January 15, 2010
NIH Podcast Episode #0101
Balintfy: Welcome to episode 101 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 Joe Balintfy, and coming up in this episode: news from a conference on trauma spectrum disorders; two reports on breast cancer risk, a study about CPR, and a report about women in science careers. But first, this news update.
Balintfy: Researchers at the National Cancer Institute have discovered genetic mutations that may contribute to the development of an aggressive form of non-Hodgkin’s lymphoma. That’s a cancer of a part of the immune system. The new findings, which appear in the journal Nature, help show how the cancer cells survive. Knowing this, researchers say, may help them develop potential new targets to treat the disease, but more study is needed.
At the National Institute of Drug Abuse, researchers are better able to explain how cocaine is addictive. A study, published in the journal Science, shows how cocaine affects a specific process in the brain. Then changes in the brain's pleasure circuits, which are also the first impacted by chronic cocaine exposure, likely contribute to an acquired preference for the drug. Researchers say this is a fundamental discovery which advances the understanding of how cocaine addiction works.
According to research supported by the National Institute on Alcohol Abuse and Alcoholism, an experimental compound can repair a defective enzyme that affects an estimated 1 billion people worldwide. When people with the defective enzyme drink alcohol, a toxic chemical accumulates in the body, resulting in facial flushing, nausea, and rapid heartbeat. This inactive form of the enzyme is also linked to increased cancer risk, and reduces the effectiveness of a drug to treat chest pain. The findings suggest the possibility of a treatment to reduce the health problems associated with the enzyme defect.
And finally, leafy green vegetables, folate, and some multivitamins could serve as protective factors against lung cancer in current and former smokers. This is according to a study supported by the National Cancer Institute. In the study, careful examination of cells coughed up by current and former smokers were compared with how much leafy green vegetables, folate, and some multivitamins those smokers took in. Researchers found that those particular substances could influence the prevalence of gene methylation in cells. Gene methylation is a chemical modification used by cells to control gene expression.
News updates are compiled from information at www.nih.gov/news. For more on these and other stories, visit that link. Now, coming up after this break, the complex issues surrounding trauma spectrum disorders, in particular, the impact of military service on families and caregivers. We’ll be right back.
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NIH, DoD and VA Holds Conference Examining Impact of Military Service on Families and Caregivers
Balintfy: The Second Annual Trauma Spectrum Disorders Conference: A Scientific Conference on the Impact of Military Service on Families and Caregivers has recently concluded here at the NIH campus. It was presented by the NIH, the Defense Centers of Excellence, the Department of Veterans Affairs, and several NIH institutes and centers, as well as HHS agencies. The term, trauma spectrum disorders, refers to any injury or illness that occurs as a result of combat or an unexpected traumatic event, and covers a broad range of psychological health and traumatic brain injury issues.
Batten: When we talk about trauma spectrum disorders, it’s an umbrella term that we use to talk about any of the things that can impact somebody after being exposed to a potentially traumatic event.
Balintfy: Dr. Sonja Batten is deputy director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. She participated in the Second Annual Trauma Spectrum Disorders Conference: A Scientific Conference on the Impact of Military Service on Families and Caregivers.
Batten: We’re also interested in other outcomes like depression, substance abuse, and also how deployment can affect family functioning, relationship functioning, how it affects children’s functioning, those sorts of things that may not actually qualify as a disorder but that certainly are of high relevance to individuals.
Balintfy: Experts at the conference discussed the needs of families and caregivers in support of military and veterans with trauma spectrum disorders. They also covered factors related to family functioning and reintegration, as well as effective approaches that facilitate treatment of trauma disorders and services to families and caregivers. Dr. Joel Kupersmith, at the Veterans Health Administration emphasizes the importance of caregivers.
Kupersmith: We have to think of the caregivers as being the primary people here. We as physicians and other healthcare professionals, are really the backup for them. And whatever we offer, whether its empathy or surgery or technology, or treatments, we are the backup.
Maholmes: Our goal was not to just present research for research’s sake,
Balintfy: Dr. Valerie Maholmes is from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. She adds that the conference gave some clear and specific directions for how to bridge research and practice, including what information has explicit implications for policy development.
