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September 2, 2004

Research Note

Morning people may have the upper hand at work and school

Morning larks may have an advantage in work or school because their body clocks make it easier for them to arrive at work on time. Those benefits may carry over into the rest of their lives, helping them to maintain regular schedules and even get better quality sleep, according to Timothy H. Monk, professor of psychiatry at the University of Pittsburgh School of Medicine.

The Pitt research, published in Chronobiology International, studied the sleep-wake and activity patterns of healthy adults to determine the relationship between “morningness/eveningness” and the rhythms with which other daily behaviors take place.

Lifestyle regularity relates to the fact that people differ with respect to how regular or irregular their daily schedules are. Simple observation reveals that some people have very regimented lives with events taking place at the same time each day, while others have much more irregular schedules

“Whether the advantage morning larks have over night owls is based on real performance or merely perception is a matter of opinion,” Monk said. “There is a perception that morning people are more productive than night people and end up getting more praise from their supervisors,” said Monk. “This is certainly true for the early morning hours, but by mid-day everyone is more or less up to speed.”

Additionally, because night owls may be slower out of the gate, their breakfast and family interactions can become hectic and missed in the rush to get out of the house.

Still, while morning larks may have an advantage at the 9 a.m. staff meeting, they may lose out on evening work-related activities, said Monk. “Morning larks, in general, do not do as well when asked to entertain a client over dinner or to participate in late-evening training, sales or bargaining sessions. Also, they generally do badly when asked to be shift workers.”

This is one of several studies being done by Monk on behalf of the National Aeronautics and Space Administration (NASA). Much of Monk’s NASA work involves the impact of sleep and circadian rhythms on performance and safety. NASA provided primary funding for the study. Additional funding was from the National Institute on Aging and National Institute of Mental Health.

Other authors include Daniel J. Buysse, M.D.; Jaime M. Potts, B.S.; Jean M. DeGrazia, M.Ed.; and David J. Kupfer, M.D., all of the University of Pittsburgh School of Medicine.


Interaction of synthetic, biological molecules studied

A group of researchers, including two Pitt professors, have been awarded a $2.8 million, five-year grant by the National Science Foundation’s Collaborative Research in Chemistry Program (CRC) to study chemical and biological self-assembly.

The research could lead to smaller, more flexible computers and clothing that monitors its wearer’s health.

Anna Balazs, the Robert Von der Luft Professor of Chemical and Petroleum Engineering in Pitt’s School of Engineering, and Gilbert Walker, an associate professor in the University’s Department of Chemistry, are working with scientists from the University of Massachusetts, NASA, and IBM Almaden to create unique new materials by exploiting synergistic interactions that arise when two distinct self-assembly processes occur simultaneously in one system. Researchers are working with two components: chaperonin proteins that self-assemble into fibers, bundles, or sheets, and synthetic block copolymers that form lamellar, cylindrical, spherical, and more complicated phases. By linking one phase to – or embedding it in – another, one self-organization process can influence the other and lead to novel assemblies.

“Understanding how synthetic molecules interact with biological molecules is essential to biomaterials and biosensors,” said Balazs. “Potential applications of this research include antimicrobial coatings, responsive materials, drug delivery, and biomolecular electronics.”


Nano-metals don’t deform in same way that ordinary metals do

Mechanical Engineering Professor Scott X. Mao and a team of researchers identified a way in which nanocrystalline metals deform, confirming that “nanostructured” metals deform differently than ordinary metals. The findings should help nanoscientists – researchers who use atoms and molecules as basic building blocks to construct minute machines, create new materials or perform molecular tasks – to develop new metals and metal coatings.

The findings of Mao’s research team were published in the article, “Grain Boundary-Mediated Plasticity in Nanocrystalline Nickel,” which appeared in the July 30, 2004, issue of the journal Science.

“These findings expand our knowledge of the nature of deformation in metals and will change the traditional way of thinking about the deformation process,” Mao said.

