Πέμπτη 16 Μαΐου 2019

Fwd: Calcium supplements

Calcium supplements
To:


How Too Much Calcium Can Break Your Bones

Views 40596

Did you know that most calcium supplements on the market today are basically limestone? Yes, that's chalk. Conceal it within a capsule, a slickly glazed tablet, or in the form of a silky smooth liquid, and it is magically transformed into a "calcium supplement": easy to swallow, "good for the bones" and a very profitable commodity for both the dietary supplement and mining industries. After all, a sizable portion of the Earth's crust is composed of the stuff

Calcium carbonate comes very cheap. But does it work?  A review published in Osteoporosis International Aug. 2008 concluded that calcium monotherapy (without vitamin d) actually increases the rate of fracture in women.  If we believe the results of this study, it would appear that calcium alone may do nothing to prevent bone fracture or the loss of bone quality. Were this the end of the story, we might write off the $100 or more we spend on calcium supplements every year as a loss, and start drinking more milk. Not so quick!

In the Harvard Nurses' Health Study, a review tracking 78,000 nurses for 12 years found that the more cow's milk they consumed, the higher rate of bone fracture they experienced; in the study, the relative risk of hip fracture was 45% higher in those women who drank two or more glasses of milk per day versus those who drank one glass or less.

In fact, in countries where both dairy consumption and overall calcium levels in the diet are the lowest, bone fracture rates are also the lowest; conversely, in cultures like the United States where calcium consumption is among the highest in the world, so too are the fracture rates among the highest (see: The China Study).

Osteoporosis, after all, is a complex disease process, involving lack of strenuous exercise, chronic inflammation, multiple mineral and vitamin deficiencies, inadequate production of steroid hormones, dietary incompatibilites and many other known and unknown factors, the least of which is in any probability related to a lack of elemental calcium in the diet. Also, osteoporosis, as defined by X-ray analysis, e.g. Dual-emission X-ray absorptiometry (DXA) scans, can only directly measure bone mineral density and not structural integrity/strength, which is the real-world indicator of whether your bone will resist breaking when under the trauma, say, of a serious fall.

If we rule out drug (e.g. steroids, synthroid, acid-blockers) and hyperparathyroidism-induced osteoporosis, arguably the two main contributing factors associated with lower-than-normal bone mineral density are:

1) Dietary Acidosis: caused by the excessive consumption of acid forming foods like starchy grains, dairy (excluding goat's milk) and meat, all of which result in the leaching of the alkaline mineral stores in our bones. (Additionally, the consumption of highly acidic substances like coffee, alcohol, sugar, over the counter and prescribed drugs, and even the metabolic byproducts of chronic stress can all put the acid/alkaline balance beyond the tipping point).  The flip-side is the under-consumption of alkalinizing fruits and vegetables, which disburden the mineral stores within the skeletal system of their sacrificial, acid-neutralizing role.

2) Malabsorption Syndrome: caused in large part by the excessive consumption of wheat, cow's milk products, soy (non-fermented) and corn.* All four of these foods, in fact, can be used to produce industrial adhesives, e.g .wheat = book binding glue, cow's milk protein (casein) = Elmer's glue, soy = plywood glue, corn = cardboard glue, and while not a problem for everyone, for many, their ingestion leads to a disruption of the absorptive capacity of the villi in the intestines by producing a "gluey coating," contributing to inflammation and atrophy of the villi. Other causes include dysbiosis, an overgrowth of unfriendly and undergrowth of friendly bacteria in the alimentary canal, as well as acute and/or chronic stress which depletes the glutamine without which the intestinal villi die (villi cell turnover occurs within 2 days, indicating even acute bouts of stress of short duration can cause profound damage). You don't see a lack of calcium or Boniva in this picture, do you?

Fortunately these two factors are completely preventable and treatable through dietary and lifestyle changes. It is increasingly clear that osteoporosis is not caused by a lack of calcium; to the contrary, it appears that excessive calcium intake may actually cause greater bone fracture rates, especially later in life! After all, the traditional Chinese peasant diet, based as it is on eating a calcium-poor, plant-based diet, included approximately 250 mg of food calcium a day – not the 1200 mg (or more!) a day the National Osteoporosis Foundation claims is necessary for women and men over 40 to maintain strong bones. 

Paradoxically, not only does the aforementioned hypothetical Chinese peasant have less dense bones than your average Westerner, but s(he) also has incomparably stronger bones. In fact, the Chinese have no traditional word for osteoporosis, and this is at least a 3,000 year old language!

These facts beg for a scientific explanation. A Dutch researcher by the name of Thijs Klompmaker, in his 2000 article "Excessive Calcium Causes Osteoporosis," provides a brilliant explanation as to why too much calcium interferes with bone health. According to Klompmaker's analysis, the consumption of excessive calcium introduced through diary products and mineral supplementation may be making our bones weaker.

Due to the fact that excess calcium can deposit into soft tissues, leading to osteoarthritis, muscle cramping, insomnia, constipation, kidney stones, and increased rates of breast and prostate cancers (note: calcium crystals like hydroxylapatite (bone meal) can be mitogenic, stimulating proliferation of cells, and are responsible for th  e screen detectability), the body prevents "calcium overload" by shunting the extra calcium into the bone, where it is stored until it can be safely excreted.

This can be a life-saving mechanisms because excess calcium in the blood can lead to the accumulation and destabilization of plaque in the arteries, can exert a hypertensive effect on the heart muscle, and may even induce cardiac arrest. In fact, according to two meta-analyses published in the British Journal of Medicine last year, 500 mg of supplemental elemental calcium a day increases the risk of heart attack by at least 24%!

There is a price to be paid for having to continually sequester excess calcium into the bone, which is that it stimulates the accelerated replication of osteoblasts (bone-building cells), and when osteoblasts replicate approximately 60-70% die as they become part of the new bone mineral matrix they lay down.  Because there are only a fixed number of progenitor cells and replication cycles available to each cell, in a given lifetime, the osteoblasts become prematurely senescent and incapable of replicating at a rate rapid enough to keep up with the osteoclasts, which break down bad bone.

These osteocasts are still much younger and active than the osteoblasts, which tips the scales in favor of increased bone turnover, resulting in a rapid decline in bone mineral density and bone quality later in life. This explains why Asians eating their traditional calcium-poor diet, for instance, have lower bone mineral density throughout their life, but reach peak bone mass later, showing slower declines than Westerners while experiencing their golden years.

Sadly, conventional medicine pays far too little, if any attention to the link between dietary and tissue acidosis/malabsorption syndrome and osteoporosis in particular, and the obvious causal link between diet and disease processes, in general. Moreover, with its questionable bias towards viewing disease as genetically predetermined and treatable with chemical therapies, the true causes of suffering are rarely perceived, treated and resolved.

In fact today a popular first-line treatment for osteoporosis is the use of bisphosphonates, a class of "bone-building" drugs (e.g. Fosomax, Actonel, Boniva, Reclast), which are made from a class of chemicals first employed to soften water in irrigation systems used in orange groves. The same toxic substance once used to prevent corrosion and scaling on industrial equipment is being given to millions of Americans to "treat" their weakening bones.

These chemicals are highly toxic, and are known to poison the group of bone-building cells known as the osteoclasts, which break down weak bone, making room for new, stronger bone that the osteoblasts put in its place. This unnatural intervention causes weak bone to accumulate beneath the new strong bone, resulting in an increase in bone density at the expense of bone quality. Three to five years into taking these drugs, though bone density usually increases, bone fracture rates may increase as well.

