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Research
Current Activities
Much of our energy in the past year has focused on defining research themes, developing research ideas,
creating research teams within the department, and building collaborative relationships. We identified four broad
research areas that reflect the interests of the faculty, principles of Family Medicine, and opportunities and
expertise for success. These areas are:
Health Promotion: Early Detection of Disease and Disease Prevention:
Cancer screening. Disease prevention and early detection is an integral part of the discipline of Family Medicine and is well suited for study in the primary care setting. Research on colorectal cancer (CRC) screening focuses on addressing disparities in CRC screening. Qualitative methods have been used to explore awareness of cancer and screening within a multiethnic patient population. These findings have been utilized in the design of a quantitative study to estimate the prevalence of CRC screening within a clinic population. An ongoing study focuses on patient preferences for attributes associated with the four different CRC screening tests that are recommended for screening.
Funding:
Shokar, NK: Career Development Program Award: Interdisciplinary Research in Women’s Health. A Berenson (PI) K12 NIH/NICHD and Office of Research in Women’s Health (ORWH). 1/06 – 12/11.
Shokar, NK (PI): Patient Preferences for Colorectal Cancer Screening. The Joint AAFP/F-AAFP Grant Awards Program. 10/04-7/06 $29,730.
Shokar, NK (PI): Colorectal Cancer in Three Racial/Ethnic Groups: Phase II. John Sealy Memorial Endowment Fund for Biomedical Research. 9/02-3/06 $70,000.
Shokar, NK (PI): Colorectal Cancer Screening in Three Ethnic Groups. American Cancer Society Intramural Grant Awards Program. 9/01-8/03 $15,000.
Publications:
Shokar NK, Carlson, CA, Shokar GS. Physician and patient influences on colorectal cancer screening in a primary care clinic. Journal of Cancer Education 2005: in press.
Shokar, NK; Vernon, SW; Weller, SC. Cancer and colorectal cancer: Knowledge, beliefs and screening preferences of a diverse population. Family Medicine 2005; 37(5):341-347.
Shokar, GS; Carlson, CA; Davis, B; Shokar, NK. Testicular cancer screening in a primary care setting. International Journal of Men’s Health 2003, 2(3): 221-228.
Osteoporosis. Another topic of interest is the early detection of osteoporosis. Recent work has focused on comparing two clinical screening tools, the Osteoporosis Risk Assessment Instrument (ORAI) and Simple Calculated Osteoporosis Risk Estimate (SCORE), in a multiethnic patient population. Findings indicate that sensitivity for the two clinical screening tools is lower than previously reported and may limit their usefulness in a multiethnic patient population. On-going research focuses on the development and validation of a screening instrument for the early detection of osteoporosis in males.
Funding:
Cass, AR (PI), Shepherd, AJ: Clinical Stratification of Osteoporosis Risk in Women from an Ethnically Diverse Population. The Joint AAFP/F-AAFP Grant Awards Program. 9/02-02/04, $20,000.
Shepherd, AJ (PI), Cass, AR: Validation of the Male Osteoporosis Risk Estimation (MORE) Index in the NHANES IV Dataset. The Joint AAFP/F-AAFP Grant Awards Program. 3/06-2/07, $23,685.
Publications:
Cass AR, Shepherd AJ, Carlson CA, Osteoporosis and risk assessment and ethnicity: validation and comparison of two clinical risk stratification instruments, Journal of General Internal Medicine 2006, in press.
McNearney T, Shepherd AJ, Chambra A, Goel N, Primary care housestaff attitudes towards osteoporosis management, Southern Medical Journal 2006, in press.
Shepherd, AJ. An Overview of Osteoporosis, Alternative Therapies 2004, 10(2): 26-33.
Chronic Disease Management
Diabetes. Type 2 diabetes mellitus continues to be an important clinical and public health problem. Departmental research focuses on screening, patient education, and management of diabetes. Projects have examined the accuracy of screening guidelines and screening practices of physicians. Others have focused on management issues and beliefs among Latino/ Hispanic diabetic patients. The effect of marital relationship on management, specifically the type of interaction or expressed emotion (like criticizing and hostility), is being examined to see possible effects on A1C. Resident research projects sponsored by the AAFP have focused on patient depression and physician adherence to treatment guidelines in the management of diabetes.
Funding.
Weller SC (PI), Baer RD: Cultural beliefs and health status in Type 2 diabetics. NSF 9/ 01 – 8/ 03 (no cost extension to 8/04) $264,830. (BCS-0108232 $171,181; BCS –0108228 $93,649).
Gosselink P: Depression Among Diabetic Patients in a Community Clinic: Prevalence, demographic correlates and effects of screening. The Joint AAFP/F-AAFP Grant Awards Program. 11/01-10/02 $2,000.
