Month: June 2015

Biostatistician’s research works toward personalized medicine

For Tania Huedo-Medina, who was born and raised in Spain, moving to Connecticut in 2006 meant leaving behind warmer weather and fresher foods, but it also meant a new opportunity to engage in high-impact research at UConn. Huedo-Medina, an assistant professor in the Department of Allied Health Sciences (AHS), is is a biostatistician who develops and applies statistical techniques that identify variables and interactions between them that make health-related treatments and prevention interventions effective in reducing disease. She hopes her results will allow medical experts to tailor prevention and treatments to individuals. Huedo-Medina has worked with dozens of health researchers at UConn and is a major resource for those on campus seeking statistical expertise on health-related issues.

In Spain, Huedo-Medina earned her BS in psychology from the University of Murcia and her MS and PhD in biostatistics from a combined program between three Madrid universities, Complutense, Autonoma and UNED. In 2006, she was appointed postdoctoral fellow at UConn’s Center for Health, Intervention, and Prevention (CHIP), and three years later she was appointed research associate. Currently, as assistant professor in AHS, Huedo-Medina is also director of the Synthesis of Individual Participant Evidence Data (SIPED) Lab, where she works with undergraduate and graduate students and collaborates with faculty in the Departments of Allied Health Sciences, Psychology, Statistics, Kinesiology, Nutritional Sciences and other health-related disciplines across the University; at the UConn Health Center; and with other universities nationally and internationally. She believes that “if you want to do research, you need to have a strong, supportive network,” something she was able to easily build at UConn. She adds that this kind of research opportunity, “I cannot imagine . . .  in Spain, unfortunately.”

With her collaborators, Huedo-Medina applies statistical methods such as meta-analysis, causality and multilevel modeling to learn about the success of health promotion interventions and treatments of chronic diseases. Meta-analysis is a methodology that combines results from different clinical studies to obtain an evidence-based and more accurate estimate of a treatment’s effectiveness and has the potential to explain health diversity. She develops causal models to analyze, for example, possible biological mediators between environmental or lifestyle characteristics and the onset of improvement of a disease. Multilevel modeling identifies correlations within related groups or over time and helps Huedo-Medina understand why treatments work similarly within the same family, the same region or other possible clusters.  She applies these methods to a variety of health-related topics, focusing on, among other chronic diseases, HIV and celiac disease.  She and her collaborators build models that identify which behavioral, environmental and/or biological differences between individuals, including genomics, metabolemics and microbiome, make treatments and/or health promotion interventions successful for some and less so for others.

Consider one of Huedo-Medina’s many research interests: the effects of the Mediterranean diet on cardiovascular disease. Huedo-Medina says that researchers “know that [the diet] is very beneficial, but for whom, and when and how much?” Many meta-analyses of the diet’s effects have been published, but they often don’t meet well-accepted standards of data credibility, don’t use appropriate statistical techniques and don’t disclose full methodological characteristics. She and other researchers conducted an “‘up-to-code” study, which revealed that, among other factors, if a Mediterranean diet is conducted as a long-term intervention, as a supervised program, including self-monitoring and social support from other participants, participants are less likely to develop a cardiovascular disease. This Mediterranean diet, Huedo-Medina points out, is “more like a lifestyle” than a short-term intervention.

Huedo-Medina believes this kind of lifestyle approach, where nor only the individual’s behavior but biology and environment for the long term are considered, is effective in preventing other autoimmune and nutrition-related problems, like celiac disease and obesity. Her future research goal is to create personalized models that predict these and related conditions in individuals. She will do this by integrating environmental, behavioral and biological data into her models. Multi-sourced data can indicate why two people who have the same health behaviors but slightly different genomes may have wildly different health-related problems. “You are not exactly the same as me. Everything that works for you (that could be healthy) may not work for me,” she says. Medical practitioners can use these models to identify the variables that make one patient different from another and design a prevention and/or treatment tailored to that patient within his or her community. This approach is called personalized medicine. Huedo-Medina believes that using statistical techniques to learn about individuals’ characteristics and environments are crucial in making personalized medicine more effective.

