When physician John Song was working at Baltimore’s Health Care for the Homeless during the 1990s, he did his best to care for the men and women seeking his help. But he knew that when he discharged his patients, he might never see them again. “Several of the patients I was taking care of died terrible deaths. They were found under bridges or alone in hotel rooms,” he recalls.

Song, assistant professor at the University of Minnesota’s Center for Bioethics and the Department of Medicine, wanted to find a way to ease end-of-life burdens for homeless individuals. In a groundbreaking new study published in the Journal of General Internal Medicine, he and a team of four other researchers have helped take the first step. With the help of six social service agencies in the Twin Cities, Song and his team interviewed 53 homeless men and women to find out how they felt about their own end-of-life care.

Many of the homeless people’s concerns were similar to those with more stable life circumstances: They wished to remain comfortable and pain-free at the end of their lives, and they did not want to be attached to machines indefinitely if their prospects were poor. But they also had unique concerns: They worried that prejudice would keep health care providers from administering the pain medication they would need in their last days and hours. Others fretted about who would be contacted to make decisions about their care. “They might be estranged from their families,” Song explains. “Some believed that family members might be punitive.” They worried that at their death, their bodies might be dumped into a common grave. (In fact, the county where a death occurs is required by law to provide burial for indigent people.)

Song’s research suggests that health care providers need to talk openly to homeless people about end-of-life issues to be sure that their wishes are known and honored. “Instead of just putting interventions in place to address what we think [homeless individuals] need, it’s important to understand, from their voices, what they’re concerned about,” he says.

Death is a daily reality for many chronically homeless people, says Song, and the average lifespan is decades shorter than others’. Song believes that respecting their wishes at the very end of their lives is one small way to help comfort and serve a marginalized and often misunderstood population.

Song is now seeking funding for a study that would provide living wills—documents that direct treatment for patients too ill to provide consent themselves—for homeless individuals. “The goal is to preserve their dignity and their autonomous decision-making,” says Song. “We hope this will help protect them when they’re unable to protect themselves.”

—Erin Peterson

Weigh More to Weigh Less

A team of researchers at the University of Minnesota School of Public Health found that women who step on the scales every day to weigh themselves are no more or less likely to be depressed than women who weigh less frequently. Moreover, the study found that daily weighing, rather than weekly or monthly, was associated with lower body-mass index levels in women age 40 years or older. Body-mass index is a measure of body fat based on height and weight. Past research has linked weight gain and obesity with depression, and the results of this study suggest that daily weighing can be a valuable tool in achieving greater weight loss and less weight gain.

Over Our Heads

A researcher at the University of Minnesota’s Carlson School of Management has proven what some real estate agents and event planners know from experience: The way people think and act is influenced by ceiling height. The research demonstrates that variations in ceiling height affect how people process information. For example, a room with a 10-foot or higher ceiling inspires abstract thinking, while a lower ceiling leads to more focus on details. One of the areas in which the research has implications is in retail stores, where design might influence consumers’ purchasing decisions.

Thwarting Toxic Shock

University of Minnesota Medical School researchers and colleagues at the University of Illinois have developed a treatment for toxic shock syndrome that is significantly more effective than current antibiotic treatment. Toxic shock syndrome is a rare but life-threatening bacterial infection that is often associated with the use of superabsorbent tampons and contraceptive items, but it can also affect men, children, and postmenopausal women, particularly following viral infections. The new therapy targets the early stages of the condition’s onset by blocking the toxin whose presence leads to the dramatic drop in blood pressure and eventual multi-organ failure that is characteristic of toxic shock syndrome.

Gender Matters in Alcohol Abuse

The ways in which men and women exhibit symptoms of alcohol abuse differ significantly, according to results of a study by researchers in the University of Minnesota Department of Psychology. Numerous previous studies of gender differences in alcohol abuse have been conducted, and most have been inconclusive. This University study differs from others in the large sample size (2,750 men and women) and in the wide range of drinking-related behaviors that were examined. The study considered 105 signs of problem drinking and found gender differences in one-third of these. Study participants who reported engaging in aggressive external behaviors such as fighting or getting arrested were overwhelmingly male. On the other hand, women were significantly more likely than men to report depression and guilt about drinking. Aggressive external behaviors are often considered red flags for identifying problem drinking, whereas internalized responses, such as those more frequently reported by women, are not. Researchers said the results suggest the possibility that women’s problem drinking may be overlooked or misdiagnosed under current diagnostic models and that more work needs to be done to determine whether gender-specific diagnostic tools need to be developed.

Water Worries

University of Minnesota researchers say there is no doubt that nitrate levels are rising in Lake Superior, but they are not sure why. High levels of the compound, produced primarily by agricultural fertilizer runoff and pollution from power plants, make water unsafe to drink, a concern because Lake Superior contains 10 percent of Earth’s supply of surface fresh water. Researchers from the U’s department of ecology, evolution, and behavior examined 10,000 pieces of data collected by agencies in the United States and Canada since 1906 and concluded that nitrate levels have risen five-fold during that time. That translates to 1.2 parts per million, which is cause for concern but still lower than the government’s drinking water advisory levels.

But because the increases have been steady rather than coincident with identifiable historical events—for example, the rise in the use of fossil fuels following World War II or implementation of the Clean Air Act in 1972—researchers say there are likely complex human and natural processes at work. Factors include the vast size of Lake Superior, which means it registers change slowly, and the conversion of decaying plant matter and sewage in the lake into nitrates. Researchers believe the primary human contributor is pollution from power plants, suggesting that Lake Superior has yet to respond to pollution controls put in place in the Clean Air Act.

—Edited by Cynthia Scott