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Research Roundup
February 26, 2008, Volume 54, No. 23

Increased Health Risks Among Women When Weighed in Public

A new Penn study points to increased health risks for women owing to their higher level of discomfort about being weighed in public.

The study, conducted by the department of psychiatry, showed that college-age females, more than their male counterparts, experience high degrees of discomfort at the prospect of being weighed in the presence of others.

The study’s authors believe that some women may avoid necessary tests and treatments when a doctor visit includes a step on a public scale.

“Weighing concern may make these women, particularly those who are overweight and already at risk for certain ailments, less likely to visit a doctor,” said Andrew B. Geier, lead author and a doctoral candidate in the department of psychology in the School of Arts and Sciences. “Hopefully, this data will show the great advantage that can be had with just a small, inexpensive change in clinic policy: weighing patients in private.”

The study also revealed that observers generally overestimate women’s weight while women tend to believe that people are underestimating their weight due to slimming clothes or cosmetics. This means that, while women in the study demonstrated they do not want people to know their weight, their true weight was lower than others’ estimates and a public weighing would correct the misperception.

Due to the increasing cost of health care, medical clinics, especially those serving poorer communities, constantly look for ways to cut costs. One common practice is to designate public space in the clinic, often a well-trafficked hallway, to be suitable for weighings. Routine clinic practice has reduced the number of scales as well. In light of this new research, it is possible, in fact the authors believe likely, that women may skip free, potentially life-saving tests, such as mammograms, rather than face the embarrassment of public weighing.

The study concludes that a partial source of female discomfort comes from the participants’ own sense that they are overweight. Study participants rated discomfort levels over a variety of weight-related scenarios. The more dissatisfied a female was with her weight, the greater the discomfort she experienced when being weighed.

“The real danger here is the heavier a person is, the more discomfort they feel and thus the more likely they may find reasons to skip appointments,” Mr. Geier said. “These may be the very people that need access to these clinics the most. If a person knows that he or she is going to be provided privacy during the weighing process, that could be a major relief, thereby tipping the scales to get them to go and get these potentially life-saving tests.”

African Americans Less Likely to Choose Epidurals

Minority and low-income patients are less likely than those who are white or more well off to agree to post-surgery epidural pain relief, according to new research from physicians at the School of Medicine. The study, published recently in the journal Anesthesia and Analgesia, examined how race, economic and educational status may influence health care choices when access to care isn’t a factor. In the overall analysis, education and income were not as important as race in determining epidural acceptance, but the researchers say the costs of improper pain treatment after surgery are large for any patient group.

“Epidurals are more effective for relieving postoperative pain, and higher levels of pain have been linked to the development of chronic pain,” says Dr. E. Andrew Ochroch, an associate professor and director of clinical research in the department of anesthesiology and critical care. “Consequently, if African Americans are either denied or denying themselves epidural for pain relief, then they may be at greater risk for postoperative complications.”

Patients who receive perioperative epidural analgesia during major upper abdominal or chest surgery, for instance, have improved lung function, which reduces their risk of pneumonia. And since they’re able to get out of bed to move around sooner, they’re primed to go home sooner than those who have severe pain.

Physicians collected data from 1,193 patients between late August 2004 and early January 2005. Sixty-four percent of all patients said they would accept an epidural if it was recommended by an anesthesiologist, while 36 percent said they would refuse. When asked if an additional recommendation from the surgeon would make them consent, acceptance rose to 78 percent. But when examining differences based on race, African American patients were less likely to say they would accept an epidural under any circumstances.

Socio-economic status also appeared to influence consent. Participants who worked full- or part-time were more likely to accept an epidural compared to those who were unemployed. Even at higher income levels–$50,000 to $75,000–white patients were more likely than black patients to accept an epidural.

The researchers hope to use this new data to help surgeons and other staff members find innovative ways to discuss perioperative anesthesia as a critical part of a patient’s care, and build anesthesia awareness components into Penn’s existing community and church-based health outreach initiatives.

Identifying Smokers for Relapse in Smoking Cessation Treatment

A new brain imaging study by researchers in the Abramson Cancer Center shows that cigarette cravings in smokers who are deprived of nicotine are linked with increased activation in specific regions of the brain. Using a novel method of measuring brain blood flow developed by Dr. John Detre, associate professor of neurology, this study is the first to show how abstinence from nicotine produces brain activation patterns that relate to urges to smoke. The findings, published in the December 19, 2007 issue of The Journal of Neuroscience, make an important contribution to understanding smoking urges, a key risk factor for relapse, at the brain level.

According to Dr. Caryn Lerman, director of the Transdisciplinary Tobacco Use Research Center and senior author of the paper, and colleagues Dr. John Detre, associate professor of neurology & radiology, and Dr. Ze Wang, research associate in the department of neurology, cravings are a hallmark of drug dependence, including nicotine dependence.  “There have been several brain imaging studies showing how subjects respond to visual, smoking-related cues, such as a picture of a cigarette or of someone smoking,” said Dr. Lerman. “However, less is known about the neural basis of urges that arise naturally as a result of nicotine deprivation. This study was designed help fill this research gap.”

The findings indicate that abstinence-induced, unprovoked cravings to smoke are associated with increased activation in brain regions important in attention, behavioral control, memory, and reward. “The craving assessments used in our study predict relapse in smoking cessation treatment,” said Dr. Lerman. “If validated in larger studies, these results may have important clinical implications. For example, perfusion MRI may aid in the identification of smokers at increased risk for relapse who may require more intensive therapy.”

Differences in English- & Spanish-speakers’ Use of Oncology Websites

In the study, The Utilization of Radiation Oncology Web-based Resources in Spanish-speaking Oncology Patients, lead by Dr. James M. Metz, radiation oncologist at the School of Medicine and presented by Dr. Charles Simone II, radiation oncologist at the National Cancer Institute, concluded that when it comes to seeking information on the Internet about their health care, Spanish-speaking oncology patients differ from English-speaking patients with regards to both frequency of use and such variables as time of Internet use, browsing patterns, and types of cancer searched.

Spanish speakers are less likely to browse for medical information during weekends and early morning hours, which suggests they may be using access at work or other specialized resources. Readers of the Spanish-language oncology website were much more likely to navigate to the site’s pages from search engines and less likely to connect from a bookmark or direct address than like-minded English-speaking users.

While the most frequently searched cancer types among English-speaking users basically mirrored the most common cancers in the US including breast, liver, skin, brain and colon cancers, Spanish-speaking users most often searched for information on gastric, leukemia, cervical, vaginal, penile and testicular cancers.

Additionally, the average visit duration to the Spanish website was significantly shorter compared to the English-only site. By identifying and acknowledging these differences, web-based radiation oncology resources can tailor content to more effectively meet the needs of their Spanish-speaking audience.

OncoLink (www.oncolink.org), managed by the Abramson Cancer Center, helps cancer patients, families, health care professionals and the general public access accurate cancer-related information at no charge. OncoLink en Español launched in September 2005.

“We began to translate OncoLink into Spanish to help bridge the digital divide between English and Spanish-speaking individuals in obtaining important health information,” said Dr. Metz, assistant professor of radiation and oncology and editor-in-chief of OncoLink. “Our study shows that even though use of our Spanish-language oncology website has quadrupled in one calendar year, Spanish resources remain scarce. We have to provide for this community.”
The Spanish-speaking community, though still not using websites for cancer information as frequently as English-speaking communities, are greatly increasing usage as a group.

Almanac - February 26, 2008, Volume 54, No. 23