Podcast 2007 Show Notes
#0046—November 30, 2007
Schmalfeldt:Welcome to episode 46 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health-the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, some startling news for parents of teen aged drivers. Also, results of new research shows that heavier people can be more affected by ozone their lighter peers. And Wally Akinso has a report about the rate of development in the brains of youngsters with attention deficit hyperactivity Disorder. But first, a study that shows family members of patients who die in the ICU are actually more satisfied with communication and involvement than family members of ICU survivors. That's next on NIH Research Radio.
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Family Members of Patients Who Die in the ICU Report Greater Satisfaction with Communication and Involvement than Family Members of ICU Survivors
Schmalfeldt: At first glance, it might seem counterintuitive. But a recent study partially funded by the National Institute of Nursing Research found that family members of loved ones who died in the intensive care unit tend to be more satisfied with the care they and the patient received than family members of ICU survivors. According to the study, family members of all ICU patients tended to rate their loved one's physical care highly. But it was the family members of loved ones who died in the ICU who tended to be more pleased with their involvement in decision-making and communications, as well as the emotional support, respect, compassion and consideration they and the patient received. Dr. Patricia A. Grady, Director of the NINR, discussed some of the reasons for this finding.
Grady: It does underscore the importance of communication, particularly in times of crisis -- that the family members and the health team members and the patient, that the communication system is good between all these major parties. And it turns out that it has a high level of importance and is such a strong factor that regardless of the outcome, if the communication is good and the people understand what are the issues, what are the problems, what is being done, what is possible, what is not possible, that they report more satisfaction.
Schmalfeldt: Dr. Grady said these findings point to ways to improve the ICU experience and decrease stress for all ICU patients and their families. The study was published in the November 13 issue of the journal Chest and received additional funding from the Robert Wood Johnson Foundation and the American Lung Association..
Schmalfeldt: Now, Wally Akinso shares some news that should make all parents of teen aged drivers sit up and take notice.
Drug-impaired Driving by Teens Remains a Problem
Akinso: It's a frightening statistic. Nearly a third of all high school seniors have driven while "under the influence" or have been in a car with an impaired driver according to a study by the National Institute on Drug Abuse. In 2006, 30 percent of high school seniors reported driving after drinking heavily or using drugs, or riding in a car in which the driver had been doing either, at least once in the prior two weeks. Dr. Timothy Condon, Deputy Director of NIDA, discusses the findings.
Condon: Well some of the interesting things, one was the fact that this was such a strikingly high number that I was a little surprised that as many students were actually smoking marijuana or using illicit drugs and getting behind the wheel of automobiles. Also, I was pretty surprised that our high school seniors actually getting into a car with drivers known to be consuming alcohol and using illicit drugs. That was a pretty big surprise to me.
Akinso: Although there was some progress between 2001 and 2003, with rates declining from 35 to 31 percent, between 2004 to 2006 rates leveled off at just under 30 percent. Dr. Condon suggests some solutions to curb this disturbing trend.
Condon: Well one of the issues, I think, affecting our young people in particular is that we don't have enough technology to do a lot of monitoring about people driving under the influence of marijuana and illicit drugs. It's not quite as far along as we have technology to assess whether people are impaired by alcohol because we have breathalyzer tests and those sorts of things for alcohol. We don't have similar technology at this point for marijuana and for other drugs of abuse. And so I think this has actually perhaps given young people a false sense of this isn't as important as alcohol. We need to do a better job of understanding how many people are in fact using illicit drugs, getting behind the wheels of automobiles because we know for example in particular marijuana effects hand-eye coordination. It effects response time. It effects perception and you certainly don't want somebody who's impaired with that drug getting behind the automobile.
Akinso: According to Dr. Condon vehicle accidents are the leading cause of death among those aged 15 to 20. He also said the lack of driving experience among teens, combined with the use of alcohol, marijuana and other substances that impair cognitive and motor abilities can have deadly results. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: When we come back, we'll look at a recent study that shows heavier people are more likely to be affected by ozone than their leaner peers. That's next on NIH Research Radio.
