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Study: Radiation Therapy Often Underused for Common Type of Non-Hodgkin Lymphoma Despite Recommendations

Patients with an early-stage, indolent form of lymphoma are increasingly being given no treatment, chemotherapy or targeted drug therapies despite strong clinical evidence that shows radiation therapy can have better outcomes, according to a study by University of Pittsburgh School of Medicine researchers that is being presented at the 57th Annual Meeting of the American Society for Radiation Oncology(ASTRO). 

Guidelines from the National Comprehensive Cancer Network and the European Society for Medical Oncology both list radiation therapy as the preferred treatment for low-grade follicular lymphoma, which is a common type of non-Hodgkin lymphoma that grows slowly. It is most likely to occur in people age 60 and older.  

Radiation therapy is the use of high-energy x-rays to treat cancer, and was the first curative therapy for lymphoma. Radiation therapy has a long history as the preferred treatment in early-stage follicular lymphoma; however, despite strong supporting evidence, it has been replaced by alternative management strategies including observation without initial treatment and novel systemic therapies.

“Our study highlights the increasing omission of radiation therapy in non-Hodgkin’s lymphoma and its associated negative effect on overall survival at a national level. This increasing bias towards the omission of radiation therapy is despite proven efficacy and increasing adoption of lower radiation therapy doses and more modern radiation therapy techniques which decrease risk of side effects,” said Austin Vargo, M.D., a radiation oncologist at UPMC CancerCenter, partner with the University of Pittsburgh Cancer Institute, and lead author of the study.  “More patients should be offered this effective yet underused treatment.”

Researchers analyzed patterns of care and survival outcomes for 35,961 patients diagnosed with early-stage follicular lymphoma as listed in the National Cancer Data Base. The study found that the use of radiation therapy in these patients decreased from 37 percent in 1999 to 24 percent in 2012 while there were increases in the use of single-agent chemotherapy and observation without any initial treatment. Patients who received radiation therapy had five-year and 10-year survival rates of 86 percent and 68 percent, respectively; those who did not have radiation therapy had rates of 74 percent and 54 percent.

“Survival with radiation therapy in these cases are higher and we think that an evidence-based approach should be used by more oncologists when discussing treatments for their patients,” said Dwight E. Heron, M.D., FACRO, FACR, director of radiation services, UPMC CancerCenter, and professor of Pitt’s Department of Radiation Oncology, Otolaryngology and Head & Neck Surgery.

Collaborators on the study were Beant S. Gill, M.D., of the University of Pittsburgh Cancer Institute; Goundappa K. Balasubramani, Ph.D., of the University of Pittsburgh Graduate School of Public Health; and Sushil Beriwal, M.D., Department of Radiation Oncology,Magee-Womens Hospital of UPMC.

Children’s Hospital of Pittsburgh of UPMC Gastroenterologist Receives Prestigious Murray Davidson Award

PrintThe American Academy of Pediatrics (AAP) has awarded Robert H. Squires, M.D., director of pediatric hepatology, a program of the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Children’s Hospital of Pittsburgh of UPMC, its 2015 Murray Davidson Award. The award was presented on Oct. 9 at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) in Washington, D.C.

The award recognizes an outstanding clinician, educator and scientist who has made significant contributions to the field of pediatric gastroenterology, hepatology and nutrition.

“I am humbled that my colleagues consider me to be deserving of an award that includes my heroes in the field of pediatric gastroenterology, hepatology and nutrition,” said Dr. Squires, also professor of pediatrics at the University of Pittsburgh School of Medicine. “While given to an individual, this very special award is a testament to my fortunate encounters with strong mentors, colleagues and patients; and to my wonderfully supportive and accomplished family.”

Dr. Squires is the principal investigator for the multi-center, multi-national National Institutes of Health-sponsored pediatric acute liver failure study group; the site principal investigator for the Childhood Liver Disease Research Network; and was the principal investigator for the Pediatric Intestinal Failure Consortium.

“Dr. Squires embodies the qualities celebrated by the Murray Davidson Award,” said Mark E. Lowe, M.D., Ph.D., director, pediatric gastroenterology, hepatology and nutrition, Children’s Hospital. “I can’t think of a more deserving awardee. We are fortunate to have him helping care for the children of western Pennsylvania.”