The side effects of taking these drugs can be life-threatening, e.g. perforation of the intestines, ulceration of the stomach and intestines, liver and kidney damage, atrial fibrillation, spontaneous bone fractures and an irreversible degeneration of the jawbone known as osteonecrosis. (View all 39 adverse effects here). To make matters worse, there is a systematic trend to label over 18 million Americans with a "disease" known as "osteopenia," when in fact this is not a clinically relevant, evidence-based term at all, based on a completely arbitrary standard that highly favors overdiagnosis and overtreatment...

Osteopenia does not describe a disease state, nor is it an accurate predictor of future bone fracture rates. Technically speaking, "osteopenia" is defined having a T score -1 to -2 standard deviations from an arbitrarily defined norm, which is the approximate age in the human life cycle for peak bone mass: 25 years of age. The Z score, were it to be emphasized, would take into the age of the person being evaluated (along with other variables such as well as sex, ethnicity, etc).

The Z-score, because it is age-mediated, takes into account that as one ages the bone naturally becomes less dense. The use of the T-score generates the illusion that older men and women who are experiencing the natural gradual decline in bone density called aging are not going through a normal process but rather a disease process. This is all the more disturbing when we take into account that higher bone density later in life has been correlated with far higher (300% or higher!) rates of malignant breast cancer.

Ultimately the present T-score based bone density scoring system provides justification for prescribing unnecessary and extraordinarily dangerous medications. Bone health has everything to do with things we control, such as our ability to stay active, and what we do or do not ingest.  Vision and gait disorders, in fact, are at least as important as low bone mineral density in contributing to increased bone fracture rates. We should not allow ourselves to be convinced that swallowing limestone supplements or metabolic poisons will in any way fill the void that a lack of genuine nutrition and exercise left there.

Here are a few tips that should help you go a long way in preventing or reversing bone loss:

1) Eat high-quality protein and vitamin C rich fruits and vegetables! All bone begins as collagen, a substance whose intricate triple helix structure is formed through the Vitamin C driven hydroxlation of the essential amino acids L-lysine and L-proline. Focusing on selecting a diet closer to our hunter and gathered predecessors (not too distant from where we are now, in biological time) appears to be a key factor in preserving both bone density and bone strength.

And remember: Vitamin C is not the same thing as ascorbic acid. Szent-Gyorgyi, who received the Nobel Prize for its discovery in 1937, himself concluded that we need a whole food source of this vitamin, e.g. paprika or adrenal extract, and not the synthetic crystals we now carelessly identify with this life-giving food factor in food in order to prevent scurvy.

2) Get sunlight! Vitamin D supplements are to sunlight, what ascorbic acid crystals are to the Vitamin C activity found in whole, raw food.  3) Vitamin K works with vitamin D, preventing hypercalcemia and ectopic calcification, as well as strengthening the bone, without altering bone mineral density. It is is found in wonderfully nutrient-dense foods like kale, and as a by-product of the metabolic activity of friendly bacteria in our gut or in cultured foods.

3) Eliminate Wheat & Gluten from your diet. No grain is more harmful to human health, with wheat having over 120 documented adverse health effects culled directly from the National Library of Medicine.

4) Incorporate bone-building/strengthening substances into your diet. For a list of over 200 carefully reviewed natural substances with value, use the GreenMedInfo.com Osteoporosisresource page.

*While soy protein and flours, consumed excessively, will contribute to intestinal issues, including malabsorption of nutrients, in moderate quantities -- and treated as a medicine, not a food -- soy has profound therapeutic properties. The byproduct of soy fermentation will generate a phytoestrogen known as genistein, for instance, which is probably one of the most powerful, evidence-based bone-strength and density preserving substances in nature.  

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.

Fwd: Current Medical Research and Practice


Current Medical Research and Practice
To:


Obesity: the major preventable risk factor of obstructive sleep apnea
Hager M Nousseir

Journal of Current Medical Research and Practice 2019 4(1):1-5

An incre asing prevalence of obesity has led to an increase in the incidence of sleep disordered breathing in the general population. Obesity is associated with anatomic alterations that predispose to upper airway obstruction during sleep, leading to complete or partial cessation of respiration called obstructive sleep apnea. The awareness of this global issue is rising, and health care systems are providing preventive measures, diagnostic, and treatment options for both conditions. To decrease obesity, lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise are needed. If these lifestyle modifications are widely applied, then not only obesity and sleep apnea will be reduced but also the incidence of serious consequences such as cardiovascular disease and health care costs will decrease greatly.


Diagnostic role of cyclin D1 as a new marker for early diagnosis of breast cancer
Hanan A Abdel-Azeem, Hesham M Mohamed, Mohamed I Seddik, Noha R Abd El-Hamid

Journal of Current Medical Research and Practice 2019 4(1):6-10

Breast cancer is the most frequent cancer in women; in Egypt it affects 37.7% of all women and accounts for 29.1% of their cancer-related mortality. Cyclin D1 protein overexpression is found in up to 50% of breast cancers. The aim of this study is to study the correlations between cyclin D1 level and stages of breast cancer (TNM staging) and to study the correlations between cyclin D1 and routine markers used in breast cancer [cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA)]. This study was performed on 80 female breast cancer patients. Ten healthy women served as controls. The patients were referred from the Assiut University Hospital and South Egypt Cancer Institute. None of the healthy women in the control group had elevated cyclin D1 level above the cutoff value. Elevated levels of cyclin D1 was detected in 80, 90, 95, and 100% of patients in groups II, III, IV, and V, respectively. There was a significant positive correlation between cyclin D1 positivity with CEA and CA15-3 concentrations. The combination of CA15-3, CEA, and cyclin D1 resulted in the highest sensitivity (95.2%), highest specificity (100%), and highest diagnostic accuracy (96%). The cyclin D1 level in samples obtained from Egyptian women with breast cancer is a good marker for the detection of breast cancer, and in the detection of metastasis as it correlates with the clinical staging of the disease. A combination of CA15-3, CEA, and cyclin D1 may be used as a panel for the diagnosis of metastasis among those patients.


Efficacy and safety of an interferon-free regimen for treatment of recurrent hepatitis C virus infection following liver transplant
Ahlam M Ahmed, Abeer S. El-Din Abdel Rehim, Ahmed S. Abd El-Mohsen Moussa

Journal of Current Medical Research and Practice 2019 4(1):11-17

Introduction Recurrent hepatitis C virus (HCV) infection after transplantation is aggressive, and its progression to cirrhosis is more rapid than in nontransplant settings. As pegylated interferon based therapies for HCV treatment after transplantation have poor tolerance, poor efficacy, and significant interactions with immunosuppression medications, and this developed the need for a new safe and effective oral regimen. Aim To evaluate the efficacy, safety, and tolerability of sofosbuvir (SOF) in combination with ribavirin (RBV) in treating recurrent hepatitis C after transplantation and also to detect any significant interaction with immunosuppressive therapy. Patients and methods Between August 2014 and January 2016, a single-center, prospective, nonrandomized, open-labeled study was conducted, in which the patients with post-transplant recurrent HCV infection were enrolled. All patients received 400 mg once-daily SOF for 24 weeks with variable dose of RBV. After treatment, patients underwent follow-up for 12 weeks. Results Sixty patients were enrolled, and their mean age was 57.67 years, with 78.3% were male. Overall, 70% had genotype 1 and 61.7% had received previous HCV treatment. At baseline, 21 patients had severe fibrosis. Median time interval from liver transplantation was 51 months, and immunosuppressive therapy was tacrolimus based in 78.3%. Median baseline HCV-RNA was 2.341.172 IU/ml. Among the patients, 12-week sustained virological response was achieved in 43 (71.7%) patients. There was no significant difference in dose and level of tacrolimus during course of therapy. Absence of hepatic encephalopathy, treatment-naive patients, nonsevere fibrosis, and low pretherapy Liver stiffness (LS) values were predictors for sustained virological response. Conclusion Interferon-free regimen containing SOF and RBV is generally safe, well tolerated, and reasonably effective in post-transplantation settings.


