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Research Roundup

  • African-Americans More Likely to Report Low Trust in Health Care Providers
  • Prevent or Delay “Middle-aged Spread” by Lifting Weights
  • Most Effective Treatments for Alcohol Dependence
  • Research Findings On Radiation-Induced Cancer
  • African-Americans’ Low Trust in Health Care Providers

    A study by researchers at the Center of Excellence in Cancer Communication Research at the Annenberg School for Communication found that African-Americans were significantly more likely than whites to report low trust in health-care providers. The research appears in the April issue of Archives of Internal Medicine.

    “Developing a better understanding of how health-care experiences and structural factors shape trust among African-Americans and whites is needed to identify specific aspects of the health-care system that should be addressed to improve trust among these populations,” said lead author Dr. Chanita Hughes-Halbert, assistant professor of psychology.

    Using data from the Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care, researchers evaluated the relationship between trust in health-care providers and sociodemographics, prior health-care experiences and structural characteristics of health care in a national sample of African-Americans and whites. Researchers found that 44% of African-Americans reported low trust in health-care providers compared with 33% of whites.

    Among African-Americans, those who had fewer quality interactions with health-care providers were about three times more likely to report low trust compared with those with more quality interactions. African-Americans who obtained medical care at facilities other than a physician’s office were most likely to report low trust. Among whites, respondents without health insurance and those without annual health-care visits were most likely to report low trust in healthcare providers.

    “Part of the challenge before us is to determine whether these lower levels of trust are associated with other indicators of differential provider ability, including cultural competence,” said co-author Dr. Oscar Gandy, Herbert I. Schiller Professor of Communication.

    Prevent or Delay “Middle-aged Spread” by Lifting Weights

    Women who lift weights twice a week can prevent or at least slow down “middle-age spread” and weight gain, a Penn Medicine researcher reported at the American Heart Association’s 46th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in March.

    A study of 164 overweight and obese (body mass index of 25-35) women between 24 and 44 years of age, found that strength training with weights dramatically reduced the increase in abdominal fat in pre-menopausal participants compared to similar women who merely received advice about exercise.

    “On average, women in the middle years of their lives gain one to two pounds a year and most of this is assumed to be fat,” said lead author Dr. Kathryn H. Schmitz, assistant professor in the Center for Clinical Epidemiology and Biostatistics. “This study shows that strength training can prevent increases in body fat percentage and attenuate increases in the fat depot—or ‘belly fat’—most closely associated with heart disease.”

    Women in the two-year weight-training program decreased their body fat percentage by 3.7 percent, while body fact percentage remained stable in the controls. The strength-training reduced intra-abdominal fat, which is more closely associated with heart disease and metabolic disturbances. More specifically, the women who did strength-training experienced only a 7 percent increase in intra-abdominal fat compared to a 21 percent increase in intra-abdominal fat among controls.

    The study—dubbed The SHE study, for ‘The Strong, Healthy, and Empowered’—examined whether twice-weekly strength-training would prevent increases in intra-abdominal and totally body fat in women who were overweight or obese. The women initially were separated by baseline percentage body fat and age. The strength training group participated in supervised strengthening classes for 16 weeks, and had booster sessions four times yearly with certified fitness professionals over two years. The control group received a brochure recommending 30 minutes to an hour of exercise most days of the week. All of the women were asked not to change their diets in ways that might lead to weight changes while they were participating in the study.

    The weight-training sessions took about an hour, and the women were encouraged to steadily increase the amount of weight they lifted. The maximal amount of weight women could lift once—called a one-repetition maximum test—increased by an average of 7 percent in bench pressing and 13 percent in leg press exercises.

    Researchers measured the participants’ body composition with a dual energy X-ray absorptiometry (DEXA) scan and measurements of abdominal and total body fat by single slice CT scan at baseline, and again at one and two years.

    “This study showed that strength training is a fairly time efficient method to prevent the small increases in weight that come with aging and may increase an adults’ risk for heart disease and diabetes,” said Dr. Schmitz.

