Don’t Confuse FEN Death And Investigation With Aid In Dying
The media has recently reported the arrest of individuals associated with a group known as Final Exit Network (FEN) on charges of assisting a suicide in Arizona, and attempting to engage in similar activity in Georgia. The cases reported in the media this week involving FEN ought not be confused with the choice of aid in dying.
Media accounts of the facts suggest that the Arizona decedent was not terminally ill and may have suffered from impaired judgment and/or mental illness.
It is important to recognize the difference between the choice of a mentally competent, terminally ill patient for a peaceful death via self-administering medications prescribed for this purpose, and the act of a distraught individual who is not dying, who may be suffering from impaired judgment or mental illness, to precipitate death. The former is a practice known as aid in dying, which has strong and growing support among the public and among medical and health policy professionals. The latter is suicide. It is essential to recognize the difference between these.
In 2008, four major national medical professional and health policy organizations adopted policy in support of aid in dying, the practice of a physician providing a prescription to a mentally competent, terminally ill patient that brings about a peaceful death. This represents a significant turning point in American society’s evolution to empower terminally ill patients with information and choices about how they will die.
The organizations adopting policy in support of aid in dying include the American Medical Women’s Association (AMWA), the American Medical Students’ Association (AMSA), the American College of Legal Medicine (ACLM), and the American Public Health Association (APHA).
The Oregon Death with Dignity Act (Dignity Act) began implementation in 1998. This law permits mentally competent individuals who have less than six months to live to obtain a prescription for medication that can be self-administered to bring about a peaceful death. It has been implemented without interruption since 1998.
Under the Dignity Act, patients must follow a strict set of procedures to establish eligibility. A physician must determine that the patient has a life expectancy of less than six months; this diagnosis must be confirmed by a second opinion. The patient must make multiple requests, waiting at least fifteen days between the first and last request, must establish capacity to make medical decisions, and must be informed of palliative care options such as hospice, if not already receiving such services. If all of these procedures are followed, and the patient is deemed eligible by the physician to obtain the life-ending medication, an Oregon physician can provide the requested prescription.
During the decade that aid in dying has been legal in Oregon, close to 30 terminally ill individuals each year have gone through the process, obtained and taken the medication, and died peacefully. Those present at these deaths, usually close family members, report that the patient was enormously relieved to be able to make this choice. On a date chosen by the patient, loved ones may gather around for a final goodbye.
The patient consumes the medication, becomes drowsy, falls deeply asleep, and after a short period of time ceases to breathe. The long road from diagnosis to curative treatment to palliative care to death has ended on terms acceptable to the patient. More patients obtain the medication than go on to use it: some fraction each year receive the medication, put it in the medicine cabinet, feel comforted to know it is there, and never take it.
Demographic data about the patients who choose to use the Dignity Act show that most are dying of cancer. The next most common terminal illness is amyotrophic lateral sclerosis (ALS). Those using the law are insured, well educated, and are receiving comprehensive pain and symptom management, typically through hospice services. Opponents of the Dignity Act legislation had argued that such a law would be forced upon the uninsured, the poor, minorities, persons without access to hospice, or disabled persons. The data have disproved this conjecture.
In addition, a number of unexpected but significant developments occurred in Oregon following implementation of the Dignity Act. Referral of patients to hospice care increased dramatically, as did physician enrollment in continuing education courses on how to treat pain and symptoms associated with terminal illness. It is likely that physicians want to ensure that no patient makes use of the Dignity Act due to inadequate pain and symptom management. This galvanized both the increase in hospice referrals and physician efforts to learn more about treating pain and symptoms.
Voters in the state of Washington considered the issue in 2008 and adopted the Washington Death with Dignity Act by the significant margin of 59% to 41%. The Washington measure is virtually identical to Oregon’s and will begin implementation on March 5, 2009.
As a result of a court case, Montana recently recognized that the freedom of its terminally ill citizens to choose aid in dying is a fundamental right protected by its state constitution’s guarantees of privacy and dignity.
Public support for empowering dying patients with the freedom to choose aid in dying is strong. A Harris poll in 2005 found that 70% of U.S. adults favor a law that would “allow doctors to comply with the wishes of a dying patient in severe distress who asks to have his or her life ended.”
When a patient does not feel able to discuss the desire for aid in dying with his or her physician, or cannot find a physician willing to provide it, the patient may seek assistance in hastening death from a family member or loved one. Unfortunately, these incidents often involve a violent means to death, such as gunshot.