Post-laser in-situ keratomileuses effects on visual field in myopia and myopic astigmatism
Dalia M. A. Tohamy, Kamel Abdelnaser Soliman, Hany Omar Elsedfy, Walid Saad Eldin Mohamed

Journal of Current Medical Research and Practice 2019 4(1):18-24

Background The suction used during the laser insitu keratomileusis (LASIK) procedure necessary for cutting of the cornea by an oscillating blade induces an increase of intraocular pressure (IOP) to approximately 60 mm Hg or even more. This acute increase in IOP during LASIK may endanger the blood flow within the retinal vessels and induce visual field (VF) depression. Purpose To identify the effect of LASIK on the visual field parameters. Settings Prospective interventional case series study performed in ELNOOR ophthalmology center. From October 2015 to October 2016. Methods Prospective interventional case series study including patients with myopia and myopic astigmatism who were deemed candidates for LASIK correction. All recruited patients underwent visual field examination immediately before,1 week and 3 months post LASIK using Humphrey 750 Visual Field Analyzer (Zeiss Humphrey Systems, San Leandro, CA, USA), with a white-on-white Swedish Interactive Threshold (SITA). LASIK procedure was done using Allegretto device (wave light EX500, ALCON, Fort Worth, TX, USA) and Moria microkeratome (MM2). Results 60 eyes of 30 patients were included in our study. Mean age was 28 + 5.6 years (range20-41), mean spherical equivalent (S.E) was -6.1 + 3.2 D (Range -1.4 to -15.1D), mean axial length was 23.5 + 1.5mm (Range 21-26.3mm). Humphrey global indexes included MD and PSD. The MD index estimates the uniform part of VF deviation, while the PSD index estimates the non-uniform part of VF deviation, reflecting the amount of localized depression of the VF. We found that (MD) shows slight decrease 1-week postoperative which is statistically significant, then improved 3 months postoperative with no statistical significant difference between preoperative and 3 months postoperative values. As regards PSD we found that there is no statistical difference between preoperative,1 week and 3 months postoperative. Conclusion The surgery of LASIK is safe and efficient, but surgeons should choose effective and safe suction mode, shorten the suction time and exclude potential retinopathy and preexisting glaucoma before surgery to improve the safety and efficacy. We found that LASIK procedure has no significant effect on visual field parameters, except for diffuse depression that occurs in the first week postoperative.


Risk-stratified outcome of congenital heart surgery in Assiut University Hospital
Khaled A Kassem, Mostafa A Abdelaziz, Ahmed I Ismael, Ahmed M Ghoneim

Journal of Current Medical Research and Practice 2019 4(1):25-33

Context Assessment of surgical performance in the field of congenital heart surgery is very difficult, so many risk scoring systems have been developed. The most popular used systems nowadays are the risk adjustment for congenital heart surgery (RACHS-1) system, Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) mortality score and categories. Aims The aims of the study were the application of the three popular risk scoring systems to Assiut University Hospital for evaluation of the outcome results, determination of the correlations between the mortality and morbidity to the risk categories of these systems, comparison with other cardiac centers worldwide, and managing the factors that lead to different outcome in an attempt to improve our performance. Materials and methods A retrospective descriptive study including all pediatric patients (ages ranging from 0 to 16 years old, excluding preterm babies) who underwent cardiac surgery in Assiut University Hospital between January 2008 and December 2017 was conducted. Statistical analysis The receiver operating characteristic curve and univariate and multivariate analyses were performed with SPSS 16.0 for Windows. Results Postoperative in-hospital mortality was 5.8%, with increasing mortality rates at the higher levels of the RACHS-1 and the ABC. The mean ABC score was 5.57 ± 2.07, which represents a complexity between ABC levels 1 and 2. The mean STS-EACTS mortality score was 0.375 ± 0.376, which placed our complexity of procedures into categories 1–2. Conclusion The RACHS-1, ABC, and STS-EACTS mortality scoring systems are useful tools for assessing mortality discharge in a medium volume cardiac center in Egypt. These scores imply a procedural-based level of complexity in the institute, which would be useful information for a longitudinal study.


Left ventricular mass index as a prognostic factor in children with chronic kidney disease
Salah-Eldin A Ahmad, Ahlam B Ali, Zeinab Abdallah

Journal of Current Medical Research and Practice 2019 4(1):34-37

Objective The objective of this study was to evaluate the effect of decreasing renal function on left ventricular mass index (LVMI) in children with chronic kidney disease (CKD) on regular hemodialysis attending Assiut University Hospital for Children, and also to evaluate left ventricular mass changes as predictor of morbidity and mortality of uremic children by using echocardiography, aiming to use it in the future. Patients and methods Baseline clinical characteristics were collected by careful history and examination. Routine laboratory methods were used to measure biochemical parameters: hemoglobin, C-reactive protein, phosphorus, calcium, parathyroid hormone, and lipid profile after patients fasted for 8 h. Echocardiographic parameters were measured within 2–24 h after a dialysis session. Results In this study, we studied 36 children on regular hemodialysis. The age of our patients ranged from 3.5 to 16 years, and the number of male patients was similar to female patients. In our study. we found eccentric left ventricular hypertrophy was predominant (38.9%) compared with concentric left ventricular hypertrophy (13.9%). We found that 52.8% of patients had increased LVMI and 47.2% had normal LVMI. Regarding the fate of our cases, 39% died during the study period, whereas the other 61% survived. Mortality among patients with increased LVMI was higher (28%) than among patients with normal LVMI (11%). Conclusion Children with CKD are prone to development of cardiac dysfunctions, so early and regular echocardiographic studies of all children with CKD to detect early cardiac changes and institute interventions and follow-up are required.


Retrospective study in cases of pregnancy-induced hypertension admitted to the ICU at Women Health Teaching Hospital of Assiut University
Golnar M Fathy, Sayed K Abd-Elshafy Mahmoud, Bahaa K AbdelNoor

Journal of Current Medical Research and Practice 2019 4(1):38-43

Objective The aim of the study was a retrospective analysis of the causes and risk factors of ICU admission, postoperative management, and outcomes of patients with pregnancy-induced hypertensive disorders. Background Hypertensive disorders of pregnancy, including severe preeclampsia and eclampsia, complicate about 10% of pregnancies worldwide, constituting one of the chief causes of maternal and perinatal morbidity and mortality worldwide. Patients and methods Our retrospective study included 186 cases of antenatal and postpartum severe preeclampsia and eclampsia patients admitted to the ICU in Assiut Woman Health Hospital in 24 months. All patients showed manifestations of severe preeclampsia or eclampsia. The study obtained an institutional ethical approval. Results In this study, the most frequent complication was HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome that occurred in 25 (13.44%) women followed by renal impairment, cerebral hemorrhage, and pulmonary that occurred in 11 (5.91%), 10 (5.37%), and nine (4.83%) women, respectively. Unfortunately, permanent blindness affected three (1.61%) women in this study and 12 (6.45%) women encountered death. Improvement occurred in 160 (86%) women, whereas six (3.22%), five (2.28%), and five (2.68%) women were transferred to other departments namely neurological, nephrological, and cardiology wards, respectively. Conclusion Reducing maternal morbidity and mortality, pregnancy-induced hypertension patients require early admission and appropriate management in the ICU.