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Ozone Can Affect Heavier People More
Schmalfeldt: If you live in an urban area, chances are you're familiar with the effects of ozone in the atmosphere. For many, an ozone alert on a hot summer day means avoiding outdoor exercise during the hottest part of the day. But for some, high ozone levels caused by the presence of sunlight mixing with pollutants emitted from vehicles or other sources can lead to more serious problems, like decreased lung function. Where short-term exposure to ozone has long been known to cause a temporary drop in lung function in many people, scientists have wondered what, if anything, a person's weight might have to do with a drop in lung function following acute ozone exposure. Researchers at the National Institute of Environmental Health Sciences, along with scientists from University of North Carolina at Chapel Hill and the U.S. Environmental Protection Agency analyzed previously-collected data on young, healthy, non-smoking men and women to see if they could answer that question. Their study provided the first evidence that people with a higher body mass index may have a greater response to ozone than leaner people. Dr. Stephanie London, an NIEHS researcher and co-author of the study, suggested a possible reason for this.
London: We are left with something we can't directly examine in this study. It's already known that obesity is sort of a state of systemic inflammation and that a number of markers of body-wide systemic inflammation are higher in more-obese people. It's also known that these markers of inflammation tend to be inversely related to lung function. And, so, it may be that because of the greater state of systemic inflammation in heavier people, they may be more responsive to the lung function decrement that occurs with ozone.
Schmalfeldt: Future studies will include a targeted pool of obese and lower weight subjects as well as measures of waist circumference, since fat deposited centrally on the body may have a greater influence on a person's respiratory response to ozone. The study was published in the November issue of the journal Inhalation Toxicology.
Brain Matures a Few Years Late in ADHD, But Follows Normal Pattern
Schmalfeldt: Now, here's Wally Akinso with a report about the rate of development in the brains of youngsters with Attention Deficit Hyperactivity Disorder.
Akinso: A study by the National Institute of Mental Health sheds some light on the brain development of youths suffering attention deficit hyperactivity disorder, also known as ADHD. According to the study the ADHD brain matures in a normal pattern but that development is delayed by three years in some regions. The delay was most prominent in regions at the front of the brain's outer mantle, known as the cortex-- the area responsible for the ability to control thinking, attention and planning. Dr. Philip Shaw, a researcher from the NIMH Child Psychiatry Branch, discusses the study.
Shaw: The current study, really ever since ADHD was first described, there's been a debate about whether it represents a delay in brain development or whether it's due to a complete deviation away from normal brain development. To address this question we looked at the cortex and we measured the thickness of the cortex across thousands of points in the brain in about 450 kids, some with ADHD some without. And we looked at how the cortex developed. What we found is that in all children the cortex starts off quite thin it then gets thicker. It reaches its peak thickness and then starts getting thinner throughout adolescence. And the big difference we find in the current study was between the ADHD kids and the kids who didn't have ADHD was in the age at which they reached this milestone of peak cortical thickness throughout the brain. So for healthy kids they sort of peak around age 7 or 8, whereas the ADHD kids they're delayed and they reach their peak at about age 10.
Akinso: In both ADHD and control groups, sensory processing and motor control areas at the back and top of the brain peaked in thickness earlier in childhood, while the frontal cortex areas responsible for higher-order executive control functions peaked later, during the teen years. Dr. Shaw compared the pattern of brain development.
Shaw: So while there was delay, the sequence or the order in which the different parts of the brain matured was very similar in both the kids with ADHD and those who didn't have it. So if ADHD was a complete deviation away from normal brain development you'd expect the sequence to be completely disrupted and it wasn't. So we think this is pretty strong evidence that ADHD is more of a delay in brain development.
Akinso: Researchers also noted that the delayed pattern of maturation observed in ADHD is the opposite of that seen in other developmental brain disorders like autism, in which the volume of brain structures peak at a much earlier-than normal age. Dr. Shaw said the findings support the theory that ADHD results from a delay in cortex maturation. He added that he hopes to find genetic underpinnings of delay and ways of boosting processes of recovering from the disorder. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt:And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, December 14th when episode 47 of NIH Research Radio will be available for download. I'm your host, Bill Schmalfeldt. And now, a personal note if I may. This represents my final episode as host of NIH Research Radio, as I am leaving the NIH to take a job elsewhere in the Federal Government. The podcast will continue, under the auspices of some of the fine professionals here at the NIH Radio News Service. It's been my honor to bring you these exciting stories over the past year and a half, and I'm looking forward to hearing about future research and discovery at the NIH as I join you in the ranks of podcast subscribers.. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
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