Huedo-Medina’s work has always been personal for her, too. Health is an important value in her family and her dream since since she was a child has been to bring to all the possibility of health. She says that as a child in Spain, she first realized what it meant to be healthy. On a child’s birthday, “the wish that you always want to ask for is to be healthy. If you are not healthy, you cannot work, you cannot fall in love, you cannot write. If you have your health, you can try to make any dream come true.” When she moved to Connecticut in 2006, these lessons didn’t stay behind. In many ways,  Huedo Medina’s dedication to her research in biostatistics and personalized medicine constantly takes her back home and reminds her of the importance of taking care of one’s health and reducing health disparities.

Members of Huedo-Medina’s lab group include undergraduate student Katie Feeney and Ali Corso and graduate students Xiaoran Li, David Dayya, Julia Shook, Nusrat Habib and Marisa Creature.

 

Letter from the Director

CHIP Director Jeff Fisher
CHIP Director Jeff Fisher

This spring, CHIP continued to play a pivotal role in fostering new interdisciplinary research collaborations for the University in the areas of health behavior and behavior change.

A second high-profile research enterprise became a center within CHIP. UConn HOPES, an interdisciplinary research collaborative involving many CHIP principal investigators and affiliates, recently received a five-year federal contract to serve as one of 13 designated Evidence-based Practice Centers (EPCs) nationwide and joined CHIP soon after the Rudd Center for Food Policy and Obesity did so. EPCs are tasked with providing healthcare providers, insurers, and policy makers comprehensive reviews of the latest research and advising them on best practices based on their scientific analyses.

New joint seed grants, detailed in a Research Highlights article below, are another way CHIP forms collaborations and shares its proven formula for securing significant external research funding with its affiliates.

To launch this year’s joint seed grant competitions with Connecticut Children’s Medical Center and UConn Health Psychiatry, CHIP hosted two networking events, where researchers each presented two slides about their expertise and then discussed possible projects with those with similar interests.

Two years ago, CHIP and the Center for Interdisciplinary Research on AIDS (CIRA) at Yale University held a similar networking event and awarded a joint seed grant of $50,000 focused on HIV/ AIDS, which led to CHIP PI Debarchana Ghosh, a UConn assistant professor of geography, winning a nearly $1 million career development award from the National Institutes of Health/ National Institute on Drug Abuse.

CHIP has funded its own annual seed grant competition with smaller awards for graduate students, junior faculty members, and senior researchers moving into new health areas for the past 14 years (this year’s winners are announced in a separate column in this newsletter). Since the inception of CHIP’s annual seed grant program and the more recent joint seed grants, approximately $34 in external funding has been returned to the University for every $1 invested in the program through new grants that used seed grant pilot data.

In addition to seed grants and related events, CHIP fosters new collaborations through its research interest groups (RIGs) focused on obesity, cancer, and eHealth/ mHealth. With 142, 109, and 118 members respectively, the groups are thriving and now creating their own three-to-five-year strategic research plans to identify overlooked problems in their health areas and to compete for funding to address those problems.

A full-time boundary spanner at CHIP also connects CHIP affiliates with similar interests, helps the RIGS recruit new members, facilitates meetings and networking events between CHIP and potential new research partners, and circulates relevant external grant opportunities. This year, in addition to the networking events, CHIP’s boundary spanner facilitated meetings with UConn’s Schools of Business, Engineering, and Dental Medicine, the Connecticut Institute for Primary Care Innovation and the Center for the Promotion of Health in the New England Workplace.

I wish you a wonderful summer and look forward to seeing you at CHIP’s Annual Meeting Thursday, Sept. 10th (where, perhaps, more new collaborations will begin).

Best,

Jeff Fisher

CHIP Director

Board of Trustees Distinguished Professor of Psychology

CHIP Awards New Joint Seed Grants with UConn Health Psychiatry, CCMC

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“People have their phones with them all the time, and we believe that their phones can be used to help them manage their own depression,” said CHIP Associate Director Deborah Cornman.