Clinical and laboratory outcomes of stem cell transplantation in patients with decompensated liver cirrhosis: single-arm pilot trial
Saad Z Mahmoud, Ehab F Abdo, Shaaban R Helal, Heba Saad Eldien, Doaa Abdeltawab, Alaa Soliman Abd-Elkader

Journal of Current Medical Research and Practice 2019 4(1):44-49

Introduction The high prevalence of hepatitis C virus-associated liver disease has led to increasing number of Egyptian patients having end-stage liver disease and requiring liver transplantation. Because of several limitations of liver transplantation, new alternative treatment modalities are required for patients with liver cirrhosis. Many study results encourage the use of autologous bone marrow-derived mesenchymal stem cells (MSCs) for liver diseases. Aim The aim of this study was to assess the efficacy of using bone marrow-derived MSC on clinical manifestations, liver function, Child–Pugh score, and Model for End-stage Liver Disease score in patients with decompensated liver cirrhosis. Patients and methods This is a pilot single-arm prospective trial that included 13 patients with hepatitis C virus-associated liver cirrhosis who received transdifferentiated MSC via ultrasound-guided percutaneous portal vein infusion plus regular conventional treatment for patients with cirrhosis. Patients were followed up weekly for the first month and monthly for 6 months. Results There was significant improvement in some clinical manifestations, including frequency of attacks of hematemesis, ascites, and lower limb edema after MSC infusion compared with baseline data. Moreover significant increase was detected in mean serum albumin level as it began with 24.62 ± 3.93 and became 27.81 ± 4.14 (P = 0.009) after 6 months of follow-up. Moreover, the results showed improvement in Child–Pugh, but no changes were detected in Model for End-stage Liver Disease score after MSC infusion compared with baseline. Conclusion Our data show that transdifferentiated MSC injection may improve some clinical manifestations and some indices of liver function in patients with decompensated liver cirrhosis with successful tolerability.


Safety of sildenafil citrate in the management of hypertensive disorders of pregnancy
Hasan S Kamel, Hisham A Abou-Taleb, Fady N Abdallah

Journal of Current Medical Research and Practice 2019 4(1):50-55

Objective This study investigated the safety of sildenafil citrate in managing hypertensive disorders of pregnancy. Patients and methods In a randomized, double-blind, placebo-controlled trial, 122 singleton pregnancies with mild pre-eclampsia between 28 and 36 weeks of gestation were randomized to either use oral sildenafil citrate tablets with antihypertensive or antihypertensive alone. The primary outcome was occurrence of maternal and/or neonatal complications. Results Headache was the most frequent adverse effect in the study and is significantly higher in the intervention group [22 (36.1%) vs. 12 (19.7%) in placebo group; P = 0.03]. In the intervention group, headache was dose related. The headache was tolerable in the majority of patients. The intervention group has an insignificant lower incidence of intrauterine growth restriction than the placebo group (1.7 vs. 6.7%, respectively, P = 0.31). The incidence of oligohydramnios was significantly higher in the placebo group than in the intervention group (16.7 vs. 8.5%, respectively, P = 0.03). No intrauterine fetal deaths have occurred in our study, and only one neonatal death occurred in the placebo group. Conclusion Using sildenafil citrate in addition to other antihypertensive drugs in the management of mild pre-eclampsia is safe and has a better maternal and neonatal outcome.


A descriptive study on the diagnosis and treatment of ventilator-associated pneumonia in the neonatal intensive care unit of Assiut University Children's Hospital
Ahmed A Mohammed, Ahlam B Ali, Nafisa H Refaat

Journal of Current Medical Research and Practice 2019 4(1):56-60

Background Neonatal ventilator-associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in neonatal intensive care units. Patients and methods Reviewing data of diagnosis and management of neonates with VAP admitted to Assiut University Neonatal Intensive Care Unit was carried out during a period of 1 year. Results The current study was carried out at Assiut Children University Hospital during the period spanning between October 2016 and November 2017 to audit the clinical practice towards management of neonates with mechanical VAP. It included 50 neonates who were diagnosed to have mechanical VAP. Conclusion The incidence of suspected VAP and concomitant antibiotic use is much higher than for confirmed VAP; therefore, inclusion of suspected episodes should be considered for accurate evaluation. There is a high diagnostic inconsistency and a low reliability of interpretation of chest radiographs with regard to VAP. Implementation of combined antimicrobial stewardship and infection control measures may lead to an effective decrease in VAP incidence and antibiotic use.


Pharmacognosy

The role of the herbal medicines, Rehmanniae radix, Citrus unshiu peel, and Poria cocos wolf, in high-fat diet-induced obesity
Min Ji Kwon, Jung Nam Kim, Eun Yeong Lim, Yun Tai Kim, Hyungwoo Kim, Myeong Ho Jung, Byung Joo Kim

Pharmacognosy Magazine 2019 15(63):363-368

Background: Herbal medicine has been used for the treatment of obesity. Obesity is a very common global health problem, and it is known to be linked to metabolic diseases. Objective: To investigate on the anti-obesity effects of herbal medicines such as Rehmanniae radix (RR), Citrus unshiu peel (CUP), and Poria cocos wolf (PCW) in high-fat diet (HFD)-induced obese mice. Materials and Methods: C57BL/6 mice were fed a normal diet (ND) or an HFD for 6 weeks, and herbal medicines were administered orally three times a week for 8 weeks. Serum biochemical parameters were detected by measuring glucose, triglycerides, and total cholesterol. In addition, histological changes were observed in epididymal adipose tissues. Results: The RR, CUP, and PCW effectively lowered both the body weight and epididymal adipose tissue weight and reduced the adipocyte enlargement. In addition, we examined the serum biochemical profiles of HFD-induced obese mice to confirm the anti-obesity effects of RR, CUP, and PCW. Compared to the ND mice, the administration of RR, CUP, and PCW efficiently reduced the glucose, triglyceride, and total cholesterol serum levels in HFD-induced obese mice. Conclusion: These findings suggested that the herbal medicines, such as RR, CUP, and PCW, are potential novel agents for the prevention and treatment of metabolic diseases, especially obesity. 


