ScienceCache

Vol. 204
Oct. 7, 2005

I THINK, THEREFORE I FALL
The patient came into the doctor’s office in a wheelchair, weighted down by a diagnosis of Parkinson’s disease, taking medication for the disorder and insisting she was unable to stand or walk. Thirty minutes later, after jogging down the hallway, she strolled out the door. No Parkinson’s patient was she. Rather, she was a perfect example of a person with “fear of falling gait,” says neurologist and Parkinson’s expert Roger Kurlan. Kurlan has seen enough cases of the condition, where a person is so afraid of falling that the mind actually affects the ability to walk, that he wrote about the disorder in the September issue of Cognitive and Behavioral Neurology to cue other physicians about the condition. According to the report, a thorough physical exam of the woman, who had been diagnosed with Parkinson’s by her physician, turned up nothing – but the woman refused to try to stand up on her own. With enough persuasion, though, the woman finally did rise, taking short and tentative steps. Upon hearing that she did not appear to have Parkinson’s or any other serious neurological condition– and that her problem was psychological, reflecting her fear of falling – the woman’s bearing improved markedly. With more encouragement and offers of help, the woman began walking around the room and even jogging down the hallway. Doctors subsequently referred her to a physical therapist to build her confidence on her feet, and they also gradually stopped her Parkinson’s medications. Her ability to walk unassisted continued for the six months the team followed her progress. “The results can be pretty dramatic when psychogenic gait disorders are treated appropriately,” says Kurlan.
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OPEN WIDE FOR NEW CLUES ABOUT LUPUS
By snipping out and analyzing tiny samples of patients’ tonsils, scientists have identified a key cellular checkpoint that is somehow bypassed in lupus patients, where harmful immune cells that normally are squelched by the body are mistakenly granted access. The in-depth look at tissue from a person’s tonsils, a technique seldom used to study the immune system, has provided doctors with key information about just what goes wrong in patients with lupus to cause their immune systems to attack themselves, bringing about symptoms like joint pain, fatigue, and other complications like kidney failure. “Tonsils are very informative,” says rheumatologist and immunologist Ignacio Sanz, who led the study. “Peripheral blood doesn’t have the organization you need to really understand the immune system. The tonsils give us a window into the immune system that we didn’t have before.” Sanz’s team focused on lymph structures in the tonsils known as germinal centers, where teeming masses of cells known as B cells and T cells glom together and swap crucial information about invaders like bacteria and viruses. The team found that in the germinal centers – sophisticated processing centers of the immune system – lupus patients have as many as 10 times the number of rogue B cells that attack a patient’s own body than do healthy people. The paper detailing the work will be in the November issue of the Journal of Clinical Investigation and became available online last night.
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GOTTAQUIT.COM CONNECTS WITH TEEN SMOKERS
GottaQuit.com, a smoking cessation campaign developed by the Monroe County Department of Public Health, effectively reached almost all teens in the county regardless of whether they smoked or not, saturating them with anti-tobacco messages, according to a report by pediatricians at Golisano Children’s Hospital at Strong. The evaluation is of the first community-based quit-smoking program that used both the web and other mass media components to target young people. The study, led by Jonathan D. Klein, showed that 94 percent of the post-campaign respondents had seen GottaQuit.com advertisements, and one in four teen smokers said they had visited the web site for help in quitting. Previous research has shown that most teen smokers want to quit but are not familiar with cessation programs. Teens also have concerns about confidentiality, parental involvement, and whether they can relate to stop-smoking counselors. “Web-based health interventions have great potential for reaching teens because this type of media is non-judgmental, confidential and does not require interaction with others,” says Klein, whose specialty is adolescent medicine. “Our study demonstrates that teen smokers are highly receptive to Internet-based cessation resources.” The study is published in the October edition of the journal Pediatrics.
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RESEARCHERS STUDY NURSING HOME QUALITY LOCALLY, STATEWIDE
A $1.28 million grant has been awarded for research on how to improve nursing home quality and patient care through better employee teamwork and management practices. The National Institutes of Health funded the four-year project, which involves surveying as many as 18,000 nursing home employees in New York State. Most prior studies have tried to explain differences in quality of care by assessing the impact of nursing home size, profit status and staffing levels on patient outcomes. But the University group led by Helena Temkin-Greener of the Department of Community and Preventive Medicine plans to take a different approach. Since nursing homes are known as “low-tech, high-touch” environments, the researchers will test the relationship between how the organization performs -- for example, the way staff interacts - -and patient outcomes. The study will evaluate leadership, communication skills, coordination of care, conflict resolution and team performance within 375 randomly selected nursing homes. “We all believe in the team process and we say that teams are good, but in long-term-care settings we have no proof that better-performing teams produce better patient-care outcomes,” says Temkin-Greener, an expert on elder care and a national authority on how to develop and evaluate programs that serve the elderly. “If we can document that teamwork is valuable, then we may be able to create relatively inexpensive quality improvements.”
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