A fraction of terminally ill patients – including those who have excellent pain and symptom management – confront a dying process so prolonged and marked by such extreme suffering and deterioration that they decide aid in dying is preferable to the alternatives. Having this option harms no one, and greatly benefits both the relatively few patients in extremis who make use of it and many more who draw comfort from knowing it is available should their dying process become intolerable. The trend in policy among mainstream medical and health policy associations is clearly in favor of supporting this compassionate option.
For more information please visit http://www.compassionandchoices.org.
Artificial Disc Replacement As Good Or Better Than Spinal Fusion Surgery
Spine surgeons at Washington University School of Medicine in St. Louis and other U.S. centers are reporting that artificial disc replacement works as well and often better than spinal fusion surgery.
The two procedures are performed on patients with damaged discs in the neck.
Researchers found patients who received an artificial disc lost less motion in the neck and recovered faster than those who had a disc removed and the bones of the spine fused.
“Those who received the artificial disc either did equally as well or a little bit better than those who had fusion surgery,” says K. Daniel Riew, M.D., a cervical spine surgeon at Washington University Orthopedics and Barnes-Jewish Hospital. “One of the most important findings was that people who got the artificial disc were able to preserve all of their motion.”
A disc in the spine is similar to a jelly donut, with a squishy center surrounded by a tough outer portion. It functions like a shock absorber between the vertebrae. When a disc ruptures, or becomes herniated, the squishy disc tissue can spread into the spinal canal and press against nerves, causing numbness, weakness or pain.
For years, the surgery to treat cervical disc disease relieved pressure by removing the offending disc and then fusing the bones of the spine together. Surgery to implant an artificial disc also removes the damaged disc, but instead of using metal rods, screws and bone grafts to fuse bones together, the surgeon replaces the disc with an implant.
Patients in the study were randomly assigned to receive either the BRYAN Cervical Disc or standard fusion surgery. Ultimately, 242 received the artificial disc, and 221 had spinal fusion. Improvement following surgery was measured with a tool called the neck disability index (NDI). Two years post surgery, patients in both groups had improved NDI scores. Both had less neck and arm pain and were less likely to experience numbness. Overall, the surgery was rated as successful in 83 percent of the patients who received artificial discs and 73 percent of those who had fusion surgery (230 vs. 194). Part of that difference, Riew says, can be explained by better motion in the neck for those who had artificial discs implanted.
He says the neck is always slightly restricted following spinal fusion surgery. Since bones in the neck have been fused together, it is impossible to regain full range of motion. But the defect is subtle.
“Fusion adds a small amount of stress in the spine above and below the fusion site, so bone can break down a little faster than normal,” Riew explains. “If the patient is a young person, then they may need another operation in 20 or 30 years. The hope with artificial cervical disc replacement is the preserved motion may protect against additional stress at other levels of the spine.”
In the short term, Riew says most patients receiving artificial disc replacement surgery recovered faster and got back to normal life sooner than fusion surgery patients.
“They didn’t need to wear a neck brace after surgery,” he says. “If they had a job, they returned to work faster. And many had a resolution of their pain faster than fusion patients. With a spinal fusion, there are some pain and activity restrictions until the bone is fully incorporated, but with an artificial disc, as soon as the disc is in, it’s ‘good to go.’”
Riew, the Mildred B. Simon Distinguished Professor of Orthopaedic Surgery, professor of neurological surgery and chief of the cervical spine service for Washington University Orthopedics, says people from outdoorsmen to couch potatoes have seemed to do well following implantation of artificial discs. Last summer, he implanted an artificial disc into a professional baseball player’s cervical spine. That player plans to return to the diamond and continue his career this season.
But at the moment, the discs are not an option for some patients. Those with arthritis or disc disease at multiple levels in the spine are not good candidates. A barrier for those who are good candidates is that many insurance companies don’t yet cover them.
The study was supported by Medtronic Sofamor Danek, which manufactures the BRYAN Cervical Disc. Riew has received or will receive financial benefits from Medtronic. The researchers reported their findings in the January issue of the journal Spine.
Heller JG, Sasso RC, Papadopoulos SM, Anderson PA, Fessler RG, Jacker, RJ, Coric D, Cauthen JC, Riew KD. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled clinical trial. Spine, vol 34 (2), pp. 101-107. Jan. 2009
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s Hospitals. The School of Medicine is one of the leading medical research, teaching, and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s Hospitals, the School of Medicine is linked to BJC HealthCare.