Effects of the herbal medicines on voltage-dependent K+ 2 channels
Jeong Nam Kim, Eun Yeong Lim, Yun Tai Kim, Hyungwoo Kim, Byung Joo Kim

Pharmacognosy Magazine 2019 15(63):369-377

Background: Identification of selective ion channel inhibitors is necessary for understanding the physiological role of these proteins. The voltage-dependent K+ (Kv) channels, Kv2.1 and Kv2.2, are expressed in pancreatic islets, and the development of selective Kv2.1 inhibitors that do not cross-inhibit Kv2.2 may be useful for the treatment of type 2 diabetes. Objective: The aim of this study was to evaluate whether herbal medicines, such as the fruit of Schisandra chinensis (SCF), Atractylodes macrocephala Koidzumi (AMK), Poria cocos Wolf (PCW), Citrus unshiu peel (CUP), Magnolia officinalis Bark (M. officinalis), Alisma canaliculatum (A. canaliculatum), Rehmanniae Radix (RR), and Corni fructus (C. fructus), modulate Kv2 channels and cause insulin secretion. Materials and Methods: We used the whole-cell patch-clamp technique to analyze the effect of these herbal medicines on Kv channels. In addition, human embryonic kidney 293 cells overexpressing Kv2.1 and Kv2.2 channels were used to confirm the role of Kv2 channels. Results: SCF, AMK, PCW, CUP, M. officinalis, A. canaliculatum, and RR inhibited Kv2.1 channel currents in a concentration-dependent manner (100–500 μg/mL). However, C. fructus had no effects on Kv2.1 channel currents. In addition, SCF, AMK, M. officinalis, and A. canaliculatum inhibited Kv2.2 channel currents in a concentration-dependent manner, but PCW, CUP, and RR had no effects on Kv2.2 channel currents. Furthermore, RR, CUP, and PCW increased insulin secretion. Conclusion: These findings suggested that the herbal medicines, RR, CUP, and PCW, are potential novel agents for the prevention and treatment of diabetes. 


Research on mechanism of traditional hot processing on velvet antler based on 1H nuclear magnetic resonance and multivariate statistical analysis
Jingfeng Li, Hui Sun, Xuefeng Bian, Nanxi Zhang, Yaping Wang, Ying Zong, Hui Zhang, Jiaming Sun

Pharmacognosy Magazine 2019 15(63):378-384

Background: The processing of Chinese materia medica is an important part for the preparation of traditional Chinese medicine (TCM) which has been believed that can change the chemical composition and physiological function. Velvet antler is a kind of precious TCM and widely used after hot processing as folk medicines in China. However, no strategy has been presented to reveal the processing principle of velvet antler. Objective: The aim of this study is to develop a method for exploring the mechanism of hot processing on velvet antler. Materials and Methods: In this study, the chemical compositions of fresh velvet antler (FVA) and hot processed velvet antler (HPVA) were compared based on the 1H nuclear magnetic resonance (1H NMR) and multivariate statistical analysis methods to explore the mechanism of hot processing on velvet antler. Results: It showed that hot processing increased phosphorylcholine, taurine, alanine, uridine, phenylalanine, uracil, tyrosine, accompanied by decreased bile acid, choline, lipid 2 and succinic acid in comparison to the FVA, which changed significantly in 52 common metabolites of FVA and HPVA. In addition, a clear separation between FVA and HPVA was obtained by using principal component analysis and 11 “chemical markers” were found by using orthogonal partial least squares discriminant analysis (OPLS-DA) approaches. Particular attention was given to the “chemical markers” with potentially beneficial bioactivities. Conclusion: The study demonstrated that 1H NMR-based chemometric approach could be a promising tool for investigation of the hot processing of velvet antler in a holistic way of TCM. 


The effects of polysaccharides from Rehmannia glutinosa on Caenorhabditis elegans
Yanyan Yuan, Nianxin Kang, Yinghui Lu, Xiangzhen Miao, Xiao Zhang, Yonggang Liu, Peng Tan

Pharmacognosy Magazine 2019 15(63):385-391

Background: Polysaccharides are isolated from Rehmannia glutinosa (RG), a well-known traditional Chinese medicine starting from ancient China. However, their effects on anti-aging activity have not yet been evaluated. Objective: To evaluate the stress resistances and anti-aging effects of polysaccharides from RG by Caenorhabditis elegans N2 wild type. Materials and Methods: Preparing the polysaccharides from Rehmanniae radix preparata (PRRP) and Rehmanniae radix (PRR), we determined the antioxidant activity in vitro, stress resistance, lifespan, fertility, physical growth, locomotion, and impact on the formation of reactive oxygen species (ROS) on C. elegans. Results: The results showed that both polysaccharides have little scavenging ability of free radicals in vitro. After PRRP and PRR treatment, the stress resistance and body bending frequencies of nematodes were significantly increased. PRRP was shown to extend the lifespan and promote physical growth of C. elegans. Both polysaccharides had little effect on fertility and locomotion ability of C. elegans but can reduce excessive intracellular ROS. Conclusion: For C. elegans organism model, both PRRP and PRR are heat resistant and antioxidant; PRRP not only can extend lifespan but can also promote growth and development. PRRP had an anti-aging effect on C. elegans without affecting their reproductive capacity. Based on the scavenging capacity of ROS, we hypothesized that the mechanism of PRRP prolonging lifespan may be related to increase resistance and remove excess free radicals in time. 


Aroma characteristic analysis of Amomi fructus from different habitats using machine olfactory and gas chromatography-mass spectrometry
Huaying Zhou, Dehan Luo, Hamid Gholamhosseini, Zhong Li, Bin Han, Jiafeng He, Shumei Wang

Pharmacognosy Magazine 2019 15(63):392-401

Background: Amomi fructus (AF Lour.) has been used to treat digestive diseases in the context of Traditional Chinese Medicine. Its aroma characteristics have been attracted attention and are considered to be effective markers for determining AF from different habitats. Materials and Methods: In this article, the odor characteristics of AF from three different habitats were investigated and analyzed using gas chromatography-mass spectrometry (GC-MS) and an electronic nose (E-nose). Results: It was found that the E-nose in conjunction with principal component analysis as an analytic tool, showed good performance and achieved a total variance of 93.90% with the first two principal components. A total of 65 aroma constituents among three groups of AF were separated, identified, and calculated using GC-MS. It was observed that the components and the contents were clearly different among the three groups. To confirm the interrelation between aroma constituents and sensors, the contents of 12 aroma ingredients and the response values of six sensors were selected to be trained and tested using the partial least squares. A satisfied quantitative prediction was presented that the contents of selected constituents were accurately predicted by corresponding E-nose sensors with the most determination coefficient of calibration and determination coefficient of prediction of >90%. Conclusion: It was revealed that the E-nose is capable of discriminating AF from different habitats, presenting an accurate, easy-operating, and nondestructive reference approach. 


Protective effect of curcumin decreases incidence of gastric cancer induced by Helicobacter pylori and N-methyl-N-nitrosourea in rats
Duangporn Werawatganon, Kanjana Somanawat, Kawiya Sintara, Somying Tumwasorn, Naruemon Klaikeaw, Prasong Siriviriyakul