In addition to Mao, Pitt researchers involved in the project included Jorg M.K. Wiezorek, an associate professor in the School of Engineering’s Department of Materials Science and Engineering and Zhiwei Shan, a Pitt Ph.D. student in Mao’s lab.

People under hypnosis feel pain similar to those with genuine pain

A brain imaging study by researchers at Pitt and the University College of London (UCL) exploring the experience of pain in hypnotized volunteers has provided new evidence for the basis of “functional pain” such as chronic low back pain, whose underlying physical cause continues to baffle doctors.

In the study, to be published in the journal NeuroImage, volunteers who were hypnotized into believing they felt pain showed strikingly similar brain activity to those subjected to genuine pain via pulses of heat at 48.5 degrees Celsius (119 degrees Fahrenheit), suggesting that some forms of pain that cannot be traced to a physical problem may have a neurological basis.

The study found that a third group of volunteers asked to imagine that they were experiencing the same pain had significantly lower brain activity than the hypnotized and genuine pain groups.

Stuart Derbyshire, assistant professor of anesthesiology and radiology at the University of Pittsburgh was principal investigator, along with David Oakley, director of UCL’s Hypnosis Unit.

“The study provides direct evidence of the brain generating pain in the absence of any actual noxious input,” Derbyshire said. “That is significant because many functional disorders, such as fibromyalgia, might rely upon similar mechanisms. We are currently running studies to test that idea with patients.”

Functional pain disorders such as chronic back pain, facial pain and fibromyalgia have no known underlying medical cause. Conversion disorders such as hysterical paralysis, where someone with a normal, healthy leg might be unable to move it, are just as poorly understood.”


Patients with most severe form of COPD more likely to harbor pneumocystis organism in their lungs

While smoking may be the most common cause of chronic obstructive pulmonary disease (COPD), severity of COPD could be influenced by a common organism that can colonize the lungs without causing outward symptoms, suggests results of a study published in the August 15 issue of the American Journal of Respiratory and Critical Care Medicine, a journal of the American Thoracic Society.

The organism, Pneumocystis jiroveci (previously known as Pneumocystis carinii), seldom causes serious problems for normal hosts, but in people with suppressed immune systems, such as transplant patients or cancer patients undergoing chemotherapy, it can result in a deadly lung infection. For patients with HIV, Pneumocystis is the most common and most serious AIDS-defining opportunistic infection.

The study, conducted at Pitt’s School of Medicine, involved 68 patients with COPD and 44 patients with other lung diseases, such as cystic fibrosis.

Pneumocystis was more prevalent in the COPD patients, especially those with the most advanced disease. Smoking history, number of packs of cigarettes smoked over time, age and gender did not correlate with the existence of the organism in the lungs.

“Pneumocystis colonization is associated with severity of COPD, and airway obstruction was significantly worse in patients whose lungs were colonized than in those patients who had no evidence of the organism. Moreover, colonization did not appear to be the result of other clinical factors or concomitant conditions,” stated Alison Morris, assistant professor of medicine in the division of pulmonary and critical care medicine at the University of Southern California. Morris conducted the study while completing a fellowship at the University of Pittsburgh under Karen A. Norris, the paper’s senior author, and an associate professor of immunology at Pitt’s School of Medicine.

“Further work will be necessary to clarify whether the presence of Pneumocystis contributes to worsening lung function or whether patients with the poorest lung function are predisposed to Pneumocystis. However the correlation between the two cannot be ignored,” said Frank C. Sciurba, associate professor of medicine in the division of pulmonary, allergy and critical care medicine at Pitt’s School of Medicine.

In addition to Morris, Norris and Sciurba, other authors from Pitt include: Irina P. Lebedeva, department of immunology; and Andrew Githaiga, M.D., department of medicine. The study was supported by the National Institutes of Health and the Canadian Institute for Health Research.


PennDOT awards $2.1 million for environmental study

The Pennsylvania Department of Transportation awarded $2.1 million for a three-year environmental research project for road reconstruction of Interstate 99. When completed, I-99 will connect U.S. I-70 and I-80 from Wolfsburg, Pa., through Bald Eagle, Pa.

