For Parish Nurses

Parish Nurse Research Update

Dear Parish Nurses - As we begin our Lenten journey, let us keep steadfast in our faith through prayer, study and worship.  These suggstions are a smattering of topics, ones that we all should pay attention to.

1.  A report published in Science Advances discusses new research that suggests that gum infection may play a central role in the development of Alzheimer's disease (AD).  The investagators carried out a series of experiments to examine the potential impact of Porphyromonas gingivalis, the major pathogen of chronic periodontitis, on AD development in mice.  The results indicated that this pathogen infiltrated the mice's brain and an increase in the production of  amyloid plaques associated with AD resulted.  While all the experiments were carried out in mice, the results are beginning to be extended to humans.  Other researchers have concluded that chronic perodontitis and infection with  Porphyromonas gingivalis have been identified as significant risk factors for developing plaques, dementia and AD. Reviewers of these research studies "have made a stronger case for pathogen-related dementia".  Dr. Singhrao, a research dentist, suggests that "geriatricians and psychiatrists should be open to the idea that gum disease [and] poor oral hygiene play a role in the onset of dementia and they should change attitudes towards accepting pathogen-related dementia". 

So, parish nurses, when was the last time you focused on dental care?  While February was National Children's Dental Health Month, this is also a topic that could be included in a number of different ways - when you are talking about AD, healthy children, health issues for adults, etc.  We need to take seriously the importanct of good oral hygiene, especially at an early age!  If you manage a number of parish nurses, consider an education program for their meetings dealing with the subject. 

2.  A study published in Family Practice examined the communication practices of primary physicians when dealing with persons with chronic conditions, namely hypertension.  The researchers found, in a survery of providers working in small primary care practices, the use of communication techniques such as active listening  resulted in a higher proportion of patients who kept their blood pressure under control, compared with clinicians who did not use these methods.  The health care providers all used similiar fundamental clinical strategies, including patient education and providing self-management tools.  The differences in outcomes seemed to be related more to the way in which the clinicians interacted with their patients than to any differences in clinical approach.  Those clinicians with "high blood pressure" control used active engagement and listening to patients as the foundation of how they interacted with their patients and govern their implementation of the clinical strategies.  Clinicalns with "lower blood pressure" control expressed less confidience in their ability to affect patient outcomes and pointed to the external issues such as lack of time, insufficient staff, or factors outside of their control such as patient behavior.   The data for this study included patient blood pressure values from electronic health records and on-site interviews on hypertension management with clinicians selected from the identified small practices.  The major difference seems to center around the clinicians' perception of control associated with outside factors (low control group) v. clinicians' active listening techniques with patients.  The authors suggested that clinicians should consider other patient factors such as culture, attitudes toward or access to healthy food and exercise and health literacy.  

Do parish nurses need another reminder that active listening is a better communication tool that lecturing, handing out printed information?  While having information available is important, the information will not be considered by the person if the person feels that they are being "brushed off" or "talked down to".  Developing connections with persons with chronic conditions is key to helping them maintain a health lifestyle in face of their chronic disease.  Check out all those active listening techniques taught in nuring school.

3.  A study done here in Denver examined how the use of cannabis exposure was linked to adverse outcomes in new borns including low birth weight and preterm delivery.  The researchers completed a retrospective chart review of 1062 newborns delivered in the University of Colorady Health System hospitals and 5 delivery hospitals in Tennessee and Virginia between 2011 and 2016.  In utero exposure to cannabis during late pregnancy was confirmed with a positive urine drug screen at delivery in 531 mothers of newborns.  The exposed infants were rigorously matched for background and other prenatal exposures with an equal number of control infants whose mothers had a negative drug screen.  At birth, outcomes examined were significantly worse for infants exposed to cannabis than for unexposed infants after various other factors were controlled.  Cannabis-exposed newborns were 82% more likely than unexposed infants to be of low birth weight, 79% more likely to be born before term, and 43% more likely to be admitted to the neonatal intensive care unit.

Colorado legalized recreational cannabis use in 2012.  While long term growth of these infants has not been done, you can see from this research that the medical costs for these infants is going to be greater that for those infants not exposed to cannabis.  As more and more states legalize recreational use, this issue may grown.  Long term studies on these children may or may not show the result of recreational use by pregnant women, time will tell.  But in the mean time, we have an opportunity to bring the issue to child-bearning women in our congregations and communities.    Please remember, cannabis is still considered an illicit drug by the federal government, and is the world's most commonly used illicit drug. 

4.  Adolescent cannabis use is tied to depression and suicidal thought, reports a new research study.  The systematic review and meta-analysis included 11 sstudies and more than 23,300 adolescents and teens.  Results showed that the cannabis users were 37% more likely to develop depression in young adulthood than their non-using counterparts. This meta-analysis demonstrated the strong association between cannabis consumption in adolescents and depression, as well as suicidal ideation and suicidal attempt, in yound adulthood.  Premorbid depression was controlled for in all the studies included in the research.  Between 1991 and 2011, 20.9% of American adolescents reported using cannabis in the previous month, and about 7% of US high school seniors used cannabis daily or near-daily.  "Despite its firm place in teen culture, regular cannabis use is associated with a host of negative consequences in this population, from impaired scholastic achievement to earlier onset of psychosis and neuropsychological decline." This research was published in JAMA Psychiatry, February, 2019.

Legalization of cannabis may be a hot topic in your state.  It may be difficult to fight the "big money" to be made by legalizing the industry or the idea that people are going to use it anyway, we might as well legalize it and have some degree of control.  But, as we know about alcohol, teen will always find a way to access the drug.  But be prepared to identify use in teens, provide information to parents, and assist in the consequences of dangerous use.

Hope to see you at Westberg.  Consider attending the Research Pre-conference sponsored by Faith Community Nursing International.

Andrea West, FCN