Pharmacognosy Magazine 2019 15(63):402-409

Aim: To study the effects of curcumin on Helicobacter pylori and N-methyl-N-nitrosourea (MNU)-induced gastric cancer in rats. Materials and Methods: Male Wistar rats were divided into three groups: control (CO), H. pylori inoculation and 30 ppm MNU in drinking water for 20 weeks (Hp + MNU), and H. pylori and MNU supplemented with 60 mg/kg curcumin for 30 weeks (Hp + MNU + Cur). The stomach was removed to examine nuclear factor kappa B (NF-κB) p65, 8-hydroxy-2'-deoxyguanosine (8-OHdG), cyclin D1, and Ki-67 in gastric epithelial cells by immunohistochemistry. The expression of apoptotic cells was measured by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling reaction and gastric histopathology. Results: Two rats in Hp + MNU developed adenocarcinoma (ADC) of the glandular stomach (40% incidence, n = 5), while in Hp + MNU + Cur, no gastric ADC was found. Histopathology of gastric ADC showed the invasion of malignant cuboidal epithelial cells to submucosal layer. The percentages of NF-κB p65, 8-OHdG, cyclin D1, and Ki-67 immunoreactive cells in Hp + MNU compared with CO were 12.20% ± 1.10% versus 1.86% ± 1.49%, 13.21% ± 0.90% versus 2.84% ± 1.29%, 66.96% ± 5.91% versus 6.06% ± 6.48%, and 42.29% ± 0.08% versus 14.95% ± 0.12%, P < 0.05, respectively. The expression of apoptotic cells significantly increased in Hp + MNU compared with CO (8.41% ± 0.01% vs. 0.53% ± 0.02%, P < 0.05). Curcumin supplementation reduced the gastric cancer incidence compared with Hp + MNU. Percentages of NF-κB p65, 8-OHdG, cyclin D1, and Ki-67 immunoreactive cells in Hp + MNU + Cur compared with Hp + MNU were 4.76% ± 3.73% versus 12.20% ± 1.10%, 1.76% ± 0.94% versus 13.21% ± 0.90%, 24.71% ± 4.62% versus 66.96% ± 5.91%, and 24.99% ± 0.05% versus 42.29% ± 0.08, P < 0.05, respectively. The apoptosis expression was significantly improved (4.14% ± 0.16% vs. 8.41% ± 0.01%, P < 0.05). Conclusion: Curcumin can reduce gastric cancer incidence induced by H. pylori infection and MNU administration through the suppression of key proteins and apoptosis involved in carcinogenesis. 


Rapid identification of medicinal leech by species-specific polymerase chain reaction technology
Yang Zheng, Beibei Lu, Yaya Yang, Zhaoqun Jiao, Liqun Chen, Pingtian Yu, Yuping Shen, Huan Yang

Pharmacognosy Magazine 2019 15(63):410-415

Background: Leech is a well-known animal-derived Chinese medicine; intentionally or unintentionally, interfusing fake products have exposed patients to high risk. Objective: In this study, we would like to find a rapid and accurate technology to identify medicinal leech. Materials and Methods: Three sets of species-specific primer were designed, and polymerase chain reaction (PCR) conditions were optimized for the four species analyzed. Specificity and sensitivity test were carried out, and the reference sample mixtures were analyzed. Finally, the developed method was used to assess the authenticity of commercially available products. Results: Three sets of species-specific primer were confirmed to have high interspecies specificity and good intraspecies stability. The limit of detection was estimated to be 1 ng for all of four assayed species. Subsequent validation demonstrated that the raw material, processed, and even highly processed products of leech can be conveniently authenticated with good sensitivity and precision by this newly established PCR-based method. Conclusion: These designed novel primer sets have shown distinct performance on the identification of adulterate products. The new technology needs no procedure for sequencing and has been successfully employed for the reliable authentication of raw material of leech and even their processed and highly processed products. 


Pentamethylquercetin inhibited the growth of hepatic ascitic tumor cell H22 by improving metabolic environment and aerobic glycolysis in monosodium glutamate-induced obese mice
Wenqi Gao, Xiao Xiao

Pharmacognosy Magazine 2019 15(63):416-422

Aim: We investigated the effects of pentamethylquercetin (PMQ) on the tumor growth in monosodium glutamate (MSG)-induced obese mice. Materials and Methods: At the age of 5 weeks, control and MSG mice were, respectively, divided into five groups (n = 10): Vehicle group; PMQ 5, 10, 20 mg/kg; and metformin (MET) 300 mg/kg groups. All mice were administrated PMQ and MET by gastric gavage from 5- to 24-week age. 22-week-old mice were injection with H22 hepatic ascitic tumor cells. After 2 weeks, animals were anesthetized and blood, tumor, and liver tissues were harvested. Results: Compared with control mice, MSG mice showed obviously metabolic disorders and larger tumor weight and volume than those of control mice. PMQ and MET administration reduced body weight, improved glucose and lipid metabolism, and insulin resistance and inhibited tumor growth in MSG mice. However, PMQ and MET had a litter effect on the tumor growth and metabolic indexes in the control mice. Furthermore, there is significant positive correlation between improved insulin resistance and inhibited tumor growth by chronic PMQ and MET treatment. Further experiments showed PMQ and MET treatment upregulated mRNA expressions of sirtuin 6 (sirt6) both in tumor and liver tissues. Conclusion: Our results demonstrated PMQ decreased tumor growth in the MSG mice and the potential mechanisms might be attributed to upregulated mRNA expressions of sirt6. 


Angiopteris helferiana, a fern with great potential medicinal value: Antiadipogenic, anti-inflammatory, and anti-diabetic activity
Ramakanta Lamichhane, Prakash Raj Pandeya, Kyung-Hee Lee, Se-Gun Kim, Dhan Raj Kandel, Hyun-Ju Jung

Pharmacognosy Magazine 2019 15(63):423-432

Background: Angiopteris helferiana is used as a traditional medicine in some parts of Nepal and South-Asian countries. It is also used in traditional Chinese medicine system. Objective: In this study, we evaluated its anti-oxidant, anti-inflammatory, anti-obesity, and antidiabetic activity in cell and animal mode. Materials and Methods: The rhizome of A. helferiana was extracted with methanol and fractionated to give dichloromethane, ethyl acetate (EA), butanol (BuOH), and water fractions. The residue was again re-extracted with water to give water extract. The anti-oxidant property was measured using 1, 1-diphenyl-2-picryl-hydrazyl assay. The extract and fractions were evaluated for the α-glycosidase inhibition activity. The antiadipogenic and anti-inflammatory activity was studied in 3T3-L1–L1 and RAW 264.7 cells, respectively. The inhibition of expression of adipogenic markers peroxisome proliferator-activated receptor gamma (PPARγ), CCAAT enhancer binding protein alpha (C/EBPα) was studied in 3T3-L1 cells. The anti-obesity and antidiabetic study was done in high-fat diet mice model. Results: The EA, BuOH fraction, and water extract showed good anti-oxidant and α-glycosidase inhibition activity. EA fraction showed good anti-inflammatory activity. EA and BuOH fraction showed good antiadipogenic activity, reducing significantly, the lipid and adipogenic markers (PPARγ, C/EBPα) in 3T3-L1 cells. The BuOH fraction at 300 mg/kg/day dose showed good anti-obesity and antidiabetic activity in the in-vivo study after the evaluation of body weight, blood lipid, blood glucose, and lipid accumulation in adipose tissue and liver. Conclusion: Overall, A. helferiana is a good source of anti-oxidative, anti-inflammatory, anti-obesity, and antidiabetic component. 


