Supplementation of vitamin D in children with obesity and vitamin D deficiency - review of outcomes in terms of obesity parameters and comorbidities

In recent years, vitamin D deficiency and obesity in paediatric population have reached epidemic levels worldwide as crucial health concerns with far-reaching consequences. There has been a substantial growth in studies dedicated to these two public health issues over the last years. Numerous studies have confirmed that excess body weight has negative impact on vitamin D metabolism, leading to a higher risk of low levels of this essential vitamin, among individuals who are overweight or obese. Vitamin D deficiency may play a role in the development of obesity-related conditions as insulin resistance, type two diabetes, NAFLD and cardiovascular disease due to anti-inflammatory properties, impact on the endocrine system and metabolic functions of this vital nutrient. Vitamin D supplementation seems to be a beneficial addition to pharmacology and lifestyle changes during obesity treatment

Feasibility and potential efficacy of commercial mHealth/eHealth tools for weight loss in African American breast cancer survivors: pilot randomized controlled trial

Weight management after breast cancer (BC) treatment in African American (AA) women is crucial to reduce comorbid conditions and health disparities. We examined feasibility and potential efficacy of commercial eHealth/mHealth tools for weight management in AA BC survivors in New Jersey. Participants (N = 35) were randomized to an intervention (SparkPeople) plus activity tracker, Fitbit Charge (n = 18), or wait-list active control group (Fitbit only, n = 17). Anthropometric, behavioral, and quality of life (QOL) outcomes were collected at baseline, 3, 6, and 12 months. Differences in outcomes were assessed using intent-to-treat analysis. Retention was 97.1%. Both groups lost weight, with no significant differences between groups. At month 6, mean weight change was: intervention: -1.71 kg (SD 2.33; p = .006), 33.3% lost ≥3% of baseline weight; control: -2.54 kg (SD 4.00, p = .002), 23.5% lost ≥3% weight. Intervention participants achieved significant improvements in waist circumference (-3.56 cm, SD 4.70, p = .005), QOL (p = .030), and use of strategies for healthy eating (p = .025) and decreasing calories (p \u3c .001). Number of days logged food per week was associated with decreases in waist circumference at 6 months (β -0.79, 95% CI, -1.49, -0.09, p = .030) and 12 months (β -2.16, 95% CI, -4.17, -0.15, p = .038). Weight loss was maintained at 12 months. This is the first study to demonstrate potential efficacy of commercial eHealth/mHealth tools for weight loss in AA BC survivors, without additional counseling from the research team. If effective, they may be convenient weight loss tools that can be easily and widely disseminated. Clinical Trials registration: ClinicalTrials.gov NCT02699983

Acne vulgaris and treatment with topical retinoids - adapalene and tretinoin

Introduction and purpose: Acne vulgaris is a disease that mainly affects young people and is associated with overactive sebaceous glands. The disease mainly affects the face but can also occur on the back. Depending on the clinical picture, we can distinguish different types of acne and make our treatment dependent on it. The aim of the study will be to compare the effects of topical retinoids on acne vulgaris. State of knowledge: Topical retinoids have a direct anti-inflammatory effect and prevent the formation of blackheads and microcomedones. Five retinoids are currently available for topical treatment of acne vulgaris. We distinguish three generations. The mechanism of action is not fully understood, but it is known that they react with the RAR and RXR receptors. In the review paper, we will compare the effects of adapalene with tretinoin. Conclusion: According to the indicated study results, there is no significant difference in the effect of treatment with adapalene or tretinoin. Adapalene showed less irritation during treatment than tretinoin. The most important thing during acne treatment is choosing the right concentration and formulation by the dermatologist so that the patient does not stop treatment

An apple a day keeps the doctor away? - a review of health benefits of apples

Introduction and purpose: Apples are a widely consumed fruit globally and are known to be a great source of nutrition. Studies have shown that apples contain high levels of antioxidants, dietary fiber, and vitamins that contribute to numerous health benefits. This paper aims to provide a comprehensive review of the impact of apples on human health. State of knowledge: The paper reviews the current literature on the health benefits of apples, focusing on their impact on various health conditions such as cancer, cardiovascular diseases, diabetes, and obesity. Additionally, it examines the role of apples in improving intestinal, immune, and cognitive function. The paper also discusses the potential mechanisms by which apples exert their health benefits, such as high levels of flavonoids, polyphenols, and dietary fiber. Summary: In conclusion, the vast body of evidence reviewed in this paper supports the notion that consuming apples regularly can contribute to better health outcomes. They may help reduce the risk of chronic diseases, such as cancer, cardiovascular diseases, and diabetes, as well as promote healthy gut microbiota and immune function. Despite the controversy surrounding the use of pesticides in apple cultivation, the benefits of consuming apples outweigh the risks. Therefore, it is highly recommended to include apples as part of a balanced and nutritious diet to promote optimal health and wellbeing. As the saying goes, "An apple a day keeps the doctor away"

