RESEARCH PROJECTS:

Oral Cancer Continuing Education Outreach – Central and Eastern Pennsylvania

MARGARET HAMILTON

Background:  

              

Need for continuing education among healthcare providers, including nurses, physicians, and oral health care providers, at community health centers on importance of routine screening.

Methods:      

                             

Through a unique partnership with the American Cancer Society, conduct continuing education courses at community health centers throughout central and eastern Pennsylvania.  The program is currently being evaluated.

 

Education & Outreach Core, Center of Discovery, Oral Cancer Center of Excellence

NINA MARKOVIC

Background:      

          

This core activity of the Oral Cancer Centre of Excellence (Program Director, Eugene Myers, was charged with education and outreach activities related to oral cancer, with an emphasis on improving early detection.

Methods:        

             

The core developed an educational video of oral cancer screening for health care professionals, distributed over 2000 copies of the video, conducted continuing education lectures, arranged community-based oral cancer screenings, participated in the Centre for Minority Health’s “Take a Loved One” activities; and edited and distributed a semi-annual newsletter to local health care providers.     

      

Tobacco Cessation Clinical Curriculum - Pilot

Background:        

       

Previous attempts to enhance the tobacco cessation activities within the clinical practice of dental students have met with resistance by faculty and students. Currently, students receive didactic instruction regarding tobacco cessation in the first and third year of dental school, but the didactic lectures have not been presented to clinical faculty.  Discussions with clinical faculty and students revealed that they perceive tobacco cessation activities to be time consuming, ineffective, and not acceptable to patients.  However, research has demonstrated that a two-minute clinical intervention can lead to smoking cessation in approximately 5% of patients, and patients welcome information and offers of support by primary care providers (including dentists).  

Tobacco cessation  intervention is a skill currently recognized as an important component of dental practice, given the negative health impact of tobacco use on oral health status.  The American Dental Association recommends that dentists include tobacco cessation intervention as part of standard practice among patients who use tobacco.  However, research indicates that only 10-30% of practicing dentists provide smoking cessation support for patients; with "lack of knowledge and skills" identified as the most frequently cited reason for not including these activities in clinical practice.              

Methods:             

        

The enhanced clinical curriculum for tobacco cessation will be evaluated for acceptability, time commitment, and feasibility among the clinical faculty and students, soliciting patients' reaction to the tobacco cessation activities, and chart documentation of tobacco cessation activities.  Pre-testing and post-testing of faculty and students (at six months) following training sessions on tobacco cessation will occur.  Patients will also be given surveys prior to and six months after the training sessions.   

             

 

Clinical Data Core, Preeclampsia: Mechanisms and Post-Pregnancy Implications

Background:   

             

This is a core activity of the Preeclampsia Program Project grant (Project Director, James Roberts that is responsible for recruitment, interviewing, and specimen collection from pregnant women at risk for developing preeclampsia; and those who are presenting at delivery with a rule-out diagnosis of preeclampsia.

Prenatal Exposures and Cognitive Development

Background:   

          

The primary hypothesis of this project, (Principal Investigator, Herbert Needleman is that organophosphate (OP) and pyrethroid exposure in utero and early childhood are associated with impaired neuropsychological development in the first three years of life. Data on actual levels of OP and pyrethroid exposure in children are scant, and there are no data on developmental effects at low doses.

At present, reference levels for OPs are derived solely from measures of acetylcholinesterase in peripheral rodent blood. No developmental data on adults or children are available. This project will address the severe void in present day knowledge of children's exposure to pesticides, and the effects of these agents on neurobehavioral development.

Methods:       

            

This is a cohort study of 440 infants enrolled at birth at the Magee-Womens Hospital.  At birth, each subject's meconium will be analyzed for organophosphate (OP) metabolites and pyrethroids, and umbilical cord blood will be analyzed for lead.  Birthweight, length, and head circumference will be measured at birth, and a neonatal neurological examination conducted. 

Children will be followed until three years of age. At each epoch, appropriate developmental outcomes will be measured and measurements of OPs, pyrethroids and lead obtained. The effects of OPs, pyrethroids, and lead on outcome will be measured; and interaction effects of the toxicants with OPs will be modeled. Other covariates to be evaluated are mother's age, education, IQ, socioeconomic status, smoking, and alcohol intake.

 

Cardiovascular Disease (CVD) Risk Among Women with IUGR Pregnancies

Background:    

            

Intrauterine growth restriction (IUGR) is a major cause of morbidity and mortality among neonates, but has not been thought to relate to a health risk among mothers until recently. In a handful of studies, a higher incidence of cardiovascular disease (CVD) has been noted in mothers bearing IUGR as compared to normal birth weight babies.