Dr. Squires served as chair of the AAP Section on Gastroenterology, Hepatology and Nutrition and was an executive council member of NASPGHAN. He has published over 70 peer-reviewed articles in major journals, 47 in the past 10 years.

“Dr. Squires is a physician with a stable internal compass that has always directed him to serve the health care needs of children in the broadest sense,” said David Keljo, M.D., Ph.D., director, Inflammatory Bowel Disease Center, Children’s Hospital. “He has consistently worked to ensure the best possible clinical care for children, displaying great character while leading the way. It was a privilege to nominate him.”

The Division of Pediatric Gastroenterology, Hepatology and Nutrition at Children’s is ranked second in the country by U.S. News & World Report’s 2015-16 Best Children’s Hospital specialty ranking for pediatric gastroenterology and GI surgery. The division consists of experts in general clinical pediatric gastroenterology, pediatric hepatology, and a broad range of specialty areas, including abdominal pain, acute and chronic pancreatitis, constipation, diarrhea, eosinophilic disorders, feeding disorders, gastroesophageal reflux and esophagitis, gastrointestinal bleeding, Inflammatory Bowel Disease Center, intestinal failure (short-bowel), irritable bowel syndrome, motility disorders, Liver Clinic, liver diseases and transplantation, metabolic disorders affecting the liver or intestines, poor growth, small bowel transplantation and ulcer disease. The division also provides a full range of diagnostic procedures and treatments related to the gastrointestinal tract, liver and pancreas.

For more information on Dr. Squires and Children’s Hospital of Pittsburgh of UPMC, visit www.chp.edu.

Pitt/UPCI Next-Gen Sequencing Test Identifies Cancerous Thyroid Nodules with High Degree of Accuracy

A next-generation sequencing test is successfully predicting which thyroid nodules are cancerous and require surgical removal, reducing the need for multiple invasive diagnostic procedures, according to researchers at the University of Pittsburgh Cancer Institute (UPCI) and Pitt School of Medicine. Their findings were recently published online in the journal Thyroid.
In up to 80 percent of cases, examination of cells collected with a fine needle from a suspicious lump in the thyroid, a gland in the front of the neck, typically can tell a pathologist whether it is benign or malignant, said lead investigator Yuri Nikiforov, M.D., Ph.D., professor of pathology and director of Pitt’s Division of Molecular and Genomic Pathology.
“However, in 20 percent of cases, the result is indeterminate, meaning we can’t say for certain whether the nodule is cancerous,” he said. “That means the patient might have a repeat needle biopsy, or will go to the operating room to have the affected thyroid lobe removed for further assessment. If it turns out to be cancer, the patient has to have yet another surgery to have the rest of the thyroid taken out.”
Three-quarters of such diagnostic surgeries are performed on what turn out to be benign nodules. Such patients could have avoided surgery if physicians were confident without surgical excision that the nodules are very likely to be harmless.
In the new study, the researchers used the latest version of the test they developed, called ThyroSeq v2.1, to look for more than 300 cancer-associated mutations in 56 genes using cells obtained from fine-needle aspiration biopsies in more than 440 patients. Of that group, 96 patients had established diagnoses through surgery, allowing the team to assess ThyroSeq’s predictive power. The team found the test was able to correctly classify 20 out of 22 cancers with high precision and accuracy. Most importantly, when the test was negative, the residual risk of cancer in those nodules was so low that surgical excision was not needed.
“We finally have a test that offers high accuracy in predicting whether a nodule is cancerous or if it is benign,” Dr. Nikiforov said.
“This molecular testing panel holds great promise for streamlining and eliminating unnecessary surgery, not just here, but nationwide,” said co-author Sally E. Carty, M.D., professor and chief of endocrine surgery, Pitt School of Medicine, and co-director of the UPMC/UPCI Multidisciplinary Thyroid Center, which has been offering the test since 2014. It also is available to and used by thyroid clinics around the country.
“Thyroid cancer now is the fifth most common cancer diagnosed in women, and it is one of the few cancers that continues to increase in incidence,” she noted. “It’s important to get to the diagnosis quickly and correctly.”
The team included other researchers from Pitt and UPCI. The project was supported by UPCI, UPMC and the Richard A. & Leslie A. Snow Fund for Thyroid Cancer Research.