The project will examine a roadway design concept promising to preserve surface and groundwater flows at their preconstruction conditions.

“Construction projects always disturb the landscape,” said Rafael G. Quimpo, the project’s principal investigator and professor of civil and environmental engineering in Pitt’s School of Engineering. “In many ways the aesthetics in highway alignment and design can emphasize the harmony between man-made structures and nature, and a general rule is that in order to preserve the ecology, a project must have minimal impact on flora and fauna in the area.”

Ronald Neufeld, professor of civil and environmental engineering and professor of environmental and occupational health in Pitt’s School of Engineering and Graduate School of Public Health, respectively, will be co-principal investigator of the study. Faculty members from Pitt’s Departments of Geology and Planetary Science and Biological Sciences will assist in the project. Environmental monitoring will be conducted in collaboration with the Western Pennsylvania Conservancy.

Stretched Material Could Lead to Next Generation of High-Speed Electronic Devices

A team of researchers led by scientists from the University of Pittsburgh and Penn State University has created a new material that promises to out-perform all other known materials for use in high-frequency devices.

“The technological implications are staggering,” said Jeremy Levy, an associate professor in Pitt’s Department of Physics and Astronomy, who investigated the properties of the new material, a novel form of strontium titanate. He and his fellow researchers transformed the normal properties of strontium titanate (a synthesized, crystalline material made up of the metals strontium and titanium, plus oxygen) by stretching it, atom-by-atom, according to a report published Aug. 12 in the journal Nature.

The result is a form of strontium titanate that is “ferroelectric”-i.e., it has a natural, spontaneous electric polarization that can be reversed by the application of an electric field-at room temperature. The new material could have a variety of commercial applications and might even lead to the next generation of high-speed electronic devices, researchers believe.

Applications for the new material could range from use in cell phones capable of operating at lower power than current models to high-density, nonvolatile storage media for computers, Levy said.

Creating the stretched strontium titanate is akin to stretching a bed sheet beyond its normal limits, explained Darrell Schlom, professor of materials science and engineering at Penn State, where the stretched material was synthesized. In this case, the “bed sheet” is strontium titanate and the “bed” is a newly synthesized crystalline material, dysprosium scandate. “What we are doing is stitching, atom by atom, the ‘bed sheet’ of strontium titanate to the ‘bed’ of dysprosium scandate,” Schlom said.

“In doing so, we can prevent the strontium titanate from wrinkling or tearing, and we can transform the properties of this sheet of material in ways that are impossible to do otherwise.”

The research was supported by a $750,000, three-year grant from the National Science Foundation.


Condom use decreases PID recurrence

Women wishing to decrease their risk for a common and serious infection of the upper genital tract called pelvic inflammatory disease (PID) should make sure their sexual partners use condoms and use them consistently, according to a multi-center study from the Pitt’s Graduate School of Health (GSPH).

Appearing in the August issue of the American Journal of Public Health, the report is the first prospective study to clearly show an association between regular condom use and a reduced risk not only for recurrent PID, but also for related complications such as chronic pelvic pain and infertility, said Roberta Ness, professor and chair of the department of epidemiology at GSPH and the study’s first author.

Consistent condom users were half as likely to have an episode of recurrent PID as those women whose partners never used condoms, the study found. Significantly, women who reported regular use of condoms were 60 percent less likely to become infertile. The rate of reported condom use appeared to have no effect on future chronic pelvic pain.

“Bacteria that cause cervical infection can travel into the upper genital tract and trigger PID,” said Ness, who also directs the women’s health program at GSPH and is professor of medicine and obstetrics and gynecology and reproductive sciences at the Pitt’s School of Medicine. “Many different organisms can cause the disorder, but most cases of PID are associated with sexually transmitted diseases (STDs) such as gonorrhea or chlamydia.”

While the study speaks specifically to a decreased risk of disease recurrence among a population of women who have already had at least one apparent episode of PID, the results may indicate a similar reduced risk for PID acquisition in the general population, Ness noted, adding that more study is needed.

