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March 31, 2005


Study pinpoints keys to health for elderly in McKeesport

A community outreach campaign by Pitt’s Center for Healthy Aging (CHA), conducted in McKeesport, has shown researchers areas they need to target the most in order to promote the CHA’s “10 Keys to Healthy Aging.” The keys are strategies, developed by the CHA, aimed at reducing risk factors in the aging population and improving quality life expectancy with a focus on preventable diseases and disability.

“Implementing the ‘10 keys’ campaign has the potential to impact the quality of lives of our older adults, lower health care costs, affect the direction of research and funding as well as influence health care policy,” said Constance M. Bayles, program director for CHA in Pitt’s Graduate School of Public Health (GSPH).

The 10 keys, selected on the basis of vast epidemiological, clinical and laboratory studies, are: maintaining social contacts; combating depression; increasing physical activity; stopping smoking; preventing bone loss; getting regular immunizations; participating in cancer screenings; lowering LDL cholesterol; controlling systolic blood pressure, and regulating blood glucose.

“We have discovered in McKeesport that colon cancer screening, cholesterol lowering, hypertension management and physical activity all are keys to target for improvement. Meanwhile, the good news in this community is that preventative health goals related to osteoporosis, smoking, maintaining social contact, mammography, influenza vaccines and depression in this population had the highest percentage of being in successful accordance with the healthy aging keys,” Bayles added.

“We found that several preventive messages were well-adopted by older healthy adults, whereas opportunities to prevent disease and maximize health in other areas were sometimes overlooked. It was discovered that individuals and diverse community organizations showed interest in learning about and implementing the 10 keys,” she said. CHA’s McKeesport community site is located at UPMC McKeesport.

Bayles’s team came to its conclusions after assessments on 544 people aged 65 and older who were recruited for a community demonstration project. Participants included 217 men and 327 women with an average age of 74.5 years. These individuals were randomized to receive either intensive healthy lifestyle guidelines with emphasis on control of hypertension and diabetes, or a brief health education with referral to community partners. All participants had access to a health counselor to help them adopt the 10 keys. Health status was monitored at entry, at six months and at one year. CHA’s ongoing community outreach campaign in Allegheny County assists with the 10 key campaign and includes the involvement of community partners, including UPMC McKeesport and the McKeesport Hospital Foundation, public speaking engagements by health care educators, health fairs, social events such as an annual dance and talent show, organized walks, a weekly radio show and free quarterly newsletters.

The next steps for the ongoing campaign are for Bayles and her team to present their findings to health care professionals and the CHA Community Advisory Board in McKeesport and surrounding communities; meet with local health care professionals and the advisory board to develop a plan to better control hypertension and cholesterol; promote colonoscopy testing and increase physical activity in this community; evaluate success of intervention programs, and further develop health counselor and community ambassador programs.

CHA is a Prevention Research Center, one of 33 such centers across the United States funded by the Centers for Disease Control and Prevention.

Bayles’s research team includes Lewis Kuller, Anne Newman, Carole Milas and Kendra Winters of GSPH, and Kathleen McTigue of GSPH and UPMC.


Study looks at resolving doctor/family conflict in care of the dying

How can a dying patient’s family members and physicians get along when faced with difficult decisions on end-of-life treatment? The medical and emotional issues surrounding the care of a dying patient are both stressful and complicated, as highlighted in a recent issue of the Journal of the American Medical Association Clinician’s Corner — Perspectives on Care at the Close of Life, which highlights the case of an 84-year-old woman with advanced dementia whose advance directive states that she does not want artificial nutrition or hydration. Over the course of her illness, her family and physicians disagreed about the use of a short-term feeding tube and intravenous hydration.

From this case study, authors Robert M. Arnold, the Leo H. Criep chair in patient care, professor of medicine, and chief, section of palliative care and medical ethics at the School of Medicine, along with Anthony L. Back, an oncologist and medical ethicist from the University of Washington-Seattle, sought ways to identify conflict and make recommendations on how to avoid the pitfalls and recognize disputes by employing useful communication tools.

“Physicians often assume that conflict is a bad thing and something that should be avoided, yet conflict handled well can be productive and the clarity that results can lead to clearer decision making and greater satisfaction,” Arnold said.

The five major types of conflict the authors identified include physician-family conflict, physician-nurse conflict, physician-physician conflict, family-family conflict and physician-patient conflict.

In the physician-family conflict scenario, family members may have concerns that hospitals do not respect their roles as caregivers, that they do not get the information they need or that the decisions are inconsistent with their wishes.

In the physician-nurse conflict scenario, previous studies in the intensive care unit suggest that physicians do not always acknowledge nurses’ points of view. In one large survey, nurses rated physician value and respect for nurse collaboration significantly lower than did physicians. When asked what the most important element of a good working relationship is between physicians and nurses, physicians answered with “a willingness to help,” while nurses answered with “mutual respect and trust.”

The authors suggested one way to avoid these types of conflicts is to negotiate a course of treatment in which all parties have a say in how best to proceed with patient care so that potential conflicts may be solved in advance of the situation. The authors also discussed how showing empathy is important because many family members of critically ill patients often have a lot of anxiety, sadness and frustration over their loved one’s situation.

Finally, using a step-wise approach, the authors recommended the following course of action if a dispute should erupt: The first step is to recognize that a conflict exists. The next step for physicians is to prepare themselves for negotiation by identifying what happened and empathize with the family and their emotions. Once the physician is ready to negotiate with the family, the physician must begin the conversation in a non-judgmental manner. The authors suggest addressing and focusing on the problem instead of the person. Physicians need to listen carefully to family members’ concerns, respond empathetically and look for options that meet the needs of both parties. If the conflict still exists, it may be necessary to involve an impartial person who can act as a mediator.


