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Nurse Shortage May Reach Crisis Sooner

In one of the most far-reaching studies of the current state of nursing, a Penn researcher has discovered that newly-minted nurses are leaving the profession at far faster rates than their predecessors, suggesting that the current shortage of nurses may reach crisis proportions sooner than anticipated.

One additional surprising finding is that beginning male nurses are leaving the profession at twice the rate of women. The research, which analyzes data from the National Sample Survey of Registered Nurses collected by the Division of Nursing in the U.S. Department of Health and Human Services in 1992, 1996 and 2000, is reported in the influential health care policy journal, Health Affairs.

"The study indicates that new nurses begin their careers with higher levels of job satisfaction, but the workplace itself seems to be convincing growing numbers to leave the bedside earlier in their careers for other professions," said Dr. Julie Sochalski, associate professor at the School of Nursing. "We know the nation is facing a shortfall of nurses. If new RNs are leaving the profession after only a few years, the shortage is likely to reach crisis proportions sooner rather than later."

As baby boomers age, thus increasing demands on the health care system, the median age of nurses is rising toward retirement. The US Department of Labor predicts a shortfall of 331,000 nurses by 2008, leading to national recruitment efforts. However, Dr. Sochalski found that nearly 136,000 nurses are working in other professions, suggesting policy makers should turn their attention to nurse retention as well as the current emphasis on recruitment.

Specifically, the research found that:

• in the most recent nurse survey, 7.5 percent of new male nurses dropped out of nursing within four years of graduating from nursing school, compared to 4 percent of women;

• the drop-out rate for both male and female new graduates is accelerating, rising from 2 percent of men in 1992 to 7.5 percent in 2000; and 2.7 percent of women in 1992 to 4.1 percent in 2000;

• among new nurses, 75 percent of women reported being satisfied with their jobs compared to only 67 percent of men; among more established nurses 69 percent of women and 60 percent of men were satisfied.

"The accelerating rate of loss in the supply of nurses, at a time of substantially increasing demand, underscores the need to determine the reasons for the exodus. And while men may not yet comprise a sizable number of the total who are leaving, the growth in their retreat from nursing is nonetheless concerning," said Dr. Sochalski.

Depression and Exposure Linked to Alternate Tobacco Product Use Among Teens 

Exposure to family and friends who smoke and elevated levels of depression significantly affect the likelihood of alternate tobacco product use among adolescents, a study by researchers from Penn's School of Medicine and Georgetown University indicates. The study, titled "Psychosocial Correlates of Alternate Tobacco Product Use during Early Adolescence," appeared in the August issue of Preventive Medicine.

Recent research shows that alternate tobacco products, including smokeless tobacco (chewing tobacco and moist snuff), cigars, cigarillos, pipes, bidis (sweet flavored cigarettes from Southeast Asia), and kreteks (clove-flavored cigarettes), are gaining in popularity among youth.  

"This trend is dangerous because alternate tobacco products can lead to cancers of the oral cavity and a host of other negative health consequences," said senior author Dr. Janet Audrain, member of the Abramson Cancer Center and assistant professor in the Department of Psychiatry at the School of Medicine.

While previous research has shown that both exposure to other smokers and depression increase the likelihood of cigarette use among adolescents, this is one of the first studies to examine the influence that these social and psychological factors have on alternate tobacco product use.

Over eight percent of the teens reported using an alternate tobacco product (smokeless tobacco, cigars, pipes, bidis and/or kreteks) in the last thirty days. Among the eleven percent of freshman who reported being current cigarette smokers (smoked in the last month), 45 percent were also current users of an alternate tobacco product. 

The researchers found that current alternate tobacco product users were significantly more likely to be male, white and current cigarette smokers. In addition, teens with higher levels of exposure to other smokers and those with greater depressive symptoms were found to be two to three times more likely to be current users of alternate tobacco products, regardless of demographic factors and current cigarette smoking.

This research was funded by the National Cancer Institute and the National Institute on Drug Abuse and was conducted by the University of Pennsylvania/Georgetown University Transdisciplinary Tobacco Use Research Center.