Could a Smartphone app help patients being treated for depression stick with their medications and make it to their appointments?

Is chronic pain causing overweight children to drop out of obesity treatment programs?

If you teach parents to cope better with their child’s chronic pain, will both the parents and their child be more engaged in the child’s medical care?

Three research teams involving CHIP investigators and new collaborators will delve into these questions during the next two years with the help of recently-awarded Dual Principal Investigator (PI) Joint Seed Grants for researchers and clinicians from CHIP, UConn Health Psychiatry, and Connecticut Children’s Medical Center (CCMC).

The new CHIP-UConn Health Psychiatry joint seed grant is making $50,000 available to one new research team focused on mental health and health behavior. The new CHIP-CCMC joint seed grants are providing $30,000 each to two new research teams focused on child health and health behavior. (Summaries of each project below).

All three of the new joint seed grants will merge top-notch research expertise with crucial clinical experience and access. The grants will allow the winners to prove both the feasibility of their proposed research programs and the strength of their new collaborations, all in support of future external grant applications for larger-scale trials.

“The federal grant environment is cut throat,” said CHIP Affiliate Beth Russell, an assistant professor of human development and family studies and a winner of one of the CHIP-CCMC joint seed grants. “For a junior faculty member, having a seed grant to help conduct a small pilot study, to gather preliminary findings, could mean the difference between being funded and not being funded.”

For more senior researchers, the seed grants also may help them apply their research expertise to new patient populations or health problems.

To launch the new joint seed grants, CHIP and each of its partners held networking events during the fall semester, where participants could present a two-minute Power Point slide about their expertise and then discuss possible project ideas with those with similar interests.

Two years ago, CHIP and the Center for Interdisciplinary Research on AIDS (CIRA) at Yale University held a networking event and awarded a joint seed grant of $50,000 focused on HIV/ AIDS, which led to CHIP PI Debarchana Ghosh, a UConn assistant professor of geography, winning a $949,336 career development award from the National Institutes of Health/ National Institute on Drug Abuse.

CHIP also has funded its own annual seed grant competition with smaller awards for graduate students, junior faculty members, and senior researchers moving into new health areas for the past 14 years. Since the inception of CHIP’s seed grant program, approximately $34 in external funding has been returned to the University for every $1 invested in the program through new grants that used seed grant pilot data.

“Even if participants in the networking events and seed grant competitions don’t win a seed grant initially, the collaborations formed through the process often come to fruition down the road,” said CHIP Director and Board of Trustees Distinguished Professor of Psychology Jeff Fisher.

A Mobile Health Approach to Improving Patient Adherence to Depression Treatment

CHIP Associate Director Deborah Cornman and her new collaborator Dr. Jayesh Kamath, an associate professor of psychiatry at UConn Health, will use their joint seed grant to expand upon an existing pilot text messaging intervention.

That intervention, created by Dr. Andrew Cislo, an assistant professor in residence in UConn Health’s Department of Medicine and Dr. Kamath, supported patients prescribed antidepressants by having a person manually send them text message reminders to take their medications.

Dr. Kamath and Cornman, who holds a Ph.D. in psychology and has spent the past 15 years at UConn developing and implementing behavioral health interventions, met at the CHIP-UConn Health Psychiatry networking luncheon in November and, before long, they had a plan for a new, broader pilot: they would create and test a customizable Smartphone app that would send patients reminders to take their medications and attend their appointments, but also do much more.

The app also will let patients track their moods, stress levels, and medication adherence and it will allow for regular communication between patients and their doctors. A web-based dashboard will help patients and providers to detect behavior patterns.

First, Cornman and Dr. Kamath will conduct formative research with patients and providers. Then, with the help of a UConn graduate student under the direction of Associate Professor of Computer Science and Engineering Bing Wang, they will develop a basic app and a customizable app. The research team will conduct a trial of the apps involving 60 patients using the basic app and 60 patients using the enhanced app. The trial will measure patients’ medication adherence, perceived relationship with their providers, and their depressed symptoms.