Obesity-Related Causes of Stillbirth Detailed in Pitt Analysis

PITTSBURGH, Aug. 26, 2015 – Obese women are nearly twice as likely as their lean counterparts to have stillborn babies for several specific, potentially preventable medical reasons, a new University of Pittsburgh Graduate School of Public Health analysis reveals.

Placental diseases and hypertension were the most common causes of stillbirth among obese women, according to the study, published online and scheduled for the October issue of the American Journal of Clinical Nutrition. The research was supported by the National Institutes of Health (NIH).

“We’ve known for some time that obese women are more likely to have stillbirths, but this is one of the first and most comprehensive efforts to figure out why,” said lead author Lisa Bodnar, Ph.D., M.P.H., R.D., associate professor in Pitt Public Health’s Department of Epidemiology. “Our hope is that this work can be used to better counsel women on the importance of a healthy pre-pregnancy weight and monitor them for complications during pregnancy that may threaten the survival of their fetuses.”

“This study also could be used to guide prevention efforts at a societal level,” she said. “If we can reduce pre-pregnancy obesity by even a small amount, through environmental or policy changes, we could significantly reduce the burden of stillbirth.”

Annually there are 3.2 million stillbirths worldwide and, of high-income countries, the U.S. is among those with the highest rates. Recent research shows that obesity is likely responsible for more stillbirths in high-income countries than other risk factors, such as smoking or advanced maternal age.

Dr. Bodnar and her colleagues examined records from 658 stillbirths that occurred between 2003 and 2010 at Magee-Womens Hospital of UPMC, which has one of the largest labor and delivery units in the country. Stillbirths were defined as cases where the baby had reached at least 16 weeks gestation and showed no evidence of life after delivery. A panel of obstetricians reviewed each case and assigned a cause of the stillbirth.

The mothers were classified as lean (normal weight or underweight), overweight, obese or severely obese based on their pre-pregnancy body mass index, a measure of weight versus height.

The rate of stillbirth per 1,000 births ranged from 7.7 for lean women to 17.3 for severely obese women.

Maternal hypertension – or high blood pressure in the mother; placental diseases or disorders where the placenta does not properly sustain the unborn baby; fetal abnormalities where the baby would have been unlikely to live if it made it to birth; and umbilical cord abnormalities were all more common in the more obese women.

“Obstetricians should monitor obese patients for these complications and quickly treat conditions like hypertension if they arise in order to reduce risk of stillbirth,” said senior author Hyagriv N. Simhan, M.D., professor and chief of the division of maternal-fetal medicine and medical director of obstetrical services at Magee. “However, we’d like to see these women before they even become pregnant. When a doctor has an obese patient who is considering pregnancy, she should be referred to a maternal-fetal medicine specialist who can counsel her on the benefits of losing weight before pregnancy, as well as safe approaches to weight loss.”

Additional authors on this research are W. Tony Parks, M.D., Kiran Perkins, M.D., Sarah J. Pugh, M.P.H., Maisa Feghali, M.D., Karen Florio, D.O., Omar Young, M.D., and Sarah Bernstein, M.D., all of Pitt; and Robert W. Platt, Ph.D., of McGill University.

This research was funded by NIH grant R21 HD067851.

Children’s Hospital of Pittsburgh Foundation Invests in Cardiovascular Regeneration Research

PrintPITTSBURGH, Aug. 20, 2015Bernard Kühn, M.D., a scientist at the Richard King Mellon Foundation Institute for Pediatric Research at Children’s Hospital of Pittsburgh of UPMC, is being awarded a $200,000 grant from the Children’s Hospital of Pittsburgh Foundation.

The grant is being provided from the Fund for Genomic Discovery, which was raised by the Foundation’s Research and Education Program Committee. Established in 2012, the Research and Education Program Committee promotes the awareness of funding needs and priorities of physician-scientists at Children’s Hospital. Through various fundraising initiatives, the committee seeks to broaden the network of philanthropists, raise money to fund the gaps between government grants, and provide seed funding for new avenues of scientific investigation.

Through hosting two events, combined with additional fundraising efforts, more than $520,000 has been raised for research.

