University Times

Nursing researchers present findings

Researchers from the Pitt School of Nursing recently presented findings at the Society for Behavioral Medicine’s annual meeting in Washington, D.C.

* Abnormal lung scans may move smokers to quit

Computed tomography (CT) screening can be useful in detecting lung cancer in its earliest stages. According to research led by Mindi Styn, CT screening also may be a handy tool in getting smokers to attempt to quit. Data from Styn’s dissertation, which was presented at the session, “Lung Cancer Screening & Treatment: Maximizing the Teachable Moment,” suggests that smokers who are referred for further evaluation as the result of an abnormal CT are more likely to try to kick the habit.

Styn examined quitting behaviors of a group of participants in the Pittsburgh Lung Screening Study, a low-dose CT screening study that involved current and former smokers between the ages of 50 and 79 who had smoked at least a half pack of cigarettes every day for at least 25 years. When controlling for other factors that influence quitting, such as marital status and symptoms of lung disease, individuals with CT referrals were more likely to have attempted, either successfully or unsuccessfully, to quit when compared to participants who did not receive a CT referral.

These results suggest that health care professionals may be able to take advantage of an abnormal CT finding in order to encourage a patient to quit smoking.

Other researchers involved in this project were: Kenneth Perkins, Marjorie Romkes and Joel Weissfield of the School of Medicine and Stephanie Land of the Graduate School of Public Health.

* Many dieters don’t cut fat

More than half of dieters ignore standard recommendations of reducing their fat intake and increasing carbohydrate consumption, according to findings from a Pitt team led by Lora Burke, professor of nursing and epidemiology.

The study, “Dietary Practices Among People Seeking Weight Loss Treatment,” used a 38-item questionnaire to identify dieters’ eating habits. Based on those responses, the researchers discovered that 55 percent of the individuals surveyed showed eating patterns consistent with the typical American diet, which is comprised of more than 40 percent fat and less than 45 percent carbohydrates.

The study examined the eating patterns of a number of sub-categories, which also resulted in findings of note. Non-white participants were likely to have higher fat and cholesterol intake, and unemployed participants had scores that indicated higher cholesterol-saturated fat intake. Additionally, individuals with no education beyond high school consumed fewer carbohydrates. The study’s findings suggest that socio-demographic factors should be considered by health care providers attempting to improve their patients’ eating habits.

Other researchers on the project included Mindi Styn, Edvin Music and Melanie Warziski, all of the School of Nursing.

* Time, not menu, influences diet maintenance

Because people are more likely to maintain a behavior if they have positive experiences when they adopt it, a group of researchers led by Lora Burke sought to learn if individuals selecting a lacto-ovo-vegetarian (LOV) diet, which includes eggs and milk but no meat, had more positive experiences in six areas that affect diet maintenance than did those who followed a more standard diet that included meat products.

Burke’s previous research suggests that a vegetarian diet has a positive influence on weight loss outcomes.

However, data from an 18-month study titled “Experiences Following a Low-Fat Diet Influence Dietary Maintenance,” in which the experiences associated with following a low-fat diet (ELF) questionnaire was administered to dieters in six-month intervals, suggest that LOV dieters and standard eaters had similar experiences during their maintenance phases.

Additionally, the ELF data, which measured experiences such as wellness, inconvenience and family support, suggested that time had greater influence on maintenance factors than did category of diet. While there was little divergence in total ELF scores between the two groups of dieters, variations within certain areas were noted. The standard group experienced a greater decline in its wellness scores over time, while the LOV group were less likely to have family support at all time points.

The research team on this project also included Mindi Styn, Okan Elci, Susan Sereika, Edvin Music and Melanie Warziski, all of the School of Nursing.

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Prostate cancer treatment, gum disease linked

Androgen deprivation therapy (ADT) has become a valuable weapon in the fight against prostate cancer. As enhanced screening tools detect the cancer in its earliest stages, an increasing number of men who are otherwise healthy are receiving the therapy. However, the growing prevalence of ADT may be cause for concern.

Researchers from the School of Dental Medicine report in the Journal of Urology that prostate cancer patients receiving ADT are three times as likely to show signs of periodontal, or gum disease, as patients who do not receive the therapy.

Earlier research demonstrated links between ADT and osteoporosis and other types of bone loss in men, but this work is the first to explore ADT’s relationship with periodontal disease, which itself has been connected to a variety of other conditions.

“People with periodontal disease are at greater risk for numerous negative health outcomes,” said Pouran Famili, professor and interim chair of the Department of Periodontics at the School of Dental Medicine and lead author of the study.

“If we can identify populations who are more likely to develop periodontal disease, as we have in this research, we may be able to target early interventions to groups like ADT recipients.”

In the study, 68 prostate cancer patients received standard screenings for various symptoms of periodontal disease, which occurs when the inner layers of gum and bone pull away from the teeth. That process creates pockets that give toxic bacteria the opportunity to attack and destroy the underlying bone and can ultimately result in tooth loss.

Of the study participants, 41 received ADT for an average of 18 months, and periodontal disease was evident in 80 percent of those men. Conversely, only 4 percent of the men who did not receive ADT had periodontal disease.

When adjusted for other factors that also may influence the development of periodontal disease, such as age and smoking behaviors, the statistical relationship between ADT and periodontal disease remained significant, with ADT recipients three times as likely to have periodontal disease as the men who did not undergo the therapy.

