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UCONN HEALTH Journal Winter 2015

Getting to the of the Matter A common gene mutation that regulates cholesterol levels may raise the risk of heart disease. 9

Blood Test Can Alert Doctors New Epilepsy Drug May Be Safer, Breaking the Cycle: How Anxious to Delirium Risk More Effective Parents Can Protect Their Kids 3 5 from Becoming Anxious Adults 13 UCONN EXAMINES Public Health IN THIS ISSUE

FEATURES DEPARTMENTS

On the Cover THE PULSE UCONN EXAMINES

When Getting Your Flu Shot, Can Public Health Timing is Everything Alert Doctors to With pharmacies Delirium Risk advertising flu Pharmacies advertising flu vaccinations in August and September are doing their 3 shots in August, elderly clients a disservice, say UConn Center on Aging researchers. The immunity when should you they gain from the vaccine in late summer may wane by the time flu season hits The Doctors Are In get yours? hard in late winter. UConn Health 1 welcomes our new As summer temperatures peaked this providers. August, pharmacies were already advertising 4-8 the influenza vaccine. But if you thought that was too early to be getting a flu shot — you were right. Getting to the Heart of the Matter 9 “When adults get the vaccine in UConn Health endocrinologist Dr. Annabelle Rodriguez- Oquendo knew there was something wrong when she saw a September, the peak effect wears off by late patient with high levels of "good" cholesterol and indicators of December. But flu season peaks in January heart disease. Her lab found that a common mutation in a gene Public Policy and February,” warns Laura Haynes, an that regulates cholesterol levels may raise the risk of heart How are challenges immunologist and gerontologist at disease in carriers. Now, they are figuring out how to fix it. New Epilepsy Drug to the Affordable UConn Health. May Be Safer, More Care Act and October or November is a much better Effective health insurance mergers impacting time to get the vaccine. That way, you’re still 5 providers? A protected when virus season is at its worst. UConn Law This is especially important for the professor answers elderly, who are at particular risk from flu. our questions. People over 65 are much more likely than 17 younger adults to have serious complications

or even die from a bout with the virus. When adults get the

One way to better stimulate the immune  vaccine in September, Lab Notes response is to administer a high-dose vaccine, “the peak effect wears“ off The future of which contains four times as much flu antigen by late December. But flu If you’re healthcare as the regular version. But the high-dose season peaks in January interested in advancement is volunteering, already here. vaccine has stronger side effects, is more and February. expensive, and may not be best for everyone. contact Lisa 5 Kenyon at the Haynes and her colleagues at UConn Breaking the Cycle: — Laura Haynes, immunologist and UConn Center ‘Talk to Your Health, funded by a Program Project Grant How Anxious Parents Can Protect Their Kids gerontologist at UConn Health on Aging at Mother’ Proves to from the National Institute on Aging, are 860.679.3956. from Becoming Anxious Adults 13 be Healthy Advice running two studies to better understand A brief therapy program that gives families parenting 7 older people’s responses to the regular flu strategies and problem-solving skills can significantly reduce vaccine and the high-dose version. The studies the chances of at-risk kids developing anxiety disorders, Honor Roll will look at how the immune system reacts UConn Health researcher Golda Ginsburg reports in the We celebrate December edition of The American Journal of Psychiatry. to the flu vaccine, as well as how to identify UConn Health's accolades. patients who would benefit from the high- 7 dose version.  Find us online: healthjournal.uconn.edu

UConn Health Journal is a publication of University Communications at the University of Connecticut. Vice President for Communications: Tysen Kendig Editor: Julie (Stagis) Bartucca '10 (BUS, CLAS) Designer: Yesenia Carrero Photographers: Peter Morenus, Sean Flynn Lead Science/Health Writer: Kim Krieger Contributing Writers: Kristen Cole; Sheila Foran '83 (BGS), '96 Ph.D.