Maholmes: We want people to walk away with this, knowing the characteristics of children’s development, for example, and how these family situations might affect the children and what they can do about it, where they can go to get help, where they can go to get resources.
Balintfy: Batten adds that it’s appropriate that agencies like NIH, the VA and Defense Centers of Excellence partner for a conference like this.
Batten: Because this really isn’t something that’s only relevant if you’re in the military or if you’re in a veteran population. It really is important for community mental health, for community functioning, and we know that America is really supporting the troops. And what we’re hoping to do is by identifying the ways that stressors can impact our service members and their families, both positively and negatively, that this has implications for America’s public health as well.Balintfy: For details on the Second Annual Trauma Spectrum Disorders Conference: A Scientific Conference on the Impact of Military Service on Families and Caregivers, visit www.nih.gov.
Pregnancy and Breast Cancer
Balintfy: Up next, we have two reports from Kristine Crane dealing with breast cancer research. In this first, she explores how hormonal changes that occur during pregnancy can affect a woman’s risk of developing breast cancer. We’ll learn that for women under the age of twenty, pregnancy is protective against breast cancer; but as women age, pregnancy can actually put them at a higher risk for developing the disease. Here’s Kristine:
Crane: There is a widely-held perception that pregnancy is protective against breast cancer.
Dr. Brinton: Pregnancy in the long run is beneficial.
Crane: Dr. Louise Brinton is the chief of the hormonal and reproductive epidemiology branch at the National Cancer Institute.
Dr. Brinton: But we actually see that in the short term, it’s a risk factor.
Crane: She says for the first five years following a birth, a woman is at an elevated risk of breast cancer.
Dr. Brinton: We know that pregnancy’s associated with a lot of changes in hormones. But we don’t know which hormones could be contributing to the risks that are associated with reproductive patterns.
Crane: Researchers do know that women who get pregnant at a younger age have a lower risk of breast cancer.
Dr. Brinton: You see about a three-fold difference in risk between a woman who has a first birth at age 35, and one who has a first birth prior to the age of eighteen, so it’s quite a substantial difference in risk, and we see really a linear increase in risk starting with very early ages at first birth, and then continuing to rise the longer a woman delays her first birth.
Crane: Dr. Brinton says that’s why women in developing countries, who give birth at younger ages, have typically had lower rates of breast cancer.
Dr. Brinton: But as those cultures are changing, and more and more women are delaying the ages at which they have their first birth and also having fewer children, we’re seeing rates of breast cancer rise.
Crane: That’s happening in China, Japan, India and South America. Meanwhile women in developed countries are waiting even longer to have children.
Dr. Brinton: And of course now we have many women who are delaying their first births until after the age of thirty-five or oftentimes after the age of forty, so it’s of concern that those women are probably placing themselves at a high risk of breast cancer.
Crane: Although the reasons for the risk aren’t entirely clear to researchers, Dr. Brinton says they have some idea.
Dr. Brinton: We think that it may relate to the fact that you are experiencing cellular changes throughout your life and that if you wait until a late age to have a first birth, that the hormones that you’re exposed during a pregnancy can initiate those changed cells into a cancer.
Crane: Dr. Brinton says other hormonal risk factors for breast cancer include an early age at first menstruation and late menopause because of the increased exposure to estrogen over a woman’s life-time.
Genes May Predict Metastatic Breast Cancer
Balintfy: Another link to breast cancer risk—in particular metastatic breast cancer—is a persons genes, their building blocks of inheritance. In this report, Kristine investigates how the genes passed down from parents may shed light on breast cancer risk.
Crane: Scientists have discovered that genes might predict a person’s risk for developing metastatic breast cancer, the advanced stage of the disease in which the tumor cells have spread throughout the body, forming metastases.
Dr. Hunter: There are susceptibility genes for metastases just like there are for developing primary cancer.
Crane: Dr. Kent Hunter is head of the Metastases Susceptibility Section in the Laboratory of Cancer Biology and Genetics at the National Cancer Institute.
