost-Benefit Analysis identify certain disorders that lead to hearing loss. Required in many states, newborn screening is also a • Data Analysis with SAS great way to identify babies with possible hearing loss. If possible hearing loss is detected, early intervention • Tribal Health Policy can be started promptly. Finally, you should be closely monitored if you are prescribed ototoxic drugs. • Media Advocacy in Public Health • Research Design and Grant Development The natural aging process causes hearing loss as well. Beginning after the • Program Evaluation age of 20, this type of hearing loss usually doesn’t get noticed until the ages • Data Linkages 55 to 65. Gradual hearing loss is the third most common long-term health • Human Subjects Protection such as sickle cell anemia or otosclerosis – a hardening of the middle ear - can cause hearing loss. Drugs resulting in hearing loss are called ototoxic and include: aminoglycoside antibiotics (such as streptomycin, neomycin, kanamycin); salicylates (aspirin) in large quantities, loop diuretics (lasix, ethacrynic acid); and drugs used in chemotherapy (cisplatin, carboplatin, nitrogen mustard). Prevention Early detection is important for preventing or managing hearing loss. Prenatal and well-baby care can Presbycusis problem in older Americans, affecting up to 40% of people age 65+ and 80% of people 85+. Evaluation activities for the Summer Institute have already begun and will continue over the next six months. We will conduct evaluations of the Summer Institute on three levels: Prevention You can’t stop the aging process, but you can be aware of symptoms of development and delivery of the training curriculum and related post-course activities, hearing loss and get see a professional if checked should you experience course evaluations, and utility of the training program over time. We are pleased to report any changes in hearing or symptoms of hearing loss. that preliminary evaluation data indicate that we have had another successful Summer Institute and we hope to continue to offer the Institute for many years to come. Tinnitus Known as ringing in the ears, tinnitus affects as many as 50 million Americans. Tinnitus is not itself a disease, but can lead to hearing loss and severely interfere with a person’s quality of life. Loud noises, middle or inner ear infections, tumors on the hearing nerve, prolonged use of ototoxic medications, and wax on the eardrum can all cause tinnitus. Visit the OHSU Tinnitus Clinic website at http://www.ohsu.edu/ohrc/tinnitusclinic/ to learn more. Prevention Avoid exposure to loud sounds and wearing ear protection when operating lawn mowers, chain saws, power tools, guns or attending rock concerts or other activities with loud noises. Indisputably, hearing is important to everyone’s quality of life. Knowing the signs and symptoms of hearing loss can lead to early diagnoses and more effective interventions. Understanding the causes of hearing loss can help you preserve your hearing now by avoiding activities that cause damage or protecting your ears while participating in certain activities. For general information on deafness and other hearing disorders, visit the National Institute on Deafness and Other Communication Disorders at http://www.nidcd.nih.gov/. To find an audiologist, visit the American Speech-Language-Hearing Association at www.asha.org. Sarah Hicks, PhD teaching Tribal Health Policy Course with Jim Roberts, (NPAIHB) page 10 page 3 Focus on Research - Jolene Feature on Hearing Loss & Prevention (continued) JOLENE: Brainchild of Former CROET Summer Intern a Big Hit Worldwide by Fred Berman, DVM – Director of CROET Toxicology Information Center Warning signs that you are being exposed to harmful levels of noise 1. You have to raise your voice to be heard. 2. You have difficulty understanding someone who is arm’s length away. 3. Speech sounds are muffled or dull after noise exposure. 4. You have pain or ringing in your ears after noise exposure. Prevention Following these simple steps from will save your hearing: Walk Away – avoid or limit exposure to noise Turn it Down – lower the volume and buy quiet appliances, equipment or toys Protect your Ears – wear ear plugs and/or earmuffs in noisy settings To find out what noises are safe, visit the Dangerous Decibels exhibit online at www.dangerousdecibels.org. Genna with Jolene Physical Trauma When Genna Martin first conceived the idea of measuring sound levels emanating from teens’ IPod ear Injuries to the head or ear structures can result in hearing loss and can be temporary or permanent. buds, few could have imagined that her invention would become so popular — and useful as a research Fractures of the temporal bone, puncture wounds to the eardrum by foreign objects, and sudden and teaching tool. Genna, a recent graduate from Boston University majoring in photojournalism, created changes in air pressure are just some examples. Jolene during a 2006 CROET summer research fellowship under the mentorship of Bill Lambert, and her father Billy Martin. Genna constructed Jolene using a fashion mannequin and a sound level meter wired to a silicon ear. To operate Jolene, the user is first asked to adjust the sound of his/her personal stereo system to the level of normal use, then the headphones or ear buds are placed on Jolene’s “ears” to Prevention Helmets and other safety equipment (seat belts, car seats, high chairs, and bike helmets) can protect the head and ears. Also, avoid placing objects in the ears – even cotton swabs! measure the sound pressure in decibels that the user’s ears are experiencing. During the summer of 2007, Jolene was put to the test during the Body World exhibit at OMSI. Genna stationed Jolene in an area of the museum just outside the main exhibit, where hundreds of teens could learn the actual sound levels they are subjecting their ears to. Genna’s research revealed that 16% of the 14 to 18 year olds who participated listened to their personal stereo systems at levels higher than what is determined to be safe by NIOSH on a daily basis. Jolene is now part of the education and research projects of Dangerous Decibels, a public health partnership of Oregon Museum