2 UConn Health Journal Winter 2015 2 THE PULSE UConn Health News

THE DOCTORS ARE IN UConn Health welcomes the following new physicians:

Ridhi Bansal, MD “ Specialties: • Internal Medicine • Primary Care Location: Canton

Philip M. Blumenshine,

MD, MAS, M.Sc.

Psychiatry Emergency Department “ Medical Director Specialty: Psychiatry Location: Farmington

— Dr. George Kuchel, director of the UConn Ethan I. Bortniker, MD Center on Aging Specialties: • Colon Prevention • Gastroenterology get a better handle on the relationship Location: Farmington between and delirium. This large study, sponsored by the National Institute on Aging, has been following 566 Make an appointment today. surgical patients over the age of 70 for the past five years, with the goal of finding new Call 1-84-GET-UCONN or visit uchc.edu Blood Test Can Alert Doctors approaches to prevent delirium and its long-term consequences in older adults. to Delirium Risk The UConn study found that patients who developed delirium had higher levels Researchers at UConn Health and Beth Israel for delirium shows two cytokines at higher- of interleukin-2 than non-delirium patients Deaconess Medical Center have found that than-normal levels in patients who develop  at all times they were tested: before surgery, NEW SINUS CLINIC a blood test could make it easier to identify delirium. Both cytokines are associated in the first two days afterward, and one LAUNCHES AT UCONN HEALTH patients at risk for delirium, the sudden, acute with inflammation. month later. Dr. Seth Brown and Dr. Belachew Tessema have established a state of confusion that most Researchers don’t yet know Read the full This is the first study to look at cytokine new sinus clinic at UConn Health Farmington. Their expertise in often affects older adults exactly how inflammation and story at levels in older surgical patients at several sinonasal disorders, sinusitis, nasal polyps, and sinus tumors allows and leads to $6.9 billion delirium are linked. The two bit.ly/1MsuraP points in time, both before and after surgery. UConn to offer surgical and nonsurgical treatment of complex in medical costs each cytokines the researchers saw in The results need to be replicated in other sinus problems. year in the U.S. The study, the blood signature, interleukin-6 studies, but if they prove to be generally published online in The and interleukin-2, can cause true, the blood signature could provide a Both doctors are UConn School of Medicine graduates and are Journal of Gerontology: swelling of the membrane around  quick way to alert doctors and nurses to board-certified in otolaryngology. Brown teaches residents as a site Medical Sciences, reports the . Chronic stress from low- seniors at higher risk of delirium. They can director for UConn’s residency program at Saint Francis Hospital that elevated blood levels level illness can also elevate both then take extra precautions to keep the and Medical Center. Tessema is a clinical assistant professor in of specific called cytokines and stress hormones The study is patients oriented. UConn Health’s Department of Surgery, Division of Otolaryngology. cytokines can hint that a such as , which over the long term can published online “If you do things such as improve a patient will develop shrink part of the brain and perhaps increase in The Journal patient’s vision and hearing, reorient them delirium during a hospital stay. an elderly person’s susceptibility to delirium. of Gerontology: to where they are regularly, promote restful  For more information, call 860.679.2804. Dr. George Kuchel, director of the UConn Kuchel and his colleagues worked with Medical Sciences. sleep, increase mobility, and stop Center on Aging and one of the authors of patients who participated in the Successful View on desktop that could be making the delirium worse, all the study, says the suspected blood signature Aging after Elective Surgery (SAGES) study to at bit.ly/1KW8hfA that can help,” says Kuchel.

3 UConn Health Journal Winter 2015 4 THE PULSE UConn Health News A PET (positron emission tomography) THE DOCTORS ARE IN scan shows blood flow and metabolic UConn Health welcomes the following new physicians: activity, used to diagnose the cause of epilepsy and for surgical planning. Tilahun Gemtessa, New Epilepsy Drug May MD, M.Sc. Specialty: Infectious Diseases Be Safer, More Effective Location: Farmington