Washington University in St. Louis
1 Brookings Dr., Campus Box 1070
St. Louis
MO 63130
United States
http://www.wustl.edu
[Via http://www.medicalnewstoday.com]
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Teaching Hospital Halves Its Rate Of Premature Births
UT Southwestern Medical Center’s primary adult teaching hospital has cut its rate of preterm births by more than half in the past 15 years, even as national rates are rising, researchers have found.
The drop at Parkland Memorial Hospital, from 10.4 percent in 1988 to 4.9 percent in 2006, was associated with a program of strictly coordinated and easy-to-access care including prenatal care for the largely minority, indigent population served by the county hospital, the UT Southwestern researchers said.
“This is a model for the uninsured in the country,” said Dr. Kenneth Leveno, professor of obstetrics and gynecology at UT Southwestern and lead author of the study, which appears in the March issue of Obstetrics & Gynecology. “I think we all should be proud of this system.”
The researchers began their analysis in response to a 2006 report on preterm births by the Institute of Medicine. The institute stated that the national rate of prematurity was 9.4 percent in 1981 and 12.5 percent in 2004, representing a 33 percent increase.
“Infant mortality is one way in which societies measure how they take care of their people, and two-thirds of infant mortality is due to premature birth,” said Dr. Leveno. “It’s a measure of the social fabric.”
Parkland has one of the country’s largest and busiest obstetrics services, with about 16,000 births a year. One in every 250 births in the U.S. takes place at Parkland. Attending physicians are faculty members of UT Southwestern’s Department of Obstetrics and Gynecology.
The researchers studied data from 260,167 women who had given birth to singleton babies at Parkland from 1988 to 2006.
Preterm birth was defined as birth before the 37th week of pregnancy, with babies weighing 1.1 pounds or more.
The decrease at Parkland was especially notable, as minority women are more likely to have premature babies because of their higher rate of poverty, the researchers noted. In 1988, Parkland began a program designed to provide minority women better care during pregnancy and birth and just after birth. When the program started, 88 percent of Parkland patients received prenatal care. By 2006, that number had increased to 98 percent.
One feature that allows smooth care in the Parkland system is a strict protocol that lays out how to respond to specific situations. For instance, if a woman goes to a satellite clinic for prenatal care and is found to have a condition that makes the pregnancy risky, she is automatically referred to the main hospital, Dr. Leveno said.
In addition, Parkland has a large staff of nurse-midwives and nurse practitioners who handle routine births, freeing the doctors to work on high-risk cases. And because the hospital is the only public hospital in Dallas County, many indigent patients receive all their medical care through the system, so they have a single medical record that is easily tracked.
“It’s a complex interaction of a lot of pieces,” Dr. Leveno said.
Other UT Southwestern researchers involved in the study were Dr. Donald McIntire, professor of obstetrics and gynecology; Dr. Steven Bloom, chairman of obstetrics and gynecology; Miriam Sibley, chief nursing officer of Parkland Health & Hospital System; and Dr. Ron Anderson, president and chief executive officer of Parkland Health & Hospital System.
Visit http://www.utsouthwestern.org/obgyn to learn more about clinical services in gynecology and obstetrics at UT Southwestern.
Dr. Kenneth Leveno – http://www.utsouthwestern.edu/findfac/professional/0,2356,14257,00.html
UT Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas
TX 75390-9060
United States
http:// www.utsouthwestern.edu
Young Ex-servicemen At Increased Risk Of Suicide
Young men who have served in the British Armed Forces are up to three times more likely to take their own lives than their civilian counterparts, research published today (March 3) has found.
Researchers at The University of Manchester’s Centre for Suicide Prevention linked UK military discharge data between 1996 and 2005 with details of suicides collected by the National Confidential Inquiry into Suicides and Homicides.
The study, published in the journal Public Library of Science (PLoS) Medicine, revealed that ex-servicemen under 24 years old were at greatest risk of suicide, with those in lower ranks and shorter military careers proving most vulnerable.
The report’s authors, Professor Nav Kapur and colleagues, were unable to prove why younger ex-military personnel had higher rates of suicide than men of the same age in the general population but suggest three possibilities.
“One explanation for the higher suicide risk among young ex-military personnel is that those entering military service at a young age are already vulnerable to suicide, which would explain why those serving for a relatively short period of time before being discharged were most likely to take their own lives,” said Kapur, lead author and professor of psychiatry and population health at Manchester University.
“A second explanation is the difficulty a minority of individuals experience making the transition to civilian life.