“Urologists and oncologists, in particular, should heed these findings and refer their patients for periodontal screening early in the course of their ADT,” said Famili, who also noted that such a referral is standard for other at-risk populations, such as transplant patients. “As the majority of these men were quite conscientious about their oral hygiene, the need for early intervention by a dental care provider is paramount. It could prevent the need for more extensive treatment down the road.”

While this research has important implications for ADT patients and their risks for periodontal disease, it does have limitations, due to its relatively small sample size and cross-sectional nature. As such, further investigation involving larger populations and longitudinal data is warranted.

The research was supported by the Osteoporosis Prevention and Treatment Center at Pitt, which receives funding from the National Institutes of Health and the UPMC General Clinical Research Center.

Other study investigators included Jane Cauley of the Graduate School of Public Health and Susan Greenspan of the School of Medicine.

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Post-surgery pain control cuts length of hospital stays

Effective postoperative pain control using continuous peripheral nerve block reduced the average hospital stay by nearly a day, Pitt School of Medicine physicians reported at a recent meeting of the International Anesthesia Research Society.

Being able to decrease the time that patients spend in the hospital helps to reduce the patient’s exposure to the risk of hospital-acquired infection and associated complications, and also has an overall economic benefit, the researchers found.

“For many people, the prospect of having pain is more stressful than the surgery itself,” said Jacques E. Chelly, professor and vice chairman of the Department of Anesthesiology at the School of Medicine.

“If they know that specialists in acute pain medicine can help to minimize the pain associated with surgery, these patients are less stressed and more willing to have the surgery they need.”

Chelly and his colleagues analyzed the hospitalization experiences of 1,527 patients.

Of those, 495 underwent surgery between July 1, 2001, and Aug. 30, 2002, and 1,032 underwent surgery following the institution of a formalized postoperative pain medicine program, called the acute interventional postoperative pain service, between July 1, 2004, and Aug. 30, 2005.

The study included patients who underwent total hip or total knee replacement, chest or prostate surgery.

“Prior to the implementation of our postoperative pain management program, the average length of hospital stay was about three to five days,” said Chelly, who also is director of orthopaedic anesthesia and the acute interventional postoperative pain service at UPMC Shadyside Hospital.

“The use of the acute interventional postoperative pain service allowed patients to recover faster, and they were discharged from the hospital an average of 0.675 days per patient earlier, for a total of 597.7 days of hospitalization saved a year.”

Before the introduction of the acute interventional postoperative pain service, postoperative pain was managed by surgeons and mostly limited, according to Chelly. “Morphine and PCA (patient-controlled analgesia) were used,” he said. “Now, we can do a peripheral nerve block and use other medications, making postoperative pain control more effective.”

Other Pitt authors of the study were Bruce Ben-David, Rama Joshi, Mark Hudson and John P. Williams, all of the Department of Anesthesiology, School of Medicine.

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Kids of breast cancer patients affected by mother’s depression

A woman’s breast cancer diagnosis can wreak as much havoc on her emotions as it does on her physical health. Mothers who experience bouts of depression during their battles with breast cancer may find that the effects reach beyond their own psyches to those of their children.

According to data analyzed by Pitt researchers and reported recently at the American Psychosocial Oncology Society’s annual meeting, children of depressed breast cancer patients were more likely to be concerned or anxious about their mother’s cancer and its implication for their families.

While children’s emotional responses to their own illnesses are well-documented, this study, “The Effect of Depressed Mood in Mothers With Breast Cancer on Their Children’s Illness-Related Concerns,” is the first to examine the relationship between children’s concerns and a mother’s cancer-related depression.

“This data should prompt new considerations among oncology clinicians,” said Beth R. Grabiak, a doctoral candidate in the health and community systems department at the School of Nursing, who led the data analysis. “We need to think about the impact depression has on the breast cancer patient’s entire family as she undergoes treatment for her cancer.”

The results were obtained through a secondary analysis of data from a randomized clinical trial that was funded by the National Institutes of Health and led by University of Washington researchers. That study collected information from 155 mothers with stage 1, 2 or 3 breast cancer and 155 of their children aged 8 to 12 years. When more than one child was in the home, each mother selected one child to be followed by the study.

Mothers’ depression was measured by the Center for Epidemiological Studies Depression Scale (CES-D), while children’s concerns about the illness were determined by their responses to a 93-item questionnaire. In addition to quantifying total illness-related worries, the questionnaire responses also shed light on three subcategories: treatment-related concerns, existential concerns and family-related concerns.

When adjusting for other variables such as children’s age and gender, depression in mothers with breast cancer significantly predicted children having higher overall concerns about the illness. Furthermore, depression significantly predicted increased family-related worries in the children.

“It would be expected for children to worry about their mothers in the face of a difficult illness. It’s somewhat surprising, however, that children’s anxieties extended to concerns about the entire family,” Grabiak said.

“Well-intentioned parents may hesitate to talk openly about the disease’s emotional impact in an effort to protect their children, who in turn may attempt to hide their concerns and suffer in silence. Yet, the child’s anxieties never disappear. They often are manifested in other ways,” Grabiak said.

Estimates suggest that nearly one-quarter of women diagnosed with breast cancer have young children, meaning that as many as 100,000 children will be impacted this year alone. Grabiak suggests that, while not every breast cancer patient will become depressed, health care providers who are involved in cancer treatment should look for signs of depression in their patients, too.

The research was funded by the National Cancer Institute.

Susan M. Sereika, an associate professor in the School of Nursing who has secondary appointments in biostatistics and epidemiology, also worked on the study.

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