A new drug that selectively affects potassium urination and hearing, and an unnerving , except with channels in the brain may offer effective tendency to turn people’s skin and eyes an extra fluorine atom  treatment for epilepsy and prevent tinnitus, blue. Because of this, it’s usually only given – seems to open only Matthew Imperioli, MD UConn neurophysiologist Anastasios to adults who don’t get relief from other KCNQ2 and KCNQ3 Specialty: Neurology Tzingounis and colleagues reported in a recent epilepsy drugs. potassium channels, Read more at Location: Farmington issue of The Journal of Neuroscience. There are five different kinds of KCNQ not affecting KCNQ4 bit.ly/1PGnMeN The existing drugs to treat epilepsy don’t potassium channels in the body, but only or 5. It was more always work, and two are important in effective than retigabine at preventing can have serious side epilepsy and tinnitus: seizures in , and it was also less Neha Jain, MD effects. One of the KCNQ2 and KCNQ3. toxic. Specialties: more effective, called The problem with The drug company that developed • Psychiatry

retigabine, helps open “ retigabine is that it SF0034, SciFluor, now plans to start FDA • Geriatric Psychiatry

KCNQ potassium acts on other KCNQ trials to see whether the drug is safe and Location: Farmington channels, which shut potassium channels as effective in people. Treating epilepsy down the signaling “ well, and that’s why it is the primary goal, but tinnitus can of overly excited has so many unwanted be similarly debilitating, and sufferers nerves. Unfortunately, side effects. would welcome a decent treatment. David Karimeddini, MD retigabine has Tzingounis’ “This drug gives me another tool, Specialty: Radiology To book an appointment, call 860.535.6232 or visit uchc.edu significant adverse research has found and a better tool, to dissect the function Location: Farmington side effects, including — Anastasios Tzingounis, that a new drug – of these channels,” Tzingounis says. sleepiness, dizziness, UConn Health neurophysiologist SF0034, which is “We need to find solutions for kids – and problems with chemically identical to adults – with this problem.” Make an appointment today. Call 1-84-GET-UCONN or visit uchc.edu

LAB NOTES Latest UConn Health Discoveries

CANCER CELLS UNRECEPTIVE TO ROGUE X CHROMOSOMES UNCOVERED  FRIENDS ARE UNRELIABLE SOURCES FOR SHE SMELLS HIM, SHE SMELLS HIM NOT Many human colon may not express  IN FARMINGTON DRINKING STUDIES Mice rely on their noses to help them navigate receptors for vitamin D, limiting vitamin D’s Humans only need the genes from one X In recent years, researchers have turned to friends of the world. But high levels of “blind” protective role against colon cancer to the early chromosome to be healthy. The extra one gets people in studies to verify what the subjects the receptors in the noses of female mice to stages of the disease, Charles Giardina and trussed up and shut down in the earliest stages report about their drinking habits. People in the same male pheromones, UConn Health’s John Peluso colleagues at UConn’s Department of Molecular of development. But female human embryonic social situations are sought out, in part, because and other colleagues, led by Lisa Stowers of The and and Center for Molecular Medicine stem cells growing in the lab sometimes of the inherent impairment caused by alcohol. But Scripps Research Institute, report in the June 4 reported in the April 14 issue of Cancer Prevention reactivate their second X. They express extra according to a UConn study published in Addictive issue of Cell. Female mice have high levels of Research. The researchers observed that adenomas genes, fouling up experiments and scuttling Behaviors, friends don’t seem to provide any new progesterone during the infertile phase of their in the colons of mice tended to repress vitamin D potential therapies. Now, researchers including information. In fact, they typically underreport what reproductive cycles, and tend to be indifferent receptors, while having elevated Class I histone UConn’s Marc Lalande and a team from Paris their acquaintances consume. The finding supports or even aggressive toward males. But during deacetylases (HDAC). However, HDAC inhibitors Diderot University have found a marker, and the so-called “protective effect” of friends described the fertile phase, progesterone levels drop and may reactivate the vitamin D receptors. They potentially a mechanism, for how the extra X in other research. A growing availability of other rises, and their nasal receptors again propose that vitamin D could still be protective reactivates — and they have an idea on how to evidence — hair and fingernail samples, for example — respond to male pheromones, the against colon cancer, but how its prevent it. They describe their findings in the may provide a better strategy for corroborating the researchers found. Female mice in receptors are expressed and May 7 issue of Cell Stem Cell. amount of alcohol subjects consume, says author their fertile phase are friendly and inhibited in cancer cells needs Michael Fendrich, associate dean of the UConn sexually receptive towards males — more examination.  Get the full story School of Social Work. perhaps because they can smell them. at bit.ly/1MIALLm