Additional authors include Richard Sweet, University of Pittsburgh and Magee-Womens Hospital of the University of Pittsburgh Medical Center; Debra Bass, M.S., and Kevin Kip, Ph.D., both of the University of Pittsburgh, and others. The Agency for Healthcare Research and Quality and from the National Institute of Allergy and Infectious Diseases at NIH funded the study.


Fluid derived from aloe plant prolongs life after hemorrhagic shock

A novel resuscitation fluid derived from aloe vera that was developed by researchers at Pitt’s McGowan Institute for Regenerative Medicine has the potential to save the lives of patients with massive blood loss, according to results of an animal study published in the August edition of the medical journal Shock. The findings could have a significant impact on the treatment of hemorrhagic shock caused by both civilian and military trauma.

In a rodent model of hemorrhagic shock, animals that were given a very small amount of the fluid, an aloe vera-derived drag reducing polymer (DRP), had significantly longer survival time and increased systemic whole body oxygen consumption, even in the absence of resuscitation with blood or other fluids, compared to animals that did not receive DRP.

“We hope this fluid will offer a viable solution to a significant problem, both on and off the battlefield. Typically, hemorrhagic shock is treated by controlling ongoing bleeding and restoring blood volume by infusing a lactate solution and packed red blood cells. Soldiers wounded in combat often lose significant amounts of blood, and there is no practical way to replace the necessary amount of blood fast enough on the front lines. When this happens, there is inadequate perfusion of the organs which quickly leads to a cascade of life-threatening events,” said senior author Mitchell P. Fink, professor and chair, department of critical care medicine and Watson Professor of Surgery at Pitt’s School of Medicine.

“Medics would need only to carry a small amount of this solution, which could feasibly be administered before the soldier is evacuated to a medical unit or facility,” he added.

In the current study, lead by Carlos A. Macias, a visiting research associate in the department of critical care medicine at the University of Pittsburgh’s School of Medicine, five of 10 rats that were injected with a small amount of a normal saline solution survived four hours after hemorrhagic shock. Of the animals treated with a same amount of saline and the aloe-derived DRP, eight of 10 survived. The animals treated with DRP also fared better in another experiment involving more severe blood loss; five of 15 survived the two-hour observation period, compared to one of 14 treated with saline solution alone. Seven animals receiving no treatment all died within 35 minutes.

In addition to Fink, Kameneva and Macias, authors of the study are Jyrki J. Tenhunen, visiting research associate in the department of critical care medicine at Pitt’s School of Medicine; and Juan-Carlos Puyana, associate professor of critical care medicine and surgery at Pitt and critical care director of the trauma/surgery intensive care units at Pitt’s medical center.

The research was supported by the Defense Advanced Research Projects Agency.


ACL injury prevention gets funding

U.S. Senator Rick Santorum, R-Pa., presented a check for $100,000 last week (Aug. 24) to sports injury researchers at the university and UPMC’s Center for Sports Medicine. The money will support continued research examining risk factors and prevention strategies for anterior cruciate ligament (ACL) injuries in female athletes.

Accepting the check was principal investigator Scoot M. Lephart of Pitt’s Neuromuscular Research Laboratory (NMRL), located within the UPMC Center for Sports Medicine, in Pittsburgh’s South Side. Santorum secured the funds through the Labor, Health and Human Services and Education Omnibus as part of the FY-2004 Appropriations Bill passed earlier in the year.

“This important and generous award serves female athletes at a critical time as we continue our ongoing Female ACL Injury Prevention Project agenda, initiated in 1995, aimed at examining the epidemic of ACL injuries in female athletes and exploring methods to prevent the injury,” said Lephart, who is director of the NMRL as well as associate professor and chairman of the sports medicine and nutrition department at Pitt’s School of Health and Rehabilitation Sciences associate professor in the orthopedic surgery department at Pitt’s School of Medicine.

“This research has significant women’s health care implications as studies have shown that female athletes are up to eight times more likely to injure an ACL than their male counterparts,” he added.