Perceptions of Primary Care Among Breast Cancer Survivors

Background: Obese breast cancer survivors (BCSs) are impacted by diminished quality of life (QOL), multiple comorbid conditions, and poor disease outcomes. Despite national guidelines recommending a healthy weight to improve QOL and outcomes posttreatment, support and education are not routinely provided to BCSs in primary care. To fill this gap, we assessed perceptions of primary care received among BCSs by weight status. Methods: Cross-sectional surveys were administered to early-stage BCSs (N = 188) from 2 New Jersey cancer centers between May 2012 and July 2013. Sociodemographics, medical history, functional health status, perceived satisfaction with one’s primary care provider (PCP), and PCP involvement in follow-up care were assessed. Results: In total, 82% of overweight BCSs and 30% of obese BCSs reported not being told by their doctor that they were overweight or obese, despite these conditions being highly prevalent (35% and 35%, respectively). Obese BCSs were more likely than healthy weight BCSs to be African American, have a higher comorbidity score, poorer functional health, and greater satisfaction with their PCPs. Conclusion: The PCP–patient encounter may represent an opportunity for PCPs to correct misperceptions and promote weight reduction efforts among BCSs, thus improving QOL and disease outcomes

Rationale and design of extended cancer education for longer term survivors (EXCELS): a randomized control trial of ‘high touch’ vs. ‘high tech’ cancer survivorship self-management tools in primary care

Abstract Background Breast, colorectal, and prostate cancer survivors are at increased risk for late and long-term effects post-treatment. The post-treatment phase of care is often poorly coordinated and survivors navigate follow-up care with minimal information or guidance from their healthcare team. This manuscript describes the Extended Cancer Education for Longer-term Survivors (EXCELS) in Primary Care protocol. EXCELS is a randomized controlled trial to test the efficacy of patient-level self-management educational strategies on adherence to preventative health service use and cancer survivorship follow-up guidelines. Methods The EXCELS trial compares four conditions: (1) EXCELS-website (e.g., a mobile-optimized technology platform); (2) EXCELS-health coaching; (3) EXCELS-website and health coaching; and (4) a print booklet. Approximately 480 breast, colorectal, and prostate survivors will be recruited through the New Jersey Primary Care Research Network (NJPCRN) and New Jersey State Cancer Registry (NJSCR). Eligible survivors (diagnosed stages 1–3) must have completed active treatment, access to a phone and a computer, smartphone or tablet with internet access, and be able to speak and read English. Patient assessments occur at baseline, 6, 12, and 18 months. The primary outcomes are increased engagement in preventive health services and monitoring for cancer recurrence and treatment-related late effects. Discussion The EXCELS trial is the first to test cancer survivorship educational self-management interventions for cancer survivors in a primary care context. Findings from this trial will inform successful implementation and engagement strategies for longer-term, post-treatment cancer survivors managed in primary care settings. Trial registration Registered August 1, 2017 at ClinicalTrials.gov, trial # NCT03233555

Understanding primary care-oncology relationships within a changing healthcare environment.

BACKGROUND: Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. METHODS: Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10-12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive immersion/crystallization analysis process. RESULTS: Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. CONCLUSIONS: With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships

Cancer Survivorship Care in Advanced Primary Care Practices A Qualitative Study of Challenges and Opportunities

Importance Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. Objective To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Design, Setting, and Participants Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Main Outcomes and Measures Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. Results The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. Conclusions and Relevance To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure

A mixed-methods analysis of the capacity of the Patient-Centered Medical Home to implement care coordination services for cancer survivors.

There are currently 15.5 million cancer survivors in USA who are increasingly relying on primary care providers for their care. Patient-Centered Medical Homes (PCMHs) have the potential to meet the unique needs of cancer survivors; but, few studies have examined PCMH attributes as potential resources for delivering survivorship care. This study assesses the current care coordination infrastructure in advanced PCMHs, known to be innovative, and explores their capacity to provide cancer survivorship care. We conducted comparative case studies of a purposive sample (n = 9) of PCMHs to examine current care coordination infrastructure and capacity through a mixed- methods analysis. Data included qualitative interviews, quantitative surveys, and fieldnotes collected during 10- to 12-day onsite observations at each practice. Case studies included practices in five states with diverse business models and settings. Eight of the nine practices had National Committee for Quality Assurance Level 3 PCMH recognition. No practices had implemented a systematic approach to cancer survivorship care. We found all practices had a range of electronic population health management tools, care coordinator roles in place for chronic conditions, and strategies or protocols for tracking and managing complex disease groups. We identified potential capacity, as well as barriers, to provide cancer survivorship care using existing care coordination infrastructure developed for other chronic conditions. This existing infrastructure suggests the potential to translate care coordination elements within primary care settings to accelerate the implementation of systematic survivorship care