5 UConn Health Journal Winter 2015 6 THE PULSE UConn Health News

HONOR ROLL THE DOCTORS ARE IN UConn Health welcomes the following new physicians:

For the second Hsung Lin, DMD consecutive “ year, UConn Specialty: Family Dentistry Health has Location: Storrs Center received a Gold Award from

Get With The Janice Oliveri, MD Guidelines,

an American Specialties: College of • Internal Medicine Cardiology and “ • Primary Care American Heart Location: Farmington Association initiative that recognizes hospitals for Houman Rezaizadeh, MD — Bradley Weisz, providing Specialty: Gastroenterology exceptional care doctoral student in Location: Farmington to heart-attack psychology at UConn victims according to evidence- based guidelines. health, both in terms of actual symptoms Bernardo Rodrigues, MD UConn Health of illness and how they perceived their Speciaty: Neurology psychiatrist Dr. health in general. Finally, they were asked Location: Farmington Kristina Zdanys to quantify how “out” they were about their was voted onto issue within their social network. the Medical Results showed that people who Lenora S. Williams, MD and Scientific characterized themselves as being the most Specialties: Advisory • Obstetrics and Gynecology Council for the “out” derived the greatest health benefits, Connecticut ‘Talk to Your Mother’ Proves especially when their confidantes included • Women’s Health Alzheimer's to be Healthy Advice mom, a romantic partner, or a close friend. Location: Storrs Center Association in “People have unseen scars and they June. She will join Bringing out the proverbial “skeleton in psychology professor and study author. may be reluctant to talk about their colleagues Rick the closet” can provide health benefits, but “It seems that people expect their stigmatized identity or experience,” Make an appointment today. Fortinsky and Dr. Call 1-84-GET-UCONN or visit uchc.edu Lavern Wright, the degree of benefit depends on who you mothers to love them unconditionally, and says co-author Bradley Weisz, a doctoral who also sit on confide in, says a new UConn study. they just assume that she will handle letting student in psychology, “but if they do the council. The study of 400 people, published in the rest of the family — including the father — choose to talk about it, then they will the Journal of Health Psychology, found know about a problem,” says Quinn. gain even more benefit from their social Hartford that people who are living with issues Researchers studied a group of people interactions than if they remain silent.” Magazine’s 2015 list of such as mental illness, substance abuse, who averaged 32 years old and who had at But while being “out” about a PHYSICIAN DIRECTORY Best Doctors domestic violence, rape, or childhood least one past experience that they kept stigmatized identity or a traumatic UConn Health has one of the largest multispecialty groups in in Connecticut abuse reap considerable health benefits hidden from others. experience can be helpful in the long central Connecticut. We cover virtually every specialty and includes 53 from discussing those issues. Participants were asked to rate their run, Quinn says that not everyone has to subspecialty in health care. UConn Health But they experience more health social networks according to differing degrees follow the same path. “It’s a matter of your faculty members. benefits — both psychological and physical of support. Those ranged from a basic level personal comfort zone,” she says. See the list of  Detailed, up-to-date information about our specialists cited UConn — from disclosing the issue to mom, a of support, such as an offer to go to lunch, to Funded by the National Institutes of is available in our online physician directory at docs at romantic partner, or a best friend than more substantial support, such as an offer Health (NIH), the study was also uconndocs.uchc.edu bit.ly/1FcVVQL from disclosing it to dad, siblings, or a of a place to stay during an emergency. They co-authored by UConn psychology close colleague, says Diane Quinn, UConn were also asked to rate their own physical professor Michelle Williams.