Grant awarded to study kids’ brain tumors

Marie E. Beckner, research assistant professor of pathology at the School of Medicine, has been awarded a $15,000 grant from the Nick Eric Wichman Foundation (NEWF) to study brain tumor invasion in children.

Beckner is collaborating with Ian F. Pollack of neurosurgery in ongoing studies of new treatments for brain tumors. The Wichman Foundation has supported studies in Pollack’s laboratory for several years.

“The NEWF funding enabled us to recently purify the leading edge of malignant brain tumor cells. We optimized a method of using filters for harvesting tumor pseudopodia, finger-like projections that are similar to the protrusions of tumor cells that extend into surrounding tissue. By combining harvests of pseudopodia obtained from multiple porous filters, we acquired material sufficient for several studies, including identification of several proteins that are increased in the leading edge of tumor cells,” said Beckner. “We are now focusing on the invasive region of the tumor cells to tailor development of new treatment strategies that block tumor invasion,” he added. The new method was published recently in the 2005 March issue of Laboratory Investigation.

NEWF was established by Karen Wichman to fund medical research for invasive brainstem tumors in children and increase public awareness of pediatric brain tumors.

Wichman’s son, Nick Eric Wichman, died in 2001 at age 8, weeks after becoming ill from an untreatable brain tumor.


Brain cells can transmit three signals at once

Generations of neuroscientists have been indoctrinated into believing that humans’ senses, thoughts, feelings and movements are orchestrated by a communication network of brain cells, or neurons, each responsible for relaying one specific chemical message called a neurotransmitter. Either neurons release a neurotransmitter that excites a neighboring cell, thereby triggering an electrical discharge and enhancing brain activity, or they dispatch a signal that quells a neuron’s activity. University researchers discovered that immature rat brain cells could fire a simultaneous three-punch salvo — three neurotransmitters bursting out of a single cell.

The Pitt researchers report in the lead article of this month’s Nature Neuroscience that, by definition, these three neurotransmitters are seemingly at odds with each other. One, glutamate, is a textbook excitatory neurotransmitter, while the other two, GABA and glycine, are quintessential inhibitory neurotransmitters.

Information is transmitted between neurons when one cell releases a neurotransmitter at a synapse, the point of contact between cells. When released from a cell, neurotransmitters are sent on a one-way ride that dead ends at the membrane of the adjacent cell. Like lock and key, they bind to specific receptors on the surface of the receiving cell, causing its electrical activity to be enhanced or inhibited.

The first week after birth marks a critical phase in the developing rat brain, a time period comparable to three months’ gestation in a human, when neurons meticulously are organizing and self-selecting to assemble into specific brain structures and neuronal networks. It has long been known that a specific receptor for glutamate, the NMDA receptor, plays a crucial role in these processes, but how inhibitory synapses, which account for about half of the brain’s cellular connections, would gain access to these receptors has long puzzled researchers. But now the Pitt researchers believe they have solved some of the mystery. During this crucial period, immature inhibitory synapses also release the excitatory neurotransmitter glutamate, and by mimicking excitatory synapses, can stimulate NMDA receptors.

“It first appeared odd to us that an immature inhibitory synapse would want to release an excitatory neurotransmitter. After all, this contradicts the most basic principles that have defined the field of neuroscience. But when we also found that this glutamate activates NMDA receptors at the most critical stage of brain development and organization, we realized that this could explain a number of fundamental questions,” explained Karl Kandler, associate professor of neurobiology at the School of Medicine, and the study’s senior author.

“These findings shed new light on how inhibitory synapses evolve and are assembled into functional circuits in the developing brain,” he added.

Many brain disorders, like epilepsy, schizophrenia and depression, involve deficits that prevent normal inhibition of cells. Kandler’s research could provide insight into the biological cause of these disorders and help to identify novel approaches for prevention and treatment. Further study could have particular implications for dyslexia and tinnitus — often referred to as ringing in the ears — which can be caused by abnormal inhibitory signaling within the auditory system, a region of the brain that is the focus of Kandler’s research.

Before there can be practical clinical applications several questions need to be answered, including how GABA, glycine and glutamate synapses cooperate to activate NMDA receptors. In the traditional sense, when inhibitory synapses are mature, they would never release glutamate, nor would they be able to depolarize a cell, both of which are required for NMDA receptor activation. But, as if by design, during the exact period when the auditory brain is undergoing refinement, the GABA and glycine neurotransmitters can produce depolarizations, a process that normally can only be achieved by excitatory transmitters.

It is not yet known how long the cells retain this unique capacity, for how long the neurons are able to release all three neurotransmitters or what causes the cells to stop releasing glutamate as they mature. But according to the study’s first author, Deda C. Gillespie, a post-doctoral associate working with Kandler, things become more normalized within three weeks of birth, or about one week after hearing is fully developed. So, perhaps early auditory experience provides the signals that stop the cells from releasing glutamate, which is a prerequisite for correctly processing auditory information.

“It will be interesting to find out whether abnormal hearing, such as partial deafness or hearing dominated by noise, which in humans can affect normal language development, would cause glutamate to still be released. Finding such an association would be intriguing, but for now this remains just a hypothesis that will require much study,” Gillespie said.

The third author of the study is Gunsoo Kim, now at the University of California-San Francisco.

The research was supported by the National Institute on Deafness and Other Communication Disorders and the National Institute of Neurological Disorders and Stroke.

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