Dr. Hunter: You could actually theoretically test women before they develop cancer to determine their risk.
Crane: That means people at high risk for breast cancer could get a blood test to determine their susceptibility for advanced disease.
Dr. Hunter: You could simply say ‘okay, you’re at high risk for breast cancer for whatever reason, family history. And we can test you now before you develop cancer, to know whether you are more or less likely to develop aggressive disease because that may enable us to monitor you better, to put you on prevention regimes that might prevent or reduce the probability of either those events happening, to know to treat you more aggressively or not. And even potentially which drugs would be useful for you rather than others.
Crane: And preventing metastases is the key to surviving breast cancer, says Dr. Hunter.
Dr. Hunter: Once it’s spread, it’s a problem. And so if we can understand and control or at least reduce the probability that the tumor’s going to spread and form these distance metastases, then we’re going to improve quality of life and survivability.
Crane: Diet can also influence susceptibility to metastatic disease. Dr. Hunter’s studies in mice have shown that a low-fat diet and high caffeine intake lower the risk of metastatic cancer.
Dr. Hunter: Diet can have an effect, and that suggests to me that there are probably small molecule agents or some sort of chemo-prevention regimes, that we might be able to incorporate into our therapeutic strategies that will hopefully tilt the balance for women with breast cancer to a less likely state of developing or having these metastatic tumors grow to the point where they become clinically relevant.
Crane: For more information on metastatic breast cancer research, visit www.cancer.gov. This is Kristine Crane at the National Institutes of Health, Bethesda, MD.
Balintfy: Coming up after this break, what research is telling about how to treat cardiac arrest patients. Stay tuned.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
NHLBI Stops Enrollment in Study on Resuscitation Methods for Cardiac Arrest
Balintfy: Welcome back. We’re going to talk about how enrollment has ended early in a large, multicenter clinical trial comparing two distinct resuscitation strategies. Both strategies were delivered by emergency medical service providers to increase blood flow during cardiac arrest. Cardiac arrest by the way is when the heart’s internal electrical system, which controls the rhythm of our heartbeats, gets out of whack—the heart can beat too fast, too slow, or it can stop beating alltogether. This is different from a heart attack when the supply of blood and oxygen to the heart is blocked. Cardiac arrest is also called sudden cardiac death and only eight percent of the patients who collapse from cardiac arrest outside a hospital survive.
Dr. Sopko: That’s a deadly disease, and not that cheerful a statistic.
Balintfy: Dr. George Sopko at the National Heart, Lung and Blood Institute’s Division of Cardiovascular Sciences explains that a large research network studied two resuscitation strategies, both involved cardiopulmonary resuscitation—or CPR—an emergency procedure that uses chest compressions to keep blood circulating.
Dr. Sopko: One strategy was, if we were to use a special device, which is a mouth piece, which kind of entraps air in the lungs and when you do the compression, then the device would facilitate the blood return, in particular the coronary flow.
Balintfy: The other strategy compared two currently used timing approaches of assessing the heart's rhythm in relation to when CPR is started by EMS providers. Dr. Sopko says there was an early versus delayed strategy for defibrillation—an electric shock to the heart to restore its normal rhythm.
Dr. Sopko: Early means that you would do a brief CPR and that would allow the paramedics to get the defibrillator ready and fire. What essentially happens in cardiopulmonary arrest and cardiac arrest is, that there is no longer cessation of the blood flow. And that can happen for two different reasons, one is that the rhythm is crazy, fast and chaotic, and the pump is unable to listen to the electrical signals, or there are no signals.
Balintfy: Researchers compared patient survival rates after EMS providers performed at least 30 seconds or 3 minutes of CPR before assessing the need for defibrillation.
Dr. Sopko: Recent research data is suggesting that perhaps having about three minutes of CPR is very important sort of to optimize some of the circulatory conditions, and then defibrillate.
Balintfy: Researchers found that different CPR durations were equally successful, and the special device does not add benefit.
Dr. Sopko: This is, why we do research… we almost thought that we had the answer. And what we found out, that there was no difference. Now, that is surprising in a sense, but again, that’s why we do research.