The role of total flavone of Camellia on cerebrovascular vasopasm after subarachnoid hemorrhage in rats
Weizhuo Lu, Jiyue Wen

Pharmacognosy Magazine 2019 15(63):433-437

Background: This study was undertaken to explore the role of total flavones of Camellia (TFC) on the cerebrovascular dysfunction in rats after experimental subarachnoid hemorrhage (SAH). Materials and Methods: The contraction and dilation of cerebral basilar artery (BA), nitric oxide (NO) level, and nitric oxide synthase (NOS) activity in rat serum and the expression of endothelial NOS (eNOS) in cerebral vessels were measured. Furthermore, the effect of potassium channel blockers, endothelium removal, L-NG-nitroarginine methyl ester (L-NAME), or prostacyclin I2 (PG I2) production inhibitor on the response of isolated BA derived from normal rats was also evaluated to explore the underlying mechanism of vasodilation induced by total flavones. Results: The contraction of rat BA to U46619 markedly increased and the vasodilation to acetylcholine remarkably reduced after SAH. Interestingly, these vascular dysfunctions were profoundly ameliorated by pretreatment of TFC. Moreover, total flavones could induce a concentration-dependent relaxation in isolated BA from normal rats, which was obviously eliminated by co-application of potassium channel blockers, ChTx and Apamin, application of L-NAME, or endothelial removal. In addition, total flavones pretreatment obviously improved the expression of eNOS in BA, serum NO level, and NOS activity at 48 h after SAH. Conclusion: These findings revealed that TFC has protective effect on cerebrovascular dysfunction after SAH and demonstrated that the protection could be due to its upregulation of eNOS expression and activation of potassium channel. 


Preventive Medicine

Information for CME Credit—Mortality Risk Reductions for Replacing Sedentary Time With Physical Activities

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s):



Pathways From Food Insecurity to Intimate Partner Violence Perpetration Among Peri-Urban Men in South Africa

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Abigail M. Hatcher, Heidi Stöckl, Ruari-Santiago McBride, Mzwakhe Khumalo, Nicola Christofides

Introduction

Although poverty is sometimes seen as a driver of intimate partner violence victimization, less is known about how it intersects with men's violence perpetration. Food insecurity is a sensitive marker of poverty that may have unique mechanisms leading to men's intimate partner violence perpetration given its association with gender roles and men "providing for the family."

Methods

Using cluster-based sampling, the team conducted an audio-assisted questionnaire in 2016 among men living in a peri-urban settlement near Johannesburg, South Africa. The aim was to examine the relationship between men's food insecurity and their use of past-year intimate partner violence, and to explore the pathways linking these two conditions.

Results

Among 2,006 currently partnered men, nearly half (48.4%) perpetrated intimate partner violence and more than half (61.4%) were food insecure. Food insecurity was associated with doubled odds of intimate partner violence (OR=2.15, 95% CI=1.73, 2.66). This association persisted after controlling for sociodemographics, relationship characteristics, and neighborhood clustering. In a structural equation model, food insecurity retained a direct relationship with men's violence perpetration and worked through indirect pathways of mental health and relationship quality.

Conclusions

Addressing men's perpetration of intimate partner violence may require examination of broader structural challenges, such as food insecurity. Future interventions should consider livelihood strategies alongside relationship and mental health approaches.



Fall Prevention Self-Management Among Older Adults: A Systematic Review

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Kumiko O. Schnock, Elizabeth P. Howard, Patricia C. Dykes

Context

Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors.

Evidence acquisition

Medical and nursing literature related to fall prevention self-management was searched in PubMed, Embase, and CINAHL (1997–2017), and relevant publications were selected by three researchers to assess whether the papers included subject characteristics and their fall prevention self-management actions and behaviors. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used by the researchers to assess the quality of the included studies and to determine the significance of the extracted characteristics.

Evidence synthesis

Searching literature through 2017, a total of 972 papers were identified, and 28 papers remained after removing those that did not meet inclusion criteria. Nine papers that addressed subject characteristics in relation to the study outcomes were included in a sub-analysis. The authors identified the following characteristics of older adults who participated in fall prevention self-management actions and behaviors: younger males, not living alone and with self-reported good health, having greater fear of falling and high fall prevention self-efficacy, and possessing high motivation for engagement with self-management activities.

Conclusions

The systematic literature review revealed the personal characteristics of older adults who engage in fall prevention self-management actions and behaviors.



Regular Sunscreen Use and Risk of Mortality: Long-Term Follow-up of a Skin Cancer Prevention Trial

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Akiaja R. Lindstrom, Lena A. von Schuckmann, Maria Celia B. Hughes, Gail M. Williams, Adele C. Green, Jolieke C. van der Pols

Introduction

Sunscreen is widely used to protect the skin from harmful effects of sun exposure. However, there are concerns that sunscreens may negatively affect overall health. Evidence of the general safety of long-term regular sunscreen use is therefore needed.

Methods

The effect of long-term sunscreen use on mortality was assessed over a 21-year period (1993–2014) among 1,621 Australian adults who had participated in a randomized skin cancer prevention trial of regular versus discretionary sunscreen use (1992–1996). In 2018, an intention-to-treat analysis was conducted using Cox proportional hazards regression to compare death rates in people who were randomized to apply sunscreen daily for 4.5years, versus randomized to use sunscreen at their usual, discretionary level. All-cause mortality and deaths resulting from cardiovascular disease, cancer, and other causes were considered.

Results

In total, 160 deaths occurred in the daily sunscreen group compared with 170 deaths in the discretionary sunscreen group (hazard ratio=0.94, 95% CI=0.76, 1.17); 59vs 76 cardiovascular disease deaths (hazard ratio=0.77, 95% CI=0.55, 1.08), 63vs 58 cancer deaths (hazard ratio=1.09, 95% CI=0.76, 1.57), and 45vs 44 deaths resulting from other causes (hazard ratio=1.02, 95% CI=0.67, 1.54) occurred respectively.

Conclusions

Regular use of a sun protection factor 16 sunscreen on head, neck, arms, and hands for 4.5years did not increase mortality.



Characteristics of Veteran and Civilian Suicide Decedents: A Sex-Stratified Analysis

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Adam G. Horwitz, Dale L. Smith, Philip Held, Alyson K. Zalta

Introduction

Few studies have examined characteristics distinguishing Veteran and civilian suicide decedents. An understanding of unique risk factors for Veteran suicide is critical to develop effective preventive interventions. This is particularly imperative for female Veterans, who have near double the suicide mortality rate of same-aged female civilians. The objectives of this study were to examine whether Veteran and civilian suicide decedents differed on risk factors and suicide-event characteristics, and to determine whether predictors changed based on sex.

Methods

Data from 116,515 suicides collected by the National Violent Death Reporting System in 27 states between 2003 and 2015 were analyzed in 2018 in sex-stratified analyses. Logistic regression models examined population differences in risk factors and suicide-event characteristics.

Results

Relative to male civilians, male Veterans were more likely to have a contributing physical health problem (AOR=1.10, 95% CI=1.06, 1.14) and to use a firearm for their suicide (AOR=1.41, 95% CI=1.36, 1.47); they were less likely to have substance use problems (AOR=0.70, 95% CI=0.66, 0.75), depressed mood (AOR=0.93, 95% CI=0.90, 0.97), or financial problems (AOR=0.91, 95% CI=0.86, 0.97). Female Veterans were more likely to use a firearm for their suicide (AOR=1.39, 95% CI=1.19, 1.63) relative to female civilians.

Conclusions

Firearm use as a suicide method was a key distinguishing feature of Veteran suicide. Means restriction and firearm safety are pertinent to preventing Veteran suicide. Given low utilization of mental health care and frequent presence of physical health problems in this population, safe storage messages may have a greater preventive impact if delivered in primary care or other nonpsychiatric settings.



Mortality Risk Reductions for Replacing Sedentary Time With Physical Activities

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Erika Rees-Punia, Ellen M. Evans, Michael D. Schmidt, Jennifer L. Gay, Charles E. Matthews, Susan M. Gapstur, Alpa V. Patel

Introduction

Excess sitting is a risk factor for early mortality. This may be resulting, at least in part, from the displacement of physical activity with sedentary behaviors. The purpose of this observational study was to examine the mortality risk reductions associated with replacing 30minutes/day sitting for an equivalent duration of light or moderate to vigorous physical activity (MVPA).