7 UConn Health Journal Winter 2015 8

BY KIM KRIEGER

Why do some patients with high 'good' cholesterol also show signs of heart disease? UConn research has found the common gene mutation that may be to blame.

Guidelines about cholesterol used to be straightforward: high- (HDL) cholesterol is healthy, and low-density lipoprotein (LDL) cholesterol is not. Relatively high levels of HDL were no cause for concern, as long as LDL was low. But recent discoveries show that may be an oversimplification. A common UConn Health endocrinologist variant in a gene that regulates cholesterol Dr. Annabelle Rodriguez-Oquendo’s lab used color stains to figure levels may raise the risk of heart disease in out where the cells were carriers with high HDL, according to a new expressing a mutant gene: those UConn Health study. areas glow yellow in this picture. Researchers examined a variant called Most of the yellow is in the missense rs4238001, which alters the type of , the cell’s made by the gene SCARB1. The variant transportation network. form of SCARB1 changes a Photograph provided by protein from a to a serine. The change Annabelle Rodriguez-Oquendo 10 UConn Health Journal Winter 2015 10

 CLINICIAN SPOTLIGHT

Carl Malchoff, MD, Ph.D. Endocrinologist

occurs in the liver receptor that grabs HDL Dr. Carl Malchoff is the medical director of the education out of the blood and breaks it down for program at UConn Health, and heads disposal. The variant protein makes the the endocrine neoplasia program receptor more fragile and less effective at within the Neag Comprehensive latching onto HDL, leading to higher levels Cancer Center. He is a frequent invited of HDL in the bloodstream. UConn Health endocrinologist Dr. Annabelle speaker on endocrinological cancer The study, led by Dr. Annabelle Rodriguez-Oquendo looks at DNA data with treatments and has authored over 55 Rodriguez-Oquendo, an endocrinologist at researchers in her lab. peer-reviewed articles and multiple reviews. He has been honored by the

UConn Health, was based on information Photo Morenus/UConn Peter about more than 5,000 people who Raynbow Diabetes Foundation for his contributions to diabetes care and participated in the Multi-Ethnic Study of research, and was listed in U.S. News & in major American cities World Report’s 2012-2013 Best Doctors. from 2000 to 2002. they can offer counseling about heart risk prevention. she would know that her high HDL Rodriguez-Oquendo and her colleagues UConn Health endocrinologist Dr. Carl Malchoff (See cholesterol would not protect  Malchoff has a general research interest charted the genotypes of the participants sidebar for more on Malchoff) uses the test to help patients her. She could then take another in the molecular pathogenesis of and tracked episodes of heart disease over a who aren’t sure whether or how they should treat their high type of cholesterol-lowering Read the full tumors of the , adrenal, and research article at pituitary glands. Specific research period of seven years. cholesterol. For example, Malchoff had one patient with high , just not one classified bit.ly/1LolG3h interests include familial papillary They found that the variant was HDL and a family history of longevity. But she had suffered a as a . thyroid carcinoma, autoimmunity associated with an increased risk of heart at a young age, and wanted more information before Malchoff and his colleagues at UConn Health are in thyroid cancer, and primary disease, particularly among men and African deciding on a treatment. working with Rodriguez-Oquendo to determine when aldosteronism. He has published more Americans, findings that were published in This particular patient tested negative for the variant. testing for the variant is most helpful. than 45 peer-reviewed manuscripts the May 20 issue of PLOS ONE. But those who test positive would be advised to use a more “My approach to patient care in an academic center is and over 35 invited reviews. The risk of heart disease among aggressive type and dose of cholesterol medication. Patients that we should look for things our colleagues in practice participants with the rs4238001 variant with the variant could also inform their children that they can’t do and do those things, so we can help them and be Education • Cornell University was up to 49 percent greater than the risk in might also have it. their partners,” Malchoff says of his role in the research. • University of Rochester School of the general population. Overall, men with “Usually if patients don’t have the variant, we assume their Now that the UConn study has made the connection Medicine and Dentistry the variant had a 29 percent higher risk of high HDL is protective,” Malchoff says. between the mutation in SCARB1 and heart disease, the • University of Virginia Medical Center heart disease than men without it. African Sometimes, however, a treatment decision might be more researchers want to figure out a way to fix it. American males with the variant fared the ambiguous, and could require further information before “We want to go deep in the cell, and figure out how to Specialties worst, with a 49 percent increased risk. For the best therapy is chosen. Another patient of Malchoff’s had repair it,” Rodriguez-Oquendo says. The researchers don’t • Diabetes and white males with the variant, the risk was 24 high levels of both HDL and LDL cholesterol. She was taking a know exactly why changing the protein in a liver receptor • Endocrine Neoplasia • percent higher. statin to lower her cholesterol, but was experiencing terrible from a glycine to a serine makes it more fragile. “We’re The gene mutation itself is not rare, muscle pain as a side effect. She wondered if there was a way really interested in understanding more about how this Office Location according to Rodriguez-Oquendo. It occurs to tell whether her high HDL protected her from the heart protein gets chewed up and degraded faster.” UConn Health Farmington in less than 3 percent of Chinese Americans, disease risk associated with high LDL. If so, could she stop The answers may impact the current standard of care 860.679.2100 about 8 percent of African Americans, and taking the statin? for heart disease prevention and treatment for patients