In addition, to the UConn researchers, Dr. Daren Anderson, vice president and chief quality officer of Community Health Centers, Inc., is working on the development and pilot evaluation of this app. This multidisciplinary research team will recruit trial participants from UConn Health’s Adult Psychiatric Outpatient Services and three locations of Community Health Centers Inc.

“People experiencing depression often do not feel like doing anything. Their energy level may be low, and it can be very difficult for them to make it to their appointments. The consequences of missing their appointments and non-adherence to their medications can be very serious, including suicide,” Cornman said.

Cornman has not previously focused on patients being treated for depression, but she has addressed mental health issues as potential barriers to medication adherence through other successful interventions, including the CD-ROM-based Life Windows intervention to improve HIV patients’ adherence to antiretroviral medications.

“People have their phones with them all the time, and we believe that their phones can be used to help them manage their own depression,” Cornman said. “But the app will have to be visually interesting, helpful, and simple to use. And that is why we are going to involve patients in the development of the app.”

The enhanced app would not take the place of appointments. Rather, Cornman and Dr. Kamath expect patients will be more motivated to make it to their appointments if the app helps engage them in their own care on a daily base and the app’s two-way communication feature creates a “therapeutic alliance,” or a more trusting relationship, between the patients and their doctors.

Creating PAW (Pain and Weight) Treatment

Up to 70 percent of obese children experience chronic pain, a condition that likely causes them to limit their physical activity and also may lead them to use food to try to make themselves feel better.

In CCMC’s obesity program, which helps children preparing for bariatric surgery and also offers non-surgical behavioral programs, clinicians noticed that children who reported having chronic pain when they entered treatment were dropping out of programs at a higher rate.

“The statistics are startling yet chronic pain is not routinely being assessed and treated as part of childhood obesity treatment programs,” said CHIP Affiliate Melissa Santos, a psychologist who serves as clinical director of CCMC’s obesity program and is an assistant professor of pediatrics in UConn Health’s School of Medicine.

Santos and CHIP PI Amy Gorin, a UConn associate professor of psychology who specializes in environmental and social factors contributing to obesity, will use their new joint seed grant to develop an in-depth understanding of how pain is affecting obesity treatment.

The new collaborators will identify the relationship between pain, depressed mood, eating and physical activity habits, and treatment outcomes for 10- to 18-year-olds seeking weight management services at CCMC. They will review charts of existing patients, survey new patients, and conduct focus groups with the patients and their family members.

Santos and Gorin also will ask study participants ages 14 to 18 years to use an existing mobile phone app, Track and React, developed by the Arthritis Foundation, to record their pain, other daily stressors and their eating and exercise. The researchers hope to determine if a mobile phone app could be a useful tool for addressing chronic pain within childhood obesity treatment and, if so, to determine what features a young audience would want in such an app.

With 150 youth and their families participating in their pilot, Santos and Gorin will be able to describe how pain affects weight management in a large, diverse sample.

Ultimately, the new research team would like to address pain as a potential barrier within the context of existing obesity treatment programs.

“Childhood obesity isn’t going away. We need to be creative in addressing the needs of our kids,” Santos said. “This pilot project, our new partnership, will address an unmet need.”

Parents as Coping Coaches

 For some children receiving outpatient services through CCMC’s pain relief program, such as those with Sickle Cell Disease, there is no such thing as a day completely free of pain.

“We need to teach parents how to deal with that, to help them with their own fears, anxiety, and sadness, so they can better support their children and help them engage in their care,” said Russell, who specializes in parenting and helping parents support their children, whether they are overcoming addiction or dealing with chronic pain.

“We’re finding to have optimal impact on children’s treatment outcomes, you have to engage their parents. You have to build a strong network and teach the whole family coping skills,” she said.

With the help of their joint seed grant, Russell and her new collaborator CHIP Affiliate Jessica Guite, a CCMC pediatric psychologist specializing in child and adolescent behavioral pain management, will refine and pilot a group intervention for parents of adolescents with chronic pain designed to decrease parents’ caregiver burden and stress and increase protective parenting behaviors and distress tolerance.