The ACL is the main stabilizing ligament in the knee joint, connecting the femur to the tibia. ACL injuries are common in fast-moving sports that involve sudden starting, stopping, turning, jumping and landing, such as in basketball, soccer and lacrosse.

“ACL injury to a young female is far more devastating than simply missing a high school sports season. This injury often requires surgical repair and lengthy rehabilitation and begins a pattern of premature arthritic changes that can significantly reduce the physical activity of women as they age, thus affecting their ability to have physically fit lifestyles,” said Freddie Fu, professor and chairman of the orthopedic surgery department at Pitt’s School of Medicine.

CORE, UPMC announce trial for additional renal call center

The Center for Organ Recovery and Education (CORE), the region’s designated organ procurement organization (OPO) and oversight authority on organ allocation announced that it will partner with the transplant center at UPMC, on a 90-day trial for the hospital to operate its own extra-renal call center.

This pilot project is intended to assess the potential benefits of an on-site call center managed by UPMC for the purpose of expediting the placement of available organs imported from outside the tri-state region with qualified recipients awaiting transplantation at UPMC.

During the 90-day period, which begins Sept. 1, CORE and UPMC will concurrently monitor organ matches to UPMC patients through the University’s extra-renal call center. Under this trial, CORE will continue to ensure the allocation of available organs to a descending match list, thus protecting the integrity of the donation process.

“CORE agrees this trial with UPMC is intended to save precious time in the matching process and will ultimately be helpful to the patient candidate due to the large numbers of transplants performed at UPMC,” said Susan Stuart, CORE’s president and chief executive officer. “Under the trial process, UPMC and an OPO from outside the region will have direct contact. CORE will, however, retain its oversight of the organ allocation process to ensure equitable distribution of organs to the best matches,” she added.

CORE remains the primary call center and intermediary of the organ retrieval and allocation process with its own call center serving 160 hospitals and nearly 6 million people in western and central Pennsylvania, the state of West Virginia and upstate New York. Since its inception, CORE has helped to provide more than 300,000 organs, tissue and corneas for transplantation.


Fund set up to support brain tumor research

A Pittsburgh-based railroad equipment supply company, Wabtec Corporation (NYSE: WAB), has announced a memorial fund to support brain tumor research and physician education at the University of Pittsburgh Cancer Institute (UPCI). The fund, created in memory of former Wabtec president and CEO Gregory T.H. Davies, will help promote scientific and clinical research on innovative strategies to prevent, detect, diagnose and treat brain tumors, diagnosed in approximately 20,000 Americans each year.

“A brain tumor diagnosis can be devastating for a patient,” said Ronald Herberman, director of UPCI and the UPMC Cancer Centers. “Not only do they infiltrate critical tissue quickly, they also tend to resist a multitude of treatments. We are extremely grateful to Wabtec for the formation of this fund because it will allow us to pursue promising, new approaches to brain tumors that can translate into vast improvements in treatment and possibly even cures.”

The Gregory T.H. Davies Brain Tumor Research and Physician Education Endowed Fund, will support the UPCI Brain Tumor Program’s ongoing efforts in neuro-oncology, neurology, neurosurgery, neuropathology, neuro-imaging, radiation oncology and translational research with the ultimate goal of reducing death and disability from brain tumors.

Wabtec and its directors contributed $300,000 to the fund, established to honor Davies, a graduate of Harvard Business School, who also worked at Danaher Corporation and Cummins Engine Company. Davies was diagnosed with a malignant brain tumor in March of this year and died in July at the age of 57.

“Greg’s courage and strength were an inspiration to everyone at Wabtec, and his legacy will live on within our company,” said William E. Kassling, Wabtec chairman, president and CEO. “Through this fund, we are striving to make sure that his legacy can have a positive impact on others who are faced with similar challenges.”

Ninety percent of all primary brain tumors occur in adults 40 to 70 years of age.