10 to 12 percent of Latinos and Caucasians This patient could be tested for the same variant. If her who are carriers of this genetic variant. That could happen Full physician profiles are in the U.S. A genetic test for the rs4238001 test was negative, she could assume that her high HDL through indirect means, such as adjusting hormone levels to available at your fingertips. Read variant is already available to help clinicians cholesterol was helping protect her against heart attack, even alter cholesterol metabolism, or in the future through direct more or request an appointment identify patients who are carriers, so that with high levels of LDL cholesterol. If the test was positive, means such as genetic therapy. at uconndocs.uchc.edu

11 UConn Health Journal Winter 2015 12 How anxious parents can protect their kids from becoming anxious adults.

A woman who won’t drive long distances because she has according to new research by UConn Health therapist-directed intervention greater the likelihood he panic attacks in the car. A man who has contamination fears child psychologist Golda S. Ginsburg. developed anxiety after one or she will struggle with so intense he cannot bring himself to use public bathrooms. Ginsburg and colleagues at Johns year, compared to 21 percent in anxiety as an adult. But A woman who can’t go to church because she fears enclosed Hopkins University tested a one-year therapy a group that received written there is also a component spaces. All of these people have two things in common: they intervention as part of a study of 136 families instruction, and 31 percent in the of anxiety that is learned, have an anxiety disorder, and they happen to be parents. where at least one parent had anxiety and at group that did not receive any taught inadvertently by These parents sought help because they struggle with least one child was between the ages of 6 and 13. therapy or written instruction. parents who model the anxiety, and want to prevent their children from suffering The study, published in the December issue Both inborn temperament behavior. It’s these learned the same way. Anxiety tends to run in families, with 30 to of The American Journal of Psychiatry, found and life experiences a role in whether behaviors and thought patterns that interventions can help 50 percent of children of anxious parents growing up to be that therapy-based intervention works. Only an adult has anxiety. The more negative change, according to Ginsburg. anxious themselves. But that does not have to be the case, 9 percent of children who participated in a experiences a person has growing up, the “The finding underscores the vulnerability of offspring of