Balintfy: Dr. Sopko emphasizes the importance of this research saying that that before these study results, there was a consensus of experts and opinions.
Dr. Sopko: And we had data from very small studies, and that’s always challenging, because small studies, many times, sound very promising, but once you put it the real life, in the real scenario, things don’t necessarily do that, that’s why we do very rigorous research, like what was what we did with the Resuscitation Outcome Consortium.
Balintfy: The Resuscitation Outcomes Consortium is the largest clinical research network to study pre-hospital treatments for cardiac arrest in the United States and Canada. Data was reviewed on approximately 11,500 study participants. Dr. Sopko summarizes the key messages from these results.
Dr. Sopko: Number one, that it is not necessarily the timing of a given strategy, it is the immediate application of CPR, a good CPR. That is absolutely critical. And that, when it does happen, to the lay-public, that simplifies, for the lay-public to get engaged. And I would encourage everybody to think about it very carefully, when you see that fellow citizen is down, do initiate CPR. Follow the appropriate rules that we check on the vital signs and everything else, and then if it’s appropriate, you do CPR, but do the CPR immediately, because the time is of the essence. Every minute counts. Every minute, your survival goes down.
Balintfy: For more information on this study and cardiac arrest, visit www.nhlbi.nih.gov.
New Publication Features Women in Science Careers at the National Institutes of Health
Balintfy: And finally in this program, a new NIH publication is highlighting the success stories of women in science. The goal is to encourage aspiring science students, as well as to serve as a guide to the diversity of staff and research areas at the NIH for both students as well as for established scientists. Wally Akinso has the details.
Akinso: The Office of Research on Women’s Health has sponsored a new book featuring the achievements of accomplished women in science at the National Institutes of Health. Dr. Vivian Pinn, ORWH’s Director, says this book is meant to highlight examples of the variety of roles, positions and contributions of doctoral-level women across the NIH.
Dr. Pinn: There are so many accomplished women at the NIH both in senior levels as well as in junior positions all enjoying or excelling in science that we wanted to put together not a directory or scientist but just a publication that could feature the accomplishments of many of the women here and to talk a little bit about how they approached their careers, what they have done, what their doing, and how they combine that with their personal lives just as an inspiration to young boys and girls, and men and women, who may be considering careers in science and don't know role models.
Akinso: The book, "Women in Science at the National Institutes of Health 2007-2008" celebrates careers and accomplishments of 289 talented female scientists and administrators who are part of the NIH community. Each NIH Institute, Center and Office recommended up 15 doctoral-level women to be featured in the publication.
Dr. Pinn: This features women from across the spectrum from those who are biostatisticians to those who are institute leaders, those who are in administration, and those who are in basically in the laboratory working on their experiments and their research on a daily basis. We ask them to tell us a little bit about their educational background and about the kind of work they’re doing. And then, what I think is most important, their personal stories, what they would like to share.
Akinso: The publication gives readers the opportunity to learn about the different paths each woman has taken and be encouraged by the women’s personal stories. Dr. Pinn hopes this book influences or brings excitement to young men and women pursuing careers in science.
Dr. Pinn: We wanted to show that women can be successful in scientific careers in a variety of positions and a variety of ways to pursue those positions. That they can advance to leadership positions, demonstrating how we’ve had a great increase in the number of women who are leaders here at the NIH over the past 15-20 years. And really to create excitement not just for young girls but for young men and women who are considering careers in science to know that they can do it—hear examples of some who have. You can see how some of these women in the book have overcome various barriers and yet they enjoy what their doing and they have pride in what they are doing and that’s what we wanted to accomplish.
Akinso: The publication honors the exemplary leadership of Dr. Ruth Kirschestein, the first woman to serve as a director of a NIH institute, who among her many accomplishments established the ORWH in 1990. Dr. Kirschstein, who spent more than 50 years as a civil servant, died in October 2009. To download an electronic copy or order a hard copy of the book, visit http://orwh.od.nih.gov/. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
(THEME MUSIC)Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, January 29th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
Announcer: 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.