$10 million grant awarded to UPCI

The University of Pittsburgh Cancer Institute (UPCI) has received a five-year, $10 million Specialized Program of Research Excellence (SPORE) federal grant to examine innovative treatment strategies designed to improve survival outcomes for patients with head and neck cancer. The grant, awarded by the National Cancer Institute (NCI), is the second SPORE awarded to UPCI – the first was awarded to the cancer institute’s Lung Cancer Program in 2001 – and is one of only four SPORE grants in head and neck cancer awarded nationally.

“Head and neck cancer is one of the most physically and emotionally debilitating cancers,” said Jennifer Grandis, principal investigator of the grant and professor of otolaryngology and pharmacology, Pitt’s School of Medicine, and director of UPCI’s Head and Neck Cancer Program. “Treatment options are limited and often leave a patient with disabling side effects that can have a devastating impact on quality of life. This grant will enable us to enhance the quality of life for head and neck cancer patients and greatly improve their prognoses through the collaborative efforts of our researchers in the laboratory and clinic.”

The grant funds four major translational research projects that focus on genetic changes that are potential risk factors for head and neck cancer, intracellular signaling proteins activated during head and neck cancer, and new treatment strategies designed to reduce the morbidity and mortality from head and neck cancer.

In the first major project in the grant, Marjorie Romkes, associate professor, center for clinical pharmacology, department of medicine, and Joel Weissfeld, associate professor, department of epidemiology, will examine the correlation between promising genetic markers for head and neck cancer and tobacco and alcohol use.

“Eighty percent of head and neck cancer patients are smokers, chew tobacco and consume large amounts of alcohol,” Romkes said. “If we can determine who among this population will most likely develop cancer, we can screen and treat them earlier, potentially improving their prognoses and quality of life.”

In another project, Grandis and Daniel Johnson, associate professor of medicine, will examine intracellular signaling proteins called Signal Transducer and Activators of Transcription (STATs) that have been linked to tumor progression in several cancers, including head and neck cancer. Albert DeLeo, professor of pathology, and Robert Ferris, M.D., Ph.D., assistant professor of otolaryngology, will head up an additional project to develop a therapeutic vaccine that targets the tumor-suppressing gene p53 In a final project, Jill Siegfried, professor of pharmacology, and Grandis will examine multiple signaling pathways implicated in the proliferation of head and neck cancer.

With 36,200 estimated new cases and 11,000 deaths in 2003, head and neck cancer accounts for 4 percent to 5 percent of all newly diagnosed cancers in the United States. More than two-thirds of head and neck cancer patients have a locally advanced stage when diagnosed, which has a poor five-year survival even after treatment.

Genetic contributor to cleft lip and palate identified

Researchers from eight countries, led by a team at the University of Iowa, including a Pitt researcher, have identified a genetic variation that significantly increases the risk of a baby being born with cleft lip and palate, one of the most common birth defects in the world.

The finding helps explain 10 to 15 percent of all cases of the common form of cleft lip and palate and points scientists in new directions for improved prediction, prevention and treatment of the condition. The study results appeared in the Aug. 19 issue of the New England Journal of Medicine. A major contributor to the paper was Mary Marazita, Ph.D., of the Center for Craniofacial and Dental Genetics in Pitt’s School of Dental Medicine.

In cleft lip and palate, the lip or both the lip and palate (roof of the mouth) fail to close. The facial defects occur in approximately one out of every 1,000 babies, with some ethnic groups affected more than others.


Study looks at how gender affects living with traumatic spinal cord injuries

Although men and women who have suffered traumatic spinal cord injuries (SCIs) report comparable levels of psychological well being, recent studies have found that older female SCI survivors experience aging differently from their male counterparts. For example, older women with SCI have higher incidences of pain, depression, and suicide than men, and are less likely to hold a job and have access to preventive healthcare. In a new study, researchers at Pitt’s University Center for Social and Urban Research (UCSUR) hope to shed light on these discrepancies.

The UCSUR study is supported by a $2.1 million, five-year grant from the National Institute of Nursing Research.

Headed by UCSUR Director Richard Schulz, a Pitt professor of psychiatry, the study is designed to provide information, resources, and support to older individuals with SCI and their caregivers. UCSUR’s study is one of the first aimed at providing a structured intervention for the growing number of caregivers of older SCI survivors, a group that has received little attention in the literature addressing the psychosocial issues of care giving.

