Foege Forges a New Link for Public Health Taking Stock for Health Safer Schools: Determining What Works Best Stroke: The Impact of Specialists Assuming New Responsibilities Serving Students McGrath Retires

ean James Curran first worked with William H. Foege at the Centers for Disease Control and Prevention (CDC), when Foege was director and Curran headed the AIDS Task Force. "I know firsthand the energy and st rength he brings to an institution," Curran says. "With each of his endeavors, he has contributed his unique vision and perspective for the betterment of health throughout the world." In February, Foege brought that vision to the Rollins School of Public Health, joining the faculty as a professor in the Department of International Health. As a public health faculty member, Foege forges another link among the school, the CDC, and the Carter Center, where he served as executive director from 1987 to 1992. In addition to his new duties, Foege will continue to serve as Fellow for Health Pol icy and senior health adviser at the Carter Center. "I am excited by the vision at Emory which desires to improve global health through research, training, and application," Foege says. "With the field experience of the Carter Center and the missions of CDC, CARE, the American Cancer Society, and Moreho use School of Medicine combined, the potential for Atlanta leadership is inspiring." From 1977 to 1983, he was director of the CDC. In addition to holding top positions at both the CDC and the Carter Center, Foege is best known for his work in the global eradication of smallpox. More recently, he has worked on the Carter Center's inter national effort to eradicate Guinea worm disease. He has been instrumental in the public health areas of child survival and development, disease prevention, injury control, and tobacco-related diseases. "Bill Foege is a true visionary who has inspired me and all of us at the Carter Center to reach beyond what we believe is possible," says President Jimmy Carter. "His expanded role at Emory will enable him to share his vision and vast knowledge with th e next generation of dreamers and doers."

Continuing a distinguished career, William H. Foege joins the international health faculty.

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ast summer, three prominent foundations--the Robert W. Woodruff Foundation, the Joseph B. Whitehead Foundation, and the Lettie Pate Evans Foundation--designated 6 million shares of their stock in The Coca-Co la Company for The Robert W. Woodruff Health Sciences Center at Emory University. The center will receive yearly dividend earnings on the more than $300 million endowment. As a member of the Health Sciences Center, the Rollins School of Public Health has received funding from the newly created fund to support two proposals. The school's first initiative involves the recruitment of a senior faculty member in US health pol icy. Funding for this search will continue for the next two years in declining amounts. The school also will receive support each year for the next three years to develop an Executive Master in Public Health degree program and additional course offerings for postdoctoral students. According to Dean James Curran, this new masters program w ill benefit public health and health care throughout Georgia. By offering classes on weekends and utilizing distance learning technologies such as the Internet, the Executive MPH will enable individuals to pursue their degrees while continuing full-time e mployment. This program will complement a specialized training program designed for field personnel at the Centers for Disease Control and Prevention (CDC), currently under development at the school. A grant from the CDC, one of four recently awarded to schools o f public health, supports the field personnel training program. (Other recipients of CDC grants were Johns Hopkins, Tulane, and the University of Washington.) The Woodruff commitment also allows the development of specialized programs for residents and fellows within the clinical divisions at Emory.

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y the year 2000, every school in the United States will be free of drugs, violence, and unauthorized firearms and alcohol and will offer a disciplined environment conducive to learning." That is the seventh goal of the 1994 Federal Goals 2000: Educate America Act. In pursuit of this goal, the Georgia Lottery for Education dispersed some $21 million to public middle and high schools in 1994 to improve school safety in the state. Schools spent $20 million on the purchase of safety technology items such as video su rveillance cameras, metal detectors, security systems, and communications equipment. Another $1 million went to drug and anti-violence education. The Center for Injury Control at the Rollins School of Public Health evaluated these interventions to see if the purchases actually created safer schools. Knox Todd, assistant professor at the center, and his research team examined school safety techno logy at 15 public schools throughout Georgia. For each evaluation, they interviewed administrators, security personnel, teachers, and students about drugs, alcohol, firearms, and violence in their school. They toured school grounds and inspected safety eq uipment. And they examined the decision-making process that led to the types of equipment purchased, the implementation and use of the equipment, and the actual impact of these interventions on safety. The researchers found that students and staff do feel safe in their own schools although they characterize other schools as potentially unsafe. The students' perceptions of safety, however, derived not from technology but rather from human relationship s. As one student told the researchers, "Our school is safe because we, the kids, choose to make it safe." In fact, many of the technological interventions funded by the lottery tended to have a negative impact on public perceptions of school safety. According to one high school teacher who was interviewed, "people in the community think that we are in dang er because of the hi-tech equipment, and this has affected school choice." "Our findings imply that the tool that was used - technology - was not the one that was needed - which was human relations," says Todd. Instead schools approached researchers with requests for non-technical support such as training in interpersonal rel ations or marketing. Because opinions vary on what makes a school safe, rigorous evaluations like this one are important. While this study is far from definitive, it is the first step toward channeling lottery funds where they can have the most impact. One of the recommend ations made by researchers is to integrate evaluation into the design and distribution of any new initiative. That way, unsuccessful approaches can be avoided and the ones that work put in place.