“However, a third possibility that we could not explore in this study is that exposure to adverse experiences during military service or active deployment played a role in the two to three-fold increase in suicide among young veterans, although many of those most at risk had not completed basic training and therefore had not deployed overseas.”
The study, funded by the Veterans Policy Unit in the UK Ministry of Defence, also found that the suicide risk was highest among young men leaving the Armed Forces within the first two years of discharge.
The risk of suicide was also higher in young women aged under 20 years compared with the general population, but the overall numbers were small.
The overall suicide risk was no greater for ex-military personnel than for civilians when all age groups were considered 16 to 49 years. Men aged 30-49 years had a lower rate of suicide than the general population.
During the study period 233,803 individuals left the Armed Forces, of which 224 took their own lives. Worryingly, the research also found that veterans had a low rate of contact with mental health professionals in the year before death just 14% for those under 20 years of age and 20% for those under 24 years.
“Whatever the explanation for our findings, these individuals may benefit from some form of intervention,” said Professor Kapur. “Initial pre-recruitment interview, medical examination and training are important in ensuring military health but it should be recognised that those discharged at any of these stages may be at higher risk of suicide.”
The University of Manchester
http://www.manchester.ac.uk
The Girl, The Tanning Bed, And The Freckle
At her 21st birthday, Julie Moore understood better than most what “having your whole life in front of you” meant. Not because she could finally order a legal drink, but because her whole life had just depended on noticing one tiny freckle.
The freckle, it turned out, was melanoma, the deadliest form of skin cancer.
Tanning booths and sun worshipping had left their mark early.
“When you are tan,” says Moore, a University of Texas at Austin graduate, “you look taller, thinner better. Girls like Paris Hilton and other celebrities are always tanned.”
Summer months make it easy to stay bronzed, especially in sunshine states like Texas. But year-round tans are harder to come by the natural way. So, to hasten the process, Moore says, she went to tanning salons, without her mother’s knowledge, from the time she was 16 to 21.
One night, she was shaving her legs and nicked herself. “Right above my knee was a little freckle. I noticed it because my mom had always told me to watch for moles.”
A few months later, “I was lying out in the sun and noticed the spot had gotten bigger. It wasn’t raised, but it was now the size of the tip of a pen still small but bigger than before.”
After putting off a visit to the dermatologist for several months, she finally went and was told that it needed to be removed. The subsequent biopsy was positive for malignant melanoma. Moore had surgery at The University of Texas M.D. Anderson Cancer Center a month later to enlarge the margins of the area to ensure removal of all cancerous cells.
Today, she is 23, free of melanoma and worships the sun only from afar.
“The myth that keeps circulating among teens is that tanning salons use ’safe rays.’ There is no such thing,” says dermatologist Dr. Adelaide Hebert, and professor of dermatology at The University of Texas Medical School at Houston.
Tanning booths use the same ultraviolet light (UV) that the sun produces. Both wavelengths of light, UVA and UVB, damage the skin. Because artificial tanning sessions take less time than the drive to the salon, clients are lulled into a false sense of safety.
“It was so much faster to get a tan by going to tanning salons. They are so cheap–$18 or $20 a month for all the sessions you want,” Moore says.
The National Cancer Institute’s website sites a 2003 study of Scandinavian women that shows women who use tanning beds more than once a month are 55 percent more likely to develop melanoma.
Yet Moore has an olive complexion, dark eyes and hair. She thought she carried a natural protection. “I never used sunscreen much,” she admits.
Women also may be more prone to cancer from ultraviolet light than men, according to various studies. “For women, even one or two sessions on a tanning bed can increase their chances of cancer manifold,” Hebert says.
Moore says that she made the same mistakes others have made over the decades. “I am young, so it didn’t occur that this could happen to me.”
UV radiation is considered the single largest environmental contributor to skin cancer, according to the American Academy of Dermatology Association. The UV radiation levels from indoor tanning devices can emit as much as 15 times more UV radiation than that from old-fashioned outdoor tanning.
The rates of skin cancer in the United States have skyrocketed. Each year, over a million new cases are diagnosed. Melanoma is now the second most common cancer in women ages 20-29.
Moore’s mother says parents need to observe their children’s bodies when they are swimming or participating in sports. “Which isn’t easy once they hit late adolescence and it’s even harder once they hit college. But, none of us can see ourselves 360 degrees, nor can we be objective about ourselves.”