13 UConn Health Journal Winter 2015 14  CLINICIAN SPOTLIGHT “ — Golda Ginsburg, Psychologist, UConn Health ”

anxious parents,” says Ginsburg. She wants debilitating anxiety, children start avoiding Rocio Chang, to do something about that vulnerability. whatever provokes the anxious feelings. If “If we can identify kids at risk, let’s try and they’re afraid of the dark, they might insist MA, Psy.D. Psychologist prevent this.” on sleeping with all the lights on. If they’re Most of the adults who participated in afraid of failing, they won’t try new things. In Rocio Chang is an assistant professor the study struggled in school and didn’t tell extreme cases, they may refuse even to of psychiatry at UConn Health and an anyone. They didn’t raise their hands, or they leave the house. expert in childhood and adult trauma. got sick before exams. They might not have One of the ways to reduce anxiety is to do She specializes in psychotherapy had any friends. As adults their anxiety still a reality check. It’s a way to recognize when with children, adolescents, adults, and biological, foster, and adoptive limits their activities and sometimes those a fear is healthy and worth paying attention families, including treatment for mood of their family members, and they are very to (a growling dog) or unhealthy (a possibly and co-occurring disorders, PTSD, and motivated to help their poisoned birthday cake). complex trauma. She is sought after to children avoid the same. In the study, some of provide specific training on assessment Physicians can often the families participated in and treatment of complex trauma, identify children at risk eight, hour-long sessions and in particular has been a resource before they develop an with a trained therapist to Latino organizations. She also anxiety disorder. Such over a period of two months. serves on the clinical advisory board kids are often hyper- Others were just given a of several grassroots organizations, aware of aches and other pamphlet that contained including Focus on Recovery United, GOODWorks, the Jordan Porco bodily sensations, and general information about Foundation, and Connecticut Public are frequent flyers at anxiety disorders and Broadcasting Network. the doctor’s office and treatments. Still others emergency room. For example, such a child received nothing at all. Education might think “my heart is racing — I’m having The families who participated in • University of Hartford a heart attack!” when a less anxious individual therapy were taught to identify the signs  • Trinity College would think “my heart is racing because I just of anxiety and how to reduce it. They I can walk past that cat and it whether there would be value • Capital Community Technical College won’t do anything.’ in providing regular ran up a hill.” practiced problem-solving skills, and If you are Specialities Other signs of children at risk for anxiety exercised safe exposures to whatever made interested in In general, children who checkups for families on • Psychotherapy for children, include avoidance of school, parties, and other their child anxious. collaborating participated in the intervention mental health issues. She adolescents, and families social situations, as well as unusual worries. “We taught the kids how to identify scary on such a had lower anxiety overall is considering approaching • Mood and co-occuring disorders study or have “Anxiety and fear are protective and thoughts, and how to change them,” than children who did not insurers about offering this • PTSD and complex trauma patients who adaptive,” says Ginsburg. “But in anxious kids Ginsburg says. participate in the intervention kind of service to families at might benefit Office Location they may not be, because these children have For example, if a child is afraid of cats and from a family with their families. risk, to see if it lowers their Child and Adolescent Psychiatry thoughts about danger and threat when there encounters one in the street, the child can intervention, Now the researchers have healthcare costs overall. UConn Health contact Golda funding from the National “I’d say we need to change really isn’t one.” first identify the scary thought: ‘That cat is 65 Kane Street For such a child, meeting a new peer for going to hurt me.’ Then the child can test that Ginsburg at Institutes of Health for a our model of mental health Gginsburg@ West Hartford follow-up to see whether to a checkup method,” says the first time can be paralyzing. Trying an thought: ‘Is it likely that cat will hurt me? No, uchc.edu, or 860.523.3745 unfamiliar might summon worries of the cat doesn’t look angry. It isn’t baring its call her office at the effects are maintained Ginsburg. “Like going to the being poisoned. To cope with this kind of teeth or hissing, it’s just sitting there. Okay, 860.523.3788. over time. Ginsburg wonders dentist every six months.”

15 UConn Health Journal Winter 2015 16 UCONN EXAMINES Public Policy

How Does the Supreme Court’s Latest ACA Decision Impact Physicians? Q&A With UConn Law Professor John A. Cogan Jr.