Methods:      

               

This is a retrospective nested case control study (Principal Investigator, Roberta Ness to examine the post-partum cardiovascular risk profile of women with previous IUGR births.  Women who had IUGR in a recent pregnancy, using a strict, standardized disease definition; and women with a recent normal birth weight baby at Magee-Womens  Hospital.  Multiple markers of cardiovascular risk, including blood  pressure, lipids, adiposity, glucose and insulin, and markers of inflammation are being evaluated approximately two to five years after the delivery of the index pregnancy.

Clinical Data Core, Obesity and Preeclampsia

Background:    

             

The Data and Clinical Core component of the Preeclampsia Program Project grant is designed to centralize recruitment, data management, and statistical consultation so that the work of the various projects can be accomplished efficiently.  The core will also organize and implement oversight of the program project by the Data Monitoring and Safety Committee and the Executive Committee.  The projects associated with this program project grant depend heavily on the ability to recruit overlapping groups of participants from a single source population, those seeking care in the Magee-Womens Hospital, Labor and Delivery Unit, and in the prenatal clinic. 

Methods:  

                       

Project leaders will assume the responsibility for the scientific direction of their project analyses, but the core provides resources to design and implement data entry and data management systems, edit data in preparation for analysis, and assist with the execution of analysis.  The core will also ensure the availability of appropriate statistical expertise for the scientific questions addressed in the program project and for the diverse types of data to be collected and analyzed by the individual projects.

Cardiovascular Disease (CVD) Risk Factors and Sexual Identity in Women

Background:     

           

Self-reported survey data supports a potentially adverse risk profile for cardiovascular disease among lesbian women.  This project is designed to assess clinical measures of risk factors for cardiovascular disease among lesbian and heterosexual women, with an enhanced recruitment of racial/ethnic minority women.

Methods:  

                   

Five-hundred lesbian women and 500 heterosexual women are being recruited for clinic-based assessments of cardiovascular risk factors; including lipid profiles, body composition, blood pressures, exercise expenditures, diet and smoking and alcohol consumption histories, and completion of psychosocial scales.  Twenty-five percent of the entire sample are racial/ethnic minority women.

Assessment of Not On Tobacco (NOT) Program among Lesbian, Gay, Bisexual and Questioning (LGBQ) Youth

Background:  

              

Rates of tobacco use have repeatedly been found to be high among gay, lesbian, and bisexual samples.  A tobacco cessation intervention developed by West Virginia University colleagues addresses the multiple facets related to smoking among adolescents, and will be piloted among a group of LGBQ youth to assess cultural relevance. 

Methods:  

                   

A focus group of older teens/young adults will meet over a series of sessions to review and critique the appropriateness of the NOT program for LGBQ youth. 

Oral Human Papillomavirus (HPV) Risk and Prevalence among Lesbians

Background: 

                 

Human Papillomavirus (HPV) is a common virus that infects the cells of the cervix. The virus can be passed on during sexual intercourse; either between a man and woman or between two women. If a woman becomes infected with certain types of HPV (types 16 and 18), and her body is unable to fight off the infection, she may be at risk of developing cervical cancer. The oral mucosa is the lining of the mouth and the back of the throat. HPV has also been associated with approximately 20-25% of cancers in the oral mucosa. The HPV type that is present in almost all oral cancers is the same type that is involved in cervical cancer (HPV16). The source of HPV infection to the oral mucosa is still unclear.

Very few studies have examined the relationship between oral HPV infection and HPV infection in the cervix of women, and there are no studies that have looked at this relationship among women who have sex with women (WSW). Our goal in this study is to examine the relationship between sexual lifestyle practices and the prevalence of oral and genital HPV infection in heterosexual and lesbian women in order to determine risk factors associated with oral HPV infection. 

Methods:    

                

Recruit, interview, and collect appropriate oral and genital samples from 100 lesbian women and 100 heterosexual women who have participated in the ESTHER project.

Socioeconomic Status and Disparities in Periodontal Disease:  Mind-Body Pathways

DEBORAH POLK:

Background:    

                              

The association between psychosocial stress and oral inflammation is being examined.  This is a feasibility study.

Methods:     

                                  

Prospective cohort study of 50 subjects

Center for Education and Drug Abuse Research

 ROBERT E. WEYANT

The oral health consequences of families with drug addicted parents have not been well characterized.  It is likely that children may be at increased risk for oral disease in such families.

Child neglect study

Background

Neglect of oral treatment needs may indicate children at high risk for overall neglect (medical, education, etc.).  This study will examine the patterns of overall neglect in high risk children.

Methods:

                                     

Longitudinal epidemiological study 400 high risk children in Pittsburgh.