Young adult children need to be encouraged to examine themselves for changes in the skin, and have parents or college room mates check their backs, and scalps periodically. Hebert, who also sees pediatric patients at Memorial Hermann Hospital-Texas Medical Center, says that melanoma tends to grow on the arms and legs of girls and the arms and backs of boys.
The sad thing, Moore says, is that while “you hear doctors and adults say all the time that tanning can cause cancer, it isn’t real until someone your age gets skin cancer. Today, there is ozone depletion and the sun is harsher. And there are those tanning salons.”
Final advice from Moore, “If you notice something new on your skin or someone’s you care about, no matter how small, even if it doesn’t fit the normal skin cancer criteria, check it out and immediately. Then act on it. It could save a life.”
University of Texas Health Science Center at Houston
7000 Fannin St., #1200
Houston
TX 77030
United States
http:// www.uthouston.edu
Springtime Allergies: Is It Time For Allergy Shots?
Jennifer Derebery, M.D., physician at the House Clinic and leading expert on the treatment of allergies, believes there a several options available to people with significant symptoms before starting allergy shots.
“One option that is not well known at this time is prescription intranasal sprays, particularly the newer classes of intranasal antihistamines, which provide topical decongestant relief for patients without the ‘addiction’ that many fear, nor the use of steroids in the nose,” said Dr. Derebery.
She also recommends environmental avoidance to her patients, which means minimizing exposure to outdoor allergens, including pollen.
Here are Dr. Derebery’s tips:
– Stay indoors during the times of heaviest pollen counts 5 a.m.-10 a.m.
– Keep windows closed
– Pollen is worse on windy days, and especially with Santa Ana’s
– Tree pollen count goes up after 3 consecutive days with temperatures of 65 degrees or higher
– Take a shower after being outside to lessen pollen exposure indoors
Allergy shots may be necessary if a person has moderate to severe symptoms for four or more months out of the year and environmental avoidance and/or appropriately prescribed medications do not provide relief.
Allergy shots allow a person’s immune system to learn to tolerate exposure to substances that would normally cause a person to have an allergic reaction, with symptoms such as a runny nose, nasal congestion and itchy eyes.
Dr. Derebery cautions allergy shots will only lessen the symptoms and some people will still need to use medications as an addition to the shots for better control.
“Allergies are a chronic condition, often genetic, caused by a person’s overly reactive immune system and it is unrealistic for people to think allergy shots will ‘cure’ them. But, the shots, called immunotherapy, can make a big difference in the comfort level and health of a patient when medications are not enough to control symptoms,” said Dr. Derebery.
About the House Ear Institute
The House Ear Institute (HEI) is a non-profit 501(c)(3) organization dedicated to advancing hearing science through research and education to improve quality of life. HEI scientists investigate the cellular and molecular causes of hearing loss and related auditory disorders as well as neurological processes pertaining to the human auditory system and the brain. Our researchers also explore technology advancements to improve auditory implants, hearing aids, diagnostic techniques and rehabilitation tools. The Institute shares its knowledge with the scientific and medical communities as well as the general public through its education and outreach programs
House Ear Institute
2100 W 3rd St.
Los Angeles
CA 90057
United States
http://www.hei.org
Discovery Provides Hope For Sufferers Of Disfiguring Bone Disease
Researchers at the University of East Anglia (UEA) have made a major genetic discovery that could lead to the effective treatment for sufferers of craniosynostosis – a severe childhood bone disease.
Craniosynostosis develops in the womb and affects one in every 2500 live births. Bones in the skulls and face of sufferers fuse together prematurely causing a range of distressing developmental problems. Some of the affected children also suffer from defects in the limbs, brain, kidneys and lungs. Depending on the severity of their disease and its underlying cause, children suffering with craniosynostosis survive from as little as a few days to as long as early adulthood.
Led by Dr Mohammad Hajihosseini, the UEA scientists focused on Apert Syndrome – the most severe of the craniosynostosis range of diseases that is caused by mutations in a gene called Fibroblast Growth Factor Receptor 2 (FGFR2). They identified a key offending molecule FGF10 and demonstrated for the first time that ‘dampening down’ the levels of this offending molecule can reverse the effects of the disease.
Published this month in the journal ‘Developmental Dynamics’, the findings are the culmination of five years work and vastly increase our understanding of this tragic childhood disease.
“The next step is to research how best to translate this discovery into an effective treatment,” said Dr Hajihosseini. “Given the appropriate funding, in the not too distant future a gel or similar vehicle could be developed that can be surgically applied to the fusing joints of the skull thus reversing the effects of the disease.”