Over the next two years, researchers at Pitt and the University of Miami will collect data on participants’ physical and mental health status, as well as the levels of physical, emotional, and practical support available to them. These factors will be examined relative to participants’ gender, age, health status, degree of functioning, access to healthcare services, and social network integrity.


Biochemical sensing systens as small as fingernail tip?

The National Science Foundation (NSF) recently awarded Pitt a $1.3 million, four-year NSF Nanoscale Interdisciplinary Research Team (NIRT) grant to develop plasmonic chip technologies for biochemical sensing.

Plasmonic chip technology-which may someday enable scientists to squeeze millions of sensor elements onto a single computer chip-promises to create nanoscaled biochemical sensing systems, says lead researcher, Hong Koo Kim, a professor of electrical and computer engineering and codirector of Pitt’s Institute of NanoScience and Engineering.

Kim and his Pitt colleagues will also investigate the fundamentals of plasmonic phenomena in nanoscale metallic structures.

“If this nanoscaled biochemical sensing technology becomes a reality, it would revolutionize healthcare-including diagnosis of disease and monitoring of health status-as well as our ability to detect toxic and hazardous biochemical agents for environmental and homeland security purposes,” said Kim.

Kim’s NIRT project involves cross-school collaboration with Pitt Professor Hrvoje Petek of the Department of Physics and Astronomy and Professors Rob Coalson, David Waldeck, and Gilbert Walker of the Department of Chemistry.


Placing relative with dementia in long-term care facility does little to ease caregivers burden

Results of a multi-site study coordinated by Pitt in this week’s Journal of the American Medical Association (JAMA) show caregivers who decide to place their relatives into institutionalized care get no relief from depression and anxiety. In fact, they suffer additional emotional trauma following their decision.

This is the first study to provide a comprehensive analysis of the emotional turmoil caregivers experience during the transition of their loved one from home to a long-term care facility.

Results from the four year study of 1,222 caregiver-patient pairs found that for the 180 caregivers who had to turn over care of their loved one to an institution, symptoms of depression and anxiety stayed as high as they were when they were in-home caregivers. These findings stand in sharp contrast to earlier findings reported by lead author Richard Schulz, professor of psychiatry and director of Pitt’s Center for Social and Urban Research, and his group showing that death of a loved one after care giving results in improvements in depression.

“Caregivers who place their loved ones in an institution do not get the sense of relief or experience the closure observed among caregivers whose loved ones pass away,” Schulz said. “They continue to feel distressed because of the suffering and decline of their loved one as well as having to face new challenges such as frequent trips to the long-term care facility, reduced control over the care provided to their relative and taking on responsibilities such as coordinating and monitoring care.”

In addition, cognitive and functional declines are common in patients who go into long-term care, and caregivers often blame themselves for this decline and question their decision to institutionalize their loved one, according to Schulz.

Caregivers who were married to the patient and those who visited most frequently had the most difficult transition. Spouses reported higher levels of depression both before and after placement and more anxiety after placement than their non-spouse counterparts. Almost half of the caregivers in the study visited the patient daily and continued to provide some form of physical care during their visits.

The patients in this study were all diagnosed with moderate to severe Alzheimer’s disease and had a median age of 80 years. Caregivers were mostly female with a median age of 63. The sample was 56 percent white, 24.2 percent African American and 19 percent Hispanic, and were primarily spouses or children.

During the study, the researchers found that African American and Hispanic caregivers were less likely to place their relative in a facility than whites; caregivers reporting greater burden were more likely to place their loved one in long-term care; and caregivers who reported that their care giving experience made them feel useful and important were less likely to place their relative in a facility.

Additional authors from Pitt include Steven H. Belle, Kathleen McGinnis, and Song Zhang. Researchers were from the University of Miami and the University of Alabama at Birmingham contributed.

The study was funded by grants from the National Institute on Aging and the National Institute for Nursing Research.

Filed under: Feature,Volume 37 Issue 1

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