Lessons from the Past

Dr. Bill Jenkins speaks Feb. 4 during the seventh annual Jean Mills Health Symposium at ECU. More than 150 participants attended the event, which focuses on addressing health disparities in the region. (Photo by Cliff Hollis)

Past lessons important to the future of community health, expert says

A small group of people can make a difference in fostering better health in a community and often have the most success in creating change, said Dr. William “Bill” Jenkins, keynote speaker for the Jean Mills Health Symposium held Feb. 4.

Jenkins, adjunct associate professor of epidemiology at Morehouse School of Medicine and senior fellow with the Institute for African American Research at the University of North Carolina at Chapel Hill, spoke about the myths and realities of community participatory research.

It begins at the grassroots level, with the endorsement and support of those living in the community. That means practicing cultural humility and not assuming you know what’s best for a community, he said.

Jenkins served two decades as supervisory epidemiologist in the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention and managed its Minority Health Activities Program. He managed the Participant Health Benefits Program, which assures medical services to the survivors of the Tuskegee syphilis study. Jenkins also served as an expert on minority issues in disease transmission as chief of the research and evaluation statistics section in the Division of Sexually Transmitted Diseases Prevention and as manager of the National Minority Organizations HIV Prevention Program.
His role in caring for the survivors of the Tuskegee syphilis study gave him a great appreciation for and understanding of best practices for community research.

The study, which ended in 1972, followed 600 men with syphilis for 40 years. Medical students, nurses and CDC physicians took samples in the field, collected and recorded data. Wherever the men they went, they were followed to make sure they did not receive treatment so results could be documented. “It was one of the best managed programs in public health history,” Jenkins said.

Many returned from World War I with the disease.

“Syphilis is the great imitator,” Jenkins said, since the disease can mimic heart disease and other ailments. “It’s a fascinating disease as much as most people think HIV is today.”

While the syphilis study eventually was condemned, it was landmark in its methodology. “How you do community research can be taught by this method,” Jenkins said.

As a result, researchers have changed practices that include institutional review boards, voluntary informed consent and federal policy for the protection of human subjects.

The basic tenets of bioethics are do no harm, be fair, allow autonomy and beneficence.

How a community benefits must be kept at the forefront. “Drug companies will pay a lot of money for community participatory research,” Jenkins said. “Just because you’re doing research in a community doesn’t mean you’re doing research for the community.”

In its seventh year, the Jean Mills Health Symposium drew 150 participants and had a waiting list, said Dr. Stephen Thomas, dean of the ECU College of Allied Health Sciences, which sponsors the event in collaboration with the ECU Medical & Health Sciences Foundation, Pitt Memorial Hospital Foundation and Eastern Area Health Education Center. The event coincides with Black History Month.

Jean Elaine Mills earned her bachelor’s degree from the University of North Carolina at Chapel Hill in 1977 and a master’s in public administration with a concentration in community health from ECU in 1984. She died from breast cancer in 2000.
Amos T. Mills III, Jean’s brother, created the symposium in an effort to keep her spirit of discovery and community outreach alive.

“Health care is the most important thing in people’s lives,” Mills said in recognizing professor emeritus Donald Ensley, who spearheaded the creation of the event and taught Jean Mills while she was a student at ECU. “If you don’t have good health, you don’t have a good quality of life.”

Video from the event will be shown on ECU’s Ch. 99 and will be posted on the College of Allied Health Sciences website at www.ecu.edu/ah.

The symposium featured more than 20 recognized experts on the principles of community engagement: mutual benefits, collaborative relationships and empowerment. Presentations focused on the scholarship of engagement and on service to the community with an engagement model addressing health disparities and minority health.

Share

Bioengineered Veins

Bioengineered veins could help patients needing bypass surgery, dialysis

RESEARCH TRIANGLE PARK, N.C. (2/2/11)–Thanks to research involving experts from East Carolina University, other universities and a Morrisville-based biotechnology firm, the day when a surgeon can pull a new human vein off the shelf for use in life-saving vascular surgeries is now one step closer to reality.

Kypson

Dr. Alan P. Kypson

“This new type of bioengineered vein allows them to be easily stored in hospitals so they are readily available to surgeons at the time of need,” said Dr. Alan P. Kypson, a cardiothoracic surgeon, associate professor at the Brody School of Medicine at ECU and an author of the paper. “Currently, grafting using the patient’s own veins remains the gold standard. But, harvesting a vein from the patient’s leg can lead to complications, and for patients who don’t have suitable veins, the bioengineered veins could serve as an important new way to provide a coronary bypass.”

The American Heart Association Update on Heart Disease Statistics reports that in 2007, in the United States, surgeons performed more than 400,000 coronary bypass procedures. Patients requiring bypass surgery may not have suitable veins or arteries available and are not candidates for synthetic grafts because of the size needed for grafting.

The bioengineered veins also show promise for patients on kidney hemodialysis. According to the National Kidney Foundation, 320,000 patients are on chronic hemodialysis. Each year, 110,000 new patients develop renal failure requiring dialysis, and the number is growing by 3 percent a year. More than half of dialysis patients lack the healthy veins necessary and must undergo an arteriovenous graft placement to have bloodstream access for hemodialysis.

Most arteriovenous grafts that are placed for hemodialysis access are made of a synthetic material, which suffers from significant drawbacks including a high rate of infection, a propensity for blockages due to clotting and a thickening of blood vessels known as intimal hyperplasia, said Dr. Jeffrey H. Lawson, a surgeon and associate professor at Duke University School of Medicine and an author of the research.

“Due to high complication rates, each A.V. dialysis graft requires an average of 2.8 interventions over its lifetime just to keep it functioning,” Lawson said. “Hence, there is a huge clinical need for a functionally superior, off-the-shelf A.V. graft that suffers from fewer complications than current materials.”

Lawson has served as a consultant for Humacyte and has received research support from the company through Duke.

In this research, scientists generated bioengineered veins in a bioreactor — a device designed to support a biological environment — and then stored them up to 12 months in refrigerated conditions. The bioengineered veins, 3 millimeters to 6 millimeters in diameter, demonstrated excellent blood flow and resistance to blockage in large animal models for up to a year.

Scientists from Duke, ECU, Yale University and Humacyte conducted the research, and Humacyte, a leader in regenerative medicine, funded it. Overseeing the research and serving as senior author of the article was Dr. Laura Niklason, founder of Humacyte and professor of anesthesiology and biomedical engineering at Yale. Niklason is an authority in regenerative medicine for arterial engineering and led the team that recently created a functioning rat lung in a laboratory.

Shannon L. M. Dahl, senior director of scientific operations and co-founder of Humacyte, is lead author on the paper. “Not only are bioengineered veins available at the time of patient need, but the ability to generate a significant number of grafts from a cell bank will allow for a reduction in the final production costs, as compared to other regenerative medicine strategies,” Dahl said. “While there is still considerable research to be done before a product is available for widespread use, we are highly encouraged by the results outlined in this paper and eager to move forward with additional study.”

Humacyte, a privately held company, is primarily focused on developing products for vascular disease and for dermal filling and soft tissue repair. The company uses its innovative and proprietary platform technology to engineer human extracellular matrix-based tissues that can be shaped into tubes, sheets or particulate conformations with properties similar to native tissues.

These can then be used in many specific applications, with the potential to significantly improve treatment outcomes for a variety of patients, including those with diabetes and on hemodialysis. The company’s proprietary technologies are designed to result in off-the-shelf products that can be used in any patient.

###

Share