University of East Anglia
http://www.uea.ac.uk
Youths Are Most Influenced By Negative Family Members And By Positive Adults Outside The Family
While children look up to and aspire to be like a positive family member or peer, they are more likely to imitate traits of other role models — including negative role models, which can lead to behavioral problems, according to a Kansas State University researcher.
Brenda McDaniel, assistant professor of psychology at K-State, worked with colleagues at Oklahoma State University-Tulsa to study the relationship of moral traits shared by youths and their role models to find predictors of outcomes like youth conduct problems.
“Understanding the relationship between youths’ view of self, youths’ view of role models and youths’ behavioral and psychological outcomes provides the knowledge to foster healthy, successful youth,” McDaniel said.
The researchers surveyed 30 boys and girls, ages 7 to 14, from Boys and Girls clubs in Manhattan and in Tulsa, Okla. McDaniel said all of the participants in the study were categorized as having a lower socioeconomic status, lower academic outcomes and being at-risk.
The study asked students who they considered to be their role models or wanted to be like, and who they considered to be their anti-role models or didn’t want to be like. Students rated their choices and themselves on 10 sets of moral constructs using a five-point scale, like being unfair versus fair and forgiving versus not forgiving. The youths also measured themselves on their pro-social behavior and relational aggression, and provided parenting styles experienced in their home.
Though the youths reported their ideal selves being most like a positive family member and a positive peer, results showed students were most similar to a positive adult outside the family. This provides support for programs such as Big Brothers Big Sisters where an adult outside the home spends time with the youth, McDaniel said.
The researchers also found that negative family members are a strong influence on the moral traits of youths. McDaniel said children who in actuality were more like a family member they didn’t want to be like had higher reports of relational aggression and also received higher forms of corporal punishment in the home, such as spanking.
“Youths’ inability to incorporate positive role model behaviors into their self-concept relates to youth conduct problems, such as acting out and starting fights,” McDaniel said. “Positive parenting and mother involvement seem to be key components, which aid this ability.”
The researchers also found that immoral traits, like lying and being unfriendly, shared between youths and all role models was significantly predictive of youth witnessing anti-social behaviors in their neighborhood, such as vandalism.
In addition, the youths were asked to name a celebrity they look up to, but the researchers found that the famous individuals had little influence on the youths’ moral traits.
The study was funded by the Oklahoma Agricultural Experiment Station. McDaniel said future research includes laboratory-site studies where interaction between youth and a role model will be recorded and coded for important information, such as interpersonal emotional exchange and physiological stress levels.
McDaniel’s colleagues for the project are Amanda Sheffield Morris, associate professor of human development and family science and Benjamin Houltberg, a doctoral student in human development and family science, both at Oklahoma State University-Tulsa.
Source: Brenda McDaniel
Kansas State University
How Male, Female Police Officers Manage Stress May Accentuate Stress On The Job
When male police officers need to de-stress, they might trade war stories — but likely not with their female colleagues.
But the guys don’t necessarily have it easy. They are often discouraged from showing emotion when dealing with stress and are expected to uphold the overtly masculine idea of what it means to be a police officer.
Research by a Kansas State University professor has found that the different ways in which men and women in the police force deal with stress may actually cause them more stress. Don Kurtz, an assistant professor of social work at K-State, studied the gender differences in stress and burnout among police officers. The work was published in the journal Feminist Criminology in 2008, http://tinyurl.com/c2p2et
He said it is the first of his research that has examined gender. While completing his doctorate at K-State, Kurtz said he was taking classes on gender and society and was researching police stress. He noticed that there was no research studying the intersection of these two areas.
“I had come from working in social work, where they were very accepting of men in the women-dominated field,” Kurtz said. “In policing, they tend to be suspicious of the abilities of women in the field.”
For the research published in Feminist Criminology, Kurtz looked at data from a survey of officers in the Baltimore Police Department. As a follow up to this part of the research, Kurtz also interviewed officers from three police departments. He found that male and female police officers have different sources of stress and different ways of dealing with it.
“Telling war stories is almost exclusively a male endeavor,” Kurtz said. “It’s quite often in a group social setting, and officers talk about stressful events that happened. What’s interesting is that they remove the fear and emotion that go along with it and replace it with these superhuman qualities.”
“I found that women felt excluded from war stories. If they started exaggerating the stories in the way that men did, they could be questioned. So it becomes a male-only way of managing stress.”
