NorTex 2013 Fall Newsletter

September 22, 2013 • NorTex

NorTex 2013 Fall Newsletter


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NorTex and the UNT Health Science Center said goodbye to Dr. Roberto Cardarelli in August 2013. Dr. Cardarelli, the Founder and former Director of NorTex, accepted a position as Chief of Community Medicine at the University of Kentucky (UK) College Of Medicine where he will lead the Division of Community Medicine, oversee several family medicine residencies associated with three hospital partners, and practice/teach at the UK College of Medicine. He will also lead the Kentucky Ambulatory Network, a 300 member PBRN established in the year 2000 with AHRQ infrastructure funding. In his new role, Dr. Cardarelli will continue to work on cross-PBRN research with NorTex. We thank Dr. Cardarelli for his founding direction and contributions to the development and leadership of NorTex! The administration of NorTex will continue under the leadership of Dr. Kimberly Fulda, Associate  Director of NorTex. Dr. Fulda is an Assistant Professor in the Department of Family Medicine in TCOM and a core member of the Texas Prevention Institute (TPI) at the UNT Health Science Center and has served as the Associate Director of NorTex since 2007. Dr. Fulda holds a Doctor of Public Health in Clinical Research and a Master of Public Health in Epidemiology and has expertise in research design and analysis. Dr. Fulda is dedicated to the continued administrative support of NorTex members and research. Please contact Dr. Fulda at for additional information.


The North Texas Healthy Heart Study was conducted as part of the Texas Center of Health Disparities, and close to 600 participants were recruited from NorTex clinics. This story, however is to emphasize how collaboration benefits not only investigators and the scientific community, but also the development of new knowledge outside of the initial scope of the project. The project itself began as a collaborative effort between faculty in the UNTHSC Texas College of Osteopathic Medicine, School of Public Health, Graduate School of Biomedical Sciences, JPS Health Systems, and 12 NorTex member clinics. Data that were collected and specimens that were stored also resulted in resources for students, faculty, and collaborators. Students utilized data to conduct research related to stress, DNA methylation, sleep disorders, APO B, and others. Faculty at Tufts University and our team published research on DNA methylation and diet and exercise. Currently, collaborations within UNTHSC are utilizing frozen serum to research testosterone levels and men’s health. These are only a few mere examples. NorTex and its members/faculty have demonstrated an unselfish spirit to collaborate and share data to generate knowledge that will ultimately improve the health of our communities.



Factors Associated with Being at Risk for Type 2 Diabetes among Mexican American and Mexican Children

Kim Fulda, DrPH is leading a group of investigators at the UNT Health Science Center, in an international collaboration with Dr. Roxana Valdés-Ramos at the Universidad Autónoma del Estado de Mexico (UAEM) in Toluca with the goal of understanding factors associated with being at risk for type 2 diabetes in children of Mexican descent living in Fort Worth, Texas and Toluca, Mexico. Fall 2013 3The study attempts to assess and compare the prevalence of psychosocial, familial, and environmental risk factors for type 2 diabetes in children 10 – 14 years of age. Patients are screened for eligibility and then scheduled for an appointment. Both the child and parent or guardian must agree to participate in the study, which includes a two-hour evaluation session during which researchers collect blood pressure, height, weight, waist and hip circumference, body mass indices, glucose level, a lipid profle and liver function test. Researchers also collect information about family structure, smoking status, body changes, diet and indications of depression, which often accompany obesity in adults. A quick neck inspection is used to check for Acanthosis Nigricans, a dark, velvety discoloration of the skin associated with obesity and type 2 diabetes. Participants receive compensation at the study visit and their laboratory results by postal mail within two weeks of participating in the study. To date, 117 participants have been enrolled at the Fort Worth site and 150 at the Toluca site.


The Rural Texas Physician Cancer Screening Program in High Risk Cancer Cluster Regions

Roberto Cardarelli, DO, MPH led a study to develop an educational evidence-based DVD on cancer screening guidelines with the goal to impact cancer-screening behavior of rural Texas physicians practicing in cluster regions with high cancer mortality rates. A total of 2,405 DVDs were delivered to physicians practicing in regions of Texas characterized by high clusters of cancer mortality. Among the physicians who completed the DVD intervention and the post-test portion of the study, analysis showed significant changes in skin cancer screening and ovarian cancer screening beliefs. Overall, a total of 218 and 339 charts were reviewed for adequacy of breast and colorectal cancer screening, respectively. 33.5% of those who were not adequately screened for breast cancer prior to when the physician completed the DVD course were offered or ordered the appropriate screening in the year after the physician completed the DVD. For colorectal cancer, 22.4% of those who were not adequately screened prior to when the physician completed the DVD course were offered or ordered the appropriate screening in the year after the physician completed the DVD. In summary, appropriately delivered continuing medical education material on cancer screening in DVD format has a significant impact on cancer screening beliefs and can improve adequacy of cancer screening among physicians practicing in high-risk cancer cluster regions.