Q What was the immediate effect of the Supreme In June, the U.S. Supreme Court Court’s ruling in King v. Burwell? turned away yet another challenge to the Affordable Care Act (ACA), The major effect was to cement the federal government’s commonly referred to as Obamacare. implementation of the law. The case dealt with a very specific issue: The Court, in King v. Burwell, the subsidies offered to low- and moderate-income people. Unlike the ruled 6-3 that the government could previous ACA case, King v. Burwell wasn’t a constitutional challenge, continue to provide premium subsidies it was based purely on a question of statutory interpretation: Could nationwide to middle- and low-income the government give out subsidies? The Supreme Court said yes. Since Americans who purchase their health the constitutional and major statutory challenges have failed, we may insurance directly from insurers on see opponents attempt to chip away at portions of the ACA they do health insurance exchanges. not like, but I think it’s safe to say we won’t see any more major cases The subsidies are a crucial attempting to unravel the whole law. component of the ACA, which requires all Americans to have health insurance. In the wake of the decision, we saw announcements Had the Court ruled against the by insurer Aetna that it intended to buy competitor government, the individual health Humana, and then that Anthem would buy Cigna. insurance market would have been Q That would bring the number of major health UCONN HEALTH thrown into chaos, says insurance law insurers in the U.S. from five to three, with expert John A. Cogan Jr., an associate UnitedHealth the third. How will these mergers professor at UConn Law. Unsubsidized, benefit the insurance companies, and how will they OUTPATIENT PAVILION healthier consumers would be driven affect healthcare providers? Located on our Farmington campus, this state-of-the-art facility out of markets, and premium costs would spike. The post-merger companies will each have a larger share of the houses a wide range of specialties. While the Supreme Court’s ruling market, thereby consolidating their power. Consolidation allows brought certainty and stability to the insurers to increase profits through efficiency gains. But these larger individuals who purchase insurance on insurers will also gain bargaining power with healthcare providers. PATIENT SERVICES BY FLOOR: the health insurance exchanges, there This is important because providers are paid directly by insurers. is still uncertainty for another group If you have doctors and hospitals negotiating with several different Floor 1 Floor 2 Floor 3 Floor 4 Floor 6 — physicians. Recent mega-mergers insurers, they have the ability to walk away from any one of those • Arrow Pharmacy • Center on • Comprehensive • Carole and • Gastroenterology insurers, giving providers some leverage. But if there are only two in the health insurance industry may • Cancer Clinical Aging/Geriatrics Spine Center/ Ray Neag • Ear, Nose & Throat insurers, that leverage is diminished. Major hospital systems and leave doctors with less bargaining Trials Office • Endocrinology Neurosurgery Comprehensive • General Surgery large physician groups will still have some bargaining power because power in the future, possibly affecting • Radiation Oncology • General Medicine • Radiology/X-Ray Cancer Center • Center for reimbursement rates, says Cogan, who of their size, but individual physicians will see their bargaining power diminish further. • Harvey & Lewis • Infectious Diseases • Huntington’s Orthodontic Care has written extensively about health Optical Shop • Internal Medicine Disease Program • Plastic and law and policy. Floor 5 Will the effect of the mergers be in line with the • Occupational • Blood Draw Station Cosmetic Surgery Q • Eye Care intent of the law? Medicine • Life Therapies/ • Vascular Surgery • Travel Medicine Physical Therapy The ACA’s express intent was to expand coverage, and it worked. • Neurology There’s nothing in the ACA regarding industry consolidation. • Neurophysiology Nevertheless, the fallout of the ACA’s expansion of coverage — efforts • Rheumatology by insurers to consolidate market share — was foreseeable. Now • Urology that the ACA is here to stay, federal and state regulators will have to wrestle with consolidation issues. REQUEST AN APPOINTMENT TODAY. Call 1-84-GET-UCONN or visit uchc.edu Winter 2015 18 17 UConn Health Journal Nonprofit Org. U.S. POSTAGE PAID Hartford, CT Permit No. 4759 UConn Health Journal 263 Farmington Avenue Farmington, CT 06030-5385 1-84-GET-UCONN

Dedicated Line for Referring Physicians 860.679.5555 • Make patient appointments • Arrange patient admissions • Engage in physician-to-physician consultation • Obtain general information and assistance

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