“This funding will allow my team to enter the field of fibrosis research, a new area of investigation for my lab. If successful, this project will provide a broadly applicable molecular-genetic blueprint for the field of cardiovascular development and for developing new drugs to reduce fibrosis in heart disease,” said Dr. Kühn, associate professor of pediatrics at the University of Pittsburgh School of Medicine. “Working directly with me on this research is Dennis Kostka, Ph.D., an expert in Developmental Biology and Computational & Systems Biology, who will offer his expertise on the computational aspects of the research.”

Dr. Kühn, also the director of research at Children’s Heart Institute, joined the faculty in September 2014, and has been focused on the unique workings of heart muscle cells. His long-term objective is to provide novel approaches and molecular targets for the treatment of heart failure, primarily by studying the mechanisms of growth and regeneration of the myocardium, the muscle tissue of the heart.

Dr. Kühn and his team of researchers are focused on cardiomyocytes, the cells of the heart muscle, and discovering ways to make them replicate and proliferate so as to enable the heart to heal itself in cases of heart failure or congenital defects.

“Dr. Kühn is one of the leading researchers in heart regeneration and this funding will give him the opportunity to further explore the growth of heart cells and the advancement of treatments for heart failure,” said David H. Perlmutter, M.D., physician-in-chief and scientific director, Children’s Hospital, and Distinguished Professor and Vira I. Heinz Endowed Chair, Department of Pediatrics, Pitt School of Medicine.

Dr. Kühn is the recipient of numerous grants and awards, including the American College of Cardiology’s prestigious Young Investigator Award, the Basil O’Connor Award from the March of Dimes Birth Defects Foundation, and Scientist Development Grant from the American Heart Association.

For more information on Dr. Kühn, please visit www.chp.edu.

Pitt School of Medicine Leads Sepsis Care Guidance in Preparation for Nationwide Hospital Requirements

PITTSBURGH, Aug. 18, 2015 – As hospitals nationwide brace for rigorous mandates for care of septic patients that will be adopted by the Centers for Medicare & Medicaid Services in October, a University of Pittsburgh School of Medicine review unveils research-based guidance to improve compliance when treating this common and deadly syndrome.

Christopher Seymour, MD, MScSepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It occurs in more than 230,000 U.S. patients every year, with most initially receiving care in an emergency department. Despite best practice, more than 1 in 5 septic shock patients do not survive.

In this week’s issue of the Journal of the American Medical Association, Pitt researchers incorporate the results of several high-profile clinical trials into a concise clinical diagnosis and treatment algorithm to aid hospitals in the implementation of the National Quality Forum (NQF) Severe Sepsis and Septic Shock Management Bundle.

“The NQF sepsis bundle comes on the heels of several high-profile sepsis deaths that highlighted the need for better recognition, prompt treatment and frequent re-assessment of patients with septic shock,” said lead author Christopher W. Seymour, M.D., M.Sc., assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine. “The sepsis problem is clear, but the solution for patients remains elusive. This new algorithm provides doctors and hospitals with a best-practice approach to assessing and treating septic shock patients as supported by the most recent evidence.”

Dr. Seymour and co-author Matthew R. Rosengart, M.D., M.P.H., associate professor in Pitt’s Department of Surgery, use their review to stress what is known about good sepsis care – that prompt clinical diagnosis is crucial, and the first step in treatment is promptly addressing the infection. Their review also points out what is less certain, such as various diagnostic and monitoring tools that can be useful in certain subgroups of patients. They highlight new evidence that suggests rigorous, one-size-fits-all septic shock protocols are not superior to good clinical assessments among patients who already received timely treatment. A variety of medications and fluid therapies also can be used to support the patient’s circulatory system, but one is not always better than another.

“We’re at an interesting juncture where major policy changes are being implemented across the U.S. for patients with sepsis, but the ‘right’ approach still has many areas of uncertainty,” said Dr. Seymour. “As a start, we know that doctors must be able to quickly diagnose sepsis and begin treatment without delay. And they must be well-versed in the different treatments available and which ones are likely to work best in different septic shock situations.”

This work was supported in part by National Institutes of Health grant K23GM104022, and more information can be found at https://www.ccm.pitt.edu/CRISMA.