    Most Effective Treatments for Alcohol Dependence

    According to a study that appears in the current issue of the Journal of the American Medical Association, researchers at Penn Medicine and 10 other sites found that the medication naltrexone, when delivered with structured medical management, or specialized alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence.

    Results from the National Institutes of Health (NIH)-supported study—“Combining Medications and Behavioral Interventions for Alcoholism” (COMBINE)—show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management (MM), an intervention consisting of nine brief, structured outpatient sessions provided by a medical health care professional. Contrary to expectations, the researchers also found that the medication acamprosate had no effect on drinking and showed no benefit in combination with naltrexone.

    COMBINE was conducted at 11 academic sites that recruited and randomly assigned 1,383 recently-abstinent, alcohol-dependent patients to one of nine treatment groups. Eight treatment groups received MM plus medications or placebo: naltrexone (100 milligrams a day), acamprosate (3 grams a day), both naltrexone and acamprosate, or placebo pills. Four of the eight groups also received Combined Behavioral Intervention (CBI)—specialized alcohol counseling that integrated cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation. Patients assigned to the specialized alcohol counseling could receive up to twenty 50-minute sessions in addition to MM. To test for any effects of pill taking (placebo), the researchers assigned some patients to a ninth group that received specialized alcohol counseling, but no pills, and no more than four visits with a health professional for general medical advice.

    During the 16 weeks of treatment and one year after the treatment, the researchers assessed the patients for the percentage of days abstinent from alcohol and time to the first heavy drinking day, defined as four or more drinks per day for women and five or more drinks per day for men. They also assessed the odds of good clinical outcome, defined as abstinence or moderate drinking without alcohol-related problems. As in other large clinical trials, the researchers found that most patients showed substantial improvement during treatment and that both the overall level of improvement and the differences among treatment groups diminished during the follow-up period. In the COMBINE study, however, naltrexone continued to show a small advantage for preventing relapse at one year after the end of active treatment.

    Research Findings on Radiation-Induced Cancer

    Dr. Virginia A. LiVolsi,professor of pathology and laboratory medicine, presented her research findings at a conference held in April to commemorate the 20th anniversary of the Chernobyl nuclear reactor meltdown. She presented her work on, “Specific Pathological Findings in Thyroid Cancer after Radiation Exposure.”

    On April 26, 1986, the number four nuclear reactor at Chernobyl Power Plant in what is now the Ukraine exploded. The fallout was 400 times more radioactive than what was released over Hiroshima during World War II, and it covered an area the size of New Jersey. Numerous radioactive elements were released into the air—including radioactive iodine, an element that is preferentially taken-up by the thyroid gland. As a result, there was a rise in cancer—and, in particular, in thyroid cancer in children. (Since the thyroids of children are much smaller than adults, it is assumed that the relative dose of radioactive iodine these thyroids received was much larger than the adult thyroids.)

    After the incident, a panel was created to study the after-effects of the accident and Dr. LiVolsi was one of the members chosen. It was found that the isotopes of radioactive iodine that are suspected of causing the outbreak of thyroid cancer have a relatively short half-life of eight days, but other isotopes that were released in the explosion—like cesium 137 and strontium 90, will last for decades. “One of the interesting aspects of this research is that we are still seeing new thyroid-cancer tumors in the exposed population—even though, after 20 years, there is no radioactive-iodine fallout left from the accident,” Dr. LiVolsi said.

    Chernobyl is still a threat to this day. The lead and steel sarcophagus initially built around the number four reactor has decayed. A replacement structure is in the planning stages. This replacement will take four to five years to assemble, cost over $800 million and be the largest movable structure ever built.

    However, information learned from the Chernobyl accident could assist medical response in the event of a “dirty bomb” explosion—a conventional explosion that scatters radioactive materials—insofar as aiding and treating future victims.

     

     



     
      Almanac, Vol. 52, No. 33, May 9, 2006

    ISSUE HIGHLIGHTS:

    Tuesday,
    May 9, 2006
    Volume 52 Number 33
    www.upenn.edu/almanac

     

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