of Science and Industry (OMSI) and OHSU’s Oregon Hearing Research Center dedicated to the prevention of noise-induced hearing loss. She makes appearances at schools and universities, scientific meetings, health fairs, and many other public events. Genna has coauthored and/or presented six publications and presentations about Jolene at national and international conferences. page 4 page 9 Feature on Hearing Loss & Prevention (continued) Focus on Research – Jolene (continued) Prevalence of Hearing Loss There is great variability with respect to the nature of hearing loss. It can occur suddenly or gradually and, depending on the cause, may be temporary, permanent, mild or severe. Gradual hearing loss affects people of all ages and is the third most common chronic health problem in older Americans (www.asha.org). Over the past 30 years, the number of Americans with hearing loss has doubled (speech and pathology assn) from 13.2 million in 1971 to 24.2 million in 2003. According to the American Speech-Language-Hearing Association, roughly 28 million Americans have some degree of hearing loss. Sources of Hearing Loss Noise-Induced: Noise-Induced Hearing Loss (NIHL) usually occurs over a period of time from repeated Genna demonstrating how Jolene works exposure to loud sounds, but it can also occur from one exposure to an extremely loud noise. Of the 40 million Americans suffering from hearing loss, 10 million have NIHL. NIHL can occur at any age with the Jolene became so popular that the National Hearing Conservation Association provided Genna with a grant to percentage of those affected rising. According to one study, the percentage of second graders with hearing produce the Jolene Cookbook: a detailed instruction manual on how to make your own Jolene. The Jolene th loss has increased 2.8 times; hearing loss in 8 graders has risen over 4 times in just 10 years (Montgomery Cookbook is available on the Dangerous Decibels website. To date, the Cookbook has been downloaded by and Fujukawa 1992). individuals in 47 US States and 14 different countries. How loud is too loud? Jolene now has siblings everywhere; all fighting against noise-induced hearing loss and tinnitus. You can see many With prolonged exposure to loud sounds, hair cells in the ear may get damaged or broken. If enough hair of them in the Jolene Family Album on the Dangerous Decibels website. Jolene even has her own Facebook page. cells are damaged, hearing loss results. Sound pressure is measured in decibels (dB). The average person can hear sounds down to about 0 dB. Such quiet sounds will not cause damage to hearing even over For more information about Jolene, visit the Dangerous Decibels website at: http://www.dangerousdecibels.org and prolonged exposure. Sounds reaching 85 dB or higher, however, can cause permanent damage to your go to the section on Outreach and Educator Resources. hearing, especially if listened to for a long time. Both recreational and industrial sounds can damage hearing. Examples include personal headphones, concerts, musical instruments, jet skis, snowmobiles, motorcycles, fireworks, firearms, lawn equipment, power tools, sirens, as well as equipment used in manufacturing, construction, farming, mining, and airline industries. page 8 page 5 Feature on Hearing Loss & Prevention What Do You Know About Hearing Loss? Feature on Hearing Loss & Prevention (continued) Do You Have a Hearing Problem? Imagine being unable to have a conversation with a loved one because you couldn’t hear them, or being unable to experience the sounds of an early spring morning. What if your children were suffering academically because they couldn’t hear the teacher? Perhaps you or someone you know may already be experiencing some degree of hearing loss. Hearing is Take this simple quiz to determine if you should have your hearing evaluated by a medical professional: Do you have a problem hearing over the telephone? Yes No important for building and maintaining relationships, as well as experiencing the world around us. It is the cornerstone for education and affects both emotional and physical well-being. Today, advancements in diagnosing (e.g. screening newborns) and treating hearing loss (e.g. cochlear implants) have substantially improved the quality of life of those living with hearing Do you have trouble following the conversation when two or more people are talking at the same time? Yes No Do people complain that you turn the TV volume up too high? deficiencies. For certain types of hearing loss, such as noise-induced hearing loss, prevention is essential for preserving a high quality of hearing. Keep reading to learn more! Yes No Do you have to strain to understand conversation? How We Hear Yes No Do you have trouble hearing in a noisy background? Yes No Hearing results when sound waves in the air produce electrical signals that send nerve impulses to the brain. There, they are interpreted as sound. The ear is divided into three parts: the outer, middle and inner ear. Sound waves enter through the outer ear and reach the middle ear. Here, the ear drum vibrates. These vibrations pass through three tiny bones (ossicles) in the middle Do you find yourself asking people to repeat themselves? Yes No Do many people you talk to seem to mumble? ear. These are called the malleus (hammer), incus (anvil) and stapes (stirrup). The ear drum and ossicles carry amplified vibrations to the inner ear. The vibrations move through fluid in the cochlea which contains hair cells. This fluid moves the top portion of the hair cells which lead to the production of nerve impulses that are carried to the brain where they are interpreted as sound. Yes No Do you misunderstand what others are saying and respond inappropriately? Yes No Do you have trouble understanding women and children? Yes No Do people get annoyed because you misunderstand what they say? Yes No If you have answered yes to three or more of these questions, visit an Ear, Nose and Throat doctor (or ENT) or an audiologist to check your hearing. Source: NIH, National Institutes on Deafness and other Communication Disorders Source: University of Washington Virginia Merrill Bloedel Hearing Research Center page 6 page 7