Sepsis infographic

UPMC Will Host Unprecedented Gathering of Concussion Experts to Share Best Treatments, Practices

PITTSBURGH, Aug. 18, 2015 – Nearly 30 leading, independent concussion clinicians and researchers from around the United States will convene at UPMC Oct. 15 and 16 with a unique purpose: to propose standard guidelines on the best practices, protocols and active therapies for treating concussions today, resulting in a white paper to be published in a medical journal and shared nationwide.

For the first time in the relatively infant science of concussion, U.S. experts are coming together to discuss what the UPMC organizers call Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion. Representatives from the National Institutes of Health and the U.S. Department of Defense, among others, also have been invited to participate.

“There’s a gaping need for a consistency of care for concussions across the country, if not the world. To try to fill that void, we’re thrilled to host a meeting of some of the greatest minds in concussion science and clinical care,” said Micky Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and the chairman of the conference to be held at the U.S. Steel Tower in Pittsburgh, headquarters to UPMC. “It is a privilege to bring together such a group, discuss the issues truly facing concussion health care today, and attempt to share with caregivers everywhere what we find to be the best evidence, science and practices in getting people better.”

The white paper is intended to make scientific, clinical and therapy recommendations for other health care providers to replicate and researchers to study further.

Over the past decade, there have been summits and conferences abroad where participants agreed upon definitions, evaluations and on-field protocols, but this marks the inaugural U.S. meeting focused strictly on active therapies, treatments and best clinical practices for concussions.

“Never before has evidence-based science and clinical experience been brought to bear in advancing concussion treatment like we’re attempting here,” said Anthony Kontos, Ph.D., research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery, and co-director of the meeting. “We believe that this meeting will bring together cutting-edge research knowledge and clinical approaches to this injury that will blaze a trail for concussion treatment moving forward.”

The invitees cut across academic, scientific and health care environments. Among those expected to attend are Julian Bailes, M.D., NorthShore University Health System (Chicago) and chairman of the medical advisory board for Pop Warner Football, and retired Gen. Peter Chiarelli, former U.S. Army vice chief of staff and an outspoken leader in research and treatment for traumatic brain injury (TBI), mild TBI such as concussion, and post-traumatic stress.

“There have been numerous advances in our understanding of concussion treatment, and this conference should facilitate the implementation of best practices to make participation in all sports safe,” Dr. Bailes said.

“I am honored to be among this group of leading concussion clinicians and researchers for a meeting that will be a critical step forward in the standard of care for concussions,” Gen. Chiarelli said. “A published consensus statement on concussion treatment will give every patient the opportunity to receive the best care, no matter where they are injured. It’s time to put aside our differences, collaborate and work together for the sake of patients everywhere.”

Added conference co-director David Okonkwo, M.D., Ph.D., professor of neurological surgery and clinical director of the Brain Trauma Research Center at the Pitt School of Medicine: “It is high time to assemble neurosurgeons, neurologists, neuropsychologists, emergency medicine physicians, physiatrists, athletic trainers, physical therapists and all the multidisciplinary health care professionals who are the primary caregivers to people, and not just athletes, troubled by concussions. Let’s effect change and improve outcomes now and for the future.”

UPMC received support to host this meeting because it is aligned with Pittsburgh’s long-standing place at the center of the field: the first sports-medicine concussion program to open its doors (2000), a leading institution in concussion research and innovation, and a model clinic with successful assessment, treatment and outcomes amid its nearly 18,000 concussion-patient visits yearly.

“We are fortunate that we have this opportunity to carry out this idea of spreading better care practices and ultimately helping so many,” Dr. Collins said. “We are looking forward to a wide-ranging, stimulating discussion that is overdue, and we feel our science, innovation and clinical experience make us well suited to serve as hosts.”

The two-day meeting is fully funded by a grant from the NFL Foundation.

“Because of the vital nature of the concussion conversation, it’s critical to support leading institutions in the country, like UPMC, that are promoting science in an effort to advance treatment, evidence and clinical experience,” said Charlotte Jones Anderson, chair of the NFL Foundation and executive vice president of the Dallas Cowboys. “The NFL Foundation is dedicated to improving the health and safety of sports, youth football and the communities in which we live, and we look forward to learning from the experts who will meet in October to further that mission.”

