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Research Briefs

Let's talk about it - As talking heads nationwide argued about "death panels," a Dartmouth study showed that, when all treatment options have been exhausted, patients feel better if they talk about end-of-life issues. Patients with advanced cancer who got palliative counseling reported a higher quality of life and better mood than patients who did not. "Comprehensive, high-quality cancer care includes interdisciplinary attention to improving physical, psychological, social, spiritual, and existential concerns for the patient and his or her family," wrote Marie Bakitas, D.N.Sc., et al. in the Journal of the American Medical Association.

Vary important research - There are huge variations in the amount of health care provided per capita in different parts of the country, as DMS research has shown for years. But perhaps, critics have argued, those differences are the result of patient preference. According to a new paper by DMS and Dartmouth College experts, that's not the case. There are big variations in the intensity of care patients prefer, but those variations exist across the country. So, they argued in Health Affairs, "more of the variation in use is the consequence of health-care system characteristics than it is of patients' preference."

A suspected whooping cough outbreak at DHMC was a false alarm. But the event had an upside in a finding that 88%-94% of vaccinated employees showed a booster response within just two weeks.

Money isn't everything - For people with mental illness, steady employment offers more than a paycheck. A DMS research team evaluated the effects of holding a job on people with bipolar disorder, schizophrenia, and other serious conditions. They found that those who were employed showed improvements in their mental health and made less use of outpatient services, saving the public about $166,000 over 10 years. In Psychiatric Services, the researchers concluded that the "reduction appears to be dramatic, certainly enough to justify offering supported employment to all persons who use high levels of service and express interest in working.

DNA and diagnoses - To find out what genetic characteristics might predispose someone to bladder cancer, a group of DMS researchers studied mutations in the epidermal growth factor receptor (EGFR), an important regulator of the cell cycle. By comparing genetic variability in hundreds of people, both those with and without bladder cancer, they found that slight changes in the nucleotide sequence did seem to affect the risk of getting the disease. "Further confirmation of these relationships could help ultimately guide cancer prevention efforts or modify clinical care," they wrote in Carcinogenesis.

DMS gastroenterologist Richard Rothstein, M.D., et al. reported in the New England Journal of Medicine on the effectiveness of a nonsurgical treatment for a precancerous esophageal condition.

Got breast milk? - In some developing countries, as many as one-third of HIV-positive mothers may pass on the virus to their children through breast milk. But intriguing research has found that children are less likely to become HIV-positive if they're fed exclusively breast milk instead of a combination of breast milk and other foods. To discover what protection breast milk might offer, a DMS team examined interactions between breast milk and the virus in test tubes. "Our results indicate that breast milk contains innate factors that potently inhibit infection with cell-free HIV," they wrote in the Journal of Acquired Immune Deficiency Syndromes.

A dash of cold water - In 2006, the U.S. Environmental Protection Agency lowered the safety standard for the allowable level of arsenic in public drinking water to just 10 parts per billion. But even that level of exposure, reported DMS graduate student Courtney Kozul, affects the expression of genes involved in the immune response in mice. The results of the study, Kozul et al. wrote in the journal Environmental Health Perspectives, showed that such exposure "can have significant effects on expression profiles in mouse lung and, more important, on the protein levels of many important immune mediators."

Movie characters who smoke, regardless of whether they're "good guys" or "bad guys," influence teens to try smoking, according to a recent study led by DMS's Susanne Tanski, M.D.

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