Methods

Participants included 37,924 men and 54,617 women in the Cancer Prevention Study-II Nutrition Cohort, of which 14,415 men and 13,358 women died during follow-up (1999–2014). An isotemporal substitution approach to the Cox proportional hazards regression model was used to estimate adjusted hazard ratios and 95% CIs for mortality associated with the substitution of 30minutes/day self-reported sitting for light physical activity or MVPA. Analyses were conducted in 2018.

Results

Among the least active participants (≤17minutes/day MVPA), the replacement of 30minutes/day sitting with light physical activity was associated with a 14% mortality risk reduction (hazard ratio=0.86, 95% CI=0.81, 0.89) and replacement with MVPA was associated with a 45% mortality risk reduction (hazard ratio=0.55, 95% CI=0.47, 0.62). Similar associations were seen among moderately active participants (light physical activity replacement, hazard ratio=0.94, 95% CI=0.91, 0.97; MVPA replacement, hazard ratio=0.83, 95% CI=0.76, 0.88). However, for the most active (MVPA >38 minutes/day), substitution of sitting time with light physical activity or MVPA was not associated with a reduction in mortality risk (hazard ratio=1.00, 95% CI=0.97, 1.03, and hazard ratio=0.99, 95% CI=0.95, 1.02, respectively).

Conclusions

These findings suggest that the replacement of modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults.



Public Health Workforce Development Needs: A National Assessment of Executives' Perspectives

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Jonathon P. Leider, Fatima Coronado, Kyle Bogaert, Elizabeth Gould

Introduction

Workforce development is one of the ten essential public health services. Recent studies have better characterized individual worker perceptions regarding workforce interests and needs, but gaps remain around workforce needs from program managers' perspectives. This study characterized management perspectives regarding subordinate's abilities and training needs and perceived challenges to recruitment and retention.

Methods

In 2017, the Directors Assessment of Workforce Needs Survey was sent to 574 managers at state health agencies across the U.S. Respondents were invited based on the positions they held (i.e., to be included, respondents had to be employed as managers and oversee specific program areas). In 2018, descriptive statistics were calculated, including Fisher's exact for inferential comparisons and Tukey's test for multiple comparisons, as appropriate.

Results

Response rate was 49% after accounting for undeliverable e-mails; 226 respondents met the inclusion criteria. The largest perceived barriers to staff recruitment were wages or salaries (74%) and private sector competition (56%). Similarly, wages or salaries were identified as the main cause of turnover by 70% of respondents, followed by lack of opportunities for advancement (68%), and opportunities outside the agency (67%).

Conclusions

The Directors Assessment of Workforce Needs Survey fills important knowledge gaps and complements previously identified evidence to guide refinement of workforce development efforts. Although competition from the private sector remains challenging, these findings indicate that recruitment and retention must be top priorities in state health agencies nationwide. Prioritizing individual state health agency workforce gaps and committing to provide specific local-level interventions to those priorities is crucial for individual health agencies.



Administrative Military Discharge and Suicidal Ideation Among Post–9/11 Veterans

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Claire A. Hoffmire, Lindsey L. Monteith, Ryan Holliday, Crystal L. Park, Lisa A. Brenner, Rani A. Hoff

Introduction

From 2005 to 2016, the Veteran suicide rate increased 25.9%. Reducing this rate is a top priority for the Department of Veterans Affairs. In 2017, a policy change expanded emergent mental health services to include previously ineligible Veterans discharged under other than honorable conditions. To date, research examining the relationship between military discharge type and suicide risk has been limited.

Methods

This study aimed to examine the association between discharge type (honorable versus administrative) and active suicide ideation among Veterans participating in the Survey of Experiences of Returning Veterans (N=850, data collection 2012–2015 and data analysis 2017–2018) using logistic regression. Stratified analyses explored whether gender, time since military separation, or recent mental health service use moderated this relationship.

Results

The prevalence of suicide ideation was significantly higher (p<0.01) among Veterans reporting administrative discharge (23.1%, 95% CI=12.8, 33.3 vs 10.6%, 95% CI=8.4, 12.8). However, after accounting for lifetime suicide attempt history, combat experiences, posttraumatic stress disorder symptoms, depression, and drug dependence, discharge was no longer associated with suicide ideation. Recent mental health service use and time since separation significantly modified this relationship. The relationship was only significant among Veterans not using mental health services (OR=4.8, 95% CI=1.3, 18.2) and among transitioning Veterans <2years from separation (OR=3.6, 95% CI=1.4, 9.2).

Conclusions

These findings suggest that recognized risk factors for suicide, such as a history of mental health conditions, account for the increased prevalence of suicide ideation among Veterans with administrative discharges and that mental health services may have the potential to mitigate such risk in this high-risk Veteran population.



Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Nancy Breen, Celette Sugg Skinner, Yingye Zheng, Stephen Inrig, Douglas A. Corley, Elisabeth F. Beaber, Mike Garcia, Jessica Chubak, Chyke Doubeni, Virginia P. Quinn, Jennifer S. Haas, Christopher I. Li, Karen J. Wernli, Carrie N. Klabunde, PROSPR consortium

Introduction

The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems.

Methods

A total of 35,009 patients aged 50–64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan–Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status.

Results

Even within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system.

Conclusions

This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.



Impacts of the Affordable Care Act Dependent Coverage Provision on Young Adults With Cancer

Publication date: May 2019

Source: American Journal of Preventive Medicine, Volume 56, Issue 5

Author(s): Justin M. Barnes, Jenine K. Harris, Derek S. Brown, Allison King, Kimberly J. Johnson

Introduction

Evidence through 2012 suggests that the 2010 Affordable Care Act Dependent Coverage Provision, extending dependent insurance coverage eligibility to age 26years, increased young adult insurance coverage and decreased cancer diagnosis stage in young adult cancer patients. This study examines Dependent Coverage Provision–associated changes in insurance coverage and diagnosis stage through 2014 in young adult cancer patients.

Methods

Using a quasi-experimental study design, analyses were conducted in 2017–2018 using 2007 to 2014 data from the Surveillance, Epidemiology, and End Results (SEER) 18 and the National Cancer Database (NCDB). Using difference-in-differences analyses applied to linear probability models, changes in the percentage of policy-eligible individuals aged 19–25years versus ineligible individuals aged 27–29years who were insured (excluding Medicaid) and diagnosed at early (Stages 0 and 1) or late (Stage 4) stages following Dependent Coverage Provision enactment were estimated.

Results

A total of 36,901 and 92,358 young adults were included from SEER and NCDB. Consistent increases in the percentage insured (SEER: 3.45 percentage points, 95% CI=2.04, 4.87; NCDB: 3.72 percentage points, 95% CI=2.80, 4.64); variable increases in early-stage diagnoses (2.25 percentage points, 95% CI=0.40, 4.10; 0.69 percentage points, 95% CI= –0.65, 2.02); and decreases in late-stage diagnoses (–1.74 percentage points, 95% CI= –3.10, –0.38; –0.58 percentage points, 95% CI= –1.46, 0.30) were observed in young adults aged 19–25 versus 27–29years.

Conclusions

These results provide clear evidence for a Dependent Coverage Provision–associated impact on insurance coverage in young adult cancer patients; however, clear impacts on diagnosis stage are less evident.