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February 21, 2013

Research Notes

Active bariatric surgery patients have less mental distress

Adults who are undergoing bariatric surgery and are more physically active are less likely to have depressive symptoms and to have received medication or counseling for depression or anxiety than their less-active counterparts, according to research led by the Graduate School of Public Health.

Said Wendy C. King, epidemiology faculty and lead author: “Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication. Recent research has focused on physical activity as an alternative or adjunct treatment.”

Adults with severe obesity are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) when compared to the general population (7.2 and 10.2 percent, respectively). King noted the importance of treating these conditions prior to surgery, as preoperative depression and anxiety increase the risk of these conditions occurring after surgery and have been shown to have a negative impact on long-term surgically induced weight loss.

King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental-health functioning, depressive symptoms and treatment for psychiatric and emotional problems, including depression and anxiety.

The study included 850 adults who were seeking bariatric surgery in 2006-09 at one of 10 U.S. hospitals.

Approximately one-third of participants reported depressive symptoms, while two in five reported taking medication or receiving counseling for depression or anxiety. “Those who reported treatment were more likely to report impaired mental-health functioning and depressive symptoms, highlighting the need for better treatment modalities,” said King.

The association between physical activity and these outcomes was strongest when only moderate-intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

Just one hour of moderate-intensity physical activity a week — or eight minutes a day — was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity. Similarly, just 4,750 steps a day reduced odds of depression or anxiety treatment by 81 percent.

Because this was an observational, cross-sectional study — meaning patients’ regular physical activity behavior and depressive symptoms were measured at the same time — it could not prove that a patient’s physical activity influenced mental-health status.

The study, published in the Journal of Psychosomatic Research, was coauthored by psychiatry and psychology faculty member Melissa A. Kalarchian and researchers from the Neuropsychiatric Research Institute in Fargo, N.D., Oregon Health & Science University and Pacific University.

It was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

New grant for efficient crude oil extraction

Researchers from the Swanson School of Engineering have received a $2.4 million grant from the United States Advanced Research Projects Agency-Energy (ARPA-E) to study methods of tapping crude oil more efficiently.

This award — in conjunction with a $1.2 million U.S. Department of Energy National Energy Technology Laboratory (NETL)  grant awarded last fall (see Nov. 8, 2012, University Times) — aims to increase the amount of oil produced in western and southern states through use of carbon dioxide (CO2) flooding, a process in which CO2 is injected into an oil reservoir for extraction.

The project is headed by engineering faculty member Eric Beckman, co-director of the Mascaro Center for Sustainable Innovation, and chemical and petroleum engineering faculty member Robert Enick, NETL Regional University Alliance Faculty Researcher.

Beckman and Enick’s design would improve upon a current CO2 flooding strategy, which involves injecting large volumes of water along with the CO2, known as a water-alternating-gas, or WAG.

Said Enick: “If a thickener could be identified that could increase the viscosity of the CO2 to a value comparable to that of the oil in the underground layers of rock, then the need to inject water would be eliminated and more oil would be recovered more quickly.”

The ARPA-E award also will foster continued collaborations between Pitt and GE Global Research and between Pitt and researchers at the NETL facilities in Pittsburgh and Morgantown.

Particle-physics research article gains award

Physics and astronomy faculty member Sergey Frolov and a colleague have won the $25,000 Newcomb Cleveland Prize, awarded to the best research article or report appearing in Science, a weekly publication of the American Association for the Advancement of Science (AAAS).

The paper, “Signatures of Majorana fermions in hybrid superconductor-semiconductor nanowire devices,” highlights the detection of the Majorana fermion, a long-sought physics particle expected to have properties ideal for quantum computing. The article was featured on the May 25, 2012, Science cover.

Frolov said: “We will continue exploring the field that we started with this paper and, in my new laboratory at Pitt, we’ll use Majorana particles to assemble the building blocks of a quantum computer.”

Frolov worked on the research detailed in the paper while serving as a postdoctoral fellow in the Netherlands at Delft University of Technology. His collaborators included Delft faculty and others from the Netherlands’ Eindhoven University of Technology.

More drug spending does not produce patient adherence

On average, only about half of a random sample of Medicare Part D recipients were adhering to their life-saving heart-failure medications, with rates as low as 36 percent in some areas.

Said lead author Yuting Zhang, a GSPH faculty member: “We found that areas with higher drug spending did not have systemically better adherence. This suggests that areas with higher drug spending are not necessarily doing a better job caring for patients with heart failure.”

Using national Medicare Part D 2007-09 data, Zhang and her colleagues pulled a random sample of 5 percent of the beneficiaries with heart failure. They found that, on average, 52 percent of the patients were filling their prescriptions for heart failure medication.

The region with the lowest adherence, at 36 percent, was the Slidell, La. area. The St. Cloud, Minn., area had the highest adherence, at 71 percent. The Pittsburgh area had an adherence rate of 49 percent.

“It will be important to look at the areas with better adherence,” said Zhang. “They could provide a useful benchmark for what is achievable, and system-level quality metrics that incorporate adherence, rather than focusing solely on drug spending, could promote more efficient use of resources.”

The study, reported in the Feb. 11 issue of JAMA (Journal of the American Medical Association) Internal Medicine, was coauthored by GSPH faculty member Shang-Hua Wu and researchers from the University of Michigan and Harvard University.

ADHD linked to greater teen substance abuse

A study led by Brooke Molina, psychiatry and psychology faculty member in the School of Medicine, showed a significantly higher prevalence of substance abuse and cigarette use by adolescents with attention deficit hyperactivity disorder (ADHD) histories than in those without ADHD.

The researchers studied nearly 600 children over eight years through adolescence to test the hypothesis that children with ADHD have increased risk of substance use and abuse or dependence in adolescence. Molina and colleagues also examined substance abuse patterns, the effects of ADHD medications over time and the relationship between medication and substance use.

The findings showed:

• When the adolescents were an average of 15 years old, 35 percent of those with ADHD histories reported using one or more substances, as compared to only 20 percent of teens without ADHD histories.

• Ten percent of the ADHD group met criteria for a substance abuse or dependence disorder, which means they experienced significant problems stemming from their substance use, as compared to only 3 percent of the non-ADHD group.

• When the adolescents were an average of 17 years old, marijuana was particularly problematic, with 13 percent versus 7 percent of the ADHD and non-ADHD groups, respectively, having marijuana abuse or dependence.

• The amount of daily cigarette smoking, at 17 percent of the ADHD group, was significantly higher than national estimates for this age. The smoking rate of non-ADHD teens was only 8 percent.

• Alcohol use was high in both groups.

• Substance abuse rates were not different for children who still were being treated with ADHD medication compared to those who were not.

The authors noted the important finding that substance abuse rates were the same in teenagers still taking medication and in those no longer on medication. These results suggest a need to identify alternative approaches to substance abuse prevention and treatment for boys and girls with ADHD.

Said Molina: “We are working hard to understand the reasons why children with ADHD have increased risk of drug abuse. Our hypotheses, partly supported by our research and that of others, is that impulsive decision making, poor school performance and difficulty making healthy friendships all contribute.”

The study was published online in the Journal of the American Academy of Child and Adolescent Psychiatry. Molina’s collaborators included researchers from the University of California-Berkeley, Ohio State University, University of California-Irvine, Florida International University and McGill University.

Support came from the National Institute of Mental Health and the National Institute on Drug Abuse.

—compiled by Marty Levine

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