In the News

Vitamins D and E May Lower Dementia Risk

Fish Oil Shows Promise in Fight Against Breast Cancer

Telephone-based Care Management Program Helps Cancer Patients With Pain, Depression

George Family Foundation Invests in Nursing Leadership at the University of Minnesota*

 

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Vitamins D and E May Lower Dementia Risk

Two new studies from JAMA/Archives publications explore the positive effect of certain vitamins on cognitive decline in the elderly. The first study suggests that low blood levels of vitamin D may increase risk for cognitive decline, and the other demonstrates that a diet rich in vitamin E may reduce the risk for age-related dementia.

Published in Archives of Internal Medicine, the vitamin D study notes that of the 858 adults aged 65 years and older who participated in the 6-year study, those with the lowest blood levels of vitamin D (defined as less than 25 nmol/L of blood) were 60% more likely to show signs of general cognitive decline than their counterparts who had sufficient blood levels of vitamin D. The low–vitamin D group was also 31% more likely to show declines in their abilities to plan, organize, and prioritize. According to the literature accompanying the study, between 40% and 100% of older adults in the United States and Europe may be vitamin D–deficient. This research raises the possibility that vitamin D supplementation may actually defend the brain against dementia, though further clinical trials are needed to confirm these results and to assess safe and effective dosages.

The second study, published in the Archives of Neurology, determined that a vitamin E–rich diet may lower the risk of adults developing dementia and Alzheimer’s disease. In the study of 5395 people aged 55 years and older, those with the most vitamin E in their diet (18.5 mg/d on average) were 25% less likely to develop dementia than their counterparts who had the least vitamin E in their diets (9 mg/d or less). The research team followed the study participants for 9.6 years, during which time 465 participants developed dementia, including 365 cases of Alzheimer’s disease. Although the study also traced how much vitamin C, beta-carotene, and flavonoids each participant consumed, only high levels of dietary vitamin E seemed to be related to protection against dementia.

Despite the promising results, the researchers involved in these two studies caution that it is still too early to make any blanket recommendations about what individuals should eat or which supplements they should take to reduce their risks for age-related cognitive decline and dementia.

Fish Oil Shows Promise in Fight Against Breast Cancer

A recent study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, provides further evidence that fish oil supplements may play a role in preventing chronic disease.

Researchers at the Fred Hutchinson Cancer Research Center in Seattle asked 35 016 postmenopausal women who did not have a history of breast cancer to complete a 24-page questionnaire about their use of nonvitamin, nonmineral supplements to treat menopause symptoms. After 6 years of follow-up in the Vitamins and Lifestyle (VITAL) cohort study, 880 cases of breast cancer were identified using the Surveillance, Epidemiology and End Results Registry.

The follow-up demonstrated that regular use of fish oil supplements, which contain high levels of the omega-3 fatty acids EPA and DHA, was linked with a 32% reduced risk of breast cancer. The reduction in risk appeared to be restricted to invasive ductal breast cancer, the most common type of the disease.

This research is the first to connect the use of fish oil supplements and a reduction in breast cancer. Researchers surmised that the concentrated omega-3 fatty acids in fish oil supplements provide a higher amount of beneficial EPA and DHA than people normally get in their diets.

Noting that this study is only preliminary, the researchers would not draw a distinct causal relationship between fish oil and prevention of breast cancer without the presence of confirming studies.

Even so, evidence continues to emerge about fish oil’s protective effect on cardiovascular disease and cancer. Harvard researchers are currently enrolling patients for a randomized vitamin D and omega-3 trial to assess the impact of fish oil supplements and vitamin D on cancer, heart disease, and stroke in 20 000 US men aged 60 years and older and women aged 65 years and older who do not have a history of these diseases and have never taken supplements.

Telephone-based Care Management Program Helps Cancer Patients With Pain, Depression

Cancer patients receiving care in geographically dispersed urban and rural oncology practices who participated in a program that included telephone-based care management and home-based automated symptom monitoring had greater improvement in pain and depression compared to patients who received usual care, according to a study in a recent issue of JAMA.