The conference will conclude with a panel discussion and media availability that is expected to be streamed live.

First-of-its-Kind Partnership: UPMC Lemieux Sports Complex Opens

CRANBERRY TWP., Pa., Aug. 17, 2015 – The UPMC Lemieux Sports Complex, a partnership between UPMC and the Pittsburgh Penguins®, officially opened to the public today. The 185,000-square-foot facility is a comprehensive outpatient center for UPMC Sports Medicine and the primary practice and training center for the Penguins, as well as home to their Tier 1 Elite youth programs.

This multi-use facility will be a destination for athletes of all ages and skill levels seeking leading-edge injury prevention and treatment from experts in sports medicine. It focuses on sports medicine and hockey-related research, including injury prevention, training, treatment, and rehabilitation.

“It’s a true partnership between elite hockey and elite sports medicine,” says Vonda Wright, MD, medical director of the UPMC Lemieux Sports Complex. “We have full clinical facilities with experts in orthopaedic surgery, sports performance, primary care sports medicine, physical therapy, athletic training, nutrition, sports psychology, concussion, and musculoskeletal radiology.”

The Lemieux Complex also houses a sports performance center and an expansion of the UPMC Sports Medicine Concussion Program, with both clinical and research space. “We’re expanding on the legacy of elite sports medicine at UPMC,” Dr. Wright says. “We’ll do novel research not only on how to prevent and treat injury, but also how to predict it.”

Five research laboratories come together at the UPMC Lemieux Sports Complex to form the Institute for Sports Performance and Innovative Research (InSPIRe). The core research initiatives of InSPIRe are concussion and traumatic brain injury (TBI), cell therapy and biologics, sports performance, BioDynamics, and material science. Research will aim to answer the prevention, performance, and protection research questions that are important to the futures of young and professional athletes.

The first-of-its-kind facility includes:

  • More than 50 sports medicine experts
  • A sports performance program led by former Pittsburgh Penguins winger, Gary Roberts
  • A practice rink for the Pittsburgh Penguins and a community rink for public use
  • More than 1,500 square feet of hockey skills performance space with a RapidShotTM system, three RapidHandsTM training stations, and a resistance skating lane made of synthetic ice
  • 54,000 square feet of clinical space
  • A physical therapy gym overlooking the Penguins practice rink
  • Aquatic therapy
  • On-site MRI and x-ray imaging
  • Dedicated sports performance space including a sprinting track and batting cages
  • Café and retail space
  • Free parking

For more information about the complex, please visit UPMCLemieuxSportsComplex.com.

Places with More Marijuana Dispensaries Have More Marijuana-Related Hospitalizations

PITTSBURGH, Aug. 10, 2015 – People who live in areas of California with a higher density of marijuana dispensaries experience a greater number of hospitalizations involving marijuana abuse and dependence, a University of Pittsburgh Graduate School of Public Health analysis discovered.

The National Institutes of Health-funded research, published online and scheduled for the Sept. 1 issue of the scientific journal Drug and Alcohol Dependence, could be informative as more states consider legalizing marijuana for medical and recreational use. It is the first analysis of the statewide impact of marijuana dispensaries on abuse and dependence, as well as the first look at population characteristics associated with marijuana-related hospitalization rates.

“As marijuana is approved for medical or recreational use, we need to carefully consider where we allow dispensaries to be placed,” said lead author Christina Mair, Ph.D., assistant professor in Pitt Public Health’s Department of Behavioral and Community Health Sciences. “Our study indicates that there are real problems associated with a higher density of marijuana dispensaries in neighborhoods. More study and monitoring, coupled with thoughtful legislation and community discussion, will be prudent to ensure that marijuana laws have the fewest negative consequences for vulnerable populations.”

In 1996, California was the first state to legalize medical marijuana, allowing physicians to prescribe the drug for medical purposes. Since then, 22 states and Washington, D.C., have enacted similar laws, and four of those states also have legalized recreational use. Pennsylvania doesn’t allow either, though it is considering permitting medical marijuana.  

Dr. Mair and her team looked at data on California hospital discharges that had either a primary or secondary medical code for marijuana dependence or abuse with at least one overnight hospital stay. The research covered 2001 through 2012, the most recent years for which consistent data were available.