Syed, I: Improving Compliance with Guidelines for Care of Patents with Type 2 Diabetes Mellitus The Joint AAFP/F-AAFP Grant Awards Program. 11/02-10/03 $2,000.
Benavides L: Perception of self-efficacy and health status in patients with Diabetes Mellitus Type 2: A predictor of outcome. The Joint AAFP/F-AAFP Grant Awards Program. 11/04-10/05 $2,000.
Benavides L: Is there a difference in intensity of physicians’ intervention among depressed and non-depressed patients with Diabetes Mellitus Type 2? The Joint AAFP/F-AAFP Grant Awards Program. 11/05-10/06 $2,000.
Publications.
Weller SC, Baer RD, Pachter LM, Trotter R, et al.: Latino beliefs about diabetes. Diabetes Care, 1999, 22(5):722-728.
Dallo FJ, Weller SC: Effectiveness of diabetes mellitus screening recommendations. Proceedings of the National Academy of Sciences, 2003, 100(18): 10574-10579.
Garcia de Alba JE, Dallo FJ, Salcedo Rocha AL, Colunga Rodríguez C, Baer RD, Perez N, Weller SC: The relative effect of self-management practices on glycemic control in Type 2 Diabetic Patients in Mexico. J of Chronic Illness 2006, in press.
Educational Research - Focus on distance education and learning styles.
Educational research within the Department centers on learning and technology issues that affect individual learners, learning processes, and learning environments to develop physicians committed to life long learning. Research topics focus on self-directed learning, the learning environment for Clerkship students at remote and rural community-based sites, and those learning environments created by the emerging Internet. Achievements include the online authoring tool called Design-A-Case. This now copyrighted template has an authoring template and a library of interactive clinical cases that can be built by case authors. These web cases have been used in our medical student education programs and our technology workshops.
Funding:
O’Donell, AA (PI): Predoctoral Training Grant: Integrating Technology and Enhanced Clinical Cases into Predoctoral Training in Primary Care (Family Medicine). HRSA/BHPR 1 D16 HP 00034-02 . 7/ 00-6/ 03. $520,000.
Shokar, G (PI): Predoctoral Training Grant: Focus in Family Medicine Education. HRSA/BHPR 2 D16 HP 00034-04 7/ 03-6/ 06. $480,000.
Publications:
Shokar, GS; Shokar, NK; Romero, CM; Bulik, RJ. Self Directed Learning: Looking at Outcomes With Medical Students, Family Medicine 2002; 34 (3): 197-200.
Shokar, GS; Bulik, RJ; Baldwin, CD. Student Perspectives on the Integration of Interactive Web-based Cases into a Family Medicine Clerkship. Teaching and Learning in Medicine, 2005; 17(1), 74-79.
Shokar, GS; Burdine, RL; Callaway, MR; Bulik, RJ. Relating Student Performance on A Family Medicine Clerkship with Completion of Web Cases. Family Medicine 2005;37(9),620-2.
Complementary and Alternative Medicine
An area of research concerns mind-body interaction. An R-21 Exploratory and Development grant, “Psychoneuroimmunology, Stress and Healthy Aging in Hispanics,” was awarded to enhance our capacity and environment for research in this area. The program supports pilot projects with seed funding aimed at development of junior faculty and interdisciplinary research on mind-body issues with a focus on stress and coping. Another project is examining the effects of CoQ10 on myotoxicity that occurs with statin use. The program also maintains an educational emphasis to integrate evidence-based information on alternative therapies into the medical curriculum.
Funding.
Sierpina, V. (PI): Psychoneuroimmunology, Stress and Healthy Aging in Hispanics. NIH/NIA Grant #: R-21 AGO23951, 2004-2007 ($900,000).
Islam, J. (PI), Sierpina, V.: CoEnzyme Q 10, Statins, and Myotoxicity, John Sealy Memorial Endowment Fund for Biomedical Research. 2003-2006 ($35,000)
Sierpina, V. (PI): Evidence-based Curriculum in Alternative Therapies. NIH/NCCAM Grant #: AT00586-05. 2000-2005 ($1,500,000).
Frenkel, Moshe (PI): Integrating Complementary and Integrative Medicine into Primary Care - The Patient Perspective. Texas Academy of Family Physicians Foundation. 05/05 to 9/06. $5,000
Publications.
Sandor, M, Sierpina V, Vanderpool H, Owen S: Spirituality and clinical care: Exploring developmental changes in nursing and medical students. Explore: Journal of Science and Healing, 2006, 2(1): 37-42.
Hall J, Bulik R, Sierpina V: Assessing the attitudes toward and practices of complementary and alternative medicine by community preceptors: A Texas study. Texas Medicine 2003, May: 50-
53.
Frenkel MA, Borkan JM. An approach for integrating complementary-alternative medicine into primary care. Family Practice. 2003 Jun;20(3):324-32.
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Predoctoral Education 