The Alzheimer’s Association encourages people with concerns about memory loss to seek medical help, knowing that a diagnosis of Alzheimer’s disease or other dementia is just the Fall 2013 4beginning of a story that will unfold differently for every individual. Often, doctors do not have adequate time to address the many questions and concerns that typically arise with a diagnosis of Alzheimer’s disease or other dementia. For 30 years, the Alzheimer’s Association has been a trusted resource for reliable information, education and support at every stage of the disease. During this time, the North Central Texas Chapter’s care coordination efforts have ensured that patients and their family members locally are realizing the best outcomes. It takes time to talk about Alzheimer’s and to direct patients and their families toward the kinds of education, support and services they need. The Alzheimer’s Association has the time and the expertise to assist when needed through the 24/7 Helpline: 1-800-272-3900. To find out how the Alzheimer’s Association services can be a resource for you and your patients, please call Susanna Luk-Jones, Director of Programs and Services, at 817-336-4949. For general information, contact the Alzheimer’s Association through our 24/7 Helpline: 1-800-272-3900 or our website:


The Appalachian Osteopathic Postgraduate Training Institute Consortium (A-OPTIC) is a consortium of postgraduate medical residency programs, hospitals, and colleges of osteopathic medicine. The Kentucky College of Osteopathic Medicine (KYCOM) is the founding academic member of A-OPTIC. The other current academic members of A-OPTIC are Lincoln Memorial University DeBusk College of Osteopathic Medicine in Harrogate, Tenn.; Pacific Northwest University of Health Sciences College of Osteopathic Medicine in Yakima, Wash.; and William Carey University College of Osteopathic Medicine in Hattiesburg, Miss. In 2009, leaders of NorTex initiated an educational teleconference presentation with A-OPTIC leadership about Practice-Based Research Networks (PBRNs). Since then, NorTex has been close partners with A-OPTIC as they started the journey of developing the A-OPTIC PBRN, a national PBRN involving four regional networks with their academic and hospital partners. Their focus and strategy is to leverage their network of residency sites and collaborations in conducting community-engaged research in rural America. They are now a registered PBRN with the Agency for Healthcare Research and Quality and the Federation of PBRNs. Their commitment to conduct collaborative and meaningful research is a refection of their perseverance over the years. NorTex has been thrilled to assist in its development through extending our expertise, resources and materials. We hope cross PBRN research will be the new level of collaboration!

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Richard Young, MD, is a Fort Worth native and a practicing family physician in north Texas. Dr. Young serves as the Director of Research and Co-Associate Program Director for the JPS Family Medicine Residency Program and has been active in a wide array of research activities. His research has ranged from prenatal care and childhood obesity to chronic disease outcomes and falls among the elderly.Fall 2013 7Currently, Dr. Young’s research interests have been aimed at the policies and costs associated with providing healthcare. His recent article titled “What Could Family Income Be If Health Insurance Were More Affordable?” (Fam Med 2012; 44(9)) explores the disparity between the relatively unchanged median household income and the exploding infation rate of employer-sponsored health insurance. Similarly, he has published an article titled, “Who Would Have Health Insurance In The Future? An Updated Projection” (Ann Fam Med 2012; 10). In this article Dr. Young

estimates that the recent passage of the Patient Protection and Affordable Care Act (PPACA), will only slow the growth of health insurance premiums. He estimates that the cost of health insurance premiums would be equal to the medium household income by 2037 compared to 2025 as previously estimated. Dr. Young is currently pursuing a solution to delivering better healthcare at a lower cost. Dr. Young also serves as the only Texas physician for the frst class of the Centers for Medicare & Medicaid Services (CMS) Innovation Advisors. On this advisory board, his projects include dismantling and re-building current guidelines for medical documentation, coding, and billing. In January 2012, Dr. Young published a book titled “American HealthScare” in which he describes flaws in the philosophy that more healthcare leads to better health, when oftentimes the opposite is true. Additionally, Dr. Young manages his own blog on www.

Dr. Young received his MD degree from the University of Texas Health Science Center at San Antonio and his undergraduate degree in chemical engineering from the University of Texas at Austin. He currently resides in north Texas with his wife Pam of 28 years. He has three children, one pursuing a medical degree at the Baylor College of Medicine in Houston, another at the University of Texas at Austin, and a third who is currently a sophomore in high school at Paschal. During his time off, Dr. Young enjoys golfing and wine.

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