Hospitalizations with marijuana abuse or dependence codes increased from 17,469 in 2001 to 68,408 in 2012. More than 85 percent of marijuana-related hospitalizations were coded as abuse, rather than dependence, and 99.2 percent were secondary codes, meaning the person was primarily hospitalized for something other than marijuana.

When the research team mapped the location of marijuana dispensaries and cross-referenced it with the ZIP code of each patient’s home, they found that each additional dispensary per square mile in a ZIP code was associated with a 6.8 percent increase in the number of hospitalizations linked to marijuana abuse and dependence.

In addition, Dr. Mair and her team found that marijuana dispensaries and hospitalizations were more likely to be located in areas with lower household incomes and lower educational attainment.

“It’s unclear if the marijuana dispensaries are simply locating in neighborhoods that tend to be more disadvantaged and already have underlying problems with marijuana abuse, or if the presence of the dispensaries is causing an increase in abuse and hospitalizations,” said Dr. Mair. “It could be a combination of both factors.”

Dr. Mair noted that research on the location of marijuana dispensaries has a parallel precedent in the location of liquor stores. This gives policymakers and public health practitioners the opportunity to learn from previous studies on the health effects of density and location of liquor stores in order to design studies that can provide similar data on marijuana dispensaries.

“Once dispensaries open, it is much harder to go back and create regulations to guide their location and density,” said Dr. Mair. “Passage of laws permitting marijuana use and sale is likely to continue, so it is critical that we continue to research the impact of dispensaries on the health of local communities to provide guidance on regulations and public health outreach to prevent abuse.”

Additional researchers on this project include senior author Bridget Freisthler, Ph.D., of UCLA’s Luskin School of Public Affairs. Co-authors are Andrew Gaidus, M.E.M., and William R. Ponicki, M.A., of the Prevention Research Center in Oakland, California.

This research was funded by the NIH’s National Institute on Drug Abuse grant R01-DA-032715.

UPCI Researcher Named Outstanding Investigator by NCI, Awarded $6.3M for Studying How Food Can Lower Cancer Risks

 Thomas Kensler, Ph.D., professor of pharmacology and chemical biology and co-leader for the Cancer Epidemiology and Prevention Program at the University of Pittsburgh Cancer Institute (UPCI), was awarded a $6.3 million Outstanding Investigator Award from the National Cancer Institute (NCI). This new award acknowledges experienced researchers and provides them with long-term support for their exceptional work.
Dr. Kensler’s research focuses on chemoprevention, or how food can be used to lower the risk of developing cancer caused by unavoidable environmental toxins.
“The NCI Outstanding Investigator Award addresses a problem that many cancer researchers experience:  finding a balance between focusing on their science while ensuring that they will have funds to continue their research in the future,” said Dinah Singer, Ph.D., director of NCI’s Division of Cancer Biology. “With seven years of uninterrupted funding, NCI is providing investigators the opportunity to fully develop exceptional and ambitious cancer research programs.”
The seven-year grant is one of just 60 awarded in its inaugural year.
Research has shown that controlling diet, increasing exercise and quitting smoking can decrease the risk of developing cancer; however, environmental toxins such as fossil fuel combustion products are more difficult to mitigate. Past studies by Dr. Kensler’s team in China, where environmental controls are less rigorous, have examined the bioactive molecules in broccoli and how they may help people there detoxify air pollutants.
“Pollution is a global problem and its effects are seen most often among the elderly, disabled, children and minorities. We need effective and affordable interventions, and using food-based strategies could be the ideal way to address this,” Dr. Kensler said.
He and his team will focus on a biological pathway known to play a role in detoxification, identify and validate biomarkers of its activity, and examine the molecular consequences of its chronic activation.
“It’s truly an honor for Dr. Kensler to be among the first to receive this prestigious award. He has pioneered our understanding of how chemically reactive constituents in foodstuffs can profoundly and positively impact tissue defense and repair mechanisms. We’re proud of the work he is doing to try and lessen the burden of cancer, not only in western Pennsylvania but around the globe,” said Bruce Freeman, Ph.D., UPMC-Irwin Fridovich Professor and Chair of Pharmacology and Chemical Biology.
Research reported in this publication was supported by the NCI under award number 1R35CA197222-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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