The study will include 32 primary caregivers of new CCMC chronic pain patients ages 12 to 18. The research team will lead three weekly, one-hour long group sessions for the parents (in four smaller groups) to teach about chronic pain, adolescent development, parent stress management, distress tolerance, and problem-solving skills.

Parents receiving the intervention will complete pre- and post-surveys, keep skill-practicing diaries, and have their results compared to those of a control group. The children of active and control participants also will complete pre- and post-surveys, so the research team can determine if the parent intervention is helping the children’s perception of their pain burden, coping skills, and treatment outcomes.

“It’s unusual for a hospital to treat the indirect patients, the parents,” Russell said. “We’re trying to help an overlooked, untreated patient population.”

Russell said she knew of CCMC’s pain treatment program and outpatient clinic, but didn’t meet its director, CHIP Affiliate Dr. William Zempsky, and Guite until the CHIP-CCMC networking event in October.

“CCMC is a very attractive partner for this work, because it has one of the state’s leading pediatric pain centers,” she said. “This will be a novel patient population for UConn.”

CHIP PI Has Been Elected to The Connecticut Academy of Science and Engineering

UConn Board of Trustees Distinguished Professor of Kinesiology Linda Pescatello recently was welcomed into a select group of the state’s top scientists.

Board of Trustees Distinguished Professor of Kinesiology Linda Pescatello is one of five UConn faculty members recently inducted into The Connecticut Academy of Science and Engineering.
Board of Trustees Distinguished Professor of Kinesiology Linda Pescatello is one of five UConn faculty members recently inducted into The Connecticut Academy of Science and Engineering.

Pescatello, a CHIP principal investigator (PI), is among five UConn faculty members and 23 individuals statewide to be elected to The Connecticut Academy of Science and Engineering this year. The new members were recognized at CASE’s annual meeting and dinner in Cromwell on Tuesday, May 19.

CASE’s main objectives are to provide information and advice on science and technology to the government, industry and people of Connecticut and to encourage youth interest in science, engineering, and technology. The non-profit institution, which is patterned after The National Academy of Sciences, was established in 1976 by the Connecticut General Assembly. Its membership is capped at 400 individuals.

UConn Provost and Executive Vice President for Academic Affairs Mun Choi nominated Pescatello for the honor.

“Dr. Pescatello has an international reputation in health promotion, particularly in the areas of the blood pressure response to exercise, especially post-exercise hypotension, and exercise genomics,” he wrote on her behalf. “Dr. Pescatello has been funded by numerous prestigious organizations to support her research in these areas, is prolific and highly cited, and has received highly prestigious awards for her research.”

Provost Choi noted that Pescatello was the first scientist to demonstrate that blood pressure is lower on the days people exercise than on the days they do not exercise. She documented this effect through the innovative use of ambulatory blood pressure monitoring.

“It humbles me to become a member of CASE when one considers the exceptional caliber and contributions of this elite scientific community within the state and beyond,” Pescatello said.

Pescatello holds three degrees from UConn and has taught at the University since 1998. She has joint appointments in the departments of allied health sciences, nutritional sciences, physiology and neurobiology, and community medicine and health care. She also has consultant privileges in the Division of Cardiology at Hartford Hospital.

The lifelong athlete’s other research interests include the influence of exercise on cancer survivors, the influence of statins on blood pressure and habitual physical activity, and the use of yoga to help manage stress and reduce substance use among college veterans and among methadone users.

Pescatello has published more than 125 scientific papers and reviews, three books (with a fourth in press), and numerous book chapters. She also has won hundreds of thousands of dollars’ worth of external research grants and has advised and mentored dozens of students.

She also recently served as the senior editor of the latest edition of the American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription, an international handbook used in medicine, rehabilitation, and fitness programs.

The other UConn faculty members elected to CASE with Pescatello are: Ki Chon, professor and department head of biomedical engineering; James Rusling, professor of chemistry at UConn and professor of cell biology at UConn Health; Alexander Shvartsman, professor and department head of computer science and engineering; and Mark (Mohammad) Tehranipoor, professor of electrical and computer engineering.