Pain and depression are the most common physical and psychological symptoms in cancer patients. Despite the prevalence and disability associated with pain and depression, however, they are frequently undetected and undertreated.

Kurt Kroenke, MD, of the Richard Roudebush VA Medical Center, Indiana University, and Regenstrief Institute, Indianapolis, and colleagues conducted the Indiana Cancer Pain and Depression (INCPAD) trial in 16 community-based urban and rural geographically dispersed oncology practices as a collaborative-care approach to managing depression and pain. Patients entered the trial from March 2006 through August 2008, with follow-up concluding in August 2009. Participating patients had depression, cancer-related pain, or both, and were randomly assigned to receive the intervention (n = 202) or receive usual care (n = 203) and were stratified by symptom type.

Patients in the intervention group received centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet. Telephonic care management was delivered by a nurse care manager trained in assessing symptom response and medication adherence, providing pain- and depression-specific education and making treatment adjustments according to evidence-based guidelines. Depression and pain symptoms were assessed at the beginning of the trial and at months 1,3,6, and 12.

Of the 405 participants enrolled in the study, 131 had depression only, 96 had pain only, and 178 had both depression and pain. The researchers found that of the 274 patients with pain, 137 patients in the intervention group had greater improvements in pain severity as assessed by the Brief Pain Inventory (BPI; 30% or greater decrease in BPI) over the 12 months of the trial than the 137 patients in the usual-care group. Of the 309 patients with depression, the 154 patients in the intervention group had significantly greater improvement in depression severity as assessed by the Hopkins Symptom Checklist (HSCL; 50% or greater decrease in HSCL) than the 155 patients in the usual-care group.

Between-group differences in secondary outcomes that were not pain- or depression-specific were also assessed, and the intervention group had better outcomes for several health-related quality-of-life domains, including mental health, vitality, anxiety, and physical symptom burden.

George Family Foundation Invests in Nursing Leadership at the University of Minnesota*

The Center for Spirituality and Healing at the University of Minnesota has announced an award of $556 000 from the George Family Foundation to create a fellowship and co-curricular program that will prepare nurse leaders in integrative health and healing. The fellowship program will provide unmatched clinical and professional development opportunities—both nationally and abroad—to selected nurse fellows. The accompanying co-curricular program will bring leaders in the field to Minnesota to conduct forums, intensives, workshops, and activities that will facilitate dialogue and strategic learning around issues associated with nursing leadership in integrative health.

According to the National Center for Complementary and Alternative Medicine, a recent nationwide government survey (December 2008) found that approximately 38% of US adults and 12% of children use some form of complementary or alternative medicine. As consumers increasingly demand health care that is more integrated and holistic, the nursing profession is well positioned to promote more comprehensive approaches to care.

In a move to meet growing interest in integrative health, the University of Minnesota’s School of Nursing, in collaboration with the Center for Spirituality and Healing, now offers a degree program that specializes in integrative health and healing.

The Doctor of Nursing Practice (DNP) in Integrative Health and Healing, one of 14 specialty areas, is the first of its kind in the country and prepares nurse leaders to work with individuals, families, communities, and health systems on ways to improve health by focusing on health promotion, disease prevention, and chronic disease management, with a special emphasis on managing lifestyle changes and incorporating the use of complementary therapies. Nurses will be prepared to provide leadership in a variety of settings including hospitals, outpatient facilities, health plans, and corporate and community organizations, as well as in private practice.

Over the next 5 years, the George Fellowship and Co-Curricular Program in Nursing Leadership will support the development of more than 40 nurse leaders and will impact hundreds more nurses who will be invited to participate in learning intensives, lectures, and workshops.

For details about the DNP degree at the University of Minnesota, visit http://www.nursing.umn.edu/DNP/home.html. For information about the George Family Foundation, visit http://www.georgefamilyfoundation.org/.

*For more information on this program and the role of nurses in integrative health care, see Alternative Therapies in Health and Medicine’s special issue