Some Immune Cells Fight Cancer,
Others Hold Them in Check

Many cancer patients generate immune cells capable of specifically attacking their tumors, but the cells rarely do, in fact, target a patient's cancer. What prevents these potentially helpful cells from taking action? And is there anything that might be done to unleash them?

The attack cells--known as cytolytic T cells--are prevented from acting by a second set of immune cells called regulatory T cells, according to a new study from investigators at The Wistar Institute. The research also shows that the regulatory T cells communicate their message of restraint to the cytolytic T cells at a distance, via a messenger chemical called TGF-beta. A report on the study appears in the September 15 issue of Cancer Research.

Previous work has focused on ways to stimulate the cytolytic T cells to act, but the new study suggests that other approaches to bringing them into the battle against cancer might be more effective. For example, a drug that inactivates the regulatory T cells or that blocks the TGF-beta chemical message they send might free the cytolytic T cells to attack a patient's tumor.

"We've known for some time that cancer patients can generate T cells able to attack their tumors," says immunologist Dr. Dorothee Herlyn, a professor at The Wistar Institute and senior author on Cancer Research study. "What we discovered in this study is that those patients also produce negatively regulating cells at the same time that keep the attacking T cells in check. The existence of these regulatory cells may help explain how tumors are able to evade the immune system. They also represent a new starting point for thinking about novel anti-cancer treatments."

The current study evolved somewhat by chance. Using cells from a human colorectal cancer patient, Herlyn's laboratory team was working to identify T cells with cancer-fighting capabilities and isolate them from other types of immune cells. At one point, one of her coworkers suggested combining different groups of isolated cell types to look for interactions between them.

"We put these two different types of immune cell together, one of which killed cancer cells in culture, the other of which did not," Herlyn recalls. "When we did, we were stunned to see that the one that had previously killed cancer cells no longer did so."

Adequately explaining the mechanisms underlying that observation required several years of additional study, she says.

The lead author on the Cancer Research study is Dr. Rajasekharan Somasundaram, at The Wistar Institute. The other Wistar-based coauthors are Lutz Jacob, Rolf Swoboda, Ph.D., Laura Caputo, Hong Song, Saroj Basak, David Peritt, Dewei Cai, Brigitte Birebent, Jin Kim, and Klara Berencsi. Collaborators on the study are Dimitri Monos, Ph.D., at HUP, Francesco Marincola, M.D., at the National Cancer Institute, and Ellen Bloome and Michael Mastrangelo, MD, a professor of medicine at Thomas Jefferson University. The research was supported by grants from the National Institutes of Health.

Head Start Provides Leg Up to Kindergartners

New research shows that Philadelphia children attending Head Start programs and other center-based child care are better prepared for kindergarten and maintain higher skills throughout the year. They achieve higher levels of early literacy and math skills and display work habits and motor skills that are more advanced than their peers.

In addition, these same children had higher attendance levels than those who had no formal preschool experiences. These findings and many others were presented at a gathering of School District of Philadelphia Head Start education at Penn.

"Never before had such a comprehensive set of early childhood data been available," said Dr. John Fantuzzo, GSE professor and lead researcher. "This convocation is evidence of the Head Start's local and national commitment to quality information that promotes readiness for children in the most challenging urban environments."

Currently, 65 percent of Philadelphia's kindergartners have center or school-based childcare experiences before they enroll in kindergarten.

Almanac, Vol. 49, No. 4, September 17, 2002


September 17, 2002
Volume 49 Number 4

The School of Veterinary Medicine invites the Penn community to celebrate 50 Years of Excellence with an Open House on September 21.
U.S. News & World Report ranks Penn #4 in it's annual Best national Universities survey.
The Penn Humanities Forum dedicates the 2002-2003 lectures, seminars, and exhibitions to the topic of The Book.
New Bioterrorism Legislation affects laboratories and clinical facilities.
Speaking Out about the conservation postcards.
Honors for faculty and staff
The 14th annual Career Conference for graduate students starts on September 17.
The 10th annual Penn Family Day is scheduled for October 5.
Research Roundup: Nurse Shortage; Alternate Tobacco Use; Immune Cells Fight Cancer; Head Start.
The Annual Crime Report from the Division of Public Safety.