Does technology make schools seem safer? Not necessarily, says a study headed by Knox Todd.

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n a recent issue of Stroke, researchers from Emory and several other research groups across the US reported that elderly stroke patients have significantly better outcomes when neurologists part icipate in their care. As a group, these patients have significantly lower mortality rates than patients who were not cared for by a neurologist within the first week of their hospitalization. However, care by a neurologist adds significantly to the overa ll cost of care. David Ballard, professor of medicine and epidemiology and director of Emory's Center for Clinical Evaluation Sciences, is one of the authors of this national study. In the study, Ballard and colleagues sought to determine if current managed care incent ives to restrict access to neurologists and other specialists might adversely affect the quality of care for persons with cerebrovascular disease. For their answer, they turned to the Medicare claims data of 38,000 beneficiaries aged 65 and older who were hospitalized for cerebral infarction, a type of stroke associated with blocked arteries in the brain. Data showed that acute stroke patients treated by neurologists had 90-day mortality rates 31% lower than those treated by internists and 36% lower than those treated by family practitioners. In their cost comparisons, the researchers found that care pr ovided by neurologists cost Medicare 18% more than that provided by internists and 31% more than that given by family practitioners. The practice behavior of neurologists may help explain the difference in outcomes. Neurologists were more likely to prescribe anti-coagulants and more likely to discharge patients to inpatient rehabilitation facilities, factors which may have lowered m ortality. Neurologists also were more likely to order diagnostic tests, such as CT scans of the brain, magnetic resonance imaging studies, and cerebral angiography. "We're seeing evidence from this research and several other studies that specialists are important to the outcomes of some common medical conditions such as cerebrovascular and cardiovascular disease," Ballard says. "By putting this information in the public domain, we can educate consumers and policy makers about how access to specialists can optimize health care outcomes."

Ballard weighs quality and cost issues associated with stroke.

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red Kennedy is an engineer by training and holds a doctorate in business. As associate dean for management and planning at the school, he recently has taken on additional responsibilities. This spring he beg an tackling distance learning and continuing education. In March Kathleen R. Miner, an associate professor in behavioral sciences and health education, became the school's first associate dean for applied public health. In her new role, Miner cultivates linkages between state and district health departments and the school, coordinating opportunities for students. According to Dean James Curran, Miner's talents are particularly suited to her new job. She is an experienced faculty leader and advocate for public health education on both the local and national level. As the current president of the Georgia Public H ealth Association, she is an active participant in public health in the state. A former state health department employee, Miner has been instrumental in the evaluation of public health programs in Georgia. She also is a popular mentor at the school.

Associate Dean for Management and Planning Fred Kennedy Associate Dean for Applied Health Kathleen R. Miner

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McGrath Retires Last fall marked the simultaneous retirement of Assistant Dean for Academic Affairs Diane McGrath and completion of an extensive self-study of the school that she had overseen. McGrath, who was hired to supervise the school's initial accreditatio n efforts, directed this self-study for reaccreditation by the Council on Education in Public Health. "She brought together hundreds of people within and outside the school to complete this report," says Associate Dean Richard Levinson. Highlighting the s chool's strengths and weaknesses, the self-study will help shape a strategic plan for the future.

Serving Students In his newly created position as director of student services, John Youngblood dispenses advice on career development and job searches, supervises enrollment and services, and oversees admissions and financial aid. "Students are the root of every thing we do," says Youngblood.