In the journal article, Kurtz suggests that in some ways women have a better chance to deal with violent cases because it’s more acceptable for women to be upset or vulnerable.
“For male officers to show emotion, it was career suicide,” he said.
Some of the cases that men find the most stressful, Kurtz said, were likely to be given to women.
“One thing I found interesting was that when officers discuss the most stressful things, it’s usually death of a child or the physical or sexual abuse of a child,” he said. “Women are more likely to handle these jobs because large police departments often assign women to these investigative units. However, it’s often seen as lower police work. In large departments where there area lot of juvenile delinquents and child abuse cases, there’s an idea that women are better at managing kids.”
One of the biggest differences Kurtz found was the role that family played in police officers’ stress. Whereas a family life can help male officers deal better with stress from the job, women may not have the same support in their own families.
“Women settle into the role of caretaker and come home to a second shift,” Kurtz said.
The strange hours of police work can be seen as more acceptable for men than women, he said.
“Although family conflicts can be distressful for men, the fact that a male officer is seen as the breadwinner makes it more OK for him to miss a birthday party, for example, so he can go to work.”
Kurtz also looked at how race changes the stress differences between men and women.
“We should expect a difference,” he said. “In American society, race complicates everything.”
For instance, white female officers are more likely to be sexualized, whereas black female officers are often seen as laborers. And, while black male officers report lower levels of stress than white men, they also report a higher rate of burnout.
Kurtz said he hopes his research will help police departments better understand how gender affects stress and that it will spur further academic study in this area.
Source: Don Kurtz
Kansas State University
[Via http://www.medicalnewstoday.com]
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Cell Microenvironments Hold Key To Future Stem Cell Therapies
Adult stem cells and their more committed kin, progenitor cells, are prized by medical researchers for their ability to produce different types of specialized cells. The potential of using these cells to repair or replace damaged tissue holds great promise for cancer therapies and regenerative medicine. However, the question that must first be answered is what determines the ultimate fate of a stem or progenitor cell? A team of researchers led by Berkeley Lab’s Mark LaBarge and Mina Bissell appear to be well on the road to finding out.
Working with unique microenvironment microarrays (MEArrays) of their own creation, LaBarge and Bissell and their collaborators have shown that the ultimate fate of a stem or progenitor cell in a woman’s breast – whether the cell develops normally or whether it turns cancerous – may depend upon signals from multiple microenvironments.
“We found that adult human mammary stem and progenitor cells exhibit impressive plasticity in response to hundreds of unique combinatorial microenvironments,” said LaBarge, a cell and molecular biologist in Berkeley Lab’s Life Sciences Division. “Our results further suggest that rational modulation of the microenvironmental milieu can impose specific differentiation phenotypes on normal stem or progenitor cells, and perhaps even impose phenotypically normal behavior on malignant cells during tissue genesis. All of this points to the rational manipulation of adult stem and progenitor cells as a promising pathway for beneficial therapies.”
Previous studies on how microenvironments affect the development of adult human stem or progenitor cells have been based on the behavior of these cells in culture (in vitro) where they are exposed to a single molecular agent. However, when these cells are in an actual human being (in vivo) they are surrounded by a multitude of other cells plus a supporting network of fibrous and globular proteins called the extracellular matrix (ECM), as well as many other nearby molecules, all of which may be simultaneously sending them instructional signals.
“With our MEArrays, we can use combinations of proteins from a select tissue to create multiple microenvironments on a single chip about two square centimeters in area,” said LaBarge. “We think this approach will give us a much more realistic picture as to how stem and progenitor cells actually behave in vivo.”
Said Bissell, a Distinguished Scientist with Berkeley Lab’s Life Sciences Division and one of the world’s leading researchers on breast cancer, “We have demonstrated that each discrete cell fate decision requires the integration of multiple pathways, and we have identified combinations of components in the human mammary microenvironment that impose distinct cell fates. These results are exciting because they indicate that we can test a large number of effectors and determine which ones to use to direct the fate of adult stem and progenitor cells. This give hope that one day – sooner rather than later – the information could be used for therapy.”
Collaborating with LaBarge and Bissell on this study were Jason Ruth, now at the University of Pennsylvania, Martha Stampfer of Berkeley Lab, Celeste Nelson, now with Princeton University, and Rene Villadsen, Agla Fridriksdottir and Ole Petersen, of the Panum Institute in Denmark.
Human breast tissue harbors two types of epithelial cells: luminal – the cells that are able to produce milk and generally the ones that become cancerous; and myoepithelial – the cells that surround the luminal cells and push milk down the ducts to the nipples, but which rarely become cancerous. Like cells in other types of tissue these breast epithelial cells are spawned from stem and progenitor cells that despite being primitive – essentially a cellular blank slate – possess the exact same genome as their differentiated daughters. Once it was widely held that adult stem and progenitor cells intrinsically “know” when to self-renew and when to differentiate into one specific tissue cell or another based on pre-determined genetic programs. However, pioneering research by Bissell, in which it has been demonstrated that interactions between an epithelial breast cell and its ECM play a major role in determining whether that cell becomes cancerous, pointed the way to the idea that the ultimate fate of a stem or progenitor cell is heavily influenced by interactions with its neighboring microenvironments.
“Adult stem cells are maintained inside a specialized microenvironment called a niche, whereas progenitor cells migrate to surrounding microenvironments that are distinct from the one around the niche,” said LaBarge. “The ability of adult stem cells to self-maintain, as well as to give rise to progenitor cells that are targeted to become a specific tissue cell, indicates an ability to respond to changing microenvironmental demands, which would mean that a stem or progenitor cell is receiving instructional information from its surroundings.”
The fact that normal cells often lose their tissue-specific functions when placed in culture is further evidence of cell fate being tied in to signals from the microenvironment. However, proving such a hypothesis has been difficult in the past because the composition of cell microenvironments is extremely complex and requires a method by which a combination of carefully choreographed interactions can be observed. Given that experiments with human adult stem cell niches cannot be done in vivo and that scientists can only learn so much from mouse models, this means that cell culture studies must be done under as close as possible to in vivo conditions.
“Our technology mimics actual in vivo conditions and enables us to perform highly parallel functional analysis of combinatorial microenvironments, and image analysis of 3-D organotypic cultures and micro patterned culture substrata,” said LaBarge. “The 3-D capability is crucial because our studies show that orientation of the stem or progenitor cells with respect to the signaling molecules can be critical to what happens next.”
The MEArrays were fabricated using micro patterning technology originally adapted by co-author Nelson that LaBarge “tweaked.” A robot imprinted arrays of 2,304 individual combinations of molecules onto a rubber-coated glass microscope slide (the rubber facilitates adsorption of the proteins onto the slide). An individual MEArray consisted of 192 unique combinatorial microenvironments replicated 12 times, with a plastic barrier running along the perimeter so that cell cultures could be placed on top.
In addition to possible contributors to the stem cell niche, the microenvironments also comprised many ECM and signaling molecules that are expressed in the breast but had not been directly linked to stem cell function before.
In all, adult mammary stem and progenitor cells were exposed to 8,000 different combinations of breast tissue protein and biological molecules. LaBarge, Bissell and their collaborators were able to distinguish between effects resulting from cell interactions with other cells and those resulting from cell interactions with the ECM or other signaling molecules. Both immortalized and primary human breast progenitors were analyzed with the MEArrays and the results were used in conjunction with physiologically relevant 3-D human breast cultures. This approach enabled the research team to identify conditions that induced cells to convert into normal breast cell types as well as conditions that kept the cells in their original, non-specialized state.
One of the most intriguing results in this study was the suggestion that modulation of stem and progenitor cell differentiation pathways might be used to “normalize” malignant breast cells.
“Normal and malignant mammary epithelial cells in 3-D cultures have distinct phenotypes,” LaBarge said. “By impairing a signaling pathway known as Notch, we are able to revert malignant breast cancer cells to a normal phenotype.”
In previous studies, Bissell and her group had identified signaling pathways that could cause “phenotypic reversion” of breast cancer cells but this had never been tried before with stem cells.
Said Bissell, “The MEArray approach may be able to teach us how to direct stem cell function in a therapeutic setting and possibly to re-program non-stem cells to acquire other stem cell fates.”
While the MEArrays in this study were used to study adult stem and progenitor cells in breast tissue, the technique should also be applicable to any of the other 200 different types of tissue cells within other organs, LaBarge said.
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Article adapted by Medical News Today from original press release.
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This research was supported in part by grants and a distinguished Fellow Award from the U.S. Department of Energy’s Office of Biological and Environmental Research and low dose program, by grants from the National Cancer Institute and from the U.S. Department of Defense’s breast cancer research program. LeBarge was a fellow of the American Cancer Society.
Source: Lynn Yarris
DOE/Lawrence Berkeley National Laboratory
